20120110 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, JANUARY 10, 2012

HEALTH POST

MAKING SENSE OF LEGIONELLA >PAGE 6

HOW EATING RIGHT CAN GO HORRIBLY WRONG

Photo: Stanley Shin

>PAGE 11

Portion distortion Why there’s no future in living large

>PAGE4

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

Jeanette Wang jeanette.wang@scmp.com The truth sucks They’re meant to help keep your home clean, but some vacuum cleaners actually contribute to indoor air pollution, say researchers from Queensland University of Technology in Brisbane, Australia. They tested 21 vacuum cleaners sold in Australia and made by 11 manufacturers. The machines were aged six months to 22 years old, and cost from less than A$75 (HK$600) to A$800. All were found to release some fine dust particles and bacteria into the air that could spread infections and trigger allergies, though newer and more expensive cleaners were generally less polluting, the researchers say. Surprisingly, vacuum cleaners with so-called High-Efficiency Particulate Air filters in some cases released only slightly lower levels of dust and bacteria. The study appears in the journal Environmental Science & Technology.

Natural born killer A natural compound in the body has shown potential in the fight against cancer. A research team led by Concordia University in Montreal has found that lithocholic acid (LCA), produced in the liver during digestion, is very selective in killing several types of cancer cells, such as those found in some brain tumours and breast cancer, while leaving normal cells unscathed. LCA could also prevent the entire tumour from growing, and prevent tumours from releasing substances that cause neighbouring cancer cells to grow and proliferate, says senior author Professor Vladimir Titorenko. The research team will next test LCA’s effect on different cancers in mice, which they hope will lead to human clinical trials. The study was published in the journal Oncotarget.

Pupils perform a fitness dance at a Yuen Long preschool as part of the Health Department’s kids’ health campaign

COMMUNITY WELLNESS

Get up and grow: campaign to feed youngsters the healthy habit .....................................................

Jeanette Wang jeanette.wang@scmp.com

Fit body, fit mind Aerobic exercise can reverse cognitive deficits in patients with psychosis, new research by University of Hong Kong’s Li Ka-shing faculty of medicine has found. The 12-week study involved 35 patients, who either followed an exercise programme (three 40-50 minute aerobic sessions weekly) in addition to their current treatment, or continued with their current treatment. Their learning ability and long-term memory were assessed before and after the 12 weeks. Preliminary results show that patients who exercised had a 26 per cent increase in mean learning test score and 27 per cent increase in memory test score, compared with only 6 per cent and 8 per cent in the other group.

Based on this finding, the medical faculty has worked with the Hong Kong Early Psychosis Intervention Society to design exercises and will launch a FitMind campaign for patients and their support networks.

> 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

In an attempt to combat the growing obesity epidemic plaguing Hong Kong children, the Health Department will launch a city-wide campaign tomorrow.

StartSmart@school.hk, in collaboration with the Education Bureau and the Leisure and Cultural Services Department, aims to promote the health of children aged two to six by reaching out to them through their schools.

The Health Department will provide pre-primary institutions with resources and training to create conducive environments for healthy eating and physical activity, and help children cultivate a sustainable healthy lifestyle.

Schools will be encouraged to formulate policies and practices, and create potent learning activities, based on department guidelines and recommendations.

Preschool children are being targeted as it is believed that is when the problem begins. Although the average birth weight in Hong Kong has remained relatively stable at about 3.2kg, the obesity rate of Primary One students has increased from 11.3 per cent in 1996-97 to 15.3

15.3 Percentage of Primary One students considered obese in 2010-11, according to Health Department figures

Childhood obesity leads to a higher chance of premature death and disability in adulthood HEALTH DEPARTMENT SPOKESMAN

per cent in 2010-11, according to the Health Department.

“Other than family, schools and communities play a crucial role in shaping dietary patterns of children,” a department spokesman says. “With about 90 per cent of children aged three to five receiving schooling in Hong Kong, using a pre-primary institution setting-based approach to promote healthy eating and physical activity may be a way to combat the growing epidemic of childhood obesity.”

The campaign launch will follow a successful pilot project in 30 schools last year based on studies that pinpointed areas in preschool care requiring attention.

The areas included the universal formulation and implementation of healthy eating and active living policies and practices; improving the quality of food served to young children; strengthening parental engagement in support of children’s diet and physical activity practices; and building staff capacity in related matters.

The pilot was rolled out in three stages. The first involved training and providing support to school personnel, food preparation staff, parents and caregivers, to give them the ability and confidence to create a healthy environment and

culture. Workshops were organised and educational materials were issued.

In the second stage, schools designed and implemented practical, lively learning activities according to preset health topics, such as eating a balanced diet with more fruit and vegetables, and drinking more water. Physical activity was also incorporated.

The educational resources helped foster co-operation between home and school.

In the third stage, these schools shared their experiences, which were consolidated into a booklet and DVD of good practices that will be disseminated to other schools.

“Childhood obesity is associated with a higher chance of premature death and disability in adulthood,” says the Health Department spokesman.

Overweight children are likelier to remain that way into adulthood, which increases their chances of developing cardiovascular diseases (mainly heart disease and stroke), diabetes, musculoskeletal disorders (especially arthritis), and certain types of cancer (endometrial, breast and colon).

The World Health Organisation estimates that the number of overweight children under five years of age worldwide was over higher than 43 million in 2010.

“A good and healthy start in life creates a strong platform for the health of later life,” the Health Department spokesman says. “It is far easier to establish desirable patterns of activity and eating than to change unhealthy habits that have become ingrained.”

For more information about the StartSmart@school.hk campaign, go to www.startsmart.gov.hk

NEWS 3 APP OF THE WEEK

Give it up for the latest in quitting technology ......................................................

Katie McGregor healthpost@scmp.com QuitGuide Free Rating 7/10 Stopping smoking is hard, and if you’ve succeeded this far with your New Year’s resolution you’re doing really well. However, if you are wavering or have already fallen by the wayside, perhaps you could do better with some help from an iPhone app.

Even without the several smoking cessation apps that are available, I believe the single greatest benefit an iPhone brings to someone trying to stop smoking is that it provides an easy distraction when you are faced with a craving. Try Angry Birds, Words With Friends, or even Crack the Code, a free app based on the game Mastermind.

However, you will find more structured support with the free QuitGuide app created by the Tobacco Control Research Branch of the National Cancer Institute, a US government agency.

The app is a directory of information that, as expected, discusses the downsides to smoking such as the expense, the impact it has on your own and your children’s health, and the argument that it gives

Since I gave up smoking about 20 years ago … I have saved enough money to buy a small house

QUIZ The numbers don’t lie: we need to pull up our socks when it comes to health. The University of Hong Kong’s School of Public Health revealed last month that Hong Kong as a whole scored a passing grade (six) on the 10-point Healthy Living Index it has devised.

Of 18,906 people surveyed from March 2009 to March 2011 as part of the school’s Family Project, the average score was 6.11, and nearly 24 per cent scored eight (very healthy).

The index includes all four common risk factors addressed at the United Nations summit on noncommunicable diseases last year – tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity – to assess a person’s risk of adverse health outcomes.

“This new index is meant to help people assess themselves and show them what areas they need to work on. It’s motivating and empowering,” says Professor Lam Tai-hing, principal investigator for the Family Project.

However, the survey also found areas where improvement is

needed. For example, 90 per cent of Hongkongers don’t eat enough fruit and vegetables and 30 per cent are considered obese.

Just how much do you know about health? Test yourself here.

1. The percentage of smokers (anyone who has smoked in the past year) in the city is: a. 10.1 b. 14.7 c. 19.3 2. How many people do the recommended amount of physical activity (2.5 hours a week of moderate-intensity activities)? a. 3 in 10 b. 5 in 10 c. 8 in 10 3. Which of these is considered a healthy body mass index? a. 18.4 b. 21.9 c. 23.0 4. Problem drinking is consuming at least how many cans of beer a week? a. 12 cans (male), 8.5 cans (female) b. 15 cans (male), 11 cans (female) c. 18 cans (male), 13 cans (female) 5. A serving of fruit equals: a. 2 small-sized fruits (such as plums) b. 1 medium-sized fruit (such as an orange or apple) c. 3⁄4 cup fresh fruit juice without added sugar How hale and hearty are you? You can find out with the Healthy Living Index interactive calculator at healthyindex.family.org.hk/en/ Answers: 1. b; 2. a; 3. b (a healthy BMI is between 18.5 and 22.9); 4. a; 5. all are correct

you wrinkles and yellow fingers, and makes you smell – information that won’t surprise a smoker.

The app becomes more useful when it helps prepare the soon-to-be former smoker for what to expect when quitting, explaining why you may feel the way you feel and why quitting is so hard. When you understand the enemy, you are better prepared to sidestep and overcome temptation.

Advice is provided on preparing to quit, with tips such as telling others your plan to quit, or anticipating and planning for the challenges ahead.

You can also read up on medicines that can help with withdrawal. “Using these medicines can double your chances of quitting for good,” the authors say.

“Keep rewarding yourself for not smoking,” the app also instructs, and provides you with a link to their web-based savings calculator.

The numbers are stunning, and since I gave up smoking about 20 years ago – after several attempts and no iPhone – it seems that I have saved enough money to buy a small house.

However, I appear to have spent it on something else.

With free support like this, together with the logistical problems faced by the modern smoker, giving up can never have been so easy.

ASK THE DOCTORS DR ANTHONY LUKE Q: I’ve heard of athletes drinking chocolate milk for recovery. Is this for real?

A: Chocolate milk has been shown to be effective as a recovery beverage following a period of increased training.

During long bouts of exercise, an athlete’s energy stores (known as glycogen) can get depleted.

Chocolate milk is rich in protein and carbohydrates.

Drinking a beverage such as chocolate milk, which has more carbohydrates and proteins than water or some sports drinks, may improve recovery because it replenishes fluids but also increases muscle glycogen storage.

In a study of cyclists riding twice with a recovery period of two hours between rides, athletes who drank chocolate milk performed better than those who did not.

A study of soccer players showed lower levels of muscle damage markers (known as creatine kinase) in athletes who drank chocolate milk as opposed to a recovery beverage with similar calories.

Milk also has calcium, potassium and magnesium, which benefit athletes.

Dr Anthony Luke is an associate professor of clinical orthopaedic surgery at the University of California, San Francisco. Reprinted with permission of the American College of Sports Medicine from its ACSM Fit Society Page spring 2011e-newsletter

4 COVER STORY

Serves us righ Portion sizes have been creeping up for decades and could be one reason for the global obesity epidemic, as Jeanette Wang explains

31 • Percentage of Hongkongers considered obese under WHO guidelines

O

ver lunch the other day, my friend, tucking happily into a bag of crisps, was shocked when I told him that a typical serving of the snack was only about two handfuls of crisps, or 28 grams, or about 15 chips.

“That’s all? Fifteen?” he asked. The crunching came to a complete stop.

It’s true, that is all. Yet in one sitting, most of us can polish off 50 crisps with ease (or about 530 calories and 33 grams of fat). The problem, says Candy Wong Sze-man, a registered dietitian, is that many people confuse “serving size” with “portion size”.

A serving is a standard amount, usually listed on a product’s food label, that’s used to help give advice about how much to eat, or to identify how many calories and nutrients are in a food.

“A portion size means the amount of food an individual chooses to eat at one time,” says Wong, who works with the Pro-Cardio Heart Disease and Stroke Prevention Centre.

“I believe we all have noticed that restaurants in Hong Kong and all over the world are serving bigger and bigger portions. So is the food industry – the size of packaged food products is growing.”

According to dietitian Mary Lou Plante, nutrition resource manager at Food Bank of Central New York, 20 years ago, for example, the average bagel was 7.6 centimetres in diameter and had 140 calories; these days, bagels are about 15.2 centimetres wide and pack 350 calories each.

Muffins were 43 grams and 210 calories each; now they’re 113 grams and 500 calories each.

Wong cites a study published in the International Journal of Obesity

in 2010, which showed that plate and food serving sizes have grown even in depictions of the Last Supper.

Researchers analysed 52 of the most famous paintings of the Biblical scene produced over the past 1,000 years and found that the main courses, bread and plates have grown by about 69 per cent in the past millennium.

Wong says there is not much local data on portion size growth in Hong Kong, but acknowledges that “food serving sizes have grown, and so have our waistlines.”

Controlling portion size is an effective, simple, reliable and sustainable tool [for] weight loss AMANDA CLARK, DIETITIAN

Faced with bigger portions, people are more likely to eat more. In a 2002 study by Penn State published in the American Journal of Clinical Nutrition, participants ate on average 30 per cent more from a large portion of macaroni cheese than from a serving half its size – without reporting feeling any fuller after.

This applies even to bad food.

Movie-goers served stale popcorn in big buckets ate 34 per cent more than those who had it in medium-sized containers, according to a 2005 Cornell University study.

People’s perceptions of normal portion sizes have correspondingly

also changed in recent decades. In 2006, experts at Rutgers university in New Jersey replicated a study done 20 years ago, in which participants were asked to serve themselves the amount considered to be a typical portion of each meal item on a buffet table. On average, only about 30 per cent of portions for lunch and dinner were within 25 per cent of the reference portion size.

Although obesity is caused by many factors, its incidence has risen along with portion sizes.

“With portions being distorted to this degree, it’s no surprise that people’s waistlines are expanding,” says co-author of the Rutgers study, registered dietitian Carol Byrd-Bredbenner.

According to the latest statistics from University of Hong Kong’s Family Project household survey, about 31per cent of Hongkongers are considered obese (body mass index of 25 and above) by World Health Organisation guidelines for Asians.

Treating obesity requires a complex mix of changing habits and thoughts, but “controlling portion size is an effective, simple, reliable and sustainable tool that can be used to bring about weight loss,” writes Australia-based dietitian Amanda Clark in her report “Overweight and Obesity: Use of Portion Control in Management” in the June 2010 issue of Australian Family Physician.

Which brings us back to my chipchomping friend: like him, most people don’t know exactly how much of something they should be eating.

Even food labels don’t help; people are easily fooled, a study published a year ago in the Journal of Consumer Research found. When people consumed a large item

labelled “small”, they felt less guilty and ate more of it – something the study authors call “guiltless gluttony”.

Conversely, our minds can be tricked into satisfying our stomachs.

Subjects in a Bristol University study in 2010 were more satisfied for longer periods of time after eating varying quantifies of food for which they were led to believe that portion sizes were larger than they actually were.

So, the first step in controlling portions is having a visual idea of what a typical serving size is – just look around this page for examples.

Here, Wong suggests other ways to help keep a lid on how much we eat: • Eat off smaller plates As we tend to finish everything on our plates, using smaller plates can help you eat less. The same applies to bowls, cups and other utensils.

• Break leftovers down Separate leftovers into small individual containers, so that when you reheat your meal the next day, the portion size is right for you without additional effort.

• Opt for smaller packages While grocery shopping, buy food in smaller packages, or divide food from big packages into suitable portion sizes in individual storage bags when you get home.

• Listen to your body According to a study published in 2010 in the Journal of Clinical Endocrinology & Metabolism, eating too quickly blocks the release of gut hormones that help make you full, causing overeating. It takes about 20 minutes for your stomach to tell your brain that it is full. Recognise the signal of satiety: stop eating when you feel are 80 per cent full.

• Reshape your meal Fill half your plate with vegetables – this helps you feel full sooner and eat less. Treat meat as a side dish rather than the focus of your meal.

• Have regular meals By having three regular main mails plus small healthy snacks (such as a piece of fruit, a tub of skimmed yogurt or a piece of wholegrain toast), you won’t go too hungry and lose control of how much you eat.

• Give yourself a treat Never be too restrictive with what you eat. Treat yourself once in a while to the food you love; this prevents you from feeling deprived and bingeing. jeanette.wang@scmp.com

COVER STORY 5

ht WHAT COUNTS AS A SERVING? Grains and cereals Servings: six to 11 daily.

A serving is: one slice of bread; about 28 grams of cereal; or 80 grams of cooked rice or noodles.

Vegetables Servings: three to five daily.

A serving is: 125 grams of vegetables; 250 grams of raw leafy vegetables.

Fruit Servings: two to four daily.

A serving is: one medium apple, orange or pear; 125 millilitres of fruit juice, or chopped or canned fruit.

Meat, poultry, fish, dry beans and eggs Servings: two to three daily.

A serving is: 57 to 85 grams of meat; 57 grams cooked beans; 32 grams of peanut butter.

The recommended serving size for portions of carbohydrates in the form of noodles (top), protein in the form of chicken (above), and fat (right) in the form of butter.

Photos: Stanley Shin

Dairy products Servings: two to three daily.

A serving is: 237 millilitres of milk or yogurt; 43 grams of natural cheese.

Fat, oil, salt and sweets Eat sparingly.

Note: serving sizes as stated by the US Department of Agriculture, Food and Nutrition Service.

6 HEALTH CASE HISTORY

Plucky s ......................................................

Eileen Aung-Thwin healthpost@scmp.com

Illustration: Angela Ho

Three years ago, Wong Mei-fung beat stage-two breast cancer with chemotherapy and surgery.

Wong (whose real name has been changed for reasons of patient confidentiality), then 72, had never married, but had built a network of close friends and relatives who supported her throughout her ordeal. Through it all, she was positive and upbeat.

She made an inspiring recovery, and the breast cancer went into remission. However, she had no idea that her health crisis was far from over, and the strength of her will and faith were about to be tested again.

During a regular check-up, her blood test showed elevated tumour markers, indicating that there was a high possibility of cancer somewhere in her body. A computed tomography (CT) scan showed multiple liver and spleen metastases, or lesions, indicating that the cancer had spread.

The doctor said her breast cancer had returned and spread to her internal organs. Little could be done for her, especially at her age, he said, and she had little time left.

Instead of accepting the dire prognosis, Wong promptly sought

LEGIONNAIRES’ DISEASE

Breathe easy – chances are you’ll neve ......................................................

Jeanette Wang jeanette.wang@scmp.com Education secretary Michael Suen Ming-yeung was among 17 reported cases of legionnaires’ disease last year, the seventh straight year in which case figures have hit double digits.

Legionnaires’ disease, a form of pneumonia, was made a notifiable disease in Hong Kong in March 1994, but previously the number of annual cases could be counted on one hand, according to statistics from the Health Department.

Suen is believed to have contracted the illness from his private washroom at the new Tamar government headquarters, which has been found to be contaminated with bacterium that causes the disease.

Should we be worried?

“We need to be aware of the disease, but there is no reason to be overly worried about it,” says Dr Samson Wong Sai-yin, an assistant professor at the University of Hong Kong’s microbiology faculty.

“The disease is not common,” says Professor Sian Griffiths, chairwoman of Hong Kong’s Prevention of Legionnaires’ Disease Committee and director of

Chinese University’s school of public health and primary care.

“Often, patients have other pathologies and usually recover.”

Further, the disease is not transmitted by person-to-person contact, eating or drinking, according to a Health Department spokesman.

Wong says the apparent increase in the number of confirmed cases reflects “a much easier and more sensitive diagnosis” that was introduced to government laboratories in 2005.

In the past, the disease could be confirmed by only either culturing the responsible bacterium, Legionella pneumophila, from the respiratory specimens (such as phlegm) of patients, or showing an increased level of antibodies against the bacteria in the blood of patients.

Both tests were rather insensitive and tedious.

The latest test, says Wong, looks for the presence of legionella antigen (certain molecules from the bacterial cells) in urine, which has been shown to be very sensitive in picking up the infection.

“Therefore, with this sensitive test, and more doctors being aware of the disease – and hence request the test more often – we are picking up more cases,” he says.

The Health Department spokesman noted that a rising trend of legionnaires’ disease has been reported by a number of countries, such as the US (from 0.39 to 1.15 per 100,000 from 2000 to 2009) and Britain (from 0.31 in 2000 to 0.61 in 2009).

“The annual notification rate in Hong Kong [0.53 in 2010] is lower than countries, like the US and Britain, and all reported cases were sporadic cases without evidence of outbreak,” the spokesman says.

An outbreak in July 1976 among delegates attending an American Legion Convention in Philadelphia first brought attention to the disease.

More than 200 cases were reported

and 34 people died. Medical investigations identified the previously unknown bacterium, which was subsequently named Legionella pneumophila.

Wong says the bacterium is ubiquitous in the environment in fresh water, and can often be found in places such as cooling towers, potable water systems, decorative fountains and whirlpools.

Infection usually occurs when the bacterium enters a person’s airways, such as inhalation of contaminated tiny water droplets while taking a shower or walking past a fountain.

The Health Department spokesman adds that infection may

Double-digit streak Reported cases of legionnaires’ disease in Hong Kong 40 30 20 10 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11* Source: Department of Health

*Provisional figure

SCMP

also occur when handling garden soil, compost and potting mixes.

The bacterium grows well in water at temperatures between 25 and 40 degrees Celsius.

“Most of us will be exposed to the bacterium once in a while, but very few of us will come down with the disease,” he says. “It’s only the highrisk people who are likely to develop the disease after exposure.”

This group includes organ transplant recipients, smokers, the elderly, those with chronic lung diseases, people with suppressed immune systems (such as cancer patients), diabetics, alcoholics and renal failure patients.

Disease can manifest in two ways, Wong says. One is Pontiac fever, a flu-like illness that is selflimiting (in other words, nothing worse than diarrhoea or a cold).

Unless it is part of an outbreak investigation, Wong says, most patients will not be diagnosed because the disease is rather mild and most clinicians will not specifically test for Legionella.

“The more classic disease is legionnaires’ disease,” he says.

However, because its symptoms and manifestations are similar to other causes of pneumonia, Wong says the disease is not always distinguishable without further

Be sure t are clean

HEALTH 7

enior more than a match for disease a second opinion. She consulted Dr Thomas Leung Wai-tong, associate director of the Comprehensive Oncology Centre in Hong Kong Sanatorium and Hospital’s department of medicine.

Leung noted that Wong’s breast cancer was not very advanced and, if properly treated, should not have recurred so quickly. He considered the remote possibility that another form of cancer had taken root, so he ordered a Positron Emission Tomography (PET) scan, a sophisticated method of seeking out cancer involvement. In addition to the liver and spleen, Leung also found cancer activity in Wong’s colon.

A colonoscopy found a 6cm tumour in her bowels, meaning Wong had colon cancer. Biopsies on the tumour and liver lesions confirmed she had stage-four cancer, which had spread to her liver and spleen. Her breast cancer, however, remained in remission.

Leung then investigated Wong’s dietary, lifestyle and genetic background in a bid to uncover the reason for her developing two different cancers.

But his efforts were futile. Wong led a healthy lifestyle and had no history of cancer in her family. In

He said that with the right treatment, Wong still had some good years ahead, and could even go into remission if lucky

er catch it

that all water faucets, filters and shower heads ned on a regular basis. Photo: David Wong

laboratory testing. It is generally believed that the disease causes a more severe form of pneumonia, resulting in death for 13 to 33 per cent of patients.

As there is no vaccine for the disease, prevention is key. Wong recommends the following: • At home, make sure that water taps and shower heads are clean and not clogged by scales. Change them if they’re blocked. Ensure your building’s water tanks and pipes are cleaned regularly.

• High-risk individuals should take caution when using humidifiers at home. Clean and disinfect such equipment regularly. There have been cases of infection from humidifiers colonised by bacteria.

• Owners of cooling towers and freshwater facilities should maintain them regularly.

• Frontline health-care workers should be aware of the possibility of infection when working with a patient with pneumonia, and investigations should be performed when in doubt. This is especially important for high-risk patients so that the correct medication can be given in time.

fact, despite her diagnosis, she appeared the picture of good health, as her blood and organ function tests were all good, and she was relatively asymptomatic and very active.

Unlike Wong’s first doctor, Leung was much more optimistic about her prognosis. He said that with the right treatment Wong still had some good years ahead, and could even go into remission if lucky.

Wong seized her chance.

Alongside chemotherapy, she was started on a targeted therapy drug (Cetuximab), which killed cancer cells without affecting the healthy cells too much. Despite her age, Wong tolerated the treatment well. She suffered few side effects, and remained active throughout the therapy. She even cheered and encouraged her fellow patients during her time at the hospital.

After six months of treatment, the metastasis in Wong’s liver had shrunk considerably and the ones in her spleen disappeared. The tumour in her colon shrank to 3cm. Despite the success of the drugs, Leung knew she needed

more aggressive therapy to remove the cancer – surgery.

The risk associated with surgery for someone of Wong’s age is higher, but she was determined to be rid of the disease. Medical advancements allowed Leung to use minimally invasive surgical methods to reduce discomfort and shorten healing times.

First, surgeons used keyhole surgery to remove the shrunken tumour from Wong’s colon. Only a 7.5cm incision was made in her abdomen alongside two 5mm holes for the fibre optic and surgical equipment.

During the operation, another minimally invasive procedure, radiofrequency ablation, was used. A tiny nick was made on Wong’s abdomen above the liver, and needle electrodes were inserted into the cancer lesions. A radiofrequency generator passed electric currents in the form of radiofrequency waves into the electrodes, which heated and destroyed the cancer cells in the liver.

The procedures were a success and quick to heal. One week later,

Wong was in full remission and discharged from the hospital.

Three months later, however, Leung found a new metastasis on Wong’s liver. This time, Leung decided to use another form of targeted treatment, called intraarterial yttrium-90 microspheres.

Millions of tiny radioactive microspheres were delivered to the cancerous lesions via a catheter inserted into the liver.

The treatment flooded the cancer cells with radiation without harming the rest of the body.

After this final treatment, Wong remained in remission.

Now 75, she is basking in her golden years.

Leung says Wong’s example shows that even late stage cancer need not be a death sentence.

With the right treatment and patient motivation, one can reclaim a normal life for years to come. “Cancer is now treated by a multidisciplinary team of specialists who can offer very effective treatment even for advanced cancer,” he says.

“Hence, I encourage people who are diagnosed with cancer to stay positive and hopeful.”

8 FITNESS

Clockwise from left: Rob Lilwall on a lesser known section of the wall; rush hour in an Inner Mongolian town; Chinese gate marks a provincial boundary

WALKING HOME

Legends of the wall ......................................................

Rob Lilwall healthpost@scmp.com You would think that finding the Great Wall of China would be easy. I had seen it on the pages of our Chinese road atlas for some time, marked clearly by a jagged symbol.

However, on my iPhone’s Google Maps, even when I zoomed in, the wall was indistinguishable from a dusty road. I suppose this dispels the myth that you can see the Great Wall from space.

It is also a myth that there is one wall. Rather there is a network of walls, built and rebuilt by various dynasties (especially the Ming) throughout the centuries. My expedition partner Leon McCarron and I plan to follow it for 200 kilometres west to the banks of the Yellow River, as part of our 5,000 kilometre walk home from Mongolia that began in November.

We knew that it was on the border between the provinces of Inner Mongolia and Shaanxi. This was apt, as the walls had been built primarily to keep out the steppe

peoples who regularly raided the Middle Kingdom throughout the past three millennia.

As we walked closer to this provincial boundary, we started to ask the locals we bumped into if they knew where the wall was. It was a lost cause (even at about 20 kilometres away from the wall), everyone told us that as there wasn’t one in the area we would have to go to Beijing, more than 300 kilometres away, where the famous, rebuilt stone sections of the wall are.

A couple of days later, having stayed overnight in the town of Fengzhen, which was just five kilometres from the provincial boundary, we set off at dawn. As we were leaving our budget hotel a young man stopped to watch us. I said hello and asked him about the wall. “Beijing,” he said.

We pressed on and came to a 50metre-long road tunnel underneath the railway, where we met an old man with a toothy smile. I asked if Chang Cheng (Putonghua for Great Wall, literally translated to “long town”) was near. When I showed him the Great Wall symbol drawn on

It is a myth that there is one wall.

Rather there is a network of walls, built and rebuilt by various dynasties

my hand, his face lit up with recognition. In his northern accent, he said to me what sounded like, “Ah, Chur Chur”, but then pointed in the opposite direction to where the map indicated.

As we were walking through the tunnel, a car screeched to a halt beside us, blocking the traffic. A smartly dressed man in his 20s asked us in English, “Can I help you?” We asked about the wall and he pointed in the direction we were going. We felt relieved.

From then on, every few minutes we would ask someone else about the wall and many pointed us in the same direction. We were getting close. After crossing a railway line and passing a power station on the outskirts of town, we turned a corner and there before us stood the wall. A hole had been cut in it for the road, and a simple Chinese gate frame indicated the provincial boundary.

On either side of the frame was a three-metre-high mound of earth, covered partly in grass. We climbed onto it, and saw the wall spreading in both directions.

To the north, in Inner Mongolia,

was a field of coal processing – piles of coal and a scattering of men and women manning the little grubby conveyer belt machines and picking through the piles by hand. All the black earth and machinery reminded me of the fortress Isengard in Tolkien’s The Lord of the Rings. On the south side, in Shaanxi, were some rolling fields rising into the mountains in the distance, and a dead straight road for us to walk along to get there.

Ironically, after all that effort to find the wall, we took a 50 kilometre detour to Datong, a city in northern Shaanxi, for a Christmas break.

Now, rested and recharged, we’re on the road again. I hope the wall isn’t as elusive this time around.

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

DIET 9

Baking is faking but when it comes to the crunch it’s better for you ......................................................

Jeanette Wang jeanette.wang@scmp.com It’s often the case that the baked version of dishes that are meant to be fried isn’t quite the same.

Baked chips just don’t have the same satisfying crunch as those deep-fried; even baked fish lacks that crispy layer that forms only in a sizzling frying pan.

Still, baking is a far healthier alternative to frying, for those who can’t live without a bit of crisp or crunch.

In this recipe by New Star Seafood Restaurant, the fat content of the rice paste net is reduced by 80 per cent by baking it, rather than

THE TASTE TEST WHEAT CRACKERS ......................................................

Jeanette Wang jeanette.wang@scmp.com

Nabisco Wheat Thins 269 grams for HK$36, City’super These sun-dried tomato and basil flavoured baked crackers (“natural flavour with other natural flavour”, the packaging states) taste just like crunchy mini-pizzas. Unfortunately, that’s due to the MSG. Verdict: has 10 grams of whole grains per serving, but that’s hardly a redeeming quality.

Waterthins Flatbread Crackers 110 grams for HK$39, City’super Thin, light and very crisp, these multigrain and honey crackers are bursting with wonderful natural flavours and a hint of sweetness.

Have them on their own or paired with cheese or dip.

Verdict: satisfying and addictive, but be warned that just 10 grams contains 41 calories.

Carr’s Whole Wheat Crackers 200 grams for HK$30, City’super You might mistake these for cookies.

Thick, crumbly, slightly sweet and baked from 100 per cent whole grain, they’re like digestives, only – dare I say – better.

Verdict: a tasty and lighter alternative to chocolate chip cookies or shortbread.

cooking it in oil, according to the Department of Health. (Of course, you could do without the net altogether; it’s hard to find, anyway.)

This dish has approximately 51 calories, one gram of fat, seven grams of carbohydrates, four grams of protein and 796mg of sodium per serving.

1 piece rice paste net ½ tomato 3 pieces Chinese kale 2 stalks celery ½ bowl corn kernels ½ tsp soya bean oil 5 slices ginger 5 strips spring onion ½ tsp salt 1 ⁄3 tsp sugar Some corn starch and water

Assorted vegetables with tiny octopus balls in rice net Serves four For the octopus paste 80 grams octopus (or shrimp) ¾ tsp salt ¼ tsp sugar 1 tsp starch 2 tbsp chilled water

This octopus balls in rice net has 51 calories and just one gram of fat

• Bake the rice paste net until crispy and set aside.

• Mince the octopus, add salt and stir in a single direction.

• Add sugar, starch and chilled water.

• Mix well.

• Drop half teaspoonfuls of the paste into boiling water and cook until done.

• Set aside.

• Peel the tomato. Discard the leaves of the kale.

• Dice celery, tomato and kale stalks.

• Blanch all vegetables (including corn) and set aside.

• Heat oil in a wok.

• Stir-fry ginger and spring onion.

• Add the octopus balls, vegetables, salt and sugar.

• Combine well and thicken with corn starch mixture.

• Transfer mixture to the baked net and serve.

This column features recipes provided by the Health Department as part of its EatSmart@restaurant.hk campaign.

For more information, visit restaurant.eatsmart.gov.hk

10 DIET

For many proponents, adopting a vegan diet is as much an ethical and ecologically friendly choice as a health one.

Photos: EPA, Corbis

NUTRITION

Living on the veg ......................................................

Dennis Thompson Vegan diets are considered by some to be extreme – a strict way of eating that exists on the radical fringes of vegetarianism.

But today, a growing number of people are giving vegan diets a second look, and some nutritionists believe that a well thought out vegan eating plan could be the most healthy way to live for most people.

“Properly planned vegan diets are healthy, nutritionally adequate and may provide health benefits in the prevention and treatment of diseases,” says Vandana Sheth, a registered dietitian and nutrition educator in the Los Angeles area and a spokeswoman for the American Dietetic Association.

Vegan diets are plant-based and exclude all animal products, even milk, cheese and eggs.

Veganism drew added attention last year from a pair of US notables.

Former president Bill Clinton – long famous for McDonald’s runs and barbecue lunches – announced in August he had converted to a vegan diet. And domestic doyenne Martha Stewart dedicated an hour-long episode of her TV show in March to the vegan lifestyle.

Research has found that people who follow a vegetarian or vegan lifestyle enjoy a number of health benefits, Sheth says. These include: • lower cholesterol levels; • lower blood pressure; • a healthier body mass index; • decreased risk for heart disease; • decreased risk for cancer; and • better control and prevention of diabetes.

“They don’t have to worry about cholesterol, because cholesterol is only found in animal products,” Sheth says. “And as

Peas, beans and other pulses, along with wholegrains, are excellent sources of protein, vitamins and dietary fibre

you would expect, vegan diets are much higher in fibre.”

Sheth says research has found vegan diets to be appropriate for people at all stages life – even those at crucial stages, such as growing children, pregnant or lactating women and highly active athletes.

One of the long-standing criticisms of a vegan diet has been that adherents will miss out on many essential nutrients that are in rich supply in animal products.

Nutritionists say that this is no longer a serious concern, although people in a vegan lifestyle do need to pay careful attention to their supply of certain nutrients.

Interestingly, protein is not one of the nutrients that vegans need to worry about, even though plants are not the best sources because their proteins do not break down into the full range of amino acids the human body needs to function healthily.

“It’s true that most plant foods don’t contain all the essential amino acids needed by our bodies, while animal proteins do,” says Andrea Giancoli, also a registered dietitian in Los Angeles and a spokeswoman for the American Dietetic Association.

“But a grain plus a bean makes a complete protein. As long as you’re getting a variety of those, you are fine – and they don’t need to be consumed at the same time.”

Sheth and Giancoli note that certain vegan “super foods”, such as soya bean products and quinoa, contain proteins that break down into all the essential amino acids.

“It is absolutely possible to get

[Vegans] don’t have to worry about cholesterol, because cholesterol is only found in animal products VANDANA SHETH, REGISTERED DIETITIAN

enough protein from beans, lentils, tofu, soya bean products and other plant sources like seeds and nuts,” Sheth says. “As long as you’re getting a varied amount throughout the day, your body can mix it up and get what it needs.”

Nutrients that vegans do have to keep careful track of in their diets, both dietitians say, include vitamin B12 – a key nutrient in cell metabolism, nerve function and blood production – and calcium, which is needed for healthy bones.

Animal products are rich in vitamin B12, and dairy products contain loads of calcium.

However, vegans can get B12 and calcium from fortified cereals and fortified dairy substitutes such as soya or rice milk. “You need to be a smart consumer and read labels to make sure you’re buying products that are fortified,” Giancoli says.

Dark-green leafy vegetables such as broccoli, collard greens and kale are also good sources of calcium.

Vegans also have to make sure they get enough iron, which is

essential in the creation of haemoglobin, the protein in red blood cells that delivers oxygen to cells and tissues.

Again, animal products are much richer in iron, although plant foods such as dried beans, dark green leafy vegetables and fortified dairy substitutes are good sources.

“Keep in mind that our bodies are able to absorb more iron from food if the meal is also rich in vitamin C,” Sheth says. “If you’re having spinach, you might have tomatoes or a citrus dressing with it to increase absorption.”

Omega-3 fatty acids probably represent the greatest nutritional challenge for vegans, the two nutritionists say. Thought to be critical for cognitive function and healthy cardiovascular function, omega-3s appear in large amounts only in fatty fish such as salmon – a dietary no-no for vegans.

Some plant sources – flaxseeds, soya beans, pumpkin seeds and walnuts, for example – contain a type of omega-3 fatty acid, but it’s not the same type found in fish and has not been proven to have the same level of health benefits, Giancoli says.

Finally, vegans need to keep in mind that it’s just as easy for them to indulge in an unhealthy diet as it is for omnivores, Sheth says.

She recommends that her vegan clients follow the US government’s guidelines for eating, the same as everyone else should.

“You’re basically just replacing the protein source,” Sheth says.

“Otherwise, it’s the same meal.”

HealthDay

WELL-BEING 11 PERSONAL BEST

Too much of a good thing ......................................................

Monica Proctor healthpost@scmp.com

A HEALTHY OBSESSION Here are some symptoms that may indicate you have orthorexia: • You care more about the virtue of what you eat than the pleasure you derive from eating it.

• You skip food you once enjoyed in order to eat the “right” food.

• You have become much stricter with yourself.

• You plan tomorrow’s menu today.

• You find it difficult to eat anywhere but at home.

• Your diet isolates you socially.

• You feel in total control when you eat the way you’re supposed to.

• You boost your self-esteem by eating healthy food.

• You look down on others who don’t eat the same way.

• You feel guilt or self-loathing when you stray from your diet.

• You spend more than three hours a day thinking about healthy food.

• Your quality of life has decreased as the quality of the food you consume has increased.

Illustration: Lau Ka-kuen

There comes a point when eating healthy becomes an obsession that’s not healthy at all – and I say this from first-hand experience.

It began a few months ago during my second pregnancy, when I was all about eating foods free of gluten, dairy, sugar and soy.

They had to be wholefood – organic, vegan and with no artificial additives, preservatives or processing.

As a holistic nutrition consultant, I would also experiment with elements of various dietary theories: avoiding nightshade vegetables like tomatoes and eggplants (nightshades are thought to contain compounds that can cause chronic joint, muscle and nerve pain); avoiding common allergens such as nuts; incorporating at least 50 per cent raw food into my diet, as well as “superfoods” such as royal jelly and cacao.

I no longer enjoyed eating at restaurants, as I would wonder where the food came from and how it was prepared. I’d visit various health stores regularly to buy the right foods. At supermarkets, I stared in shock at others’ shopping baskets, wondering how their health was.

It turns out there’s a name for this sort of obsessivecompulsive behaviour with food: orthorexia nervosa. The term was coined in 1997 by Dr Steven Bratman, an alternative medicine consultant from the United States. It’s derived from the Greek “ortho”, which means “correct” or “right”, and “orexis”, which means “appetite”, and is intended as a parallel with anorexia nervosa (“without appetite”).

Bratman, who claims to have had the condition himself, describes orthorexia as an unhealthy fixation with healthy eating and claims that, in rare cases, this focus may turn into an obsession so extreme that it can harm personal relationships and emotional well-being, and lead to severe malnutrition and even death.

I contacted the Hong Kong Eating Disorders Association for advice, but the people there could not provide me with any information.

“Since we mainly deal with the cases of anorexia nervosa and bulimia nervosa, we are not familiar with orthorexia,” the e-mail response said.

While orthorexia nervosa is not a formal medical condition, the Eating Disorders Coalition in

Washington, which represents more than 35 eating disorder organisations in the US, thinks it should be considered a separate psychiatric illness, to explain a growing health phenomenon and enable patients get treatment. Yet the lack of knowledge about the syndrome and clinical acceptance results in most doctors not making a diagnosis.

Orthorexia may often provide a sense of superiority and being in control CATRIONA ROGERS, COUNSELLING PSYCHOLOGIST

Hong Kong-based counselling psychologist Catriona Rogers, who has seen two cases of orthorexia, says she would resort to tools such as counselling, cognitive behavioural therapy and the emotional freedom technique to treat the condition – and more importantly understand the deeper roots. “Orthorexia may often provide a sense of superiority

and being in control, as a spin-off effect to deeper causes such as low self-esteem,” she says.

She adds that new media trends on the need to be healthy are creating a similar pressure to the need to be thin. “You end up with a lot of fear-based communication telling you that if you don’t buy this product or the other you won’t feel this great sense of well-being,” she says.

Dr Donald Li Kwok-tung, a practitioner in family medicine, believes the key word is moderation. “These people consider their eating habits almost as a religion, which leads to antisocial behaviour,” he says. “A clinical psychologist will be required to uncover the underlying reasons.”

Dr Michael Cheng, another general practitioner, says it’s not only advertising trends promoting images of health, but also the consensus among the community on what is considered healthy that creates peer pressure. “There’s no scientific evidence behind some of these health products,” he says.

Registered dietitian Kendy Tam sees a fine line between diet and disorder. She says: “As long as the person can eat healthily and follow a daily balanced diet with a normal level of flexibility, it’s fine.”