20111227 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, DECEMBER 27, 2011

HEALTH POST THE IMPORTANCE OF A SECOND OPINION >PAGE 3

Illustratio n: Stephe n

Case

HOW TO BEAT THE HANGOVER BLUES >PAGE 6

The worth of mirth There’s no denying the healing properties of laughter >PAGE 4

2 NEWS APP OF THE WEEK

HEALTH BITES

Get the goodness of green at the touch of a screen

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Katie McGregor healthpost@scmp.com Green Smoothies US$1.99 Rating 8/10 Green smoothies are not the exclusive domain of the raw food movement, but I first learned about them while researching an article for Health Post.

With the knowledge that green vegetables give you the goodness without the sugar load from fruit, I was so inspired by the tales of weight loss and of feeling full all morning and energised all day, that I started having a green smoothie of my own design every morning. I have not been disappointed but, after some months, need a bit more variety.

Raw Family’s Green Smoothies app is a treasure trove of recipes

including some for facials – aloe, avocado and cucumber – and some to benefit pets (fish oil, water, olive oil, catnip and wheat grass).

You can browse the recipes for people, or search by ingredient or by category.

In the introductory guide, Victoria Boutenko – who wrote both the app and the book Green for Life – advises: “Learn to prepare a really delicious green smoothie so that you are always looking forward to the next one.” This is a good suggestion, as many of us might find the taste of blended green vegetables alone to be too “green”.

However, a little banana or apple hides that green taste surprisingly well.

The recipe categories, such as Savoury Soups or Green Puddings, help dispel any mental blocks you might have about drinking green vegetables. After all, gazpacho is a chilled soup enjoyed the world over, and you just need to add chilli or ginger if you want to heat it up.

This being an American app, there are some vegetables that are not available here. However, I will not be put off and have decided to experiment by using any local vegetable I can find that best matches the photos.

The app also comes with an ingredient directory, allowing you to read up on the benefits of the fruits or vegetables, together with the nutritional breakdown per serving.

For further inspiration, watch the videos: learn about a man who lost 45.5kg in 14 weeks and another who combats diabetes, and listen to a song by Boutenko.

A busy lifestyle had made me stick to the tried and tested original McGregor smoothie, but with this app, I am now looking forward to a more varied and vibrant new year.

Jeanette Wang jeanette.wang@scmp.com

Hair today, more tomorrow Help is here for people with hair that’s thinning, losing volume or lacking density and those suffering from a tight or dry scalp.

Next month, Aveda will launch a hair care range that’s said to be 97 per cent natural and to reduce thinning/loss by 33 per cent.

Called Invati – Sanskrit for “invigorate” – the range contains a blend of ayurvedic herbs, turmeric and ginseng to energise and rehabilitate the scalp. The line includes an exfoliating shampoo, thickening conditioner and scalp revitaliser, priced from HK$290.

Rhythm and snooze A discovery by scientists at the Salk Institute for Biological Studies in California could lead to safer treatments for asthma, allergies and arthritis. Their study, published this month in Nature, found that proteins (cryptochromes) that control the body’s circadian clock also interact with metabolic switches that are targeted by certain anti-inflammatory drugs, helping to regulate sugar metabolism in the body. By timing the administration of drugs according to patients’ biological rhythms, the scientists say the drugs’ side effects – such as high blood sugar levels, insulin resistance and diabetic complications – may be avoided. In addition, the findings may help explain the connection between sleep and nutrient metabolism in our bodies, including why those who work night shifts or erratic hours are at higher risk of obesity and diabetes.

Vitamin E linked to muscle repair It’s common in food, particularly nuts, seeds, vegetable oils, green leafy vegetables and fortified cereals, but what exactly does vitamin E do for you? Georgia Health Sciences University researchers have finally figured it out – with evidence. Cell biologist Dr Paul McNeil mimicked what happens in the body during exercise by using hydrogen peroxide to produce free radicals and found that tears in skeletal muscle cells did not heal unless pretreated with vitamin E. The antioxidant appears to be essential in repairing tears in the plasma membrane caused by everyday activities, such as eating and exercise. Muscle cells that remain unrepaired eventually waste away and die.

ASK THE DOCTORS DR PETER KO PUT-SHUI Q: I’ve been running long distances of between 10 and 42 kilometres since I was 18, and I’ve never taken supplements for my joints. But now at 30, I’m wondering if I should start. What do you recommend?

A: From the literature and clinical experience, we know that joint supplements such as glucosamine or chondroitin are effective in treating osteoarthritis (degenerative joint disease). However, the studies have conflicting results. Although some studies show the supplements may slow down the progression of osteoarthritis, there is no solid proof.

There is no study that has confirmed that these joint supplements help to repair or grow new cartilage or stop cartilage from suffering further wear and tear or damage. The major advantage of

these supplements is that they carry minimal risks. Having said that, there are risks that still need to be considered, including allergic reactions, impaired glucose tolerance, drug interactions, stomach upsets, nausea, heartburn and diarrhoea. They also have a high sodium and potassium content, and patients on medications for hypertension and heart disease should be careful.

In short, from a medical point of view, I do not recommend the use of similar supplements regularly to keep a runner’s knees healthy because there is no strong scientific evidence to show any protection against natural or excessive wear and tear or damage in the leg joints.

Dr Peter Ko Put-shui is a specialist in orthopaedics and traumatology

> 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

Raising the salad bar Here’s a convenient way to have a healthy – and affordable – lunch delivered to your door.

Starting from January 9, celebrity chef Alvin Leung will offer a selection of five salads at a promotional price of HK$38 each (regularly HK$78), with a calorie count of between 390 and 610 per serve. Apart from his take on classics such as the nicoise, caesar and chef’s salad, Leung will offer ling mut (Cantonese for lemon and honey) salad with chicken breast and give the all green salad his inimitable twist, with sesame, kaffir lime and tofu. Go to www.beautifood.com.hk for more details.

Baby talk Mind your language when speaking to babies: infants as young as 12 months of age listen to and track word patterns that will support the word learning that usually occurs between 18 months and two years.

Research by the University of Notre Dame’s baby lab suggests babies can distinguish different kinds of words, such as nouns and verbs, by their sound. “If I were to say to you, ‘Oh look, it’s a dax’, you might not know what a dax is, but the cue ‘it’s a’ lets a baby know that what follows is an object,” says the lab’s director, Jill Lany, an assistant professor of psychology. Babies can use these patterns as clues to the meanings of new words they are learning. By about 15 months, they’re able to track more complicated “non-adjacent relationships”.

MEDICAL 3 CASE HISTORY

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Eileen Aung-Thwin healthpost@scmp.com Mary Chay, 46, has always taken her health seriously. She doesn’t smoke or drink and even bought a package for annual health checks.

This attention to her health paid off. In 2009, a routine check-up revealed a lump in her left breast.

Her doctors did a biopsy and confirmed it was cancerous.

The doctors needed to know the extent of the cancer to decide on a suitable therapy. Chay (whose real name is withheld for reasons of patient confidentiality) underwent a positron emission tomographycomputed tomography (PET-CT) scan, which helped the doctors analyse the metabolic and biochemical activity in her body as well as the anatomy and stage of the cancer.

Not only was the lesion in her breast more than 2cm in diameter, the cancer had also spread to the axillary lymph nodes in the armpit region. The doctors decided to put Chay on six courses of chemotherapy to shrink the tumour, and to control the spread of the cancer through the lymphatic system. If the chemotherapy was

Nine out of 10 cases of TB go undetected.

Most people’s immune systems can suppress the bacteria, preventing a full-blown infection

successful, she could have surgery to remove the cancer.

After three months of chemotherapy, Chay had another PET-CT scan. The good news was the lesions in the breast and axillary lymph nodes had shrunk. The bad news – the scan detected that one of the lymph nodes near her trachea (wind pipe) was enlarged. Her doctors believed the chemotherapy was only partially successful; surgery would not help Chay if the cancer was spreading despite the drugs.

She had another chemotherapy course before repeating the scan.

The lymph node had enlarged even further. Her doctors tried another chemotherapy drug without success.

Chay sought a second opinion with specialists at Hong Kong Sanatorium and Hospital. There, the oncologist wanted to see if the enlarged lymph node was indeed related to the cancer. Because the node was within the thoracic cavity, it was hard to reach and required specialised skills and equipment.

Dr Lam Bing, director of the Respiratory Medicine Centre, stepped in.

In the past, a technique called transbronchial needle aspiration (TBNA) would have been used.

In this procedure, doctors use a CT image as a static “map” to guide them. A small tube is inserted into the patient’s airway and down the relevant bronchial branch, close to the lymph node in question.

However, because the lymph node is located outside the airway, doctors can only guess its exact location. So, a needle is used to pierce the airway and, hopefully, the lymph node several times to extract the tissue. Poking about blindly carries risks – a blood vessel might be punctured. As a result, TBNA is

Illustration: Angela Ho

Second opinion, second chance

used by fewer than 10 per cent of pulmonologists worldwide and has only a 50 per cent to 60 per cent success rate of locating the correct lymph node.

By the time Chay needed the biopsy, technology had provided new solutions that significantly reduced these risks.

Lam used an endobronchial ultrasound-guided TBNA (EBUSTBNA), which carries a 95 per cent success rate of hitting the target. In this procedure, the bronchoscope has a small ultrasound probe at its tip, which allowed Lam to “see” the enlarged lymph node in real time and accurately insert the needle into the lymph node to extract the tissue.

The biopsy showed that the enlarged lymph node was not caused by the cancer; instead, Chay

had tuberculosis. Chemotherapy had impaired her immune system, which had previously held the tuberculosis bacteria from multiplying.

Lam says tuberculosis is common in Southeast Asia, and there are 6,000 cases each year in Hong Kong alone. However, the rate of infection is actually much higher, as nine out of 10 cases of TB go undetected. Most people’s immune systems can suppress the bacteria, preventing a full-blown infection.

Chay underwent curative surgery to remove the cancerous lesions in her breast and axillary lymph nodes.

She was also given hormonal therapy and later pronounced free of cancer.

Tackling the TB was easier. Chay was given a six-month course of medication. She had to take four

types of medication for two months, followed by two other types for four months.

Lam says that so long as a patient is diligent about taking the medications regularly, TB is not difficult to cure. However, failure to comply with the regimen can result in a dangerous drug-resistant form of TB. Chay, who has always been conscientious about her health, followed Lam’s orders to the letter and is now enjoying her newfound health.

Lam says Chay’s case is a pertinent reminder that new symptoms in a cancer patient may not necessarily be related to the disease and should be investigated with an open mind. Tissue biopsies are crucial for accurate diagnoses, avoiding unnecessary treatments.

4 COVER STORY

Jest a minute We all know that laughter is the best medicine, but the modern world can take the humour out of life. Jennifer Huang meets the healers who have a funny way of doing things

C

hinese people aren’t funny, at least according to a survey of university students in Hong Kong and on the mainland. Associate Professor Yue Xiaodong of City University, who conducted the poll, found that there is a cultural ambivalence among Chinese towards humour.

Asked to rate the importance of humour, the Chinese undergraduates valued it in general but had a significantly lower assessment of their own sense of humour.

The students were also asked to identify the key attributes of humour and of the Chinese character – and the results showed virtually no overlap. The study was recently published in the International Journal of Humour Research.

“Core personality traits of the Chinese are different than, say, those of Americans, who associate humour with creativity,” Yue says.

“With the Chinese, there is no such connection.”

Yet humour and laughter has have long been thought to promote good psychological and physiological health, and have been used as forms of therapy both in Western and Chinese medicine.

The earliest forms of humour therapy can be found in the ancient Chinese medical text Huangdi Neijing, which recommends the use of comedy or clowning to treat patients.

Recently, scientists at Oxford University presented a study on the analgesic effect of laughter.

Evolutionary psychologist Robin Dunbar led a series of experiments that measured the pain threshold of people after they watched 15 minutes of a video. Those who watched slapstick comedy such as Mr Bean could endure a higher level of pain than those who watched a golf instruction video.

“It’s not the comedy that’s important, but the laughter,” says Dunbar. The physical act of laughing, especially a belly laugh, activates the release of endorphins, the body’s natural painkiller.

“Endorphins are detectable at least half an hour after release, maybe as much as an hour,” Dunbar says. “The effect of laughter from a comedy video lifts the pain threshold by about 20 per cent.”

Leadership and laughter coach Anand Chulani uses his talents as a comedian to help children cope with pain. He recalls the time when he ran a two-hour workshop at Ronald McDonald House in Sha Tin – a place where seriously ill children can spend time away from hospital with their families – for 200 patients and their parents, without a Chinese translator. An eight-yearold girl, fresh from a chemotherapy session, entered the room.

“I couldn’t imagine the physical pain she was in,” Chulani says. “I couldn’t speak to her in English, and I’m coming from a place where I would do anything to put a smile on her face. So I was doing funny faces, speaking gibberish, and pretty soon the entire room started speaking gibberish, too.

“When this little girl opened up and laughed, I saw the tension in her cheeks dissipate and pain release.

She told her parents later, ‘Until now, I never knew what it was like not to be in pain.’”

Chulani developed the LOL Method, which uses laughter to empower children, and has worked with more than 40,000 youngsters around the world who have experienced unspeakable violence.

He also helps adults (“retired kids”, he calls them) manage daily stress, using silly movements and absurdity to disrupt patterns of tension.

Laughter is a healing tool that can treat anything from intense pain to daily irritations. Using his method, Chulani was able to defuse an angry situation in which he and a Hong Kong taxi driver were screaming at each other in their respective languages. In minutes, after a few choice comments, the screaming turned into uproarious laughter.

“We’re all in psychological pain, always trying to blame or force our pain on others,” Chulani says.

COVER STORY 5

e “You can use laughter to shift from pain to relief – to connect to others, to heal and to release that tension.”

Yue claims, however, that thousands of years of Confucian puritanism have worn away the instinct for laughter among the Chinese. “Confucius – he is to blame,” he says. “[ Confucius] despised humour because he was concerned about establishing rule and order in society,” he says.

“Humour tends to jeopardise that kind of formality – it’s subversive.”

Because of the impact laughter has on people’s wellbeing, Yue works through his research to promote humour in the classroom, hospitals and prisons.

“It is a tough battle to promote humour,” he says. This is because many believe that humour is a specialised skill and not necessarily everyone can practise it. “It is true, telling jokes is hard, but is humour an innate talent or gift? No, it is something that must be cultivated, and that takes time.”

Jameson Gong, a US comedian, brings laughter to Hong Kong by fostering the comedy club scene and doing stand-up comedy workshops.

“The comedy club scene is growing all over Asia, because people want to laugh,” he says.

“People come to relieve their stress after a long day at work.

[Comedians] take them out of the reality of a bad economy. They want to be taken on a journey.”

Gong founded the Takeout Comedy Club in New York’s Chinatown after the September 11 terror attacks in 2001. It was a way to use comedy as a response to tragedy. He brought Takeout Comedy to Hong Kong in 2007 to introduce the next generation of local stand-up comedians.

“Chinese people don’t laugh as much as they should, but it’s changing,” Gong says. “With laughter, the potential is enormous.”

That’s why Takeout Comedy has been performing regularly in Tin Shui Wai, where there is a high incidence of teen suicides, and at the Mental Health Association.

Gong has had to adjust his schtick to a more local sense of humour. He says sarcasm doesn’t go over well with the Chinese, who seem to prefer a more slapstick style.

While people feel free to laugh out loud among friends, Gong observes that in larger audience settings, many laugh quietly on the inside. He cites a set that he did when a woman seated in the front row began laughing loudly and was told to hush by her boyfriend.

Silent, mirthful smiles or polite laughter will not trigger that endorphin response, however.

“Polite laughter is not going to do it,” Dunbar says. “There are two major types of laughter: Duchenne and non-Duchenne laughter.

Asians are padded with inhibitions and with propriety … As a girl, bursting out with laughter is not considered proper VISHWA PRAKASH, LAUGHTER YOGIC MENTOR

Duchenne laughter is uncontrolled, physically causes creases at the corner of eyes. You can’t fake it unless you’re a very good actor.”

Vishwa Prakash, a yogic mentor who has taught laughter yoga in Hong Kong and the United States for 10 years, says laughing depends on how free you are within yourself and has a lot to do with culture.

“Asians are padded with inhibitions and with propriety – there is a right way to handle a fork, sit in a certain manner, don’t pick your nose, and so on. As a girl, bursting out with laughter is not considered proper,” he says.

Prakash argues that true laughter is less about comedy than a playful state of mind, which can only be generated internally.

“Laughter within must be brought about organically, sweeping away our analytical inhibitions,” he says.

“Laughter provoked by jokes can’t deliver this connection.”

Casual observers stumbling on a session of laughter yoga might find it unsettling to see grown-ups clapping, waddling around like toddlers and bursting out laughing in unison for no discernible reason.

“The idea is to be playful like a child, to break the barriers,” says Dick Yu, a laughter coach who leads workshops in public parks across the city.

On Sunday mornings, you can find his group in Victoria Park by following the sudden peals of laughter: “A-LO-ha-ha-ha-ha-ha!”

“Normal adults have many boundaries and restrictions. Most Hong Kong people are not so happy.

They are under high stress, and it isn’t easy to change,” says Yu, through an interpreter.

“So, members of the club come together to imitate this act of laughing. It depends on the individual whether it is a real laugh or starts out as imitation at first – and then real laughter occurs unconsciously.”

Prakash recalls one laughter club meeting where an elderly man, the father of an orthopaedist, came in a wheelchair and clapped and laughed throughout the session. The doctor explained that his father was very ill but wanted to try laughter as a way to help himself.

After a few sessions, the elderly man did not return, and Prakash feared the worst. It wasn’t until several weeks later that he returned, but this time with probes, tubes and bottles attached.

“That was a very special occasion,” Prakash says. “He was immobile, obviously in intense pain, but there was still merriment in his eyes. It touched my heart.

I knelt down in front of him, and tears rolled down his face.

In the end, he wanted to die with laughter in his heart.” healthpost@scmp.com

Left, above and below: members of a laughter yoga group led by coach Dick Yu (top) laugh and clap during their regular Sunday session in Victoria Park. Photos: Nora Tam

6 HEALTH HANGOVERS

Moaning after the night before ......................................................

Jennifer Huang healthpost@scmp.com It’s happened to the best of us. An evening of excess and alcohol turns overnight into a wretched morning mess. You slink through the remainder of the day hating life. The queasiness, the raging headache, the multiple trips to the bathroom, the onset of flu-like symptoms, that odd feeling that your insides have been pickled – it is enough to make you swear off drinking forever. Until the next time.

Friends will offer up their secret hangover cures, each nastier than the next: a big greasy breakfast, pickle juice, chocolate milk, a whole cabbage, sauerkraut with tomato juice, or more tequila. Another old fallback, known as “the prairie oyster”, calls for a raw egg with vinegar, Worcestershire sauce, salt, pepper and Tabasco sauce. The strategy is based less on science than witchcraft and works by simply distracting you from your alcoholinduced nausea with an even more stomach-churning concoction.

Remedies are notoriously unreliable because the reason for hangovers is not well understood.

While dehydration is commonly thought to be the culprit, alcohol acts on the body in a number of ways, all of which contribute to the development of the hangover.

“Hangovers don’t get a lot of attention in the medical community because [they are] your own fault,” says Brenna Haysom, founder of New York-based pharmaceutical company Rally Labs. “Most doctors don’t want to encourage drinking and there are more worthy causes to spend their time on.”

Haysom had been studying hangovers for over a year before she developed Blowfish, a morning-after remedy she claims is effective. She didn’t plan to make this her life’s work. Before graduating from business school, Haysom was working in finance in New York and leading a lifestyle not unlike many professionals in Hong Kong – long work hours, socialising late at night, drinking, more drinking, wretched hangover and repeat. Frustrated with the “hocus-pocus hangover products” available on the market, she decided to make her own.

Of course, the best way to deal with a hangover is avoid drinking so much in the first place, which is not quite so helpful while you’re in the throes of misery. The body can only process a certain quantity of alcohol in a given time. But just how much is too much depends on the drinker’s body mass, gender and genetics.

Also, certain types of alcohol (such as whisky, brandy or red wine) contain a higher quantity of compounds called congeners than clear spirits (gin and vodka).

Congeners not only lend flavour to the liquor, they also contribute to the effects of a hangover. Typically, a hangover hits several hours after you stop drinking and your blood alcohol levels drop. So by the time you’re feeling it, it’s often too late for precautions.

Many East Asians may be more susceptible to hangovers because of the way they metabolise alcohol, according to a 2005 study by Masako Yokoyama of the Mitsukoshi Health and Welfare Foundation in Tokyo.

Generally, the body handles alcohol in a two-step process: an enzyme converts ethanol into a toxic compound, acetaldehyde, which is

then further broken down into acetate by a second enzyme.

Roughly 40 per cent of East Asians have what is commonly known as “Asian flush syndrome”, wherein a genetic variation affects the rate at which these alcohol-metabolising enzymes perform, resulting in an acetaldehyde buildup and a whole host of unpleasant physiological reactions, such as nausea, headache, accelerated heart rate, sweating, shortness of breath and flushing of the skin.

Haysom makes no secret of the Blowfish formula, which is simply an

Hangover studies don’t get a lot of attention in the medical community.

Most doctors don’t want to encourage drinking BRENNA HAYSOM, RALLY LABS

effervescent tablet made from common items you could purchase from your local supermarket.

“Sure, I guess you could get the same results by taking two aspirin, a cup of coffee, water, an antacid and [a sports drink],” she says. “But you’d have to go through all those separate steps.”

The first thing to remember is that alcohol will dehydrate you. It inhibits the release of an antidiuretic hormone called vasopressin, which

increases urinary output. It can also cause gastrointestinal distress leading to diarrhoea, vomiting or worse. Some studies have shown that even well-hydrated subjects will develop hangover headaches, suggesting that there is more at play than simply dehydration. But dehydration can certainly exacerbate the severity of hangover symptoms. So sufferers would be well advised to keep a clear path to the bathroom and have something on hand – such as water, oral electrolyte solutions, coconut water or sports drinks – to replenish additional fluid loss.

A 2008 report by Joris Verster, assistant professor at Utrecht University in the Netherlands, says a hangover might be a type of immune system activation which is independent but concurrent with dehydration that follows after drinking alcohol.

“To your body, alcohol is essentially a poison,” Haysom says.

“So it makes sense that it will produce an immune response. This is why you can stay hydrated while drinking vodka all night, but still develop flu-like symptoms.”

Non-steroid anti-inflammatory medications such as aspirin, ibuprofen or naproxen can relieve head pain, but they are tough on the stomach and should be used cautiously. Drinkers should avoid taking acetaminophen after a binge because of extra damage to the liver.

Dr Michael Oshinsky of Thomas Jefferson University in Philadelphia this year led a team of scientists to induce hangover headaches in well-hydrated rats. The experiments showed that acetate, which was once thought to be a relatively harmless metabolite of pure alcohol,

actually contributes to hangover pain. As the revellers in Lan Kwai Fong are most certainly concerned about acetate levels, they would be relieved to know that, in this study, caffeine and Ketorolac (a non-steroid anti-inflammatory drug) blocked ethanol-induced hypersensitivity. In other words, aspirin and a cup of coffee might just be the thing to keep the hangover headache at bay.

Many people avoid coffee for fear of dehydration and stomach irritation. However, caffeine not only alleviates headache pains but also combats fatigue from poor sleep. As blood-alcohol level drops, so do the sedative effects, leaving the body in a highly charged state. After people come home drunk and crash in bed, they will often wake up in the middle of the night and continue until morning in fitful sleep.

The fatigue, dizziness, and irritability might also be related to hypoglycaemia. Alcohol impedes the ability of the body to regulate blood-glucose levels. As low blood sugar may contribute to hangover intensity, many people swear by fruit juice, sports drinks or a highcarb breakfast.

And if all else fails, you could always try the “hair of the dog that bit you”, an idiomatic reference to a folk remedy for rabies, which in hangover parlance simply means to have another drink. The idea may not be far-fetched, as some researchers support the idea that hangovers are in part a mild form of alcohol withdrawal.

“That Saturday morning bloody mary might help,” Haysom says.

“You’ll still be suffering the consequences, but it will let you come down a bit easier.”

FITNESS 7 WALKING HOME

It’s a relief to get the weight off ......................................................

Rob Lilwall healthpost@scmp.com Last week’s section of our long walk from Mongolia to Hong Kong took us over the border from Inner Mongolia and into Shanxi province, where ridge-backed mountains roll across the landscape like huge breakers in an earthy sea.

My expedition partner Leon McCarron and I are relieved to finally end of the first of five legs of our 5,000-kilometre journey. My wife, Christine, joined us last Wednesday in Datong, where we are taking a week off over Christmas.

We were really looking forward to this rest. Our bodies and minds are tired from the strain of almost six weeks on the road. We’ve had to

cope with extreme cold while walking an average of 30 kilometres a day, with all the gear we need to survive and thrive on our backs.

My previous major expeditions were on bicycles, which meant that all the weight was carried on wheels rather than my back, and I had gears to help me up steep hills. It was, therefore, no big deal to take lots of spare bits and pieces (like a 1kg copy of War and Peace I once carried for a whole year on the bike before getting round to reading it).

But on a walking expedition, you feel the weight of your pack with every step you take, pounding your feet and compressing your shoulders, hips and back. This weight greatly increases your chance of injury. So, it is imperative to try to cut gear down to the bare essentials.

Road sweepers rest near the border of Inner Mongolia and Shanxi province

The snow has disappeared from the grasslands, enabling the walkers to make good time. Photos: Rob Lilwall However, because this is a winter expedition, and we’re documenting the trip on decent cameras, it has so far proved very hard to travel trim.

This is what I have in my rucksack: • For camping – a sleeping bag (good to minus 27 degrees Celsius), lightweight tent, petrol stove and two small pots, some food (1½ days’ worth) and a thermos of water.

(Water freezes too fast to drink in normal bottles.)

• For personal things – an e-reader, a diary, a Putonghua vocabulary list and first aid kit; a pile of camera things plus associated cables and backup facilities. I’m wearing all my clothes, apart from a spare pair of gloves and socks.

That’s about it, and it still weighs 20kg. We have, therefore, been brainstorming ways to streamline our packs. Our more radical lines of thought involve getting rid of our tents and stoves, and instead using bivouac bags (a thin, wind- and waterproof fabric shell that slips over a sleeping bag, providing more insulation), and eating biscuits at night so we don’t have to cook.

But with temperatures around minus 20 degrees at night for another month, this option will no doubt result in many miserable hours of cold. However, at least we are now out of the Gobi Desert and encountering villages and towns at least a few times a day rather than once a week, so our chances of sleeping indoors, shielded from the elements, are much higher. And with the huge weight saving, we’ll be able to walk faster and farther every day, and also reduce our injury risk and pain from small injuries, which are starting to increase in frequency.

On a walking expedition, you feel the weight of your pack with every step you take

Mentally, the expedition has been exhausting, too: the multiple daily interactions with people on the road to whom we have to explain ourselves and try to make friends, and the stress of never knowing where we will spend the night.

We had planned to stay at a cheap hotel in Datong, but it was fully booked. Fortunately, we met a man outside the hotel who invited us to stay with his friend who lived nearby, so I write this sitting in a warm bed in his friend’s hallway, with Leon asleep next to me.

This week off will allow our minds and bodies to recover before we hit the road again – along the Great Wall for 200 kilometres west to the banks of the Yellow River.

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 new expedition, Walking Home From Mongolia, which is in support of the children’s charity Viva. www.walkinghomefrommongolia.com

EAT SMART ANTS ON THE GRASS

A gluten-free classic for those who are mung friends ......................................................

Jeanette Wang jeanette.wang@scmp.com The vermicelli used in this dish is made of 100 per cent mung bean starch, not the rice variety. They might look similar uncooked, but after mung bean vermicelli is soaked, it becomes soft, slippery, springy and – unlike rice vermicelli – translucent.

That’s why the Asian staple is also known as glass noodles, cellophane noodles or bean thread. With no discernible taste, it makes an excellent addition to almost any food and readily picks up the flavours of broths and sauces.

It’s particularly suitable for those who are sensitive to wheat or gluten. It’s also low in sodium, a good source of iron and easy to digest. Give this recipe by the Chinese Cuisine Training Institute’s English-Speaking Dining Society a go. And don’t worry, there are no insects involved in the dish – the “ants” are actually minced beef.

Ants on the grass Serves 4 For the marinade ½ tsp fine salt 2 tsp starch 1 tsp canola oil Ground white pepper to taste 120 grams minced beef 5 pieces sliced ginger 3 cloves garlic 1 red chilli 80 grams vermicelli 300 grams spinach 100ml chicken stock 2 tsp canola oil 2 tsp Shaoshing wine Salt and ground white pepper to taste

• Marinate the minced beef.

• Chop the ginger, garlic and chilli.

• Soak the vermicelli in water.

• Drain and set aside.

• Wash spinach, blanch in boiling water then cool in cold water.

• Drain, chop, and set aside.

• Heat the chicken stock. Add spinach and vermicelli • Transfer to a plate and set aside.

• Sauté the beef until done and set aside.

• Heat oil in a wok. Saute the ginger, garlic and chilli.

• Add beef and Shaoshing wine.

• Season and serve on the vermicelli and spinach.

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

8 WELLBEING PERSONAL BEST

TASTE TEST BABY FOOD ......................................................

The riddle of mum’s middle ......................................................

“What does it look like afterwards?” a twenty-something asked me the other day, referring to a mother’s stomach after birth.

The answer: if you’re a Victoria’s Secret Angel and under 30, it looks pretty normal fairly quickly. But if you’re like me – the average Jane, 42, and just had a third child – it resembles a fleshy, droopy pouch, spilling over the waist band. The “mummy middle”, as people call it, is fat, loose and distorted compared with the rest of your body.

Those photos in ads for stomach fat suckers suddenly seem terrifyingly familiar. And while your legs (below the knees) and upper torso might have slimmed down several months after birth, the middle is comparatively exhausted.

Well-meaning friends tell you to give yourself some time. But life is short, and with not a pair of jeans in sight, it was time to reclaim denim, bikinis and an aligned profile that hasn’t been airbrushed with remedial underwear.

The Cambridge Weight Plan – from Britain but now in Hong Kong – appealed to me on many fronts.

First, it’s nutritious. Secondly, it was created by a team from Cambridge University for obese patients to lose weight quickly for safer surgery and a more successful outcome, so it’s not a fly-by-night operation.

It’s a range of shakes, snack bars, soups and porridges that can be taken solely for a limited period instead of food, or as meal replacements combined with a healthy diet. Once you’ve lost the weight, the products can help maintain the scale.

I like the concept because it’s not meant to be used solely in the long term. It’s designed to help you shed excess kilos and set you up with good habits to keep it off. The food is also reasonably priced, from HK$27 for a shake, soup or porridge, or HK$38 for a bar or packet drink.

Low in fat and carbohydrates, each shake sachet (flavours such as chocolate and choc mint are palatable) contains 138 calories plus one-third of all your daily nutritional requirements, including iron, calcium, vitamin C and zinc.

“You could actually live on it if you had to,” says Sarah Armstrong, founder and director of Cambridge Weight Plan Hong Kong.

However, not all experts agree these diets are the way to go. “I don’t recommend using this kind of diet for weight loss in the long term,” says Patricia Chiu, a registered dietitian with the World Cancer Research Fund Hong Kong.

Illustration: Bay Leung

Suzanne Harrison healthpost@scmp.com

I miss real food – the tastes and textures – to the point that walking past restaurants makes my mouth water

“The diet is too restrictive for some people, especially men and those who engage in regular exercise. Compliance is usually low, and people usually crave normal foods. Moreover, the diet is very low in caloric content.

This type of … diet is usually for obese patients who need rapid weight loss before surgery, and under a doctor’s supervision.”

Cambridge offers an initial consultation with every client (you can’t buy their products in a shop) to check your medical history and physical situation, and follow-up

consultations in person or through e-mail, every week if you wish.

“I think the reason why it works is because of [this] support,” says Jean Hudson, who last year lost 27kg in four months through the Cambridge diet, and has kept the weight off.

After my consultation, it was agreed that losing up to 6kg was the goal, at the rate of one to 2kg per week to get back to my usual, pre-baby weight.

I also began doing more exercise – Pilates once a week, yoga as often as possible and an hour of brisk walking daily, building up to a 45minute jog five days a week and walks on other days.

“The first week, you can be a bit tired, so take it easy with exercise,” suggests consultant Katia Geiger.

(Consultants, who are often former clients, are trained by Cambridge.)

The plan I chose was: breakfast of a boiled egg and fat-free yogurt; a Cambridge snack bar mid-morning (the toffee one is best); a shake for lunch; a handful of almonds and a couple of cherry tomatoes midafternoon; and a shake and small salad for dinner. Grains are not great for bulging bellies, so even wholegrain bread has to be avoided.

However, I varied the plan a little: a shake for breakfast; a shake and salad for lunch; dinner of a fist-sized piece of protein with vegetables.

Snacks were a handful of almonds and/or a piece of fruit, such as melon. I also had a skimmed milk tea or latte somewhere in there, and occasionally a mug of warm skimmed milk at bedtime.

Two and a half weeks into the plan, I have gone from 63.5kg to 61.5kg, and back up to roughly 62kg.

For the most part, I haven’t been hungry, but miss real food – the tastes and textures – to the point that walking past street-side restaurants makes my mouth water.

One weekend was difficult. I broke, scoffing a delicious hamburger while watching a surf competition in Tai Long Wan, rationalising that hiking all that way made up for it. Plus, packing my shake maker in a small backpack did seem silly. I cut myself some slack.

Then, a week later, I crumbled altogether, with wine, fatty lamb and spuds while on a Friday night out with friends. I also had to feed a hangover. So I took two steps back and soldiered on.

One more week and I expect another 1.5kg to drop. In three weeks, I should be down to about 58kg or 59kg. So far, the muffin top has receded, no doubt thanks to exercise, as well.

The festive season is a challenge, but that’s the good thing about it: unless you’re on doctor’s orders, you can give the plan a rest for special occasions and go back to it.

Jeanette Wang jeanette.wang@scmp.com Ella’s Kitchen Organic Baby Food 120g for HK$18.50, ThreeSixty Organic pears, peas and broccoli are puréed to a smooth paste that goes down easy and tastes great. Mix with chopped protein, fruit or veg for a meal, or eat alone as a snack.

Verdict: A great way to get your child – from four months onwards – to eat greens.

Rafferty’s Garden Organic Super Hero 120g for HK$20.90, ThreeSixty Made with puréed organic apple, carrots and sweet corn, this product is very similar to the one above. It’s also for infants from four months old.

Verdict: Has a pleasant, natural sweetness that kids will approve of.

KaliBio Cool Fruits 90g for HK$16.90, ThreeSixty Chill this tiny sachet in the fridge for a refreshing dessert or snack. Apple, peach and apricot purée is mixed with fruit juice concentrate for natural energy on the go.

Verdict: Not only for children, but also adults struggling to meet their five-a-day requirement.