20111101 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, NOVEMBER 1, 2011

Illustration: Tom Jellett

HEALTH POST PROTEIN-FILLED CRAB GETS THE HARD SHELL >PAGE 8

GET A KICK OUT OF AN MMA WORKOUT >PAGE 9

Local menace

Southern Chinese, including Hongkongers, are more susceptible to nasopharyngeal carcinoma >PAGE 4

2 NEWS HEALTH BITES ......................................................

Jeanette Wang jeanette.wang@scmp.com

When too many bubbles cause trouble Teens who frequently guzzle non-diet, carbonated soft drinks are significantly more likely to be aggressive, according to a study published online in Injury Prevention. In a survey of 1,878 youths aged 14 to 18 in Boston, Massachusetts, researchers found the effects of such drinks were of the same magnitude as alcohol or tobacco. Thirty per cent of the respondents had high soft-drink consumption – five or more cans (355ml) a week – and they were more likely to have drunk alcohol and smoked at least once in the previous month, carried a gun or knife, and perpetrated violence against peers, family members or partners.

APP OF THE WEEK

Mind games What you don’t know can’t hurt you, and that applies to fitness goals, too. Northumbria University researchers have found that deceiving the brain can lead to a 5 per cent improvement in sporting performance, showing that athletes have a reserve of energy that can be tapped. In their study, trained cyclists raced against an avatar on a computer screen that they believed was moving at a speed equal to the cyclist’s personal best. The avatar, though, was actually going 1 per cent faster, yet the cyclists were able to match it.

However, when participants were aware that the avatar was going faster, the motivation to access this reserve was not effective, the study found.

Why is the sky so high?

Curiosity is a huge factor of success in school, and, combined with conscientiousness, can have as big an effect on performance as intelligence, according to a study published in the journal Perspectives on Psychological Science.

Researchers performed a meta-analysis, gathering data from about 200 studies involving about 50,000 students. “Curiosity is basically a hunger for exploration,” says co-author Sophie von Stumm of the University of Edinburgh. With it, she says, one will read widely or perhaps travel the world to try different foods – activities that could help grades and possibly work performance. “It’s easy to hire someone who has the done the job before and, hence, knows how to work the role,” von Stumm says. “But it’s far more interesting to identify those people who have the greatest potential for development, i.e., the curious ones.”

Pain, begone Intensive stretching classes are as effective as yoga to ease that bad back, according to the largest US randomised, controlled trial of yoga to date, published by the Archives of Internal Medicine. In the trial, 228 adults with moderate lower back pain were randomly assigned to 12 weekly 75-minute classes of either yoga or stretching that emphasised the torso and legs, or a comprehensive self-care book, The Back Pain Helpbook. The class participants also received instructional videos and were encouraged to practise at home for 20 minutes daily between their weekly classes. Both yoga and stretching were more effective than the book, with better back-related function and diminished symptoms at 12 weeks, and less use of pain medications for at least six months.

Hope for leukaemia patients Scientists from the University of Arkansas for Medical Sciences have developed a new potential leukaemia therapy that targets only cancer cells, starting to kill them as early as four hours after the start of treatment, while sparing healthy cells. The molecules used to create this agent are structurally similar to the compound found in many gout treatments and over-the-counter products used to treat warts, which also prevent cell growth. It’s unlike many current chemotherapy treatments, which affect both cancer and healthy cells, causing side effects including fatigue, hair loss, nausea, anxiety and depression. Researchers will test the treatment in animals and pinpoint the most effective method.

Don’t get behind in fitness – it’s a matter of motivation ......................................................

Katie McGregor healthpost@scmp.com 101 Revolutionary Ways to Be Healthy Free Rating 9/10 “Does it really matter if I put my run off until tomorrow?” That’s a thought I can certainly identify with.

I had tapped “Surprise me” on the 101 Revolutionary Ways to Be Healthy app and turned up tip 19: “Fake it till you make it... act as if your commitment were unwavering.” Underneath the tip you can tap to learn more, and I soon found myself engrossed in an article written by a cognitive psychologist discussing how unconscious “mental frames” can sabotage our good intentions.

The article spoke loudly to me, and I realised that I did carry a saboteur of my own, a sneaky little voice that tells me that an extra day doesn’t really matter since I’m not a serious runner.

Of course, one day leads to another, and before you know it, you’re even further from your goal.

Acting as if my commitment is unwavering, and that I am an athlete, may well be the tool to disarm my unwanted passenger.

Most of us do need an external motivator or two to deal with these inner voices. Sometimes it’s the “fat me” picture on the fridge. For others it’s the motivation bounding out of a

personal coach or the threat of team disapproval for not showing up.

This app can be used on its own or with any of the above and is a fun way to fill your head with some motivational messages, facts and figures on a daily basis.

Unlike so many other messagea-day apps, the information is quality stuff. The app’s creators, Experience Life, make a good job of being “your antidote to all the fuss and nonsense that dominates the

Unlike so many other message-a-day apps, the information is quality stuff. It’s motivating, too vast majority of health and fitness publications”. They claim that being healthy is a revolutionary act, and this talk in itself is motivating.

You can pick up the core tips while offline, but you do need an internet connection to read more of the associated articles. The app is attractively laid out, and you can choose to browse through the messages, or be surprised.

The 101st tip is probably the simplest to achieve: “Pass this app on.” It is my pleasure to do so.

> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; e-mail advertising@scmp.com

MEDICAL 3 CASE HISTORY

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

Eileen Aung-Thwin healthpost@scmp.com Sarah May, 61, had trouble walking.

Although she is a vivacious and active woman who loves travelling, she could not walk far before her legs would cramp up. Her feet were also constantly cold. But May (real name withheld for patient confidentiality) knew very well what was ailing her.

Fourteen years ago, she had been diagnosed with peripheral arterial disease (PAD), a common circulatory problem in which the blood flow to her legs was reduced because her arteries had been narrowed by a build-up of fatty material – a condition called atherosclerosis.

Atherosclerosis is more commonly known to affect the coronary arteries of the heart and in the brain, where they can cause heart attacks and strokes. However, atherosclerosis is a systemic disease and can also take place in arteries supplying blood to other parts of the body, such as the legs, arms, lungs and kidneys.

In PAD, the reduced blood circulation to the legs can cause painful cramps when walking, leg weakness and numbness, coldness in the feet, poor wound healing, ulcers and even gangrene.

Although PAD is not well known – only 26 per cent of respondents to an American phone survey said they were familiar with the condition – it carries a health risk to patients. One in five PAD patients will suffer death for cardiovascular reasons, experience a heart attack or stroke or require admission to hospital. The risk of death is increased in PAD patients whether they exhibit the symptoms or not.

May had all the classic risk factors for developing PAD – diabetes, hypertension and a smoking habit. In 1996, she underwent a balloon angioplasty – in which a deflated balloon on a catheter was placed into the narrowed arteries in her leg and inflated to widen the constricted area before being removed.

Although her condition improved for a while, May persisted in her smoking habit, and the arteries renarrowed, causing the walking difficulties.

Late last year, after more than a decade of bearing with the revived symptoms, May finally sought help.

She was referred to assistant

professor Dr Bryan Yan Ping-yen, a specialist in cardiology in Chinese University’s department of medicine and therapeutics.

A previously conducted computed tomography (CT) angiogram showed Yan that May’s femoral arteries were blocked at the points where they joined with the abdominal aorta.

Yan explains that because the blockages occurred over time, the body adapts and gets blood to her legs via other blood vessels. However, those other routes are less efficient at moving blood – Yan likens it to travelling via narrow back alleys instead of cruising down the highway – resulting in her pain.

If May’s condition is untreated and deteriorates further, she could develop ulcers and gangrene in her legs. At that point, she could lose her limbs.

Although bypass surgery could have treated her condition, it was a big operation that involved rerouting blood flow around the blocked arteries and would usually require general anaesthesia and a longer recovery period.

Instead, Yan suggested a minimally invasive and lower risk endovascular therapy to clear the blockages and insert two stents to keep the arteries open and allow blood to flow normally again. This procedure would only require local anaesthesia, and May could stay awake throughout the process.

As May’s case was very severe given the long history of her condition, the plaque that closed off blood to her femoral arteries was very hard – “like concrete”, Yan says. He had to insert catheters through her elbow and both her femoral arteries to attack the plaque from above and below.

Yan then had to chip his way through the plaque with pointy wires in the catheters. After the arduous task of chiselling through the rockhard plaque and unclogging the arteries, Yan then inserted two stents where the aorta splits into the femoral arteries, forming an inverted V-shape to keep the blood vessels open. The way the two stents touch gave rise to the moniker “kissing stents”.

The procedure was a success.

That night, May noticed that her feet were no longer cold, and the very next morning, May could walk without pain and cramping.

A slight, though rare, complication arose when a clot formed in her arm

Illustration: Angela Ho

Get back into circulation

after the procedure and needed to be removed in a separate operation the following week.

With the circulation restored, May relished her newfound mobility and was soon taking overseas trips.

However, she still needs to keep her diabetes, hypertension and smoking habit in check.

Yan says PAD can be easily diagnosed by using a non-invasive method called the Ankle-Brachial Index or ABI. In it, a person’s blood pressure at the ankle is taken and divided by the blood pressure at the arm.

Because the blockages occurred over time, the body adapts and gets blood to her legs via other blood vessels

A healthy person’s ankle blood pressure should be the same or higher than the blood pressure in the arm, and the ABI should be above one. An ABI of less than 0.9 indicates disease, and an ABI around 0.5 would already be accompanied by severe symptoms.

As PAD is a lifestyle-limiting disease, and patients carry an increased risk of death by cardiovascular causes, heart attack or stroke, Yan says it is important – and easy – to get an early diagnosis and treatment of this disease.

ASK THE DOCTORS DR PIAN YIP Q: My two brothers and mother have all done lasik surgery without a problem.

But recently a friend told me his friend’s lasik surgery was botched and he now has to walk around with a huge magnifying glass just to read things. I’m thinking of getting lasik, but now I’m worried. What are the chances that something will go wrong?

A: It was a pity that your friend was not satisfied with the lasik surgery. Grave complications can occur after lasik,

causing irreparable damage to the eye, but such cases are very uncommon. Since its approval in 1998, it has been performed on millions of people with minimal side effects.

Immediately following the surgery, you might experience such complications as mild pain, tearing and itchiness, but they are usually transient. Most achieve better vision after lasik, but a number of them do complain of haziness, especially when driving at night (a phenomenon we call “glare”).

Dry eye is also very common after lasik. It usually takes a few months to subside but can remain as a permanent problem in some individuals and can result in hazy vision, irritation and even infection.

Under- or over-correction is another risk that you need to know about. In your friend’s situation, if he was rendered long-sighted after lasik (that is, overcorrected), reading would be difficult, necessitating a magnifying glass.

Serious complications such as

infection and weakening and bulging of the cornea are very rare, and the latter is preventable by a meticulous screening process before the procedure.

Lasik is a very safe and effective procedure, but there are some risks you need to know about. You should talk to your eye specialist regarding the potential risks involved and whether you are a good candidate.

Dr Pian Yip is a specialist in ophthalmology

4 COVER STORY

Killer cancer Southern Chinese, including Hongkongers, are 25 times more likely to get nasopharyngeal carcinoma, although rates are falling, writes Richard Lord

Illustration: Tom Jellett

C

hapman To (not the actor) had heard of nasopharyngeal carcinoma, but he had no idea what the disease involved. No one he knew had ever suffered from it. But when a lump on the left side of his neck didn’t go away for three months (lymph node inflammation is a classic symptom of the cancer known as NPC), he went to see his doctor.

And on October 31, 2008, at the age of 27, he was diagnosed with stage-three NPC. “When I found out, I couldn’t believe it,” says To, who has now recovered. “My mind was totally blank. Was I going to survive? I wanted to hide. I kept thinking: ‘Why me?’ ” It’s a common story. If you’re not southern Chinese, chances are NPC is the biggest killer cancer you’ve never heard of. If you are southern Chinese, then it’s a killer cancer you really should have heard of, because your chances of getting it could be 25 times higher than other people.

Nicknamed Cantonese cancer, NPC affects the nasopharynx: that’s the part of the head behind the nose, and above and behind the mouth. It’s the most common cancer of the head and neck in Hong Kong. According to the Hong Kong Cancer Registry, in 2008, the last year for which figures are available, it was the fifth most common cancer among men in Hong Kong, and 12th

COVER STORY 5

in the genes among women. (It’s roughly twice as common in men, and prognosis for males is also worse.) Although it mainly affects people from Guangdong, Guangxi and Hainan, it accounts for 18 per cent of all cancer cases in China. It also affects younger adults more than most other cancers, striking most commonly in their 30s and 40s.

There is at least some good news where NPC is concerned: its incidence in Hong Kong has been gradually falling over the past three decades, from more than 30 cases per 100,000 population to fewer than 10. No one’s quite sure why. The problem is, NPC remains fiendishly hard to detect because most of its symptoms can easily be mistaken for those of far more benign conditions.

These include inflammation of the middle ear, potentially causing ear blockage; hearing loss and tinnitus, but only on one side; fever; nasal obstruction; nosebleeds; and headaches.

“People think there’s nothing wrong, and 99 per cent of the time they’re right,” says Dr Peter Teo Man-lung, an oncologist at the Central Comprehensive Cancer Centre. “But the 1 per cent really matters.”

As in To’s case, the symptom that often prompts sufferers to first seek medical attention is persistent lymph node enlargement, because it’s less easily dismissed as something trivial. But this often manifests itself relatively late – and late diagnosis is the bane of NPC treatment.

“The distribution of the disease on presentation is still the same as it was 30 years ago,” Teo says.

“Stage three is still the most

10 • Percentage of NPC cases that present at the first stage (where there is a 90 per cent recovery rate)

common stage of detection. It’s important that we see more people present in stage one, but we’re not seeing that yet.”

Dr Daniel Chua Tsin-tien, associate director of the Comprehensive Oncology Centre at Hong Kong Sanatorium and Hospital, says NPC does at least “provide some hints for us to detect it in the early stages”, hearing loss being key among them. But he agrees that early detection is still a problem: only 10 per cent of patients present at stage one, when prognosis is good, with a recovery rate of 90 per cent, he says. A further 30 per cent present at stage two, when their chances of recovery drop only slightly to 85 per cent. The most common stage to present is three – 35 per cent of patients – when the recovery rate is 70 per cent; and 25 per cent present at stage four, when it falls to 55 per cent.

Precisely what causes a person to develop NPC is unknown, but medical consensus points to three factors. “Number one is racial,” Teo says. “Certain southern Chinese are predisposed to developing NPC; several genes have been identified, the presence of which will predispose people to it.” So if a close relative has had the disease, it makes sense to get screened for it.

The second is infection by the ubiquitous Epstein-Barr virus, a member of the herpes family, which infects most people at some point in their lives and is associated with various cancers, Teo says.

The third is environmental factors, mainly diet.

“It’s multifactorial, like lots of other cancers,” says Dr Ambrose Ho Chung-wai, associate ear, nose and throat (ENT) consultant, at Tung Wah Hospital. “People don’t know how the three factors interact with one another, but the genetic factor is the biggest. If people from Guangdong migrate, for example to the United States, the first generation get it at the same level, but the second generation don’t. That could be caused by changes in diet in infancy and childhood.”

The link with diet is still

Certain southern Chinese are predisposed to developing NPC; several genes have been identified, the presence of which will predispose people to it DR PETER TEO, ONCOLOGIST

contentious. The key suspect is salted food – both in one’s ancestral diet and when fed to infants – and in particular a chemical compound called nitrosamine, a by-product of the preservation process. But as Chua says: “We’re not sure what specific diet component it is. We know that salted fish in the past was a problem; of course, these days the diet is changing, and it’s especially given less to small children, which may be one reason there’s been a decline in incidence in Hong Kong. There’s been a similar pattern in Singapore.”

Moreover, says Dr Victor Hsue Chan-chee, specialist in clinical oncology at Hong Kong Adventist Hospital: “The link with consumption of certain foods is not really proven. People say it’s caused by salted fish congee and so on, but that’s not yet supported by studies.” He thinks the decline in cases in Hong Kong could also be caused by a reduction in exposure to the Epstein-Barr virus, and by increased awareness of the disease among ear, nose and throat specialists and general practitioners.

However, says Ho: “We teach medical students about it, but whether GPs can pick it up is another matter. The nasopharynx is in the middle of the head, so it’s hard for a doctor to do an examination without referring the patient.”

He adds that the statistics also might not be completely reliable.

“We diagnose more for other cancers because we screen for them, so we think there are more of them. For NPC, there’s still no common screening programme,” Ho says.

Considering its historical prevalence in Hong Kong, there have been very few public campaigns about the disease here.

“There’s very little education coming from the government side,” Chua says. “Most information comes from professionals and other organisations and societies.

I’d say public knowledge is not very good, that’s why so many present at such a late stage.”

Teo adds: “We really need to reinforce the public health

message. We have to drill into Hong Kong people’s minds the idea of playing safe.”

Often the symptoms seem to have no known cause or are benign – but it’s up to ENT surgeons to exclude malignancy, Teo says.

When NPC is detected, the first line of treatment is radiotherapy – with chemotherapy if the cancer is more advanced than stage one.

“Because the tumour is very deep inside and tends to grow into the bone and so on, surgery is not considered the first option,” Chua says. “The first is usually radiation: NPC is more sensitive to it than other tumours.” In the past, long-term damage to surrounding sensitive areas was a problem, he says, but improvements in imaging technology mean that it’s no longer a major issue.

Unfortunately, unlike many cancers, short-term lifestyle changes probably won’t make much difference to the chances of you getting the disease. “Any carcinogenic factors operating will cause cancer in only 20 to 30 years’ time – there’s a time lag,” Teo says.

Even smoking is less of a factor than you might think, unlike with many head and neck cancers; still, living a generally healthy lifestyle is the best way to reduce your chances of getting NPC or any cancer. And that includes avoiding salty and other preserved foods.

Fortunately, overall recovery rates are about 65 per cent – “so we can say NPC, in general, is more curable than other cancers,” Teo says.

After four initial doses of chemotherapy and three back-up doses – plus 38 sessions of radiotherapy, all between November 2008 and March 2009 – To made a full recovery.

And he, at least, has brought away something positive from the experience.

“Before, I was kind of an anxious person, always angry, and I always put a lot of pressure on myself,” he says. “Now I’m much happier. I choose to eat healthily, I go to bed earlier and I feel more relaxed.” healthpost@scmp.com

6 HEALTH NUTRITION WATER

How much do you really need to drink ......................................................

Monica Proctor healthpost@scmp.com Few people know that American artist Andy Warhol actually died of water intoxication. After routine gall bladder surgery at the New York Hospital (now the New YorkPresbyterian Hospital), staff overloaded his body with fluids, causing a fatal heart attack.

Yes, while drinking water is a healthy habit, too much can lead to a condition called hyponatremia, in which there is not enough sodium (salt) in the body fluids outside the cells.

Long distance runners who drink too much plain water and people who work in climates that cause excessive sodium loss through sweating are at an increased risk.

Sodium is vital for maintaining blood pressure, and for nerves and muscles to work properly. When the sodium level in fluids outside the cells drop, water moves into the cells to balance the levels, causing the cells to swell.

Brain cells, confined by the skull, cannot handle the swelling and cause most of the symptoms of hyponatremia. These include confusion, hallucinations, seizures, fatigue, irritability, muscle spasms, cramps and nausea.

However, these symptoms are similar to the effects of dehydration, so a patient may be given more water, worsening the condition.

So, how much water do we really need?

The Health Department recommends six to eight glasses (or about 2.5 to three litres) of fluid per day, supplementing with foods that contain high moisture content, such as fruits and vegetables.

The Institute of Medicine in the US states that adult men need about 13 cups (three litres) of fluid per day; women, about nine (2.2 litres).

Statistics show that one-third of Hongkongers are drinking fewer than six cups of fluids a day and 16 per cent are drinking more than eight.

The fact is, there is no one-size-

fits-all standard. One’s needs are based on age, weight, activity, climate, diet and health concerns.

Dr F. Batmanghelidj, author of the book Your Body’s Many Cries for Water, recommends an ounce (25ml) of water for every two pounds (900 grams) of body weight.

If you weigh 150 pounds (68kg), you should drink 75 ounces (2.2 litres) of water.

He had experienced the healing power of water when he was a political prisoner in Iran, using water to treat other prisoners when medicines were lacking.

“Sedentary people can drink less,” says registered dietitian Carmen Lo Ka-man. “But don’t forget that water is vital for waste elimination and breathing.”

Children, athletes and the elderly are more prone to dehydration.

Older adults are likelier to become dehydrated because their sense of thirst declines. Pregnant women and nursing mothers need more water. Antihistamines and certain antidepressants increase hydration needs.

“By the time you feel thirsty, you are already experiencing the symptoms of dehydration,” says Dr Edmund Li Tsze-shing, an associate professor of food and nutrition at the University of Hong Kong.

As a general rule, to prevent dehydration, monitor your urine. A hydrated body will have clear,

colourless urine, while a mildly to severely dehydrated body produces yellow to dark brown urine.

To avoid hyponatremia, especially athletes, drink only as much fluid as you lose to sweating during a workout or race.

Find out how much fluid you’ll need by monitoring your sweat rate.

Weigh yourself naked before and after an hour-long workout.

For each kilogram of weight lost, you have lost one litre of fluid. Add to this figure the volume of fluid you drank during the workout, if any. The total fluid loss is your sweat rate per hour, which for an average person is between 0.8 and 1.4 litres per hour during exercise.

If you’re planning to exercise for more than 90 minutes, Lo suggests sports drinks with electrolytes. In addition, the American College of Sports Medicine recommends that athletes drink half a litre of fluid a couple of hours before exercising.

For sedentary folk, Li says water is the best fluid for hydration.

“Soda and fruit juice can add a lot of calories – just a glass of orange juice can account for 120 kilocalories,” he says. Caffeinated drinks such as coffee and tea are diuretics (which increase urine excretion) and should also be taken in moderation. Alcohol has a dehydrating effect, so drink it minimally, if at all.

WHICH IS THE BEST THIRST QUENCHER? Dr Edmund Li Tsze-shing, an associate professor of food and nutrition at the University of Hong Kong, says water – any kind – is the best fluid for hydration.

Take your pick according to your preference and health condition.

Distilled: water is boiled and the steam condensed to remove contaminants and minerals. Has the blandest taste of all.

Mineral/spring: mineral water contains a specified amount of trace minerals; spring contains naturally occurring minerals. Both hydrate and replenish minerals.

Vitaminised: purified water with added flavours and vitamins. Hydrates but may cause diarrhoea in excess. Watch out for sugar and calorie content.

Sparkling: carbonated water with no extra calories. Those with kidney concerns should consult a doctor before drinking.

Sports water: purified water with added carbohydrates and electrolytes, formulated for those doing high-intensity exercise.

Stewed chicken with balsamic vinegar, from a local dining society’s recipe

EAT SMART STEWED CHICKEN

Want a low-fat, low-salt dish?

Get yourself into a stew ......................................................

Jeanette Wang jeanette.wang@scmp.com Produced in Modena and Reggio Emilia in Italy since the Middle Ages, traditional balsamic vinegar is made from reduced grape juice that has been aged (in some cases for more than 12 years) in wooden casks.

The dark brown syrupy vinegar is both slightly tart and sweet, making it a versatile pantry staple.

When it comes to balsamic vinegar a little goes a long way. It can be combined with olive oil for a light salad dressing or bread dip. It is also drizzled on seafood and used in a few desserts.

As a quick and simple marinade, it adds a wholesome savoury flavour to meat in an instant, like in this stewed chicken recipe from the English-speaking Dining Society of the Chinese Cuisine Training Institute.

A tablespoon of balsamic vinegar has just 14 calories and 4mg of sodium, compared with the Chinese cooking staple, soy sauce, which has fewer calories (10) but a whopping 920mg of sodium per tablespoon.

That’s why this recipe has been labelled “3 Less” by the Health Department: it has reduced salt, sugar, and fat or oil.

Stewed chicken with balsamic vinegar Serves 4 3 ⁄4 zucchini 11⁄2 onions 6 pieces white mushrooms 11⁄2 tomatoes 2 cloves garlic Some parsley 400 grams of skinless chicken meat 1 ⁄2 tsp fine salt Ground white pepper to taste 1 tbsp olive oil 100ml balsamic vinegar 100ml chicken stock A few sprigs of fresh thyme

• Cut zucchini, onion and white mushrooms into thick slices. Cut tomato into wedges. Chop garlic and parsley. Set everything aside.

• Cut chicken into eight pieces and season with salt and ground white pepper.

• Heat olive oil in a cooking pan. Sauté onions, white mushrooms, zucchini and garlic.

• Add balsamic vinegar, chicken stock, tomatoes and fresh thyme.

• Add chicken and simmer for 12 minutes.

Add parsley. Serve.

This column features recipes provided by the Health Department as part of the department’s EatSmart@restaurant.hk campaign. For more information, visit restaurant.eatsmart.gov.hk

HEALTH 7 FROM THE EXPERTS

Flu vaccine no shot in the dark ......................................................

Jeanette Wang jeanette.wang@scmp.com The impending winter brings with it the influenza season, and this year, the Health Department is stepping up its vaccination drive.

Compared with last season, those aged between 50 and 64, as well as the obese, have now been included as a target group for the influenza vaccination. This was based on recommendations by the Scientific Committee on Vaccine Preventable Diseases under the Health Department’s Centre for Health Protection, because the local influenza epidemiology showed a higher risk of flu-related deaths and admissions to intensive care units in this age group last season.

Furthermore, local and overseas evidence suggests that obesity – that is, having a body mass index of 30 or above – is an independent risk factor for severe influenza A (H1N1) 2009 (human swine influenza virus) infection, and is linked with ICU admission or death.

“It is likely that [this] strain will continue to circulate in the 2011-12 season,” says a Health Department representative.

Among others at risk of serious infection are those with chronic

illnesses, elderly (65 years and above) and disabled people in residential care, children (six months to under six years), health workers, pregnant women, and people working with poultry and pigs.

But apart from these priority target groups, the seasonal influenza vaccination is recommended and suitable for everyone, except those with known contra-indications.

In Hong Kong, the two subtypes of influenza A virus, H1N1and H3N2, are most commonly seen, with peaks from January to March and from July to August. The virus spreads mainly by respiratory droplets, and is characterised by fever, sore throat, cough, headache, muscle aches, runny nose and general tiredness.

Although it is usually self-limiting, with recovery in two to seven days, it can be serious for the weak and frail.

It may be complicated by bronchitis or chest infection, and even death can occur. Earlier this year, a casebased surveillance system was set up in collaboration with the Hospital Authority and private hospitals to monitor flu-related ICU admissions or deaths from January 24 to March 31during influenza peak season. A total of 123 severe cases, including 34 deaths, were recorded.

Vaccination is safe and effective in preventing flu infection in 70 to 90 per

It takes about two weeks for vaccinations to provide protection. Photo: AFP cent of healthy adults, says the World Health Organisation. Among the elderly, immunisation prevents severe complications and death in 60 per cent and 80 per cent of cases, respectively, it says.

There are two types of vaccines in Hong Kong: the “flu shot” – an inactivated influenza vaccine containing dead viruses – and a nasal-spray vaccine, a live attenuated influenza vaccine that contains weakened viruses. The difference between them is that most

inactivated influenza vaccines are licensed for use in those aged six months or older – whether healthy, with chronic medical problems, or pregnant. But live attenuated influenza vaccines are licensed for use only among healthy, nonpregnant people aged two to 49.

It takes about two weeks after vaccination for antibodies to develop in the body and provide protection.

Of course, the usual prevention measures, such as good personal hygiene, balanced diet, regular

exercise, adequate rest, and no smoking, are also important.

As the circulating seasonal influenza strains may change from time to time, it is vital to get a vaccination every year. The vaccine composition is updated each year to enhance protection.

This year’s influenza vaccine composition contains a human swine flu virus (A/California/7/2009 (H1N1)like virus); an A/Perth/16/2009 (H3N2)-like virus; and a B/ Brisbane/60/2008-like virus.

This is as recommended by the WHO and the Scientific Committee.

To encourage the target groups to get vaccinated, the government has a number of free and subsidised vaccination programmes and schemes. From today, eligible people and residents of elderly or disabled homes can get free immunisations.

In addition, since September 26, children are entitled to a HK$80 subsidy per dose of seasonal influenza vaccine (for one or two doses) received from enrolled private doctors, and the elderly can receive a HK$130 subsidy per dose of flu vaccine and HK$190 per dose of pneumococcal vaccine.

For more details, visit the Centre for Health Protection website www.chp.gov.hk

8 DIET NUTRITION CRABS

All it’s cracked up to be ......................................................

Elle Kwan healthpost@scmp.com It’s hard to mosey down a street or wander through the supermarket these days without seeing the green armies we know and adore as hairy crabs. With their khaki armour and bound-up claws, the beady-eyed blighters squint up at buyers, almost daring us to eat them. To some, they probably look more fearsome than fabulous.

Whoever first braved them – to steam and separate them – must have been overjoyed to discover the sweet flesh and creamy roe nestling within. Now we know and pay for the fact that hairy crabs are quite simply delicious.

Living in a fishing centre, Hong Kong people have a natural love for fruits of the sea and have embraced crabs year-round in their various guises. From the soft-shell types (fried or peeking from curry) to the lengths of spindly pink Alaskan crab legs, we can’t get enough of crustaceans. What about the

much celebrated typhoon shelter speciality?

Crabs, like other seafood, have a reputation for being high in cholesterol. But they can be a good choice, if eaten with caution, says dietitian Mimi Sham. Because crabs are sold by weight with their shells on, we are unlikely to eat as much as, say, prawns. “It’s still high [in cholesterol], but the focus is on how much of it you eat,” says Sham.

In fact, Sham says cholesterol levels in foods should not be the only contributor when trying to measure intake. Our body creates cholesterol by itself, and the main threat to levels in the body is the presence of saturated fat. To measure accurately, total fat content needs to be examined alongside the type of fat present, particularly whether it is saturated or not.

A 100-gram portion of crab has fewer than three grams of fat, with just a small proportion of that being saturated. “If you look at those aspects, then crab is not a food item that would be classed as high in cholesterol,” says Sham.

Crab is high in zinc – great for neurological function, wound healing and management of our immune systems NICOLE WONG, NUTRITIONIST

Crab is a low-fat, high-protein food. “The only disadvantage is that when people are allergic, it is often to the protein found in a food. We see this commonly with crab and shrimp,” says Sham.

It is high in zinc – great for neurological function, wound healing and management of our immune systems, says Nicole Wong, a nutritionist at NutraCare Consultancy. She says the World Health Organisation guidelines recommend a daily zinc intake of no less than 7mg for men and 4.9mg for women. A piece of crab typically yields 7.4mg. The crustacean also has high levels of the trace mineral selenium, an antioxidant found in enzymes that can prevent freeradical damage and reduce heart disease and the risk of cancer.

Crab, which is found at the lower end of the food chain, also has much lower mercury levels than that found in larger fish higher up in the chain, such as tuna and mackerel.

Enjoy the in-season hairy crabs, however, with caution. While similar in nutritional plus points to other

crabs, hairy crabs have about three times more cholesterol than other crabs of the same weight, says Wong. It is found mainly in one place: the roe. The rich yellow eggs are high in fat and, at 530mg per five-tael crab, contain almost as much cholesterol as two egg yolks.

That’s nearly twice the recommended daily adult allowance of 300mg advised by the US Food and Drug Administration.

Wong says that eating male crabs, which hold more meat but less roe, is a good way to avoid excessive cholesterol intake.

Having them steamed is the healthiest cooking method. About two hairy crabs a week is safe, or one every two weeks for those on lowcholesterol diets.

It’s also worth watching what you eat following a crab feast. “For the next few days after eating hairy crab, I would advise watching out for other foods with high cholesterol, such as egg yolks, cuttlefish and offal,” says Wong.

That way, you should be able to have your crab and eat it.

RECIPE FOR HEALTH CRAB SALAD

A delicate touch and fresh ingredients needed for this exotic take on seafood ......................................................

Elle Kwan healthpost@scmp.com For a healthier fix, try this nutritional salad featured on the menu at Nobu in the InterContinental hotel.

With antioxidant-rich spinach and dressing created from olive and truffle oils with white miso, this dish offers an exotic yet simple medley that doesn’t overwhelm a crab’s delicate flavours. “Nobu loves eating and making this salad for guests,” Erik Idos, the restaurant’s executive chef, says, referring to its creator, Nobu Matsuhisa.

Perfect for a lunch or light dinner, Ido advises spending time hunting down fresh ingredients. The salad itself can be put together in minutes.

Nobu’s baby spinach salad with dried miso and king crab leg For the dry miso 2 ⁄3 cup (180 grams) white miso • Use a palette knife to spread miso as thinly as possible onto a non-stick baking tray.

• Dry the mixture in a 110-degree Celsius oven for one to two hours, being careful to avoid darkening the miso.

• Crumble evenly, and store in an air-tight container.

For the salad 2 cups baby spinach 1 tbsp olive oil 1 tsp truffle oil 1 ⁄2 tbsp yuzu juice

3 pinches of freshly ground pepper 1 tbsp white dry miso 1 tbsp grated Parmesan cheese 1 pinch of salt 1 piece cooked king crab leg • Put baby spinach inside a large mixing bowl.

• Add olive oil, truffle oil, yuzu juice, ground pepper, dry miso and Parmesan cheese.

• Season with a pinch of salt to taste.

• Mix ingredients together well.

• Heat the king crab leg in the oven until warm and then slice into bite-sized pieces.

• Arrange the crab on a plate and sprinkle the spinach salad on top.

• Garnish with more Parmesan cheese as desired.

Baby spinach salad with dried miso and king crab (left) by Erik Idos (above). Photo: Dickson Lee

FITNESS 9

Vincent Siu is one of the first three local fighters to take part in an MMA competition. More Hongkongers are starting to take up the sport, trainers say. Photo: Dickson Lee

SWEAT MMA

This regimen really packs a punch ......................................................

Ben Sin ben.sin@scmp.com Last year the mixed martial arts scene in Hong Kong was thriving, as it was in the US. Shows from multiple organisations were held every other month locally and in Macau. Hongkongers were jumping on the bandwagon, with martial arts gyms offering classes for men, women and children of all ages.

Then, scandal hit. In October last year, Damien Roche, director of the Kontact MMA Training Centre in Central, and promoter of an MMA event set to take place at Macau’s City of Dreams that month, fled town. He had allegedly embezzled most of the event’s funding, reportedly HK$13 million. Fighters who had flown in from overseas to join the multimillion-dollar event were left stranded in Hong Kong with no pay and plenty of questions.

Michael Haskamp – who had been organising a rival event, the Legend Fighting Championship series – thought the scandal would deal a death blow to the growth of the MMA scene in the city.

He’s glad he was wrong. The sixth edition of Legend took place on Sunday at the City of Dreams, following the success of Legend FC 5 in July.

Haskamp says the partnership with the venue has benefited both sides, with the location boosting the credibility and legitimacy of both the sport and the series.

MMA, a free-flowing combat sport that combines elements from

martial arts and wrestling, is arguably the fastest growing sport in the world. In the US, it has gone from an obscure subculture in the mid-1990s to a form of mainstream entertainment – and fitness workout – in a little over a decade. It is close to replacing boxing as the world’s most popular combat sport.

Haskamp says MMA combines multiple elements of a workout. “For a while, there was a stigma that MMA was just some violent sport.

But people are realising it can be a fitness exercise, too,” he says. “It helps strength, endurance, stamina, and it’s a great social sport, too.”

Michelle Kang, manager at Impakt Academy of Mixed Martial Arts in Central, says business for MMA classes has picked up over the past couple of years. “Now, most men are interested in at least trying out a class,” she says. Impakt has roughly 20 clients taking exclusive one-on-one MMA classes, plus those who take group classes.

More women are also joining in, according to the trainers, mainly because it’s great for weight loss and muscle toning.

Lauren Wong Suk-yee, 25, a dancer, combines yoga and MMA to strengthen her body. “I used to be very weak, always getting sick and spraining and straining my legs if I danced or walked too much,” she says. “MMA has really helped. It works the muscles that most people don’t even know they have.”

Most people do the sport to get a good workout, says Impakt lead trainer Alain Ngalani. “I understand not everyone is going to be a

Bruce Lee was a pioneer of MMA. He created a style which mixed many elements VINCENT SIU CHI-TUNG, MMA TRAINER

professional fighter,” says the hulking Cameroonian-born fighter who’s represented Hong Kong in muay Thai tournaments.

“They’re learning because they want to get fit, and MMA training is really one of the best sports around for general fitness.”

Liu Wenbo, the two-time youth boxing champion of China, who headlined Legend this past weekend, shed 10kg of fat in about six weeks. He says he could never drop weight during his boxing days, but MMA’s unique combination of grappling, striking and footwork did the trick.

Half the training is dedicated to conditioning and cardio, says Kenny Yeung King-ho, Hong Kong’s first MMA fighter. “People used to think it was barbaric sport. But we only spar half the time in training. The rest is about fitness and getting our bodies in shape,” he says.

Ngalani, who claims nearly half of his students are women and teenagers, says: “[MMA] is not dangerous if you’re just training, and training properly.”

The success of the sport locally was something former banker Haskamp, 33, had always envisaged.

He started Legend in 2009 with Chris Pollak, a former classmate at Columbia Business School. The pair noticed Hong Kong was lacking an MMA scene.

“Hong Kong, thanks to Bruce Lee and Jackie Chan and their movies, is arguably the capital of martial arts,” he says. That’s why, to him, the absence of MMA in the city “didn’t make sense”.

Since Legend started, Haskamp has seen a local scene that once featured mostly foreign fighters blossom into a local affair. This past weekend, Vincent Siu Chi-tung became the third Hong Kong fighter to participate in an MMA event.

Siu, 30, a trainer at Impakt who has been practising karate for nearly a decade, took up MMA recently because he says it is the future of combat sports.

“There are more variations and styles,” he says.

By all accounts, the sport still has a long way to go in Hong Kong before it achieves the mainstream acceptance it has in the US and Europe. But it’s getting there.

“You know who was a pioneer of MMA? Bruce Lee. He started out with wing chun, then he created a style which was a mixture of many different elements, which took the best bits of each art and blended them into one,” Haskamp says.

“That’s what MMA is. It’s had a Hong Kong heart from the beginning.”

FIGHT CLUBS Impakt Central, tel: 2167 7218 www.impakt.hk Hong Kong’s largest dedicated MMA gym also offers training in Brazilian jujitsu, kyokushin karate, muay Thai and other forms.

All-access membership costs HK$1,000 a month, though private lessons cost extra.

JAB MMA Central, tel: 2851 6684, www.jabmma.com JAB offers training of all levels for MMA, jujitsu, boxing and kickboxing.

It started a children’s MMA course this summer.

Monthly membership starts at HK$1,000, and personal training starts at HK$300 per session.

Triquest MMA+Fitness Academy Tsim Sha Tsui, tel: 8201 2822, www.triquest-mma.com Besides the usual training, it offers krav maga, the official self-defence regimen used by Israeli forces. It focuses on personalised workouts, with an emphasis on fitness.

Annual membership is HK$500, with additional costs for classes.

10 FITNESS WORKING OUT

Conquer your fitness fears ......................................................

Mary Squillace A fear of flab might motivate many of us to go to the gym, but for some, fitness-related apprehension is a roadblock to starting a workout routine. According to a 2011 Mintel report, people who do not belong to gyms often cite “feeling out of place” as a reason for not joining.

Here, Jim White, owner of Jim White Fitness & Nutrition Studios in Virginia, and Ruth Frechman, an American Council on Exercisecertified personal trainer, share tips for conquering common workout fears.

“I can’t do a single push-up” For newbies who don’t yet have the upper body strength to perform a single push-up, the thought of attempting the move in front of strangers can be daunting.

Solution Start with beginner modifications and then build up to the regular version. For example, you can perform the move with your knees on the floor or at an incline.

“I’d also recommend [seeking] the advice of a personal trainer,” White says. “Your trainer can help you find other exercises to build strength.”

“I don’t want to get too bulky” One of the biggest myths among women is that they’ll build too much bulk if they start working out, White says.

Solution “Women need to trust that building lean muscle speeds metabolism, burns fat and will contribute to building a nice body,” White says. Most women don’t produce enough testosterone to bulk up from a few gym sessions a

week. While you may gain a few kilograms early on due to the fact that muscle weighs more than fat, you’ll lose weight in the long run.

Research at the University of Alabama at Birmingham found that women on a strength-training programme for 25 weeks lost significant amounts of belly fat.

“I don’t have time to get results” “People think that unless they work out for an hour they won’t see results, so they feel as if they [shouldn’t bother working] out at all,” Frechman says.

Solution Do shorter workouts, but make them count. “Even 30 minutes of exercise will make a huge difference,” Frechman says. A study published in the Journal of Physiology has shown that short bursts of exercise with short recovery breaks in between – highintensity interval training – has the same effect as longer endurance exercise on performance and muscular adaptations that reduce the risk of diseases, like type 2 diabetes. On a stationary bike, try doing 10 intervals of one-minute sprints followed by one minute of rest, three times a week.

“I don’t know where to start” A newcomer’s first few gym experiences can be overwhelming, between the labyrinth of machines and seemingly endless exercise options.

Solution Educate yourself. Pick up a book or magazine that explains muscle groups or use a video to bolster your confidence. When you’re ready to hit the gym, do 30 minutes of cardio and 30 minutes of weight training three times a week. Spread them out over six days or combine them over three.

“I’m going to be sore” You want a better body, but you don’t want to walk like Frankenstein for days after your first workout.

Solution “[When you first start exercising], limit your time to 30 minutes so you don’t overexert yourself,” says Frechman. “And stretch [properly] after working out.”

You might be a little sore after your first few workouts, but you shouldn’t be in debilitating pain. If you’re not sure how much exercise is too much, work with a personal trainer who can teach you how to do exercises without hurting yourself and help you understand your limits. Also be sure to build recovery days into your workout routine.

McClatchy-Tribune

Rob Lilwall is no stranger to living out of a backpack for months; here he camps in snowy Siberia. Photo: Rob Lilwall

WALKING HOME

A load of logistics ......................................................

Rob Lilwall healthpost@scmp.com I’m usually the sort of person who goes on holiday without even knowing where I might be staying on my first night (before I got married, at least). However, for my 5,000kilometre winter walk from Mongolia to Hong Kong, in addition to getting physically fit, there have been all sorts of other bits of planning. To be honest, I sometimes think the actual expedition is going to be easy compared with these protracted negotiations and preparations.

First, there has been the acquiring of gear. In the past, I have often been on long cycling expeditions, where it is actually easy to load huge weights into your panniers, and apart from being slowed down a bit, there is not that much extra physical strain.

However, this time we are walking, so my expedition partner and I will need to carry everything on our backs, which will be incredibly wearisome.

An experienced adventure journalist and Everest summiteer recently advised me that when it comes to packing we should “halve what is in [our] backpacks … and then halve it again” and then we would have the right amount of things.

This is excellent advice, but hard to follow, as even when we only have the essentials, we still have so much.

What would you take with you if you had to carry everything on your back for six months?

Our list basically consists of essential clothes and camping gear. It will be winter, with temperatures around minus 20 degrees Celsius, so we need a decent tent, sleeping bag and stove, as well as lots of warm Berghaus clothes.

We are also taking some gadgets with us to stay in touch with and document our journey – cameras, phones and a lightweight laptop.

We’ll need a first aid kit (especially for those blisters), music to listen to by

day, and a Kindle for reading at night.

These may not seem essential, but keeping our morale up is as crucial as keeping our bodies going.

Furthermore, for much of the journey, we will also be carrying inflatable kayaks, which we will use to paddle down rivers (the Yellow and the Pearl).

So all this, plus food and water supplies, will amount to about 20kg – no more, we hope – and organising this list has also taken a lot of time.

A big part of our preparation has involved researching our route. Half of this has been logistical research – finding out about the weather conditions, border crossings, terrain, places to resupply with food and water. The other half has involved learning more about the history – ancient and modern – that has happened along our route.

As long as we are fit to walk, can find a place to sleep every night, and our batteries don’t run out, we should be fine

For example, two days into our journey we will walk through a pilgrimage site in the Gobi Desert where a great Mongol saint is buried; two months in, we will encounter China’s longest road tunnel (the second longest in the world), though we still don’t know whether we’ll be able to sneak through it rather than climb over the mountain through which the tunnel runs.

Finally, I have been trying to learn Putonghua. I was working on Cantonese (my wife’s mother tongue) until about six months ago, but for this trip I have had to switch, and have been busy trying to learn through a mixture of book study and listening to the excellent ChinesePod mp3s, which I can do as I go on my training hikes in the Lantau hills.

So it has been an incredibly exhausting four months of preparation, and I have sometimes felt like a plate spinner – trying to work on many tasks at the same time and hoping they don’t all come crashing down. If just one goes wrong, the whole expedition could fail.

But then I have to remind myself that as long as we are fit to walk, can find a place to sleep every night, and our batteries don’t run out, we should be fine. As Livingstone once said, “I will go anywhere, as long as it is forwards”.

I have tried to prepare mentally – bracing myself for months of adrenaline and exhaustion, and missing my wife, Christine. It is now only a week until we depart, and I think we are ready, or at least ready enough. And in a way, it will be a relief to actually start this huge thing.

Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of a television series, a book and many motivational talks. Every week in Health Post, he will write about the progress of his new expedition, Walking Home From Mongolia, which supports the children’s charity Viva. www.walkinghomefrommongolia.com.

WELL-BEING 11

PERSONAL BEST

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

Sasha Gonzales healthpost@scmp.com In 1954, Englishman Roger Bannister became the first person to run a mile in less than four minutes.

It was a feat many believed impossible, but in front of about 3,000 spectators at a meet between the British Amateur Athletics Association and the University of Oxford, the then 25-year-old medical student pushed himself to complete the race in three minutes, 59.4 seconds. After the race, Bannister said: “Doctors and scientists said that breaking the four-minute mile was impossible, that one would die in the attempt.”

Forty-six days later, Bannister’s rival, Australian John Landy, smashed his record by about two seconds, and since then, many other athletes have gone on to achieve the “unachievable”.

“No one can say, ‘You must not run faster than this, or jump higher than that’,” Bannister says of his achievement. “The human spirit is indomitable.” Dealing with naysayers is one thing, but what if the voice that tells us we must not do something is coming from inside us?

We don’t all set out to break records every day, but Bannister, Landy and the countless other athletes who succeeded them are living proof that if one is motivated enough, anything is possible.

Whether it’s losing weight, saving money, completing a project or anything else we’ve decided to do, if there is no drive, no zeal, then our goals will not be met. Motivation is the force that galvanises us into action and spurs us on to complete what we set out to do.

If you think motivation is linked solely to mental ability and staying power, think again. According to Elisabetta Franzoso, author, and

well-being trainer and coach from the Singapore-based InsideOutYou Coaching & Training, emotions are what bring you forward in life.

“The doers are the people who are more in touch with their emotional side, because emotions are what drives a person to action and inspires them to keep at something,” Franzoso says. “People who merely talk about doing something but don’t act on their intent use their intellectual side. All talk but no action can lead to negative thinking, and this is why many people stay stuck with their goals. You can have an intention, but if it remains just that, then it is nothing.”

According to Franzoso, some people are more motivated than others because they know how to harness their emotions. If you’re excited, passionate and enthusiastic enough about a new project, for example, you’re more likely to start it and see it through. Your desire is what propels you to get it done. The stronger the desire, the more motivated you feel.

But it’s not just positive emotions that drive us. Negative ones, too, hold a certain power, says Franzoso, but they must be channelled correctly or they can have an opposite effect and be demotivating.

“The best tennis players, like Serena Williams and Rafael Nadal, are fuelled by the healthy side of anger,” she points out. “You can see it in the way their bodies tense up as they play. Anger, when tapped into and channelled constructively, can be a good thing. It’s what makes these athletes play harder and more defensively. They play to win because they simply will not accept defeat or settle for second place.”

Anyone who’s had to work to strict deadlines will attest that fear, frustration, anxiety and stress can also be strong motivating forces. The

same can be said of past failures.

“Your failures can motivate you when you start looking at them in terms of lessons and experiences, and not as failures,” Franzoso says.

“Mistakes are life experiences, but we have been conditioned to see them as a bad thing. Instead, tell yourself that, although negative, these experiences enriched you in some way. Ask how you can learn from them and how these lessons can move you towards your goals.”

If motivation is all about emotional awareness, how can you ensure you are always in tune with your feelings?

First of all, do not be emotionally closed off. Do not fear what you feel, and certainly do not block out your emotions.

“When you avoid your emotions it shows up as self-sabotage,” Franzoso says. You might be on track to getting the body of your dreams, but if you aren’t connected to how you feel when you work out (happy, proud, energised), you can lose your motivation and get derailed from your plans.

Illustration: Martin Megino

If you feel it, you can do it

Tennis players like Serena Williams and Rafael Nadal are fuelled by the healthy side of anger ELISABETTA FRANZOSO, TRAINER AND COACH

Soon, you will start finding excuses not to exercise. Likewise, by not confronting how you feel when you don’t want to work out (weary, lazy, uninterested), you will find it hard to make progress.

Second, be less self-critical. We are more likely to do something (and stick to it) if we believe we can, says Franzoso, so quit the negative selftalk, get rid of self-limiting beliefs, and try to focus on your more positive attributes and abilities.

Focus too much on the negative and you will find yourself feeling unproductive and unable to move

THE TASTE TEST TOFU

Sun Fat Heung Oat Bran Fresh Bean Curd Dessert 400 grams for HK$7.80, Wellcome While oat bran makes this even more nutritious, it gives the bean curd a patchy, inconsistent texture that is hard to swallow. It’s also pretty bland.

Verdict: lacks smoothness and taste; I couldn’t eat more than few spoonfuls of this.

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

Jeanette Wang jeanette.wang@scmp.com

Vitasoy Dessert Tofu 220 grams for HK$5.50, Wellcome Who knew pre-packaged food could taste as good as freshly made stuff?

Made from organic soya beans, this was smooth, light and so silky that I downed the whole packet – all 145 calories and 3.3 grams of fat – in under a minute.

Verdict: dangerously delicious; best to savour every mouthful to avoid overeating.

forward. For example, if you convince yourself that you don’t have the willpower to cut out junk food or that you aren’t good enough to be promoted at work, you’ll soon start to believe it, subconsciously creating that expectation for failure.

One of the best ways to bring out your emotional side is with art therapy. Music, art, dancing and writing are perfect vehicles to express positive as well as negative feelings. Workshops, seminars and books or audio CDs about selfexpression and emotional awareness can also help you tap into your emotional resources, as can sports and relaxing activities such as meditation.

Since motivation makes you act with regards to the feeling, you’ll find it easier to achieve your goals as you become more in tune with your emotional side. It’s important to nurture this relationship with your emotional self so that you never lose focus. As long as you can keep those positive vibes going, motivation levels will remain at their peak.

Morinaga Tofu Soft 290 grams for HK$24.90, Wellcome This was so soft that it disintegrated as soon as I tried to slice it. It did, however, take my simple home-made noodle soup up a notch. The package provides an interesting recipe for a pineapple-orange breakfast shake.

Verdict: fresh and tasty, but would be easier to eat if it held together better.