20120207 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, FEBRUARY 7, 2012

HEALTH POST AUTISM AND ACUPUNCTURE >PAGE 4

LEARN YOUR CRUST: BREAD MYTHS >PAGE 10

Teaching the body’s immune system to fight cancer >PAGE 6

A shot in the arm

2 NEWS APP OF THE WEEK

QUIZ

Snappy titles make it pure and simple to work it out

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Katie McGregor healthpost@scmp.com Men’s Health Workouts Lite Free Rating 10/10 Men’s Health magazine is a riveting read, even for a woman. The titles alone – “Get in shape and lose that belly” and “Are you tough enough for this workout?” – are fascinating. The tone of the app is equally sensational, with a choice of five workouts, such as “Build New Muscle, Fast”, or the “Spartacus Workout”.

The latter utilises the same techniques that helped the cast of Spartacus: Blood & Sand “drop their body fat into single digits”, and with the “NCAA Abs Workout” you “steal the North Carolina Tar Heels’ abs routine for instant results”.

There is a workout that is bound to be a winner in Hong Kong: the “Crowded Gym” routine.

There are no training videos as there are with most such apps. But the workouts are well documented with step-by-step photos and descriptive text with quick tips.

You are advised as to the number of reps and sets you should be doing.

You can set a timer, and “log a set”, so you can build up a history of your workouts. You can also select workouts from an alphabetical listing or by body part.

Users are encouraged to choose a workout to achieve your desired goal – for example, building new muscle. There is no shortage of exercises to choose from, and that keeps the app interesting.

For example, for the vanity muscle, the abs, there are 15 different exercises to select. If you do get bored, you can always click to upgrade for US$1.99 to the full version, which has 25 workouts and 165 exercises.

Although I am impressed, I realise that I am not the target market for this app. So I asked a friend who regularly bench presses more than his body weight in the gym for his critique.

As expected, he approached his task with the cynicism of someone who knows his way around a gym.

But even he came back impressed.

“There’s something for everyone, whatever you want to achieve,” he said. “And it’s free.”

Jeanette Wang jeanette.wang@scmp.com Cardiovascular disease (CVD), the number one killer globally, is not about to take a break. An estimated 17.3 million people died from it in 2008; by 2030, the World Health Organisation predicts, the toll will rise to 23.6 million.

Experts speaking at last month’s Asia Cardiocare Summit in Hong Kong warned of an impending heart health “crisis” in Asia, in large part due to the rising prevalence of typetwo diabetes and other interrelated risk factors.

“Diabetes is the single most important risk factor of CVD,” says Dr Francis Chow Chun-chung, head of the Chinese University’s division of endocrinology and diabetes, and executive councillor of the Asia Diabetes Foundation.

CVDs are a group of disorders of the heart and blood vessels, and of these, coronary heart disease and stroke are the leading causes of death. Research shows that having diabetes almost doubles one’s risk of developing CVD, which accounts for up to 70 to 80 per cent of deaths in people with type-two diabetes.

In the past two to three decades, an upward trend of diabetes has been seen across Asian countries, according to Chow. Dr David Waters, emeritus professor in the department of medicine at the University of California, San Francisco, says the biggest jump in diabetes figures will be in Southeast Asia – from 22 million in 2000 to 38 million by 2030.

Apart from diabetes, the modifiable risk factors of CVD include high cholesterol,

high blood pressure, obesity, physical inactivity and smoking.

“To reduce this burden of CV morbidity and mortality, we must take an early proactive approach towards lowering total CV risks through lifestyle changes and early identification of multiple interrelated risk factors,” Chow says.

How much do you know about heart disease and diabetes? Test yourself here.

1. World Health Organisation figures show what percentage of global deaths were due to CVD in 2008? a. 20 per cent b. 25 per cent c. 30 per cent 2. According to the Centre for Health Protection, what was the percentage of deaths by CVD in Hong Kong in 2009?

A: As long as the symptoms are not severe and can be controlled with or without medication, exercise is safe for people with asthma. Activity is a common trigger and many people, especially endurance athletes, suffer from “exercise-induced” asthma (EIA). EIA can be diagnosed with a drop in forced expiratory volume of approximately 10 to 15 per cent after a six- to eight-minute exercise challenge and a positive response to B2-agonist medication. It is typically advised that athletes with EIA use their inhaler (puffer) 20 minutes before exercise to see if this decreases symptoms. A

physician should be able to recommend how to optimise medications to reduce symptoms.

Swimming has been shown to be helpful, as the humidity of air around water is easier on hyper-reactive airways. Athletes may have fewer symptoms when they engage in water sports compared to land sports.

Asthmatics should use appropriate medications, such as inhaled B2 agonists, leukotriene inhibitors, inhaled cromolyn sodium and/or inhaled corticosteroids for optimal control.

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, spring 2008 newsletter

> 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

4. Statistics show that CVDs are killing people at a younger age in Asia.

In the rest of the world, 16 per cent of deaths occur before the age of 60.

In Asia, the rate is: a. 18 per cent b. 22 per cent c. 27 per cent Answers: 1. c; 2. b (CVD is the second leading cause of death in HK behind cancer); 3. a; 4. c

How paying cash will help you kick the junk food habit Ellen Warren

Q: My eight-year-old son has bad asthma and experiences some wheezing when he exercises. Is it safe for him to exercise? I heard swimming is better for patients with asthma.

3. A Chinese University study tracked 6,830 diabetes patients for 10 years.

How many developed serious complications (cancer, CVD, end-stage renal disease) within five years? a. 1 in 4 b. 1 in 6 c. 1 in 8

EATING WELL

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ASK THE DOCTORS DR ANTHONY LUKE

a. 10.2 per cent b. 15.6 per cent c. 18.1 per cent

We all know that junk food is bad for you. It’s devoid of calories, packs on the pounds and is awfully, almost impossibly, hard to resist.

It turns out, however, that you’ll buy less junk food if you put away your credit (or debit) card and always pay cash. That’s the finding of a recent Cornell University study published in the Journal of Consumer Research.

Unhealthy foods are impulse

buys, says study author Manoj Thomas, an assistant professor of marketing at Cornell. “The pain of paying in cash can curb impulsive urges to purchase such unhealthy food products,” he writes.

We buy fewer of these “vice” foods if we’re paying with real money instead of plastic.

“When you pay in cash, there is something that makes you feel bad – to part with money,” says Thomas.

And the study shows that “when you feel bad about paying with cash, you start paying more attention to the health qualities of your choices.

You start asking yourself, ‘Is this healthy? Should I be buying it?’”

Participants in one shopping test bought 42 per cent more junk food (US$14) when they paid with a credit card than those paying in cash (US$9.89). The method of payment didn’t make a difference to healthy groceries. Both the credit and cash groups spent about US$17.50 on products such as oatmeal and fat-free yogurt.

Thomas isn’t suggesting that everyone should stop using credit cards to buy food. But for people who have trouble resisting junk food, “going to the bank and getting cash might be worth it”.

McClatchy-Tribune

NEWS 3 PREVENTION

HEALTH BITES

Caught the flu? Don’t forget your manners

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Jeanette Wang jeanette.wang@scmp.com Milk it for what it’s worth Whether in a latte, smoothie or with cereal, drinking at least one glass of milk a day could boost brain and mental performance. A recent study by University of Maine researchers tracked the milk consumption habits of more than 900 men and women aged 23 to 98, and put the participants through a series of brain tests – including visual-spatial, verbal and working memory tests. Those who drank at least one glass of milk each day were found to have an advantage.

Those with the highest intake of milk and milk products scored highest, regardless of age and other lifestyle and diet factors that can affect brain health.

In fact, milk drinkers tended to have healthier diets overall. The study was published in the International Dairy Journal.

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Jane Glenn Haas

How to commit social suicide It’s a potentially great way for people to strengthen relationships, but a new study reveals that Facebook isn’t such a good thing for those with low self-esteem. Such people seem to behave counterproductively, bombarding friends with negative titbits about their lives and making themselves less likeable, according to the study, to be published in the journal Psychological Science.

In their study, the University of Waterloo researchers asked students for their last 10 status updates; each set was then rated for how positive or negative it was. “Coders” – undergraduate Facebook users not friends with the participants – rated how much they liked the person who wrote them. People with low self-esteem were more negative than people with high self-esteem – and the coders liked them less.

We can work it out What does being committed to your marriage really mean? Psychologists from University of California, Los Angeles, who tracked 172 married couples over the first 11 years of marriage, found there are two meanings: “I like this relationship and I’m committed to it” and “I’m committed to doing what it takes to make this relationship work.” Of the couples studied, 78.5 per cent were still married after 11 years and 21.5 per cent were divorced. Those in which both people were willing to make sacrifices for the sake of the marriage were more effective at solving their problems, and significantly more likely to have lasting and happy marriages, say the researchers. They recommend against “bank-account relationships”, in which you keep score of how often you get your way and how often you compromise. The research is published online in the Journal of Personality and Social Psychology.

Diet drinks a health fizzer They may seem like healthier alternatives, but calorie-free soft drinks have been linked with an increased risk of vascular events such as stroke, heart attack and vascular death, in a new study published online in the Journal of General Internal Medicine. In contrast, regular soft drink consumption and a more moderate intake of diet soft drinks did not appear to have the same link.

The researchers from the University of Miami and Columbia University analysed data from 2,564 people – their soft drink (diet and regular) consumption habits and the number of vascular events over a 10-year period. Those who drank diet soft drinks daily were 43 per cent more likely to have suffered a vascular event than those who drank none, after taking into account pre-existing vascular conditions such as metabolic syndrome, diabetes and high blood pressure. However, the researchers say further research is necessary before any conclusions can be drawn on the effects of sugar-free drink consumption.

Don’t laugh – there is a socially proper way to have the flu. Anna Post, great-great-granddaughter of the doyen of proper etiquette, Emily Post, has written the ground rules for flu etiquette.

According to the Health Department’s Centre for Health Protection, Hong Kong has entered the winter flu peak season.

Often passed off as a common cold, flu can cause medical complications, especially among the elderly, young children and those with chronic medical conditions.

“Don’t be that guy who spreads the flu to family, friends or colleagues,” Post says. Too many people “go about their daily business instead of taking care of themselves – which also takes care of others,” she adds. “This is inconsiderate, but we see it a lot – especially in this economy. People are not putting their own health first, and they don’t care about anyone else.”

In the workplace: if you have flu symptoms at work, let your boss

know right away that you need to go to the doctor. Just say: “I don’t feel well. I think I might have the flu.”

Better to have others pitch in at the office than risk them falling ill.

In social situations: normally it would be rude to cancel on a dinner party or a big event at the last minute, but if you’re sick, call with your regrets and go to see a doctor.

Air travel: it’s tough to point out someone’s behaviour mid-flight, but flu is highly contagious. If there’s no other seat available, try saying, “I can see you’re not feeling well. Would you mind covering your mouth when you cough? Thanks.” Most people will do the right thing.

When she flies, Post takes extra tissues and an alcohol-based hand sanitiser. If she sits next to “that guy”, she asks him to use the items.

Post’s tips are available at flufacts.com. She is part of the “Are You That Guy?” flu campaign developed in collaboration with the US National Foundation for Infectious Diseases.

The campaign also urges those with flu symptoms to see a doctor.

McClatchy-Tribune

4 MEDICAL TCM

A case ......................................................

Elizabeth Snouffer healthpost@scmp.com

Brenda Yau, with her son Warren Yip, is among a growing number of parents who are trying acupuncture for their autistic children. Photo: Dickson Lee

CASE HISTORY

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Wynnie Chan healthpost@scmp.com Chan Kwok-ching, 36, has had repeated bouts of intense vaginal itching and soreness for the past two years. Each episode has been being accompanied by a burning sensation around her vaginal opening when going to the toilet as well as a thick white cottage cheeselike vaginal discharge and genital swelling.

Chan (whose name has been changed for patient confidentiality reasons) was diagnosed with recurrent vulvovaginal candidiasis, a condition typically found in menstruating women and commonly known as a vaginal yeast infection, or thrush.

“During a lifetime, 75 per cent of all women are likely to have at least one vaginal infection, and up to 45 per cent have two or more,” says Ho Pak-chung, chair professor of obstetrics and gynaecology at University of Hong Kong.

Vaginal yeast infections are typically caused by a fungus called Candida albicans. Trace amounts of

The practitioner said that my kidney and spleen were weak and my liver meridian wasn’t working properly CHAN KWOK-CHING

the fungus are normally found in the mouth, on the skin, and inside the vagina and the intestinal tract. Yeast thrives in moist and warm environments, but the acidic environment of the vagina usually helps to prevent an overgrowth of yeast. If the vagina becomes less acidic, for example during menstruation or pregnancy, or with the use of contraceptive pills or antibiotics, an overgrowth of yeast can then cause a vaginal infection.

After Chan’s initial diagnosis was confirmed by microscopic analysis and culture of a sample of cells taken from the vagina, she was treated with a single dose of an antifungal intravaginal pessary (a specially shaped lump of medication that’s inserted into the vagina like a tampon) and a topical antifungal cream.

Since then, she has been plagued by monthly episodes of vaginal itching and burning. Her symptoms have been so debilitating that Chan shies away from her friends. “The discharge is really bad; the stench is so awful I can smell it myself,” she says. “I don’t want my friends to notice. It’s so embarrassing.”

Illustration: Angela Ho

Path of yeast resistance

Baptist University’s School of Chinese Medicine opened a privately financed speciality clinic in December in the Tsim Sha Tsui Kai Fong Welfare Association Building on Nathan Road. It features a “Children Autism Treatment Zone” – a place where children get weekly acupuncture treatments.

The zone has been placed in a far corner of the clinic with soundproofed walls.

“Some children get upset when the needles are inserted, and there can be a lot of noise,” says acupuncture specialist Lau Chi-ling, one of the clinic’s Chinese medicine practitioners.

A young patient sits for 30 to 60 minutes with needles inserted in their head, neck, jaw, hands and feet.

The treatment rooms, furnished with a television, sofa, table and books, are designed to distract and entertain them while they wait for the process to take effect.

Warren Yip Hun-yun, 13, is treated there once a month by Dr Peng Zeng-fu, director of the autism

MEDICAL 5

in point for autism zone and a senior lecturer with the clinical division of the School of Chinese Medicine. Yip has been getting acupuncture therapy since being diagnosed with autism spectrum disorder (ASD) at age four.

After the first eight months of acupuncture in the head and tongue, along with regular appointments with a speech therapist, he could speak a complete sentence.

“Acupuncture works for many of my patients. Their speech improves and they are much calmer,” says Peng. Autism is a developmental disorder that appears in the first three years of life and affects the normal development of social and communication skills.

Different people with autism can have very different symptoms, so health care providers think of autism as a “spectrum” disorder. There is no known cause for autism, although there is strong scientific evidence that genetics may be a factor.

Peng believes acupuncture works for autism because the stimulation of the heart meridian – which starts from the heart and branches into the eyes (including the tongue), small intestine and little finger on the left hand – has an effect on brain activity.

For a time, she tried to wash the area as often as possible, scrubbing with soap and using sprays and douches many times a day.

Unfortunately, this made things worse. “When I told my doctor, she said that excessive washing changed the alkaline levels [in my vagina] and made the yeast grow out of control.”

Chan was advised not to wear synthetic knickers, tights or tightfitting trousers, since they trap moisture and promote the growth of yeast.

Following her initial bout of thrush, each episode was treated as it occurred, until last month when her doctor decided to use more aggressive tactics. Chan was prescribed a seven-day course of anti-fungal suppository (bulletshaped medication inserted into the vagina), followed by an oral antifungal medicine once a week for six months.

Worried that the oral medication could cause headaches, nausea and possibly liver disease as side effects, Chan recently started seeing a practitioner in traditional Chinese medicine. “The practitioner said that my kidney and spleen were

Many treatments are reported to be effective, but the vast majority are ineffective TOBY MOUNTJOY, AUTISM PARTNERSHIP

“The ability to control emotion and improve speech patterns is related to the heart system,” he says.

Some patients do see results after a few sessions, but others never do.

Hong Kong resident John Greene decided to try tongue acupuncture on his autistic six-year-old son after seeing positive results from a 2003 study by Professor Virginia Wong Chun-nei of the University of Hong Kong’s department of paediatrics and adolescent medicine. The study stated that acupuncture therapy had demonstrated improvement in core features (language, social communication and cognition) and secondary features (hyperactivity,

weak and that my liver meridian wasn’t working properly. This was the reason why I had toxic damp heat making the yeast grow out of control.”

Chan was prescribed herbal decoctions and now has regular acupuncture to clear excess damp heat and rebalance her body. She was told to avoid dairy products, spicy or greasy foods, sugar and alcohol because yeast feeds on these kinds of foods. Instead, she has to include winter melon, radish, gingko nuts, chives and lotus seeds in her cooking; the practitioner said it would help get rid of dampness and strengthen her spleen and kidney.

In addition to trying Chinese medicine, Chan now takes a probiotic supplement containing the friendly bacteria Lactobacillus acidophilus that is said to be able to control yeast overgrowth – a tip she picked up on the internet.

“I’m crossing my fingers that all of these treatments work,” she says.

“I want to have my life back, see my friends, go shopping and swimming, and not have to dread waiting for the thrush to come back.”

attention, aggression, temper tantrum, sleep and functional independence).

A Chinese medicine specialist at a clinic in Central recommended that Greene’s son have acupuncture twice a day for 60 sessions. There was no progress in the boy’s condition.

“As with so many other treatments, tongue acupuncture did not appear to work for our son,” Greene says.

Peng admits experts don’t know why acupuncture works for some patients and not others. But this doesn’t deter parents from wanting to try the therapy. Peng says his waiting list for new autistic patients aged from two to 14 years old is in the hundreds, and it takes about a year to get a place.

Patients at the autism zone require about 30 to 40 needles per session. More than half are inserted into the head. Each session costs about HK$300, and it’s recommended that patients go through six to 12 months of treatment, starting with twice weekly appointments.

Yip’s mother, Brenda Yau Soming, says her son has symptoms

such as insomnia and anxiety, and that “without acupuncture treatment, he can’t sleep”.

She says that acupuncture is effective and “reasonably affordable” compared with other therapies such as speech, applied behaviour analysis and sensory integration therapies, which cost as much as HK$800 per session.

A close friend recommended the treatment, and Yau took months to overcome her fear of it for her son.

Initially, the boy was afraid and had to be held down while the needles were inserted. Now he doesn’t fight it. “We think he understands that acupuncture helps, because if he didn’t want it, we probably couldn’t hold him down now,” Yau says.

Autism is on the rise, according to statistics from the Health Department. The number of new cases rose from 1,023 in 2008 to 1,790 in 2010, or 75 per cent. Last April, Food and Health Secretary Dr York Chow Yat-ngok estimated there were 70,000 autism patients in Hong Kong.

Dr Ronald Leaf – co-director of Autism Partnership, a global agency dedicated to the behavioural treatment of autism – says:

“Tragically, in autism many treatments are reported to be effective, but the vast majority are ineffective.”

Toby Mountjoy, associate director of Autism Partnership, adds: “Hopeful parents will invest money in all kinds of treatments and will do them in conjunction with others – three or four at a time. This makes it very difficult to know what is actually working for the child.”

HKU’s Wong says there are many claims from therapists of complementary and alternative medicine of curing autism, but there is little scientific proof.

In April last year, her team of researchers published a study review to determine the effectiveness of acupuncture in ASD patients in improving core autistic features.

The study included a review of 10 trials involving a total of 390 children aged between three and 18 years.

The researchers found no evidence that any form of acupuncture is effective in the treatment of ASD. But Wong says they also couldn’t rule out that “certain forms of acupuncture might ameliorate certain aspects of ASD in some patients”.

6 COVER STORY

Recent advances in cancer vaccines offer hope to millions of sufferers worldwide, writes Elaine Yau

H

e seemed to be doing everything right for a healthy life: he did not drink or smoke, and had been running and swimming every day for the past decade. But Lai, 46, a policeman, was diagnosed with first-stage nasopharyngeal cancer in 2006.

The next two months of radiotherapy went well, destroying all his cancer cells. But seeing people around him suffer a relapse after successful treatment, Lai is worried the cancer will strike again.

“A colleague of mine got his nasopharyngeal cancer successfully treated in 2006, but it spread to his lungs in 2011,” he says.

But recent advances in cancer vaccines provide hope for Lai and millions of other sufferers worldwide. Immunotherapy, in particular, holds promise.

Oncology experts are manipulating cancer-causing viruses to develop vaccines that trigger the immune system to attack cancerous cells.

Globally, a host of cancer vaccines are in the pipeline.

According to a University of Michigan Health System report published in November, the types of cancer with the highest number of active clinical trials worldwide last year were melanoma (40), breast (34), lung (30), prostate (22) and brain (20). Unlike common vaccines for diseases such as polio and measles, which are given to healthy people for lifelong immunity, these vaccines are for those already afflicted with cancer.

Professor Anthony Chan Takcheung, director of the Hong Kong

Testing (clinical trials worldwide in 2011) • 40 melanoma • 34 breast cancer • 30 lung cancer • 22 prostate cancer

Cancer researchers Dr Janice Tsang (left), Professor Dora Kwong and Professor John Nicholls. Main picture: Anthony Chan, professor of clinical oncology, Prince of Wales Hospital. Photos: Dickson Lee, Edmond So

Cancer Institute and the Sir Y.K. Pao Centre for Cancer at Chinese University, is at the forefront of research on using the Epstein-Barr virus (EBV) to treat nasopharyngeal cancer, which strikes 1,000 new victims every year in Hong Kong.

“EBV has been identified for more than 40 years. There are many investigations into its role in causing cancer, but not much has been done on the use of the virus itself as a therapeutic target,” Chan says. The University of Birmingham in Britain is also doing EBV research, but it’s for a vaccine for various types of lymphoma, such as Hodgkin’s disease.

Last year, Chan’s team recruited 18 patients – including Lai – for the first phase of a clinical trial. All the patients had early-stage nasopharyngeal cancer that had yet to metastasise or spread to other parts of the body.

They had completed radiotherapy and chemotherapy.

Antigens that swarm on the surface of EBV cells were extracted and put into the vaccine, which was then injected into the patient’s body. The flood of antigens triggers the immune system to sound the alarm, rousing T-cells (a type of white blood cells that plays a central role in the body’s immune system) to zoom in on the antigens and attack the tumour.

Each patient was given three vaccine shots – one every three weeks. “With no serious side effects observed in the patients, the vaccine has been shown to be safe,” Chan says. Results of the clinical trial were presented at the American Society of Clinical Oncology’s annual meeting in Chicago in June. Immunotherapy is almost an opposite approach to traditional cancer treatments such as chemotherapy and radiotherapy, which kill cancer cells but also weaken the immune system, Chan says.

An added advantage of cancer

Figh chan

hting nce

COVER STORY 7

vaccines is they’re mostly free of side effects, such as hair loss, mouth ulcers and skin rashes, which are often seen with traditional treatments.

A phase-two clinical trial by University of Strasbourg researchers in France, which was published in October in The Lancet Oncology, showed that combining standard platinumbased chemotherapy with the new cancer vaccine TG4010 enhances the effect of chemotherapy and slows down the progression of advanced non-small-cell-lung cancer, the most common type of lung cancer, compared with chemotherapy alone.

In another study last year, researchers at the National Cancer Institute in the US found that a vaccine with tumour-associated antigens slowed cancer disease progression by a few months in some of the 26 female study participants with metastatic breast or ovarian cancer.

Provenge, the first tumour vaccine approved by the US Food and Drug Administration in 2010 to treat prostate cancer, targets an antigen called prostatic acid phosphatase, which is found in about 95 per cent of prostate cancers. It was found to extend life in cancer patients for around four months with very few side effects.

Professor Tony Mok Shu-kam, a specialist in lung cancer treatment from Chinese University’s clinical oncology department, says major breakthroughs have been seen in cancer vaccine research that involve an antigen known as MAGE-A3, which occurs in 30 per cent to 40 per cent of lung cancer cases. “The vaccine is under investigation,” he says.

“About 2,200 patients with early-stage lung cancer are randomised to receive the vaccine or a placebo after chemotherapy or standard surgeries.”

Chan has just begun the second phase of his research, recruiting patients with metastatic nasopharyngeal cancer – stage-two cancer that has spread to other

The Epstein-Barr virus has been identified for more than 40 years, but not much has been done on its use as a therapeutic target PROFESSOR ANTHONY CHAN

organs such as the lungs and liver – to see whether the vaccine is effective in shrinking the cancer.

He says more than 90 per cent of nasopharyngeal cancer patients, including those at very advanced stages, can have their primary tumours eradicated after about two to three months of traditional treatments such as chemotherapy and radiotherapy.

But two to three years later, 30 per cent of these patients will relapse, with the cancer spreading to other parts of the body.

“Treatment for metastatic disease is palliative in nature, and in general it’s impossible to cure the disease at this stage,” Chan says. “Metastasis in such cases is caused by residual cancer cells.

“The reason for metastasis to afflict the 30 per cent of patients while sparing the 70 per cent must have something to do with the immune system.”

The University of Hong Kong’s faculty of medicine, working with the Queensland Institute of Medical Research in Australia, is also researching immunotherapy for nasopharyngeal cancer. Called adoptive immunotherapy, it involves harvesting T-cells from a patient’s blood and exposing them in vitro to EBV antigens that have been linked together to form polyepitopes. (An epitope is the part of an antigen that is recognised by the immune system.)

The T-cells are then injected back into the patient to trigger the body’s immune response.

Between August 2008 and April

2010, 14 metastatic patients with stage-four cancer received the T-cell injections once every two weeks. A total of three to eight vials of T-cells were administered.

The patients survived for an average of 17 months after treatment, compared with 10 months for other nasopharyngeal cancer patients in similar condition and treated during the same period by the university.

John Nicholls, clinical professor with HKU’s department of pathology, says this type of immunotherapy was first used overseas in the early 2000s for a tumour associated with EBV that afflicts bone marrow or liver transplant patients – but HKU is the first to use it for nasopharyngeal cancer.

How long until a vaccine is developed? Chan declines to give a time frame, saying it depends on many factors. But history shows that it usually takes at least eight years for a cancer drug to go through four stages of clinical trials before it is approved by the government for treatment.

Not all cancers are caused by viruses, but those that are tend to present a window of opportunity for researchers, says Professor Dora Kwong Lai-wan, head of HKU’s clinical oncology department.

Apart from nasopharyngeal cancer and lymphoma, these include liver cancer and cervical cancer.

With the cervical cancer vaccine now used to prevent human papillomavirus infection among young women, she says scientists are tinkering with the concept of a preventative EBV vaccine, although there are no clinical trials yet.

Mok says vaccine treatment is still experimental. But large tumours are unlikely to respond to vaccines because of their sheer size.

“There is only so much killing the immune system can do,” he says.

But there’s no doubt this is an exciting time for immunotherapy research. Says Kwong: “It opens new doorways, allowing us to see whether we can fight cancer by strengthening our own immunity.” elaine.yau@scmp.com

8 FITNESS BUFFING UP FOR THE BIG DAY WEEK 1

My bridal bootcamp ......................................................

Jeanette Wang Jeanette.wang@scmp.com In his glory days, not so long ago, Chalothorn Vashirakovit was a Lycra-clad road racer with nary an ounce of fat on his 1.75-metre frame. Then life – as many of us know it – happened in 2007: work stress, lack of time, good food and the irresistible draw of social outings.

The bike rides ground to a halt.

Since then, Chalothorn, 30, has gone from 68kg of mostly muscle to 74.3kg and a lot more fat. By Asian standards, his body mass index of 24.3 puts him, according to the World Health Organisation, in the “moderate to high risk” category of an undesirable state of health.

“When I started having breathing problems or my clothes wouldn’t fit I would go back to the gym again [but it would only last] for two months,” says the Thailand-born investment associate with a global investment firm, who moved to Hong Kong from Singapore last year.

“Then, after losing 2kg or 3kg, I’d stop going and put the weight back on again.”

This has created something of a wardrobe problem, particularly with office wear. Chalothorn says he can no longer fasten the top button of his dress shirts, and that with a 5cm wider waistline, squeezing into work trousers has become problematic.

Still, he hadn’t felt a pressing need to work out, eat more healthily and lose weight. Until now. With an impending wedding in six weeks, Chalothorn is determined to look his best for the big day. His goal: “I want to be lean and to lose 5kg.”

To help him achieve this, Health Post has teamed up with Pure

Chalothorn is highly motivated, he’s on the right track and has made a strong start MATTHEW HA (ABOVE), PERSONAL TRAINER

Fitness to put Chalothorn through a six-week exercise programme, working out four times a week at the Admiralty branch under personal trainer Matthew Ha and boxing coach Jimmy Leung.

The first session two Fridays ago was easy enough. As with all new clients at Pure Fitness, Chalothorn had to complete a questionnaire on his general health and exercise history and habits, and personal targets and goals.

He then went through a body composition assessment that not only analyses key fitness parameters such as strength, flexibility and body fat, but also calculates his so-called body age.

The result: his body is 27 years old, “but you can be even younger – about 23”, says Ha. Lowering his body fat percentage from 19.69 – measured through the pinch test – to 14 per cent and below will slash off two years. Boosting flexibility – improving his sit and reach test score from 31.7 centimetres to at least 38.2 – would cut another two years.

Other areas to work on are abdominal strength (he managed 34 crunches in 60 seconds; the ideal is a minimum of 53) and muscle endurance (he held the squat with back against the wall for 71 seconds; the ideal is at least 121 seconds). He did perform well in one test: his bicep strength was considered “elite”.

Based on these findings, Ha and Leung have devised a fitness programme for Chalothorn.

The first week focuses on circuit training to work the cardiovascular system and promote effective fat burning, particularly around the abdomen. The training will also lay the foundation for the upcoming Bulgarian Bag workout, a relatively

advanced exercise tool for developing power, strength and muscle endurance.

Chalothorn did three sets of a series of between nine and 12 exercises – using body weight, free weights or the weight machine as resistance – that worked the body from head to toe.

“The programme is certainly a good check on how unfit I am,” says Chalothorn.

“After the first session, I was exhausted and my body was aching. It gradually adjusted and I felt better at the following sessions, but there’s still much work to be done.”

Though physical changes are not apparent yet, he says he feels mentally refreshed. “[He has] good cardiovascular fitness, thanks to his background in cycling,” says Ha. “But he needs more abdominal and core work, as well as general weight training.”

Chalothorn’s diet is also set for a makeover. He typically skips breakfast, declaring it “a waste of time”, has roast meats with rice for lunch, and finishes off with a big dinner because “I work long hours and by that time, I am so hungry”.

Vegetables and fruit don’t get much of a look in.

Ha advises reversing his diet – starting the day with a good breakfast and ending with a smaller, carbohydrate-free dinner with a balance of protein and vegetables. “Chalothorn is highly motivated,” says Ha, “he’s on the right track and has made a strong start.”

So what keeps Chalothorn going, when it starts to hurt?

“The first thing is wanting to be in better shape for the wedding,” he says, “and the second – and almost equally important reason – is the fact that my progress is being published here.”

Health Post will chart the progress of Chalothorn Vashirakovit (top) who hopes to lose 5kg in time for his wedding in six weeks. Photo: May Tse

SWEAT

App lets you find cache on treasure hunt ......................................................

Matt McNab Want to spice up your hiking experience? Looking for something more interesting than going for a run, but with the same amount of exercise? Try Geocaching (www.geocaching.com), a modernday treasure hunt that uses GPS co-ordinates for directions and locations of hidden caches.

The premise is simple: find the cache, sign your name and either leave or swap a small item for one from one of the site’s five million users. The domain has listings for more than 1.6 million geocaches worldwide, including Hong Kong, located in almost every environment imagineable.

It’s free to register and use the website, but it does offer a US$30 a year premium membership. For casual users, this membership isn’t necessary, as the majority of the geocaches’ locations are available free of charge. For an avid user or frequent traveller, the premium content is a must-buy.

A premium membership allows the user to filter the website’s maps and gives you the ability to find geocaches along your planned route. It also gives access to parent company Groundspeak’s two other GPS-related sites, Waymarking and Whereigo.

The site’s most unusual feature offers the ability to place “trackables” – small tokens that can be tracked as they are moved from cache to cache and state to state.

The trackable can either be a “geocoin”, a minted coin of the user’s own design, or a “travel bug”, a small tag that is attached to the item the user wants to track. Travel bugs may be purchased only from the Geocaching site, but geocoins may be minted by a number of third-party manufacturers, all of which are listed on the site.

If you think you need an expensive GPS device to find the caches, fret not: apps are available that turn your smartphone into a GPS device. Geocaching offers a licensed app for US$10, but similar third-party apps are available for free, such as C:Geo Opensource or GeoBeagle, which function similarly to Geocaching’s app to get your hunt rolling.

McClatchy-Tribune

FITNESS/ DIET 9 WALKING HOME

Quick fixes for the walking wounded ......................................................

Rob Lilwall healthpost@scmp.com I’ve biked 50,000 kilometres from Siberia to England, traversed the length of Israel on foot, and walked London’s infamous 290-kilometre ring road in six days. But I’ve never used a medical kit as much as on my current expedition: walking 5,000 kilometres from Mongolia to Hong Kong.

Walking, especially with a heavy backpack, gives your body quite a hammering. In addition, my nutrition intake has been questionable, as I’ve been living on instant noodles and biscuits for three out of four meals. I haven’t been sleeping in the best conditions, either: Mongolian ger, Chinese caves, truck stop roadhouses; and in our tents in deserts, mountains and on the frozen banks of the Yellow River. There have been times when I’ve gone without a shower for two weeks.

Living like this is not conducive to good health, so this is what I have been using in my medical kit: 1. A good blister kit This consists of anti-blister gel, and I lubricate my feet every morning.

Also some plasters and tape, and a bottle of iodine as an antiseptic.

I also use it to disinfect unboiled water. My first big roll of tape is running out, but I’m glad that through a mixture of prevention and early treatment, blisters have yet to really slow me down.

2. Some basic antibiotics Treating water with the iodine, as mentioned above, is key to prevention. But when you are eating in local restaurants and people’s homes, a few bugs are inevitable. I always carry Ciprofloxacin, which has always worked within 24 hours of taking it. But it’s also important to have a proper check-up once I get home. As I discovered after cycling home from Siberia, dysentery can be

Trekking over rough terrain can take a toll on the body; a medical kit for the 5,000km walk. Photos: Rob Lilwall stunned into inactivity, but can continue to live in one’s guts.

Another antibiotic I carry is Doxycycline, which is both a preventative against malaria and can also be used to treat minor infections, such as infected blisters.

3. Anti-inflammatory drugs For sore and swollen joints, I have off-the-shelf ibuprofen and also some stronger drugs recommended by my physiotherapist. I also have ankle and knee supports and bandages, which are handy for inflamed and sore joints.

4. Painkillers These include some general ones such as paracetamol and also the much stronger (but potentially addictive) co-codamol.

5. Plenty of laxatives You may smile, but it’s no joking matter when you are walking across the Gobi for two weeks, and the only sight of a piece of fruit or vegetable you get is on the back of your laptop.

When you get “bunged up” for a few

Laxatives are dangerous things when you are sleeping in a tent and have to head out into the freezing cold to relieve yourself in the middle of the night when they kick in ROB LILWALL

days or more, energy levels go down drastically, and all things in life seem mournful and depressing until you get some relief. That said, laxatives are dangerous things when you are sleeping in a tent and have to head out into the freezing cold to relieve yourself in the middle of the night when they finally kick in.

The only things I haven’t used in the kit are some anti-diarrhoea tablets and some antihistamines. But spring is just around the corner, so the bees and wasps and other stinging things will be out soon. So I have been making good use of my medical kit, which justifies its 500 gram weight in my pack.

As you may not have internet access to do research, it’s important to keep the instructions for medications handy. I usually cut them out and store them in the kit.

It’s also very helpful to have a professional or two whose opinions you really respect, and who you can e-mail or call when you need advice.

Once, while cycling around Australia, having just crossed Papua New Guinea, I came down with a severe fever. The local doctor I saw in Melbourne told me it was the flu. My doctor friend, Aric, in Hong Kong, said it sounded like malaria. I went to the local hospital for a blood test, where they established that indeed it was malaria, and so admitted me and treated me properly.

Aric’s long-distance diagnoses and advice came in handy once again on this trip for a tooth problem.

I had to buy some additional antibiotics, which we were able to get easily at a Chinese chemist.

For other injuries, it’s also worth having a connection to a physiotherapist and podiatrist – in my case Aaron Smith and Douglas Horne respectively, from Sports Performance in Central, who have given me advice by e-mail when I have suffered injuries.

I’m no doctor, however, which is why I suggest you seek professional advice before you pack your bag and head out on your expedition. But don’t forget those laxatives.

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

EAT SMART STEAMED ABALONE

Low salt and no guilt in this shellfish indulgence ......................................................

Jeanette Wang jeanette.wang@scmp.com Abalone is one of the four treasures in Chinese cuisine – along with sea cucumber, fish maw and shark fin – that are believed to not only bring good health, but also fortune, when eaten. So it’s common for this pricey shellfish to grace dining tables during special occasions and festivals.

Low in fat and high in protein, abalone is a good source of selenium, a nutrient with antioxidant properties that protect the body’s cells from damage.

From a Chinese medicine perspective, it’s said to increase appetite and have a positive effect on the immune system, liver and

kidneys. It is also supposed to brighten and heal eyes.

Instead of cooking it in the traditional way by stewing in a thick, salty sauce, this recipe by Megan’s Kitchen restaurant in Wan Chai steams the abalone with just a sprinkling of sugar to bring out its natural flavour.

Each serving contains about 132 calories, six grams of fat, 15 grams of protein and five grams of carbohydrate.

Steamed abalone with ginger and fresh bean curd sheets Serves 4 4 pieces Dalian abalone 160 grams fresh bean curd sticks 5 slices ginger 1 stalk spring onion

1 tsp sugar 2 tsp light soy sauce 2 tsp olive oil • Wash and trim abalone. Set aside.

• Cut fresh bean curd sticks into shorter lengths.

• Shred ginger and spring onion. Rinse.

• Place the bean curd sticks on a plate, and the abalone on top.

• Sprinkle with sugar and steam for 10 minutes.

• Top with shredded ginger and spring onion.

• Pour the pre-heated olive oil over it.

• Serve with light soy sauce on the side.

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

Good health and fortune could be yours with this dish

10 DIET NUTRITION

Half-baked beliefs ......................................................

Elle Kwan healthpost@scmp.com Most people would agree that you can’t live on bread alone. Beyond that, however, there are many points of contention about the staple. We debunk a few of the common myths.

White bread is bad for you Truth: when foods are eaten, the body breaks them down into their components, one of which will be sugar. Different foods break down at different rates. White bread is particularly quick, sending a sudden rush of sugar into the bloodstream. (Such foods are said to have a high glycaemic index.)

Great variations in levels of blood sugar are linked to the risk of old-age diabetes, obesity and cardiovascular diseases. A 2007 study by Lund University in Sweden showed that eating low glycaemic index breakfasts can improve concentration and working memory (a type of short-term memory).

So, in that sense, white bread is bad for you. But if you’ve grown up on it, the grains and chewy texture of a wholegrain loaf may be tough to get used to. If you must eat white bread, check the label and ensure it has as few ingredients as possible, says Katherine Dale, a registered naturopathic doctor. Enriched or fortified breads sound nutritious but those additional vitamins or minerals are chemically added during baking. Many white breads also contain vegetable shortening, which Dale says is very difficult for the body to digest. Ingredients that are named using a combination of letters and numbers are another warning sign: they are preservatives, which extend the shelf life of baked

goods. Dale’s advice: buy fresh bread and freeze it.

Brown is better than white Truth: much of the brownness we associate with wholesome goodness actually comes from added colouring. “It’s a myth that the darker the bread the better it is for you,” says Christine Jonkers, a nutritionist at Super Natural. Bread manufacturers often use brown sugar or caramel to colour bread brown in an effort to make it look healthier. The most nutritious breads are judged not by colour but by flour.

Locate the words “wholegrain flour” on a label. “Wholegrain [bread] has the most fibre, vitamins and minerals,” says Jonkers. Most of the goodness in a grain is found in its shell, which is removed during the refining process that creates white and wheat flour, resulting in less nutritious bread. “Fibre cleans your intestines, which makes you take in more nutrients and gives you a fuller feeling,” says Jonkers.

Danny Ho, executive pastry chef at Hotel Icon in Tsim Sha Tsui. Photo: Edmond So Bread crusts are not nutritious Truth: the crust is, in fact, a rich source of antioxidants and may provide a much stronger health benefit than the rest of the bread, according to a study by German researchers published in the Journal of Agricultural and Food Chemistry in 2002. Using a conventional sourdough mixture containing rye and wheat flour, the researchers found that the process of baking bread produced a novel type of antioxidant, called pronyl-lysine, which was eight times more abundant in the crust than the crumb. The compound was not present in the original flour. In general, dark-coloured breads (such as pumpernickel and wheat) contain

higher amounts of this antioxidant than light-coloured breads, say the researchers.

Bread will make me fat Truth: Dr Atkins and his low-carb, high-protein diet may have propagated this myth. Jonkers says that low-carb diets don’t fulfil bodily requirements in the long term. Eating too much protein can produce toxic waste in the body and tax your kidneys, she says.

In a 2006 case report, experts from the New York University school of medicine describe a life-threatening complication of the Atkins diet in a 40-year-old obese woman who was

Wholegrain [bread] has the most fibre, vitamins and minerals CHRISTINE JONKERS, NUTRITIONIST, SUPER NATURAL

hospitalised for ketoacidosis. The authors state that a low-carb diet can lead to the production of acids (called ketones) in the liver that build up in the blood, leading to the condition.

A low-carb diet has also been linked with constipation and diarrhoea, bad breath, headache and general fatigue.

Strive for balance, says Dale.

Bread spread with peanut butter and banana or flax seed oil with scrambled eggs offer a long-lasting hunger fix with a host of nutritional benefits. “You want to think about balancing out your protein, fat, carbohydrate and omega oils daily,” she says.

RECIPE FOR HEALTH RYE SOURDOUGH

Things you knead to know ......................................................

Elle Kwan healthpost@scmp.com Sourdough is thought to be one of the first leavened breads. The secret ingredient is a “starter” of flour and water that ferments when a lactobacillus bacteria culture is added, and it’s this starter that gives the lightness to the dough. This living culture is fed and preserved for use in successive loaves. Because of this process, sourdough has been found to aid the digestive system and, according to the University of

Guelph in the Canadian province of Ontario, has a lower glycaemic index than other types of bread.

Hotel Icon executive pastry chef Danny Ho shares his recipe for a rye sourdough loaf. Rye is low in saturated fat and higher in potassium and iron than wheat flours, and imparts a nutty richness.

Where you can, use wholegrain flours for maximum health benefits.

Starters can be made, borrowed or bought – but a dry yeast also works well.

Since you will need to let the bread “prove” (or rest) for 12 to 14

Chef Danny Ho makes sourdough (left and right); finished loaves (above right).

Photos: Edmond So

hours, it’s worth starting the process at night and letting the mixture develop while you sleep. You can come back to it in the morning – maybe in time for breakfast.

Recipe (Makes one loaf) 70 grams sourdough starter 400ml water 245 grams rye flour 245 grams bread flour 12 grams salt • Mix the starter with the water.

• In a separate bowl, combine flours and salt. (If you don’t have a starter, mix one teaspoon of instant yeast with the dry ingredients, and combine with the water.)

• Gradually stir dry ingredients into wet with a spoon until the flour is mixed well.

• Cover with plastic wrap and let it rest for 15 minutes.

• Mix again with the spoon for about two minutes.

• Cover and allow to rest for another 15 minutes.

• Mix a final time and then cover it. The mixture should be silky and smooth in texture.

• Allow to rest at room temperature for roughly 12 to 14 hours.

• After proving, the dough should have almost doubled in volume and be spongy and slightly sticky.

• Stretch and fold the dough.

• Shape for baking.

• Cover and let it rest for 15 minutes.

• Put the dough into a proving basket or a bowl lined with a floury kitchen towel, and cover with plastic wrap.

• This final proving should last between one and 1½ hours, until the dough is airy and spongy.

• Sprinkle flour over and score the dough with a sharp knife and bake it in a preheated 240-degree-Celsius oven till the crust turns a deep golden brown.

• Cool before eating.

WELL-BEING 11 ......................................................

P. Ramakrishnan rama.p@scmp.com The rigmarole of a gym is not for everyone. The unpredictability of weather can be a hindrance for those who like to go for a run outside, and team sports are for a chosen few. But anyone can dance at any age and at any time, right? “I suppose,” says Bethany Taylor, an interior design student. “All you need is some great music and some space.”

She started dancing at age four, when her mother took her to baby ballet in Muscat, Oman, and trained at the Emma Tse Elite Dance Academy in Hong Kong for years.

“I’ve tried pretty much every style of dance – ballet, hip hop, contemporary, tap, jazz, salsa, street,” says Taylor, 22. “My favourites are ballet and street dance; one form is strictly disciplined and the other, freestyle. I love how much attitude and fun you can have with street, while ballet is so elegant. And which girl didn’t want to be a ballerina growing up?”

Although dance is a personal and individual experience for her, it’s helped Taylor in her modelling profession, too. “It gives you amazing control over your body, and you know what angles your body looks good at. It also helps with stamina. Shoots are always so long, and you’re usually standing up, so [training for dance] helps to keep you going for long periods of time.”

Three years ago, Taylor opted to go to college in London instead of taking the difficult route of professional dancing. Although she gave up the hard-core discipline of ballet, she’s found other forms of expression through a range of classes at Studiodanz in North Point.

“Classes are mostly taught in Cantonese, but it’s helped me learn faster as I’m not distracted by what’s said and I follow the movement.

I’m forced to concentrate and pick up faster, which has been an excellent form of self-discipline.

And dance is the finest form of motion and discipline.”

What drew you to dance?

Ballet is so beautiful and elegant. It’s really high art. I may not do it much any more, but I still appreciate it.

Now I dance for fun, and it is the most fun way to exercise.

Is there any particular dance you’d like to try?

Zumba – it’s half exercise, half dance, and looks really fun. It’s a

THE TASTE TEST PASTA SAUCE ......................................................

Jeanette Wang jeanette.wang@scmp.com

Lucini Spicy Tuscan Tomato Sauce 720 grams for HK$90, City’super I like my Arrabbiata really spicy.

Although this all-natural, no-sugar-added sauce didn’t quite live up to its “very fiery” promise, it was full of fresh and tangy flavour from vine-ripened plum tomatoes.

Verdict: gives the humble homecooked pasta dish a touch of flavour and class.

FIT AND FAB

Dance in her pants

Dancer Bethany Taylor.

Photo: Sabrina Sikora Photography

concoction of salsa and aerobics.

I’ve been meaning to go, and this year I’ll do it.

What’s your diet like?

Processed food is a definite no, but the word “diet” really puts me off as I don’t believe in dieting. If you eat properly, watch your calories, but don’t deprive yourself, maintain portion control and eat a healthy amount. You don’t need to follow whatever diet is in fashion.

What’s been a memorable dance class?

At Pure Fitness in Central, choreographer Tony Stone [who has worked with stars like Salt-N-Pepa, Falco and LL Cool J] came to teach for a brief session,

and it was a serious dance-off and workout. For three hours we were moving non-stop. It was a good class. He’s in his 50s but is in amazing shape.

What other ways do you stay fit?

Gym about four times a week, which keeps my cardio up. I have regular sessions with a personal trainer, and he’s really tough. The day after our sessions, I hate him – but it’s worth going to. I do my own body conditioning regime at home to keep toned, and go to street dance classes a few times a week at Pineapple Dance Studios [in London] more for fun. There’s no exercise that I hate. I have so much energy and love being active.

All you need is some great music and some space BETHANY TAYLOR, DANCER AND MODEL

Dave’s Gourmet Wild Mushroom Pasta Sauce 723 grams for HK$70, City’super The mushrooms, chopped finely in this sauce (left), are not readily apparent, but in the mouth they create a taste explosion of porcini and shiitake that will jazz up any old pasta lying around in the pantry.

Verdict: thick and bold, it’s worth every cent of its premium price.

Le Ricette di Montanini Bolognese Ragu 190 grams for HK$32, City’super Don’t expect chunky Americansized mince; this sauce (right) is much better than that. The beef and pork mixture is slow cooked until it breaks down and melts into the vegetable base, for a rich sauce that’s great for pasta or lasagne.

Verdict: the perfect portion for a restaurant-standard meal for two.

What’s the secret to looking really lean and toned?

Before a shoot, I cut my carbs and salty foods, and just have proteins and vegetables. And I drink a lot of green tea and water. If hungry during a lengthy shoot, I snack on cashews and bananas.

What’s your favourite health food?

It has to be quinoa; it’s so easy to prepare and so tasty. It fills you up but doesn’t make you bloated, and you can add whatever you like to it.

My favourite combination at the moment is with celery, feta and ham. I’m also a massive fan of making fresh soups. It’s cheap and easy, and you get your daily dose of veggies.