The Straits Times
Published Feb 28, 2017
Eat better, drink less, exercise more and get enough sleep are common advice for heart health.
But studies suggest that a major lifestyle overhaul is not the only way to help your heart. Even small changes can make substantial differences.
Eventually, little changes can add up, said Dr David Goff, director of the cardiovascular sciences division at the National Heart, Lung, and Blood Institute in Bethesda, Maryland, in the United States.
"Any small change you make in a positive direction is good for you," he says. "It's not an all-or-nothing phenomenon."
Physical activity is a perfect example, he said. Official guidelines recommend 30 minutes of moderately intense activity on most days.
It is ideal to get at least 150 minutes of exercise weekly but getting less than that has benefits too.
When the researchers looked at deaths from all causes, they saw the sharpest drop in mortality when exercise jumped from half an hour to 11/2 hours each week.
Just getting up for a minute or two to interrupt bouts of sitting may also improve health, the study added. And moving for as little as eight minutes a few times a day provides the same cardiovascular benefits as an uninterrupted 30 minutes.
Dr Goff said: "If you can't find 30 minutes a day, try to find five or 10 or 15. Anything is better than nothing." The philosophy applies to dietary improvements, too, he added.
According to the National Institutes of Health, an ideal meal plan includes lots of fruit, vegetables and whole grains, with limited amounts of fatty meat and oils.
But eating an imperfect diet with more of the good stuff is better than giving up entirely.
That is the conclusion from a 2016 study that created food- quality scores from the self- reported diets of about 200,000 people.
Over a course of about 25 years, the study found, people whose diets scored lowest had a 13 per cent higher risk of coronary artery disease than those in the second worst group.
Not taking soda and other sugar- sweetened beverages can also help eliminate a few hundred calories a day and help in weight control.
It helps to lower blood pressure, harmful cholesterol and the potential for diabetes - risk factors for heart disease, Dr Goff said.
Large long-term studies have shown that people who average one sugary drink a day have a 20 per cent higher risk of heart attack than those who rarely drink any.
It is not just food and diet, said Dr Michael Miller, director of the Centre for Preventive Cardiology at the University of Maryland School of Medicine and author of Heal Your Heart: The Positive Emotions Prescription To Prevent And Reverse Heart Disease.
Heart strength can also come from battling stress by boosting emotional health in simple and unexpected ways, he said, such as enjoying a good laugh.
In a small 2005 study, Dr Miller played movie clips for 20 people. When they watched a scene that made them laugh, 19 of them experienced dilation of the blood vessels.
In contrast, a stressful scene led to constriction in 14 of the 20 viewers.
Since then, Dr Miller said, other small studies have found similar results, including one showing that vessels stay dilated for 24 hours.
Dilation also allows more blood to flow, lowering blood pressure as well as heart rate.
"Cross-talk" between the brain and heart explains the potential long-term benefits of laughter, Dr Miller said.
Belly-laughing releases endorphins, triggering receptors in blood vessels to produce nitric oxide, which, in turn, dilates blood vessels, increases blood flow and reduces the risk of blood clots.
People are far more likely to laugh when they are with friends, Dr Miller said, and this added yet more evidence of the health benefits of being social.
Accumulating evidence suggests that another easy way to help your heart is to listen to music.
Several studies have shown that, during recovery from surgery, listening to relaxing music leads to less anxiety and a lower heart rate.
Dr Miller said: "I tell patients to listen to music they have not heard in a long time but which, in the past, had made them feel really good."
He also recommended mindfulness meditation and hugging.
"Considering that stress probably accounts for a third of heart attacks, it can have a dramatic effect if you do all of these things in sync," he said.
THE WASHINGTON POST
Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts
Wednesday, March 1, 2017
Saturday, January 14, 2017
Women lose out to men in extra healthy years
Salma Khalik Senior Health Correspondent
PUBLISHED JAN 14, 2017
Men added 5.5 healthy years to their lives, while it was 4.9 years more for women
Women here are living longer but lagging behind men when it comes to adding extra healthy years to their lives.
In the decade between 2003 and 2013, men added 5.5 healthy years to their lives. Women, on the other hand, are living only 4.9 healthy years more.
According to the Global Burden of Disease 2015 published in The Lancet last year, women spend the last nine years of their lives in ill health, and men 7.5 years.
Some of the factors that create the years of ill health towards the end of life can be prevented, said Dr Amy Khor, Senior Minister of State for Health. In an interview with The Straits Times, she said it is good that Singaporeans are living longer, but not if those added years are lived in pain and suffering.
In 2015, life expectancy for women here was 84.9 years and for men, 80.4 years, making people here among the longest-living in the world. But women spend 10.7 per cent of their lives in ill health, and men 9.4 per cent. In fact, men here top the world in terms of the number of healthy years they live, according to The Lancet report.
Dr Khor said: "It is really important to tell women, 'Yes, you have got longer lives, but we want you to change your lifestyle to increase your years in good health'."
She chairs the Women's Health Committee, set up in 2012 to focus on problems faced by women to help them reduce the burden of ill health. Under its current three- year road map, which started in 2015, the committee is focusing on three big culprits: osteoporosis, diabetes and cancer.
Osteoporosis, a disease in which bones become so brittle that they break easily, is a major cause of poor quality of life for some women, said Dr Khor. Women experience a rapid loss of bone mass in the years following menopause, unless they work at retaining bone density.
She said: "I see women in their 50s in the community with knee guards, complaining about pain. It (osteoporosis) is part of ageing, but we can delay it."
For diabetes, the focus of the committee is on gestational diabetes mellitus (GDM) - which affects one in five pregnant women here - since it puts both the mother and baby at risk of diabetes in future.
The committee wants such pregnant women to control the GDM and change their lifestyle after giving birth to prevent the diabetes from recurring. For women with obesity, a major risk factor for diabetes, it is getting them to eat better and exercise more.
With cancer, the aim is to encourage women to have screening for breast, cervical and colorectal cancers, which are preventable or very treatable. The committee is working with the Breast Cancer Foundation (BCF) to provide funding for lower-income women to get mammograms. BCF agreed to fund screening of 40,000 women over five years from end-2014.
Dr Khor said getting women to be healthier has spillover effects, because they have influence over three generations - their parents, spouses and children.
PUBLISHED JAN 14, 2017
Men added 5.5 healthy years to their lives, while it was 4.9 years more for women
Women here are living longer but lagging behind men when it comes to adding extra healthy years to their lives.
In the decade between 2003 and 2013, men added 5.5 healthy years to their lives. Women, on the other hand, are living only 4.9 healthy years more.
According to the Global Burden of Disease 2015 published in The Lancet last year, women spend the last nine years of their lives in ill health, and men 7.5 years.
Some of the factors that create the years of ill health towards the end of life can be prevented, said Dr Amy Khor, Senior Minister of State for Health. In an interview with The Straits Times, she said it is good that Singaporeans are living longer, but not if those added years are lived in pain and suffering.
In 2015, life expectancy for women here was 84.9 years and for men, 80.4 years, making people here among the longest-living in the world. But women spend 10.7 per cent of their lives in ill health, and men 9.4 per cent. In fact, men here top the world in terms of the number of healthy years they live, according to The Lancet report.
Dr Khor said: "It is really important to tell women, 'Yes, you have got longer lives, but we want you to change your lifestyle to increase your years in good health'."
She chairs the Women's Health Committee, set up in 2012 to focus on problems faced by women to help them reduce the burden of ill health. Under its current three- year road map, which started in 2015, the committee is focusing on three big culprits: osteoporosis, diabetes and cancer.
Osteoporosis, a disease in which bones become so brittle that they break easily, is a major cause of poor quality of life for some women, said Dr Khor. Women experience a rapid loss of bone mass in the years following menopause, unless they work at retaining bone density.
She said: "I see women in their 50s in the community with knee guards, complaining about pain. It (osteoporosis) is part of ageing, but we can delay it."
For diabetes, the focus of the committee is on gestational diabetes mellitus (GDM) - which affects one in five pregnant women here - since it puts both the mother and baby at risk of diabetes in future.
The committee wants such pregnant women to control the GDM and change their lifestyle after giving birth to prevent the diabetes from recurring. For women with obesity, a major risk factor for diabetes, it is getting them to eat better and exercise more.
With cancer, the aim is to encourage women to have screening for breast, cervical and colorectal cancers, which are preventable or very treatable. The committee is working with the Breast Cancer Foundation (BCF) to provide funding for lower-income women to get mammograms. BCF agreed to fund screening of 40,000 women over five years from end-2014.
Dr Khor said getting women to be healthier has spillover effects, because they have influence over three generations - their parents, spouses and children.
Tuesday, January 10, 2017
Memory screening for those who keep forgetting things
10 January 2017 | Research
Source: Dr Kinjal Doshi
Being forgetful can simply be a reflection of ageing - but it can also spell something more sinister.
It may, for instance, point to a heightened risk of getting dementia down the line.
People who have memory- related or cognitive problems - such as in making decisions or judging the steps needed to carry out a complex task - may benefit from a memory screening test.
Memory screening is like a health check-up for the brain.
It can help uncover the possible reasons behind difficulties associated with remembering things and other cognitive functions, said Dr Kinjal Doshi, principal clinical psychologist at the neurology department of the Singapore General Hospital (SGH).
Memory screening is usually done in hospitals.
It may be carried out by specialists or trained nurses, and its cost will be part of the consultation fee, Dr Kinjal added.
The screening comprises a few tests, each lasting 20 to 30 minutes, that evaluate a person's ability to learn new information, and follow simple commands and language, among other things.
Anyone aged 18 and above can be screened. "Early detection can help to slow the progression of dementia," said Dr Kinjal.
In some cases, the doctor may need a more comprehensive assessment of the patient's cognitive abilities to establish the extent and cause of his memory difficulties, she added.
The patient will be referred to a psychologist for cognitive testing. A session may take at least two hours. It costs $300 for subsidised patients at SGH.
POOR SLEEP LINKED TO DEMENTIA
Dementia is expected to be a growing problem as Singapore's population ages.
According to a study published in 2015, about 28,000 people in Singapore aged 60 and above - or one in 10 - had dementia. The number is set to soar to 80,000 by 2030.
People who are afflicted with dementia tend to display difficulties at concentrating on tasks, finding words to articulate themselves and recalling recent events.
They may also have problems navigating around in the way they used to, said Dr Simon Ting, a senior consultant in the neurology department at the National Neuroscience Institute (SGH campus).
Some people may exhibit personality or mood changes.
Medical help should be sought if the symptoms start to affect one's daily life, said Dr Ting.
An example would be when the person has trouble keeping track of finances, medications or appointments.
To keep dementia at bay, it is important to set aside time every day to stimulate your brain, said Dr Kinjal.
This can include learning something new and practising different memory strategies.
A good night's sleep may be yet another shield against dementia.
Poor sleep has been linked in studies to dementia, said Assistant Professor Julian Lim of the signature research programme in neuroscience and behavioural disorders at Duke-NUS Medical School.
Studies carried out on animals have shown that a peptide associated with Alzheimer's disease, called beta-amyloid, is flushed out of the brain during sleep.
"Although research is still ongoing, it appears that the clearance of these toxins from the brain during sleep might be an important protective factor against memory loss and dementia," said Prof Lim.
To get better sleep, avoid using computers or electronic devices a few hours before going to bed. Also, try not to take caffeine or alcohol too close to bedtime, he added.
Lengthy daytime naps are also a no-no, as they may make it harder for one to get a good night's rest.
Some types of medication can also affect sleep, so patients may want to check with the doctor for alternative options, said Prof Lim.
They should spend time with friends and family members, and also exercise regularly.
"These activities can reduce the level of hormones associated with chronic stress and increase metabolism, both of which may improve sleep quality at night," he added.
###
Give your brain a workout
Learn something completely new: You can pick up a new language or musical instrument. Or read a book on a topic you are not familiar with. If you are a technical person, try reading history.
Take up a new hobby. The more challenging this is, the more it will benefit your brain.
Pay heed to your daily life: Keep a close eye on what you do or encounter daily. Take note of the environment and your interactions with people. This helps to keep your brain cells working.
Spice up your routine: Carry out mundane daily tasks in a refreshing way. If you are right-handed. try brushing your teeth with your left hand.
Shuffle the apps on your mobile phone every now and then, so you have to think a little harder to remember where you had placed a particular app.
Varying routines that you tend to perform without much thought can help create new brain pathways.
Try different ways to remember things: Start by memorising small amounts of information - a shopping list, for example - and slowly move on to something more complex. Learn to recognise patterns and create methods that will help you to recall information. Some people create rhymes or think of an image for certain words.
Have fun with mind-bending games: Play games or take part in activities that require you to solve problems or devise a strategy. Ideas include crossword puzzles, cards, mahjong and sudoku. Such activities will train your brain to recall things better.
Source: Dr Kinjal Doshi, principal clinical psychologist, department of neurology, Singapore General Hospital
Source: Dr Kinjal Doshi
Being forgetful can simply be a reflection of ageing - but it can also spell something more sinister.
It may, for instance, point to a heightened risk of getting dementia down the line.
People who have memory- related or cognitive problems - such as in making decisions or judging the steps needed to carry out a complex task - may benefit from a memory screening test.
Memory screening is like a health check-up for the brain.
It can help uncover the possible reasons behind difficulties associated with remembering things and other cognitive functions, said Dr Kinjal Doshi, principal clinical psychologist at the neurology department of the Singapore General Hospital (SGH).
Memory screening is usually done in hospitals.
It may be carried out by specialists or trained nurses, and its cost will be part of the consultation fee, Dr Kinjal added.
The screening comprises a few tests, each lasting 20 to 30 minutes, that evaluate a person's ability to learn new information, and follow simple commands and language, among other things.
Anyone aged 18 and above can be screened. "Early detection can help to slow the progression of dementia," said Dr Kinjal.
In some cases, the doctor may need a more comprehensive assessment of the patient's cognitive abilities to establish the extent and cause of his memory difficulties, she added.
The patient will be referred to a psychologist for cognitive testing. A session may take at least two hours. It costs $300 for subsidised patients at SGH.
POOR SLEEP LINKED TO DEMENTIA
Dementia is expected to be a growing problem as Singapore's population ages.
According to a study published in 2015, about 28,000 people in Singapore aged 60 and above - or one in 10 - had dementia. The number is set to soar to 80,000 by 2030.
People who are afflicted with dementia tend to display difficulties at concentrating on tasks, finding words to articulate themselves and recalling recent events.
They may also have problems navigating around in the way they used to, said Dr Simon Ting, a senior consultant in the neurology department at the National Neuroscience Institute (SGH campus).
Some people may exhibit personality or mood changes.
Medical help should be sought if the symptoms start to affect one's daily life, said Dr Ting.
An example would be when the person has trouble keeping track of finances, medications or appointments.
To keep dementia at bay, it is important to set aside time every day to stimulate your brain, said Dr Kinjal.
This can include learning something new and practising different memory strategies.
A good night's sleep may be yet another shield against dementia.
Poor sleep has been linked in studies to dementia, said Assistant Professor Julian Lim of the signature research programme in neuroscience and behavioural disorders at Duke-NUS Medical School.
Studies carried out on animals have shown that a peptide associated with Alzheimer's disease, called beta-amyloid, is flushed out of the brain during sleep.
"Although research is still ongoing, it appears that the clearance of these toxins from the brain during sleep might be an important protective factor against memory loss and dementia," said Prof Lim.
To get better sleep, avoid using computers or electronic devices a few hours before going to bed. Also, try not to take caffeine or alcohol too close to bedtime, he added.
Lengthy daytime naps are also a no-no, as they may make it harder for one to get a good night's rest.
Some types of medication can also affect sleep, so patients may want to check with the doctor for alternative options, said Prof Lim.
They should spend time with friends and family members, and also exercise regularly.
"These activities can reduce the level of hormones associated with chronic stress and increase metabolism, both of which may improve sleep quality at night," he added.
###
Give your brain a workout
Learn something completely new: You can pick up a new language or musical instrument. Or read a book on a topic you are not familiar with. If you are a technical person, try reading history.
Take up a new hobby. The more challenging this is, the more it will benefit your brain.
Pay heed to your daily life: Keep a close eye on what you do or encounter daily. Take note of the environment and your interactions with people. This helps to keep your brain cells working.
Spice up your routine: Carry out mundane daily tasks in a refreshing way. If you are right-handed. try brushing your teeth with your left hand.
Shuffle the apps on your mobile phone every now and then, so you have to think a little harder to remember where you had placed a particular app.
Varying routines that you tend to perform without much thought can help create new brain pathways.
Try different ways to remember things: Start by memorising small amounts of information - a shopping list, for example - and slowly move on to something more complex. Learn to recognise patterns and create methods that will help you to recall information. Some people create rhymes or think of an image for certain words.
Have fun with mind-bending games: Play games or take part in activities that require you to solve problems or devise a strategy. Ideas include crossword puzzles, cards, mahjong and sudoku. Such activities will train your brain to recall things better.
Source: Dr Kinjal Doshi, principal clinical psychologist, department of neurology, Singapore General Hospital
Sunday, September 18, 2016
Critical illness health insurance
Dr Larry Haverkamp
The Sunday Times
18 September 2016
A problem with business versus consumers is conflict. On the one hand, firms are tempted to boost profits by selling high-margin products.
The conflict is apparent in financial services like banking, investments and insurance. A reader wrote and asked me: "How about critical illness insurance? Is it worth the money? Should I buy it?"
My analysis is that critical illness health insurance is worth the money if you have a big budget. Like a Rolls-Royce automobile, it is a nice car, but do you really need it to move from point A to point B? It goes beyond the basics. That is the short answer: Here are the details:
DOUBLE COVERAGE
The biggest reason not to buy critical illness health insurance is that it is double coverage. That is because you are already covered under MediShield Life and maybe under a private insurer's intergrated plan(IP) as well.
That makes it double coverage, which you can live without. But wait. Isn't double coverage health insurance disallowed?
Correct. But critical illness insurance is an exception.
The double coverage makes critical illness almost like gambling. If you fall ill, you win the lottery and collect a large one-time payout that you can spend however you like. You need not spend it on medical care since that is already covered by MediShield Life.
Critical illness covers 37 diseases. You can file a claim to collect if you fall ill from any of them. The more common ones are major cancers, heart attack of specified severity, coronary artery by-pass surgery, kidney failure and stroke.
Actually, your critical illness coverage can go beyond these 37 illnesses. Great Eastern Life, for example, has an add-on policy (a rider) which increases payouts and expands the coverage to 92 diseases.
But it is going to cost you. Like most things you buy, the basics are cheapest and add-ons - like extended coverage - are usually more profitable for firms and more costly for consumers.
It seems it would be important to covered under these illnesses but, as mentioned, you are covered already through your MediShield Life and possibly an integrated plan if you purchased one. Do you need an IP policy on top of MediShield Life? That is a hot topic that I will answer in the near future.
WHY DOUBLE COVERAGE
The rationale for double coverage of health insurance is that its purpose is to pay for lost wages.
OK. There is a certain logic to that. You have one insurance policy - MediShield Life - to pay for your medical costs and another to pay for lost wages.
The only issue is your wages may not be cut off when you fall ill. Many employers continue to pay wages if the time off is not too long, like for a month or so.
It also depends on the job. Lower income and hourly workers are more likely than salaried workers to have their wages cut when they miss work because of illness. Ironically, they are also the ones who are the least able to afford critical illness health insurance with its riders.
A side point worth considering is the employer has an insurable interest when employees continue receiving wages while on medical leave. It is reasonable therefore that employers - rather than employees - provide the insurance coverage.
AN UNUSUAL RISK
Another side point: Could an unintended effect of critical illness insurance be that it could increase risk to the insured?
For example, I have a friend who had heart bypass surgery and made a claim under his critical illness plan. He was relieved that bypass surgery was one of the 37 illnesses covered under his plan but unfortunately. it covered triple bypass surgery and he only needed a single bypass.
So his claim was denied, and he had to pay with MediShield Life and his own savings. While it was a surprise, his employer continued to pay, so his costs were manageable.
He made the prudent decision. but it is an individual choice and someone on a budget might be tempted to delay the surgery. It is risky, but exactly how risky is not known for many diseases.
The joke at the time was he should have asked the doctor if he would please do two more bypasses since he was in there working on his heart already.
Then he could have collected on this critical illness insurance. Of course, it was only a joke since no doctor would do that, and my friend didn't even ask the doctor.
A Sunday Times article from 2011 told the story of breast cancer patient Theresa Tan who had her critical illness claim rejected because hers was an early stage breast cancer.
She had three critical illness policies and was surprised to learn that all covered only later stages of cancer. All rejected the claims she made for her mastectomy surgery.
lhaverkamp@smu.edu.sg
An adjunct professor at SMU, Dr Haverkamp contributes this column weekly to help our readers understand money matters better
The Sunday Times
18 September 2016
A problem with business versus consumers is conflict. On the one hand, firms are tempted to boost profits by selling high-margin products.
The conflict is apparent in financial services like banking, investments and insurance. A reader wrote and asked me: "How about critical illness insurance? Is it worth the money? Should I buy it?"
My analysis is that critical illness health insurance is worth the money if you have a big budget. Like a Rolls-Royce automobile, it is a nice car, but do you really need it to move from point A to point B? It goes beyond the basics. That is the short answer: Here are the details:
DOUBLE COVERAGE
The biggest reason not to buy critical illness health insurance is that it is double coverage. That is because you are already covered under MediShield Life and maybe under a private insurer's intergrated plan(IP) as well.
That makes it double coverage, which you can live without. But wait. Isn't double coverage health insurance disallowed?
Correct. But critical illness insurance is an exception.
The double coverage makes critical illness almost like gambling. If you fall ill, you win the lottery and collect a large one-time payout that you can spend however you like. You need not spend it on medical care since that is already covered by MediShield Life.
Critical illness covers 37 diseases. You can file a claim to collect if you fall ill from any of them. The more common ones are major cancers, heart attack of specified severity, coronary artery by-pass surgery, kidney failure and stroke.
Actually, your critical illness coverage can go beyond these 37 illnesses. Great Eastern Life, for example, has an add-on policy (a rider) which increases payouts and expands the coverage to 92 diseases.
But it is going to cost you. Like most things you buy, the basics are cheapest and add-ons - like extended coverage - are usually more profitable for firms and more costly for consumers.
It seems it would be important to covered under these illnesses but, as mentioned, you are covered already through your MediShield Life and possibly an integrated plan if you purchased one. Do you need an IP policy on top of MediShield Life? That is a hot topic that I will answer in the near future.
WHY DOUBLE COVERAGE
The rationale for double coverage of health insurance is that its purpose is to pay for lost wages.
OK. There is a certain logic to that. You have one insurance policy - MediShield Life - to pay for your medical costs and another to pay for lost wages.
The only issue is your wages may not be cut off when you fall ill. Many employers continue to pay wages if the time off is not too long, like for a month or so.
It also depends on the job. Lower income and hourly workers are more likely than salaried workers to have their wages cut when they miss work because of illness. Ironically, they are also the ones who are the least able to afford critical illness health insurance with its riders.
A side point worth considering is the employer has an insurable interest when employees continue receiving wages while on medical leave. It is reasonable therefore that employers - rather than employees - provide the insurance coverage.
AN UNUSUAL RISK
Another side point: Could an unintended effect of critical illness insurance be that it could increase risk to the insured?
For example, I have a friend who had heart bypass surgery and made a claim under his critical illness plan. He was relieved that bypass surgery was one of the 37 illnesses covered under his plan but unfortunately. it covered triple bypass surgery and he only needed a single bypass.
So his claim was denied, and he had to pay with MediShield Life and his own savings. While it was a surprise, his employer continued to pay, so his costs were manageable.
He made the prudent decision. but it is an individual choice and someone on a budget might be tempted to delay the surgery. It is risky, but exactly how risky is not known for many diseases.
The joke at the time was he should have asked the doctor if he would please do two more bypasses since he was in there working on his heart already.
Then he could have collected on this critical illness insurance. Of course, it was only a joke since no doctor would do that, and my friend didn't even ask the doctor.
A Sunday Times article from 2011 told the story of breast cancer patient Theresa Tan who had her critical illness claim rejected because hers was an early stage breast cancer.
She had three critical illness policies and was surprised to learn that all covered only later stages of cancer. All rejected the claims she made for her mastectomy surgery.
lhaverkamp@smu.edu.sg
An adjunct professor at SMU, Dr Haverkamp contributes this column weekly to help our readers understand money matters better
Sunday, October 26, 2014
The Dangers of Eating Late at Night
By JAMIE A. KOUFMAN
OCT. 25, 2014
ACID REFLUX is an epidemic affecting as many as 40 percent of Americans. In addition to heartburn and indigestion, reflux symptoms may include postnasal drip, hoarseness, difficulty swallowing, chronic throat clearing, coughing and asthma. Taken together, sales of prescribed and over-the-counter anti-reflux medications exceed $13 billion per year.
The number of people with acid reflux has grown significantly in recent decades. Reflux can lead to esophageal cancer, which has increased by about 500 percent since the 1970s. And anti-reflux medication alone does not appear to control reflux disease. A Danish study published this year concluded that there were no cancer-protective effects from using the common anti-reflux medications, called proton pump inhibitors, and that regular long-term use was actually associated with an increased risk of developing esophageal cancer.
What is responsible for these disturbing developments? The answer is our poor diet, with its huge increases in the consumption of sugar, soft drinks, fat and processed foods. But there is another important variable that has been underappreciated and overlooked: our dinnertime.
I specialize in the diagnosis and management of acid reflux, especially airway reflux, which affects the throat, sinuses and lungs. Airway reflux is often “silent,” occurring without telltale digestive symptoms, like heartburn and indigestion. Most of the tens of thousands of reflux patients that I have seen over the last 35 years are well today because I treat reflux by modifying my patients’ diets and lifestyles.
Over the past two decades, I’ve noticed that the time of the evening meal has been trending later and later among my patients. The after-work meal — already later because of longer work hours — is often further delayed by activities such as shopping and exercise.
Typical was the restaurateur who came to see me with symptoms of postnasal drip, sinus disease, hoarseness, heartburn and a chronic cough. He reported that he always left his restaurant at 11 p.m., and after arriving home would eat dinner and then go to bed. There was no medical treatment for this patient, no pills or even surgery to fix his condition. The drugs we are using to treat reflux don’t always work, and even when they do, they can have dangerous side effects. My patient’s reflux was a lifestyle problem. I told him he had to eat dinner before 7 p.m., and not eat at all after work. Within six weeks, his reflux was gone.
In my experience, the single most important intervention is to eliminate late eating, which in the United States is often combined with portions of large, over-processed, fatty food. Europeans have fewer cases of reflux than we do, even though many of them eat late. That’s most likely from portion control. In France, for example, a serving of ice cream is typically a single modest scoop, while in America, it’s often three gargantuan scoops.
For my patients, eating late is often accompanied by overeating, because many skip breakfast and eat only a sandwich at lunch. Thus the evening meal becomes the largest meal of the day. After that heavy meal, it’s off to the sofa to watch television. After eating, it’s important to stay upright because gravity helps keep the contents in the stomach. Reflux is the result of acid spilling out of the stomach, and lying down with a full stomach makes reflux much more likely.
And if you add an after-dinner dessert or bedtime snack? Again, reflux is a natural consequence. In a healthy young person, the stomach normally takes a few hours to empty after a moderate-size meal. In older people or those who have reflux, gastric emptying is often delayed. Further, those dessert calories tend to be high in carbohydrates and fat, and high-fat foods often create reflux by slowing digestion and relaxing the stomach valve that normally prevents reflux. Other popular but notoriously bad-for-nighttime-reflux foods and beverages are mints, chocolate, soft drinks and alcohol.
Many of my patients find that eating earlier alleviates their allergies, sinusitis, asthma, sleep apnea and diabetes symptoms. Although these conditions may not seem linked, postnasal drip and a cough are typical reflux symptoms that can easily be mistaken for something else.
Some of my patients who arrive complaining of reflux already eat healthfully. For them, dining too late is often the sole cause of their problem. And yet, hearing that they need to change the timing of their meals is sometimes a challenge they cannot meet.
A New Yorker with reflux came to see me because both her father and uncle died of esophageal cancer and she was afraid of getting it, too. This patient was a prominent businesswoman and her nightly routine included a 9 p.m. dinner at an elegant restaurant with at least two bottles of good red wine for the table. Her reflux was serious, and I explained that changes were needed.
She listened, then left and did not come back to see me for a year. When I saw her again, she explained what had happened. “For the first two months I just hated you,” she told me, “and then for the next two months — I was having some trouble swallowing — I figured I was going to die of esophageal cancer.” Then she nudged me and added, “You know, we’re the reason that it’s not so easy to get 6 p.m. reservations at the good restaurants anymore.”
To stop the remarkable increase in reflux disease, we have to stop eating by 8 p.m., or whatever time falls at least three hours before bed. For many people, eating dinner early represents a significant lifestyle shift. It will require eating well-planned breakfasts, lunches and snacks, with healthy food and beverage choices.
Jamie A. Koufman is a physician in New York who specializes in voice disorders and acid reflux.
Link
http://www.nytimes.com/2014/10/26/opinion/sunday/the-dangers-of-eating-late-at-night.html?_r=0
OCT. 25, 2014
ACID REFLUX is an epidemic affecting as many as 40 percent of Americans. In addition to heartburn and indigestion, reflux symptoms may include postnasal drip, hoarseness, difficulty swallowing, chronic throat clearing, coughing and asthma. Taken together, sales of prescribed and over-the-counter anti-reflux medications exceed $13 billion per year.
The number of people with acid reflux has grown significantly in recent decades. Reflux can lead to esophageal cancer, which has increased by about 500 percent since the 1970s. And anti-reflux medication alone does not appear to control reflux disease. A Danish study published this year concluded that there were no cancer-protective effects from using the common anti-reflux medications, called proton pump inhibitors, and that regular long-term use was actually associated with an increased risk of developing esophageal cancer.
What is responsible for these disturbing developments? The answer is our poor diet, with its huge increases in the consumption of sugar, soft drinks, fat and processed foods. But there is another important variable that has been underappreciated and overlooked: our dinnertime.
I specialize in the diagnosis and management of acid reflux, especially airway reflux, which affects the throat, sinuses and lungs. Airway reflux is often “silent,” occurring without telltale digestive symptoms, like heartburn and indigestion. Most of the tens of thousands of reflux patients that I have seen over the last 35 years are well today because I treat reflux by modifying my patients’ diets and lifestyles.
Over the past two decades, I’ve noticed that the time of the evening meal has been trending later and later among my patients. The after-work meal — already later because of longer work hours — is often further delayed by activities such as shopping and exercise.
Typical was the restaurateur who came to see me with symptoms of postnasal drip, sinus disease, hoarseness, heartburn and a chronic cough. He reported that he always left his restaurant at 11 p.m., and after arriving home would eat dinner and then go to bed. There was no medical treatment for this patient, no pills or even surgery to fix his condition. The drugs we are using to treat reflux don’t always work, and even when they do, they can have dangerous side effects. My patient’s reflux was a lifestyle problem. I told him he had to eat dinner before 7 p.m., and not eat at all after work. Within six weeks, his reflux was gone.
In my experience, the single most important intervention is to eliminate late eating, which in the United States is often combined with portions of large, over-processed, fatty food. Europeans have fewer cases of reflux than we do, even though many of them eat late. That’s most likely from portion control. In France, for example, a serving of ice cream is typically a single modest scoop, while in America, it’s often three gargantuan scoops.
For my patients, eating late is often accompanied by overeating, because many skip breakfast and eat only a sandwich at lunch. Thus the evening meal becomes the largest meal of the day. After that heavy meal, it’s off to the sofa to watch television. After eating, it’s important to stay upright because gravity helps keep the contents in the stomach. Reflux is the result of acid spilling out of the stomach, and lying down with a full stomach makes reflux much more likely.
And if you add an after-dinner dessert or bedtime snack? Again, reflux is a natural consequence. In a healthy young person, the stomach normally takes a few hours to empty after a moderate-size meal. In older people or those who have reflux, gastric emptying is often delayed. Further, those dessert calories tend to be high in carbohydrates and fat, and high-fat foods often create reflux by slowing digestion and relaxing the stomach valve that normally prevents reflux. Other popular but notoriously bad-for-nighttime-reflux foods and beverages are mints, chocolate, soft drinks and alcohol.
Many of my patients find that eating earlier alleviates their allergies, sinusitis, asthma, sleep apnea and diabetes symptoms. Although these conditions may not seem linked, postnasal drip and a cough are typical reflux symptoms that can easily be mistaken for something else.
Some of my patients who arrive complaining of reflux already eat healthfully. For them, dining too late is often the sole cause of their problem. And yet, hearing that they need to change the timing of their meals is sometimes a challenge they cannot meet.
A New Yorker with reflux came to see me because both her father and uncle died of esophageal cancer and she was afraid of getting it, too. This patient was a prominent businesswoman and her nightly routine included a 9 p.m. dinner at an elegant restaurant with at least two bottles of good red wine for the table. Her reflux was serious, and I explained that changes were needed.
She listened, then left and did not come back to see me for a year. When I saw her again, she explained what had happened. “For the first two months I just hated you,” she told me, “and then for the next two months — I was having some trouble swallowing — I figured I was going to die of esophageal cancer.” Then she nudged me and added, “You know, we’re the reason that it’s not so easy to get 6 p.m. reservations at the good restaurants anymore.”
To stop the remarkable increase in reflux disease, we have to stop eating by 8 p.m., or whatever time falls at least three hours before bed. For many people, eating dinner early represents a significant lifestyle shift. It will require eating well-planned breakfasts, lunches and snacks, with healthy food and beverage choices.
Jamie A. Koufman is a physician in New York who specializes in voice disorders and acid reflux.
Link
http://www.nytimes.com/2014/10/26/opinion/sunday/the-dangers-of-eating-late-at-night.html?_r=0
Sunday, August 31, 2014
許達夫醫師抗癌法
台灣腦神經外科名醫許達夫目前已經幫一萬多位病患開過腦部手術，但是他自己卻被醫師宣佈罹患癌症活不過三年，七年過去了，仍然非常的健康，他還向氣功大師學了一套平甩功，他要分享抗癌結合中西醫的自然療法.
Taiwanese Neurosurgeon, Dr. Shu was diagnosed with 3rd-stage colorectal cancer back in January 2003, but he managed to survive without devastating surgical procedures. Hope his story will inspire those who are fighting cancer.
我是名醫 我對抗癌症(Video in Chinese)
LINK
許達夫醫師自然醫學醫療網
http://www.nsshu.com/front/bin/cglist.phtml?Category=119471
Letter to Cancer Patients (English)
http://www.nsshu.com/front/bin/ptlist.phtml?Category=325031
Arm Swing QiGong(甩手功)
http://www.nsshu.com/front/bin/ptlist.phtml?Category=420577
抗癌资料，来自：约翰·霍普金斯大学
Cancer Information from Johns Hopkins University
癌細胞最重要的食物---糖(Video in English/Chinese)
Taiwanese Neurosurgeon, Dr. Shu was diagnosed with 3rd-stage colorectal cancer back in January 2003, but he managed to survive without devastating surgical procedures. Hope his story will inspire those who are fighting cancer.
我是名醫 我對抗癌症(Video in Chinese)
LINK
許達夫醫師自然醫學醫療網
http://www.nsshu.com/front/bin/cglist.phtml?Category=119471
Letter to Cancer Patients (English)
http://www.nsshu.com/front/bin/ptlist.phtml?Category=325031
Arm Swing QiGong(甩手功)
http://www.nsshu.com/front/bin/ptlist.phtml?Category=420577
抗癌资料，来自：约翰·霍普金斯大学
Cancer Information from Johns Hopkins University
癌細胞最重要的食物---糖(Video in English/Chinese)
Friday, March 14, 2014
Why getting enough sleep matters
By Michael Chee
March 14. 2014
Last year, an opinion-editorial that I wrote on the perils of short sleep received an unexpected flood of attention. Some wrote tongue-in-cheek commentaries on local sleep patterns. A few concerned parents made appeals on forum pages to have morning-session secondary schools start later. Others thanked me for helping them counsel their children. Is this acknowledgement that the effects of sleep on health are being taken more seriously? Perhaps not.
Independent surveys have shown that, on average, East Asian young adults sleep one to two hours less a night than their European and Australian counterparts.
In the past 12 months, more evidence regarding the growing menace of short sleep has emerged. Market research has identified midnight to 1am as ‘prime time’ for mobile usage in Malaysia. Yet, unpublished data from student surveys indicate that our elite students sleep less than five to six hours a night. Students in one school averaged less than five hours.
Developing brains need sleep. Memory consolidation — the process where what we learn is made more resistant to forgetting and interference — benefits from sleep as memories formed during the day get reactivated in deep sleep.
Data gathered from more than 120,000 people worldwide showed that adults who had the best performance in an Internet-based, standardised test set were those who reported sleeping seven hours at night.
A new finding last year found that when we sleep, channels for waste and neurotoxic substances open up by as much as 60 per cent more. Indeed, in other research, removal of beta-amyloid, a substance implicated in Alzheimer’s disease, was found to be substantially higher during sleep.
SOCIAL NORMS
GUIDE BEHAVIOUR
Why do many seemingly successful, motivated persons continue to give sleep the short shrift?
In East Asia, hard work is worn as a badge of honour. We know top students who have bragged about their all-night cram sessions, akin to smokers who boast it is their non-smoking friends who die from lung cancer. However, epidemiological data do not lie. Like betting against the house in a casino, most people and societies eventually lose if sleep is habitually sacrificed.
Like most good things, more hard work is not necessarily better. Beyond a point, returns for effort turn negative. Work from my lab has shown that a single night without sleep reduces the maximum rate at which one can process visual information by about a third. Our capacity to block out irrelevant, interfering information is likewise reduced and not dissimilar from that observed with cognitive ageing.
This is not to say I am decrying quality effort. On the contrary, there are productivity gains to be realised from getting adequate sleep.
Even before Twitter and Facebook, social networks exerted powerful influence on collective behaviour. About 17 years ago, it was found that the friends of overweight people had an alarming tendency to themselves be overweight. By and by, consumption norms for entire societies started shifting; ‘heavier’ has become the new normal.
The same appears to be happening for attitudes to sleep. Indeed, the nihilism I encounter when speaking to many students is troubling. Many know they are not getting enough sleep, but few seem willing to do anything about it. “I’m just going to have a short life” was the response of one student. While people have the right to lifestyle choices, if such a choice affects others and society negatively by raising healthcare costs, should governments not weigh in?
In the case of smoking, legislation has been passed to significantly reduce the risk of exposure to passive cigarette smoke. Smokers can be readily observed and cigarettes purchases can be taxed. But how are we going to reduce the costly burden of lack of sleep if corporate and government leaders themselves sleep little (perhaps as a result of favourable genetic endowment) and expect others to do likewise?
PROMOTING GOOD SLEEP
While insufficient sleep elevates the risk of death and several chronic illnesses, its effects are cumulative over long periods and are masked by other more visible risk factors. This results in sleep being downplayed when positive health tips are being dispensed.
With the advent of wearable, personalised health monitors (for example, Jawbone’s ‘UP’, an app that helps one understand how he sleeps, moves and eats so he can make smarter choices), I foresee the day when people compete to get ‘good quality’ and ‘personalised for me’ sleep.
Using sophisticated time-locked auditory stimulation applied during deep sleep, researchers have been able to boost memory performance in young adults. This may be extended to improve cognition in older people, who tend to have poorer sleep.
As biological signals to sleep and wake up later kick in when children turn 13-14 years old, secondary schools that start one hour later might find their average students improving test scores.
If health warnings fail, we can exploit vanity concerns. Research sponsored by Estee Lauder suggests that the skin of sleep-deprived young women shows less resilience to stresses such as ultraviolet light and ages prematurely. Beauty sleep has value! And when there are fortunes to be made, sleep can be commercialised just like the exercise industry.
If you are sleeping one to two hours longer on rest-days than on workdays, you are probably not getting enough sleep. If you fall asleep at work or in class regularly, your brain is telling you something.
Even for the die-hard, utility maximising economist, where sleep is concerned, the only bargains on offer are Faustian ones. Similar to exercise and good diet, improving sleep duration and quality can improve productivity, short-term well-being, long-term health and ultimately the economy. Nothing to sniff at, and lots to sleep over!
ABOUT THE AUTHOR
Michael Chee is Professor at the Neuroscience and Behavioral Program at Duke-NUS Graduate Medical School and a National Medical Research Council STaR Investigator. This commentary was written to commemorate World Sleep Day on March 14 on behalf of the Singapore Sleep Society.
March 14. 2014
Last year, an opinion-editorial that I wrote on the perils of short sleep received an unexpected flood of attention. Some wrote tongue-in-cheek commentaries on local sleep patterns. A few concerned parents made appeals on forum pages to have morning-session secondary schools start later. Others thanked me for helping them counsel their children. Is this acknowledgement that the effects of sleep on health are being taken more seriously? Perhaps not.
Independent surveys have shown that, on average, East Asian young adults sleep one to two hours less a night than their European and Australian counterparts.
In the past 12 months, more evidence regarding the growing menace of short sleep has emerged. Market research has identified midnight to 1am as ‘prime time’ for mobile usage in Malaysia. Yet, unpublished data from student surveys indicate that our elite students sleep less than five to six hours a night. Students in one school averaged less than five hours.
Developing brains need sleep. Memory consolidation — the process where what we learn is made more resistant to forgetting and interference — benefits from sleep as memories formed during the day get reactivated in deep sleep.
Data gathered from more than 120,000 people worldwide showed that adults who had the best performance in an Internet-based, standardised test set were those who reported sleeping seven hours at night.
A new finding last year found that when we sleep, channels for waste and neurotoxic substances open up by as much as 60 per cent more. Indeed, in other research, removal of beta-amyloid, a substance implicated in Alzheimer’s disease, was found to be substantially higher during sleep.
SOCIAL NORMS
GUIDE BEHAVIOUR
Why do many seemingly successful, motivated persons continue to give sleep the short shrift?
In East Asia, hard work is worn as a badge of honour. We know top students who have bragged about their all-night cram sessions, akin to smokers who boast it is their non-smoking friends who die from lung cancer. However, epidemiological data do not lie. Like betting against the house in a casino, most people and societies eventually lose if sleep is habitually sacrificed.
Like most good things, more hard work is not necessarily better. Beyond a point, returns for effort turn negative. Work from my lab has shown that a single night without sleep reduces the maximum rate at which one can process visual information by about a third. Our capacity to block out irrelevant, interfering information is likewise reduced and not dissimilar from that observed with cognitive ageing.
This is not to say I am decrying quality effort. On the contrary, there are productivity gains to be realised from getting adequate sleep.
Even before Twitter and Facebook, social networks exerted powerful influence on collective behaviour. About 17 years ago, it was found that the friends of overweight people had an alarming tendency to themselves be overweight. By and by, consumption norms for entire societies started shifting; ‘heavier’ has become the new normal.
The same appears to be happening for attitudes to sleep. Indeed, the nihilism I encounter when speaking to many students is troubling. Many know they are not getting enough sleep, but few seem willing to do anything about it. “I’m just going to have a short life” was the response of one student. While people have the right to lifestyle choices, if such a choice affects others and society negatively by raising healthcare costs, should governments not weigh in?
In the case of smoking, legislation has been passed to significantly reduce the risk of exposure to passive cigarette smoke. Smokers can be readily observed and cigarettes purchases can be taxed. But how are we going to reduce the costly burden of lack of sleep if corporate and government leaders themselves sleep little (perhaps as a result of favourable genetic endowment) and expect others to do likewise?
PROMOTING GOOD SLEEP
While insufficient sleep elevates the risk of death and several chronic illnesses, its effects are cumulative over long periods and are masked by other more visible risk factors. This results in sleep being downplayed when positive health tips are being dispensed.
With the advent of wearable, personalised health monitors (for example, Jawbone’s ‘UP’, an app that helps one understand how he sleeps, moves and eats so he can make smarter choices), I foresee the day when people compete to get ‘good quality’ and ‘personalised for me’ sleep.
Using sophisticated time-locked auditory stimulation applied during deep sleep, researchers have been able to boost memory performance in young adults. This may be extended to improve cognition in older people, who tend to have poorer sleep.
As biological signals to sleep and wake up later kick in when children turn 13-14 years old, secondary schools that start one hour later might find their average students improving test scores.
If health warnings fail, we can exploit vanity concerns. Research sponsored by Estee Lauder suggests that the skin of sleep-deprived young women shows less resilience to stresses such as ultraviolet light and ages prematurely. Beauty sleep has value! And when there are fortunes to be made, sleep can be commercialised just like the exercise industry.
If you are sleeping one to two hours longer on rest-days than on workdays, you are probably not getting enough sleep. If you fall asleep at work or in class regularly, your brain is telling you something.
Even for the die-hard, utility maximising economist, where sleep is concerned, the only bargains on offer are Faustian ones. Similar to exercise and good diet, improving sleep duration and quality can improve productivity, short-term well-being, long-term health and ultimately the economy. Nothing to sniff at, and lots to sleep over!
ABOUT THE AUTHOR
Michael Chee is Professor at the Neuroscience and Behavioral Program at Duke-NUS Graduate Medical School and a National Medical Research Council STaR Investigator. This commentary was written to commemorate World Sleep Day on March 14 on behalf of the Singapore Sleep Society.
Tuesday, February 11, 2014
Why the humble cauliflower packs powerfully nutritious punch
Tuesday, 11 February, 2014, 11:01am
Jeanette Wang jeanette.wang@scmp.com
The vegetable is gluten-free and diabetic-friendly, with a low glycaemic index. So why don't we eat more of it, asks Jeanette Wang
Imagine eating bangers without mash or curry without rice: palatable, but tough. As popular and effective low-carb diets are, the truth is a meal without a starchy carb - rice, noodles or potatoes - often doesn't satisfy.
Serene Loong, who describes herself as "in my late 30s with middle-aged metabolism", knows the feeling well. Tired of not fitting into her clothes, in 2010 she embarked on a low-carb diet and lost 10kg in three months. But once she reintroduced carbs to her plate, "the weight came back with a vengeance" and the scale returned to 58kg.
Cauliflower is very versatile and can be treated like a piece of protein
Matt abergel, owner of yardbird
"To restrict certain foods like mashed potatoes or rice serves to make us want it more," says Loong. "So I thought, why not make mash or rice from the stuff you're supposed to eat more of anyway, such as vegetables?"
Scouring the internet for recipes, she eventually found an alternative: cauliflower. Chopped, cooked and blended with a bit of cream cheese or butter, the cruciferous vegetable resembles and tastes like mashed potatoes - but with fewer calories and fat, and about a third less carbs.
The only trouble was preparing and cooking the cauliflower mash took at least 20 minutes. Taking inspiration from instant mashed potatoes, Loong decided to develop a similar product using cauliflower.
Cauliflower Mash by Zero Cuisine. [1]After a year of research and development with a food technician in Singapore, Zero Cuisine was born. Loong says each serving of her instant cauliflower mash - just add water - is made from 300 grams of fresh cauliflower and contains 60 calories, 15 grams of carbs, one gram of fat and five grams of fibre.
That's 63 per cent fewer calories, 38 per cent fewer carbs, 92 per cent less fat and 150 per cent more fibre than traditional mashed potatoes made with cream and butter.
Zero Cuisine is scheduled to hit grocery stores next month. In the meantime, Loong is selling samples via international crowdfunding site Indiegogo (igg.me/at/ZeroCuisine [2]) in a bid to raise US$10,000 to keep her business going.
It's certainly a good time to be dealing with cauliflower. Food trend experts have named it a hot commodity for 2014: the Canadian Press last month crowned it "the new kale" (last year's veggie superstar) and Baum+Whiteman, a US-based food and restaurant consultancy, identified cauliflower as one of 30 buzzwords in food this year.
"Cauliflower is extremely versatile and, in many ways, can be treated like a piece of protein," says chef Matt Abergel, owner of Yardbird, a bustling yakitori outlet in SoHo that serves up sweet and spicy Korean fried cauliflower. "It's not difficult to find good quality cauliflower and it's relatively inexpensive."
Gluten-free and diabetic-friendly with a low glycaemic index, the vegetable is a good substitute in dishes that call for traditional carbs or protein. At Washington's downtown Cedar Restaurant, cauliflower is grated into rice-sized pieces and cooked in a similar way to risotto. In California's Superba Snack Bar, a thick slab of grilled cauliflower is served - and said to be as satisfying - as a T-bone steak.
Still other chefs have used cauliflower to make pizza crust, hash browns and popcorn, giving the pale, pungent and unpopular vegetable a new lease on life.
"I grew up with a lot of vegetables and cauliflower was one of them, so I have no prejudice on its flavour profile or its smell," says Richard Ekkebus, culinary director of the The Landmark Mandarin Oriental hotel in Hong Kong, whose signature dish is sea urchin in lobster jello with cauliflower, caviar and crispy seaweed waffle.
"In a lot of food cultures, smelly ingredients such as cheese or stinky tofu are seen as absolute delicacies.
"What I like about cauliflower is its versatility in utilisation: raw, finely chopped and then just blanched for a couscous-like texture, caramelised in a skillet and roasted till fondant, or cooked thoroughly as a purée. They're all worthy preparations."
In spite of its recent rise in the culinary world, cauliflower has always ranked highly in health and nutrition.
It's a good source of vitamin C, folate, potassium and fibre. According to the USDA National Nutrient Database, 100 grams of raw cauliflower - about one cup of chopped pieces - contains just 25 calories, two grams of protein, 0.3 grams of fat, five grams of carbohydrate, two grams of dietary fibre and two grams of sugars.
Cauliflower is part of a family of cruciferous vegetables - including broccoli, brussels sprouts, cabbage and kale - that are rich in organic compounds called indoles, which have a positive impact on cellular health.
Diindolylmethane (DIM) is one such compound that has shown to support the immune system and help keep hormones, especially oestrogen, in balance.
Breast, prostate and other areas of hormone-related cellular health rely on this balance. DIM has been proven to increase the good kind of hormone metabolites and decrease the kind that can derail health.
DIM may also protect normal tissues in cancer patients during radiation therapy and may prevent or mitigate sickness caused by radiation exposure in healthy people, according to a study on mice by Georgetown University published in October in the Proceedings of the National Academy of Sciences.
Cruciferous vegetables are also rich in another compound, sulforaphane, which has shown in tests on rodents to inhibit some cancers either induced by carcinogens or arising from genetic make-up.
Johns Hopkins researchers have also found that the compound helps prevent the severe blistering and skin breakage brought on by the rare and potentially fatal genetic disease epidermolysis bullosa simplex.
Many people shy away from cauliflower, however, because of its smell. Playing around with cooking methods can help you enjoy the vegetable.
"Cauliflower is very dense and has a low water content, so cooking it over high heat with a good amount of fat is best," says Abergel. "Cauliflower also takes well to strong flavours, like spice and vinegar. Personally, I like to deep fry or caramelise cauliflower."
Try seasoning cauliflower with the curry spice turmeric: the combination has shown potential for the treatment and prevention of prostate cancer, say researchers at Rutgers University.
Google "cauliflower recipes" and you won't be short on ideas. The 10 best cauliflower recipes named by The Guardian in an article last year include cauliflower and pear bake, cauliflower omelette, a French cauliflower gratin, and roasted cauliflower tart with oat-walnut crust and lemon herb filling.
The worst way to cook cauliflower is boiling, say University of Warwick scientists. In their 2007 study, boiling appeared to have a serious impact on the retention of cancer-protective substances called glucosinolates found in cruciferous vegetables.
After boiling for 30 minutes, cauliflower lost 75 per cent of the phytochemical. Steaming for up to 20 minutes, microwaving for up to three minutes and stir-frying for up to five minutes showed no significant loss of the compound.
The bottom line to reap the health benefits of cauliflower and its cruciferous cousins: eat the real thing. A 2011 study by Oregon State University found that an enzyme called myrosinase, which helps with the absorption of glucosinolates, is missing from most of the supplement forms of the compound.
jeanette.wang@scmp.com
Jeanette Wang jeanette.wang@scmp.com
The vegetable is gluten-free and diabetic-friendly, with a low glycaemic index. So why don't we eat more of it, asks Jeanette Wang
Imagine eating bangers without mash or curry without rice: palatable, but tough. As popular and effective low-carb diets are, the truth is a meal without a starchy carb - rice, noodles or potatoes - often doesn't satisfy.
Serene Loong, who describes herself as "in my late 30s with middle-aged metabolism", knows the feeling well. Tired of not fitting into her clothes, in 2010 she embarked on a low-carb diet and lost 10kg in three months. But once she reintroduced carbs to her plate, "the weight came back with a vengeance" and the scale returned to 58kg.
Cauliflower is very versatile and can be treated like a piece of protein
Matt abergel, owner of yardbird
"To restrict certain foods like mashed potatoes or rice serves to make us want it more," says Loong. "So I thought, why not make mash or rice from the stuff you're supposed to eat more of anyway, such as vegetables?"
Scouring the internet for recipes, she eventually found an alternative: cauliflower. Chopped, cooked and blended with a bit of cream cheese or butter, the cruciferous vegetable resembles and tastes like mashed potatoes - but with fewer calories and fat, and about a third less carbs.
The only trouble was preparing and cooking the cauliflower mash took at least 20 minutes. Taking inspiration from instant mashed potatoes, Loong decided to develop a similar product using cauliflower.
Cauliflower Mash by Zero Cuisine. [1]After a year of research and development with a food technician in Singapore, Zero Cuisine was born. Loong says each serving of her instant cauliflower mash - just add water - is made from 300 grams of fresh cauliflower and contains 60 calories, 15 grams of carbs, one gram of fat and five grams of fibre.
That's 63 per cent fewer calories, 38 per cent fewer carbs, 92 per cent less fat and 150 per cent more fibre than traditional mashed potatoes made with cream and butter.
Zero Cuisine is scheduled to hit grocery stores next month. In the meantime, Loong is selling samples via international crowdfunding site Indiegogo (igg.me/at/ZeroCuisine [2]) in a bid to raise US$10,000 to keep her business going.
It's certainly a good time to be dealing with cauliflower. Food trend experts have named it a hot commodity for 2014: the Canadian Press last month crowned it "the new kale" (last year's veggie superstar) and Baum+Whiteman, a US-based food and restaurant consultancy, identified cauliflower as one of 30 buzzwords in food this year.
"Cauliflower is extremely versatile and, in many ways, can be treated like a piece of protein," says chef Matt Abergel, owner of Yardbird, a bustling yakitori outlet in SoHo that serves up sweet and spicy Korean fried cauliflower. "It's not difficult to find good quality cauliflower and it's relatively inexpensive."
Gluten-free and diabetic-friendly with a low glycaemic index, the vegetable is a good substitute in dishes that call for traditional carbs or protein. At Washington's downtown Cedar Restaurant, cauliflower is grated into rice-sized pieces and cooked in a similar way to risotto. In California's Superba Snack Bar, a thick slab of grilled cauliflower is served - and said to be as satisfying - as a T-bone steak.
Still other chefs have used cauliflower to make pizza crust, hash browns and popcorn, giving the pale, pungent and unpopular vegetable a new lease on life.
"I grew up with a lot of vegetables and cauliflower was one of them, so I have no prejudice on its flavour profile or its smell," says Richard Ekkebus, culinary director of the The Landmark Mandarin Oriental hotel in Hong Kong, whose signature dish is sea urchin in lobster jello with cauliflower, caviar and crispy seaweed waffle.
"In a lot of food cultures, smelly ingredients such as cheese or stinky tofu are seen as absolute delicacies.
"What I like about cauliflower is its versatility in utilisation: raw, finely chopped and then just blanched for a couscous-like texture, caramelised in a skillet and roasted till fondant, or cooked thoroughly as a purée. They're all worthy preparations."
In spite of its recent rise in the culinary world, cauliflower has always ranked highly in health and nutrition.
It's a good source of vitamin C, folate, potassium and fibre. According to the USDA National Nutrient Database, 100 grams of raw cauliflower - about one cup of chopped pieces - contains just 25 calories, two grams of protein, 0.3 grams of fat, five grams of carbohydrate, two grams of dietary fibre and two grams of sugars.
Cauliflower is part of a family of cruciferous vegetables - including broccoli, brussels sprouts, cabbage and kale - that are rich in organic compounds called indoles, which have a positive impact on cellular health.
Diindolylmethane (DIM) is one such compound that has shown to support the immune system and help keep hormones, especially oestrogen, in balance.
Breast, prostate and other areas of hormone-related cellular health rely on this balance. DIM has been proven to increase the good kind of hormone metabolites and decrease the kind that can derail health.
DIM may also protect normal tissues in cancer patients during radiation therapy and may prevent or mitigate sickness caused by radiation exposure in healthy people, according to a study on mice by Georgetown University published in October in the Proceedings of the National Academy of Sciences.
Cruciferous vegetables are also rich in another compound, sulforaphane, which has shown in tests on rodents to inhibit some cancers either induced by carcinogens or arising from genetic make-up.
Johns Hopkins researchers have also found that the compound helps prevent the severe blistering and skin breakage brought on by the rare and potentially fatal genetic disease epidermolysis bullosa simplex.
Many people shy away from cauliflower, however, because of its smell. Playing around with cooking methods can help you enjoy the vegetable.
"Cauliflower is very dense and has a low water content, so cooking it over high heat with a good amount of fat is best," says Abergel. "Cauliflower also takes well to strong flavours, like spice and vinegar. Personally, I like to deep fry or caramelise cauliflower."
Try seasoning cauliflower with the curry spice turmeric: the combination has shown potential for the treatment and prevention of prostate cancer, say researchers at Rutgers University.
Google "cauliflower recipes" and you won't be short on ideas. The 10 best cauliflower recipes named by The Guardian in an article last year include cauliflower and pear bake, cauliflower omelette, a French cauliflower gratin, and roasted cauliflower tart with oat-walnut crust and lemon herb filling.
The worst way to cook cauliflower is boiling, say University of Warwick scientists. In their 2007 study, boiling appeared to have a serious impact on the retention of cancer-protective substances called glucosinolates found in cruciferous vegetables.
After boiling for 30 minutes, cauliflower lost 75 per cent of the phytochemical. Steaming for up to 20 minutes, microwaving for up to three minutes and stir-frying for up to five minutes showed no significant loss of the compound.
The bottom line to reap the health benefits of cauliflower and its cruciferous cousins: eat the real thing. A 2011 study by Oregon State University found that an enzyme called myrosinase, which helps with the absorption of glucosinolates, is missing from most of the supplement forms of the compound.
jeanette.wang@scmp.com
Tuesday, February 4, 2014
Cancer 'tidal wave' on horizon, warns WHO
4 February 2014 Last updated at 06:33
Large numbers of people do not know there is a lot they can do to reduce their exposure to risk
The globe is facing a "tidal wave" of cancer, and restrictions on alcohol and sugar need to be considered, say World Health Organization scientists.
It predicts the number of cancer cases will reach 24 million a year by 2035, but half could be prevented.
The WHO said there was now a "real need" to focus on cancer prevention by tackling smoking, obesity and drinking.
The World Cancer Research Fund said there was an "alarming" level of naivety about diet's role in cancer.
Fourteen million people a year are diagnosed with cancer, but that is predicted to increase to 19 million by 2025, 22 million by 2030 and 24 million by 2035.
The developing world will bear the brunt of the extra cases.
Chris Wild, the director of the WHO's International Agency for Research on Cancer, told the BBC: "The global cancer burden is increasing and quite markedly, due predominately to the ageing of the populations and population growth.
"If we look at the cost of treatment of cancers, it is spiralling out of control, even for the high-income countries. Prevention is absolutely critical and it's been somewhat neglected."
The WHO's World Cancer Report 2014 said the major sources of preventable cancer included:
Smoking
Infections
Alcohol
Obesity and inactivity
Radiation, both from the sun and medical scans
Air pollution and other environmental factors
Delayed parenthood, having fewer children and not breastfeeding
For most countries, breast cancer is the most common cancer in women. However, cervical cancer dominates in large parts of Africa.
AdvertisementDr Chris Wild, WHO: "We're not going to be able to address this problem by simply improving treatment"
The human papillomavirus (HPV) is a major cause. It is thought wider use of the HPV and other vaccines could prevent hundreds of thousands of cancers.
One of the report's editors, Dr Bernard Stewart from the University of New South Wales in Australia, said prevention had a "crucial role in combating the tidal wave of cancer which we see coming across the world".
Dr Stewart said human behaviour was behind many cancers such as the sunbathe "until you're cooked evenly on both sides" approach in his native Australia.
He said it was not the role of the International Agency for Research on Cancer to dictate what should be done.
But he added: "In relation to alcohol, for example, we're all aware of the acute effects, whether it's car accidents or assaults, but there's a burden of disease that's not talked about because it's simply not recognised, specifically involving cancer.
"The extent to which we modify the availability of alcohol, the labelling of alcohol, the promotion of alcohol and the price of alcohol - those things should be on the agenda."
He said there was a similar argument to be had with sugar fuelling obesity, which in turn affected cancer risk.
Meanwhile, a survey of 2,046 people in the UK by the World Cancer Research Fund (WCRF) suggested 49% do not know that diet increases the risk of developing cancer.
A third of people said cancer was mainly due to family history, but the charity said no more than 10% of cancers were down to inherited genes.
Amanda McLean, general manager for the WCRF, said: "It's very alarming to see that such a large number of people don't know that there's a lot they can do to significantly reduce their risk of getting cancer.
For most countries, breast cancer is the most common cancer in women.
"In the UK, about a third of the most common cancers could be prevented through being a healthy weight, eating a healthy diet and being regularly physically active.
"These results show that many people still seem to mistakenly accept their chances of getting cancer as a throw of the dice, but by making lifestyle changes today, we can help prevent cancer tomorrow."
It advises a diet packed with vegetables, fruit, and wholegrains; cutting down on alcohol and red meat; and junking processed meat completely.
Dr Jean King, Cancer Research UK's director of tobacco control, said: "The most shocking thing about this report's prediction that 14 million cancer cases a year will rise to 22 million globally in the next 20 years is that up to half of all cases could be prevented.
"People can cut their risk of cancer by making healthy lifestyle choices, but it's important to remember that the government and society are also responsible for creating an environment that supports healthy lifestyles.
"It's clear that if we don't act now to curb the number of people getting cancer, we will be at the heart of a global crisis in cancer care within the next two decades."
Large numbers of people do not know there is a lot they can do to reduce their exposure to risk
The globe is facing a "tidal wave" of cancer, and restrictions on alcohol and sugar need to be considered, say World Health Organization scientists.
It predicts the number of cancer cases will reach 24 million a year by 2035, but half could be prevented.
The WHO said there was now a "real need" to focus on cancer prevention by tackling smoking, obesity and drinking.
The World Cancer Research Fund said there was an "alarming" level of naivety about diet's role in cancer.
Fourteen million people a year are diagnosed with cancer, but that is predicted to increase to 19 million by 2025, 22 million by 2030 and 24 million by 2035.
The developing world will bear the brunt of the extra cases.
Chris Wild, the director of the WHO's International Agency for Research on Cancer, told the BBC: "The global cancer burden is increasing and quite markedly, due predominately to the ageing of the populations and population growth.
"If we look at the cost of treatment of cancers, it is spiralling out of control, even for the high-income countries. Prevention is absolutely critical and it's been somewhat neglected."
The WHO's World Cancer Report 2014 said the major sources of preventable cancer included:
Smoking
Infections
Alcohol
Obesity and inactivity
Radiation, both from the sun and medical scans
Air pollution and other environmental factors
Delayed parenthood, having fewer children and not breastfeeding
For most countries, breast cancer is the most common cancer in women. However, cervical cancer dominates in large parts of Africa.
AdvertisementDr Chris Wild, WHO: "We're not going to be able to address this problem by simply improving treatment"
The human papillomavirus (HPV) is a major cause. It is thought wider use of the HPV and other vaccines could prevent hundreds of thousands of cancers.
One of the report's editors, Dr Bernard Stewart from the University of New South Wales in Australia, said prevention had a "crucial role in combating the tidal wave of cancer which we see coming across the world".
Dr Stewart said human behaviour was behind many cancers such as the sunbathe "until you're cooked evenly on both sides" approach in his native Australia.
He said it was not the role of the International Agency for Research on Cancer to dictate what should be done.
But he added: "In relation to alcohol, for example, we're all aware of the acute effects, whether it's car accidents or assaults, but there's a burden of disease that's not talked about because it's simply not recognised, specifically involving cancer.
"The extent to which we modify the availability of alcohol, the labelling of alcohol, the promotion of alcohol and the price of alcohol - those things should be on the agenda."
He said there was a similar argument to be had with sugar fuelling obesity, which in turn affected cancer risk.
Meanwhile, a survey of 2,046 people in the UK by the World Cancer Research Fund (WCRF) suggested 49% do not know that diet increases the risk of developing cancer.
A third of people said cancer was mainly due to family history, but the charity said no more than 10% of cancers were down to inherited genes.
Amanda McLean, general manager for the WCRF, said: "It's very alarming to see that such a large number of people don't know that there's a lot they can do to significantly reduce their risk of getting cancer.
For most countries, breast cancer is the most common cancer in women.
"In the UK, about a third of the most common cancers could be prevented through being a healthy weight, eating a healthy diet and being regularly physically active.
"These results show that many people still seem to mistakenly accept their chances of getting cancer as a throw of the dice, but by making lifestyle changes today, we can help prevent cancer tomorrow."
It advises a diet packed with vegetables, fruit, and wholegrains; cutting down on alcohol and red meat; and junking processed meat completely.
Dr Jean King, Cancer Research UK's director of tobacco control, said: "The most shocking thing about this report's prediction that 14 million cancer cases a year will rise to 22 million globally in the next 20 years is that up to half of all cases could be prevented.
"People can cut their risk of cancer by making healthy lifestyle choices, but it's important to remember that the government and society are also responsible for creating an environment that supports healthy lifestyles.
"It's clear that if we don't act now to curb the number of people getting cancer, we will be at the heart of a global crisis in cancer care within the next two decades."
Monday, February 3, 2014
Cancer cases on the rise in Singapore
Published on Feb 03, 2014
Worrying trend of more lifestyle cancers like prostate, breast tumours
By Linette Lai
CANCER is on the rise in Singapore - especially those linked to bad habits associated with the modern lifestyle, including smoking and eating too much.
According to the latest available figures from two years ago, 12,123 people were diagnosed with cancer, up from 10,576 in 2008. This marks an increase of nearly 15 per cent.
One reason for these numbers, said National Cancer Centre Singapore (NCCS) director Soo Khee Chee, is an ageing population. The NCCS is Singapore's leading cancer treatment and research centre.
"In developed countries like ours, people are living longer. Previously, people would die before they got cancer," he said.
But what is more worrying is how "lifestyle cancers" such as prostate, breast and colo-rectum cancers are contributing to the rise as well.
Prostate cancer cases went up by 52 per cent from 2003 to 2012, when cases of breast cancer also rose by 25 per cent.
These cancers are, respectively, among the top three most common in men and women. They are also known as "developed world cancers" because they are associated with the lifestyle in these countries.
One factor that increases the chance of cancer is smoking, said Professor Soo.
"Overall, the rate of smoking is moving downwards, but there is a trend of more younger people here taking it up," he said.
Health Promotion Board figures from 2010 showed that 16 per cent of young people aged 18 to 29 smoked regularly, up from 12 per cent in 2004.
Other factors contributing to the rise of cancer here are poor diet and lack of exercise, because we are "overfed and eating the wrong food", Prof Soo said.
Having fewer children and having them later also increase a woman's chances of getting cancer, he added.
Cancer remains the No.1 killer in Singapore, with 30 per cent of deaths in 2011 caused by the disease. This is five times more than deaths caused by accidents, violence and poisoning together.
But the outlook is not all bleak.
The chances of getting cancer can be lowered dramatically by modifying one's lifestyle. Stopping young people from smoking, for instance, "will almost decrease cancer deaths by a third if we succeed", Prof Soo said.
Some of the most common cancers are also those which have the highest survival rates.
Breast cancer - which is the most common cancer in women - has a five-year overall survival rate of 89 per cent. This means that 89 of every 100 people diagnosed with breast cancer were still alive after five years. The corresponding figure for lymphoma was 70 per cent, while that for colon cancer was 60 per cent.
"Cancer is not a death sentence," said Prof Soo. "It would be a pity if cancer patients go into despair or give up because they think that way."
linettel@sph.com.sg
Worrying trend of more lifestyle cancers like prostate, breast tumours
By Linette Lai
CANCER is on the rise in Singapore - especially those linked to bad habits associated with the modern lifestyle, including smoking and eating too much.
According to the latest available figures from two years ago, 12,123 people were diagnosed with cancer, up from 10,576 in 2008. This marks an increase of nearly 15 per cent.
One reason for these numbers, said National Cancer Centre Singapore (NCCS) director Soo Khee Chee, is an ageing population. The NCCS is Singapore's leading cancer treatment and research centre.
"In developed countries like ours, people are living longer. Previously, people would die before they got cancer," he said.
But what is more worrying is how "lifestyle cancers" such as prostate, breast and colo-rectum cancers are contributing to the rise as well.
Prostate cancer cases went up by 52 per cent from 2003 to 2012, when cases of breast cancer also rose by 25 per cent.
These cancers are, respectively, among the top three most common in men and women. They are also known as "developed world cancers" because they are associated with the lifestyle in these countries.
One factor that increases the chance of cancer is smoking, said Professor Soo.
"Overall, the rate of smoking is moving downwards, but there is a trend of more younger people here taking it up," he said.
Health Promotion Board figures from 2010 showed that 16 per cent of young people aged 18 to 29 smoked regularly, up from 12 per cent in 2004.
Other factors contributing to the rise of cancer here are poor diet and lack of exercise, because we are "overfed and eating the wrong food", Prof Soo said.
Having fewer children and having them later also increase a woman's chances of getting cancer, he added.
Cancer remains the No.1 killer in Singapore, with 30 per cent of deaths in 2011 caused by the disease. This is five times more than deaths caused by accidents, violence and poisoning together.
But the outlook is not all bleak.
The chances of getting cancer can be lowered dramatically by modifying one's lifestyle. Stopping young people from smoking, for instance, "will almost decrease cancer deaths by a third if we succeed", Prof Soo said.
Some of the most common cancers are also those which have the highest survival rates.
Breast cancer - which is the most common cancer in women - has a five-year overall survival rate of 89 per cent. This means that 89 of every 100 people diagnosed with breast cancer were still alive after five years. The corresponding figure for lymphoma was 70 per cent, while that for colon cancer was 60 per cent.
"Cancer is not a death sentence," said Prof Soo. "It would be a pity if cancer patients go into despair or give up because they think that way."
linettel@sph.com.sg
Saturday, February 1, 2014
The ethics of end-life sedation and hydration
Saturday, Feb 01, 2014
The Straits Times
By Andy Ho
The National University of Singapore medical school just launched an online casebook about ethical dilemmas that doctors face, including end-of-life issues, which have been on my mind a lot lately.
My mother passed away at 81 less than two weeks ago from end-stage adenocarcinoma of the lung.
Diagnosed 14 months earlier, she was virtually symptom-free for the first 13 months. So she did quite well considering also that the median survival time for such cases is about 8 months.
Locally, lung cancer is the third most common malignancy in women. And the adenocarcinoma variety is the most common form of lung cancer in women, often non-smokers like my mother.
Because the adenocarcinoma often begins in the outer parts of the lungs, symptoms like cough, shortness of breath and blood in the sputum are not common: my mother never had them.
She stayed active and independent until the final month of her life when the cancer started producing the antidiuretic hormone (ADH). In health, it is the pituitary gland in the brain that produces ADH, which normally maintains the delicate balance of water and salt in the body.
When a cancer itself starts producing ADH - this is called the syndrome of inappropriate antidiuretic hormone (SIADH) production - it upsets the body's delicate balance of water and salt. In SIADH, the kidneys stop producing urine, so the body retains too much water and does not have enough salt. At this point, the patient becomes weak, confused, delirious and may fall into a coma.
Because the body retains water excessively in SIADH, the patient is not allowed liquids. At this point, I asked if my very delirious and distressed mother could be sedated continuously until death.
This is called continuous deep sedation (CDS), during which fluids are concurrently discontinued. even if there is no SIADH.
My mother had, on several previous occasions, expressed her wish to many of us separately that she wanted to suffer as little as possible. Hence my request for CDS, to render her unconscious until she died.
But CDS is controversial the world over. A 2013 University of Chicago survey found that 10 per cent of US doctors have carried out the procedure before.
The idea is to make the dying patient - with intractable suffering that cannot be alleviated despite optimal treatment - go into deep sleep. However, in sedating the patient to unconsciousness, the doctor must avoid using so much of the sedative that the patient stops breathing, which might be construed as active euthanasia.
The balancing act is required because the drugs that induce and maintain deep sleep can also suppress the brain centre that controls our automatic breathing. That is, CDS may hasten death unintentionally. But it is still permissible under the doctrine of double effect.
Originally developed in Roman Catholic theology, this doctrine states that an action is morally permissible even though it may also lead to serious harm, such as the death of a human being, because it does much good.
Thus, some consider CDS to be ethically permissible, since sedation for the delirious is par for the course anyway and, used for the dying, can offer much comfort.
However, CDS may also be accompanied by the withholding of hydration, which would make it look like euthanasia by stealth.
The reason given for withholding fluids in CDS is always that it is common practice in palliative care not to rehydrate dying patients. Also, withholding fluids causes them no symptoms of suffering that can be discerned, save for a dry mouth, it is said. It is also claimed that, under the circumstances, fluid withdrawal does not quicken death anyway.
But most family members would beg to differ: water is needed for life, so how could withholding fluids benefit the dying? It certainly can't make the patient more comfortable, one feels.
Some argue, though, that as the body's systems begin shutting down with death approaching in the very ill, the kidneys can no longer excrete the additional fluid that an intravenous (IV) drip delivers. That fluid could pool in the lungs, causing the patient difficulty in breathing, it is argued.
While there is a medical consensus that appropriate sedation does not shorten life per se, there is vigorous disagreement over whether fluids should be concurrently withheld in CDS.
It seems more prudent not to assume that a dangerously ill patient who does not receive hydration should feel no thirst.
In fact, one should assume that she experiences thirst - unless disease has destroyed the centre for thirst (in the part of the brain called the hypothalamus).
Retrospective studies of hydration and thirst in the dying have produced data that is hard to interpret, especially in patients dying of lung cancer with SIADH, like my late mother.
But it would be unethical to do prospective studies on the issue, which would require the random assignment of some dying patients to fluid withdrawal and others to artificial hydration by IV drip, when it is their comfort that should be uppermost.
Therefore, many doctors would set up drips for such hospitalised patients if they can no longer drink (unless there is SIADH).
Clearly, scientists don't yet have a firm grasp of the benefits and harms of dehydration or rehydration in this situation, so clinicians will continue to manage terminal hydration in ways that they are personally comfortable with.
Experience in palliative care - in hospice rather than hospital settings usually - supports the view that most patients with death imminent do die in comfort without drips. But it is hard to believe that they are not also thirsty. Perhaps, being semi-conscious or unconscious on CDS, they just can't communicate their thirst.
Mercifully, my mother passed away in her sleep before a decision on CDS was made for her.
But it still remains for the profession to discuss the issue and come to a consensus on CDS for the terminally ill and also whether it should be accompanied by dehydration or rehydration.
The Straits Times
By Andy Ho
The National University of Singapore medical school just launched an online casebook about ethical dilemmas that doctors face, including end-of-life issues, which have been on my mind a lot lately.
My mother passed away at 81 less than two weeks ago from end-stage adenocarcinoma of the lung.
Diagnosed 14 months earlier, she was virtually symptom-free for the first 13 months. So she did quite well considering also that the median survival time for such cases is about 8 months.
Locally, lung cancer is the third most common malignancy in women. And the adenocarcinoma variety is the most common form of lung cancer in women, often non-smokers like my mother.
Because the adenocarcinoma often begins in the outer parts of the lungs, symptoms like cough, shortness of breath and blood in the sputum are not common: my mother never had them.
She stayed active and independent until the final month of her life when the cancer started producing the antidiuretic hormone (ADH). In health, it is the pituitary gland in the brain that produces ADH, which normally maintains the delicate balance of water and salt in the body.
When a cancer itself starts producing ADH - this is called the syndrome of inappropriate antidiuretic hormone (SIADH) production - it upsets the body's delicate balance of water and salt. In SIADH, the kidneys stop producing urine, so the body retains too much water and does not have enough salt. At this point, the patient becomes weak, confused, delirious and may fall into a coma.
Because the body retains water excessively in SIADH, the patient is not allowed liquids. At this point, I asked if my very delirious and distressed mother could be sedated continuously until death.
This is called continuous deep sedation (CDS), during which fluids are concurrently discontinued. even if there is no SIADH.
My mother had, on several previous occasions, expressed her wish to many of us separately that she wanted to suffer as little as possible. Hence my request for CDS, to render her unconscious until she died.
But CDS is controversial the world over. A 2013 University of Chicago survey found that 10 per cent of US doctors have carried out the procedure before.
The idea is to make the dying patient - with intractable suffering that cannot be alleviated despite optimal treatment - go into deep sleep. However, in sedating the patient to unconsciousness, the doctor must avoid using so much of the sedative that the patient stops breathing, which might be construed as active euthanasia.
The balancing act is required because the drugs that induce and maintain deep sleep can also suppress the brain centre that controls our automatic breathing. That is, CDS may hasten death unintentionally. But it is still permissible under the doctrine of double effect.
Originally developed in Roman Catholic theology, this doctrine states that an action is morally permissible even though it may also lead to serious harm, such as the death of a human being, because it does much good.
Thus, some consider CDS to be ethically permissible, since sedation for the delirious is par for the course anyway and, used for the dying, can offer much comfort.
However, CDS may also be accompanied by the withholding of hydration, which would make it look like euthanasia by stealth.
The reason given for withholding fluids in CDS is always that it is common practice in palliative care not to rehydrate dying patients. Also, withholding fluids causes them no symptoms of suffering that can be discerned, save for a dry mouth, it is said. It is also claimed that, under the circumstances, fluid withdrawal does not quicken death anyway.
But most family members would beg to differ: water is needed for life, so how could withholding fluids benefit the dying? It certainly can't make the patient more comfortable, one feels.
Some argue, though, that as the body's systems begin shutting down with death approaching in the very ill, the kidneys can no longer excrete the additional fluid that an intravenous (IV) drip delivers. That fluid could pool in the lungs, causing the patient difficulty in breathing, it is argued.
While there is a medical consensus that appropriate sedation does not shorten life per se, there is vigorous disagreement over whether fluids should be concurrently withheld in CDS.
It seems more prudent not to assume that a dangerously ill patient who does not receive hydration should feel no thirst.
In fact, one should assume that she experiences thirst - unless disease has destroyed the centre for thirst (in the part of the brain called the hypothalamus).
Retrospective studies of hydration and thirst in the dying have produced data that is hard to interpret, especially in patients dying of lung cancer with SIADH, like my late mother.
But it would be unethical to do prospective studies on the issue, which would require the random assignment of some dying patients to fluid withdrawal and others to artificial hydration by IV drip, when it is their comfort that should be uppermost.
Therefore, many doctors would set up drips for such hospitalised patients if they can no longer drink (unless there is SIADH).
Clearly, scientists don't yet have a firm grasp of the benefits and harms of dehydration or rehydration in this situation, so clinicians will continue to manage terminal hydration in ways that they are personally comfortable with.
Experience in palliative care - in hospice rather than hospital settings usually - supports the view that most patients with death imminent do die in comfort without drips. But it is hard to believe that they are not also thirsty. Perhaps, being semi-conscious or unconscious on CDS, they just can't communicate their thirst.
Mercifully, my mother passed away in her sleep before a decision on CDS was made for her.
But it still remains for the profession to discuss the issue and come to a consensus on CDS for the terminally ill and also whether it should be accompanied by dehydration or rehydration.
Sunday, January 5, 2014
Loneliness shortens lifespan of the elderly
The Sunday Times
Theresa Tan
5/1/2014
Loneliness does not just break hearts, it also significantly increases the risk of earlier death among Singapore's elderly.
And it does not matter if they live by themselves or with families as the risk of dying earlier is the same in each case, according to a nationally representative study of 5,000 seniors here on the ageing process.
"I thought living with your spouse or children would boost your life expectancy as you have someone to talk to and take care of you," said Associate Professor Angelique Chan of the Duke-NUS Graduate Medical School, who led the study, which was commissioned by the Ministry of Social and Family Development.
"But you can live with a big family and still feel very lonely. Or you could live alone but feel that you're wanted by family and friends."
Sharing the findings with The Sunday Times, she revealed how in 2009, she and a team of researchers started tracking 5,000 Singaporeans aged 60 and older. Through face-to-face interviews, the seniors were asked about their physical and mental health, family relationships, living arrangements and social networks, among other things.
To measure loneliness, questions such as how often they felt a lack of companionship or felt isolated from others were asked.
Two years later in 2011, the researchers revisited the seniors and found that 447 had died.
The data showed that those who said they were lonely in 2009 were more likely to have died by the end of 2011, said Prof Chan, who is writing a paper on the study.
This shows that feelings of loneliness hasten death "significantly", she added.
More men than women in the research said they were lonely. Living arrangements also had no effect on life expectancy.
Experts told The Sunday Times that the study mirrors research overseas which associated loneliness with earlier death and a decline in basic abilities such as walking.
Negative emotions, such as loneliness and depression, also increase the chances of infection, heart attack or stroke, said Duke-NUS Graduate Medical School dean K. Ranga Krishnan, who was not involved in the study here.
"Your entire body reacts when you feel down. When you feel lonely, you may not want to take medicine or take good care of yourself."
As to why more men than women said they were lonely, Tsao Foundation's Hua Mei Centre for Successful Ageing director Peh Kim Choo said that men tend to find it harder to share their feelings.
They also typically build their lives and identities around their jobs and their role as the family's breadwinner. When they retire, they might feel lost and alone.
Women, however, do not "retire" from their mothering and caregiving roles, she said, unless they fall ill.
Dr Reshma Merchant, a National University Hospital geriatrician, said many of her patients feel lonely despite living with their families as their spouse or close friends had already died.
She said: "They accept loneliness as part of the norm of being old."
With loneliness being linked with the risk of dying earlier, Dr Huang Wanping, senior clinical neuropsychologist at the Institute of Mental Health, believes it is crucial to focus more attention on the mental health of seniors.
To reduce loneliness, families can spend more time with their elders and encourage them to take part in activities, suggested the experts who were interviewed.
Retired cleaner Fan Ah Mai, 84, has never married, depends on government financial aid and lives alone in a one-room rental flat in Bendemeer. Yet Madam Fan, who was not interviewed for Prof Chan's study, is not lonely.
Every weekday, she goes to the Lions Befrienders Senior Activity Centre at the foot of her block to chat with friends and take part in exercise sessions and handicraft classes. Once a week, she helps to prepare meals for other seniors.
"I'm contented," she said.
theresat@sph.com.sg
Theresa Tan
5/1/2014
Loneliness does not just break hearts, it also significantly increases the risk of earlier death among Singapore's elderly.
And it does not matter if they live by themselves or with families as the risk of dying earlier is the same in each case, according to a nationally representative study of 5,000 seniors here on the ageing process.
"I thought living with your spouse or children would boost your life expectancy as you have someone to talk to and take care of you," said Associate Professor Angelique Chan of the Duke-NUS Graduate Medical School, who led the study, which was commissioned by the Ministry of Social and Family Development.
"But you can live with a big family and still feel very lonely. Or you could live alone but feel that you're wanted by family and friends."
Sharing the findings with The Sunday Times, she revealed how in 2009, she and a team of researchers started tracking 5,000 Singaporeans aged 60 and older. Through face-to-face interviews, the seniors were asked about their physical and mental health, family relationships, living arrangements and social networks, among other things.
To measure loneliness, questions such as how often they felt a lack of companionship or felt isolated from others were asked.
Two years later in 2011, the researchers revisited the seniors and found that 447 had died.
The data showed that those who said they were lonely in 2009 were more likely to have died by the end of 2011, said Prof Chan, who is writing a paper on the study.
This shows that feelings of loneliness hasten death "significantly", she added.
More men than women in the research said they were lonely. Living arrangements also had no effect on life expectancy.
Experts told The Sunday Times that the study mirrors research overseas which associated loneliness with earlier death and a decline in basic abilities such as walking.
Negative emotions, such as loneliness and depression, also increase the chances of infection, heart attack or stroke, said Duke-NUS Graduate Medical School dean K. Ranga Krishnan, who was not involved in the study here.
"Your entire body reacts when you feel down. When you feel lonely, you may not want to take medicine or take good care of yourself."
As to why more men than women said they were lonely, Tsao Foundation's Hua Mei Centre for Successful Ageing director Peh Kim Choo said that men tend to find it harder to share their feelings.
They also typically build their lives and identities around their jobs and their role as the family's breadwinner. When they retire, they might feel lost and alone.
Women, however, do not "retire" from their mothering and caregiving roles, she said, unless they fall ill.
Dr Reshma Merchant, a National University Hospital geriatrician, said many of her patients feel lonely despite living with their families as their spouse or close friends had already died.
She said: "They accept loneliness as part of the norm of being old."
With loneliness being linked with the risk of dying earlier, Dr Huang Wanping, senior clinical neuropsychologist at the Institute of Mental Health, believes it is crucial to focus more attention on the mental health of seniors.
To reduce loneliness, families can spend more time with their elders and encourage them to take part in activities, suggested the experts who were interviewed.
Retired cleaner Fan Ah Mai, 84, has never married, depends on government financial aid and lives alone in a one-room rental flat in Bendemeer. Yet Madam Fan, who was not interviewed for Prof Chan's study, is not lonely.
Every weekday, she goes to the Lions Befrienders Senior Activity Centre at the foot of her block to chat with friends and take part in exercise sessions and handicraft classes. Once a week, she helps to prepare meals for other seniors.
"I'm contented," she said.
theresat@sph.com.sg
Health coverage: Are you overinsured?
Published on Jan 05, 2014
Many who buy top plans may face cash crunch as premiums shoot up in later years
By Salma Khalik Senior Health Correspondent
Many Singaporeans complain about paying high premiums for health insurance plans, especially after last year's rather steep rise in premiums, with some premiums more than doubling.
But what most of them don't realise is that they are probably forking out such high premiums because they have over-insured themselves and are paying for a level of insurance they are unlikely to need.
Today, more than two million Singaporeans and permanent residents are paying for higher medical insurance coverage than offered by the basic MediShield. They are on Integrated Shield Plans or IPs, which ride on the basic MediShield, but offer higher payouts based on private hospital rates or the equivalent of being treated as private patients in a public hospital.
This is good since the basic insurance is pegged at subsidised B2 and C class rates and will not offer enough coverage for those opting for a higher ward class, such as B1 or A class in a public hospital.
What is surprising, however, is that more than half of those on IPs, or 34 per cent of all Singaporeans and permanent residents covered by MediShield, have opted for the most expensive plans - those pegged at treatment in private hospitals. This does not reflect the actual usage of hospital care today, with less than 20 per cent of local residents opting for private hospitals and the rest going to a public hospital.
Do one in three Singaporeans require private hospital medical insurance when fewer than one in five are treated at private hospitals?
Why do so many buy insurance plans they are unlikely to use?
They do so partly because it is easier to downgrade a health insurance plan than to upgrade. Four of the five insurers - NTUC Income, Great Eastern, AIA and Aviva - have plans in all three IP categories. Prudential no longer offer IPs for public hospital B1 wards.
Also many buy into the plans when they are young and when the premiums are highly affordable. Up to the age of 49, Medisave can fully cover the premiums charged for these private plans, so policyholders do not feel the pinch of out-of-pocket payments
But from age 50 onwards, policy holders will have to top up their premium payments in cash, as the premiums all exceed the $800-a-year cap for premiums paid with Medisave. Each year, up till the official retirement age of 62, they will need to top up their premium payments with cash amounting to several hundred dollars. But again, as many are still working, the amounts appear affordable.
But beyond the age of 62, premiums rise steeply, averaging $4,000 a year for those aged 75. The highest premium currently charged, at the age of 100, is $8,483 a year.
Today, on average, men can expect to live to the age of 80 and women 84.5 years. A man aged 65 in 2012 can expect to live to the age of 83.5 years and a woman to 86.9 years. And life expectancy is still going up.
Already, there are more than 10,000 people aged 90 years and older and close to 1,000 who have passed the century mark.
Based on current premiums, people on private hospital plans will need to pay between $120,000 and $180,000 in premiums for those 30 years after retirement, depending on which insurer they are with.
Unless they buy riders, which pay for the portion of their hospital bill which they will still need to pay in spite of insurance, they will also need to pay thousands, perhaps even tens of thousands of dollars, for their hospital treatment.
Riders which start at about $30 a year for children, go up to about $2,000 a year for seniors.
The actual amount people will need to put aside is likely to be far higher, as health inflation has always been higher than general inflation, and premiums will rise as cost of medical treatments goes up.
So those who opt for insurance pegged at treatment in private hospitals must ask this basic question: Can they afford the thousands of dollars in premium payments in their post-retirement years?
Different people have different priorities, as well as different levels of savings. After doing my maths recently, I've decided to downgrade my medical insurance plan.
One reader wrote to me to say that she opted for the top plan, and pays extra for a rider, so she will not need to pay any out-of-pocket expenses should she need to be hospitalised. She said: "Even though the premium and rider are costly, I am determined to continue with my plan for as long as I can. In the worst-case scenario, I am willing to cut down on my transport and food to service my plan, including the rider."
She has considered her options and made her choice. But not many people have given as much thought to their IPs.
I prefer to downgrade and spend more on living healthily and getting regular health screening to stay healthy and out of hospital.
And should I fall seriously ill in my old age, I will turn to public hospitals, which have excellent doctors and whose bills I can probably afford on my downgraded health insurance plan.
salma@sph.com.sg
facebook.com/ST.Salma
Many who buy top plans may face cash crunch as premiums shoot up in later years
By Salma Khalik Senior Health Correspondent
Many Singaporeans complain about paying high premiums for health insurance plans, especially after last year's rather steep rise in premiums, with some premiums more than doubling.
But what most of them don't realise is that they are probably forking out such high premiums because they have over-insured themselves and are paying for a level of insurance they are unlikely to need.
Today, more than two million Singaporeans and permanent residents are paying for higher medical insurance coverage than offered by the basic MediShield. They are on Integrated Shield Plans or IPs, which ride on the basic MediShield, but offer higher payouts based on private hospital rates or the equivalent of being treated as private patients in a public hospital.
This is good since the basic insurance is pegged at subsidised B2 and C class rates and will not offer enough coverage for those opting for a higher ward class, such as B1 or A class in a public hospital.
What is surprising, however, is that more than half of those on IPs, or 34 per cent of all Singaporeans and permanent residents covered by MediShield, have opted for the most expensive plans - those pegged at treatment in private hospitals. This does not reflect the actual usage of hospital care today, with less than 20 per cent of local residents opting for private hospitals and the rest going to a public hospital.
Do one in three Singaporeans require private hospital medical insurance when fewer than one in five are treated at private hospitals?
Why do so many buy insurance plans they are unlikely to use?
They do so partly because it is easier to downgrade a health insurance plan than to upgrade. Four of the five insurers - NTUC Income, Great Eastern, AIA and Aviva - have plans in all three IP categories. Prudential no longer offer IPs for public hospital B1 wards.
Also many buy into the plans when they are young and when the premiums are highly affordable. Up to the age of 49, Medisave can fully cover the premiums charged for these private plans, so policyholders do not feel the pinch of out-of-pocket payments
But from age 50 onwards, policy holders will have to top up their premium payments in cash, as the premiums all exceed the $800-a-year cap for premiums paid with Medisave. Each year, up till the official retirement age of 62, they will need to top up their premium payments with cash amounting to several hundred dollars. But again, as many are still working, the amounts appear affordable.
But beyond the age of 62, premiums rise steeply, averaging $4,000 a year for those aged 75. The highest premium currently charged, at the age of 100, is $8,483 a year.
Today, on average, men can expect to live to the age of 80 and women 84.5 years. A man aged 65 in 2012 can expect to live to the age of 83.5 years and a woman to 86.9 years. And life expectancy is still going up.
Already, there are more than 10,000 people aged 90 years and older and close to 1,000 who have passed the century mark.
Based on current premiums, people on private hospital plans will need to pay between $120,000 and $180,000 in premiums for those 30 years after retirement, depending on which insurer they are with.
Unless they buy riders, which pay for the portion of their hospital bill which they will still need to pay in spite of insurance, they will also need to pay thousands, perhaps even tens of thousands of dollars, for their hospital treatment.
Riders which start at about $30 a year for children, go up to about $2,000 a year for seniors.
The actual amount people will need to put aside is likely to be far higher, as health inflation has always been higher than general inflation, and premiums will rise as cost of medical treatments goes up.
So those who opt for insurance pegged at treatment in private hospitals must ask this basic question: Can they afford the thousands of dollars in premium payments in their post-retirement years?
Different people have different priorities, as well as different levels of savings. After doing my maths recently, I've decided to downgrade my medical insurance plan.
One reader wrote to me to say that she opted for the top plan, and pays extra for a rider, so she will not need to pay any out-of-pocket expenses should she need to be hospitalised. She said: "Even though the premium and rider are costly, I am determined to continue with my plan for as long as I can. In the worst-case scenario, I am willing to cut down on my transport and food to service my plan, including the rider."
She has considered her options and made her choice. But not many people have given as much thought to their IPs.
I prefer to downgrade and spend more on living healthily and getting regular health screening to stay healthy and out of hospital.
And should I fall seriously ill in my old age, I will turn to public hospitals, which have excellent doctors and whose bills I can probably afford on my downgraded health insurance plan.
salma@sph.com.sg
facebook.com/ST.Salma
Sunday, November 3, 2013
Herbal Supplements Are Often Not What They Seem
November 3, 2013
The New York Times
By ANAHAD O’CONNOR
Americans spend an estimated $5 billion a year on unproven herbal supplements that promise everything from fighting off colds to curbing hot flashes and boosting memory. But now there is a new reason for supplement buyers to beware: DNA tests show that many pills labeled as healing herbs are little more than powdered rice and weeds.
Using a test called DNA barcoding, a kind of genetic fingerprinting that has also been used to help uncover labeling fraud in the commercial seafood industry, Canadian researchers tested 44 bottles of popular supplements sold by 12 companies. They found that many were not what they claimed to be, and that pills labeled as popular herbs were often diluted — or replaced entirely — by cheap fillers like soybean, wheat and rice.
Consumer advocates and scientists say the research provides more evidence that the herbal supplement industry is riddled with questionable practices. Industry representatives argue that any problems are not widespread.
For the study, the researchers selected popular medicinal herbs, and then randomly bought different brands of those products from stores and outlets in Canada and the United States. To avoid singling out any company, they did not disclose any product names.
Among their findings were bottles of echinacea supplements, used by millions of Americans to prevent and treat colds, that contained ground up bitter weed, Parthenium hysterophorus, an invasive plant found in India and Australia that has been linked to rashes, nausea and flatulence.
Two bottles labeled as St. John’s wort, which studies have shown may treat mild depression, contained none of the medicinal herb. Instead, the pills in one bottle were made of nothing but rice, and another bottle contained only Alexandrian senna, an Egyptian yellow shrub that is a powerful laxative. Gingko biloba supplements, promoted as memory enhancers, were mixed with fillers and black walnut, a potentially deadly hazard for people with nut allergies.
Of 44 herbal supplements tested, one-third showed outright substitution, meaning there was no trace of the plant advertised on the bottle — only another plant in its place.
Many were adulterated with ingredients not listed on the label, like rice, soybean and wheat, which are used as fillers.
In some cases, these fillers were the only plant detected in the bottle — a health concern for people with allergies or those seeking gluten-free products, said the study’s lead author, Steven G.
Newmaster, a biology professor and botanical director of the Biodiversity Institute of Ontario at the University of Guelph.
The findings, published in the journal BMC Medicine, follow a number of smaller studies conducted in recent years that have suggested a sizable percentage of herbal products are not what they purport to be. But because the latest findings are backed by DNA testing, they offer perhaps the most credible evidence to date of adulteration, contamination and mislabeling in the medicinal supplement industry, a rapidly growing area of alternative medicine that includes an estimated 29,000 herbal products and substances sold throughout North America.
“This suggests that the problems are widespread and that quality control for many companies, whether through ignorance, incompetence or dishonesty, is unacceptable,” said David Schardt, a senior nutritionist at the Center for Science in the Public Interest, an advocacy group. “Given these results, it’s hard to recommend any herbal supplements to consumers.”
Representatives of the supplement industry said that while mislabeling of supplements was a legitimate concern, they did not believe it reached the extent suggested by the new research.
Stefan Gafner, the chief science officer at the American Botanical Council, a nonprofit group that promotes the use of herbal supplements, said the study was flawed, in part because the bar-coding technology it used could not always identify herbs that have been purified and highly processed.
“Over all, I would agree that quality control is an issue in the herbal industry,” Dr. Gafner said. “But I think that what’s represented here is overblown. I don’t think it’s as bad as it looks according to this study.”
The Food and Drug Administration has used bar-coding technology to warn and in some cases prosecute sellers of seafood found to be “misbranded.” The DNA technique has also been used in studies of herbal teas, which showed that a significant percentage contain herbs and ingredients that are not listed on their labels.
But policing the supplement industry is a special challenge. The F.D.A. requires that companies test the products they sell to make sure that they are safe. But the system essentially operates on the honor code. Unlike prescription drugs, supplements are generally considered safe until proved otherwise.
Under a 1994 law, they can be sold and marketed with little regulatory oversight, and they are pulled from shelves generally only after complaints of serious injury. The F.D.A. audits a small number of companies, but even industry representatives say more oversight is needed.
“The regulations are very appropriate and rigorous,” said Duffy MacKay of the Council for Responsible Nutrition, a supplement industry trade group. “But we need a strong regulator enforcing the full force of the law. F.D.A. resources are limited, and therefore enforcement has not historically been as rigorous as it could be.”
Shelly Burgess, a spokeswoman for the F.D.A., said that companies were required to adhere to a set of good manufacturing practices designed to prevent adulteration, but that many were ignoring the rules.
“Unfortunately, we are seeing a very high percentage — approximately 70 percent — of firms’ noncompliance,” she said, “and we are very active in taking enforcement actions against such violations.”
DNA bar coding was developed about a decade ago at the University of Guelph. Instead of sequencing entire genomes, scientists realized that they could examine genes from a standardized region of every genome to identify species of plants and animals. These short sequences can be quickly analyzed — much like the bar codes on the items at a supermarket — and compared with others in an electronic database. An electronic reference library at Guelph, called the International Barcode of Life Project, contains over 2.6 million bar code records for almost 200,000 species of plants and animals.
The testing technique is not foolproof. It can identify the substances in a supplement, but it cannot determine their potency. And because the technology relies on the detection of DNA, it may not be able to identify concentrated chemical extracts that do not contain genetic material, or products in which the material has been destroyed by heat and processing.
But Dr. Newmaster emphasized that only powders and pills were used in the new research, not extracts. In addition, the DNA testing nearly always detected some plant material in the samples — just not always the plant or herb named on the label.
Some of the adulteration problems may be inadvertent. Cross-contamination can occur in fields where different plants are grown side by side and picked at the same time, or in factories where the herbs are packaged. Dr. Gafner of the American Botanical Council said that rice, starch and other compounds were sometimes added during processing to keep powdered herbs from clumping, just as kernels of rice are added to salt shakers.
But that does not explain many of the DNA results. For instance, the study found that one product advertised as black cohosh — a North American plant and popular remedy for hot flashes and other menopause symptoms — actually contained a related Asian plant, Actaea asiatica, that can be toxic to humans.
Those findings mirror a similar study of black cohosh supplements conducted at Stony Brook University medical center last year. Dr. David A. Baker, a professor of obstetrics, gynecology and reproductive medicine, bought 36 black cohosh supplements from online and chain stores. Bar coding tests showed that a quarter of them were not black cohosh, but instead contained an ornamental plant from China.
Dr. Baker called the state of supplement regulation “the Wild West,” and said most consumers had no idea how few safeguards were in place. “If you had a child who was sick and three out of 10 penicillin pills were fake, everybody would be up in arms,” Dr. Baker said. “But it’s O.K. to buy a supplement where three out of 10 pills are fake. I don’t understand it. Why does this industry get away with that?”
The New York Times
By ANAHAD O’CONNOR
Americans spend an estimated $5 billion a year on unproven herbal supplements that promise everything from fighting off colds to curbing hot flashes and boosting memory. But now there is a new reason for supplement buyers to beware: DNA tests show that many pills labeled as healing herbs are little more than powdered rice and weeds.
Using a test called DNA barcoding, a kind of genetic fingerprinting that has also been used to help uncover labeling fraud in the commercial seafood industry, Canadian researchers tested 44 bottles of popular supplements sold by 12 companies. They found that many were not what they claimed to be, and that pills labeled as popular herbs were often diluted — or replaced entirely — by cheap fillers like soybean, wheat and rice.
Consumer advocates and scientists say the research provides more evidence that the herbal supplement industry is riddled with questionable practices. Industry representatives argue that any problems are not widespread.
For the study, the researchers selected popular medicinal herbs, and then randomly bought different brands of those products from stores and outlets in Canada and the United States. To avoid singling out any company, they did not disclose any product names.
Among their findings were bottles of echinacea supplements, used by millions of Americans to prevent and treat colds, that contained ground up bitter weed, Parthenium hysterophorus, an invasive plant found in India and Australia that has been linked to rashes, nausea and flatulence.
Two bottles labeled as St. John’s wort, which studies have shown may treat mild depression, contained none of the medicinal herb. Instead, the pills in one bottle were made of nothing but rice, and another bottle contained only Alexandrian senna, an Egyptian yellow shrub that is a powerful laxative. Gingko biloba supplements, promoted as memory enhancers, were mixed with fillers and black walnut, a potentially deadly hazard for people with nut allergies.
Of 44 herbal supplements tested, one-third showed outright substitution, meaning there was no trace of the plant advertised on the bottle — only another plant in its place.
Many were adulterated with ingredients not listed on the label, like rice, soybean and wheat, which are used as fillers.
In some cases, these fillers were the only plant detected in the bottle — a health concern for people with allergies or those seeking gluten-free products, said the study’s lead author, Steven G.
Newmaster, a biology professor and botanical director of the Biodiversity Institute of Ontario at the University of Guelph.
The findings, published in the journal BMC Medicine, follow a number of smaller studies conducted in recent years that have suggested a sizable percentage of herbal products are not what they purport to be. But because the latest findings are backed by DNA testing, they offer perhaps the most credible evidence to date of adulteration, contamination and mislabeling in the medicinal supplement industry, a rapidly growing area of alternative medicine that includes an estimated 29,000 herbal products and substances sold throughout North America.
“This suggests that the problems are widespread and that quality control for many companies, whether through ignorance, incompetence or dishonesty, is unacceptable,” said David Schardt, a senior nutritionist at the Center for Science in the Public Interest, an advocacy group. “Given these results, it’s hard to recommend any herbal supplements to consumers.”
Representatives of the supplement industry said that while mislabeling of supplements was a legitimate concern, they did not believe it reached the extent suggested by the new research.
Stefan Gafner, the chief science officer at the American Botanical Council, a nonprofit group that promotes the use of herbal supplements, said the study was flawed, in part because the bar-coding technology it used could not always identify herbs that have been purified and highly processed.
“Over all, I would agree that quality control is an issue in the herbal industry,” Dr. Gafner said. “But I think that what’s represented here is overblown. I don’t think it’s as bad as it looks according to this study.”
The Food and Drug Administration has used bar-coding technology to warn and in some cases prosecute sellers of seafood found to be “misbranded.” The DNA technique has also been used in studies of herbal teas, which showed that a significant percentage contain herbs and ingredients that are not listed on their labels.
But policing the supplement industry is a special challenge. The F.D.A. requires that companies test the products they sell to make sure that they are safe. But the system essentially operates on the honor code. Unlike prescription drugs, supplements are generally considered safe until proved otherwise.
Under a 1994 law, they can be sold and marketed with little regulatory oversight, and they are pulled from shelves generally only after complaints of serious injury. The F.D.A. audits a small number of companies, but even industry representatives say more oversight is needed.
“The regulations are very appropriate and rigorous,” said Duffy MacKay of the Council for Responsible Nutrition, a supplement industry trade group. “But we need a strong regulator enforcing the full force of the law. F.D.A. resources are limited, and therefore enforcement has not historically been as rigorous as it could be.”
Shelly Burgess, a spokeswoman for the F.D.A., said that companies were required to adhere to a set of good manufacturing practices designed to prevent adulteration, but that many were ignoring the rules.
“Unfortunately, we are seeing a very high percentage — approximately 70 percent — of firms’ noncompliance,” she said, “and we are very active in taking enforcement actions against such violations.”
DNA bar coding was developed about a decade ago at the University of Guelph. Instead of sequencing entire genomes, scientists realized that they could examine genes from a standardized region of every genome to identify species of plants and animals. These short sequences can be quickly analyzed — much like the bar codes on the items at a supermarket — and compared with others in an electronic database. An electronic reference library at Guelph, called the International Barcode of Life Project, contains over 2.6 million bar code records for almost 200,000 species of plants and animals.
The testing technique is not foolproof. It can identify the substances in a supplement, but it cannot determine their potency. And because the technology relies on the detection of DNA, it may not be able to identify concentrated chemical extracts that do not contain genetic material, or products in which the material has been destroyed by heat and processing.
But Dr. Newmaster emphasized that only powders and pills were used in the new research, not extracts. In addition, the DNA testing nearly always detected some plant material in the samples — just not always the plant or herb named on the label.
Some of the adulteration problems may be inadvertent. Cross-contamination can occur in fields where different plants are grown side by side and picked at the same time, or in factories where the herbs are packaged. Dr. Gafner of the American Botanical Council said that rice, starch and other compounds were sometimes added during processing to keep powdered herbs from clumping, just as kernels of rice are added to salt shakers.
But that does not explain many of the DNA results. For instance, the study found that one product advertised as black cohosh — a North American plant and popular remedy for hot flashes and other menopause symptoms — actually contained a related Asian plant, Actaea asiatica, that can be toxic to humans.
Those findings mirror a similar study of black cohosh supplements conducted at Stony Brook University medical center last year. Dr. David A. Baker, a professor of obstetrics, gynecology and reproductive medicine, bought 36 black cohosh supplements from online and chain stores. Bar coding tests showed that a quarter of them were not black cohosh, but instead contained an ornamental plant from China.
Dr. Baker called the state of supplement regulation “the Wild West,” and said most consumers had no idea how few safeguards were in place. “If you had a child who was sick and three out of 10 penicillin pills were fake, everybody would be up in arms,” Dr. Baker said. “But it’s O.K. to buy a supplement where three out of 10 pills are fake. I don’t understand it. Why does this industry get away with that?”
Monday, October 14, 2013
Paying for value in health care
The Straits Times
Loke Wai Chiong
14/10/2013
THE introduction of universal health insurance through MediShield Life is the Government's latest move to keep health care affordable and to provide peace of mind to Singaporeans.
However, there is concern in some quarters that rising costs will soon place medical care out of the reach of many if nothing is done to keep costs in check. Universal coverage may ease the financial burden of a serious illness when it strikes. But there is still silence on the broader issue of long-term affordability.
If health-care costs continue to rise uncontrollably, it will not be enough to increase medical savings or collect higher premiums when the insured person is younger. The fundamental challenge is to control costs.
Globally, there are four commonly adopted payment systems. The first is fee for service, where every individual activity is separately paid for. The second is the block grant or block budget system, which refers to a wholesale budget for a hospital. The third is episode-based payment through diagnosis-related groups. This system classifies inpatient and day surgery cases into one of hundreds of possible groupings according to the patient's diagnosis and treatment. The final payment system is called capitated general practitioner (GP) payment. This is a fixed, risk-adjusted sum paid by a patient (or for a patient) regardless of actual use.
In all these systems, hospitals are paid for treating a patient for a given condition and not for the results achieved.
By increasing volume, hospitals can increase their income, regardless of the quality or appropriateness of the care provided. In other words, delivering high-quality health care efficiently does not always generate higher revenues for hospitals or doctors.
In fact, there are perverse incentives for health-care providers willing to provide only mediocre care, since doing so can bring in even more revenue. For example, medical complications such as in-hospital infections can result in longer hospital stays, thus producing more revenue for the provider.
The current payment modes reflect and perpetuate the failures of existing health-care systems. We may be paying for disjointed, uncoordinated medical advice, when we should be receiving holistic care with an integrated outcome.
Singapore has tried the first three of the four payment systems listed above. Today, it operates a hybrid model suited to its health-care policy and needs.
There have also been early steps towards a system more focused on population health and treatment outcomes. These include the organisation and integration of services into Regional Health Systems, the opening up of Medisave for primary care of chronic diseases and the development of the Chronic Disease Management Programme for General Practitioners.
Globally, policymakers and insurers are considering the benefits of a value-based contracting payment system. This is a system in which patients pay only for good, effective and agreed-upon or contracted outcomes of care, rather than the processes that go into it.
However, it is not easy to implement such a system.
Most systems find it easier to reward process compliance. For example, doctors may focus on improving indicators which yield the most points, or which "check the boxes". This may involve complying with various processes such as calling for a blood test to be done biannually, rather than developing ways to improve outcomes.
Doctors, insurers and patients all have differing access to and understanding of medical information. This makes it difficult to determine what sort of care is appropriate and necessary, and can lead to providers gaming the system. For instance, providers can introduce unnecessary or more expensive tests, treatments and services to get higher revenue when it comes time for reporting and claiming payment.
In fact, it would seem almost too complex to put the patient's medical problem central in the payment system, given the broad scope of medical problems that patients may present with, and the challenge to define where care processes "begin" and "end". For example, does the care for a patient who has undergone hip surgery end when he leaves the hospital or when he is able to walk independently?
For a contracting value system to work, three building blocks must be in place. The first is to delineate care services into "units of care". This means paying only for integrated care services or products that lead to an effective final treatment outcome based on best available evidence, and which is agreed upon by both the patient and the doctor.
Payment could be on a per illness basis, such as treatment for an acute heart attack or a fracture. It could also be based on per year of care and continuous across primary (such as GP) and hospital care settings - for example, chronic diabetes care.
The second building block determines what and how to measure the core outcomes that patients and professionals aim to achieve. These must be both measurable and meaningful. These are easier to identify once the types of care are determined.
Take a patient's recovery from a heart attack. The measures to evaluate whether the hospital has done its job could include high rescue rate, low mortality and morbidity as measured three months after the heart attack.
For frail elderly people with multiple chronic diseases, measures could be based on the quality of life, low readmission rates, and the patient's sense of empowerment and self-management of the ailments concerned.
The third building block of a contracting value system is then to contract for desired outcomes. Payment for medical services is made when contractual terms are fulfilled.
These three building blocks will enable an environment which encourages care organisations to be holistic and innovative in delivering the best possible care to their patients.
In Singapore, the development of such integrated care outcomes and indicators is already under way, although time will be needed to work out all the necessary building blocks.
The day may soon come when payment by the Government or the insurer to the health-care provider is ultimately tied to the achievement of better health of the patient and the population.
Value-based payment or payment for outcomes may turn out to be the most important factor in ensuring that MediShield Life becomes a sustainable solution.
stopinion@sph.com.sg
The writer is director of Global Healthcare Centre of Excellence, KPMG in Singapore. KPMG is a network of professional services firms.
Loke Wai Chiong
14/10/2013
THE introduction of universal health insurance through MediShield Life is the Government's latest move to keep health care affordable and to provide peace of mind to Singaporeans.
However, there is concern in some quarters that rising costs will soon place medical care out of the reach of many if nothing is done to keep costs in check. Universal coverage may ease the financial burden of a serious illness when it strikes. But there is still silence on the broader issue of long-term affordability.
If health-care costs continue to rise uncontrollably, it will not be enough to increase medical savings or collect higher premiums when the insured person is younger. The fundamental challenge is to control costs.
Globally, there are four commonly adopted payment systems. The first is fee for service, where every individual activity is separately paid for. The second is the block grant or block budget system, which refers to a wholesale budget for a hospital. The third is episode-based payment through diagnosis-related groups. This system classifies inpatient and day surgery cases into one of hundreds of possible groupings according to the patient's diagnosis and treatment. The final payment system is called capitated general practitioner (GP) payment. This is a fixed, risk-adjusted sum paid by a patient (or for a patient) regardless of actual use.
In all these systems, hospitals are paid for treating a patient for a given condition and not for the results achieved.
By increasing volume, hospitals can increase their income, regardless of the quality or appropriateness of the care provided. In other words, delivering high-quality health care efficiently does not always generate higher revenues for hospitals or doctors.
In fact, there are perverse incentives for health-care providers willing to provide only mediocre care, since doing so can bring in even more revenue. For example, medical complications such as in-hospital infections can result in longer hospital stays, thus producing more revenue for the provider.
The current payment modes reflect and perpetuate the failures of existing health-care systems. We may be paying for disjointed, uncoordinated medical advice, when we should be receiving holistic care with an integrated outcome.
Singapore has tried the first three of the four payment systems listed above. Today, it operates a hybrid model suited to its health-care policy and needs.
There have also been early steps towards a system more focused on population health and treatment outcomes. These include the organisation and integration of services into Regional Health Systems, the opening up of Medisave for primary care of chronic diseases and the development of the Chronic Disease Management Programme for General Practitioners.
Globally, policymakers and insurers are considering the benefits of a value-based contracting payment system. This is a system in which patients pay only for good, effective and agreed-upon or contracted outcomes of care, rather than the processes that go into it.
However, it is not easy to implement such a system.
Most systems find it easier to reward process compliance. For example, doctors may focus on improving indicators which yield the most points, or which "check the boxes". This may involve complying with various processes such as calling for a blood test to be done biannually, rather than developing ways to improve outcomes.
Doctors, insurers and patients all have differing access to and understanding of medical information. This makes it difficult to determine what sort of care is appropriate and necessary, and can lead to providers gaming the system. For instance, providers can introduce unnecessary or more expensive tests, treatments and services to get higher revenue when it comes time for reporting and claiming payment.
In fact, it would seem almost too complex to put the patient's medical problem central in the payment system, given the broad scope of medical problems that patients may present with, and the challenge to define where care processes "begin" and "end". For example, does the care for a patient who has undergone hip surgery end when he leaves the hospital or when he is able to walk independently?
For a contracting value system to work, three building blocks must be in place. The first is to delineate care services into "units of care". This means paying only for integrated care services or products that lead to an effective final treatment outcome based on best available evidence, and which is agreed upon by both the patient and the doctor.
Payment could be on a per illness basis, such as treatment for an acute heart attack or a fracture. It could also be based on per year of care and continuous across primary (such as GP) and hospital care settings - for example, chronic diabetes care.
The second building block determines what and how to measure the core outcomes that patients and professionals aim to achieve. These must be both measurable and meaningful. These are easier to identify once the types of care are determined.
Take a patient's recovery from a heart attack. The measures to evaluate whether the hospital has done its job could include high rescue rate, low mortality and morbidity as measured three months after the heart attack.
For frail elderly people with multiple chronic diseases, measures could be based on the quality of life, low readmission rates, and the patient's sense of empowerment and self-management of the ailments concerned.
The third building block of a contracting value system is then to contract for desired outcomes. Payment for medical services is made when contractual terms are fulfilled.
These three building blocks will enable an environment which encourages care organisations to be holistic and innovative in delivering the best possible care to their patients.
In Singapore, the development of such integrated care outcomes and indicators is already under way, although time will be needed to work out all the necessary building blocks.
The day may soon come when payment by the Government or the insurer to the health-care provider is ultimately tied to the achievement of better health of the patient and the population.
Value-based payment or payment for outcomes may turn out to be the most important factor in ensuring that MediShield Life becomes a sustainable solution.
stopinion@sph.com.sg
The writer is director of Global Healthcare Centre of Excellence, KPMG in Singapore. KPMG is a network of professional services firms.
Thursday, July 18, 2013
'We are sure that we have a way to treat myopia'
Published on Jul 18, 2013
By Poon Chian Hui
FOR 16 years, doctors at the Singapore National Eye Centre (SNEC) have been trying to find a way to stop myopia in its tracks.
They say they finally have the answer: eyedrops with a concentration of 0.01 per cent atropine.
"We are at a stage where we are sure that we have a way to treat myopia," said SNEC medical director Donald Tan, adding that the eyedrops could be available for prescription in the next six months. "This is a breakthrough in the fight against myopia here."
With 80 per cent of people afflicted by the time they turn 18, Singapore is considered the myopia capital of the world.
The eyedrops do not cure myopia, but they seem to slow down its degenerative effects by up to 60 per cent. This means that a short-sighted child, whose eyesight would normally get worse by 100 degrees a year, will only experience a 40-degree increase.
For decades, it has been known that atropine, which is extracted from certain plants, can be used to counter myopia. The drug seems to stop the eyeball from growing longer, a hallmark of myopia. But it has not been widely used because of the side-effects caused by eyedrops with 1 per cent atropine, the normal available dose.
As the drug dilates the eye's pupil, letting in more light, children needed to wear sunglasses before going out in the day. Atropine also stops the eye muscles from working, making it harder to focus on near objects.
That meant that children needed to wear bifocal eyeglasses when reading. Several other studies also found that when the use of atropine stopped, the myopia "rebounded".
The answer was eyedrops with 0.01 per cent atropine.
In an SNEC study which began in 2006, 400 short-sighted children were put on daily eyedrops with three different concentrations: 0.5 per cent, 0.1 per cent and 0.01 per cent. The children were tracked for five years.
Results showed that side-effects were minimised for the most diluted eyedrops. Children did not need sunglasses or bifocals, but could go about their daily lives as usual. There was almost no rebound effect when the eyedrops were stopped for a year.
After five years, those on the 0.01 dose also fared the best, with the least decline in their eyesight.
The findings were presented at an international conference earlier this week.
Dr Lam Pin Min, an ophthalmologist at KK Women's and Children's Hospital, said he was "certainly looking forward" to the new eyedrops.
Currently, he prescribes regular (1 per cent) atropine to several young patients. But they have to use special spectacles due to the side-effects. With price tags of $400 to $1,000, the cost of the spectacles can be "prohibitive", said the MP for Sengkang West.
chpoon@sph.com.sg
By Poon Chian Hui
FOR 16 years, doctors at the Singapore National Eye Centre (SNEC) have been trying to find a way to stop myopia in its tracks.
They say they finally have the answer: eyedrops with a concentration of 0.01 per cent atropine.
"We are at a stage where we are sure that we have a way to treat myopia," said SNEC medical director Donald Tan, adding that the eyedrops could be available for prescription in the next six months. "This is a breakthrough in the fight against myopia here."
With 80 per cent of people afflicted by the time they turn 18, Singapore is considered the myopia capital of the world.
The eyedrops do not cure myopia, but they seem to slow down its degenerative effects by up to 60 per cent. This means that a short-sighted child, whose eyesight would normally get worse by 100 degrees a year, will only experience a 40-degree increase.
For decades, it has been known that atropine, which is extracted from certain plants, can be used to counter myopia. The drug seems to stop the eyeball from growing longer, a hallmark of myopia. But it has not been widely used because of the side-effects caused by eyedrops with 1 per cent atropine, the normal available dose.
As the drug dilates the eye's pupil, letting in more light, children needed to wear sunglasses before going out in the day. Atropine also stops the eye muscles from working, making it harder to focus on near objects.
That meant that children needed to wear bifocal eyeglasses when reading. Several other studies also found that when the use of atropine stopped, the myopia "rebounded".
The answer was eyedrops with 0.01 per cent atropine.
In an SNEC study which began in 2006, 400 short-sighted children were put on daily eyedrops with three different concentrations: 0.5 per cent, 0.1 per cent and 0.01 per cent. The children were tracked for five years.
Results showed that side-effects were minimised for the most diluted eyedrops. Children did not need sunglasses or bifocals, but could go about their daily lives as usual. There was almost no rebound effect when the eyedrops were stopped for a year.
After five years, those on the 0.01 dose also fared the best, with the least decline in their eyesight.
The findings were presented at an international conference earlier this week.
Dr Lam Pin Min, an ophthalmologist at KK Women's and Children's Hospital, said he was "certainly looking forward" to the new eyedrops.
Currently, he prescribes regular (1 per cent) atropine to several young patients. But they have to use special spectacles due to the side-effects. With price tags of $400 to $1,000, the cost of the spectacles can be "prohibitive", said the MP for Sengkang West.
chpoon@sph.com.sg
Monday, April 2, 2012
One-minute self-cure exercise for a healthy and happy life
by leesa86 - Mar 11, 2012 at 8:05 am
MBLAQ‘s Mir was able to finally cure his back problems.
On the most recent episode of SBS ‘Star King‘, a guest by the name of Lim Hyun Suk revealed his one-minute self-cure exercise for a healthy and happy life.
MBLAQ’s Mir has been seeing a doctor for a long while trying to fix his back problem to no avail, but his condition improved greatly after meeting with this amazing guest.
Lim remarked, “I discovered this minute self-cure exercise after perfecting my martial arts skills. If you complete this exercise on a regular basis, it will help you maintain good health.”
Baekdoosan leader Yoo Hyun Sang who received a negative score after taking a flexibility test was able to bend his back 10cm more than before, after completing the one-minute exercise.
Lim Hyun Suk was also able to maintain his balance on one foot, even when 10 male panel members tried to push him to the ground.
Source & Image : OSEN via Nate
Star King’ participant Lim Hyun Suk once again surprises viewers with his miracle cure
by choiwj - Apr 1, 2012 at 9:15 pm
Stars that guested on the latest broadcast of SBS‘s ‘Star King‘ were once again met with miracle improvements with the help of Lim Hyun Suk‘s one-minute self-cure exercise.
The March 31st episode was a continuation of last week’s one-minute self-cure exercise by guest Lim Hyun Suk. The exercise is a procedure which shows drastic health improvements by tapping on the acupuncture points on the arm and the hand.
The first member to receive the “miracle cure” was comedian Kim Ji Sun. She complained of not being able to fully lift her left leg, which was immediately cured.
X-5‘s leader Gun also received treatment after being unable to bend sideways due to his back pains. Kim Chung‘s eyesight of 1.2 instantly improved to 2.0.
Also, MC Park Mi Sun who had been suffering from constipation, received treatment to the center palm of her hands and Jewelry‘s Semi was cured from pains to the stomach.
Check out his amazing cures below (video in korean no sub):
Click to watch video on youku
Source & Image: Newsen via Nate
MBLAQ‘s Mir was able to finally cure his back problems.
On the most recent episode of SBS ‘Star King‘, a guest by the name of Lim Hyun Suk revealed his one-minute self-cure exercise for a healthy and happy life.
MBLAQ’s Mir has been seeing a doctor for a long while trying to fix his back problem to no avail, but his condition improved greatly after meeting with this amazing guest.
Lim remarked, “I discovered this minute self-cure exercise after perfecting my martial arts skills. If you complete this exercise on a regular basis, it will help you maintain good health.”
Baekdoosan leader Yoo Hyun Sang who received a negative score after taking a flexibility test was able to bend his back 10cm more than before, after completing the one-minute exercise.
Lim Hyun Suk was also able to maintain his balance on one foot, even when 10 male panel members tried to push him to the ground.
Source & Image : OSEN via Nate
Star King’ participant Lim Hyun Suk once again surprises viewers with his miracle cure
by choiwj - Apr 1, 2012 at 9:15 pm
Stars that guested on the latest broadcast of SBS‘s ‘Star King‘ were once again met with miracle improvements with the help of Lim Hyun Suk‘s one-minute self-cure exercise.
The March 31st episode was a continuation of last week’s one-minute self-cure exercise by guest Lim Hyun Suk. The exercise is a procedure which shows drastic health improvements by tapping on the acupuncture points on the arm and the hand.
The first member to receive the “miracle cure” was comedian Kim Ji Sun. She complained of not being able to fully lift her left leg, which was immediately cured.
X-5‘s leader Gun also received treatment after being unable to bend sideways due to his back pains. Kim Chung‘s eyesight of 1.2 instantly improved to 2.0.
Also, MC Park Mi Sun who had been suffering from constipation, received treatment to the center palm of her hands and Jewelry‘s Semi was cured from pains to the stomach.
Check out his amazing cures below (video in korean no sub):
Click to watch video on youku
Source & Image: Newsen via Nate
Friday, January 6, 2012
Extract from Report on National Strategy for Palliative Care
Coordinated by the Lien Centre for Palliative Care
Besides deaths due to infection, acute coronary events or injuries, most
people will experience a period of progressive disease and disability before death. More than half will have some form of chronic illness before death. This period may extend from days to months to years before death, based on the trajectory of the illness.
Three illness trajectories have been identified:
(a) Progressive cancer trajectory
Patients with progressive cancer have a gradual decline in physical
ability over weeks, months or sometimes years. The patient’s physical
ability declines rapidly during the final days or weeks before death when
the disease overwhelms the patient’s functional reserves.
Despite longstanding WHO recommendations (since 1990) to involve
palliative care from cancer diagnosis, specialist palliative services
traditionally catered to this group of patients only during the last days or
weeks of life. However, as mentioned previously, there is a move
towards initiating palliative care further upstream in the trajectory to
interface with disease-modifying cancer treatment.
(b) Chronic organ failure trajectory
Patients with organ failure, especially heart and lung failure, have a
gradual decline in physical function over many months or years, with
occasional episodes of exacerbation. During these acute exacerbations,
the patient experiences worsening of the symptoms and is often
admitted to the hospital. Each episode may be severe and may result in
death, although the patient often survives many episodes. The timing of
death is often unpredictable and sudden.
Specific needs for patients in this group include empowering patients
and families on how to recognise symptoms and prevent the worsening
of symptoms through the effective use of medications. Patients may
require home oxygen and appropriate home adaptations. Home care
teams can provide treatment at home to reduce the need for hospital
admission.
(c) Dementia and frailty trajectory
Patients in this group start with a low baseline of cognitive and physical
disability due to decreased cognitive ability (such as Alzheimer’s disease
or other forms of dementia), or frailty as a result of decreased reserves in
multiple organ systems. Patients may survive many years and may
succumb to an acute event, such as pneumonia.
Patients in this group require the caregivers at home to meet basic
needs of patients. In the absence of caregivers, these patients will
require quality care in long-term care facilities.
Link:
http://www.lienpallcare.org/sites/default/files/Report_on_National_Strategy_for_Palliative_Care%204Jan2012.pdf
Besides deaths due to infection, acute coronary events or injuries, most
people will experience a period of progressive disease and disability before death. More than half will have some form of chronic illness before death. This period may extend from days to months to years before death, based on the trajectory of the illness.
Three illness trajectories have been identified:
(a) Progressive cancer trajectory
Patients with progressive cancer have a gradual decline in physical
ability over weeks, months or sometimes years. The patient’s physical
ability declines rapidly during the final days or weeks before death when
the disease overwhelms the patient’s functional reserves.
Despite longstanding WHO recommendations (since 1990) to involve
palliative care from cancer diagnosis, specialist palliative services
traditionally catered to this group of patients only during the last days or
weeks of life. However, as mentioned previously, there is a move
towards initiating palliative care further upstream in the trajectory to
interface with disease-modifying cancer treatment.
(b) Chronic organ failure trajectory
Patients with organ failure, especially heart and lung failure, have a
gradual decline in physical function over many months or years, with
occasional episodes of exacerbation. During these acute exacerbations,
the patient experiences worsening of the symptoms and is often
admitted to the hospital. Each episode may be severe and may result in
death, although the patient often survives many episodes. The timing of
death is often unpredictable and sudden.
Specific needs for patients in this group include empowering patients
and families on how to recognise symptoms and prevent the worsening
of symptoms through the effective use of medications. Patients may
require home oxygen and appropriate home adaptations. Home care
teams can provide treatment at home to reduce the need for hospital
admission.
(c) Dementia and frailty trajectory
Patients in this group start with a low baseline of cognitive and physical
disability due to decreased cognitive ability (such as Alzheimer’s disease
or other forms of dementia), or frailty as a result of decreased reserves in
multiple organ systems. Patients may survive many years and may
succumb to an acute event, such as pneumonia.
Patients in this group require the caregivers at home to meet basic
needs of patients. In the absence of caregivers, these patients will
require quality care in long-term care facilities.
Link:
http://www.lienpallcare.org/sites/default/files/Report_on_National_Strategy_for_Palliative_Care%204Jan2012.pdf
Monday, October 17, 2011
The Qigong Walking Exercise
28 September 2011
by Miss Cheah
Dear Friends,
The Qigong Walking Exercise that I am teaching at
different venues is good but needs at least 1 hour a day
to practice for good results.
Since many of you are still working, here is one exercise
I believe can help you solve the “time” problem. Just 15
minutes a day and good results can be expected if you do
it diligently everyday for a period of 2-3 months.
It also depends on the individual’s health condition and
diligence in completing 15 minutes of holding up the legs
each time.
This is a really simple exercise to help you increase your
energy.
The English text is my translation from the Chinese text.
Lie down on your back, raise your legs as shown in the
photo.
Maintain 90 degrees at thighs with body, 90 degrees
at knee joints and 90 degrees at ankles.
Keep this posture for 15 minutes or longer.
Start with as long as you can manage and add on the
minutes.
That’s it!
1) Drink before and after the exercise 300cc of warm
water. Breathe normally. Don’t hold back your breath.
Using the energy from your waist and “Dan tian” to hold
your legs in that posture as long as you can manage.
2) When you are lying down in this posture, blood will
flow back to your liver and kidneys ensuring fast detoxing
and increasing your metabolism. You will feel very
“soared” with your legs and your pituitary gland will be
activated to hasten the detox process and the toxins in
your body will be excreted via sweating.
3) When you are lying in this posture, your body is
getting rid of the “toxin” in your body. They your good
body cells will be stronger and has definitely a good
control of any bad cells (including cancer cells) inside
your body.
4) Since you are using your waist’s energy to support the
legs, your Shenqu (CV 8)and Ming Men (GV4) of the main
acupressure points) were used to do the breathing, your
Front and Back main Meridians will be cleared and
connected. Thus your minute skin pores will be opened to
help with the “detox” process. With breathing through the
Dan Tian, it helps to lessen the burden of breath on your
lungs. Therefore, you heart functions will be stronger
with the result that your blood pressure will also be
lower.
5) When you sweat, the acidic toxins will be excreted,
your blood lipid (fatty deposits) will be burnt. Spleen is
in charge of our 4 limbs. Therefore, your blood sugar
level will also be stabilized with the result your spleen
function is being improved. End result is that you will
feel more calm and gentle.
6) When your legs are up, your small intestine’s movement
will be activated and your bladder’s muscles will be
stronger. Therefore, constipation, abnormal menstruation,
prostate problems can all be avoided. Also, once your
digestion and excretion systems are in order, you will
have good appetite and can maintain your normal body
weight.
7) When your legs are up, your spine is straight. That
means your whole body’s muscles will be strengthened. Qi
and blood will flow smoothly throughout your body. Your
joints can easiy have more bone marrows and the nerves
alongside your spine are well connected with all parts of
the body. Thus degeneration of joints and growth of bone
spurs can be avoided.
8) When your legs are up,all your inner organs are
working in harmony. Your brain burden will be less and
thus can function better, resulting in clear heads, better
memory and no more insomnia. Also you will have better
tolerance and stronger will power.
Therefore, the longer you can hold up your legs in that
posture, the better and long living you will be.
Credit:
http://shuangxingfu.blogspot.com/2011/09/qikung-walking-exercise.html
by Miss Cheah
Dear Friends,
The Qigong Walking Exercise that I am teaching at
different venues is good but needs at least 1 hour a day
to practice for good results.
Since many of you are still working, here is one exercise
I believe can help you solve the “time” problem. Just 15
minutes a day and good results can be expected if you do
it diligently everyday for a period of 2-3 months.
It also depends on the individual’s health condition and
diligence in completing 15 minutes of holding up the legs
each time.
This is a really simple exercise to help you increase your
energy.
The English text is my translation from the Chinese text.
Lie down on your back, raise your legs as shown in the
photo.
Maintain 90 degrees at thighs with body, 90 degrees
at knee joints and 90 degrees at ankles.
Keep this posture for 15 minutes or longer.
Start with as long as you can manage and add on the
minutes.
That’s it!
1) Drink before and after the exercise 300cc of warm
water. Breathe normally. Don’t hold back your breath.
Using the energy from your waist and “Dan tian” to hold
your legs in that posture as long as you can manage.
2) When you are lying down in this posture, blood will
flow back to your liver and kidneys ensuring fast detoxing
and increasing your metabolism. You will feel very
“soared” with your legs and your pituitary gland will be
activated to hasten the detox process and the toxins in
your body will be excreted via sweating.
3) When you are lying in this posture, your body is
getting rid of the “toxin” in your body. They your good
body cells will be stronger and has definitely a good
control of any bad cells (including cancer cells) inside
your body.
4) Since you are using your waist’s energy to support the
legs, your Shenqu (CV 8)and Ming Men (GV4) of the main
acupressure points) were used to do the breathing, your
Front and Back main Meridians will be cleared and
connected. Thus your minute skin pores will be opened to
help with the “detox” process. With breathing through the
Dan Tian, it helps to lessen the burden of breath on your
lungs. Therefore, you heart functions will be stronger
with the result that your blood pressure will also be
lower.
5) When you sweat, the acidic toxins will be excreted,
your blood lipid (fatty deposits) will be burnt. Spleen is
in charge of our 4 limbs. Therefore, your blood sugar
level will also be stabilized with the result your spleen
function is being improved. End result is that you will
feel more calm and gentle.
6) When your legs are up, your small intestine’s movement
will be activated and your bladder’s muscles will be
stronger. Therefore, constipation, abnormal menstruation,
prostate problems can all be avoided. Also, once your
digestion and excretion systems are in order, you will
have good appetite and can maintain your normal body
weight.
7) When your legs are up, your spine is straight. That
means your whole body’s muscles will be strengthened. Qi
and blood will flow smoothly throughout your body. Your
joints can easiy have more bone marrows and the nerves
alongside your spine are well connected with all parts of
the body. Thus degeneration of joints and growth of bone
spurs can be avoided.
8) When your legs are up,all your inner organs are
working in harmony. Your brain burden will be less and
thus can function better, resulting in clear heads, better
memory and no more insomnia. Also you will have better
tolerance and stronger will power.
Therefore, the longer you can hold up your legs in that
posture, the better and long living you will be.
Credit:
http://shuangxingfu.blogspot.com/2011/09/qikung-walking-exercise.html
Thursday, October 13, 2011
Exercise method by a 102 years old - 趕快看 102歲了,不用眼鏡,長壽健康法
Dear friends,
This is an introduction to 19 exercises + a meditation method for maintaining good health by a 102 years old, Mr Chui who still has a real set of teeth, excellent eye sights and keen sense of hearing.
His flexibility and energy level puts me who is half his age to shame.
崔介忱的健康情況,他今年102歲了, 不用眼鏡,長壽健康法
一個人活到101歲(2010年時)，又沒病痛，牙齒全口真牙，不戴眼鏡能讀報紙，一定有其養生之道，人瑞崔介忱先生(101歲)，他的長壽健康法
飯勿吃太飽，覺要睡得好，運動每天做，營養不可少，盡量找快樂，切莫尋煩惱，赤子心常在，百年也不老，不作虧心事，人格比天高，為人不貪墨， 子孫也逍遙。
Link
http://www.youtube.com/watch?v=5Z4caCs3lj0&feature=related
http://healthinfoshare.files.wordpress.com/2011/07/101e6adb2e784a1e79785e7979be79a84e4babae7919ee9a48ae7949fe6b395.pdf
This is an introduction to 19 exercises + a meditation method for maintaining good health by a 102 years old, Mr Chui who still has a real set of teeth, excellent eye sights and keen sense of hearing.
His flexibility and energy level puts me who is half his age to shame.
崔介忱的健康情況,他今年102歲了, 不用眼鏡,長壽健康法
一個人活到101歲(2010年時)，又沒病痛，牙齒全口真牙，不戴眼鏡能讀報紙，一定有其養生之道，人瑞崔介忱先生(101歲)，他的長壽健康法
飯勿吃太飽，覺要睡得好，運動每天做，營養不可少，盡量找快樂，切莫尋煩惱，赤子心常在，百年也不老，不作虧心事，人格比天高，為人不貪墨， 子孫也逍遙。
Link
http://www.youtube.com/watch?v=5Z4caCs3lj0&feature=related
http://healthinfoshare.files.wordpress.com/2011/07/101e6adb2e784a1e79785e7979be79a84e4babae7919ee9a48ae7949fe6b395.pdf
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