YOUR GUIDE TO LIVING WELL
TUESDAY, NOVEMBER 15, 2011
HEALTH POST The shisha trend is getting doctors hot and bothered >PAGE 4
Fume service
HOW I ESCAPED THE DIABETES DEATH SENTENCE >PAGE 6
CAN EXERCISE STAVE OFF THAT WINTER COLD? >PAGE 8
2 NEWS APP OF THE WEEK
HEALTH BITES ......................................................
Calorie counter measures up on processed food but falls short on vegetable matters ...................................................... Katie McGregor healthpost@scmp.com NuCal Nutrition Calculator Free Rating 5/10 In the latest push to help Hongkongers eat healthier, the Centre for Food Safety (CFS) has released this app to help track your diet on the go, using nutrition data on prepackaged food. It follows up from a similar internet widget rolled out last year to help promote the centre’s nutrition labelling scheme. You have to first set up a personal food database by keying in the nutritional information of your favourite food items. After that, key in how much of the food you ate, and the app will work out your estimated nutrient intake and show you a chart of how that measures up against what’s recommended. Everything is saved, so you can track your eating history. The first thing on my wish list for this app would be some kind of barcode reader or other magic that could enter this data from the label into your iPhone. My eyesight isn’t what it used to be, but I still challenge anyone of any age to read the data on a can of tuna. I squinted hard and entered all the data, which includes calories, fat, protein, carbs, fibre and sodium. (There is a lot of salt in tuna; even more in pasta sauce.) I also noticed that there are no nutrition labels on the large amounts of fruit, vegetables and other healthy, unprocessed foods that I eat. Without this information
and assuming you do eat the odd vegetable, you need to refer to any one of the many other excellent apps available, or visit an online database to enter this data. An inapp database would have been a great feature. Unfortunately, to get a total of your day’s consumption, you need to key in the amount eaten for each food all in one go at the end of the day. While this is not impossible, it probably means you need either a good memory or a notebook. I wish I could give a more enthusiastic review, as I do support anything constructive our government does. The saving grace is that this app is available in English, Cantonese and Putonghua.
ASK THE DOCTORS DR ANTHONY LUKE Q: I find it easier to run in the cold. I feel faster when running, and I like running marathons. Is there any advantage to running in the cold? A: This may feel like something you experience; however, it seems that the reverse is true. Participants in prolonged, physically demanding cold-weather activities are at risk of a condition called “thermoregulatory fatigue”. When a person exercises in the cold, body heat is lost. Our body’s defence against the cold is to shiver – where your muscles contract to make heat – and vasoconstriction, where the blood vessels narrow to divert blood from the extremities to maintain core body temperature. Wearing appropriate clothing helps the body conserve heat. There is scientific evidence that suggests prolonged and/or repeated exposure to the cold, as well as possibly expected fatigue from exercise, may impair the body’s normal responses
of shivering and conserving heat with vasoconstriction when cold. This can put a person at higher risk of hypothermia. In addition, many individuals with exercise-induced bronchoconstriction develop narrowing of their airways in the cold, making it more difficult to breathe. Common symptoms are chest tightness, wheezing or coughing. Studies suggest that nearly one in five athletes may have some degree of bronchoconstriction. Certainly, it is not dangerous to run or exercise in the cold. But the human body probably performs better in a temperate climate than in a cold one. So, stay as warm as you can this winter. Dr Anthony Luke is an associate professor of clinical orthopaedic surgery at the University of California, San Francisco. Reprinted with permission of the American College of Sports Medicine, ACSM Fit Society Page, Winter 2011, p2.
> 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
Jeanette Wang jeanette.wang@scmp.com You’re getting hot under the collar It’s no coincidence that it’s been a relatively toasty autumn. The Annual Greenhouse Gas Index of the US National Oceanic and Atmospheric Administration shows a steady upward trend that began with the Industrial Revolution. The index, based on data collected by more than 100 airsampling sites worldwide, rose from 1.27 in 2009 to 1.29 last year. This means the combined heating effect of long-time greenhouse gases in the atmosphere and emission-releasing human activities has risen by 29 per cent since 1990, the index’s baseline year. Carbon dioxide is a key contributor to the index, but other greenhouse gases include methane and nitrous oxide. There is one positive: there has been a continued drop in two chlorofluorocarbons – CFC11 and CFC12 – since the late 1990s because of an international agreement, the Montreal Protocol, to protect the ozone layer. Go nutty for health and happiness Just an ounce (about 30 grams) of mixed nuts a day can help keep heart disease away for patients with metabolic syndrome (MetS), an increasingly common condition that is reflected in the rise of obesity worldwide. A new study by Spanish researchers published in the American Chemical Society’s Journal of Proteome Research provides the first evidence of the benefits of nuts in humans. Twenty-two MetS patients were put on a nutenriched diet – consisting of raw and unpeeled walnuts, almonds and hazelnuts – for 12 weeks, compared with another group of 20 who were told to avoid nuts. The nut group was found to have in their bodies higher levels of serotonin, a substance that helps transmit nerve signals and decreases feelings of hunger, makes people feel happier and improves heart health.
How we take each other at face value Call it superficial, but how your face looks can significantly influence the success of getting that dream job. Researchers at Rice University and the University of Houston have found that people with birthmarks, scars and other facial blemishes are more likely to receive poor ratings in job interviews. Their research, published online in the Journal of Applied Psychology, involved two studies. In the first, 171 undergraduate students watched a computermediated interview and were asked to recall information about the candidate. The second study involved face-to-face interviews between candidates who had a facial birthmark and 38 fulltime experienced managers enrolled in a master’s degree programme. In both studies, the interviewers, distracted by the facial blemishes, recalled less information about the candidates and, hence, gave lower overall evaluations of them.
Think happy thoughts for your child A new study has found that a growing foetus gets chemical signals through the placenta about the mother’s mental state – and this could affect the baby’s development after birth, including the risk of neurological problems and psychiatric disorders. Researchers at the University of California, Irvine, recruited pregnant women and checked them for depression before and after they gave birth. They also tested the babies after birth. The team found, to their surprise, that what slowed the babies’ development was changing conditions. But should a depressed mother before birth be left that way for the well-being of the infant after birth? No, according to the researchers. A more reasonable approach would be to treat women who have symptoms of prenatal depression – but the challenge is detecting it early.
Raise the barbell for charity Work up a sweat for a good cause: Pure Fitness and the Hong Kong Cancer Fund have partnered to raise funds for cancer research. All you have to do is register on the website (www.cancer-fund.org/sfc/purefitness), pay a HK$100 fee plus a minimum HK$500 sponsorship and do at least a 30-minute workout at a Pure gym. In return, you will be supporting vital research programmes and clinical trials, not to mention burning calories and getting a complimentary special-edition Tshirt and a certificate of your achievement. It’s definitely a win-win deal.
MEDICAL 3 CASE HISTORY
...................................................... Eileen Aung-Thwin healthpost@scmp.com Harry Fung has always loved being out and about socialising. Even at age 80, one of his life’s delights was to go to the tea house every day to meet his buddies, sip some tea and perhaps enjoy a bite of dim sum. But Fung (whose has been name has been changed for reasons of patient confidentiality) had been finding it harder and harder to get around. He could barely walk for a few minutes on flat ground before becoming short of breath and feeling tightness in his chest. Fung has suffered from chronic obstructive pulmonary disease for the past 18 years, a progressive lung disease brought on by a 40-year habit of smoking two packs of cigarettes a day. People with the disease often have chronic bronchitis, emphysema or both. With chronic bronchitis, airways are perpetually irritated and inflamed, resulting in a chronic cough and excess mucus. Emphysema is a condition in which the lung’s air sacs, called alveoli, lose their elasticity or are reduced in number because the walls between them are destroyed. This results in less oxygen and carbon dioxide exchanged in the lungs. When Fung’s doctor told him his smoking habit was affecting his breathing and his health, he promptly stopped. He also religiously took medications – inhaled bronchodilators to open the airways, breathed in steroids to reduce lung inflammation, and swallowed anticholinergic medications to reduce mucus production. With his steely discipline, Fung continued to enjoy reasonably good health until 2009, when his condition worsened. Chronic obstructive pulmonary disease can be worsened by a bacterial or viral infection, or environmental factors such as pollution. Each episode can take four to six weeks for full recovery. Last year, he suffered six such episodes. Fung’s lung performance – and capacity for exercise – dropped sharply. He was put on oxygen therapy, but it didn’t help, and his regular pulmonary doctor said Fung was out of options. Fung turned to Dr Lam Bing, director of the Respiratory Medicine Centre at Hong Kong Sanatorium and Hospital. Lam, looking at Fung’s chest X-rays, saw that his patient’s lungs were enlarged, his body’s attempt to compensate for reduced lung function. However, the enlarged lungs pressed down on the diaphragm. The diaphragm is a large sheet of muscle separating the chest and abdominal cavities that normally takes a somewhat domed shape when relaxed. When it flattens, the diaphragm enlarges the chest cavity, creates a negative pressure and helps the lungs to draw in air.
In Fung’s case, his flattened diaphragm had very little range of movement left, resulting in very shallow breathing. During exertion, therefore, his body could no longer breathe deeply to take in the necessary oxygen and had to resort to rapid, shallow breaths. Lam explains that once the breathing rate is too high, Fung would feel short of breath. The emphysema also reduced his body’s efficiency in inhaling oxygen and exhaling carbon dioxide. Lam proposed lung-reduction surgery. Removing parts of the lung that were no longer functioning would create some room in the thoracic cavity for the diaphragm to spring back into shape. This surgery was popular in the 1980s until an American study found that it carried a high risk – three months after surgery, the mortality rate was six times higher than for those who did not have surgery. However, patients who survived the initial three months had a similar life expectancy to those who did not have surgery and enjoyed much better lung and exercise capacity. So, doctors were keen to find ways to reduce the risk. Instead of removing parts of the lung, scientists found a low-risk procedure using local anaesthesia to install a one-way valve in the airway leading to the part of the lung that no longer worked. This way, air could only exit that particular lobe, thereby collapsing it. But doctors found this method had one big drawback: sometimes, communication pathways develop between lobes of the lungs called collateral flow. When this is present, the lobe fails to collapse properly because it is still receiving air. Last year, Hong Kong obtained the technology to check for collateral flow and to install the one-way valve. Fung jumped at the chance. A xenon computed tomography scan showed Fung’s right and left upper lobes were not working. He was in stage four of chronic obstructive pulmonary disease, meaning he had only 30 per cent of overall lung function left. Using a method called the Chartis System, collateral flow was found in Fung’s right lung but absent in the left, and so the one-way valves were installed in that section. Fung was given only sedation and local anaesthesia. The next day, a chest X-ray showed that Fung’s left upper lobe had already collapsed, and he was discharged. Two weeks later, Fung’s lung function test showed an improvement of 37 per cent, and he could already walk for 10 to 20 minutes on level ground. Two months after the procedure, Fung’s condition had regressed to stage two and he had a 75 per cent improvement in lung function. Thanks to the tenacity of medical science in pursuing new medical solutions, and to his own never-saydie attitude, Fung can now breathe more freely and is again enjoying his daily tea sessions.
Illustration: Angela Ho
Second wind for ex-smoker
4 COVER STORY
Hookah, line Shisha bars are gaining popularity in Hong Kong, but are smokers of the aromatic tobacco playing with fire? Elaine Yau follows her nose
M Shisha bars are a hit among locals and expats. Photos: Jonathan Wong
Holy smokes
200 The number of puffs a person would typically make during a hookah session, equivalent to inhaling a litre of smoke, a WHO report says
ahesh Daryanani first tried a hookah when his friend took him to a shisha bar 10 years ago. He fell in love instantly with the blend of tobacco, fruit and molasses. “It’s relaxing and calms me down,” the Hong Kong-born Indian says. A former cigarette smoker, Daryanani, who owns a travel agency, prefers smoking shisha because it doesn’t give that “sick and dry” feeling got from smoking cigarettes. “There’s no similar yucky feeling even if I smoke shisha for two hours. It’s like breathing flavoured air. You feel light-headed for a few seconds [after a puff]. If the shisha is made right, you can’t feel tobacco.” He goes to Ra Restaurant & Lounge in Tsim Sha Tsui every day after work to smoke shisha and unwind. One serving, which can last up to two hours for a solitary smoker, costs HK$150 there. Daryanani is among a growing number of Hongkongers taking to smoking water pipes – a trend that is worrying doctors who say that smoking shisha, contrary to what many enthusiasts think, could be just as harmful as cigarettes. A Department of Health spokesman says they have long advised against water-pipe smoking since it causes the same kind of diseases as cigarettes. These include oral, lung, stomach and oesophageal cancers, reduced lung function, heart disease and decreased fertility. Ornate metal-and-glass water pipes, or hookah, are used for smoking shisha. Available in a wide variety of flavours, from mint and strawberry to guava, the tobacco is covered with foil and roasted with charcoal that burns to about 450 degrees Celsius – nearly half the temperature of cigarette smoke. The vapour then passes through a water chamber and is inhaled slowly and deeply. Enthusiasts say shisha feels smooth and lacks the piquancy of cigarette puffing. Dr Roland Leung Chung-chuen, a specialist in respiratory medicine, says it is a misguided belief that water filtration can cleanse shisha of all its toxins. “There are toxins like tar in shisha that are insoluble in water,” he says. “There are more than 3,000 chemicals in tobacco that are well documented. We don’t know how many of them are water-soluble. The efficiency of filtration by water is in doubt.” Dr Tony Mok Shu-kam, lung cancer expert and professor at Chinese University’s clinical oncology department, says most of the carcinogens found in tobacco
come from the water-insoluble hydrocarbon family. Although the Department of Health’s Tobacco Control Office says it has not conducted a study on hookah use in the city, shisha suppliers and bar owners say they have seen a large increase in the number of customers. Brian Lalji, owner of Ra, says his shisha bar is so crowded that the staff sometimes have to turn people away. “Customers were mostly expatriates before. Recently, more and more locals come. Six years ago, there were just two to three shisha bars. Now there are more than 25 bars serving it.” His brother, Nav, 24, used all his savings and borrowed some of his mother’s money to start Hookah Hutt a year and a half ago, selling shisha sourced from India, China and Egypt. Nav, the only shisha supplier in Hong Kong, says his business turnover has doubled over the past year. “It was just a small store [when I started] and I sought customers through Facebook. There were just five customers per month,” the Hong Kong-born Indian says. “Now I have five customers a day and I am planning to open another store.” While the origins of shisha are disputed (some say it originated in India; others Persia or Turkey), it has gained immense popularity since the 16th century, spreading from the Middle East to the United States, Canada, Britain and elsewhere. In the US alone, there are more than 300 hookah bars, many located near universities and malls. Nav, who has been smoking shisha since he was 18, says it is a “great social lubricant” that helps him make new friends. A communal shisha session – where smokers with individual plastic mouthpieces pass around the hookah – can last up to two hours. “It’s like drinking alcohol. I only do it socially,” says Nav, who smokes three times a week. “People went for coffee with friends before; now they go for shisha.” And it seems shisha even goes well with food. Dody Adel Wakim, a co-owner of Egyptian restaurant Sahara in SoHo, which serves shisha alongside a wide array of Middle Eastern dishes, says his restaurant has drawn more local clientele. “People love it so much; [they] like to order food, drinks and shisha as an addition,” he says. A World Health Organisation (WHO) report in 2005 on shisha smoking found that an hour-long shisha session involves inhaling 100 to 200 times the volume of smoke inhaled when smoking a cigarette. It also found that water filters out less than 5 per cent of the nicotine. Shisha users draw deep breaths
for a much longer duration than with cigarettes, Leung says, and this poses a lot of harm. “A chain smoker of cigarettes throws a cigarette away after puffing on it a few times. But shisha smokers do it for a long session. They are exposed to a lot of second-hand smoke. The total amount of smoke inhaled is also much larger.” According to a 2005 study by Dr Kamlesh Asotra, the biomedical science research administrator for the University of California Tobacco-Related Disease Research Programme, the burning charcoal creating the hookah smoke produces 143 grams of carbon monoxide per one gram of shisha – 11 times the amount found in a gram of cigarette tobacco and equal to a single cigarette. Hookah tobacco also contains
COVER STORY 5
and stinker
significantly higher quantities of toxic heavy metals such as arsenic, nickel and lead compared to cigarettes. “In a single hookah smoking session using 20 grams of hookah tobacco, the hookah smoker is exposed to several-fold greater quantities of the addictive stimulant nicotine for up to 45 to 60 minutes. This is equivalent to chain-smoking 15 cigarettes,” Asotra wrote in the August 2005 issue of the TobaccoRelated Disease Research Programme Newsletter. “Hookah smokers are exposed to three-fold greater amounts of carbon monoxide than cigarette smokers. One of the reasons for the greater carbon monoxide concentrations in hookah smoke is the charcoal that is added to enhance the burning of the moist
tobacco concoction,” he wrote. For all the health warnings associated with the habit, scientific research on shisha smoking is scant compared to cigarette smoking. There are also conflicting studies. Dr Kamal Chaouachi, a tobacco expert who teaches at ParisDauphine University and has researched shisha for 15 years, told The Guardian in a report in August that it was “ludicrous and unscientific” for the WHO to claim that shisha smoke was 200 times more toxic than cigarette smoke. He added that Royal University of Saudi Arabia researchers found that shisha smoke was 30 times less concentrated in chemicals than cigarette smoke. “While about 5,000 chemicals have been identified so far in cigarette smoke, chemists and
It’s like breathing flavoured air. You feel light-headed for a few seconds after a puff MAHESH DARYANANI, TRAVEL AGENCY OWNER
pharmacologists from Saudi Arabia only found 142 chemicals in shisha,” Chaouachi says. “A medical team in Pakistan found that shisha smoke can be much less carcinogenic and radioactive than cigarette smoke.” Mok says there are too few scientific studies that compare water-pipe and cigarette smoking to reach a definitive conclusion. “Most of the talk about waterpipe smoking is just hot air. There are no comparison studies on how smoking patterns affect health. We don’t know whether a continuous long session of shisha smoking is better or worse than … lighting up throughout the day,” Mok says. “On the list of countries [where there are the most lung cancer cases], the Middle East, which has the highest number of shisha smokers, is ranked only six or seven,
far lower ranked than America and Europe,” the expert adds. For all the contradictions in scientific findings, Daryanani says he is not worried. “Everything can kill you. If you are supposed to die, you die. If you are not, no matter what you do, you won’t die.” Nav, the supplier, says more customers are turning to a tobaccofree version of shisha called herbal shisha. “Around 20 per cent of my clientele have bought it. The tobacco leaves are replaced by tea or other leaves. The smoke might not feel as thick or flavourful, but it’s a healthier and safer alternative.” And the smoker believes he will be fine as long as he exercises restraint: “Everything good or bad should be taken in moderation.” elaine.yau@scmp.com
6 HEALTH Diagnosed with diabetes at age 10, Elizabeth Snouffer, 47, continuous to live a full, happy life. Photo: Thomas Yau
WORLD DIABETES DAY NOV 14
My bitter-swee ...................................................... wing, I watched as my father cried Elizabeth Snouffer healthpost@scmp.com
In 1975, an emergency room doctor told my parents that I wouldn’t live past 35 years and that it was unlikely I could have children. I was only 10 when I heard the words: “She’s a juvenile diabetic.” I was hyperglycaemic, meaning there was too much sugar in my blood. The insulin-producing beta cells in my pancreas that would normally move the sugar from my blood to muscles and tissue for energy had been wiped out. My immune system had turned against me, leaving me in a near comatose state, with a blood sugar level 14 times the normal amount. When they rolled me out of that consultation room to admit me into the critical unit of the paediatric
and my mother, expressionless, waved goodbye to me. The gravity of the situation was difficult for me to fully understand and I had no idea that it would be my job for the rest of my life to take on the role of a human pancreas until a cure was found. Perhaps the doctor wished to remedy this when he rushed me to the diabetes clinic en route to the paediatric wing. He pointed out a man with an amputated leg and a blind woman with bandaged eyes. He told me this was what diabetics looked like when patients didn’t care for themselves. Later that evening, a sobbing night nurse stormed into my room, threw a bundle of diabetes reports onto my lap and ran down the hall. I learned later that her 14-year-old son had recently died from diabetes.
That night, I promised myself: “Diabetes will not destroy me.” Today, it’s hard for me to imagine the madness of my first day with juvenile diabetes, now referred to as type 1. I celebrated my 35th birthday in 1999 and the birth of my daughter the following year. Insulin – the hormone my body no longer produces – was discovered by Charles Banting in 1923. Before then, children who were diagnosed with diabetes never lived past a few weeks. Injectable or exogenous insulin saved my life in 1975, but it’s a very dangerous and difficult drug to administer. Learning how to manage insulin takes intelligence, skill and a lifetime of trial and error. Too much of it causes shock, coma and possibly death, and too little increases risks for severe complications such as blindness and possibly death.
TRADITIONAL CHINESE MEDICINE
Buffalo horn too late to save rhino? ......................................................
Rhinos are killed for their horns, believed to have medicinal properties. Their numbers have dwindled to fewer than 30,000. Photo: AFP
Elizabeth Snouffer healthpost@scmp.com Three weeks ago, the WWF joined the International Rhino Foundation in declaring the Javan rhinoceros extinct in Vietnam. The last was found dead, without its horn, from a gunshot wound. There are now fewer than 50 Javan rhinos remaining, all in one national park in Indonesia. They are among three critically endangered of the five rhino species in the world. These animals have roamed the earth for 50 million years and, while they were thought to number one million in the 1800s, there are fewer than 30,000 today. They are prized for their horns, which are worth three times the price of gold on the black market. According to a WWF report, Vietnam is the pre-eminent destination for this trade, where the horn is used primarily as a traditional medicine for cancer. But the problem is not restricted to Vietnam. In South Africa, the number of black rhinos poached for their horns may top 400 this year from 13 in 2007. In the mid-1980s, Hong Kong traded tonnes of rhino horns locally and on the mainland. Conservationist groups such as California-based Saving Rhinos believe the loss of rhinos, especially in Africa, has been fuelled by wealthy China’s demand for their horns even though trade in them was officially banned there in 1993. The horn – usually shaved or
HORN AGAIN RECIPE A modern take on xi jiao di huang tang, by assistant professor Lin Zhixiu of Chinese University’s School of Chinese Medicine. Original source: Thousand Ducat Formulas (qian jin yao fang) Ingredients: buffalo horn extract (cornu bubali, or shui niu jiao) 30-60 grams, radix rehmanniae glutinosa (Shu Di Huang) 24 grams, Peony root (radix paeoniae, or Shao Yao) nine ground, then boiled – is used as a remedy for a variety of ailments including fever, poison, nervous tics, seizures or convulsions and even as an aphrodisiac. The formula for xi jiao di huang tang, or rhinoceros horn (xi jiao) and rehmannia (Chinese foxglove root)
grams, mountain peony (cortex moutan radicis, or mu dan pi) six grams. Actions: clears heat, cools the blood, nourishes the yin, dispels blood stasis and stops bleeding. Indications: fever, various types of bleeding due to excessive heat, black and tarry stools, scarlet tongue with prickles, and a thin rapid pulse. Some patients become delirious. decoction, was written during the Tang dynasty more than 1,000 years ago. Ancient Chinese medical literature designated rhino horn as a remedy for high fever, delirium or convulsions caused by virulent bacterial infections and other blood diseases, says Lin Zhixiu, an
assistant professor at Chinese University’s School of Chinese Medicine. Although a team of researchers from Chinese University in 1990 found very little evidence of the horn’s healing properties, most specialists of traditional Chinese medicine (TCM) still believe in its potency for releasing heat in the blood. Dr Shi Qingqing, of the Eu Yan Sang clinic in Central, says that ancient culture matters. “It’s hard to forget thousands of years of success and healing. Observation and effect are what have always been crucial in traditional Chinese medicine versus Western research, which relies on isolated lab reports,” he says. Even so, Shi says he would never prescribe medicine created from illegal endangered-animal parts. “I believe rhino horn is effective, but of course I cannot prescribe it,” he says. “Do people still use it underground? I think so.” Hong Kong ratified provisions on the illegal trade in endangered species in response to the Convention on the International Trade in Endangered Species in 1976. It introduced more stringent regulations in the 1990s and further restrictions in the past decade. Lin confirmed the mainstream TCM community in Hong Kong stopped prescribing rhino horn in 1993. “But do I believe in its potency? Yes,” he says.
Professor Albert Leung Wingnang, director of Chinese University’s Chinese medicine school and a member of the Agriculture, Fisheries and Conservation Department’s Endangered Species Advisory Committee, says rhino horn is becoming obsolete with the growing preference for Western medicine. “[It] was once a powerful medicine for serious infectious diseases that are no longer common,” he says. Today, TCM practitioners use buffalo horn instead, which “is nearly as efficacious, but only in larger amounts”, says Lin. He believes properties responsible for alleviating intense fever are due to the minerals and keratin found in the horns of the rhino and buffalo. Overall, the use of animal parts in TCM is dwindling, according to Professor David Fong Wang-fun, chairman of Chinese medicine at Baptist University, who believes rhino horn was never a part of mainstream TCM. Dr Shi Jianbin, head of the China programme of wildlife trade monitoring group Traffic, believes China’s 1993 ban on the use and sale of rhino horn has worked. “Since then, rhino horn has been removed from the traditional Chinese medicine pharmacopoeia. This is a great achievement and contribution to the conservation of rhinos.”
HEALTH 7
et life with diabetes For the first 10 years, there was a lot of guesswork, but my mother did her best. In 1976, I took two injections a day and my diet consisted of no more than 30 grams of carbohydrates per meal (about 250 millilitres of unsweetened fruit juice or two slices of white bread). Snacks were not allowed, and I was hungry all the time. Machines for testing blood sugar had not yet been invented, so I used urine test strips four to five times a day, but it didn’t matter much: I was usually in the “bad zone”. By 1983, I needed four injections a day. The morning of my Scholastic Aptitude Tests (an evaluation of verbal and maths skills for high school students in the US), my blood sugar was five times the normal level, although I somehow pulled off a score in the 85th percentile.
I learned that her 14year-old son had died from diabetes. That night, I promised myself: ‘Diabetes will not destroy me’
I went to university, abstained from Greek parties, graduated with a respectable 3.8 grade-point average, but understandably was exhausted most of the time. At 21, I had met only one other person with juvenile diabetes: he died during his third year of college due to complications. As a young professional in 1987, I bought my first diabetes glucometer, which told me the exact amount of sugar in my blood with one finger prick. By the mid-1990s, my regime amounted to just under 100 injections and finger pricks a week. Meanwhile, the composition of synthetic insulin was just beginning to improve. In 1997, I collapsed on a street in Manhattan and crawled to a vendor begging him for a cola. That was a turning point my life.
Someone said I absolutely had to call Dr Andrew Drexler, then director of the diabetes clinic in New York’s Bellevue Hospital I told Drexler that I was a failure and that despite my best intentions, I just couldn’t beat this monster. He held my hand and told me he was going to help me thrive. In one year, I recovered fully with insulin levels near to those of a healthy 34-yearold woman. Drexler, now living in California, is still my doctor today. I started to volunteer again for diabetes organisations and became a mentor for other children. Then I started to get really excited about this new thing called the “pump”. Instead of injecting up to eight shots a day for survival, the pump delivers a constant drip of insulin into my body, 24/7, via a catheter. It’s close to an artificial pancreas, but I’m still the brain behind it.
While research has neither found the cause nor the cure for type-1 diabetes, better care and technology have helped me better manage my day-to-day regimen. It’s given me a richer life and a healthier outlook. For the past 14 years, I have travelled the world as a partner, parent and communications specialist. Today, I have far exceeded the death sentence first given to me in 1975. The sad truth, however, is that one out of 20 people with type-1 diabetes will die from insulin shock. A journalist recently asked me to name the one thing I couldn’t manage diabetes without. That’s easy, I said: hope for a cure. Check out Elizabeth’s blog at www.diabetes24-7.com. For more information about type 1 diabetes, visit the Hong Kong Juvenile Diabetes Association at www.hkjda.org.
8 HEALTH People who exercise regularly report fewer colds than those who are inactive. Photo: Reuters
PREVENTION
Can staying fit stave off a cold? ...................................................... Dr David Nieman healthpost@scmp.com The common cold is the most frequent illness you’ll have during your lifetime. More than 200 different viruses cause it, with adults suffering two or three colds each year and young children about six or seven. Rhinoviruses, which often attack in autumn and spring, and coronaviruses, which are common during winter, are to blame 25 per cent to 60 per cent of the time. Cold viruses are passed from person to person by being inhaled into the nose and air passageways. They are also spread by simple handto-hand contact with an infected person or with contaminated objects such as door knobs, phones or computer keyboards. The viruses can live for hours on hands and hard surfaces. Damp, cold or draughty weather does not increase the risk of getting a cold. According to most cold researchers, cold or bad weather simply brings people together indoors and leads to more person-toperson contact. Vitamin C, another common
remedy, does not prevent colds, but it may slightly reduce the severity and duration of symptoms. Resting, drinking plenty of hot fluids and seeking whatever comfort one can derive from over-the-counter remedies is still about all that can be done to treat most colds. Whether one gets sick with a cold after a sufficient amount of the virus has entered the body depends on many factors that affect the immune system. Mental stress, low food intake, rapid weight loss, lack of sleep and poor hygiene have all been associated with impaired immune function and increased risk of infection. But can you prevent a cold through regular exercise? When surveyed, people who exercise on a regular basis report fewer colds than their inactive peers. Several exercise training studies with adults support this belief. In these studies, subjects in the exercise groups walked briskly for 35 to 45 minutes, five days a week, for 12 to 15 weeks during autumn or winter, while the control groups remained physically inactive. The results were in line with the claims: walkers experienced about
half as many days with cold symptoms as the sedentary controls. Several large population studies have also shown that frequent aerobic activity compared with a sedentary lifestyle leads to fewer sick days during the cold season. During moderate-to-vigorous exercise (brisk walking, cycling, swimming, sports play), several positive changes occur in your immune system, including an enhanced movement of important immune cells throughout the body. Stress hormones, which can suppress immunity, are not elevated during moderate exercise. Although the immune system returns to preexercise levels very quickly after the session is over, each session represents a boost that reduces the risk of infection over the long term. Heavy bouts of exercise, however, can have the opposite effect. For example, after running a marathon, the body is inflamed for about half a day with high levels of stress hormones, cytokines and suboptimal immune function. During the ensuing one to two weeks, the odds of becoming sick increase twofold to sixfold, depending on the time of year. During periods of heavy
training, the immune system reflects the physiological stress experienced by the athlete, and illness rates climb. Even a good thing like exercise can be carried too far, and each individual needs to find the right balance between training workloads and rest. For more information, check out the American College of Sports Medicine’s free Exercise and the Common Cold Current Comment Fact Sheet at www.acsm.org. We live in a world where viruses and bacteria are omnipresent, waiting to pounce on any of us with weakened immune systems. In summary, your best strategy is to keep immune defences operating normally by following a variety of lifestyle habits: • Exercise moderately on most days of the week. This will improve the ability of the immune system to detect and destroy viruses. • Avoid overtraining and chronic fatigue. Heavy exertion causes immune dysfunction throughout the body, leading to an increased risk of illness. Another caution: do not exercise with a fever. This can lead to more severe symptoms, relapse and sustained fatigue.
• Eat a well-balanced diet to keep vitamin and mineral pools in the body at optimal levels. Nutrient supplements are typically not needed by healthy adults and will not boost immune function above normal levels. • Keep life stresses to a minimum and practise stress management techniques. Mental stress has been shown to increase the risk of catching the common cold, so learn to control the burden and pace of life. • Obtain adequate sleep on a regular schedule. Sleep disruption has been linked to suppressed immunity. • Limit exposure to viruses and bacteria by practising good hygiene. Wash your hands frequently, and avoid touching your eyes and nose (the primary route of introducing viruses into the body). Also, give your immune system an edge by receiving the flu shot and other recommended vaccinations every year. Dr David Nieman is a professor of health and exercise science, and director of the Human Performance Labs at Appalachian State University, Boone, North Carolina. Reprinted with permission of the American College of Sports Medicine, ACSM Fit Society Page, Winter 2011, p5.
PET HEALTH
There’s life in the old dog yet – but it will take a few adjustments to keep his tail wagging ...................................................... McClatchy-Tribune
It’s important that older dogs keep active, but don’t overdo it. Photo: AP
Most dog owners consider their pets to be part of the family and want them to be happy and healthy their entire lives. As dogs age and become seniors, pet owners need to make special adjustments to their dog’s routine. The American Kennel Club’s Canine Good Citizen Programme director and certified applied animal behaviourist Mary Burch offers tips on caring for your dog and keeping him active as he becomes a senior.
Watch that diet: As dogs get older, their appetites tend to decrease. Feed your dog smaller meals more often if he is not able to eat all of his dinner. Avoid giving your senior dog large amounts of human food, as this can cause weight gain, which can cause problems for joints and organs. Check with the veterinarian on whether he needs a senior diet. Keep moving: Muscles will atrophy from lack of use, so make sure to keep your older dog active. Nice, gentle walks and playing ball will
keep your dog fit. “Don’t overdo the exercise,” Burch says. “Your grandmother wouldn’t want to go jogging with you, and it’s also not a good idea for your 14-year-old dog.” Behavioural health is important, too: Caring for your senior dog’s physical health is important, but so is behavioural and emotional health. Don’t let your older dog lie around doing nothing as you take a younger dog off to outings. Your senior dog may enjoy a ride in the car and a trip to the park, even if all you do there is sit and enjoy the day together.
FITNESS/ DIET 9 WALKING HOME
EAT SMART MINCED MUTTON
A top down approach ....................................... Rob Lilwall healthpost@scmp.com After four months of hectic preparations, last week my cameramanfriend Leon and I finally boarded a plane and flew to Ulan Bator. The capital is the landing point prior to starting our six-month Walking Home From Mongolia expedition, in which we will walk 5,000 kilometres from the Gobi Desert to Hong Kong via rural, snowy China. As we flew into Mongolian airspace and looked out of the window, the vast expanse of the Gobi filled our line of sight to the horizon. This sea of yellow-brown nothingness was broken only by the thin, dark line of a railway snaking north, and about every 10 minutes or so by a tiny cluster of houses or a patch of dark rocks. We worked out that roughly every two minutes our plane was covering the same distance (about 150 kilometres) that will take us a whole 24 hours when we set off southwards on foot in a few days’ time. This made us reflect on both the remarkable speed of modern travel and the enormous task we were about to undertake. After two hours above the desert, we descended towards Genghis Khan airport on the outskirts of the capital. Several huge chimneys spouted lines of smoke into the subzero air, lines of grey houses stretched out in grids, and on the fringes were an increasing number of perfect white, round shapes – the famous Mongolian ger tents. Although our expedition is going to start from Sainshand, a wild east desert town about 300 kilometres south of the capital, we have spent the past three days in Ulan Bator to collect final supplies, garner as much information as possible about the Gobi route, meet contacts and learn about modern Mongolia. The landlocked country may have the lowest population density in the world (just over one person per square kilometre, compared with about 6,480 in Hong Kong) and does not feature prominently in international political or economic headlines, but there is actually a lot going on here at the moment. After it became fully independent
from Russian support in the early 1990s, the country struggled through recession and a socialist-trained leadership. In recent years, however, with huge deposits of gold, copper and other resources being discovered and hence attracting foreign investment, the economy is starting to boom. There are signs of this all over the city as sleek, curvy buildings are starting to appear. The contingent of foreigners, although relatively small, is growing fast. The city has also been changing greatly due to an influx of nomads seeking work and opportunities, especially after a particularly harsh winter devastated their flocks a few years ago. This has resulted in the “ger city” growing around the outskirts. While these settlements allow better access to education, health care and potential jobs, they are also deeply impoverished and have added to one of Ulan Bator’s biggest issues – pollution. All day,
Mongolia has just over one person per square kilometre, compared with about 6,480 in Hong Kong
brown smog hangs over the city, which is enclosed by a bowl of surrounding mountains. You can’t see the end of some streets because of the haze. Interestingly, the factories and increasingly dense traffic are not the main culprits; stoves built into the centre of every ger are used to burn cheap, dirty coal and, for the poorest families, whatever litter that’s available. As I write this, we spend our final night in the capital, and tomorrow we catch the train to Sainshand. We have received all sorts of advice about the Gobi: there may or may not be wolves, and we may or may not encounter nomad camps that will put us up for the night. The weather is also an unknown: it’s been around minus 17 degrees Celsius at night and is likely to drop. One thing we do know for certain is that if we keep the railway line in view, we cannot get lost, as it leads directly to where we need to go. I am excited to start this adventure, although I am unsure what each day might bring. It is time to find out. Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of a television series, a book and an acclaimed motivational talk. 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
Mutton is particularly nutrient dense – if you can get past its smell.
Prince Charles’ favourite food tops list if you want nutrients ...................................................... Jeanette Wang jeanette.wang@scmp.com As red meat, mutton has had a bad reputation. But, in moderation, the meat of mature sheep – what Prince Charles once called “my favourite dish” – can be good for you. According to a research paper by University of Wollongong associate professor Peter Williams published in the journal Nutrition & Dietetics in 2007, mutton is particularly nutrient dense. It’s the richest source of thiamin, vitamins B6 and B12, phosphorus, iron and copper, among the four red meats (the others being beef, veal and lamb). Though saturated fatty acids – bad fat – make up 40 per cent of total fatty acids on average in lean red meat, mutton leg, as used in this dish, is relatively low in fat (it’s 85 per cent lean). Mutton muscle is also a good source of heart-healthy omega-3 fats. Compared with lamb, mutton has a stronger taste, deeper colour and chewier consistency. Try this recipe by the Hospitality Industry Training and Development Centre of the Chinese Cuisine Training Institute and see for yourself. Minced mutton with orange and lemon Serves 4
Rob Lilwall (right) and his cameraman Leon arrive in Ulan Bator for the start of a 5,000-kilometre walk back to Hong Kong. Photo: Rob Lilwall
For the thickening: 80ml chicken stock
2 tsp starch 1 tsp fine salt Ground white pepper for taste • Mix all ingredients well. • Set aside. For the dish: 180 grams skinless, boneless mutton leg 10 water chestnuts, peeled 3 Chinese black mushrooms, soaked and dried 1 ⁄2 onion 1 ⁄3 stick Chinese celery Some Chinese parsley Some spring onion Orange and lemon peels to taste 1 tbsp canola oil 500 grams lettuce leaves • Mince the mutton. • Finely dice the chestnuts, mushrooms, onion and celery. • Finely chop the parsley, spring onion and peels. • In a preheated wok, add oil and lightly sauté the onions. • Add mutton and sauté until light brown. • Add chestnuts, mushrooms and celery. • Add parsley, spring onion and peels. • Add thickening and continue to sauté. • Serve with lettuce leaves. 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
10 DIET People who have cereal breakfasts have a lower BMI. Photo: Edmond So
NUTRITION BREAKFAST
Skip it and you’re toast ...................................................... Jennifer Huang healthpost@scmp.com Breakfast is, as the saying goes, the most important meal of the day. In spite of this common wisdom, people often cite lack of appetite or busy schedules as reasons why they forgo their morning meal. Others abstain to get a little extra sleep or as a way to watch their weight. But these reasons may actually be selfdefeating. “You should eat as early as possible after you wake up,” says David Chan, a dietitian and founder of Tetra Nutritional Consultation Centre. “It breaks a 10- to 12-hour fast. And if you prolong the fast, your general condition decreases, your memory suffers, you become less energetic and can even develop gastrointestinal problems.” There has long been a trend towards skipping breakfast in industrialised Asian countries, which may be a problem for those concerned with issues of productivity and obesity. In Hong Kong, a Behavioural Risk Factor Survey done in April last year by the Centre for Health Protection found that 5.5 per cent of 2,000 Hong Kong residents interviewed skipped breakfast. And as many as 14 to 15 per cent of primary school students skip breakfast, according to the CHP’s Child Health Surveys conducted in 2006 and 2008. “Honestly, if I wake up really early and don’t eat breakfast, I feel low on energy and have the hunger vultures swirling around me by
10am,” says Michelle Markoff, a Hong Kong-based artist and fashion designer. To stave off hunger, it is essential to fuel the brain in the morning, says Chan. “Your brain needs blood sugar for functioning. Without it, you can’t work energetically or efficiently. Prolonged starvation can mean a lower metabolism throughout the day and possibly [compromised] functioning of the organs.” In addition to a sluggish metabolism, some studies have shown that skipping breakfast has been associated with a decreased ability to lose weight as well as a higher body mass index (BMI). “If you don’t eat breakfast, it changes your metabolism and may change your sense of hunger,” says Professor Leung Lai-kwok of Chinese University. “The actual mechanism is not known, but it affects the part of the brain responsible for satiety.” Skipping your morning meal may ultimately lead to unhealthy dietary choices and imbalanced eating during the day. “I’m pretty disciplined each morning to pick something up to eat,” says finance professional Helen Tse. “Because if I don’t, I will get the munchies around mid-morning and that’s when I will hit the muffins.” Chan says people who skip breakfast tend to eat a lot more later in the day. “By lunchtime they will be very hungry and [are] likely to overeat. Because of the lack of satiety, they may then snack on desserts, candies, chocolate and
[If I] don’t eat breakfast, I feel low on energy and have the hunger vultures swirling around me MICHELLE MARKOFF, FASHION DESIGNER
sweets – much of which would exceed the calories of a balanced breakfast itself.” In a study published in the British Journal of Nutrition in 2007, Dr John de Castro found that eating in the morning produces greater feelings of satiety than eating later in the day, and is associated with lower intake of calories overall during the course of the day. But eating a big breakfast is not better either, according to research conducted by Dr Volker Schusdziarra of the Else KrönerFresenius-Foundation. The study, published this year in Nutrition Journal, found that high breakfast energy intake is not automatically associated with low whole-day intake. In fact, the report says “for the purpose of reducing daily energy intake in obesity prevention or treatment, a reduction of breakfast calories can be helpful.” But the role of breakfast in terms of obesity risk is controversial, says Chan. Many other factors should be considered, such as the type of breakfast a person eats.
Dr Sungsoo Cho, director of Kellogg Research Centre’s Nutrition Research Group, led a study published in the Journal of the American College of Nutrition in 2003 that looked at types of breakfasts and their effects on BMI and calorie intake. It was found, in fact, that skipping breakfast did not affect the total calorie intake, but breakfast skippers were among the three groups with the highest BMIs. People who ate primarily dairy – or just meat and eggs – didn’t fare much better, whereas those who ate breakfasts consisting of grains and cereals had the lowest BMIs. It is worth noting that in this study sponsored by the Kellogg Company, bread eaters had only an average BMI, possibly owing to the fact that people in this group ate on the go, which is considered a “dysregulated” pattern of eating. In Hong Kong, bread, noodles, congee and eggs are popular breakfast options, as is eating out. Almost a third of the breakfast eaters in the 2010 Behavioural Risk Factor Survey dined out for breakfast five or more days a week. While this may be convenient and inexpensive, beware of foods high in fat and low in dietary fibre. “We recommend a balanced breakfast, with carbohydrates, protein and low fat,” says Chan. “That is a carbohydrate-based breakfast with less than 40 grams of carbohydrates – roughly two slices of bread, a bowl of noodles or a bowl of cereal. I also recommend 30 grams of meat as a protein source.”
YUM ... BUT WHICH ONE IS HEALTHIER? Registered dietitian Heidi Chan gives two examples of breakfasts: Breakfast A • Satay beef with instant noodles or vermicelli • Scrambled eggs • White toast with butter • Hot coffee with two packets of sugar Breakfast B • Beef slices with macaroni • A hard-boiled egg • Plain whole-wheat toast • Hot coffee with reduced-fat milk and one tsp sugar The answer is B. “Both breakfasts are similar,” says Chan, “but if we take a closer look, menu B is lower in calories with less fat and less sugar.”
WELL-BEING 11 PERSONAL BEST
THE TASTE TEST TEA
Two can play these games
Herb yourself right with these curious concoctions
...................................................... Erin Davis Who knew that Love Dice and Naughty Truth or Dare had become such valuable commodities in the app world? Apparently, iTunes did. Search for “apps for couples” or “apps for relationships”, and you will find at least a dozen. In all sincerity, how many Kama Sutra and intimate, contortionist bedroom-position apps does one couple need – and what exactly sets the dozens apart from each other? My question, of course, is purely rhetorical. If I truly wanted to know the answer, this article would instead be titled “My Favourite Apps Featuring 69”. I’m no prude; I simply happen to like a little more substance in my relationship apps. Therefore, I give you six wholesome and fun iPhone and iPad apps for couples.
Illustration: Bay Leung
Fooducate Plus (US$3.99) Couples who diet together should buy it together. This is not the most eloquent motto, but it seems to fit for Fooducate Plus. This app is
perfect for couples looking to either establish or sustain a healthy diet. Fooducate Plus gives you the skinny on all the fatty ingredients you should avoid. It allows you to scan the barcodes of grocery items (as long as they’re manufactured in the United States) using the camera of your mobile device. The app will then inform you of that specific item’s calories and customer rating, and will even provide healthier food alternatives. Let Fooducate Plus be the voice of reason (and yes, occasional disappointment) in your relationship. Goodbye, megacheesy pork puffs. Couples Getaway Journal (US$1.99) This application will have you kissing pre-trip hysteria goodbye. All vital trip information – recommended hotels, car rentals, airlines and local attractions – are tucked into this nifty little app. Gone are the days of illegible coffee-stained sticky notes and missing packing lists. You and your partner can make your own trip inventories without fear of coffee or Fido sabotaging them. Couples Getaway Journal also pays homage
Who says that simply because you and your lover can’t traipse through Europe, you can’t visit it on your iPhone? to those of us with forgetful vacation brains by including a journal that allows users to upload a daily picture and tidbits about your trip. It also reduces the odds of forgetting that romantic restaurant and scenic view that you and your loved one should not miss. As an added bonus, the app keeps track of your expenses – a downside (or maybe an upside) when you realise your funds don’t allow for yet another novelty shot glass. Nifty Date Ideas (99 US cents) This is useful the next time your partner asks: “What should we do on our date?” Have him or her defer to the Nifty Date Ideas app.
Or if you wear the date-planning pants in the relationship, you can select any number of date options, ranging from creative, outdoor, indoor, romantic, date night or cheap. If you’re feeling creative, then consider making a movie together. Just find odd props around the house, then come up with a funny scenario to act out. Too theatrical? Perhaps you and your significant other might prefer “Date Night” suggestions such as “find an open spot away from city lights to look at the stars”. For those turned off by silliness, beware. This app includes a Video Scavenger Hunt that will have you imitating mannequins in storefront windows, as well as Spin the Bottle, which could seem slightly superfluous for two. 6,501 Crazy Facts (free) Whether it’s a swanky restaurant or a seedy diner, you and your significant other will inevitably be forced to wait for a table at some point in your relationship. Now instead of staring lovingly into each other’s eyes (or at that jackalope mounted on the wall), you can entertain one another with 6,501 Crazy Facts. A few reviews complained that the “facts” are erroneous and repetitive. But for a free app, does it really matter if “the sixth sick sheik’s sixth sheep sick” isn’t really “the toughest tongue-twister in the English language”? After all, it relieved you from the blank stare of the jackalope on the wall – at least for a few seconds. Ticket to Ride: Europe (US$6.99) Who says that simply because you and your lover can’t physically traipse through Europe, you can’t visit the beautiful continent on your iPhone? Certainly not the folks at Days of Wonder, creators of the board game Ticket to Ride: Europe, which now has a mobile version. The game’s premise is that you have to build your own personal railway route through Europe. The game allows up to four players, but if you prefer date night for two, that’s not a problem. There’s nothing like just the two of you having a romantic evening together in iEurope. Ticket to Ride: Europe is a bit pricier – at US$6.99 – than other board-game apps, but when compared with the cost of crumpets and French pastries, it’s a perfectly sensible alternative. Love Cards (free) Jennifer Lopez famously sang that “love don’t cost a thing” – and now yours doesn’t have to, either. Do not underestimate the power of a love e-mail or text. Consider it the modern-day equivalent of a college-ruled love letter from days past. The Love Cards app allows you to select from 72 love-inspired images. Alongside the image of your choice, you can insert a personalised message before you send it. Some of the images may border on juvenile (lots of red hearts), but, again, beggars can’t be choosers when it comes to free apps! McClatchy-Tribune
...................................................... Jeanette Wang jeanette.wang@scmp.com
Twinings Camomile & Spiced Apple 20 bags for HK$29.90, Market Place by Jasons Camomile is known to help you sleep better, and having a cup of this before bedtime did indeed ease me into sweeter slumber. Could it be psychological? Whatever, it works. Verdict: Apples and cinnamon complement the delicate camomile flavour perfectly.
Clipper Organic White Tea 26 bags for HK$27.50, Wellcome Said to contain more antioxidants than any other tea, white tea is made from the buds and first leaves of the plant used to make green and black teas. This batch hails from China’s Fujian province. Verdict: Light and refreshing – both hot and cold.
Yogi Echinacea Immune Support 16 bags for HK$50, Market Place by Jasons With a mix of echinacea root (said to support immunity), astragalus root (said to boost energy), and elderberry and mullein leaf (said to aid respiratory function), it has an overpowering herbal smell. Verdict: Pleasant minty aftertaste – if you can get over the strange smell.