20120403 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, APRIL 3, 2012

HEALTH POST CASE STUDY: SURVIVING NASAL CANCER

JOY OF LESS, OR HOW TO DECLUTTER

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The gourd life Going vegan without going mad >PAGE 6

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

Jeanette Wang jeanette.wang@scmp.com

APP OF THE WEEK

You call yourself fit, soldier? ......................................................

Katie McGregor healthpost@scmp.com Boot Camp Challenge US$3.99 Rating 7/10 When veteran US Army fitness instructor and certified personal trainer Lori Patterson tells you she’s going to help build a better you, it sounds intimidating. But Boot Camp Challenge comes from good stock – it’s by exercise app developer lolo.

Of all the apps reviewed, one that I still use and enjoy is the lolo Easy 10K with Jeff Galloway. The format for Boot Camp Challenge is similar, using a personable expert in the field, a flexible programme and lolo’s funky “beat-sync” technology that shifts the tempo of your iPod music to suit the challenge.

Patterson recommends that you train three times a week, and the app comprises 18 sessions where the first and last are quick benchmark tests, the idea being you should see some improvement after nine weeks or so.

Lolo apps are practical. You – not the apps – set the equipment at hand, choosing from a list which includes a chair, a jump rope, a dumbbell, elastic tubing or nothing at all. Lastly, you select your level: beginner, intermediate or advanced.

Boot Camp Challenge is designed to help you burn fat and improve functional mobility and strength through a programme that mixes elements of aerobic exercises, yoga and strength training. Each exercise is demonstrated on video and lasts between 26 seconds and two minutes. However, most exercises are simple enough so you can just plug in your headphones and follow along.

Your level will determine the length of your training sessions; beginners start at 25 minutes and build up to 59 minutes; advanced users have a more intense workout of 35 to 50 minutes. No two days are the same, and that is refreshing.

If you are short on time, choose the beginner option and increase the tempo through the beat-sync technology to push you harder. You’ll still get a good workout.

ASK THE DOCTORS DR ANTHONY LUKE Q: I have heard about using devices and mobile apps to help me lose weight. Do these tools really work?

A: There is good evidence that use of self-monitoring tools – whether a monitoring device, an online software program or mobile phone – helps remind people to exercise.

In a study published in Medicine & Science in Sports & Exercise, researchers from the University of Pittsburgh demonstrated that overweight individuals who used self-monitoring entries on paper, on a personal digital assistant (PDA) or on a PDA with daily tailored feedback messages all increased their activity levels significantly after a six-month programme with daily reminders. The individuals who received personalised reminders were more likely to follow their exercise programmes. The people who were better at selfmonitoring had a larger percentage of weight loss with exercise. These findings have been supported by similar studies that show compliance with use of selfmonitoring tools is related to better

adherence to medical recommendations.

There are many approaches available for self-monitoring, from the simple pedometer to a GPS watch or smartphone. Newer technologies include personalised monitoring devices with accelerometers (technology that can assess your movements) that you can wear. The heart rate monitor is useful for gauging exercise intensity. Some devices even monitor health variables such as weight and blood pressure.

Online or mobile tools to gather data on health can be useful to promote selfawareness regarding your health goals, whether that means exercising regularly, taking medications or controlling blood sugar. Of course, the effort you put into using new technologies probably relies on the same willpower you need to take care of yourself and reach your goals.

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’s ACSM Fit Society Page

> 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

Better to hope for the breast Does early detection of breast cancer really save lives? New research published today in the Annals of Internal Medicine questions whether finding cancer early is better. The study involved 39,888 women with invasive breast cancer in Norway – 7,793 of whom were diagnosed after a country-wide mammography screening programme was rolled out. The researchers found that an estimated 15 per cent to 25 per cent of cases of breast cancer detected represented over-diagnosis – in other words, detection that would not go on to cause symptoms or death. The authors noted the unrecognised harm of over-diagnosis. The anxiety of false-positive results eventually goes away, but women who are diagnosed with cancer that otherwise would not have progressed are forever altered by that diagnosis. The authors recommend watch-andwait strategies with non-invasive, early-state tumours, but recognise that this approach may be difficult for women to support. Until better screening tools are developed, they say women should be educated that some cancers detected by mammography represent over-diagnosis.

Living on borrowed grime You could be adding up to 37 million bacteria to the air in a single room every hour, say Yale University researchers. The good news is that this is largely due to the stirring up of material on the floor that’s mainly been left behind by previous occupants. And less than 0.1 per cent of the micro-organisms commonly found indoors are infectious. That said, that’s a lot of dirt, shows the study, recently published in the journal Indoor Air. The researchers measured and analysed biological particles in a single ground-floor university classroom over a period of eight days – both when occupied and vacant. At all times the windows and doors were kept closed. Human occupancy was linked with “substantially increased airborne concentrations” of bacteria and fungi, and especially large spikes for larger-sized fungal and bacterial particles – meaning they’re more likely to linger and recirculate.

Wonders never crease The secret to a longer life could lie in a drug called rapamycin, shown to extend lifespan in lab animals. The catch? The drug, used for immunosuppression in organ transplantations, has also been linked to impaired glucose tolerance and insulin sensitivity, hallmarks of diabetes. But there is hope. Researchers at Whitehead Institute for Biomedical Research and the University of Pennsylvania have teased apart the drug’s activity at the cellular level to gain an understanding of its anti-ageing effects. This means there may be a chance of developing a longevity drug without the adverse effects associated with rapamycin. Rapamycin works by mimicking the agedefying effects of calorie restriction. So, while we wait for the drug, perhaps we could all simply eat less.

Womb and gloom for big girls Heavier female babies are more likely to develop diabetes and related metabolic risks when they grow up compared to males, according to a study from The University of Western Australia in Perth. “What happens in the womb affects future heart disease and diabetes risk,” says Dr Huang Rae-chi. “Female babies are particularly prone to this increased risk; and females who are at high risk of obesity and diabetes-related conditions at age 17 show increased obesity as early as 12 months of age.” Huang examined 1,053 17-year-olds from an Australian birth cohort, with follow-ups done at eight intervals from age one. The 17-year-old girls with the greater waist circumference, triglycerides, insulin and lower HDL cholesterol were heavier from birth with consistently higher BMI thereafter. Birth weight had no statistical impact on metabolic risk factors in males. From The Journal of Clinical Endocrinology and Metabolism.

NEWS 3 QUIZ SKIN CANCER

MIND AND BODY INFECTION

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How stress can inflame many diseases

Jeanette Wang jeanette.wang@scmp.com Janey Helland of Mapleton, Minnesota, didn’t think twice when tanning in high school and college.

“I used tanning beds to get ready for homecoming and prom,” she says. “In college, I tanned before a trip to Barbados, because I didn’t want to get sunburned.”

At age 21, Helland noticed an abnormal spot on her leg. It was melanoma, and the diagnosis changed her life. “I really didn’t know what my future was going to look like, or if I’d even have one,” she says.

Rates of skin cancer are rising dramatically in the United States, especially among people under 40 – even as rates of some other cancers are falling – the non-profit Mayo Clinic in Minnesota says. A study in this month’s issue of Mayo Clinic Proceedings found that the incidence of melanoma had increased eightfold among young women and fourfold among young men from 1970 to 2009.

Women in their 20s and 30s were hit hardest.

The use of indoor tanning beds, the researchers speculate, is a key culprit behind this alarming trend.

“A recent study reported that people who use indoor tanning beds frequently are 74 per cent more likely to develop melanoma, and we know young women are more likely to use them than young men,” says lead investigator Dr Jerry Brewer, a dermatologist. Childhood sunburns and ultraviolet exposure in adulthood may also contribute to melanoma development, the researchers say.

Brewer says the lifetime risk of melanoma is higher in males than females, but the opposite is true for young adults and adolescents.

In Hong Kong, statistics from the Hospital Authority’s Cancer Registry show the incidence of skin melanoma has remained relatively stable in the past decade, with an average rate of 0.3 per 100,000 people

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Jeanette Wang jeanette.wang@scmp.com

aged between 20 and 44, and a rate of 0.6 per 100,000 people for all ages.

Two years after her diagnosis, Helland is cancer-free and dedicated to educating others.

“It’s better to be safe than sorry,” she says. “My advice is to educate yourself and research the risk factors.”

As summer approaches, it’s worth noting the dangers of excessive sun exposure and tanning.

Test yourself on skin cancer here.

1. Which of these are risk factors for skin cancer? a. Fair skin b. Having a relative with skin cancer c. Many moles 2. How much of the sun’s UV rays break through clouds and rain? a. About 3-6 per cent b. About 31-45 per cent c. About 60-80 per cent 3. Which skin cancer is considered the most serious and can spread to other areas of the body? a. Basal cell, non-melanoma skin cancer b. Squamous cell, non-melanoma skin cancer c. Melanoma skin cancer 4. What does melanoma skin cancer usually look like? a. A large, irregular mole b. A rough, scaly patch c. A large, red bump Answers: 1. all are correct; 2. c; 3. c; 4. a

CANCER SELF-EXAMS

Hands-off approach works best ......................................................

Agence France-Presse Celebrity appeals for British men to fondle their testicles to detect early signs of cancer are a waste of time and possibly harmful, an opinion piece published by the British Medical Journal says.

Singer Robbie Williams and the Leicester Tigers rugby team are among those who have lent their names to a campaign for men to be “testicle aware”, just as women are encouraged to look for dangerous lumps in their breasts.

But in a personal view published

Robbie Williams has lent his voice to the cancer campaign. Photo: Reuters

in the journal last month, Dr Keith Hopcroft, a general practitioner in Essex, southeast England, dismisses calls for a man to “grope his gonads or caress his crown jewels” as “wellmeaning whimsy, with the potential to do harm”.

“There is no good evidence that routine testicular self-examination is of any benefit,” he writes. “The chances of discovering something significant from routine selfexamination of the testicles are minuscule. At least 50,000 men would need to examine themselves for 10 years to prevent one death.”

Hopcroft says the “testicle aware” campaign is based on the notion that this form of cancer is a silent killer, with no symptoms of pain.

The campaigners argue men should look for painless swelling that, they say, is a possible sign of cancer. But, Hopcroft argues, at least half of patients with testicular cancer usually experience pain.

The real question is teaching men to be aware of this symptom and act on it swiftly, rather than “turning the nation’s blokes into ball-watching neurotics”, he says.

Cortisol, or the “stress hormone”, is produced naturally by the body to assist in various processes, including regulating blood pressure and cardiovascular functions, and boosting metabolism. The steroid hormone, which is produced by the adrenal glands, also enhances the integrity of blood vessels and reduces allergic and inflammatory responses. But stress can thwart the efforts of cortisol, say researchers at Carnegie Mellon University in Pittsburgh, in the US. The study is published in the Proceedings of the National Academy of Sciences.

Lead researcher Sheldon Cohen, a psychology professor whose work focuses on the effects of stress on the mind and body, has found that prolonged stress causes immune cells to become insensitive to cortisol’s regulatory effect on inflammatory response. In turn, runaway inflammation is thought to promote the development and progression of many diseases.

Psychological stress is linked with a greater risk of depression, heart disease and infectious diseases. But until this new research, it was not clear exactly how stress influences disease and health.

Inflammation plays a role in many diseases and this model suggests why stress impacts them as well SHELDON COHEN, PSYCHOLOGY PROFESSOR

The team did two studies. In the first one, after completing an intensive stress interview, 276 healthy adults were exposed to a virus that causes the common cold and were monitored in quarantine for five days for signs of infection.

Prolonged stress was found to be linked with the inability to regulate inflammatory response. These people were more likely to develop colds when exposed to the virus.

In the second study, 79 healthy participants were assessed for their ability to regulate the inflammatory response. They were then exposed to a cold virus and monitored for the production of pro-inflammatory cytokines, the chemical messengers that trigger inflammation.

Those who were less able to regulate the inflammatory response produced more of these messengers when infected. “The immune system’s ability to regulate inflammation predicts who will develop a cold, and provides an explanation of how stress can promote disease,” Cohen says.

“When under stress, cells of the immune system are unable to respond to hormonal control and produce levels of inflammation that promote disease. Because inflammation plays a role in many diseases, this model suggests why stress has an impact as well.”

4 HEALTH SOCIAL WELL-BEING

The significant others ......................................................

Jane E. Brody It is now two years since I lost Richard, the man I lived with and loved for 44 years, and I have to admit, the second year was harder than the first.

At first I was busy navigating a seemingly unending number of legal and financial issues, which were foreign territory to me. I figured out how to undertake the many household duties that had been my husband’s, and I learned to ask for or hire help when tasks were more than I could handle.

The first year, my wonderful immediate family (two sons and daughters-in-law, four grandsons, a son-in-law by marriage, and brother and sister-in-law) and half a dozen close friends saw to it that I was included in all manner of activities with people I love, from visiting the Grand Canyon and celebrating holidays to evenings at the theatre, concerts, museums and films.

I also tackled some longneglected but necessary household projects, such as replacing ill-fitting windows and doors and repairing or discarding broken furniture.

Things quietened down a lot in the second year. People returned to their lives and, I guess, expected that I had learned how to cope on my own. And to a large extent that was true.

I got the car serviced and inspected. I changed light bulbs (even though a doctor had told me to stay off ladders), kept the pavement swept, disposed of the rubbish and recycling, pruned the grapevines, and periodically cleaned the drains and gutters. But something was clearly missing.

There was an emptiness that may be hard to understand unless you’ve been through it.

Take last New Year’s Eve. I had no plans, but the day before, a very thoughtful friend invited me to dinner with her husband and another couple, after which we joined two other couples for dessert. Then all nine of us went to the park to watch the fireworks; thousands of revellers were whooping and hollering and generally having a great time.

Everyone but me.

I was very sad. To me, alone in a crowd, nothing about this new year seemed celebratory.

The same sadness recurred two

Social interaction – be it with family, friends, church or volunteer groups – gives our lives focus and meaning. Photo: Corbis

months later, on Super Bowl Sunday, when I sorely missed the company of people close to me who were elsewhere, cheering the New York Giants on to an unexpected victory.

I am by nature a happy, optimistic, can-do person, unaccustomed to feeling vulnerable and adrift. It helped somewhat to vent these feelings to close friends and a therapist.

But a book I found in my personal library, Healthy at 100

by John Robbins, may well prove to be the most helpful. I’m not sure how I missed perusing this

Those with close social ties and actually unhealthy lifestyles lived longer than those with poor social ties but more healthpromoting habits

marvellous book when it was published, in 2006, but I’m awfully glad I found it.

After 200-plus pages of informed discussion of life-enhancing issues such as diet, exercise and mental stimulation, Robbins devotes a major section to relationships. He notes the importance of others in our lives and takes issue with self-absorption, with the “me” generation that focuses on itself to the neglect of others.

Robbins cites an illustrative study published in 1983 by Larry Scherwitz, then a psychologist at Baylor University in Waco, Texas, who taped the conversations of nearly 600 men, a third of them with heart disease. Scherwitz counted how often the men used first person pronouns I, me, mine – and found that those who used them more often were most likely to have heart disease and, when followed for several years, most likely to suffer heart attacks.

The psychologist advised: “Listen with regard when others talk. Give your time and energy to others; let others have their way; do things for reasons other than furthering your own needs.”

I think it’s time for me to get

out of myself, to join a cause I believe in and to work hard towards its goals. I’m not sure yet what that cause might be. My brother and sister-in-law, despite their busy lives, contribute their time, energy and money to the Christian housing organisation, Habitat for Humanity, and take pride in how their efforts help others.

I suspect, though, that I may need something that connects me more directly to people I care about. In college, I was the unofficial dorm therapist; so perhaps I could function again in a one-on-one advisory capacity for people in need of a sounding board.

In study after study cited by Robbins, people in loving relationships with spouses or friends were healthier than those lacking this intimacy, even when the latter had healthier living habits.

One such study of 7,000 men and women living in Alameda County, California, led by Lisa Berkman, an epidemiologist at Yale University, found that people who were not connected to others were three times as likely to die over the course of nine years as those who had strong social ties. The kind of social ties did not matter. They included family, friends, church and volunteer groups.

Furthermore, to the surprise of Berkman and her co-author, S. Leonard Syme of the University of California, Berkeley, those with close social ties and unhealthy lifestyles actually lived longer than those with poor social ties but more health-promoting habits. Of course, those who lived healthily and had strong social ties lived the longest.

In another study, which was called the Beta-Blocker Heart Attack Trial and involved 2,300 men who had survived a heart attack, those with strong social connections faced only one-quarter the risk of death of those not socially connected, even when factors like smoking, diet, alcohol, exercise and weight were taken into account. In fact, being socially connected had a greater influence on survival than the heart drug being tested.

The demonstrated benefits of social involvement raise serious questions about the generational splits in society today. The three-generation household in which I grew up is no longer the norm – in fact, just the opposite.

When people become too old or infirm to live on their own, they typically move or are moved to facilities with other old or infirm individuals, often far away from family and friends and thereby depriving them of connections to people who can provide loving support. The resulting loneliness can be a killer, even in the absence of a fatal disease.

Robbins points out that in traditional societies that lack modern medicine yet are famous for long life expectancies, “the generations are not artificially separated, and people at every stage of life feel a part of things and have something to contribute”.

I can only hope that this will be the case during my own last years.

The New York Times

Illustration: Angela Ho

MEDICAL 5

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Eileen Aung-Thwin healthpost@scmp.com Ben Cho was 30 years old when he was diagnosed with nasopharyngeal carcinoma, or cancer of the nose.

Although rare in other parts of the world, where it tends to affect fewer than 10 out of a million people, the cancer has a much higher incidence among males in Hong Kong – 200 to 300 out of a million.

According to 2009 statistics from the Hospital Authority’s Cancer Registry, it’s the seventh most common type of cancer in the city – ranked sixth among men but not in the top 10 among women. People from South China, along with those in Northern Africa and Alaska, are at greater risk for this otherwise rare disease.

This insidious disease can be hard to spot. Its early symptoms can be as nondescript as a stuffy nose, headaches and frequent ear blockage. Other symptoms include nose bleeds, blood in the saliva or a lump in the neck caused by a swollen lymph node.

Add to that the difficulty in inspecting the nasopharynx – the upper part of the throat behind the nose – and diagnosis is often delayed. Hence, the tumours are often detected late, when the disease is already quite advanced.

Cho (name changed for patient confidentiality reasons) was lucky that he was diagnosed before the cancer had spread to other parts of his body, which nasopharyngeal carcinomas are prone to do.

Therefore, he was given radiation therapy to kill the cancer cells, followed by chemotherapy to stop the disease in its tracks.

But the cancer was resilient. Cho started to suffer nose blocks and nose bleeds not long after his treatment ended. The carcinoma had returned.

An endoscopy and biopsy

CASE HISTORY

How to face down a killer confirmed that a tumour was again growing in Cho’s nasopharynx, smack in the middle of his head. At 2cm, the lesion was too large to be removed by either the endoscope or by a minimally invasive, robotassisted alternative.

Against such an aggressive cancer, dramatic measures were needed, and Professor William Ignace Wei, head of Hong Kong Sanatorium and Hospital’s surgical department, stepped in.

Two decades ago, Wei had pioneered a surgical technique that enabled access to the centre of the head using a “maxillary swing

The trauma to the face and jaw muscles only meant that he had to take smaller bites of food than he used to

approach”. Essentially, he had figured out how to open up the face, take tumours out of the nasopharynx, and put the face back together. Cho was going to need this radical surgery to save his life.

First, Wei drilled holes in the facial bone. A special plate would later be screwed to these holes to hold Cho’s face together afterwards.

Next, using an oscillating saw, he cut into Cho’s face from the ear to the bridge of the nose, just under the eye. He then made an incision down the middle of the face and then cut towards the back of Cho’s throat before slicing back towards the ear.

That part of the facial bone and structure was now completely severed from the rest of the skull, and held to the head by the skin and muscle of the face.

Wei then folded back the dislodged quarter of Cho’s face to reveal the nasopharynx – and the tumour. With a clear view of the lesion, Wei could completely and precisely remove the offending growth without damaging the vital carotid artery, which provides the main blood supply to the brain. The artery passes nearby on its way to the brain.

He also cut into the healthy tissue around the tumour and had it microscopically analysed immediately for cancer cells, and kept cutting until the tissue came back clear of abnormal cells.

Wei says cutting open the face is the easy part of the operation, but removing the tumour entirely without damaging the surrounding tissue and organs is often the greater challenge.

Once the cancerous tissue was removed, Wei started to put Cho’s face back together. The flap of his face that had been swung open was returned into position. Mini-plates and screws were used to hold the piece of bone in place, and sutures stitched the skin back together.

For the next 10 days, Cho had to rely on intravenous feeding, then slowly started to ingest food normally as the wounds healed.

Cho later found that he could not open his mouth as wide as before.

The trauma to the face and jaw muscles from the surgery restricted the range of his jaw’s movement, but this minor inconvenience only meant that he had to take smaller bites of food than he used to.

Six months later, only faint lines show where the incisions on Cho’s face had been, and the casual observer might not even notice.

More importantly, eight years on, Cho remains cancer-free.

6 COVER STORY

Roo Embracing a plant-based and your body will thank

W

hen Shara Ng first turned vegetarian some 20 years ago to enhance her spiritual life, she never expected the diet to damage her social life.

“It was very difficult because few people knew about vegetarianism,” says Ng, 49, a secretary who shunned meat as her meditative practise required a “compassionate” diet. “My friends felt that I was strange, and when we dined out they found my diet annoying. It was quite a hard time for me.”

Things have changed since then.

She has made new friends with the same meatless dining habits – and her circle of friends has been growing in recent years.

Vegetarianism, along with veganism (which excludes all animal products including eggs and dairy), is more popular than ever in Hong Kong and worldwide. The growing number of vegetarian and vegan options – eateries, products and even cookbooks – shows there is demand fuelling the supply.

Restaurant and cafe chains have hopped on the bandwagon – even 7-Eleven stores in the US, more than 100 of them, last year began carrying vegan versions of dishes such as pad Thai and linguine tikka masala.

Celebrities such as rock star Ozzy Osbourne and actor-comedian Russell Brand have joined the vegan fray, too.

Ng, who turned vegan seven years ago, founded the Hong Kong Vegan Association in 2009, and in August that year started the Meat Free Monday Meetup (meetup.com/Meat-Free-HongKong), a group that dines together at 7.30pm every Monday in a different vegetarian spot each week. The group’s membership has grown from fewer than 10 to nearly 800, and about 30 join in each week.

At the University of Hong Kong, the Less-Meat Monday Campaign started by final-year student Helen Kwok Hiu-lam is gaining ground.

Late last year, she managed to persuade campus caterers to offer a larger range of vegetarian dishes on Mondays, and to place a “Green Grin” sticker on these items.

Kwok, 23, says the response has been encouraging and has spread beyond HKU. The English Schools Foundation has invited Kwok and her team to share their knowledge with student representatives.

“Hopefully, the meat-free-once-aweek idea will go ESF-wide soon – if not all over Hong Kong primary and secondary schools.”

There are many reasons to go vegan, but the main initial factor, it seems, is not usually health.

COVER STORY 7

ots and all diet is easier than you might think, you for it, writes Jeanette Wang

Eight years ago, Marcus Turner, 49, rid himself of all animal products, including leather and wool, for animal welfare reasons.

Even his seven pet dogs are vegan.

“It’s unnecessary and disgusting,” he says of factory farming.

Environmental issues are another popular motivation. A United Nations report in 2010 noted that as the global population surges towards a predicted 9.1 billion people by 2050, diets rich in meat and dairy are unsustainable, and a global shift towards a vegan diet is vital to save the world from hunger, and to avoid fuelling poverty and the worst effects of climate change.

Often, the health benefits of a plant-based diet encourage people to stick at it. “Most people find they become healthier. You save a lot of money because you don’t go to the doctor as much,” says Victor D’Aquino, 63, a board member of Club O, an organisation that promotes “living a life according to the laws of nature” and serves free vegetarian dinners at its Mong Kok headquarters weekly.

Evidence of the benefits of plantbased diet is compelling. One of the most comprehensive studies is The China Study, which looked at dietary and lifestyle factors linked with disease mortality of 6,500 adults across 170 villages in China. Led by Cornell University professor emeritus T. Colin Campbell, it was a 20-year partnership with Oxford University and the Chinese Academy of Preventive Medicine that began in 1983.

Campbell, who has been researching diet, nutrition and disease since the late 1960s, says: “I have come to see that the benefits produced by eating a plant-based diet are far more diverse and impressive than any drug or surgery used in medical practice. Heart disease, cancer, diabetes, stroke and hypertension, arthritis, cataract, Alzheimer’s, impotence and all sorts of other chronic diseases can be largely prevented.”

He found that nutrients from animal-based foods increased cancer tumour development, while nutrients from plant-based foods decreased it. There is also “impressive evidence” that good nutrition can reverse advanced heart disease, relatively advanced cancers of certain types, diabetes and other degenerative diseases.

Based on his research, Campbell authored The China Study, the book that converted former US president Bill Clinton to a plant-based diet – and led to an 11kg weight loss.

Vegetarianism is nothing new to Chinese culture, as Eastern religions

such as Buddhism and Taoism promote such a diet. But Dr Neal Barnard, founder and president of the Physicians Committee for Responsible Medicine (PCRM) based in Washington, says traditional plant-based diets are being swamped with unhealthy foods and fast-food items, and this is driving obesity and diabetes rates in China “through the roof”.

In a study he co-authored that was published in the American Journal of Health Promotion in 2010, 113 employees at a US insurance company went through a voluntary 22-week intervention programme.

All participants had a body mass index of 25 and above, and/or a previous type-2 diabetes diagnosis.

The 68 people who were put on a low-fat, vegan diet lost an average of 5.1kg and cut 4.7cm from their waistlines. The rest, who kept to their habitual diets, gained 0.1kg and 0.8cm around the waist on average.

To motivate people to switch to a plant-based diet, PCRM launched the 21-Day Vegan Kickstart in 2009, a free online programme based on Barnard’s research that offers daily recipes and expert and celebrity tips.

A vegan can still meet all nutritional requirements – provided the meal is well planned CANDY SIN, DIETITIAN, WORLD CANCER RESEARCH FUND HONG KONG

It has helped more than 150,000 Americans lose weight and improve their health. A Chinese version (21DayKickstartChina.org) of the challenge was launched last month.

“Our research shows the best way to lose weight and reverse disease is to jump into a completely low-fat, plant-based diet for three weeks,” says Barnard.

But is such a diet a balanced one?

Zhejiang University researcher Duo Li, in a study published last year in the Journal of Agricultural and Food Chemistry, reviewed dozens of articles published in the past 30 years on the biochemistry of vegetarianism. He found that vegan diets tend to lack key nutrients such as iron, zinc, vitamin B12 and omega-3 fatty acids. Vegans therefore tend to have raised blood levels of homocysteine and lower HDL (“good” cholesterol) levels, both risk factors for heart disease.

Candy Sin Kamling, a registered dietitian with the World Cancer Research Fund Hong Kong, also mentions those nutrients, along with protein and calcium that a plant-based diet may lack. But she says: “A vegan can still meet all nutritional requirements – provided the meal is well planned.”

That seems to be the experience of Agnes Tam Nga-yin, 25, whose parents were worried that she wouldn’t get enough nutrition when she turned vegetarian seven years ago.

“However, time has proved that a plant-based diet is a lot healthier. I do not get an upset stomach, skin allergies, or catch a cold as often as before,” says Tam, a HKU research assistant. “When I read or write essays, I feel so focused.”

Even Ng’s golden retriever, a frail abandoned dog she adopted a year ago, is thriving on a vegan diet. “It is now very fat,” she says.

Transitioning to a plant-based diet may be daunting for meat lovers, but Turner says it’s not as hard as people imagine. “I gave up smoking 20 years ago and it was 1,000 times harder. To go vegan, I did it in one attempt.”

Besides, with such a diet becoming more mainstream, there is a lot more information and products available to make the switch easy. Still, many vegans in Hong Kong agree that the city could do with more vegan options.

Cheese, for example, is often a stumbling block for potential vegans, says Turner. “For some reason, cheese is one of the more difficult products to give up. To find a good vegan cheese is like finding the Holy Grail.”

He did eventually find this “Holy Grail” in Scotland. Last year, Turner started importing the non-dairy Sheese – which, trust me, tastes remarkably like the real thing – into Hong Kong. “The drastic step was to become the distributor so that I could get my own supply.”

But if you find cheese – or other animal products – difficult to give up, don’t beat yourself up over it.

“I have tried being ‘pure’ vegan for some periods, but I’m very flexible with my diet,” says Shima Shimizu, 32, a raw food chef and founder of Sesame Kitchen cooking school. “I don’t think the ‘purity’ of your diet is important.

You can experience the benefits of eating more fresh fruits and vegetables without being 100 per cent vegan. Listen to your body and try to make the best choices as much as possible.” jeanette.wang@scmp.com

Helen Kwok (top) started Less-Meat Monday at HKU last year to promote a vegetarian lifestyle; vegetarian linguine with Italian tomato sauce (above); members of Meat Free Hong Kong enjoy dinner at the Man Bo Vegetarian Restaurant in Ho Man Tin (below). Photos: Warton Li, Jonathan Wong

8 FITNESS

SPORTS PERFORMANCE GOING VEGETARIAN

Down the garden path ......................................................

Sasha Gonzales healthpost@scmp.com If you think a diet free from meat can’t satiate – much less energise – the average person, Chad Lykins will prove you wrong. For the past 10 years he’s been vegetarian, and yet has been able to train daily for, and conquer, triathlons and trail-running races.

“Vegetarianism is great for athletes,” says Lykins, an assistant professor at the University of Hong Kong’s faculty of education. “Some athletes that have become vegetarian think that their bodies recover faster and are more able to absorb nutrition. I am healthier and feel that I am doing my small part to promote a sustainable lifestyle.”

Perhaps more persuasive of the benefits of a plant-based diet is the list of star vegetarian athletes: athletics icon Carl Lewis, tennis greats Billie Jean King and Martina Navratilova, six-time Ironman winner Dave Scott, boxer Mike Tyson and Olympic hurdler Edwin Moses, to name a few.

It may not seem ideal for competing athletes, but wellplanned vegetarian diets can be as balanced and nutritious as traditional ones, providing adequate energy and protein, and helping athletes of all kinds

meet the energy requirements of their respective sports.

In 1990, Lewis embraced a vegan diet, one that includes no eggs or dairy products. Prior to the switch, the nine-time Olympic gold medallist was a meat-eater who skipped meals frequently. In his introduction to Very Vegetarian, a collection of recipes by American chef Jannequin Bennett, Lewis writes that athletes do not need protein from meat to be successful.

Daphne Wu, a freelance dietitian with Life Enrich Training and Consulting Centre in Jordan, says it is possible for top athletes to be vegetarian, but their performance depends on their food choices, since many plant-based foods tend to be high in calories – 100 grams of nuts, for example, provides 650-750 calories, and 100 grams of potato chips about 500 calories.

“If they do not include suitable meat alternatives in their daily meal plan, they will not be able to support the demands of daily training,” says Sally Poon, a sports dietitian with Private Dietitian.

Poon says a lacto-ovo vegetarian diet – one that includes dairy and eggs – is easier to stick to than a vegan diet because it increases food options. It also supplies vitamin B12, which helps the body make the red blood cells that carry oxygen to muscles.

Vitamin B12 is found naturally only in animal products and a deficiency can result in anaemia.

Vegans can get B12 from supplements, fortified soy milk and the yeast extract Vegemite, Poon says. Mushrooms are also a good source of B vitamins.

Vegetarian athletes might also be at a higher risk of developing anaemia because iron from plant foods – also called non-haem iron – is not as easily absorbed as iron from animal sources.

“Iron helps produce red blood cells,” Wu says. “A lack of it can therefore affect one’s sporting performance, particularly if one is an endurance athlete.”

Non-haem iron can be found in leafy green vegetables, legumes and beans. Other decent sources include fortified breakfast cereals, dried fruits and gluten-based meat alternatives.

These foods are best consumed with vitamin C-rich foods, such as citrus fruits and some vegetables, to increase the absorption of nonhaem iron, Poon says. Avoid beverages, such as coffee and tea, and adding unprocessed bran to these meals, as this will only decrease the absorption of non-haem iron.

Vegetarian athletes who participate in contact sports might also want to step up their

I am healthier and feel that I am doing my small part to promote a sustainable lifestyle CHAD LYKINS, VEGETARIAN ATHLETE

intake of calcium, which builds strong bones and reduces the risk of bone fractures. Dairy products, tofu, sesame seeds and dark, leafy greens are all excellent sources of this mineral.

Protein is also crucial to athletic performance because it builds and repairs tissues and makes hormones, enzymes and other body chemicals. It helps in the contraction of muscles, too, while regulating bodily processes, such as water balance. As plant proteins may be short of one or more essential amino acids, the building blocks of protein, food sources need to be combined to ensure all amino acids are consumed, Poon says.

“Combining different types of plant foods allows low levels of amino acids in one food to be complemented by the high levels

of amino acids in the other,” she says. “For example, eat legumes with grains, or legumes with nuts or seeds.”

She also advises eating these foods in moderation, since excess protein is stored in the body as fat.

Lykins says he made the mistake of overloading on protein when he first turned vegetarian.

“I was eating high-sodium, heavily processed meat substitutes once a day. I was also eating too much dairy.”

These days, he gets nutrients mainly from avocados, beans, fruits, nuts, seeds, oils and grains.

When he craves junk food, he heads to McSorley’s Ale House in SoHo for a veggie burger and fries.

Vegetarians are generally believed to be healthier than non-vegetarians.

Poon says that their risk for certain lifestyle diseases, like overweight or obesity, heart disease, high blood pressure, type-2 diabetes and some forms of cancer, tend to be lower, as a plant-based diet is lower in saturated fat and cholesterol, and higher in carbohydrates, fibre, folate, carotenoids, vitamins A and C, magnesium and other phytonutrients.

As long as their food choices are smart and varied, there is no reason why the performance of vegetarian

DIET 9 Chad Lykins runs on Pik Shan Path in Mid-Levels.

Photo: Jonathan Wong

TCM

The yin and yang of a meat-free regimen

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Jeanette Wang jeanette.wang@scmp.com

athletes should be affected. Lewis said that he enjoyed his best year of track competition in 1991, several months after becoming a vegetarian.

Former Ironman triathlete Brendan Brazier, who became a vegetarian in 1990 when he first started running, says he initially made the switch to enhance his athletic performance.

In those early years, he got his food combinations wrong and suffered from a lack of energy, but his performance improved dramatically once he learned to eat the right foods. One of the main benefits of a vegan diet for athletes, he says, is that it’s alkalising, which minimises muscle inflammation and lactic acid build-up.

Brazier, 36, is so convinced of the benefits of veganism for athletes that he has carved a second career out of spreading the word about it.

He is the author of the best-selling The Thrive Diet and has created a line of award-winning, vegan, whole-food products called Vega.

Lykins too has started developing his own sports nutrition, a vegan performance snack bar that he says isn’t full of processed junk, but still tastes great. “I never found one, so I developed my own.”

Having gained the approval of his running and hiking buddies, Lykins says the snack bar will be on sale in Hong Kong next year.

SHAKE AWAY Chad Lykin’s ultrarunner smoothie (blend everything and drink up) 84 grams almonds, soaked for at least four hours 4 dates, soaked for at least four hours 2 cups iced water 2 bananas 1 cup additional fruit (blueberries, pineapple or strawberries all work) 2 tbsp chia seeds (optional) 1 tbsp brown rice protein (optional)

Traditional Chinese medicine (TCM) teaches that humans should eat all kinds of foods, similar to the modern idea of a balanced diet.

The plants-only diets now associated with vegetarianism are not mentioned in the ancient Chinese literature on proper eating.

In fact, some passages seem to specifically endorse diets that include at least some meat. For instance, the Huang Di Nei Jing Su Wen – the first volume of the Yellow Emperor’s Classic of Internal Medicine – says: “When one takes the tastes of cereal, fruit, meat, and vegetable in combination, it can invigorate the essence and nourish the vital energy.”

The book, which dates back to the late Warring States Period (475BC-221BC), also says that “medicines are used to fight the evils, cereals are used to nourish the body, and fruits, meats and vegetables to aid the efforts – all the tastes working together to reinforce the vital qi and essence”.

Shen Nong’s Herbal Classic, written in the Eastern Han dynasty (AD25-AD220), also mentions meats, such as chicken and wild goose fat, among foods that can improve health and delay ageing.

That said, a plants-only diet can still be consistent with TCM, says registered Chinese medicine practitioner Vincent Lee Yu-ming, a Hongkonger who’s doing a PhD in Chinese medical science at the Beijing University of Chinese Medicine.

“Meat can be beneficial, but if you eat too much of it you usually get diseases such as stroke, diabetes, asthma, obesity – these were indicated some 2,000 years ago,” Lee says. “In fact, in ancient times, most people in China had mainly vegetarian diets as it was difficult to find meat to eat.”

Also, TCM considers dairy products, especially cow’s milk, unsuitable for humans in most circumstances. Lee says it’s harmful to drink milk and eat eggs every day, because they are cold and wet in nature and, in TCM theory, serve to nourish yin.

While milk and eggs can help treat some diseases caused by a yin deficiency – such as fever caused by heat syndrome – Lee says daily consumption can damage the digestive system, leading to colddamp syndrome and a reduction of qi, the body’s vital energy.

“In TCM, every type of food has a different nature, some are hot and some cold,” Lee says.

If you’ve been eating meat for a long time, the body becomes contaminated and polluted VINCENT LEE, TCM PRACTITIONER

The nature of a food is defined by observing its effects on the human body. Typical cold foods include watermelons, turnips, pears, laver and clams; hot foods include ginger, Chinese spring onions, Chinese chives, garlic, chillis and mutton.

“Cereals are the best foods for supporting life because most are yin-yang balanced in nature, which means they’re suitable for most people to eat every day,” Lee says.

In general, in TCM there are three concepts to follow when picking food, he explains. First, choose foods that are in season. “Eat watermelon in summer, oranges in winter, pears in autumn. Foods in season are usually good for health,” he says.

Second, eat local. “It’s similar to eating in season. The food is planted in the same environment in which we live, so we think it will have the same function to help improve our health. In TCM, we think different types of soil can nourish different people.”

Third, eat food specific for your body constitution. “In TCM, we think people have different body situations – some may be in a situation of disease, others are of different ages and have different nutritional needs.

“Some people have weakness of qi in the blood or too much fire in the body,” he says. “If you’re weak in the body and usually feel cold, you have to eat more food that’s warm in nature to help strengthen the body. If you’ve got too much fire in the body, eat food that’s cold in nature.”

The best method to know your body constitution, says Lee, is to get diagnosed by a TCM practitioner.

“Or you can listen to your body; our bodies know how to choose food.”

Lee turned vegetarian himself eight years ago. He became vegan three months ago after seeing videos of the production of milk and eggs.

“If you’ve been eating meat for a long time, the body becomes contaminated and polluted, so sometimes the body may not understand what’s most suitable for it,” he says. “Sometimes, after trying a vegetarian diet, the body will become clear. It will be easy for the body to know what’s best.”

He says he feels physically stronger and has better endurance since switching to a plants-only diet.

He also relaxes more easily, has better bowel movement, and falls ill less frequently.

“It’s more than the physical – mentally, I feel more flexible and creative,” he says. “My mind is more calm and peaceful. My personality has also changed – I’m more gentle and polite. I have more compassion towards people and animals. I can live in a simple way with less desire.”

10 WELL-BEING WALKING HOME

Every slog has its day ......................................................

Rob Lilwall healthpost@scmp.com 6am I wake to the sound of my alarm clock and push my face towards the pre-dawn light and an incredible display of giant karst mountains, forested hillsides and deep valleys in the north of Xinglong, in the municipality of Chongqing.

I shout to my expedition partner and cameraman, Leon McCarron, a few metres away, that it is time to get up. A groan in reply. Ten years younger, Leon is supposed to be the sprightly one, but he confesses that the past four months and 3,000 kilometres of tough walking have aged him at an unnatural speed.

6.30am After packing our rucksacks and downing our first instant coffee, we follow the farmers’ track onto the road. We brace ourselves for another long day. Today we aim to cover 41 kilometres – out of the mountains and down to the next town, Baiyangping in Hubei province.

7am We walk across a bridge spanning a 100-metre deep gorge. From a hillside on our right we hear shouting, and peering through the undergrowth we see the townsfolk have gathered for their morning exercises (a blend of tai chi and aerobics). They invite us to join in – which we do, rather clumsily – before walking with them through the town.

9am We have left the town behind us, walked through a two-kilometrelong tunnel (saving us a two-hour climb) and emerged into the sunshine. It is time for our first break of the day, which we generally take every seven kilometres or so, or roughly every hour and a half. We lay down our packs and stretch our leg and back muscles (essential in helping prevent injuries).

Crossing a river gorge in the southwestern municipality of Chongqing. Photo: Rob Lilwall We also eat as many cheap biscuits as possible, and check our smartphone map for our location.

An old lady comes over to say hello. She has a strong accent which we barely understand, but she is patient and smiles a lot. She picks up my walking poles and Leon shows her what they are for. She chuckles to herself walking up and down the road with them.

1pm We have almost descended the mountain on a series of little paths which cut through steep farmers’ fields and villages, and across driedout streambeds. This saves us the long distances of walking on the road’s switchbacks. Occasionally, a village dog starts yapping; but Chinese dogs haven’t yet come close to biting us, and they back off if we wave a hiking pole at them.

We stop at a village shop to buy some water and biscuits. A crowd gathers and a teenage girl shyly practises her English, before the

crowd joins in to explain the best shortcut down the mountain.

3pm We enter the “slog” part of the day, in which our bodies are tired and our feet are sore. But we still have a long way to go to reach the day’s target, and so we press on. To help time pass, we talk about various things. Some are practical, such as route options; others are more trivial – like why Al Pacino so rarely makes a decent film

To help time pass, we talk about various things. Some are practical, such as route options; others are more trivial

these days. After a while we plug in our digital music players to listen to music and audiobooks. The road is winding around a series of spurs and up yet another spectacular valley.

and his friend ask us lots of the usual questions about what we are doing.

7.30pm The day has waned, the slow moon is climbing and it is now dark, but we still have about an hour of walking left. We are on autopilot – putting one (very sore) foot in front of the other. Really, all I am looking forward to is finding a place to sleep.

10.10pm I put on the various camera batteries to charge, set the alarm clock and am ready to sleep. I aim for at least 8½ hours each night at the moment, as the walking is exhausting.

Tonight, I am late to bed, but the day went well. We saw yet another beautiful segment of China and met some great people. Hopefully, tonight’s sleep will give me the strength to do it all again tomorrow.

9.30pm We have made it to the town. We find a ludian (family roadhouse with a couple of beds and a television) for 40 yuan (HK$50), put down our bags and venture downstairs, where the host’s wife serves us a mild vegetable and pork hotpot. On the wall is a poster of Mao Zedong wandering around a paradise-like garden wearing a garish coat; the TV is on loudly in the background; our host

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 being filmed for another National Geographic series, and is in support of the children’s charity Viva. walkinghomefrommongolia.com

EAT SMART

Make room for mushrooms, the healthy meat alternative ......................................................

Jeanette Wang jeanette.wang@scmp.com With a strong woody aroma and flavourful meaty taste, tea tree mushrooms – also known as willow mushrooms – can help to silence those carnivorous cravings if you’ve just started out on a vegetarian diet.

This recipe by Light Vegetarian Restaurant in Jordan combines many different vegetables for a dish that offers a wide range of nutrients.

“Capsicums provide vitamin C, while asparagus is rich in folic acid and beta-carotene. Both carry antioxidative power,” says

Kathleen Yau, an executive committee member of the Hong Kong Nutrition Association.

“In addition, mushrooms are rich in dietary fibre and lotus root contains carbohydrates.”

1 tsp salt Starch mixed with a little water

Stir-fried tree mushroom with lotus and asparagus Serves 4

● Slice tea tree mushrooms, lotus root

Handful of dried cloud ears 2 spears asparagus 200g tea tree mushrooms 1 lotus root 1 piece each yellow, red and green capsicum 1 ⁄2 fresh lily bulb 2 tsp olive oil

● Season with salt and thicken with

● Soak cloud ears in water until soft,

then rise and trim. Set aside. ● Rinse remaining vegetables. Peel

asparagus and slice into sections. and capsicum. ● Blanch all vegetables. Heat oil in a wok.

Stir-fry the vegetables. starch and water mixture and serve.

Recipe provided by the Health Department as part of its EatSmart@restaurant.hk campaign.

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

WELL-BEING 11 THE TASTE TEST CEREAL DRINKS PERSONAL BEST

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Jeanette Wang jeanette.wang@scmp.com

Illu str atio n: S are ne Cha n

Reclaim your time and space

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Jacinta Read healthpost@scmp.com Parkinson’s Law states that work expands so as to fill the time available for its completion.

Likewise, clutter expands to fill the space available for its existence.

And so do meaningless, time-wasting, valueless activities.

My ideal financial status will always be beyond my reach. Every now and then, I throw up my hands in despair at the fact that there is just never enough time or space – or money – to create more of the time and space that I think I need before I have the life I really want.

I am tired of feeling like a victim of my circumstances.

I have always been a fan of cliches such as “less is more”, “waste not, want not”, “plan your work and work your plan”, and “a place for everything, and everything it its place”.

This year is the time to delay no more. We all have the same allotment of 24 hours in a day, and this is reason enough to opt for quality over quantity.

Life is too short to waste energy trembling in the face of the to-do list: battling the paper tiger, crying over expired food at the back of the fridge or searching for something to wear in a wardrobe that is bursting at the hinges.

There are too many things I would rather be doing, fun stuff like painting, writing, playing with my children and reading for pleasure.

These desires are different for everyone, but it is a common story we hear too often: simple pleasures being sacrificed on the altar of busyness. I am determined to live intentionally, not so I can squeeze even more in, but so that I can really enjoy what I have today instead of believing the myth that happiness will come only after achieving X, Y and Z. In order to take the stress out of streamlining my life, I am making some little changes that are making a big difference in my life: they are all

about setting limits on things. First, a reality check: are my expectations reasonable?

It is surprisingly easy to swing between extremes in any area of life.

For example, I’ve been fat and lazy all winter, so now I’m going vegan and training for marathons. Or, I’ve been neglecting my creative self, so I am going to quit my job and become a starving artist.

Moderation takes discipline and is usually more successful at standing the test of time. Rather than recklessly throwing myself at my ideals, I am going to take it slowly. Balance is my friend.

Nutrition: I can’t grow my own vegetables and cook all my daily

Clutter creates stress in a way that is sometimes only noticeable by its absence after a big spring clean

Milo with Cereals 5 × 35g for HK$23.50, Market Place

by Jasons A chocolate malt classic with a twist – added cereal for dietary fibre. It’s a filling liquid snack with 141 calories, three grams of fat, 24.5 grams of carbs and four grams of protein.

Verdict: not as sweet as regular Milo (which is a good thing) and has just the right amount of oats so the drink isn’t cloying. meals from scratch, but I can try to use as many fresh, locally grown foods as possible. Home delivery veggie boxes are available in Hong Kong and are a great way to ensure a good amount of the healthy stuff is eaten every single week.

Exercise: before I had children, I enjoyed two-hour workouts at the gym six days a week. This is not an option now, but most days, I can fit a quick workout in, being mindful not to spend too long chatting to friends or resting between sets. I try to walk instead of taking the bus and take the stairs instead of the lift.

Television and internet: I’m not ready to rid television from my life completely, but I have stopped channel surfing and tend to switch off the box after watching whatever show I turned it on for.

I have turned off the push notifications on my phone so that mail only comes in when I say it can. I use the Read It Later app on my iPad so I don’t pander to every online article or site that pops up throughout the day.

Paper: I don’t like my scanner enough to go 100 per cent paperless, but I can sift out the junk mail downstairs at the mailbox to prevent it coming through my door at all. My rule is to touch a piece of paper only once, and it has only three options: the bin, filing cabinet or my purse (to take to the post box or wherever else it needs to go).

Clutter: excess is ugly – figuratively and literally. Clutter creates and perpetuates stress in a way that is sometimes only noticeable by its absence after a big spring clean.

As much as I struggle to admit it, I don’t actually need 28 pairs of shoes.

I don’t need six months of groceries stocked in my kitchen at all times.

My daughter does not need to own every Disney princess doll.

Rather than worrying about the possibility of regretting getting rid of something, I am focusing on the joy of giving excess things to people who do need them – and taking pleasure in the empty space they leave behind once they are gone.

Xongdur Sesame Cereal, Low Sugar 5 × 25g for HK$22, Green Barn Food (tel: 3175 8666) Each sachet of this organic drink from Thailand contains eight wholegrain cereals: pearl barley, lotus seed, mung bean, soya bean, brown rice, millet, maize and hom nil rice.

Verdict: light and enjoyable. The sesame is an interesting addition and makes it taste like a healthier version of the local black sesame paste dessert.

Quaker Instant Oats Drink, Chocolate Flavour 5 × 33g for HK$9.80, Market Place

by Jasons This contains 1.4 grams oatmeal soluble fibre (which may help promote heart health), 4.4 grams dietary fibre (which may help fill you up and decrease risk of obesity) and is high in calcium (330mg per serving).

Verdict: a filling, not-too-sweet drink. The oats sink to the bottom, so you will need a spoon.