New Docs On the Block | Gain the Edge Over Joint Pain | New Clinics | Vendors Of The Year 2013 | Corporate Charity | New Year Babies | Intrathecal Drug Delivery 21 Food Note 22 UpClose
A self-confessed hypochondriac, Senior Dietitian Ms Sarah Sinaram gets her satisfaction from helping her clients achieve their health goals. 37 Made Me Smile 38 Ask The Experts 39 Social Media
10 M anaging Chronic Diseases Understand the six most common chronic diseases and how you can manage them.
19 We Are What We Eat Diet can be a tool to get healthy and prevent disease symptoms. Learn the right foods to eat to combat chronic diseases.
33 The Best Workout for 28 Weight Loss Myths Your Fitness Goals Busted! We all know that Obesity is linked with many exercise is good for us. chronic diseases including We explore three of the diabetes, cardiovascular hottest workouts and disease and hypertension. how they can help you We debunk six common meet your fitness goals. weight loss myths.
14 Combat the Three Highs as a Family High blood pressure, high cholesterol and high blood sugar are three common chronic conditions with few obvious symptoms. Here are tips on how to care for a loved one with these conditions.
21 Brown Rice and Tofu Salad with Sunflower Seeds A healthy one-dish meal laden with nutrients. This recipe is easy to prepare.
24 Swap It Do you love foods in the “unhealthy” category? Make small changes 16 Freedom from Chronic by swapping for healthier Diseases choices to avoid putting Simple changes to your diet and lifestyle can reduce on extra weight or becoming at risk of the incidence of chronic chronic disease. disease. Learn what you can do to prevent them. 26 Nutrition in a Pill With so many types of health supplements out there, which is best for you? Get all your common questions about health supplements answered here.
35 Exercise in Your Office Discreetly Learn simple exercises you can do in your office. And what’s best, you can do it so discreetly that your 32 The Effect of Smoking on neighbour may not even know you are working Chronic Diseases out! Smoking gives you bad breath and is linked with a list of illnesses including several chronic diseases. Find out more about how you can nip it in the bud. 30 Getting it Controlled Get an illustrative perspective to the management of common chronic skin and eye conditions.
Editorial Dr Melvyn Wong Writers Magdalene Lee, Juliana Yeo, Joanna Lee, Jacquelyn Tan, Stella Phua Creative Tan Wee Yen, Edd Chua, Koh Jia Qian Advisory Panel Cardiology Endocrinology Orthopaedic Surgery Dermatology Psychiatry Gastroenterology Physiotherapy Urology Medical Oncology Neuro-Interventional Radiology Neurology Radiology Ear, Nose & Throat Obstetrics & Gynaecology Paediatrics General Surgery
Dr Abdul Razakjr Dr Abel Soh Dr Bernard Lin Dr Chris Foo Dr Joshua Kua Dr Kelvin Thia Mr Lim Hun Teck Dr Lim Kok Bin Dr Lynette Ngo Dr Manish Taneja Dr N V Ramani Dr Ong Keh Oon Dr Stephen Lee Dr Tony Tan Dr Wendy Sinnathamby Dr Wong Kutt Sing
The information contained in this publication should not be regarded as a substitute for detailed medical advice in individual cases. All rights reserved. No part of this publication may be reproduced in any form or by any means without the written permission of the publisher. Please address all correspondence to The Editor, Raffles HealthNews Email: [email protected] Raffles HealthNews is published by Raffles Medical Group Ltd 585 North Bridge Road, Raffles Hospital #11-00, Singapore 188770 www.rafflesmedicalgroup.com
Printed by Xpoprint (Asia) Pte Ltd Issue 01 - February 2014
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This brown rice recipe is easy to prepare and could help to improve our general health Page 21
Hello Readers! Welcome to our first issue of Raffles HealthNews in 2014. I trust all of you had a wonderful Chinese New Year break. It would be a good time now to sit down and set your health goals for the year if you haven’t done so. This issue of HealthNews focuses on the growing and menacing problems of chronic diseases in our society. Chronic diseases are long term diseases that pose a significant physical, financial, and emotional toll on every facet of humanity especially in the developed world.
In Singapore, about 10 per cent of our population are diabetic and around 25 per cent are hypertensive. New drugs are manufactured constantly to battle and control these problems but they are expensive and are not without side effects. In our cover story, we find out more about what the top chronic diseases in Singapore are and how they are still highly preventable with the right treatments (Page 10). Are you suffering from common chronic skin and eye problems? How can you better manage them? Page 30
What are some fun and new exercises that you can do to better manage your health this year? Page 33
Patients diagnosed with chronic diseases need to monitor their lifestyle, watch their diet and go for regular check-ups. Hence, the caregiver or family member plays an important role as well. Read on to find out more on how you can care for your loved ones and better manage chronic diseases together (Page 14). The best thing we can do within our limits is to control risk factors - balanced diet, regular exercise, smoking cessation and managing stress. Research has also shown that eating certain foods can strengthen the body and help prevent diseases. Find out more about how we can make use of our diet plan to treat and/or prevent chronic diseases (Page 19). We hope this issue of Healthnews will be able to inspire you to take actions and make positive changes in your life for better prevention against chronic diseases. Not forgetting that this is also a month where it is full of love - I would like to take this opportunity to wish all readers a very Happy Valentine’s Day. Remember, good health is the greatest gift that any one of us could ever have!
Dr Melvyn Wong Guest Editor Senior Physician Leader Raffles Medical
CONNECT WITH US AT: http://www.youtube.com/user/RafflesHospital
Newsroom New Docs on the Block Dr Teo graduated from NUS in 2000. She obtained her M Med (Internal Medicine) in 2004 and was elected a Member of the Royal College of Physicians (UK). She pursued her interest in Dermatology and completed her Advanced Specialist Training in Dermatology at Changi General Hospital (CGH) and National Skin Centre. She became a qualified dermatologist in 2009. She has special interest in immunobullous disorders such as pemphigus and bullous pemphigoid, as well as collagen vascular disorders affecting the skin. In 2012, she developed the Immunodermatology Service and implemented protocols to standardise the care of immunobullous patients. Besides helming the Immunobullous Clinic at CGH, Dr Teo also developed the Eczema Clinic. She has extensive experience in treating recalcitrant, difficult-to-manage cases of atopic eczema in both adults and children. She is proficient in laser surgery and has trained dermatologists on the use of Dr Rachael Teo Specialist in Dermatology & Consultant laser in treating skin disorders including pigmentary disorders, acne scarring and birth marks. Raffles Skin & Aesthetics
Dr Ooi Wei Seong is a Medical Oncologist who graduated from Trinity College Dublin with honors distinction in 1999 in Ireland. He obtained MRCP (UK) certification and became a member of the Royal College of Physicians (UK) in 2003. He started his oncology training at St Vincent’s University Hospital in Dublin after that and later spent three years at Sunnybrook Odette Cancer Centre in Toronto as a clinical fellow in oncology. He then returned to Singapore and obtained his specialist accreditation in medical oncology in 2012. Prior to joining Raffles Hospital, Dr Ooi was practicing at National Cancer Centre Singapore (NCCS). He was Visiting Consultant to KKWCH Breast Cancer. He was a recipient of the Singapore Health Quality Service Award in 2011 for his exemplary service to patients. He is a Clinical Tutor at Yong Loo Lin School of Medicine, in addition to providing teachings to junior doctors, nurses, Duke-NUS students, and elective fellows. He is now a visiting specialist at the NCCS. Dr Ooi Wei Seong Specialist in Oncology & Consultant Raffles Cancer Centre
Dr Ooi has keen interest in thoracic oncology, comprising of lung cancer in addition to breast cancer, as well as head and neck cancer. He is also actively involved with multiple investigatorinitiated and pharma clinical trials. He also has special interest in bone health and mechanisms of bone metastases in cancer patients.
Gain the Edge Over Joint Pain A crowd of close to 600 participants joined our team of speakers from Raffles Orthopaedic and Physiotherapy centres on 26 October 2013, at the jointly organised health seminar by Raffles Hospital and Channel NewsAsia: Gain The Edge Over Joint Pain. Our orthopaedic specialists presented effective options on available treatment options and potential new advances in managing joint pain due to sports injuries and/or ageing. During the two Q&A sessions, participants wasted no time in asking the speakers questions that they were concerned with, as they waited patiently for their turns. In an interview, Dr Ho Kok Yuen, Specialist in Anaesthesia & Consultant, Raffles Pain Management Centre, said: “The key message of this seminar is to help participants understand and realise that joint pain can happen to anyone, whether young or old. And we have to take a proactive approach in managing chronic joint pain.” The seminar received positive feedback with many commented that the session was very helpful and they have learnt much from the speakers. Mr Steven Teo, a participant, who has knee problems, shared that the speakers’ presentation had shed some light on what he could do to address his knee issues.
Seminar Speakers L-R: Dr Ho Kok Yuen, Mr Lim Hun Tuck, Dr David Wong, Dr Lim Yeow Wai, Dr Bernard Lin and Mr Steve Lai (Host)
Newsroom New Clinics We are pleased to announce that Raffles Medical has opened a new clinic at Yew Tee Point, and another clinic that is integrated with dental services at Bedok Mall. Operating hours are: Bedok Mall 311 New Upper Changi Road #01-45/46 Bedok Mall Singapore 467360 Raffles Medical Clinic Monday to Friday:
8.30am to 1.00pm 2.00pm to 5.30pm
Raffles Dental Mon - Wed Fri - Sun: Thursday: Yew Tee Point
8.30am to 1.00pm 2.00pm to 5.30pm 8.30am to 1.00pm 2.00pm to 5.30pm 6.30pm to 9.30pm
21 Choa Chu Kang North 6 Yew Tee Point #01-02 Singapore 689578 Monday to Friday:
8.30am to 1.00pm 2.00pm to 5.30pm
Relocation of Raffles Surgery Centre On 6 January 2014, Raffles Surgery Centre relocated to level 2 of Raffles Hospital. Patients can continue to expect seamless services at the newly furnished premises. For further enquiries or to book an appointment, please call 6311 1140.
Vendors of the Year 2013
BANKING & FINANCE
Raffles Medical Group was once again voted a preferred employee healthcare provider by HR practitioners in 2013 according to Human Resources. With this, the group has garnered a track record of seven consecutive years of being a preferred choice of HR practitioners.
As the only healthcare provider that offers direct and integrated medical services and group insurance coverage, the group aspires to enable its partners to optimise their professional healthcare expertise efficiently, so as to improve productivity, promote a healthy workplace and manage chronic diseases better. The group has partnered with many prominent clients throughout its 37 years in the Singapore healthcare industry, gaining a wealth of knowledge and experience to support its clients. It now has 81 clinics across the island. “We will continue to expand geographically and also offer our services directly to our partner companies so they come through our core services,” said Dr Joseph Soon, General Manager of Raffles Medical.
MANUFACTURING ENGINEERING OIL & GAS CONSTRUCTION
Newsroom Corporate Charity Boys’ Brigade – Share a Gift On 7 December, close to 50 staff from Raffles Medical Group came together in the blazing heat in support of the Boys’ Brigade’s annual Share-AGift 2013. A total of 17 cars lined up at Kallang at 2.30pm with the mission to deliver 170 bags of food supplies to 100 underprivileged families. The participants, including some children as young as 4 years old, were glad to be able to participate and help the needy.
Staff of RMG getting ready for the flag off
It was a fun and exciting session, and Dr Tan Joo Peng, Senior Manager, Raffles Medical summed it up best. “It reminded me that in our everyday rat race for financial success, that there exists a less fortunate group amongst us who really need our help and companionship.”
170 bags of food supplies for the needy Delivering food supplies to the underprivileged families
RMG Christmas Charity The first ever charity event that involved the whole organisation took place on 11 December 2013. Staff were encouraged to team up with their colleagues to sponsor items ranging from groceries to useful gifts for four adopted beneficiaries. The items collected reached a total of 252 elderly residents from Peacehaven and Rochore Kongsi, as well as 313 children and teens from Gracehaven and Prison Support Services. The response was overwhelming as many stepped forward to do their part in cheering the beneficiaries during the Christmas season through their generous giving.
Staff from different departments giving generously to the beneficiaries.
Project Haiyan In early November 2013, a powerful tropical cyclone, known as Typhoon Haiyan, swept through parts of Southeast Asia and in particular, devastated Philippines killing 6,069 people. In support of those who were greatly affected in Philippines to rebuild their homeland, 24 donation tin cans from the Singapore Red Cross Society were placed at specialist centres and clinics in Raffles Hospital to encourage generous giving for this cause.
Newsroom New Year Baby On 1 January 2014 at 12:02 am, Raffles Hospital welcomed the first baby boy, Leong Jan Sen, who was delivered by Dr Cordelia Han, Specialist in Obstetrics and Gynaecology & Consultant, Raffles Women’s Centre. Baby Jan Sen is the first child of Mr Leong Ed Mund, 33 years old, and Mdm Wendy Teo, 31 years old, who are both Singaporean Chinese. He weighed 2.5kg and measured 47cm tall. Besides being the first 2014 baby to Raffles Hospital, Jan Sen is the first grandchild to the Leong and Teo families.
Mr and Mrs Leong Ed Mund welcomes their first child on New Year’s Day
Raffles Hospital presented a hamper to the happy family and rejoices with them on this joyous occasion. On top of this, Dr Jazlan Joosoph, Specialist in Obstetrics and Gynaecology & Consultant, Raffles Women’s Centre, also delivered six babies on the same day, much to the delight of their families. This is indeed a great way to start the New Year!
Our six babies, together with their proud parents, delivered by Dr Jazlan From left to right: Mdm Bhuvan Subramanian, Mdm Norhidayah Binte Hassan, Mdm Indah Ambasari Abdullah, Mdm Jankauskaite Ausra, Mdm Prima Hayuningputri and Mdm Nor Asmidah Bte Jaffar
Implantable Pain Therapy for Chronic Pain Intrathecal drug delivery (IDD) is a special way to deliver pain relieving medication directly into the intrathecal space, which is the liquid-filled area around the spinal cord. It involves inserting an implantable device such as a pump under the skin and this procedure is performed under local anaesthesia. Advantages of IDD include: • Manage pain more effectively • Improve quality of life • Reduce dependence on oral medication intake and the side effects People who may benefit from this treatment are those who: • Have suffered moderate to severe chronic pain for more than three months. • Have failed to achieve adequate pain relief with other treatments or experience troublesome side effects because of the drugs. • Have a disease causing the pain, for example: - Intractable chronic back pain - Severe degenerative conditions of the spine - Persistent pain even after surgery on the spine - Osteoporosis - Advanced cancer pain This service is offered at Raffles Orthopaedic Centre. For more information or an appointment, please contact 6311 1222 or email [email protected]
DISEASES Our life expectancy has increased over the years but are we living in the pink of health? A global study revealed that even though life expectancy has increased by an average of about 10 years since 1990, chronic diseases such as high blood pressure, diabetes and cancer are more threatening than infectious diseases today. But here’s the good news! Chronic diseases are highly preventable if we avoid risk factors such as tobacco use, unhealthy diet, physical inactivity and alcohol.
Managing the Six Most Common Chronic Diseases in Singapore
controlled with medications either taken orally or inhaled. These medications help to control the inflammation of the airway and keep it open during an asthma attack. Two main categories of medication: • Bronchodilators help to relax and open up the airways • Anti-inflammatories help to make the airway less sensitive to triggers
1. Asthma In Singapore, about 20 per cent of children and 5 per cent of adults have asthma. Causes & Risk Factors Asthma attacks occur when the sensitive airways react to certain triggers such as allergens like animal fur, dust, pests, insects, pollen, smoke, food, and medications. Colds and viral infections are also common triggers of asthma. Treatment Asthma is incurable but can be 10 HealthNews
Manage asthma by: • Knowing their medications and using them regularly and with the correct technique • Avoiding trigger factors by all means • Knowing what to do during an asthma attack • Going for regular check-ups
2. Chronic Obstructive Pulmonary Disease (COPD) COPD is the seventh principal cause of death in Singapore with about 440 deaths in 2010. Causes & Risk Factors Smoking is the major cause of COPD. It damages the lining of the airways of the lungs, causing it to become inflamed and damaged. Other risk
factors include air pollution, lung irritants, dust or chemicals. Treatment Smoking cessation is key to prevent worsening of COPD. Lifestyle changes together with medications can make a significant impact on the progress of patients suffering from COPD. Four main treatment methods • Bronchodilators allow the relaxation of the muscles around the airways in the lungs to improve air flow. • Corticosteroids help to decrease mucus production and reduce airway inflammation. • Antibiotics treat any underlying infection of the lung. • Surgery includes lung volume reduction surgery or lung transplantation. It involves removing part of or replacing the entire lung of the patient. Manage COPD by: Gaining better protection with either an influenza vaccination or pneumococcal vaccination.
3. Diabetes Mellitus Of the local adult population, one in three suffer from this disease. It is estimated that by 2050, about one
CoverStory enzymes in the stomach that break down carbohydrates. Manage diabetes by: • Having regular check-ups • Managing your blood pressure and cholesterol • Quitting smoking • Engaging in physical activities
million people (15 per cent of the adult population) may be diagnosed with diabetes. . Three major types: • Type 1 Diabetes (early-onset or insulin-dependent diabetes) is the more severe form of diabetes and typically occurs in children or young adults. The body stops producing insulin due to damaged pancreatic cells. • Type 2 Diabetes (late-onset or non-insulin-dependent diabetes) occurs more frequently to those above the age of 40, particularly those who are obese or physically inactive. In this case, the body did not produce enough insulin. • Gestational Diabetes Mellitus (GDM) occurs in about 2 to 5 per cent of all pregnancies whereby the women show high blood glucose levels during pregnancy. Causes & Risk Factors • Family history • Dietary factors • Age & weight • Inactivity Uncontrolled diabetes can lead to increased risk in coronary heart disease, stroke or kidney diseases. Treatment Diabetes can be controlled through one’s diet and medication. Treatment for Type 1 Diabetes: • Daily insulin injections Treatment for Type 2 Diabetes: • May include oral medications or insulin therapy Oral medications: • Used to improve the blood glucose level through stimulating your pancreas to produce more insulin, inhibiting the release of glucose from the liver or blocking the
4. Hypertension (High Blood Pressure) Just less than one in four Singaporeans aged 40 to 69 years suffer from hypertension. In the age group of 60 to 69 years, more than one in two persons suffer from this condition.
How to read blood pressure (BP) 110 / 70 mmHg Systolic BP (when the heart is pumping) If >140mmHg, one is likely suffering from hypertension
or the narrowing of certain blood vessels. If left untreated, hypertension can lead to other problems such as coronary heart disease, heart failure, stroke and kidney failure. Treatment Medications are usually given to control blood pressure that is not controlled by lifestyle changes to prevent health complications. The four main categories of these medicines are: • Angiotensin-converting enzyme inhibitors (ACEIs) and Angiotensin receptor blockers (ARBs) work on the same pathway in the body to reduce blood pressure levels. • Beta-blockers work by slowing one’s heartbeat and reducing the work the heart needs to do to pump blood around the body. • Calcium channel blockers prevent calcium from entering cells in the blood vessel walls and heart. This helps to relax the muscular walls and in turn, lower the blood pressure. • Diuretics work by helping the kidneys to get rid of salt and water via the urine. This reduces the blood volume the heart needs to pump thereby reducing the blood pressure. Manage hypertension by: • Incorporating a healthy lifestyle such as regular exercise and abstinence from smoking • Monitoring your blood pressure aiming to maintain it at normal levels. *Refer to Blood Pressure Guide • Following up regularly with your GP to check for complications of high blood pressure Blood Pressure Guide
Blood Pressure Systolic BP (mmHg) Diastolic BP (when the heart is relaxed between beats) If ≥90mmHg, one is likely to suffer from hypertension measured in millimeters of mercury (mmHg)
Less than 130
140 or greater
Causes & Risk Factors In 95 per cent of cases, the cause of hypertension is unknown. For the other 5 per cent, hypertension may be caused by hormonal imbalance, kidney disease HealthNews 11
CoverStory Blood Pressure Diastolic BP (mmHg) Normal
Less than 80
90 or greater
5. Lipid Disorders (e.g. High Blood Cholesterol) 17.4 per cent of the adult population has high blood cholesterol and it is most prevalent among Malays (22.6 per cent).
Triglycerides A type of fat that is carried in the blood by VLDL. Excess calories, alcohol, or sugar in the body are converted into triglycerides and stored in fat cells throughout the body. Excess triglycerides can put one at a greater risk of pancreatitis and coronary diseases.
Causes & Risk Factors • Hereditary lipid disorders • Increased dietary intake of cholesterol and fat • Obesity • Lack of physical activity Excessive bad cholesterol in the blood may get deposited in the blood vessel walls, resulting in the narrowing and hardening of the blood vessels (atherosclerosis).
6. Stroke It is the fourth leading cause of death which accounts for 9 per cent of total deaths in Singapore. Causes & Risk Factors - Age and family history - Smoking - Obesity - Unhealthy diet (e.g. excess alcohol or foods high in saturated fat and salt) - Sedentary lifestyle - Other medical conditions e.g. poorly controlled Diabetes Mellitus, high blood pressure, atrial fibrillation (irregular heart beat) or high LDLcholesterol
Treatment Lipid lowering medications may be used to bring down the cholesterol level to target level. This can be used in conjunction with lifestyle intervention, or when lifestyle intervention fails to adequately lower the cholesterol level to target level.
Figure showing the building of plaque on the artery walls
Types of Cholesterol Cholesterol travels through the blood attached to a protein called a lipoprotein. Lipoproteins are classified as high density, low density, or very low density, depending on how much protein there is in relation to fat. • Low density lipoproteins (LDL) Known as the “bad” cholesterol, LDLs contain cholesterol and fat that tend to cause the buildup of plaque on the walls of arteries. • High density lipoproteins (HDL) Known as the “good” cholesterol, HDLs help the body to get rid of bad cholesterol in the blood. The higher the level of HDL cholesterol, the better. If levels of HDL are low, the risk of heart disease increases. • Very low density lipoproteins (VLDL) Similar to LDL cholesterol, VLDL contains mostly fat and not much protein. 12 HealthNews
Four main groups of medications: • Statins act on the enzyme to restrict the production of cholesterol in the liver • Fibrates help to stimulate the breakdown of the lipoproteins • Bile acid sequestrants help to bind bile acids at the intestinal level • Niacin help to decrease the formation of LDL-cholesterol in the liver Manage lipid disorders by: 1. Screening and diagnosis 2. Lifestyle intervention 3. Medications Blood Cholesterol Guide
Treatment Medication, surgery and rehabilitation are considered the three main treatment modalities. Three main methods: • Medications: Blood-thinning drugs like “antiplatelet” and “anticoagulant” are used for primary or secondary prevention of stroke. • Surgery: When there is severe narrowing in a neck artery leading to a minor stroke or transient ischemic attack (TIA), carotid endarterectomy will be conducted to remove the narrowing and reduce the risk of another stroke. For those who are not suitable for surgery, angioplasty (ballooning) and stenting are other available options. • Rehabilitation: One will undergo exercises that aim to help them recover from deficits and learn adaptive skills to cope with disabilities. Manage stroke by: - Going for regular check-ups once a year and follow up if there is any complication. HN
CoverStory Alzheimer’s Disease And Dementia A progressive disease that affects memory and brain functions. Symptoms include: Memory loss, difficulty in expressing oneself, swallowing problems and mood swing.
Chronic Obstructive Pulmonary Disease (COPD)
A group of lung diseases that block airflow and make breathing difficult. Symptoms include: Shortness of breath, chronic cough, wheezing and chest tightness.
High Blood Pressure (Hypertension) A condition in which the blood pressure in the arteries is elevated. Symptoms include: No visible symptoms. It is often called the silent killer.
Asthma A chronic inflammatory disease that results in inflaming, narrowing and obstructing of the airway. Symptoms include: Shortness of breath, pain or tightness in chest, coughing or wheezing attacks.
Diabetes A disease in which the blood glucose or sugar levels are too high as the body is unable to produce enough insulin. Symptoms include: Increased thirst, frequent urination, extreme hunger, fatigue and frequent infections.
Stroke This condition occurs when the blood supply to part of the brain is cut off, resulting the brain cells to die. Symptoms include: Paralysis or numbness of body parts, severe headaches, trouble with walking, speaking and seeing.
High Blood Cholesterol (Lipid Disorders) Lipid disorders are a group of medical conditions which refer to excessive levels of fatty substances including cholesterol (a waxy, fat-like substance obtained through food or synthesis within the body) in the bloodstream. The main biological functions of lipids include storing energy, signaling, and acting as structural components of cell membranes. Symptoms include: No symptoms per se. The only way to detect high cholesterol is through a blood test.
Source: Dr Steve Yang, Specialist in Respiratory Medicine & Consultant, Raffles Internal Medicine Centre Dr Stanley Liew, Specialist in Endocrinology & Consultant, Raffles Diabetes & Endocrine Centre Dr Sarah Jane Packer, Family Physician, Raffles Executive Medical Centre Dr Wong Wei Mon, Senior Physician, Raffles Medical Dr Mohammed Tauqeer Ahmad, Specialist in Neurology & Consultant,Raffles Neuroscience Centre
Three as a Family
High blood pressure, high cholesterol and high blood sugar are three common chronic conditions with few obvious symptoms. Caring for a loved one with these diseases can seem overwhelming emotionally, physically, and financially. As such, the role of the caregiver in management of chronic diseases cannot be undermined. Patients with chronic disease need to monitor their levels, diet and exercise, and meet up with health care professionals regularly. If they are seniors, they may also have other health problems and complications that may make their condition more worrying. Here’s how you can help care for your loved ones:
Ignorance is not bliss
Do not ignore the diagnosis. You can do something about it. Most chronic diseases can be properly managed and kept under control. If your family member has just been diagnosed, they may feel vulnerable, confused, worried, sad or angry. It may take time for one to adjust to and accept the realities of chronic disease. Stand by them and help them understand that it is not the end of the world.
Learn what the healthier food options are, and offer that to them. Encourage or remind them about the benefits of healthy eating. Nagging or forcing a person to eat healthy can be counterproductive. Ms Sarah Sinaram, Senior Dietitian, Raffles Diabetes & Endocrine Centre recommends consuming more of the following foods: fruits, nuts, vegetables, fish, leaner meats, and whole grains. They should take less full fat dairy, drink alcohol in moderation, avoid sugar sweetened beverages and choose unsaturated fats and oils over high saturated fats or oils.
Encourage them to get active. Offer to accompany them to exercise. Exercise can lower cholesterol level, triglycerides, risk of blood pressure, insulin resistance, and risk of diabetes. According to Dr Abel Soh, Specialist in Endocrinology & Consultant of Raffles Diabetes & Endocrine Centre, research found that dietary changes and exercise aimed at reducing weight can lower one’s risk of developing type 2 diabetes by more than 50 per cent. And you need not do a marathon, just brisk walk for at least 30 minutes five times a week. Yes, it’s that easy.
Keep their weight in check. Encourage them to lose weight if they are overweight. Research also showed that by losing five to ten per cent of your body weight can potentially normalise blood pressure and blood sugar in people with mild to moderate hypertension or diabetes.
Encourage them to quit smoking as smoking increases their risk of having complications such as heart attacks and strokes. Dr Stanley Liew, Specialist in Endocrinology, Raffles Diabetes & Endocrine Centre added: “Smoking cessation can help patients improve their cholesterol profiles by boosting their good HDL cholesterol levels”.
Finally, help them to check their condition. Purchase relevant monitoring equipment to help with the monitoring. Accompany them on their doctor’s visits, show interest and cheer them on in the fight against their condition. You should also help examine a diabetic’s hands and legs to look out for sores or infections.
Warning Signs Diabetes It’s an Emergency!
If your loved one is experiencing:
Call their doctor if they feel:
1. Chest pain / pressure
Numbness, tingling, or pain in feet or legs
2. Fainting or fall unconscious
Sores / infections on feet
4. Shortness of breath
High blood sugar
Low blood sugar
* These can worsen and become emergency conditions. Head to the emergency department straight away.
Hypertension Hypertensive Crisis
When to call the doctor
• Blood pressure readings at 180/110 or higher
Blood pressure is still high despite prescribed medication
Symptoms: fatigue, nausea, shortness of breath, light-headedness, headache, excessive sweating, problems with your vision, or confusion
• Potential damage to the body’s organs
Symptoms of Hypertensive Crisis • Headache or blurred vision • Increasing confusion • Seizure • Increasing chest pain • Increasing shortness of breath • Swelling or fluid build-up in tissues
High Cholesterol Signs to take note of Complications: • Chest pain
When to see a doctor Blood test for fasting lipids
• On medication: once to twice a year • Achieved target on diet control: once every three years
• Heart attack • Stroke * If your family member with high blood pressure experiences these, go to the emergency department right away.
• Upon diagnosis, and regularly subsequently
Follow up on complications • As deemed necessary
Do you usually associate ageing with chronic diseases? Ask anyone with a chronic illness and they would probably tell you the extent of how their illness has inconvenienced them. For example, coping with rising medical bills, requiring long term medication, regular doctor’s visit and/or treatment and diet restrictions. Wouldn’t it be nice if all these do not need to take place? The good news is you can reduce the risk of chronic diseases through dietary and lifestyle modifications. Let Dr Tan Joo Peng, Deputy Physician Leader, Raffles Medical, share with you how dietary and lifestyle changes can reduce the incidence of chronic diseases.
LiveWell Get it Checked
Obesity is increasing rapidly worldwide. Thus, it is important to monitor your Body Mass Index (BMI) level. A BMI value of 23 and above is an indicator that your weight is out of the healthy weight range for your height and you are at risk of certain diseases such as type 2 diabetes, hypertension, hyperlipidaemia cholesterol, heart disease, and certain cancers. Additionally, valuable information can be obtained by measuring waist circumference, which reflects abdominal fat accumulation. In many studies, waist circumference is a strong predictor of Coronary Artery Disease, stroke, and type 2 diabetes, even with acceptable BMI levels. Be informed of the state of your health with regular annual health screening.
Maintain Adequate Daily Physical Activity Modern lifestyle in developed nations has reduced people’s opportunities to expend energy, whether in the work environment, at home or while travelling. We may even find ourselves spending more time sitting in front of the computer screen be it for work or leisure. Like it or not, regular physical activity plays a key role in maintaining a healthy weight and reduces risk of common chronic diseases as well as others such as osteoporotic fractures, osteoarthritis, depression, and erectile dysfunction. Even a small amount of regular activity can lower the risk of developing major chronic diseases like coronary heart disease, stroke, and type 2 diabetes by up to 50 per cent. Regular exercise can cut the risk of premature death by 20 to 30 per cent. Spending too much time watching television per day is associated with increased obesity rates among adults and children especially if each session is accompanied by food and beverages high in calories. HealthNews 17
LiveWell Eat Tasty Yet Healthy Foods
Healthy food does not always mean bland or tasteless. It is about selecting the right ingredients and using the appropriate cooking method. Medical experts have long recognised the effects of diet on the risk of Cardio Vascular Disease (CVD). The following discusses five aspects of diet for which strong evidence indicates important health implications.
• Fat - When it comes to fats, replace saturated and trans fats with unsaturated fats, including sources of omega-3 fatty acids. By replacing saturated fats with unsaturated fats, this will reduce the risk of CVD by reducing serum low-density lipoprotein (LDL) cholesterol (bad cholesterol). • This is because trans fatty acids produced by the partial hydrogenation of vegetable oils have unique adverse effects on blood lipids and increase risks of CVD. Both the effects on blood lipids and the relationship with CVD risk are considerably more adverse than for unsaturated fat. • In many developing countries, trans fat consumption is high because partially hydrogenated soybean oil is among the cheapest fats available.
• Fruits and vegetables - Ensure generous consumption of
evidence indicates that high intake of fruits and vegetables will reduce the risk of CVD and stroke.
• Whole grains - Consuming grains in whole grain, highfibre form has double benefits. Firstly, consumption of fibre from cereal products has consistently been associated with lower risks of CVD and type 2 diabetes. Secondly, higher consumption of dietary fibre also appears to facilitate weight control and helps prevent constipation.
• Sugar - Limit consumption of sugar and sugar-based beverages. Sugar (free sugars refined from sugarcane or sugar beets and high-fructose corn sweeteners) has no nutritional value except for calories and, thus, has negative health implications for those at risk of overweight. Furthermore, sugar contributes to the dietary glycemic load, which exacerbates the metabolic syndrome and is related to the risk of diabetes and CVD.
• Sodium - Limit sodium intake. The principle justification for limiting sodium is its effect on blood pressure, a major risk factor for stroke and coronary disease.
fruits and vegetables and adequate folic acid intake. Strong
Watch Your Alcohol Intake Most people are unaware that regular drinking of alcohol can lead to a wide range of long-term health problems, including cancers, strokes and heart attacks. For example, men who regularly drink more than three to four units a day are three times more likely to have a stroke.
Keep Stress in Check
Psychological problems, including stress, are the underlying reason for one in five visits to a General Practitioner. If left unchecked, stress can lead to further health problems such as high blood pressure, anxiety, and depression, just to name a few.
The health benefits of quitting smoking are immediate. After 20 minutes, your blood pressure and pulse return to normal. After 24 hours, your lungs start to clear. After three days you can breathe more easily, and your energy increases. Keep it up and you’re adding years to your life. Research shows that people who quit smoking by the age of 30 add 10 years to their life.
Improve Your Sleep
Most healthy adults sleep for an average of seven to nine hours a night. If you’re not getting enough sleep, it can affect relationships, your performance at work, and delay recovery from illness. Good sleep begins with a good bedtime ritual and some simple lifestyle changes.
The effects of chronic disease do not only affect the patient, but also the people around him/her. More often than not, loving your family means being responsible for your own health. If you need to make changes to your lifestyle, start today! HN 18 HealthNews
What We Eat New research continues to demonstrate that certain foods can strengthen the body and help prevent disease - an approach that will perhaps someday allow us to depend less on medical treatments such as pharmaceutical drugs and interventional procedures to stay healthy. Our experts share a big picture plan on how we can use diet to treat chronic diseases.
Avoid refined carbohydrates.
More than 90 per cent of the carbohydrates we consume in our diet are in the form of refined and processed foods and few of these are healthy. Refined carbohydrates are digested quickly leaving you feeling hungry quicker and may result in over-eating. Consumption of refined carbohydrates can also result in blood sugar spikes.
Can food treat disease? “The principle of practising moderation when eating can help prevent chronic diseases,” said Ms Sarah Sinaram, Senior Dietitian, Raffles Diabetes & Endocrine Centre. Sarah explained that a healthy diet focusing on prevention can be tweaked as necessary for specific diseases to reduce symptoms. Sarah first shared a golden rule: Eat food that nourishes and sustains the body. Although the ideal would be to eat only such food, however, this rule is especially important for those diagnosed with a chronic disease. With this in mind, here are some essential dietary specifics that she has recommended to nourish and sustain us all.
Fill up on fibre.
Eat plentiful amounts of vegetables, unprocessed intact whole grains like brown rice, oatmeal, quinoa, barley, starchy vegetables (e.g. potatoes, yams and corn). In fact, with their high fibre, low in fats and high protein, legumes seem to be a common denominator among all populations studied for longevity and health.
Everything in moderation, even ‘good-for-you’ foods.
Sarah also pointed out that diets that recommend a “little this and a little that” - such as dark chocolate, walnuts and olive oil can easily lead people to believe it is all right to eat large quantities of these foods. Thereby, causing one to consume too much fats and too many calories. While these foods may be good for you in small quantities, they can easily be overeaten. Instead, she suggested focusing on the primary foods the diet recommended and using the others as a condiment or an occasional treat.
EatSmart Foods that fight diseases Sarah recommended the following dietary changes if one is already battling with chronic diseases:
People who suffer from rheumatoid If you have arthritis can do arthritis much through diet to help symptoms. She suggested removing all inflammatory components of the diet, including processed foods, white flour, sugar, and some vegetable oils. Be sure your diet includes more green leafy vegetables and all types of berries as they contain phytochemicals which prevent diseases. Additionally, she suggested that those with osteoarthritis - the most common form of arthritis should keep their weight down because excess weight stresses
joints. “Weight If you have reduction is very diabetes important when it comes to treating diabetes. A loss of as little as 5 to 7 per cent of body weight will result in a great improvement in the blood sugar level,” shared Dr Abel Soh, Specialist in Endocrinology & Consultant, Raffles Diabetes & Endocrine Centre. He added that belly fat is particularly dangerous for people with diabetes in addition to its cardiovascular risks as abdominal fat increases insulin resistance. Exercise is also an important factor. In addition, Sarah advised reducing dietary fat intake and keeping calories under control are 20 HealthNews
EatSmart also essential pointers. Reducing total If you have high blood fats in your diet cholesterol and especially unhealthy fats (i.e. saturated and trans fats) can help lower blood cholesterol. Fat in the blood is known as lipidemia. When a fluid becomes thicker, as blood does when lipidemia increases, it becomes more difficult for blood to flow through the vessels and requires more pressure. High fat meals can cause lipidemia that
If you have digestive problems and/or heart disease
lasts up to six hours.
Both of these very common health problems can be improved with proper diet plans. To optimise digestive health and to improve (sometimes even reverse) heart disease, one should consume more fruits and vegetables (especially green leafy ones), lean protein and some whole grains. Indeed, if your diet emphasises these foods now, you will be boosting the odds against diseases in the years to come, be it with food or drugs. HN
Here’s a useful guide on food portion control, which is a critical part of successful weight loss and weight management.
Fruits Fats, Oil, Meat Sugar, Alternatives Salt
Your hand can help you measure the right amount of food to eat Examples of 1 serve
(1 cup) Rice Pasta Fruits Vegetables
Handful Palm (90g) Meat Fish Poultry
(30g) Nuts Dried fruit
Brown Rice and Tofu Salad with Sunflower Seeds Ease of preparation:
Why Brown Rice? Brown rice is the “unrefined” version of white rice. Unlike white rice, brown rice still has the side hull and bran. The side hulls and brans provide “natural wholeness” to the grain and are rich in proteins, thiamine, calcium, magnesium, fibre, and potassium. For those trying to lose weight or suffering from diabetes, brown rice can be a healthy staple given its low glycemic rating which helps reduce insulin spikes. One cup of brown rice contains 88 per cent of the recommended daily value of manganese, a nutrient that plays an important part in fighting free radicals. Manganese is part of a compound known as superoxide dismutase, an antioxidant that prevents damage from free radicals created during the energy production process. Manganese is also important for deriving energy from protein and carbohydrates and plays a key role in the synthesis of fatty acids. Phytonutrients are compounds naturally found in plants that have anti-inflammatory properties and tend to act as an antioxidant. Brown rice is a great source of these plant compounds, especially phenolics.
Benefits of Brown Rice 1. Rich in Selenium Reduces the risk for developing cancer, heart disease and arthritis. 2. Promotes Weight Loss High in fibre and keeps bowel function at its peak. Fills the stomach leading to smaller meal portions. 3. Rich in Anti-Oxidants The antioxidant capacity of brown rice tops the charts with other foods like blueberries, strawberries and other fruits and vegetables.
2 - 4 Servings
Ingredients • 200g (1 cup) brown rice • 2 celery sticks, trimmed, thinly sliced • 1 small red capsicum, halved, deseeded, coarsely chopped • 75g baby spinach leaves • 2 tablespoons raisins • 40g (1/4 cup) sunflower seed kernels • 200g Japanese tofu, thinly sliced Dressing • 2 tablespoons fresh orange juice • 1 tablespoon salt-reduced soy sauce • 2 teaspoons honey • 2 teaspoons freshly grated ginger Tip: If Japanese tofu is unavailable, use normal white tofu. For a different flavour, you can replace the tofu with 2 cooked single chicken breast fillets.
Nutritional information Calories: 220cal Total Fats: 10g Total Carbohydrates: 56g Dietary Fibre: 5.5g Protein: 17g
Preparation 1 Cook the rice in a large saucepan of boiling water following packet directions. Rinse under cold running water. Drain off excess water.
3 Place the rice, celery, capsicum, spinach, raisins and half the sunflower seeds in a large bowl. Drizzle over the dressing and toss to combine.
4 Divide the rice mixture among serving bowls and top with the tofu. Sprinkle with the remaining sunflower seeds to serve.
2 To make the dressing, combine the orange juice, soy sauce, honey and ginger in a small bowl.
Source: Ms Sarah Sinaran, Senior Dietitian, Raffles Diabetes & Endocrine Centre
UpClose with Ms Sarah Sinaram
Senior Dietitian | Raffles Diabetes and Endocrine Centre | Raffles Hospital
Photo by Edd chua
Senior Dietitian Ms Sarah Sinaram gets her satisfaction from helping her clients achieve their health goals. Read on to learn about her life, her work, and her philosophy towards food.
UpClose Hi Sarah, why did you choose to join Raffles Hospital? I graduated from Flinders University of South Australia, Adelaide, and have been working as a dietitian for eight years now. Working in Raffles is great as I get to meet both local as well as international clients. Because of the different profiles, I get to face new challenges which keep me on my toes.
What’s a typical day for you like? First thing I do is to check on the patient schedule to find out how many patients I will be seeing that day. In between patients, I prepare articles or patient education materials. I also conduct talks and workshops for corporate clients.
Are there any specific character traits unique to a dietitian? Most dietitians will tell you that they are secretly big foodies, perfectionists at their work and health conscious. You also need to enjoy talking to and meeting people. I see different cases from diabetes, pregnancy to paediatrics.
What do you enjoy most about your work?
I try to consume lots of vegetables and two servings of fruits every day. Some days I can, but if I eat out I can’t. I keep away from greasy, oily foods and sugar sweetened beverages.
Any memorable patient stories to share with us? Oh yes, plenty! There was this lady who was newly diagnosed with diabetes. Due to her work, she ate out often and hardly had time to exercise. She seemed inundated by her diagnosis and the need for lifestyle change. After reassuring her that she only needed to make small changes and after a few reviews, she started to eat better, opting for lower fat choices and having fruit and vegetables, and she even made time to exercise! She lost more than 10 per cent of her body weight in six months. The best part is that she maintained her lifestyle changes even after that! A client travelled all the way from Kuala Lumpur to see me for advice about his diet. A few weeks after the consultation, he emailed to let me know that his post-meal sugar levels were within target range. Just today, another client emailed to let me know that he had lost weight. It’s a great feeling knowing that I played a role in helping them meet their health goals. I also had a young underweight girl from Vietnam who told me that the diet preoccuption was working for her and she had gained weight.
Any tips for patients to manage their health and avoid chronic diseases? Have balanced meals I realise that many people do not have balanced meals. If one or more food groups are continuously missing from your diet, this could put you at risk of poor nutrition and chronic disease. Have a variety of foods to ensure you are meeting your nutrient requirements and practise moderation when eating.
Can you share some less known fact about your life? I am a self-confessed hypochondriac so that motivates me to eat healthy. I try to ensure that we always stock healthier foods at home. There are different types of rice at home and, two to three types of fruits and vegetables in the fridge every day. We usually have the white rice whenever my hubby laments that he misses it. There is some snack food in my house and I secretly monitor how fast it moves and who is eating it. I enjoy ice cream and I limit my intake to one scoop each time. You could call that an occupational hazard. HN
It’s a great privilege helping people achieve their health goals. Every client is unique so the advice that I give needs to be personalised and practical.
Do you have any tips to keep fit and stay healthy? Any health mantra you live by? Prevention is better than cure. I believe a person should have the freedom to eat whatever they want but they have to practise moderation when having “not so healthy” foods. It’s all about portion control.
Swap it If you’re someone who lives to eat, giving up certain yummy food could be one of the insurmountable tasks on your list. To make matters worse, you may have many of them belonging to the “unhealthy” category. Wouldn’t it be nice if you could continue your indulgence without worrying about putting on extra weight or end up putting yourself at risk of some chronic diseases? Making small changes by swapping for healthier choices can add up to make an overall difference. Ms Sarah Sinaram, Senior Dietitian, Raffles Diabetes & Endocrine Centre has the following suggestions for you.
Fats and Oils Sauces, salad dressings, flavourful gravies, all these may seem harmless and essential to make a dish more appetising. But did you know that a tablespoon of, say regular mayonnaise, would contain 5g of fat? Below are some common ingredients that you can swap with to make your meals tasty and healthy at the same time. CRAVING Item
Meat Some meats are healthier than others; even their cuts and preparation methods can make a difference.
Fruits and Vegetables Eating more fruits and vegetables are encouraged. As we don’t eat most of them in their raw form, the method of preparation would be key.
Grilled vegetables, stir fried or baked vegetables
Tuna chunks in water
Butter on baked potato
Chilli or herbs or pepper
Deep fried meats
Baked or roasted potato
Fatty cut meats
Lean cut meats
A glass of fruit juice
A piece of fruit and water
White meat - fish, chicken
Lean meat or mince
Tuna in oil
Breads, Cereals and Grains This category of food usually forms a third of each meal to keep us full. Why not consider those that are packed with more vitamins, nutrients and minerals instead? CRAVING
Soft wholemeal or wholegrain bread
White polished rice
Brown rice, basmati rice
Cream based pasta
Tomato based pasta
Sugar coated cereals
Whole grain cereal
Snacks If you are someone who loves eating chocolates, ice cream and chips, we know that asking you to give them up all at once could be tough. But you don’t have to. The key is eating in moderation. Below is a portion guide, based on 140 calories, that you can take note of the next time you indulge in your favourite snacks. CRAVING
A milk chocolate bar
5 small squares of milk / dark chocolate
A pint of ice-cream
2 small scoops of ice-cream
Donut with icing
Just slightly over half a donut with icing
A packet of potato chips
10 pieces of potato chips
A cup cake
Half a cup cake with icing
Chocolate nut spread
2 knife spreads full (1 flat tablespoon)
A packet of candy-coated chocolate
31 mini candy-coated chocolate
A packet of preserved mango with sugar
4 strips of dried mango with sugar
Drinks Can’t seem to break away from sweetened drinks? Consider these options and moderate your intake. CRAVING
ur time yose, t x e n u The calls, pa craving er what you consid wap it with could s tise portion or prac ntrol. co
Coffee with condensed milk
Coffee with skimmed milk
Hot chocolate with whole milk and whipped cream
Hot chocolate with skimmed milk without whipped cream
Nutrition in a
Who needs supplements? Is eating supplements alone sufficient for the nutrients that I am lacking in? Can supplements replace my daily diet? What types of supplements should I be eating then? Can I take supplements if I am suffering from diabetes or cardiovascular diseases? What if I am a vegan or vegetarian, how do I supplement my nutrition intake? The usual culprits that cause chronic diseases: unhealthy diet, physical inactivity, obesity, abnormal blood lipids, high blood pressure, high blood glucose and being overweight, makes one worry about what food they can eat and if they have adequate intake of nutrients. Here are some supplements to assist your nutritional intake and to prevent chronic diseases:
Cardio Omega 3 It is necessary for heart health as it helps to reduce blood pressure, lower cholesterol and triglyceride levels. Omega-3 fatty acids cannot be made in the body and hence it is classified as an essential fatty acid and must be obtained from either the diet or in supplement form. Omega-3 fatty acids are important for infants and a developing foetus for the proper development of the brain and retina of the eyes. Omega-3 fatty acids can support cardiovascular health by mitigating blood pressure, cholesterol levels and relaxing blood vessels.
Probiotic Acidophilus with Pectin Lactobacillus acidophilus (L.acidophilus) is the most commonly used probiotic or “friendly” bacteria. Such healthy bacteria inhabit the intestines and vagina and protect against the entrance and proliferation of “bad” organisms that can cause disease. This is especially helpful for those who are suffering from constipation or diarrhoea. L. acidophilus also produces lactase, the enzyme that breaks down milk sugar (lactose) into simple sugars. People who are lactose intolerant do not produce this enzyme. For this reason, L. acidophilus supplements may be beneficial for these individuals.
EatSmart “First and foremost, we should rely on natural foods to meet our nutrient needs as absorption of nutrients is highest from foods. Supplementation shouldn’t be viewed as an insurance policy against an imperfect diet. It is always a food-first approach, then supplements,” said Ms Sarah Sinaram, Senior Dietitian, Raffles Diabetes & Endocrine Centre. Supplements are not intended to be a food substitute because they cannot replicate all the nutrients and benefits of whole foods, such as fruits and vegetables. However, supplements may be useful for certain people who are lacking the necessary nutrients. They should consult their doctor or a registered dietitian when deciding if they need a supplement or choosing one.
Who Needs Supplements? •
Vegans and some people on vegetarian diets
Anyone on a low-calorie diet (intentional and unintentional)
People who suffer from food allergies or intolerances
Picky eaters who limit food groups, or have limited variety within food groups
Anyone with a poor diet
People suffering from diabetes
People who suffers from chronic diseases
It is always a foodfirst approach, then supplements!
Conclusion While a balanced diet should provide our complete vitamin quota, our busy work schedules often make us eat out of convenience and thus having us almost no time to plan for a nutritive diet. Furthermore, the consumption of processed foods which are lower in vitamins and minerals may increase our intake of sodium and saturated fats. Hence, nutritional supplements may help you make up for the shortfall and to achieve the optimum health you deserve. HN
CoQ10 50 mg Coenzyme Q10 is an important vitamin-like compound that is present throughout the body. CoQ10 is an important fat-soluble antioxidant that is uniquely able to protect the cells’ energy production machinery, known as mitochondria, from free radical damage. Coenzyme Q10 is also necessary for the production of energy in cells of the body.
Vitamin B-12 Vitamin B-12 aids folic acid in regulating the formation of red blood cells, and helps in utilisation of iron, thereby preventing anaemia. It is also required for proper digestion, synthesis of protein, and metabolism of carbohydrates and fats. Strict vegetarians will require Vitamin B-12 supplementation as this vitamin is primarily obtained from animal products.
Weight Loss Myths Busted!
Looking good is desirable. I’m not talking about good looks alone as our weight also determines how we look. The craze to look slim and attractive is common especially among youths and young adults. However, this craze does not reflect the reality. The National Health Survey in Singapore showed that there is a rising trend of people being obese from 6 per cent in 1998 to 10.8 per cent in 2010. What is more disturbing is the fact that obesity is closely linked to chronic diseases. Studies showed that those weighing more than 10 per cent of their normal weight will have increased risks of developing common obesity-related chronic diseases such as diabetes, cardiovascular disease and hypertension. Before you start getting rid of those excess fats to improve your conditions of chronic diseases, here are six debunked myths of weight loss to help you shed your pounds the right way!
Interested to find out the approaches of Western doctors and TCM physicians in treating obesity? Scan this QR code to find out more.
GetGorgeous Myth 1: Fad diets are tested and proven to help you lose weight by celebrities!
Fact: Fad diets usually hold claims
Tip: Instead of looking for an easy way out, try setting realistic goals for your weight loss plans? Dr Liew advised: “The recommended weight
of rapid weight loss with little or no
loss is about 0.5 to 1kg per week.”
scientific evidence supporting its
Myth 3: Snacking between
effectiveness. It also claims that exercise is not necessary and one can
meals will make me gain weight.
merely lose weight just by eliminating
Fact: According to Ms Sarah
or eating certain foods. Fad diets are not fab at all. Even though weight loss may occur, they are difficult to sustain for a long period of time and there’s a higher chance of one suffering from nutritional deficiencies.
Sinaram, Senior Dietitian, Raffles Diabetes & Endocrine Centre, it is all right to snack on a low-calorie food such as an apple or yoghurt before one’s next meal. “We can still lose weight as long as you consume fewer calories than you use. Curbing your hunger pangs and skipping meals can result in one’s tendency to eat more during the next meal,” she said. Tip: Keep track of what you eat and drink by using a food diary. This
Tip: Follow the nutritional
helps you to be aware and keep
recommendations on dietary intake
those extra calories at bay.
by the Health Promotion Board. Eat
Myth 4: Morning is the best
at least five to seven servings of rice and alternatives and add two servings each of fruits, vegetables and meat.
Myth 2: Slimming pills burn
time to exercise and in order to shed the fats, I need to get a good workout of at least 20 minutes.
fats like magic.
Fact: Be it morning, afternoon
Fact: Think slimming pills can help
of calories burnt whenever you
or night, you get the same amount
to curb appetite and burn fats? You
exercise. Dr Abel Soh, Specialist in
might want to reconsider.
Endocrinology & Consultant, Raffles
According to Dr Stanley Liew, Specialist in Endocrinology & Consultant, Raffles Diabetes & Endocrine Centre, slimming pills, powder or supplements may have side effects and negative health
Myth 5: Focusing on sport reduction exercises or using vibrating machines can help me lose weight.
Diabetes & Endocrine Centre, said: “Although it is recommended for one to engage in at least 10 minutes of moderate-intensity aerobic activity, calories are still burned during the first few minutes of physical activity.”
implications if used unsupervised in
Tip: To shed off those extra
the long-term. Slimming supplements
pounds, try to incorporate at least
should not be a substitute to healthy
150 minutes of moderate-intensity
eating and exercise.
aerobic activity per week.
Fact: Thinking of getting rid that bulky stomach of yours by using vibrating machines or doing abdominal exercise, there’s a likely chance that things may not go in your favour. Despite the claims that spot reduction exercises and vibrating machines focus on targeted fat loss, it is untrue that they help in reducing fat from certain parts of the body. Tip: “Try focusing on aerobic or cardiovascular exercises such as running and swimming. These exercises help you to burn more calories and in turn, achieve weight loss more effectively,” said Dr Soh.
Myth 6: Certain foods such as
cabbage, celery and grapefruit can aid in burning fat.
Fact: There are no foods that can burn fat. However, one thing is for sure: cabbage, celery and grapefruit, which belong to the category of fruits and vegetables, are low in calories and high in fibre, so incorporating more of such foods into one’s diet is a good way to lose weight. Tip: Make sure your caloric intake does not exceed your caloric output to achieve weight loss effectively. HN
Psoriasis? Psoriasis is a fairly common inflammatory skin disease that affects the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin, forming thick red scaly patches with silvery scales that are sometimes itchy. Psoriasis is a chronic relapsing disease. Having psoriasis can be embarrassing for some people, and they may avoid swimming and other situations where the patches are shown. It can also be disabling, especially when associated with psoriatic arthritis.
Symptoms • Red patches of skin covered with silvery scales, commonly over the knees, elbow joints, around the umbilicus. The scalp is also frequently affected. • Itching, burning or soreness • Nail changes such as pitting, thickening, ridging or separation from the nail bed (onycholysis)
Getting it Controlled
• Stiff and swollen joints
Treatments • Topical: Coal tar containing preparations, topical corticosteroids, Vitamin D analogues, salicylic acid and calcineurin inhibitors • Light Therapy (phototherapy): Narrow band UVB phototherapy, PUVA therapy and excimer laser
Having chronic skin and eye problems is not something that we look forward to. It does not just affect the skin and eyes; it can also affect your sleep, social life and overall well-being. But the right management of such conditions and simple prevention tips can make a difference.
• Oral or injected medications (for
Facts and information provided by:
• Avoid psoriasis triggers (e.g.
Lifestyle & Home Remedies • Maintain a healthy weight • Use a moisturiser regularly
Dr Rachael Teo
Dr David Chan
infections, smoking, excessive alcohol
Specialist in Dermatology & Consultant
Specialist in Ophthalmology & Consultant
Raffles Skin & Aesthetics
Raffles Eye Centre
• Learn how to manage stress
What are dry eyes?
Atopic dermatitis (eczema) is a very common skin condition. It is a chronic
Blepharitis is an inflammation that
relapsing condition that may be
affects the eyelids and usually involves
associated with other atopic conditions
the part of the eyelid where the
like asthma or hay fever.
eyelashes grow. It commonly occurs
Dry eyes occur when your tears are not
when tiny oil glands located near the Eczema may affect any area of your
able to provide adequate moisture for
base of the eyelashes malfunction
skin, including arms and legs, body,
your eyes, therefore making you feeling
which leads to inflamed, irritated and
eyelids and around the nipple area.
uncomfortable. Tears can be inadequate
if you do not produce enough tears or if
It tends to flare periodically and then subside. The cause of atopic dermatitis
Blepharitis is often a chronic condition
may result from a combination of
that is difficult to treat. Blepharitis can
inherited tendencies for sensitive skin,
be uncomfortable but it does not usually
skin barrier defects and alteration in the
cause permanent damage to your sight.
body’s immune system.
• Watery and red eyes
you produce poor quality tears.
Symptoms • Increased eye irritation from wind or smoke • Eye fatigue • Sensitivity to light
• Itchy dry red patches in the affected areas
• Gritty and burning sensation in the eye
• Stinging, burning or scratchy sensation in eyes
• Eyelids that appear greasy
• Difficulty wearing contact lenses
• If infected, skin may ooze, crust and become painful
• Itchy, red and swollen eyelids
• Periods of excessive tearing
• Flaking of skin around the eyes
• Blurred vision, often worsening after focusing for prolonged period
• Itching is usually worse at night • Generally dry skin
Treatments • Medications: Corticosteroid creams or ointments, antibiotics, oral antihistamines, oral or injected corticosteroids and immunosuppressive drugs • Light Therapy (phototherapy): Narrow band UVB therapy
Lifestyle & Home Remedies • Bathe in lukewarm water, avoid excessive bathing • Choose mild soaps without dyes or perfumes
• Sensitivity to light
Treatments • Clean the affected area regularly with warm water help control symptoms
Treatments • Closing tear ducts to reduce tear loss • Cover eyes with special contact lenses • Unblocking blocked eye glands
• Eye drops or ointments containing steroids can help control inflammation in the eyes and eyelids.
• Eye drops containing antibiotics applied at the eyelids may help control blepharitis caused by a bacterial infection.
- Prescription eye inserts that work like artificial tears
Lifestyle & Home Remedies
• Moisturise your skin regularly
• Clean your eyes daily with warm water
• Wear cool, smooth-textured cotton clothing
• Stop using eye makeup with inflamed eyelids
• Avoid triggers (e.g. rapid changes of temperature, sweating, stress) that may worsen inflammation
• Control dandruff that is contributing to blepharitis
- Antibiotics to reduce eyelid inflammation
- Prescription eye drops to control eye inflammation
Home Remedies • ‘Add tears’ (drops or ointments with the over-the-counter eye drops for mild cases • Wash eyelids with warm water to control inflammation • Use mild soaps to wash your eyelids HealthNews 31
EFFECT of SMOKING on CHRONIC DISEASES The
There is no doubt that smoking is harmful to our health. Not only does it give you respiratory problems, smoking is closely linked to chronic diseases such as diabetes, high blood pressure (hypertension), high blood cholesterol (lipid disorders), asthma, and COPD (Chronic Obstructive Pulmonary Disease). Source: Dr Steve Yang, Specialist in Respiratory Medicine & Consultant, Raffles Internal Medicine Centre
What’s the Link Between Smoking and Chronic Diseases?
One in two heavy smokers die from a smoking-related illness e.g. chronic diseases. In Singapore, 14.3 per cent
85.7% Non Smokers
Fast Facts Every cigarette takes 7 minutes off your life Over 2,500 Singaporeans die every year from smoking-related illnesses Smokers have a shorter lifespan of 10 years compared to non-smokers Smokers
of the population are smokers. Diabetes: A 50 per cent increase in risks for smokers
Lipid Disorders: Smoking lowers highdensity lipoprotein cholesterol (HDL-C) or
COPD: 80 to 90 per
Stroke: Four times the
cent of deaths are caused by smoking
“good” cholesterol by
Hypertension: Rise in blood pressure by 10 mmHg or more for up to an hour after smoking
“START” Quitting by having a “Stop Smoking Plan”:
S = Set a quit date T = Tell family and friends that you plan to quit
A = Anticipate and plan for the
challenges you’ll face while quitting
R = Remove cigarettes from your surroundings
T = Talk to your doctor about getting help to quit
5 to 10 per cent Asthma: 20 to 35 per cent of asthmatic adults are smokers
risk for smokers than non-smokers
Kicking the Butt through Medication and Therapies 1. Nicotine Replacement Therapy - Replaces cigarettes with other nicotine substitutes like nicotine gum or patch
2. Non-Nicotine Medication - Uses smoking cessation medications to reduce cravings and withdrawal symptoms
- Hypnosis: Strengthens one’s resolution to quit smoking - Acupuncture: Triggers the release of endorphins (natural pain relievers) to manage smoking withdrawal symptoms - Behavioural Therapy: Focuses on coping skills and breaking bad habits - Motivational Therapy: Motivates one to quit by giving them a reason to do so. HN
The Best Workout for Your Fitness Goals
For the greatest overall health benefits, experts recommend that you do at least 20 to 30 minutes of aerobic activity three or more times a week. On top of that, it is also advisable to work on some type of muscle strengthening activity and stretching twice a week. Regular exercise can help prevent heart disease, stroke, high blood pressure, non-insulin dependent diabetes, osteoporosis and obesity. It can also improve your mood while helping you to better manage your stress levels. Here are some fitness workouts that can help you attain your fitness goals.
Mixed Martial Arts (MMA) An extreme combat sport in which contestants are permitted to use the fighting techniques of wrestling and boxing and also those of martial arts such as kickboxing, judo and karate.
Muay Thai A combat sport from Thailand, Muay Thai uses stand up striking with beautiful symphony of kicks, punches, knees and elbows. It is the ultimate high intensity stand up fighting discipline, which kills calories and conquers stress.
Zumba An aerobic fitness programme featuring movements inspired by various styles of Latin American dance and performed primarily to Latin American dance music.
Benefits Lose weight
Build and maintain muscles
For a good and proportionate build
To burn fat and calories
Improve mental health Improve cardiovascular health
To develop muscular strength and improve agility
Full body Workout
ShapeUp Mixed Martial Arts Workout Song: “It’s My Life (Dance Remix)” by Bon Jovi, “I’m the Best” by 2NE1 and “Super Bass” by Nicki Minaj
MMA has the unique ability to teach people reflex control, which is something a lot of other workout regiments do not teach. Reflex control is critical to living a much balanced lifestyle as it is important for a number of aspects of life, like operating machinery and driving a car.
Zumba Workout Song: “Waka Waka” by Shakira, “Boom Boom Pow” by Black Eye Peas and “Moves like Jagger” by Maroon 5
Heart health is critical for a number of reasons, because your heart is responsible for blood flow throughout your body and brain, and together with healthy body, it is important for stamina. Dr Teo Swee Guan, Specialist in Cardiology & Consultant, Raffles Heart Centre advises: “Not only that, but the more you work out the heart, the more resilient it will be. An endurance athlete’s heart rate can go as below 50 bpm!” A healthy heart allows you to feel more alert and refreshed.
Muay Thai Weight loss is a great benefit associated with martial arts. To shed one pound of fat (i.e. 3,500 calories), you must lose 500 calories from your diet daily. By participating in an hour of moderate intensity martial arts, you can easily burn 500 calories. If you have a higher than usual body mass index, you may be surprised at how much weight MMA can help you lose. MMA has the ability to work out almost every core muscle in your body. Instead of building muscles outward, mixed martial arts can build lean muscle, which increases your agility and makes you more athletic. It also strengthens your calf muscles, thigh muscles and arm muscles. These are the muscle segments that you will be working out the most. MMA has shown to improve one’s mental health as well. Mixed martial arts, like karate and other disciplines, can keep you focused and strengthen your cognitive abilities. According to Dr Joshua Kua, Specialist in Psychiatry & Consultant, Raffles Counselling Centre, physical activities have been shown to be beneficial for those with depression. Hence MMA as a form of physical exercise may have similar effect. Who knows, it could be that you needed mixed martial arts all along! 34 HealthNews
Workout Song: “It’s My Life (Dance Remix)” by Bon Jovi, “Blurred Lines” by Robin Thicke Zumba classes are intended to provide a large calorie burn through aerobic activity done with interval training in mind. Depending on body weight, gender, fitness level and other common physical factors, the number of calories you burn in a typical Zumba class is equivalent to that of any fast social dancing hour, such as salsa or disco. For most people, that can add up to 400 to 600 calories burned per hour. Zumba is a dance and fitness class at the same time. Aside from its heart-health benefits, Zumba provides a workout for the whole body. It ensures that maximum calorie burning will continue to take place as one works out. This workout speeds up the body’s metabolism and burns off the fat quickly making a person lean and thin which is a great achievement in a short time! Several studies have shown that significant increases in lean body mass achieved by training the major muscles can help boost resting metabolic rate, hence burning more calories. Regular training will build up your stamina and put your body in good shape. The body will be familiar with the arduous routines and become stronger.
The hardest thing about exercise is to START doing it. Once you are exercising regularly, the hardest thing is to STOP. So … 1. 2. 3. 4. 5.
Be consistent Follow an effective exercise routine Set realistic goals Get a buddy Make your plan fit your life HN
Exercise in Your Office Discreetly
We spend more than 50 per cent of our waking hours in office. Finding time to exercise is a common problem that most working adults have. Yet, if you have a desk-bound job, chances are that you need the exercise much more. Deskbound jobs minimise movement leading to increase in body weight. They also increase strain on the back, wrists, neck and eyes.
Mr Lim Hun Teck, Chief Physiotherapist, Raffles Physiotherapy Centre, shares five simple exercises you can do discreetly in the comfort of your own office to stretch, tone and even strengthen your muscles.
By your desk
Multitasking is not new. The next time you are reading by your desk, doing simple admin work or even speaking on your phone, you can also strengthen your calves and ankles with these simple moves discreetly.
• Stand and hold onto your chair. Rest your left foot on back of your right calf.
• Tiptoe on your right foot and hold for 20 to 30 seconds. • Repeat three times. Switch legs and repeat.
Working hard on your company’s bottom line doesn’t mean you need to neglect your own. This exercise can tighten and strengthen your gluteus muscles, and relieve back pain.
• Lift one buttock up almost off the chair by squeezing your gluteus muscles. Hold for 10 seconds.
• Change sides and repeat.
Under the table
You can work your abs during a meeting or while working on your computer and no one would even notice.
• Increase the height of your chair so that your feet are off the ground. Sit up tall and hold your abdominal muscles tight.
• Lift one knee until it is slightly above your hip. Hold for 10 seconds.
TIP: Straighten your legs if you have space under the table to give your tired legs a good stretch.
• Slowly lower leg. Repeat 15 times. Change legs.
By the photocopier
If you are going to be by the photocopier watching copies spew out, you might as well make full use of this time with some leg toning and strengthening exercises. These leg lifts and swings use the muscles in the leg you are moving and also use the weight of your body to strengthen the leg you are standing on for support. Remember to hold onto the copy machine for balance!
• Lift one leg to the back or side, keeping it straight. Slowly lower it. Change sides.
• In the same position, bend your right knee. Swing your leg forward and back for 30 seconds. Repeat with left leg.
With a water bottle
We all know that water is good for health. It contains zero calories, keeps you hydrated and prevents constipation. What’s more, you can now use your water bottle in the office to trim your waistline!
• Hold the water bottle at chest level.
• Twist back to centre.
Beyond exercise, here are some other ways to lose calories painlessly.
• Twist to the right as far as you can.
• Twist to the left. Repeat 10 times.
Maintain good posture. It requires you to use muscles to keep your tummy tight and back straight. Do it often to build abdominal strength, alleviate lower back pain and to feel more confident.
Breathe deeply. This simple action helps you relax and lowers heart rate. Breathe in through your nose and out through your mouth.
Laugh often. Laughing tightens your stomach muscles, exercises your diaphragm, works your heart, relieves stress and helps you stay positive.
Made Me Smile
Dispensing Care and Compassion Ms Tang Hui-E
Dialysis Nurse Clinician, Raffles Dialysis Centre What she loves about her job is being able to make a positive difference to someone’s life in spite of their illness. Find out more about Ms Tang Hui-E, Dialysis Nurse Clinician, Raffles Dialysis Centre and her motivation to give her best at work and to her patients. Ms Tang does her routine check on the dialysis machines every morning to make sure that they are all functioning well.
Tell me about your daily job routine. I provide individualised care to the renal patients and ensure that dialysis equipment is working properly. In general, the basic duties of a dialysis nurse are to consult the doctors regarding a patient’s overall treatment plan and to alert the doctors to any changes in a patient’s condition. Kidney failure affects many other body processes including cardiovascular, pulmonary and gastrointestinal systems. Therefore, dialysis nurses like myself must be aware of the signs of kidney failure and must evaluate the patients regularly to make sure that the treatments are effective. As a nurse clinician, my working hours are typically during day time. But there would be times when I need to cover my colleagues from other shifts.
Checking on one of her regular patient’s dialysis treatment.
What do you love about your job? I love my job because I can have the ability to make a positive difference to someone’s life in spite of their illness. Because dialysis purifies the blood from toxins and balances body fluid make-up, dialysis nurses must interpret blood lab values, which will determine the impact of treatment. The treatment goal is to bring each patient’s blood values as close to normal as possible. I love to see my patients leaving the centre feeling better after each dialysis session.
What motivates you to serve with a smile?
Educating one of her nurses on how to take note for different patients’ needs and some of their special concerns.
Providing clear patient education with motivational encouragement is a major component of the dialysis nurse role. I need to possess strong communication and leadership skills together with a positive outlook to manage and motivate my patients. Therefore, the kind of satisfaction I get is when I know I have the ability to assure and render professional care to my patients. This truly motivates me to give my best at work. It is also through the smiles and warmth from the patients, knowing that they will always be in my good hands, that makes me smile and feel contented. #MadeMeSmile is a Twitter tag that is used to sharing on what made you beam. It could be your experience with us and/or someone who made you smile during your visit. Share with us something that ‘made you smile today’. Simply follow and tag us on Twitter (@RafflesMedGrp) and share with us what #MadeMeSmile.
Disinfecting the machines thoroughly for the next patient’s use.
Ask The Experts
It is said that if I consume 1.5 litres of water every morning after waking up, the water will clean my bowel, as well as toxins found in my body. They mentioned that water therapy is beneficial to patients with hypertension and diabetes. How effective is water therapy, and will it cause my body any harm?
In general, an adult would need to consume approximately 2.5 litres of water daily. However, we obtain about a litre of water from food. Therefore, this leaves only 1.5 litres to be consumed in the form of fluid. In other words, most of us need to drink around six to eight glasses of fluid a day. This amount should be spread out during the course of the day as guided by our thirst sensation. The concept that a large amount of water consumed in the morning can cleanse the bowel may be over simplistic. Most of the water we drink is absorbed in the gut, and then used by the cells in our body. The kidneys would excrete the excess water. So, very little water is left behind in the gut to “clean” the bowel. Otherwise, we would all be having diarrhoea after drinking a large amount of water.
Dr Stanley Liew Specialist in Endocrinology & Consultant Raffles Diabetes & Endocrine Centre
There is no scientific evidence that “water therapy” has any specific benefits to people with hypertension or diabetes. In fact, healthy diet, regular exercise and keeping body weight in the healthy range are the best lifestyle modifications for people with hypertension and diabetes. Consuming 1.5 litres of water at one go can even be harmful as this is almost approaching the limit which can result in water intoxication. Also, drinking an excessive amount of fluid is not advisable for those with weak heart, which can be present in people with hypertension and diabetes. If in doubt, you should consult your doctor.
I have a 17-year-old son who works out in the gym three to four times a week and runs long distance thrice a week. He takes whey protein whenever he goes to the gym. His friend recently introduced creatine supplement to him and he is very interested in taking it. Is it safe for him to take creatine supplement considering his young age? Are there any side effects and what are the do-s and don’t-s?
There is evidence that creatine supplementation can enhance the performance of exercise involving repeated sprints or bouts of high-intensity exercise separated by short recovery periods. For example, a developed athlete undergoing resistance training to increase body mass, interval and sprint training sessions or sports with intermittent work patterns (e.g. soccer or basketball). The Australian Institute of Sports recommends that creatine supplementation should be limited to experienced and welldeveloped athletes. Children or adolescents should avoid using such supplements as it has not been adequately studied in those under 18 years old. With age and regular training, your son can make good improvements in his performance. Your son should also focus on his dietary intake and make sure he is getting sufficient nutrition from his food instead of relying on supplements. 38 HealthNews
Ms Sarah Sinaram Senior Dietitian Raffles Diabetes & Endocrine Centre
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