August 2007


Obesity Epidemic – Can America learn from Singapore TAF programme?

It is sad to read headline news recently like this one in the Philadelphia Inquirer Americans getting ever fatter. In most states, a new report says, 1 in 5 is obese. But little is being done about it“.

This came right after Trust for America’s Health (TFAH) released the report “F as in Fat: How Obesity Policies are Failing in America, 2007”.

Notwithstanding some experts think the estimates in the report are conservative because people are underreporting their weight in surveys, 85% of the Americans surveyed believed obesity has become a public health epidemic. Yet it seems that most Americans aren’t doing much about it and they are not only getting fatter, but they are actually getting fatter faster.

The unfortunate young generation

Washington Post reported that “A new report gives District (Washington DC) children a dubious distinction: Nearly one in four of those ages 10 to 17 is overweight, making them the heaviest kids in the country.

In the Los Angeles Times, Jim Marks, a senior vice president of a healthcare philanthropy group was reported that he was so discouraged that “These children could be the first generation to live sicker and die younger than their parents“.

Obesity costs America US$117 billion a year in preventable healthcare expenditures and Mark said that it “is pushing the healthcare system to the breaking point“.

How can it so high and still growing when corrective measures at the local and state levels have been implemented? Example, nine of the states with the highest percentages of overweight kids track the MBI (body mass index) of students, improve the nutrition of school lunches or limit the sale of high-calorie foods in school vending machines or snack bars.

However, it seems that the desired effect is doubtful. Weeks ago, I watched a documentary on Singapore TV station, Channelnews Asia in which one of the experts commented that although American schools provide healthy meals, kids are flocking to the vendor machines filled with irresistible unhealthy snacks and beverages. It also showed that young teenagers are getting diabetes and are experiencing heart diseases.

Should America learn from Singapore ?

Although being criticized from time to time even by foreign media, Singapore’s TAF (Trim and Fit) programme which was launched in 1992 by the Ministry of Education (MoE) and refined through the years have reduced the percentage of overweight students (primary schools to pre-university levels) from 14% to 9.8% in 2002.

No system is perfect but the result has been impressive. Many children have emerged from the TAF Programme fitter and more aware of the importance of keeping a healthy lifestyle; and the number of students passing the Singapore government’s National Award for Physical Fitness (NAPFA) test went up from 58% in 1992 to 82% in 2002.

MoE works with the Health Promotion Board (School Tuckshop Programme), school canteen operators and parents closely to make the “TAF programme a more meaningful part of school life, with due emphasis on the physical, nutritional and psychological aspects. It will work with schools to introduce activities and programmes that are inclusive, fun-filled and interesting for all students, so that they take pride and ownership in their own health and physical well-being.”

5 + 4 about Good Cholesterol.

Cholesterol, the fat-like substance is the word that most people especially the middle-age group and above hate to hear.

It is a constant advice that we should all cut down or avoid red meats, seafood and products from animal fats because they are high in cholesterol or are high saturated fatty acids which will raise the triglycerides (a form of fat made in the body) and cholesterol levels in the body. However, for most people, without the wonderful delicious pork, beef, mutton, liver, skin of poultry, ham, bacon; drunken prawns, chilly/pepper “Sri Lanka” crabs, “hum/tua tao/lala” (clam), “sotong” (squid, cuttlefish), lobsters; butter, lard, egg yolk, etc., life will be meaningless.

That is just negative which we remembers. The flipped side is that our body needs cholesterol for functions such as making hormones. Besides being found in those products above, it is also produced in our body.

There are good and bad cholesterols. They can’t dissolve in the blood and have to be transported through the bloodstream in different carriers called lipoproteins. Low-density lipoproteins (LDL or “bad” cholesterol) deliver cholesterol to the body, while high-density lipoproteins (HDL or “good” cholesterol) take cholesterol out of the bloodstream to the liver which will then passes them out of the body.

We are told the higher your HDL cholesterol, the better it is. Now, I learned that biological reality is more complex as genes direct the body’s production of HDL and that many of us might not be lucky enough to inherit genes that result in a lot of HDL. Luckily, genes are only part of the story because lifestyle factors and, to a smaller extent, medications can strongly influence HDL levels.

The National Cholesterol Education Program (NCEP) and the American Diabetes Association advise people to aim for HDL levels of at least 40 mg/dL. An even more protective goal, according to the NCEP, is 60 mg/dL or higher.

Why is having high HDL cholesterol is important?

At first, scientists believed that HDL was simply a garbage collector that picked up cholesterol from an artery’s walls and delivered it to the liver for disposal. That’s still considered the main role of HDL, but research is starting to suggest that HDL can help protect the heart in many ways:

  • Reverse cholesterol transport. HDL latches onto LDL embedded in an artery wall, lugs it back into the bloodstream, and carries it to the liver. The liver collects cholesterol from the HDL particles, packages it into bile salts and bile acids, and dumps it into the intestines for excretion.
  • Antioxidant activity. LDL cholesterol in the artery wall is bombarded by oxygen free radicals, which turns it into oxidized LDL cholesterol. Oxidized cholesterol is the stuff that’s actually responsible for arterial damage — and research shows that HDL can help protect LDL cholesterol from free radicals.
  • Anti-inflammatory action. HDL helps to quiet the inflammation of an atherosclerotic plaque. Elevated levels of C-reactive protein (CRP) reflect the inflammation of such a plaque and HDL may neutralize CRP’s tendency to perpetuate the inflammatory cycle.
  • Antithrombotic activity. Plaque rupture triggers the formation of an artery-blocking blood clot. By halting the flow of oxygen-rich blood, the clot kills heart muscle cells (heart attack) or brain cells (stroke). HDL reduces clot formation and accelerates the healing process that dissolves clots.
  • Endothelial function. Blood vessels plagued with atherosclerosis sustain other damage. In particular, the endothelial cells lining the arteries fail to produce normal amounts of nitric oxide, the chemical that allows arteries to dilate (widen) when tissues need more oxygen. HDL helps preserve nitric oxide production and protect endothelial function.

How much does HDL help?

The Framingham Heart Study was responsible for many landmark discoveries about HDL cholesterol, and the Physicians’ Health Study helped confirm that HDL was protective, reporting that various HDL subtypes are all helpful. Data continue to show that the good cholesterol is very good indeed.

  • Heart disease. Low HDL levels are associated with an increased risk of heart attacks, while high levels are protective. According to the Framingham Heart Study, cardiac risk rises sharply as HDL cholesterol levels fall below 40 milligrams per deciliter (mg/dL). In general, each 1 mg/dL rise in an HDL cholesterol level can be expected to cut cardiac risk by 2% to 3%.
  • Stroke. Strokes come in many forms, but the most common type, ischemic stroke, shares many risk factors with heart attack. High HDL cholesterol levels reduce the risk of stroke; in several studies, HDL cholesterol is a much better predictor of risk than LDL cholesterol, particularly in people older than 75.
  • Erectile dysfunction. Normal erections depend on many things, including healthy arteries that produce good amounts of nitric oxide. It’s no surprise, then, that the Massachusetts Male Aging Study found that 16% of men with low levels of HDL cholesterol had erectile dysfunction, but none of the men with the highest levels did.
  • Longevity. Several investigations suggest that high HDL levels are linked to longevity, particularly exceptional longevity. Other research links high levels of HDL cholesterol to preserved cognitive function in old age. More research is needed to learn if HDL deserves the credit or if other genetic factors are responsible.

Ways to raise your HDL

  • Exercise. Exercise is an important way to boost HDL levels. On average, sedentary people who start to exercise regularly can expect their HDL levels to rise by 3% to 20%. The benefit can occur with as little as one mile of walking or jogging a day, but the more you do, the better your result. Brisk walking for 40 minutes a day is a good target, but if you need more help, aim higher.
  • Watch your dietary fats. Saturated fat won’t affect your HDL cholesterol, but it will raise your LDL cholesterol. The latest American Heart Association (AHA) guidelines call for limiting saturated fat to less than 7% of your total daily calories. Reduce your intake of trans fats to less than 1% of your total daily calories. Trans fat lowers HDL cholesterol and raises LDL cholesterol, a double whammy to health. But unsaturated fats like virgin olive oil may boost HDL levels, and the omega 3 fats in fish, nuts, and canola oil may promote cardiac health even if they don’t affect your HDL reading.
  • Watch your carbs! Or at least the types of carbs you’re eating. Diets that provide large amounts of rapidly absorbed carbohydrates are clearly linked to low levels of HDL cholesterol. Avoid highly refined carbohydrates in favor of coarsely ground, whole grain, unrefined carbs like whole grain bread, oatmeal, and beans.
  • Alcohol. Moderate drinking will raise HDL levels by about 4 mg/dL, which should cut cardiac risk by about 10%. This translates to one to two drinks a day for men, and one drink a day for women. For this “prescription,” count 5 ounces of wine, 1½ ounces of liquor, or 12 ounces of beer as one drink.
  • Weight control. Obesity is linked to low HDL levels, but weight loss can help. Exercise and diet are the dynamic duo for weight loss, but shedding excess pounds will boost HDL levels over and above the independent effects of regular exercise and a healthful diet.

WANT TO REDUCE WEIGHT? PLAY SOCCER Sports scientist Peter Krustrup and his colleagues from the University of Copenhagen, the Copenhagen University Hospital and Bispebjerg Hospital did a research which showed that playing soccer is healthier, burn more fat and more fun than jogging.

For a period of 12 weeks, a group of soccer players and joggers have been active for one hour 2-3 times a week. The participants have been continuingly subjected to tests: fitness rating, percentage of body fat, total mass of muscles, cholesterol, blood pressure, insulin sensitivity and balance.

After the period, the result :

* Soccer players – lost 3.5 kilos of fat, gained more than 2 kilos of extra muscle mass
* Joggers – lost 2 kilos of fat, no change in total muscle mass.
* Both groups – showed significant improvements in blood pressure, insulin sensitivity and balance

Peter Krustrup said that “Soccer is an all-round form of practise because it both keeps the pulse up and has many high-intensity actions. When you sprint, jump and tackle your opponents, you use all the fibres in your muscles. When you jog at a moderate pace, you only use the slow fibres.”

Although both groups moved at the same average speed, soccer is more fun than jogging because jogging focuses on oneself, which led to the joggers noticing their efforts and the breathlessness and can lead to them feeling sorry for themselves. Soccer players forget it is hard because all contributed to the effort as they focus on the game and don’t notice that their hearts are pounding.

Therefore, to fight obesity and inactivity, soccer seems to be an obvious alternative to jogging and fitness.

Will you blame your friends if you become obese ?

James Fowler from Harvard University and Nicholas Christakis from the University of California, San Diego seem to suggest so. They co-authored the report which was published in the New England Journal of Medicine recently, basing on a 32-year (between 1971 and 2003) closely study of a network of 12,067 friends and relatives. 

They concluded in their study that obesity is a socially contagious phenomenon because “areas of the brain that correspond to actions such as eating food may be stimulated if these actions are observed by others“. Thus, weight gain in one person apparently influenced weight gain in others:- 

  1. a person’s chances of becoming obese increase by 57 percent if that person has a friend who is obese.
  2. Same-sex friends and siblings had more influence on the subject’s weight gain than those of the opposite sex.
  3. If a spouse became obese, the likelihood that the other spouse would become obese increased by 37 percent.

Is that why more than one third of the US population is overweight while 60 million US adults are obese? 

Well, one of the reasons – blame it on your friends !

Health benefits of peppermint

Candy and ice cream come to mind. But peppermint is also an age-old herbal medicine that has been used to treat a wide range of abdominal woes, from flatulence to stomach cancer to gallbladder disease.

But does it really work? Peppermint has fared a bit better than many herbal medicines in clinical trials. Several studies have shown that peppermint oil seems to be fairly effective at relieving irritable bowel syndrome (IBS), a collection of symptoms that includes abdominal cramping and pain, bloating, constipation, and diarrhea. In 2007, Italian investigators reported that 75% of the patients in their study who took peppermint oil capsules for four weeks had a major reduction in their IBS symptoms, compared with just 38% of those who took a placebo pill.

There are also findings — admittedly from studies of iffy quality — that topical application of peppermint oil helps relieve tension headaches and that a combination of peppermint and caraway oils can help with recurrent indigestion.

The oil that’s extracted from the peppermint plant contains lots of compounds. Menthol is the most abundant and pharmacologically important.

Menthol is an ingredient in many conventional over-the-counter products, including cough lozenges and muscle pain ointments like Bengay. Menthol creates that familiar cooling sensation by stimulating nerves that sense cold (your mouth has some of these nerves, which is the reason products containing menthol “taste” cool); it also inhibits those that react to painful stimuli. The effect doesn’t last long, but sometimes a brief reprieve or distraction from a cough or a muscle ache does wonders.

One explanation for how peppermint oil might help IBS sufferers is that the oil — and perhaps especially the menthol — blocks calcium channels, which has the effect of relaxing the “smooth” muscles in the walls of the intestine.

Peppermint oil also relaxes the sphincter that keeps the contents of the stomach from backing up into your esophagus. That’s why people troubled by heartburn (gastroesophageal reflux) are advised to avoid peppermint. It’s also the reason peppermint oil is often sold these days in enteric-coated capsules designed to bypass the stomach and dissolve in the small intestine.

People do occasionally have bad reactions to menthol and peppermint. In 2007, Swedish doctors reported the case of a 44-year-old man who got a runny nose every time he brushed his teeth. Allergy tests showed he was allergic to the menthol in his toothpaste. Several years ago, Israeli doctors reported the case of a woman whose mouth and throat were chemically burned by the large amount of peppermint oil she took to treat a cold.

~~ extracted from Havard Medical School newsletter ~~