20111129 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, NOVEMBER 29, 2011

HEALTH POST

SEVENTY-ONE AND ULTRARUNNING >PAGE 8

BARLEY: THE GRAIN YOU NEED TO LOAD UP ON >PAGE 10

Bad-hair month helps focus attention on men’s health

>PAGE 4

More than lip service

2 NEWS APP OF THE WEEK

HEALTH BITES

Calm your brainwaves, and stress ebbs away

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Pears, pears, pears For that traditional poached pear recipe or holiday hamper, try the new varieties of pears that Market Place by Jasons has stocked up on. The Comice (HK$4.50 each) is sweet, juicy, and has soft, creamy flesh, while the slender and speckled Holland Conference (HK$4.50) is crisp and crunchy with a small core. For a real treat, try the Holland Sweet Sensation (HK$8.80, pictured), which has an attractive red skin and a super-sweet, fresh taste.

Katie McGregor healthpost@scmp.com Silva Relaxation Free Rating 9/10 Listening to what sounds like a demented woodpecker for 15 minutes for relaxation does seem unlikely, but with this app, it works.

Example: one Saturday, we had a dinner invitation, but by 6pm – after a day of work, shopping in Sham Shui Po and watching a family member play rugby – I simply felt like collapsing. Instead, I lay down, plugged my headphones into my iPhone and switched to the app.

Twenty minutes later, I arose totally refreshed and ready to sparkle with effervescent dinner conversation. (At least, I thought so.)

The Silva Method teaches how to consciously lower your brainwave activity and enter the relaxing “alpha state” – where brainwave frequency is between eight and 12 Hertz, below the human hearing threshold – at will, while remaining awake. This app guides you into deep relaxation using a tapping sound to mimic this frequency.

There are three relaxation sessions: Quick (17 minutes), the one I tried, is for re-energising while

Jeanette Wang jeanette.wang@scmp.com

you’re on the go; Tranquil (20 minutes) calms and encourages peaceful thoughts; Deep (30 minutes) is recommended at least once a week for intensive stress management.

Laura Silva, the daughter of the method’s late founder, Jose, talks you through the sessions. She tells you to listen to the background tapping indirectly. Then, she instructs you to tell yourself: “Body, it is time to relax.” She then guides

you to focus on different parts of your body, to “sense the skin covering your forehead”, and so on.

Before you know it, the tapping sound picks up speed, apparently mimicking the waking brain “beta” frequency (16 to 30 Hertz). Laura says: “At the count of three, you will open your eyes, be wide awake, feeling fine and in perfect health.”

You do wake up feeling so, and this is my only complaint: you cannot use the app to go to sleep.

Hope for post-surgery prostate cancer patients Hong Kong Cancer Fund, in collaboration with Queen Elizabeth Hospital, has launched a pilot one-year surgery subsidy scheme for urinary continent devices, to help patients with incontinence, a side-effect of prostate surgery.

The artificial urinary sphincter (AUS) and the male sling have been used in more than 10,000 patients worldwide in the past 30 years. Though effective, they are uncommon in Hong Kong, with only about 10 operations done in public hospitals in the past 11 years. Cost is a factor – AUS costs around HK$70,000, and the male sling HK$30,000. “For this reason, some patients prefer to suffer the inconvenience and distress caused by incontinence rather than pay for the surgery,” says Dr Ho Lap-yin (above), the hospital’s associate consultant in surgery. The scheme, with funding of HK$1.15 million, will help needy patients receive proper post-surgical care.

An exercise in productivity Working out can be tiring, but in the long run, getting 150 minutes of moderate to vigorous exercise a week can help you feel more alert during the day and improve your sleep quality by 65 per cent. The new US study published in the journal Mental Health and Physical Activity tracked the physical activity of a nationally representative sample of more than 2,600 people aged between 18 and 85 via an accelerometer. Participants who met the activity guidelines were 65 per cent less likely to feel sleepy during the day, were 68 per cent less likely to have leg cramps while sleeping, and 45 per cent less likely to have difficulty Photo: NYT concentrating when tired.

Chew gum, lose weight?

A study in the American Chemical Society’s Journal of Medicinal Chemistry shows that an appetitesuppressing hormone called human PYY can be delivered into the bloodstream orally. This was done by using vitamin B12 – which passes through the digestive system with relative ease – as the vehicle. Past studies have shown obese people have lower concentrations of PYY in their bloodstream. Says Syracuse University chemist Dr Robert Doyle: “If we are successful, PYY-laced gum would be a natural way to help people lose weight.”

> 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

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Wynnie Chan healthpost@scmp.com Joey Wong Choi-ling (name changed for patient confidentiality reasons), 10, had a runny nose, sore throat and cough for a week that developed into a headache and high fever. Worried, her parents took her to Yan Chai Hospital in Tsuen Wan, where she was admitted for testing.

Doctors found an enlarged and tender lymph node on the left side of Choi-ling’s neck. After she spent a month in hospital, despite intravenous penicillin and exhaustive investigations including blood and

To avoid the disease, beware of unfamiliar or stray cats, and make sure that you don’t get bitten microbiological tests, no underlying cause for her fever was found. Then Choi-ling lost vision in her right eye, and doctors immediately referred her to the ophthalmology unit at Caritas Medical Centre in Sham Shui Po. There, doctors Benjamin Chu and Victor Tam examined her pupillary reaction to light using the swinging flashlight test, which involves shining light into one eye and then the other.

A normal reaction is for both pupils to constrict each time light is shone into them, and dilate when the light is in the midst of moving to the other eye.

In Choi-ling’s case, the left pupil constricted promptly, but the right

showed an initial weak constriction to the direct light, followed by dilation.

This indicated a dysfunction of the optic nerve. On further examination, she was found to have neuroretinitis, an inflammation of the retina and optic nerve in her right eye.

There was swelling of the optic nerve head with a “macular star”, so described because of the abnormal pattern of bright streaks in the centre of the retina. These streaks are made up of lipids, fatty substances normally found in the blood.

These findings suggested catscratch disease, and this was confirmed by a blood serum test for the Bartonella henselae bacteria that causes this disease. A month before falling ill, the girl had travelled to the mainland, where she had been in close contact with cats and dogs.

About 40 per cent of cats carry Bartonella henselae at some time in their lives. Kittens under a year old are likelier to be infected. Although fleas spread the bacteria among cats, there’s no evidence to suggest that fleas transmit the disease to humans.

The bacteria live in the saliva of infected cats but don’t make the animals sick. They’re transmitted if the saliva comes in contact with a human via the eye or a bite or scratch.

Most people with cat-scratch disease develop an infection at the site of the cat scratch or bite. Within a couple of weeks, one or more of the lymph nodes close to the injury site become swollen and tender – typically those around the head, neck, and upper limbs. The victim may develop fever, headache, fatigue, rash, sore throat and a poor appetite.

Most cases, says Chu, clear up within a month or two without any treatment. Choi-ling’s case was atypical. Such victims usually experience a lingering high fever, and

ASK THE DOCTORS DR WAYNE HU HSING-CHENG Q: I have had some difficulty passing stools for a few weeks, and today I cannot pass anything. I have been desperate for the loo for two hours. What can I do?

A: Constipation is a common complaint; most patients have so-called functional constipation or irritable bowel syndrome.

Patients may have a slow-moving gut or poor co-ordination and non-relaxation of the pelvic floor muscles on going to toilet.

Symptoms of the latter are a sensation of anal blockage and inability to move the bowels despite having the urge. In irritable bowel syndrome, the gut is hypersensitive, and patients often have alternating diarrhoea and constipation.

However, if symptoms are recent (as perhaps in your case), you have to be careful that constipation is not a manifestation of an underlying disease such as bowel cancer or obstruction.

Further investigations, probably including a colonoscopy, would be important. Surgery would generally be

needed if cancer or bowel obstruction were the underlying cause.

Treatments for functional constipation include increasing dietary fibre, water intake and exercise. Drugs such as lactulose and polyethylene glycol cause more water to be retained in the intestines and result in softer stools.

Stimulant laxatives such as senna cause contractions of the intestine but should preferably not be taken long term.

If the problem lies in failure of the pelvic floor relaxation, biofeedback therapy and retraining of the muscles is of proven benefit.

If there has not been any bowel movement for two weeks, it may also be necessary to remove any impacted stool, either by enema or manual removal, prior to treatment of the chronic constipation.

Dr Wayne Hu Hsing-cheng, a specialist in gastroenterology and hepatology, is on Health Post’s advisory panel

some get an eye infection, such as neuroretinitis or parinaud oculoglandular syndrome (an eye problem similar to conjunctivitis).

Choi-ling was treated with a combination of oral antibiotics: 300 milligrams of rifampicin every day for a week and 100 milligrams of doxycyline twice a day for five weeks.

Her fever resolved as soon as treatment was initiated, lymph node swelling gradually subsided, and her vision improved. The macular star took longer to resolve, but three months after diagnosis at a follow up visit to Caritas Medical Centre, no optic nerve damage was found and the symptoms had not recurred.

The good news is that having one episode of cat-scratch disease usually makes you immune to it for the rest of your life. To avoid the disease, beware of stray and unfamiliar cats, and avoid playing rough with them to prevent being bitten or scratched.

Always wash your hands after handling a cat.

Illustration: Angela Ho

Fever starts from scratch

4 COVER STORY

Let’s hair Growing a moustache is one way of drawing attention to the increasing problem of prostate cancer, says Jeanette Wang

F

or the past month, friends, colleagues and even strangers have scrutinised Nicolas Koehl’s facial hair.

Sometimes they’re tactful and say he looks better without it. Other times they’re more direct, and call his moustache stupid.

Koehl, 31, an IT engineer who moved to Hong Kong three years ago, doesn’t mind. In fact, drawing attention to the moustache he’s been painstakingly grooming since November 1 is exactly the idea.

That’s how he gets the chance to deliver his one-minute pitch on a subject close to his heart.

“You know, this moustache is for ‘Movember’, and the whole point is to raise awareness of men’s health, particularly prostate cancer. I’m doing it not only to raise funds for cancer research, but also because my dad had prostate cancer.”

Since Movember began in Australia in 2003 with 30 men (known as Mo Bros) and women (Mo Sistas), the number of registered participants on movember.com has increased exponentially. Last year, 447,808 Mo Bros and Sistas worldwide raised a total of A$72 million (HK$552 million). Since 2003, there have been a cumulative 1.1 million participants, including such celebrities as James Franco and cyclist Lance Armstrong.

A$178 million has been raised.

Awareness of prostate cancer has also gone up. According to the Movember Foundation, there was a “frighteningly low level of awareness” of the disease in 2003.

Some early participants were even unsure of where the prostate was in their bodies. (It’s the walnut-sized gland that surrounds part of the tube which carries urine from the bladder to the penis.) It was shocking for a

Kody Hennessey lost his father to prostate cancer. Photo: May Tse

45 Incidence per 100,000 of prostate cancer in 2009 (in 1989, the incidence was only 7.2 per 100,000) HK Cancer Registry

condition that is the most commonly diagnosed form of male cancer in many Western countries.

In Hong Kong, the incidence of the disease has increased at the fastest rate for all cancers affecting men. According to the Hospital Authority’s Hong Kong Cancer Registry, the crude incidence rate in 2009 was 45 per 100,000, making it the third most common cancer among men. In 1989, that figure was 7.2. The death rate is also up, from 2.6 per 100,000 in 1989 to 9.3 in 2009, ranking it as the fifth biggest cancer killer among men.

Dr William Foo Wai-lum, director of Baptist Hospital’s Radiotherapy and Oncology Centre and medical adviser to the Hong Kong Cancer Fund, says Hong Kong is simply catching up with the West, where prostate cancer has been the No 1 cancer in men for the past 10 to 15 years. “[The incidence in Hong Kong] is not even comparable to the West; we’re just catching up,” says Foo. “It’s a lifestyle thing.”

Obesity, lack of exercise, and a diet that’s high in meat and fat and low in veggies – “part and parcel of the Western lifestyle”, says Foo – are

what doctors think are risk factors for not only prostate cancer but also for all modern cancers and conditions such as coronary heart disease, hypertension and diabetes.

Weight is a huge factor. A study

by Duke University Medical Centre in North Carolina revealed in May that obese men face an elevated risk of their prostate cancer worsening, even when treated with hormone therapy to suppress tumour growth.

Genetics accounts for “minimal” cases, says Foo. It’s a disease of men aged over 60 and its risk increases proportionately with age. “You can take a biopsy of the prostate of practically any man about age 80 on the street and I’m sure you’ll find one-third have prostate cancer,” he says.

The median age of incidence was 73 years in 2009. With the city’s ageing population, the number of cases can only be expected to rise.

Scientists have yet to identify the biochemical mechanisms underlying daily habits that lead to cancer, says Foo. Still, adopting a healthy lifestyle is advisable.

Koehl, a Swiss-Canadian, decided to overhaul the way he lived following his father’s prostate cancer diagnosis in mid-2008. A stressful move to Hong Kong a few months later was also a factor. “I realised that working in Hong Kong and living such a busy life would come with a price,” he says. So, he switched to a vegetarian diet and started playing sports regularly. He lost more than 22kg from his 1.9 metre, 93kg frame.

Getting regular health check-ups can also help. A prostate-specific antigen (PSA) test is a common way to determine the potential risk of developing prostate cancer. The test measures the amount of PSA, a

15

Hong Kong health check-up: men and women compared Life expectancy

Percentage who are daily cigarette smokers (at least one a day)

Men

79.7

Processed meat consumption Percentage eating it at least two days a week

Percentage not removing the fat from meat before eating

Percentage eating at least five servings of fruit and vegetables a day

40 22

29

26 14

25

11 Women

6

85.9 Sources: Census and Statistics Department, Department of Health

Note: all figures from 2009

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COVER STORY 5

it for health CHECKING UP ON THESE ISSUES WILL HELP AVOID CHECKING OUT EARLY With each decade of men’s lives come new health concerns. It’s worth equipping them with the facts so they can be aware of what they need to talk to their doctors about at different stages of life. A few health checks apply to all decades: skin cancer, weight and blood pressure, cholesterol and mental health (depression and anxiety).

20s • Testicular cancer – it’s the most common cancer affecting young men • Harmful alcohol, tobacco and other drug use • Self-harm and suicide • Sexually transmitted diseases

30s • Testicular cancer • Harmful alcohol, tobacco and other drug use • Blood glucose (diabetes) • Sexually transmitted diseases • Eye checks for glaucoma and other conditions 40s • Prostate and colorectal cancers (particularly if there is a family history) • Blood glucose • Blood tests to check kidney/liver function and iron • Eye checks for glaucoma and other conditions

50s • Prostate and colorectal cancers • Blood glucose • Blood tests to check kidney/liver function and iron • Tetanus booster (every 10 years) • Eye checks for glaucoma 60s and onwards • Prostate, colorectal and bowel cancers • Blood glucose • Blood tests to check kidney/liver function and iron • Pneumonia vaccine (from 65) • Bone density • Eye checks for glaucoma Source: Movember Foundation

Nicolas Koehl, whose father’s prostate cancer is in remission, kept a moustache for ‘Movember’ to spotlight men’s health issues. Photo: Felix Wong

protein produced by cells of the prostate gland in the blood.

An elevated PSA level can result from a number of factors, including benign prostate enlargement or inflammation of the urinary tract.

Therefore, additional tests are needed. For example, if the doctor suspects cancer, a biopsy of prostate cells will likely be ordered to confirm the diagnosis. That’s how Koehl’s father was diagnosed. He had radiation treatment and is now in remission.

Kody Hennessey’s father, however, was not as fortunate. “He was a very healthy and positive person. But one day we found out his PSA was very high after a routine health review for insurance. He passed away one year later [in 2008 at age 59],” says Hennessey, 28, a business development manager

Binge drinkers Percentage who had at least five glasses of alcohol on one occasion in the month

If you take a biopsy of the prostates of some 80-year-old men, I’m sure you’ll find that one-third of them have prostate cancer DR WILLIAM FOO WAI-LUM, BAPTIST HOSPITAL

Overweight or obese Percentage with body mass index greater than 23

with TMax Group who was inspired by his late father to keep a moustache for Movember.

The PSA test is controversial.

“The proponents think PSA will pick up early prostate cancer, but the opponents question whether picking up prostate cancer early can save lives. No conclusion has actually been reached,” says Foo. Recent draft recommendations from the US Preventive Services Task Force suggest that the test may not save lives. The task force says the test often delivers flawed results.

Two out of three men with raised PSAs do not have prostate cancer.

This means they will endure unnecessary tests, such as the invasive biopsy. And about 15 to 25 per cent of men with prostate cancer may not have raised PSAs. But a Mayo Clinic study released

Going for regular health check-ups Percentage of those aged 15 or above

last month found a clear link between the PSA test and care. The study tracked more than 600 men aged between 40 and 79. Those in their 40s and 50s with a baseline PSA at or above the median PSA were more likely to undergo a biopsy and be diagnosed with low-risk prostate cancer. But nearly nine in 10 of the tumours found in both age groups were classified as “low risk”.

According to the Health Department in Hong Kong, prostate cancer is not always an aggressive disease. Many with the condition do not have symptoms and do not die from it. These men do not really need treatment. The treatment may have side effects of its own, and can cause more problems than the cancer. “Sometimes, [prostate cancer] won’t even affect your life,” says Foo.

For those who do have symptoms, common ones of the condition include difficulty or delay in urinating, a slow or weak stream of urine, blood in urine, and pain in the lower back, pelvis and hips.

Regardless of the efficacy of the test, the goal of Movember is to change the way men think about their health. Health Department figures show that Hong Kong men are generally less healthy and access health services less frequently than women.

“I think this is universal in city men,” says Foo. “When the economy is not that prosperous, men just want to make a living, support a family and improve their living standards.”

Perhaps the moustache will help change the face of men’s health. jeanette.wang@scmp.com

Death rate from malignant neoplasms (Hong Kong’s No 1 killer) Per 100,000 (age-standardised)

Reported Aids infections in 2009

150

49 30

14

70

19 149

64 83

14

4

0

12 0 SCMP

6 HEALTH FROM THE EXPERTS

A common disease that proves hard to stomach ......................................................

Jeanette Wang jeanette.wang@scmp.com ’Tis the season to be jolly, but also for gastroenteritis, a common disease that’s also known as stomach, or gastric, flu. It’s not positive news for the festive period, though it can be prevented easily by taking simple precautions.

Gastroenteritis is usually a mild disease and can be caused by a variety of pathogens (diseasecausing agents).

The condition is frequently termed as “flu” because its cause is usually viral. However, this loose terminology can be confusing, because flu viruses are not the culprits; rotavirus and norovirus are the main ones in Hong Kong that have been identified.

According to Dr Carmen Wong, medical officer of the Health Department’s Central Health Education Unit, these viruses can infect people year-round, though they tend to do so during the cooler months of the year, peaking in late winter. The viruses inflame the mucus membranes of the gastrointestinal tract (stomach and small and large intestines), causing diarrhoea and vomiting. Other symptoms include headache, fever and abdominal cramps.

“In general, the symptoms begin one to two days after infection and, depending on the type of virus, may last for up to 10 days,” she says.

Most people do not get seriously ill, but complications and even death can occur if infected people are not given proper management and care.

According to a report published last year in Clinical and Experimental Gastroenterology, there are billions of incidences of gastroenteritis worldwide each year.

In children under five, it accounts for 1.5 million to 2.5 million deaths – or 12 per cent.

It’s particularly easy to occur in institutional settings like residential care homes for the elderly

Deaths tend to occur in developing countries where there’s limited access to hydration, good nutrition and primary health care; many infant deaths are due to dehydration caused by gastroenteritis.

The viruses are typically contracted through the faecal-oral route, by consuming contaminated food or water, or contact with contaminated objects or the vomit or faeces of an infected person.

Infection can also be spread by air particles, produced during violent vomiting.

Though usually a childhood disease, anyone can fall victim. “It’s particularly easy to occur and is spread in institutional settings such as residential care homes for the elderly or disabled, or schools,” says Wong.

From January 2007 to last month, about two-thirds of the 431 norovirus-associated outbreaks in Hong Kong occurred in homes for the elderly. About one-third of the 49 rotavirus outbreaks took place in child-care centres and kindergartens, and another third in homes for the elderly.

Infants, young children, the elderly, the disabled and those who have a compromised immune system should seek early medical advice.

In Hong Kong, Rotarix and RotaTeq are registered vaccines to prevent gastroenteritis caused by rotavirus. They are both given orally to children six weeks and older.

To prevent gastroenteritis, the Health Department advises: • Eat only thoroughly cooked food, particularly if it’s seafood and shellfish.

• Wash hands thoroughly before handling food and eating, and after using the toilet and changing diapers.

• Wear gloves when cleaning up vomit, faeces and contaminated areas and objects. Clean and disinfect promptly and thoroughly with one-in-49 diluted household bleach and wash hands thoroughly afterwards.

• Maintain good indoor ventilation.

• Rest at home and refrain from school or work when sick.

• Approach family doctors for information and advice if parents are considering getting their babies vaccinated against rotavirus infection.

DR CARMEN WONG

Rotavirus is so named because of its wheel-like appearance

Sperm must be treated with res if fatherhood is the horizon

TRADITIONAL CHINESE MEDICINE

Formulas going west get los ......................................................

Elizabeth Snouffer healthpost@scmp.com In 1999, Airborne, a herbal supplement company started by a teacher in the US, began marketing a cold remedy, claiming its proprietary formula – said to include traditional Chinese medicine (TCM) ingredients – had immune-boosting qualities. Oprah Winfrey became a huge fan, touting the product’s preventive magic on her television show in 2004. By 2007, Airborne was worth US$300 million.

The company linked its efficacy to a special formula resembling a popular TCM remedy, yin chiao, which includes a proprietary herbal blend of lonicera (honeysuckle flower), forsythia (St Jonh’s wort), schizonepeta (hairy sage), ginger, Chinese vitex, isatis and echinacea.

The formula also contains vitamins, electrolytes, amino acids and antioxidants.

But there had been no credible evidence of Airborne’s efficacy, and an ABC News report disclosed that the company’s clinical trials were carried out by two laypeople. In 2008, the US Federal Trade Commission fined Airborne US$30 million for deceptive advertising.

Bad press, however, hasn’t affected Airborne’s business. Last year it was the market leader in the US$250 million immune health sector in the US. In Hong Kong, health products chain Nature’s Village sells five to six different types of Airborne supplements nearly

every day. “It’s popular,” says Aman Dhillion, store manager for the Lyndhurst Terrace outlet. “People come to our store looking for it.”

It seems, however, that yin chiao isn’t quite the cold remedy you expect it to be.

According to Dr Liong Ching, an instructor at Chinese University’s School of Chinese Medicine, “cold syndrome” is associated with white secretions, a runny nose, chills, lethargy and a slow pulse, and that requires a completely different prescription.

Yin chiao is a very popular powder prescribed to patients for febrile disharmony or “hot syndrome”, a common summer ailment. The concoction contains honeysuckle flower, St John’s wort, hairy sage, fermented soybean, balloon flower, mint, burdock, liquorice root and bamboo leaf.

Febrile disharmony is associated with feeling hot and feverish, having a rapid pulse, sweating and having a sore throat.

“It is very common in Hong Kong, but not so much in the north. Yin chiao is not preventive for colds and flu and is traditionally prescribed to relieve only symptoms indicative of heat,” says Liong.

Many other over-the-counter products are touted as updated TCM remedies, but the way they are marketed in the West may not always agree with what the Chinese experts say.

Gingko biloba is one example.

With worldwide sales worth hundreds of millions of dollars each

Airborne has proved a popular cold remedy desp

I don’t know any specialist who would prescribe dong quai as a herbal remedy on its own DR LIONG CHING

spect on

HEALTH 7 MALE FERTILITY

Lifestyle hits where the sperm counts ......................................................

Marni Jameson Most men don’t give much thought to their prenatal care, but according to male-fertility experts, what guys do now could make the difference between becoming a dad or not.

Unlike women, who have all the eggs they will ever have when they’re born, men produce sperm all day long.

Sperm takes two to three months to fully mature, so a guy’s behaviour during the previous 90 days will affect the baby he makes, or whether he can make one at all, says Dr Sijo Parekattil, director of urology at Winter Haven Hospital in Florida, where he specialises in male infertility.

Although society tends to focus on women when couples can’t conceive, about half the time it’s down to the guy, says Parekattil, who was among several infertility and adoption experts who spoke recently at a conference near Orlando, Florida.

Among the more common sperm-killing behaviours are keeping phones in trouser pockets and using laptops on laps, which raises sperm temperature. Other

behaviour that is not conducive to fatherhood are smoking, excessive drinking, frequenting saunas and hot tubs, wearing tight underwear, using recreational drugs including marijuana, taking male supplements and getting sick.

Dr Ashok Agarwal, director of the Centre for Reproductive Medicine at the Cleveland Clinic, has conducted several studies on the effects of mobile phone radiation on sperm.

In one lab study, he found that the viability of sperm exposed to mobile phone radiation for one hour dropped by 11 per cent compared with control samples.

His research also found that sperm count, motility (the abillity of sperm to move properly towards an egg) and viability dropped more as that exposure went up.

“Mobile phones emit radiation, which can potentially harm the sperm in men who carry their phones in their pockets or on their belts,” Agarwal says. “We believe these harmful effects are due to the proximity of the phones to the groin area.”

A bout with the flu can lower sperm count, too, which is why experts recommend that men trying to have children get flu shots.

st in translation

pite questions about its effectiveness. Photo: AP year, it is a modern-day TCM bestseller billed as being able to boost brainpower.

But Liong says: “The brain enhancement functionality of gingko biloba is not present in ancient Chinese literature. In fact, in the Pharmacopoeia of the People’s Republic of China 2005, considered the most authoritative compendium for all aspects of TCM, the therapeutic effect of ginkgo biloba is not listed as a brain enhancer. It’s used for excessive coughing or excessive secretions, especially related to women.

“I really don’t disagree or agree with the product being used as an enhancer for the brain or memory, but I would never prescribe it as such.”

What about dong quai, also known as Chinese Angelica, which has been used for thousands of years in TCM for women’s health issues?

It has seen a recent resurgence in popularity, being sold as a standalone herbal remedy worldwide to help support hormonal balance and maintain healthy oestrogen and progesterone levels in women.

Liong, like many Western gynaecologists, has her concerns. “I don’t know any TCM specialist who would prescribe dong quai as a herbal remedy on its own,” she says.

“It must be used in a formula.” That formula is: Chinese angelica, Sichuan lovage, Chinese foxglove and white peony root.

According to the Pharmacopoeia, it is this herbal combination that promotes regulation and well-being before, during and after menstruation.

Prescribed to promote qi (the vital energy that flows through all living things), the formula revitalises blood flow that often gets stuck during premenstrual syndrome, thereby averting symptoms such as swelling, abdominal pain, fatigue, cold limbs and lower back soreness.

According to Memorial SloanKettering Hospital, dong quai has shown to increase the growth of breast cancer cells in lab tests, and may also contain compounds that can cause cancer in high doses.

However, Liong believes that dong quai’s potency is modified when prescribed in the traditional formula. A believer in its therapeutic effect, she still prescribes it.

Mobile phones emit radiation, which can potentially harm the sperm in men who carry their phones in their pockets or on their belts ASHOK AGARWAL, CLEVELAND CLINIC

Chronic diseases, such as high blood pressure and diabetes, also take their toll.

Obesity can foster low sperm counts because excess fat causes men to produce more female hormones, Parekattil says.

When men take supplements such as anabolic steroids, their bodies think they’re making too much testosterone and shut down the testicles, which actually atrophy, Parekattil says. Once guys stop taking supplements, sperm production can take up to a year to resume.

“A man’s lifestyle can impact the DNA organisation inside the sperm and the surface properties of the sperm, which are critical for penetrating the egg, fertilising it and helping the embryo get to full term,” says Dr Michael Witt, a urologist and male-fertility specialist who divides his time between Winter Park and Atlanta.

Sometimes all men need to do to give their sperm a boost is just avoid these sperm-unfriendly behaviour and conditions, Witt says.

Besides having a better understanding of how lifestyle and anatomical stresses can affect sperm, men trying to become dads also benefit from another advance in male infertility: in-home sperm-test kits.

Although the tests aren’t as sensitive as those in the urologist’s office, they are more convenient and less embarrassing than giving a sample at the doctor’s office.

A normal sperm count is about 40 million motile sperm per ejaculation, according to the World Health Organisation. Most men produce that well into their 70s.

However, of those men who have problems with infertility, 10 per cent to 15 per cent make no sperm, and a

further 30 per cent have low sperm counts.

Among all men, about one in seven has a varicocele, in which excess blood vessels impair the count and quality of sperm, Witt says. Surgery to remove the veins often restores fertility.

Like 15 per cent of American couples, Clay and Wendi Harris of Orlando couldn’t have a baby despite trying for five years.

“We were tested seven ways to Sunday,” Clay Harris says.

After five failed rounds of in vitro fertilisation, they had just about given up. Then tests showed that Harris, 38, had a sperm count in “the mid-range”. However, Witt reviewed Harris’ sample and thought the sperm quality would improve if he had varicocele surgery.

So, last November, he had the surgery, and afterward, “my sperm count went through the roof. It skyrocketed to 90 million.”

Now the Harrises are expecting a baby boy in early February.

“When we go for our weekly ultrasound,” says Clay Harris, “we just stare at the baby on the monitor and hold hands.”

McClatchy-Tribune

8 FITNESS

Jennifer Murray limbers up during a hike on Black’s Link. The agile grandmother believes life is like riding a horse: if you fall off, you just have to get back on. Photo: K.Y. Cheng

STAR ATHLETE THE ULTRA GRANDMA

Age shall not weary her ......................................................

Ben Sin ben.sin@scmp.com I meet Jennifer Murray on a drizzly, windy morning on Stubbs Road, halfway up The Peak, near where she lives.

It’s less than a week before she competes in Racing the Planet Nepal, a six-day ultra-marathon that covers 250 kilometres of uneven terrain. Most of her serious training is over. These final few days are for relaxing and resting her body.

“Let’s walk to Black’s Link,” Murray says, taking off before finishing her last syllable.

Lean, vibrant and full of vitality, the 71-year-old looks a decade younger. She will be, by far, the oldest participant in the 220-person field for one of the toughest foot races in the world. As per race rules, she’ll be carrying her own equipment, including sleeping bag, clothing and a week’s worth of food.

She’s expected to be hiking from 8am to 8pm each day. Her goal for the race is to start slowly (“I know I can’t beat the youngsters uphill”) but make up ground on the descent (“I’m pretty good with downhill”).

Altitude sickness and heatstroke are two concerns for ultra-marathon participants – usually men in their 20s and 30s – yet Murray’s husband, children and grandchildren aren’t concerned about their matriarch. In fact, they’re probably relieved.

“Oh, compared to my helicopter

stints, this is relatively mild,” says Murray. “My family is probably glad I’m doing this instead.”

The “helicopter stints” she refers to include two Guinness World Record-setting trips – one for flying around the world solo (in 2000, at age 60) and another for flying with a co-pilot from pole to pole in 2007.

The latter took two tries, because on the first attempt, in 2003, she crashed in Antarctica during a blizzard.

Murray suffered a dislocated elbow, fractured ribs and went into shock. Her co-pilot, Colin Bodill, a decade younger, broke his back and was bleeding internally. The first thing they said to each other when they woke up in a hospital in South America 21 hours later was: “We need to find ourselves another helicopter.”

So, Murray is a daredevil, and this ultra-marathon isn’t her first, and it won’t be her last. As we make the uphill trek to Black’s Link, Murray tells me her story.

Born in the US but raised in Britain, she moved to Hong Kong in 1966 with her husband, Simon Murray, the former Hong Kong taipan who is now the executive chairman of investment firm GEMS and an adventurer himself.

Having studied textile design in school, Murray opened her own textile shop in Stanley in the 1970s and had three children. As business expanded, she pursued a personal interest in art and ended up holding

I’d be lying if I said the near-death experience with the crash didn’t faze me at all JENNIFER MURRAY

several art exhibitions. When her children left for university in Britain, she decided to leave the business so she could visit her children.

Murray says all this as we are on a steep incline, and she isn’t even out of breath. Her daughter, Christy Powell, and the family dog, Tasha, are along for the hike.

“We hike up here nearly every morning,” says Powell, an author with an upcoming book release.

“Even Tasha; she may be the healthiest dog in Hong Kong.”

Black’s Link is a stretch of wavy, unpaved trail that sometimes becomes too narrow for comfort – the edge of the mountain is just a couple steps to the side – and we’re hiking in full power-walk mode. It’s an OK achievement for Powell and me, two healthy adults in the prime of our lives. For Murray and the nine-year-old dog (that’d make her 63 in human years)?

Impressive.

Murray is actually a late bloomer of sorts. “I didn’t start becoming very active until I turned 35, when I joined a long-distance runners’ club,” she says. “Later, we moved to Lamma for a few years, and that’s when my husband and I joined the Lamma marathon.”

She first took up helicopter flying in 1994, after her husband bought one and had no time to fly it.

In 1998, she took part in the 240kilometre Marathon des Sables, a six-day trek through the Sahara Desert.

Almost all of her adventures have been tied to charity fund-raising through sponsors and collaborations with organisations.

Her latest one, Racing the Planet Nepal – which ended on Saturday – raised funds for the Friends of Scott Polar Research Institute, a polar research centre at Britain’s Cambridge University.

Murray ended up dropping out of the race in the midst of the 38kilometre stage three, after completing the first leg of 27 kilometres in 10 hours, 37 minutes and the second of 32 kilometres in 10 hours, 50 minutes.

She pushed herself to the limit just to make the time cut-off for stage two (which she learnt about only late into the stage). “After that sprint, I was wiped out the next day by the time I got to checkpoint 2 and knew the final 10 kilometres was an ascent of 1,300 metres with no available transport,” Murray wrote in her race blog. “For once, I did the sensible thing and reluctantly called it a day.”

But you can be sure that this unsuccessful attempt, much like her previous failed helicopter exploits, is not going to stop her from taking on new challenges.

“I’d be lying if I said the neardeath experience with the crash didn’t faze me at all,” Murray says. “I was indeed scared for a bit, but then in the end, I realised that life is like riding a horse: if you fall off, you just have to get back on.”

FITNESS 9 WALKING HOME

Gateway to Gobi ................................................

Rob Lilwall healthpost@scmp.com On November 14, my cameraman friend Leon McCarron and I finally set off from the Mongolian outpost town of Sainshand on our 5,000-kilometre walk home to Hong Kong. Our first challenge was to traverse the Gobi Desert from north to south. The Gobi is a place I remember learning about at school. On maps it was typically shown in shades of blue to identify it as a cold desert.

You could argue that walking into it in late November was asking for trouble, not just because of the fast-encroaching winter, but also the large amount of food, water and cooking fuel we would need to haul to reach the next town 250 kilometres away. These supplies weighed more than 80kg – far more than we could carry on our backs – and so we were grateful that British desert explorer Ripley Davenport offered to give us his old humandrawn trailer named “Molly Brown”.

Molly just happened to be rusting away in a shed in Sainshand, and having retrieved her, we were delighted to discover that she was a sturdy iron beauty of a beast. So having loaded her up with supplies and clipped her to our rucksacks, we dragged her out on a southerly compass bearing, in search of a desert track we had spotted on Google maps.

I always find the first few steps of an expedition tremendously exciting, as my thoughts wander between thinking that I am crazy to be attempting such a thing, but also grateful for having a chance to at least try. We crested the final hill out of town, and before us rolled an endless yellow-brown sea of empty, ruffled sand. In the distance was a bank of epic wind-carved hills: the Gobi was waiting for us, daring us to enter.

We strode onwards into the emptiness, but within a few hours, our pace slowed to a trudge as we took shifts dragging Molly. During daylight on that first day the temperature was mild, but as the

Rob Lilwall (right) and cameraman Leon McCarron set off from Sainshand on the first day of the 5,000-kilometre walk home to Hong Kong; below, the pair are welcomed in from the cold by Mongolian herdsmen. Photo: Rob Lilwall sun dropped below the horizon and we set up camp, the mercury plummeted to minus 10 degrees Celsius. We were shivering as we prepared food on a petrol stove, but before long we were in our sleeping bags. I drifted off to sleep, reassuring myself that it always takes the first week or so of an expedition to get camp drills down pat.

We continued south for the next two days, before reaching our first target – the pilgrimage site of Khamarin Khiid, where Danzan Ravjaa, a Mongolian Lama Buddhist saint from the 19th century, is laid to rest.

I was not there as a religious pilgrim (I’m Christian rather than Buddhist), but I did admire the beauty of the monastery, set in the middle of this lonely expanse.

Arriving at a place of pilgrimage so early in the expedition also gave me pause to reflect on my own journey to try to walk home in the next six months. I like the concept of journeying as a pilgrimage. It is an ancient practice in which we are required to dig deep and endure tests of both body and character in order to reach our destination.

In my case, that’s home and my wife, Christine.

Having left the pilgrimage site, we continued through the desert, and over the following days, the

I like the concept of journeying as a pilgrimage. It is an ancient practice [that] ... tests both body and character weather took a turn for the worse.

Instead of the benign, expansive sea of yellow-brown sand, the Gobi turned white with snow and became brutally cold. I began to feel that now, having enticed us in, it was ready to consume us. But we pressed onwards and were relieved that every couple of days we came across a ger (the traditional white felt nomad tent) where goat herders usually invited us in to share a cup of hot milky tea and, if it was near sundown, to stay the night. But apart from our ger stays, we had to endure increasingly freezing nights in the tents, with temperatures approaching minus 30 degrees. One morning, a terrible blizzard almost blew our tents away. (You’ll have to wait for the TV series next year to see what happened.)

And then finally, the empty

horizon of desert was broken by a line of dark, rectangular shapes: the border town of Zamyn Uud. We entered at dusk and discovered that this desert outpost was now a hive of industrial growth (as Mongolian-Chinese trade increases), with spewing chimneys, choking traffic and drab motel-lined streets holding forth in every direction. But after 13 days without a shower (a personal record), we were relieved to have made it across the Mongolian side of the Gobi.

Next we cross into China, where 400 more kilometres of sand await us before we reach the more populated heartlands of Shanxi province. Although I am pleased that our bodies are holding up pretty well after the first 250 kilometres of walking, I am also sobered by the thought that we have completed only 5 per cent of our total distance ... and the whole of China now awaits us.

Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of an acclaimed motivational talk, a book and a National Geographic TV series.

Every week in Health Post, he will write about the progress of his latest expedition, Walking Home From Mongolia, which is in support of the children’s charity Viva. You can track him at www.walkinghomefrommongolia.com

10 DIET NUTRITION BARLEY

A grain of sense catching on ......................................................

Margaret Wee healthpost@scmp.com Not only is barley good for making refreshing barley water for hot days, but it’s also gaining wider recognition for its nutritional benefits.

Barley, grown worldwide mainly for livestock feed and beer and whiskey production, originated in Ethiopia and Southeast Asia and was one of the first grains to be domesticated for human consumption. Koreans, Hebrews, Egyptians, the Spanish, Chinese, Greeks and other communities considered it an important part of their diets and cultures.

Although wheat and potatoes eventually replaced barley as a staple food in modern diets, the latter is now experiencing a renaissance. Its nutritional properties have elevated it to the status of “functional food”, a term given to foods that reduce the risk of developing disease or promote better health.

Barley is a highly nutritious whole grain, being an excellent source of iron, potassium, folate, vitamin E and antioxidants. It is also a good source of dietary fibre, with 200 grams of barley providing more than half of the daily recommended intake. Unlike other grains that contain fibre only in the outer bran layer, barley contains fibre throughout its entire kernel.

“Barley has a higher fibre content than brown rice. Half a cup of barley provides 3 grams of fibre, compared to 1.75 grams for brown rice,” says registered dietitian Kathleen Yau.

Like omega-3 oil-enriched eggs and calcium-fortified fruit juices, barley is being added to foods such as nutrition bars, breakfast cereals, confectioneries and ice cream. Most recently, Italian researchers found a way to make “heart healthy” pasta from barley flour instead of traditional semolina flour. They produced noodles that had high amounts of soluble and insoluble fibre, antioxidants and other healthy compounds.

“Barley is very low in fat, has cholesterol-lowering properties, reduces the risk of hardening of the arteries and prevents cardiovascular disease,” says Mylene Khoo, a registered dietitian with Tetra Nutritional Consultation Centre. It is also thought to reduce the risk of colorectal cancer, have anti-ageing properties and limit the growth of prostate cancer cells.

The propionic acid produced from the insoluble fibre in barley is thought to inhibit the enzyme involved in the production of cholesterol by the liver, lowering blood cholesterol. Beta-glucan, a soluble fibre found in barley and other whole grains, reduces bad cholesterol by binding to bile acid in the digestive system.

When the bile acids are excreted along with the fibre, the liver produces new bile acids, using up more cholesterol.

This lowers the amount of cholesterol. Consuming three to six grams of beta-glucan daily – an amount found in less than 100 grams of whole-grain barley – has been shown to lower blood cholesterol significantly.

Barley’s low glycemic index (GI) makes it an excellent food for

Barley can be added to anything from savoury and sweet soups to braised meat dishes DIETITIAN KATHLEEN YAU

diabetics as regulating blood sugar levels is an large part of diabetes management. GI measures how quickly carbohydrates enter the bloodstream.

Low-GI foods (with a score of 55 and below) release carbohydrates at a slower rate, keeping blood sugar levels stable over longer periods than high-GI foods. Pearl barley, for instance, has a GI of only 22, and pot or dehulled barley has a GI of 35.

Barley also has a positive effect on insulin response, which is an important factor in blood glucose control for diabetics. When carbohydrates are consumed, blood glucose levels rise and the body releases insulin. However, blood glucose levels peak and fall faster than insulin. This lag between the stabilisation of glucose and insulin levels results in hunger pangs in between meals even though the

body does not actually need more glucose.

In a United States Department of Agriculture study involving 17 obese women with increased risk for insulin resistance, scientists found that consuming 10 grams of barley beta-glucan significantly reduced insulin response.

The high fibre content of barley makes it digest relatively slowly.

This is good news for weightwatchers as the feeling of satiety lasts longer, and insoluble fibre helps prevent constipation and reduces the risk of colorectal cancer.

It also feeds the good bacteria in the large intestine, producing a shortchain fatty acid called butyric acid that is necessary for a healthy colon.

The proliferation of healthy bacteria prevents disease-causing bacteria surviving in the intestinal tract.

Eating foods enriched with barley is easy, but adding barley to the Asian diet through cooking is easier than you think.

“Barley can be added to anything from savoury and sweet soups to braised meat dishes. For Chinese people, it’s easier to consume barley than oatmeal, which is more familiar to Westerners,” Yau says.

Khoo recommends soaking barley in water for 20 minutes and boiling it until it is translucent. “Mix

it with rice, in a sweet dessert like pudding or use it as an ingredient in soup. You can also mix it into prepared congee and add beef or pork,” she suggests.

Exactly how much barley should you consume to enjoy its health benefits? There is no official recommendation. “Usually, we advise consuming half a cup of barley per meal. This is to prevent bloating due to its high-fibre content,” Khoo says.

But since people in Hong Kong generally do not get enough fibre in their diets, Yau says there is no harm in eating more.

“We are always asking people to eat more fibre because it’s very difficult to meet the recommendation of 25-30 grams of fibre a day.”

Nevertheless, those with food allergies should exercise caution.

Although it is generally well tolerated, barley flour and beer have been known to cause allergic reactions.

Its gluten content, in particular, can have adverse effects on people who are gluten intolerant or suffer from celiac disease. And if you are a diabetic on drugs to lower your blood sugar, it may take you some time to find the right amount of barley to balance the effects of your medication.

EAT SMART SCRAMBLED EGG WHITE

Here’s a cholesterol-free treat that really is all that it’s cracked up to be ......................................................

Jeanette Wang jeanette.wang@scmp.com If you like eggs but don’t want extra cholesterol, this dish by The EnglishSpeaking Dining Society of the Chinese Cuisine Training Institute is for you.

One large egg (50 grams) has about 185 milligrams of cholesterol, all of which found in the yolk, according to the US Department of Agriculture. That’s more than half the recommended daily dietary cholesterol intake of 300mg for healthy people, and nearly all the 200mg limit for those with heart disease, diabetes or high blood cholesterol.

Egg white is not only cholesterolfree but also fat-free (the egg yolk has 5 grams fat and 1.5 grams saturated fat).

A single egg white contains just 17 calories and provides 3.6 grams of protein.

With added spinach and reduced fat and salt, this dish makes for a nutritious meal.

Scrambled egg whites with spinach and shrimps Serves 4 60 grams shrimp, peeled 150 grams spinach 8 eggs, whites only 1-2 pieces dried scallop, soaked 1/2 tsp fine salt 1 tbsp starch Ground white pepper to taste 1 tbsp canola oil 100ml chicken stock 1 tbsp Chinese wolfberries, rinsed 1 ⁄2 tsp fine salt 2 tsp starch 2 tbsp water

• Blanch shrimps. Set aside.

• Boil and strain spinach. Chop finely.

Set aside.

• For mixture 1: beat four egg whites. Mix with shrimp, scallop, 1⁄2 tbsp starch, 1⁄4 tsp salt and ground white pepper. Set aside.

• For mixture 2: beat four egg whites.

Mix with chopped spinach, 1⁄2 tbsp starch, 1 ⁄4 tsp fine salt and ground white pepper.

Set aside.

• Heat 1⁄2 tbsp oil in a wok. Add first mixture and sauté until done. Transfer to a plate. Repeat with remaining 1⁄2 tbsp oil and second mixture. Transfer to same plate.

• In a small pot, add chicken stock, wolfberries, salt, starch and water. Cook till combined and pour over eggs. 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

With reduced fat and salt, this makes a nutritious meal

WELL-BEING 11 PERSONAL BEST

THE TASTE TEST DAIRY ALTERNATIVES

Cool runnings

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

Jeanette Wang jeanette.wang@scmp.com

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The onset of colder weather often brings on the winter blues, with corresponding ailments such as colds, congestion, seasonal depression and fatigue.

But perhaps the biggest problem is one’s tendency to be a sloth when the mercury plunges.

Shorter days and chilly winds sap any motivation you might have to leave your armchair and do something active, let alone go out for a morning run.

Exercise provides a natural boost to both mood and health. Studies have shown regular exercise is an effective way to alleviate mental stress, improve cognitive performance and boost energy.

The unfortunate irony is that we find it most difficult to exercise during the winter when, arguably, we need it most.

Those of us who have trouble adhering to an exercise programme typically blame our lack of time or energy or winter’s early darkness.

When we truly believe we can’t maintain an exercise regimen, we become hopelessly disempowered when it comes to making any positive change.

So first you must change the internal dialogue. This starts by understanding – regardless of your personal circumstances – that you really do have what it takes to fight the winter blues. Empower yourself with thoughts such as: “I can and will get healthier this season.”

Before embarking on your winter exercise journey, you must ask yourself: “Why am I doing this?” An honest, thoughtful and realistic answer is required. Are you doing it to lose weight, improve your strength, to look good for spring or for a special valentine? Perhaps it is to keep up with your grandchildren.

Base your answer on what you would like to do, something that is personally meaningful, rather than what you think you ought to do. That is, don’t answer this question with a line that simply sounds right.

Try to create a vivid mental picture of your goal. Visualising yourself as thinner, stronger or more confident, for example, conjures up positive and pleasant emotions.

Once you have a specific, personalised and somewhat challenging goal and image in mind, you’re ready to begin the process.

The process is the everyday work – your chosen method(s) of exercise – that will get you closer to your goal.

You should not feel compelled to fit into a generic programme.

Instead, fit an exercise programme to your needs and characteristics.

If you are looking for a social atmosphere, think about joining a class – there’s Zumba, Pilates, yoga, spinning, swimming, all types of dance, to name but a few.

If you are looking for something more private, inquire at your local gym about personal training. Or don’t leave the house at all. Buy an exercise DVD or a video game console as a special holiday gift.

And listen to some music.

Studies have shown that listening to your favourite music during

Illustration: Bay Leung

Greg Chertok healthpost@scmp.com

exercise can improve results, both in terms of motivation (people exercise longer and more vigorously to music) and as a distraction from fatigue.

Think about ways to incorporate exercise into your daily activities. The benefits of moving throughout the day were demonstrated in a recent study of fidgeting by researchers at the Mayo Clinic in the US. Simply being restless – standing, pacing, toetapping – can burn about 350 calories a day. Walking briskly between errands, stretching in the shower or contracting your stomach muscles while at the office are some of the novel, easy ways that you can fit exercise into your life.

Don’t let the word “work” in workout mislead you. Whichever exercise method you choose, the experience should be enjoyable.

With a goal, image and process firmly ingrained in your mind, the journey begins.

As you would with a new pair of sneakers or a sentimental piece of jewellery, be proud of yourself. It’s enticing to say: “I’ll fit exercise in when I can” and be content with that. But making it an anticipated and essential part of your day – like eating and showering – completely changes your attitude.

Those who write down their goals tend to accomplish significantly more than those who do not. So personal slogans and reminders around the house, car and office will keep you motivated and on track.

Don’t let the word “work” in workout mislead you.

Whichever exercise you choose, it should be enjoyable

We can achieve more, in all of life’s domains, if we restructure our attitudes. Start viewing your good health as a critical but engaging part of your daily life and fight those winter blues with a healthy dose of exercise.

Greg Chertok, M.Ed, is a sport psychology counsellor and fitness trainer at the Physical Medicine and Rehabilitation Centre in New Jersey. Reprinted with permission of the American College of Sports Medicine, ACSM Fit Society Page, Winter 2011, p6.

Blue Diamond Almond Breeze Chocolate 946ml for HK$39.50, ThreeSixty This soy- and lactose-free drink is as smooth and creamy as skim chocolate milk, and it is unlike other thin and chalky dairy alternatives. It’s also rich in antioxidant vitamin E. Verdict: has a pleasant almond aftertaste, but is a little sweet.

Sanitarium So Good Vanilla Bliss 1 litre for HK$28, ThreeSixty With a strong, sugary vanilla flavour, you can hardly taste that this is soy milk. It has a consistency similar to skimmed milk, and will probably go well with a bowl of bland muesli.

Verdict: I’ll make it an occasional treat, but it’s way too sweet.

Freedom Foods So Natural Rice Milk 1 litre for HK$26.90, ThreeSixty The carton makes it clear that you have to shake this well before pouring.

Made with brown rice, it’s watery and dotted with specks of white sediment. I had a sip and couldn’t drink any more.

Verdict: the least palatable of the three products