20130101 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, JANUARY 1, 2013

HEALTH POST Although underfunded, local scientific researchers are on the cutting edge

Bright sparks

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HEART RATE VARIABILITY >PAGE 4

HAPPY FOODS FOR WINTER

Illustration: Corbis

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2 NEWS APP OF THE WEEK

HEALTH BITES ......................................................

Fertility at your fingertips ......................................................

Hard to swallow Do you judge a pill by how it looks? Some patients do.

Researchers from Brigham and Women’s Hospital in Boston have found that some patients who receive generic drugs – which are clinically equivalent to the brand name version, but often vary in appearance – are more than 50 per cent more likely to stop taking the drug before they should.

The researchers studied a large national database of patients taking anti-epileptic drugs and found that interruptions in the patients’ use of the drug occurred significantly more frequently when the pills had a different colour. Breaks in anti-epileptic drug use for even a few days can raise the risk of seizures and have important medical and social consequences for patients.

The study was published in the Archives of Internal Medicine.

Katie McGregor healthpost@scmp.com Ladytimer Period and Ovulation Calendar HK$23 Rating 9/10 There are two approaches to getting pregnant: either get on top of the maths to pinpoint your fertile period, or take the “shock and awe” approach and practise baby-making on a daily basis. If you want to take the mathematical approach, then this iPhone app can help.

Fifth download lucky, the app met two important criteria in that it had enough functionality to be useful, yet was easy to use. This contrasted to an earlier download, Fertility Friend, which offered endless stress-inducing options in an ugly, war tank-type interface.

Start by typing in your period cycle and length. If you don’t know, the app promises to work it out for you. Next, enter your last period start and finish date, and you’re off.

The app displays a calendar showing your expected ovulation date, which is estimated to be 12 to 16 days before your period starts.

Your most fertile period is estimated to be the three days preceding ovulation.

Tap the boy/girl baby icon and the calendar changes to show which days are best for making boys, and which for making girls. I am not sure of the science behind this, but it makes the calendar prettier.

So far, the predictions are estimates based around period dates, but a primary fertility sign is the rise in your body temperature, which follows ovulation. Start tracking this using the app to allow it to fine-tune its estimates.

Other options include tracking your mood, physical symptoms, pill usage and the results of an ovulation test (should you take one). You also get to track your sex life, which is discretely indicated on your calendar with a little heart.

The good news is you shouldn’t need the app for too long: for couples who are under the age of 35 and have unprotected sex on a regular basis, statistics show that 85 per cent of women will conceive within one year.

ASK THE DOCTORS DR JACOB CHENG YEN CHUAN Q: My son has developed a habit of squinting both eyes tightly shut. He puts his chin down onto his chest and twitches his head. This lasts for three to five seconds. Some days it is worse than others. Is this just one of those things that come and go or could it be a sign of something more serious?

A: The squinting of both eyes may be due to many problems but the most frequent cause is due to refractive errors. He could be short-sighted (myopic) if he squints to look at something in the distance. This means that he has poor distance vision. He could be far-sighted (hyperopic) if the squinting happens when he is trying to read something

Jeanette Wang jeanette.wang@scmp.com

up close. This means he has poor near vision. If he is squinting to see both far and near distance, he could have astigmatism accompanied with either shortsightedness or far-sightedness.

If you notice your son squinting more often and he has problems following objects, it is best to take him for an eye examination. Other causes can include sensitive eyes, allergies or inward growing eyelashes.

Dr Jacob Cheng Yen Chuan is a specialist in ophthalmology and the medical director of retina services at Eagle Eye Centre at Mount Alvernia Hospital in Singapore

> 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 Printed and published by South China Morning Post Publishers Ltd, Morning Post Centre, 22 Dai Fat Street, Tai Po Industrial Estate, Tai Po, Hong Kong. Tel: 2680 8888

Hope for the breast Breast cancer patients could soon have more treatment options, following a new study that finds a subtype of breast cancer can be changed by manipulating a gene-altering molecule called a transcription factor. Scientists from the Garvan Institute of Medical Research in Sydney have shown in the laboratory how the transcription factor ELF5 causes breast cancer cells to develop an aggressive subtype that lacks sensitivity to oestrogen and does not respond to known antioestrogen therapies. “This raises the therapeutic option of manipulating ELF5 levels to treat breast cancer,” says lead investigator Chris Ormandy. “There is also the possibility of testing ELF5 levels in tumours to predict response to treatment.” The research was published in the journal PLoS Biology.

No gout about it Scientists have identified 18 new genetic variations that increase levels of uric acid in the blood, paving the way for improvements in the treatment and prevention of gout. Gout is the most common form of inflammatory arthritis, affecting up to 2 per cent of the world’s population. It’s caused by high levels of uric acid that form small crystals in joints and tissues, leading to pain and swelling. The study, published in Nature Genetics, is the largest worldwide study on gout. An international team of researchers analysed the genetic data of more than 140,000 people from more than 70 individual studies from Europe, the US, Japan and Australia. “Abnormal levels of uric acid have been associated with various common diseases and conditions, but causal relationships are not always clear,” says Dr Veronique Vitart, from the University of Edinburgh, one of study’s lead authors.

“Gaining insight into the genetic components of uric acid levels offers a very useful tool to tackle these issues and to further our understanding of these conditions.”

Hard-hitting truth Men and women with mental health disorders, across all diagnoses, are more likely to have experienced domestic violence than the general population, according to research published in PLoS ONE. Researchers from King’s College London and the University of Bristol reviewed 41 studies.

Compared to women without problems, women with depressive disorders were 2½ times more likely to have experienced domestic violence, women with anxiety disorders were more than 3½ times more likely and women with post-traumatic stress disorder were around seven times more likely.

HEALTH 3 FROM THE EXPERTS

Life wasn’t meant to be queasy ......................................................

David Tan healthpost@scmp.com Britain’s Catherine, Duchess of Cambridge made headlines recently when news of her pregnancy broke after she was admitted to hospital suffering from acute morning sickness. Morning sickness is an unwelcome side effect that can detract from the joy of pregnancy.

“Nausea and vomiting are one of the most common side effects of early pregnancy, affecting 70 to 80 per cent of all pregnant woman,” says Dr Julia Dresel of the Kandang Kerbau Women’s and Children’s Hospital in Singapore. “The expression ‘morning sickness’ is misleading, since it is not a real sickness, but a feeling of nausea that can last throughout the whole day.”

The degree of nausea and vomiting varies widely between women, and as in the duchess’ case, can be so severe that it warrants a stay in hospital. While severe morning sickness occurs in women carrying both boys and girls, it is commonly associated with women carrying girls or multiple fetuses.

Severe morning sickness, or hyperemesis gravidarum, is defined by the loss of at least 5 per cent of total body weight and affects about one in 200 to 500 pregnant women. Weight loss occurs because of frequent vomiting and the inability to keep down food and liquids, leading to dehydration and malnutrition.

The condition can lead to medical complications and should be rapidly treated with anti-sickness medication and intravenous

hydration. Before the introduction of intravenous treatment in the 1950s, severe morning sickness could prove fatal to both mother and fetus.

One rare complication that can arise is a neurological disorder known as Wernicke’s encephalopathy. This occurs because of a lack of vitamin B1.

Women who are admitted to hospital for severe morning sickness are typically given supplementation of this vitamin and electrolytes through intravenous hydration.

Causes of morning sickness

[Morning sickness] is not a real sickness, but a feeling of nausea that can last the whole day DR JULIA DRESEL, KANDANG KERBAU WOMEN’S AND CHILDREN’S HOSPITAL IN SINGAPORE

remain poorly understood but it is believed that several factors are involved.

One theory points towards high levels of the pregnancy hormone human chorionic gonadotropin that peaks during the first trimester, before falling after week 12. This hormonal change at the early stage of pregnancy coincides with the time when symptoms of morning sickness predominantly appear.

Another hormonal change that happens during pregnancy is a flood of progesterone that causes

relaxation of smooth muscle, which includes the muscles of the digestive tract. Because of this, the passage of food slows down and can lead to nausea and vomiting after a large and heavy meal.

In addition, fatty and strongly flavoured foods are believed to induce feelings of discomfort.

On the other hand, low blood sugar levels, particularly in the morning after a long period without food, can also cause nausea. Some expectant mothers find relief by eating small amounts of food frequently throughout the day and in the morning before rising.

To avoid dehydration, pregnant women are encouraged to drink more fluids. But drinking plain water can become difficult because of changes in their sensation of taste.

Simple alterations such as adding lemon or orange juice to water to make it more palatable or drinking herbal teas are believed to help.

Ginger is a common folk remedy for nausea that is used in Asia.

While not scientifically proven, wristbands that press on the acupuncture point pericardium-6, situated on the underside of the wrist between the two tendons, have been reported to relieve nausea.

Fortunately, while severe morning sickness cases can lead to complications for both mother and fetus, the milder morning sickness experienced by most women is not linked with a higher risk of miscarriage, or with a less robust pregnancy.

David Tan is a research scientist at the A*STAR Institute of Medical Biology, Singapore. He holds a PhD in stem cell biology from the University of Cambridge

The Duchess of Cambridge has focused attention on acute morning sickness. Photo: Reuters

NUTRITION CELEBRITIES’ COOKBOOKS

TV chefs roasted over unhealthy recipes ......................................................

Jeanette Wang jeanette.wang@scmp.com Home-cooked meals made from scratch are said to be beneficial for long-term eating habits rooted in a balanced, healthy diet. A new study, however, finds that recipes created by popular television chefs – a main source of inspiration for many home cooks – don’t contain the most desirable nutritional content.

Published last month on the British Medical Journal website (bmj.com), the study found that the

average television chef recipe contains more protein, fat and saturated fat, and less fibre per portion than own-brand supermarket ready meals (which already have a bad reputation).

The research team, based in an arm of the British National Health Service in Tees, and Newcastle University, randomly selected 100 main meal recipes from five bestselling cookery books and 100 ready meals from three leading British supermarkets.

Recipes were included from Jamie’s 30-Minute Meals and

Ministry of Food by Jamie Oliver, Baking Made Easy by Lorraine Pascale, Kitchen by Nigella Lawson, and River Cottage Every Day by Hugh Fearnley-Whittingstall. Ownbrand ready meals were from Asda, Sainsbury’s and Tesco.

The researchers then compared both types of meals to dietary guidelines published by the World Health Organisation (WHO) and the British Food Standards Agency (FSA).The average recipe created by a television chef was high in fat (27.1 grams) and saturated fat (9.2 grams) and low in sugar (8.3 grams) and salt

(1.6 grams), according to guidelines from Britain’s FSA. In contrast, the own-brand supermarket ready meal was high in saturated fat (6.8 grams), had a medium level of fat (17.2 grams) and salt (2.0 grams), and was low in sugar (6.8 grams).

Despite reported efforts from the industry to reduce the salt content of prepared meals, only 4 per cent of the ready meals met the WHO recommendation. The recipes were more likely to comply with the recommendation, although the researchers point out that salt used for seasoning was not assessed.

They say that maximum nutritional benefit “is likely to be derived from home cooking of nutritionally balanced recipes primarily using raw ingredients, rather than relying on ready meals or recipes by television chefs”.

The authors also suggest including nutritional information on recipes in cookery books.

Consideration should also be given to regulation of the recipes demonstrated by television chefs similar to that which limits the advertisement of foods classified as high in fat, salt, or sugar, they add.

4 HEALTH HEART RATE VARIABILITY

Fire in my belly Hans Holdhaus can assess patients’ stress levels by measuring their heart rate variability. A healthy heart speeds up with stress. Photo: Felix Wong

Jeanette Wang jeanette.wang@scmp.com What are your odds of burning out in high-stress Hong Kong? It seems mine are low, even after living for nearly two fast-paced years here.

This is according to Hans Holdhaus, a specialist in burn out prevention and corporate health promotion, who recently monitored me for 24 hours via a portable electrocardiogram (ECG) device.

Holdhaus, head of the health management department at IMSB Austria Institute for Sports Medicine and Science, says I have “good total vitality”. My energy typically dips between 4pm and 5pm, and, contrary to what I believe, I’m more of an evening person than a morning one.

It’s amazing the conclusions Holdhaus could draw from just one simple measurement: my heart rate variability (HRV), or the beat-to-beat changes in heart rate.

A healthy heart speeds up with increased activity or stress and slows down during relaxation. This is the result of the interplay of two components of the body’s autonomic nervous system: sympathetic and parasympathetic.

The former causes the heart rate to rise, while the latter slows it. When working well together, they ensure that the heart rate is steady but ready to respond to changes. So, a higher HRV is a good thing. Reduced HRV is associated with a higher risk of cardiovascular death.

In a recent study published in the journal PLoS ONE, researchers from the University of New South Wales in Australia discovered that

reduced HRV best predicts cognitive disturbances, such as concentration difficulties commonly reported by people with chronic fatigue syndrome.

The researchers recorded the heart beats of 30 chronic fatigue syndrome patients and 40 healthy individuals via ECG and analysed the participants’ cardiac responses to cognitive challenges. Both groups performed with similar accuracy, but the patients took significantly longer to complete the tests than the healthy participants. They also had greater heart rate reactivity, low and unresponsive HRV and prolonged heart rate recovery after the cognitive challenge.

Holdhaus believes in the potential of HRV measurements to help boost performance in corporations by safeguarding the health and productivity of staff.

Following successful collaborations with companies in Europe since 2007, the Austrian was recently in Hong Kong to market his services here. “In Europe, the companies’ feedback is that they don’t have as many people resign, employees are not sick as often and absenteeism is lowered,” he says.

In the past, HRV measurements were used mainly in the medical area, for post-stroke patients in hospitals. These days, elite athletes, such as the Austrian Olympic team, also use them. The measurements can show the effectiveness of a training regime, if there’s sufficient recovery or sleep, and so on.

Improved technology has helped. In 1906, Dutch physician Willem Einthoven’s ECG machine weighed 300kg. Holdhaus’ ECG device from Switzerland is

lightweight and about the size of a deck of cards – he claims it’s the tiniest in the world.

The device consists of three adhesive electrodes connected via colour-coded cables to a recorder.

It’s simple to set up and not a hindrance to use. You can get on with your daily tasks, and only need to take it off when you are showering or swimming.

You need to simultaneously pen an activity diary. The more detail the better, as this helps Holdhaus more accurately attribute cause and effect at any given point in time.

At the end of 24 hours, the device powers itself off. Return the gadget to Holdhaus, and he uploads the data to a computer and analyses it within two days. A 45-minute consultation with the client follows.

I’m shown a two-page report, anchored by a fire-like chart – a spectrogram. Holdhaus explains

It’s amazing the conclusions Holdhaus could draw from measuring my heart rate variability that an intense fire with a high blaze shows a person with more vitality, youthfulness and fitness. A small blaze, with little colour or contrast, points to exhaustion or disease.

The blue on the graph indicates very low frequency HRV changes, and is associated with the extent of one’s physical resources and power.

Holdhaus says I have “very good resources” and likens me to an oven filled with a lot of firewood: “You are

Vital statistics The spectrogram below is a graph of the writer's heart rate variability, which was measured by a portable electrocardiogram device worn for 24 hours. The measurements shed light on one's biorhythm, stress levels, quality of sleep, biological age, and so on — and provide a good basis for developing a personalised work-life balance programme. no variability

Heart rate variability (Hertz) 0.5 0.4 0.3 0.2 0.1

10 :0 0 12 :0 0 14 :0 0 16 :0 0 18 :0 0 20 :0 0 22 :0 0 00 :0 0 02 :0 0 04 :0 0 06 :0 0 08 :0 0

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

Source: IMSB Austria

Time of day

strong variability SCMP

the type who is always pushing. You like to do things. You are not someone who says, ‘Today I’m going to sit on my sofa the whole day and watch TV’.”

The flames represent low (below 0.15 Hertz) and high frequency HRV changes. Low frequency flames reflect the body’s performance orientation and are distinctly affected by mental and emotional processes. “Most of your flames are below 0.1 Hertz – and this is because you have not had sufficient rest.”

Holdhaus says.

He is right: I was feeling exhausted from running races three weekends in a row and was fighting a stubborn bout of flu.

High-frequency flames are dominated by breathing and linked with positive body perception.

Holdhaus concludes that my highlight of that day was between 8pm and 11pm – where the graph had the highest flames and a constant blue of up to 0.2 Hertz.

True again: while walking home, I had bumped into a person I was particularly fond of, and hadn’t seen in a while, and we decided to have dinner and drinks.

From the intensity of the flames during office hours, Holdhaus could tell I wasn’t having a very challenging day at work. He explains that sometimes clients show very low flames during office hours, but very intense flames after, indicating a lack of interest at work. Sometimes the reverse is seen, indicating a passion for work but possible problems at home.

He could also tell that I hadn’t slept well that night. Spot on: I woke up repeatedly in coughing fits.

Over 24 hours, I had a total of

MEDICAL 5 CASE HISTORY

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Eileen Aung-Thwin healthpost@scmp.com

Ho

To find out your HRV, send an e-mail to h@byholdhuas.com

Matt’s best hope now lay in keyhole surgery to remove the cancer-stricken part of his stomach ela on: Ang Illustrati

76,320 heartbeats, or 53 beats per minute on average. The optimal is anything below 105,000 total heartbeats, says Holdhaus.

“You have a very economical system. People who are stressed usually have a total over 130,000, or about 95 to 100 beats per minute, with no difference between night and day.”

Holdhaus says my heart data is great, a reflection of my 13 years of endurance training.

Overall, I scored optimally on physical activity and mental resilience, but Holdhaus says my quality of sleep and body age (29 years, versus my chronological age of 30) – both affected by my fatigue and illness – could be improved.

He advises that I need to allow my body more time to recuperate.

He says recovery strategies vary for individuals, but from my graph he can tell that chilling and socialising over good food is the kind of relaxation my body thrives on.

He also advises “small interventions”, such as taking short breaks throughout the day, having a real lunch break and doing basic breathing exercises (inhale counting one to four, hold for two seconds, exhale counting one to five – repeat five to eight times). “For people who are highly stressed,” says Holdhaus, “this is hard work.”

He suggests I do another measurement (costing HK$2,900) in six to 12 months’ time, to see if my lifestyle changes improve my HRV: “Changes can be visualised within three months, but in some really bad cases, it can take up to a year.”

Brandon Matt was having an extended bout of indigestion – or so he thought. He frequently had gastric discomfort, such as bloating, pain and a sense of fullness.

At 84 years old, Matt (whose name has been changed for reasons of patient confidentiality) already had a long list of age-related health woes, including cardiac problems, diabetes and hypertension.

A general practitioner recommended that Matt underwent an endoscopy to investigate his stomach ills.

During the procedure, a long, thin tube with a light and camera at the end was inserted into his stomach via his throat. Doctors found a suspicious looking ulcer in the mid-section of his stomach lining. A biopsy confirmed that Matt had stomach or gastric cancer.

Matt was referred to an oncologist. Surgery to remove the affected part of his stomach was the only available cure. However, after reviewing Matt’s health condition, the oncologist concluded that open surgery was not a good option.

Matt was a relatively big man at over 1.8 metres tall and weighing more than 82kg. He was reasonably fit for his age. However, given his existing heart and pulmonary problems, open surgery would be much too strenuous and traumatic for his body. The amount of blood loss during and after surgery as well as the large wound that surgery would leave behind stacked the odds against a smooth recovery.

The oncologist referred him to Dr Michael Li Ka-wah, director of minimally invasive and robotic surgery development at the Hong Kong Sanatorium and Hospital.

Matt’s best hopes now lay in keyhole surgery to remove the cancerstricken part of his stomach.

The technique would only require small incisions in the abdomen so that special endoscopes called laparoscopes could be passed into the abdominal cavity to carry out the operation.

Carbon dioxide or nitrous oxide gas would be used to inflate the abdomen to create space for the surgeon to see and to work. This would result in much smaller wounds, less blood loss and pain, and a much quicker recovery time.

While reviewing Matt’s medical history, Li found that the patient had open abdominal surgery many years ago for an unrelated condition. This

Surgery cut down to size meant that Matt very likely had adhesions – bands of tissues that form between abdominal tissues and organs, and cause them to stick together. Normally, these tissues and organs would have slippery surfaces that helped them slide against each other.

Adhesions would add to the challenges of minimally invasive surgery, says Li. But he remained undeterred, as it remained Matt’s best chance of a cure. During surgery, Li discovered multiple

adhesions in Matt’s abdomen. He painstakingly cut through them to clear a path to the stomach. This alone took almost two hours.

Once Li reached the stomach, he found that the cancerous ulcer lay in the middle. If the ulcer had been located any higher in the stomach, Li would have had to remove the entire organ. But the cancer’s position allowed Li to retain some of Matt’s stomach.

Li then dissected the lymph nodes around the stomach. Cancer

cells can break away from the lesion and travel to other parts of the body through the bloodstream or the lymphatic system. If the cancer cells enter the lymphatic system, they can end up in lymph nodes and start growing there. Often, the lymph nodes closest to the cancer site are affected first.

Cutting away the lymph nodes was a delicate process, as Li had to take care not to nick the major blood vessels running through the area.

After Li was done, the small incisions in Matt’s abdomen were stitched up.

The next day, Matt’s recovery seemed on track, as he was able to sit up and be fairly mobile. In the evening, however, he suddenly vomited blood.

Li and his team used an endoscope to investigate, and found that a blood vessel near the surgical site in the stomach was bleeding. He was able to stop the bleeding by using special clips to close off the blood vessel.

Meanwhile, good news came in from the laboratory. The pathologist found no sign of cancer in any of the 30 sample lymph nodes removed during surgery.

The rest of his recovery was uneventful, and he was discharged 10 days later.

In future, Matt will probably have to eat smaller, more frequent meals.

The scarring in his stomach from the surgery will probably limit the natural ability of his stomach to stretch to accommodate food. The smaller organ size will also reduce the amount of food it can store.

Matt may also be at risk of some unpleasant effects such as weight loss, malnutrition, poor appetite, indigestion, diarrhoea and other digestive problems.

He will also have to closely monitor his nutrition as problems such as calcium malabsorption and anaemia can crop up.

Li says that minimally invasive surgery manages to bring results that are as good as those of open surgery, but with less trauma to the patient’s body.

6 COVER STORY

Against the odds, three young Hong Kong researchers have made groundbreaking medical discoveries, says Elaine Yau

Full of bright ideas H

ong Kong has long been maligned for its meagre investment in research and development. Less than 1 per cent of the territory’s gross domestic product is spent on research, compared to 2.5 to 2.8 per cent in the US, South Korea, Japan and Singapore.

When University of Hong Kong (HKU) chemistry professor Vivian Yam Wing-wah won a 2011 L’OréalUnesco Award for Women in Science, she lamented that doing research in this city is a lonely journey, with writing proposals to compete for funding taking up precious time.

Medical researchers in the city run into the same obstacles in their quest to find cures for diseases and develop vaccines. But in spite of the unfavourable environment, many beat the odds to deliver groundbreaking findings published in prestigious medical journals.

Here are three young researchers whose passion and determination in seeking medical breakthroughs have helped put Hong Kong on the medical research map.

The pandemic expert Leo Poon Lit-man was thrust into the front line of the city’s war against severe acute respiratory syndrome (Sars) in 2003, when he became one of the first researchers in the world to decode the genome of the Sars-associated coronavirus, which was previously unrecognised.

Instead of resting on the laurels of this crowning achievement, Poon, an associate professor with HKU’s Li

The exact origin of Sars, for example, is still not known. Poon says the masked palm civet is the main carrier of the coronavirus, but not the origin, and it possibly got the virus from other animals.

He had discovered the first coronavirus in bats, and says it’s possible that bats are the natural reservoir of the virus. However, he and other researchers are still doing studies to confirm this.

Poon says identifying viruses is critical to the protection of public health: “It can prompt the government to put relevant preemptive measures in place.”

This was seen during the bird flu outbreak in 1997, which prompted the implementation of various measures over the years, including banning the sale of live aquatic livestock in wet markets.

Vincent Wong is developing new tests to predict liver cancer.

Photo: Edward Wong

Ka Shing Faculty of Medicine, dived into more studies on bird flu, swine flu, coronaviruses and astroviruses.

He is using the smallpox vaccine to develop a universal vaccine that can fend off both human and animal flu viruses.

Vaccines presently can protect against seasonal flus (H1N1 and H3N2) affecting humans. But the vaccines are not effective for preventing infections caused by animal flu viruses, due to the differences in surface proteins

between the viruses. “We hope that people can get only one shot that can protect against different forms of flu,” says Poon.

He is also working with researchers worldwide to hunt for new viruses in animals. Scientists now know there at least 50 different astroviruses circulating in animals, compared to just a few known in the past.

The Sars outbreak also prompted the search for new coronaviruses in animals.

“We need to know more viruses, their origins and evolution. The quantity of virus species is way beyond our imagination,” says Poon. “Most viruses are not harmful to humans. But some are and we need to identify them.”

Poon, who graduated from Oxford University’s Sir William Dunn School of Pathology in 1999 and joined HKU in 2001, says the search for the viruses’ origins, given their propensity to mutate and evolve, is taxing.

The stem cell specialist A landmark 2010 HKU study found the cancer stem cell that causes gastrointestinal cancer patients to suffer a relapse, raising hopes for developing better treatments to reduce death rates of the secondbiggest cancer killer.

Roberta Pang Wen-chi, assistant professor of the HKU medicine faculty’s department of surgery, was part of the research team.

Pang, 33, says the study, which was carried out on mice, proved that the cancer stem cell (CD26+) is the culprit for metastasis (the spread of cancer from one organ to another) after surgery and chemotherapy in gastrointestinal cancer patients. The study was featured on the cover of

COVER STORY 7

Roberta Pang was part of a team that conducted landmark research into cancer stem cells. She hopes the findings will revolutionise treatment for cancer patients. Photo: May Tse Cell Stem Cell, the highest-ranked journal for stem cell research according to the Association of American Publishers.

There are about 4,000 new cases of gastrointestinal cancer every year.

Over half of the patients suffer from a relapse or metastasis after treatment. The cancer spreads from the intestine to the liver because the two organs are connected by a portal vein. When this happens, there’s only a 10 per cent chance the person will live for five more years.

While the 2010 study was groundbreaking, Pang says a big obstacle remains. That study was done using a patient’s tumour sample, but this is not always available to researchers. “We need to develop a method to find CD26+ non-invasively to further our research,” she says.

Pang and her colleagues came up with an idea: look for the marker in blood, since cancer stem cells were found in the portal vein. A study was started to look for circulating cancer stem cells, involving more than 200 patients whose cancer had not yet metastasised.

“The results were promising,” she says. “Over 60 patients later suffered from metastasis and all of them were found to have high levels of the marker.”

Pang is compiling the results and will submit a paper to a medical journal. She hopes the findings can revolutionise the treatment given to gastrointestinal cancer patients.

“If the concept is embraced by the medical community, we will hold discussions with the

pharmaceutical companies to do a pilot study,” she says. “ If patients can know from day one whether they will suffer from metastasis, [more effective treatment can be devised].”

Pang says researchers around the world are racing to explore cancer stem cells in their quest to find cures for the disease. Solving the stem cell

We need to know more viruses, their origins and evolution.

The quantity of virus species is way beyond our imagination LEO POON (PICTURED), PANDEMIC EXPERT

Photo: Thomas Yau

mystery, she says, can revolutionise cancer treatment.” Though chemotherapy can eradicate a lot of tumour burden and shrink the tumour greatly, it can’t target the cancer stem cells,” she says.

She says cancer stem cells are similar to human stem cells, in that they can detoxify themselves. Both forms of stem cells can therefore

keep growing despite absorbing a lot of toxins.

Pang, who completed her PhD study in HKU’s department of medicine in 2006, has won industrial and international study grants such as that awarded by the US National Foundation of Cancer Research.

Her petite stature belies a fierce determination to unlock the secrets of cancer – even if it takes up most of her life.

“Usually, a surgery on liver cancer finishes late in the afternoon and when the tumour issue is brought to us, it’s already 6pm,” she says. “The process of taking apart the tumour for single cells take three to four hours, which means working late into the night alone in the lab.

But all the effort is worth it as my research can hold great promise for cancer patients.”

The liver guru With more than a quarter of the local adult population afflicted with fatty liver, helping people beat the disease is a mission of Vincent Wong Waisun, a professor with Chinese University’s department of medicine and therapeutics.

One of his studies was on the use of Fibroscan, a non-invasive imaging method that uses sound waves to evaluate the degree of liver stiffness, or scaring, known as fibrosis.

The study, the largest of its kind in the world, scanned 246 patients with fatty liver. It found that the Fibroscan had more than 90 per cent accuracy in the measurement of cirrhosis. Results were published

in the Journal of Hepatology in 2010.

“Doctors do not need to use the conventional and invasive method of extracting tissue for tests to see whether a patient suffers from severe liver disease,” he says.

Wong, 36, has had around 140 papers published in medical journals so far. Another of his studies that gained widespread recognition was published in the Journal of Clinical Oncology in 2010 that spanned a decade tracking patients suffering from hepatitis B. The study was prompted by the need to differentiate severe and less severe hepatitis B sufferers. He says: “Hepatitis B is a common disease in Hong Kong that affects 10 per cent of adults, a quarter of whom will die from cirrhosis or liver cancer. We don’t have enough resources to provide antiviral therapy to all hepatitis B sufferers.”

Starting in the late 1990s, 1,400 hepatitis B patients were studied; 10 per cent of them developed liver cancer during the period. Five factors were found to be critical – age, whether the patient has cirrhosis, and levels for albumin, bilirubin and hepatitis B viral DNA. “We made a formula using the five factors. Doctors can use the formula to assess whether the patient is likely to develop liver cancer and receive specialised treatment,” he says.

Wong was awarded the Outstanding Young Person award last year by the Junior Chamber International Hong Kong for his research. elaine.yau@scmp.com

8 DIET NUTRITION

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Rachel Oliver healthpost@scmp.com Happiness comes from within, or so the saying goes. Many would suggest we take this phrase in its literal form, by taking a good, hard look at the food we eat on a daily basis. And anyone suffering from the “blues” this winter (or at any other time of the year) could be welladvised to take note: there is such a thing as a meal that makes you happy, experts say.

We’re not talking about meals commonly available in fast-food chains. According to nutritional experts, types of “happy” food would look less like a burger, chips and a fizzy drink and more like turkey or wild salmon, dark green vegetables, and sweet potatoes or basmati rice for the main course.

For dessert it would be citrus fruits, raw chocolate, berries, nuts and seeds.

What makes this meal “happy” is the collection of nutrients it packs: tryptophan (turkey), omega-3 (salmon), vitamin B12 (turkey and salmon), folate (green vegetables), niacin (brown rice), vitamin B6 (nuts), phenylalanine (nuts and seeds), magnesium (chocolate) and vitamin C (citrus fruits).

When combined, they spark the necessary chain of events that allow us to release more of the “happy neurotransmitters” produced in our bodies, such as serotonin and dopamine.

The route to plentiful serotonin namely lies in a tryptophan-rich diet, but the essential amino acid can only do its job when combined with other key nutrients, says Bernice Cheung Ho-ki, dietitian at the Chinese University of Hong Kong’s Centre for Nutritional Studies.

“The conversion of tryptophan to serotonin is a two-step process [which] requires catalysts like vitamin B6, folate, niacin and B12,” she says.

The same goes for dopamine, which requires phenylalanine, tyrosine, folate, niacin and vitamins C and B6, she says.

Key components of a “happy food” diet, according to Alicia Maetzener, nutritional therapist at Vitality Centre in Central, are things like tyrosene-rich almonds (make you alert), avocado (has healthy fats and B vitamins), eggs (Maetzener recommends omega-3 eggs with vitamins B and D), and fish, in particular wild salmon.

MOOD BOOSTERS Tryptophan: egg, soya, walnut, lean meat, almonds, sesame, pumpkin, buckwheat Vitamin B12: egg, milk, liver, lean meat, seafood Phenylalanine: egg, oat, lean meat, soya bean, black bean, peanut, pumpkin seed, almond, sesame, pistachio Folate: egg yolk, liver, beans, green leafy veggies, pumpkin seed, chestnut, flaxseed, gingko Vitamin C: orange, strawberry, guava, grape, tomato, green capsicum, kiwi Vitamin B6: wheat, liver, black bean, soya bean, banana, chestnut, pistachio Niacin: oat, brown rice, liver, fish, peanut, pumpkin seed, sesame Source: Centre for Nutritional Studies, Chinese University of Hong Kong

Eat and be merry There have been several studies on omega-3 and its effects on mood.

“The people who get seasonal affective disorder tend to be in North America and [northern] Europe, but not so much in Japan [in North Asia] where the diet is higher in fish,” says Maetzener.

Omega-3 and vitamin B are specifically used in treating those with mood disorders, adds Benita Perch, naturopathic practitioner at

Poor eating relates to poor mental function.

With food and mood … there is no doubt there is some link.”

DR EDMUND LI, FOOD SCIENCE EXPERT

Integrated Medicine Institute in Central. “I tend to give depressive patients omega-3 and B-complex,” she says.

Perch stresses the importance of good quality fats – like those found in coconut or avocado oils – in any diet designed to elevate mood.

“Our cells are made of protein and the phospholipid bilayer. They are the gateway to the cell. If that layer is made up of good quality fat

then they can function better,” she says. “[A lack of] fatty acids can be the reason why some people are depressed.”

Ironically, eating fat can be a good way of preventing ourselves from, well, eating fat. Anita Cheung, founder and director of i-Detox in Central, stresses the importance of “good fat”, because it can help prevent those less used to healthy eating from veering away from the “happy diet” and in the direction of more alluring – but far less nutritious and beneficial – type of meals.

“The nervous system is fat-based,” Cheung says.

“Every cell needs fat but the nerve cells are more fatdependent. So the basic diet should contain a healthy fat contingent like macadamias and cashews. And when we are satisfied with our fat intake from healthy foods, then we crave bad fats less.”

Variety ultimately is the key to happiness, experts say.

“In general there is no magic formula. There are no single nutrients that can do it all,” says Dr Edmund Li, associate professor with the School of Biological Sciences at University of Hong Kong.

“There is a lot of data that suggests poor eating relates to poor mental function, so a healthy balanced diet is sensible. With food and mood … there is no doubt there is some link there.”

Common sense does tend to prevail, then, if we seriously want to eat our way to happiness.

Perch recommends an antiinflammatory wholefood diet. Strike out white food, fried food, red meat and sugar, and load up on brown rice, wholewheat pasta, legumes, beans, fruits and vegetables. “You should be eating at least nine servings of fruit and vegetables every day,” she says. “It’s a complete lifestyle change.”

But anyone who is too wary of the prospect of having to be too healthy to be happy will at least take comfort in one of the top happy foods: chocolate.

“Cacao is packed with antioxidants,” says Cheung.

“It provides many minerals we are deficient in, such as magnesium, which boosts endorphins, the bliss chemical.”

It is also a good source of chromium, iron, manganese, zinc, copper and omega-6 fatty acids.

DIET 9 HEALTHY GOURMET

THE TASTE TEST PESTO ......................................................

A mother’s table influence

Jeanette Wang jeanette.wang@scmp.com

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Andrea Oschetti healthpost@scmp.com Eating habits develop in our youth and our parents’ relationship with food influences us more than what they preach.

When I was a kid I did not like fish and vegetables. I went to a Catholic school run by nuns where discipline was strict. Some evenings, at home, my mother would find in the pocket of my uniform the classic Italian panino, with a hole in the top, filled with a mixture of what I did not want to eat but was forced to.

“I never pushed you to eat fish nor vegetables,” says my mum, Liliana – although she hid vegetables in the dishes I liked.

Restrictions and pressure on children do not work and generate an exaggerated focus on food, making it a means to assert independence, preclude selfregulation, and – when the parents aren’t around – encourage the child to eat what is forbidden.

My eating habits have not been admirable for my entire life and during my years as a management consultant, I stopped exercising and enjoyed way too many client dinners and business class meals. I became overweight. But I always had in mind my mother’s attitude towards well-being, and eventually I took action to regain my health.

My mother’s focus has always been to use food, not necessarily to lose weight, but to improve health.

She was into organic and wholegrain before they were trendy. Food was the medicine she used to delay the kidney failure that is hereditary in my family. Despite years of dialysis and a kidney transplant, today she looks young and full of energy – because of the way she eats.

Back in the 1970s and ’80s, there was limited knowledge of nutrition.

My mother has never been an uncompromising follower of any healthy diet. She ate real food (meaning non-industrial) that she and my dad cooked at home.

“For many years, I chose for our family a cuisine with a lot of variety and vegetables,” says my mum.

“Pasta has always been part of our table, but often accompanied by vegetables. Sunday was the exception: ragout lasagne, cannelloni, roasts and dessert.”

“When you were coming of age,” she tells me, “my consciousness about the relationship between food and well-being grew. Meat declined drastically and, although it was not part of the family tradition, we began eating fish. I also started focusing on organic food.

“I bought wholegrain flours rather than refined. At first, you did not like my bread, but with time you got used to the new flavours.”

Pesto alla Genovese HK$60 for 130 grams, City’super Originating in the northern Italian city of Genoa, pesto got its name from pestâ, the Genoese word for “to pound” or “to crush” – which is traditionally how this sauce is made.

This organic version from Italy contains 45 per cent basil and 44 per cent extra virgin olive oil.

Verdict: the most oily and salty of the three, the coarsely minced basil leaves provide a very strong herby flavour.

Andrea Oschetti makes crespelle with radicchio at home with his mother Liliana.

The substitution of ingredients in recipes has always been a part of mum’s cooking style.

Reducing sugar was hard for our family as we all have a sweet tooth, but she experimented with alternative sweeteners and made desserts with lots of dried and fresh fruits.

Looking back at my youth, I found 10 lessons she practised that formed the way I eat now.

1. Food is about healthiness, rather than weight.

2. Make your own meals.

3. Parents lead by example.

4. Restriction and pressure don’t work.

5. Serve small portions at home to avoid forming the habit of eating beyond hunger.

6. The home meal is a sanctuary.

Breakfasts, lunches and dinners should not be skipped, interrupted by phone calls or eaten in front of the television.

7. Make it easier to eat healthier.

There was no junk food at home, and peeled fruit was often available.

8. Eating healthily is not a religion with strict dogmas. Focusing on making your favourite dish healthier, one ingredient at a time, is more important than sourcing the latest superfood.

9. Make vegetables interesting.

The crespelle base is made from buckwheat flour mixed with water and salt.

10. Sports and outdoor activities are fundamental and also influence what we eat.

Crespelle with radicchio and parmesan cheese Makes 12 250 grams buckwheat flour 600ml water 1 tsp salt 500 grams radicchio 100 grams grated parmesan cheese Olive oil • Mix the flour, water and salt a little at a time until smooth.

• Let the mixture rest for 30 minutes, covered with cling film.

• Heat up a 12cm pan. Add a drop of oil and pour a ladle of the mixture in it.

• Rotate the pan so a uniform thin layer of mixture is formed.

• When it starts to brown, flip to brown the other side.

• Set the crespelle aside and repeat one ladle at a time.

• Stir-fry the radicchio over a high heat until it becomes soft.

• Fill each crespelle with some grated parmesan and radicchio.

• Fold the crespelle in half and put it in a pan over a medium heat until the cheese melts.

Healthy Gourmet is a weekly column by private chef Andrea Oschetti. cuoreprivatechef.com

Gastronomia Toscana Pesto Genovese Tradizionale HK$60 for 150 grams, City’super Made in Tuscany, Italy, this fresh pesto has a shelf life of only 30 days – but if it even lasts that long in your fridge I’d be amazed (it certainly didn’t in mine). Made with extra virgin olive oil (38 per cent) and basil (26 per cent), and speckled with pine nuts (12 per cent) and parmesan and pecorino cheeses.

Verdict: full-bodied flavour, good consistency and not too oily. My favourite of all the products.

Buitoni Reduced Fat Pesto with Basil HK$69.50 for 198 grams, City’super This American version of the Italian classic isn’t too traditional. It contains 34 per cent less fat than regular pesto (17 grams vs 26 grams per 62 gram serving) and has a thicker, creamier consistency more akin to a spread or dip than a sauce.

Verdict: the least salty and oily of the three, and with a strong parmesan flavour.

10 FITNESS MARATHON MANIA WEEK 5

Rachel Jacqueline gets help with running injuries at Stanley Ho Sports Centre.

Photo: Warton Li

Strain check ......................................................

Rachel Jacqueline healthpost@scmp.com During my long run this week, I felt a familiar stabbing pain in my right knee. I grimaced at the pain caused by an iliotibial (IT) band that’s tighter than a piano string.

Runners are no strangers to injury. In a study of 725 male marathon runners published in the Scandinavian Journal of Medicine & Science in Sports in 2008, 54.8 per cent had sustained one or more injuries in the year prior to a race.

“Among the 50 marathon clinic participants last year, 20 of them had some sort of musculoskeletal complaint in the course of their 12week preparation,” says Dr Simon Yeung, director of Standard Chartered Hong Kong Marathon’s free training clinic.

The main cause of running injuries is a rapid increase in mileage or intensity, says Dr Michael Tse, director of the Active Health Clinic at University’s of Hong Kong’s Institute of Human Performance. “It is important to progress slowly, increasing your distance by about 10 per cent each week, until you reach your maximum training distance.”

For more intense workouts, a dynamic warm-up may help reduce potential injury risk. Tse suggests light jogging, followed by movements such as butt kicks, knee lifts and lunges. “Work on the hot spots, like tight hamstrings, hip flexors and ankles,” he says.

Yeung also recommends alternating terrain to work different muscles and avoid overloading any particular one. Unfortunately, some people are more injury prone than others due to biomechanics, joint flexibility, musculoskeletal balance and technique.

Before you start running seriously or if you are feeling a twinge of an injury, Tse recommends getting a postural assessment and spending time working on correct form.

Incorporating strength training in your programme will help you recover faster.

While injuries should be treated by a professional, some simple preventative measures can help.

Ilotibial band syndrome What: A stabbing pain on the side of the leg, just above the knee, made worse by running downhill.

Cause: The main cause, says Yeung, is tightness in the hip abductors and IT band – a tough group of fibres that run on the outside of the thigh from hip to shin.

Tip: Using a foam roller may help release the IT band, says Tse. Gently roll the foam roller up and down the length of the IT band.

Tightness in the hip flexors, the group of muscles that are responsible for lifting your knee, can contribute to IT band pain.

Remember to stretch them.

Patellofemoral pain syndrome (aka runner’s knee) What: A constant ache underneath your kneecap when running that gets worse as the intensity of running increases.

Cause: An imbalance of the quadricep muscles, says Yeung.

Typically this means weakness in the muscle above the inside of the knee and tightness in the muscle on the outside of the knee.

Tip: Strengthen the weak muscle and reduce tension in the tight one to keep your kneecap better aligned, says Tse. He recommends using a leg extension machine in the gym to work on developing the weak muscle, or sitting on a chair with an ankle weight on the affected leg and slowly raising the foot at a slight outwards angle.

Plantar fasciitis What: Sharp pain at the base of the heel, particularly in the morning.

Cause: “Overtraining may cause microtears in the fascia – the muscle fibres in the arch of the foot – which causes inflammation and extreme pain at the heel,” says Tse. Other possible causes include having the wrong shoes or being flat footed.

Tip: Roll the arch of the foot on a hard round object, such as a golf ball. “It will cause some pain, but if you do this exercise regularly, the pain will subside,” says Tse. Stretch your calves: the easiest way is by standing on the edge of a step and putting downwards pressure on the heel. “Tightness can lead to increased Achilles and calf tension during each stride and put a lot more stress on the plantar fascia,” says Tse. Marathon Mania is a 12-week series leading up to the Hong Kong Marathon on February 24. For more preparation tips, go to facebook.com/hkmarathon

RACHEL’S DIARY It’s only been a few weeks but I can already feel the impact of speed sessions on my running. I am feeling much stronger during runs and keeping a faster pace with ease. I joined a group for track training this week. This meant my speed work was a little different from the plan, but I benefited from the forced drills and intensity required by working out with others. The IT band forced an extra rest day this week, but I supplemented it with a yoga session to keep the body moving.

Marathon training plan: weeks 4 to 6 The writer moves into the second three-week block of the 12-week training plan designed by running coach Clinton Mackevicius.

Drills consist of two sets of 60 high-knees, 60 bum-kicks, 20-metre knee-drives, and 2 x 10-metre strides.

PE = perceived exertion, on a scale of 1 to 10, with 10 being the hardest.

MON

TUE

WED

THU

Strength and speed

Rest

Medium pace

Focus

Active recovery

Duration

50-60 minutes 55 minutes

Description Run at PE 5.

Drills

Warm up at PE 5 for 15 minutes.

Rest two minutes between each of these efforts: 7 min at PE 7 6 min at PE 7 5 min at PE 7.5 4 min at PE 8 3 min at PE 8 2 min at PE 8.5 1 min at PE 9 Drills

FRI Threshold session

65 minutes 51 minutes Run at PE 6

Warm up at PE 5 for 15 minutes.

Each of these sets consists of eight segments of equal duration. Alternate between PE 7.5 and 6.5 for each segment: Set 1 – 90 sec x 8 = 12 min Set 2 – 60 sec x 8 = 8 min Set 3 – 30 sec x 8 = 4 min Set 4 – 15 sec x 8 = 2 min Cool down at PE 5 for 10 minutes. Drills.

SAT Rest

SUN Long slow run 75-90 minutes Steady-pace run at PE 5 to 6, incorporating 15-second surges at 10 per cent faster pace every 5 minutes

SCMP

WELL-BEING 11

Personal trainer turned restaurateur Martin Lorentsson on a spin bike at Pure Fitness. His Eat Right Food programme offers a variety of healthy meals delivered to the doorstep. Photo: Edward Wong

FIT & FAB

Trainer sets the meals in motion ......................................................

Rachel Jacqueline healthpost@scmp.com After personal trainer Martin Lorentsson discovered his clients weren’t losing weight due to a combination of poor diet and indulgent lifestyles, he decided to establish one of Hong Kong’s first healthy restaurants, Eat Right, on Staunton Street in SoHo in 2006.

“You can work out a lot, but 75 per cent of your results are based on the food you eat,” says Lorentsson, 42, who moved to the city 11 years ago. “When I realised my clients were eating crap, I asked them: ‘What if I delivered healthy food to you; would you promise to stick with the diet?’”

His clients agreed and so, along with the restaurant, Lorentsson also created the Eat Right Food programme, which offers nutritious meals delivered to the doorsteps of busy Hongkongers.

Entering the food business hasn’t been without challenges, and if he had to do it all over again the Swede admits he’s not sure he would be a restaurateur in Hong

Kong. “The rent is a killer. You have to be different to survive in this market,” he says.

But passion motivates, and at the core of Lorentsson’s personal training and healthy eating crusade is a desire to inspire people to be their best.

“I always want to help people,” he says. “The best machine we’re ever going to get is our body, and many people have no idea what to put in it to get the best out of it.”

At the height of his career as a group training instructor at Pure Fitness, Lorentsson would work – and therefore exercise – for up to 24 hours a week. To reward himself he would have a glass of wine and some chocolate.

These days, his regime is less intense thanks to his new baby – and he and his partner have another on the way.

“But I still try and squeeze in a few hours on the bike when I can,” he says. He claims he is in the worst shape of his life, but his physique would still make many envious. It’s all down to a healthy diet, he says.

What’s your food philosophy?

I believe in trying all kinds of food. I ate raw food the other day and loved it. Raw food doesn’t mean you have to be a tree hugger – it’s all about variation. But I think that is just one way and I don’t believe you have to cut out meat from your diet to be healthy. I think all kinds of food will give you the benefits your body needs. My most important tip, though, is portion control.

You can work out a lot, but 75 per cent of your results [are] based on the food you eat MARTIN LORENTSSON

How can restaurant food be healthier?

It’s all about the way food is cooked.

At Eat Right, for example, we look into a recipe we like and change a few things around to make it healthier. For example, by using brown rice or cooking with olive oil.

What’s your own secret indulgence?

I eat plenty of chocolate. But since I’ve scaled back on my training, I’ve also had to scale back on what I eat.

What do you love about group training?

It’s a challenge to make sure you give everyone the key to reach their own goal. Everyone’s goal is

different and people are on different levels – some people come for socialising, some people are training for a marathon. It’s the same with food. What I try to do is to give people an education so they can continue with a healthy lifestyle on their own. I don’t necessarily want people on my programme for five to 10 years. I want people to learn from me and then implement that in their own lives.

What’s the most common feedback you get from participants?

Often people think to be healthy they need to cut out carbohydrates,

but these include potatoes and vegetables. Your brain and body need carbs for energy. We all have different carbohydrate needs, but it’s still part of a balanced diet.

How important do you think organic food is in a diet?

Not as important as I wish it was.

You’re getting a lot of pesticides in non-organic vegetables and a lot of other bad stuff such as added hormones in meat. But at the end of the day it comes down to your wallet. If, for example, you’ve got kids the question is: “Should I give my child one apple, the organic one at HK$25, or should I give them five apples for HK$15, which will last a whole week?” I believe the message should be: eat organic when you can and when your wallet allows.

What’s your hope for a healthier Hong Kong?

I would love to have some competition in the market for the healthy food delivery programme, because that would keep me on my toes. I would also love to see people eating healthier and asking for healthier food at restaurants.

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JANUARY 1, 2013 SOUTH CHINA MORNING POST