Author Archives: drdanielwai

3 Scientifically Proven Way to Prevent Diabetes: sleep, move, eat

Tsunami

Photocredit: Danilo Rizzuti/freedigitalphotos.net

My article on the Coming Tsunami of Diabetes: how to dodge it has just been published.

Diabetes is an extremely serious problem in Singapore. 1 in 9 adults have it and by 2030, 1 in 5 adults are going to get it.

I personally love the first scientifically proven way: sleeping. Not sleeping enough increases our stress hormones (adrenalin and cortisol) which raises our sugar, and increases our hunger hormone so we want to eat more.

The second is what all doctors say: exercise. I had previously written about the power of exercise.

The third is to eat healthy. Avoid artificially processed starch such as white bread,  white rice and juices. Whole grains should be taken instead. Yes even Michelle Obama supported it.

Remember: sleep, move, eat.

Sweden just endorsed the Low Carbs High Fat Diet

Finally, Sweden has done it: in the latest expert committee convened, it has formally endorsed the low carbs high fat diet. Ever since Dr Atkins advocated the high fat and low carbohydrate diet, many people have used it to lose weight. The only drawback apparently is the boredom: patients are sick at eating cheese omelet every day. Unfortunately, Dr Atkins did not like publishing in main-stream medical journals. It created a management gap on obesity: while patients who went on the diet definitely got impressive results, doctors remained extremely skeptical.

Well for the past 10 years many studies had been done and had all found one thing: low carbs high fat diets are better than the traditionally-advised low fat high carbs diet. Patients lose more weight, has better blood sugar (which we expect) but watch this: patients who are taking a low carbs high fat diet also has better cholesterol levels!

The evidence has been so overwhelming that I am surprised that we doctors have resisted it for so long. Unfortunately doctors are all bound by the Hippocratic Oath which asks us to always respect our teachers. This may sometimes make us unwilling to challenge the “conventional wisdom”.

Indeed for all my patients with diabetes, I strongly advise the low carbs high fat diet. However I advise them to eat the healthier fats such as fats from fish, nuts, olive oil etc. Indeed a very Mediterranean diet which has been shown to save lives.

Nanotechnology to detect blood clots

Photo Credit: Christine Daniloff/MIT

Blood clots in the legs are commonly called the Economy Class Syndrome, whereas passengers in the coach class develop potentially life-threatening blood clots in their legs when they sit around not moving for a long time. The other group of people at risk are patients who just have surgery in the pelvis or legs, and cannot walk around.

Sometimes those blood clots break and travel to the lungs and block the big lung arteries, killing the patient.

Now, a group of researchers led of Sangeeta Bhatia, a doctor and a bioengineer, had found a way to detect these clots early, by using nanotechnology.

Blood clots are rich with thrombin. So iron oxide particles coated with special peptides are injected into mice. Should the particles encounter thrombin, the special peptides react with thrombin, releasing substances that can be detected in the urine. Iron oxide particles have already been approved for human use by the FDA.

At the moment, doctors have to look for late signs of blood clots in the leg which includes a swollen feet, and breathing difficulties (late stage). It is then confirmed by an ultrasound of the leg veins which is labor-intensive. This technology has the potential to greatly help us pick up the blood clots before they arise.

World Diabetes Day Singapore 2013

WDD 2013

Mark the day – 10 November 2013. As diabetes affects 11.3% of Singaporeans, the number of families with one or more members are becoming very high. This year the Diabetes Society of Singapore is going to have an event packed with activities at the Suntec Convention Centre. There are tons of free stuff there:

Free Hba1c test (cost $30)

Free eye photos (cost $30)

Free feet check (cost from $25 at least)

Free consultation with diabetic nurse educators, pharmacists, dieticians (cost from $25 each)

Total free stuff: $160 plus the goodie bag!

In fact since every year the DSS celebrates the World Diabetes Day, you can just get your eyes and feet checked free of charge over there, as they are supposed to be screened yearly as well.

Pravin, a patient with type 1 diabetes will also be there to share his experience. He was diagnosed to have type 1 diabetes at age 7, but had learnt to live with the illness, and is now an engineer. He also runs marathons, climb mountains and volunteers overseas to help other people with diabetes.

So just go to Suntec this Sunday!

Twilight of the Elites?

Twilight of the Elites: America After Meritocracy

Hayes made an excellent argument why meritocracy is not working in America now. The Elite has found new ways to protect their offspring from dropping out of their group, by employing extensive networks of tutors, coaches and personal connections to make sure their children will join prestigious schools that will lead to them joining prestigious colleges. Opportunity for the poor to climb to the top is becoming scarce. This is very much like the situation in Singapore. The Elite is becoming out of touch with how normal people lives and cannot understand their problems, although they are supposed to represent us. In turn there is erosion of trust in all the major institutions.

Interestingly the solution Hayes proposes is to decrease inequality, the opposite of meritocracy. This is similar to Stiglitz’s proposal on his book.

Singapore is run with the principle of meritocracy. Doctors like me must be considered as part of the “winning” group. Interestingly the same kind of problems described by Hayes is also happening in Singapore. The government is now aware of this erosion of trust and is changing its stance to have more “inclusive” (read; non-meritocratic) growth.

A must read for anyone who is concerned about competition in society.

Urine Spills in Factories Making Generic Drugs

capsulesPhoto credit: antpkr

I love the US Food and Drug Administration (FDA). They set the standards for generic drug safety, allowing small countries like Singapore to save a lot of time and money to check on the quality of generic drug manufacturing. Unfortunately, what they found in the Wockhardt factory was not pretty: urine on the floor, dirty uniform, moldy storage areas.

Yikes! I would not give my patients these drugs, no matter how cheap they are!

On the other hand, this piece of news creates a problem for doctors and patients. Generic drugs are much cheaper than the originals and allow governments to treat a lot more patients. While the rich patients would of course demand genuine medication, it is not feasible to treat everyone with expensive branded medication. We need the generics and we need to make sure that their standard of quality is good.

The best way to ensure quality compliance is spot checks. Keep up the good work, FDA!

2 Hour wait at Singapore Specialist Clinic

ImagePhoto credit: Ambro

A poor patient has been made to wait at the specialist’s clinic for 2 hours for every visit in a government hospital in Singapore. She did not even dare to go to the toilet for a break because she was afraid that she would miss her turn. The writer quite kindly pointed out that the doctors and nurses at the clinic were doing their best, just that there were way too many patients.

As a doctor I understand the doctor’s point of view, but I had also brought my wife to see her doctor before and we had to wait for 1-2 hours at that same hospital. That was despite the fact that the gynecologist and I were friends (we were made to wait just like everyone else and I thought that was the absolute right thing to do).

How long is too long? One should of course see what other countries are doing. Well researched data are however only readily available for America, where the average wait was 21 minutes. Patients described their wait as about 2 hours in Germany.

Patients feel disrepected when they are made to wait too long and that is the primary reason they would not recommend their doctor. It has gotten so bad that in America, a frustrated patient sued a doctor after waiting for 4 hours and won $250 in a small court.

There are many reasons of long waiting times. The primary reason is of course high demand (many patients) and low supply (lack of doctors/funding/doctors sick). This kind of problems can only be resolved by having more doctors and funding which many governments are reluctant to do because it means higher healthcare spending.

Sometimes patients are late for their appointment. When they arrive later, the doctor is already seeing other patients and they have to be “squeezed in” and this causes longer waits for everyone. On the other hand, it is difficult to expect patients to be on time when doctors make them wait…

Sometimes new medical problems occur. This happens when an appointment is booked for a routine visit lasting 15 minutes, but the patient has a new problem that needs to be addressed. Of course the doctor would need to tend to that problem as well, making other patients wait.

However, another reason is the practice of overbooking. Some patients do not turn up and do not have the courtesy to inform the clinic. To avoid letting the clinic and doctors left idle, it is a common practice for clinics to overbook their patients. However, that creates a long wait when everyone actually turns up. While we can ask patients to tell us early if they decide not to come, technology may be the solution. Most patients usually stick to their appointments, but some don’t. By analyzing past patient behavior, they can predict the total patient volume accurately 95% of the time. Hopefully this will let us manage our resources better and cut down on waiting time for patients.

Problem of Slimming Drugs sold as “Supplements”

ImagePhoto Courtesy: Health Sciences Authority Singapore

If you are taking Oxylite Pro now, stop taking them immediately. The Health Sciences Authority of Singapore had issued an alert after Oxylite Pro had been found to cause liver injuries. An analysis of the ingredients found the potent chemicals 1,3-dimethylamylamine (DMAA) and yohimbine. Those chemicals have caused liver injuries.

Oxylite Pro is marketed as a magic weight loss supplement. Looking at the ingredient from its website, it probably works to some extent, as it contains DMAA and yohimbine which are stimulants and caffeine that increases the metabolic rate, and certain plant extracts that increases thyroid hormone which in turn increases the metabolic rate.

Mainstream Western medication can be toxic if taken inappropriately. That is why even paracetamol (Panadol) in overdoses can harm the liver. That is the reason only doctors can prescribe registered medication as we need to carefully weigh the potential pros and cons of any single medication. We must help, not harm patients.

A healthy diet (low in saturated fat and refined carbohydrates, high in good protein and fibre) and regular exercise is the best way of weight loss. Please discuss with your doctor before you want to take any of the over-the-counter supplements that promise quick fixes for weight loss.

Counterfeit Drugs a problem in Indonesia

fake drugsPhoto courtesy:  Victor Habbick,

I am sometimes asked about the huge price difference of drugs between Indonesia and Singapore. Rent, labor, the strong Singapore dollar, and differential pricing are all factors. However, there is one very important factor – fake or counterfeit drugs. Counterfeit drugs have become a huge problem in Indonesia. The pharmacies used to buy drugs from “independent medication sellers”, but are now buying them simply online.

I had come across instances when I simply switched medication from overseas to Singapore ones, and saw huge differences in the effect of lowering blood pressure and blood sugar. I can only surmise that the “strengths” of the medications are different.

Part of the problem reported was that the pharmacies find it difficult to differentiate between genuine and fake medication. I totally agree. There is no way for even pharmacists and doctors like us to differentiate between the fake and real thing, since boxes, logoes can all be faked. The only way to ensure that the drugs are genuine is to buy direct from the Big Pharmaceutical Companies themselves.

Pharmacists and doctors must realize that fake drugs may not contain any active ingredients, and can also contain harmful ingredients. They must make a stand to sell the real thing to their patients. Patients must also buy medication from registered pharmacies and not from dodgy ones.

Tom Hanks has Type 2 Diabetes

Tom Hanks 2009

Photo credit: Wikipedia

I love Tom Hanks. From Forrest Gump to Angels & Demons, I have always enjoyed watching him perform. He is professional, willing to gain or lose 20kg just to fit into the look of a role.

He has just declared that he has developed type 2 diabetes mellitus at age 57. Also, he has been having “high sugars” (likely prediabetes) from age 36.

Type 2 Diabetes mellitus is a disease of high blood sugar, when the body cannot make enough insulin to bring the sugar down in the blood. It happens especially in people who are overweight and obese, because when they gain fat tissue, their body becomes resistant to the effect of insulin. At first, the pancreas makes more insulin to overcome this resistance and their blood sugar is still normal. Over time, however, the pancreas becomes weak and blood sugar starts to rise a bit (prediabetes) and then a lot (frank diabetes).

8.3% of Americans have diabetes, and 11.3% of Singaporeans have diabetes. The high blood sugar wreaks havoc in the body, getting attached to everything in the body, preventing their normal function. If uncontrolled, diabetes can lead to blindness, kidney failure, amputations of the lower limbs, heart attacks and strokes. Fortunately, good control of diabetes can prevent all these complications.

The most important thing is through lifestyle modifications. The most important thing is to control the amount of carbohydrate intake and exercise regularly. Tom Hanks has said that he would not be taking on roles that require weight gain any more. Well he is someone that can lose 26 pounds (12kg) just through sheer determination, so I think he can do it.

Indeed, Tom Hanks has had quite a good run with his prediabetes. He only “graduated” from prediabetes to diabetes after 21 years! In Singapore, a study done by Prof ES Tai showed that 35% of patients with prediabetes develop diabetes in 8 years. So Mr Hanks have largely avoided developing diabetes at a much earlier age, and should be congratulated.

It is also very encouraging to know that celebrities like Tom Hanks would openly admit their chronic medical condition. It can lead to better recognition of the illness by the public, and lead to healthy discussion by patients at risk and their doctors. Well done Mr Hanks!