Commentary: Unable to look sideways? Unusual signs of diabetes often unnoticed, ignored or denied

SINGAPORE: A patient once consulted me because his eyes could not look sideways.

He was surprised when I said we needed to check his blood glucose level, as part of routine medical tests, as this symptom could suggest diabetes as a possible cause.

Some diabetics may not display common symptoms, making it a silent, dangerous disease, says Chairman of Healthway Medical Group's Medical Board Philip Koh.

And just as I suspected, his subsequent test results revealed he had diabetes.

Diabetes, as a condition where the body produces insufficient insulin resulting in high blood sugar levels, can give rise to a wide array of acute and less commonly talked-about but related complications such as blindness and kidney failure.

In this man’s case, his diabetes had damaged blood vessels and nerves, and paralysed muscles in his eyes that control eye movements. He recovered after a few months after receiving treatment and practising ways to place his diabetes under control.

Many people like him have seen me for complaints seemingly unrelated to diabetes, including multiple episodes of skin abscesses, numbness in their fingertips and blurring vision. They did not exhibit any common symptoms and yet were eventually diagnosed as diabetics.

A DREADED DISEASE

In his 2017 National Day Rally speech, Prime Minister Lee Hsien Loong highlighted diabetes as a serious national problem facing Singapore. While the disease is well-known and often cautioned about, the increasing frequency of its diagnoses paints a sobering picture.

Today, one in nine Singaporeans has diabetes. This figure is three in 10 or those over 60. In 2014, about 440,000 Singapore residents aged 18 years and above had diabetes, and this number is estimated to grow to 1 million in 2050.

As a family physician for more than 20 years, I have diagnosed my fair share of diabetes patients.

But like what Mr Lee mentioned in his speech, one main challenge dealing with this dreaded disease is it hardly has any clear symptoms in its early stages, and often presents itself in many diverse and surprising ways.

Patients might ignore early symptoms and simply go on with their lives despite experiencing discomforts like increased fatigue, or attribute these to other reasons like stress at work or the hot weather.

Common symptoms include increased thirst, unexplained weight loss and tiredness – signs that often go unnoticed as patients do not feel sick and consult a doctor. Years could go by before one finds out about their condition.

The body is also very adaptable to change, meaning diabetes can be silent because symptoms only show after significant damage has been inflicted.

Without early diagnosis, medical intervention and proper management, diabetes can eventually lead to disabilities and other life-threatening diseases even though it is not fatal in the short term.

Many with diabetes also suffer from high cholesterol and high blood pressure. If they smoke, diabetes compounds their risks of heart attack, stroke and kidney.

Those who suffer from diabetes may experience substantial organ damage by the time they start treatment, owing to diabetes remaining undetected for years.

PREGNANT WOMEN AT RISK

Pregnant women would do well to heed caution where gestational diabetes afflicts many non-diabetic pregnant woman, usually in the second or third trimester of pregnancy.

About 10 per cent of pregnant women suffer from this condition. Raging pregnancy hormones increase as the pregnancy advances and counteract the action of insulin.

Thankfully, it can be discovered during the early pregnancy screening, and insulin injections can keep the pregnancy viable.

But gestational diabetes poses risks to both foetus and mother, including greater risks of early labour or premature birth and low blood sugar in the baby soon after birth.

Both mother and child also face increased chances of developing diabetes later in life.

POTENTIAL DIABETICS IN SELF-DENIAL

The most worrying segment of diabetics are those at high risk but also in huge denial even when they experience glaring symptoms of this disease.

I have met many overweight and obese patients who continue to make unhealthy lifestyle choices and live lives of inactivity, despite having a family history of diabetes, which increases their susceptibility to the disease.

So many engage in excessive eating and lead sedentary lifestyles, without any effort to exercise.

A 2016 study led by the National University Hospital and Janssen Pharmaceuticals, found that Asians are more prone to Type 2 diabetes than our Western counterparts.

Asians are more prone to develop diabetes at much lower levels of obesity because they are unable to mount an appropriate insulin response to a glucose load, the study shows.

Furthermore, Singapore’s rapid development has led to changes in our daily lifestyles – causing the average Singaporean to become less active and eat more high-caloric diets. Both these habits further exacerbate the risk of obesity, and consequently, diabetes.

LIVING WELL WITH DIABETES

Despite all this, the prognosis isn’t all bad. Even though diabetes can present itself in surprising ways, the disease can be managed and controlled once detected.

I was impressed with one patient’s commitment in changing his lifestyle that allowed him to lose 10kg of his initial bodyweight of 75kg in one year.

The patient, Mr Chan, managed it by waking up one hour earlier every day to go for brisk walks, cutting out all sweet drinks, replacing his favourite roti prata breakfast with a slice of wholemeal bread, and cutting down his rice intake.

Today, Mr Chan is on just one basic medicine for his diabetes, and has it well under control.

Having diabetes is not a death sentence. It is more like a life sentence.

Most diabetics can live comfortably without suffering the dire complications of diabetes by making sensible healthy food choices, committing to regular exercises, and adhering to daily medicine.

But early detection is a critical first step and being mindful it can manifest in many ways should give us cause to be more vigilant.

Dr Philip Koh is Chairman of the Medical Board of Healthway Medical Group. He is also a Family Physician who practices at Healthway Medical Tampines Clinic.


Taken from this article:
Commentary: Unable to look sideways? Unusual signs of diabetes often unnoticed, ignored or denied

Not just sugar: You might be eating your way to pre-diabetes and not even know it

Lose weight? Exercise? Maybe another day, you tell yourself, tucking into your plate of chicken rice and washing it down with some "dinosaur" drink. Sure, the weighing machine has been displaying higher numbers of late, and you’ve had to upsize your clothes – the way you’ve been upsizing your fast food meals.

But you’re feeling fine, so everything’s okay, right?

That’s the insidious thing about pre-diabetes, the stage before it becomes full-blown Type 2 diabetes. There are no symptoms, no signs that your pancreas isn’t producing enough insulin for your body to make use of sugar. There are also no indications that the excess sugar is building up in your blood stream, leading to higher-than-normal blood sugar levels but not high enough for a diagnosis of Type 2 diabetes.

One in seven people in Singapore have pre-diabetes, and 50 per cent of patients with Type 2 diabetes do not even know they have the condition.

HEART DISEASE, KIDNEY DAMAGE AND ERECTILE DYSFUNCTION

Pre-diabetes, in itself, is a sign of diabetes and the accompanying elevated blood sugar level only shows up in blood tests. As for those pre-diabetes symptoms that you may have read about on the Internet – hungrier and thirstier than normal, weight loss despite eating more, going to the bathroom more frequently, and feeling more tired than usual – they "already point to a more advanced stage of diabetes," said Dr Vivien Lim, Gleneagles Medical Centre’s endocrinologist.

A blood test done in the doctor's office is the definitive way of finding out where your blood sugar levels stand. Doctors usually test for the impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or both. According to the World Health Organization, you have pre-diabetes if your fasting blood glucose ranges from 6.1mmol/L to 6.9mmol/L. Diabetes is defined as equal to or greater than 7mmol/L.

Any food that increases the risk of being overweight or obese will predispose you to diabetes.

About one in seven people in Singapore have pre-diabetes, and 50 per cent of patients with Type 2 diabetes do not even know they have the condition, said Dr Lim.

Here’s why it doesn’t pay to ignore your blood sugar levels. When the bloodstream gets flooded with sugar, it can cause damage to the vessels that supply blood to the vital organs. This is because high levels of sugar in the blood turn the life-sustaining liquid into a damaging soup that causes the blood vessels to harden over time.

A cascade of problems can follow. At first, the high blood sugar level saps your energy, makes your vision blurry, and messes with your mood and concentration. From there, it is a slippery slope to cardiovascular disease, heart attacks, strokes, kidney damage and, if you’re male, erectile dysfunction.

You will be more susceptible to infection, blindness, and nerve damage. You’ll heal from injuries slowly, if at all, putting simple cuts at risk of turning into situations that require amputations.

NOT JUST SUGAR – IT’S YOUR WEIGHT

Diet is a big part of the pre-diabetes equation. But it goes beyond cutting down on sugar and desserts, and swapping white rice for brown one. It is also about the char kuay teow, nasi lemak (especially when paired with fried meats), nasi or mee goreng, and orh luak you’ve scarfed down, said Dr Lim.

"This is an area that is prone to misconceptions,” she said. "We know that being overweight or obese predisposes one to diabetes. Hence, any food that increases the risk of being overweight or obese will predispose you to diabetes."

And the experts have the research to substantiate it.

Type 2 diabetes is caused by excess fat in the liver and pancreas, according to Professor Roy Taylor of Newcastle University, who spent four decades studying the lifestyle condition. The excess fat in the liver causes the organ to respond poorly to insulin and produce too much glucose. The excess fat in the pancreas leads to the cells that produce insulin to fail.

But you are not doomed to a lifetime of insulin shots if you have been diagnosed with Type 2 diabetes. Losing less than 1g of fat from the pancreas through diet can re-start the normal production of insulin, said Prof Taylor.

"The good news for people with Type 2 diabetes is that our work shows that even if you have had the condition for 10 years, you are likely to be able to reverse it by moving that all-important, tiny amount of fat out of the pancreas," he said in the Science Daily article.

Without intervention, at least 35 per cent of those with pre-diabetes will progress to Type 2 diabetes within eight years.

The same reversal can also be said of pre-diabetes, according to Dr Khoo Chin Meng, senior consultant with the Department Of Endocrinology at the National University Hospital.

“Studies have shown that those who lose weight or reduce their waistlines within a year of receiving a diagnosis of pre-diabetes are significantly more likely to return to normal glucose tolerance than adults who don’t,” he said. Without intervention, at least 35 per cent of those with pre-diabetes will progress to Type 2 diabetes within eight years, he added, citing the Prediabetes Appropriate Care Guide.

Exercise will also help to re-sensitise the body to absorb sugar from the blood, said Dr Lim. However, she cautioned that not every patient with pre-diabetes will succeed in reversing it. “Having weight loss does not necessarily guarantee pre-diabetes reversal. And, in general, it is likely to occur only in those who are overweight or obese.”

ARE YOU AT RISK OF PRE-DIABETES?

As it turns out, there are individuals who are at higher risk of developing pre-diabetes than others. As established earlier, those who are overweight or obese (a BMI higher than 30) belong to this group, said Dr Khoo. Certain ethnic groups, such as Indians and Malays, are more prone as well. Other factors include a family history of diabetes, a history of cardiovascular disease, hypertension, gestational diabetes, polycystic ovary syndrome, and/or being over the age of 40.

“If you have multiple risk factors, that should alert you to screen for pre-diabetes,” said Dr Khoo. If you don’t have any risk factors, screening for diabetes is recommended for age 40 and above. Weight is again a big indication of risk; those with obesity should consider getting screened at an even younger age, he said.


Taken from this article:
Not just sugar: You might be eating your way to pre-diabetes and not even know it

Commentary: Just because you're thin doesn't mean you're healthy

SYDNEY: According to the Australian Institute of Health and Welfare, 63 per cent of Australian adults are overweight or obese.

But it’s much harder to estimate how many are within a healthy weight range but have poor diets or sedentary lifestyles. These can cause significant health problems that will often be missed because the person appears to look “healthy”.

Your diet, not your body weight, is the best indicator of internal well-being, says one observer.

Obesity statistics often take estimates of body fat using body mass index (BMI). Although BMI isn’t perfectly correlated with body fat percentage, it’s a quick and easy method for collecting data using just the person’s height and weight.

If the BMI is higher than 25, a person is considered “overweight”. If it’s above 30, they’re considered “obese”. But BMI doesn’t tell us how healthy someone is on the inside.

Using additional lifestyle measures, such as diet and exercise frequency over the last year, a recent report from the Queensland Health department estimated 23 per cent of those who are not currently overweight or obese are at risk of being so in the future.

These figures indicate that the percentage of unhealthy-weight individuals does not accurately capture the percentage of unhealthy-lifestyle individuals, with the latter number likely to be much higher.

NOT ABOUT STAYING LEAN

Many people think if they’re able to stay lean while eating poorly and not exercising, then that’s okay.

But though you might appear healthy on the outside, you could have the same health concerns as overweight and obese individuals on the inside.

When considering risk factors associated with heart disease and stroke or cancer, we often think about health indicators such as smoking, cholesterol, blood pressure and body weight.

But poor diet and physical inactivity also each increase the risk for heart disease and have a role to play in the development of some cancers.

So even if you don’t smoke and you’re not overweight, being inactive and eating badly increases your risk of developing heart disease.

Little research has been done to compare the risk diet and exercise contributes to the development of heart disease in overweight versus skinny but unhealthy individuals.

However, one study measured the risk of different lifestyle factors associated with complications following acute coronary syndrome – a sudden reduction in blood flow to the heart.

It found adherence to a healthy diet and exercise regime halved the risk of having a major complication (such as stroke or death) in the six months following the initial incident compared with non-adherence.

UNHEALTHY DIETS BAD FOR YOUR BRAIN TOO

Recent research has also shown over consumption of high-fat and high-sugar foods may have negative effects on your brain, causing learning and memory deficits.

Studies have found obesity is associated with impairment in cognitive functioning, as assessed by a range of learning and memory tests, such as the ability to remember a list of words previously presented some minutes or hours earlier.

Notably, this relationship between body weight and cognitive functioning was present even after controlling for a range of factors including education level and existing medical conditions.

Of particular relevance to this discussion is the growing body of evidence that diet-induced cognitive impairments can emerge rapidly — within weeks or even days.

For example, a study conducted at Oxford University found healthy adults assigned to a high-fat diet (75 per cent of energy intake) for five days showed impaired attention, memory and mood compared to a low-fat diet control group.

Another study conducted at Macquarie University also found eating a high-fat and high-sugar breakfast each day for as little as four days resulted in learning and memory deficits similar to those observed in overweight and obese individuals.

These findings confirm the results of rodent studies showing specific forms of memories can be impaired after only a few days on a diet containing sugar water and human “junk” foods such as cakes and biscuits.

BODY WEIGHT NOT THE BEST PREDICTOR OF INTERNAL HEALTH

Body weight was not hugely different between the groups eating a healthy diet and those on high fat and sugar diets. Negative consequences of poor dietary intake can occur even when your body weight has not noticeably changed.

These studies show body weight is not always the best predictor of internal health.

We still don’t know much about the mechanisms through which these high-fat and high-sugar foods impair cognitive functioning over such short periods.

One possibility is that our blood glucose levels change from eating high-fat and high-sugar foods. Fluctuations in blood glucose levels may impair glucose metabolism and insulin signalling in the brain.

Many people use low body weight to excuse unhealthy eating and physical inactivity. But body weight is not the best indicator of internal well-being.

A much better indicator is your diet. When it comes to your health, it’s what’s on the inside that counts. Yu really are what you eat.

Dominic Tran is a postdoctoral research associate at University of Sydney. This commentary first appeared on The Conversation. Read it here.


Taken from this article:
Commentary: Just because you're thin doesn't mean you're healthy

Commentary: Fight anorexia by confronting the fear of weight gain

SAN FRANCISCO: Anorexia nervosa is a psychiatric illness that primarily effects young people during their adolescence. While anorexia is relatively uncommon, it can be lethal.

Indeed, despite its relatively early onset, anorexia can last for several decades for more than half of those afflicted. It can lead to many associated psychiatric and medical risk factors, which in part explains why anorexia has the highest mortality rates of any psychiatric disorder.

There is an urgent need to understand the condition of anorexia better, as treatments to deal with it have had little effect, says one observer.

Those who suffer with anorexia have a powerful fear of weight gain and a cruelly distorted self-perception. As a result, some restrict caloric consumption to fewer than 400 calories per day, which is less than a quarter of what is typically recommended for adolescents.

Those with anorexia may quickly become emaciated and lose more than 25 per cent of their typical body weight. This rapid weight loss causes cardiac abnormalities, structural and functional brain alterations, irreparable bone disease, and in some instances, sudden death.

The effective treatment of anorexia is therefore very important.

FEW ADVANTAGES IN SPECIALISED TREATMENTS

Colleagues and I recently completed the largest analysis ever undertaken of outcomes for existing treatments for anorexia.

We pooled the findings from 35 randomised controlled trials between 1980 to 2017, which cumulatively assessed the outcomes of specialised treatments in over 2,500 patients with anorexia, and examined outcomes according to both weight, and the core cognitive symptoms of anorexia, such as fear of weight gain and a drive for thinness.

I am sad to say that what we found was bleak. In essence, specialised treatments for anorexia, such as cognitive behavioural therapy, family-based treatment and emerging medication treatments, appear to have few advantages over standard control treatment-as-usual, such as supportive counseling.

In fact, the only advantage of specialised treatments, relative to control treatment-as-usual conditions, was a greater chance of having a higher weight by the end of treatment. There was no difference in body weight across specialised versus control treatments at follow-up.

In addition, there were no differences in the core cognitive symptoms of anorexia between specialised versus control treatments at any one point.

This means that, even if a treatment helps restore normal weight, a focus on thinness and an unease around eating is common, making a relapse into low weight likely.

Equally importantly, specialised treatments do not appear to be more tolerable to patients, with comparable rates of patient dropout to control treatments.

When time trends within these data over the last four decades were analysed, it was found that the outcomes of specialised treatment are not incrementally improving over time.

MORE THAN WEIGHT

These findings are sobering. The notion that our best efforts to advance treatment outcomes over the last four decades have failed to move the needle is cause for grave concern.

However, an important outcome of this study lies in giving those of us who study and treat anorexia a better idea of how we might move the needle. We believe these findings speak to an urgent need to better understand the neurobiological mechanisms of anorexia.

We can no longer assume that improvements in patient weight ought to be the terminal goal of treatment for anorexia, and will confer improvements in cognitive symptoms.

While weight normalisation reduces the acute risk of complex medical events, ongoing fear of weight gain and food intake will likely mean future bouts of low weight and starvation.

We have reached a plateau in the treatment of anorexia. Future research endeavors must elucidate the precise mechanisms that underpin cognitive symptoms of anorexia, and altering these mechanisms must become the goal of treatment.

Stuart Murray is assistant professor of psychiatry at University of California, San Francisco. A version of this commentary first appeared on The Conversation. Read it here.


Taken from this article:
Commentary: Fight anorexia by confronting the fear of weight gain

Can you – should you – eat food that has passed its expiry date?

It might have been a while since you last needed something from the larder. Other than the mustiness and odd strands of cobweb, there might also be a few forgotten cans, jars or packs of food and drinks from a while back that make you wonder: Are they still edible?

The expiry date is naturally your best indication. But when you look closer at the stamped date, it actually reads “Sell by”, “Use by” or “Best before” instead. Do they mean the same thing as the expiry date?

It seems like a waste to throw food out, but is that milk or bread safe to consume? CNA Lifestyle finds out from the experts.

No, according to Consumer Reports. The sell-by date is to inform retailers when to take the item off the shelves. But it isn’t the same as the expiry date. Milk, for one, could last five to seven days past its sell-by date before turning sour, said the website.

Use-by dates, on the other hand, are for highly perishable food, said Natalie Goh, Mount Elizabeth Novena Hospital’s chief dietitian. “It can be dangerous to eat foods that have passed their use-by dates,” she said.

Meanwhile, the best-before date indicates “how long the food will be at its best quality,” said Goh. For example, chips may not be crispy past this date but the lao hong snack may still be edible. But if you have any doubt, do not eat it even if the food is within the date, she said.

HOW EXPIRY DATES ARE DETERMINED

“The expiry dates of food products are determined by a combination of factors, such as the types of the ingredients used, the manufacturing process, the type of packaging used, and how the food product is stored,” said a spokesperson from the Agri-Food & Veterinary Authority Of Singapore (AVA).

It can be dangerous to eat foods that have passed their use-by dates.

Some food companies commission microbial challenge studies, which deliberately introduce harmful micro-organisms such as Listeria moncytogenes into the food that is being tested, according to Londa Nwadike, assistant professor of Food Safety, Extension Food Safety Specialist at University Of Missouri, Kansas State University.

The contaminated food is kept under conditions that it is likely to encounter during transportation, in storage, in the store and at home – and tested at various lengths of time, wrote Asst Prof Nwadike in her article in The Conversation. This helps to determine the point at which the level of micro-organisms present is too high for safety.

Sometimes, micro-organisms are not added at all, and the test simply monitors the taste, smell, texture and appearance of the food to determine the longest possible time it can be kept without compromising its quality and safety, wrote Asst Prof Nwadike.

Food companies then remove at least several days from this duration to set the use-by date. However, there is no “standard for the length of this safety margin” and the margin is “set at the manufacturer’s discretion”, noted Asst Prof Nwadike.

The testing isn’t a once-off affair either. According to the HACCP Mentor, food manufacturers should submit their food products for retesting every time they introduce new equipment to the manufacturing process, or change the recipe, formulation or even the pack size.

To ensure that the manufacturers – both local and overseas – comply with Singapore’s food safety standards and requirements, the AVA “monitors, inspects and samples” the food products. However, the onus of setting the expiry dates lies with the food manufacturers,” said the spokesperson.

EXTENDING FOOD’S SHELF LIFE

Whether it’s sardines or orange juice, the same tricks are generally used to extend the product's life span: Less moisture and/or more acidity, sugar or salt levels. Sometimes, heat and preservatives such as benzoates are used, too.

As a result, the shelf life of foods such as eggs, bread and milk can be extended from days to months, depending on the food, processing and packaging techniques, said Dr Matthew Zhao, packaging technologist with Singapore Polytechnic’s Food Innovation And Resource Centre.

Even for food products that are still within the expiry dates, if you suspect any spoilage, just discard. Don't risk food poisoning.

Jarred items such as jam, peanut butter and sauces can be extended for months, while juices and stock in tetra packs can last from months to years, he said.

That canned food and convenient frozen bites, including fish balls, fish fingers, crab sticks, nuggets and dumplings, which you stash in the freezer for emergencies? They should be good for a couple of years, said Dr Zhao.

WHAT TO THROW OUT, WHAT TO KEEP

What if the can of fruit cocktail in your larder has just exceeded its expiry date by a mere few days? Seems like a waste to chuck it.

Chances are, you can go ahead and dig in as canned foods can still be eaten a few days after their expiry date, said Toby Amidor, a nutrition expert and author of The Easy 5-Ingredient Healthy Cookbook. That is provided the can looks fine and you have stored it properly in a cool, dry, dark place, he said.

Dairy products such as yoghurt, milk and cheese are generally safe a few days past their sell-by dates, unless you see signs of spoilage, said Amidor. Milk, for instance, is drinkable up to five days past the sell-by date, he said. Cheese, especially the hard varieties, can last a little longer.

Obviously, rusty and/or bloated cans as well as anything that has sprouted mould belong in the bin. Other signs to look out for include badly dented cans; leaking or bulging cans/lids; cracked jars or jars with loose lids, or those that appear to have been opened, said Goh from Mount Elizabeth Novena Hospital.

But what about food such as cereals, chips, biscuits and other foods that have lost their crunch? Is it still ok to eat them if they are just a little after their expiry dates? The rule of thumb: If the packaging’s appearance is different from the norm, or it has an unusual odour after opening, do not eat its contents.

Still undecided? You're better off skipping food you're not sure of, said Goh. “Even when it comes to food products that are still within the expiry dates, if you suspect any spoilage, just discard. Don't risk food poisoning,” she said.

For a second opinion on how long a food stays safe to eat, you can check the free app created by the US Department Of Agriculture.

What if you only realise the food has passed its expiry date after eating it? Wait and see if there are any symptoms, said Dr Reuben Wong, gastroenterologist from Gleneagles Hospital. These would include diarrhoea, vomiting and/or fever. You should seek medical help immediately if you do.

“The body has a defense system in the form of strong acid in the stomach that will help kill incoming germs. It is believed that taking activated carbon or probiotics might help, but there is no firm evidence that this would prevent food poisoning per se," he said.


Taken from this article:
Can you – should you – eat food that has passed its expiry date?

Is it ok to skip meals, even occasionally? Here's what happens to your body

Between waking up and getting ready for work, you might have just enough time to down a cup of coffee before you have to get out of the house. Or your boss just handed you a report at 12pm that needs completing in an hour’s time.

Whatever the reason, meal-skipping happens. So, what’s the big deal, right? We over-eat anyway, so we can stand to miss a couple of meals in a day.

You might lose a little weight but there are other health issues to contend with, say experts.

For starters, skipping just one meal causes your blood sugar levels to plummet. If you skip breakfast, it means your body has gone without fuel for nearly 12 hours – assuming your last meal was at 8pm and you begin your day at 7am. Imagine starting your car’s engine when its tank is empty, and you get the picture.

“Consistently (skipping meals) might lead to issues such as poor concentration, poor-quality diet and slowed metabolism for some,” said Apple Chan, a dietitian from Gleneagles Hospital. “This usually does not happen overnight. It’s the chronic, low consumption that happens over months or even years.”

In fact, unsated hunger pangs may cause you to over-eat at your next meal – not a good thing if you’re watching your calorie intake. More importantly, there’s also the diabetes risk.

In a study published in the medical journal Metabolism, researchers found that skipping meals during the day and eating one large meal in the evening created elevated fasting glucose levels and a delayed insulin response – conditions that can lead to diabetes in the long run.

But what if you try to redeem yourself by grabbing a cup of Milo or a couple of biscuits? Don’t these stop-gap measures go some ways in placating your rumbling tummy? Yes, but not nearly enough. “That is definitely not going to last you till your next meal,” said Chan.

At the very least, she said, ensure that your snack has the basic nutrient components: Carbohydrates, fats and protein. “All of these provide for the different functions the body requires for energy sustenance.”

Instead of just a cup of Milo, she recommended adding a tuna sandwich with avocado. That way, you get some carbs from the bread, protein from the tuna, and fats from the avocado and Milo. No time to head to the deli? Fix yourself some wholemeal crackers, cheese and Milo from the pantry. Or stash some cereal bars (they usually contain all three nutrients) in your office drawer.

Here’s a look at what other health issues can happen when you skip meals.

YOU WON’T LOSE WEIGHT IN THE LONG RUN

You might notice your clothes feeling looser and think you’ve lost weight from skipping meals. But it’d be a bad idea to use this method to pursue your ideal weight. “More than 50 per cent of the rapid weight reduction is fluid, which can lead to serious low blood pressure,” cautioned Chan.

She said that a study on obese individuals showed that at the 5-per-cent weight loss mark, continued fasting will actually result in less fat burning and more water loss. So, there might be an initial drop in weight due to the loss of water, but it will plateau after a while, she said.

Incidentally, once your body detects a shortage in food, it goes into self-preservation mode. Chan explained: “If the body detects that it is constantly receiving less than the required amount of food intake, it compensates by reducing energy expenditure.”

Some individuals may think that skipping meals can help them drop their weight as it is rather similar to the popular diet method known as intermittent fasting. Basically, it oscillates between periods (it can be hours, days or even weeks) of eating and fasting without having to mind what foods to stay away from.

“Skipping meals and other types of intermittent fasting may not be realistic for most people, and it does have the potential to backfire if it triggers unhealthy snacking or overeating later on,” Chan said.

“Even though intermittent fasting results in quick weight loss, it's often fluid loss and might not be substantial and sustainable in the long run. There are also some risks associated, such as dehydration and heartburn.

“Although I might not oppose healthy individuals opting for such diets for short periods of time, individuals with medical issues, such as diabetics and eating disorders, should refrain from them,” cautioned Chan.

YOU LOSE MUSCLE MASS

Say goodbye to the muscle gains you’ve worked so hard for at the gym because your body will start to cannibalise your muscles, usually within four to six hours of not eating, said Chan.

“During the early stages of fasting, the body can tap on back-up glycogen reserves. But even so, these stores can be depleted within 24 hours,” she said.

If you’re counting on increasing your fat burn through ketosis (the process where fats get broken down by the body for use as energy), it is only after one week of fasting or food deprivation that it happens, said Chan. By then, your body would have torched through considerable amounts of muscle for fuel.

YOU GET GASTRIC PROBLEMS

You’re not giving your stomach a break by skipping a meal or two. The reason is this: Your stomach produces digestive juices to break down the food that you eat. Even when there is no food to digest, it continues to do its job at the usual time that you eat.

“Prolonged periods without food tend to lead to acid reflux, gastritis and stomach acid. Excessive amounts of digestive juices might erode your intestinal lining and cause ulcers,” said Chan.

YOU START TO EAT JUNK FOOD

Ever notice how your resolve to stay away from doughnuts and fried chicken dissolves when you’re super hungry? That’s because when your blood sugar levels are low, your body wants you to grab hold of the easiest fuel to burn.

Unfortunately for us, that’s usually sugar and fat as they can raise the blood sugar levels quickly, said Chan. “You also tend to eat more ravenously when food becomes available, so your diet goes out of the window.”

YOU GET BAD BREATH

During the periods when you skip meals, your mouth produces less saliva and you might end up with a dry mouth. It is the perfect condition for bacteria to flourish, which in turn, can generate odour in your breath.

“If you have to skip a meal, drink sufficient water to keep your mouth moist and help to stimulate saliva production,” said Chan.


Taken from this article:
Is it ok to skip meals, even occasionally? Here's what happens to your body

Feel stuck in life as you get older? It might be your ego, says Tan Kheng Hua

Tan Kheng Hua – the actress who stole a scene in Crazy Rich Asians from Michelle Yeoh with just a wordless stare that would shrink the largest of testicles – was sitting on my sofa, looking fabulous in her T-shirt and jeans, snacking on murukku. And it occurred to me, quite simply: I want what she’s having.

The Singaporean actress who’s making a new life in Hollywood at the age of 57 knows how you feel – and she’s got advice on how to age according to your rules.

Not the murukku, mind you (I had another tub squirrelled away for eating my emotions), but the way she’s growing older… and feeling happy about it.

“At 40, in terms of my career, I felt jaded, old… I remember, I just felt like, oh gosh, I really needed to change,” said Kheng, in an unfiltered conversation for our CNA Lifestyle podcast series House Party For 2. “I just felt… stuck.”

It’s a sentiment many of us who are no longer in our 20s (or 30s) can relate to. It’s a growing realisation that you’re so far from where you wanted to find yourself; that perhaps you’re starting to simply “exist” instead of “live” like you once did when your joints didn’t ache as much.

This, however, is Kheng at age 57: “I just have never felt more free, more independent, more at peace, more myself. I feel myself finally on a path where I think this is really how I want to grow old and eventually die,” she said. “I feel so much lighter.”

I first met Kheng back in 1997. She was already a respected name in theatre, had recently come off starring in Singapore’s first English-language drama series Masters Of The Sea, and had just started what would be 11 years on the sitcom Phua Chu Kang. I was acting in my very first play, and Kheng was very kind to me when other theatre folk were less than warm. At the reception, she marched right up to me where I was stationed at the buffet table (my history of emotional eating goes back a long way) and told me straight up that I had done a good job. Her encouragement meant a great deal to 19-year-old me.

It was also a wonderful counterbalance to my mother telling me she would never watch another theatre show ever, now that she’d been psychologically scarred from watching her teenage son play a gay, drug-addled, stripper / porn star with mommy issues who wears a sequined thong and dies of an overdose. I told her it was art. Mum said it was a good thing she didn’t bring grandma.

I think there is a big difference between ‘how do I want to live?’ and ‘how do I want to die?’

I’d bump into Kheng over the years and we’ve stayed friendly. But the woman on my couch had a different energy than what I remember. She really did feel lighter. Even as we talked about dying.

“I think there is a big difference between ‘how do I want to live?’ and ‘how do I want to die?’” said Kheng. “About 10 years ago, I was going through some pretty difficult times in my life… And that was actually when I came about this concept that has helped me a lot then and now: Rather than thinking about how I want to live, I started thinking about how I want to die – and then work backwards from that.”

It might sound dark, but the woman’s got a point.

“The first thing I did was really visualise who were the people I wanted around me when I die. And, immediately, you will then answer all your questions about who are the important people in your life today – the people who you should actually consider deeper and in a more profound way,” she said.

“And then, suddenly, your world becomes very clear. Because from maybe 30 people or 300 things that you think you need today because this is how you want to live, it is whittled down to a very comfy bed and maybe about three people… It just gives you some perspective.”

Kheng has been doing a lot of thinking – or practising a “review on life”, as she calls it – since she upped and moved to Hollywood to explore new terrain. She’s been working, having scored roles on Grey’s Anatomy and Netflix’s Medical Police, as well a series regular spot in the Kung Fu reboot pilot from US TV network The CW. But she hasn’t been on her own like this since her university days, said Kheng. And that’s forcing her to “man up” and “just sort it out”.

Here’s what she’s learnt from those “review on life” sessions.

If you want to feel excited about what you do, you need to surround yourself with like-minded people, to be “immersed in talent”. It’s the vibe you’re looking for. “Once you find the right people that you vibe with, you just suddenly feel like waking up, and working hard, and doing something. And the day just suddenly becomes enjoyable.”

Next, it’s about tackling your ego. “Honestly, ego is the enemy,” said Kheng. “Don’t get me wrong – for anyone who wants to be good at what they do, ego is necessary. But ego is still the enemy in that it can make your life centred around something which may not necessarily propel you towards where you really want to go.”

Maybe it’s important to be curious rather than to be defensive and keep going for something that you may be past your use-by-date for, you know?

For example, offered Kheng, if her ego had made her turn down jobs just because they weren’t big roles, she would have missed out on Crazy Rich Asians, the UK miniseries Chimerica and HBO Asia’s The Garden Of Evening Mists.

“In the last five years, I’ve played more supporting characters than I’ve played lead. In fact, perhaps, in my entire career, I have played more supporting characters than I have leads. I want as much recognition as anybody else, okay? I won’t lie about that” she said. “But these projects were great to be on. My daily life had a quality. My daily acting life had a quality that I loved and that I want every single day of my life.”

“So the ego can be your friend and it’s very, very necessary,” said Kheng, “and the ego can be the enemy – and it is up to you and your character to discern which ego you want.”

And that brings us to accepting the ugly truth. “Maybe it’s important to be curious rather than to be defensive and keep going for something that you may be past your use-by-date for, you know?” she said. “Because when you try too hard in anything – whether it’s fashion or losing weight or acting – it never looks good. And it doesn’t feel good.”

“A real curiosity brings about a sense of humility. And those qualities bring about a sense of peace.”

It’s important to grow old gracefully, said Kheng, just as long as you play by your own rules. "'Graceful' is not just Audrey Hepburn, you know? It’s not just Grace Kelly. 'Graceful' is about some sort of truth and honesty. And if honesty to you is cussing every sentence that comes out of your mouth, then you know what? Go for it."

Now that is advice I can go for. Sorry, mum.

Listen to the full House Party For 2 podcast to find out how Kheng auditions against thousands of actors per role, and what she makes of people thinking Crazy Rich Asians wasn’t "Singaporean enough".

New episodes of House Party For 2 are published every Sunday at cna.asia/podcasts.


Taken from this article:
Feel stuck in life as you get older? It might be your ego, says Tan Kheng Hua

How to give compassionate, constructive feedback in the workplace

Imagine a company where directness is prized above all else. Managers deliver blunt, harsh feedback in the name of efficiency.

Now, imagine another company with a very different culture. Here, directness is nowhere to be found. Managers are accommodating and kind, overlooking mistakes or issues so as not to hurt feelings.

What’s the problem with each? The first creates a toxic culture of brilliant jerks that drives people out and eats itself from within. The second ignores issues until they build up and affect business metrics.

We have all seen these companies in the news, as a trending topic or even firsthand. You may be at one now! But it’s when we combine directness and compassion that we create a culture in which people can truly thrive at work.

People want feedback that helps them grow and improve. But how you deliver it matters, too.

At Thrive Global, the behaviour-change tech company I founded, we call this compassionate directness. It’s our core value – the one that fuels all the others.

Compassionate directness is about empowering employees to speak up, give feedback, disagree and surface problems in real time. But it has to be done with compassion, empathy and understanding. It’s what allows us to course-correct, improve and meet challenges while also building teams that collaborate and care for one another.

Of course, you can’t just declare you have a culture of compassionate directness. You have to create an atmosphere of mutual trust. When we get feedback from someone we trust, we know our best interests are at heart. We can see that the feedback isn’t some kind of personal attack, it’s actually a kind of support because it’s offered in the spirit of helping us improve. Without an atmosphere of trust, feedback can be a catalyst for stress and self-doubt. If you’ve ever found yourself puzzling over what your manager really meant, or whether there was some kind of coded message hidden in the feedback you received, it may be a sign that you’re not working in an atmosphere of trust.

How feedback is delivered is one of the most vital – and underappreciated – indicators of a company’s success.

People are hungry for feedback that helps them grow and improve. According to a survey by Zenger/Folkman, a leadership development consultancy, 92 per cent of people agreed that “negative feedback, if delivered appropriately, is effective at improving performance.”

But that’s a big if. A recent Gallup poll found that only 26 per cent of employees strongly agree that the feedback they’re getting is helping them improve their work. Poorly delivered feedback makes us disengaged and disempowered. As we see at many hard-charging companies, including hypergrowth brands like Away luggage, directness without compassion can work – until suddenly it doesn’t.

In contrast, cultures that value only compassion go off course in another way. Years ago, I worked with a leader who had a habit of giving critical negative feedback padded with so many positives that his direct reports often came away thinking they were getting a promotion. Studies have long shown that managers have a tendency to soften feedback out of aversion to what they perceive as conflict. When this happens, challenges that should easily be identified and dispatched are instead allowed to take root and fester – and the opportunity to course-correct (“Captain, perhaps we should go around that iceberg”) is lost.

“By presenting subpar performance more positively than they should, managers make it impossible for employees to learn, damaging their careers and, often, the company,” Michael Schaerer and Roderick Swaab, organisational behaviour experts, wrote recently in Harvard Business Review.

It needs to be said: Being told we’re missing the mark can be a blow to our ego and even our identity. That’s why it’s so important to shift our mindsets around how we receive feedback. Constructive feedback, after all, is how we learn and grow. It’s the basis for healthy parenting, lasting friendships, career development and so much more. If we shelter our children, friends and colleagues from information that might enrich and enhance their lives, we’re not being caring – we’re actually doing them a disservice.

For many of us, especially those of us who have been raised in families or within cultures that encourage indirectness, compassionate directness may seem really hard. Fear holds us back – fear of negative reaction or of rocking the boat. It doesn’t just apply to workplace situations. Have you ever agonised over whether to tell individuals they have spinach in their teeth? The same is true for receiving feedback and learning to see it as information we can use to improve instead of letting our negative self-talk take over.

When we flex our compassionate-directness muscle, we’ll find that it becomes easier and more natural. And we’ll see benefits at work, at home and in our relationships.

Recently, I received a comment about Thrive’s all-hands team meeting continuously starting late. There was a clear reason in that our Leadership meeting, which directly precedes the team meeting, often runs late. And though it may not have been as noticeable in our New York headquarters, the person commenting explained how remote offices and employees felt like their time wasn’t being respected as they waited for us to dial in. It was a great piece of feedback that we wouldn’t have acknowledged had it not been raised, and it had a simple solution – we now start our team meeting 10 minutes after the hour to make sure that we have time to dial in.

To get started implementing compassionate-directness into your own life, here are some of my favourite related microsteps, which are small, science-backed actions you can start taking immediately to build habits that significantly improve your life.

GIVE ONE PIECE OF CONSTRUCTIVE FEEDBACK AND LET IT STAND ON ITS OWN.

Don’t undermine your message by padding it with irrelevant positive statements. This might be uncomfortable at first, but research shows that people are hungry for constructive feedback.

BEFORE YOUR NEXT ONE-ON-ONE, PAUSE TO REFLECT BEFORE GIVING FEEDBACK.

If you’re stressed or rushed, you’re more likely to deliver feedback without compassion or empathy – even if that’s unintentional.

WHEN YOU NOTICE A PROBLEM, FIND A WAY TO SURFACE IT IMMEDIATELY.

Don’t just hope a problem will go away, or assume someone else will fix it. When you speak up with compassionate directness, everyone benefits.

IN YOUR NEXT MEETING OR ONE-ON-ONE, CONSIDER ANOTHER PERSON’S PERSPECTIVE.

It can be as simple as pausing before a meeting to ask yourself, “Where is this person coming from?” By zooming out, you’ll be better able to see others’ motivations and understand their priorities.

WHEN YOU RECEIVE CONSTRUCTIVE FEEDBACK, WRITE IT DOWN AND COME BACK TO IT LATER.

This will allow you to move beyond the emotion of the moment and consider more dispassionately whether it holds truth for you.

TURN A DIGITAL EXCHANGE INTO AN IN-PERSON CONVERSATION.

A lot of nuances of human communication are lost in digital interaction. When you get to know your co-workers as people instead of just names in your inbox, you’ll build trust and camaraderie.

ONCE A DAY, HAVE A CONVERSATION WHERE YOU MOSTLY LISTEN.

Don’t underestimate the power of your silence. Instead of giving your opinion or changing the subject, invite the other person to go deeper.

Arianna Huffington © 2018 The New York Times


Taken from this article:
How to give compassionate, constructive feedback in the workplace

How to be good: 9 ways to be a person who lives and expresses 'goodness'

By the end of the year, I felt tired and overwhelmed, ready to peel away onionskin layers of regret. That’s most likely why, when I wandered by a Little Free Library, Nick Hornby’s book How To Be Good called out to me, the bright yellow cover a beacon, the title offering redemption for mistakes large and small.

The book tells the story of a doctor boldly (and hilariously) navigating the rocky road of self-improvement: “Just because I wasn’t good,” the protagonist muses, “it didn’t mean I was bad.” But as I reached the novel’s end, I realised I had not arrived at the answer to what exactly it means to be good. So, I asked Mr Hornby.

“It’s a constant theme, isn’t it?” he emailed in response. “Especially now, when we have no excuse not to know what’s going on. We are bombarded with images of others less fortunate than ourselves. What are we supposed to do about it?”

This is the question. What are we to do? As we struggle to confront an ever-growing number of crises, how can we be good to ourselves and others? The starting point is understanding what we mean by “goodness.”

Rachana Kamtekar, a professor of philosophy at Cornell University, explained goodness by way of ancient Greek philosophy: “For Plato, goodness is the same as happiness. We desire appetitively because of our bodies. We desire emotionally because of our sense of self in contact with other human beings. And we also have rational desires to understand how to do what’s best. Our goodness requires all of these capacities to be developed and then expressed.”

This can be a lifelong process – something that is never perfectly realised but should always be struggled for. “Goodness is impermanent and organic, meaning it can progress as well as regress,” said Chan Phap Dung, a senior monk at the Plum Village meditation center founded by the Zen master Thich Nhat Hanh. And that is why, he said, we have to be steadfast in caring for ourselves and the world at large. “In politics and culture, in the media and corporations, we have cultivated conditions that have produced a lot of violence, discrimination and despair for which there is a collective level of responsibility.”

Because many of us have a complicated relationship with what it means to be good, it can help to reframe the subject and widen it. “Some people flinch when they ponder whether or not they or others are ‘good’ because the words ‘good’ and ‘goodness’ have long been associated with obedience,” the author and former Dear Sugars podcast host Cheryl Strayed shared in response to a query from The Times.

“I reject that definition,” she said. “Goodness is expressed through lovingkindness, generosity of spirit and deed, and the thoughtful consideration of others. It can be as simple as offering to let someone ahead of you in line and as complicated as making yearslong sacrifices of your freedom because someone you love needs your help. Over the course of a lifetime, most of us do both.”

Goodness is an act of being and doing.

Goodness is an act of being and doing, requiring that we not only engage but reflect on the intentions behind our actions. Goodness may give rise to immediate satisfaction or demand sustained sacrifice (as those who have fought to bring about social change can attest). Regardless, using it as a lodestar helps point us to what really matters.

The insights below – gathered from a variety of people who think a lot about what it means to be good – are far-reaching. Some suggestions are small, others audacious. Make them your own. Allow them to spark a bit more goodness in you.

9 WAYS TO BE GOOD

1. Be kind.

Harriet Lerner, psychologist and author: “Kindness is at the center of what it means to be good. It may require very little from us, or the opposite. It may require words and action, or restraint and silence. Everything that can be said can be said with kindness. Every tough position we have to take can be taken with kindness. No exceptions. Being a good person requires that we work toward that unrealised world where the dignity and integrity of all human beings, all life, are honoured and respected.”

2. Pay attention.

Brother Chan Phap Dung, senior monk, Plum Village: “In the Buddhist tradition, the training starts with learning how to stop and come back to the present moment and enjoy our breathing. We stop to recognise what is happening within us and around us: Our feelings, our thinking, whether our body is relaxed or in tension, who is there in front of us or what are we doing. With repetition, we begin to see and understand ourselves better – and choose to do one thing rather than another.”

3. Ask hard questions.

The Rev. William J Barber II, civil rights activist: “As a public theologian, I tend to look at what has lifted us when we found ourselves at our lowest – what has called us to a better place. How are we, as a nation and as a people, using life itself to create good for the poor and broken and captive and for those who are made to feel unaccepted? We must constantly raise that question as we live life –  seeking to answer it not only individually, but together. We need to embrace those deepest moral values that call us to, first and foremost, seek love, truth, justice and concern for others.”

4. Put challenges in perspective.

Dan Ariely, behavioural economist, Duke University: “In Judaism, it says that if you save one person, you can look at yourself as somebody who has saved the whole world. In that regard, what goodness means is to scale the problem down to the size where we can have an impact – and then have the impact. If you think about global warming or poverty, you say to yourself, “I can’t; I can’t solve it.” But if you think about one ton of CO2 or one person in poverty, then we can have an effect.”

5. Hold yourself accountable.

Rachana Kamtekar, professor of philosophy, Cornell University: “You have to know what your different motivations are, know how strong they are and if you can get some of them to pull against the others. I was a smoker in my 20s and 30s. Like many smokers, I resolved to quit on multiple occasions. When I was 40, I told my son and his buddies that I had been a smoker and had quit. I knew if I ever smoked again, I was going to have to tell them. My aversion to those kids thinking of me as a smoker swamped any desire I had to smoke. When I added to my rational resolution this prospect of something like shame – that I was going to have to face these kids and say, “I am a smoker” – it changed.”

6. Buy with intention.

Rose Marcario, CEO, Patagonia: “We’re facing an existential climate crisis, intractable social issues and unprecedented income inequality. Think of yourself as a citizen instead of a consumer and vote with your dollars. Buy organic because, with chemical agriculture, we are doing irrevocable damage to topsoil, pollinators, oceans and rivers due to chemical runoff. And buy quality. Make sure that whoever you buy from takes responsibility for the entire life cycle of their product. Most importantly, buy only what you need. Keep your stuff longer and keep it in use longer.”

7. Invest in the greater good.

Ron Freund, vice president, Social Equity Group: “A good investment is one that integrates your value system with the investments that you make and offers a risk level and return that meets your needs. Firms in the industry have demonstrated clearly there’s no loss from investing in a socially responsible portfolio. Consider green bonds that have a specific focus to help the community. It could be toward climate change, church retrofits, or housing that supports seniors and low-income people.”

8. Engage.

Cheryl Strayed, author and former Dear Sugars host and columnist: “Cultivate a sense of optimism. Remember to be grateful. Be happy for others when good things happen to them. Stop complaining about the people, jobs or situations that make you miserable and find a way to change it or end it instead. Go for a walk every day. Goodness is action. It’s being kind, honest, considerate, respectful and generous. It’s holding love in your heart.”

9. And, no matter what, keep trying.

Nick Hornby, author: “I think all one can ever really do is to try and keep goodness close to you as an ambition – make sure that it’s one of the ways in which you think.”

Simran Sethi © 2018 The New York Times


Taken from this article:
How to be good: 9 ways to be a person who lives and expresses 'goodness'

Myth busting: Smacking the warm bus seat before sitting prevents piles

You may not see many people doing it now on public transportation – especially with everyone trying to minimise contact with any type of surface – but you’re eventually bound to spot one.

We’re talking about the practice of smacking the bus or MRT seat before sitting down on it.

So why do some people do it? The rationale, at least for those who believe this old wives’ tale, is that that it’s supposed to cool the seat down – because the body heat left behind by the previous sitter can do strange things to your bum, like cause piles or haemorrhoids.

Myth busted: “There is actually no proven harm in sitting on a warm seat,” said Dr Sabrina Wee, the head of the Gastroenterology Workgroup at SingHealth Polyclinics. Instead, she said, what does harm you is how long you spend sitting on something, regardless of whether it’s warm or not. And most of the time, it takes place somewhere more private than a bus – your toilet seat.

WHAT CAUSES PILES AND WHO ARE LIKELY TO DEVELOP THEM?

Piles, also known as haemorrhoids, are swollen veins that can occur in the anus or rectum, said Dr Wee. They can cause pain, itchiness and bleeding when they become inflamed. “In Singapore, it is estimated that about 33 per cent of Singaporeans suffer from haemorrhoids,” she said.

Both men and women, regardless of age, can develop piles for a variety of reasons. Straining is certainly one way as the action causes blood to pool in the veins around the anus. For that reason, constipation, diarrhoea and childbirth are common culprits as they cause you to strain, said Dr Wee.

Interestingly, prolonged sitting or standing can also contribute to piles; the action allows gravity to push the swollen blood vessels down and out of the anus. For this reason, individuals with jobs that require them to sit a lot, such as taxi drivers and office workers, are prone to developing piles.

WHAT RELIEF IS THERE FOR PILES?

Obviously, sitting on a hard surface while having a case of inflamed piles is a painful experience – whether or not the seat is warm. But typically, the inflammation subsides on its own in about two weeks.

During this time, Dr Wee advised to avoid sitting too much. If you have a desk-bound job, stand instead of sit at your desk. If you must sit, get a cushion to ease the swelling, she said.

It also makes sense to try and soften your stool during this period, so get on a high-fibre diet, limit fatty food (it can exacerbate constipation) and increase your fluid intake to 2 litres a day, she said. While on the toilet, avoid prolonged sitting and excessive straining.

While a warm seat doesn’t give you piles, having a warm sitz bath – where you literally sit in water – can actually help to relieve the pain if you already have it, said Dr Wee. There are also over-the-counter medicated creams and ointments to reduce the pain during a flare-up.

“Surgery may be required if the methods above do not help, and the piles do not resolve,” said Dr Wee. “Consider seeing a specialist if the piles are persistent and especially if there is recurrent bleeding.”

But the moral of the story is: Prevention is always better than cure. “Take adequate fluids and fibre, avoid straining when moving bowels, and avoid long sessions on the toilet,” said Dr Wee.


Taken from this article:
Myth busting: Smacking the warm bus seat before sitting prevents piles

Knuckle cracking: It's annoying to others but can it also cause arthritis?

Cr-aaack! Hearing the sound of someone’s knuckles being popped either makes you want to crack yours too, or it just gives you the shudders. Sometimes, the snapping sound comes from your knee or hip, but you've not done anything other than get up from your seat.

So, what’s going on with your joints and why are they popping away? “Popping” would be the right word for it because the sound actually comes from air bubbles bursting in your joints, said Dr Soumen Das De, Associate Consultant with the Hand & Reconstructive Microsurgery Centre at National University Hospital.

If you’re trying to stop someone’s irritating knuckle-cracking habit, you’ll need a better reason than saying "you’re ruining your joints".

Yes, there is naturally dissolved air in your joints, and when you crack them, you create a negative space that lets the dissolved air form bubbles, he explained. “This process typically happens within seconds. The joint cannot be cracked for several minutes afterwards because the air needs to re-accumulate in the joint space.”

The snapping sound can also be caused by a tendon sliding over a bony protrusion or excessive motion between bones, said Dr Das De.

WHY THE KNUCKLES?

You’d notice that many people, who crack their joints, tend to do it to their knuckles. What makes them so irresistible to manipulate?

“Knuckle cracking is a common behaviour enjoyed by many. It can become a habit or a way to deal with nervous energy; some describe it as a way to release tension,” said Dr Robert Shmerling on Harvard Health Publishing.

Furthermore, “the small joints of the hand, such as the knuckles or metacarpophalangeal joints, are easier to crack,” said Dr Das De. “Larger joints, such as the knee and elbow, require a considerable amount of force to generate the same degree of negative pressure.”

But having said that, there are individuals who derive satisfaction from cracking their backs.

WHAT’S THE DAMAGE?

Should you listen to your mother and abstain from cracking your joints? Happily, the answer is no, you don’t have to. (Sorry, Mum!) “There is no evidence that cracking a joint increases the risk of long-term degeneration and osteoarthritis,” said Dr Das De. The damage it can cause, though? Annoying the heck out of the people around you.

All that said, this does not give you the licence to pop your joints with abandonment. Ringo Yee, Principle Physiotherapist at Tan Tock Seng Hospital, said that injury to the soft tissue, ligaments or surrounding structures of the affected joint, such as blood vessels, is possible. “Typically, pain is the first common symptom. Other signs relating to soft tissue injury, such as swelling, may occur,” he said.

And if you’re constantly cracking a particular joint, such as your back, to ease the pain, you might be better off seeing a chiropractor instead. A study in the Journal Of The American Medical Association found that pain in the lower back is only momentarily relieved by cracking the back, and wouldn’t add up to any significant improvements.

It’s also not a good idea to be constantly cracking your neck, according to a Healthline article: “Cracking your neck too forcefully can pinch the nerves in your neck. Cracking your neck too hard can also strain the muscles around your joints and the joints themselves. When your muscles or joints become strained, moving your neck can feel like a chore."

The article also cautioned against overdoing the neck cracking as it can over-stretch your ligaments permanently, and increase your chances of developing osteoarthritis.

WHAT YOU SHOULD NEVER CRACK

According to Yee, getting your partner or colleague – unless he or she is medically trained – to crack your neck or back for you is a bad idea. “They may unknowingly exert too much force and cause pain. The possible injuries are ligament sprains, fractures and dislocations.”

That said, if you experience persistent pain, swelling, bruising and stiffness after a massage that involves cracking your neck and/or back, see a doctor immediately to rule out any injuries.

Individuals who have “joint osteoarthritis and recent bone, joint and/or soft tissue injuries (e.g. tendon, ligament) should refrain from this habit because there is a considerable risk of re-injury,” warned Dr Das De. “If you are recovering from an injury and are in doubt about cracking your joints, it is always prudent to check with your doctor.”

In fact, even the joint cracking that results from the manual therapy techniques used by physiotherapists should be avoided for certain individuals, said Yee. These include patients with fractures, tumours, infections, inflammation, or are on long-term steroidal use or anticoagulation medication.


Taken from this article:
Knuckle cracking: It's annoying to others but can it also cause arthritis?

Myth busting: Why pregnant women develop dark patches on the face

When it comes to the dos and don’ts in life, you’ve probably heard a few cautionary tales. Don’t walk in the rain; you’ll catch a cold. Eating chocolates will lead to acne breakouts.

Some of these make sense, but some are also old wives’ tales or myths. Sometimes, the latter persist like warts that refuse to go away because the “advice” seems medically sound on surface level (for example, many think that cracking your fingers will lead to arthritis). Others could be time-honoured practices passed down from generation to generation – so they can’t be wrong, right?

For the first instalment of our health myth buster series, we’re taking a look at something that affects many pregnant women: Melasma, or those dark facial patches that the superstitious think are caused by evil spirits.

Yes, you may laugh at how silly the notion is but there are still people of the older generation who believe there are supernatural reasons to it. The darker the patches, the more malevolent the spirits latching on to you are. Also, that pregnant women are vulnerable because the discolouration is seen more often on their faces than non-pregnant individuals.

WHAT CAUSES THESE DARK PATCHES TO APPEAR?

As you might already know, there is nothing remotely supernatural about these patches. Your skin naturally produces a pigment called melanin, which determines the colours of your eyes, hair and skin. Sometimes, your skin produces more melanin than usual when, for instance, you’ve been out in the sun.

If you are prone to melasma, the higher amount of melanin will concentrate in areas such as the cheeks, forehead, bridge of the nose and chin – and create these dark patches, said Dr Angeline Yong, consultant dermatologist at Angeline Yong Dermatology.

According to her, there are three types of melasma. And the deeper the pigmentation, the harder it is to treat:

• Epidermal melasma: Brown with well-defined borders and affects the top layer of skin.
• Dermal melasma: Blue-gray patches that affect the deeper dermis level.
• Mixed melasma: Brown-gray pigmentation affecting both the epidermal and dermal layers of the skin.

OTHER THAN PREGNANT WOMEN, WHO IS LIKELY TO GET MELASMA?

It can be common for mothers-to-be to develop the patches, which is also known as “the mask of pregnancy”. The reason lies with their higher levels of female sex hormones that trigger melasma, said Dr Yong.

Similarly, situations such as being on oral contraceptives and hormone replacement therapy – both of which increase hormonal levels – can also increase your risk of melasma.

Your complexion may also get patchy if you're using skincare products that contain alpha-hydroxy acids, or you're on certain antibiotics and antihistamines. These compounds can cause your skin to become sensitive to sunlight and cause it to pump out more melanin as protection, said Dr Yong.

Other reasons include hormonal changes, inflammation, stress, thyroid disorders and age.

Genes also play a role; you are likely to develop melasma if your mother has it, according to a study published in the Journal Of The European Academy Of Dermatology And Venereology.

Situations such as being on oral contraceptives and hormone replacement therapy – both of which increase hormonal levels – can also increase your risk of melasma.

HOW IS MELASMA TREATED?

Melasma is difficult to treat because it’s a “complex condition caused by multiple factors”, said Dr Yong. “The condition also tends to relapse because the factors are not always easy to identify and control. While you can manage melasma, it has no permanent cure.”

To treat melasma, Dr Yong advocates using sun protection (including wearing a hat and a broad-spectrum sunscreen of SPF50 and above when you're out) and the following:

• Topical treatments

These include a combination of hydroquinone, tretinoin and a steroid, said Dr Yong. Together, they exfoliate, and inhibit melanin formation and cell activity. Sometimes, azelaic acid, kojic acid, ascorbic acid and/or cysteamine hydrochloride may also be used in addition to the combo, she said.

• Oral tranexamic acid 

It reduces heavy bleeding during surgery and menstruation, said Dr Yong, but oral tranexamic acid is also known to reduce melanin production. According to studies, said Dr Yong, twice daily doses of oral tranexamic acid showed improvements in melasma after four weeks.

• Chemical peels 

Usually, a combination of lactic and salicylic acids is used to slough off the outermost layer of skin. This encourages cell regeneration to create a brighter and less pigmented complexion, said Dr Yong.

• Laser treatments

"Picosecond laser treatments are another excellent solution to reduce melasma," said Dr Yong. She prefers them to traditional Q-switched lasers as there is less damage to the surrounding tissues. This also helps to prevent the pigmentation from returning with a vengeance should there be inflammation.

Can the above treatments be used on someone whose melasma is caused by a medical condition such as a thyroid disorder? Can the skin disorder be treated concurrently as the medical issue?

“I see no harm in embarking on treatments for melasma, particularly topical agents, which do not conflict with or impair thyroid treatments that you may be taking concurrently,” said Dr Yong.


Taken from this article:
Myth busting: Why pregnant women develop dark patches on the face

Researchers say build healthy habits by tying it to an existing one

We’re all creatures of habit. We tend to wake up at the same time each day, brush our teeth, have morning coffee and commute to work, following the same patterns every day.

So why is it so hard to form new healthy habits?

It's not about willpower, good habits happen when we set ourselves up for success.

Behavioral scientists who study habit formation say that many of us try to create healthy habits the wrong way. We make bold resolutions to start exercising or lose weight, for example, without taking the steps needed to set ourselves up for success.

Here are some tips, backed by research, for forming new healthy habits.

STACK YOUR HABITS: The best way to form a new habit is to tie it to an existing habit, experts say. Look for patterns in your day and think about how you can use existing habits to create new, positive ones.

For many of us, our morning routine is our strongest routine, so that’s a great place to stack on a new habit. A morning cup of a coffee, for example, can create a great opportunity to start a new one-minute meditation practice. Or, while you are brushing your teeth, you might choose to do squats or stand on one foot to practice balance.

Many of us fall into end-of-the-day patterns as well. Do you tend to flop on the couch after work and turn on the TV? That might be a good time to do a single daily yoga pose.

START SMALL: B.J. Fogg, a Stanford University researcher and author of the book Tiny Habits, notes that big behavior changes require a high level of motivation that often can’t be sustained. He suggests starting with tiny habits to make the new habit as easy as possible in the beginning. Taking a daily short walk, for example, could be the beginning of an exercise habit. Or, putting an apple in your bag every day could lead to better eating habits.

In his own life, Fogg wanted to start a daily pushup habit. He started with just two pushups a day and, to make the habit stick, tied his pushups to a daily habit: going to the bathroom. He began by, after a bathroom trip, dropping and doing two pushups. Now he has a habit of 40 to 80 pushups a day.

DO IT EVERY DAY: British researchers studied how people form habits in the real world, asking participants to choose a simple habit they wanted to form, like drinking water at lunch or taking a walk before dinner. The study, published in the European Journal of Social Psychology, showed that the amount of time it took for the task to become automatic – a habit – ranged from 18 to 254 days. The median time was 66 days!

The lesson is that habits take a long time to create, but they form faster when we do them more often, so start with something reasonable that is really easy to do. You are more likely to stick with an exercise habit if you do some small exercise – jumping jacks, a yoga pose, a brisk walk – every day, rather than trying to get to the gym three days a week. Once the daily exercise becomes a habit, you can explore new, more intense forms of exercise.

MAKE IT EASY: Habit researchers know we are more likely to form new habits when we clear away the obstacles that stand in our way. Packing your gym back and leaving it by the door is one example of this. Wendy Wood, a research psychologist at the University of Southern California, says she began sleeping in her running clothes to make it easier to roll out of bed in the morning, slip on her running shoes and run. Choosing an exercise that doesn’t require you to leave the house – like situps or jumping jacks – is another way to form an easy exercise habit.

Wood calls the forces that get in the way of good habits “friction.” In one study, researchers changed the timing of elevator doors so that workers had to wait nearly half a minute for the doors to close. (Normally the doors closed after 10 seconds.) It was just enough of a delay that it convinced many people that taking the stairs was easier than waiting for the elevator. “It shows how sensitive we are to small friction in our environment,” said Wood. “Just slowing down the elevator got people to take the stairs, and they stuck with it even after the elevator went back to normal timing.”

Wood notes that marketers are already experts in reducing friction, inducing us to spend more, for example, or order more food. That’s why Amazon has a “one-click” button and fast-food companies make it easy to supersize. “We’re just very influenced by how things are organized around us in ways that marketers understand and are exploiting, but people don’t exploit and understand in their own lives,” she said.

REWARD YOURSELF: Rewards are an important part of habit formation. When we brush our teeth, the reward is immediate – a minty fresh mouth. But some rewards – like weight loss or the physical changes from exercise – take longer to show up. That’s why it helps to build in some immediate rewards to help you form the habit. Listening to Books on Tape while running, for example, or watching a favourite cooking show on the treadmill can help reinforce an exercise habit. Or plan an exercise date so the reward is time with a friend.

TAKE THE HEALTHY-HABITS WELL CHALLENGE: Now that you know what it takes to start building healthy habits, try the new Well Challenge, which gives you a small tip every day to help you move more, connect with those you love, refresh your mind and nourish your body. Just sign up, and I’ll send you a daily email about your next challenge.

By Tara Parker-Pope © The New York Times 


Taken from this article:
Researchers say build healthy habits by tying it to an existing one

Researchers: pessimism may be heritable and optimism can be learned

Researchers say pessimism may be heritable and optimism can be learned

When you watch the news these days, it’s hard not to be pessimistic – and even harder for some people, depending on genes and socioeconomic status.

Yet battling your inner Eeyore can have profound effects. Research suggests that optimists earn more money, have better relationships and even live longer. And the thing is: Optimism can be learned.

Optimism can be learned.

“Pessimism is one of the personality traits that’s highly heritable, but also modifiable by specific exercises,” said Martin Seligman, director of the Positive Psychology Center at the University of Pennsylvania and author of The Hope Circuit.

In other words, you can blame your parents for your bleak outlook, but you don’t have to resign yourself to it forever. Here are four ways to start walking on the sunnier side of the street.

VISUALISE YOUR BEST POSSIBLE SELF 

Imagine your dream life in 10 years – what would it look like? How would it feel? Now sit down and write about it: Once a week, for six to eight minutes, for one or two months. Spend each session focusing on your “best possible self” in a single domain, such as family, career, romance or health.

Though it might sound like wishful thinking, dozens of studies show that imagining your ideal future can actually boost your levels of optimism.

Dozens of studies show that imagining your ideal future can actually boost your levels of optimism.

Sonja Lyubomirsky, a psychology professor at the University of California, Riverside and author of The How of Happiness, has employed this exercise with hundreds of subjects. It works, she said, because you’re strengthening your “optimistic muscles” by “thinking about all your dreams coming true as opposed to worrying about the worst possible outcome.”

ACCEPT THE INEVITABILITY OF DISAPPOINTMENT

Constantly expecting the worst? According to Laura Oliff, associate director of the American Institute for Cognitive Therapy, it might be because you’re hoping to protect yourself from disappointment.

Many of the negative things we predict never actually happen – and that, even when they do, we usually recover pretty quickly.

But by trying to insulate yourself from life’s ups and downs, you’re missing out on something else, too: The “positive anticipation of events,” which Dr Oliff called a “very valuable” and “joyful” feeling. (For proof, just think about the pleasure of anticipating a vacation.)

As Dr Oliff pointed out, “You’ll be disappointed at times no matter what.” So if your choice is between positive expectations that are occasionally proven wrong or negative expectations that are occasionally proven right, you might as well go with the former.

While this mind-set shift is easier described than done, Dr Oliff said it can help to remember that “many of the negative things we predict never actually happen” – and that, even when they do, we usually recover pretty quickly.

ARGUE AGAINST YOURSELF 

So your co-worker got the promotion you were angling for. And your mind is filling with thoughts like: I’m bad at my job. I’ll never move up the ladder. I might as well quit right now.

When you enter that pessimism spiral, Dr Seligman says the trick is to first recognise the voice making those negative remarks, then argue with it as if it were “an external person whose mission in life is to make you miserable.”

The trick is to first recognise the voice making those negative remarks, then argue with it as if it were “an external person whose mission in life is to make you miserable.

How would you argue with your nemesis? You’d present evidence to prove them wrong, such as: I’m not bad at my job – my co-worker has been here for two years longer than I have. Or: I’ll eventually get promoted – another position is opening up soon.

Turning this type of self-argument into a habit requires a little practice. “It’s not instantaneous,” Dr Seligman said. “But on the other hand, it’s not really onerous and difficult. It’s something that most people can acquire in a few days.”

PUT THINGS IN PERSPECTIVE 

Another evidence-based approach to boost your optimism is to intentionally counteract your extremely negative predictions with extremely positive ones. This will enable you to find the middle of the road – or, as Dr Seligman said, to “put things in perspective.”

Let’s say you have a doozy of a fight with your partner. She leaves the house, slamming the door on the way out. If you’re like many humans, Dr Seligman said you’ll naturally be attracted to the “most catastrophic interpretation”: This is the end, I’m unlovable, I’m going to die alone.

Another evidence-based approach to boost your optimism is to intentionally counteract your extremely negative predictions with extremely positive ones.

As a counterbalance, imagine the least catastrophic interpretation, too: Your partner’s on the way home with a tub of ice cream and will never mention the disagreement again.

Between those two poles is where you’ll find the sweet spot – the realistic interpretation. It might be: She’ll come back in a few hours, we’ll talk, it’ll be weird tomorrow and then back to normal. Though not as pleasant as the ice cream scenario, this outlook is far better (and far more plausible) than the ultra-pessimistic one with which you started.

By consistently practicing the two previous strategies – arguing against yourself and putting things in perspective – Dr Seligman said you can make changes that stick.

“This is not armchair stuff,” he said. “These are things that have been tested with literally thousands of people.” Over time, he said these exercises can produce long-lasting results that “basically permanently change extreme pessimism into something much less pessimistic.”

That sounds like something to be optimistic about.

By Susan Shain © The New York Times


Taken from this article:
https://cnalifestyle.channelnewsasia.com/wellness/how-to-be-more-optimistic-12452836