The China Study and Obesity

The China Study - How I came across this book
Recently I came across an interesting Youtube videos depicting Bill Clinton sharing his new diet following his bypass surgery.

It made me curious as I have heard about The China Study (a book) being mentioned a few times by some of my friends. I bought a copy and had a brief look through it. One of the topics which I found interesting is on obesity as it is very prevalent among Malaysians.

What is obesity?
The Body Mass Index (BMI) is a standard expression of body size, taking into account an individual's weight and height. It is calculated by dividing an individual's weight in kilograms with the his/her corresponding height squared (kg/m2). A person is considered overweight if his/her BMI is more than 25. Likewise, obesity is defined as BMI exceeding 30.

What are the consequences of obesity?

1. Increased blood cholesterol levels
2. Glucose intolerance predisposing to diabetes
3. High blood pressure
4. Sleep apnea
5. Bone problems
6. Unable to do enjoyable activities
7. Reduced physical mobility
8. Affect mental health

Solution?

The China Study emphasizes on the adoption of a whole food, plant based diet with reasonable amount of exercise. However, this lifestyle change must be long term to provide sustained weight loss and reduce the risk of chronic diseases.

Why some people still can't lose weight on plant based diet?

1. Taking too many refined carbohydrates such as sweets, pastries, and pasta
• These foods are too high in readily digested sugars, starches, and fat
• Also known as junk food vegetarians - not consuming nutritious diet
2. Never engages in physical activities
• Losing weight is all about balance between energy intake from food and energy release from physical activities
• Low physical activity results in increased energy input which is makes losing weight much harder
3. Family predisposition for overweight bodies
• This individual need to be more vigorous in diet and exercise

"If weight was gained slowly, over periods of months and years, why would you expect to take it off healthily in a matter of weeks?"

How does it work?

Some people who followed this diet overall consumed lower calories despite them spending more time eating larger volumes. This can be explained by the fact that fruits, vegetables, and grains have low energy density due to the high fiber content. In other words, these people eat more nutritious, filling foods in larger quantities without exceeding their daily calorie intake.

Some people consume more calories despite being on this diet. One of the hypothesis made by the author is that the excess energy consumed from wholesome plant food is burned as heat during rest.

Conclusion

In summary, the author recommended whole food, plant based diet to aid in weight loss. However, in my personal opinion the most important thing to note here is to incorporate more unprocessed food, fruits and vegetables into our daily diet. The World Health Organization (WHO) recommended that an individual should consume at least 400g of fruits and vegetables of varying colors daily.

Additionally, try to incorporate more physical activity in your daily lifestyle. Aim for at least 15-45 minutes of physical activity per day.

Atopic Eczema/Atopic dermatitis

Why am I writing about this?

Two weeks ago I was requested to give a brief overview regarding eczema/dermatitis to a group of pharmacists. Since eczema/dermatitis is commonly seen in practice I would like to shed some light regarding this condition. 

What is eczema/dermatitis?

The terms eczema and dermatitis are synonymous. Therefore they can be used interchangeably. For the rest of this post I will be using the term eczema. It essentially refers to a group of skin condition characterized by inflammation and itchiness.

Examples of eczema/dermatitis:

1. Seborrheic eczema (due to overgrowth of malasezzia yeast)
2. Atopic eczema (common in childhood)
3. Allergic contact dermatitis (eg. allergy to nickel)
4. Irritant contact dermatitis (eg. prolonged, repeated exposure to harsh detergents)
5. Discoid eczema (Coin shaped)

I will elaborate more on atopic eczema since it is one of the most commonly encountered skin conditions among Malaysian children.

Atopic eczema

Atopic eczema is a chronic inflammatory itchy skin condition that develops in early childhood. It typically cycles between remission and exacerbation. It is closely associated with allergic rhinitis and asthma. 

The exact mechanism underlying atopic eczema still remain to be fully elucidated. Numerous mechanisms have been proposed, all of which lead to dysfunction of skin barrier. This results in water evaporation from the skin and increased penetration of allergens and microorganisms, resulting in immune response.

Management of atopic eczema includes the avoidance of trigger factors. Certain foods have higher likelihood of causing allergic reactions and hence worsen atopic eczema. However not all of these food need to be avoided. It depends on whether the child develops exacerbation on these food. Allergic skin prick test may be warranted if it is uncertain which food results in exacerbation.



Other common trigger factors:

1. Wool clothing
2. Animal dander
3. House dust mites
4. Sweating
5. Perfumed products
6. Exposure to cigarette smoke

One of the common symptoms in eczema is itchiness, which lead to scratching. Scratching, in turn leads to perforation of the skin, leading to increased water loss, increased allergen penetration, and secondary bacterial infection. Affected patient has to make sure their fingernails are kept short. Additionally, patients need to be advised on the methods to reduce itching; pinch, press, apply cold.

With regards to bathing, there are different recommendations given by different guidelines. Essentially it boils down to patient lifestyle.One of the main concern of frequent bathing is that it will lead to increased water loss from the skin. However, bathing helps with the removal of dead skin flakes, microorganisms, and sweat. Therefore, if a patient is leading an active lifestyle frequent bathing is advised. However, apply moisturizer afterwards to prevent water loss. Gentle, non-perfumed cleanser is recommended to prevent excessive moisture loss from skin.

Since one of the main issue in atopic eczema is excessive water loss away from skin, moisturizers is the mainstay treatment for this skin condition. Moisturizers should be non-perfumed. There are many forms available, ranging from creams to ointments to prescription emollient devices. However there is no significant difference in terms of efficacy between the different formulation. The most effective moisturizer would be the one that the patient prefers to use. 

Demineralized water

All about demineralized water

Recently I have been bombarded with numerous questions regarding the different types of water filtration technology available on the market. Of particular interest is reverse osmosis which is gaining popularity. I have searched for information and the World Health Organization provides the best overall summary regarding demineralized water.

What is demineralized water?

Demineralized water refers to water which are almost or completely free of dissolved minerals. It is the result of distillation, deionization, membrane filtration (reverse osmosis or nanofiltration), electrodialysis or other technologies.

What are the health risks of consuming demineralized water?

Direct effects on intestinal mucous membrane, metabolism, and mineral homeostasis or other body functions

Demineralized water has negative taste characteristics which one could adapt over time. However, demineralized water is less thirst quenching, resulting in potential overconsumption of water. Additionally trial on human volunteers had reported increased diuresis (increased urination), reduced in serum potassium levels, and increased elimination of sodium, potassium, chloride, calcium, and magnesium, all of which are essential minerals in human body.

Little or no intake of calcium and magnesium

Demineralized water have very low or no content of calcium and magnesium, both of which are essential for a wide range of function. Epidemiological studies had reported possible association between demineralized water intake and increased mortality and morbidity from heart diseases, increased risk of fracture in children, and an increased risk of neuronal disorders. 

Low intake of some essential elements and microelements from low mineral water

Modern diet may not be an adequate source of minerals and microelements, considering society nowadays tend to consume foods which are high in calorie but low in essential nutrients. This might be compensated by the trace amounts of minerals and micoelements found in drinking water. An epidemiological study in Russia had reported possible association between demineralized water consumption and slower physical development in children.

High loss of calcium, magnesium, and other essential elements from in food prepared in low mineral water

Preparation of food in demineralized water may result in substantial loss of essential elements from the food. 

Possible increase in dietary intake of toxic metals

Demineralized water are very unstable and are very aggressive to materials which it comes into contact. Demineralized water readily dissolves metals and some organic substances from pipes, coatings, storage tanks, and containers.

Possible bacterial contamination

Demineralized water contains very low amount of residual chemical disinfectant, such as chlorine. Chlorine is important in killing of microorganisms and preventing their growth in drinking water.