Total Health and Fitness Revolution [new and revised] 0468946773, 9780995443877

Table of contents :
Title page
CONTENTS
Acknowledgements
A Short Profile of Dr Joseph Cheung
Foreword
Features of the Second Edition
Introduction: A Beautiful Cruise to a Beautiful Dream
Chapter One It’s Time for Better Health
Good Health
Total Good Health
Our Nation’s Huge Health Bill - What Has Gone Wrong?
Chapter Two Physical Fitness - the Lynchpin of a Healthier Life
Types of Exercise and Their Biomechanics
Anaerobic Biomechanics
Aerobic Biomechanics
Aerobic Exercises - Targeting Cardio-Pulmonary Fitness
Walking, Power-Walking, Jogging
Walking and Power Walking
The Ambling Walk
The Power Walk
Jogging
Swimming
More on Biomechanics
The Special Benefits of Swimming
Swimming Styles
Freestyle
Breaststroke
Effective Training - Stretching, Warm-up, Cool-down
Cycling and Rowing
Bike Tracks
Exercise Bikes
Rowing
Rowing Machines
Injuries From Exercise
Living in Harmony with the Environment
The Power of Nature
Natural Disasters
The Eastern Way
The Take-Home Message
Chapter Three Food, Drinks, and Nutrition - Power Source or Power Drain
The Junk Food Demon
What is Food?
Macronutrients
Carbohydrates
Fats
Omega 3 and Omega 6
Saturated Fats
Palm Oil
Proteins
Plant Proteins
Soybeans and Soy Protein
Fibre
Micronutrients
Vitamins
Minerals
Bad Food, Healthy Food, Junk Food and Fad Diets
Glycation (the result of high heat cooking)
Free Radicals and Antioxidants
The Basic Food Pyramid
Vitamin and Mineral Supplements
Beverages
Soft Drinks
Coffee
Tea
Alcohol
Poor Nutrition
The Metabolic Syndrome
Diets
The Pritikin Diet
The Dean Ornish Diet
The Atkins Diet
The Asian Diet
The Mediterranean Diet
Weight Watchers Diet
The CSIRO Total Wellbeing Diet
The Polymeal Diet
Fad Diets
‘Meal-replacement’ Diet Plans
Low-carbohydrate Diets
High-fibre Diet (the F-plan diet)
‘Rapid-weight-loss’ Diets
The Summing Up - Choosing a Sensible Diet
A Sensible Approach to the Good Life
Go For Your Life
My Personal Experience of Maintaining Perfect Weight
Dining Out - Its Pleasures and Pitfalls
Chapter Four A Healthy Lifestyle
The Baby Boomers and Generation X
The Discerning Healthy Lifestyle
Exercise and a Balanced Eating Plan
Sleep
Personal and Social Relationships
Recreation
The Irrational Lifestyle
Smoking
Quitting smoking
Drug Abuse
Gambling
Alcohol Abuse
TV Addiction
Internet Addiction Disorder (IAD)
Choosing the Right Content
Over-reliance on the Car
Chapter Five Common Medical Problems: How to Avoid Illness and be a Winner
Colds and Flu’s
Prevention
Hypertension (High Blood Pressure or HBP in short)
Preventing/modifying your HBP
Heart diseases (CVD) and Hypercholesterolemia
Prevention/amelioration of CVD
Cancers in General
Prevention
Asthma
How to Prevent Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Prevention / Amelioration
Osteoarthritis
Prevention /Amelioration
Obesity and the Metabolic Syndrome
Prevention and Amelioration of Obesity
Childhood Obesity
Preventing Childhood Obesity
Diabetes Mellitus (DM)
Prevention
Food Poisoning and Gastroenteritis
Prevention
Colo-rectal Cancer (CRC)
Prevention
Constipation
Prevention/Amelioration
External Thrombotic Haemorrhoids (Piles)
Prevention/Amelioration
Mental Illness - Depression and Dementia
Prevention
Lower Back Pain
Prevention
Prostate Cancer
Prevention
Osteoporosis
Prevention
Common Eye Problems
Preventative Measures
Blepharitis
Prevention/Amelioration
Stroke
Prevention
Transient Ischaemic Attack (TIA)
Shoulder and Foot Injuries
Torn Shoulder Tendon
Prevention
Plantar Fasciitis
Prevention
Take Home Message
Chapter Six The Eastern Way of Maintaining Health and Fitness
Chinese Medicine
Herbal Medicine
Acupuncture
The Roots of Acupuncture
The Effects of Acupuncture
Other Therapies Using Acupoints
Tai Chi
The Health Benefits of Tai Chi
Qi Gong
Ayurveda
Yoga
Meditation
Neuroplasticity
Chapter Seven Longevity The Eternal Dream of Eternal Youth
The Incredible Hunza People
How to Live Longer
Studies in Ageing and Longevity
The Dubbo Studies
The Melbourne Studies
The Australian Longitudinal Study on Women's Health (ALSWH)
The Okinawa Centenarian Study
Major Factors for a Healthy Long Life
Caloric Restriction
Lifelong Physical Exercise
Regular Medical Check-ups
Maintain a Sensible Lifestyle and Manage Tension, Anxiety and Stress
Avoid Excess Radiation
Moderate Alcohol Consumption
Maintain Your Social Network
Contribute to Society
The Top Ten Factors influencing Longevity
Recent Findings in Relation to Ageing
Key Genes and Molecular Pathways
Neurogenesis and the Possibility of an Ageless Brain
Resveratrol - the First Anti-ageing Drug?
Promising Anti-ageing Molecules
Telomerase Can Reverse the Ageing Process
Regenerative Medicine
Stem Cell Therapy
PRP (Platelet Rich Plasma)
A Final Thought
Special Section A Master Eating Plan
Appendix A Checklist for Cereals
Appendix B List of Common Antioxidants
Appendix C Foods Rich in Antioxidants
References

Citation preview

Dr Joseph Cheung Total Health and Fitness Revolution

First published by Possible Press, 2012 Sydney, Australia

Email: [email protected] Phone: 0468946773 Copyright © Joseph Cheung, 2012, 2013, 2019 First edition 2012, printed twice, reprinted 2013 Second edition, revised and updated, 2019 First ebook edition, 2020 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form by any means, electronic, mechanical, by photocopy or otherwise, without the prior writer permission of the publisher and copyright holders.

Title: Total Health and Fitness Revolution ISBN: 9780995443877: ebook

This book is dedicated to my late father who taught us the meaning of life and the virtue of hard work

CONTENTS ACKNOWLEDGEMENTS A SHORT PROFILE OF DR JOSEPH CHEUNG FOREWORD FEATURES OF THE SECOND EDITION INTRODUCTION: A BEAUTIFUL CRUISE TO A BEAUTIFUL DREAM CHAPTER ONE IT’S TIME FOR BETTER HEALTH Good Health Total Good Health Our Nation’s Huge Health Bill – What Has Gone Wrong? CHAPTER TWO PHYSICAL FITNESS – THE LYNCHPIN OF A HEALTHIER LIFE Types of Exercise and Their Biomechanics Anaerobic Biomechanics Aerobic Biomechanics

Aerobic Exercises – Targeting Cardio-Pulmonary Fitness Walking, Power-Walking, Jogging Walking and Power Walking The Ambling Walk The Power Walk Jogging Swimming More on Biomechanics The Special Benefits of Swimming Swimming Styles Freestyle Breaststroke Effective Training – Stretching, Warm-up, Cool-down Cycling and Rowing Bike Tracks Exercise Bikes Rowing Rowing Machines Injuries From Exercise Living in Harmony with the Environment The Power of Nature Natural Disasters The Eastern Way The Take-Home Message

CHAPTER THREE FOOD, DRINKS, AND NUTRITION – POWER SOURCE OR POWER DRAIN The Junk Food Demon What is Food? Macronutrients Carbohydrates Fats Omega 3 and Omega 6 Saturated Fats Palm Oil Proteins Plant Proteins Soybeans and Soy Protein Fibre Micronutrients Vitamins Minerals Bad Food, Healthy Food, Junk Food and Fad Diets Glycation (the result of high heat cooking) Free Radicals and Antioxidants The Basic Food Pyramid Vitamin and Mineral Supplements Beverages Soft Drinks

Coffee Tea Alcohol Poor Nutrition The Metabolic Syndrome Diets The Pritikin Diet The Dean Ornish Diet The Atkins Diet The Asian Diet The Mediterranean Diet Weight Watchers Diet The CSIRO Total Wellbeing Diet The Polymeal Diet Fad Diets ‘Meal-replacement’ Diet Plans Low-carbohydrate Diets High-fibre Diet (the F-plan diet) ‘Rapid-weight-loss’ Diets The Summing Up – Choosing a Sensible Diet A Sensible Approach to the Good Life Go For Your Life My Personal Experience of Maintaining Perfect Weight Dining Out – Its Pleasures and Pitfalls CHAPTER FOUR

A HEALTHY LIFESTYLE The Baby Boomers and Generation X The Discerning Healthy Lifestyle Exercise and a Balanced Eating Plan Sleep Personal and Social Relationships Recreation The Irrational Lifestyle Smoking Quitting smoking Drug Abuse Gambling Alcohol Abuse TV Addiction Internet Addiction Disorder (IAD) Choosing the Right Content Over-reliance on the Car CHAPTER FIVE COMMON MEDICAL PROBLEMS: HOW TO AVOID ILLNESS AND BE A WINNER Colds and Flu’s Prevention Hypertension (High Blood Pressure or HBP in short) Preventing/modifying your HBP

Heart diseases (CVD) and Hypercholesterolemia Prevention/amelioration of CVD Cancers in General Prevention Asthma How to Prevent Asthma Chronic Obstructive Pulmonary Disease (COPD) Prevention / Amelioration Osteoarthritis Prevention /Amelioration Obesity and the Metabolic Syndrome Prevention and Amelioration of Obesity Childhood Obesity Preventing Childhood Obesity Diabetes Mellitus (DM) Prevention Food Poisoning and Gastroenteritis Prevention Colo-rectal Cancer (CRC) Prevention Constipation Prevention/Amelioration

External Thrombotic Haemorrhoids (Piles) Prevention/Amelioration Mental Illness – Depression and Dementia Prevention Lower Back Pain Prevention Prostate Cancer Prevention Osteoporosis Prevention Common Eye Problems Preventative Measures Blepharitis Prevention/Amelioration Stroke Prevention Transient Ischaemic Attack (TIA) Shoulder and Foot Injuries Torn Shoulder Tendon Prevention Plantar Fasciitis Prevention Take Home Message

CHAPTER SIX THE EASTERN WAY OF MAINTAINING HEALTH AND FITNESS Chinese Medicine Herbal Medicine Acupuncture The Roots of Acupuncture The Effects of Acupuncture Other Therapies Using Acupoints Tai Chi The Health Benefits of Tai Chi Qi Gong Ayurveda Yoga Meditation Neuroplasticity CHAPTER SEVEN LONGEVITY THE ETERNAL DREAM OF ETERNAL YOUTH The Incredible Hunza People How to Live Longer Studies in Ageing and Longevity The Dubbo Studies The Melbourne Studies

The Australian Longitudinal Study on Women's Health (ALSWH) The Okinawa Centenarian Study Major Factors for a Healthy Long Life Caloric Restriction Lifelong Physical Exercise Regular Medical Check-ups Maintain a Sensible Lifestyle and Manage Tension, Anxiety and Stress Avoid Excess Radiation Moderate Alcohol Consumption Maintain Your Social Network Contribute to Society The Top Ten Factors influencing Longevity Recent Findings in Relation to Ageing Key Genes and Molecular Pathways Neurogenesis and the Possibility of an Ageless Brain Resveratrol – the First Anti-ageing Drug? Promising Anti-ageing Molecules Telomerase Can Reverse the Ageing Process Regenerative Medicine Stem Cell Therapy PRP (Platelet Rich Plasma) A FINAL THOUGHT SPECIAL SECTION A MASTER EATING PLAN

APPENDIX A CHECKLIST FOR CEREALS APPENDIX B LIST OF COMMON ANTIOXIDANTS APPENDIX C FOODS RICH IN ANTIOXIDANTS REFERENCES

Acknowledgements In 2005, I first thought of writing a book based on my 40-odd years’ clinical practice to help people avoid chronic medical conditions. Back then, the idea seemed daunting, but it was also an exciting challenge to me. Since then, this manuscript, like a great many others by budding writers, has gone through cyclical phases of disappointment, set-backs, uncertainty and frustration. Without the great support and encouragement of my family as well as my many wise friends and learned colleagues, it might never have been able to get off the ground. I am particularly thankful to my scholarly son, David, who has regularly kept me up to date with a steady stream of new books and relevant clippings, and to my charming daughter, Deborah, who brought her editing skills and linguistic talent to the introductory section. I am very proud to see them both pursuing their medical careers with great zest. My indebtedness extends further, to my two valiant brothers: Nelson, the beloved dental surgeon, and Stanley, the ground-breaking neurosurgeon in Hong Kong, for their invaluable support and advice on numerous topics; and also to Mandy, from whom I learnt what courage really means. I am grateful to all the hard-working staff in my old Glenroy Road Clinic – they are an incredibly energetic and dedicated bunch of people. And, as regards my many delightful patients, past and present, I feel indebted to all of them for the numerous lessons in life they taught me, helping me to open my eyes and to build up my clinical experience. Last, but not least, is Jan Scherpenhuizen, my superb editor and publisher. Without his great talent, skill and visionary spirit, this book would not have been possible. I am greatly appreciative of his timely advice and tireless assistance right through our close association. I would like to say a big thank you to him for helping my dream come true.

A Short Profile of Dr Joseph Cheung Dr Cheung, OAM, was brought up in Hong Kong, the third son in a family of five. His father, an ENT professor at Sun Yat Sen University in Canton, China, impressed upon all his children the virtue of being a good scholar and a hard-working community-minded professional. As a result, Dr Cheung’s older brother, Nelson (now deceased), became one of the most popular dental surgeons in Sydney, and his younger brother, Stanley, was renowned as one of the top neurosurgeons in Hong Kong prior to his retirement.

Left: Young Joseph at a sporting event in Hong Kong, 1949, where he won the breast-stroke champion-ship Not satisfied with just scholastic achievements, the young Cheungs were constantly encouraged to participate in all manner of sports and attained remarkable achievements in open swimming championships and crossharbour swims in Hong Kong during the post-war years. Regular physical exercise has since become part and parcel of Dr Cheung’s life. In 1960, Dr Cheung graduated from the University of Sydney. He soon moved back to Hong Kong to serve in Kwong Wah Hospital, the best and

biggest charity hospital in the colony, before being forced to flee with his family to Canada during the notorious riot of 1969. There he studied pathology under Professor D Magner, the head of the Canadian Tumour Registry, and the Department of Pathology of the University of Ottawa. Joseph participated in research into renal transplants and ovarian cancer, and in publications on those topics. After returning to Australia and settling into a medical clinic in Melbourne, Dr Cheung continued to practise what he preached by swimming and jogging daily. He even made a successful run in the 1988 marathon from Frankston to the city as part of the celebration of the Bicentenary year of the nation. Over the years, he started to notice the therapeutic benefits of Oriental medical practices such as acupuncture and Tai Chi. He has since fervently promoted these aids to health to his patients, with excellent results, as published in his article in the American Journal of Chinese Medicine in 1985. His proudest moment came in 1998 when he was awarded the Medal of the Order of Australia (OAM) on Australia Day, for his service to medicine and the community, in particular, to the Australian Chinese Medical Association.

Dr Cheung feels deeply honoured that his efforts have been recognized and he has vowed to continue to serve the community at large by promoting the preventative measures of regular exercise, sensible eating and lifestyle that contribute to the ultimate healthy longevity.

Foreword Dr Joseph Cheung has devoted his life to the service of the community. As a general medical practitioner, he is both loved and respected, not just for his dedication to patients’ welfare, but also for the manner in which he approaches the myriad problems that have crossed his desk. Dr Cheung is not just a medical professional who listens, examines and analyses before trying his best to resolve the problems presented to him, he is also a firm believer in the power and benefits of preventative medicine. He takes great care to educate his patients, in order that they become aware of the reasons they have taken ill and, importantly, the measures that can be taken to prevent future mishaps. There is another dimension to Dr Cheung’s professionalism. His lifelong interest in the Eastern ways of health maintenance has enormously broadened his overall perspective on health care, enabling him to comfortably introduce principles of alternative medicine into his practice. This book embodies his beliefs on how to improve and maintain good physical and mental health in a holistic manner that will benefit both young and old alike. It is well thought-out and written in a manner easily understood by the layperson. The only ‘medical’ section is a Chapter devoted to preventive medicine, alerting readers to tell-tale signs of common diseases and appropriate action that can be taken to prevent them. The importance of exercise, including Tai Chi is emphasized and, unusually for a book of this genre, it contains a section on healthy eating. The reader also gets a glimpse into aspects of alternative medicine as practiced in the East and how they can be incorporated into our daily lives. The motivation behind this book is Dr Cheung’s desire to impart the knowledge and experience he has accumulated over many years to present and future generations. It is a personal tale and well told. Associate Professor Kong Wah Ng MBBS (Monash), MD (Melbourne), FRACP, FRCP (Edinburgh) Former Director Department of Endocrinology & Diabetes St Vincent’s Hospital, Victoria, Australia

Features of the Second Edition Considering the recent rapid advances in medicine which have resulted in many new concepts, definitions and discoveries, my editor/publisher Jan Scherpenhuizen suggested an updated version of the text was in order and I could only agree. The time has come to revise the entire text since my first edition was launched in 2012. The new material my readers will find in this edition is as follows: A section that introduces a new branch of medical science aptly called Regenerative Medicine. This fascinating medical therapy is well set to just about revolutionize the treatment of human diseases, whether curable or incurable. I am pretty confident, more than ever, that more magical advances will be in the pipeline to offer immense benefit and great joy to patients and everyone of us. Updates in almost every chapter, with particular emphasis on diets and antioxidants, those ubiquitous chemicals that influence and control our body’s internal biological reactions right down to the sub-cellular level. The real story of the most super-super-obese person in the world on record and their tragic ending. There is a lesson to be learned by every single overweight/obese sufferer. I make no apologies regarding collecting and cramming so much information in medicine and health in this compact book, and I am convinced more than ever that the principle aim of this book, to advocate a healthy lifestyle with regular exercise, will continue to revolutionize the well being and happiness of my readers, and assist in the much needed improvement of the health of our society. March 2018 Year of the Dog Joseph Cheung, OAM

Introduction: A Beautiful Cruise to a Beautiful Dream It was a glorious autumn day in Vancouver, in September 2005, when my son and I embarked on the Island Princess for our cruise to Alaska. She was a magnificent ship by any standard and the newest addition to the P&O fleet. Our departure from the terminal in the late afternoon, into the inland sea, went nearly unnoticed, so imperceptible was the ship’s motion. The tranquil waters sparkled in the light of the setting sun. On board the polished timber deck, hundreds of passengers lay relaxing in chairs, strolling the half-mile around its circumference and chatting over their coffees. Amidst the banter and smiles we could only feel a surge of happiness, swept up in the mood of the crowd that was nothing short of celebratory. But I was then struck by a sudden thought. We were here with tourists, most of whom were in good health, enjoying a mobility and independence which allowed them to travel as they pleased. But what of the four million people, in Australia alone, who suffer painful joints from osteoarthritis; the two million with osteoporosis whose fragile bones are at risk from any fall; the tens of thousands who undergo major surgery after a heart attack; and the 30% of adults and 20% of children affected by obesity and all its problems? Wouldn’t it be wonderful to be able to improve the health of these people? And what if everyone could maintain their good health and fitness to the point where they could work for as long as they wished; play sport and engage in hobbies and travel for far more years than they would ever have expected? My conviction that this is possible is the driving force behind this book. I hope to persuade more people to remain aware of the steps they can take to improve and maintain their health. My own awareness was triggered when I realized that, after years of adopting a lifestyle which included a programme of exercise, diet modification and the use of some Eastern health practices, my overall health was better than for the 20 years previous. Hard to believe? But absolutely true! During that time I have continued to work as a full-time general practitioner. I used to suffer

countless respiratory-tract infections due to my contact with sick patients. Nowadays, my immunity has strengthened to the point where I remain virtually free of respiratory illnesses – colds, sore throats and chest infections alike. In the pool, I have been able to swim longer distances and clocked better times. My blood cholesterol and sugar levels remain excellent. My BMI (body mass index) is a healthy 21. Naturally, I am ecstatic about my good health, and I am convinced, more than ever, of the importance of encouraging others to set their own goals and enjoy a swift improvement in their fitness. Thus this book is the crystallization of years of clinical practice as well as my personal experience in achieving good health and longevity. I have endeavoured to include much of the most up-to-date scientific research behind the facts presented. I have also tried to use common medical terms and avoid jargon as much as possible. I am keen to pass on my health concepts to all, but suggest that babyboomers and generation-Xers may find these of greatest benefit. My approach to health and fitness is rather unusual and could completely change the way you live and work. In the end, I hope to revolutionize the direction and methods currently employed by the government and health bodies. This book is not just a diet guide or programme of exercise techniques. It is an exploration of the meaning of total good health: a state of both physical and mental fitness that ultimately leads to a long and healthy life. Facts presented will be backed up by a body of fascinating medical and scientific studies, and interesting surveys of the different regimes that people adopt. In Chapter One, we shall find out about common good health and how it differs from the ideal of total good health. We will also discuss the huge health problems our nation will face in the foreseeable future. Chapter Two examines the biomechanics and physiology of exercise and physical fitness. We look at the benefits of exercise and how the reader can best create a fitness regime to their advantage. In Chapter Three we consider the most recent data on nutrition and healthy food plans, and pin-point the critical differences between good and bad diets.

Chapter Four contains an analysis of the merits and failings of a range of different lifestyles – lifestyle currently being regarded as one of the critical factors affecting longevity. Chapter Five looks at preventive medicine. We discuss the common acute and chronic medical conditions which have featured prominently in my experience as a hospital doctor for nine years and family physician for 35 years. We will also look at the keys to prevention. In Chapter Six we consider mainstream Eastern philosophy and practices which help maintain fitness and health. The final chapter, Chapter Seven, deals with longevity and the so-called ‘fountain of youth’ – for many, the most sought-after dream, and one which has been elusive until now. In this new updated and revised edition, a section has been added at the end of Chapter Seven (Longevity) to briefly introduce to the readers the exciting new research about ‘Regenerative Medicine’ – an intriguingly new concept in medicine that could revolutionize future medical treatments for many acute injuries to our organs as well as most intractable chronic diseases which are known at present. At the end of the book is a special section, in which I offer my own Master Diet Plan, which contains tips on a quick and easy way to cook, as well as a number of recipes. By consciously practising the advice in this book, you will notice a gradual improvement in your health, and come to feel more energetic and more capable than ever before. This guide is intended to help you achieve ideal health and a longer lifespan. It is intended for all age groups. However, the earlier you follow the guidelines, the higher the chances of maximizing the benefits are. Do not put it off until you are old and unwell, because by then many chronic afflictions may have already been firmly entrenched, and the benefit of this book will therefore be limited.

Chapter One It’s Time for Better Health Good Health ‘Good health’ is defined by the WHO (World Health Organisation) as a ‘state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. When we talk about a life of good health, most people would understand this as comprising three basic elements – physical, mental, and emotional health. A physically healthy person should be able to perform all daily tasks, enjoy sports and hobbies, and be free of chronic conditions such as hypertension, diabetes, cardiac problems and the like. Mentally, they would be stable in mood and outlook, and be free of depression and other more serious psychosis. Emotionally, they would enjoy loving relationships with family, feel fulfilled and satisfied with work and hobbies, and relate happily with friends and colleagues. For many people, a fourth element – the spiritual – may also be regarded as essential, as affirmed by those strong in their faith and belief in God. A congregation of Christians may feel elated after a church service, especially at the end of a good sermon. So too, Buddhists at their temples and Moslems in their mosques enjoy the ‘mass effect’ of religious gatherings and ceremonies on the mind and body. The powerful influence of such rituals is indisputable, and has been an essential feature of human life since time immemorial.

Total Good Health I define Total Health as an all-inclusive state of physical fitness and mental stability, associated with good nutritional habits and social interactions; and ideally complemented by Eastern methods of health maintenance.

After many years of consulting for tens of thousands of patients, both in the clinic and at their homes, I have come to recognize the important relationship between the development of many diseases and lifestyle. I have the experience now to know what makes the average person fall ill; why some people become sick more often than others; and some ways to help a healthy person ward off unexpected heart problems or even cancer. I also understand the factors which allow certain people, like Charlie Booth, to celebrate their hundredth birthday and still have ‘plenty of punch left yet’ (see The Age 15/3/04).

Our Nation’s Huge Health Bill – What Has Gone Wrong? My experience is drawn from my work as a family doctor in Melbourne and Sydney for 40 years. The huge number of diseases and disabilities that I have treated in this time reflect the typical medical problems we encounter in this country. Yet, in the last ten to twenty years, I have observed an alarming trend in patterns of disease, notably in the steady increase of chronic medical conditions such as obesity, high blood pressure, hypercholesterolemia, diabetes and osteoarthritis – a full-blown picture of what is now known as the ‘metabolic syndrome’. Each element of this syndrome is expensive to diagnose, to treat, and to follow up. The numerous complications that could arise from these chronic medical illnesses are even more problematic and more expensive to alleviate. And this, unequivocally, is the problem we face now. Some idea of the extent of the nation’s health problems is easily gleaned by simply checking the report released in 2013 by the A.H.A. and Centres for Disease Control/Prevention, which states that within our population 34% of people suffer from obesity, 13% have hypercholesterol, 33% hypertension, 8% diabetics with a further 38% pre-diabetics and 34% metabolic syndrome. An astonishing 32% of adults take no exercise, while somewhere between10 to 17% of teenagers also do not exercise. At the current time, we are at a crossroads in the nation’s health dilemma, pondering on ways to remedy our chronic problems, especially those associated with the ageing population over the next 30 to 40 years. The story in America is no better. It has been estimated that due to the behavioural changes that have overtaken American society, chronic health

conditions are now found in every family. By 2030, according to current projections, 150 million Americans will have some chronic degenerative disease, and 42 million will be too disabled to attend schools, work, etc. Although overall Commonwealth health spending had reached $48 billion by 2006, the Productivity Commission report in November 2004 forecast that, as the number of elderly people quadruples and thus consumes disproportionately many more health dollars, the cost to the nation by 2040 could be $2.2 trillion in today’s currency. This estimate is absolutely mindboggling – medication costs alone will soar to $50 billion a year from today’s $7.5 billion, and hospital costs to $86 billion from today’s $2 billion. This report appeared to have the backing of then treasurer Peter Costello who warned that it was time to act immediately to prevent a future fiscal blow-out. The government of the day established a ‘Future Fund’ with an initial investment of $16 billion with the promise that more money would be forthcoming from the sale of Telstra. This is a sensible step towards dealing with future national debt, initially set up to help meet unfunded super payouts, amongst others. However, the projected colossal health bill has not been identified as one of the items to be tackled by this ‘Future Fund’! Where are we to find the $ 2,200 billion to cover these future health costs? What if the government could not afford this huge health bill in time? Does it mean that we will have to bear the pain of arthritis, suffer diabetic complications like blindness and kidney failure, and wait months instead of weeks for a breast or prostate cancer operation? Chances are that this may well be the grim reality, given the currently accelerating increase in obesity, diabetes and arthritis, reflected in the rapid rise of spending on their treatment. Let us pause and assess the situation – because the core of many of these calamities may be due to unhealthy lifestyles: sedentary habits and the excessive consumption of unhealthy high-calorie food, cigarettes and alcohol. Unfortunately, people will not change their unhealthy habits over- night without sufficient motivation, which may not be acquired without some powerful persuasion. Nevertheless, all is not lost. If my readers follow the fitness principles in this book and practise what I have been practising for the last 20 years, by the

time they are in their sixties they may find themselves sailing into several more decades of good health and productive work. An excellent example of the benefits of regular exercise is former Prime Minister John Howard, who was the second-longest serving PM in Australian history. Well into his sixties and his fourth term in office, Howard showed little sign of weariness or slowing down. His exceptional fitness and stamina may have had much to do with his well-publicised morning power-walk. If enough of us work on our health, not only will we personally enjoy our later years, but the nation will be saved billions of dollars which could be used to fund other worthwhile causes, such as research into genetics, stem cells, longevity and the looming national water crisis. By then you may regard the ageing process as a much happier event than you had ever envisaged. The end results? A healthier and stronger nation and a brighter prospect for the future.

Chapter Two Physical Fitness – the Lynchpin of a Healthier Life Everybody remembers the ‘Life. Be In It’ TV ads in the 70s, from what is probably the first media campaign sponsored by the government to promote physical activities as part of a get-fit programme. It began in 1976 and seemed to work well, catching the imagination of a large number of people. Soon after, we witnessed an increasing number of people jogging on the suburban pavements and in the parks. Joggers and walkers of all sizes and ages appeared, from teenagers to the over 70s. Often they’d be out early in the morning, so that it might still be jet black on the road during winter times while daylight saving was in force. More recently, early in 2005, as part of a strategy to tackle the alarming trend of obesity and physical inertia among the general population, the Victorian government launched its keep-fit programme ‘Go for Your Life’, urging people to adopt a more physically active lifestyle. They were encouraged to frequent our many well maintained parks and gardens, alone, in groups or with family, and go for a healthier life. This is one example of how an intelligent government with initiative can help counteract the unfortunate cultural attitude of ‘eat, drink, and do nothing’ which has developed over the last decades in our modern society. I am sure there will be a significant decrease in chronic sickness and society will be healthier once again if the ‘Go for Your Life’ campaign runs long enough in the media, in tandem with other initiatives, such as providing more bike tracks and public swimming pools, increasing physical education in schools and improving the standard of food available in school tuck shops. Other sensational fitness and health programmes are regularly in the news headlines, such as the Frankston to Melbourne Marathon in Victoria, the City to Surf Fun Runs in Sydney. Triathlons, half-marathons etc. are all events which contribute to the fitness and health of many people. Ideally, these and many other events will be held more often and even more heavily and widely promoted in schools, workplaces and the community. Keep-fit planning in Australia is a relatively recent government initiative.

Overseas, scientific research and promotion started much earlier. For example, in Britain, research into the health of 31,000 London bus drivers and conductors by M.N. Morris was completed more than 50 years ago (see Modern Medicine of Australia, June 1991). The report had concluded that the drivers were found to have more heart problems than the conductors. In the mid-1960s, John F. Kennedy set up the President’s Council on sport and fitness in the U.S. Canada produced the Lalonde report in 1972 and hosted the Second World Conference on exercise, fitness and health in 1988. Two years later, the National Heart Foundation of Australia followed the major world trend in making exercise a major focus in its campaign to make heart attack less prevalent. Those reports, studies and recommendations, just over that short period alone, amounted to hundreds and thousands of pages. The evidence so far suggests convincingly that physical activity, in combination with adequate nutrition, is probably the single most important factor contributing to good health and increased longevity.

Types of Exercise and Their Biomechanics As prominent American professor and cardiologist, Joel Khan has stated, exercise is a particularly potent ‘heart disease fighter’ and has been shown to lower the risk of death by up to 50%. Exercise is usually divided into anaerobic and aerobic, which have vastly different biomechanics from one another. The basic difference between the two can be described as follows: Aerobic exercise is the kind of activity which we associate with fitness training and sports activities. Anaerobic exercise, on the other hand, is any kind of physical movement and activity we perform daily, consciously or subconsciously. This type of exercise is performed by an electrician working on an electrical appliance; a factory worker on the assembly line; an office worker typing at the computer and occasionally shifting their stiff legs or stretching their arms in a big yawn, or walking to another desk to talk to a colleague – all of them working and labouring on and off all day, intermittently rather than continuously. Another typical example is a housewife who starts her morning by preparing the children’s breakfast, driving them to school, then visiting the supermarket, returning home to sort out the groceries, putting loads of clothes into the washing machine and

hanging them out on the line, etc. Anaerobic Biomechanics Anaerobic activities involve the intermittent use of mostly small groups of muscles. Energy is consumed in two forms. Glucose provides the main source of fuel, along with ATP, a compound which delivers a lot of energy and is stored in the muscles in small amounts. With sudden strenuous activity, the available store of ATP is rapidly depleted and results in the formation of lactic acid, which creates aches and cramps to show that the store of energy has been depleted. This form of energy production may suit a certain individual well, such as a weightlifter who wants to generate maximal strength in lifting a heavy weight in a split second, or a sprinter wanting to run the fastest 100 metres, but the energy so supplied will not last longer than 10 seconds! After a day of anaerobic exercise, we may be tired and achy despite not having done anything strenuous or sustained. This kind of activity does not stimulate the cardiovascular system to promote fitness nor build up the store of ATP but still burns a certain amount of calories and creates lactic acid. Aerobic Biomechanics Aerobic exercise utilises large muscle groups and kicks in after about 15 minutes of continuous activity. The term ‘aerobic’ refers to the fact that sustained activity stimulates the cardiovascular system creating a greater supply of oxygen which is utilised by your body to break down its fat stores and convert them into energy, replenishing the ATP. The waste products of water and CO2 (carbon dioxide) are quickly expelled by the lungs and skin and no lactic acid is produced. It has been estimated that the longer you exercise, the higher the proportion of your energy that comes from fatty acids (up to 40% after 40 minutes of moderate exercise) – this simply equates to more fat being burned from your body. The average person has 600,000 kilojoules (a kilojoules is an energy unit) stored as fat in their body, compared to about 7000 KJ of glycogen, therefore fat is clearly the richest energy source in the body. Your aerobic exercise

expenditure is unlikely to ever require all of your reserves of energy. In an article in 1984, H.B. Simon calculated that the glycogen store in the body could only supply enough energy for a 10 km run, whereas the fat stores would last for a 2,000 km run! The level of glucose in the blood of those involved in strenuous exercise has been found to be up to 400% or more above that detected in the sedentary state. The muscles of individuals who regularly do aerobic exercise become well-trained and able to absorb a large quantity of glucose which is accessed during exercise from their greatly swollen blood supply, at many times the rate normal to sedentary people. Diabetics suffer from an inability to process sugar, due to the weakening of their pancreas, which in healthy people produces plenty of insulin. Vigorous exercise uses up a lot of sugar and stops the pancreas from having to work so hard, which is why many clinicians now urge diabetics to exercise more. Due to its many benefits, aerobic exercise must be central to any programme of fitness and it will remain the focus of the rest of our discussion of exercise. It exercises not only the body’s big muscles, but also the heart and lungs. It pumps blood to every part of the body and supplies nutrients and oxygen to them, while flushing out hidden waste products from the body – and from the brain too – leaving you healthier, leaner and feeling better. Many doctors have already turned to exercise to keep fit. According to a report published in The Guardian (1990), a study carried out by Harvard Medical School showed that almost 75% of doctors surveyed exercised regularly and dieted too. Just ask yourself, ‘what better example do I need?’ What is more, aerobic exercise can be performed by any age group, from a few years old to the 100 year olds. As the nation is ageing and starts to consider the enormous financial burden and social cost of poor health within the next 20 to 30 years, no one could fail to see the massive benefits to society if all nursing-home residents, retirement-village retirees, the elderly and the not-so-elderly, could be gently nudged into some sort of regular physical activity and maintained on the programme, so that they became more mobile and independent and had fewer expensive medical illnesses and dangerous falls. The benefits of exercise for those groups of people will be immense.

The bulk of the population at present, naturally, is composed of children, teenagers, the young, the middle aged, and baby boomers (people in their 50s and 60s, estimated to make up about 20% of the nation’s total population). They are the ones that will reap the most benefit to their health by practising aerobic exercise. It has been estimated that if only 1% more people become more physically active, $200 million could be shaved off the health-dollar budget annually.1 With a more ambitious target of 10% more people ‘getting off their butts’ a huge $2 billion would be saved annually for better use. And the benefits are not only fiscal, because that10% of the populace will enjoy better health, better stamina, and be more productive. The immediate and future benefits to the nation are huge. The benefits of exercise are multitudinous, the foremost being proven protection of the heart and blood vessels, greatly lowered blood cholesterol and sugar, and weight loss to some extent as well (particularly with some exercise like marathon running – have you ever seen an overweight marathon runner?) Exercise can also help improve the quality of life of people suffering lung diseases like asthma and emphysema and help delay early onset of osteoporosis. Suitably programmed exercise has been shown to reduce falls in the elderly and combat depression from any cause. We’ll elaborate more on this in Chapter Five.

Aerobic Exercises – Targeting Cardio-Pulmonary Fitness In sports-medicine circles it has been well-known for years that aerobic exercise confers the greatest benefit to your heart and lungs. The main reasons, as we have noted above, are that such activities involve large muscles in your body, stimulate and train your heart muscles to beat stronger, and possibly even open up more smaller arteries (the collaterals) to supply blood to those parts of the heart which are starved of blood due to partly or badly blocked arteries. Vigorous exercise will help open up most, if not all, of the blood vessels in your body with a steady faster blood flow that gives you a healthy warm feeling throughout. This last benefit continues to be experienced for some considerable time after the actual activity stops. At the same time, you will breathe in more air/oxygen and get rid of any stagnant air which has not been or could not be breathed out while sitting still reading,

writing, or working in front of the computer.

Walking, Power-Walking, Jogging Of the many varieties of aerobic activity, jogging, swimming and cycling are considered the top three in regard to enhancing your cardio-pulmonary function (CPF) and have been rated ten out of ten. Others vary from four to eight, and will be listed at the end of this chapter. As the purpose of this chapter on exercise is mainly concerned with simple, popular physical activities, easily accessible to the general public, I will only choose walking, jogging, and swimming for detailed discussion. Land-based exercises like walking and jogging have certain advantages, while the waterbased activity of swimming has others. You may pick either one or both, or even include other more specialised activities like cycling, rowing, canoeing, or group activities such as golf, tennis, dancing, etc. Handy Hints Always choose favourite activities, particularly ones you did some time ago or in your teens, as they are the ones you will most likely stick with until the end. Unaccustomed exercise may sometimes cause some unexpected minor injuries of the soft tissues such as strained muscles, ligaments and tendons, particularly if you ignore the golden rule of ‘warm up, cool down, and stretch’. Walking and Power Walking Walking is the most basic physical movement for any land-based mammal and humans are no different. We all have to walk, every day, be it from one room to the other; from the house to the garden to appreciate the spring blossoms; to the garage to get into the car; to the post box to check the mail, and, of course, to go down the street for the milk and papers. All these are short trips that won’t give you much CPF benefit and most people just stop at that, and go no further. Many parents drop their children right at the front gate of the school with the car and pick them up afterward, rather than letting the children walk or walking with them. Many people drive to work, when

they could easily walk, jog or ride a bicycle. Most walk hardly ten to 20 minutes a day. Now that every office is fully equipped with labour-saving electronic machines like phones, faxes, copiers, scanners, and personal mobile phones there’s little need to leave the office. Even going to the deli to get lunch, down and then back up 15 floors via the staircase, has become too Herculean an effort for most young men and women, let alone weighty executives and managers. The lift is far better – whisper-quiet and ultra-fast. But just pause and ask yourself: what better and easier way to start your body’s engine than just taking a walk? Although walking is rated only six out of 10 regarding the CPF benefit, it is the safest, the easiest and most convenient exercise to do, and the least expensive to begin. Even if you are on the lowest rung of the economic ladder, there is nothing to stop you from walking as long as you have a pair of shoes. Once having started, you will most likely become ‘addicted’ to walking as you become fitter and begin to enjoy all its benefits. How much and how often do you have to walk? Well, that could vary a great deal from person to person, but basically it depends not so much on your age but on how active you have been all along. For instance, the 60 year old who handles all the household chores like shopping, gardening, and is not overweight, would have no trouble starting to stroll for half an hour, three to four times a week, and could easily extend this to more. A longer faster walk, for most days of the week should be comfortable after, say, a month or so, when the CPF (heart and lungs) and body have become conditioned. On the other hand, the weighty 30 year old who has been in a sedentary job ever since leaving high school would find it hard to walk even 20 minutes once a week. They would need to start off for ten-minute sessions for a few weeks first, and combine this with some healthy dieting to help shed a few kilos. From then on, the pace may be slow, but they will progress steadily after a longer interval of catching up. But anyone can get there if motivated. We often have people advise us, with the best intentions, how much, how often, and how fast we should walk. There are no hard and fast rules. Even recommendations from official health organisation bodies differ, from between three days a week, to every day of the week; from vigorous aerobic exercise to moderate exercise. As one specialist remarked, ‘I hate all those guidelines. They are probably drawn up by someone who has got too much

time on their hands’. However, from my own personal experience, the best guideline for the beginner is to listen to your body. Because the condition and the level of energy of your body varies from day to day, and even from morning to evening, you should not stick to a rigid regime. If you feel tired on any given day, walk a shorter distance more slowly to avoid over-exerting your body and producing too much inflammatory reaction which manifests itself as muscle stiffness and aches. Go home and take a hot shower to soothe your body and go to bed a little earlier. Then you’ll wake up the next day feeling refreshed and knowing that your body has fully recovered with the milder exercise and will be ready to perform better in your next scheduled walk. Keep up your easy walk for at least a few months before you develop a more demanding routine. By then, your body will already be better conditioned, with an improved CPF, stronger leg muscles, healthier joints, and plenty of stamina.

The Ambling Walk The typical ambling walk is usually taken early in the morning or at night in summers, and in the afternoon or evening in winter-time. It is wise to take note of the approximate temperature at the time, particularly in cities like Melbourne with its famous ‘four seasons in one day’. This is just common sense, because your purpose is to get fit and not to brave freezing temperatures, nor to suffer under a scorching sun. The Chinese have long believed that the environment has a great impact on our health, and that we should try to adapt to live in harmony with Mother Nature. The ambler will start walking at a relaxed pace, spine upright, head level, arms down and swinging naturally without effort, and breathing entirely through the nose. The speed is most likely about three to 4.5 kmph (kilometres per hour). After five to ten minutes at this ‘warming-up’ speed, the walker should then be able to walk faster: about 5.25 to six kmph, back still upright, both arms still down but swinging in a more forceful, faster way. Swinging the arms serves an important role in helping propel the legs and body forward and functioning as a ‘pacemaker’ in controlling your speed. The breathing becomes deeper now, but is still through the nose, with one

breathing cycle (inhalation and exhalation) every four steps. The walker will maintain this posture and action right to the end, before slowing down and reverting to the easy walking manner for about another five to ten minutes. During this important ‘cooling-down’ period, the walker will relax again, the sensation of the rushing blood and warmth in the limbs and face slowly subsiding, and the breathing becoming easier. The entire body will feel refreshed and ‘loosened up’, the mind clearer, calmer and the spirit elevated, perhaps partly due to the effect of endorphins. According to Dr Murray Allen from Simon Fraser University in Canada, this group of morphine-like substances produced in the brainstem, which are activitygenerated, are known to induce feelings of calm, relaxation, wellbeing and mellowness.2 Naturally, the amount of endorphins released depends, in a linear ratio, on the intensity of the physical activity. Thus, a good workout of power walking or jogging will make one more invigorated in body and more elevated in spirit than when one just walks in a casual manner. The Power Walk Once you have settled into the training routine, you will surely start to enjoy your daily walk. You might feel that you want to walk longer, extending your exercise from 30 minutes to over an hour, five to seven days a week. Why not? Particularly if you have begun training young and are reasonably active, you should be able to walk faster and longer or, better still, upgrade yourself to power walk (or a brisk walk). Power walking has been the new craze since the 90s, simply because the power walker can cover the same distance and terrain as a jogger, but just take longer to arrive. Power walkers enjoy almost the same benefit on their CPF as the joggers but they face less risk of injury and are not limited so much by age. Power walking, in fact, is a variant of the brisk march or drill march long practised in the army and well-recognised as a way of keeping soldiers at a peak level of fitness. After the initial warm-up, the typical power walker’s pace increases with a longer and faster strides and both arms swinging more forcibly; preferably with the elbows bent, as in jogging and running, to help move the legs faster and propel the upper body forward. The breathing rhythm will be the same

for all ambling walkers, power walkers and joggers – one breathing cycle for every four strides. But now the power walker will most likely have to breathe out through the mouth as the tempo of the walk intensifies, so that all the used-up or ‘waste’ air which contains little oxygen can be more effectively blown out and replaced by fresh air. At a more intense level of training, the power walker will inhale the fresh air through both the nose and mouth, almost automatically by instinct and reflex – just as is done by a jogger or runner. The average speed of a power walk would be around six to 7.5 kmph – not bad compared with the jogger’s nine to 12 kmph. Jogging Jogging has been a fashionable physical activity in Australia since 1976 when the government launched the ‘Life. Be In It’ keep-fit campaign. In its heyday, joggers, young and old, in colourful shorts and track suits, ran around everywhere, early in the morning in many suburban streets, around sports ovals and through public parks. The practice has gone through a series of peaks and troughs since then, as a reflection of people’s enthusiasm and governmental encouragement. Of course, like any other sport or recreation, there is always a hard core of enthusiasts who have discovered the rewarding health benefits for their CPF and physical fitness, and tend to keep pounding the suburban pavements by day or night, come rain or hail. In recent years, as the newspapers report, jogging appears to have returned to vogue. The rangers of Parks Victoria, using their people counter, have estimated that there has been a growing number of joggers and runners using the famous tan track around the botanical gardens and Albert Park in 2001. One of the driving forces behind this appears to be the corporate organisations nearby and in the CBD that have finally recognised the benefits of having physically fit workers. They have moved to pour money into organising team competitions and to encourage their staff to take part in more fitness-promoting exercise. Jogging begins more or less in the same way as a power walk – five to ten minutes warm-up walking before gradually moving onto the faster power walk. But when the jog really takes off, the jogger’s body and legs are continually propelled off the ground into the air somewhat, powering forward with only one foot briefly touching the ground at a time. The power walker,

on the other hand, will frequently have both feet on the ground, albeit briefly, all during their walk. A very important point for the jogger is ‘heel strike’, which means that the heel touches the ground first before the rest of the foot, so that the strongest and the most solid part takes the full impact of the entire bodyweight (which could be up to 100 kg or more!). Together, with wearing good modern jogging shoes, attention to the heel strike is the only way to protect one’s feet from the common injury called plantar fasciitis (the inflammation or tearing of the fan-shaped large ligament of the foot) and other problems with the bones of the foot. As expected, the jogger’s arms and shoulders swing more violently to power the body forward, exactly like a runner but comparatively slower and in a more relaxed fashion. The breathing, of course, is more forceful and rapid, in proportion to the speed of jogging, but still keeping within the rule of four to one (four steps to one breathing cycle). As jogging is an intense exercise and rated ten out of ten for its CPF endurance, you can imagine the amount of air your hard-working diaphragm has to suck in and blow out in order to supply enough oxygen to the pounding heart and to the large muscles throughout your body. Jogging is a much more tiring and demanding form of physical activity than walking. Older and less fit joggers are well advised to have a medical checkup with their GP before taking up jogging, or before graduating from power walking to jogging. You must make sure that your heart is reasonably healthy. There are many tests which can screen you for problems from chest X-rays and blood tests to an ECG which will record the electrical activity of your heart or an ECHO cardiogram which utilizes ultrasonic waves to create a video image of the pumping heart. Better still, ask for an exercise ECG to gauge your heart’s ability to handle the increased workload from a more intense level of exercise. You are also well advised to constantly monitor your body’s own signs to avoid overwork and injuries. Such signs are commonly presented as excessive breathlessness, undue weakness, aching in the leg muscles and dizziness, or discomfort and even pain in the chest (called ‘angina’, an indication of suboptimal supply of blood and oxygen to your heart). A properly structured jogging programme, based on the principles of the gradual increase of intensity, supported by a balanced and nutritious diet and

adequate sleep for the body to recover fully, will never fail to help you build a sound foundation of athletic fitness. This exercise will deliver an immense reward in the form of a greatly improved CPF, the acquisition of superior endurance, and a mental toughness you have never experienced before. Long before my first, and sadly my last, marathon run in 1988, I used to jog about six kilometres most mornings of the week and kept myself fit and healthy before conducting consultations at our clinic along with two other partners, both easily 20 years my junior. As ours was a long-established family GP clinic in a well-populated suburb, my workload was constantly heavy because of my seniority. Often I worked literally non-stop for about 12 hours, regularly about twice a week, yet I was still able to cope with all the stress and frustration that is part and parcel of life in a medical clinic – unlike the two younger partners. They were heard moaning and groaning, sighing and complaining, about how tiring and exhausting it was handling so many patients a day. However, the day-journal records showed that one of the partners had, in fact, handled less than half the number I went through for most of the time he was with us! This incident was probably the turning point where I began to recognize the health benefits of regular exercise.

Swimming More on Biomechanics Of all the aerobic exercises, swimming is easily the best, the gentlest and most relaxing. Although it does not compare that well with jogging on weight control (being rated eight out of 10 compared with the 10 out of 10 of jogging), it tops the list on other benefits such as improved digestion (eight out of 10), a more restful sleep (eight out of 10) and vastly better cardiovascular and cardiopulmonary functioning (rated 10 out of 10). For an average 70 kg person, swimming uses about 10 kilo-calories (K-Cal) per minute. For a 30-minute swim, you spend about 300 K-Cal. This is not much, as an average person in the Western world takes in about 3,000 K-Cal (as food/drinks) per day. 300 K-Cal only amounts to one tenth of the daily calories consumption. But, consider the following statistics: (1) A sedentary person who does not exercise to burn off that 300 K- Cal,

would been converting that amount to fat and accumulating it to the tune of 10 kg of bodyweight per year (almost all fat cells are composed of 85% fat and 15% water) – quite a worrying weighty figure. (2) Through a process of thermogenesis, the body in effect uses up more than just the 300 K-Cal during the 30 minutes of exercise, because one of the cornerstones in aerobic exercise effect is raised BMR (basal metabolic rate) resulting in raised heat production. Basal metabolic rate is the minimum amount of energy you use to maintain your body function: this is about 1,200 to 1,300 cal per person per day though the figure varies depending on the individual’s sex, age and bodyweight. Aerobic exercise itself is not very efficient in producing energy – it has been worked out that during aerobic metabolism, only 25% of the material (glucose and fatty acids) is turned into ATP, while the other 75% is burned away generating heat, water and carbon dioxide. The last two substances are dissipated into the atmosphere, but the heat energy is utilized in warming the muscles, the blood and the heart, thereby speeding up the enzyme reactions that create the fuel you burn (this is the famous ‘Krebs cycle’). In other words, the raised BMR will cause more glucose/fat to be burned off for some time after your 30-minute exercise. (3) As you practise more aerobic exercise, your body becomes better conditioned and fitter, which means that your muscle cells become bigger and more efficient at using oxygen and fatty acid/glucose as fuel to produce energy. (4) You might not be aware of the fact that your muscles are the biggest consumer of your daily calorie intake – they are estimated to use about 90% of your daily energy consumption. Therefore, since your muscles swell considerably from regular exercise, they are continuously ‘silently’ burning up more and more of your body fat, which is a happy thought for weightconscious individuals. (5) Regular moderate aerobic exercise will raise not only your body’s BMR but also a host of other chemical processes in the body. The total effects from these are mildly higher body temperature, better circulation of your bloodstream, body and joint fluids, better digestion, sharper yet more relaxed mind, and increased basal burning of fat. The effects do not just stop after exercise; they will keep going for a few days.

You can now visualize how moderate, regular aerobic exercise will heighten your body’s fitness and health, in addition to increasing your muscle mass which in turn will efficiently control your store of body fat. (6) Recent research at three U.S. universities has shown that aerobic exercise can increase brain size and improve memory. A group of older people aged 55 to 80 participated in a programme of aerobic exercise over the course of a year. The participants showed a growth of 2% in the hippocampus – that part of the brain that deals with memory and spatial navigation. The above physiological effects and benefits are not confined to swimming only, of course; they apply equally well to all other aerobic exercises. Ancient documents and hieroglyphs show that swimming has been known and enjoyed since the beginnings of mankind, as a leisure activity, a sport, and a safety skill. In the last 100 years, swimming has become more popular and practised by many people to improve their health and fitness. There have been numerous proofs of the therapeutic effects of swimming on people suffering from chronic illnesses, the most notable case being that of the great Australian swimming icon Dawn Fraser, the golden girl, who won four gold medals and set 39 world records from 1950 to 1960. Fraser was also the first female to swim 100 metres in under one minute – a record that remained unbroken for 16 years. She is truly the living wonder of the swimming greats in history, and was an idol of mine in my university days, together with John Hendricks, Olympic 100 metre freestyle champion, and freestyle triple gold medallist, Murray Rose. (Hendricks happened to be a classmate and friend of my brother in Sydney’s Fort Street High.) However, it might shock you to know that Dawn was frail and plagued by illness as a little girl. She also suffered from asthma as her father did. Despite her physical handicaps, her general sickliness and asthma amazingly disappeared after she decided to learn swimming at the age of six, in the local Balmain pool. Within a few years, coached by her much beloved brother and her cousin (a swimming coach), she even won the senior women’s swimming championship at the age of 11, beating every one of the more experienced swimmers. While Dawn Fraser is no doubt exceptional, anyone with health problems can also benefit a great deal from swimming. The Special Benefits of Swimming

Swimming is particularly beneficial for almost all chronic medical conditions, notably coronary artery diseases, heart conditions, diabetes, arthritis (all forms), asthma and emphysema (COAD), low back pain, myofibrositis, and most forms of musculoskeletal afflictions. It should be used as part of the training programme in the rehabilitation process for patients after heart attacks, after CABG (a ‘by-pass’ operation of the heart) and angioplasty/stent (unblocking of the coronary arteries). Patients in many post-operative situations such as mastectomy (breast removal), ‘frozen shoulder’ operations, and many others, should be encouraged to exercise in warm water to hasten their recovery. Not only will the gentle therapeutic movements prove beneficial but the harmonious group-therapy environment nurtures hope and helps uplift the spirits. Some of the reasons swimming is often endorsed as superior to most landbased physical activities are as follows: (1) The buoying power of the water supports all parts of your body equally from head to toe, leading to a sensation of weightlessness. The limbs can move more freely and widely in the water; whereas in all normal land exercises your body must bear the weight, mostly on your lower limbs and joints – not a good feeling when you have aching joints and might even have trouble making your way to the nearest bus stop. (2) The resistance of the water (compared with the air, the water is 1,000 times heavier) means that it offers a gentle challenge to your arms and legs, so that you are obliged to execute your movements in a slow but steady fashion, exactly similar to those practised by Tai Chi practitioners. And Tai Chi has been found to be very effective in relieving pain, stiffness and fatigue. (3) The way you breathe in the water is not unlike the ‘pursed lips’ technique mentioned in jogging, and is generally helpful to the asthmatics because of the build-up of intra-bronchial pressure. (4) Swimming is one of the few sports that can build up your stamina and improve the resilience and flexibility of your joints and muscles. (5) Swimming causes less strain on your heart, due to the simple fact that you are in a prone position, so your heart can pump the blood more evenly with

less effort to all parts of your body. Swimming is also easier on the heart because it exercises mostly the upper body muscles which are more easily supplied with blood because of their closer proximity to the heart. (6) Swimming is a whole-body exercise – it involves almost every joint, every muscle and every major organ in your body. Isn’t that amazing? (7) The combined effects of buoyancy, resistance and the massaging action of the water form an ideal environment in which you can move forward, or just move around, in slow motion, effortlessly and relaxingly, gliding along gracefully like our very ancient ancestors – the marine animals. For anyone looking for a most relaxing and comfortable way to exercise, swimming is, in my opinion, second to none. Swimming Styles These have evolved considerably since the 1908 Olympic Games in London. Prior to that, people just swam in three basic styles, namely, breaststroke, sidestroke, and backstroke. All three were basically similar to each other – they all used both hands sculling under water for propulsion, and utilised a style of kick simulating the frog (hence the breaststroke has always been called ‘frog style’ in Chinese). Since then, maybe due to some inspiration or experimentation, swimmers discovered that they could swim faster by lifting their arms above the water, and that their speed would be further enhanced by kicking the legs with a flutter instead of using frog-like kicks. This new style of swimming was obviously enthusiastically embraced and popularised by the Australians and so was called the ‘Australian crawl’ which has since been the fastest style and used in the official ‘freestyle’ event. The backstroke too has changed – no more both hands sculling and frog-kicking legs; instead, it is almost a crawl performed while floating on the back with the arms going in the opposite direction. The fourth official style, the butterfly, is a latecomer, but is fast approaching the speed of the backstroke. However, it is the most strenuous and the most difficult style, not suitable for those seeking mild to moderate aerobic swimming exercise for their CPF and so will not be discussed here.

Freestyle This is the fastest yet the most relaxing, and the one I would encourage you to adopt for the following reasons: 1) It involves the movement of the upper arms in a continuous motion, with some flutter kicking of the legs, resulting in a smooth forward propulsion of the body. Once you have learned how to coordinate your stroke, kicks and the breathing technique from your coach, you should be able to swim at a relaxing speed and easily accelerate through the water at will. By increasing the training period and varying the duration and the speed, you will achieve better endurance (staying power) and build up a stronger body. 2) Because your body is predominantly propelled through the water by the alternate sculling of your arms using your shoulder and upper back muscles such as the latissimus dorsi, helped by leg movements at the hip joint and thigh level, you are practically training all the major muscle groups of your body and reaping the full benefits of aerobic exercise. 3) With improved technique, you will be able to move most of your joints in a wider range of movements, giving you more flexible and stronger joints. Breaststroke Some people find this stroke easier to learn and more comfortable. That’s fine, as long as you can master the style and get into a regular workout. At some stage you might change your mind and prefer freestyle or backstroke which is what happened to me. I used to be the leading breaststroke swimmer in our swimming club in Hong Kong, and a finalist in the open championship, not long after WWII ended. I first discovered its main advantage during the Hong Kong harbour open-sea competition where it enabled me to frequently check my position by raising my head high above the waves to make sure that I was not swept to the wrong destination by the tidal currents that rushed through the harbour twice a day. One year the harbour did experience a powerful current due to the stronger-than-usual incoming tide in the morning. Being a breaststroke swimmer, I was able to adjust my swimming direction and avoid being swept to the other end of the harbour, unlike hundreds of freestyle swimmers. So I

ended up reaching the right destination and being one of the first ten finalists, even though I was hopelessly under-trained, owing to my intense preparation for the looming matriculation exam, and my speed was nowhere near as fast as many freestyle swimmers at the time. Just good luck, I reckon. Over time, however, I gradually learned correct freestyle technique from the club’s swimming coach and by watching other lap swimmers. By constantly analysing and understanding the body/stroke movements, I had completely changed over to the freestyle because of the benefits noted above – increased relaxation, stamina, joint flexibility and strength. But clearly breaststroke is still very useful in any situation where you want to keep your head up and check points of reference and your surroundings. With some practice you can even swim incredibly slowly, so slowly that it could merge into a hybrid form of floating-cum-water-treading to conserve your energy, serving as an important part of a survival plan as in the case of a shipwreck, boating mishap or water-sport accident etc. where it would be the best means of keeping afloat while awaiting rescue. Caution – For the seniors (50s and over), the not-so-fit, and anyone with heart, lung and/or blood-pressure problems, or a strong family history of heart attack, etc.: see your local GP for a full check-up before you consider taking up any exercise with moderate intensity such as powerwalking, jogging, swimming, cycling, etc. just to rule out any unexpected medical condition which you may not have noticed such as high blood pressure, anaemia or diabetes. Your GP will be able to pick it up and get it under control prior to you getting into long-term training. A good check-up gives you peace of mind and provides a solid base for you to commit yourself to a life-long exercise regime for better health and longevity. Effective Training – Stretching, Warm-up, Cool-down With regard to the training (the workout) – here I am only concerned about the freestyle as the principles apply equally to breaststroke, backstroke or whatever. And I will also point out the key elements in your stroke later, to enable you to swim faster but in a more relaxed and effective way. All these, of course, are based on my assumption that you have done some freestyle

before but want to renew your training for better health, or that (as a beginner) you have already joined a swimming class and are able to swim. Stretching It is best to begin your session with stretching your major muscle groups for a few minutes, either on land or in the water at the shallow end of the pool. Just like a slow-motion morning drill, stand and raise both arms to shoulder width, drop them down slowly and raise them again from the sides, swing them a few times slowly in circles. In the water, bend forward and practise your freestyle arm stroke slowly and roll your body from side to side, to get the feel of the water. Warm-up This essential preparation, together with the cool-down, will pop up everywhere in all forms of sports and fitness training, irrespective of whether it is aerobic or anaerobic. It is part and parcel of any worthwhile activity, and a cornerstone of all healthy exercise. You must not skip your warm-up even though you think you have not enough time that day – try to shorten your main training session instead of omitting your warm-up. It is just one of the golden rules in every sports training book and of every sports coach. The second stage and the real warm-up starts in the water when you push off the wall at the shallow end of the pool. Stroke slowly in a relaxed manner, making sure you breathe deeply by using the abdominal muscles. This is the best time for your hand to ‘scull’, or to ‘pull’ the water with your flexed elbow, exactly like an oarsman sculling. If you have rowed a boat or paddled on a surfboard before, you will instantly experience the same ‘feel’ with your hand. Swim in this comfortable manner for at least eight laps (some coaches consider 50 metres as one lap, as in the Olympic pool, but for our purpose, 25 metres is one lap). By the end of your warm-up, you will start to feel warm in the water, because your skin and muscles are now exuding heat. Now you are ready for more real action – the main part of lap swimming and stroke technique refinement. But first, let’s look at a few basic requirements for lapswimming:

Push-off When you push off the wall with your feet, make sure you pull your legs in tight, as if squatting in a horizontal position, so that when you push against the wall it is like jumping up high. You push the wall strongly and hold your body like an arrow to get the best streamline effect through the water. Near the end of your relaxing glide, with one of your arms making a powerful stroke through the water, surface and take in your first breath, quickly and gracefully. In the push-off, you will have at least two seconds’ rest to recover in the process and you have a faster start than if you physically swim for that distance. With lap swimming, you will have an open turn followed by another push off every time you reach the end of the pool. The Turn The open turn has always been the official turn for the freestyle when the swimmer is required to touch the wall with one hand before push-off or risk being disqualified. However, the official rule changed recently when someone performed a tumble turn or flip turn (just like a somersault done in the water) without the hand touching the wall and that seemed to have saved a split-second – one of the reasons why the Olympic records kept tumbling down! However, the tumble turn is harder to learn and perform well. Even good Olympic swimmers may sometimes have their feet slip off the wall or misjudge the distance before they flip over. And you have to hold your breath longer than an open turn throughout the whole performance. So the tumble turn is usually for the competition swimmers and really not suitable for people interested in mild to moderate swimming just to keep fit. The open turn, on the other hand, needs no training. It is almost a spontaneous action when you reach the wall to pull yourself up to the wall, take a deep breath and then submerge your curled-up body against the wall, and push off. The Main Workout After your warm-up swim of eight to ten laps, you will continue to swim lap after lap, gradually increasing the power in the sculling action of your arms.

You will feel greater water-resistance to your stroke because of the stronger, faster action, and also feel the water flowing faster alongside your face at the moment when you breathe in the air in the trough created by your head parting the water. The Cool-down Practically every experienced coach with a sound scientific background will tell you that the cool-down is just as important. Try your best not to skip the warm-up and cool-down even though you are in a hurry on the training day. Rather, shorten the main workout. The basis is simple – at the end of your workout, your body is flooded with mobilized body hormones such as adrenaline and some waste products in the bloodstream that need to be disposed of. The cool-down swim of about six laps of easy freestyle or breaststroke gives enough time for your heart, lungs and muscles to slow down and for your liver to cease breaking down glycogen and fatty acids. Your whole body will feel relaxed and comfortable and your mind will be clearer and more refreshed. Failing to cool down will leave your muscles over-pumped with blood which can lead to cramps, headaches and dizziness. How Frequently One Should Train I think it is reasonable to swim only once a week for the first month to give your body enough time to recover, and to give yourself plenty of time to practise the stroke technique, the turn, the push-off, the stretching, the warmup and cool-down. After that, you could comfortably swim twice a week for another month, and so on. Three to four times a week is probably what most people can afford to devote to swimming because of its more complicated requirements; unlike with jogging and walking you can’t just walk out your door and start swimming any time of day or night. If you are a beginner or over 50, be content to just do ten laps after your warm-up swim during your first month to give yourself plenty of time to adjust. As with walking and jogging you must allow your body enough time to get used to this new physical activity. Your heart and lungs need time to gradually expand and strengthen. Your large muscle groups certainly need a lot more time to repair all the damage through the training (any physical activity will cause damage and death to the tissue cells by the thousands if not millions).

This is exemplified by the case of a simple bruise, when your body will take more than a week to mop up and dispose of the damaged cells and replace them with new and healthy ones. Through the stimulation from training the muscles will become bigger and stronger to meet the next challenge. Your joints too need more time to recuperate – the stretching of the ligaments and joint capsules from the stroking and kicking generates enough strain and stimulation for them to need to re-model and strengthen their fibrous attachments so that they will be tougher and more stretchable. This means more flexible joints capable of executing a wider range of movement, and healthier cartilage for arthritic patients. After one month of a typical swimming exercise programme (at least two to three times a week) you should be able to gradually increase your laps by three to five laps per week, so that by the end of the second month of workout, you will be able to swim between 25 and 30 laps. For the over-50s and individuals who have been relatively inactive, it might be better to play it safe and delay the increase of laps after the first month. Maintain the same level of training for a few weeks to make sure your heart/lungs (CPF) have been able to catch up before the next increase. This is particularly essential if you feel tired after the morning swim, out of breath when walking and shopping, or experience occasional chest pain or persistent aching shoulders. In that case you should see your GP for a blood test, an ECG, or whatever they recommend. It may not mean anything drastic, as it is most likely that you have just over-trained and that your CPF and muscles need more time to recuperate, but it is best to be sure. Given a good break, you should be able to start to increase your routine by three to five laps per week for another month and then maintain that level until you are ready to increase the number of laps again. In other words the 50-pluses, and the not-so-fit should not continuously increase the number of their weekly laps without interruption, and they should take longer in their workouts to achieve the target of their maximum number of laps in comparison to younger persons. What to do When Sick Normally, a well-conditioned individual has better resistance to ordinary colds and flu’s and may not get even one all year. If you do, you generally

have a milder case. You might not even notice it and keep on training. However, that is not the proper way to look after your health because, if you have a cold or viral illness, your body will require extra energy and nutrients to fight the infection. Ideally, you should stop training in the water to conserve more energy, to avoid infection in your ear, nose or throat, and to avoid passing the germs to other swimmers (even though the chance is pretty remote in practice, because of the huge amount of water diluting the infectious organisms and the constant filtering and disinfecting process of the pool system). The following tell-tale symptoms should alert you: Feeling tired and listless. Your swimming time and the number of strokes per lap noticeably going backward and your sculling becoming weaker. Having difficulty in your concentration at work. Mild dizziness on shifting your position. Nose running, voice becoming hoarse, throat a bit ticklish, some coughing, etc. Anytime when you have temporarily stopped your workout due to sickness or some other reason and want to return to your programme, you might have to start from scratch and gradually build up your mileage. This way, you are assured of sensibly protecting your body from over-exercise and overexertion. It won’t take long before you can catch up with the training because you have already laid down a sound foundation right from the beginning of your programme.

Cycling and Rowing Now that we have described ambling, power walking, jogging and swimming in some detail, we should take a quick look at some other physical activities and sports. Rowing and cycling are the ones most worth mentioning. Both are reasonably good sports for physical fitness but, unfortunately, both have some drawbacks in regard to their accessibility and safety for the average individual. For example, to access the training facilities for rowing you have to be a member of a rowing club, which usually caters exclusively to public

schools and universities, and only occasionally for sporting clubs. As in Melbourne which the Yarra flows through, rowing and training activities are almost all performed on a river, the boats being stored in the boatsheds along the riverfront. Sydney is even doing better, utilising mile after mile of the wide and picturesque Parramatta River as a training ground. On any given morning, whatever the season, up to a dozen boats full of rowers can be found training there, their coaches following behind in motor boats, shouting through their loudspeakers. It is a different story with cycling, which has a large following both in NSW (NSW Cycling) and in Victoria (Cycling Victoria), where well-publicised annual events are regularly run in which thousands of cyclists take part, mostly in groups of family units cycling together in great excitement as if going for a picnic. You can understand the popularity of cycling when you consider that in the old days a bicycle was a treasured Christmas gift. In addition to this element of nostalgia, the bicycle owes its popularity to its easy availability and simple design. However, in large cities like Sydney or Melbourne, the traffic is getting busier and nastier every day. So it is just simple arithmetic that the chances of a cyclist getting struck by a car on the road have become many times higher these days, and road authorities have ample statistics to confirm the fact. So much so that NSW recently introduced a new regulation restricting motorists to keeping one metre distance from cyclists, and it seems to work. Bike Tracks A positive development, initiated by the government and local councils, is the extensive ‘bike track’ networks established in many areas. The compulsory wearing of helmets and use of standard attachments such as headlights, flickering lights and illuminated reflectors on the bike are also positive developments, but accidents still happen, and, sadly, often with fatality. All this tragic loss of innocent lives, in my view, will never end until motorists, who are most often the offenders, can be better educated. Their driving skills and attitudes need to be regularly updated and tested, with zero tolerance on their blood alcohol and drug levels. Police cars and speed cameras can only be viewed as inadequate deterrents and can never replace a well-structured teaching and guidance programme focusing on proper road use and driving

attitude from a young age onward. Bicycle riding actually puts a much greater emphasis on training the legs rather than the whole body. It does provide a good workout for the heart and lungs. The CPF endurance benefit is rated as effective as swimming and jogging, but it is still not as effective as jogging in achieving weight loss. Joggers have much more ready access to open spaces for training than cyclists do, and jogging is much safer too. Exercise Bikes A safe alternative is to turn to the exercise bike, which, like the treadmill, is undeniably safer and ready any time of the day regardless of the weather, and can be used for a good, scheduled workout even by the elderly. By doing so, of course, the cyclist will miss the exhilarating feeling of speed and being buffeted by the fresh cool air. Nor will they be able to enjoy the endlessly changing scenery in the country or the inspiring sights of a beautiful city like Lucerne in Switzerland.

Rowing Rowing is another good aerobic exercise. Most of your joints and large muscle groups will be mobilized during rowing – the legs, arms, back, abdomen and buttocks. The motion of the sculling is not unlike the one executed by the arm of a freestyle swimmer, but the similarity ends there because, most of the power of the rower comes from his legs. Recent research seems to indicate that rowing uses more energy than cycling, if one is working out at the same level of intensity. Rowing Machines Again, like jogging and cycling, these days you can always find a mechanical substitute in the variety of rowing machines. And they are still great fun for the fitness seeker who wants to experience different forms of physical exercise. Perhaps a good introduction to exercise machines is to visit a wellequipped gym or fitness centre for a beginner’s free trial. Or go to a gym-

equipment shop and sample all the different machines before you make up your mind whether you will join the gym as a member or pick up your favourite machine to be delivered to your home. Some swimming pool centres have incorporated a gym or fitness complex, and you can use the facilities in both centres – ideal for younger people and the more fitnessminded.

Injuries From Exercise From time to time, one hears of reports about all kinds of injuries, usually from the daily newspapers and TV news; or someone you know whose children or friend sustained a fracture, a sprain, or even a heart attack during a sporting event; or how an apparently fit participant has collapsed during a marathon or even a fun- run, and died subsequently. No one can deny that injuries can and do happen with any physical activity. But then you also have to be reconciled to the fact that any form of human activity may cause injuries, either through carelessness or just plain accident. Talking about accidents, I could recall hundreds of cases of them going through our clinic every year – ranging from minor bruises and sprained fingers and ankles to serious burns when a child reached up to the stove and tipped over the frying pan full of hot oil. One of my patients was severely scalded when he opened the radiator cap on an overheated engine. Elderly people may suffer extensive bruising and fractures simply through tripping on the pavement. The first nasty home accident that I can recall from working in the Glenroy Road Clinic in the early days, happened to a man who slipped on the wet grass while mowing the lawn and had his toes, boots and all, cut clean through by the lawnmower’s blades. Even in your own home and your peaceful back yard, you are not immune from unexpected injuries. For instance, a woman in her forties who was keen to keep herself physically active preferred to carry buckets of water from the tap at the rear of the house instead of using the garden hose. Her faithful playful poodle would keep her company as she carted water to her beloved flower beds and vegetable plots. She carried out this ritual hundreds of times with absolutely no trouble. But

one fateful evening, she was in a hurry to go out for dinner, so she carried two buckets of water at a time instead of the usual single pail. She lost sight of the dog and panicked that she might be about to trample her playful pet. She lifted her leg in an awkward way and lost her balance because of the extra weight of the two buckets of water. She twisted and fell heavily onto the concrete steps. The injuries that followed were horrific – there was extensive bruising to her face, chest, shoulder and both knees, as well as fractures to three ribs, a wrist, and a kneecap! A real catastrophic trauma, totally out of the blue, and all in the haven of her own back yard. Some years ago, a survey was carried out by the Cardiff royal infirmary, England, about the incidence of sports and exercise-related injuries over a six-week period. It was strongly critical of the almost ‘lemming-like’ urge of people trying to copy keep-fit activities, and cynically questioned whether the middle-aged, over-weight individuals jogging around pavements, looking ‘pale and pained’, were really doing themselves a good service. The number of patients was 350 in total. The great majority (287) actually received their injuries through contact sports. Only 63 patients attending the emergency department suffered injuries through non-contact activities like jogging. The survey specified that the injuries from the latter group were mainly soft-tissue types, with some of them diagnosed as suffering from a stress fracture in the ankle. The survey also pointed out that as most joggers took up running in cities during rush hour, their lungs could suffer damage in the long term, and that some individuals could have serious hidden medical condition such as coronary atherosclerosis, not detected or not detectable by their GP. There was a very unusual case study in the MJA many years ago, in which it was reported that a fit and experienced 28-year-old athlete suffered severe heatstroke after a competition distance race event in the country in hot, humid conditions. He was reported to have developed disseminated rhabdomyolysis (meaning widespread dissolution of his body muscles) and acute renal failure. This man had not run a similar distance in the last five years and, although he eventually recovered, the authors strongly emphasized the hazards of competitive running in extreme heat for an individual who is not optimally prepared.

Remember Emma Carney, our top triathlon world champion with twenty-one world cup wins, was Number One for the longest period in the history of the sport, and had won nine Australian triathlon titles? She was reported suddenly fallen ill while training for the world cup in Canada, ambulanced to the hospital and diagnosed as suffering a serious heart condition. My guess is that Emma probably suffered a serious rhythm irregularity, as she was treated with an implantable defibrillator after a second attack in Australia while jogging. She had no option but to retire from the very demanding and highly competitive sport she loved. Petra Thomas, the strong-willed Australian butterfly world champion is known to have undergone several shoulder reconstructions due to over-use and hard training. And again, the latest example of a casualty was Grant Hackett, the world champ in the 1,500 metre freestyle. He was reportedly suffering from a shoulder injury requiring some sort of surgery and had to miss the Commonwealth Games swimming events in 2006. This demonstrates that butterfly stroke is extremely wearing on shoulder joints. Freestyle is usually less so, but not too far behind for those training hard to maintain their speed records and defend their glory. Again, reports of all sorts of limb and joint injuries, capped by a few sudden deaths of ‘fun-runners’ are not new, with most of them reported during Sydney’s annual city to surf run (as I discovered through a personal communication from my old friend Peter, a Director of Anaesthesia at a large regional hospital in Sydney, who was in charge of the St John’s ambulance overseeing the emergency service for those ‘fun runs’). On the other hand, it is interesting to note that the annual marathons held in Melbourne appear to be less hazardous as far as injuries are concerned. Perhaps this is due to the fact that marathon participants are generally fitter and healthier than the fun-run participants? Probably so, because they usually go through better preparation, being fully conscious of the fact that they have to be in peak form to be able to participate in this gruelling run. Or, could it be just a plain fact that the ‘fun run’ is a misnomer by implying that the run from Sydney city to the beach is full of ‘fun’ and pretty easy and that anyone can just hop onto this bandwagon at any time, irrespective of whether they have a heart problem or breathing difficulties or are not physically fit enough to cover the distance? I think both reasons make sense.

All these reports seem to suggest that physical exercise is ‘no good’ for you, and that severe injuries and sudden death could happen to anyone without the slightest clue nor the slightest warning before collapse. However, this is not true, in my view. If you analyse the cases with a level head, you will see there is no cause for alarm – but, nonetheless, it underlines the need to be alert for such injuries that might occur while exercising. But how can you be sure exercise has more benefits than dangers? Well, I need to point out to you the following vital facts: First of all, by far the great majority of severe injuries and deaths occur during competitive sports, contact sports, and high intensity physical exertion, such as football matches, tennis (even a social match among friends), fun-runs, marathons and world championships. The risk will be even higher for those training to maintain world records and their prestige, but is extremely low in mild-to-moderate intensity physical activities such as ambling, power walking, jogging and swimming etc. Mild-to-moderate exercise, carried out regularly is what we intend to promote in these pages. Through my own personal experience and through ample evidence in medical and sports research papers all over the world, sensible exercise has been proven to have the greatest health benefit of any measure you can take. In essence, every workout will help promote better blood circulation, clean out your system of waste products, enhance your metabolic rate and directly and indirectly invigorate your body and mind.

Living in Harmony with the Environment The Power of Nature Furthermore, for all kinds of outdoor physical activities, you have to keep an eye on the environmental factors when organising your exercise and sports. Mother Nature is still, and will remain, the master of our environment, irrespective of whatever technological advances people may make. You only have to look locally at the tragic loss of lives in that mighty storm during the ill-fated Sydney to Hobart Race a few years back to realise how powerful Mother Nature is. Those beautiful, expensive yachts were no protection against a furious sea. The list of natural disasters that appears below includes

only some of the well-known ones: Natural Disasters Mankind has always been prey to these ‘acts of God’ like Cyclone Tracey, which caused widespread damage in 1974 and almost flattened Darwin. Similarly, the ‘killer hurricane’ Irma swept over the Caribbean Sea in Sept 2017 with waves up to 6m high attacking the Florida/Miami district and causing one of the largest evacuations in U.S. history. Nature put on one of its most awesome displays when half the top of massive Mt St Helens in North America was literally blown off in 1980. Just this year and closer to home but on a smaller scale was the volcanic eruption in Bali, a favourite resort of Australians, which caused over 500 flights to be cancelled and stranded thousands of tourists, while 60,000 people were evacuated. Then there was the horrendous inundation and damage done to New Orleans and Louisiana in 2005, by hurricanes in the US and the huge dust/sand storms that struck Saudi Arabia and Kuwait in 2011, reportedly stretching over 1000 miles and described as being like the reverse of tornadoes. During the catastrophic Tsunami on Boxing Day of 2004, an entire region in Indonesia was literally washed off the surface of the earth leaving 167,000 dead in Aceh. The massive waves travelling across several continents resulted in a death toll numbering in the hundreds of thousands. Huge damage was caused to banana plantations in northern Queensland by cyclone Larry, 2006, which sent banana prices soaring ten times higher. The ancient city of Pompeii, fell victim to a huge volcanic explosion that saw the city and its population completely buried by volcanic ash and debris. The Eastern Way The Chinese have long recognised the immensely powerful influence that nature has on our body and health. China’s most revered medical treatise the Huang Dei Nei Qing (the Yellow Emperor’s Medical Treatise) contains numerous references on how to live in harmony with the elements of nature.

Relating those Chinese concepts to our keep-fit programme simply means realising that most ordinary people should not go against the harsh elements such as the extreme heat and cold when they engage in physical activities. Think of doing your exercise in the cooler morning or evening times during the summer heat, and in the warmer late morning and during the afternoon on cold winter days. Postpone your walking and jogging on gusty and windy days, and certainly don’t try it while the cyclone or typhoon is raging! Wear protective gear and clothing to shield yourself from the harmful effects of the sun, etc. You may say all these precautions are just plain common sense, and indeed they are. But still you will witness some individual becoming too adventurous or just forgetting to be cautious and then something happens… More serious injuries like collapse and sudden death in the fun-run or marathon could be grouped roughly under two broad categories – those in the younger age group under 30 to 40, and those older than 40. It has been analysed and reported that the younger group involved in sudden death cases shows evidence of congenital cardiovascular conditions (which means they are born with a faulty heart or arteries). This is particularly true in children, according to Professor John Sutton, head of the biological sciences at Sydney’s Cumberland College. Sutton observed that sudden death in children and teens was usually caused by congenital CV conditions such as, notably, hypertrophic (also called obstructive) cardiomyopathies (a heart with abnormal muscle and a swollen left side, also commonly involving the partition of the heart), congenital coronary artery disease, ruptures of the aorta (the big artery of the heart), valvular problems or abnormal heart rhythms, etc. The most common cause of sudden death in the older group is straightforward coronary heart disease. It has been recommended that organisers of high-intensity sports should make sure that all participants be screened for obvious medical problem before being allowed to register. Tips and advice to help avoid getting injured should also be distributed to the potential participants to heighten their awareness of possible problems. The following table shows the ratings of different types of exercise on fitness and health: Rating (out of 10) of exercise re health effects (10 being the best) Weight loss Improved Sleep CV endurance Walking 6 6 6

Jogging Swimming Cycling Skipping Dancing Rowing Golf

10 8 9 7 7 7 3

8 8 8 5 7 8 3

10 10 9 7 7 8 4

The Take-Home Message (1) Regular physical exercise is vital for anyone aiming to achieve an enjoyable, healthy and independent life. A longer life is also a highly probable result, if not a foregone conclusion. (2) Those who start physical fitness training from a young age reap the maximum benefit. (3) Only mild and moderate exercises will keep you fit and healthy with negligible injuries, while strenuous training would proportionately cause more injuries than benefits. (4) Keep in mind the importance of the key roles played by ‘Warm-up, Cool-down, Stretching’, as part and parcel of your every workout. (5) Walking and jogging, in moderation, are the cornerstone of all landbased, keep-fit exercises and sports. (6) Swimming is the most relaxing and therapeutic physical activity for your body. (7) For the not-so-young or the not-so-fit, a good overall medical checkup of your cardio-pulmonary system is not only desirable but mandatory. (8) Never fail to listen to your body for warning signs.

Chapter Three Food, Drinks, and Nutrition – Power Source or Power Drain The Junk Food Demon Often these days, anywhere from the sporting field to the schoolyard, and in the home, you hear young children and teenagers demanding junk food and bargaining with their parents: ‘Mum, I feel thirsty after school, can I take a couple of cans of soft drink or energy drink for my PE session? My mate always does, and he runs faster than me...’ ‘Oh please, Mum, give me more pocket money tomorrow so I can get something at the tuck shop...’ ‘I’m telling you, Mum, I was starving. Can I have a double burger, plus a coke, plus a large serve of chips for my lunch tomorrow? The sandwich you packed for me does nothing for my tummy. I had to pinch heaps of chips from Larry...’ ‘No? What about half a Kentucky deep-fried plus a double-serve ice cream with chocolate topping? Oh, Mum, I’m really starving, please, my legs feel like jelly. I can’t do my homework; I miss my ice cream and chips’. Haggling and begging for junk food, soft drinks, snacks, and other fattening foods is pretty commonplace in this day and age, and is natural for children and young adults who have been bombarded by fast-food ads on the TV on a daily basis. Many parents feel powerless to steer their children toward good eating habits, and are frustrated by the perpetual wrangling with their children about food. What should we do? I believe this is an extremely complex issue involving food culture, TV influence, peer pressure, school education and societal attitudes, which will not be resolved by simple dogmatic answers. For the purpose of this book, I will only explore the medical side of this huge social problem later in this chapter. But first of all, let’s find out what food is and how it keeps our body nourished, before we explore the dangers, the myths, and the alarming trends that are directly and indirectly associated with an excess of food and drink. Only by thoroughly understanding what food is and how it can energise our entire biological system, can you design a healthy menu, draw up your

guideline (or war plan, if you like) for good family eating habits, and advise your innocent children with confidence. Stick to your guns, but do take time to explain the underlying reasons for your decisions. Inevitably, the medical science of nutrition will one day become the king- hit that should knock out all the fad diets which are currently on the market, though no doubt some will survive despite the demands of logic because of the appeal of these nonsense diets to gluttons, the obese, the naïve, and the ignorant.

What is Food? Food has always been the most important focus for any living creature, large or small. To seek it is an instinct. In China many people quote these words of Confucius with glee: ‘appetite for food and sex is a natural instinct’. But this does not mean we know what is good for us by instinct! Nothing could be further from the truth – which is why the new science of Nutrition is so important. Medical texts categorise food as nutriment – that which nourishes and energizes the body. The basic division is between what are defined as micro- and macro-nutrients. Macronutrients These consist basically of carbohydrates (or ‘carbs’), lipids (fats), and proteins. All three can become a source of energy (in other words, interchangeable) yielding respectively four, nine, and four kcal/gm (calories per gram), while alcohol yields 7 kcal/gm. Carbs and fats are normally burned off first to produce energy, while proteins are conserved as the latter have the most vital role to play in the body as the so-called ‘building blocks’. Carbohydrates Carbohydrate is the bulk component of all forms of grains and cereals, and is also present in many vegetables, fruits and legumes. After digestion, its complex structure turns into glucose and other simple sugars. As glucose is the primary source of energy for all human cells (in fact it is the only fuel your brain uses to function) you can see why it is so important for us to have

most of our daily food as carbs such as rice, bread, pasta or potato so that we will have a readily available fuel. As has been discussed above, during anaerobic exercise, although some energy-rich ATP is produced, it is usually not enough to meet our body’s requirements. Aerobic exercise, on the other hand, produces much more ATP for our energy needs. So there is good reason to believe that carbs are the key food for endurance performance exercise, notably the marathon, but they are also equally essential for longer workouts in jogging and swimming. Some recent research has indicated that the best time to replenish your energy with concentrated carbs drinks is within the first two hours after your workout. Fats The simplest forms of fat are the fatty acids. Of these there are more than 40 varieties in nature, but only three of them – the polyunsaturated fatty acids (PUFA in short) including omega 3 and omega 6 – are called Essential Fatty Acids (EFA) because your body needs them to turn into important hormones and enzymes in order for the body to function properly. EFA can only be obtained from the small number of foods which contain them in their original form, while many other non-essential fatty acids (NEFA) are readily available, as our bodies can manufacture them through the digestion of any of the many fats and oils in our food. As fats are high in caloric value (at nine kcal/gm compared with four kcal/gm from carbs), they are valuable as a sustained-release fuel which generates a lot more ATP during aerobic exercise. Any form of aerobic exercise will break down your body’s fat store into NEFA and provide you with a steady stream of energy. Omega 3 and Omega 6 Most marine animal fats are rich in EFA (omega 3) while omega 6 comes from plant origin. Simply, we can say that the good oils come from fish and vegies only. This has only been discovered during the last 15 to 20 years, but sadly has not been publicised and promoted sufficiently strongly until recently, and only after many warnings and much pressure from national medical organisations in the developed countries. One of the greatest ironies in our campaign for better nutrition is that in developing countries in South East Asia people are doing exactly the opposite – flocking like lemmings to

gobble down junk food, fast food, and unhealthy food instead of their traditionally healthy staple diet composed of carbs with lots of green vegies. Saturated Fats Bad oils (the saturated fats) are plentiful in land-animal meat and all dairy products such as milk, cheese and cream. There are exceptions, however. According to a report in a newspaper3 a few years ago, kangaroo meat – of which we have no lack in Australia – is found to be exceedingly lean with a solid supply of proteins, rich in conjugated linoleum acid (one of the 3 EFA) – five times more than exists in lamb. As this EFA is a known anticarcinogen (anti-cancer substance), it seems that ‘roo meat’ could provide us with more than just food for thought! Instead of simply culling kangaroos when their numbers become too large it would be better for their fur and meat to be processed as fur/leather goods for export and a cheap source of healthy protein for the public. Palm Oil At this juncture, we must clear the air about the ingredient generically referred to as ‘vegetable oil’ – the term is a misnomer and misleading labelling, because a large part of it is palm oil. Now palm oil is quite ubiquitous – it shows up as a major ingredient in most processed foods we consume in the form of ice cream, pastry, sausages, biscuits, cakes, etc. It has also been widely used for cooking and deep-frying in restaurants, cafes, takeaway shops and eating places because, in comparison to other cooking oils such as olive oil, peanut oil and canola oil it is cheap. Palm oil is produced on a huge scale in Indonesia and Malaysia, and is, therefore, substantially cheaper for both producers and food manufacturers. Recently, after a group dinner at a reputable club restaurant, casually commenting on the wonderfully aromatic fried dish to the maître d' I asked if a good quality oil had been used. He answered back convincingly that ‘vegetable oil’ was the only oil they used, as it is more stable in cooking and resistant to going rancid. He added that, ‘no restaurant can afford to use peanut oil anymore – it’s just too expensive’. This confirmed my conviction that there is no beating cooking at home where we can control the quality of the ingredients and

make sure that only good healthy oils such as peanut, olive and sunflower seed are used. The frightening truth is that palm oil contains no less than 50% saturated fat and is clearly a no-no when it comes to heart health. But you may not be able to pick out the name ‘palm oil’ among the long list of ingredients due to the food-labelling law loop-hole – how frustrating to the health conscious public! Nowadays, my routine while shopping is to scrutinise all food labels and avoid anything containing ‘vegetable oil’ like the plague. Proteins This is perhaps the most important macronutrient. Proteins are regarded as the building blocks of the body because they are crucial to the growth of cells and the tissue of our skin, bones, joints, and internal organs; crucial for the constant repair of cells and tissues; and crucial to the maintenance and production of the blood-clotting mechanism and the dozens of important hormones and enzymes that control and run our biological system. All proteins ingested are broken down in our digestive tract into basic units of amino acids (the most basic components of all proteins) and peptides (more complex groupings of amino acids) before they are re-absorbed into the blood which, at any given time, could be found to contain twenty or more varieties of amino acids. Of the essential amino acids required by our body, nine of them are usually best sourced from animal proteins (land or marine animals) as plants in general (with the single exception of soybeans) do not contain the full range of proteins. Why is protein crucial? For the answer, you only have to look at our genes, which are the most vital basic unit of heredity. They determine what you are and how you look and develop from birth to death. There are many thousands of genes being carried by the 46 chromosomes in the nucleus of every single cell in your body. Each gene is a molecule of DNA which, as everyone knows, appears as a double helix structure (two strands wound around each other and linked by hydrogen bonds) composed entirely of tens of thousands of amino acids in a special sequence and joined together by peptide bonds (linkages between amino acids and other chemical groups). Then, take a look at the skeleton that provides a supporting framework for your whole body. It

is an immense network of proteins and amino acids forming architecturally ingenious scaffolding for rock-like minerals like calcium carbonate to be incorporated into, to give it the hardness and strength to support the muscles, brain and internal organs. Another reason, therefore, that a large proportion of the energy which is forever being generated and consumed by our body should come from carbs is to spare the proteins, which have far too many other essential functions to fulfil to be burned off wastefully. It follows, too, that more proteins are needed for special situations in life such as during rapid growth in childhood, puberty, adolescence, pregnancy and breast feeding, during illness and injury, convalescing after an operation, etc. Finally, don’t forget to feed yourself with a bit more fish or lean-cut meat to help you recover properly after your regular workout, because every workout will cause some wear and tear damage to your body tissue, however trivial, and requires plenty of amino acids from proteins for repairing and rebuilding. Plant Proteins Proteins from plants deserve a special mention here because of their benefits in regard to heart health. Plant proteins are usually concentrated in wellknown foods such as legumes (peas, beans …) nuts, seeds, etc. Some of them have a high profile in nutritional value and yet are cheap and widely available – soybean protein in particular being the most important one which needs to be elaborated upon further here. Soybeans and Soy Protein Soybeans are a legume that has been in the food chain for more than 5,000 years in China and was later adopted by other Asian countries. Foods made from soya beans are commonly referred to as ‘soy’. Traditionally, in China, soy is found in tofu, a coagulated liquid soy extract, and tofu ‘flower’ which is similar to tofu but sweetened and consumed as a light dessert. Soy is also used in drinks or simply cooked with other vegies and meat. With its recent introduction to the Western world, we are seeing a lot more variety of food

products made from soy – such as soymilk, yoghurts, ice cream, breads, breakfast cereals and snack bars. Soybeans are composed of 30% carbs, 38% protein and 18% oil – 85% of which is unsaturated good oil. What makes it stand out from other plant produce is the fact that it is the only legume that contains all the nine essential amino acids in the amounts required by your body. One other unexpected surprise is its calcium content – being 300mg on average per 250ml in soy milk – practically the same as cow’s milk! Simply said, soy is a high-quality source of protein with a price tag affordable to everyone. Highly concentrated soy protein has been produced locally in Australia for some time, notably by the Solae Company in Sydney, and Soy Products P/L, in Melbourne, who make a gluten-free soy compound under the brand name F.G. Roberts, using non-GM soy. Such isolate, which is claimed to be 90% protein yet carb and fat free, has been put to good use as the basic macronutrient in most types of soy foods such as soymilk, soy yoghurt, and soy ice cream. A diet rich in soy protein should be favoured by anyone conscious of heart health. There has been much interest in its benefit to heart health in food and medical research circles. Results from a meta-analysis of 38 clinical studies, published in the New England Journal of Medicine in 1995, concluded that soy-protein consumption led to a significant reduction in total blood cholesterol and LDL compared to animal protein. This impressive study was swiftly followed up a few years later by studies by the U.S. Food and Drug Administration, as well as the U.K. health authority, both of which supported the findings. One other added bonus from soy protein is its natural isoflavones which are known antioxidants – a protector of your body’s health as we shall see below. My advice – have regular soy foods, and a handful of nuts (just beware of peanut allergy in some individuals) every day, in preference to most landanimal proteins and some dairies. The soy foods and nuts mix well with breakfast cereals, can be a tasty ingredient in your dinner, or even a healthy snack when you are hungry and don’t know what to eat. Soy protein, like any other protein, will ward off your hunger and sustain you through your busy working day, yet it is capable of lowering your bad cholesterol and protecting your heart and blood vessels and your skeletal system. Some of my patients

screwed up their faces when I urged them to try soymilk, and told me frankly that they didn’t like its characteristic ‘beany’ flavour. But nowadays the choice and flavours in soy foods are so much wider and tastier that there is really no excuse for anyone to avoid these wholesome foods any longer. Fibre Fibre is basically composed of long chains of carbs with strong bonding. It is present in most of the food we eat but, despite the important role it plays in our wellbeing, it is somehow the most neglected macronutrient as far as medical research is concerned. There are clearly many different varieties of fibres: some are indigestible for humans, such as those present in fibrous green vegies and grass but are the staple diet for animals like cattle and sheep which rely on special enzymes to break down the strong bonding of the long chains and free the carbs which is their only source of energy. However, believe it or not, even some of the animals who depend entirely on fibrous food may not have their digestive system appropriately geared up to digest the fibres thoroughly enough. The cute and lovable panda bear is a unique example. Some years ago, a research team from the World Wildlife Fund was invited by the Chinese government to participate in a joint research project with the main purpose to save the dwindling population of giant pandas (estimated to have shrunk to about 1,000, with their habitat confined only to the province of Sichuan and part of Gansu and Shanxi). As the team studied the panda’s eating habits and analysed their droppings, they discovered, to their dismay, that these bamboo-leaf- eating animals could barely break down their food, as most of the leaves were only half digested or even intact in their droppings! And yet, giant pandas have been roaming those regions and eating bamboo leaves for more than half a million years. It seems they have yet to acquire a more efficient enzyme to do the tough work of breaking down their food! For humans, most cereal fibres appear to be digestible with good benefit. Some years ago, a research paper by CSIRO food-research division, published in the Australian Medical Journal4, stated that bran from oats, rice and barley, but not wheat, on being digested, was found to yield starch, nonfatty acid lipids, and oils rich in linoleum acid which is one of the EFA

mentioned under fats. The opinion given at that time strongly implied that it was this EFA that helped lower LDL (low-density lipids, commonly known as ‘bad cholesterol’). I am not quite sure how much influence this article contributed to the momentum of the Oat Diet craze that swept the North American continent at that time, but one thing that is certain is that the CSIRO is highly respected and its research findings have been consistently reliable and highly commendable. And that particular research paper has undeniably uncovered the valuable properties of those three cereals for our health. These days, most nutrition scientists will tell you that oatmeal is a real health food, and that its digestible fibre is beneficial for people suffering from constipation, or suffering from a depletion of lactobacillus (our normal, friendly intestinal flora). One word of warning – excess fibre, particularly the indigestible varieties, may irritate the bowels in some individuals, causing bloating, flatulence and tummy pains. Although the condition is not harmful, it could be annoying and socially embarrassing at times. Nevertheless, it is not an issue for most people, for all you need to do is avoid particularly fibrous and stringy vegies, try out other types of cereals and vegies, or adjust the number of serves of vegetables at meal times to discover what your digestive system can manage. Micronutrients Under this category are included vitamins and some elements. They are essential for health, and are usually consumed in minute amounts, probably less than 1 gm a day. Being in such minute amounts, you might say that most of them function in our body like catalysts (substances that alter the rate of the chemical reaction and yet remain unchanged themselves in the end), to facilitate or speed up some important metabolic reactions that are happening all the time. Vitamins These possess one carbon atom and are therefore viewed as organic substances. They are generally grouped as either fat-soluble (A, D, E, and K)

or water-soluble (the B group and C). The fat-soluble vitamins and vitamin B12 are usually produced in the far end of the small intestine and stored in the body, while the rest has to be replenished from time to time from external food sources only. Essentially, vitamins are critically important for normal growth and body functions, and anti-oxidative protection. Their key role has become increasingly clear as more research is uncovered. For example, we now know that a lack of vitamin D not only causes poor bone health, but it is also partly responsible for high blood pressure, congestive heart failure, poor brain health, and damage to your arterial walls. Minerals Our bodies still need many inorganic elements to function properly, the commonest ones being sodium, chloride, potassium, calcium, sulphur and phosphorus, as present in our circulating blood, body fluids, inside the cells and in the cell membrane. They are also largely regulated by our kidneys to reach a balanced state, to maintain optimal pH (the acidity or alkalinity) of the blood for our body’s chemical and metabolic reaction to proceed. There are also other elements present in much smaller quantities that are called ‘trace elements’ such as iron, zinc, iodine, selenium, copper, and manganese. Do not look down on them just because your body needs only a tiny bit of them – you can get very sick without the trace elements.

Bad Food, Healthy Food, Junk Food and Fad Diets Glycation (the result of high heat cooking) A warning about glycation. You may think, now that you are familiar with all the important ingredients of the macro- and micro-nutrients, it will be just a simple matter for you to distinguish the healthy from the unhealthy food and diets. Not quite. Unless you go shopping in the market to get your bread, rice and pasta for your carbs, lean cuts from the butcher or fish from the fish market, fresh veggies and fruits from the produce market and prepare and cook them at home without eating any ready-made meals, you might not be following a healthy diet. This is because most pre-packed food, takeaway food and restaurant food is not nutritionally balanced. More likely than not, it

has been over-heated, over-salted, over-cooked, is too oily, contains too much land-animal meat and fat, or, where dessert is concerned, contains too much sugar and cream in too large a serve. Just to give you a simple example, meat and fish are often ‘fiery roasted’ by the chef. During this cooking process, the flame is allowed to jump onto the meat (often pre-coated with syrup) to create a ‘browning’ effect and a wonderful aroma. The meat so cooked looks and tastes great, but such searing actually produces ‘glycation’ (also called glycosylation) in which the sugar linkage with the protein structure becomes damaged and generates excess free oxidative radicals (see next page for more details). Excess free radicals could damage the mitochondria (the factory in your cells), and theoretically accelerate your ageing, damage the DNA in your cells, and may even cause cancer. Glycation also happens in your blood when excessive sugar coats the proteins or lipids as occurs in diabetics, but this aspect is less well known than those effects generated by unhealthy cooking methods as described above. Glycation can go on to become Advanced Glycation Endproducts (generally called AGEs) which are even more damaging to your health and increase the risk of CVS and cancers. Other examples, such as the popular takeaway foods, are usually no more than some sort of deep-fried product. The oil is usually heated to excessively high temperature (easily over 300 degrees) causing changes in its nature from being good oil to the ‘trans’ form which is well-known nowadays to be harmful to your arteries and heart. And you can be sure that the shop owner would not be prepared to change the tankfuls of denatured oil every day, which means that the foods so turned out are fully soaked with unhealthy trans oil! It has been estimated that just a 2% increase of trans fat in your diet may give you a hefty 90% increased risk of heart attack. So how could you rate your cardiovascular system healthy if you have frequent takeaways, BBQ roasted ducks and pork, or deep-fried chicken, in addition to generous servings of ice cream and dessert? And who could you blame except yourself for your obesity, bad heart or cancer if you have consistently chosen to ignore the high risks from unhealthy foods despite repeated warnings from health experts? As far as fast food goes, you might think twice before ordering your favourite fried rice and sweet and sour pork when I tell you that a reliable survey has

found some unsavoury facts in regard to take-aways: 1: A large percentage of foreign bodies such as skin and bones has been found among the contents. 2: It feeds bad bacteria that can produce endotoxins. 3: In itself it contains dead bacteria and endotoxins. 4: Processed meats (bacon, sausage, salami etc) may be even worse and present an even higher risk of damage to your cardiovascular system. They may also contribute to the formation of cancers, due to the fact that they contain an unhealthy quantity of nitrates and preservatives and 4 times as much salt as natural unprocessed food. Free Radicals and Antioxidants In recent years, there have been increasing concerns about the accumulation in our bodies of molecules called ‘free radicals’, also labelled as reactive oxygen species (ROS). This could be any molecule with a ‘free’ oxygen atom after it has either lost or gained an electron. As we all know, we cannot live without oxygen. Every day, every minute, we have to breathe in oxygen which is carried by a special protein in the blood to every part of our body, to enable the trillions of cells in our body to carry out cellular metabolism. And only by cellular metabolism are we able to generate energy and achieve growth. Without energy, we cannot think and talk, we cannot breathe and move and our hearts cannot beat. On the other hand, however, oxygen can also become our foe when it is over abundant, ‘unstable’ and highly active. It can then cause a destructive chain reaction, oxidising and deforming our cells and even possibly the DNA (our genetic material). This can result in conditions such as cancer and a deterioration of organ function leading to any number of illnesses and an advancement of the ageing process. Normally, excess ROS are quickly neutralized by your body’s own antioxidants and enzymes and antioxidants from nutrients, or rendered harmless by recombining with another ROS. Thus the importance of maintaining a healthy level of antioxidants. Free radicals are generated as part of the cellular processes and respiration (meaning the normal biological activities of the cells) and are therefore continuously appearing in every single cell of your body. ROS are also generated by phagocytes (a type of immune cell) when they destroy invading

viruses and bacteria, as happens when you’ve caught a cold, or flu, or any infection. In addition, they are also produced when you are exposed to harmful outside influences like UV radiation, X-rays, pollution, cigarette smoke, many harmful chemicals and fumes including household sprays etc. When the balance between free radicals and antioxidant supply is tipped in favour of ROS, the destructive effect on our cells, tissues, arterial walls and DNA is collectively termed ‘oxidative stress’. This type of stress has now been implicated as a major cause of heart disease, atherosclerosis, Alzheimer’s disease, arthritis and cancers, among other ailments. Antioxidants have been known for decades, but their action in relation to our body has not been fully understood until very recently. According to Professor L Packer of the University of California (Head of the Packer lab, one of the world’s leading antioxidant research centres), you have five major powerful antioxidants forming a sort of network in your body, consisting of vitamin C, E, glutathione, lipoic acid and Co Q10. These five key members in the network constantly boost up each other’s power to control free radicals, protect your heart and blood vessels, and slow down the ageing process. All except glutathione are sourced from foods, particularly vegies and fruits which are rich in substances called polyphenols, isothiocyanates, and carotenoids. The polyphenols or flavonoid family is a group of several thousand substances, with 50 of the common ones existing in abundance in tea, coffee, red and black berries, and red wine, as well as in fruits and flowers with colours. (Take note that blueberries have been ranked Number One for antioxidant activity by the U.S. Dept of Agriculture). The carotenoids are also found in great supply in red, orange and yellow fruits and veggies (the carrot is perhaps the most well-known one), and also in some leafy vegies such as broccoli and Brussels sprouts. The betacarotene is particularly powerful in its antioxidant activity. The isothiocyanates are more plentiful in dark green-leafed vegies which are usually rich in many other cancer-lowering chemicals. N.B. – For more details on antioxidants, their types, sources, and protective action, please refer to the appendix at the end of this book. All these antioxidants are important to your body as they constantly mop up the harmful free radicals before they produce any damage to your arteries,

heart, fat, proteins and DNA. But, as yet no one is sure which antioxidants work best, nor how their intricate network might protect your tissue and cells most effectively. The collective wisdom says that the best and the safest course is to have a wide variety of fruits and veggies, according to the simple rule of five vegies and two fruits a day. Assuming that you take care not to heat up your frying pan too high, that you choose only polyunsaturated oils for cooking like sunflower seed and canola, and peanut oil, you can still enjoy fried food. Cold-pressed extra-virgin olive oil is often regarded as the very best oil for salads. You can also cook with it but only at low temperatures (180 degrees or lower). Cook your vegies mainly by steaming, or stir-fry with a minimal amount of oil. Let us now turn our attention to the ideal proportion of meat, vegies and starch recommended for a healthy diet.

The Basic Food Pyramid The Basic Food Pyramid is the most promoted and talked about food model of the proper balance of the foods you require daily. It has gained the support of sensible nutritionists and GPs all over the world. The incredibly simple diagram makes understanding of the principles easy. Essentially the overall concept is as follows: (1) Carbohydrates (bread, rice, cereal, pasta, etc.) – five to 12 servings daily, adjusted according to how much physical activity you engage in. This forms the broad base of the Basic Food Pyramid, showing you the importance of eating plenty of carbs for most of your daily food requirements. Just to help you remember the idea, carbs serve as the main fuel and generate practically all the energy required to get your heart pumping and your body moving, sparing the catabolism (breaking down of nutrients) and wasteful destruction of the all-important proteins in your body. (2) Vegetables – three to five servings. A lot of vitamins and minerals are found in both vegetables and fruits. They are also the only source of Omega6 oil – one of the three EFA, or the ‘good oils’. (3) Fruits – two to four servings. You should make a habit of eating a variety

of vegies and fruits because the types and the quantity of vitamins and minerals you get from each one are distinctly different. So the more diverse the fruits and veggies you eat, the better balanced your micronutrient intake will be. (4) Proteins from dairy products (milk, cheese, yoghurt, not cream) – two to three servings. Preferably skim milk or ‘skinny milk’ and low- cholesterol cheese for the older age group. Full-cream milk and excess cheese could quickly send your blood cholesterol over the normal limit. Also, be aware of the fact that dairies could be contaminated, even if in small amounts, by hormones, steroids, antibiotics, growth hormones and pesticides. Therefore, people suffering from some allergies should take extra care. I once had a female patient whose blood cholesterol was unacceptably high for no reason. Then she recalled that she had consumed lots of cheese over that period. She confessed apologetically, ‘My fault, doc. I love cheese, it’s my favourite. I can’t help eating it every day.’ She realised her mistake and her cholesterol was back to normal next time. The clear-cut relation between high-cholesterol food and your blood-cholesterol level could not have been better demonstrated than in the case of this particular woman which was far from an isolated one. (5) Proteins from meat, poultry, fish, eggs, and plant proteins such as legumes and nuts – two to three servings. These days most people are more aware of the danger of eating animal fats and that, ideally, the fat and skin should be trimmed off from the cuts before you put them under the grill which will cause more fat to run off. Plant proteins from legumes and nuts are far more beneficial to your heart and health than animal meats except those derived from marine animals. But as fish and seafood may not be everyone’s favourite, and some people still ‘cannot live’ without BBQ chops, sausage and roasts, we have to compromise and allow them some animal meat during the ‘weaning off period’ of about two to three months. Their intake should then be gradually reduced to once weekly or less later, and not more than 200 gram per serve. Anything over 200 gm is an over-serve, as pointed out by most sensible dieticians, and could lead to overweight and obesity. Always keep in mind that all meat from land animals contains AGEs

(Advanced Glycation Endproducts ) and are therefore more or less toxic and harmful to the body. Now it has been discovered that your cooking methods can turn good food into bad food. For example, using dry heat to fry or roast, can increase AGEs by up to 100 times or more, while moist heat such as boiling and poaching, or adding spices and seasoning minimises AGEs, according to a report by The Australian Academy of Anti-Ageing Medicine conference, Melbourne, Oct 2017. (6) Fats, oils, sugars – keep these to the minimum and use only the good oils: PUFA oil like olive oil, peanut oil, sunflower-seed oil, walnut oil, grape-seed oil, among others. Oils from marine animals and plants are generally beneficial to our cardiovascular system. This fact has long been known in medical circles, as early as the 70s, as proven by a research article in the medical journal, The Lancet, in 1978, by H.O. Beng & J. Dyerberg. In their studies on Greenland Eskimos, they found that their diet consisted of 70% fat from fish and other marine animals, yet they were known to have a very low incidence of heart attack. They concluded that this was because the high-fat diet from marine animals was full of Omega-3 oil which actually protects the heart and blood vessels against the build-up of harmful atheromatous plaques.

Vitamin and Mineral Supplements It has been found in recent years that some modern-day farming practices appear to be faulty and have caused subtle, sometimes rapid, depletion of important essential minerals in the soil and/or vitamins in the produce so that consumers may not get all the nutrients they require from their daily food alone. For that reason, a few years ago, the U.S. Centre for Responsible Nutrition informed the public that they should have mineral and vitamins supplements in their daily diet, again in a graphic pyramid, with its broad base of multivitamins with minerals and folic acid for everyone. Another powerful reason why we need more vitamins and anti-oxidants supplements comes from a study on the discovery of chemical spray on farm produce in Sweden which established that even our common apple trees are usually sprayed 16 times with 36 different pesticides! Such research figures often send a shockwave through us consumers, but we shouldn’t lose sight of the facts: most agricultural pesticides are usually checked by the relevant

authorities for commercial use and are deemed to be harmless to humans. Furthermore, regulations exist to forbid spraying for a certain number of days before harvesting. The main detrimental effects of the chemical sprays is that they reduce Vitamin D and naturally produced flavonoids (antioxidants from plants). This fact further underlines the importance of those supplements in our daily diet. Higher up the ladder are the calcium supplements and antioxidants such as vitamins E and C. The 2002 issue of the Journal of the American Medical Association contained a report by Fletcher and Fairfield advocating that all adults should take a multivitamin and mineral supplement daily to avoid some chronic diseases such as cardiovascular disease, neural tube defects, colon and breast cancer, osteopenia and fractures. In Australia, the general recommendation is for a daily multivitamin (vitamin B group) plus folic acid (200 mg) plus calcium (1,000 mg). However, as we in Australia generally have ready access to a plentiful variety of fruits and vegetables, we are probably in a better situation than our American cousins. Nevertheless, to be on the safe side, anyone over 50 would do themselves a service by having a daily multivitamin B complex with minerals. If you’re a small-boned person and are unable to get a healthy dose of the sun frequently enough, you must add a single pill of 1,000 mg calcium carbonate in combination with vitamin D. For people who are not fond of fish for dinner, a daily intake of omega-3 deep-sea fish-oil capsules, up to six a day, or 3 gm, will give you a healthier heart and blood vessels. My advice – refer to the basic food pyramid – a colourful copy should be available from a health-food store or from a dietician. Follow this simple guideline and do your shopping in a regional produce market, if possible, to get the freshest vegetables and fruit of the day. Those in supermarkets tend to be the produce from the fridge or cool-room. Concentrate more on green, leafy vegetables, and fruits of all colours to stock up on your antioxidants. Steam your vegies with drops of good oils such as olive oil, canola oils, sunflower seed oil and peanut oil. Add some spices and herbs (many of them contain antioxidants) to enhance the flavour and enrich your cuisine. Avoid cooking your meat with high heat. Steer away from hardened oils like margarine and shortening as these are

usually the commercial products of hydrogenation: converting the liquid oil into a more stable, hardened fat form, mainly for the sake of easy handling. Such processes strip these essential oils of their biological goodness, turning them into harmful forms that are damaging to your cardiovascular system. After an extensive review of literature on cereal grains and legumes, Professor Jim Mann, of the University of Otago, concluded that eating a variety of wholegrain and high-fibre foods from grains and legumes will reduce the risk of the onset of diabetes by at least 25%. In my view, your chance to develop the type II diabetes (the common type) should be close to zero if you follow the Basic Food Pyramid in addition to maintaining a regular physical-exercise programme. After a while spent on a simple healthy food diet, you may notice how quickly you lose your taste for takeaway food, junk food and other calorierich food. You will begin to appreciate the natural flavours and richness of the meat, seafood, and other wonderful produce that you have personally hand-picked from the market. Likewise, your family will soon be able to distinguish good, natural, wholesome food from harmful, unnaturally enriched junk food. From then on, it will be easy sailing to maintain good eating habits within the family, by simply reminding them about the simple principles from the basic food pyramid until they, too, become used to the basic concepts. Like everything else, it is best to teach sensible eating habits from a young age when children are more receptive. They will never forget the simple way you cook your meat and/or fish with a good sauce and spices, and how fresh, natural and colourful all those vegies and fruit are when you bring them home after shopping.

Beverages If you mention ‘drinks’ to different age groups, you will receive a wide range of responses. For instance, a colleague might expect a beer, a connoisseur of wine may be hoping to receive a glass of Grange, while a teenager may be keen to have a Coke, and a child will, most likely, look forward to a chocolate or a strawberry milkshake with a big grin. But a health fanatic may simply say, ‘hey mate, make mine mineral water.’

But drinks and beverages play a more important role in nutrition than one might imagine. Anything can be turned into a drink, depending on the culture, tradition, religion and availability of local ingredients. For example, take wine: most fruits can be turned into alcoholic drinks. Grapes alone have dozens of varieties which can be made into hundreds of wines, each with its own taste and bouquet. For our purposes, I will just discuss our most commonly consumed drinks such as alcoholic beverages, coffee, tea, and soft drinks. Soft Drinks I shall start with ‘soft’ drinks first. Soft drinks are composed of a whole class of beverages usually carbonated (saturated with carbon-dioxide gas) to give them sparkle and a tangy taste, sweetened by sugar and flavoured by all sorts of fruits and plant products. For example, Kava, a popular soft drink in Fiji and nearby islands, is made from the root of a shrub. The Cuban people enjoy their own soft drink made from fermented sugar-cane juice. In South East Asia, sweetened soy-bean juice is popular and nutritious with its plant proteins. Some people in Eastern Europe like to consume their own special drink made from fermented stale bread. Plain carbonated drinks without sugar or flavouring are called soda water, club water, mineral water, sparkling water, etc. Europeans developed carbonated water in the 16th century to imitate the effervescent nature of waters from famous mineral springs, believing that the therapeutic value was in the effervescent nature. The popularity of such beverages soon spread wide and far. Today, soft drinks have a wide variety of natural and artificial flavourings with added edible acids. Natural flavours include fruits such as lemon, lime, orange and grape, ginger ale, and root beer, etc. These are mostly derived from fruits, nuts, berries, roots, herbs, and other plant sources – the most well-known and dominant ones on the market being Coca Cola and Fanta. ‘Coke’ is interesting in that its plant ingredient comes from the nuts of the tropical evergreen tree called kola (or cola) which is rich in caffeine – the same chemical as in coffee – which acts as a powerful stimulant on your central nervous system. So a cola-based drink is no different from coffee as

far as it being addictive and a stimulant is concerned. In the manufacturing process, carbon-dioxide gas is pumped under pressure into chilled, purified water to create the sparkle, effervescence, and the pleasant tangy taste. The colder the water and the higher the pressure, the more the gas will be dissolved and kept in the soft drinks. The sugar content could be as high as 15% which means that if you have gulped down one litre (three standard cans) of refreshingly cool soft drink on a hot summer day, you could have ingested two thirds of a cup of concentrated syrup! Many people fail to realise that soft drink can have that much sugar in it and often inadvertently run into great trouble. For example: every so often a young or middle-aged man has complained to me that they could not understand why they had felt excessively thirsty and tired lately. Sometimes they might disclose that they felt embarrassed for going to the toilet so frequently. When the results of a general medical check seemed quite normal, a routine urine and blood-sugar test often gave us both a big shock, by revealing the level of blood sugar to be up to two to three times higher than normal. And then the truth came out that these people had been on a soft-drink binge for days, turning them into ‘instant diabetics’! The fact that childhood obesity is partly caused by excessive consumption of sugar-filled soft drinks and high-calorie fizzy drinks has now been finally recognised in the U.S. which, sadly, is leading the world in childhood obesity – averaging about 16% and even as much as 25% in some southern states. But the authorities were quick to perceive the danger and have started fighting back. Early in 2005, eighteen states passed legislation aimed at tackling childhood obesity, and one of them, Connecticut, has gone even further by announcing a state-wide ban on school canteens selling soft drinks and unhealthy snacks (including chocolate and junk foods). The state governments mean business this time in their struggle against childhood obesity – but it also means bad business to the powerful soft-drink industries which clawed in $US 700 million in just 2004 alone. Australia is again following the lead, albeit slowly. Victoria was the first to ban the sale of high-kilojoule fizzy drinks and some sugar-added fruit drinks in state schools in 2007, while South Australia banned lollies and soft drinks in 2008. NSW and Queensland just label such high-energy drinks and food as

‘red’, to be restricted in their sale to school children to twice a year. Not enough, according to the AMA which advocates a total ban. This could not be a better idea, in my opinion, but we should also campaign for a total ban on unhealthy snacks in all schools. The important message is, think twice next time before you pick up a can of ‘refreshing’ soft drink on a hot summer day; it could entice you to become a member of the ‘instant diabetics club’. Coffee This ubiquitous beverage, drunk by nearly two thirds of the world’s population, comes from the coffee beans of the Arabian coffee tree, an evergreen tropical tree probably introduced to the Arabian Peninsula from Ethiopia where coffee trees have been known to be growing wild since before 1,000 A.D. It is now the leading tropical commercial crop in Brazil and Columbia – the top producers in the world. Due to the great fluctuation in harvest/production (entire coffee plantations have been known to be wiped out by virus outbreaks or storms) and world demand, the coffee price on the world market has been regulated by the International Coffee Organisation since 1962. Coffee beans are bright red in colour when they ripen, and have to be roasted so that the heat acts on the oil to give it its distinct aroma and flavour. The finished products range from the popular light brown to the almost charred one (the Italian roast). There are quite a few different ways to brew and drink coffees, the most notable being: (1) ‘Turkish’ coffee is a finely powdered, heavily sweetened coffee mostly drunk by Middle-Eastern people. (2) Black coffee, mostly favoured by westerners. (3) French coffee, such as café au lait, which is basically coffee with as much scalded milk in it as hot water. (4) The unique mocha from the Yemen region of Arabia, and some coffee from Sumatra, Indonesia and Columbia, is highly prized and sought after by connoisseurs.

(5) Many other new coffee drinks, introduced on the market over the last few decades, such as espresso, cappuccino, mochaccino, skinny white, long black, etc, have proved extremely popular. You can even order a soy coffee with or without caffeine. And you can not only brew your own favourite coffee in different ways by using a coffee filter, a drip filter, a percolator, or the increasingly popular automatic coffee machine, you can even have your coffee ‘instantly’ just by adding hot water to the ‘instant coffee’ powder (actually, instant coffee was introduced on to the market in 1867 by Gail Borden in Illinois but had not gained popularity until after WWII ). Then there is the instant ‘coffee bag’ which seems to be one of the indispensable items in hotel rooms and tourist lodges in the U.S. and Canada. With the explosion in global travelling and films showing al fresco coffee places in overseas cities like Paris and Vienna, metropolitan cities in Australia have quickly acquired the coffee culture. For quite some time now we have seen the mushrooming of coffee lounges, cafes, café bars, and pavement coffee places similar to the numbers you see in European cities. Shopping malls, retail stores, airports, and even some small takeaway shops and eating places in the narrow lanes in the city all offer coffee. In recent years, franchised coffee-shop chains like Starbucks, Grinders and Hudson, have expanded to Australia from their American operations and appeared to be heading into intense competition for more business. It looks like the entire nation has become addicted to coffee. In the old days, coffee was popular due to its aroma and its fatigue-allaying property derived from caffeine. It was often used as medicine to help fight shock, fatigue and pneumonia. (In fact, caffeine was used decades ago in some old-fashioned headache powders, like Bex and Vincent’s APC – banned since due to the severe damage to the kidneys caused by one of their ingredients). The coffee houses in those days were well known across the continents as centres for gossip, gambling and literary and political discussions. There was Will’s coffeehouse in London, famous as a resort of wits and poets such as Johnson, Addison, Sheridan, Goldsmith and other notables who exercised a profound influence in English literature and politics. A similar trend happened in France.

The modern coffee culture is entirely different. People frequent coffee lounges for gossip, or as a part of their leisurely lifestyle, or just for the sake of having a cup of coffee because they ‘can’t do without one’. Without the slightest doubt, coffee is the world’s most popular and commonly used stimulant, and a somewhat addictive beverage. You can find it served anywhere and everywhere. It seems such an innocent and popular habit to get up in the morning and grab a cup of coffee first thing to invigorate your mind and prepare you for a long day’s work. Just one cup a day won’t harm you, will it? After all, most people have been persuaded that only if they drink coffee excessively will they become irritable, depressed, with an upset stomach and disturbed sleep – but surely not one cup? Disappointingly, yes, even one cup a day can cause caffeine addiction, according to the latest research from the Johns Hopkins medical school in the U.S. They have found that caffeine withdrawal could be a real mental disorder – strong words indeed. If in doubt, see how you feel next time when you deliberately miss your morning cuppa for just a couple of days… In regard to insomnia from coffee consumption, apart from some of my colleagues who claim to be immune to this chemical, the majority of us are still made up of similar biochemistry, and are susceptible to caffeine’s stimulating effects. The effects will vary according to many factors, just as the intoxicating effects of alcohol vary from person to person. The take-home message for coffee drinkers is, as with soft drinks, avoid drinking strong coffee regularly to avoid troublesome palpitations or becoming addicted to it. Certainly don’t indulge at night as this aromatic chemical is really capable of keeping you awake and making you depressed the next day. Tea As ubiquitous as coffee, tea is made from the brewing of the cured and dried young leaves and tips of the tea plant Camellia sinensis. It was the world’s most popular beverage until being taken over recently by coffee. Its generic name sinensis means ‘of Chinese origin’, for the tea plant was first cultivated by the Chinese about 5000 years ago, and China still remains the largest tea producer in the world. The other two most important countries are Sri Lanka and India which has extensive plantations on the foothills of the Himalayas in

Assam, Darjeeling. Japan and Taiwan are rapidly catching up, but producing different varieties. Apart from Asian countries, the countries of Western Europe (particularly the U.K.) are the major tea-drinking areas in the world, importing and consuming nearly one third of the world’s production. Tea is ubiquitous in English culture, whether it be the short break from work of morning or afternoon tea or the more extended ritual of the tea party or Devonshire tea. In England and Australia, it is a common practice to enjoy a cup of tea with a biscuit, and allow the body to recover and acquire more energy for more work. The mild content of caffeine in your cuppa will undoubtedly refresh your mind and provide energy for the rest of the day, without the addictive effects of coffee. There are two major commercially important tea plants – the Chinese variety and the Assam variety, together producing six main types of tea: green, black, oolong, red, white, and yellow, of which only the first three are the most well-known and used. (1) The green teas. These are not fermented like other types but are quickly dried by the sun and steamed to preserve their colour, then pan- roasted before being packed in airtight containers for distribution and export. This process appears to help preserve the important health- enhancing ingredients in the tealeaves. (2) The black teas. Much preferred in the Western world, these are fully fermented leaves produced by a long process of oxidation, fermentation, and drying before curing. This process produces more flavour but less beneficial compounds (and even the loss of some). (3) Oolong teas. These are only partially fermented and not rolled, so that the leaves are left long in one piece. They are produced mainly in Taiwan and favoured by the locals. (4) Herbal teas. There are also some other teas and tea-like beverages on the market, the most popular ones being those fragrant (or scented) teas like jasmine, the lai chee, the rose – the result of the addition of fragrant flowers into the tealeaves, while the flavoured ones are created by adding flavourings such as strawberry, lemon and wild berries. Herbal teas are produced from the leaves or flowers of a wide variety of

plants, chosen mainly for their medicinal properties, such as camomile which is calming, or the very popular medicinal drink in Hong Kong and China called leun cha: literally ‘cool tea’. People suffering from a sore throat or flu flock to leun cha shops to have a few herbal medicinal teas. These cool down their fever and cleanse the bugs from their system. It is just about the cheapest way for the Chinese working class to fight common ills. This practice is as common in China as the Australian habit of buying over the counter ‘cold and flu’’ tablets. You don’t need to see a doctor or a chemist – and just hope that the remedy will fix your problem as promised by the manufacturer. In recent years there has been a growing interest in the beneficial effects of tea on our health, and the interest is not confined to complementary medicine practitioners. Even in international medical conferences on health and longevity, green tea has been singled out for its great benefits in the prevention of cardiovascular diseases. The current consensus is that tea drinking offers the following benefits: (1) Low caffeine. The low content of caffeine in tea, as contrasted to coffee, serves as a mild stimulant to the brain and the body so that one can think more clearly, and build up more energy and strength to work, yet the caffeine content is not strong enough to cause real addiction as coffee does. (2) Antioxidants. Tea is one of the best sources of polyphenols and carotenoids. (3) B-complex vitamins – tea is a very good source of them. (4) Other constituents – amino acids, chlorophyll, vitamins C and E, some essential minerals like manganese and zinc. And also tannin which gives you the mildly tangy taste. Recently, tea has been found to contain catechins (a special flavonoid) which in test-tube studies has promised to be more powerful than vitamin C, E and other anti-oxidants. It stops oxidation of LDL, improves cholesterol and triglyceral levels, regulates blood sugar and reduces inflammation that is harmful to the body. Green tea is generally regarded as healthier than black tea and oolong tea as

most of its antioxidants are preserved since the tealeaves are sun-dried and pan-roasted but not fermented. Other types of tea drinks such as canned tea, tea bags, instant tea, herbal teas etc. have been found to contain little in the way of antioxidants. Therefore, to derive added benefit for your health, go for the green teas regularly and leave the black tea as an occasional drink for its flavour. One word about the art of brewing tea – ideally use water at a lower temperature for the good quality teas and the green teas, say approximately 70 degree C, so that most of the amino acids will be dissolved and infused into the cup, giving you the tea flavours. In reality, you can never extract all of the amino acids from the brewing unless you eat the tealeaves as well. On a medical tour in Han Zhow, China, I visited the biggest producer of Dragon Well tea (a much sought-after green tea). The company’s spokeswoman insisted, in accord with a belief that is part of the local culture, that one of the factors which helped make the girls of nearby Soo Zhow the most beautiful in China was that ‘they drink plenty of Dragon Well Teas, wash their face with the tea, and chew up the leaves as well.’ So, girls, if you are looking for good skin and exceptional beauty, here is your god-sent opportunity to try it out! Using water just off the boil will only cause more seepage of the tannin which gives you the tangy taste. Please also note that green tea should be stored in the fridge in an air-tight container to keep longer and to conserve the antioxidants. Some people even suggest putting it into the freezer after being opened, especially if you have bought a large quantity, or you don’t drink tea often. It makes sense to put its use-by date on hold by simply freezing it! TIPS – go for green tea; drink it regularly for mild intellectual stimulation and for its rich antioxidant protection. Remember to brew your tealeaves in hot water not more than 80 C, and store your unused green tea in an air-tight container in the fridge. Alcohol ‘Nothing more excellent nor more valuable than wine

has ever been granted to mankind by God.’ Plato This beverage has been hailed as the oldest, the most popular and the healthiest known to mankind. Alcoholic drinks have been found in practically every culture and civilisation for the last many thousand years of human history. Taken in small to moderate quantities, alcohol adds a simple pleasure to our lives, enhances our social interaction, and complements our healthy and balanced lifestyle as a modern and gregarious people. Of all the alcoholic drinks, wine, particularly that produced from grapes, appears to be the healthiest and the most important and will provide the main focus of this chapter. Although wine production was first recorded around 3,000 BC, there has been some evidence of its use as early as 7,000 BC. As we all know, wine has been a valuable part of the social aspect of our modern society, an indispensable adjunct to any successful dinner party. But not everyone is aware of the increasing scientific evidence that wine, taken in moderation, is healthy and benefits the heart. How and when did all this talk of benefits to your heart and the coronary arteries start? Well, first of all, Louis Pasteur, the great French medical scientist whose name became renowned through the invention of pasteurised milk, remarked that, ‘wine is the most healthful and most hygienic of beverages.’ Indeed, his pronouncement seemed born out when, in 1979, it was discovered that the French, with their food high in butter and cream – clearly an atherogenic diet – suffered a peculiarly low incidence of heart attack among Western nations. As this situation went contrary to the expectations of the time it was aptly named the ‘French paradox’. When their lifestyle was further explored, including their drinking habits, the researchers eventually picked up the clues. The Copenhagen Heart Study, published in 1995, concluded that low to moderate wine intake was definitely beneficial and could lead to a 50% reduction in death from heart disease, stroke, and other causes. The important term here is ‘moderate’ which is about two standard drinks a day for men and one for women. A standard drink is approximately 150 mls. So if you stick to this rule, you will probably avoid addiction and run much less risk of having a heart attack or stroke (up to 50% less than a teetotaller). All of which simply means that you will live longer. It was so exciting to read about this research report a few years ago when the

news first broke out in the newspapers that almost all of my wine- loving friends – the Melbourne Chinese wine connoisseurs – got into a very festive mood at our monthly wine-tasting gathering in the local French restaurants. It outweighed every other possible topic in terms of interest. My friends couldn’t help but exclaim: ‘Have you heard about this news?’ ‘Planning to scoop up more vintage stuff?’ ‘Come on; have more red from Chateau Batailley, one of the best in Bordeaux, just to celebrate this great news.’ But, you may ask, which alcoholic beverage is best for me when there are hundreds? True, there are beers of all sorts and many brands. Some contain higher alcohol and can bowl you over after a few cans. Some are more bitter than the others. There are spirits such as whisky, brandy, gin, and rum – all pretty potent stuff. One day my respected ophthalmologist friend, Bill, handed me a bottle of Laphroaig with a glint of mischief in his eye. ‘Joe, I nearly died from just one gulp of this stuff, so don’t overdo it,’ he declared in his most serious tone. (Laphroaig is a 10-year-old Islay malt Scotch whisky.) As always, I just burst out laughing in response to his colourful language. There are also numerous other flavoured spirits (liqueurs), like Tia Maria, Cointreau, liqueur Muscat … all exceptionally nice to sip but too sweet to drink in quantity. Then, there is white and red wine, commonly consumed by ordinary diners. They are produced from a great variety of white and black grapes. Now, this is where one could get dizzy over the choice. Why? Because in the white grape category alone, you can choose from up to 105 different varieties, according to Tom Stevenson in his The World Wine Encyclopaedia. Of course only the most popular types such as Chardonnay, Gewurztraminer, Pinot Blanc, Riesling, Muscat grains, Sauvignon Blanc and Semillon, have been cultivated and made it to the table. The black grapes altogether number about 61 different varieties, largely responsible for the majority of red table wines. The most popular and wellknown varieties are Cabernet Sauvignon, Cabernet Franc, Pinot noir, Shiraz, Merlot, and Grenache. The French used to dominate the red table- wine market due to their ability to produce fine grades of red grapes and turn them into red wine of superior quality and diversity – producing 76 million hectolitres of wine each year (1988 statistics). Sadly, however, most of them are just ordinary wines mass-produced for profit. Superior quality wines can

only be made in small quantity. And even those bearing glorious appellations may be a disappointment at times. On the other hand, some smaller vineyards turn out wines of outstanding beauty. One such example being the Mount Mary winery run by that good retired doctor, John Middleton, in Victoria’s Yarra Valley vineyard region which has remained one of the top boutique wineries in Australia. In recent years, younger countries like Australia, New Zealand, and Chile are fast catching up to the French, in both the quality and quantity of their wines. In Australia in particular, new vineyards have been springing up like mushrooms, and the Australian wine export industry is now talking profit in billions instead of millions. They have developed many innovative methods in producing fine wines with consistency, yet the pricing goes very favourably against European wines, earning them a reputation for excellent value for money. And, indeed, many Australian fine wines are incredibly cheap in comparison and have become the favourite table drink in England. Often, too, quite unexpectedly, some have found their way to the dining table in many EU countries including Italy and France – the two major wine producers of the world! Sadly, however, the great success turned sour in 2006 as the mushrooming of local vineyards backfired and resulted in an over-supply of grapes. Hundreds of tons of good quality grapes have been deliberately left to rot on the vines by some budding vineyard operators – what a heart-breaking waste of all that labour and effort. So much for the varieties of alcohol. But, the question of which one to choose remains elusive. Should it be beer, spirits, liqueurs, or wine? And even of the wines, should you drink the white because you find it tastes sweeter, and fruitier (as those first exploring wine often do)? Or the deep red-coloured table wines for their beautiful crimson colour, at times reminiscent of the romantic evenings you have had with your first love? Unfortunately, the answer is not clear-cut as we still do not have a complete and thorough study on the effects of all the ingredients. But there has been increasing evidence that the many compounds in wine contribute significantly to good health. Let’s take a closer look at them: The Beneficial Aspects of Alcohol

(1) The alcohol itself – wines, red or white, contain an average of 13 to 14% of alcohol by volume. The organic chemical ethanol is the main alcohol present in beers, spirits and wines. Scientific studies on ethanol stress, time and time again, that it is basically a depressant of your central nervous system (CNS), qualitatively no different from the anaesthetic that puts you to sleep before an operation. But, you may ask, why would you feel more stimulated and talkative after a drink at the party? That is exactly the point. What happens after drinking a little is that the small quantity of alcohol is rapidly absorbed into the bloodstream, reaching the reticular system in the brain, dampening its operation. This system normally controls part of your cortex (the thinking part of your brain), so when it is dampened you are freed from inhibition and self-restraint. The resulting effects are familiar to everyone: you become more confident, vivacious and talkative (the changes are generally more obvious in individuals who are otherwise quite shy or repressed). This effect of mild to moderate alcohol intake is what makes it a helpful social tool for many individuals, helping them to interact freely with other people and communicate better. However, the more you drink at a single sitting the more you will experience the harmful effects of ethanol: initially, you may find your judgement and observation becoming blunted as the ethanol begins depressing and clouding your higher senses more deeply. Then, as your CNS is further depressed, you become increasingly irresponsible, which is frequently the point where some people begin arguing and brawling. As you imbibe more and more, all of your senses become blunted – your vision becomes blurry, your speech becomes slurred and incoherent, you may not hear other people talking, you might not feel much pain if you tumble in the toilet, even if you bruise your head badly on the washbasin. And finally, you will find that your legs ‘just won’t go’ – they literally let you down and you slump onto the floor, ‘just somewhere in the hotel, mate, don’t ask me where’, and go into deep sleep, often snoring loudly. The consequences can be more devastating if you drink and drive, particularly after a late-night partying. Research has shown that the combination of your CNS depression by alcohol, fatigue from hectic social activities, and the yearning of your tired and anaesthetised brain to shut down is far too powerful for anyone to be able to resist. What comes next? A picture familiar to everyone from the news – someone heading straight into a

roadside tree, or a power pole, or gully or some other place the car is not meant to go. It is tragic enough if you injure or kill yourself, but often someone else is the victim of such foolish behaviour. Over the years, there has been so much carnage on the road, particularly during festive times like Christmas, New Year and Easter long weekends. State governments and road and traffic authorities have been doing their best to curb the damage by enforcing the 0.05 blood-alcohol limit with random roadside breathalyser tests and radar speed checks at strategic points. They also utilise colourful slogans like ‘If you drink and drive, you are a FOOL’ and these help to further emphasise the message. The NSW authority has also long introduced another penalty of ‘double demerit points’ to punish unruly and undisciplined motorists. All these well-tried tactics seem to have had a measure of success and managed to reduce the annual road toll. Now that you have learned the keyword for alcohol consumption is moderation and are determined not to go over the two-drink guideline, you will be understandably anxious to know what health benefits the ethanol in the wine has, other than the mild stimulation and enhanced confidence it affords at social gatherings. Well, there are some studies which have shown that alcohol per se, in moderation, is associated with a reduced risk of heart attack because of its ability to increase HDL (high density lipids – the ‘good cholesterol’) the beneficial aspects of which have long been proven. It has the function of mopping up LDL (low-density lipids – the ‘bad cholesterol’) and preventing it from building up in the walls of your coronary arteries. Moderate intake of alcohol is also known to help your body’s insulin control your blood sugar better, and lessen your chances of becoming diabetic. Alcohol may also help protect you against dementia, but your genetics could play a more dominant role in this. So if you stick to the one to two drinks per day rule, you will already have less chance of having a heart attack than people who are teetotallers. But hang on, there will be more to come – you will enjoy more health benefits if you have wine instead of beer or spirits, because more recent scientific studies have unearthed some important compounds in wine, especially red wine, that could help maintain your system’s health. They are: (2) Antioxidant polyphenols and carotenoids. The colours of most flowers

and fruits are due to the presence of such compounds – the richer the colour, the more concentrated the polyphenols. For example, all the berries have lots of polyphenols, and out of all of them, the blueberries are the best. So it is hardly any surprise that the intense red/dark blue colour of the skin of the black grape must be pretty rich in such healthy compounds. Those of special interest are called resveratrol and flavonoids and have been shown to protect LDL from the harmful free-radicals which could turn them into atheromatous plaque. They also inhibit several other agents known to cause platelet aggregation and problems with coronary-artery degeneration. All these effects have one thing in common, i.e. protecting your arteries from cholesterol-plaque build-up and clot-forming tendencies. Recently, researchers have discovered that grape seeds are a powerful source of antioxidant. This helps confirm the popular belief that red wine is healthier than white, because red is fermented with both the skin and the seeds, while white is fermented only with its skin. Many studies from around the world have confirmed the virtues of moderate alcohol consumption. As we will see in Chapter Seven, its benefits frequently feature in studies of longevity. Take-Home message (1) Drinking in moderation is better than not drinking at all. (2) Avoid more than two standard drinks per day (one standard drink being 150 mls: a bottle of 750 mls contains enough for five glasses. The average drink with dinner should be about one glass only). (3) Red wine is more protective of your cardiovascular system than any other alcoholic drink. (4) Regular moderate red-wine consumption will most likely prolong your life. Excessive alcohol will damage your liver (cirrhosis), cause delirium tremens as a withdrawal symptom, cause Wernicke’s encephalopathy and give you an ‘alcoholic brain’ – a loose but handy name commonly used in hospital and general practice to imply the overall impairment in intellectual function, skills, memory and judgement in alcoholics.

Poor Nutrition Now then, what would happen if you throw away the concepts laid out in the basic food pyramid and go on consuming all those ‘goodies’ you are bombarded with daily in front of the TV set? Your poor nutrition would put you at risk of developing any number of chronic medical disorders. Professor Marc Cohen, head of the Department of Complementary Medicine, RMIT university, Melbourne, in his recently published work5, quoted from statistics of the National Heart Foundation showing that 60% of all deaths in Australia are due to nutrition-related disorders such as CVD (related to fats and oils), NIDDM (type II diabetes, related to sugars), and cancers (which are often linked to an overabundance of free radicals). The Foundation claimed that, in 1998, 40% of all deaths in Australia were due to atherosclerotic cardiovascular disease (heart attacks and other problems) caused by high cholesterol. Believe it or not, in 2002 L. R. Ferguson estimated that one third of all cases of cancers were diet-related and could be modified by healthy eating. The Australian National Nutrition Survey of 1995 revealed that a large number of children, up to 44%, ate no fruits nor vegetables, and adults were found to maintain habits not much better: ABC news announced in early Jan 2018 that ‘less than 4 % of Australian people eat the recommended vegetable and fruits’. Can you think of anything else more incredible when you take into consideration that Australia is a land of plenty? And who is to blame for ignoring the hitherto traditionally healthy way of eating – the working parents? The children? The TV? Market forces? Food manufacturers? The government? Maybe all of them. The Metabolic Syndrome All this consumption of deep-fried, over-cooked junk food, and poorly balanced meals with their over-rich carb content and meagre portion of fruit and vegies, is producing many over-weight people suffering from a disorder called Metabolic Syndrome, or Syndrome X (SX for short, also called Insulin Resistance Syndrome, or the lesser known Reaven’s Syndrome, or Deadly Quartet in the U.S.). Currently there are a billion people in the world suffering from obesity, and 25% of U.S. adults have SX, according to WHO.

SX indicates a constellation of factors that if present together, greatly increase the risk of diseases like diabetes, cardiovascular disease and stroke. It poses a risk in the domains of sugar metabolism, fat metabolism, high blood pressure, and obesity. You need to take only one glance to realise that this potentially serious syndrome has got a lot to do with the sugar and fat in our food as well as our sedentary habits. And yet, not very many years ago, the medical profession was still greatly puzzled by a clinical phenomenon where some diabetic patients just did not respond to their own insulin’s control on their blood-sugar level; and, in the insulin-dependent diabetics, a disproportionately large amount of insulin had to be given in order to just stabilise the blood sugar, even though most were put on strict diets. Hence the label of ‘syndrome X’ (X being the unknown factor and ‘insulin-resistance syndrome’). This puzzle has now been better understood after much research and many clinical studies in different countries, and the name ‘metabolic syndrome’ appears, quite aptly, to be the most adopted term for this complex disease, the causes of which are entwined with the metabolism of two of the most important nutrients for our body – carbohydrates and lipids. You may be excused for asking why most of the SX cases seem to have occurred in developed countries and particularly in the U.S. where medical health care and treatment are supposed to be highly developed. The answer is plainly and painfully simple – it is due to a morbid food culture and high-tech food technology, entrenched sedentary habits and driving market forces. In the U.S. improved food technology has greatly reduced the cost of food, by nearly 30%, allowing a more generous serving which, in turn, acts instantly as an incentive for the consumer to return more often. Then, there is the public’s bombardment by the ever-so-convincing, mouth-watering advertisements commissioned by the food giants to promote their junk food. It is incredibly hard to resist this indoctrination. The problem is further compounded by the increased time children and teenagers spend in front of the ‘entertaining’ box. About two years ago, there was an interesting survey carried out by the Australian Division of General Practice attempting to find out the sphere of influence of commercial TV ads on children’s eating preferences. The results should send a shiver up the spine of every concerned parent. It found that a child who watched TV four hours a

day in a six-week school holiday period would have seen 649 ads for junk foods, 404 for fast food, 135 for soft drinks and 44 ads for ice cream. It sounds incredible, but is a daily fact of life in nearly every household and every suburb in Australia. This marketing appears to be a key contributing factor in the rise of excess weight and obesity. As the then CEO of VicHealth, Dr Rob Moodie, observed, since the market has become the backbone of our political and civil life, the marketing of junk food has been highly successful and will continue to be so. His opinion was that we may have to impose some sort of ‘fat tax’ to put a brake on its dramatic influence on our society’s rapidly climbing obesity curve. Not a bad idea, in my opinion – for the tax collected from high-density rich food could be put to good use to combat the basic cause of SX by strongly promoting healthy food, healthy eating habits and a healthy lifestyle. As we all know, a strong and successful nation-wide campaign costs money, easily to the tune of tens of millions of dollars. It has been estimated that the number of fast-food restaurants in the U.S. has doubled in 25 years, while the number of obese people has increased fourfold in 15 years. This cannot simply be coincidence. The cuisine in the U.S. is another culprit – the food there tends to be deep fried and very sweet. In fact, a recent documentary on TV vividly depicted the life in a town it called the ‘Deep Fried City’ where obese and grossly over-weight people roamed around food stalls and restaurants which seemed to churn out nothing but huge servings of deep-fried food, takeaway food and finger food, often topped with much chocolate, cream and ice cream! (Here, perhaps, I should remind the readers that any food which has been deep-fried, oil fried or dry roasted to give you those wonderful aromas will give you AGEs – Advanced Glycation End products that raise the risk of heart and blood vessel problems and cancers.) There are numerous anecdotes about the unhealthy food culture in the U.S. For example – there was this young real-estate agent I met in Brisbane in mid 2005. We were chatting over a cup of coffee after a successful property deal. As soon as I mentioned the generous food service on the Alaska cruise ship, he was all excited and told me how, while he and his family were touring in the U.S. they could not believe their eyes when the meal was served up at the

restaurant – ‘Wow, so huge! There is no way we could finish the food.’ He told us how his wife and their daughter wound up sharing one plate and feeling quite satisfied! On the other scale, some European countries such as France, Italy, and Asian nations such as China, Singapore and Vietnam, tend to cook good quality food, providing a smaller serving with more variety, as reported in The Age (2/2/04). While overseas, the reporter observed, workers in France and Italy visited fast-food outlets and cafes no less frequently than back home, but the food served is high-quality reasonably healthy cuisine and expensive (which automatically limits the quantity the consumer purchases). Consequently, few workers appeared overweight or huge. So it seems that home cooking could yet remain one of the few saving factors to help beat the epidemic of Syndrome X in developed countries, as confirmed by a U.S. study published in The Lancet (Jan. 2005). In the survey, 3,000 adults aged between 18 and 30 were observed, regularly interviewed and checked for 15 years. The authors concluded that there was a ‘strong connection’ between fast-food habits and over-weight leading to SX with insulin resistance. They found that those who visited fast-food outlets more than twice a week had gained an average of 4.5 kg, and their insulin resistance had increased two times more than those who ate fast food only once a week. We can deduce from this that you would not gain any weight if you limit your indulgence to only a few times a year. The proof is practically beyond doubt. One of the major contributing factors is the over-supply of food in the developed countries. During the Great Wars and the Depression, you hardly noticed any over-weight people in the street, let alone the obese and the grossly obese. Most people were not rich. They worked harder and usually stayed with basically healthy food and home meals, while rich, high-calorie food was scarce and expensive. People just managed to survive on meagre rations as my family did during the Japanese invasion and occupation of Hong Kong in WWII. We couldn’t afford to indulge in rich food or a highenergy diet, and never put on weight no matter how much we ate of what was available. The only student in my class who looked like being on the verge of getting over-weight was the son of a rice merchant! Incidentally, he was the only one in our class who never showed up in the school yard nor the sports

ground, proving again the cause-and-effect relationship between being overweight and inertia. But, since WWII ended, the change has been dramatic. All sorts of foods have started rolling in and there has never been any lack of them. The last few decades have also witnessed a sudden surge in rich, high-energy foods like deep-fried oily food, rich dairy products, chocolates and sweets, concentrated and energy-rich desserts and drinks. The rich foods are tempting, highly palatable and possibly addictive. You could be eating more and more without being aware of the rapid increase in your waistline, at the same time exercising less and less because of the excess weight and cloggedup arteries. One can only eat so much, but there is so much to temp our appetites these days that many people tend to discard more healthy food for treats. In other words, people are consuming more and more, at the same time they are also wasting tons and tons of food. In February 2004, The Age newspaper reported on a survey carried out by Roy Morgan Research. It revealed that in Australia alone, people threw away $5.3 billion worth of food – of which $2.9 billion was fresh food, $600 million was in unfinished drinks and the left-over food amounted to $870 million. You can imagine the figures could be many times more in the U.S. Hopefully, people may start to think twice before they throw away fresh food and drink with the recently introduced short ad on TV calling the audience to join the ‘War Against Waste’ – a lively short clip even attractive to the younger age group. It is quite an interesting and powerful clip and should be shown on the screen more often during school holidays in the place of junk foods. During my recent cruise to Alaska, I was greatly surprised to see so many of my fellow passengers were quite big. Later in the cruise, I was shocked to encounter quite a few really overweight passengers, some being alarmingly morbidly obese. I realised they were most likely Americans, because, in our first fire-drill talk and demonstration night in the huge theatre, only a handful of passengers showed their hands with a feeble cry of ‘yes’ when the facilitator asked how many of us were from Australia, while most of the rest put up their big hands with a thunderous ‘yeah’ when asked how many were from the U.S.!

One day in the 24-hour dining room on the top deck, while enjoying the tranquil blue-and-white glacier-surrounded seascape with my son, a huge, morbidly obese man shuffled sluggishly past our table. He looked 200 kg plus and seemed to move with difficulty. Ultra-large-sized dinner plates are provided for breakfast, lunch, and dinner, and a big woman nearby had hers piled up high with so much food that I reckoned my son and I together would have struggled to finish it off. Yet that awesome female tackled the mountain of food with great delight and sheer joy. It was quite disturbing. Perhaps one of the reasons why many people have become deadly attracted to cruises may be the tempting thought that on board the luxury liners you can eat as much as you like, almost anything you fancy, anytime of the day and night! The cuisine in the formal dining room is excellent, easily of five-star standard, with wonderfully courteous service provided by the well-trained waiters. For the first few days, I could not help being pleasantly impressed by the speed of the service and the instant attention from the staff – the moment you finished one course, you could almost expect a friendly ‘Sir, have you finished? Can I take your plate away?’ just behind your shoulder. Any drink or special order would be delivered right in front of you within the shortest possible time, against up to half an hour in some of the top restaurants around town in Melbourne. Soon, I had discovered that they had at least two to three waiters allocated to each table of six to eight diners – 800 crew members serving about 2,000 passengers. If you happened to arrive early at the designated formal dining room, you would likely be greeted warmly by half a dozen smiling waiters, including the all-important floor captain or manager at the entrance. All these nice, well-dressed waiters would swarm upon the customer and thoroughly pamper them, as soon as they sat down – an experience never to be forgotten! Not only the dining-room service is impressive – a visit to the galley is even more breathtaking. They will explain to you that the passengers are catered to by a whole team of expert corporate chefs, cooks and pantry staff, helped by another team of storekeepers, butchers, fish and kitchen hands, working together to turn out different menus each day and an a la carte menu every night. The amount of food they prepared each day is really mind-boggling,

and I am going to list just the major items below: Fish: 680 kg (1,500 lb) Poultry: 816 kg (1,800lbs) Beef: 953 kg (2,100 lbs) Lamb: 209 kg (460 lbs) Pork and pork products: 454 kg (1,000 lbs) Salads: 726 kg (1,600 lbs) Sandwiches: 1,500 each Mayonnaise: 127 ltrs (28 gals) Potatoes: 908 kg (2,000 lbs) Vegetables: 1,134 kg (2,500 lbs) Pastas: 227 kg (500 lbs) Soups: 550 ltrs Flour for bread/pastry: 771 kg (1,700 lbs) Pastries: 6,000 Ice cream: 409 ltrs (90 gals) Cakes/pies: 300 Butter: 227 kg (500 lbs) Fresh fruits: 3,175 kg (7,000 lbs) Coffee: 2,137 ltrs (470 gals) Sugar: 181 kg (400 lbs) That’s only for one ship! There are dozens of cruise ships doing trips on the oceans every single day, including super- and mega-liners, easily over 8 to 10 storeys high, with the latest and the biggest being the ‘Ovation of The Seas’ reportedly able to take on 5000 passengers plus the crews – can you imagine the total amount of food consumed by all these holiday makers and sightseers? And they all seem to have voracious appetites, too, once they are in the blue waters and let go of their restraint. Really amazing! The 24-hour restaurant always has a buffet-style presentation of all kinds of food in unlimited supply – truly a floating paradise for gourmets and gluttons alike. On the land tours, too, not only did the combined souvenir shops, bars, cafes and eateries outnumber anything else, the servings were ever so generous as they were all geared to cater for the American tourists. In every port we stopped over at, there were at least one or two shops specialising in churning out freshly made toffee and chocolate drum-sticks, attracting

crowds of mainly female tourists. Even the typical simple cookies sold in the cafes and delis were four times the size we have in Australia. The cruise to Alaska, in the gastronomic sense, proved to be an eye-opener for my son and me. As they say, you have to see it to believe it. Research reveals that women’s eating habits are more sensible than men’s. Women have been found to consume more fibre, more vitamins and minerals, eat more seafood and poultry, but less takeaway and processed food. Could this fact be a major contributor in regard to the longer lifespan of the female sex? Do not neglect, also, the fact that women are usually physically far more active in doing shopping, walking, cooking, cleaning, and even gardening, than many men who consistently allow themselves to be stuck to their chairs and desks in their offices, or are often seen exhausted on arriving home and slumped into a lounge chair in front of the ‘box’. A healthy diet and being physically active are two of the paramount ingredients of longevity. To add one more bit of support to this theory, I would like to quote a recent research report from the Harvard medical school in Boston which states that ‘regular consumption of fish meals is a deterrent to atrial fibrillation in the elderly’. Atrial fibrillation, ‘AF’, is an irregular, chaotic and rapid contraction in the top half of the heart. In America alone, two million people are suffering from AF. It often affects the heart and is one of the major sources of emboli (freely circulating blood clots) which, can block the arteries in the brain causing a stroke, can be drawn into the coronary arteries causing a heart attack, can get into the renal artery causing damage and shut-down of the kidneys, or into the arteries in the legs causing pain, loss of feeling or even the death of a toe. So choosing your food wisely and sensibly can make a huge difference to your health. By following the Basic Food Pyramid, you have much less chance of becoming sickly and obese with all the defects that come with Syndrome X. Instead, you will have a healthier, stronger, more active and agile body and be able to enjoy your life to the full.

Diets ‘The popularity of dieting proves that people will go to

great lengths to avoid going to great widths’ Carl Ottavi (columnist & humorist) Sometime after the end of WWII, while most nations involved were busy repairing the damage and destruction and started nation-building, most people had just had enough means to manage living frugally on the most basic diet of carbs, vegies, fruits and minimal oils, without cars, TVs and computers – it was clearly a very Spartan yet healthy lifestyle. On the North American continent, however, it was an entirely different story. Because the U.S. homeland suffered no damage from the scourge of the war, people lived in a relatively cosy and sheltered environment and could afford to continue indulging in high living. As heart attack, obesity and other chronic conditions kept rising, all sorts of fad diets began to emerge on the local scene. Paradoxically, such fad diets even attracted world-wide attention, perhaps more due to the idolisation of the only superpower in that era rather than an urgent need of the then under- nourished people of the rest of the world to try to lose weight. The most famous diet at the time was the Pritikin diet, soon followed by Dean Ornish’s. One of the latest, in recent years, is the Atkins diet. In between, as usual, there have been many many more; some are promoted by the enterprising, others by the naïve, the greedy and those keen to get rich quick. I will just select some of the well-known ones and analyse their value. The Pritikin Diet Nathan Pritikin was an engineer by profession and had nothing to do with dieting, health, nor medical matters until 1955 when he suffered a heart attack. It is clear that, prior to his heart attack, like so many of his compatriots in America, his diet was unbalanced, unhealthy and energy-rich, reportedly consisting of the daily consumption of a three-egg breakfast, a pint of ice cream, plus generous servings of butter and whipped cream. The acute medical event completely changed his outlook regarding food and diet. He spent many years studying and researching numerous kinds of dietary habits in many countries and eventually came up with his own diet – the wellknown Pritikin diet which is basically a low-fat diet. He stopped eating all kind of meats, replacing them with a variety of plant-based foods, and started

jogging/running a few miles a day. Within months, his cholesterol dropped 50%, his angina chest pain disappeared, and his abnormal stress levels returned to normal. The diet book he created reflecting these changes was a hit at that time and was closely linked to his Pritikin longevity centres established all over the U.S. where even the weight conscious rich and the famous were in regular attendance. The centres advocated a two-pronged approach to weight loss by adhering to the Pritikin diet while maintaining a sensible exercise regime. Amazingly, the autopsy report on Nathan Pritikin, 28 years after his heart attack, indicated that his blood vessels were ‘as clean as a pre-adolescent’s’. The Pritikin diet was unique at the time because of its balance of elements: up to 80% complex carbs (bread, rice, pasta, cereals, etc.), low fat content of about 5%, greatly reduced cholesterol and salt, and at least 10% of proteins. For the Americans of the day, the Pritikin could be regarded as almost revolutionary in alerting people that too many chops and steaks with their inherent high cholesterol content put their heart health at risk. What was not known to Pritikin at the time but what we know now is that fat can be classified into the essential and the non-essential oils and that the essential oils such as the omega-3 oil which comes from fish, is important for the proper function of our body and it is beneficial to have more than the 5% he dedicated to this component. The Dean Ornish Diet Another famous diet was promoted by the cardiologist Dean Ornish, who ran a laboratory designed to demonstrate that heart disease could be reversed. Together with Elizabeth Blackburn, a Nobel Prize-winning scientist, he show-cased a revolutionary method. The regime focussed on a diet rich in plant-based food with less than 10% fat. It also included moderate exercise, required giving up smoking and emphasised the importance of having good social support, and stress-reduction activities such as tai chi, meditation and yoga. These not only helped participants lose weight and lower their blood pressure and cholesterol, but also helped them turn on the genes for good health and turn off the genes for bad health, all within three months. This is truly an extraordinary achievement in such a short time.

The Atkins Diet Dr Robert Atkins, a GP in New York City, literally ate his way into the limelight and into the millionaire club after launching his diet book 30 years ago. Fifteen million copies have been sold just in the U.S. alone. In it, he emphasised a diet rich in proteins but low in carbs, arguing that the low carbs equated to reduced calories for the body and hence reduced the chance to accumulate fat; while excess protein intake could replace carbs as fuel for energy. For overweight people, the Atkins diet practically gave them a green light to indulge in large servings of sizzling steaks and chops, mouthwatering BBQ and bacon and eggs for breakfast, etc. etc. All this without the slightest harmful effects on their CVS, while actually losing weight, according to Atkins’ misinformed theory. It must have seemed a godsend! Particularly when it was a diet coming straight from the mouth of their good doctor. He presumably only had their wellbeing and good health at heart, so why wouldn’t they believe it? Judging by the number of copies sold, the Atkins book must be either extremely persuasive, or there must have been a lot of gullible gourmets around who were only too willing to listen to what they wanted to hear. The paradox was, as Robert Atkins practised what he preached, instead of losing weight, he was discovered to be a very overweight person (115 kg). In fact, he had heart problems plus high blood pressure and was obese with a BMI reaching 35. (BMI is the Body Mass Index, up to 25 is regarded as normal, 25 to 30 is overweight, beyond that will be obese and very obese.) His cardiologist pointed out that he was diagnosed with cardiomyopathy as early as 2000. It was followed by a heart attack in 2002 and he died in 2003, at the age of only 72. In other words, Robert Atkins’ diet is deeply flawed right from the start – a meal plan high in protein, fat and bad cholesterol will unequivocally bring you clogged arteries and an unhealthy heart, leading to cardiomyopathy and heart attack. The only defence of Atkins’ diet is his own fervent claim that it was ‘at least tasty.’ Many people who first took up his diet encountered upsets in the digestive system in the form of nausea, bloating and constipation. The latest news about Atkins’ enterprise came in 2005: the once mighty

Atkins Nutritionals Inc., the company that produced all the low-carbs products that fed the diet craze, filed for bankruptcy after reporting a loss of over $400 million in the previous year because of rapidly dwindling sales and heavy debts. A similar fate befell its British arm. About 30 million people in the U.S. and three million in Britain are believed to have followed the Atkins diet. The collapse of Atkins’ empire has been expected for some time since his death from heart problems and overweight had been much publicized in the press. The truth of the matter is that you cannot fool the people for too long. The Asian Diet As agriculture has been the traditional way of life in Asian countries, their diets naturally consist mostly of carbs (rice in the southern regions, wheat and barley in the northern regions, depending on the type of grains that will grow) and vegetables, with meat being consumed sparingly. The type of meat consumed is mostly chicken and duck, fish and seafood. Pigs are slaughtered only on festival occasions and for big events. Dairy farming is practically non-existent. Cow’s milk, butter and cheese are foreign to Asians. There are minor exceptions, of course, for example, the nomadic tribes in northern China and the Mongolian region depend heavily on dairy products from their herds of goats, yaks and whatever they can muster and keep. In China, bulls and cows are too highly-valued for the tilling of rice paddies to be slaughtered and consumed on the dining table. In other words, Asian diets are heart-healthy in general. Carbohydrates form the staple of their daily meal and the main energy source. This is supplemented by plenty of fresh, green-leafed vegies for fibre and vitamins and minerals which ensure the smooth working of the metabolic machinery. The amount of unhealthy animal fats is limited, and cooking is usually done with mono-saturated oils like peanut oil. Most Asian meals have no provision for desserts either. Asians certainly never dream of whipped-cream topping, chocolate mousse, rich cheese cakes and the likes. Whatever cakes and biscuits they have after dinner and during festivals are mainly made from carbs with sweetened fillings of nuts, seeds, plants etc. A piece of fruit after dinner is the usual rule in most sensible and better educated families these days.

The only thing this diet lacks is protein from meat. Many isolated and inland areas of Asia have long been sorely lacking in this regard until recently, resulting in numerous cases of iron deficiency, anaemia and malnutrition. However, with many of these communities becoming more affluent recently, and a more thriving fowl population and improved animal husbandry, malnutrition is beginning to disappear fast. And in fact, the opposite situation is starting to emerge now in Asian cities, as the number of obese people has soared to a new height. For example, in China alone, according to WHO data, there were 200 million overweight individuals already in 2003. A frightening statistic! The Mediterranean Diet This traditional diet has been practised for thousands of years by people living around the Mediterranean ocean, notably the Greeks, Italians and Spanish. It is a world-class cuisine, hailed by nutritionists and health workers all over the world as the healthiest diet with its benefits for the heart and supposedly cancer-preventing potentials. Surprisingly similar to the Asian diet, the Mediterranean diet is rich and vibrant with plenty of vegetables in the form of zucchinis, tomatoes, broccoli, capsicums (or red, green and yellow peppers), asparagus, yellow squash, etc. These are mixed with lean meat, cooked with the good virgin olive oil, and consumed heartily with a large bowl of pasta or chunks of homemade bread, and a glass of red wine. A typical daily menu reflecting the authentic Mediterranean diet, viewed on a pyramid scale, is something like this: mostly complex carbs in bread, pasta, rice, couscous, polenta, other whole grains, and potatoes, with moderate amounts of vegies, fruits, beans, legumes and nuts, a good splash of olive oil, and some cheese and yoghurt. Then, on average once a week, fish or poultry, in addition to eggs and sweets. About once a month, meat from land animals is consumed, only in a small quantity. The Mediterranean diet is basically as much a poor farmer’s diet as the Asian diet is. Its well-balanced ingredients of complex carbs, vegies, legumes and nuts, lean meat proteins, healthy good oil, and fresh fruits, is far superior to the modern day diet with its fast food. The only fat or oil comes from the olive which has been cultivated for more than 5,000 years. The variety of vegetables and fruits is more than enough for your needs in terms

of essential vitamins, antioxidants and minerals. It is really an excellent diet for any age group and any type of worker. It is almost a classic replica of the Basic Food Pyramid. The sad thing is, among the younger generation of the Mediterranean nations, the attraction to this wonderful, healthy, home-grown cuisine is fast fading. Along with the world-wide trend in flocking to junk food and fad diets, contemporary youngsters are growing up fatter and fatter with bulging bellies. In stark contrast to what people saw 30 years ago, Greek and Spanish adults are now among the podgiest Europeans. A recent survey by the European Union of its people has found approximately 30% of the children are overweight. This obesity epidemic has got the Greek government so worried in recent years that it has taken the initiative to sponsor a world-first conference to promote healthy Mediterranean cuisine, with experts, professors of medicine, directors and heads of nutritional institutions being invited from all over the world. But it is quite clear that much more has to be done to reverse the trend. Weight Watchers Diet Anyone who is seriously contemplating losing weight sensibly should try the Weight Watchers diet, without a doubt. It is not yet a gold standard in nutritional circles, but it has been around for so long that it is almost a household name in Australia. The WW diet is an excellent eating plan to help overweight people lose weight in a most sensible way. It allows 1,200 Kcal for woman and 1,500 Kcal for men, so that you can still carry on your exercise without starving. As we know, a minimum of 100 gm of carbs is required to be ingested per day to avoid breaking down the lean tissue (the important proteins) in our body. As 100 gm of carbs will generate about 450 Kcal, you can see a 1,500 Kcal will still give you a lot of room for your other energy needs. In the eyes of Rosemary Stanton, the well-known Australian nutritionist, the WW diet is way above all other commercial weight-reducing diets currently being promoted in Australia. In the WW workshop, which is at the heart of the WW programme, clients are usually given an eating plan based on the Points Weight-Loss System.

They have their weight checked, are given a talk, and required to return regularly to have their weight re-checked and recorded. Their Body Mass Index (BMI) is regularly assessed, and although it is not in all ways the ideal measurement for obesity, the BMI is the most convenient and popular tool for this purpose. One of the biggest advantages is belonging to a group of people who all share the same purpose. There is always spare time for individual members to compare notes, to make new acquaintances, to catch up with old friendships, or participate in other intra-club health-promoting activities. So joining a WW club could bring you more than just the primary benefit of weight loss! At present, the WW has a 12-week programme with weekly support and a six-week maintenance plan to help you maintain your new lower weight. The WW also offers tips and advice for the family and demonstrations as well as encouraging people to do warm-up, stretching, and exercises. What is more, WW is also running a WW at Home Programme with their ‘Time for Success Programme’ in which you have the choice of two kits. The basic one is called a DIY (Do It Yourself) kit: a 12-week programme consisting of a points finder (a table of foods with nutritional values in points being allocated to each) and fun menu planners which are an entertaining way to keep track of your weight loss. The second programme – the Ultimate kit – is more comprehensive, offering more support, with a better points-value guide to foods. There is also a DIY weight-loss programme for men to lose one kg per week. For some time now, the WW has also made it an integral part of their programme to encourage members to exercise – another wise move. The CSIRO Total Wellbeing Diet In this muddy minefield of dieting, rapid weight-loss, miracle diets like the grapefruit diet, cellulite diet, etc. etc., you only find mud, rocks and dirt, and little gold – unless you count fool’s gold. However, the scene changed completely when this CSIRO diet book was published early in 20056. The book is a rare gem in this field. It is the accumulated effort of the co-authors, two dedicated medical food and obesity researchers based at the University of Adelaide, Drs M Noakes and P Clifton, along with many other dieticians and nutritional scientists in the CSIRO divisions who have tested hundreds of

volunteers since 1997. The CSIRO is Australia’s national science agency established in 1928, and today ranks in the top 1% of world scientific institutions in 12 out of 22 research fields. The quality of their research is indisputably dependable. After much experimenting with different types of dieting, combined with research on weight loss and nutrition, and feedback from volunteers, these researchers have finally settled on their own diet plan. This diet, they solemnly declare, is like no other and almost guaranteed to help you lose on average 0.5 to one kg per week. The core of this diet is its ‘protein plus, low fat, moderate carbs approach’, in addition to plenty of vegies, fruits and plant proteins. Basically it is similar in principle to the basic food pyramid with just some modification on the carbs/proteins ratio so that you will be eating more meat proteins and less carbs than you will with the basic food pyramid. The approximate breakdown of the macronutrients is as follows: Carbs Proteins Good fats

CSIRO Diet Plan 36% 33% 20%

Basic Food Pyramid 40 to 50% 20% 10 to 15%

The concept of higher proteins/lower carbs to help weight loss seems to have gathered momentum in recent years after the release of several research studies, with most of them reaching the same conclusion that overweight people would feel less hungry for longer periods if fed more protein rather than more carbs or more fatty food. An important factor is that these people tend to be happier with more protein in their food because it takes longer to break down than other forms of food which convert quickly into fat. Therefore they are more willing to stay on such a diet longer, even though they are actually eating less in quantity. It’s just common sense that the more food you eat, the more you will put on weight. So the fact that overweight people are contented with less food on this diet and willing to stay with it is welcome news. The cornerstone of the CSIRO diet plan is the way it is structured on a dayto-day, week-to-week basis, over a 12-week period. The weekly menus are easy for anyone to follow, so you need not scratch your head as to what to buy, what to cook, how much to eat, and how to cook. There are 100 recipes

for healthy meals, covering soups, salads, sauces, seafood, fowl, land animals, vegies and desserts. They are simple to follow, and are nutritionally balanced as well as a proven recipe for steady weight loss, provided you adhere to the plan with minimal deviation or modification. After you have tried it out for 12 weeks and achieved the desired weight loss you will be shown another plan – the Wellbeing Diet-maintenance plan – designed to help you maintain your newly found but healthy lower weight (‘healthy’ is the keyword). The Polymeal Diet The last to join in the ‘battle of the bulge’, the Polymeal constitutes the latest research findings about food and lifestyle, reported on in an article in the British Medical Journal. The researchers of the Polymeal have come up with this heartening diet that includes the daily addition of 150 mls of wine and 100 gm of chocolate. Just the thought of a glass of good vintage wine under your nose and half a box of exquisite Swiss chocolates melting slowly in your mouth cannot fail to have food lovers scrambling to this diet plan. This diet recommends four fish meals (with about 114 gm of fish each meal) per week, and 400 gm of vegies, fruit, almonds and garlic, in addition to 150 mls of wine and 100 gm of chocolate every day. The researchers claim that the wine will reduce your chances of cardiovascular disease (CVD) by 32%, the fish by 14%, and the vegetables, fruit and chocolate by another 21% – in total a hefty 76% reduction of CVD risk. The Polymeal researchers claim that, as most premature deaths occur due to CVD, this great reduction of risk will lead to the much increased life expectancy people are looking for. Basically the Polymeal is sound in principle, as we already know that a glass of wine is good for the heart and that plenty of vegies and fruit will give you more antioxidants to protect your health. It is also well established that fish and its oil is more beneficial to your heart and blood vessels than the flesh from most land animals (though the 14% reduction is somewhat disappointing). The value of fish in the diet is underlined by the case of the Greenland Eskimos who enjoy excellent heart health while eating little else. But the 100 gm of chocolate is an interesting new addition. Pure dark

chocolate contains only cocoa solids – a kind of stimulant – while the yummy milk chocolate contains an insignificant amount of butter oil and full-cream milk powder. However, recent research has already strongly backed up chocolate as a good food since it was found to contain the antioxidant phenolics. The fact that 42.5 grams of milk chocolate contains as much phenolics as 125 mls of red wine is quite exciting and unexpected good news, adding a little bit to your enjoyment at the table and lots of health-giving antioxidants.

Fad Diets Quite out of the blue, fad diets have mushroomed fast and thick in developed countries in recent years. The reason is simple – those peddling fad diets can see clearly they are going to pocket lots of easy money from the overweight, the gullible, the naïve, the gluttons, the rich and the over- fed. For a variety of social and economic reasons an increasing number of women have joined the workforce and find little time to cook. By the same token, men do not necessarily want to be involved in the preparation of meals after a hard day’s work to compensate for this shift in roles. This helps explain why such a large number of people are turning increasingly to fast food, junk food, and dining out in restaurants. This can only result in an increase in childhood obesity and all its attendant ills. Without clear-cut advice from their busy working parents or healthconscious teachers, to whom will children turn? As happens in most cases, popular magazines and TV ads, or the internet, appear to be the main source of information for the hapless youngsters of today who are easy targets for the snake-oil salesman. The cost? According to the Victorian AMA’s official magazine, just in Victoria alone, people are spending $1 million per day on such fad diets, which equates to about $1 billion in three years – the same amount Australia will spend in helping Indonesia to re-build the vastly devastated regions after the Boxing Day tsunami disaster! Fad diets are mentioned here not because any one of them has any virtue at all, but because, by analysing their common characteristics, you will be able to distinguish the difference between the faddy and the healthy diets. Most commercially promoted weight-loss or slimming diets could be roughly

grouped under the following types: ‘Meal-replacement’ Diet Plans These include the so called ‘soup diet’ as appeared on a commercial TV show in Melbourne a few years ago and are simply a starvation or semi- starvation diet, as you only ingest up to 150 cal per meal, not enough to produce the required energy to carry out your daily activities, which means that you are at risk of rapid loss of glycogen (the fuel for anaerobic metabolism), water, and important body proteins. And there is not much energy left for you to do any extra tasks in your garden or garage, let alone to do some stretching and take a brisk walk after work. However, some of the more well known ones seem to have fared better and stood the test of time. They usually advise the consumer to eat supplementary vegies and fruit and maintain a regular exercise regime. Low-carbohydrate Diets The low carbs in your food will reduce your energy production leading to lower BMR (basal metabolic rate) to as much as 30% below normal, so that as soon as you come off this diet plan, your weight will rapidly increase because of re-hydration and slowing down of the burning off (due to lower BMR) of the increased food you have now taken. So you are back to square one. Again you will not have enough energy generated to keep you warm and running. High-fibre Diet (the F-plan diet) This is essentially a high-dietary-fibre, low-fat, low-cholesterol diet, popularly promoted in Britain in the 80s to help people to lose weight, to fight some cancers and to protect the heart, in the misguided belief that this combination alone would be the ideal one. Nowadays, as you look back to our Basic Food Pyramid, you will be able to see immediately how unbalanced such a diet is. It has absolutely no scientific, medical, or nutritional rationale at all. Sometimes it makes you wonder how some people could be so naïve.

‘Rapid-weight-loss’ Diets The recipes for this type of diet rely on certain chemicals/herbs/minerals to force the water content out of your body, causing weight loss at a faster rate. Whatever weight you have shed off, up to 80% of it is actually water, and, disappointingly, the loss of fat from your body amounts to only a fraction. What is more, as soon as you come off such diets and get back to your favourite junk food and high-energy food, you will regain all the weight you have lost, even much more in most cases, due to the ‘rebound’ compensation mechanism of your body’s system of endocrines (internal hormones). By a simple comparison of these ‘miracle slimming diets’ with our Basic Food Pyramid, I am pretty sure you will have no trouble in picking out the major fault of all of them – they are all unbalanced: they are lacking in one or more essential nutrient. Following any such diet can cause much harm to your health as a whole. Early in 2005, one of the commercial TV stations listed a number of eating plans labelled ‘vitality diets’ including Atkins’ and one other proposed by the Australian national heart foundation advocating a balanced diet with reduced fat. This programme was intended for the benefit of the general viewing public and invited the CSIRO to offer their opinions. The results were that the National Health Foundation’s balanced diet plan with reduced fat was unanimously rated the best, while the Atkins was deemed the worst. The Summing Up – Choosing a Sensible Diet Now that we have described and analysed the major famous players in the dieting fields, the next step is to select those with a sensible, reasonably balanced approach to our nutritional needs: (1) The Mediterranean diet – this one has stood the test of time and has been hailed by renowned nutritionists as the healthiest diet. It provides one with sufficient carbohydrates for energy, proteins to maintain body growth, and antioxidants to keep you healthy without putting on excessive weight. The diet is easy to follow and the food is tasty, healthy and a pleasure to adhere to for life. (2) The Asian diet – again is a good choice, as the framework of this diet is

strikingly similar to the Mediterranean one and ideal when enough protein and iron is added for healthy body growth. (3) The Weight Watchers – this very popular diet is not only sensible but also flexible enough to suit most people’s requirements, as explained in some detail above. (4) The Pritikin diet – although incredibly popular in the U.S. at the time when it was introduced has essentially been superseded. (5) The CSIRO Total Wellbeing Diet. It is my verdict that this is, so far, the only scientifically researched and tested weight-loss diet plan worth your trial. It is especially suitable for anyone desperate to shed harmful excess, even if they suffer from type II diabetes, hypertension, insulin resistance and other chronic conditions. For the ordinary, physically active person exercising regularly at moderate intensity, the Basic Food Pyramid supplies you with more energy from the highly complex carbs and is still the best food plan to follow. Alternatively, you can stick to a modified CSIRO diet plan with more carbs to make sure you have extra ATP. After all, the CSIRO diet plan is also designed to allow flexibility for anyone, as long as any modifications are nutritionally sound and balanced. You are advised to strictly adhere to their plan only if you want to lose weight. Please note that the CSIRO Diet book is available from most bookstores. The price has recently dropped 30% to about $22 after a reprint – real value for money for the overweight and the weight conscious.

A Sensible Approach to the Good Life Go For Your Life As fad dieting booms, the medical bodies in Australia have been quick to realise the danger to overweight people desperately seeking a ‘quick-fix’ who always end up being more obese, and slowly but surely drift into the scary domain of metabolic syndrome. In response to this concerning trend, the Victorian branch of the AMA, largely through the effort of its weightmanagement spokesman Dr R. Kausman, has created an Australian first by securing the cooperation and financial backing from the Victorian

government in launching a public health campaign to combat the problem of fad diets. The campaign, as part of the ‘go for your life’ state government initiative, was officially launched by the health minister Bronwyn Pike in January 2005 (it boasts having 229 parks, gardens and reserves to help Victorians enjoy a great outdoor life). It will spread the word in all public places in the form of brochures, posters and educational materials. It will also need a lot of assistance from local GPs to educate the weight-conscious and get the message across that the only way to lose weight is to have a balanced diet plus physical activities – exactly the same concept and vision I have promoted throughout this book. My Personal Experience of Maintaining Perfect Weight My personal experience has been that – unlike Robert Atkins – I have remained very healthy with a bodyweight maintained continually around 60 kg since my graduation from high school in Hong Kong. Somewhat strangely, I recently recalled an incident from 50 years ago that, although seemingly trivial, remains a fond and vivid memory. It happened on a magnificent day in Hong Kong when our entire matriculation class went to the famous Repulse Bay to relax and forget about a stressful exam. My little group of close friends decided to hire a small tent on the beautifully white sandy beach and play cards. As we left the administrative pavilion after paying the fees, we spotted an automatic weighing machine near the front entrance and hopped onto it in turn, just for the curiosity of seeing how much we had lost after the ‘big exam’. You had to insert a 10 cent coin to get the machine to print out your weight, and I can still recall myself looking at the little card with the figure 128 lb printed on it, as if I have just seen it a few minutes ago! The human memory is really amazing. And now, my weight remains exactly the same in spite of the large serving of food I eat every day, in addition to regularly dining out and the occasional nine-course Chinese banquet. My life has been a busy one since my return from Canada, and has never ceased its frantic pace due to a greatly increased workload and paper work as a senior partner in the busy clinic. Yet strangely, I have not put on even an extra kilo in all that time. In short, I cannot escape the conviction that the combined effect of a healthy, balanced diet and regular moderate exercise is the reason behind my

increased stamina and maintenance of an optimally controlled body- weight. Likewise, you can achieve your goal to be fit by going down the same path. Dining Out – Its Pleasures and Pitfalls These days, as society becomes increasingly prosperous, cafes and restaurants are opening everywhere. Dining out with family, friends, colleagues and business associates has never been simpler and more popular and you can sample any type of cuisine you fancy in the most pleasant and, at times, opulent settings. Most establishments have soft music to please your ears, and a few even employ a pianist on Friday and Saturday nights. All sounds very tempting, even to the point of addiction. There is nothing wrong with an occasional dinner out. That is one way of discovering new recipes, new ingredients, the culture and background of different cuisines, and the centuries-old skills of their cooking methods. One is often left speechless by the elegant and delightful presentation, or thoroughly overcome by the exquisite taste of the specialty of the house. And, the best part of the deal is that after the party is over you and your spouse have no dishes to wash. So why not enjoy dining out more often? Well, the trouble is, frequent dining out carries its own risk. As it turns out, recent surveys have discovered that many baby boomers (the first one turned 60 in 2005) are now starting to suffer some serious chronic medical conditions such as obesity, high blood pressure, diabetes and heart disease – the metabolic syndrome. I am pretty convinced that part of the fault lies in certain unhealthy aspects of their lifestyle such as frequent dining out and sedentary habits. The reasons eating out too much can be counter-productive are manifold. You see, restaurants serve nice and tasty food, but not necessarily good healthy food. Of the European cuisines, only the Mediterranean food gives you plenty of good vegies cooked in good oils. The French is also good in that they give only a small serve as part of the concept of ‘new cuisine’ which means you get just enough exquisite cuisine for your palate but not enough for you to put on weight (in contrast to the American style). The other point to constantly keep in mind is what sort of dish you are going to order. For instance, choosing a deep-fried lamb chop over a poached fish can make a huge difference, which should be obvious when we remember that some restaurants re-cycle their cooking oil for deep-fried food, and such re-used oil

can change into harmful trans-fat oil. Then there are those ever-tempting desserts that are so delicious but highly fattening. At this point, you must exercise extreme care, keep your cool, avoid the wickedly rich and creamy ones, and resist that large serve of yummy cake. Make sure your cholesterol and sugar levels remain unaffected, as it takes a good deal of exercise to burn off those buttery, creamy, fatty and sickly sweet foods. Fat and oil contain more than twice as many calories as carbs and proteins – which simply means that you need to exercise twice as hard to burn off fat as you do for the same amount of protein or carbs. Asian restaurants, on the other hand, are well-known for providing adequate amounts of green vegies and appear to serve good healthy dishes. However, you could be tricked as well if you make the order without thinking. As it goes, many of the stir-fry dishes may not be precisely a stir- fry but start with deep-frying the meat before putting it back into the main stir-fry. This seals in the flavours making them more intense and appetising, and shortens the time to turn out a dish too, but the result is much less healthy. Most of the time, however, with seafood such as steamed fish, crabs, prawns or scallops in shallot and ginger, together with plenty of green-leaf vegies, you can’t go wrong. These are probably just as healthy as home cooking provided that you do not over-order or over-eat. Another strategy, I learned from a good friend, that has been immensely helpful and can put your mind more at ease, is to inform the waiter taking your order that you prefer less oil, salt and sugar in your dishes! It might surprise some readers to know that we have found the staff are usually happy to oblige, and so we enjoy our meals more to our hearts’ desire. Try that at your next outing. Dining out is otherwise a very enjoyable experience, socially and gastronomically, but it is a sound policy to reserve it for special occasions.

Chapter Four A Healthy Lifestyle ‘Life is not a matter of holding good cards, but of playing poor cards well’ L Robertson

The Baby Boomers and Generation X Perhaps there is no other single word more sacred to the baby boomers than ‘lifestyle’. Yes, we are talking about the baby boomers again. If they seem to pop up everywhere and have consistently been in the limelight, this is because this 20% of the population fills most core roles in our society. Baby boomers are the generation born after WWII, between 1946 and about 1965. The first baby boomer turned 60 in 2005 and officially retired in 2010. So those aged between 40 and 60 are baby boomers and, according to the Australian Bureau of Statistics, there are about 5.4 million of them in Australia. The offspring of the boomers, commonly termed ‘Generation X’, are aged between 28 to 40, number 3.2 million and have much less spending power and political clout, except a few famous young celebrities. Baby boomers occupy important government positions and are active in every respectable profession and business, the media, academia, research institutions, etc., as well as forming the bulk of the work-force in every trade and office. The baby boomers, in spite of being born after a devastating world war, were mostly well cared for. They had no lack of good food, good schooling and had a happy childhood. On growing up, they were offered a world-class tertiary education, plenty of job opportunities and an unemployment rate as low as you can imagine, often less than 1% – sounds almost like a dream today. They were the ones who witnessed the Vietnam War and experimented with marijuana and other drugs. They campaigned for freer sex, adopted an ‘anything-goes’ attitude influenced by the permissive trend in American society after WWII, and generally became a bit of nuisance to their more conservative parents. (Now these boomer parents of the 60s and 70s have started to signal their strong disapproval of their children as their own

attitudes and behaviours are coming back to bite them). It may seem that the baby boomers have got everything: the money, the prestige, the power, the prosperity, and the ultimate lifestyle. But do they have true contentment? From the 70s, the alarm bells started to ring. Many baby boomers discovered that their health had gone awfully wrong, with a large number of them suffering from the debilitating effects and complications of cardiovascular disease, diabetes, obesity, lung cancer, prostate cancer, bowel cancer, and the newly established metabolic syndrome. They had become victims of the lifestyle they so cherished with its rich diet and philosophy of indulging in ‘whatever turns you on’. Many suffer from depression, anxiety, and nervous disorders that often are a result of some chronic medical condition. This suggests that ‘having everything’ and doing exactly as you like is not a recipe for lasting happiness. A research paper from the QMIR Berghover Medical Research Institute has recorded that almost 40% of cancer deaths (approximately 16,700 per year in Australia) could be avoided simply by changing to a healthy lifestyle. Professor Joel Khan, a preventive cardiologist in the USA, sounded a similar warning in 2013, when he remarked that people ignore the natural remedy of adopting a healthy lifestyle and opt for surgical or medical solutions like coronary stents, by-pass surgery, taking statins and diabetic tablets, but these high-tech measures only offer a false sense of security as their effects only represent temporary symptomatic cures so long as the patient’s lifestyle remains the same. In the USA and Canada alone, 1 million stenting and bypass operations are performed per year. Just the stenting can cost up to $20,000 per case, and it is much more for a by-pass (CABG). The professor was convinced that over 75% of CVD and so most of the expense, together with the post-op pain, medication and loss of time and income could be avoided simply by adopting healthy habits! All this disease and unhappiness shows that, whatever else the post-war generation have, they lack discernment and given the choice of everything have not chosen what is good for them. In this chapter, I shall describe the differences between the ‘discerning’ and the ‘irrational’ lifestyle. The discussion, naturally, is not exhaustive. It is only intended to give an overview of what you can do to enhance your wellbeing or to avoid those things that will bring you ill health and unhappiness.

The Discerning Healthy Lifestyle Exercise and a Balanced Eating Plan As we saw in chapter two, regular physical activity is the most basic yet indispensable factor in keeping your body and mind functioning well. The first step is always the hardest, as the Chinese saying goes – ‘of all the ten thousand tasks, the hardest one is to get started’. Once you have started and kept practising it will become habit and part of your daily routine. Furthermore, as Chapter Five shows, the best thing we can do for ourselves is to simply adopt the basic food pyramid eating plan. Be sure also to treat yourself with a glass or two of good local red wine, perhaps a few times a week, being conscious of the fact that a good quality Australian red wine is ridiculously cheap by comparison with imported reds. Remember also the two key words: balance and quality. As the French say, ‘tout est une question d’equilibre’ meaning everything is a matter of balance. Or, as Confucius, the greatest Chinese teacher and philosopher put it, ‘take the middle road, and adopt a moderate attitude.’ All these wise sayings serve as a reminder that we must have a balanced variety of foods, not preferring one food in excess and neglecting the others. It is generally wiser to focus on the quality of things rather than the quantity. Consider the book French Women Don’t Get Fat by Mireille Guiliano. Mireille describes how a French woman is satisfied with just a small piece of superfine dark chocolate melting in her mouth and enjoys a pleasure even half a dozen Snickers bars could not afford. By choosing quality it is easier to settle for a smaller quantity because of the cost. One of the biggest contributing factors to longevity is caloric restriction as we will see in our final chapter. Sleep When you are told that you spend almost a third of your life sleeping in bed, it may sound incredible to you, but it is absolutely true, because most of us sleep between six to eight hours out of the 24 hours we have for a day. Some people can function well with less; for example, Winston Churchill slept only

about five hours, and Margaret Thatcher even less, spurring some British scientists to look for the ‘Thatcher gene’. On the other hand, Albert Einstein, that great genius of the scientific world, slept more than 10 hours a day! Although no one quite understand why we sleep, we now know quite a bit from scientific studies in sleep laboratories about sleep and how it happens. There are the REM (Rapid Eye Movement) stages and the NREM (NonREM) stages. NREM is the deepest and most refreshing stage of sleep, tremendously important for your body and mind’s recovery. REM refers to the dominantly dreaming stages in which your brain’s activity increases as it processes the day’s experience, as does your blood pressure, heart rate and blood flow. You need both types of sleep in cyclical patterns – you generally start your cycle with 80 minutes of NREM sleep, followed by 10 minutes of REM sleep. Such cycles will repeat all night with less and less NREM and more and more REM towards the end of your sleep. The overall balance of these stages during your sleep is important. A good sleep of six to eight hour’s duration means that you feel reasonably satisfied and refreshed. But how does one consistently get a proper sleep? By observing the basic principles listed below: Tips for Good Sleep (1) Avoid coffee, tea, cocoa, cola drinks and chocolate before bedtime as all of them contain caffeine which stimulates your brain, resulting in poor sleep. (2) Avoid alcoholic beverages, too, because alcohol helps induce light sleep only and will upset the normal sleep structure based on REM/NREM. (3) Cease all serious mental and physical activities at least half an hour before sleep to prepare your brain to slow down, shut down and sleep. (4) Reserve your bedroom exclusively for sleep (and sex), without any hint that you use it as your portable office or study. This reinforces your mind’s association of bed with sleep. (5) Avoid any clock or noisy gadget in the bedroom, particularly for older people whose sleep patterns contain more of the lighter REM type and may

be easily awakened by a little noise. However, light music or soothing sounds may help some people sleep better. (6) Establish a routine. Try to awaken and rise at the same time every day. Forget about making up for lost sleep by sleeping in on weekends. If you are genuinely fatigued, go to bed early and your body’s biological clock will adjust accordingly. Alternatively, take a nap, for not more than 20 minutes after lunch. Many people feel relaxed and re-energized, and often report that they sleep better that night. The reason is probably because a ‘catnap’ is not unlike a shorter REM phase of a sleep cycle, most relaxing and refreshing. (7) Exercise in the late afternoon or evening, get into a shower, have your healthy dinner, and you will find your sleep more relaxed and refreshing. (8) If you are religious, take time to pray. One often finds that by connecting to one’s spiritual side the mind becomes calmer and it becomes possible to drift off into a peaceful slumber. This is quite similar, in principle, to meditation, which we will look at in more depth in Chapter Six. If you still have trouble getting to sleep, you may have to consult a sleep expert or read up on the subject (a number of references are listed at the end of this book). Personal and Social Relationships As human beings are gregarious animals, we all need company and feel more comfortable and secure by living in families, groups or communities. One cannot create a perfectly healthy lifestyle without being part and parcel of a congenial interpersonal network, the most basic one being your immediate family: your spouse, children, siblings, in-laws and other relatives. Having a spouse or partner can afford much physical, emotional, and intellectual support, especially in difficult times. A happy and harmonious relationship will always enhance your inner happiness and help you to live longer. Statistics show that those who live alone have a shortened life expectancy. Raising children can be a great source of joy. It can be wonderful to nurture them and witness their progress as they become healthy, contributing members of society. Maintaining good relationships and regular contact into their adult years is also a most rewarding part of family life.

The next most important source of support is your social network, particularly your circle of friends. Professor Mary Luszcz, of the School of Psychology and Gerontology at Flinders University, Adelaide, regards networking with friends as lending more social and mental support than your relatives can offer as your peer group shares the same level of education and intellectual interests. Therefore, communication is freer with much less sense of obligation and fewer barriers to effective interaction. Quite often, as a matter of fact, your friends could be the first ones to alert you or remind you of the need for a medical check-up for breast cancer, prostate cancer or a medical check that might unearth some nasty condition in the early stage while it is still amenable to treatment. This sort of help is often missing in close and intimate relationships due to a blind spot which clouds one’s objectivity. This is the basis of the wise advice conventionally given to doctors not to treat their own family. Ideally, you should also foster a good working relationship with your colleagues and the office staff, however temporary or mobile they might be, knowing that nearly the greater part of your life will be spent associating with them. All this social interaction, communication, and obligation-free networking is vitally essential to help you maintain your sanity, cognitive ability, youthful outlook and a broader perspective. Recreation After work you need some meaningful activity. You cannot just sink into the lounge chair watching TV all night, as many of the programmes won’t suit either your tastes or your intelligence. You will be bored before long. And what about the whole weekend when you have no visitors, when your children have gone to their friend’s place or are doing their own thing? Your holidays, too – up to four weeks long – how do you pass your time when you have not planned to go away, or are sick of going away, long drives, queuing up at the airport and being crammed into the confined seats in the economy class? What are you really going to do to spend your time? My advice is that you must start picking up something you like to do for

pleasure. It’s never too late. In fact, people should have several types of hobbies, preferably totally unrelated to their work. Such hobbies will open up your mind to a new dimension other than the limited scope of your profession. They serve to give you a new stimulus and exercise the dormant areas of your brain to give it a better perspective into the wonders of modern science, of nature, of artistic works and of countless other aspects of life. You might want to take up gardening, horticulture, pottery, painting (including oil, watercolour and china painting), reading, drawing, yoga, Tai Chi. You could try singing, playing a musical instrument, card-playing, chess, mah jong, knitting or interior decorating. Or you could join a local group devoted to any one of dozens of activities like walking, hiking or photography. Ten years ago, my wife and I started a mah jong group with three other couples. This Chinese national game requires four persons – nicknamed the ‘four legs’ – to play at the table. So four couples will form two tables nicely, in our case with the husbands playing on one table and their wives on the other. We played only once a month, rotating the venue regularly so that each couple hosted the event about three times a year. The hosting couple would set up an afternoon tea mid-way through the game and organise the dinner at the end of the day, usually at one of the Chinese restaurants as that night’s final leg. The most enjoyable part of the day, was not the game itself, not even with a lucky winning streak, nor the tempting plate of cakes and sweets someone would bring from one French bakery or another. It was all the chatting and laughing, in the most delightful atmosphere, during the tea-break and again at the dinner. Such regular interactions with your friends help cement friendships and ensure a healthier and more fulfilling life. To this end, I composed a simple little Chinese poem describing the Joy of Mah Jong. My daughter, Deborah, translated it into English and published it in Qi magazine (the official gazette of the Australian Chinese Medical Association of Victoria) of which she was the editor at the time. A call to play mah jong is eagerly received by thousands The national game has occupied families in their millions But the joy of winning with ‘three dragon tiles’ ‘The four winds’, or ‘the thirteen orphans’

Is no match to playing at your home with good friends

At the time, I composed the poem in a playful mood. But soon, word got around to a couple who were friends of mine – both dentists and great mahjong players. The husband enjoyed my poem so much that he had it painted by a Chinese calligrapher and framed for the lounge room wall. I felt rather honoured by the appreciation. To explore more hobbies and activities, drop into your municipal community centre and check out what they have to offer that suits your interests. By getting into a hobby group, or a sporting group devoted to golf, bowling, cycling, etc. you are also getting into a very useful and healthy network. You will meet interesting people, many with similar goals, and be able to chat about all sorts of topics way outside your profession. This will vastly widen your hitherto confined outlook, enrich your mind and activate your brain. This, in my opinion, is one of the best ways to stop your brain degenerating into Alzheimer’s or Parkinson’s disease. A few years ago, a visiting professor of psychology from the USA also stressed this point saying, ‘if you don’t use

it, you lose it’.

The Irrational Lifestyle Smoking Take note of this brief but powerful fact: Nothing in the world can kill more people per year than tobacco smoking – not the Great Wars, not car accidents, not heart diseases, and not even natural disasters. Frightening? Yet it is the sober, absolute truth. According to a WHO survey on World No Tobacco Day (31 may 2004) 5 million smokers die every year, or one in every 1000 adults worldwide. The number was predicted to rise sharply to 10 million deaths by 2025. What is even more distressing is the growing trend of children, aged between 12-17, picking up this habit. Just in Australia alone, nearly 270,000 in this group currently smoke, and about 70,000 young people start smoking each year (or roughly eight out of 10 new smokers are children or adolescents). The alarm bell has sounded, and we have seen the AMA’s Victorian president calling for an urgent meeting of health authorities, saying that the good effort put in by the Quit campaign over the last 20 years appeared ineffective and is not helping. Quit’s Victorian chief called for increased federal funding to fight this ominous trend and to further restrict tobacco advertising. It was recently revealed by the market research company AC Nielson that more than $3.5 billion worth of cigarettes were sold by supermarkets alone last year, an increase of 7% on the previous year. This equates to $3.5 billion literally gone up in smoke, as well as bringing poor health, chronic diseases, lung cancer and eventually death to the smoker. Is it not the greatest irony of this century – that people work hard and use the money to buy ill-health and reserve themselves a premature death? What is worse is a recent comment on passive smoking by the US Surgeon-General which revealed that after 20 years of scientific research, there was absolute proof that there was no safe level of exposure to passive smoking, and no amount of air filtration could get rid of the health hazards of passive smoking. This means that your health could be affected in some way even if you have inhaled only trace amounts

of second-hand smoke, in a room fitted with efficient filtering devices – another unwanted shock to smokers and passive smokers alike. But all these miseries come as no surprise, because cigarettes, besides being addictive due to their nicotine content, are truly a multi-potent slow poison in disguise. According to the latest guidelines from the Australian lung foundation, 8,060 new cases and 6,911 deaths of smokers were recorded just in 2003 alone. The five-year overall survival rate after a lung-cancer operation is a miserable 12 – 14%. The risk of death from smoking is so high that I never fail to emphasise its dangers to those few patients who stubbornly stick to this filthy and risky habit. ‘Do you know,’ I tell them, ‘that the cigarettes you’re smoking a packet a day of contain 4,000 chemicals and poisons?’ Then I explain to them the well-known poisons like arsenic, acetone, and carbon monoxide, which will slowly but surely damage the immune defence of the respiratory tract, starting from the lips, tongue, throat and sinuses, down to the bronchial tree. Such noxious chemicals can damage the DNA, and the cells will end up with malignant changes as the first step of heading towards a full-blown cancer. The mortality rate for lung cancer is very high – only one in every seven sufferers survives after being operated upon and receiving proper therapies; the rest usually die of severe pain, shortness of breath, pneumonia, or the unbearable suffering caused by the cancer spreading and running wild in the body. Even for that more fortunate 14% who have survived with treatment, the prospect of a reasonably comfortable life is beyond reach. Many have to rely on a carer’s help and live with a portable oxygen cylinder, day and night for years, just to get about and manage their very limited activities. What a wretched and pathetic life! The serious message to anyone and everyone is: never play around with tobacco and cigarettes. Treat them like poisonous snakes, if you like. Erase them from your memory cells as if you have never known them. By doing that, you can save tens of thousands of dollars of your hard-earned money. Money you can use to improve your home, treat yourself to good quality clothes and food, send your children to a better school or give your family a surprise treat by taking them to a resort for a memorable holiday. By not smoking or simply giving up smoking, you can breathe easier. No more

smelly cigarette odours in the house or in your clothes and hair. You will feel more energetic and be able to take up activities you may have been longing to but have been too breathless to do before. You will feel more refreshed and much healthier, both mentally and physically: ask anyone who has actually experienced the benefits of quitting. Quitting smoking Consult your family doctor to select the best option for you, to discuss how to access the most effective anti-smoking drugs like Zyban and Champix. Many of my grateful patients returned to express their joy at being ‘clean and healthy’ and for the tremendous savings they enjoyed from giving up smoking. Alternative Solutions Apart from the above medications, there are a number of alternative therapies available that may be quite effective and may suit some people better. The two most well-known ones are Hypnosis and Acupuncture – both having been around for centuries and used in many cultures. Today both are accepted methods of medical treatment for many illnesses and can be used to help people to overcome addiction to smoking and alcohol. Hypnosis During hypnosis, the practitioner guides the subject through a relaxation exercise, either by talking or by utilizing pre-recorded tapes. Once deeply relaxed, the subject becomes susceptible to suggestions such as that they will be more conscious of the harm from smoking and more motivated in their goal to quit. They may also be provided with suitable tapes to take home to reinforce what they have gone through in the first session. Success depends on many factors, including the subject’s willingness to be hypnotised and their imagination. Up to 30% of people find this therapy helpful. Acupuncture Acupuncture works in an entirely different fashion (see Chapter Six for more detail). Although it has been practised for over 2,000 years by the Chinese, the acupuncture points most effective in treating addiction were only

discovered, by chance in the 70s by my brother Stanley and fellow neurosurgeon, Dr Wen. While treating a drug addict in Hong Kong they found that by using auricular acupuncture (needling the ear point) the addict lost his craving for opiates. Since the publication of their discovery in 1973, auricular acupuncture has been utilized to treat addictions for smoking and alcohol as well, with varying success. As chief acupuncturist in my clinic in Melbourne, the success rate in helping my patients to quit ranged from between 50 to 70%, certainly well above the placebo effect of 30%. Drug Abuse Years ago we used to talk about drugs as one of the most important and commonly available therapeutic means available to treat patients, fight disease and save valuable lives. Not these days. Now we have to re-classify all drugs as either therapeutic or addictive ‘hard’ drugs. On one hand, you have the traditionally vital prescription drugs used to help lower high blood pressure, lower blood cholesterol, help prevent serious complications in diabetes, and save patients’ lives in heart attacks, and so on. On the other hand, you have ‘hard drugs’ that have absolutely nothing to do with helping people’s lives but plenty to do with destroying them. These substances, as most people know, are heroin, hashish, cocaine, amphetamines, ecstasy, ice, etc. Every now and then, some new variety is peddled on the streets, GHB being the latest, the introduction of which has been followed by a spate of over-doses and deaths. Such incidents abound – the hottest spots usually being pop concerts, night clubs and pop music festivals. These regularly cause sensation in the media and are a never-ending nightmare for society. In the fifties when I was a student, we were not aware of any serious and widespread drug addiction problems. One never heard of addicts smashing into chemist shops and medical clinics to steal drugs, drug running and cartels involved in violent struggles over control of its trade. But drugs are now looming as possibly the biggest social problem facing many countries particularly Australia and the USA. It was reported by Channel 2 in July 2017 that the number of drug addicts in the USA could be as high as 20.5 million, and about 259 million patients received opioid treatment. About 1 in 3 Americans were on addictive drugs of some sort, legal or illegal. These

include many commonly prescribed drugs like sleeping pills, anti-anxiety drugs and antidepressant drugs which are also addictive when used on a longterm basis. Due to its long coastlines which are hard to surveil adequately, Australia has been identified as a soft target by drug dealers and smugglers. Just within the last two years, Australian Federal Police and the Australian Border Patrol have busted the two biggest drug smuggling operations into Sydney ever discovered, the first and the biggest being the 1.4 tonnes of cocaine seized in Feb 2017. A second seizure of 1.28 tonnes of cocaine made in Sydney in Jan 2018 led to the dramatic arrest of a well known Australian livestock and construction figure, Rohan Arnold, in a Belgrade luxury hotel by Serbian police tipped off by the AFP. Its street value was estimated at about A$500 million! The only realistic assessment of this trend is that these will not be the last operations by international drug syndicates, and that is truly a frightening prospect. Sadly the over-whelming majority of drug addicts are young people who are normally the ones expected to work hard and contribute a great deal to building a strong and healthy nation. But by experimenting, or being under peer group pressure to chase the short-lived pleasure of a ‘high’, they quickly and irrevocably succumb to the addictive effect of those hard drugs. All too often, these young people have their careers, loved ones and their families broken up, and their youthful and promising lives totally destroyed. Gambling This is another serious social sickness that has reached epidemic proportions everywhere in the world. Despite its ills we often see it glamorised in movies and TV programmes which show glittering casinos filled with well-heeled big-time gamblers, their arms around attractive women in stunning dresses loaded with dazzling diamonds. In a casino you can quickly become dazzled by the opulent surroundings and enticed to unload all your hard- earned wages, your savings, your house, and even someone else’s money. Few people come out of a casino with their pockets filled with banknotes – sadly, it is usually the other way round. Too many become hopelessly addicted and start defrauding their employers, or committing some other crime, ending up in jail or suffering some other tragic consequences.

However, most people are sensible enough with gambling. Their strategy usually is – stop when you have won some money or, if they lose, stop when they have lost the amount put aside for that trip. They don’t go to the ATM for more money. That way the total loss per year is kept negligible; in fact they may win a fair share, depending on their luck. This strategy should be adopted and adhered to by 99.9% of gamblers, would-be gamblers, and ordinary thrill-seeking people. The other 0.1% who can afford it can exempt themselves from this rule and gamble as much as they see fit, like Kerry Packer. Packer, once the richest man in Australia, reportedly lost $25 million at a London casino. The conclusion? To gamble without a set plan is equivalent to going to war without a strategy. But, according to The Art of War (written by the renowned Chinese military strategist Sun Tze), the best strategy of all is to ‘win the war without actual fighting’, which for us could simply be translated as ‘don’t go anywhere near the casino at all!’ Alcohol Abuse I have elaborated in detail in the previous chapter on foods and beverages that wine (red in particular) has been rediscovered as beneficial to your heart and arteries. However, I have also been emphatic that you should not exceed the limit of two standard drinks per day per man, and less for woman. For people who are not endowed with a healthy and strong liver and stomach, drinking a smaller quantity per day and less frequently per week would probably be more sensible if you want to avoid over-taxing your system, yet keep it adequately nourished with anti-oxidants. Unfortunately there is a certain amount of alcohol abuse endemic in Australian society. As a result, many fall victim to such tragic events as car accidents, fatal crashes, drowning, domestic violence and disorderly and sometimes ugly behaviour at festivals, sports events and the notorious ‘schoolies celebrations’ after HSC exams. The problem does not stop there. As alcohol is an organ-depressing drug, its abuse will poison your liver. It will damage your pancreas, causing pancreatitis with unbearable tummy pains for years to come; will cause hallucinosis where the sufferer may be terrified by frightening dreams or

voices; will cause loss of your ability to think, to retain balance while moving around and, in the end, will often land you in the realm of encephalopathy (brain damage). The statistics are even more worrying. As a nation, we have now 3,700 deaths per year related to alcohol abuse, costing billions of dollars. And now, another disturbing fact has recently emerged. According to the National Drug Research Unit based at Curtin University in Canberra, 60% of 14 to 17 year olds drink, 30% of them regularly. Eighty-two per cent of this last group became drunk enough to cause themselves physical harm (it is a fact that alcohol intoxication will do more harm to teenagers under 16 as their brains are not yet fully developed). It has also been reported one teenager dies from alcohol consumption every week, and 60 are hospitalised. Obviously urgent action from all levels of organisations in the nation is required to stem the flow, just as much as in the war against drug abuse and gambling addiction. The message is clear – drink strictly to the rule of one to two glasses, and not more than once a day. Red wine is better than all other alcoholic drinks, nutrition-wise. Binge drinking is disastrous. TV Addiction Years ago people talked about ‘the box’, meaning the ubiquitous television with its large vacuum tube projecting electron beams on to the square fluorescent screen. Today, the box has inevitably been expanded and reinvented as an electronic media complex including a DVD player, karaoke machine, computer game console and more. By its own merits, the TV and its extensions have been a huge success in breaking down the communication barriers between nations. It has become a truly global media which offers entertainment, instant news, educational programmes and live sport broadcasts for practically every family in the world. So the TV is good for you and for the family. Right? Yes, but only up to a point. You see, although TV is such a wonderful invention, it has its own limitations and problems.

Once you develop the habit it is too easy to spend much more time than you can afford to in front of the TV. Especially if you have cable, there’s always something to watch; an educational documentary, an entertaining film or an addictive series of comedy or drama. You may even try to keep yourself wide awake well into the early hours of the morning to catch the end of a sporting event such as the Davis Cup or the World Cup soccer final which, as often happens, is played in a different time zone. Naturally you will feel listless, tired and have no energy the next day because you have temporarily upset your body’s biological clock for no useful purpose. You could have recorded the programme and watched it the next day after work. And don’t think that is only a one-off for that special programme. Chances are that you will do it again and again if you are a tennis fan, a soccer fan, or a keen golfer. Next time could be the American Open, followed by another French Open, and so on. You could become addicted to such a habit, finding it enjoyable to watch the tennis match in the early hours, all by yourself, with no one disturbing you. But your health will be penalised in the long term. Besides, you have already sat in front of the box for far too long to do your body any good anyway. Sitting motionless with your eyes glued to the screen, your body may be all tensed up from the tension and excitement of fast sports; you may have forgotten to blink your eyes to lubricate them; or the tension could have easily affected your digestive process to give you nausea and stomach ache. And you have also missed your regular refreshing walk, put off ringing up someone for a relaxing talk, forgotten to email your relatives and friends, and much more. Now the sceptical reader may think that I am beating up these trivial dangers of TV watching or just pouring cold water over the TV lover’s head for no good reason. Absolutely not. The next paragraph will present you with a powerful testimony to my conviction. It will also send a chill up the spine of every concerned parent. In January 2010, a new study was published in Circulation, a leading world journal on cardiovascular diseases, in which Professor David Dunstan of Melbourne’s Baker IDI Heart and Diabetes Institute revealed a startling new link between TV viewing and premature death. The research team had monitored over 8,000 Australian adults (all free from Cardiovascular Disease) and found that the risk of them dying of CVD jumped to 80% for

those watching TV for four hours or more a day. What is more, such viewers also entertained a 46% higher risk of death from all causes. The basic problem, as explained by Professor Dunstan, ‘is about the body’s position and prolonged sitting of the viewers, which lead to lack of muscle movement so essential for the metabolism of glucose and the maintenance of many regulatory processes in the body. The other worrying point is, even those people who compensate for their TV habits with more exercise still die sooner.’ Many of the same problems are relevant to internet addiction which is the subject of the next section. Internet Addiction Disorder (IAD) Internet addiction disorder (IAD), also known as ‘problematic internet use’ or ‘pathological internet use’, is defined as the overuse of the internet causing interference in daily life. Due to rapid technological advances and the widespread use of internet communication tools and devices, IAD is now a global concern, and takes many forms such as online gambling addiction, online gaming addiction, cyber-sex addiction and communication addiction disorder (compulsive chatting). These often merge together or involve other types of addiction including the obsessive use of media platforms such as Facebook, Twitter and Instagram. Australia appears to be leading the world, ahead of the US and Canada, in the number of people addicted to the internet. It is estimated that 13.4 million people aged 14 and over are spending 19 hours per week online. Just take the smartphone as an example. No one could fail to notice most teenagers talking on their mobile phones or tapping out messages on the street or the train. A 2015 report from the Psychological Society estimated that the average person checks their smartphone no less than 221 times per day. Older Australian teenagers are now spending over 6 hours a day multi-tasking with various media. Internet Addiction Disorder, although not officially recognised as a mental disorder, can have the following harmful effects: 1) approximately 2.5 times increased risk of depression 2) disruption of social life due to the time devoted to Internet use 3) chronic insomnia – indirectly affecting the immune system

4) some structural brain changes (according to two separate Taiwanese research studies in 2009 and 2011) See how much of your health and wellbeing you may sacrifice by being glued to the screen? A wealth of research has provided plenty of powerful and convincing evidence about the link between excessive TV and internet use and bad health. The message is crystal clear – reduce your screen time to live longer and healthier. Yet, it is not only the amount of time spent on the screen that is of concern. As we shall see in the following section, what you watch can also be important. Choosing the Right Content As TV has been on the market for many decades, you might be excused for thinking that all those enticing programmes in the TV guides have been officially approved, for good general entertainment. Don’t fool yourself. For one thing, the appropriate official agency would not have the man-power or the resources to thoroughly check every programme transmitted by every channel every day of the year, for the category they should belong to. For another, official perception of what is appropriate for most audiences may not be appropriate to the current social climate. For example, are those films full of violence, murder, fast cars and horror, really so harmless that they should be allowed to be broadcast even though officially limited to certain hours? In my opinion, most of the violent content should be totally banned or severely censored for viewing – even for adults – as all of it is capable of inflicting some degree of psychological damage. As you know, human brains are highly intelligent organs – not only can they think, but also they are highly receptive and can learn fast through copying and imitation. It cannot be guaranteed that some less mature and less stable brains, of any age group, after heavy bombardment from those violent films, will not be imprinted with those events. It may be possible for such less stable people to start mimicking the violent actions and directing them at persons toward whom they have harboured some untold prejudice and hatred. Such instances abound, reaching their pinnacle in those widely publicised schoolyard shootings in American high schools which have even happened in primary schools. Then there are the Hoddle Street killing in Victoria, the Port

Arthur massacre in Tasmania, the innocent killing of hostages by an unstable individual in Sydney’s Martin Place, as well as the senseless murder of a Parramatta police station’s accountant by a disturbed 15-year-old school boy among many other tragic instances. Horrific stuff. But who is to blame for introducing these ideas into those young heads? Maybe we have to wait for some enlightened sociologists and neuroscience researchers to work it out together. All these cases are instances of copycat violence, and all of the perpetrators have been subjected to exposure to unhealthy violent media. It is no different from the indoctrination (or ‘brainwashing’) of the young Red Guards during China’s Cultural Revolution and the series of violent terrorist acts carried out under the pretext of religious war by extremists (again the effects of brainwashing). It just shows how easily and dangerously the human brain can be influenced by repeated exposure to violence, murder, rape and religious and political indoctrination. My message – maintain your sanity by choosing healthy DVDs and TV programmes (including those available in other media like computer games, even iPhones and iPads with which you can download many variety of games and programs), preferably limiting your exposure to news, documentaries, travelogues and non-violent entertainment. Better still, spend less time curling up in front of that box, find something more worthwhile to do in the house or in the garden: play with your kids, take a walk, or communicate with other people via the phone or computer. Over-reliance on the Car No one in Australia would ever doubt the convenience and necessity of having your own car to go to work, to take your children to school, for bringing back those heavy groceries to your house or to take the whole family out for an excursion. Because our cities sprawl over large areas, you cannot always depend on public transport to get from one place to the other fast and on time. It is only in smaller, high-density cities such as Hong Kong and Singapore that it is easy to survive without a car. Those who do so save themselves a considerable amount of money and also do the environment a favour. Automobile advocates have often chosen to ignore problems like traffic jams, accidents, long delays, and the increasing amount of time we

spend behind the wheel in modern-day city traffic. What about our efficient electric trains, most relaxing ferry trips and all the back-up buses? These should be embraced and the personal and social benefits of their use should be promoted much more vigorously. However, it can often be physically demanding to catch a train, even with an efficient transport system. For instance, the fast, underground rail system (the ‘metro’) in Hong Kong is built in such a way that, more often than not, you have to walk up and down many flights of stairs to reach the long stretch of platforms before you can board the train, and the same again after disembarking. In other words, only fit, healthy people are able to use the underground transport system without undue effort and too many hassles. That is the Hong Kong system – designed only with fit and healthy passengers in mind. Here in Australia, fortunately, the design of our transport system is vastly different – it caters for all age groups and the disabled with the incorporation of lifts for those who find it difficult to negotiate flights of stairs, making it one of the safest, most comfortable and enjoyable transport systems in the world. This is one of the important factors which has helped Sydney win its reputation as one of the world’s most liveable cities. The only major problem of having your own car in Australia is that you could become dependent on it as the sole means of transport. As you are driving your car all the time, day-in and day-out, you might simply have forgotten that you can and, indeed, should choose to walk when you do little errands such as getting something from the corner shop or taking your children to the kinder and back. You might have forgotten how important it is to your body to move around physically as much as you can. Then you run the risk of getting overweight, building up excessive bad cholesterol in your blood, and even getting sugar diabetes and arthritis later on. Dick Hamer, the former Victorian premier, knew the benefits of frequent physical activity. He ordered that his chauffeured car be parked a fair distance from the Houses of Parliament so he could get a decent walk on his way to work. Everyone would do well to follow the example of this very sensible practice. A brisk morning walk will warm up your heart and body, and freshen up your mind before you start your day. With the same

reasoning, I generally park my car a good ten minutes’ walk from the downtown venue for a meeting or function, which is also good for my digestion afterwards when I take a stroll back to the car. Now and again a patient (usually a housewife) will come to ask for medication to help her lose weight. When I ask how long she has been putting on weight, invariably it is since she bought a car and started using it for every little errand. Some of these patients had gained an extra 10 to 15 kg before they became alarmed. In the end, they all returned to their normal size once they realized the problem and readjusted their lifestyle. The following event could have happened to anybody. In fact it happened to me some twenty-odd years ago. It was during my month-long annual leave when we had no plan to go anywhere so that my son and daughter in their senior years in the Melbourne University medical school and the PLC respectively would have some more spare time to reflect on their work for the coming year. I spent most of the time catching up with my reading, sorting out the colour photos and negatives (yes, this was way back in the old days before digital cameras), doing an occasional bit of light gardening, with the rest of my time for just eating and enjoying the fine Chinese cuisine turned out by my good wife. But one day, on climbing up the six or seven steps of our terraced rear garden, I was acutely aware of my heavy breathing, and of labouring to drag my feet up the steps. Normally I just ran up and down those steps as if on even ground. I was somewhat puzzled, but not less worried just in case it could be a warning sign of mild congestive heart failure. Meanwhile, the possibility of being overweight also came to my mind. Indeed, on hopping on the bathroom scales, I discovered, to my dismay, that I had put on a good ten pounds within just a few weeks! That was it; the alarm bell had sounded, and I was inspired to taking up regular jogging and a morning swim, which I have practised ever since. The message is simple – walk all the short distances for errands and use your car only for long distances and places that are hard to reach by public transport. In doing so, you are also contributing to the reduction of carbon in the atmosphere and a greener and more sustainable environment – a much talked about topic of global significance.

Chapter Five Common Medical Problems: How to Avoid Illness and be a Winner In my medical practice of over half a century, I have detected a distinct change in the pattern of disease in the population – the most obvious being the rapid rise of chronic conditions, clearly reflecting the ageing of the population, the increasing affluence of society and the baby boomers with their ills, their unhealthy lifestyles and all the consequences. Thirty years ago, acute infections like tonsillitis, middle-ear infection, appendicitis, heart attack, stroke, and asthma seemed to be the dominant problems to be dealt with. Now in addition to these, problems with mental health have recently become an increasingly important issue. In general, ageing introduces arthritis of the joints, osteoporosis of the spine and hip joints, high blood pressure, enlarged prostate (BPH) and cancer. Affluence gives us diabetes, overweight, obesity, high cholesterol, and cancer of the lungs, bowels and skin. Naturally, the location of a medical clinic will largely determine the type of diseases being treated there. For example, doctors in the outer suburbs tend to see more illness associated with babies, children, and young families; those in the industrial areas encounter more work-related injuries, while GPs in the older suburbs with most of the residents growing old together tend to manage patients full of chronic conditions, often in the multiples! Over the years, I have started to perceive that many acute illnesses and chronic medical conditions could be prevented – or at least they could be delayed or ameliorated – by following some rules and practices which I have gained through years of experience and research in the field. It is a sort of preventative medicine that I have been following for nearly two decades. These are not fool-proof measures with an iron-clad guarantee. It is impossible for medicine to offer that while it deals with a multitude of variable factors like genetic make-up, environmental influence, and many others, largely out of our control; but essentially my suggestions are logical, well-tried, time-honoured measures, consistent with medical science. Simply put, I like to uphold the century-old medical axiom:

Prevention is better than cure. Regular medical check-ups are essential. Although the tips and advice from my years of experience, on top of updated medical knowledge, could help you get out of lots of serious trouble, this does not mean that you can stop seeing your local GP for check-ups – far from it. This is because only regular medical check-ups will tell you why you start to feel chest pain when you rush to the bus stop, why your heart keeps pounding fast even when you are not rushing about, why you start to pass urine so often, or have to get up so many times at night to do it. A check-up can show whether you are coming up with a potential medical condition or not, and if you are, nip it in the bud before it starts to affect your health. Above all, regular check-ups will tell you how healthy your body and systems are, in comparison with, say, a few years ago. As a matter of fact, in my view, nothing is more important in maintaining health than going to see your GP regularly for check-ups to make sure all your important systems are operating happily. You take your car for regular servicing to make sure it runs well. Airlines carry out meticulous maintenance schedules according to a strictly observed servicing manual to prevent disastrous accidents. So why neglect your own body and your precious health? In the following pages I shall list those more common and well-known conditions. But before we begin it is worthwhile remembering the advice that applies to all illnesses: by getting adequate exercise, nutrition and sleep you build up your body’s resistance to every kind of disease and help stave off the premature deterioration of your body.

Colds and Flu’s These are no doubt the most prevalent illnesses we encounter in general practice. Naturally, during the winter months nearly half or more of the patients in the waiting room are coughing, sneezing, and blowing their noses. It could be a mild affliction lasting only days, but it could also become more

than a nuisance and last for weeks. The point could not have been more colourfully illustrated than by one of the clinical teachers in my student days. He declared that sailors told him that they would rather get gonorrhoea than a cold, because, ‘just three shots of penicillin will fix the clap, but a cold hangs on for weeks!’ 7 With minor colds, it is the coughing fits resulting in insomnia that usually upset the patient most. But with flu, you can be very ill and bed-ridden for a few days and it may even develop into pneumonia which can sometimes be fatal. So it is important to take these everyday illnesses seriously. This topic will be explored in greater depth later. Prevention The basic principle is to avoid catching the ‘cold’ virus in the first place and to build up your body’s immune defence. For both colds and flu’s, try the following tips: Avoid Infection Avoid talking to people who cough and spit and sneeze. Better still, get out of their way and steer clear of these rich sources of the offending virus. In fact, any considerate person with a cold should cover their breathing passages with a tissue or hanky while coughing and sneezing and put the soiled ones into a plastic bag for disposal. If this was a standard practice we would have much lower incidence of these diseases. It is just a simple measure of hygiene that should be taught from primary school to help reduce the spread of the disease and ‘sickies’ in the workplace. An excellent example illustrating how simple hygienic measures can control the spread of even a fatal viral infection can be found in the epidemic of the SARS virus in South East Asia in 2003. By getting the general public to wear masks, gloves and gowns, and practise frequent hand-washing (plus simultaneously thoroughly isolating and eliminating reservoirs of the virus) SARS was eventually brought to a standstill, but not without great financial loss to the country’s economy due to the slaughter and burning of tens of millions of chickens and birds.

Keep Warm Wear adequate clothing to keep warm. Getting chilled slows down your circulation, reducing the activity and number of white bloods cells and your resistance to infection. Make Sure Your Space is Well-Ventilated Regularly ventilate your house or your work place whenever possible to flush out the viruses brought in unknowingly by family members and visitors. I have seen numerous examples where the parents caught the virus from their sick children one after the other. The children, of course, had caught the bug from the crèche, the kinder, or the primary school. In one instance, on my home visit, all four members of the household were lying in bed, sick, in various stages of flu! It is simple logic that if you only catch a few virus particles in the air, your body’s defence system can deal with and eliminate the invaders quickly. A large dose of virus, on the other hand, may tip the balance of the scales and overwhelm your body’s defences, even though you may have encountered the virus before and have the ability to produce antibodies to fight the specific invading bugs. Get a Flu Shot An annual shot of the CSL’s flu vaccine in the autumn months between March and May is indisputably the best way to safeguard your body from the severe epidemic influenza virus. The latest directive from the New South Wales Department of Health, however, has now recommended that we should not have the flu vaccine too early in the year but be inoculated closer to the start of the flu season which peaks in July/August. By getting your shot in about May to June the strength of the vaccine will be maintained strongly enough to cover you right up to September/October. The older you are, the more necessary the flu shots are, as the older age group tend to have lower resistance to infections. A bad flu could easily land you in the hospital with viral pneumonia and all the complications in the world including serious ones such as lung abscesses and heart attack. It can even prove fatal. Generally speaking, for anyone who suffers a chronic condition like a heart problem, sugar diabetes, COPD, arthritis or cancer, it is highly recommended they go

to their GP for a flu shot. The recent ‘swine flu’ (human swine H1N1 influenza 09) pandemic underlines how seriously such dangers need to be taken. The virus originated in Mexico, early in 2009, from an infected pig which had infected a Mexican boy. It did not take long before the virus spread to the U.S. and Canada. The swine flu virus travelled so fast that in no time it had a firm grip on many other countries before the World Health Organization declared H1N1 a global Pandemic influenza – the highest level of alert, meaning literally that the disease had gone out of control, spreading throughout the entire world and could no longer be contained in any region. However, in Australia, most of the swine flu cases were relatively mild, except in some vulnerable people who had co-morbidities like asthma, CVD and immuno-compromised status. The swift response from the government in making the anti-flu medications (Tamiflu and Relenza) available and quickly developing a swine flu vaccine (Panvax) freely available to the public, has clearly done wonders in arresting the spread and stopping the devastation of human lives. This is truly a marvel of modern day medicine achieved through the combined efforts by the WHO and international communities. But then, something unthinkable happened in the 2017 flu epidemic in Australia. Everyone seemed to have been stricken with some sort of flu. Published statistics showed that a record number of 233,400 confirmed cases of flu had been reported (you can imagine that being only the tip of the iceberg). This was more than double the number of cases reported in 2016 (one of the victims being a young mother in Canberra who had been vaccinated). There were 745 deaths against the 5-year average of 176. Yet as the 2017 batch of vaccine had 4 protective flu strains instead of the normal 3 the situation seems absurd – a better type of flu vaccine that gives less protection! Now this flu – a subtype (H3N2) – seems to be finding its way to the UK, causing a great concern and earning it the nickname of the ‘Killer Aussie Flu’ which has been compared to the Hong Kong flu of 1968. After much checking and research, the Health Department could not wait to present an explanation for this anomaly near the end of 2017, which was that the H3N2 subtype has somehow mutated (changed nature) since the vaccine was formulated, and had therefore become ineffective against H3N2 strain

which has been found to be the main culprit of most of the flu cases in 2017. One must admire their detective work and lateral thinking! Another laudable initiative of the Australian government – supported by Liberal and Labour politicians alike – is the decision to provide pregnant mothers, people with chronic medical problems, and all people over 65 with a free flu shot annually, and an additional pneumococcal vaccination every five years. It has saved much misery and many deaths among the elderly, as well as preventing a great deal of debilitating sequelae from viral pneumonia. Keep the above points in mind, for you will have plenty of chance to practise them every winter.

Hypertension (High Blood Pressure or HBP in short) This is the most common chronic condition (as distinct from acute infections like colds and flu’s) most family doctors encounter in their clinics. HBP is now regarded as a hereditary risk factor and NOT a disease, meaning that you will probably have some degree of high blood pressure if one of your parents has it, and this probability will be quite high if both parents have it. About 20 to 30% of Australians suffer from HBP, but the figure could be up to 50% in people over 60, according to Garry Jennings, director of Melbourne’s Baker Heart Research Institute. The incidence is rising more rapidly in the developing countries, Jennings said, mainly due to lifestyle changes such as poor diet and lack of exercise. Recent research published in The Lancet has predicted that the number of HBP sufferers will jump 60% globally, from 972 million to 1.56 billion, almost like a pandemic disease. The trouble with HBP is that, because it is so commonplace, many people tend to become complacent and start treating it light-heartedly. You may often hear comments like, ‘Love, it is only your blood pressure playing up, what is the big deal, ha!’ Or I have people tell me, ‘Doc, I’ve had a bad day, absolutely stressed out, I think my blood pressure must have shot through the roof’. However, this seemingly minor medical condition can exert a most damaging effect on the entire cardiovascular system. Anyone who has had the chance to read the statistics from life insurance organizations on the relation of early death to an individual’s high BP will have little doubt that HBP is a major factor in heart attack, stroke, and kidney failure – a triple

king-hit with fatal consequences. A survey published in the 2012 British Medical Journal, revealed some surprising findings on patients’ points of view. Patients considered stress its main cause, and few knew HBP could damage their kidneys. Furthermore, a lack of symptoms often prompted them to cease medication, partly due to the fear that long-term medication might affect their health. Alternative medicines were widely used and often deemed ‘more effective’. People over 30 should have their BP checked by their GP. If HBP is in your family you should have it checked even earlier. Fortunately, quite a number of new drugs that have proved to be very effective in lowering HBP have been made available on the market. In some patients, up to three or four types of medication are required to block the different types of chemicals in the body that cause HBP. So don’t be surprised if your GP keeps adding different tablets to help lower your BP to the acceptable level of 130/85 (a 2016 Heart Foundation guideline has upgraded it to 140/90 as high normal). I am not concerned here about how to treat HBP, as your fully trained GP is well equipped to deal with that aspect. What I am more concerned about is how to help you control your BP better and stay near normal: Preventing/modifying your HBP Exercise Regular moderate exercise has been found to be one of the most effective, non-drug treatments to lower HBP, according to the Baker Heart Research Institute. This is completely in line with my own findings that years of regular, moderate exercise will keep your weight down, keep your heart in top shape and your body’s internal chemistry under better control, all of which will contribute to preventing HBP. This is in complete agreement with cardiologist Dr Dean Ornish (see the entry on Ornish under ‘Diet’), Professor J Kahn, a preventive cardiologist, and many other experts mentioned in this book. Regular Meditation This has been widely practised in the East since antiquity, particularly as part

of the spiritual discipline of a number of religions. You don’t need any special technique. Just put aside a half hour to an hour most days, pick a quiet corner, sit down and focus on a certain word, thought, or sensation, and put everything else to the back of your mind. For the religious person, the simplest and the most popular focus is prayer. Research has shown that any form of meditation, if practised regularly, can benefit many body functions including heart rate and blood pressure. The profound relaxation derived from a short daily meditation can help your body cleanse itself of the harmful chemicals it releases when stressed. These chemicals send your BP up and it might eventually stay high if the stress is sustained for a long time. Case Study A patient consulted me about the prolonged headaches she suffered, mostly during her rostered day-on. Her BP proved to be quite high even on a second visit. All tests failed to find the cause of her HBP. Accordingly, medication was prescribed but proved to be ineffective and higher doses were tried. She often hinted that her work was too much for her. I did not give much thought to stress-related illnesses in those days, and I was not aware of Eastern methods of relaxation which were still not well known in Australia at that time. Then, one day, on a regular three-monthly check (she never wanted to check her BP more frequently than quarterly because she was ‘too busy’), I was amazed to see her BP had dropped well within normal. Her BP mysteriously remained normal even after her medication had been reduced slowly from three types to one. On questioning, her face brightened up with a happy smile, for the first time ever since her attendance at our clinic. She told me that she had stopped working for quite a while! Ever since then, for the last ten years, she has been able to take only one kind of tablet to control her BP and she appears relaxed at every visit. Quite amazing that stress and tension could affect some people to such an extent! Practise Tai Chi/Qi Gong These could be said to be forms of moving meditation. Both are traditional health exercise methods originated in China. By performing Tai Chi, you will

reap the benefit from meditation as well as from being physically fitter. This will be discussed in more depth in Chapter 6. Sensible Diet A balanced eating plan will help you control your weight. In particular, reduce your salt intake as repeatedly advised by leading heart specialists all over the world. When you buy canned or processed food, make sure you check the ingredients to make sure that content of the salt (or sodium chloride) is not higher than 120 mg per 100 gm. At a recent medical conference, we were shocked to discover a tomato juice (packed as a fruit drink), in which the salt content was many times higher than most tomato sauces on the market! It is clearly a wise policy to check out the products in your shopping trolley carefully. Interestingly, recent research done at the Queen Mary University of London has discovered that people who consume nitrate-rich food – greens like lettuce, kale, spinach and celery etc. – experience a drop of 10mm of their BP within a few hours, the effect lasting all day. Maintain a Healthy Weight Obesity has now been recognized as one of the biggest contributors to many health hazards such as HBP, CVD, type 2 diabetes, stroke ... just to name a few. You should always check your weight weekly and maintain your BMI under 25 if possible. Maintaining a healthy weight is the bottom line of a good, healthy life. Stop Smoking Since smoking can cause a whole spectrum of damage including raising your BP, you will have a good excuse next time to dodge any pressure from your peer group to share a puff. Get rid of all your cigarettes and be a clean person.

Heart diseases (CVD) and Hypercholesterolemia To the average person, CVD generally means heart attack, and

hypercholesterolemia means too much cholesterol (the fat in the blood). But actually they mean much more than that. Medically speaking, CVD represents a whole spectrum of conditions affecting all different parts of the heart including its muscles, arteries (the coronaries), valves, the electrical system, etc., plus all other arteries in your body. Coronary heart disease (CHD) is the main health problem confronting society at present. So on Father’s Day on 3/9/2017, the National Health Foundation seized this opportunity to televise nationally, calling all Australians to see their family GP to have their heart checked on Father’s Day, emphasizing that this is the best way to prevent a cardiac arrest (heart attack) which kills 10,000 Australian a year. Hypercholesterolemia, (or more correctly hyperlipidemia), means any excess of the fatty substance (lipids) in your blood – but cholesterols (LDL – the bad cholesterol, and HDL – the good cholesterol) are the main components affecting your body as well as the best known to the general public. High levels of bad cholesterol cause a build-up of plaques in the arteries. When these soft, blister-like growths burst in the coronary arteries, you have the classic heart attack happening. Worse still, such plaques often give no sign of their presence and can only be detected by a coronary angiogram (an imaging procedure that shows the condition of the coronary arteries in the heart), a CTCA (a CT coronary angiogram), or a Calcium Score. The latter two are non-invasive (unlike a standard coronary angiogram), with the CTCA being a CT scan of the heart minus the injection of a dye via a cannula close to the coronary arteries. On the other hand, the HDL has been known for over 20 years to be beneficial to your heart and arteries. It was not fully understood why this is so until recent research discovered that the HDL activates an enzyme in the arterial wall linings to protect the artery from being clogged by LDL buildup. How many Australians are found to have excess cholesterol? The figure is 50% of men, as estimated by surveys from 1980-2000, according to Professor A Tonkins of the National Heart Foundation, and about 40 to 48% according to a Monash university survey on people aged 25 to 60. And yet according to the American Heart Association’s yearly statistics (2013) only 13% of Americans have cholesterol over the mark, even though 34% are obese and

another 34% suffer from metabolic syndrome. Maybe more Americans have heeded the warnings after Bill Clinton’s heart attack and kept up their statins (lipid lowering medications). According to an editorial in the February 2003 issue of MJA, CVD remains the leading cause of death in Australia (up to 40%). Expenditure on CVD drugs under the Pharmaceutical Benefits Scheme totals $1.2 billion annually, or 12% of the total bill. These figures are only a conservative estimate, and will surely go up every year. The Productivity Commission Report in 2004 estimated that by 2040, the total drug bill will cost $50 billion, of which CVD drugs alone will cost a chunky $6 billion! The total cost of CVD to Australia has been estimated to be about $14 billion per year! Quite unbelievable. So how best to prevent so much costly heart disease so that our nation’s fiscal state can remain under control and healthy along with our hearts? I suggest you read the following and start practising the principal points from today, until the day when you can’t any longer – in other words make it a lifelong habit if you want a long life. This advice is valid for everyone, no matter their age. Prevention/amelioration of CVD Switch to Healthy Foods Drastically reduce your proteins from animal sources (except rabbit and kangaroo) to avoid the build-up of bad cholesterol. Increase your intake of seafood, particularly fish. Even five years ago, the Australian Heart Foundation had already advised the general public to eat two fish meals a week, preferably ‘fatty fish’ such as the Atlantic salmon, herring, cod, barramundi and sword fish, because ‘fatty fish’ are rich in omega-3 oil. David Colquhoun, a cardiologist and professor of medicine at Queensland University, has written an article advocating people eat more fish. According to a recent meta-analysis of 200,000 people over 11 years (certainly a huge survey with a reliable analysis) people who eat fish three times a week were found to have 25% lower risk of heart attack, while those who eat fish five times a week do even better with a reduction of 40% lower risk of heart attack as well as 30% less chance of stroke! This large- scale survey has

absolutely swept away every single doubt about the benefit of fish in protecting your heart. Supplement your diet with fish-oil capsules (specifically EPA and DPA, the two polyunsaturated fatty acids). The American Heart Association recently recommended that anyone who suffers a heart attack should be put on 1,000 mg of EPA-DPA a day. But to lower your cholesterol, you may have to take between three to six capsules a day (one capsule usually contains 1,000 mg). Some brands of fish oil are more powerful – up to 3 or 4 times more concentrated – others are from deep-sea sardines/salmon which is supposed to be more pure and free of mercury and other contaminants, still others are harvested from the krill supposedly found only in the pristine deeps of the South polar sea. So it may be worth your while to shop around for a good quality brand. Nowadays, Omega-3 fish capsules are a commonplace commodity available everywhere. Have more vegies and fruit in your daily meals – the benefits to your heart and arteries are many, as explained in Chapter Two. Eat a handful of nuts a day a few times a week, or more if they are a favourite. The Nurse’s Health Study on 86,000 subjects and the Adventists Health Study on 26,000 people, found nuts to be beneficial to the heart and to aid in losing weight due to their rich source of plant proteins and PUFA. Have a standard-sized glass or two of red wine with your dinner, a few times a week, to reduce the risk of CVD. Take up Jogging or Swimming The benefits of moderate exercise such as jogging and swimming, in helping your heart to become stronger, fitter, and healthier, are confirmed by every recent heart survey carried out in the world: a) Way back in 1984, H.B. Simon produced some documentation on his research proving that the exercising muscles helped increase production of HDL. This was further confirmed recently in 2003 by the research team from Melbourne’s Baker Heart Research Institute that the exercising muscles release lots of HDL which plays a paramount role in ‘mopping up’ the bad cholesterols from the coronary arteries.

b) Some years ago, a German research team compared two groups of patients after angioplasty – one group being put through daily exercise whereas the other remaining sedentary. After only one month’s trial, they found the exercising group had much better blood flow into the heart muscles, doubling that of the sedentary ones. The team analysed the results and discovered that this was due to improved function of the coronary arteries due to the effect of nitric oxide (a powerful dilator of arteries). c) A new study on 2,000 men in Wales, recently published by the British Heart Foundation, found that vigorous activity (climbing stairs, swimming and jogging) conferred maximum protection to the heart and promoted physical fitness, while moderate exercise (golf, digging and dancing) was still beneficial. But the least active group or those doing only light exercise (walking and bowling) had the highest instance of premature death. Furthermore, two recent important findings (both in 2005) have proved beyond doubt that good exercise will not only make your body stronger and healthier, but will also greatly improve your heart function. It is your heart that keeps you alive by supplying energy to every part of your body. A stronger heart gives you a longer life: d) Professor D Goldspink of Liverpool’s John Moores University, in his study on the effects of ageing on cardio-pulmonary function, has found one of the reasons why women generally outlive men (life expectancy being 82 as opposed to 77) is because the male heart has lost about 25% of the ‘contractile cells’ in the heart when reaching their 70s while the female heart lost none. How amazing! It can be interpreted that the male heart has become weaker, per se, on reaching the 70s, because the ‘contractile cells’ are the core muscle cells of your heart. However, the good news is, according to the professor, that men can improve their heart function by regular exercise – aerobic of course. e) A recent report by the Royal Melbourne Hospital-operated HARP programme dealing with heart failure and COPD (chronic obstructive pulmonary disease) has discovered that getting chronic heart failure sufferers to exercise has led to a marked improvement of their symptoms and functions. f) The latest guidelines compiled by the National Heart Foundation

(published in the Medical Journal of Australia, Jan 2006) as a new evidencebased endorsement, has overturned previous advice by recommending all people with stable heart diseases to adopt an exercise programme. The official guidelines advised that they should not be discouraged from being physically active and should aim for activities similar to those of the general public, that is – half an hour of moderate activity a day to reduce their symptoms. This will also contribute to reducing the deathrate by up to 25%. Such a recommendation, coming from the peak heart health body, based on current evidence, should be something to seriously consider and embrace with open arms. There are many other fringe benefits to gain from regular exercise – the wellknown ones being a slower heart rate that cuts down your heart’s workload, an increased BMR giving you improved circulation and immune response. Additionally, the increased production of endorphins and enkephalin will give you a lift in spirits and more inner calm, etc. The over-all picture is, of course, that the more intensive the exercise you can perform without problems, the better protection to your heart. Naturally, it never hurts to have a general fitness check before you undertake any exercise of more than moderate intensity. Watch Your Waistline As most people are now aware, there is an epidemic of obesity in the developed nations. As pointed out by both Professor Garry Jennings and Professor A Tonkin, if your excess weight is mainly focused around your tummy, you run a much higher risk of CVD than if it is distributed around your hips and thighs. Few people doubt the direct relationship between excess abdominal fat and indiscriminate eating habits, notably indulging in unhealthy junk food. Bill Clinton, the former U.S. president, had this to say after his quadruple coronary artery bypass surgery in September 2004: ‘The brush with death I have had may be the biggest impact of all’. One of the main troubles, he said, was that nowadays the American family spent almost 50c of their food dollar on eating out, mainly on fast-food, while 30 years ago they tended to spend 70c of their food dollar on food they prepared at home. What a striking contrast in lifestyle within just three decades! This said, Bill Clinton himself

has since reportedly followed a very healthy diet of plant-based, low-fat, vegan food. The latest survey (Time, 26th Nov 2007) on Americans’ eating habits has found that Americans spent more in restaurants ($390 billions) than in grocery stores ($364 billions), further confirming their unhealthy eating habits. Cease Smoking Many years ago, I had come across a series of unusual photos, published in a reputable medical journal (NEJM) demonstrating how a smoker’s coronary artery went into spasm as soon as he smoked, resulting in an attack of angina (chest pain due to insufficient blood supply to the heart). If your coronary arteries are unhealthy and already choked up by cholesterol plaque, a frightening heart attack could easily be the next shock waiting to happen. Manage Your Stress In this modern world, I doubt that anyone can escape from the many different sources of stress. Stress can easily make you feel tired and yet unable to sleep, as pointed out by Moses Wong, a well-known psychiatrist/hypnotist in Melbourne, in his latest book Tired of Being Tired? where he succinctly explored and analysed the pathology of insomnia as relevant to our daily stress. Nevertheless, whether stress per se can bring on a heart attack or not is still debatable. Perhaps it is all the conditions associated with stress that could damage your heart in the long run, especially if your heart is already in a bit of trouble. For example, George Bush Snr, U.S. president in the 90s, felt unusually tired and short of breath one morning after a 40-minute jog at Camp David. He was flown immediately to hospital and diagnosed as suffering from atrial fibrillation (AF in short), a common form of irregular heartbeat. The cause? Quite likely the tremendous workload and pressure and the associated fatigue from the stresses surrounding the first Gulf War and the Kurdish calamity. How to manage? I can’t say it is easy. But the best way is, again, for you to make every attempt to build up your inner calm regularly by the daily

practice of meditation, Tai Chi, Yoga, or other relaxation techniques relying mainly on deep, long, nourishing breathing which increase powerful positive emotions such as pleasure and deep relaxation. The relevant aspect of such a practice is to tune up your body and mind over a long period of time. With inner calm they are much better able to withstand the stressful challenges that are part and parcel of our life.

Cancers in General In our modern society of high technology and advanced medical science, it still comes as a nasty shock to anyone that cancer is one of the biggest causes of death in humans, about 12%, second only to cardiovascular disease which accounts for 30 to 40% of deaths. Just the very mention of the word can send a chill up anyone’s spine, and produce an untold sadness of the heart, particularly if you have witnessed the pain and suffering of someone close to you stricken by the disease. Prevention While acknowledging that cancer can come from many sources, including things like genetic factors which we cannot yet change, I am going to discuss some measures you and I can take, to stave off most cancerous conditions, bearing in mind certain facts Professor David Whiteman identified in Dec 2017: there are eight factors that greatly enhance the risk of getting cancers – smoking, excessive alcohol consumption, being overweight, poor dietary habits, inadequate physical exercise, unhealthy UV light exposure, infection (e.g. hepatitis B and C) and some menopausal hormonal therapy. Alcohol is now known to be a potent cause of breast cancer, and being overweight/obese as greatly increasing the chance of contracting cancer of the liver and oesophagus. Regular Exercise This phrase has been one of our recurrent themes and will continue to pop up everywhere in this book. It may sound incredible to sceptics, but my personal observation, backed up by past medical experience and current scientific

studies, tells me that regular moderate exercise could be one of the best safeguards against the development of most types of cancers. The medical evidence has been available and a matter of discussion in the scientific world for decades, ever since Sir MacFarlane Burnet, the world renowned director of Walter & Eliza Hall, a research institute based in Melbourne, announced his hypothesis that the protective white cells in our blood constantly carry out surveillance and eliminate harmful bodies. These include not only invaders like bacteria and viruses, but also budding cancer cells in our own tissue when they disobey the normal regulatory control of the body. Recently there has been research evidence which indicates that oxidative radicals or free oxygen radicals can damage your body tissues and cells including the gene cells, possibly producing budding cancer cells. We will return to this subject later in regard to anti-oxidants. Simply put, the analogy is that your body’s immuno-defensive system behaves like a well-organized army composed of various substances including white cells, antibodies, ‘killer cells’ and interferon (a substance created from virus-infected cells). Their ability to fight and annihilate the enemy is largely determined by your state of health and fitness. Let me put it this way: your immune system is sluggish, weakened and over-run by germs and cancer cells if you are tired, depressed, run down, plain drunk, or hooked on drugs; in contrast, it is vibrant, powerful and capable of mopping up any would-be cancer cells in no time if you maintain good health and physical fitness. In other words, in theory, lifestyle changes can switch your genes on and off to promote good health or ill-health even though you need hundreds of different genes interacting with each other in order to do so. In future, you will probably hear more from geneticists and cellular biologists about this fascinating research into these cellular and sub-cellular interactions. The above phenomenon is well demonstrated in one of the cases I was involved in at the Ottawa General Hospital in Canada, many years ago, when I was participating in research with the pathology department headed by Professor Magner who was also head of the Canadian Tumour Registry: Case Study

A young woman was discovered to have spreading ovarian cancer. Miraculously, she survived 13 years before she died of kidney failure from blocked ureters (connecting tubes from the kidneys to the bladder). At autopsy, we found that the cancer growth in the ovaries and every cancer colony in her body were either completely enclosed by tough tissue sealing off their escape routes or showing signs of dying. In addition, we had uncovered evidence of a powerful host immune response in the form of sarcoid-like granulomas (fleshy collections of immune cells) throughout her body. This finding suggested that the young woman had put up a strong fight in response to the spread of ovarian cancer cells and gained the upper hand in the complete control of the cancer. Interestingly and to my great joy, while I was working on this book an article appeared in an issue of the Journal of the American Medical Association, confirming the benefit of exercise in the fight against cancer. In their study, the researchers and scientists analysed data on 3,000 women with breast cancer. They found that those who walked at a moderate pace for three to five hours a week had their risk of death reduced by up to 50% as against those who were inactive. How exciting! This wonderful news was immediately taken up by Dr Carolyn Kaelin of Boston’s Brigham and Women’s Hospital. She said that they now ‘recognize and embrace exercise as a component of treating women with breast cancer.’ Early in 2018 on 19th January, the journal Science outlined an exciting new cancer test named CancerSeek, developed by an international team led by Johns Hopkins University in the US. This test can detect eight of the most common cancers long before they become harmful, and is surprisingly sensitive and accurate for the following cancers: bowel, breast, lung, pancreas, liver, stomach, ovary and oesophagus. The price tag is likely to be US$500. It would be commercially available within a year or so even though it is awaiting a much larger scale testing which may take years. This seems to me to be ground-breaking news and might easily be one of the most exciting events of this century for the medical world. A popular Chinese saying is that good news does not come twice. However, the current ‘Year of the Dog’ seems to fly in the face of this conventional wisdom, because just a month ago ABC TV broadcasted an exciting report that Professor J McGhee of the University of New South Wales had been able to visualize cancers

from a 3D scan, by wearing 3D goggles and utilizing VR technology that had been developed for use in gaming. This is the kind of high-tech application that we can look forward to more of in this high-tech age! Eat Healthily Damaged DNA could turn into a cancer cell and start a chain of events. Evidence from the Packer Lab of the University of California suggests that antioxidants are highly effective against disruption and damage to DNA by free radicals. Healthy nutrition from a sensible and balanced diet with plenty of antioxidants keeps your immuno-defensive system happy and strong and can nip cancer in the bud. Poor nutrition from junk food and fad food will only weaken your system and feed the enemy. It has been estimated that up to 30% of cancer cases are due to poor nutrition. Maintain Your Mental Health A healthy lifestyle and a happy outlook will help enhance the vigour of the immune system and brighten up its spirit, while mental depression is known to depress your immune system.

Asthma Asthma is basically a reversible airways obstructive condition due to bronchial muscle spasm. It involves swelling and inflammation of the lining mucosal tissue and excessive mucus production clogging up the airways. Asthmatics present with a wheezing cough, shortness of breath and tightness in the chest, and find it hard to breathe during an attack. Children are the most common sufferers as their airways are narrower, and they are not yet at a stage where they can meet the challenge from a whole spectrum of particles in the air. The worst offenders are grass pollens and the powerful allergens associated with carpet mites that can breed in floor coverings, and even in bed sheets. There are many other triggering factors such as exercise, emotion, cold air, infection and certain well-known drugs like aspirin, NSAIDS and Bblockers. There were 378 deaths from asthma in Australia in 2011, a similar amount proportionally to those in the USA and UK, which is reportedly somewhat

higher than the instance in most European countries. The majority of the deaths have been found to be due to the following reasons: Faulty inhaler technique, meaning the medication has not reached where it should in sufficient amounts. Usually a spacer or nebuliser is highly recommended. Not taking enough oral or inhaled corticosteroids as prescribed, due to ignorance or fear of side effects from corticosteroids. Neglecting their Asthma Action Plan as set down by their GPs which should be adhered to religiously and reviewed yearly. How to Prevent Asthma Stop Smoking Smoking should be the last bad habit for an asthmatic to pick up. Just the smoke inhaled could cause spasms in the bronchial tree, in addition to the chronic inflammatory effect. Eventually smoking destroys the normal linings and gives you more respiratory problems. Avoid Allergens Replace lawn with ground cover or mondo grass, or the type of grass producing the least allergens (check with your friendly local nurseryman). Better still, use natural paving material such as timber decking, brick paths, slate tiles etc. for the most part of your garden. Avoid allergen-producing shrubs, bushes, and trees. There are plenty of flowering shrubs you can plant to brighten up your garden which won’t cause you any trouble. Avoid using carpet and all dust-retaining materials for floor coverings. Replace them with floor tiles and timber, so that you only need mop the floor instead of vacuuming and blowing out minute allergens from the machine. You can never be sure if your vacuum cleaner is designed to filter 100% of the floor dust. The top brand on the market capable of doing a good job is understandably quite expensive. The alternative may be the installation of a central vacuuming system – the beauty of which is that the dust and allergens will be sucked up into the receiving bag outside your house instead of going through the vacuum cleaner you are holding. Wear an efficient mask to perform any dusty jobs to minimize fine particles

and allergens getting into your lungs. During days with hot gusty winds which often bring in heavy amounts of grass pollens from inland grasslands, try not to venture out if possible. Have a rest at home, close all the windows and doors to reduce the amount of pollens entering into your house. Good air conditioners often have very effective filters to remove most of the dust and pollens and should be safe to operate if the weather is uncomfortably warm. Keep away from all kind of fumes (especially those from organic solvents such as insect sprays) as the chemicals in them could irritate your airways or even bring on an asthma attack. You can become allergic to the spray as well. Case Study A middle-aged man has regularly come to see me for the last 7 or 8 years to be supplied with corticosteroid ointment for his outbreaks of moderately severe itchy eczema which often covers his whole body and upsets his daily life and sleep until he applies several tubes of the ointment. Naturally he was also allergic to many other things in the environment such as pollens, carpet dust, chemical sprays etc. etc. One day he walked into the clinic just after the staff had sprayed an air-freshener along the corridor and lightly into my room. Immediately this man rushed out of my room and out of the clinic, visibly upset and fighting for his breath. Fortunately, he recovered, but we also learned our lesson and have kept a watch on the air quality in the clinic ever since. The clinic manager and I now have to watch our staff like hawks to ensure the use of any chemical spray is kept to a minimum. Once the same patient also told me that he had recently bought a new metal cook pot to replace an old one but he had had to throw it away due to the distress he had experienced from the metallic smell it emitted upon being put on the stove for the first time. However, he was philosophical about all his medical misery and picked up his courage to do post-graduate studies at Sydney University in which he experienced some success. Exercise Sensibly Some individuals should avoid strenuous exercise, particularly on a cold chilly day, or when they have a cold, to reduce the onset of ‘exercise-

induced asthma’. Swimming is the best form of exercise for asthmatics because of the relaxing and rhythmic movements of the limbs, and the build-up of intra- bronchial pressure to keep the bronchial tree open. Besides, the warm moist air above the pool water is soothing for the air passages. More Tips * Avoid catching colds and flu, because they can serve as a powerful trigger for your asthma. * Consult your GP regarding any sort of infections to avoid bringing on an asthma attack. * Build up your antioxidant store – the significantly beneficial effects of antioxidants such as lycopene (plentiful in tomatoes) and carotene (in carrots) have just been discovered. With great interest, I have noticed for some time that a number of my asthmatic patients have moved up north to Queensland to ease their asthma. They do get better up there, but their asthma flares up as soon as they return to Melbourne! A number of reasons could be responsible for this. First of all, houses in Queensland, in general, use much less carpet but more floor tiles and timber to keep them cooler. Secondly, I have the impression from talking with one of the leading Brisbane real estate agents, that Queenslanders love to fill their gardens with lush green tropical plants and trees, doing away with the prolific pollen-producing plants like wattles which abound in Melbourne. Thirdly, the very different design and construction of houses in Queensland facilitates extremely effective ventilation under them which helps avoid the build-up of damp, mildew and mould whose spores could induce asthma attacks. Lastly, there is no denying that we have more winter ills like colds and flu’s in the southern states which could easily trigger off asthma attacks, while Queenslanders in general are bathed in warm sunshine and moist cleaner air.

Chronic Obstructive Pulmonary Disease (COPD) This is a disease of adults over 45 typically presenting with persistent

obstruction of the airways associated with varying proportions of chronic bronchitis, asthma, and emphysema. Oddly enough, while mortality from heart disease is slowing down, that from COPD has increased by 165% from 1965 to 1998, and has now become, after heart attack and stroke, the fourth most common cause of death. In Australia, the number of COPD cases in people over 55 was 310,700 in 2012 and accounted for 4% of all deaths, according to the latest statistics, from AIHW. According to David Smallwood, director of the COPD and HARP programme at the Royal Melbourne Hospital, it costs the nation $1 billion to manage this disability. Prevention / Amelioration Stop Smoking Smoking is the leading cause of COPD. It has been estimated that up to 90% is caused by cigarette smoking. Tragically, up to 85% of smokers refuse to quit, often waiting until they have lung cancer, throat cancer, or a heart attack. This is clearly largely due to the nicotine addiction and partly to the culture and the prevalent attitude of society. The investment in encouraging smokers to quit has already borne much fruit, as proven by the figures published by the Australian Chronic Disease Alliance. These show that the efforts to reduce tobacco consumption over the past 30 years (at a cost of $176 million) has saved the community at least $500 million and created benefits worth $8.4 billion. The consequences are also fast catching up with women who started smoking some twenty years ago. It has been found that the instance of cases is increasing at a rate that may soon overtake breast cancer as the number one killer of females. Since a spate of law suits against tobacco companies around the world and the enormous publicity this has generated, many governments are now willing to impose a ban on smoking. This follows a long campaign by ASH (Action on Smoking and Health), the AMA and other organisations that have fought hard to see smoking banned. Most states in Australia enforced a ‘stubout’ day from July 2007. This move was encouraging, and should show a favourable outcome in years to come.

In 2011, the federal government was to introduce plain-package measures and to increase the tax on cigarettes to make them less attractive to smokers. This is in line with a worldwide trend. The WHO reported in July 8 2011 that more than half of the world’s population in 19 countries has at least some sort of anti-smoking measures. These range from vividly repellent graphic images on the packet to compulsory free-airtime anti-smoking programming. For its part, the tobacco industry is fighting back with a multimillion-dollar campaign against governments everywhere. Let us hope that people power will eventually prevail.8 Regular Exercise You may wonder what on earth exercise has got to do with helping these sufferers, who are often pictured leaning on something blowing, puffing and gasping for breath. Yet this is the very point – because all of them have one thing in common, that is, they all rely heavily on their respiratory muscles, the chief one being the diaphragm, which need to be in good shape to overcome the blocked airways and get enough oxygen. So current corrective therapy is aimed at strengthening the respiratory muscles in the early stages while also working on other muscle groups with regular, appropriate exercise. The programme can be initiated by your doctor or physiotherapist (there is a Pulmonary Rehab Programme available online at http/lungfoundation.com.au/patient-support/pulmonary-rehab-programs-2/) As soon as your body becomes stronger, you will find that performing any chore will require less effort and cause less shortness of breath. Most low intensity activities such as strolling, Tai Chi, relaxed swimming and supervised gym work can be a good start. Eat More Vegies and Colourful Fruits Because cigarettes are full of toxins and harmful free radicals, eating plenty of highly coloured vegies and fruits will ensure that you take in a rich supply of anti-oxidants to help counteract and neutralise the damage. Avoid High Altitudes, Dust and Polluted Environments Avoid living at a high altitude because the air will be thinner the higher you go above sea level, which means you will breathe in less oxygen and feel more breathless. Living in the country, however, may provide you some

relief because of the better air quality. Keep out of dusty, fume- filled premises and main roads with heavy traffic to minimize inhalation of more pollutants. One often sees on TV some heavily polluted industrial cities in China, India and Indonesia where the sky is blanketed in greyish black smoke and wonders how many residents there are in danger of turning into COPD cases. It is recommended that you use your handkerchief, a dust-mask or any paper mask, even in the Sydney CBD, particularly during peak hour traffic, to filter out all unwanted dust in such unfavourable conditions.

Osteoarthritis Osteoarthritis (OA for short) is the most prevalent chronic joint disorder in developed countries. Just in Australia alone, over four million suffer from it, which is about one in five people between 45 to 65 (the baby boomers). Over the age of 65, nearly 75% have OA, with twice as many women being affected as men. It is projected that by 2040, up to 25% of the total population will suffer from OA. The cost to the nation, just in 2000, was already a hefty $9 billion. The future cost of treatments to the nation will be staggering, to say the least. As is commonly known, over the past few decades the total replacement of hip and knee joints has been the main procedure for addressing these ailments. Such operations are performed by surgeons using a console near the patient to control dexterous robotic arms which they can view in a magnified 3D field enabling the removal of tumours or cancers from hard-to-reach areas with great precision. These procedures have become common but are relatively expensive. However, as robots are becoming more sophisticated and more popular, surcharge fees are being reduced or even waived by some hospitals – a move which must be welcome to patients. OA is simply an inflammation of the joint – we might say a kind of ‘wear and tear’ as a blanket description – leading to swelling, stiffness, pain and destruction of the cushioning cartilage. OA is now looked upon, NOT as a disease NOR as a degenerative condition, but as a slow and effective repair process happening in the structurally altered joint with no pain – an ‘overuse, flare and repair model’.

For some, due to overwhelming insult, the repair becomes inadequate, leading to tissue and functional damage and ‘joint failure’. The risk factors are related to genetic disorders, obesity, injury and occupational hazards. Therefore, OA sufferers will find it difficult to walk if the hip or the knee joints are affected. Even a mild to moderate degree of OA can cause fairly annoying pain, anxiety and irritability. Such mobility problems lead to a vicious circle where the pain becomes a disincentive for the sufferer to exercise, and the lack of exercise makes the joints stiffer and more painful when movement is necessary. OA treatment requires some sort of painkillers and anti-inflammatory medications (NSAID) to relieve the symptoms and make it possible to get around. Unfortunately, all NSAIDs carry some unwanted side effects, such as stomach upset, possibly leading to haemorrhage from gastric ulcers. Most of the NSAIDs have the potential to irritate and damage your kidneys by interacting with certain medications needed for HBP and heart problems. Therefore, the ideal strategy, as always, is to avoid OA in the first place. Prevention /Amelioration Exercise Start your exercise programme well before OA has got you. Moderate exercise gives you a healthy flow of warm blood and lubricating fluid to all your joints housing the resilient cartilage inside, and their surrounding tissues on the outside. By stimulating the joints and helping to make them basically stronger, the onset of OA will be delayed and the damage and suffering when OA sets in later on will be minimized. The increased fitness of the muscles around your joints will better balance your body and lessen the likelihood of falling (falls resulting in nasty injuries are pretty common with OA sufferers due to sudden sharp pains causing the leg to give way). Which exercise is the best? Swimming and water-aerobics should be your first choice. Moving and stroking in the warm, buoyant water is the most relaxing way to train your joints and muscles to become healthy. As part of a holistic approach, exercise is now incorporated into most

management plans advocated by medical institutions such as RACGP and NICE. This approach takes into consideration the patient’s lifestyle, occupation, mood, leisure activities, training in self-management, exercise and physical activities, as well as any physiotherapy they may be undertaking. Reduce Your Weight It is just common sense that a lighter body will impose less burden and pressure onto your weight-bearing hip, knee, and ankle joints and will reduce the wear and tear on them. Eat Healthily Do not neglect your balanced diet plan with sufficient proteins from fish and plants, generous helping of green vegies and a variety of fruit. For who knows which vegetables, fruit or meat contain the essential nutrients to help your cartilage inside the joints remain strong and healthy? Nutritional science is still not fully fledged, and has a fair way to go to answer many of these questions. Learn and practise the Eastern way of therapy if you are affected by OA in its early stages. It has been proven that meditation, various relaxation techniques, Tai Chi, Yoga, etc. are the best drug-free way to relieve pain, anxiety and the stiffness in your joints. Naturally, the practice of these gentle exercises early on could help maintain your joints and muscles to delay and even arrest the onset of OA. Check with your local council or Chinese organisation about such classes. Omega 3 and Glucosamine Glucosamine has not been on the market for long in Australia although it has been used in Europe for a decade. It is an extract taken from the shells of crabs, lobsters and prawns. There are promising indications that when it is taken in capsule form, in combination with Omega-3 fish-oil capsules, it helps to keep joints healthier and provide relief for sufferers. A double- blind study in Europe has found that its effect on osteoarthritis is as good as NSAIDs but without the latter's side effects. A number of rheumatologists have recently recommended them as safe and worth taking as it has no known

serious side effects, thus far. You may not see any improvement for up to a few months but many who have persisted in taking them claim good benefits in the long run. It is often sold on the market in combination with chondroitin, another natural supplement believed to nourish cartilage. Mineral Waters One other avenue of relief open to most OA sufferers is mineral spring water like that at the very popular springs at Daylesford and Hepburn Springs in country Victoria. The mineral content of those spring waters is said to be therapeutic. And I have had many patients of mine attest to the value they have derived from imbibing them. Eventually, if you can afford it, the Dead Sea spa resort in the Middle East is famous for its therapeutic effect on OA. This is said to be purely due to the heavy mineral content of the water which is rich in potassium chloride, magnesium and other elements. The Dead Sea itself is a fascinating place. It is actually part of the Mediterranean that was cut off and became an isolated inland sea. Over the years its seawater became highly concentrated from evaporation due to the soaring temperature (up to 120F). So now the water there is ten times more salty than normal seawater and very buoyant. You can get in and float in the water and never sink. Good fun. People visit the Dead Sea to seek treatment for OA, others go there to have their psoriasis (a kind of chronic dermatitis) treated or cured because the UVB at the Dead Sea, being 1,500 ft below sea level, is just the right strength to cure psoriasis!

Obesity and the Metabolic Syndrome This troublesome problem, the legacy of our modern affluent society, is fast reaching epidemic proportions, and will be, in my view, one of the biggest headaches for doctors, health workers and governments world-wide. About 64% of adults in the U.S. are overweight, and about 30% are obese (BMI > 30). Much of the rest of the world, including Australia, is close behind. The number seems to swell by 10% every decade (the incidence of obesity, in real terms, has actually doubled since 1980). The cost? It is estimated that just in

the U.S. alone, $40 billion per year is spent on weight control (drugs, diet programmes, and surgery). Professor Paul O’Brien, head of the Centre for Obesity Research and Education, Melbourne, had this to say in 2005: ‘Obesity is shaping up to be the major health care problem and one of the most frequent causes of st preventable death in Western countries in the 21 century’. In his view the only successful way to help the helplessly obese return to normal health is to put a clamp around the stomach to control the food intake, a procedure known as laparoscopic adjustable gastric banding or LAGB for short. Most conventional measures currently employed, such as diet, exercise and pharmaceutical means, have not had much success. He and his team has performed 2,700 gastric bandings over a span of 10 years, with the lowest complication rate ever recorded, yet achieving more than 50% weight reduction for the individual patient – quite a remarkable feat in modern surgery. Apart from LAGB, which seems to be the preferred gastric procedure in Australia, there are a few other gastric operations such as gastric by-pass, partial gastrectomy and sleeve gastrectomy. These, especially sleeve gastrectomy, have been more popular in the U.S. Currently, in Sydney, momentum has been gathering around Dr Ken Loi of the Gastric Surgeon Society who rightly proposed at a GP gastroenterology seminar that the society would initiate the process of registering and collecting the data on the surgery performed so that the benefits and complications of each type of operation can be compared and evaluated. LAGB is virtually a life-saver for the obese going into a downward spiral. The number of obese people in Australia is conservatively estimated at five million and is shaping up as a mountainous problem for gastric surgeons to tackle. It all sounds like magic – one stroke from the scalpel and your morbid overweight problem disappears forever. Correct. However, in practice it is not a guarantee of smooth sailing. A great deal of personal involvement is required from the potential candidate: firstly they have to spend tens of thousands of dollars for the operation to pay the surgeons, anaesthetist, hospital charges etc. Then, pre- and post-operatively, they must join physical exercise classes to keep fit, follow a dietician’s guidance and undergo regular blood tests to monitor the level of iron, vitamin B12, folate, homocysteine,

vitamins A,D,E, zinc and thiamine, and take supplements if found deficient. What’s more, they need to visit their GP regularly, and do an annual DEXA test for osteoporosis. ALL these are to be monitored for life, to prevent the candidate from building up unhealthy fatty tissue by slipping back into their unhealthy lifestyle. And is that the end of the demands? Not quite. Sometimes the unexpected can happen. For instance, one of my patients who was not even 30 years old lost that much weight and body tissue – 120 kilos – that loose skin literally hung down in flaps from his whole body like clothes on the clothes line. He did not have the foggiest idea before his gastric bypass that the procedure could have such an unpleasant consequence. So this poor guy needs to submit himself to another surgeon’s knife – only this time it is a plastic surgeon who is required to trim off all the unsightly redundant skin. In the end, the way I look at it, we need a powerful two-pronged attack – only a strong political will over-riding all levels of resistance and vested interests, and a keen awareness of this fast-approaching health crisis by all health professionals, will succeed in a similar fashion to the national heart health campaign and the anti-smoking campaign. GPs, as first-line contacts with obese patients, will have the most powerful influence to help change their lifestyle, choose a suitable drug or refer them to a surgical team for LAGB. That obesity is the ‘consummate pathogen’ increasing the risk of diabetes, CHD, stroke, HBP, arthritis, etc. is a foregone conclusion and well known in medical circles. What is less familiar to most people is that the obese respond poorly to many therapeutic measures. For example, in my experience as the chief acupuncturist of our clinic over the last 25 years, I have been frustrated by the rather poor result of acupuncture treatment to relieve the low back pain (LBP in short) and arthritic knees in overweight and obese patients. I could not understand why at the time and failed to correlate the poor response to the metabolic syndrome until now. In the next section, we will elaborate more on this unique syndrome. What is more frightening, however, is the childhood obesity now looming large as a part of this general trend towards a weightier population, resulting in a weightier liability to society. We will return to this problem later. But now – just look at the following news headlines from over the last few years:

Fat Flyers a Drag as U.S. Airlines Burn More Fuel Airlines had to spend literally an extra $US 275 million in 2000 alone for an additional 1.4 billion litres of fuel burnt in counteracting the drag. Hospital Turns Pregnant Woman Away as too Fat A Melbourne woman was told to lose 8 kg when her BMI was found to be 41, too high for a safe delivery of her baby. Australia – it’s a Great Waist Land More and more Australians have become so obese that they just cannot fit into the basic hospital equipment such as gowns and beds, X-rays, ultrasounds, CT and MRI machines, so that their diagnostic reliability has been compromised. During operations, doctors battle to get the intravenous drip into the veins or to insert the breathing tubes into the wind pipe of these patients. Cherry Picker Rescues 270kg Man This incident occurred in Sydney in March 2004. The hugely overweight man, in his late 30s, was found unconscious by his mother. As his body was so big, he could not be carried out the door by the ambulance men called in. The normally simple ambulance operation had necessarily turned into a fourhour rescue involving police, the fire brigade, ambulances and medical specialists. He could only be lifted out of his third-floor unit with the cherry picker of a fire truck after the window was cut out! Can anyone imagine anything more frustrating (some might say comical) than an attempt to get a sick patient to hospital turning into a mammoth task of emergency rescue, demanding so much manpower, time and effort, simply because of the patient’s bodyweight? The World’s Heaviest Woman Dies in July 2017 As reported by the Washington Post, an Egyptian woman named Eman Ahmed Abd El Aty, whose bodyweight in 2016 was 1100 lb (or 433 kg ), had become totally bedridden with CVA. She was also found to have severe Metabolic Syndrome besides other medical conditions. An Indian bariatric surgeon made a heroic effort to save the patient by performing a sleeve gastrectomy on her in March 2017. Post-op she had lost an impressive 550 lb. She continued to lose weight, dropping to 389 lb in April and after having been transported back to UAE hospital in May, she was scheduled to have

liposuction soon thereafter. She was seen sitting in a wheelchair, smiling and waving to reporters at a news conference in July 2017, preparing to celebrate her 37th birthday in September. However, shortly thereafter she was reported to have passed away. How unfortunate for this woman that after so much effort had been performed to save her from the misery of extreme obesity, she did not survive to experience a better life. It must be wondered if a rapid loss of weight, whatever means are taken to achieve that goal, might possibly cause sudden or unexplained death. Swelling Demand for Obesity Surgery As noted above, an increasing number of people are rushing to have gastric band surgery. The rate was growing at 6% per month! However, the head of the Royal Prince Alfred Hospital Lipid Clinic in Sydney, Professor David Sullivan commented that such surgery or pills for obesity should only be a short-term, stop-gap measure, and that people should look at the long-term solutions involving changes to the way we live as a society. Metabolic Syndrome Revisited Some readers may think this is a repetition of what I have said in Chapter Three – true, partly. Honestly, my view is that any globally crucial topic is well worth emphasising in order to leave a deeper imprint on our memory. And indeed, metabolic syndrome is now looming larger than Everest in the medical world, and deserves any amount of emphasis to alert everyone to its dangers. Simply put, this serious, highly dangerous chronic medical condition is the result of regular over-indulgence in highly rich and fatty food, deepfried food, junk food and soft drinks, while neglecting vegies, fruit and exercise. Over-indulgence in junk food can turn your body’s normal chemistry upside down, wrapping you in blubber and filling you with inertia. The treatment of this complex, chronic condition is incredibly difficult and costly, and requires hard effort and long-term management. It has been estimated that in the U.S. the number of obese people has increased fourfold in 15 years, and about 25% of people suffer from metabolic syndrome. This is obviously closely related to the number of fast food outlets and restaurants, as the number of them has doubled in two decades. Obesity and Cancer

A highly impressive recent survey in the U.S. on nearly one million people, spanning 16 years, was published in the prestigious New England Journal of Medicine. The results were clearly convincing in implicating obesity as an important cause of cancer. The conclusion was that obesity (defined as having a BMI of at least 40 as opposed to 25 for a normal person) significantly increases the risk of dying from almost all types of cancer, accounting for 14% of deaths from cancer in men and 20% in women. The heavier the subject is, the higher the chance of death is. Some of the findings are listed below: For women Uterine cancers are six times more common in the heaviest women compared with those of normal weight Kidney cancer is five times more common Cervical cancer is three times more common Breast, gall-bladder and pancreatic cancer were more than twice as common For men * Liver-cancer deaths are more than six times more common in the heaviest men than those of normal weight * Pancreatic cancer is more than twice as common Prevention and Amelioration of Obesity As you have already realized by now, being overweight or obese is pretty resistant to medical treatment. In many ways, obesity is a form of addiction – being physically and psychologically addicted to overindulging in food and drink. I believe the best approach to this problem on a large scale, is to tackle its basic cause – to thoroughly educate the public regarding a healthy lifestyle, starting from the kinder and primary school stage. We need to put pressure on food producers and commercial eateries to turn out healthier food and meals in smaller serves, and to phase in a hefty ‘fat tax’ on high-energy and high-cholesterol food to make these items too expensive for children to consume in excess. The following measures should be immensely beneficial in changing your lifestyle: Exercise

This is as yet the most formidable weapon in the battle against obesity. Maximum loss of bodyweight up to a few kilograms a week can be achieved with serious exercising. Despite all the shocking headlines, some outstanding examples of very cheering news have been recorded which emphasise how effective exercise is. The programme ‘the Shrinking Women’9 reinforced the unfailing principle that a combination of regular exercise and a healthy eating plan will almost certainly help you overcome any weight problem. It showed three women who have lost more than 240 kg between them (from 76 kg for one to 88 kg for the other) just through regular exercise, terminating their junk food habit and returning to healthy home cooking. Recently the reality TV show ‘The Biggest Loser’ again demonstrated many obese and super-obese men and women losing from 50 to 80 kg or more, just by intensive gymnastic training and jogging. The transformation is incredible – turning a depressed obese person into an attractive, fit and confident individual. The lesson we have learned from all this is – if there is a will, there is a way. By sheer determination and common sense, these admirable people simply set their goals and transformed themselves back to normal. None of them even bothered to join any slimming club; they just adopted a sensible diet and exercise. If they can do it, you can do it too. Healthy Diet Diet is vital and anyone suffering with weight problems should study Chapter Three carefully. Choose one of the well-proven meal plans it recommends. Also be sure to make use of my Master Eating Plan in the special section following Chapter Seven, which also contains all the essential ingredients for healthy eating and a selection of easy to make recipes. Take up a Hobby Take up more outside interests and hobbies to occupy your time. If you are fully occupied with your work, your hobbies and your family, you will be more satisfied and less likely to indulge in unhealthy ‘comfort eating’ and other destructive addictive behaviours like smoking. Drug Treatments Recently introduced drugs have been tried as a solution to obesity. However they appeared to only work on some individuals and tended to have

unpleasant side effects. A number have come and gone without living up to their promises. The only drug remaining which seems to be somewhat useful is Duromine which suppresses appetite as an auxiliary aid to getting you started on your weight-reduction programme – this is a sound and practical therapeutic method adopted by most GPs and highly recommended by Dr B Sproule, a Sydney GP specializing in obesity management. Childhood Obesity Many years ago I happened to spot a colour picture of a group of Chinese children and teenagers in The Age newspaper. I could not believe my eyes – they were all so distinctly overweight, and a few were even obese. ‘This is incredible!’ I mumbled to myself, for in all my younger days spent in Hong Kong, literally none of my school friends were overweight, right up to the time when I went onboard the Changte, the slow boat to Sydney, for my medical education. While at school, we ate a lot, like all hungry teenagers; but we also played a lot of soccer, hand-ball, basketball, gymnastics and were always chasing and wrestling each other. Undeniably the scenery has dramatically changed. Why? Some point their finger at the recent prosperity in China which has brought with it the rapid influx and availability of good food, rich food, high-energy food, beer drinking, the increasingly popular craze for fast food such as MacDonalds and Kentucky Fried Chicken … simply too much ‘good life’, and too soon. With China’s economy now fast catching up with that of the U.S. and its society rapidly becoming more affluent, it is anyone’s guess whether or not China’s youth population will not catch up with their American cousins in the obesity race. It seems inevitable that many more nations will follow unless the perils of this course become universally recognised. The great jump in the number of fat children in the developed world has been rapidly developing into a pandemic. Childhood obesity is now regarded as a time-bomb ready to explode in the face of the governments concerned, if not enough is done within the next five to ten years. As with the topic of metabolic syndrome, I am convinced that this momentous medico-social problem deserves more serious attention; but the approach and treatment of

the subject matter will be different and should be interesting. The statistics that follow speak for the enormity of the problem itself: * A report from the Institute of Medicine says that about nine million American children aged over six are currently considered obese. * According to the Medical Journal of Australia the number of obese children jumped from 1.5% in 1985 to about 10% in 2000 * In a 2002 Australian Institute of Health and Welfare publication it was stated that 18% of boys and 22% of girls were overweight or obese. * The Royal Children’s Hospital survey in 2002 on 2,500 children in Victoria found one in four was overweight or obese. * In Western Australia, research on 1,500 children for eight years from their infancy onward had discovered that overweight children had higher blood pressure, and lower HDL, than slim ones. * A few years ago, a joint study was made by Sydney’s Royal Prince Alfred Hospital and a Hospital in Hong Kong of the arteries of 72 overweight and obese children aged between nine and 11. The researchers, led by RPA cardiologist David Calermajer, for the first time in medical history, found the thickening of the artery walls and impaired blood vessels which are usually only present in adults. This clearly sends us a warning that even children as young as nine can already show such ominous signs which will lead to heart disease and stroke in their adulthood. The study was published in the International Journal of Obesity. * Early in 2005, a documentary from Channel Nine showed a 16 year old in the U.S. reportedly weighing a huge 420 lb. His life was said to be hanging in the balance due to the severe workload on his CVS from the gross obesity. Naturally he had all the signs of diabetes too. He perished not long after. Former U.S. president, Bill Clinton, was the first celebrity to take up the cause to combat childhood obesity after his quadruple coronary by-pass operation. Having recognised the grave nature of this socio-medical problem, he had this comment to make: ‘the bottom line is, we have got too many kids too overweight, and they are walking bombs’. He worked in conjunction with the American Heart Association to help educate and persuade food

manufacturers and restaurants to produce more healthy food. His campaign appeared to have drawn a welcome response from the fast-food giant McDonalds in Australia which announced that it would introduce a healthier menu which would include a good dose of salads, with or without apple. According to McDonalds CEO, Guy Russo, their Salads Plus menu ‘has been a great success and now makes up about 5 percent of their business’ and that the corporation wants to be seen as part of the solution in combating childhood obesity. This sounds like a sensible business decision and a good start into a new era of corporate cooperation, but, in fact, it turns out to be just lip service. The reality is that, unfortunately, like all corporations and commercial enterprises chasing after profits, their core products have not changed significantly. McDonalds packaged meals always come cheaper with a Coke and oily French fries to entice the unwary. The Governor of Arkansas was another person to wake up to the danger of childhood obesity after he was told by his GP that he was suffering diabetes at the prime age of 47. He immediately legislated to make his state the first in U.S. history, and also the first in the world, to have the BMI of its 400,000 children checked, PT to be re-introduced into school, and children to be forced to exercise. He himself took the initiative and started doing vigorous exercise. His decisiveness and swift action should earn the admiration of all concerned. As concerned parents and health professionals, we ought to question ourselves as to how many of our politicians have woken up to this ‘time bomb’ and proceeded to do something about it? Disappointingly, not many. The Australian federal government is considering organising some national campaigns to tackle this huge problem. In 2006, the Victorian government announced that sugar-filled soft drinks would be banned from all state school canteens from 2007, but there is no blanket ban on fatty food and lollies. The South Australian government went one step further by banning junk foods from school canteens from 2007. But NSW and Queensland have no plan at all on total bans on soft drinks and junk foods, despite a recent research study from Sydney University which was conducted on 5,400 students from 90 public schools. The results pointed to the conclusion that bad diet and overeating were the main reason for childhood obesity. Maybe greater pressure needs to put onto governments of all persuasions to wake up, hurry up and

spend up! Preventing Childhood Obesity Apart from the above two-pronged attack, involving healthier food and compulsory exercise in school, more has to be done to combat childhood obesity due to its huge future implications to the whole nation. The following principles should be considered: Community Responsibility Involve every level of the society – from parents, teachers and principals, to government officials and departmental heads. We need to utilise every means to show children the real risk of carrying excess weight. They must be taught to enjoy healthier natural food and to stop over-eating, spending less time on food and more time on play at lunch recess. Exercise must be made compulsory. With this sort of concerted effort it will not be long before they sense that we really mean business and they will be more than willing to conform. Total bans on all soft drinks and junk foods in all schools should be viewed as the first step, albeit a small one, in the right direction. Once such guidelines have become routine, it will be a norm among children to accept and adhere to healthy habits for the rest of their lives. They must be taught what is right and what is wrong and be shown the correct way to get physically fit again. Without our guidance, children can become confused and easy prey to junk food ads. For while corporations and advertisers should be made to behave responsibly, ultimately parents are responsible for their children’s eating habits and need to be informed and encouraged in this regard. Advertise Health Governments must provide more funding to health-related organisations for the production of regular advertising campaigns to expose the risks from junk food, fast food and energy rich foods. We should point out the benefits of fitness and exercising, using the healthy lifestyle of celebrity sports idols as an example, etc. Children’s young brains are very impressionable and capable of absorbing most of the key points, which, if repeatedly emphasized, they will keep for life.

Health professionals and well-known sportsman should be invited to appear regularly on TV or talk-back radio to discuss nutrition, food and drink, exercise, hygiene, and keep-fit sports, to help educate children who are usually more impressed if they admire or are entertained by the presenter. Impose a Fat Tax Impose a ‘Fat Tax’, as hinted at several years ago by Dr Moody of Vic Health. Such measures could be effective in encouraging producers of junk and unhealthy food to switch to more health friendly products. Increasing the cost of unhealthy foods will serve as another disincentive to children to choose them. Introduce Healthy Tuck Shops School tuck-shops, particularly those operated by outside interests, should be completely re-vamped and re-organised to make sure that only healthfriendly food and drinks are sold to children. Organise an Anti-Obesity Conference A national ‘Summit Conference’ to tackle childhood obesity should be organised by the Federal government to involve the nation’s top bodies in the medical field (AMA), nutrition (CSIRO), other health professional organisations, education department heads, school principals and teachers, fast-food corporations, food and drink manufacturers, etc. The groups would work toward a consensus of opinion, strategies could be hammered out, and a concerted effort implemented nation-wide. The important point is, the success depends a great deal on the key phrase ‘concerted efforts’ and ‘nation-wide’. If there is a will, there is a way.

Diabetes Mellitus (DM) Generally known to lay people as sugar diabetes, it is the world’s fastest growing disease afflicting mostly those adopting an irrational lifestyle. Understandably Diabetes Mellitus (DM), whether insulin dependent, noninsulin dependent or the mixed type, is most common in highly developed nations such as the U.S., Australia, Britain, etc. purely as a result of higher

living standards and societal affluence. But surprisingly, some of the Pacific nations have also started emerging as potentially serious sufferers with their fast upward trend in DM, possibly due to a combination of factors including the quick adoption of the Western type of energy-rich carbohydrates, fatty food and junk foods while ignoring their own traditionally healthy, lowenergy diet. Worldwide, the number of DM sufferers was about 200 million in 2000, and is expected to double by 2030! In Australia, it is now confirmed by a national survey, that previously known diabetics in the population number about 3.8%, plus an equal number diagnosed at survey, plus another 10 to 16% of potential diabetics (based on the impaired Glucose Tolerance Test) will add up to somewhere between 17.6 and 23% of the total population. This implies that roughly one in five people is either a known diabetic or likely to become one soon. The latest news is that 280 new DM cases are being reported every day, or roughly one every five minutes. One of the dreadful complications in DM is ulcers in the toe due to impaired blood circulation. According to the figures from the Royal Melbourne hospital, up to 25% of such ulcerated toes will lead to infection, osteomyelitis (bone infection) and, in the end, amputation. In Australia, about 3,000 amputations have been performed per year. Thirty per cent are toes and 10% are feet, the rest being major ones, from the knee or even higher up. Amputations are done to save patients’ lives but clearly at a horrifying cost to the victims and, not unexpectedly, a ready-made cause of depression for many of them (up to 15% of depressions are due to chronic illnesses). One other less well-known complication of diabetes is DKD or diabetic kidney disease, which affects about 30% of those who suffer from DM. Sufferers DKD, can rapidly worsen if their ongoing hypertension is not kept well under control. This in turn will lead to renal failure that will require them to undergo troublesome renal dialysis (up to three times per week) for the rest of their life, and therefore affect their quality of life in a seriously deleterious fashion. Most people are familiar with the standard treatment of DM. In this section, I am more concerned about how to prevent DM happening to you. But please take note of the latest guidelines from the RACGP as follows: Lifestyle is crucial (including keeping your weight down) – healthy lifestyle

will get you out of NIDDM with all its misery. Self-monitoring of blood sugar is not indicated for most DM patients who would benefit more from regular checks at their GP’s or diabetic clinic. Take proper care of your feet and eye and renal function as indicated in previous guidelines. Prevention The basic principle is not to over-work your pancreas and, at the same time, dispose of the glucose (basic sugar) effectively and efficiently by the following measures: Cut Down On Sugar Minimise ingestion of all rich, sugary carbohydrates and drinks, such as cakes, lollies, desserts and soft drinks as you have no hope of burning off that much sugar except by high-intensity exercise. For most of us, it is far better to eat plain carbohydrates such as pasta, noodles, multi-grain bread and rice because these complex carbohydrates will slowly release the glucose for your daily energy production, and will avoid over- saturation of your system by sugar. You might even have to think twice before you go for the good red wine. Although a couple of standard drinks of red are allowed in order to help your CVS, the alcohol content of up to 13% (plus some sugar) could easily upset your blood sugar if you are a diabetic. Control your Weight As mentioned before, it is now clear to medical professionals and researchers all over the world, that obesity generally goes hand in hand with other serious diseases such as DM, hypertension, CVD and stroke and turns into a fullblown metabolic syndrome which is notoriously difficult to treat. It goes without saying that watching your bodyweight like a hawk to keep your BMI under 25 will pay you a handsome dividend in the long run. Exercise Regular exercise of moderate to high intensity plays a crucial role in the

prevention and control of DM. It works simply because regular, substantial exercise will give you a large muscle mass, and muscles are born with an insatiable appetite to consume sugar, like a V8 car engine thirsty for petrol. Once the glucose has been brought inside the muscle cells, it is ‘locked in’ and burned to supply energy to your body. It cannot leak out into the blood to cause trouble. Recent research has uncovered yet another bonus from exercise. It has shown that the blood of those who exercise responds better to their body’s insulin and remains better controlled than it does in sedentary people. So all this explains clearly why exercise has been enthusiastically embraced by DM specialists everywhere.

Food Poisoning and Gastroenteritis In a practical sense, these terms are almost interchangeable and involve vomiting, abdominal cramp and diarrhoea. Although by far the majority of cases in adults are caused by germs and their toxins in food – straightforward food poisoning – it is a different story in children and babies where most cases are caused by a common entero-viral infection. Thankfully, the oral vaccine introduced a few years ago has proved to be very safe and effective and has become an important addition to the childhood immunisation programme. This seemingly minor disease, so commonly encountered in many family clinics, can maim or even kill. Occasionally the havoc it can cause is reflected in sensational news headlines, as happened recently in December 2017 when the Ovation of the Seas, the world’s largest cruise ship, had to dock in Hobart to get medical treatment for the 200 passengers struck down by a gastro virus called norovirus. Interestingly, a month later in January 2018, another large cruise ship – the Sea Princess – was forced to interrupt its 14-day pleasure cruise to New Zealand and berth at Brisbane for another 200 passengers sick with gastroenteritis caused by the same virus! Apparently taking a cruise on one of these huge ships is no guarantee of smooth sailing. Nevertheless, over 80% of gastroenteritis in adults is caused by the salmonella group of germs which contains over 2,000 serotypes. According to the ACT Health authority, we are seeing five million people affected by food poisoning in Australia every year, meaning one in every four

persons! The blame was laid squarely on kebabs. The trouble probably is that many of the food handlers or owners of cafes, restaurants and eating places are ignorant of the laws and guidelines on food-handling which specify that kebab meat must be kept above 60 degrees C, and salads (the other common offender) must be kept at five degrees C. Any food prepared and not used must be refrigerated. People in general must be aware of the simple fact that germs will multiply fast in any unused food which has been left at room temperature, until there is a sufficient quantity of germs to cause food poisoning. The warmer the temperature, the faster the spread of contamination. The minor cases happening at home and private functions may just give you tummy pain, some vomiting and diarrhoea, but many other more serious cases could easily land you in the hospital, and could even be fatal if you are unlucky enough to have ingested an overwhelming dose of Salmonella. Large outbreaks have occurred time and time again even in Australia, mainly in metropolitan cities and densely populated suburbs. Just in Victoria alone there have been several outbreaks serious enough to have been flashed across the front pages of newspapers and TV news. I believe it is interesting and educational to describe some of these outbreaks: The first one, as I recall, started in Springvale, Victoria, which had a concentrated Vietnamese Chinese community. Its source was some pork-buns which obviously had salmonella-contaminated fillings. Hundreds of people became sick, many hospitalised. The culprit was found to be a delicatessen which was forced to close down soon afterwards after prosecution and fining. Another case was found in a takeaway shop in Footscray, another Melbourne suburb, which was selling contaminated pork-buns which resulted in hundreds of cases of gastroenteritis. One of my patients and his son both became ill after they consumed those buns on their way home from an outing. The boy was so ill that I had to refer him to be admitted into the Royal Children’s Hospital. The third case happened in a busy, cheap-eat Pizza Restaurant, well known locally in Camberwell, Melbourne. Chicken was the source of contam-ination that time and caused more than 90 cases of salmonella poisoning around Christmas 2003. Out of the 90 victims, 62 adults and 14 children were

awarded a $200,000 Federal Court settlement. One child was forced to have her appendix removed for some unclear reason. The latest, and the largest, happened in Melbourne, in December again, which is a hot and busy month there. This was at a Turkish restaurant in Brunswick. The outbreak caused more than 400 cases of food poisoning; three people were hospitalised. In between these outbreaks, an Indian-run curry restaurant was taken to court over some animal droppings in the takeaway food, causing sporadic cases of food poisoning reported to the health department. Inspection by health officers had uncovered stale, contaminated food, some even mouldy, and obviously not kept refrigerated. The common factors for anyone concerned to take note of are that food poisoning happens more often in hotter months, in festive seasons, in large parties, and in small and poorly supervised takeaway shops whose operators fail to observe food hygiene. The source is usually from chicken and kebab meats and salads, but of course, could also be from any type of food. Seafood is no exception, and personally I’ve had a few minor food poisoning incidents after consuming cooked oysters (naturally it could have been worse if raw). Warning – do not think that only food from takeaways or restaurants can give you food poisoning. It can happen at home as well if you fail to observe the common-sense measures of basic hygiene. Prevention Preventing viral gastroenteritis in children and babies is now a surprisingly straightforward matter – you simply feed them two doses of a ‘gastro vaccine’, developed by researchers and clinicians at the Royal Children’s Hospital in May 2006. It was not cheap when first introduced, costing $220. However, as the vaccine is said to be 100% effective it would be worth it even at that price. Since then, however, to the great relief of all new parents, the vaccine has been made available free as part of the national childhood immunisation programme. For food poisoning, it is a more complicated matter:

Avoid Contamination As the infective germs (usually Salmonella and staphylococcus) thrive on meat proteins and juice, it is a good habit to pre-wash any meat you bought from the markets or local butchers, and re-pack it into clean plastic bags yourself. Similarly, wash it again before cooking. Choose your meat carefully. Look for a good shiny colour, avoiding any cuts that have lost their lustre and look dull. Make sure it is firm to the touch with not even a slightly ‘slimy’ sensation, and be aware of the smell which should be fresh with no odd or unpleasant odours. Make sure cutlery and crockery are kept clean and well-protected from flies and crawling insects which are known to carry hepatitis germs in addition to numerous others. Do not leave your food and meat out of the fridge for too long. Always put it back when you have finished the preparation. Even salads are no exception because of the salad dressing and other sauces which could provide nutrients to bacteria. This reminds me of my very unpleasant encounter with food poisoning derived from salads in a top hotel. A Hard Lesson in Precaution An unforgettable episode happened over 15 years ago when my family stayed in a reputable five-star hotel – the Hyatt, in downtown Singapore. My wife was wise enough to order a hot meal for her lunch, as she always did at any overseas restaurants, just to be on the safe side. I tended to be more complacent and adventurous. There, in the luxurious dining room, I could not resist sampling dozens of exotic salads from a magnificent array in the special salad buffet luncheon, all neatly and beautifully displayed on row upon row of cleanly covered tables. In such a congenial and lavishly opulent setting in a top-class hotel, who would have thought that you could still get into trouble? I certainly didn’t think so, not in my wildest dreams. Yet, I started to feel the onset of hours of tummy cramps and nausea that afternoon on our way back to Melbourne. I had to skip the lovely dinner offered on the plane, and that’s not like me, as my family knows that I never missed those well-balanced, well-presented hot meals in their cute little dinner boxes. I continued to suffer gnawing tummy pain until the next day before it eased off after some diarrhoea. But the trouble did not stop there. For many years after the incident my

robust appetite failed to return. I was not unduly concerned until a check-up gastroscopy discovered the ‘bug’ in my stomach – Helicobacter pylorus. This ubiquitous stomach bug can thrive in the stomach’s acids, and is known to cause peptic ulcers and even cancer. That was it. Clearly, either some of those colourful salads or the dozens of exotic spicy sauces in that magnificent hotel must have been contaminated by one of the chefs or food handlers and caused my food poisoning, and I got the stomach bug as an extra farewell gift! The message? Never touch uncooked food, lukewarm meals or leftovers while overseas. Even though they may look fresh and innocent, you have no way of telling how long they have been left out in the open or whether they have been ‘re-cycled’ from the last serving, and contaminated by one of the food-handlers who carries those bacteria. Ensure Food has been Cooked Properly Of course, this point applies mainly to party food and outdoor entertainment events such as family picnics and backyard BBQs. Over the years, I have noticed that, although most of my patients contracted gastroenteritis from ham rolls, sandwiches, pizzas and takeaways, up to 10 or 15% reported to me, typically on Monday, that they fell ill after a BBQ the day before. We have to understand that when everyone is in a party mood, talking, drinking laughing and having fun, the busy host might forget to wash their hands while preparing foods and drinks. They might leave the raw chops and sausages outside in that nice, balmy Sunday sun for too long. Maybe some chops were cooked only on one side and have been hurriedly handed over to a hungry guest waiting impatiently for his turn. Add a few grogs and some inevitable over-eating after the footy game ... all these little factors could combine and make a few partygoers sick. Bacteria is encouraged to grow faster on the surface of poorly-cooked meat because of the favourable temperature and the nutritious meat juice. In general, do not touch lukewarm pre-cooked or pre-warmed food. When eating out, take the effort to demand a piping hot meal or ask the waiter to take it back to re-heat. That little trouble could save you a much bigger one. Be doubly alert to cooked seafood such as oysters which are particularly well known as a frequent source of salmonella. Sometimes part of an oyster farm, usually located at an estuary, is inadvertently contaminated by sewage

outflow from an inflowing river or nearby farms. Avoid Overeating and Excess Alcohol Overeating will dilute your stomach acid and digestive juices and compromise their ability to kill bacteria. Alcohol depresses all of your body functions. It can reduce your resistance in general and slow down your digestive system. Choose Your Venues Carefully Keep away from small, run-down eating places, takeaway shops, and restaurants with any tell-tale signs that the standard of hygiene in the premises leaves something to be desired. Check their toilets for cleanliness or attempt to have a passing peep into the general working area of the kitchen before you make up your mind whether you would prefer somewhere else of a more acceptable standard. To have your meal in a cheap but grubby eatery may save you a few dollars but it will often turn out to be a false economy.

Colo-rectal Cancer (CRC) This cancer of the large bowel has recently been rated as one of the top five killer cancers. In an AMA seminar I attended in 1994, Professor D English pointed out that CRC kills about 5,000 people in Australia annually, quite a large number indeed. It is even worse in the United States where it is the second most common cancer affecting130,000 people yearly, mostly people over 50. Yet, it occurs at less than half the frequency in Okinawa, the island famous for the number of centenarians it produces. This much lower incidence is thought to be largely due to the excellent protective factors provided by the Okinowans’ healthy levels of physical activity and vegetable diet. As the reader will find out in a following chapter, the efficacy of maintaining all these habits is well proven and should be upheld at all time. But, on the other hand, you may wonder why more people have not died of this cancer, noting the following: 1) You normally cannot see nor feel its presence when it starts off as a small lumpy tumour called a polyp. The majority of these are situated somewhere

between the rectum to about 12 cm high along the left part of your large bowel. 2) Whatever symptoms you may have noticed could seem trivial and benign, such as some occasional constipation, perhaps accompanied by a little tummy pain, etc. Frequently, people just off-handedly blame something else and do not bother to seek a medical check-up. 3) Even the more alarming symptom of seeing blood on the toilet paper or in the toilet bowl might still not be enough to spur some people to see their GP to find out why. ‘I thought it was probably my haemorrhoids, so I didn’t bother to come until after seeing more blood the last few mornings,’ is the usual explanation. For example, a friend of mine, an active leader of a Chinese organization in Melbourne, had been bothered by recurrent diarrhoea, up to half a dozen times a day, for almost a year. But his GP, a complementary medicine advocate, thought that all his trouble had been due to his unbalanced, irregular meals from different restaurants he attended in his busy social rounds and community functions. She brushed off his other warning signs and ordered him to adopt two different types of ‘health diet’. Each one lasted three months at a time, with no improvement. But his GP pressed on with her third health diet. When he jokingly recounted the whole story while having dinner with my wife and me, we became alarmed and I sent him straight for a proper check-up. Inevitably he had to undergo a colonoscopy. The surgeon’s report came like a bombshell to him, telling him that he had a CRC, ‘the size of an apple, partly eating through the bowel’! Tragically, he succumbed to fatal complications from the spreading cancer despite several heroic attempts by a team of surgeons and oncologist to save him. The message – see your GP for a proper check-up for any bowel trouble bothering you for more than a month. Go for another one if you have not improved or are not satisfied that it has been properly investigated. Prevention Healthy Diet Combined with Sensible Exercise Professor D English, a gastroenterologist, has asserted that, ‘Healthy diet and good exercise can ward off CRC’. I could not agree more. A healthy diet, full

of fresh veggies and fruits containing lots of anti-oxidants, is often capable of arresting the damage inflicted by free radicals to your cells and DNA. Damaged DNA is now regarded as a highly probable trigger to turn the cell into cancer. L.R. Ferguson reckoned in 2002 that, ‘one third of all cancers were dietrelated’. It sounds a lot, and may or may not be entirely correct; but in my experience and reasoning, perhaps more than one third of cancers could be prevented by balanced diet, nutritional supplements, a healthy lifestyle and good regular exercise. Tai Chi This gentle martial art of moving exercise which involves slow, controlled movements, through its hour-long, continuous action, can help you build up good physical fitness, and a relaxed mind.10 No one can dispute the fact that a healthy body with a relaxed, low-stress mind will give you at least a lower risk of most forms of disease, including cancers. Regular Bowel Movement A number of research clinicians are convinced that a faster passage of digested food would shorten the contact between the lining of the bowel and whatever cancer-causing substances are contained in faeces. Emptying your bowels daily ensures a healthier bowel lining and less chance for the formation of cancer.

Constipation Our gastrointestinal tract (GIT) is full of bacteria living in peaceful coexistence with the host. Research has found there are more than 400 types of bacteria in our GIT, numbering approximately 100 trillion, or 10 times more than the human cells, and weighing about two kilograms in total. Pardon me, two kilograms of germs in my bowels? Correct, and quite incredible! But they all live in harmony with our body and, in fact, benefit it by helping to digest our food and by contributing micronutrients and vitamins. These help to maintain our intestinal walls and protect our gut against pathological

bacteria and carcinogens. Also, last but not the least they have been found to program our immune system possibly via the ‘methylation’ mechanism which involves the process of replacing hydrogen atoms with a methyl group. Phew! All that vital help from those lowly bacteria, the same ones that used to be looked upon as semi-parasitic organisms living off the nutrition in our gut. We will surely see more studies in the future that stress the relevance of these gut bacteria as a significant factor that contributes towards a healthy life. This kind of symbiosis, naturally, is not a one-way affair. It requires the host, which means you and me, to provide them with proper food and nutrients for them to thrive happily so they can look after you better. Constipation is surprisingly common among the older age group, not to mention those in nursing homes and hostels. But the prevention is surprisingly just as easy if one practises the following guidelines: Prevention/Amelioration Eat More Fibre Have a large bowl of cereal in the morning. My favourite is still the traditional, piping-hot porridge with milk or soy milk. I have tried All Bran before without much satisfaction, and I suspect the reason is the predominant, insoluble fibre in that bran which is unhelpful to the bacteria in the gut. Naturally, other cereals may serve some people just as well. You may have to experiment with different ones to find one you are happy with. Of course, different ethnic groups would have their own favourite breakfast foods which could be just as satisfying. One of the reasons why porridge is a powerful breakfast food which can help prevent constipation is that oat fibre is soft and soluble and a good medium for your bowel’s bacteria. At the other end of the scale are the usual vegetable fibres which, though indigestible by humans, do help become part of the bulk of your motion and stimulate your bowel movements. One point of note, however, is that not everyone can tolerate excess insoluble fibres like bran as they may over-irritate your bowels, resulting in loose motions, diarrhoea and stomach cramps. In such a case, you need to regulate

your intake or even do away with them next time. Follow your cereal with multigrain bread and a piece of fruit. A word of caution – you are well advised to check out the sugar content of the pre-packaged cereals. Many years ago, Professor A Sali of Melbourne, compiled a list of breakfast food and discovered that only two or three of the breakfast cereals contained less than 5% sugar – one of them was the wellknown WeetBix – whereas the rest contained at least 15 to 25% sugar – unacceptably high as a breakfast food. A Solution From Yoga Adopt the yoga posture for constipation by kneeling on a padded floor, keeping your upper body upright and rigid, both hands on your waist and start abdominal deep breathing. Within 10 to 15 minutes, you may start to feel the urge to go to the toilet. The reason why this posture often helps is not quite clear, but I suspect that one of the mechanisms could be the stiffening of several of the large internal muscles along the pelvic floor and the back wall of the abdomen, putting pressure on the large bowels to move faster and create the sensation of needing to use the toilet. Exercise Maintain your daily walk or exercise. Do not forget that a sedentary lifestyle is the commonest cause of constipation, especially in elderly people. Every time you walk or jog, you are exercising your intestine at the same time. You are begging to get constipated if you are a couch potato. Eat Right Eat at least three pieces of fruit per day. Green leafy vegies daily are a must. Follow the five vegies and three fruit rule. Chew your food slowly and thoroughly. This will help your digestion as well as give you a better appreciation of your food. Drink enough water or fluid just to satisfy your thirst. The more salty your food is, the thirstier you will feel. Forget the myth that ‘three litres of fluid per day is a must for everyone’. There really are no set rules for the amount of water one should drink. The excess water you imbibe will not cleanse your system as is claimed by some health freaks – it just goes through your kidneys and makes you go to the toilet more

frequently.

External Thrombotic Haemorrhoids (Piles) A very common, and annoying condition, usually complained about by patients as a sore lump in their back passage. Sometime there is evidence of blood on the toilet paper or even in the bowl. Some sufferers just show their discomfort through body language as they waddle into the room with difficulty, wearing a pained expression on their face. Now and then, such patients will refuse to sit down and you know the reason behind it. Such haemorrhoids (or piles) often happen when people try to empty their bowels in a hurry, or try to finish the job with undue force, causing the veins around that area to become engorged and remain engorged outside the anus. This creates the perfect situation for the engorged veins to go into thrombosis (clotting) if something is not done about it. Once the pile becomes thrombotic, it will stay outside the anus and give you much pain, discomfort and painful defecation for weeks to come. Prevention/Amelioration A Balanced Diet and Regular Exercise Have a balanced diet at all times – basically a five-veggies, three-fruits food plan, with suitable bulk cereals and fruit for breakfast. Have three meals a day and eat enough each time. Skipping meals and fasting do not help the matter at all – in fact could often be the start of a bout of constipation, no matter how mild and brief. Regular exercise of moderate intensity will generally strengthen your bowel muscles as well as exercising the bowels themselves, helping them to move faster and better. Relax Always relax after breakfast, waiting for the feeling to come before you go to the toilet. Your bowels will usually give you the signal that they want to open up to expel the rubbish. This means that your bowels will automatically empty their contents for you, and you don’t really have to push hard to

defecate. Any persistent force will only push the engorged vein out of the anus and become a potential pile. Manual Help When you feel some discomfort and a lump at the anus (the opening of your back passage) you may have to gently push the engorged vein, using a soft moist pad, back inside the back passageway, well past the rim of the muscular anal sphincter, say for a minute or two. Or, you may even have to lie down for a while (the best position to adopt is the classic ‘knee-chest’ posture) to help the engorged tissue/vein remain ‘inside’, become disengorged and disappeared. And, if necessary, you have to religiously repeat the same routine every day to prevent the occurrence of this painful external thrombotic pile. The reasoning is that once inside the emptied anal canal, the engorged vein will quickly flatten and will not form a haemorrhoid. Lying down flat will distribute the blood circulation more evenly and quickly restore all too normal.

Mental Illness – Depression and Dementia Depression has now been rated as the second most common condition people go to their GP for, mainly because 15% of all moderately ill patients suffer some form of mood disorder, although the actual number suffering major depression, which is hereditary, accounts for only 4 to 5% – according to the Australian Institute of Health and Welfare. According to the figure announced by WHO in 2015, the number worldwide was about 47million. Prevention Maintain Physical Health Although depression is sometimes hereditary and difficult to prevent, 15% of sufferers are afflicted with secondary depression: depression arising from moderate illnesses and chronic medical conditions. Avoiding such chronic conditions such as overweight, diabetes, CHD and HBP, osteoarthritis, would also spare these sufferers from depression. Again, people should be strongly encouraged to have regular exercise and nutritionally balanced eating habits

in order to prevent all these chronic medical illnesses. By keeping your body in a healthy state and physically fit, you have already avoided being among the 15% of people suffering depression because of them. Target Your BMI Even the much dreaded dementia can be prevented by long-term control of your bodyweight, as confirmed by a study recently published in the British Medical Journal in 2005. The 27-year longitudinal, population-based study on 10,000 participants discovered 7% of dementia among the subject group. Of these, the obese were found to run a 74% higher risk of dementia, while among the overweight the risk was 35% greater. The conclusion is that obesity in middle age increased an individual’s risk of future dementia, independently of their co-morbid conditions. This evidence-based, long-term study on such a large number of people has put beyond doubt the immense health benefit of regular exercise for both your physical wellbeing and your mental health. Recently, it has been found that elderly people who are depressed or suffering from chronic conditions, could have their mental state brightened up a great deal if encouraged to participate in physical activities. Many residents in nursing homes and retirement villages have reaped the benefits since joining in with organized activities. A few of my patients from one of these enlightened retirement villages could not wait to tell me how much they enjoyed the group activities and how much fitter they felt physically. Without exaggeration, they all looked much happier and alive. Participate in Hobbies Seek out hobby groups such as indoor bowling, chorus singing, crafts, reading, mah jong, bridge, dancing, Tai Chi, or outdoor physical activities such as hiking, walking, cycling and gardening. Being in a group will enhance your interpersonal skills, will enable you to learn from each other, and improve your communication. All these occupations change your outlook, provide a window on wider outside interests and serve to energise your brain and keep it working healthily. They could possibly be a powerful antidote to Alzheimer’s disease. It is now well recognised that keeping such favourite pets as a cat, dog or

budgie, who you can play with, talk to and care for, can lift your physical energy, keep you busy all day and generate much mental stimulation. Lower Back Pain LBP is a condition frequently encountered in general practice. It affects nearly everybody at some time in their life. Currently LBP accounts for about 5% of GP consultation in Australia, and the indirect cost to the nation from absenteeism, loss of wages and productivity etc. is about $15 billion – a huge waste indeed. It is nearly always the result of heavy lifting, incorrect posture in lifting, a sudden increase in workload, or just due to being physically unfit through sedentary habits. Occasionally, nevertheless, some cases of LBP are unexplained and you need to consult your GP to rule out any more sinister conditions such as certain types of primary bone cancer, many other types of cancer secondarily spread (metastatic) from other organs, notably from prostate, lung and breast cancer, or maybe an inflammatory condition of the spine called ankylosing spondylitis. Most LBP is due to strain or injury to the muscles, ligaments or facet joints (the pair of small joints of the vertebrae of the spine). Disc prolapse (‘slipped disc’) and sciatica are not so common, but still due to the same cause – just much more painful and serious. Prevention Regular Exercise It is best to start from childhood. Children who exercise frequently during their school years will have much less trouble with their back than the ones who do not. Suitable exercise such as power-walking, jogging, cycling and swimming will help stretch and strengthen the back muscles and ligaments around the bony vertebrae and facet joints, enabling them to withstand the sudden and unexpected strain of a fall and any kind of bending and lifting. Build up your physical training gradually to avoid straining the muscles and ligaments. Adhere to the golden rule of ‘warm up, cool down, and stretch’. Try not to jerk or pull/push suddenly. Another point to note is that those who

begin their physical workout at middle age or older, must avoid overexercise, as this in itself could strain your back. Good Posture Poor posture in standing and sitting could transfer the weight of the upper trunk more to the movement-orientated facet joints instead of the weightbearing vertebrae and discs, causing strain, inflammation and pain in the facet joints – collectively branded as ‘LBP with facet joint arthritis’. Correct Lifting Learn the correct lifting technique – even bending your back over instead of bending your knees to pick up little things on the floor could strain your facet joints and soft tissues. If you have some knee problems as many elderly do, then the best compromise is to use one hand to hold on to something like a table or bench to help support your upper body before bending down or picking up things from the floor. And if the parcel or goods are heavy, don’t hesitate to ask someone else to help. Before you are going to lift and carry a lot of fairly heavy stuff, you can do yourself a favour by warming up for ten minutes first; it will help establish good circulation in your muscles and joints, preparing them better before the actual lifting and carrying. Always start on lighter weights before attempting heavier ones. It is helpful to take a break in between lifting to allow your back and soft tissues to recover.

Prostate Cancer According to the Prostate Cancer Foundation of Australia, after lung cancer, prostate cancer is the second most common fatal cancer afflicting men. Approximately 10,000 men are diagnosed with prostate cancer every year in Australia. Of them, 2,600 die, most of whom are over 70 years of age. It is much more common in the USA where there are about 180,000 cases per year. Yet it is extremely rare in Okinawa – about 80% less common than in North America.

Prevention Appropriate Exercise Regular moderate-intensity exercise (but not high-intensity exercise) could possibly help to lower the risk. It has been postulated that a higher presence of energized white cells which constantly watch and eliminate abnormal cells could help nip the cancer cells in the bud before they can turn nasty. Beneficial Supplements There is some evidence that a number of substances may reduce the risk of prostate cancer. These are mainly anti-oxidant-type nutrients such as selenium, lycopenes, vitamins E and D. Lycopenes can be found in cooked tomatoes, tomato sauces and ketchup. The extension of this could mean some other anti-oxidants like tea, red wine, colourful vegetables and fruits, would also be useful if ingested regularly on a long-term basis. Three important components are: Flavonoids (plant hormone blockers) – this phytoestrogen is found in soy and other legumes. There are studies which indicate that they can kill prostate cancer cells, or retard the growth of tumour cells. Some studies conducted on animals suggest they could prevent their growth altogether. Lycopene and carotenoids, which are best sourced from tomatoes. These recently received attention from a Harvard study which showed that they might provide protection against prostate cancer. More studies are needed and will be done. Vitamin D, vitamin E and other anti-oxidants. Some research suggests there is a link between high vitamin D levels and low prostate cancer Regular GP Visits A regular check-up by your GP is very important. Just like breast cancer and cervical cancer, a digital examination through your rectum in addition to a blood test on PSA (prostate specific antigen) with an occasional imaging of the prostate forms a kind of surveillance for BPH (benign prostatic hypertrophy) and prostate cancer. This is currently the approved method of keeping a check on the prostate.

Even though you may be only 30 or 40 years old, prostate cancer and death could still happen to you, as it did to a middle-aged heart specialist from a teaching hospital I happened to have professionally associated with many years ago.

Osteoporosis A new definition has been put forward by the Royal College of Physicians/Bone and Tooth Society as, ‘a progressive, systemic, skeletal disease characterized by low bone mass and microarchitectural deterioration of bone.’ Osteoporosis is now a major public health problem throughout the world according to an article published by Cummings and Melton in The Lancet in 2002. Indications are that it will become even more common as the population ages. Bones soften over time, mainly in the vertebrae and the hip bones in osteoporosis, owing to the loss of calcium/minerals through the reabsorption of bone minerals by osteoclasts (bone cells) outpacing the ability of your body to form new bones through osteoblasts. Once this deterioration has reached a certain point, fractures can occur from just a simple tumble or an innocent twist of the hip. Worldwide, it has been estimated that 50% of women and 25% of men will have a fracture sometime in their life. Forty-six per cent of fractures will happen in the vertebrae, 16 % will be of the hip, and 16% of the wrist. One third of men and one fifth of women will have died within a year of suffering a hip fracture.11 Of those who survive, many will have great difficulty in managing their daily lives without help. And the fractures further create huge problems and complicated morbidities. Osteoporotic fractures are traumatic to the sufferers and costly to the nation when you consider the following statistics: In 2001, nearly two million Australians had osteoporotic conditions – 75% were women. This number will increase to 6.2 million by 2021 if nothing is done about it, resulting in a fracture every 3.5 minutes according to Professor Marcus Seibel of the University of Sydney, who spoke at a seminar in Sydney in February 2018. He indicated that 20% of women with spinal

fractures can expect another one within a year He also reminded the audience of four risks: 1) being over 70 years 2) minimum trauma [this is vague] 3) taking the medication called Prednisolone in doses of more than 7.5mg over two to three months 4) having a bone density score lower than -2.5 In Melbourne alone, the direct cost was up to 1.9 billion (estimated by Access Economic 2001), while nationally, according to Professor John Eisman of the University of New South Wales, it costs over $7 billion per year.12 Just in our clinic, I have come across an increasing number of elderly people with osteoporotic fractures. The following account is one classic example: An elderly woman at our clinic asked for a home visit as she found it difficult to walk properly because of ‘some pain’ in her hip. I had joined the clinic only for a few years then. I answered the call and found this meticulously tidy lady in bed. She said she had great trouble doing her house chores in the last two days since she ‘tripped a bit’ on the rear doorstep when she finished hanging up her washing in the back yard. On examination, I found the foot of her affected side unmistakably turned outward – the tell-tale sign of a fractured hip joint. X-rays were ordered and confirmed the diagnosis. She was admitted into hospital quickly for a pin-and-plate operation to help stabilize the fractured hip-joint. Unfortunately, within only six months, the clinic was notified of her death in the nursing home where she was undergoing convalescence and rehabilitation. It was extremely saddening, as this petite woman was well- known for her fighting spirit. How could such a tragic event happen? That was in the 70s when osteopenia (the earlier stage of bone loss) and osteoporosis were not a hot topic in the medical world or much discussed in public. Very little research, practically no treatment and no reliable statistics had been carried out until recently. She could have had her osteoporotic fracture prevented had she lived today when a great deal more is known regarding the prevention, treatment, and early detection of osteoporosis. Prevention

Appropriate Exercise Weight-bearing exercises, such as walking and jogging, and some weightlifting with dumbbells have become the gold standard in the prevention of osteoporosis. It helps your bones grow stronger and faster, due to the gravitational pull stimulating the osteoblasts in your skeleton to form more bone, thus outpacing the constant resorptive process of the osteoclasts. The resulting new bone tissue (trabeculae) proves to be structurally much stronger, up to 16 times, than those formed by pharmacological means such as the modern day anti-resorptive drugs – according to findings by the Royal Melbourne Hospital’s bone metabolism research team. In other words, the quality of the bone is far more critical than the quantity of the bone (the BMD – meaning bone mineral density) that you have built up by taking antiosteoporotic drugs. When you are in a weightless state for some time, like the astronauts, you will start to lose some bone mass, and that explains why astronauts always have to undergo vigorous medical tests including bone-mass appraisals after they have returned to the earth. Similarly, bone re-absorption will happen to your body if you have been sick and lying in bed for perhaps a few weeks, because you have had insufficient gravitational pull from the earth to stimulate your bone growth. Quit Smoking and Limit Alcohol Intake It is not surprising that cigarette smoking is damaging to your bones since cigarettes have been found to contain 4,000 harmful chemicals. Babies born to smoking mothers are almost always low in birth-weight and stunted in their growth. Excessive alcohol consumption has been implicated in many medical studies and seminars as one of the causes that accelerate osteoporosis. Stock up on Vitamin D and Calcium Stock up your body’s vitamin D by exposing yourself to the sunlight daily for about 30 minutes in winter and not more than twenty minutes in summer, before 10 a.m. and after 4 p.m. Keep an eye on the UV level forecast on the TV and your smart phone to avoid unnecessary exposure to the harmful ultra-

violet light. Furthermore, you can make sure you have sufficient vitamin D by taking a supplement daily. Like taking an iron supplement to overcome anaemia, a vitamin D supplement in tablet form does help. Have regular tests to ensure that your vitamin D is kept up to an appropriate level. Of course, apart from the sunlight, you can also obtain vitamin D from foods like fish, sweet potatoes (especially the purple ones) and shiitake mushrooms. Take in more calcium-rich food such as canned fish (which often contains bones), broccoli and beans, or resort to calcium tablets as a supplement for the sake of convenience. But always be aware that calcium supplements in any artificial form may not be so readily absorbed and incorporated into your skeleton as the calcium from food. Do not ignore your daily nutrition. Keep to a balanced diet plan and eat a variety of food as widely-ranged as possible, as you never know which calcium compound in which food will benefit you most. Avoid Falls This will reduce the incidence of osteoporotic fracture. Fall prevention has now been attracting more attention in community groups, nursing homes, and at retirement villages etc. where the nurses and community workers are kept alert to the high risk of a fall. Take measures to eliminate things that could cause falls such as eyesight impairment, weakened limb muscles from sedentary habits, poor posture, or brain- function disturbance affecting your balance such as in Meniere’s disease, middle-ear infections, etc. as well as clearing up the clutters of toys, shoes, and electric wires that may trip up the unwary elderly. Any fall in an osteoporotic person is a potential disaster to their health and wellbeing. Wear comfortable shoes that give you a better grip, better support and stability. No more high-heel or fancy shoes. Use a walking stick to steady your body while walking, and look out for the uneven pavement, pot-holes, stones and slippery patches on the road... Better still, find a companion to walk with you, or even to hold your arm to give you more support. A companion is far better than a dog, which may cause you to lose your footing and balance. Dog owners sometimes find themselves caught in the unenviable situation of having their dog stuck in a ferocious fight with another canine owned by someone out for a walk just like them. Try a Hip Protector

A hip protector used by the frail and elderly to cushion the harsh impact of a fall is a novel idea and worth further exploration. Have a full check-up by your GP, including the basic blood tests and X- rays of your thoracic spine, specifically requesting the radiologist to look for signs of vertebral fracture as this is often omitted or not looked for in their reports. You may then have a DEXA scan which could indicate clearly your critical bone mass density (BMD) in the lumbar spine and your hip joint, giving you an excellent idea of whether or not you have osteopenia or the more serious osteoporosis, so that you can receive the appropriate treatment.

Common Eye Problems Eye problems, mainly visual impairments, such as refractive errors, cataracts, glaucoma and AMD (short for Age-related Macular Degen-eration), are seen continually more often in general practice due to the ageing population. Just glaucoma alone is currently causing blindness in about three million Americans, as well as putting another three million at risk. According to the medical update seminar held at the Royal Melbourne hospital, the number of visually impaired persons aged older than 55 will increase from 4.4 million in 2002 to more than double that in 2032. Five per cent of people over 80 years old will be legally blind. Currently, in Australia, about 300,000 are blind or near-blind. The common causes of blindness, in descending order of frequency, are: (1) AMD (2) Glaucoma (3) Cataracts (4) Diabetic retinopathy (damage to the blood vessels of the retina due to long-term diabetes) For any one of the above problems, you are well advised to consult an eye specialist for future management. You should certainly not be running to an optician or a chemist for advice (as some of our patients sometimes do) to try to save a few dollars. In the end it will cause more harm and suffering to you if you delay the appropriate treatment by your eye specialist.

Preventative Measures Stop Smoking Cigarette smoking is known to cause up to four times more risk of developing AMD and cataracts. To quit is your first and foremost priority. Avoid Excess UV Prevent exposure to excess UV light by wearing good quality sunglasses and avoiding being unprotected outdoors at certain periods during the day when the UVB is at its highest. Watch Your Blood Pressure Treat your blood pressure and maintain it within normal limits. HBP is a contributing cause of glaucoma. Avoid Steroids Avoid steroids in any form, even the ointment, as they can increase the chance of getting cataracts and glaucoma, according to eye-specialist, R. Abel. Control Your Blood Sugar See your GP or diabetic clinic for a better management of your blood sugar level, maintaining it at below 6 mmol/l so that you can make sure you won’t get any of the eye problems from diabetes. However, the goal post has been continuously shifting – according to the latest research studies, ideally your fasting blood sugar level should be between 4.5 and five (even though the currently accepted normal range is up to six). The higher you go, according to the report, the more chance you could have of complications to your eyes, your heart, your kidneys and your toes. Maintain a Healthy Diet Food that is good for your eyes is important not only as a part of your plan to avoid diabetes, but also as a good source of anti-oxidant supplementation. All the green vegetables, colourful fruits, tea and red wine are a rich source of anti-oxidants such as vitamin A, C, E, zinc, lutein and zeaxanthine, now

being actively promoted by ophthalmologists. Exercise and Avoid Stress Avoid chronic stress – American ophthalmologist, Robert Abel Jr. in his book The Eye Care Revolution repeatedly emphasizes that glaucoma is a disease of stress. Chronic stress causes higher levels of adrenaline and raises your blood pressure and the pressure inside your eyes. Glaucoma is basically an increased intra-ocular pressure causing damage of the optic nerve (although the exact mechanism is still not known). Normally we all have some sort of stress from our work, family, colleagues and other factors, but this is usually short-lived and will not affect us much long term. To help relieve chronic stress, Abel urges people to walk, do Tai Chi and meditate for 10 minutes in a quiet spot every day to relax the whole person. In itself, it makes sense, and is part and parcel of the healthy lifestyle I invariably advocate. As always, exercise will also help. Regular exercise of moderate intensity will aid you in having healthier eyes simply because of its beneficial effects on your blood sugar and cholesterols. Having said that, it must be acknowledged that genetic and age factors will always play a large part in the final course of our eyesight.

Blepharitis This is an extremely common affliction of the eye among patients over 50. It entails a kind of low-grade inflammation of the eyelids, possibly caused by bacteria, dandruff, or some medication or cosmetics. Generally the patient feels something in their eyes, a somewhat gritty sensation that can be quite annoying. Eye specialists make it clear that there is little you can do to alleviate the condition except use antibiotic eye drops and an eye-care solution to clean the eyelids. It may even be necessary to take antibiotics on a long-term basis. Prevention/Amelioration You may possibly avoid this condition by refraining from rubbing or fiddling

with your eyelids with unclean fingers. Apply a warm, moist, clean face towel to your eyes daily for a minute or two and then gently massage and clean your eyes. Perform this several times a day and you may be surprised to find that this annoying eye condition becomes more controllable or even disappears altogether. The essence is cleanliness of the eyelids and promotion of healthy circulation. In addition, a good dose of regular exercise of moderate intensity and a healthy, nutrition-rich diet will invariably help invigorate the blood flow in the eye region, adequately nourish the tissue to resist bacterial growth and help stamp out this most annoying nuisance.

Stroke Every year 48,000 elderly Australians suffer a stroke (cerebral vascular accident – CVA) or transient ischaemic attack (TIA). In 2007 the Lancet warned that 10% of the world’s population would die from CVA. Early return of a stroke is common – up to 15% in the first week, 20% died within 30 days. Only 30-50% of survivors may be able to remain independent afterwards. It is a common misconception, however, that only the elderly are susceptible to such events. Every year we see about 2,000 people younger than 45 also suffer a stroke, and another 19,000 who are still active in the workforce (according to statistics from Strokesafe for Life, 2005). Another common misconception is that you cannot prevent or control stroke. Except in regard to the haemorrhagic type, this pessimistic view is, once again, outmoded and totally wrong. The view today is that, apart from a few uncontrollable factors such as age, gender and a positive family history of stroke, you can do a lot to lower the risk of one. Prevention Regular Blood Pressure Checks Check your blood pressure regularly with your GP. High blood pressure has been known to be the most important risk factor for stroke, so try your best to lower it by following the tips in the section on HBP.

Quit Smoking Smoking increases your BP and reduces oxygen in the blood circulating in your brain. As smoking can make the coronary artery in the heart go into spasm, the same undesirable effect can happen to the arteries in your brain. Besides, no one is sure yet what further harm the 4,000 chemicals and poisons in cigarettes might inflict on the blood vessels. Lower Your Cholesterol This will prevent damage to your blood vessels. A build-up of cholesterol plaques in the artery walls in the vulnerable part of your brain will easily block the circulation and starve the brain (non-haemorrhagic stroke) or cause rupture of the vessel walls (haemorrhagic stroke). There are many ways for you to lower your cholesterols as listed in the entry on hypercholesterolemia in this Chapter. Recently, The Lancet published the results of a large European study, conducted over five years on more than 20,000 people, which found that the daily use of cholesterol-lowering drugs (statins) reduced stroke by 25%. As a result, some leading neurologists, stroke specialists and even the National Heart Foundation’s chief medical advisers are now much in favour of prescribing statin drugs to heart patients, stroke patients and high-risk patients. Statins seem to be able to make the blood vessel walls healthier in addition to lowering lipids. Having healthy blood-vessel walls, particularly in regard to the inner lining called the endothelium, is recognised as one of the most important factors in preventing heart attack, stroke and kidney failure. Diet and Exercise Go for a balanced, low-salt, low-fat diet. People taking up moderate exercise are also less likely to have a stroke simply due to lower BP and cholesterol, with an increase in HDL to keep their arteries healthier. Prevent Atrial Fibrillation (AF: irregular heartbeat) This is a rather common cause of stroke, mainly because the turbulent blood flow in an irregularly beating heart facilitates the formation of clots inside the heart chambers. This is particularly true with the left atrium which may have a narrow passageway. The clots so formed are often fragile and can easily

break off into the blood stream to be carried into the brain where they block an artery causing a non-haemorrhagic stroke. So if you have noticed any palpitation, check with your doctor who can restore your heart’s normal regular rhythm by several means. If the AF persists, you will most likely be prescribed some blood-thinning agent like warfarin and some new generation anti-thrombotic drugs to prevent clot formation and potential stroke. Interestingly, a recent survey has found that regular intake of omega-3 fish oil could dramatically reduce the incidence of AF, indicating that AF may somehow be the result of unhealthy coronary arteries, possibly upsetting the specialised heart tissue which regulates your heart’s rhythm. Fish oil and the drug statins can restore these blood vessels to a healthier state, and thus greatly reduce the chance of getting a stroke. Manage Your Stress Having your stress adequately managed could greatly lower your chance of getting AF. Chronic stress brings with it an increase of some undesirable hormones, chemicals, insomnia, and general under-performance of all your systems, thereby imposing, both directly and indirectly, an extra burden on your heart. Control Your Bodyweight and Avoid Excess Alcohol By avoiding obesity, you literally help control your BP, your cholesterol, and your diabetes – the three most important risk factors for stroke, as all of them damage your entire circulatory system, including that of your brain. Nowadays it is well known that a glass of wine, particularly red, is good for your CVS (cardiovascular system). But excessive alcohol has the opposite effect by raising your BP in addition to causing cirrhosis of the liver.

Transient Ischaemic Attack (TIA) This is known as the ‘mini-stroke’ and is a warning sign caused by the same mechanism that causes stroke, but in a much milder form. Usually one recovers from it in a day or two. Though mild and brief, TIA is still

frightening enough. It is a timely reminder to change your lifestyle and avoid the disaster of a real stroke which promises to strike anytime. Sometimes a check-up by your GP may uncover a badly blocked artery in your neck, quite unsuspected by you or anyone else; often in such cases, a new artery can be used to replace the clogged section and avoid further damage to the brain.

Shoulder and Foot Injuries In our family clinic, I have come across a wide spectrum of injuries in accidents that happened at home, in the streets, in the schoolyard, and in factories. Most are in the category of minor cuts and bruises and are not worth mentioning. But a few of them are rather interesting and have become easily diagnosed since the introduction of the ultrasonic imaging method which, in experienced hands, is able to pick up almost all of the soft tissue injuries to tendons, ligaments and muscles. I am going to list a couple of such common injuries below, so that you may be able to avoid them by following simple guidelines. Torn Shoulder Tendon Typically an elderly woman, about 60, would come in and tell me that lately she had noticed a fair bit of pain in one of her shoulders (or both in the rare case). She would be unable to raise her arm on that side to comb her hair or even to scratch her neck and ear. Going to bed is even more troublesome as the shoulder aches all night no matter which side the sufferer tries to lie on. Often such shoulder injuries happened after an accidental fall on one shoulder or on both hands, or after lifting something heavy above shoulder-height, or simply after hanging up the washing! The ultrasonic scanning almost unfailingly reports a full thickness tear of the supraspinatus tendon (which is the tendon responsible for pulling up your arm from the horizontal level). Treatment is never easy and tends to be an ongoing business involving essentially intra-articular injections by your GP or radiologist, preferably performed under ultrasound guidance. This will relieve the gnawing pain until an operation to sew the broken ends of the tendons together can be performed. Months of rehabilitative physiotherapy are also needed. The

trouble is that the operation, more often than not, will not completely end one’s woes. Therefore, taking measures to prevent this kind of injury is very worthwhile. There are also a few other common injuries to guard against, like partial tendon tear, tendonopathy and bursitis. Bursitis is becoming very common due to over-exercising, which causes inflammation of the bursa: the protective cuff of a tendon. A more serious complaint is ‘frozen shoulder’ or capsulitis, which requires prolonged treatment. Prevention Sensible Exercise Start gentle exercise daily, preferably when you are still young or before middle age. The ideal types of exercise are Tai Chi, stretching, Yoga and swimming. All these involve gentle, sustained, all-round movement of your joints with their encased tendons and ligaments, helping them to become more supple, more resilient, stronger, thicker and healthier. A strong, healthy, well-lubricated tendon is obviously best suited to withstand the strain from normal daily chores. The key phrases are gentle exercise, starting young and regular workout. Never fail to do some warm-up exercise, or light jobs before you perform a heavy task such as lifting or heavy gardening involving your shoulders. Tendons and ligaments, perhaps more than your muscles and internal organs, require quite a few minutes’ warm-up to build up their strength for a heavier job. Never over-estimate your strength. Be conscious of the rule of thumb that you are losing 10% of your strength every decade from the age of 20 onward. Be also acutely aware that lifting things over shoulder height carries a much heavier strain on that particular shoulder tendon which could easily snap if already frayed due to years of disuse, under-use, or plain abuse. Once snapped, the torn tendon will give you years of pain and disability in addition to endless nights of insomnia. Plantar Fasciitis This is the inflammatory damage to the large, fan-shaped ligament under

your foot, stretching from the heel bone to the toe bones. When it becomes inflamed (invariably on the heel end), the victim will often have great difficulty standing on their feet when they first get out of the bed in the morning because of sharp pain, plus lots of ‘pins and needles’ in the heel. Such pain in the feet could last for months, causing a lot of hardship as the sufferer will find it hard to do their daily errands and activities. Fitnessconscious individuals often end up deeply frustrated and don’t know what to do as they must give up their power walking and jogging until the injury is healed. Of course, treatments are available in the form of traditional acupuncture or the modified type which uses the Codetron machine, or ultrasonic therapy in some X-ray clinics. As usual, prevention is best. Prevention As this condition is predominantly caused by over-use such as that involved in an excessively long walk, or jogging and running which practically involves a heel strike at every step, you can avoid this happening to you by building up your exercise programme slowly and steadily, at least for some months before you increase the duration and the workload. Any sudden increase in your training programme could cause injuries to your heels, feet, ankles, and knees. Otherwise, the second important point is to train on a cinder type of jogging track and to wear jogging shoes fitted with good quality insoles. The shoes need not be expensive as long as they are comfortable. The treadmill generally has a huge advantage over outdoor concrete pavement and tar roads because of its in-built buffering system which automatically minimizes trauma to the heels. Lastly, an adequate warm-up is a must to prepare the plantar ligaments and the heel bones to withstand the impact of jogging and running. Another Lesson Learned First Hand In 1987, I was aware that there would be a marathon held in Melbourne in 1988 to mark the Bi-centennial Year of Australia’s Independence. It struck me then that it would be a good idea to participate in the race, partly to fulfil my childhood dream of being a marathon runner, for I well remembered

thrilling to the story narrated to me by my older brother about the famous Greek runner who brought the good news of victory by running 150 miles from Athens to Sparta. Participation in the race would also allow me share the spirit of the Bi-centenary Year’s celebration. Altogether it appealed to me as an excellent event in a memorable Year (as 1988 has two 8s, a figure symbolizing wealth and fortune, that year was significant in the eyes of the Chinese). For a few years already, I had been in the habit of jogging three to four miles most mornings. I followed the advice by the Australian marathon champion, Robert De Castella, and started to build up my daily mileage to six miles a day, and eight to 10 miles some weekends. But I was still in full-time general practice and shouldering most of the workload because the new junior partner had a lukewarm attitude towards family medical practice. Therefore, I was not able to be fully dedicated to the training schedule. In fact, I had only been able to trial run a half marathon twice, and a full marathon once (with some difficulty) within two months before the race. This could be translated as being under-trained and under- prepared, as the standard advice was to have at least two to three full runs within two months of the race. In the end, although I ranked in the middle of 5,000 runners in that 24-mile race from Frankston to the Arts Centre in Melbourne, my time at four hours was a disappointment to me. And I paid the penalty for my inadequate training with precisely this wretched plantar fasciitis in both feet, hurting me for months until I cured it myself by Codetron therapy (the needleless acupuncture). This therapy, incidentally, was first introduced into Australia in 1988 by Dr Tom Tsiang and Benny Foo, the leading medical acupuncturists at the time. I was truly grateful to these two colleagues who had imported the machines from Canada in time for my self-treatment, for I could not bear the thought of sticking acupuncture needles into my own heels and legs (or having anyone else do it for that matter). th Interestingly enough, while property hunting in Cairns on 9 October 2005 and walking out of my hotel, a headline in the Courier Mail caught my eye – ‘Melbourne marathon starting today’, and it went on to say that there were 8,000 participants that year, but still running along the same route starting from Frankston to the CBD and ending at the Arts Centre. The temperature was predicted to be within a very pleasant 10 to 16 degrees. Clearly the

crowd is growing every year, and this is a good sign, for it implies an increasing number of people are again catching onto the idea of jogging, running and keeping fit, with some of them doing well enough to run the marathon. Take Home Message Inadequate training and preparation will only result in below-par achievement, with the potential for all sorts of injuries to your body.

Chapter Six The Eastern Way of Maintaining Health and Fitness ‘The most beautiful thing we can experience is the mysterious. It is the source of all art and science’ Albert Einstein13 Most people, including doctors, would be surprised to know that, before the turn of the twentieth century, mainstream Western medicine, as is practised today, was actually regarded as ‘alternative medicine’ throughout most of the world. Even today, it has been estimated that only 10 to 30% of human healthcare is delivered in the form of conventional, biomedically-oriented Western medicine. The rest of the world is using many other different healing systems, of which the Indian and the Chinese ones predominate. The Indian and the Chinese health systems have been developed over several thousand years, long before Western medicine had established a foothold at the turn of the twentieth century by making surgery safer and by the discovery of powerful antibiotics that cure life-threatening infections. Western medicine approaches healthcare via direct, interventional methods and has worked wonders, particularly with acute illnesses, mass vaccinations and surgical operations. Its basic principle is to target the disease, study the cause and the pathology and develop the specific drugs or the operation to fight and eliminate them. In doing so, particularly when carried out by specialists, it tends to look at the individual as a series of isolated systems, organs or body parts instead of treating the patient as a whole and integrated person. Over the years, it has been shown that many chronic ills such as osteoarthritis, diabetes and mental illnesses have responded poorly to modern Western medical therapies. The frustration and dissatisfaction of the patients have driven more and more of them to seek alternative pathways for relief. It has been found that almost half of the population in the U.S. have sought socalled ‘alternative’ (or perhaps more appropriately ‘complementary’) medicine to get relief. Australians are not slow on that path either.

The Eastern health systems are well organised and embrace their own philosophical, spiritual and scientific thinking. They emphasise the critical role the individual’s participation plays in controlling their own health and believe that the body is capable of healing itself and staying healthy with suitable diet, exercise and meditation. This is augmented by herbal medicine used according to the knowledge and experience accumulated through thousands of years of research. Above all, the central concept is to restore balance in your body’s systems and to reinforce the vital energy (which is called ‘chi’ or ‘qi’ in the Chinese system). Eastern health therapies seem to work very well alongside Western mainstream medicine, notably in the chronic conditions mentioned above. This is because, through several thousand years’ experience, the Eastern health system has discovered the basic principle that a healthy diet, regular exercise and daily meditation are usually effective in helping patients with chronic medical conditions restore their health and maintain it. The patients also feel that by their participation in healthy dieting and regular exercise they have regained the control of their own body, instead of being controlled by drugs or surgical means. These Eastern principles of healing appear to have an incredibly powerful effect on the patient’s mind and attitude, and can directly help motivate them to continue with the therapies. Warning It must be realized that, to date, there is no magic cure for most chronic medical conditions. Eastern health therapies are not meant to cure but to help relieve pain, ease stiff joints, balance the working relations in your internal organs to strengthen the vital life energy in your body and restore your confidence and feeling of wellbeing. Beware of snake-oil salesmen who boast of ‘instant cures’ or ‘quick fixes’. All their sweet-talk is nothing but a conman’s well-rehearsed spiel used to rip off the desperate and the gullible. There are all too many such types, not only among incompetent herbalists in the East. They also pop up in the West (remember the films The Great Imposter made in 1961, or Catch Me if You Can made in 2002?). The reader may be able to recall the latest medical imposter was a man from India. He had in some way come to possess a dead doctor’s identity and brazenly practised in several Sydney hospitals as a

visiting doctor, treating patients! How he managed to get through the strict scrutiny of the medical board is anybody’s guess. Also, not all complementary medicine is useful. Sometimes its use may even be dangerous, as it may be ineffectual and just delay proper diagnosis and treatment. There have also been a few reports alleging that some Chinese herbal medicine has been found to contain undeclared substances such as anti-histamines or heavy metals like arsenic and cadmium at a level 10 times above the accepted standard, and other contaminants like Viagra and steroids have been found. Always consult your family doctor first about any of your medical problems before seeking treatment from complementary therapies. As most of us are aware, Western diagnostic aids and technologies are highly developed and extremely reliable in this day and age. Without proper investigation in the form of blood tests, X-rays, imaging and biopsies to establish the correct diagnosis, appropriate treatment might not be found and the result could be disastrous.

Chinese Medicine Chinese medicine is one of the oldest healing systems and began nearly 2,000 years ago. Most of its concepts, theories, and practices which are based on the observation of nature, life cycles and diseases, have largely been recorded in the famous treatise Huang di Nei Jing (the Yellow Emperor’s Treatise of Internal Medicine) compiled in about 470 BC. The key principles of Chinese medicine centred firstly on the balance of Yin and Yang, which are opposing energy forms – Yin being feminine, cool, passive and dark, while Yang represents masculine, warm, active and bright energy. Secondly, much emphasis has been placed on qi (the pin yin version of chi) which has no equivalent word in English. I believe that ‘qi’ could be interpreted as a collective term representing vital life energy in the form of circulating blood, nerve impulses, and the spirit. Blockage or weakening of qi is the cause of diseases and medical problems. So the priority of therapy is to unblock the qi channels (called ‘meridians’) and/or reinforce the qi by various means.

Acupuncture uses needles, inserted at different points along the qi channels to unblock them or reinforce the qi, usually to good effect. It works particularly well with pain due to chronic medical conditions such as arthritis. These days, millions of people try acupuncture primarily to relieve their pain. This subject will be expanded further later on in the chapter. To balance the Yin and Yang and to strengthen the qi, the Chinese utilise herbal medicine, Tai Chi and Qi Gong. These will only be outlined briefly under separate headings below, as a more elaborate discussion is beyond the scope of this book. New Dimension in Chinese Medicine Back in 1996, I toured China with a medical group, led by the eternally energetic medical education tour leader, Dr Benny Foo. I was greatly astonished to witness the incredible changes happening in the practice of traditional Chinese medicine (or ‘TCM’). In the leading training college in Beijing, we saw TCM practitioners using ultrasonic imaging and CT scanners, along with all sorts of laboratory diagnostic methods we usually employ in Australia, to help make a more definitive diagnosis. Their therapies also included using plaster (over layers of newspaper) to treat fractured limbs and traction machinery for prolapsed disc in the neck and lumbar spine. At the same time, they retained their time-honoured therapeutic tools such as acupuncture, moxibustion and dried herbal medicine. It seemed a fine way of marrying the medicine of East and West and getting the best of both worlds. Herbal Medicine The history of Chinese herbal medicine can be traced back as early as 500 BC. In about 200 BC, the renowned Chinese surgeon Hua Tor, together with another great physician, contributed many important descriptions on the use of medicine. But it was Hua Tor’s pupil Wu Pu who compiled the first Chinese pharmacopoeias by collecting and categorizing most of the materials and descriptions from Hua Tor. This work was called Shen Nong Ben Cao Jing (The Chinese Pharmacopoeia). It described 365 substances derived from animals, plants and mineral sources.

From this prototype, the official version called the Tang Ben Cao was published in 659 AD. It contained 850 medicines and was compiled with the blessings of the government (the mighty Tang Dynasty) nearly nine centuries before the famous Nuremberg Pharmacopoeias appeared in the West in 1542 AD. In 1600 AD, the great work by the most famous Chinese herbalist, Li ShiChung, was compiled – the Ben Cao Kang-mu (The Chinese Pharma-copoeia in Manuscript). In 52 volumes, it describes 2,000 substances – all collected from the fields – and has the most logical system of classification. This great work by this incredibly dedicated Chinese herbalist remains the most important reference book on Chinese herbal medicine for all TCM practitioners today. Ben Cao is basically a textbook of pharmacology, the bible for the TCM practitioner. It represents a large selection of crude drugs whose therapeutic value has been proven through centuries of usage and experience. There are numerous reputable Chinese medicine colleges. In Hong Kong alone, there were at least half a dozen such well-established institutions in my time before I moved to Australia to study medicine at the University of Sydney in 1954. Practitioners of TCM graduating from these schools would have attended some three to four years of formal classes on traditional theories of diseases, the balance of Yin and Yang and the inter-connection of the different Chi. They would have learnt about the Four Basics of Diagnosis – observe, listen, question, decide – and the all-important concept of the Eight Categories – Yin/Yang, external/internal, cold/hot, empty/solid. The pharmacology of Ben Cao would also have been central to their studies. Once the practitioner has made a diagnosis, they will decide on the type of treatment you need. They may prescribe some herbs, usually in dried form, in various proportions. The patient boils these and drinks the extract, to balance the Yin and Yang and warm up the ‘cold’ or cool the ‘hot’. About 80% of traditional Chinese drugs come from herbal plants, while the rest are derived from fungi, animal products and minerals, fruits, vegetables and cereals. These substances, particularly the herbs, are traditionally supplied in their raw state and have to be boiled thoroughly until their essence is extracted and they can be taken.

The study of herbalism is extremely challenging and requires an enormous amount of dedicated effort, money and time and the coordination of experts from botanical, biochemical, and pharmacological fields. My late father, formerly a professor of the ENT department of the Sun Yat Sen University in Kwangtung province was one of these dedicated people. From his teens, he took great interest in Chinese medicinal plants and spent his whole life in Hong Kong collecting, preparing, identifying, correctly naming and categorizing their Latin names. Eventually he organized the local TCM practitioners and their college students to jointly go out every Sunday to the hills and villages to collect and identify specimens. A few years before he passed away, he and one other leading practitioner of Chinese medicine, in collaboration with a group of devoted helpers, compiled five volumes describing commonly consumed medicinal plants in Hong Kong. This fine work was written both in Chinese and English, with all plants properly identified by their Latin nomenclature and nicely photographed in colour in their natural habitat. Called Chinese Medicinal Herbs of Hong Kong, it was published in 1978 and became well known among the traditional Chinese medical practitioners and scholars interested in herbal medicine. It was a great achievement for all concerned. Just in the Hong Kong-Kowloon peninsula area of 30 square miles, according to my late father, approximately 2,400 varieties of plants can be found. Out of these, about 1,100 are medicinal herbs used by the Chinese. Descriptions of half of the commonly consumed varieties have now been compiled in their book, providing an important and very handy reference for anyone interested in Chinese herbal medicine. It is fascinating to note that the Chinese can find some medicinal use for almost every part of a plant. For example, with an ordinary mulberry tree, its root can be used as an antitussive (to control coughing) and as a diuretic (to make more urine), while the leaves are antipyretic (fever reducing), the branches are also used to reduce fever and pains and the fruit is regarded as ‘nourishing to the blood’. Such are the wonders of human knowledge and experience recorded and passed on from generation to generation for the last 2,500 years. All this knowledge was gained without modern biochemical analysis, without animal experiments and without the aid of computers!

Taking traditional Chinese medicine is very different from taking its western counterpart. As most of it comes in dried form, it has to be soaked in water and boiled for some hours to extract all the goodies before you drink it undiluted. You can imagine the dried-grass smell and the often bitter taste. In recent years, this has been modified to the extent that many varieties of pills and tablets have been made from extracts of herbal medicine, as are often shown to me by my Chinese patients. They visit their relatives in China and bring back all these modern versions of herbal medicine in colourful tablets, nicely packed in boxes and packets, making life much easier. Coming back to the TCM practitioner – if they feel that your problem is more centred on your qi dysfunction, they may decide that you should try acupuncture to ‘unblock’ some meridians, in addition to using Tai Chi, to reinforce your chi.

Acupuncture The Chinese have used acupuncture, along with Chinese herbal medicine, as a major therapeutic resource for the last three to four thousand years. In addition to its incredible effect on the regulation of qi, it has been known to relieve many types of physical pain (except those induced by cancer). In recent years, two leading neurosurgeons in Hong Kong, H.I. Wen and S.Y.C. Cheung, have even discovered how to successfully treat drug addiction using electro-acupuncture, paving the way for the subsequent widespread use of such methods to treat all sorts of drug addictions including nicotine and alcohol addiction. Acupuncture has gained such a favourable reputation that even those Americans who were initially sceptical now flock to the local acupuncture clinics by the millions every year. Basically acupuncture involves inserting fine metallic needles into the strategic acupuncture points along the invisible ‘meridians’ or channels. An American Chinese professor in Anatomy, W Cai, has claimed these channels coincide closely with the major nerve trunks in the body. Quite a few articles on this topic based on his research findings were written a few years ago. By stimulating these points numbering from a few to dozens, the vital life energy flow in your body can be harmonized or enhanced to give you a feeling of

wellness or of heightened energy. The great ancient Chinese surgeon Hua Tuo, a skilful acupuncturist, believed in using only a minimum number of needles to achieve the desired therapeutic effects after a correct diagnosis. The Roots of Acupuncture Acupuncture can be traced back to the Stone Age when people used stone knives or small, sharpened stones to press on certain parts of their body to seek relief from pain. Such therapy performed in the Stone Age was recorded in Shuo Wen Jei Zi, a book published in the Han Dynasty (206 BC). But such crude tools were quickly replaced by sharpened animal bones and bamboo. By the Shang Dynasty (1600 BC), as bronze casting was well developed, bronze needles took over as a much more precise tool in acupuncture. Then again, in about 600 BC, iron and steel needles dominated the field as these were more malleable and easily handled. They could be made into fine and flexible needles called ‘hair needles’ which were favoured by many acupuncturists in those periods. Meanwhile, acupuncture points and their related meridians had been traced and recorded, either by renowned physicians like Pien Chueh and Hua Tuo in their own works, or by court officials appointed by a number of emperors to compile the information. For example, the topic of acupuncture occupied a large part of the ancient Huang di Nei Jing alongside a dissertation on the fundamental medical theory and practice of the time. Ling Shu, (The Celestial Secrets), the part of the treatise recording most of the knowledge of acupuncture, even included a paragraph stating that, ‘the ear is the place where all the channels meet’ foreshadowing the development of present day auricular acupuncture. During the great Tang and the following Sung Dynasties (618 to 1368 AD), acupuncture training was formally established at faculties in the Imperial Medical College for all students aspiring to be TCM practitioners. Two lifesized, hollow bronze figures were cast, with a total of 657 well-defined acupuncture points marked and engraved on the surface. Using such a 3-D replica of the human body was an unbelievably clever idea and must have made a huge impact on students learning acupuncture at that time. Acupuncture had also spread, as early as the 6th century, to Japan and the

countries of South East Asia. In 1683 a German physician introduced it to his country and, soon thereafter, it was brought to France and other European nations. The Effects of Acupuncture The key component of acupuncture is the regulating and harmonizing of the vital life-energy flow in the invisible channels in the body. The theory is that illness and pain have upset the steady flow of qi along the meridians. Needles inserted at the strategic acupoints can unblock the channels and reset the natural flow of the qi, causing the ills and pains to disappear. Acupuncture has naturally been a great puzzle to the Western scientific community for a long time, as nobody has ever been able to comprehend why a needle inserted into your big toe can stop your migraine headache, or one in your ear could relieve the pain in your knee. However, that the effects of acupuncture are undeniably real has recently been further verified by brain imaging, blood tests and other investigational methods, even though we don’t quite understand how and why it works. It has been discovered that stimulating acupoints can cause biological responses, can affect the body’s blood and immune system and, as is well known to many neuroscience researchers, it can cause the release of endorphins and enkephrins in the brain to act as your body’s own pain-killers. Endorphins flow to the painful areas, blocking the pain signals’ contact with the nerve endings, so that they are perceived by your brain as much weaker or even eliminated. Other brain chemicals (neuro-transmitters) have been found to be released into the blood stream that could also influence the experience of pain or trigger off more chemicals, enzymes and hormones which play a major role in the internal regulating system of your body. Equally important to the patients is that acupuncture therapy is safe, indeed much safer than taking pills or other Western medications, provided, of course, that a proper aseptic technique is used and some rules of common sense are followed by the practitioner. In my 25 years as a medical acupuncturist, I have never had a single case of hepatitis or even any minor infection caused by acupuncture. The few

complaints I have encountered have concerned a little dizziness or some discomfort from the needles. This low degree of impact is amazing in comparison to the whole spectrum of side effects involved with Western medicine from widespread itchy skin rashes and stomach upset, to serious complications of allergic reactions like Steven-Johnson Syndrome and anaphylactic shock (extremely worrying and frightening). And, indeed, most such complications have been witnessed in quite a few of our patients who developed violent allergic reactions to their medications. In our clinic in Glenroy, which was a typical family medical practice, I found acupuncture most useful in relieving pain from any source except cancer. Electro-acupuncture, where electric pulses produced by a machine augment the effects at acupuncture points, proved particularly effective. In my small study of 204 patients treated over four years, approximately 74% enjoyed significant pain reduction well beyond three months. Twenty-five per cent of patients reported complete relief of pain after all other common Western therapies had been tried and pronounced a failure! It was incredible to me at the time and spurred me on to offer my patients the choice of acupuncture from then on, until recently when the short- sighted government bent to pressure from TCM organizations and made the requirements to practise acupuncture more difficult for senior medical practitioners. Similar unnecessary regulations by the government, who succumbed to pressure from the radiologist crowd, to cease the on-site X- ray service provided in our clinic, provided to many hundreds of needy patients, often makes me wonder if some senior government officials are really adequately informed and knowledgeable in their portfolios. Political expediency? Or bureaucratic myopia? You can form your own verdict. Other Therapies Using Acupoints Moxibustion Moxibustion is sometimes used as an alternative therapy to warm the acupoint and promote the flow of qi and blood along the meridian. This is achieved by burning moxawool or some other medicated material close to the selected acupuncture points. To protect the patient’s skin from the heat and avoid burns, the acupuncturist may place something between it and the fuel –

usually a piece of ginger, garlic, or some salt. Cupping This is another variation of acupuncture. The operator first creates a vacuum in a cup that is made of glass, porcelain, bamboo or plastic, either by extracting the air or by igniting some material inside it. The cup is then attached to the desired points or diseased part of the body. The effect is to dredge the meridian and promote the movement of the qi and blood along it, thereby regulating the Yin and Yang. At the end of the procedure, you will see a large bruise on the sites where the cups have been attached, indicating a collection of toxins etc. which will be cleaned up by the body’s scavengers. Acupressure This is the easiest method of all. The fingers or fingernails are used to massage the relevant acupuncture points for about 20 to 30 minutes, or until the pain or the symptoms are relieved. Naturally, acupressure is only used for minor discomfort or ailments.

Tai Chi Legend has it that this ancient form of exercise, meaning ‘Supreme Ultimate’ in Chinese, was established about 800 years ago by a senior Taoist monk residing at the monastery at Wu Dong Mountain, after his chance observation of a battle between a graceful crane and a coiled snake. But historical records put the origins of Tai Chi boxing at somewhere between 300 to 600 years ago when the first series of movements were devised by the legendary founder, Chang San Fan, a general in the Ming Dynasty. The arts were subsequently passed on to different masters who modified the styles and named the new forms after themselves. Today there are at least four popular styles known as Chang’s, Young’s, Ng’s and Wu’s. All of them are basically quite similar, only varying from one another in terms of speed, posture and some slight difference in the movements. The number of movements in Tai Chi starts from a basic 24 to over 100 that require up to an hour to perform. You can practise Tai Chi alone, in a class, or as a mass exercise as happens daily in many parts of China where

hundreds of practitioners can be seen performing these smoothly flowing movements in huge open public places early in the morning. Why must it be done in the early morning and not the late morning or in the evening after office hours? Because, according to Tai Chi masters, you will absorb pure chi from the earth in those hours when the day breaks. The heart of Tai Chi is in its graceful movements which are executed slowly while your mind is alert and you concentrate on every movement, on balancing your body, on shifting your stance and posture, and on deep and rhythmic breathing using your abdomen (abdominal breathing has played a pivotal role in Chinese martial art for a long time). Tai Chi may look simple, gentle and effortless, but by the end of a practice session, many people feel all warmed up and are perspiring. Some can even feel their chi flowing into their abdomen! Because Tai Chi is mainly a continuous flowing movement of all the muscles, joints and almost all parts of the body, in a most relaxing and balancing way, any person can learn and perform it unless they are too sick to stand. So it is easy to understand why Tai Chi is often part and parcel of the holistic approach in Chinese medical treatment involving herbal medicine and acupuncture. The three forms of therapy are complementary to one another in balancing the Yin and Yang, regulating the chi flow and reinforcing the vital life energy. The Health Benefits of Tai Chi It is an excellent form of exercise for all age groups ranging from young children to 80 and 90 year olds. Because of its gentle, free-flowing yet controlled movements, a kind of virtual meditation in motion, it is even suitable for those with chronic painful conditions such as arthritis, myositis, fibrositis, (possibly even cancer pain), especially for injuries from work, and for rehabilitation of people recuperating from operations. Tai Chi should also be an effective complement for other forms of rehabilitation such as physiotherapy and hydrotherapy, but so far I have yet to witness such an ideal marriage in Australia, possibly due to a lack of communication and cooperation among the concerned professions. With proper promotion and wider recognition of the virtues of Tai Chi, such a combination may one day evolve and bring in greater health benefits to patients with chronic

conditions. Tai Chi is good for your heart and circulatory system. Its gentle, continuous movements, unlike other types of fast and jerky exercises, guarantee a smooth circulation of blood to your heart with minimal stress. This means your heart will not get tired easily and your endurance will be enhanced accordingly. People with angina (chest pain due to reduced blood flow to the heart) and restricted peripheral circulation should experience more relief from practising Tai Chi than from most other forms of exercise. Tai Chi practice results in healthier, more efficient lungs. Because it involves continuous yet slow deep breathing through the diaphragm and abdominal muscles, prolonged and regular practice of Tai Chi can increase your capacity, giving you bigger lungs and a healthier bronchial tree. This is good news for asthmatics and sufferers of chronic lung disease – as a better functioning respiratory system means more oxygen for the body and less medication for the patient. A stronger yet more flexible spine is another benefit as the essence of Tai Chi movement rests in the spine, each movement being initiated by the trunk and followed by the limbs. The balancing of the trunk has to be constantly controlled by the brain – hence the key phrase ‘concentrating on the mind power instead of the physical force’. Furthermore, Tai Chi emphasizes the correct posture of the head and neck in addition to constant contraction and relaxation of major muscles in the neck and the back, thus greatly helping people suffering from ‘whiplash’ injuries of the neck and chronic lower-back syndrome. Other more subtle benefits include better balance, endurance, coordination and fine motor control, sharper reflexes, better digestion and metabolic rates and improved flexibility of all the joints. It also improves your awareness of your body, your postural alignment and muscle strength. Tai Chi also stimulates the mind. Although the movements are simple, it has great diversity and is therefore mentally challenging as you continue to learn. Learning and mastering a new set of movements gives you satisfaction and a sense of achievement. So if you keep going like most followers do, you will never ‘finish’ learning Tai Chi. As a logical consequence, your mind is kept active all the time while enjoying this group exercise. What better way can

you find to activate an elderly person’s brain while they are performing a graceful, relaxing exercise that will endow them with poise, balance, coordination and endurance? Recently, researchers from Tufts Medical Centre in Boston who analysed 40 studies done on thousands of Tai Chi practitioners have drawn the conclusion that the practice of Tai Chi ‘significantly reduced stress, anxiety and depression owing to their flowing arm movements, breathing, balance, shifting weights constantly and focussed awareness’’. That pretty much puts the health benefits of Tai Chi in a nutshell.

Qi Gong Qi Gong or Chi Kung, is a much older method of health maintenance practised in China, as far back as 3,000 years ago. The basic principles of Qi Gong and Tai Chi are quite similar. Both methods incorporate gentle movements and meditation to strengthen the qi and direct its flow through the body to promote health and inner calm and to alleviate stress. However, Qi Gong has fewer movements, tends to hold postures for a few seconds longer and is not as fluid or as graceful as Tai Chi. The advantage of Qi Gong is that the movements are much easier to perform, even if you have very stiff joints such as in advanced osteoarthritis of the hip or the knee. Some styles of Qi Gong involve only the upper body, so that the movements can even be practised by patients severely disabled with arthritis of the lower limbs or very weakened, bed-ridden cancer sufferers. In a Qi Gong class, as with Tai Chi, students usually start with meditation and deep-breathing techniques to experience their own qi before commencing the forms. Otherwise, the effects and benefits of Qi Gong are quite similar to Tai Chi.

Ayurveda Ayurveda, meaning ‘science of life’ is the ancient healing/health system of India. It is possibly the oldest medical system in the world. Said to be have

been practised about 5,000 years ago, it is based on the Hindu texts of the Vedas which describe life in philosophical, spiritual and scientific terms. The original aim of Ayurveda was to maintain physical health and wellbeing so that people could pursue spiritual growth. The principles are based on the concept of vital life energy prana and seeking a balance of the mental, physical and spiritual. It promotes a healthy lifestyle through the consumption of wholesome food, regular exercise, daily meditation and moderation. These will be presented to the patient as therapeutic advice and then it is up to them to take it up and maintain their health. The theory of this health system rests on the belief that all life on earth is composed of prana, as well as five key elements. The prana and the five elements are changing all the time inside our bodies and outside in nature. The balance of these forces gives you good health. To restore and balance these forces, you are advised to adopt a vegetarian diet and practise yoga and meditation. To give one’s prana a lift, one practises breathing exercises called pranayama. In a typical consultation and treatment, herbs, supplements and remedies are always given. And, as Ayurveda teaches the importance of cleaning out your digestive system of toxins that build up all the time, a series of purification treatments including purgatives and vomiting could be prescribed. Ayurveda still remains the dominant healing system in India, but, as with Chinese medicine, it is often used in conjunction with Western medicine. Its herbs, remedies and therapies are not well known outside of India. Yoga is the only Ayurvedic healing method that has gained popularity in the West in recent years, however, the anecdotal evidence I have from my patients who have used Ayurvedic remedies has been generally favourable.

Yoga ‘Yoga’ is a Sanskrit word that means union – one of the mind, body and the spiritual training method. Its daily practice aims to bring all the life’s interacting forces into harmony. There are several varieties of yoga, all of

which focus on breathing techniques, gentle stretches and balancing exercises, in a series of carefully performed postures (asanas). Health Benefits of Yoga Daily practice of yoga can help the joints remain more flexible and to move through a greater range due to the slow stretching exercises involved. The meditation that forms part of yogic exercise brings with it the benefits inherent in any form of meditation – that is, relief of stress and anxiety. The deep breathing in a yogic training session, as with all deep-breathing exercise, will help your heart, lungs and diaphragm muscles to become stronger and make your body more relaxed. However, as yoga is essentially a static, postural exercise, it is lacking in many of the important health benefits of aerobic exercise. Warning – as yogic postures are often precise and delicately balanced, even gentle yoga can be harmful if done incorrectly. Therefore, it is vital that one is taught by a properly trained instructor and periodically performs under their supervision.

Meditation Meditation could be regarded as one of the oldest and most common practices in Eastern systems of health and healing. It has its root in most religions of the world, from the oldest Buddhism to Western Christianity. Often spiritual leaders use meditation to achieve a state of peace, inspiration or closeness to the Divine. The constant practise by these people, particularly in the East, has inevitably convinced them of the great benefits to both their mental as well as their physical health. This knowledge has since been passed on from generation to generation for thousands of years and has long been an integral part of the healing system. Meditation did not get into the headlines until the 60s when the Beatles first practiced transcendental meditation with the Indian yogi Maharishi Mahesh Yogi. Nowadays, it has become widespread because of its health benefits. Above all, it could be rated as one of the cheapest therapies in the world for

the alleviation of stress and pain as it does not require any expensive nor elaborate equipment. All you need is somewhere quiet and peaceful to sit. There is no need for medicine or remedies either. And it can be carried out by anyone, as pointed out by the Harvard University professor, Herbert Benson, who did research into the effects of meditation. Benson called it ‘the relaxation response’ which can be achieved by concentrating on any phrase or sound. In his view, it is the regular practise, not the specific technique, that brings about the response.14 Health Benefits In the last few decades, research carried out regarding the effects of long term meditation on health in general has pointed to the following conclusions: 1) Regular meditation can affect many physical functions such as your heart rate, blood pressure, and the levels of your stress chemicals. 2) It can significantly relieve chronic pain such as fibromyalgia (muscle pains and aches, whether localized or all over your body). 3) It can calm down your anxiety levels so that you can handle your daily stress better. 4) In general, meditation can profoundly influence your physical health. Recently, neuroscience researchers uncovered some unexpected findings by studying the brainwave activity of Tibetan monks who have been practising regular meditation for years. Tibetan monks, like many Taoist monks, Indian yogis and Chinese Buddhist monks, practise meditation daily as part of their religious training and are also renowned for their mental discipline, resolve and inner calm under adversity. An article in The Age reported on the study of meditating monks using brain scans, conducted by Richard Davidson, a neuro-scientist at the University of Wisconsin. Gamma waves are among the highest frequency and most important electrical brain impulses. These fast moving and unusually powerful waves were discovered to be more highly activated and moving in a far better organized and co-ordinated fashion in the brains of the monks than in those of the novices. This finding clearly displays that the brains of the monks are capable of achieving a higher level of awareness in meditation than that enjoyed by the average person. This is due to the fact that ‘the

intense gamma waves found in the monks have also been associated with knitting together disparate brain circuits and so are connected to higher mental activity and heightened awareness.’15 In his previous research, Davidson had pinpointed the left prefrontal cortex of the brain as a region associated with happiness, positive thoughts and emotions. Now, he has also pinpointed this part of the brain as the region where the activity involved with meditation is most intense. Putting these two findings together may very likely mean that intense, regular, long-term meditation can condition the brain in such a way that an individual can feel happy and dwell on positive thoughts and emotions even though they are in the most adverse conditions and under tremendous pressure. A parallel situation seems to exist in those individuals with powerful motivation and mental toughness – they too probably have more gamma waves and a heightened level of brain activity in their left prefrontal cortex from the time they start aiming high as a child, regularly augmenting, planning and revising their goals, perhaps in a similar way to a monk doing his meditation. We may never know, unless these highly motivated people are prepared to come forward to undergo EEG, functional MRI and brain imaging. Davidson’s other finding is that meditation not only changes the workings of the brain in the short term, but also appears to be capable of moulding more permanent changes, and the changes are ‘dose dependent’. This means that the more you practise meditation, the more powerful the gamma wave activity in your brain will be. Consequently, one will stay happy and contented and enjoy more controlled emotions and positive thoughts. Neuroplasticity Neuro-scientists used to think that from childhood the wiring of our brain cells (neurons) was fixed with little room for change. Today, after Davidson’s investigations and experiments on meditation, the concept has completely changed and nerve cells in the brain are now seen to be like plastic and brain wiring is able to be changed, modified and augmented. This has led to the modern concept of ongoing brain development which is termed neuroplasticity. The conclusion – practitioners of meditation have extolled its benefits for

millennia. Now neuroscience seems to be on its way to helping to unravel the mysteries of this part of the Eastern healing system. Meditation has now been proven to elevate awareness. If practised regularly for long enough, it will arm you with a greater ability to control emotional and physical pain. You will be happier in general and acquire the overall health benefits that result from lower levels of stress.

Chapter Seven Longevity The Eternal Dream of Eternal Youth If there is one wish common to all humanity it is a long life. One of the world’s oldest written works, The Epic of Gilgamesh, tells of the King of the ancient realm of Mesopotamia and his quest for immortality. ‘Long Live the King!’ is the wish expressed by the nation as the greatest blessing to be bestowed upon their sovereign. In old China, it was required that the emperor be addressed as Wan Shui, meaning ‘ten thousand years’ – a title symbolic of a reign of ten thousand years and beyond. The following legend epitomises the irresistible allure of the promise of eternal life. This tale concerns the emperor Shih Huang-Ti of the Ch’in dynasty (221-207 BC), who unified China (Ch’in gave China its western name). The emperor established the traditional imperial system and was renowned for his intelligence. During his twilight years he became obsessed with the quest to find a legendary plant that had the magical power to confer longevity. One of his eunuchs who had long resented the emperor’s cruelty and harshness became aware of his master’s desire and convinced him that the miracle plant could be found in a far remote island off the Korean peninsula. Such a sacred plant, the eunuch warned him, could only be picked and handled by children who were pure and innocent. He volunteered to lead the fleet to that island for his beloved emperor. Having won his master’s trust, the wily servant picked 500 boys and girls and sailed away. Of course that was the last glimpse Shih Huang-Ti had of his ships which sailed on to the island which is today called Japan. The 500 pairs of children were said to be the ancestors of the Japanese people. No miracle plant was forthcoming. Yet such lessons never deterred someone anew from taking up the challenge. Like Ponce De Leon, a Spanish explorer of the 15th Century who believed in a ‘fountain of youth’ that was said to be the secret to eternal life. He set sail to an island north of Cuba but failed to find the ‘fountain’. Eventually he was made governor of Florida and died in 1521 at the young age of 61. Even today the search continues, but the focus has shifted from magic plants and fountains to miracle drugs. Humankind’s passion for this quest can be

seen in the flourishing global anti-ageing industry which is said to be worth US $60 billion a year in the United States alone. In Australia there are countless anti-ageing products in the form of creams, pills, diets and potions, all peddled by snake-oil salesmen using everything from door-to-door sales to the ubiquitous internet. One of the so called ‘cures’ for ageing is advertised as ‘The Hormone Cure’. This aggressively marketed product is said to be a Human Growth Hormone (HGH) taken by injection. HGH is normally secreted by the pituitary gland, and is known to improve skin, eyesight and other features symbolic of youthfulness. However, according to Professor S. Boyages at Sydney’s Westmead Hospital, these are not true HGH but a substance that stimulates the body’s production of HGH which can just as well be increased by regular exercise! The Incredible Hunza People Many years ago, a programme aired on Australian TV called ‘The Fountain of Youth’. It showed a tribe of long-living people inhabiting the Hunza valley – somewhere in a remote region of Russia. It claimed that many of the inhabitants lived well over a hundred years, some being as much as 160 years old. The documentary showed these people worked hard most of the time, labouring on the farm, on the hillside and riding horses into the mountains. They collected huge bundles of firewood and carried them to their villages on their backs. They lived on simple food in addition to some ‘special berries and jelly’ from the wild that they enjoyed and said they could not do without. And they attributed their longevity to their diet and the motto of ‘work hard and love life’. Although these people have never been able to substantiate their real age due to the lack of reliable records of birth and death (and so their claims could just be exaggeration), a study of their lifestyle appears to contain some clues as to why they have long lives – that is, they work hard, consume simple low-calorie food and maintain a zest for life. This conclusion tallies, in some aspects, with the latest theories and factual findings on what contributes to longevity. The following are just some of the facts about longevity – also called lifeextension:

1: So far the longest life span for a human is 122 years, attained by the French woman Jeanne Calment. 2: In 1991, the American Academy of Anti-Ageing Medicine (A4M) was set up as a non-profit organization entirely devoted to research and development of life-extension. Over 90% of its members are doctors and medical scientists. 3: Long before that, there have been quite a few longevity advocates or life-extensionists favouring the concept of longer lifespans for humans. Recently a great deal more research units have been well established in most well-known universities all over the world, including Australia. 4: A survey in the US has found that 91 years is the ideal median life span and that 41% of people believe that life extension is good for society while 51% hold the opposite view.

How to Live Longer Although the quest for longevity is as old as civilization, modern scientific research on ageing only started to take off in the last 50 years. Professor B Morris of Adelaide University has been researching the field for decades and is a member of the International Research Centre for Healthy Ageing and Longevity (IRCHAL). According to him it is only recently that ‘technical and conceptual advances in genomics research have begun to bring us to the point of understanding the precise molecular events that make us age’. This means that the future manipulation of such molecular events will enable us to live a longer and healthier life. This is extremely exciting, given that as recently as 1990, Professor M Little, of Sydney’s Westmead Hospital, suggested that even if all cancer was eliminated, the mean lifespan would increase only by two to three years. During the twentieth century, life expectancy had been prolonged by 27 years, but further progress in that regard was considered impossible by the 1990s when biologists had agreed that human cells could last no longer than 90 years. Even individuals in an ideal society free of accident, suicide, drug abuse, nutritional shortage and infectious disease could still expect an average lifespan of only 82 years. That was the prevalent view of researchers until recently.

Yet the view has become much more optimistic, thanks to the diligent and ingenious exploration of our basic molecular structure carried out by medical and biological researchers all over the world. For example, the Human Genomic Project and the mapping of human genes have provided a tremendous amount of information about our genes that could previously only have been dreamt of. It is true that there has been no discovery of an inbuilt mechanism or a particular gene for ageing that can be eliminated with a pill or injection or by adding genes, but recent experimental research into the biological ageing process has identified key genes and intracellular pathways responsible for ageing and longevity. A bit over a decade ago, I attended two international conferences on healthy ageing and longevity, the first was held in Brisbane, in mid-March, 2005, in the world-class convention centre in South Bank. Eighty-five of the world’s leaders in health, government, the WHO, and research into ageing and biological and molecular studies participated. The second conference was held in Melbourne in mid-October, 2006, in the magnificently designed Convention Centre in South Bank. Both conferences presented a wealth of cutting-edge research in the areas of age-associated diseases and highly important research into the understanding of the fundamental biology of ageing itself. More recently I attended the Longevity Conference in Melbourne in 2016. Some of the speakers were concerned with perennial topics like AGEs (advanced glycation end products) and dealt with their pathogenesis and implications in depth, while others discussed Telomere studies by researchers at other centres which confirmed or extended on original findings that telomeres play an important role in human longevity. There was also a novelty therapy that has been designed to inject new life into damaged human joints and tissues, based on coordinated research and ethical experimentation – this will be discussed in detail in the section on Regenerative Medicine (see page 235). This chapter summarises the essential data on the consensus on longevity from the lectures, studies and research papers discussed at these conferences. At the conclusion of the Melbourne conference, there was a session where ten top tips for longevity were drawn from the international group of sixteen experts on the panel. There was also a panel of a half dozen centenarians who

shared their wisdom with us which I will be making reference to. We shall also look into the findings from longitudinal studies on ageing carried out locally and overseas, before wading into the more complex yet highly promising areas of basic biological and molecular research reports. The world’s longest-lived people include the Okinawans of Japan, the Ikaria of Greece, the Nicoya of Costa Rica, the Sardinians of Italy, and the Loma Linda of California, according to The Blue Zones by Dan Buettner.

Studies in Ageing and Longevity In attempting to isolate the most important factors related to a graceful ageing process and longevity I have considered a number of important studies and cross-referenced the results. Among the most important of these are the following. The Dubbo Studies A 15-year study, commencing in 1988 and carried out by Professor J. McCallum of Victoria University, Melbourne. The study focused on a group of 2,805 men and women in Dubbo, NSW, a small country town with a population of under 40,000. Its purpose was to discover the factors involved in healthy ageing among the 1233 male and 1572 female participants, all of whom were born before 1930. In 1988, the first cohort was examined using blood tests on lipids and glucose, spirography for lung function and ECGs for heart health. The emphasis was on their CVD and dementia status. Subsequent investigation in 2000 found that fewer than half of the participants were still living, making further study unlikely. Professor Simon, the chief researcher, discovered that FBG (blood sugar level) was a useful predictor of CHD and mortality in persons over 60 who did not have diabetes, and that gardening on a daily basis could guard against dementia. The Melbourne Studies These were carried out on 1,000 people aged 65 years and over and ran from

1994 till 2002. They were led by Professor H. Kendig of the University of Sydney. The Australian Longitudinal Study on Women's Health (ALSWH) Directed by Professor Gita Mishra of Queensland University, this is a national, prospective study of over 58,000 women in four separate cohorts of different age groups, with the most recent group born between 1989 and 1995. It is easily the largest study of its type involving Australian women, and is also one of the largest in the world to date. One reason for the importance of this study is that women are the largest group of unpaid carers in Australia and the OECD, providing over two-thirds of primary care-giving, equivalent to one billion dollars per week in economic terms. There have been many reports produced on women's physical and mental health, including the chronic diseases which affect them and the prevalent causes of hospitalisation and death for female patients, altogether adding up to many thousands of pages. In the 2013 report on mental health, younger females were found to exhibit the highest incidence of mental health disorders, with depression being the most prevalent followed by anxiety. Mental health disorders among women have increased from 13% to 18% over the survey period, mostly among females with lower education, lower incomes, and who are not in relationships. However, this trend appears to decrease with age. Other reports produced during the ALSWH attribute the increased prevalence of chronic medical conditions in women to their longer lifespans. In the main, this includes osteoarthritis, asthma, diabetes and cardiovascular disease, in addition to less serious conditions such as issues with sleep and urinary incontinence. Many female sufferers also have co-morbidities which act to raise the death rate, particularly being overweight or obese. Furthermore, as females live longer, they are more likely to suffer from dementia, falls resulting in fractured hips, and sensory impairments. The osteoarthritis rate was found to be 20% for the 50-67 age group, 51% for the 67-85 group, and 70% for the over 85 group. Breast cancer was discovered to be the most common type of cancer and has the highest morbidity rate, and is more common in overweight or obese females.

Diabetes is rapidly increasing, except for in those women on a Mediterranean diet. Additionally, many female asthmatics still smoke. This very important study is destined to keep going until, I believe, the oldest woman has reached the milestone age of 100. My impression is that the majority of the ALSWH’s findings and outcomes seem to go very well hand in hand with what the average GP in Australia experiences. The Okinawa Centenarian Study The OCS is the world’s longest running, population-based study of centenarians. In 2005, it was in its twenty-ninth year, with over 700 centenarians examined and well over 200 scientific papers published. It was first founded by Dr Makoto Suzuki in 1976 and is now supported by Drs C. and B. Wilcox, both geriatricians from the Pacific Health Research Institute of Hawaii. Okinawa, one of the 161 island prefectures of Japan, is home to the highest ratio of centenarians in the world (close to 50 per 100,000 in 2004). Altogether, the OCS has studied a total of 2,644 Okinawans (430 males, and 2,214 females). Among them, a total of 12 super-centenarians averaging 110 years old have also been studied. Generally speaking, the female centenarians outnumbered the males by five to one. It is of interest to note that the ratio is one to one among the Centenarians in Sardinia, Italy, quite likely due to the more stressful responsibilities Sardinian wives reputedly take on in regard to family finance and managing the house. The 2004 statistics showed a new batch of 252 centenarians – 41 are males, 211 are females, and all are farmers with little higher education. Of them, 40% still lived at home (21% alone) and the rest were in institutions. A noteworthy point is that a high proportion of them were still independent as shown by the following: Of the group aged 92 – 80 % were active and independent Of the group aged 95 – 65 % were active and independent Of the group aged 99 – 40 % were active and independent Of the group aged 100 – 30 % were active and independent Of the group aged 102 – 25 % were active and independent The OCS teams regularly visit the islanders to chat to them, observe their

lifestyle, habits, emotional and mental state, and check their hearts, lung function, blood pressure, skin health and nutritional balance. The significance of genetic factors is underlined by the study which has shown that the Okinawan centenarians have a specific type-2 genetic pattern known to be associated with a low risk of autoimmune disease (the production of antibodies that damage one’s own tissues).

Major Factors for a Healthy Long Life Drawing on the above studies we can conclude that the following are the main factors involved in healthy ageing and longevity: Caloric Restriction This basically means no more than simply eating less food. Maintaining prudent dietary habits and avoiding high-energy and high-calorie food appears to be the most vital and critical component to healthy ageing and longevity. Animal experiments have proved it. A study of the Hunza culture and all the major longitudinal studies of aging also point to the same conclusions. All have something in common, that is – the main ingredients of these diets are plants, beans, sweet potatoes, vegetables, fruits and whole grains. This means having less meat and more vegetables, no more rich desserts and cheesecake, avoiding deep-fried and unhealthy junk food, and sticking to the recommendations made in Chapter Three. What is more, studies of the above people have also found that those who consume the most vegies and fruits have 15% lower risk of dying than those who eat the least. By adopting a low-calorie diet you will lose weight and have a smaller body instead of a big, unwieldy one. The best way to steer away from chronic disease is to maintain a healthy BMI. Okinawans’ BMI ranges between 20 and 22 on average. On the other hand, I have noticed most of the patients in our clinics have BMIs between 25 to 30 and over compared to the healthy range of 20 to 25. Lifelong Physical Exercise

Throughout this book, I have put great emphasis on the virtues of regular exercise and the maintenance of physical fitness, based on my own personal experience over more than 20 years. I am happy to say that the idea has been staunchly supported by studies and research findings on longevity from all over the world. The major health benefit of physical exercise and fitness lies, of course, in its highly protective effects on your heart and circulatory system (CVS). We have known for decades that CVS diseases kill more people than all other diseases and cancer put together. CVS problems often kill people in their prime. So it is highly reasonable to say that preventing CVS disease will add at least ten to 20 or more years of life to anyone who cares to keep their heart and blood vessels healthy and strong. Prof M. Skalicky (among many other researchers) has found concrete evidence in her experiment with the Sprague-Dawly rats. The rodents voluntarily exercising on the wheels regularly recorded a much lower death rate than caged ones afforded little or no exercise and even those that were forced to exercise. The human side tells the same story – the Okinawan centenarians and the tribal villagers in the Hunza Valley have all been observed to be physically active till their 90s and possibly 100s. The famous French woman, Jeanne Calment, the oldest human on record, lived to 122 years old. She learned fencing at the age of 85 and was still riding a bike when she was 100. Let me illustrate some of the points mentioned above by another one of the living examples among my patients. Just the other day, a man strode effortlessly into my consulting room to see me for a minor problem. His posture was upright and he was of medium built and muscular, with no potbelly. I was somewhat amazed to learn that he was 82 – but he was like someone in their sixties with an alert mind, sharp hearing and good eyesight. Well, honestly, I have not seen such a healthy 82 year old for a long time. Fascinated, I enquired about the secrets of his vigour. He was still working as a motor mechanic, six days a week, ‘all day long, never stop a moment. I love my work and love talking to customers. Don’t eat junk food.’ Obviously this man had got the right ingredients for healthy ageing – he works hard in a physical job, eats well, enjoys talking to people, and loves to serve. Sometimes these real life people may sound like genetic freaks. Sceptics

believe longevity simply ‘runs in the family’, or people are ‘just plain lucky to have a long-living parent’. In reality, this is not always so. One morning in our clinic, on calling for a Mrs N.T., I noticed a well- dressed petite lady get up from her chair with the minimal help of a walking stick and walk steadily if slowly toward me. Very pleasant, alert and smiling, she spoke with a soft but clear voice throughout the consultation. On checking her personal details, I nearly fell off my chair when she reassured me she was 95, though she talked and joked like most 70 year olds. ‘What is your secret?’ I asked, unable to hold back my eagerness to learn. ‘Oh, I played lots of tennis all my life till my husband passed away some 10 years ago. He was a wonderful caring man. We ate healthy home-cooked meals, but I also love chocolate. I’m mad about it’. ‘But how old did your parents live to?’ I asked, expecting evidence of a hereditary factor. ‘Oh, not very old – Mum only about 70, and Dad a bit better: 80’. It also turned out that her sister died even earlier with cancer. The other fascinating aspect about this graceful lady was that she was surprisingly independent, managing all her personal affairs and household chores with no help other than a regular cleaner for heavier jobs. How amazing! A healthy 94 year old whose parents’ lifespan was pretty ordinary. How else on earth could one best describe this genetic oddity other than being the product of the environmental forces which had greatly enhanced her genetic potential? Judging by her petite profile, I suspect that she might also be following a CR diet, supplemented by extra antioxidants from her beloved chocolates. Regular Medical Check-ups It is perhaps not an over-statement to say that the extra 27 years added to our expected lifespan in this century is largely the result of better medical facilities, newer and better diagnostic tools and easier access to more affordable medical care, as well as to improved hygiene and sanitary infrastructure. When you feel out of sorts, off-colour, or are feeling ill and have a medical check-up, your doctor can often pick up the clues. In more difficult cases the problem can usually be diagnosed with the aid of blood tests and modern, incredibly reliable hi-tech imaging methods, such as CT, ultrasonic, MRI and

PET scanners. So, over the last few decades, more cancer cases and hidden medical problems have been uncovered, treated and cured, than have ever been cured before. Maintain a Sensible Lifestyle and Manage Tension, Anxiety and Stress Particularly avoid smoking and drug and alcohol abuse. Keep away from habitual and addictive gambling, pick up good hobbies and know how and when to relax and your life will be more pleasant, fulfilling, and healthy. A recent study on 3,600 participants in the Framingham Offspring Study has confirmed long-held beliefs that stress may lead to heart disease. The participants were followed for 10 years and evaluated, and it was found that those with tension, stress or anxiety had about a 25% increase in the risk of coronary heart disease, atrial fibrillation and total mortality (women fared slightly better by 5%). Everyone will encounter some sort of stress, anxiety and tension in their everyday life – these are simply the psychosocial facts of life. Such reactions are inevitable. The only solution lies in the ways one tackles them, so that instead of allowing the stress to literally hurt the brains, the heart, and, indirectly, the entire system, one must divert and channel such emotional force from the vulnerable heart and body by either one or all of the following ways: (1) Treat challenges and setbacks in a philosophical manner, saying to yourself that they are just facts of life, everybody gets the same treatment, why worry, and in that manner let the frustration fizzle out. With your regular meditation and Tai Chi exercise group support, your mind and heart will be unruffled by most stress and you will be able to handle difficult situations better. (2) Console yourself that the stress is only temporary. It won’t be there forever! Just finish the job, go home and watch your favourite footy team, or enjoy yourself dining out with loved ones, close friends or whatever you enjoy most. You can share your woes with your loved ones and then the burden is less. Just offloading can make you feel remarkably better. (3) As the centenarians at the Queensland conference collectively advised,

treat your troubles with a sense of humour. Talk to someone you like to speak to most, not necessarily your spouse or family members. Maybe a friend, someone who is a good listener, a nice person, or just anyone intelligent with a good sense of humour. Often your problem can be turned into a source of amusement for both of you. Instead of stewing inside you, it may give you a hearty laugh. Laughter, as it is often said, is the best medicine. (4) Start to learn the Eastern way of managing stress – meditation, Tai Chi, Qi Gong, Yoga, or acupuncture and acupressure. Regular practice in any of these should endow you with inner calm and a serene mind. (5) If you are religious, go to your church, talk to your minister or pastor or congregation and you will find that your shared religious faith and fellowship can do much to heal the sores inflicted by hardship and sorrow. (6) Should all the above methods fail, it may then be that your problem is best sorted out with a counsellor, psychologist, or psychiatrist. Using the above stress-release tips may significantly reduce your CVS risk. Given the 25% increase in heart attack risk from chronic stress, this is well worthwhile when we consider that CVS mortality is the single biggest threat to your longevity. And what is more distressing is the growing evidence that stress and anxiety are becoming more widespread and deeply entrenched in our modern society. My feeling is that we need many more ways than those above to help combat stress and anxiety – perhaps the government mental health authority should consider setting up free pilot clinics and hotlines just to provide on-the-spot advice and support. They could help people understand the basics and to organise simple, non-pharmacological aids such as meditation, Tai-chi and Yoga as group therapy. In the end, the public should be encouraged to manage their own stress. Avoid Excess Radiation Keep away from too much exposure to ultra-violet light, B type (UVB) which causes melanoma, one of the most aggressive cancers. UVB is usually most intense around mid-day, on the beach, on the snow-field and in higher altitude areas such as mountains. One must also be aware of the risks

involved with the use of a solarium where the artificial sunlight might give you a melanoma along with your nice golden tan. A Cautionary Cancer Case from Canada While working in the Ottawa General Hospital in Canada, I witnessed an autopsy on a man of about 60. He was described as being reasonably healthy until he had a ‘black mole’ cauterised from his scalp in a country town. Within a year of two, he developed multiple serious complaints and perished. At autopsy, one could see the horrific devastation of practically every organ by the metastatic melanoma cancer cells, in numerous foci and masses, in black, pink and white whorl after whorl. It remained yet another puzzle in medicine as to how and where this man could get his UVB from, when the Canadian summer lasts not more than two months! But if it can happen there, then how much more cautious do we need to be in Australia! Moderate Alcohol Consumption The Okinawan women do not drink alcohol at all and only 50% of the men do, so it is clear that it is possible to do very well without alcohol altogether. However, in studies in the West, those drinking a moderate amount of alcohol fare better than teetotallers on longevity. In fact, one of the Queensland centenarians, in his list of recommendations for a long life included ‘always drink gin and tonic’ much to the amusement of the audience. However, as we saw in Chapter Three, red wine is scientifically proven to have the most benefit due to its rich supply of antioxidants, particularly resveratrol. Maintain Your Social Network Several of the studies presented at the conferences presented good evidence that a healthy network of friends helps you better than relatives to achieve healthier longevity by encouraging each other to get checked-up. Furthermore the friendship of your peers, being free of obligation, is a real benefit in helping anyone overcome depression. Contribute to Society

An Adventist centenarian in California has told how she always maintained an active daily routine of voluntary work in order to give her ‘a sense of purpose’. She says she loves to talk to people and looks upon strangers ‘as friends she has not met yet.’ Loneliness shortens one’s life but even those without family can find friendship and companionship by going out into the word and giving service. We might say, in other words, that loneliness can be overcome by love. In a broader sense, love is not limited to one-on-one relationships. Love is universal and could mean anything, including your love of nature, of the digital camera you have just bought, of the new idea you have just discovered on the internet. It could be a new friend who shares the common goal of getting fit. As the centenarian mentioned above has found – love and service gives a sense of purpose to life. Considering all of the above information, I am reasonably confident that, with further understanding of the precise molecular events that make us age, an era has finally come when the baby boomers who follow good advice can add five to 10 years onto the present average life expectancy of 85 for females and 77 for males. Generation X can be expected to live to become healthy and independent centenarians. In fact, British research, published in the London’s Sunday Times,16 has estimated that the average professional woman now in her 20s is likely to live into her mid-90s, and those born in 20 years’ time could even come close to achieving a mean lifespan of 100, if overall health status keeps improving at the present rate. To me, this recent forecast is very encouraging in hinting that a longer human lifespan may partly be due to the human genetic evolution towards a healthier and smarter gene, more resistant to diseases and oxidative damage by free radicals. Naturally, present medical advances and improved childhood health care are equally indispensable in our pursuit of healthy longevity. Molecular research may one day unravel the real secret of ageing. We may soon understand how Madame Jean Calment lived to 122 years or why a turtle can expect to survive to 174 years and longer. Well, the key to unlocking these enigmas man be found somewhere in the following research findings we shall be looking at after the tips for longevity by the sixteen world experts at the Melbourne conference.

The Top Ten Factors influencing Longevity (1) Good genes – the inheritance of healthy genes remains fundamentally the most important factor. (2) Being in control of your future and your own old age – the experts agree that healthy ageing is best acquired through adopting a healthy diet, maintaining regular exercise, steering away from cigarette smoking and excessive alcohol, reducing your weight to below 24 in BMI, and your debt to the minimum. You are also encouraged to voice your opinion on public health issues and help improve your environment. (3) Having positive and meaningful personal relationships – then ageing will become an enjoyable process and you will embrace the transition to each stage of life. (4) Avoiding conflict and confrontation – in any personal and interpersonal situation, this philosophy will maintain your inner calm and minimise biophysiological upset. (5) Avoiding extremes – this is all about balance on everything we do in our lives. (6) Never giving up your quest for knowledge – an active mind is the best safeguard against Alzheimer’s disease and many mental illnesses. (7) Adaptability – this remains perhaps one of the critical intuitive ways for any species to survive in a harsh environment. Human beings are no exception. (8) Population strategies – as a citizen, clearly you should share some responsibility to help the government to remove the threats to public health and to maintain harmony in your society. (9) Having good health care – there should be a universal insurance programme and basic social welfare security for every citizen. Ready access to free medical management has been proven as one of the factors of healthy ageing for the Okinawans. (10) Having goals in your life – pursuing a meaningful purpose in your life

should never fail to give you the impetus and energy that is required for healthy ageing.

Recent Findings in Relation to Ageing (Please note, some readers might find the following research and studies somewhat technical and dry. Skip them if you wish.) Key Genes and Molecular Pathways Professor B. Morris, professor of the molecular sciences and genomics laboratory at the University of Adelaide, has identified key genes and intracellular pathways that could influence ageing and longevity. Those pathways are influenced in turn by dietary factors. Insulin and insulin-like growth factor (IGF) also act upon cells and cause ageing. Transcription factors are a type of genetic material involved in directing how we function. In diverse species, one of the transcription factors is named FOXO (a group of Forkhead box genes). Its subgroup O has been found to be crucial in suppressing the IGF. This slows down ageing, but FOXO can be suppressed by adverse biological processes caused by poor diet, which increase ROS production (ROS are Reactive Oxygen Species, a type of free radical). ROS are thought to be responsible for the onset of all those common chronic medical conditions such as hypertension, CVD, type 2 diabetes, and Alzheimer’s which cause ageing and a shortened life span. In humans, FOXO subgroups 3a, and -1 and -4 are of considerable interest. There is already emerging evidence, according to Professor Morris, that some less complex organisms utilize plant-based polyphenols such as resveratrol to achieve better health and a longer life span, with the help of the sirtuins gene (see below). What is now clear, he said, is that life span is tractable, and many of the basic mechanisms are now known. More understanding of processes controlled by FOXOs should allow us to develop a new class of agents that will better prevent or repair life-threatening damage. Neurogenesis and the Possibility of an Ageless Brain

Professor P. Bartlett, director of the Queensland Brain Institute, pointed out that our brain’s neurons number 10 to the index of 12, each of which has up to 10,000 connections. This makes it an extremely complex organ, indeed. What is even more amazing is that it is capable of constantly adjusting and changing in response to all sorts of stimuli. Its plasticity also allows for increasing storage of new neurons and memory. The new discovery that the brain can produce new nerve cells throughout its life, and that it has the ability to replace damaged or dead nerve cells has radically changed scientific thinking, Bartlett said. Using nerve stem cells, neuron regeneration is now possible. Any type of neuron, astrocytes and oligodendrocytes (the last two are non-neurone cells found throughout the central nervous system) can be grown in the culture into thousands of new neurons. But the new stem cells will survive only if regular stimuli are applied. BDNF activates neuronal production, as will exercise, but growth hormone and prolactin inhibit neurogenesis. Therefore, by better understanding the factors that control neurogenesis, Professor Bartlett said, we may have a means to help older individuals produce more brain cells and maintain their cognitive function. Resveratrol – the First Anti-ageing Drug? Professor D. Sinclair of the Harvard Medical School’s department of pathology, described his research on a highly-conserved family of deacetylase enzymes called the ‘Sirtuins’, named after the yeast Sir2 longevity protein (humans have 7 Sir2 genes while yeast only has 1). Experiments in CR (caloric restriction) give the most reliable results in delaying ageing in scientific experiments. CR creates a stress-inducible defence mechanism and the Sir2 gene and its copies mimic CR and have been shown to extend the lifespan of lower organisms such as yeast, worms, flies and bees in laboratory tests. Professor Sinclair found that the yeast life span could be extended up to 30%. But the Sir2 gene needs an activator to swing into action, and the best natural activator is resveratrol, a polyphenol from plant products such as red wine, green tea, and some Asian medicinal herbs (currently in trial to treat cancer and diabetes). Professor Sinclair and his co-workers have been able to find some 18 similar molecules they called STACs (sirtuine activating compounds) and

synthesized a variety of improved molecules. All of them have been tested and are able to mimic the mechanisms of CR and extend the lifespan of every simple organism which possesses the Sir2 gene. These experiments carry an important implication, as the future search for longevity drugs will be along the same line – polyphenol derivatives to activate the Sir2 gene to mimic the CR mechanisms in resisting disease and extending lifespan. Promising Anti-ageing Molecules Professor A. Linnane, of the Epworth Medical Centre in Melbourne, discussed the potent role of coenzyme Q10 in protecting sub-cellular metabolism and preventing the mitochondrial DNA mutation that is due to damage by free oxidative radicals. Professor S. Rattan, of the department of molecular biology, at the University of Aarhus, Denmark, discovered Kinetin and Zeatin have powerful antioxidant properties that enhance human cells’ abilities to resist stress and have an anti-ageing effect on human skin fibroblasts (the core cells that form tough fibrous tissue in the body). Peptides are molecules formed by amino acids created during digestion. Dr R. Holliday, of Sydney, has presented findings on a dipeptide – a double peptide – called Carnosine which is present in high concentrations in the muscles and the central nervous system. Carnosine possesses a range of beneficial properties. It is an anti-oxidant that promotes anti-glycation of proteins, and chelation – a special process whereby chemical agents in the body combine with harmful metals such as lead and mercury to prevent damage to the vital organs. Experiments on human fibroblast cells have shown that Carnosine prolongs cell life to a striking degree. Carnosine has also been shown to be able to attack cancer cells under certain circumstances. Increased Longevity in Mice Research by the University of Washington’s medical school, published in the journal Science, late in 2005, has reported the creation of genetically modified mice that live 20% longer than normal, simply because the modified gene enables the mice to produce more catalase, a natural antioxidant enzyme, to swiftly counteract free radicals. The researcher

claimed this is more effective than taking antioxidants as pills, vitamins or other supplements. This is clearly another forward stride towards a better and more effective way of prolonging the human lifespan. More development along that line will be on the way. Telomerase Can Reverse the Ageing Process A recent research article from the journal Nature featured in the Guardian (28 November, 2010) reported that a group of researchers at the Dana-Farber Cancer Institute, Harvard Medical School, have discovered an experimental treatment to rejuvenate old mice. Most cells in our body contain 23 pairs of chromosomes carrying our DNA. At the end of each chromosome is a protective cap called a telomere. When a cell divides, the telomeres are cut shorter. This process repeats until the telomeres have completely worn away and the cell either dies or stops functioning – a wear and tear process that happens in ageing. So what the Harvard team did was to inject an enzyme called telomerase into mice genetically made to lack such an enzyme and therefore prematurely ageing. After just one month, they showed substantial restoration, the damaged tissues had been repaired and the signs of ageing reversed. The growth of new neurons was also evident in their brains. Naturally, such a discovery has caused great excitement in the scientific world, as well as a great deal of controversy. The biggest unknown factor is whether the enzyme telomerase, which is usually switched off in adult humans – an evolutionary precaution to stop cells growing out of control – could cause the risk of cancer to soar. While there are as yet quite a few unresolved issues, such an anti-ageing treatment in tablet form, called TA 65, is already available on the market in the U.S. at a cost of $25,000 a year. Conclusions The recent technical and conceptual advances in genomics and cellular metabolic processes have clearly heralded an era of more in depth understanding of the mechanisms of ageing. This is a giant step forward and will soon lead to the discovery of useful medicine to help us prevent the damaging effects of free oxidative radicals (ROS) and the resulting chronic

diseases and to achieve healthy ageing. The above research findings on the FOXO gene and Sir2 gene and their pivotal role in protecting the tissue cells against chronic diseases and ageing amply illustrate the importance of cutting-edge research in enhancing human health with the exciting prospect of healthy longevity. The newer antioxidants and anti-ageing molecules discovered and studied by the conference presenters have naturally brought hope that increasingly useful and effective anti-ageing medicine will be in the pipeline in the foreseeable future. These wonder drugs, literally the modern version of the ‘elixir of youth’, if used in combination with my programme of regular exercise, sensible diet and the adoption of a healthy lifestyle, will almost be a guarantee of healthy and independent longevity to any one of you, particularly if you’re from generation X or are a baby boomer. By then my dream from the beautiful cruise will have turned into a blissful reality.

Regenerative Medicine If you had broken your leg after a fall while mountain climbing or at a soccer game, wouldn’t you wish that the doctor could fix it with a few injections rather than by putting pins and plates inside your leg? Or if you suffered from severe arthritis of both knees or hips, wouldn’t you be ecstatic if you were told that you would be spared the painful and troublesome operation required for the total replacement of your hip or knee and only needed a few injections prepared from your own blood or tissue? These are just a couple of the scenarios suggested by the emergence of a new branch of medicine called Regenerative Medicine. This is not a mere pipe dream but a new field of study uncovering new ways in which we might treat our injuries and diseases by harvesting our own body’s regenerative capabilities. The term ‘Regenerative Medicine’ (RMed for short) was first coined in 1992 by Leland Kaiser, but it was not much known until it was greatly promoted by W.A. Hasaltine, the founder of Human Genome Sciences. It involves molecular biology, genetics, immunology, biochemistry and tissue engineering – each of which is used to replace, engineer and regenerate human cells and tissues to restore normal functioning. Or, alternatively, it may be used to regrow, repair and replace damaged and diseased cells and

human tissue. Now of course, humans can already repair their own damaged tissue, as is commonly seen with a shallow wound or a grazed knee. If you are scratched by your cat or a rose bush it will quickly mend by itself in a matter of days or weeks, leaving you with only a minor scar or mark. It might surprise you to know that your liver, too, if partly removed, can grow back. Fantastic, you may say. However, there are other important organs like our brain or heart, which do not repair themselves properly and return to normal functioning when damaged, after a heart attack or stroke for instance. Yet some animals show a much higher level of regenerative ability. For example, the Zebra fish in South East Asia can repair its own heart, and lizards can regrow a chopped-off tail many times. So we can easily imagine that the biggest aim in RMed is to find a way to grow an important organ from a patient’s own cells when it becomes injured or damaged or fails. Organ failures, such as those of the kidney, heart and lung, are getting increasingly common in all developed countries. In Australia alone, it has been reported as many as 1600 patients are on waiting lists for transplants, simply because there are not enough donors. So the ultimate aim of stem-cell research, inevitably, is the regeneration of new organs. So how could we find the silver bullet to restore us from a state of chronic disease back to normal status, repair acute injuries or normalise congenital defects? First we must understand that the human body already possesses some restorative elements and bioimmunological mechanisms designed to repair and regenerate our skin and constantly produce new blood from our bone marrow, as well as new cells to replace damaged ones. This can be observed in simple soft-tissue bruises, or the constant replacement of the inside linings of our intestinal walls during digestion, and the uterus after every menstruation, etc. Yet our understanding of the body’s regenerative powers has been deepened by the diligent research carried out through the global cooperation of RMed centres which have conducted experiments down to subcellular levels. This has allowed them to develop two major therapeutic tools: stem cell therapy and platelet rich plasma therapy. Stem Cell Therapy

This therapy is not new to many people as a number of success stories or ‘break throughs’ have already been reported intermittently in the media for some time. In those cases, blood from the umbilical cord after the delivery of a baby was used to extract stem cells to treat mainly blood disorders. Stem cells have been described as pleuripotent or multipotent, meaning they are still very original and undifferentiated and therefore capable of changing into any kind of cell and tissue. They are able to move into injury sites on their own to carry out repairs, or they can be injected directly to begin the rejuvenation/healing process. In addition to displaying such magical abilities, they are found to possess paracrine effects – they secrete growth factors and cytokines and generate new blood vessels with the vascular endothelial factor (VEGF) so the new cells and tissue will survive. In other words, stem cells are naturally encoded to grow into the desired tissue, as they create their own blood supply. Stem cells can be harvested from many sources, the most popular being mesenchymal tissue – a sort of loose tissue in between cells similar to that which is found in fatty tissue deposits. This tissue seems to be an easy target site for these particular cells, called mesenchymal stem cells (MSC). Since 2015, attempts have been made to harvest MSC from Wharton’s jelly, a kind of gelatinous substance in the umbilical cord and umbilical cord linings, for studies involving the treatment of CVD. Stem cells have also been obtained from bone-marrow aspirate (aspirate is material drawn up using a syringe). This aspirate has been reported to heal union-resistant fractures. Stem cells obtained from cord blood, on the other hand, are only capable only of repairing blood disorders by transforming into different blood cells. These embryonic stem cells are indeed unique in being able to self-generate and self-differentiate into various tissue types. Such stem-cell therapies, in the words of an orthopaedic surgeon practising and researching in Sydney, are going to ‘revolutionise’ future orthopaedic practices in terms of treating chronic degenerative conditions in hips, knees and spines, and soft-tissue injuries such as tears in muscles, tendons and ligaments. N.B. There is a dedicated centre for research work on RMed in Melbourne called ARMI based at Monash University, Clayton, comprising of 15

research groups. PRP (Platelet Rich Plasma) PRP therapy is another new technique which utilises your own body tissue to treat injuries and degenerative body parts. It is a newcomer in this field, relatively unknown until 1970. It was first used in Italy in open-heart surgery. PRP operates basically by drawing a certain amount of blood from a vein and putting it into a centrifuge to separate it into pure blood cells and serum so that there are three to five times more platelet cells than are present in normal blood. This concentrated fluid is found to have an increased amount of cytokines and several other growth factors that assist in promoting healing and are particularly useful in dentistry, orthopaedics and dermatology. The problem with PRP is that, firstly, methods of preparation have not been standardised. They vary considerably; in fact, only two of them have been recognised by the US FDA. Secondly, there have not been enough independent trials and studies to find out how effective PRP therapy is in common orthopaedic conditions such as osteoarthritis of the knees and hips. At the ninth A4M Longevity World Conference, I met Dr Peter Louis, a speaker on this topic and one of the prime-movers of PRP therapy, at a large Malvern clinic in Victoria. I became convinced that PRP had a bright future ahead as I learnt how much enthusiasm he had put into this budding branch of medical therapy. He informed me that some medical groups practising PRP in Sydney charged about A$200 per injection (with patients needing up to three injections), which is relatively cheap compared with the US$1500 charged in the US. So, although a lot more research and studies are needed, Regenerative Medicine will clearly become a unique and exciting tool which will revolutionize future medical therapies for human beings and be used along with the advice contained in my Total Health and Fitness Revolution!

A Final Thought As a final thought on this fascinating topic of human health, wellbeing and longevity, I would like to offer my own philosophy of living which can be summed up in a few simple words: Love life Live in the present Enjoy maintaining your total good health today To be able to serve and contribute more Towards a better society tomorrow

Special Section A Master Eating Plan Recently I went to a well-known local bookshop to browse around. Being particularly interested in health and exercise, I headed straight to the Health and Wellness section. To my great amazement, publications on health, nutrition and exercise were grossly outnumbered by the diet and how-to-loseweight books, to the tune of nearly 10 to one! As the number of people becoming overweight has increased by 10% every 10 years over the last few decades, and most of them are willing to shed some of their body fat, diet books have practically become bestsellers by default. Do Diet Books Work? Everyone has been asking the same question on diet books. To be honest, I do not think anyone, including nutritionists and dieticians, could give you a straightforward answer, and most of them probably don’t know either. As we saw in Chapter Three, there have been quite a few major changes in the basic principles recommended to the public. Firstly it was the high- carb low-fat low-protein diet pioneered by Nathan Pritikin, but it did not work for Robert Atkins, so he went the opposite way and proposed his low-carb high-protein high-fat diet. His diet plan seemed to work on some people and had divided the nutritional world until his death in 2003 from heart attack, at the relatively young age of 72. Many cardiologists were reportedly of the opinion that his demise was the inevitable result of his unhealthy diet plan. So there you are, another popular diet being trashed and viewed as highly risky. Recently, nevertheless, the idea of having more protein in the diet has gathered momentum as more nutritionists and clinicians have started to analyse the Atkins diet and found that more protein (such as meat and nuts) appears to satisfy a person’s hunger pangs better than more carbohydrates so that they are more willing to stick to the diet plan to lose weight. Now, as everybody knows, the latest and the most popular diet plan devised by CSIRO has raised the protein level to 33% as against 20% in the Basic Food Pyramid, and it has been aptly branded as a ‘protein plus’ diet. Based on their research and studies on overweight people for a number of years, CSIRO claims the diet really works. But so have those promoted by Nathan Pritikin’s

low-fat high-carb diet in the 70s, Dean Ornish’s ultra-low-fat high-veggie diet in recent years, and Weight Watchers’ popular diet plans for decades. Yes, my dear readers, they do work, every one of them, but with some reservation, as elaborated further below. Is There Such a Thing as an Ideal Diet? When you scan the hundreds and hundreds of diet books in bookshops and have perhaps been bombarded by endless promotions on how to lose weight and ‘look great and desirable...’ you often wonder why on earth people would want to waste their time and energy looking for an apparently elusive answer. The reality is that most diets work, but only on some people, and maybe for a short time, depending on how motivated, how serious and how consistent they are. For example, the Pritikin and the Ornish diet did help many people, particularly celebrities, but many others found them too plain and tasteless to follow long enough. Even Atkins’ diet and the so called ‘blood-type’ diet did well for some people and produced numerous testimonials from ‘grateful clients’. And now, the CSIRO, Australia’s giant quasi-government-funded research organization has weighed in with their scientifically proven diet, and the book has become a huge success ever since its publication in 2005. But then, when the crunch comes, only those that have stood the test of time offer the best chance to help you lose weight – and all of them have one thing in common, that is, caloric restriction (CR). Which are they? They are the Mediterranean diet, the Asian diet, the Weight Watchers diet, and the Basic Food Pyramid – whichever one you want to pick is not an issue as long as you follow the guidelines and be consistent. And, above all, most of the advocates of the above diets and the authors of sensible diet books have not missed a key point in asking participants to actively exercise. Back to the Basics The fundamental principle of a healthy diet is to lower your energy (calories) intake. A healthy food plan means you have enough carbohydrates, proteins, fibres, good oils and other essential micronutrients such as vitamins and minerals, but structured within an overall 1,200 to 1,500 calories per day. It has been estimated that our hunter-gatherer ancestors survived on 1,000 to 1,500 cal, compared to men and women of today gobbling up 2,000 to 3,000

cal a day. Can you imagine anything worse than this? How can you manage not to put on weight if you have up to 1,500 cal of food/fuel to spare and yet are physically far less active than your hard-working ancestors? No one should fail to see the absurdity of this discrepancy. So the simplest and the most basic answer for anyone seriously attempting to lose weight and keep healthy is to cut out or greatly reduce high-energy food such as creamy, oily, deep-fried, sickly sweetened stuff to reach the goal of caloric restriction (or CR). CR not only keeps your body and mind fit and healthy, but has also been proven scientifically and epidemiologically to be the only factor, other than genetics, known to prolong our lifespan. So please always keep CR as your foremost perspective when you follow the master meal plan that is coming next. What Sets This Master Meal Plan Apart? When I browsed through diet books from bookstores and libraries and studied their eating plans, menus and ingredients, I noticed one thing in common in all of them, which is, they are rather confusing, complex, structured and restrictive. For example, in the latest Atkins’ diet book, there are pages after pages of tips, claims and counter-claims and testimonials of followers of his diet, how you should follow the ‘four phases’ of dieting according to his plan, and the ‘eight rungs of the ladder’ on low-carb foods – altogether taking up 180 pages. The rest of his book, another massive 250 pages, is devoted to his low-carb high-protein high- fat diet and ‘carb counting’. Reading all those diet books and trying to follow their recipes is not unlike going through your university course again, but with one distinction – that your university course could start you on a brilliant career instead of sending you spinning with a dizzy head into the doldrums of the recipe maze. In this day and age, when most people spend longer hours at work, more time at recreational activities, with their partner, with their family or socializing with friends, how can you be expected to dwell on the detailed eating plan and recipes for hours or even days just to learn how to shop, how to cook, what to cook, and how much to eat in order to maintain a healthy body? It is also plainly getting beyond a joke for most busy working people to figure out how many teaspoons of oil and herbs, or how many hundreds grams of lamb

meat and broccoli to use. This is only for your dinner. The same nightmare repeats for your breakfast and lunch. And, we are not talking one day, but seven days a week, 365 days a year, because, as conventional wisdom goes, you must not skip meals, you must have three square meals a day to avoid the harm to your body’s metabolism. Why should you waste so much time and effort each day, worrying about what you eat when there are, as the French saying goes, so many other enjoyable things to do with your life? Perhaps, if you spend less time dwelling on food, drink, cooking and eating, you would be healthier and live longer because of the extra time you put in on your workouts, networking and socializing. For most working couples, particularly professionals and those engaged in competitive trades, the situation could quickly reach the breaking point unless you resort to short-cuts such as buying your lunch at cafes, takeaway shops and franchises, and dining out often. However, these short-cuts will actually cut your life short and undermine your health because of the simple and undeniable fact that most of these ready-made meals contain high proportions of trans fat in addition to sugary and high cholesterol ingredients. The serving size is far too large for the weight and health conscious. Just to warn you about the hazard of serving size, as quoted in the Atkins diet book, the size of a typical hamburger had jumped six times from 1957 to 1997 and a serving of soft drink of 8oz had exploded to 32oz in the same period. As a consumer, you may welcome the huge increase of serving with open arms because you may think you have got your money’s worth. But the danger lies exactly there: that by eating all these fast restaurant foods in large serves regularly and frequently, your waistline and bodyweight will expand equally fast, bringing with it the inevitable nasty diseases such as HBP, heart attack, diabetes and even the metabolic syndrome. Finally, assuming that you may have forgotten everything I have mentioned above, you would do well to remember that ‘fast food means a fast track to bad health and death’. All this will change, however, by following the master meal plan. The plan is designed with busy working couples in mind. It will help you through the maze of dieting plans and recipes with the weights and measures of ingredients, and how best to prepare and cook your daily meals, in the most

simple and healthy ways. I have learned all this from years of observations and practice of home cooking – a lot of common sense garnished with nutritional science. It offers an easy-to-follow guideline, with no rigid, structured recipes, portions and weekly plans. It is simple once you have grasped the idea and is as incredibly flexible as you are creative. The central theme of the master eating plan is based on only two main actions: 1) Select the ingredients (the foods) from the broadly classified list as follows: (a) cereals (carbs) (b) vegetables (c) fruits (d) legumes, nuts and seeds (e) fish and other marine animals (f) meat (g) oils for cooking and for dressing (h) herbs, spices, sauces, garnishes and other condiments to flavour your food. Most of the common ingredients will be found in Appendix A. Although it is advisable to eat as much variety of food as possible, you will find it less of a hassle during your working days to prepare meals made from a few common ingredients such as fish, chicken and some animal meat, and perhaps up to a dozen or so of your preferred vegetables and fruits in season. Restrict fancy stuff and special dinners to the weekend when you can afford more time to follow some special recipes from your favourite magazines or cook books. 2) Select your preferred cooking methods from those I will describe as part of my ‘Quick & Easy’ way of healthy eating. After a few practice runs, even a novice will have no trouble preparing a healthy dinner. Best to stay with the simplest method for a while until you have mastered its basic technique before attempting others for variety. Then you can completely forget about the dozens of other eating plans, claims of weight-reduction in ‘six weeks’, maintenance meal plans and all the other shaky theories and ‘miracle meals’ from books and magazines. But before we look at how to prepare a nutritious dinner we will consider the only other simple meals you have to consider:

Breakfast and Lunch Simply a matter of ‘mix-and match’ of cereals with other ingredients as illustrated by the sample menus. Any of these meals should take you no more than a few minutes to prepare. Sample Breakfast Cereal – ¼ cup of oats (traditional or 1 minute variety) with 1 cup of water in a deep porridge bowl, heat up in the microwave till the porridge rises (about 1 minute and 40 seconds). Add ½ cup of cold low-fat milk or soy milk, a pinch of sugar. Done. A piece of wholemeal toast with vegemite, peanut butter or some other spread is optional. Avoid butter or margarine. Nuts – a handful of mixed nuts gives you balanced plant proteins. Nuts, or some other proteins such as poached eggs or baked beans, will help delay your hunger until lunch time. Fruit – you must have a small serve of fruit such as strawberry, kiwi or half an apple, to start you off with good antioxidants. Variations Instead of oats, you can choose muesli, WeetBix or rice bricks with hot or cold milk or soy milk or rice milk – any combination to suit your fancy and taste. You just pick your cereals, milk, bread, fruit, and nuts from the extensive list of foods in the appendix and enjoy an infinite variety of healthy breakfasts to give you the best start to your day. In general, steer away from rich, unhealthy hot meals such as fried bacon, sausages, salami, hot dogs – all these preserved meat products should only be consumed occasionally, perhaps when dining out. Regularly indulging in them gives you a much higher risk of heart trouble, blocked arteries and even cancers. Sample lunch As working people, I am sure few of us can afford the luxury or the time for an elaborate meal or a long ‘lunch’ at midday break. I would suggest the following common ones most people would go for instead of takeaways and

junk foods: The Faithful Sandwich The ubiquitous, time-honoured lunch food. You can have any kind of filling ranging from the most healthy canned fish (tuna, sardines, herring, salmon), avocado and salads, to the run-of-the-mill stuff like vegemite, peanut butter nut-spread and tahini (ground sesame). Avoid highly sweetened, salted, and high cholesterol ones like jams and chocolate. There is a wide range of breads from Turkish to rye to grain. A focaccia is also a popular alternative. Noodles, Pastas, Rice, Polenta Just have ¾ cupful in a plastic container (microwave-proof), top with some of your leftovers, or canned tuna, semi-dried tomatoes, olives, and a sprinkle of ground black pepper and a dash of oil like walnut, avocado, or extra virgin olive. Put it into your office microwave for a few minutes and you will appreciate this steamy and flavoursome meal, particularly on a cold day. Soup Soup makes an extremely easy and quick lunch and can be as wholesome and tasty as you could fancy. You can also cook it ahead of time and store in the fridge (to be used within a few days) or the freezer (for months). Hearty soups are all based on using good quality chicken stock or vegetable stock, throw in a variety of chopped herbs and vegetables. Put a scoopful or cupful into a container, heat it up in the microwave in your office and you will be rewarded with this quick, yet satisfying meal. Salad Weight-conscious people usually try salads as a replacement meal to help reduce their weight. It is a good intention misguided, because often there are insufficient carbs or protein in them for satiety, so that you will end up feeling hungry well before dinner. Besides, most of the salad dressings tend to be creamy or oily and may contain unhealthy fats to the detriment of your heart. One remedy is to mix in a good quantity of beans, legumes and lentils to give it more substance. Do away with commercial dressings and use your own healthy, flavoursome ones such as a good oil like extra virgin olive, avocado, macadamia or grape seed, with a dash of balsamic vinegar or other

tasty sauces. Fruit A must-have after lunch, to help digestion and keep up the supply of antioxidants. Dinner This requires more time for the preparation of meat and vegies maintaining the simple principle that you cannot do without cereals (carbohydrates), vegies (fibre, antioxidants, vitamins and minerals) good oil and fruit for every meal. Regard meat from land animals and fowls as optional, or limit them to every second day, or preferably once a week; while fish and seafood should be consumed as often as possible as your main source of protein, and for their cardiovascular protective effect from the omega-3 oil. Some typical examples will be given under the Quick & Easy healthy eating plan (shortened as Q & E way for convenience). Using the two concepts of the master eating plan and the cooking methods from Q & E, you can create an endless variety of tasty, healthy meals by matching and substituting ingredients picked from the food list. Discover the Q & E way of Healthy Eating Let us start by talking about the three primary items of good housekeeping: shopping, measuring, and preparation. Tips on Shopping Once a week, check your stock in the fridge, freezer, and pantry, make out a list of what you want to buy – select from Appendix A (the food/ingredients). Shop at your favourite supermarket and fruit and vegies shops on your way home after work, or take time off to browse in your local fresh produce market during weekends and days off. As we have vast farmland stretching from tropical Queensland to temperate Victoria, you will have no trouble finding most of the vegetables and fruit in the list, including many of the Asian greens and exotic varieties. Choose highly coloured ones such as dark green broccoli, spinach and pak choi rather

than lettuce; more tomatoes, red/green/yellow capsicum, blueberries, red grapes rather than white grapes, artichoke, etc. And, as always, the smart shoppers shop with the seasons because they know that the produce will be at its height of freshness yet lowest in cost. To shop for more than two you may have to go out twice a week, or slip out at lunch hour for bits and pieces. The key idea is to just shop from your prepared list and avoid hanging around the confectionary or cake section, so that you can dodge the unhealthy temptation and will not waste your valuable time on rich, high-energy food and junk food. For land-animal meat, get a variety of beef, lamb and chicken. Select lean cuts with the skin off, and the maximum fat-free rating for mince. Avoid pork unless you can get it very lean. Avoid meat on sale because of a shorter useby-date and avoid meat packs with excess visible fat, although some butchers are very skilful at hiding the fatty part of the meat during packaging. If you have found that is the case with a certain cut, just mark that down and choose a different cut next time, or change your supermarket/butcher – as this kind of practice is close to pulling the wool over your eyes, or just plainly cheating (how could any shopper undo the packaging to inspect the content?). Fortunately, Australia is endowed with huge coastal areas teeming with fish, together with a vast network of river systems also full of fresh-water marine animals, in addition to many local fish farms and even crocodile farms. You have the choice of fresh-water or salt-water fish, prawns and shrimps, yabbies and crayfish. Most can be found in fish markets and well stocked supermarkets. What sort of fish should you buy? That depends partly on your taste, your budget, and your purpose. If you like fatty fish, sardines, herring, Murray cod, perch and salmon are good choices. But the last three are quite expensive. On the lower rung of cost are blue grenadier, gemfish, trevally and flathead. Crustaceans like crabs, lobster and prawns are generally more expensive but would no doubt serve as good treats at the weekends for your family or your close friends, and would be particularly welcome at your barbecue party. For busy professionals, nothing could beat the convenience of fish fillets, of which you may prefer the boneless type such as rock ling, salmon, dory,

gemfish and trevally. These are probably the most convenient to prepare in a limited time frame, say, half an hour. But, as fish markets are not that easy to find in some suburbs, you may have to think about purchasing extra and keeping them in the freezer for future use. If you follow this plan, divide the fillet/cutlet into desired portions, e.g. 500 gm for four persons, and put them into freezer bags for the freezer. Stick an adhesive label on the plastic pack; use a permanent marking pen to write the type of fish, weight and date, to identify it better and quicker when you want to defrost it for cooking. Fish can keep easily up to three months in the freezer. It is not a bad idea to stock up on some canned fish such as tuna, sardines, herring, etc. for a quick and convenient lunch or part dinner, knowing that the bones in the canned fish are more helpful to your bones than calcium tablets. For example, one small tin of sardines of 120 gm contains over 400 mg of calcium, nearly half of your daily need. A Handy Hint for Keeping Vegies Ready to Hand Vegetables are always required to be washed. After removing the stems, seeds, and peel. Cut them up into cubes, or slice them either lengthwise or across before storing them in plastic bags in the fridge, to be handy for everyday cooking. Measuring The Q & E way of eating is time-saving as well as labour-saving. Forget about grams, kilograms, ounces and pounds, millilitres and fluid ounces and tablespoonfuls. Throw away your scales, energy (calorie) counter and carbcounter. They are all a bit of nuisance and a waste of your valuable time and energy when you have just returned home from a day of hard work on a tight schedule and are yearning for a simple and healthy meal After all, cooking is a kind of art and food and eating are part of enjoying life; it should be treated as fun and not as a scientific experiment that requires accuracy in measuring your ingredients. To start with, you only need a few simple kitchen aids as listed below: Plastic Measuring Cups Hard to break and easy to handle. They are generally marked clearly in ¼, ½,

¾ and 1 cup sizes, sometimes with equivalent millilitres. The biggest advantage of these is that you can instantly check the quantity of food you want with them. For example, for your breakfast porridge, mix ¼ cup of 1 minute oats with 1 cup of water, put into the microwave for two to three minutes and it’s done, piping hot. Or, for your dinner, roughly pack your cooked rice or vegies into the cup to see instantly the amount you desire. Remember, a bit more or a bit less of your food would not make a world of difference, because your body’s metabolism also varies from day to day. Even though you may feel you have put on weight, there is no need to panic, because we have a new simple and reliable way to help you check and control your bodyweight. This will be explained in detail later. A Standard Scoop and Large Serving Spoon You can find them in any shop selling kitchenware. Pick up a couple of different sized ones with heat-resistant handles. They are handier than measuring cups for cooked vegies, soup, legumes, nuts, berries, yoghurt, etc. as they measure and serve you the right portion in one scooping action – fast yet accurate enough. The serving spoon is another helpful utensil if you can find a suitable size holding approximately two or three tablespoons full. Plastic Bottle Adapters Get a few plastic adaptors with spouts to replace bottle lids. Use them for cooking oils, soy sauces, cooking wines (such as dry sherry, red and white wines and Siu Hing wine for Chinese cooking). These serve to pour out, within seconds, the desired amount of all those liquids straight from the bottles in a reasonably well-controlled manner to save time while cooking. However, many of the producers of cooking liquids have come to realize the modern trend and have modified the lids to make it easier to pour out the content quicker in a steady flow, without fiddling with a lid or cork. Forget Your Scales The reason you can forget about your scales when you come to your meats and fish is because all meats sold in the supermarkets are nowadays reliably weighed and nicely packed for you, with detailed labelling telling you how

many grams inside. So a pack of approximately 500 gm (1/2 kg) will do fine for a family of four happy to eat less land-animal meat, while up to 800 gm may be needed for the same number of people who need more protein for their growth, sports, etc. Fish is not that much different either, because you can check with the fishmonger about the weight of a piece of fillet, or salmon’s tail, or a whole John Dory, and mark it down on the white butcher’s paper used to wrap up the fish. Say, a rock ling fillet chosen for your dinner for four persons scores a bit over ½ kg, you will know to serve a quarter (about 120 gram) of the fish to each member of your family. Naturally, a bigger serving should go to the one most physically active on that particular day, and a smaller portion to the one doing overtime in front of the computer. It will not take you long before you are able to adjust the serving quantity of meat, fish (protein), pasta, rice, potatoes, bread (carbohydrates) and cooked vegies on each person’s plate. Note – before you start using any of the above rapid measuring aids, do some home-work and quick checking in your kitchen first. This is not hard to do: for example, for your dinner, put a scoopful of cooked rice, pasta, vegies or stir-fry, separately and then all together, onto your plate, just to give you some idea how much food from one scoop will actually amount to when put on the dinner plate. Often, people are surprised to find that the scoopful is too much, so next time they only fill it ¾ full when actually dishing up the food, or change to another smaller scoop. After a few trials, one soon discovers the desirable amount instinctively without fussing about ounces and grams. A Few Handy Containers These are for holding condiments and spices such as salt, sugar, garlic and ginger. Choose ceramic jars, preferably the size of a Chinese rice bowl, for retaining natural flavours and easy cleaning. It is convenient during cooking to just take a pinch of salt, sugar and spice, sprinkle it into the food being cooked to enhance the flavours, and do away with teaspoons, tablespoons, or measuring spoons. After some practice, you will find that your sensitive fingers know how much salt, sugar, spice and herbs to pick up for the amount of food being cooked, for your own preference and for the special requirements of others. People with heart conditions, for instance, are advised to reduce their salt intake while many others may jump through the roof if

you empty a whole packet of hot chilli powder into the dish instead of just a sprinkle. Setting up the Kitchen The Cook-top Installing a gas-operated cook-top is probably one of your best home-ware investments. Select one that comes with an electronic lighting device. Gas gives you instant heat, yet is quickly adjustable. It has long been regarded as indispensable for frying and stir-fry cooking, while the electric oven remains the choice for baking, roasting and braising. In Melbourne, because of the vast natural gas fields in Bass Strait, it is more economical to use this fuel rather than electricity. It is a far cry from the gas produced from coal in the old days which was much more poisonous and expensive too. Electric cook tops still reign supreme in the country for the simple reason that electricity is far more readily accessible than gas. Sometimes the safety of gas appliances may come into question, but that is debatable except for the elderly and infirm who may occasionally inadvertently leave the gas turned on without knowing, due to poor memory, poor eyesight or deafness. An efficient air-extractor overhead is a must, to prevent the inevitable buildup of oily vapour and cooking odours in the kitchen. The Surrounds Try to devise a sensible lay-out around the cooking area. The following tips may help: Install a splash-back on the wall (even if it is tiled) behind the cook-top; it can be a soft metal sheet like aluminium or stainless steel, for easy cleaning and disposability after years of use. The most popular modern material these days is glass, which leaves the tiles behind them visible. Arrange all your frequently used ingredients in bottles, jars, and various containers on a large tray either on the left side (for right-handers) or right side (for left-handers) of the cook-top, to allow you to use both hands while cooking. Particularly in Chinese style stir-frying which often demands fast action, you can use your left hand to pour in oil, wine, sauce, and condiments

from the tray on the left while stirring with the spatula in your right hand. Cooking Needs The Basics Basically you should have peanut oil, light olive oil, grape-seed oil and sunflower-seed oil for frying and cooking as they have a higher burning point (up to 400 F) before decomposing and turning smoky. You also need other nutritious and tasty good oils such as extra virgin olive oil (cold-pressed), walnut oil, sesame oil, chilli oil, and avocado oil, to spread onto cooked vegies or mix into salads. Balsamic vinegar is a must for Italian dishes. Also close at hand should be condiments like salt and pepper, raw sugar, curry, Chinese 5-spice powder, and a thickener like cornflour – all in jars and cups for easy access. The more sophisticated home chef would probably want to have a spice rack within reach of the cooking area for ready access to the most used spices such as basil, coriander, cumin, turmeric, thyme, paprika, nutmeg, cinnamon, etc. Next are cooking wines such as dry sherry and Chinese cooking wine. Also handy to have are flavourful sauces including dark and light soy sauce, oyster sauce, sweet chilli sauce and fish sauce. The all Important Stock and How to Prepare it Do not forget this important ingredient as you will need it in most of the dishes, particularly in vegetable ones if you want extra flavour The easiest way to prepare it is to take a large saucepan of eight to 10-litre capacity and fry chopped garlic, ginger and spring onion fried in ¼ to ½ scoop of cooking oil. Add a small whole chicken (skinned), or broken up chicken carcasses, any spare bones, any leftovers from a fish, like the head or tail), some cheap cuts of pork and bacon (trimmed of fat). Stir for three minutes or till golden, add enough water to cover well over the bones, then add a few more sprigs of spring onion, celery, carrot, or even apples to harmonise the meaty flavour. Bring it to a boil, then simmer for about four to six hours, cool down, tip the rich liquid stock into the desired number of containers (glass if hot, and plastic if cooler) and place them in the freezer for your cooking needs. Before you defrost the stock for use, make sure you

remove the hardened layer of animal fat and discard it. You may be amazed at the amount of bad fat coming out from chicken, and much more from pork, beef and bacon even after careful trimming and skinning – that’s what we call ‘hidden cholesterol’. Cooking Methods While the world-renowned Chinese cuisine can be prepared 30 to 40 different ways according to the type of ingredients, the intensity of the burning fuel, the timing of the cooking temperature and some other factors, the Western way (including world-class French and Italian cuisines) utilises less than eight or nine methods. With your home cooking to be done within a limited time, however, you need only learn three to four basic techniques to cook healthy meals daily. From each one of them, you can derive a few more tricks in future by variation and modification. Let me show you these four ways – easily the simplest of all cooking methods, with some typical recipes. Please note that all recipes shown in this section are meant for four people desiring a healthy meal. You should reduce the amount by half for two people, or increase by half again for six: Method One – Slow Cooking Use a crock-pot which is simply a ceramic pot slowly heated by electric elements.17 This device can take up to four hours to cook a decent dinner, and up to eight hours if you want your meat really tender. Try to prepare the ingredients the night before and put them in the pot in the morning before you go to work. Turn it on slow mode and come home for your piping hot dinner. The easiest cooking method of the lot! Sample recipe – mustard chicken drumsticks in Mediterranean vegies Ingredients Meat 4 medium-size skinless chicken drumsticks Vegetables 2 medium-sized zucchini ½ a red capsicum ½ a green capsicums

1 small eggplant 3 carrots 1 large brown onion 2-3 roma tomatoes 1 handful of sun-dried or semi-dried tomatoes 8-10 black kalamata olives Marinade ½ a cup of stock ½ a cup of white wine 1 dash of light soy 1 heaped tablespoon of grainy mustard 1 pinch of salt and pepper Cereals bread, or rice, or pasta Soak the drumsticks in a bowl with a mixture made from the stock, wine, soy sauce, mustard paste and pepper. Leave it overnight in the fridge. In the morning, take out the meat and put it into the crock-pot. Empty the chopped vegies evenly over the meat before carefully pouring the liquid the meat has soaked in all over the vegies, followed by splashes of extra virgin olive oil. Mix well. Sprinkle with pinches of salt and pepper before putting the lid on (preferably a glass one for easy checking) and switch to slow cook. Then off you go to work knowing there will be a hot healthy dinner ready the instant you get home. Variations You can make many variations of this meal. For instance, substitute chicken thigh for the drumsticks or ½ a kilo of lean beef, lamb or quail. You can even try fish, but seafood tends to become too firm with prolonged cooking. Use red wine for red meat and white for white meat and seafood. The sauce could be a hot one with curry and Indian spice, or an Asian one with Chinese five-spice, light soy sauce, oyster sauce, or a sweeter type in Hoi Sin sauce. Create more varieties by using root vegetables like potato, sweet potato, yam, and cruciferous ones such as Brussels sprouts, cabbage, cauliflower, and marrows like pumpkin, cucumber, and any kind of legumes, peas and beans.

Just pick those you feel like having from the food list in the appendix and put them in. It is as easy as that. Tips for a Quick Lunch Fix Scoop up some hot juice from the crock pot. Mix it into a cup of cooked rice with chopped cooked mushrooms and creamed corn from the tin, and you have a tasty instant risotto for lunch the next day. Or bring a cupful of the hot juice to the boil, add some canned tuna, finely chopped parsley and chives and pour into half a cup of couscous, cover and wait 15 minutes for the stuff to swell and you are rewarded with a delicious healthy lunch. Method Two – Stir-fry Probably the Chinese cooking method best known to the Western world because it is easy to learn, uses only a minimum of oil and is the fastest, most economical way to prepare a meal. Sample recipe – spicy sea dory with snake beans Ingredients Meat ½ kg sea dory fillets (or rock ling, or some other boneless fish) Vegetables ½ kg of snake beans (or French beans, or snow peas) spring onion bamboo root, water chestnut mushrooms Marinade cornflour soy sauce oyster sauce 1 dash of white wine Condiments 1 tablespoonful of Chinese 5-spice powder chopped garlic, ginger Cereals 1 cup of cooked rice or pasta or noodles Combine cornflour, sauces and wine and marinate the fish (cut into chunks)

in the mixture. Mix the spices with the chopped garlic and spring onions. Pour a dash or two of peanut oil into a wok or non-stick frypan, heat to medium or high for a minute before tipping the spice mix into it. Cook for a few minutes until the garlic turns golden yellow but don’t allow it to burn. Quickly add the fish, stir and turn constantly with a spatula, for a minute or two, pour in the vegies, half a scoop of stock and pinches of salt and sugar before covering with a lid. Cook for a further three to five minutes, depending on whether you like your vegies crispy or limp. Make sure the stock in the stir-fry doesn’t dry up. Serve on cooked rice, pasta or noodles. Variations Instead of fish try chunks of skinless chicken breast, beef, pork, or a bit of a mix is OK. Veal mince or fat-free beef mince makes a great quick dish with snake beans, too, but probably will not taste as good as the variation with chunks which generally retain their goodness and flavour better. You can choose an entirely different sauce such as black bean, garlic, hot paste, or the somewhat sweeter Hoi Sin sauce. Curry and chilli sauce are also excellent accompaniments. Method Three – Oven Cooking Using your oven is another labour-saving way to cook, but cooking time is longer and uses more fuel. For this method, you can bake, roast, casserole, or char-grill under the grilling elements. Make sure you put your food into an oven-proof baking dish or wrap it in baking paper. The average temperature range is from about 200 C to 250 C. Cooking times range from about 30 minutes to an hour or even more to roast a large piece of meat. A casserole is probably the dish to make as you put all the prepared ingredients into the casserole (choose a ceramic one for steady heat) and place in the oven. Sample recipe 1 – baked rack of lamb with vegetables Ingredients Meat 1 kg rack of lamb Vegetables 2 small carrots

¼ kg pumpkin ½ cup peas ¼ kg sweet potatoes 2 small zucchinis 2 onions Condiments salt pepper wholegrain mustard ½ sprig of rosemary parsley chives olive oil red wine ½ a lemon Rub salt and pepper into the rack and coat with the mustard. Chop the vegies into cubes. The smaller you cut them the softer they will be so prepare them according to your preference. Put the vegies into the baking dish, with some olive oil, half a lemon’s juice, a dash of red wine and a sprig of rosemary, and mix them well. Preheat oven to about 230 C, place the lamb rack on top of the vegies in the baking dish and put into the oven, cover with foil and roast for 40 minutes before removing the foil. A further 10 minutes cooking will turn the lamb golden brown. Sprinkle with chopped chives and parsley and serve. Variation You may use lamb chops, a veal rack, or even chicken breast and drumsticks for meat. Any kind of root vegies or even apples will help enhance the flavour. Any kind of sauce or paste will equally be successful. You only need to look up the food list to think of what you fancy before you create your own version. Sample recipe 2 – spicy quail in red wine casserole Ingredients Meat 4 quails bacon slices

Vegetables 4-6 medium-sized mushrooms 2 medium-sized red onions 2 large carrots 1 red capsicum 1 green capsicum 1 tin of beans (300 to 400gm) or lentils and/or peas Condiments 1 glass of red wine 1 bunch made up of rosemary, thyme & sage 1 pinch of sea salt 1 pinch of black pepper 2 garlic (two cloves), 2 bay leaves Wash the quail, trim the fat from the bacon and discard. Cut the bacon into strips. Pre-heat oven to 200C. Fry the bacon strips in a thick-based saucepan on medium heat in a dash of oil, till golden. Add some stock, the mushrooms, vegies and herb bundle, then cook on a low heat for five minutes. Tip in the red wine and simmer until the juice is reduced by half. Empty the tin of beans into the pan and bring to a boil, then simmer for another five minutes. Lightly season, then pour all into the casserole and place the four quails on top. Lightly brush with olive oil before placing the casserole into the oven for one hour when the birds turned golden and crisp. Serve on pasta, rice or polenta. Variation You may substitute two poussins (small, baby chickens, preferably free-range and organic), one medium chicken or four large fat-free sausages for the quails. For vegies and lentils, you can use any combination. Just feel free to pick those you fancy, and I am sure they will all work well. If you prefer more greens, chop up some spinach, or parsley, or coriander leaves and spread them on top just before you remove it from the oven. Method Four – Boiling Cooking in boiling water is clearly one of the easiest and the most basic methods, used for millennia prior to cooking oils were discovered. The food is simply put into very hot water, brought to a boil and simmered until

cooked. When you cook noodles, pasta and rice, you are using this method. The extension of this is a meal of ravioli, caramella, meat balls, risotto – all done by boiling. Naturally all kinds of soup are created by boiling and are a great way of enjoying a wholesome meal for many people. The Chinese often cook their vegetables in boiling water or stock so that they can be done quickly, retaining all the pleasing green for a healthy dinner. Chinese chefs have long regarded this method as rather crude and have since refined it to the current practice which is not unlike the way poached eggs are done in the West. Poaching is a wonderful way of cooking when you keep the water (or stock, bouillon, or milk) just below boiling point. It is commonly reserved for quality fish, sea-foods, or a fine cut of fillet steak. You might be surprised how tender and flavoursome a steak prepared like this can be. Sample recipe – barramundi in spring onions, ginger and soy Ingredients Meat 1 whole medium-sized Barramundi (about ¾ kg) Vegetable 2-3 spring onions Condiments Sliced ginger in fine shreds ½ a scoopful of light soy 2 tablespoons of oil The fish should be gutted and scaled. You might prefer to have this done by the fishmonger to spare yourself the mess. Fill a large saucepan (about fourlitre) with two and a half litres of water, bring to a boil, then slip the whole fish in, making sure it is well covered. Bring to the boil again for ½ to one minute, then simmer for a further two minutes. Turn off the heat and leave the fish in the saucepan undisturbed for about 20 minutes. To check if it is cooked, before taking the fish out, poke a bamboo skewer or fine bamboo stick into the fish. A properly cooked fish will offer little resistance. While waiting for the fish to cook, chop the onions and ginger. Heat the oil in a small saucepan and fry them for a minute or so and tip in the light soy. When the fish is ready place it on a plate and pour the sauce over it. While serving the flesh watch out for bones. This dish goes well with cooked rice or

noodles. How do I Know it Works for Me? This master meal plan is designed as a one-size-fits-all healthy eating plan to suit anyone from a large family to a single person no matter how busy they are. Following the tips on shopping and setting up your kitchen and stove will help you save time. The Q & E way of cooking is epitomized by the above recipes which will reward you with fast but tasty and wholesome family dinners, day after day. After a while, you will settle into a routine and treat shopping and cooking as part of your daily work, not a chore. It is a valuable skill that you can improve anytime during weekends and holidays by learning new recipes from cookbooks, magazines or from friends. Above all else, you must treat this master eating plan as a guide and a framework to fast-track your daily meal preparation in the most flexible way, with infinite variations as illustrated in the above basic recipes. No less important is the basic concept, when you come to the evening dinner – the main meal for the majority of us – that you must have only two main foods groups in mind, which are the cereals and vegetables. Meat can be added, on occasion, as an extra source of protein, only because some essential amino acids cannot be obtained from plants (other than soy protein). Always complete your dinner with some fruit rather than dessert. The principle is simplified in one line as: Dinner = cereal + vegetables + fruit, +/or fish (or occasionally landanimal meats) This will work for the majority of people, irrespective of their body type, gene type, blood-group type, or whatever theoretical type is currently the fad. The master meal plan comes with the following variations, flexibility, checks and balance: Flexibility and Common Sense Although you will stick to the principle according to the Basic Food Pyramid that carbohydrates should take up 40 to 50% of your total daily food, proteins about 20% and good oil 10 to 15%, you must temper this rule with common sense. For example, a fast-growing, physically active teenager will need a

bigger serve of meat and lentils than an adult who only hangs around the computer most of the time and whose only exercise is walking the dog. But if the entire family is hungry after a good weekend hiking trip or a snow trip, naturally you should cook more food to satisfy their needs. Apart from that, there are only two facts you need to take notice of. The first is that people who engage in anaerobic body training such as weightlifters will need more protein. The second is that those involved in aerobic endurance sports need more carbs. In other words, you should not be strictly limited by the guideline suggesting one cup of cereal with two serves of vegetables and 200 gm of meat. You should feel free to have more, or less, of any of the main components of your meal to match your body’s metabolic need against your physical exertion of the day, without feeling guilty. After all, cooking and eating should be an enjoyment, as ingredients of your health, and part of your life, and should not be restricted by the rule book as long as you adhere to the health food guide – the Basic Food Pyramid. Special Needs People in a special category need to adjust the plan accordingly. For example, anyone who is overweight should eat more meat (fish is particularly good) and nuts/lentils to help curb their appetite, while cutting down on carbohydrates and oil. Pregnant women, lactating mothers and growing children all need more protein, particularly dairy products, to sustain their health and wellness. Keeping Track Now, the final crunch. As you proceed with the master eating plan, it is just natural that you might ask, how do I know if I put on weight or have a few kilos taken off under this meal plan when I have my food served to me without accurate measurement? My advice is, don’t worry. When you throw away your kitchen scales, when you ignore tedious measuring in grams and ounces, it does not mean that you do not have any way to monitor your weight. In fact, there are at least three simple yet accurate methods by which anyone can keep a check on their bodyweight. Here are the two most scientific ones: (1) Purchase a good quality set of digital scales. While undressed, check your weight once a week, and always hop on the scale at the same time of the day

for more accuracy. You can do it every morning if you want to, for example, before your morning exercise, or before breakfast, and you will be guaranteed absolute control of your weight, week by week, just by adjusting the serving size of your food. What is more, if you know your height in cm, you can easily work out your BMI (your weight in kilos, divided by your height in metres squared). A healthy weight should fall in between 20 to 25 BMI. So say if your BMI has risen to 24 from 22, you know that for the next few weeks you must reduce the serving size of your food, increase the duration of your exercise, and, I am sure, your BMI will fall back in no time, to your great satisfaction. Simply said, you now will have absolute control of your own body chemistry and metabolism, without bothering about a few grams more here or a few calories less there from your cooking. And this is the start for you to feel the freedom and enjoyment at cooking and eating, while completely eliminating all the stress and triviality inherent in following most recipe books, cooking manuals, weight-reduction guides, ‘weight loss in 6 weeks programmes’ ... and the entire load of similar nonsense – most of which is probably not worth a crumpet. (2) Take a measuring tape, check the circumference of your tummy (the biggest part of course). The consensus of medical opinion today is that the measurement of your waist fat (also labelled ‘central fat’) is the most reliable guide as to how much unhealthy fat your body has. The bigger the circumference of your waist line, the more prone you are to heart attack, diabetes, etc. The standard is that it should not be more than 102 cm for men, and 88 cm for women. This waist-fat measurement has now become another helpful tool to check your heart health because it will quite accurately reflect the amount of unhealthy body fat irrespective of your body type, shape, height and environment. If you could combine the practice in (1) and (2) and adjust your food intake by serving sizes, pick only the healthy food from the list and practise the Q & E cooking methods, it is practically guaranteed that you will become the master of your body, your weight, your health, and your destiny. Now, all you need to do to start your new found freedom in cooking and eating is to go through the extensive list of food under different categories in

Appendix A, plan your menus in advance, do most of the shopping at the weekends or after work, and start turning out all the healthy dishes you fancy or want to create from your own personal preference, by way of this master meal plan and Q & E cooking. It is really as simple as that. Bon Voyage!

Appendix A Checklist for Cereals (only the wholesome types with low sugar or GI) 1. Ready to Eat Bread (high-fibre white, wholemeal, multi-grained, rye, sourdough, soy, linseed), Wholemeal muffins, crumpets, WeetBix, wheat flakes, and similar products with low sugar content Rice cakes, crackers and biscuits Muesli of all different brands, or, better still, make your own. 2. To be Cooked Pasta of all kinds Rice – white, brown, wild, bran Noodles – rice or wheat, buckwheat Bulgar – cooked whole wheat Oats – rolled, instant, flakes, bran Barley – pearl, rolled, flakes Corn – maize, polenta, sweet corn Others – couscous, tapioca, sago Note – item 1. Breakfast foods can be snacks, and usually require liquid accompaniments such as milk (low fat), soy milk, and rice milk. Or, in the case of bread, you need spreads such as vegemite, sesame, jam, or dip into a tray of balsamic vinegar and olive oil. Avoid the regular use of butter and margarine. Checklist for Vegetables 1. Green leafy vegetables Lettuce spinach bok choy baby bok choy broccoli Chinese cabbage cauliflower Brussels sprouts 2. Roots/stems/bulbs

rocket choi sum watercress cabbage

silverbeet gui lan kale

carrot parsnip celery bamboo

potato radish rhubarb asparagus

3. Marrows, shoots & others zucchini pumpkin squash winter melon alfalfa bean sprouts beans peas capsicum: (all colours) fungi & white fungi mushrooms red and green tomatoes

yam sweet potato leek water chestnuts

beetroot turnip onions

eggplant Ghit melon other sprouts sugar snap peas capers champignons

bitter melon si melon corn snake beans olives field

Note: those items in bold print are either Chinese or S.E. Asian produce, and can easily be purchased at the market or Asian grocery, even though not regularly stocked by supermarkets. Checklist for Nuts, Seeds & Legumes (dried beans and peas) baked beans split peas chickpeas lentils red beans kidney beans green beans black beans Brazil nuts almonds cashews hazelnuts macadamias peanuts pecan nuts Pistachios pine nuts walnuts pumpkin seeds sesame seeds soybeans sunflower seeds (note products like tofu, etc.) Checklist for Fruit apples apricot cherries custard apples grapefruit guava kiwifruit loquat

avocado fig honeydew lychee

bananas durian jackfruit lemon

lime mandarin nectarine orange peach pears rambutan starfruit watermelon blackberry cranberry gooseberry raspberry strawberry raisins and sultanas

mango passionfruit pineapple plum (prune) blueberry loganberry green grapes

Checklist for Fish & Marine Animals 1. Fatty fish perch sardines herring mackerel Murray cod anchovies blue-eye cod eel 2. Saltwater fish rock ling bream John Dory swordfish gemfish whiting

sea perch flounder garfish

3. Crustaceans, Molluscs & Others crabs crayfish prawns yabbies abalone shrimp mussels oysters scallops

nashi pawpaw tangelo rockmelon boysenberry mulberry black grapes

salmon pilchards

tuna trout

flathead snapper barramundi

sole trevally

lobster clams

scampi calamari

Checklist for Land Animal Meat chicken turkey quail pigeon beef lamb veal pork duck rabbit kangaroo venison crocodile frogs animal organs – brain, liver, heart, tongue, oxtail, kidney, tripe Checklist for Good Oils grapeseed light olive peanut macadamia sunflower seed corn oil

avocado sesame

walnut canola

extra-virgin cold-pressed olive oil Checklist for herbs, spices and condiments basil bay leaves chives coriander dill mint oregano parsley rosemary lemongrass tarragon thyme Chinese cumin sage 5-spice cinnamon cloves garam masala curry cardamom ginger mustard ground pepper nutmeg turmeric vanilla chilli paprika sauces – Hoi Sin, sweet chilli, fish, oyster, soy pastes – shrimp, black bean, curry, vinegar, beverages – beer, red wine, white wine, cooking sherry balsamic vinegar

Appendix B List of Common Antioxidants Antioxidants are compounds with a chemical affinity for free radicals. They are usually present in abundance in the body and readily available to neutralize the free radicals before they can cause damage. But your body’s own antioxidants can be depleted to some extent if you have been exposed to internal stress such as viral and bacterial infection, chronic diseases and emotional and mental stress. They can also be depleted by exposure to radiation, pollutants and toxins, UVB or through cigarette smoking, drug taking, excessive alcohol consumption, injury, trauma, ageing, and intensive exercise. Therefore, you should never become complacent about your body’s antioxidants. You must constantly aim at building them up by regularly consuming food and drinks rich in them as well as avoiding conditions and habits which deplete them. Basically antioxidants can be grouped into five classes: 1) enzymes – such as catalases, peroxidases, and superoxide dismutase 2) peptides – such as glutathione 3) phenolic compounds – such as vitamin E and plant flavonoids 4) nitrogen compounds – various amino acids 5) carotenoids – most notably beta-carotene N.B. – There is another group that is, strictly speaking, not antioxidant, but they have the properties to enhance or re-build the body’s antioxidant store. Vitamin C, for instance, helps to recycle vitamin E, and NAC (N- acetyl cysteine) provides an important element that helps the body to regenerate its own store of glutathione. Some of the major antioxidants are listed below in alphabetical order: Alpha Lipoic Acid – a recently discovered antioxidant. It acts by lending out an electron to ‘used up’ vitamin C or E to restore their role as antioxidants. Alpha lipoic acid is produced in the body but usually in insufficient quantities for optimum health. Therefore, it has to be sourced from our plant food such as tomatoes, peas, broccoli, etc.

Carotenoids – a group of compounds found in many fruits and vegetables, particularly in those with brightly coloured skin such as carrots, tomatoes, beetroot, etc. Beta-carotene is the most notable one. Synthetic compounds usually have little biological effect. Chocolate – this tempting indulgence has surprisingly been resurrected as a beneficial nutrient. It has been discovered by researchers at the University of California to carry high levels of chemicals known as phenolics (the same antioxidant found in colourful fruits and vegetables).18 It has been reported that 1.5 ounces of milk chocolate contains nearly the same amount of phenolics as a five-ounce glass of red wine. Coenzyme Q 10 (CoQ 10) or ubiquinone – is a potent free radical scavenger in lipid and mitochondrial membranes. In experiments on mice affected by familial ALS (a kind of brain neuron disease), CoQ 10 has been found to be more neuro-protective than vitamin E and resulted in the extended survival of the mice. There have been similar findings in regard to other brain diseases such as Parkinson’s, motor neurone and Huntington’s diseases. Every process in our body requires CoQ 10. Without CoQ 10, cell death occurs and life stops. CoQ 10 can be purchased in 50 mg or 100 mg capsules from health stores, pharmacies, etc. Cordymax – this one is interesting as it is said to be a well-known herb from Tibet and has been shown in clinical studies to improve stamina, fight fatigue and enhance lung and antioxidant function. Gingko Biloba – usually prescribed for poor circulation, it is said to also have proven antioxidant properties. Idebenone – is an analogue of Coenzyme Q 10 but believed to have more advantages over CoQ 10. Glutathione – Glutathione is our tissue cells’ own major antioxidant. It is a tripeptide (meaning three peptides bound together) that must be produced in the cell. But yeast is a good natural source of it. Extensive research and clinical trials have consistently demonstrated that glutathione will enhance the immune response system. It is a powerful antioxidant that helps regulate other antioxidants, neutralizes free radicals and raises levels of fighter T cells

(a type of killer cell of the immune system that will destroy harmful viruses, bacteria, etc.). It detoxifies the liver, removing 12 known carcinogens (cancer-inducing substances) from the cells and suppresses the growth of tumours. It is, therefore, a most important substance produced by our own body for the benefit of the entire immune system. Glutathione detoxifies by conjugating with most ‘foreign’ compounds and then expels them from the body through the biliary system. Immunocal – is a natural protein and is the only clinically proven natural food supplement to consistently optimize the levels of Glutathione in the cells. Melatonin – found by researchers to be one of the most potent endogenous scavengers of toxic radicals in the brain, and is useful in protecting the dopamine neurons in the brain, thus slowing down and even preventing the onset of Parkinson’s disease, etc. (se Neuropathy Digest Feb 98) Microhydrin – is silica hydride, and claimed to be the most powerful electron donor (antioxidant) as well as the smallest nutritional particle ever discovered. It appears to be a very promising powerful antioxidant in the future. N-Acetylcysteine (NAC) – is produced in living organisms from the amino acid cysteine, and is found in foods. It is a powerful antioxidant. NAC is rapidly absorbed, and is rapidly absorbed and metabolised in the body to produce intracellular Glutathione. Olive Oil – this contains several antioxidants. Cold-pressed extra-virgin olive oil is best because no chemicals are used in the extraction process. Phenolics – these are naturally occurring antioxidant substances found in the skins of many brightly coloured fruits, berries, vegetables and herbs, and also in the skins and seeds of the black grape varieties. Red Wine – the juice and skin from red/black grapes is a rich supply of antioxidants. Now recently a super antioxidant has been discovered inside the seeds of these grapes which may offer significant protection against certain types of cancer, heart disease, rheumatoid arthritis, cataracts and many other chronic and degenerative diseases. In the new study, researchers has extracted

a compound called ‘Activin’ from the seeds. Activin is a new super oxidant, found to be up to seven times more potent than vitamins C, E and beta-carotene. This effect is considered to be due to the highest concentration of flavonoids in the seeds. Activin could therefore be a nutritional ingredient and not a drug. That research may also explain why red wine is more beneficial than white wine – because red wine is fermented with the seeds while white wine is not. Red grape juice has recently been found to play a role in reducing blood clots and preventing heart disease. And the study of resveratrol, extracted from the red grape skins, has indicated its cancer-fighting properties. Selenium – This element is required only in minute amounts and is normally ingested from a balanced diet. It is toxic in large doses. Tea – known to have antioxidant properties. Green tea, in particular, is said to have additional compounds that may assist in other ways. Vitamin E (Tocopherols) – this is a collective term for eight related compounds all naturally occurring essential fat-soluble nutrients. They are found predominantly in the following oils: corn, soybean, olive, palm, rice bran and barley. Yes, all in oil form. They have been shown to have powerful antioxidant, anti-cancer and cholesterol-lowering properties, though in varying degree for different compounds.

Appendix C Foods Rich in Antioxidants Vegetables tomatoes peas/beans spinach broccoli carrots beetroot corn soybeans capsicums choy sum sweet potatoes pumpkins

Fruit Cereals plums potatoes oranges rice bran watermelon barley blueberries blackberries cranberries strawberries raspberries avocado cherries grapes grape seeds (extracts)

Others chocolate red wine tea herbs olive oil barley oil

NB: The list is not meant to be exhaustive, as antioxidants can be found in many other cereals, highly coloured vegetables and fruits. The best policy is to consume a variety of them daily, as the scavenging action on the harmful free radicals will be more complete and more efficient due to the combined mechanism of antioxidants from different food groups.

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1

A research paper, issued by the Australian Chronic Disease Alliance, (November, 2004).

2

(see Australian Dr Weekly, 14 February, 1992)

3

The Age, April 27, 2004

4

Australian Medical Journal, number 153:123, 1990

5

Braun, L, Cohen, M, Herbs and Natural Supplements, Elsevier, 2005

6

Noakes, Manny and Clifton, Peter; The CSIRO Total Wellbeing Diet; Penguin Group, Australia, 2005 7

While this is true we must not forget that there are a lot more serious sexually committed diseases than gonorrhoea, some of which are incurable, and it is important to treat being sexually responsible very seriously. 8

See The Age July, 2011

9

Channel 7 (27/10/06)

10

See Chapter Six

11

(Cooper, 1997, American Journal of Medicine).

12

Annual Women’s Health Updates, Sydney, 19 Feb, 2011

13

Quoted in Maslow, AN H, Motivation and Personality 2nd ed. New York, Harper & Row, 1970, p

th

154 14

See Herbert Benson, The Relaxation Response, first published1975

15

The Sunday Age, Jan 9 2005, Agenda, page15

16

The Australian (October 31, 2005)

17

You can also use a slow cooker made from stainless steel or a rice cooker or even put the same dish in a ceramic casserole in the oven on a low temperature though this is less fuel efficient. 18

September 1996 issue of The Lancet