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1) Berries .They are low in calories but high in vitamin and essential minerals.They are high in fibre and that leads to reduced hunger and increased feeling of fullness.

2) Apple. Apples are high in fibre and water - that makes you feel full faster.Eating apple 30 min to an hour before meals reduce overall calorie intake. Some studies have also shown that high intake of apple may reduce hypertension, reduce bad cholesterol and possibly help with reduction of stroke.

3) Tomato. Tomato is rich in lycopene ( an antioxidant ) which is linked to many health benefits like reduced risk of heart disease and cancer. They are also a great source of vitamin c, potassium, folate and vitamin k. Again it is high in water and fibre contents - and allows you to feel fuller faster and consume less calories

4) green leafy vegetables - Like lettuce, cabbage, kale, spinach are excellent choices of to lose weight.They are packed with vitamins, minerals and plant nutrients like vitamin A, C, K, folate, magnesium, calcium, iron and potassium.Taking more Vegetable allow you to eat more and weight less. In fact vegetable has almost no fat in them if no oil or butter was used in the cooking process. In general, taking more fruits and vegetables have been shown to slow down onset of dementia and reduced incidence of cardiovascular diseases like heart attack and stroke.

5) Eggs- One boiled egg contain 40% of your daily vit d requirements, 25% of your daily folate requirements.It provides you with high quality protein to build muscles and it raises your good cholesterol. They make you feel fuller longer by increasing levels of a hormone that makes you full , delays rate at which food leaves the stomach. This makes you feel more satisfied and therefore lower the desire to eat later in the day.

6) Fish: salmon and tuna - These fish have many health benefits. They are rich in omega 3 fats - hence improving good cholesterol, reducing inflammation. They improve your vision and brain health. They are rich in protein and therefore help your body heal and maintain muscle mass. Eating more salmon and tuna can promote weight loss and decrease belly fat in overweight individuals.

7)Nuts: almond, cashew, walnut, peanuts - Nuts when consumed as part of a low-calorie diet may aid weight loss and lower blood pressure in people who are overweight and obese. They may improve cholesterol levels and reduce risk of heart diseases

8) Olive oil in replacement of other oil types for cooking - Olive oil is rich in oleic acid - this is a healthy monounsaturated fat that reduces inflammation and has power antioxidants that can reduce cholesterol and risk of heart diseases. It is quite resistant to high heat - hence making it a healthy choice for cooking.

9) Oat - Oats are among the healthiest grains on earth. They can help with lowering blood sugar, weight loss and reducing risk of heart diseases. They are a great source of carbohydrate and fibre and rich in protein, vitamins and essential minerals.They reduce sugar absorption and increases sensitivity of insulin.

10) brown rice - Brown rice is whole grain - so it contains the outer fibre layer, the middle starchy layer called endosperm and the inner nutrient rich core called the germ. White rice in contrast is processed grain where the outer fibre layer and inner germ have been removed, leaving behind only the starchy endosperm. This process removes much of the fibre and nutrients. Weight for weight, brown rice has a lower glycemic index compared to white rice, therefore,reducing diabetes.It promotes fullness because of its high fibre content and leaves you feeling satisfied but yet lowers your sugar and calories consumed.

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Ketogenic diet is a very popular diet that has Gained immense popularity in the last decade, primarily because of its successful short term effect on weight loss. I have in my previous videos spoken about Intermittent fasting and Mediterranean diet. Today we will touch on Keto diet.
So what is Keto-diet? It is a low carbohydrate diet with moderate amount of protein restriction with no fat restriction. So if you look at the dietary macronutrients in percentage - its about 5-10% carbohydrate, 30-35% protein and 55-60% fat. The whole idea is to reduce the carbohydrate intake to less than 50g per day which is about 3 slices of bread or 1 serving of plain pasta or rice.In addition, there is also a restriction of protein intake to 1-1.5g per 500g body weight. So if you are about 70kg in weight - then you can take about 140-200g of protein a day.That is about 30 boiled eggs or 6 pieces of grilled chicken breast. Typical keto diet includes plenty of meat, eggs, fish, nuts, seeds, oil, butter and vegetables.

So when your body is starved of carbohydrate, it undergoes a metabolic change to start breaking down the carbohydrate stored in your body.When even that stored carbohydrate is used up in about 3 days - the body will start to utilise fat stored in our body as a source of energy to produce ketones and ketoacid as the primary source of energy.

Keto-diet has been shown to effectively reduce weight and BMI, abdominal circumference, blood pressure and blood triglyceride , fasting blood glucose and hba1c, increase High density lipoprotein ( or good cholesterol ), reduce hyperinsulinemia, improvement in insulin sensitivity.

There are some common short term side effects of Keto diet,. Collectively we can term them “ Keto-flu “- fatigue, headache, dizziness, nausea, vomiting, constipation and low exercise tolerance.
Symptoms typically resolve after few days to weeks as the body adjust to the low carbohydrate ketogenic state. Ensuring adequate fluid intake can help counter some of these symptoms. Long term adverse effects include hepatitis steatosis ( fatty liver ) , overall lack of protein in the body, kidney stones and vitamin and mineral deficiencies.

There are also a few groups of patients that should not be on Keto diet. They are
- diabetic on insulin or oral medications
- patients with liver or renal failure
- pancreatitis patients
- and those with rare cases of inborn disorders of fat metabolism

As with all forms of diet, there are challenges. Firstly - discipline and compliance to stick to the diet. Good results are often seen in patients who stick to it for 3-6 months or beyond. The issue however, with all lifestyle changes are that humans tend not to stick to the routine. And because its so restrictive on the diet, it is hard to follow over the long run. Secondly, As it is a major shift in body metabolism, frequent monitoring with a doctor is necessary and close monitoring of renal function is crucial. There has been cases where patients do run into problems with hydration and electrolyte imbalances which could potentially be dangerous. Thirdly, because this diet is heavy on meat : which may include red meat and processed meat as well. Hence there are also health concerns with regards to high consumption of red meat and processed meat. Finally, the transition from a ketogenic diet back to a standard diet should also be a gradual and well controlled one.

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The Mediterranean diet otherwise known as MedDIet is based on traditional food fare that are consumed by people in countries bordering the Mediterranean sea such as Greece and Italy. Interest in this diet became popular as people living there generally live longer, with much lower incidence of chronic diseases as compared to Americans. And in recent studies - this healthy, prudent dietary pattern has been shown through scientific evidence to contribute to the prevention of chronic disease.

This meta-analysis of multiple studies has concluded that the Mediterranean diet
1) reduces obesity and abdominal fat and waist circumference
2) reduces Cardiovascular diseases like stroke and heart attack
3) reduces the risk of diabetes and may even improve the sugar control in diabetic patients
4) improve hypertension and increase the levels of good cholesterol HDL
5) in fact there are evidence also to suggest that mediDiet can increase life expectancy and improve quality of life and well being! ( medidiet pic 2 )

So what comprises the MediDiet? Principles of the diet are :
On a daily basis:

• •Consume more than 7 servings of vegetables and whole fruits
• •Choose staples which are wholegrains such as whole grain bread, red / brown rice, oats, wholegrain based pasta or other carbohydrates
• •Snack on baked nuts, seeds and beans instead of deep fried snacks like potato chips
• •Cook with oil that contain healthy oil such as Olive oil
• •Season with natural spices and herbs and less sugar and salt
• •Drink plain water

On a moderate basis which is about 2 to 3 times a week

• •Consume healthily prepared seafood such as crabs, clams, prawns steamed.
• •Fish that contain healthy fats such as mackerel, salmon, tuna
• •Poultry such as chicken that is roasted or boiled - not deep fried
• •Eggs, natural cheese and Greek yoghurt
• •1 to 2 glasses of red wine a week - who doesn’t like that?

Rarely - 1 to 2 times a month:

• •consume Red meat such as beef or pork

Avoid as much as possible :

• •Refined grains such as white bread or white rice
• •Processed meat and foods such as ham, bacon and processed cheese
• •Sugar Laden foods such as cakes, ice cream, fruit juices, soft drinks
• •Refine oils such as soybean oil, canola oil, cottonseed oil
• So a recommended meal can be as follow
• Breakfast: oatmeal with greek yoghurt topped with fresh fruits
• Lunch : whole meal bread with egg, chicken breast and fresh vegetables
• Snack - handful of baked nuts
• Dinner - lightly stir fried salmon with vegetables and brown rice
• And lets not forget about exercising in chronic disease prevention on top of MediDiet - in fact there are now on going studies to evaluate whether Exercise on top of MediDiet may give rise to even better health benefits. This predimedplus study has been ongoing since 2014 and I look forward to the results when they do publish at the end of the study.
• So please adopt a healthy lifestyle where you
• •Exercise at moderate intensity for at least 150 mins a week
• •Have meals together with family and friends to foster togetherness.
• Thank you for watching till the end.
• I hope I have provided some insight on the mediterannean diet and I look forward to seeing you achieve your health goals in the coming year.
• Please click on the subscribe and notification button to receive updates whenever we produce a new video.

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intermittent fasting refers to a dietary plan where you alternate periods of eating with periods of fasting.When we fast - our body switches from utilising sugar and carbohydrate from the food we eat to utilising fat stored in our body as an alternative source of energy - hence burning fat and reducing obesity. we now have access to food all times of the day. And we snack frequently. And that has lead to an epidemic of obesity and lifestyle related medical conditions like diabetes and hypertension.

how is intermittent fasting beneficial for you?
1) Firstly it can help in weight loss and combating obesity.Studies have demonstrated that Intermittent fasting can help reduce 3-8% of weight over 24weeks.It can also help to reduce waist circumference by 4-7%.
2) Secondly, It can improve hypertension and hyperlipidemia and reduce risk of heart attack and stroke.
3) It can also help in managing diabetes by reducing insulin-resistance and inflammation.
4) It has also shown evidence in improving cognitive function like memory, executive function and global cognition.
However there are also certain groups of patients which I would not recommend for intermittent fasting.

They are
- growing children less than 18 years old
- pregnant ladies and mothers who are breast feeding
- underweight patients and patients with eating disorders
- lastly diabetic patients who have very volatile sugar levels and are on diabetic medications

In humans, the 3 most widely studied intermittent fasting regimes are
- alternate-day fasting ( where you eat for one day and fast for the next )
- 5:2 fasting where you eat 5 days a week and fast 2 days a week and a daily time-restricted feeding where you only eat within a window of 4-8 hours a day.

One of the most popular and most acceptable daily time restricted feeding plan is a 16:8 plan.You can eat your meals within a 8 hours window and fast the next 16 hours. You can shift your 8 hour fasting window up and down the day to suit your lifestyle.

But is there a best time of the day to eat? Recent studies have shown that there is a circadian system within our human body that orchestrates metabolism in a daily 24 hour cycle. Circadian rhythms in glucose, insulin, lipid levels, energy expenditure and appetite peaks in the morning to afternoon - implicating that earlier in the daytime is actually optimal for food intake. Hence if you combine a 16:8 intermittent fasting plan and shift the 8 hour feeding window to earlier in the day -> it may have give you optimal results in terms of lowering blood pressure, lowering post meal insulin levels and improving insulin sensitivity - which can give you better sugar and weight control, reducing appetite in the evening and reducing oxidative stress. From the various studies, there are lots of early evidence that point to the health benefits but I would still want to highlight a few important points or potential pitfalls.

1) Not everyone is able to endure starvation - so its not a solution that suits everyone
2) secondly, there is no clear guideline on what to eat during intermittent fasting - if you do follow the 16:8 rule but you are taking a lot of fried fatty food and trans-fat and candies with sweet soft drinks during that 8 hours of feeding, then it would not have any benefits on your health. A wholesome healthy diet is still important
3) For effective weight loss - you will have to combine physical activities and exercise with the diet. Weight loss is always 70% diet and 30% exercise.
4) There are patients with medical conditions that may not be suitable for intermittent fasting .so if you do have chronic medical conditions, alw

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This is an infection that is caused by the herpes simplex virus that is very contagious and often spreads through human to human contact.The herpes simplex virus family has 2 members : HSV1 and HSV2. HSV-1 is mainly transmitted through the oral to oral contact causing oral herpes , commonly known as cold sore. HSV1 however is not limited only to oral herpes, it can also cause genital herpes as well. HSV 2 is a sexually transmitted infection that causes genital herpes. These are mild infections and are generally harmless but may lead to potentially fatal complications for newborns, pregnant women and those with weakened immune system.

An estimated 3.7. billion people under the age of 50 have HSV 1 infection globally ( that is about 67% of the human population ).An estimated 491 million people aged 15-49 worldwide have HSV 2 infection.

HSV 1 transmission occur mainly via contact with the virus in sores, saliva or surfaces in and around the mouth. So kissing and sharing of utensils are some of the common modes of transmission. The greatest risk of transmission is when there are active sores appearing. Most HSV 1 infections are acquired during childhood and not uncommonly from their parents. Oral herpes infection is mostly asymptomatic, but when symptoms do occur it can be very uncomfortable. Infected persons often experience first a tingling, itching or burning sensation around their mouth before the onset of painful sores or vesicles. The sores will resolve on their own usually within 7-10 days. But can recur periodically throughout our lives. Other common symptoms of HSV 1 infections include fever with muscle aches, lymph nodes swelling, swollen red gums

HSV 2 is mainly transmitted during sex through contact with genital or anal surfaces, skin, sores or fluids of someone infected with the virus. It can be transmitted even if the skin looks normal and in the absence of symptoms. Genitalia herpes can be asymptomatic or have mild symptoms that can go unrecognised. When symptoms do occur, one or more painful vesicles or ulcers may appear in the private area. Again, it may be preceded by pain, itching or burning sensations. Other symptoms of HSV 2 infection can include fever with. Muscle aches,swollen lymph nodes. These symptoms can resolve , but with HSV infections, they can recur periodically.

Treatment objective for HSV infections are to Reduce the severity of symptoms, Speed up the healing process. In patients with very frequent recurrence, to reduce the frequency. Unfortunately, HSV cannot be cured. Once you have it, the virus stays with you. Hence, to avoid spreading this virus to others those with active oral herpes should avoid oral contact with others and avoid sharing objects that touched saliva until symptoms have fully resolved. individuals with genital herpes should abstain from sex until symptoms have resolved fully too.

However, given the fact that HSV can be transmitted even when no symptoms are felt,avoiding promiscuous sexual activities and using condoms are some other ways to reduce HSV transmission.

HSV-2 infection increases the risk of acquiring HIV infection by approximately 3 fold. Additionally, people with both HIV and HSV-2 infection are more likely to spread HIV to others. Hence it is recommended to screen for HIV infection when someone has been diagnosed with HSV-2

In rare circumstances, Herpes simplex virus can be transmitted from mother to child during delivery, causing a condition called neonatal herpes. It is rare but when it does occur, can lead to serious consequences such as death to baby, brain infection with permanent neurological disability to the infant and even eye infection with potential blindness.

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Syphilis is a sexually transmitted infection that can cause serious health problems without treatment. It is caused by a spiral bacteria called traponema pallidum. In Singapore, we are seeing an average of about 1500 cases of newly diagnosed syphilis yearly for the past 5 years. In Europe and America, there has been an increase in the number of syphilis cases, going up by as much as 70% over the past 10 years. Syphilis is spread from person to person through sexual contact with the infected ulcers called chancres. Chancres can occur in, on or around the penis, vagina, anus, rectum and lips or mouth. They can spread during vaginal, anal or oral sex. Pregnant ladies with syphilis can also transmit the infection to their unborn child.

You can start to show symptoms of syphilis 10 days to 3 months from the exposure. Syphilis is referred to as “ The Great Pretender “ as its symptoms can mimic many other diseases. The infection can be divided into a few stages - Primary, secondary, latent and tertiary syphilis.

The primary stage is the first stage of infection. A skin papule or bump will first appear and subsequently develop into an ulcer or multiple ulcers that are often painless, firm and round. The chancre usually last 3-6 weeks and disappear on its own whether or not you receive the treatment. And if left untreated, the disease progressed to the secondary stage within 1 to 2 months. In the secondary stage, there are a few prominent signs that may occur. First would be skin changes like a rash, hair loss or skin growths called condyloma lata. Secondly, patients may develop flu like reactions.

1) The typical rash usually appear as rough red or reddish-brown spots or patches on the body, palms and soles and they usually do not itch. However it may appear in various forms as well that may be mis-diagnosed as other conditions. 2) Condyloma lata are skin growths that can be skin coloured or greyish white. They are typically raised and occurs in moist areas like the groin, private and peri anal area, even mouth and armpit. They tend to occur near to where the initial chancre was seen. They can be mistaken as warts in some cases. 3) Hair loss is another common skin change. Loss of hair (known as alopecia ) may occur on the scalp, eyebrow or beard area in patches or widespread. The flu like symptoms that may occur includes fever, headache and body ache,lethargy and fatigue, sore throat, swollen lymph nodes, loss of appetite and weight loss

Secondary syphilis will progress to latent syphilis if no treatment is given. This stage is the hidden stage where there are no symptoms and signs and it can last for years. However individuals in the latent stage may still be infectious and spread the bacteria to their sexual partners. Finally about a third of patients with latent syphilis will progress to tertiary syphilis where the bacteria will attack our internal organs and result in serious medical complications.

The doctors must first have a high index of suspicion as symptoms of syphilis may mimic many other conditions.When someone who has a history of sexual exposure presents with primary or secondary syphilis symptoms, a venous blood sample is all we need to achieve a diagnosis. For patients in the primary, secondary and early latent syphilis, a single dose of benzathine penicillin injection is recommended. In patients in late latent syphilis or syphilis of unknown duration, 3 doses of benzathine penicillin injection is recommended at weekly intervals. Alternatives if patients are allergic to penicillin includes doxycycline and tetracycline. People receiving syphilis treatment should abstain from sex until they are proven to be cured.

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Chlamydia is a very common sexually transmitted infection that can infect both men and women. It is almost twice as common in women than men. In Singapore, it is the most common bacteria sexually transmitted disease. It is caused by the bacteria chlamydia trachomatis. You can get chlamydia by having vagina, anal and oral sex. Infections can also occur when partners share sex toys that have become contaminated with the bacteria. You can’t get chlamydia from kissing, hugging or holding hands,sharing food or drinks, using a toilet after someone else.

Chlamydia infections are very treatable and curable. And it is important to receive treatment as soon as possible to prevent serious complications.If left untreated, it can cause permanent damage to a woman’s reproductive system, resulting in infertility. It also increases her chance of ectopic pregnancy in future, this is a non viable pregnancy that occurs outside the womb. Chlamydia infection in pregnancy is also potentially dangerous. It can increase the risk of premature birth and still birth. Babies born to women with chlamydia can be infected in the eyes and lungs when passing through the birth canal. Now the biggest challenge to treatment remains in the diagnosis. Why so? Because Chlamydia is called the silent infection. About 70% of ladies and 50% of men do not show symptoms. And even if there were symptoms, they would only show up weeks after initial exposure.As a result there is delayed diagnosis and uninterrupted rapid transmission from individuals to individuals because no symptoms equals no problem, right? Definitely wrong.

When symptoms do occur in men, we may experience burning sensation when passing urine,discharge from the penis, increased frequency of urination, Pain in the testicles. In Females, they can present with painful sexual intercourse, abnormal vaginal discharge, abnormal inter menstrual vaginal bleeding,pelvic pain, pain on passing urine

You can however reduce the chance of catching this infection by being in a long term monogamous relationship with your partner, using condoms the right way every time you have sex. The groups of patients who are at higher risk of chlamydia infections include Sexually active young individuals ( generally younger than 25 years old ), gay and bisexual men , patients who have a history of STDs. Hence you should get yourself routinely tested even if you have no symptoms if you are a sexually active young adult or if you have had unprotected sex with casual partners or sexual workers.

What tests can we do to diagnose Chlamydia infection? Firstly, a urine PCR test. Secondly, a swab test can also be done from the affected area. When the diagnosis has been confirmed, It can be treated with a course of antibiotics like doxycycline or azithromycin. It can be easily transmitted between sexual partners so it is advisable that your partner is tested and treated at the same time to avoid re-infections. It is important also to recognise that you may get repeated chlamydia infection in future even if you have been treated and recovered fully this time round. Sexual activities should also cease until you have finished your medications and your sexual partner has also been treated.

Now, in my practise, when I test someone for chlamydia infection, I would also encourage screening for the other sexually transmitted infections like gonorrhoea, syphyilis, hiv and hepatitis b & c. Take note that having chlamydia infection can increase your risk of getting HIV.

To watch my 4 video series on HIV , click on the link on your top right now.

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Gonorrhoea is a well known sexually transmitted infection. It is caused by the bacteria Neisseria Gonorrohoeae and it is commonly known as the “ clap “. This bacteria is mainly found in the discharge from the penis and in the vaginal fluid of infected individuals. They can then be transmitted from person to person through unprotected vaginal, oral or anal sex or through sharing of vibrators or other sex toys that have not been washed or covered with a new condom each time they’re used.
The bacteria can cause infection of the male and female reproductive and urinary system and less commonly, the throat or eyes.

In serious cases, it can even spread within the patient’s blood stream resulting in a condition known as disseminated gonococcal infection ( DGI ) where the bacteria can infect distant sites of the body like the skin, the joints, even the heart or brain. The infection can also be passed from a pregnant woman to her baby and without treatment, gonorrhoea can cause permanent blindness in a newborn baby. The bacteria cannot survive outside the human body for long and is not spread through kissing, hugging, toilet seats or sharing of bathrooms, towels, cups, plates or cutlery. Gonorrhoea is a tricky bacteria. It can infect you and yet cause no symptoms. 10% of men and 50% of women do not show symptoms.

And when you do, typical gonorrhoea infection symptoms in men includes
a) Painful or burning sensation when peeing
B) a thick yellowish discharge from the penis
c) even painful or swollen testicles

In females, the symptoms are often milder. They can have
A) painful or burning sensation when peeing
b) increased vaginal discharge
C) Vaginal bleedings in between periods

Rectal infections in both genders may result in
a) Anal itching and discharge
b) Soreness
c) bleeding
d) painful bowel movements.

Diagnosis can be obtained easily by either a swab test to send for microscopy and culture or A urine PCR testing. Blood tests are not helpful in making a diagnosis. In my practise, I would also advise to screen for other sexually transmitted infections like chlamydia, syphillis, hiv and hepatitis b&c. I would share more on these other STDs in future videos. Stay tuned.

Once diagnosis is confirmed, treatment would involve the usage of antibiotics to kill the gonorrhoea bacteria. We can either use an injectable form of antibiotics or oral form or even a combination. Abstinence from sex is usually advised until you have been told you no longer have the infection. You should also repeat the test after treatment to ensure that you have already been cleared of the infection. Take note that you may catch the infection again despite recovering from the previous one.

Your sexual partner or partners should go through testing to make sure that they are not infected. This will help prevent re-infection to yourself.

Patients at risk of gonorrhoea infection includes. those who engage in promiscuous sexual activity & those who do not use barrier methods of contraceptions such as condoms. When left untreated, gonorrhoea can cause complications and long term medical issues. In females, the gonorrhoea bacteria may spread up the female reproductive organs to the uterus and ovaries resulting in a serious condition called pelvic inflammatory disease. Acutely they can experience lower abdominal pain, fever and even pain during sexual intercourse.

In the long run, they may even experience long term pelvic pain, infertility and even increase risk of ectopic pregnancy. And if you unfortunately catch the infection during pregnancy, gonorrhoea can cause increased risk of miscarriage, premature labour and birth, infant eye infection and possibly blindness

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Seborrheic dermatitis is a common skin disease that causes an itchy rash with scaly patches. In this video, we are discussing the common causes of Seborrhoeic Dermatitis, Triggers and treatment options.

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Hi, My name is Dr Chen Yiming.
In this week’s video, I will be sharing about seborrheic dermatitis.
What is seborrheic dermatitis?
What is the cause of it and who are prone to having it?
What are the common triggers and how do we treat it?

If you are new to my channel, click on the subscribe button now.What is seborrheic dermatitis?
It is a form of eczema where there is prominent inflammation on parts of the body where there are a lot of oil producing glands like the scalp, the eyebrow, the nose and the upper back.
It will result in itching, redness of the skin and skin peeling and dandruff over the affected area.
This is the classical appearance of someone with seborrheic dermatitis.

The cause of seborrheic dermatitis is still not fully understood.
But it is believed to be genetical in origin and has also been linked with an overgrowth of a type of yeast on our skin called malassezia furfur.

Who gets seborrheic dermatitis?
It can occur classically in two groups of patients
1) Infants and in
2) Adults between 30-60 and more commonly in males than females.
Seborrheic dermatitis is also seen more commonly in patients with Parkinson’s disease and AIDS.

Common triggers for the onset of the condition include
1) stress and lack of sleep
2) Hormonal changes
3) Cold, dry weather
4) harsh detergents, solvents and soaps
5) some medications like lithium, psoralen.

Infants with seborrheic dermatitis often have a classical presentation called cradle cap.
This will appear as scaly, greasy, yellowish looking patches over the scalp and sometimes on their bottoms.
This is usually harmless and will resolve on its own most of the time. It is also non contagious.
You could help your child remove the excess scales by applying coconut oil or olive oil on their scalp for 3-4 hours before washing it off with a gentle hydrating shampoo like Johnson and Johnson baby shampoo or cetaphil baby shampoo.

In adults, treatment of seborrheic dermatitis includes a combination of
1) Antifungal cream to remove the overgrowth of yeast on our skin
And if it occurs on the scalp, antifungal shampoo is also very helpful.
Some examples of anti fungal shampoo includes - nizoral shampoo, selsun or selenium sulphide shampoo,
2) Steroid creams or lotions can also be applied on the affected areas to reduce the itch and inflammation. However these have to be advised by your doctor has long term steroid use has its associated side effects.
3) If you have thick scalp scales - cocois ointment ( which is a combination of salicylic acid + coal tar + coconut oil and sulphur ) would be very useful in helping remove excess scales.

Understand that seborrheic dermatitis is a harmless but irritating skin condition that can affect a person’s well being and self confidence.
There are treatment options which are very effective!
Consult a doctor today if you think you have seborrheic dermatitis.
Subscribe like and share this video if its of any benefit.
Till the next time, stay safe and stay healthy.

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Today I will be sharing about a very very itchy and irritating condition called urticaria or hives.
Most of you must have had this before.
Very itchy bumps on the skin that comes and go and looks like mosquito bites.
What are these caused by?
What is the treatment ?
What are the red flags to look out for?
Watch till the end.
And if you are new to my channel, click on the subscribe button now.

What is urticaria or hives.
These are itchy raised bumps that can occur on the skin.
They can look like individual small bumps like these or may involve large patches of our skin.
They are warm and hot and extremely itchy.
It may be associated sometimes with swelling of the eye and lips in what is known as angio-oedema.

On a microscopic level, what happened is that
- there is a sudden release of large amounts of histamine from our immune cells
- and that results in a sudden enlargement of small blood vessels within our skin
- followed by a rush of fluid out of our vessels into our skin causing an itchy swelling.

Urticaria is very common.
About 20% of us would have experienced at least 1 episode of this at any time of our lives.

If these hives are short-lived, they are termed acute urticaria
If they last for more than 6 weeks, then they are called chronic urticaria.

Today I will focus more on acute urticarias, which are hives that generally last for days to weeks.
In my practice, this is commonly seen in children.

Some of the common causes of acute hives are
1) fever and viral illnesses
2) reaction to allergens like dust or latex
3) parasitic infections like mites or scabies or insect bites
4) physical stimulations like sun exposure, or change in temperature from hot to cold or vice versa
5) less commonly drug or food allergy
In 50% of the time, we may not be able to identify any cause and that can be very frustrating for the child and parents

The hives come and generally disappears within 24 hours but another batch of hives may appear in the same area or a different area.
This process may repeat itself for many days or weeks.
It is so itchy that it may affect sleep and lessons or work.

Are treatments available for hives?
Yes of course.
Antihistamines are the main treatment of choice
Some of the drowsy ones are piriton, diphenhydramine, hydroxyzine or promethazine
The non drowsy ones includes Zyrtec, loratadine, telfast, aerius
In some instances, we may even add in a different class of antihistamines like ranitidine or cimetidine.

Now if we are able to identify any triggers, the next course of action would be to treat the triggers or to avoid the triggers.
Treat the viral infections, or avoid that particular drug that may trigger the hives.
This will possibly prevent the same thing from happening again.

If you have had hives before, keep this medications in your medicine cabinet because hives tend to recur.

Now, are there any signs which indicate that these hives are due to the more sinister causes?
If you notice that each individual spot lasts more than 24 hours OR
They cause bleeding under the skin OR
After the hives disappear you notice a brownish pigmentation that is left behind?
Then you may need to see a dermatologist for a skin biopsy to exclude the possibility of a vasculitis.

Otherwise in the large majority of cases, they are harmless.

Thank you for watching till the end.
Subscribe and like my channel.
Hope this video helps in the treatment of your urticaria.
Treatment is straightforward and some of the medications are available over the counter.
Till the next time, stay safe

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This is the thyroid gland. It is a small butterfly like gland at the centre of our throat.It’s responsible for producing our thyroid hormones which has important functions.However the thyroid gland can become sick. As a result it may produce excessive amount or insufficient amounts of thyroid hormones. Today we will talk about a condition where the gland produces excessive amount of thyroid hormones Causing hyperthyroidism. This condition is known as Graves’ disease.

Firstly, what is hyperthyroidism? Hyperthyroidism occurs when your thyroid gland produces too much thyroid hormones. This will accelerate your body’s metabolism causing a whole spectrum of symptoms. 1) heat intolerance 2) excessive sweating 3) Increased appetite - eating much more than usual 4) yet losing weight 5) palpitations 6) anxiety, nervousness and irritability 7) fatigue or tiredness 8) change in bowel habit - going to the toilet more often 9) tremors or trembling of fingers and hands 10) swollen neck in some cases 11) in ladies, change in your menstrual pattern

And in Graves’ disease, you may also noticed Protrusion of your eyeballs with red and dry eyes. In some cases, even double vision. If you have any of the above symptoms, please see your doctor early for evaluation.

One of the most common causes of hyperthyroidism is Graves’s disease. This is an autoimmune condition. Your body produces an antibody that instead of attacking external invading agents, attacks your own thyroid gland. The name is thyrotropin receptor antibody or TRAb for short. TRAb will circulate in the blood stream and attaches itself onto the thyroid gland resulting in an excessive production of thyroid hormones.

Your chance of getting graves’ is higher if - you have a family history - or have a history of other autoimmune conditions like rheumatoid arthritis or SLE - if you are a female in your forties - if you are under intense stress- if you are pregnant - or smoker

Now if I suspect a patient of having hyperthyroidism from graves’, I would send off their blood sample for - thyroid hormone levels and - the thyrotropin receptor antibody ( TRAb ) And if physical examination revealed a swollen thyroid gland I would order an Ultrasound of the neck to confirm the diagnosis.

Treatment of Graves’ disease involves 3 key process

Firstly, reduce the symptoms caused by high thyroid levels so that the patient will feel better. A class of medications we often use to achieve this is the beta blockers. It can help to reduce the palpitations, trembling of hands and even anxiety and nervousness. Some patients report symptoms relief within hours to days of starting this medication.

Secondly, reduce the thyroid hormone levels by administering anti thyroid drugs such as carbimazole, methimazole or propylthiouracil. These medications cause the thyroid gland to produce less thyroid hormones. Generally upon starting these medications, I expect the thyroid hormone levels to normalise in 2 months’ time.

Thirdly, to treat the grave’s disease itself. The first option would be radio-iodine. This involves the taking radioactive iodine in a capsule of liquid form that slowly destroys the cells of the thyroid gland, thereby reducing hormonal production. It may eventually result in hypothyroidism.

This treatment is not suitable for pregnant ladies or breastfeeding mothers. The other option would be to remove the thyroid gland through a surgery. This is only considered if the thyroid gland is so swollen that it is pressing on your windpipe causing breathing issues or sometimes in pregnant ladies who are unable to tolerate or are allergic to all the antithyroid medications.

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One of the treatments for gut dysbiosis is consuming probiotics.What is probiotic?What is prebiotic?How should you choose your probiotic the next time you are at the pharmacy?The consumption of probiotics have a number of health benefits.They help to digest food, destroy disease-causing cells and even produce vitamins.In addition, probiotics can also reduce inflammation within our body and promote antibody productions. Boosting of antibody level enhances immunity and reduction of inflammation may help to improve various health issues such as eczema and improve the overall wellness of the body. The most common bacteria found in probiotics belong to groups called Lactobacillus and Bifidobacterium.
What about prebiotics?Prebiotics are essentially plant fibers that cannot be fully digested and absorbed by our body.They are, however, food for our gut micro-organisms.Hence, the intake of prebiotics would encourage growth of probiotics within our gut which may help the host to achieve a balanced gut microbiome state. Examples of food rich in prebiotics are whole grains, barley, banana, onions, garlic, soybeans and green leafy vegetables.

You can also take supplements which contain prebiotics.The term synbiotic refers to products combining probiotics and prebiotics. It is essentially a mixture of live micro-organisms and the food they require to thrive.This synergistic effect helps live good bacteria colonise the intestine and provides sustaining effect on our health.
So then, how should we choose our probiotics?Commonly, people look at the CFU or colony forming units.This refers to the number of micro-organisms in one serving.The average CFU count per serving is between 1 and 10 billion.While it’s important to have enough of these little guys in the product, it is important to understand that higher CFU doesn’t necessarily mean a better product.
We have to also consider whether the probiotics are alive.Dead or inactive probiotics may provide similar benefits of live probiotics. However, since they are dead, they are not able to self-replicate like live probiotics and cannot colonise our gut to bring about long lasting effects.On the other hand, live bacteria are able to self-replenish and establish a healthy microbial ecosystem. Moreover, to reach our gut, probiotics have to survive the challenging condition of our digestive system.A majority of good bacteria would be killed by the acidic environment of our stomach and cannot make it to the intestines. There is now special micro-encapsulation technology for probiotics to protect them from the digestive juices of our gut, allowing them to reach the large intestine intact.Last but not least, the strain or strains of bacteria.Through multiple studies, we now understand that there are differences between the microbiome makeup amongst humans living in different parts of the world.Someone living in Singapore will have a different gut microbiome compared to someone living in America, due to culture, behaviour, dietary factors and age.This implies that the good bacteria required by population groups with different backgrounds also differs.So, a product with clinical studies supporting its unique positioning for your population background will most likely provide you with the most beneficial probiotics.

Precision formulation is an emerging trend in the world of probiotics.Research centres worldwide are keen to develop formulations for consumers with different cultural backgrounds or patients from specific disease groups.

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All of us will experience aging of the skin.
On a microscopic level, there is reduced skin cell and skin thickness, reduced water and hyaluronic acid molecules, reduction of skin collagen and reduction in the skin support structures.
the skin becomes more dry and rough, more wrinkled with fine lines, more lax and saggy and you will start to see the buildup of pigmentations.

Now, there is one particular skincare that can potentially combat skin ageing.
Retinol is a wonder drug for the skin.
These 5 fantastic changes will happen to your skin when you start using retinol in your skincare regime.
1) It increases new skin cell growth and thickness of skin
2) reduces fine wrinkles
3) reduces pigmentations
4) improves skin texture and reduces roughness
5) improves collagen and skin support structure giving you firmer skin

The effects of retinol are gradual so do use it continuously for 6 months of more to start seeing beautiful glowing skin.
Now there are some mild side effects to retinol.
They include skin dryness, skin redness, skin irritation and itch, skin peeling

However, these side effects are uncommon and are generally seen in patients with dry and sensitive skin.
So if you do encounter any of these side effects, do try these few steps
A) reduce the amount you apply each time
B) reduce the frequency of application - meaning instead of applying every night, reduce it to alternate nights
C) or apply a layer of moisturiser first before the retinol.

Now then, what are some of the recommendations to ensure the maximal effectiveness of retinol?
1) Use it at night.
Retinol is a rather unstable molecule and it can degrade easily on exposure to sunlight.
Therefore application at night is the best way to allow it to have maximal effectiveness.

2) Using it together with moisturiser.
We know that retinol, even at a low concentration can cause some irritation and skin dryness.
Therefore the application of moisturiser is important and synergistic.
My patients often ask me whether they should apply the moisturiser before or after retinol.
The answer is it depends.
If your skin is sensitive, I would recommend using moisturiser first followed by retinol just to reduce the irritation.
But if your skin can tolerate retinol well, I would use retinol as the first layer after washing ur face to ensure maximal absorption.

3) We do know that the application of retinol may make your skin slightly more sensitive to the sun in the day.
Hence the application of sunblock with SPF of 30-50 in the day would be crucial, especially in Singapore where we have strong sun all year round.

Lastly, can you combine retinol with other skincare?
Like I’ve mentioned above, combination with moisturisers are highly recommended.
There are studies that have demonstrated improvement of skin thickness and quality by combining retinol with other agents like vitamin c.
There are also studies that demonstrated improvement of skin pigmentation and sun damage when combining retinol with hydroquinone.

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Rule number 1 : exercise.
Exercise has so many benefits to one’s health, it should be the top priority in life. We know that glucose is heavy utilised by working muscles within our body.
Therefore when you exercise and make your muscles work harder, It helps to lower blood glucose levels through the increased consumption of glucose.
Following that same thought, when you increase the proportion of muscle mass in your body, you will also be able to consume the sugar in your blood more effectively compared to someone with lower overall muscle mass.
Exercise can also help us combat obesity.
Obesity, as we know is one of the top cause of type 2 diabetes.
Losing just 5-10% of your body weight can actually have a significant reduction on your blood sugar levels. Studies have shown that regular exercise reduces sugar levels in individuals with type 2 diabetes.
The recommended exercise per week is at least 150 mins of moderate to vigorous physical activity. Do consider a mixture of aerobic and resistant exercises.

Rule number 2: Diet
We should try to avoid regular rapid spikes in blood sugar levels that will overwhelm our body system and increase the risk of diabetes.
Firstly, choose more complex carbohydrates and avoid added sugar in your diet and drinks. Carbohydrate is basically the main source of energy for the human body.
It gets broken down during digestion and causes a direct increase in blood sugar level after a meal.
When you consume food and beverages laden with added simple sugar like soft drinks and candies and cakes, it will result in a rapid sudden spike in your blood sugar levels.
Refined carbohydrate like white bread, pasta and white rice can also cause a spike in our blood sugar levels post meal. Consuming more complex carbohydrate like whole grains, legumes, vegetables and whole fruits are better as they are digested much more slowly thereby releasing sugar into our blood stream in a gradual manner.
Last but not the least, consider eating smaller frequent meals throughout the day.

Rule number 3: Manage your stress
Studies have shown that leading a stressful life can actually adversely affect blood sugar levels! Hormones such as cortisol are being produced when we get stressed and these hormones can cause our blood sugar levels to go up. As such, relaxation activities such as meditation and yoga are said to help decrease blood sugar levels.

Rule 4: Get enough rest.
A good night’s rest is essential for promoting overall good health.
Poor sleep can lead to issues such as reduced insulin sensitivity, increase in appetite and weight gain. Lack of sleep also increases cortisol levels in the body which can result in higher blood sugar levels. Always aim to sleep for 7 to 8 hours at night.

Rule 5: Kick the bad habits.
Smoking and drinking can increase your risk of diabetes.
It is said that smokers are 30 to 40% more likely to develop type 2 diabetes than those who do not smoke. This is because nicotine can reduce the effectiveness of insulin, resulting in insulin insensitivity in the long run.
And for those who are already diabetic, smoking exacerbates diabetic related health problems such as nerve damage, heart and kidney disease, poor blood circulation and retinopathy.
Avoid alcohol. Alcohol puts your liver under stress and this will prevent it from functioning properly in regulating blood sugar levels.

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Urinary stones form when urine stay too long in the bladder it becomes hard because of high level of minerals in the urine. In this video, we are discussing the symptoms and signs of urinary stones. What are the other causes of blood in the urine?
When you see blood in the toilet bowl, where can it come from?

Some of the common causes of blood in the urine can be
1) Urinary tract infections
2) Stones in the urinary system
3) Growths in the urinary system, some of which can be cancerous
4) Enlargement of the prostate in men
5) Medications that can cause bleeding such as aspirin or anticoagulants like warfarin.
6) Less commonly, kidney inflammation like glomerulonephritis

So I will zoom in on One of the most common cause of blood in your urine, STONES.
These stones are usually made of of minerals and crystals like calcium oxalate, uric acid, struvite or cysteine.
When the patient do not drink enough water or if there is an excess or build up of these minerals in the urinary systems, stones can occur.

Symptoms of urinary stones include
1) Pain.
If the stones are formed in the kidneys, you can experience back pain especially in the loin
If the stones are in the bladder, you can experience lower abdominal pain
And if the stones are stuck in the ureter - you can experience intense loin to groin pain which can be excruciating

2) Of course, blood in the urine.
Stones in the urinary system is amongst the top cause of blood in the urine.
They can cause damage to the lining of the urinary system and that can cause trauma and bleeding.

3) Infection
Stones can cause urinary tract infections
And that can lead to smelly urine, pain on urination, frequency and urgency.
In severe cases, that can lead to fever and an extreme feeling of unwell.
This is urgent and immediate medical attention is required.

4) In serious cases,
Stones can result in a complete blockage of urine flow from the kidney.
That can result in a swelling of the kidney in a condition called hydronephrosis.
This could lead to irreversible kidney damage and failure.
This is a medical emergency that needs to be treated immediately.

Diagnosis of stones can be achieve through
a) urinalysis showing blood in the urinary system
b) X-ray of the urinary system
c) ultrasounds
c) CT scans

Treatment of stones depend on the size of the stones.
a) Stones that are small are often treated conservatively. They are usually less than 1 cm.
Painkillers like Panadol and NSAIDs can be given.
Drinking plenty of water can flush these stones out of your body.

However when they are bigger than 1 cm, treatment is not as straightforward as they tend to get stuck. Some of the methods of stone removal done by the urologist includes
a) shockwave lithotripsy to blast these larger stones into smaller pieces so that they can be passed out
b) surgical removal of the stones
c) Endoscopic removal of the stones

Take note that if you have had stones before, your risk of having recurrent stones again in the next 5 years is as high as 50%.
So to reduce the risk of it happening again,
a) Drink plenty of plain water - you can take 10-12 cups of water a day
b) eat more fruits and vegetables
C) cut down on meat

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What is VO2 max? How do you measure it & how do you train to improve it.
What are the health implications of low VO2 max?

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VO2 Max measures the maximum amount of oxygen the body is able to absorb and utilise while exercising as hard as you can. A high VO2 Max value means that your body is able to take in larger volumes of oxygen and utilise them while working out. This also means that your body is more efficient in producing energy during the aerobic stage of exercising.
It is typically used to measure the aerobic fitness and endurance of an individual.
The unit of VO2 max is in ml/kg/min.

The most accurate way is to measure a person’s VO2max in a laboratory-based setting. In the testing centre, one would be required to don a face mask while running on a treadmill or riding a stationary bike.
Test subjects will be made to exercise as intensely as possible and the actual oxygen intake will be then be measured following which the VO2 max value will be calculated

VO2 max can also be measured outside the lab and these sorts of tests are known as submaximal tests.
With the help of certified fitness trainers or health care professionals, VO2 max can be gauged through activities such as the 2.4 KM run test or multistage bleep test.
For those with a lower fitness level or who are not medically fit for excessive physical exertions, the Cooper 1.5 mile walk-run test or treadmill test can be used

The increase in our fitness levels, it can prevent muscle catabolism and physical disabilities, thereby increasing the quality of life in our senior years.
With the increase in our fitness levels, there is a greater reduction in the chance of hospitalisation and entering long term care in our later years.
In the short term, Improving our VO2max can also benefit such as Increased endurance, allowing us to have better stamina to carry out daily activities, Better management of stress levels & Strengthening of our immune system

We will need to put in hard work and discipline in maintaining a regular exercise schedule and at the same time, gradually improve our performance levels.
There are two training methods that can help.
1) High-intensity interval training (HIIT) and Tabata related exercises can help to improve VO2 max levels.
This is because it requires the individual to exercise as hard as possible in a fixed time interval of say 30 to 60 seconds before he is allowed to take a short break or to proceed on to a lower intensity exercise.
This method of training helps to push the aerobic capacity of the individual by working the heart at its near max rate.
It would be good to don a smartwatch or heart rate sensor to better monitor your heart rate during the workout.
With a real-time visualisation of your heart rate, we can try to aim for 80% or more of your maximum heart rate (MHR).
Understand more about your heart rate training zones in an earlier episode by clicking on the top right of your screen now.
2) Endurance activités like running or cycling can improve the VO2max capacity. For example, when covering 5KM and 10 KM runs, try to constantly improve your timings and keep the heart rate at more than 70% of MHR.

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A rare complication called Multisystem inflammatory syndrome in children (MIS-C) is a serious condition that appears to be linked to coronavirus disease.

As we speak, the COVID-19 virus is still spreading rapidly across the world.
The risk of severe disease and death has been the highest in older people and in persons with underlying chronic conditions such as cardiac disease, chronic lung disease and cancer.
Thankfully, the condition is largely mild in children even though COVID19 vaccination for children under the age of 12 has not begun in most of the world.

However, as of mid-2020, clusters of children in Europe and North America have been reported to require ICU care with a multi-system inflammatory condition due to COVID19 that bears some resemblance to Kawasaki disease and toxic shock syndrome.
This condition is now known as Multisystem Inflammatory Syndrome in Children associated with COVID-19, ( or MIS-C for short )
If you are a parent and you haven’t heard of this condition, make sure you watch till the end of this video.
I will be discussing the diagnostic criteria for this syndrome and what are the signs and symptoms to look out for that should prompt you to bring your child to the emergency department or nearest doctor.
As the number of cases of Children Diagnosed with COVID-19 in Singapore rise, we will start to see more cases of MIS-C.
Multisystem inflammatory syndrome in children is an uncommon illness that can occur 2-8weeks after the initial COVID-19 infection.
The incidence of MIS-c has been reported to be about 0.14% among all children with COVID19 infection.
In Singapore, as of 9 NOV 2021, a total of 5 cases of MIS-C were reported to MOH.

Both the Centre for Disease Control and Prevention ( CDC ) and World health organisation ( WHO ) have published diagnostic criteria.

This is the diagnostic criteria from CDC ( insert picture )
It basically means that we need to suspect MIS-C in someone younger than 21
who has been tested positive for COVID-19 within the past 4 weeks
presenting now with fever and multisystem organ damage that has no other plausible explanation for the signs and symptoms.

This is the diagnostic criteria from WHO ( insert picture ), which Singapore is currently adopting.
It lays out more specific pointers which are easily identifiable.

Age 0-19
With evidence of current or recent COVID-19 infection
High fever of 38.5 degrees Celcius for more than 3 days
Various signs and symptoms of each organ system involvements
Elevated markers of inflammation in the blood such as CRP and Procalcitonin
Excluding other sources of bacteria or viral infection

Now, these diagnostic criteria may seem very confusing to you.
Therefore I will attempt to summarise some of the salient features that you should be looking out for as worried parents.

If your child younger than 19 years old has been diagnosed with COVID-19 within the past 2 months,
And If he or she developed a sudden fever of more than 3 days
Be careful if your child is also having
- lethargy, drowsiness or confusion
- headache
- red and swollen eyes
- red and swollen hands and feet
- rash on the body
- Shortness of breath
- chest pain
- abdominal pain, vomiting or diarrhoea

There are treatments available for MIS-C.
And thankfully, most children recover from it.
At this point, the medical world is still not sure why it occurs and which kids will get it.
And there is evidence that suggests that a small proportion of these kids may get long term heart complications.

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Learn about the S.M.A.R.T goal-setting system to help you achieve better health in the new year!

S.M.A.R.T goals is a very useful tool in laying out the steps to achieve a particular set of goals.
It can help you evaluate whether these targets are within reach.
SMART stands for specific, measurable, attainable, relevant or realistic and timely or time-bound.

First, be specific about your goals.
When you set a goal like “ I want to be healthy “ - what does it really mean?
When you are not specific about your aim, it makes it hard to even plan how to go about doing it.
So instead of “ I want to be healthy “ - perhaps you should set a goal like “ I want to lose weight “ or “ I want to achieve a healthy BMI “
Once you have that specific target in mind, the next step is to make it quantifiable or measurable.

Secondly, set measurable goals
You should at this point set a quantifiable way of letting yourself know how far, or whether you have achieved your goal.
This will come in the form of measurable figures such as losing 10 kgs of weight or able to do 10 chin-ups or walking for 30 minutes every day.
With a figure in mind, you can now see how far you are away from your target.
It can also be a great form of motivation when you see yourself getting closer and closer to your measurable target.

Third, ensure that your goals are attainable.
Avoid aiming too high or too low. You know yourself best!
Are you able to reach your goals safely or might you be reaching for the stars too soon?
Always remember that fitness is a marathon and not a sprint.
For your own wellbeing and also for confidence building, always layout goals that are achievable at your current level of fitness or capacity.
Avoid contemplating on farfetched goals of losing 20 to 30 kgs in 3 months because not only is it impossible, excessive dieting and exercise can result in injuries.

Fourthly, Make your goals relevant.
Pick a goal or goals that are relevant to your current state.
If you are already happy with your weight, then a weight loss goal will not be relevant for you.
Instead, an exercise goal like “ running 10kilometres a week “ may be more relevant or motivational for you.

Lastly, Goals have to be time-bound.
You will need a definite timeline so that it creates a sense of urgency.
My suggestion will be to set mini-goals or milestones that can be achieved at stated intervals.
For example, with the aim of doing 10 pull-ups by the end of 6 months, you can set a milestone of 2 pull-ups in the first month, 5 pull-ups by the 3rd month and so on.
Stay disciplined, keep track and review your progress consistently.

Now with this framework in mind, let me show you an example of a SMART Goal to quit smoking

My SPECIFIC goal is to quit smoking.
The timeline I set for myself is by December 2022.
I ensure that my goal Is ATTAINABLE by allowing myself to reduce the number of cigarettes I smoke by 2 sticks a month.
See that I am setting a TIME-BOUND target at a monthly milestone that is MEASURABLE.
This goal is definitely RELEVANT to me as I can achieve better health by quitting smoking.

Setting SMART goals is the first step towards achieving better health and fitness.
Remain confident, be patient and stay focused on your goal.
Soon you will be on your way to a healthier lifestyle this year.
Be sure to involve your family and friends in your goals.
They can be the bedrock of encouragement, especially during times where motivation tapers off.

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The fourth lifestyle to reverse aging is through your diet and nutrition. There are a few ways where meals and diet can slow down or reverse aging. Firstly, control the timing of your meals. - I will be introducing the concept of intermittent fasting. Secondly, control the contents of your meals - lean towards more fruits and vegetables and less meat. Thirdly, control the way you cook - cook with lower temperature and less oil.

First concept - Time your meals to incorporate some form of fasting. Scientists have long known that dietary calorie restriction in non-primate animals slows aging while maintaining good health and body functions.Rats and mice fed 30-50% fewer calories shows various physiological health benefits, lower incidence of chronic diseases and up to 50% increase in length of life. Therein lies the concept of intermittent fasting. Basically, intermittent fasting refers to a dietary plan where you alternate periods of eating with periods of fasting. When we fast - our body switches from utilising sugar and Carbohydrate from the food we eat to utilising fat stored in our body - this will help burn fat and reduce obesity.

The 3 most widely studied intermittent fasting regimes are
a) alternate day fasting, where you fast for one day and eat the next day
b) 5:2 fasting where you eat 5 days a week and fast 2 days a week
c) A daily time-restricted feeding where you only eat within a window of 4-8 hours a day. For example, you only eat from 10am-6pm everyday and fast for the rest of the 16hours.

Second concept - Control the contents of your meal.The benefits of dietary restriction can also be found by changing the macro nutrient profile to reduce meat intake without any changes to calorie level. Lets use the popular Mediterranean diet as an example. The Mediterranean diet has been associated with longer telomeres and therefore reduced aging. It can also help lower the risk of heart disease.

It may be challenging to have a Mediterranean diet daily in Singapore.So let me just introduce two concepts to make it easier for you to have a healthier diet.The quarter quarter half strategy made famous by Singapore’s health promotion board and the 3-5-7 healthy heart principles. Firstly , what’s a quarter quarter half strategy. Fill up 1/4 of your plate with healthy protein like lean meat, fish or plant based protein like tofu. Next , fill up the next 1/4 of your plate with whole grain : ideally this portion should include brown rice or wholemeal bread. Unfortunately when eating out, its hard to find brown rice, so white rice would be an alternative in the Asian context. Lastly, fill up 1/2 of your plate with fruits and vegetable. Aim for 2 servings of fruits and 2 servings of vegetables per day.

So then, what’s the 3-5-7 healthy heart principles? 3 highs : high in fibre, high in whole food and high in plant based protein. Again consume plenty of fruits and vegetables, soy products, beans and legumes. Whole lean meat and avoid processed ones like bacons and sausages. 5 lows: low in alcohol, fat, cholesterol, salt and sugar. 7: Eat 70% full - always aim to eat till you are only 70% full

Third concept - Control the way you cook. Foods cooked with high heat develop toxic compounds called Advanced glycation end products or AGEs for short. AGEs can contribute to hardening of the arteries, stiff joints, wrinkles, and more. AGEs are found in high quantities in processed foods such as American cheese, fast food and dark colas. Try substituting them with low-fat cheese, dried fruit, fruit juice and air-popped popcorn. Also cook your food at lower temperatures.

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The third lifestyle change to reverse aging is physical exercise. Physical exercise can not only help us manage chronic medical conditions like blood pressure, high cholesterol and aid with sugar control, it can also lengthen our life expectancy and may even reverse aging.
People who participate in moderate to high levels of physical exercise have a lower death rate compared to individuals who are not physically active. Moderate levels of exercise have been correlated with preventing ageing and improving quality of life.

A study in the online journal PLoS Medicine looked at data on 650,000 adults ( including some who were obese ) and found that walking just 15 minutes a day was associated with living 2 years longer. Looking at normal-weight individuals only, the data showed that walking 30 minutes a a day, 5 days a week was associated with an increase in life span of more than 7 years.

On a cellular level, the process of ageing can be slowed down by sustained exercise. A study published in 2009 showed that sustained physical training in young and middle-aged athletes was associated with higher telomerase activity, increased expression of telomere-stabilising proteins and therefore longer telomeres, compared to sedentary people. The same research group recently conducted another randomised controlled trial in non-athletes to demonstrate that exercise increases telomerase activity and telomere length.

The results of the study were published in 2018 in the European Heart Journal. The researchers recruited 124 middle aged men and women who were in good health but did not exercise. During the 6 months study, participants were randomly divided into four groups.1 Control group and three exercise groups that did different types of exercises 3 times a week. 1 group did endurance training ( walking or running 45 min a day ) Another group did high intensity interval training. They worked out for 4 min at high intensity followed by a 4 min rest - this cycle was repeated 4 times. And the third group did resistance training with various weight machines.

Blood samples were taken before, during, and at the end of the study to measure telomere length and telomerase activity in white blood cells. At the end of the study, those who exercised, regardless of the type, had better cardiorespiratory capacity than at the beginning of the study. Telomerase activity was 2-3 times higher in the group who did endurance or interval exercises, compared to the control group.

This effect, however, was not observed in people who did resistance training. Similarly the telomere length was greater in those who did endurance or interval exercises, but not in those who did resistance exercise.These results suggest that endurance exercises such as running, brisk walking, or swimming and high intensity interval trainings are more effective to keep longer telomeres and delay cellular aging.

How then should you structure exercise into your life? The recommended exercise duration per week is to commit to at least 150 mins of moderate to vigorous physical activity. Moderate to vigorous physical activities refers to any form of exercise that raises and maintains your heart rate at > 50% maximal heart rate. A simple formula to calculate maximal heart rate is 220 - your age.

Do consider a mixture of aerobic and anaerobic (resistance training) exercises. One good recommendation can be high intensity interval training which cleverly incorporates the 2 types of exercise regimen in one. Try to spread out your entire 150 mins of exercise evenly thoughout the week - meaning 30 minutes of exercise 5 days a week.

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There is a 5 year study on 25 men diagnosed with low-risk prostate cancer. 10 of them were asked to make comprehensive lifestyle changes while a control group of 25 men maintained their lifestyle habits. The lifestyle changes focused on four main areas.

First, eating right : Adoption of a whole food, plant-based diet that was low in fat and processed carbohydrates
Secondly, moderate exercise : 30 minutes walks, 6 days a week
Third, stress management : participation in meditation, yoga and other relaxation techniques for an hour a day
Fourth, social support : Attendance at an hour long support-group meeting once a week.

The researchers took blood samples and measured the length of the participants’ telomeres at the start of the study and again after 5 years. The men who made comprehensive lifestyle changes experienced an average of 10% increase in their telomere length. Men in the control group had their telomeres shrink an average of 3 percent. Furthermore, there appeared to be a relationship between the “ dose “ of lifestyle change and the body’s response - the more positive the lifestyle choices someone made, the longer their telomeres grow.

The first lifestyle change to reverse aging is sleeping well and managing stress.People who live the longest report sleeping for 6-7 hours each night. Lack of sleep of less than 5 hours a night more than doubles the risk of death from cardiovascular disease.

Studies have shown that one of the biggest risk factors to obesity is lack of sleep. There is a 55% more likely chance of developing obesity for adults and this increases to a whopping 89% for children who have insufficient sleep.

There is study published in the journal SLEEP which found that a twin who slept less than 7 hours a night was more likely to have a higher BMI than his or her siblings who slept more. Sleep studies have consistently shown that for most people, getting 7-8 hours will make a big difference to your health.A study on medical interns showed that those that were made to work more than 24 hours straight were 36% more prone to making serious medical errors than those who had enough rest. A study conducted by the University of South Australia compared the effect of staying awake against the effect alcohol has on our functional performance and it was found that they are comparable.

Avoidance of chronic stress is associated with a slower loss of telomeres in most studies and with decreased cortisol levels. Cortisol is a hormone that is released from our body to help us deal with stress. A chronically high cortisol level compromises the immune system, causes cardiac damage and arterial hardening and is associated with facial ageing. Stress can be countered by social connection, spirituality and married life, all of which are associated with longevity. Practising mindfulness meditation have been reported to increase telomerase activity and prolong telomere lengths. According to some studies, people with mental disorders like bipolar disorders, schizophrenia and major depression and post-traumatic stress disorder have shorter telomeres. Stress and mental illnesses, therefore have direct effects on the aging of our cells, with consequences for health over the course of life.

The Second lifestyle change to reverse aging is to stop smoking. Smoking has been shown to reduce both appetite and life span, not to mention the increased risk of cancer. It results in accelerated telomere shortening. Smoking can accelerate skin pigmentation and skin aging. It can also cause accelerated loss of collagen in the skin, resulting in skin thinning.

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Ageing is the process of becoming older. At the cellular level, there is an accumulation of cellular damage with time.

Our hair starts to thin. Balding starts to occur. Grey hair starts to appear. Our brain’s volume peaks in the early 20s and then begin to shrink thereafter. Our eyes start to fail as we develop long-sightedness and even cataract. Ageing causes hearing loss, starting from the higher frequencies. Our taste perception declines too. Salt detection declines and bitter taste is exaggerated. Our muskuloskeletal system starts to weaken. There is loss of muscle and bone mass, with an increase in body fat. Our strength declines by 1.5% per year and that decline accelerates to 3% after 60 years old. Wear and tear occurs in our joints, resulting in back and neck pain, hip and knee osteoarthritis.

We get less efficient at recruiting different areas of our brain. Ageing reduces the ability to learn. Intelligence and motor skills decline with age. People start noticing the subtle changes in their ability to remember or to multi-task. Sadly, ageing is also associated with many neurological disorders like dementia and Parkinson’s disease.

On a cellular level, a few changes happen.
Firstly, telomere shortening. Telomeres are DNA structures, shaped like a “hairpin”, found at both ends of chromosomes. They act like a counter to ensure that cells do not divide indefinitely like cancer cells. With each cell division, the telomeres shorten until they disappear. When that happens, the cell can no longer divide and enter a stage called senescence.

Leonard Hayflick and Paul Moorhead found in the early 1960s that normal human fetal fibroblasts in culture reach a maximum of approximately 50 cell population doublings before becoming senescent.

We know now that telomere dysfunction accelerates the aging process and the accumulation of senescent cells contribute to aging.

The good news is, telomere shortening can be countered by the action of telomerase, an enzyme that lengthens telomeres during each DNA replication.

Secondly, accumulation of errors in our DNA can result in ageing too. The DNA sequence in our body can undergo mutation. These mutations can happen due to errors of replication during cell divisions. They can also happen due to external insults from physical, chemical and biological agents. To minimise these errors, humans have evolved a complex network of DNA repair mechanisms and are capable of correcting most of them.

However, with time, the DNA repair mechanisms start to fail too. When too much DNA error accumulates in the cell , our body will destroy that particular cell as a protective function. And when the rate of cell death exceeds rate of cell replication - aging occurs.

Thirdly, Stem cell exhaustions. The decline in the regenerative potential of tissues is one of the most obvious characteristics of aging. When our store of stem cells are gradually used up, the rate of production of new cells will slow down and eventually stop.

Fourthly, there are diseases which may accelerate aging. Conditions like obesity and compromised immune system will accelerate aging. Obesity causes oxidative stress and inflammation, which may increase the rate of telomere shortening.

In human studies, telomere length measured from our fat cells was significantly shorter in obese patients compared to never-obese ones. Interestingly, it appears that physical activity may protect patients from telomere shortening due to obesity.

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Welcome back to sg dr wellness. I’m dr Chen Yiming.
In this last video of The Eye series, we will be talking about floaters. Have you ever seen these dark spots or squiggly lines in your vision? They come and go and can be really irritating.What are they and what causes them? Should you be worried if you See them?

Floaters are small dark shapes that float across your vision.
They can look like spots, threads, squiggly lines.
They move as your eyes move - so when you try to look at them directly, they tend to dart away. When your eyes stop moving, floaters slowly drift across your vision.
You try to blink them away, but they’re still there. It can be very irritating.

Most people have floaters that come and go, and they often don’t need treatment. But floaters can be a sign of a more serious eye conditions. So if you notice many new floaters that appear suddenly and don’t go away, please seek medical attention right away.

You are at a higher risk of getting floaters if you are
- older ( usually above 50 )
- very short sighted
- or have diabetes

So what causes floaters?
Most floaters are due to ageing.
As we age, tiny strands of your vitreous humour stick together and cast shadows on your retina. Those shadows appear as floaters.
Sometimes, floaters can have more serious causes, including
1) eye infections
2) eye injuries
3) Uveitis ( inflammation in The Eye )
4) bleeding in The Eye
5) Vitreous detachment - when the vitreous humour pulls away from the retina
6) Retinal tear
7) Retinal detachment

Retinal tear or retinal detachment can be a medical emergency as they can lead to blindness and loss of vision.

Symptoms that points to retinal tear and detachment includes
- when a lot of new floaters appear suddenly, sometimes with flashes of light
- or when you see a large dark shadow like a curtain or a blurry area in your vision that doesn’t go away.
Please consult your doctor right away.

How are floaters diagnosed?
Your eye doctor can perform a dilated eye examination where eyedrops are give to widen your pupil. They will then look into your eye using a special machine. In doing so, they are able to accurately and very quickly diagnose the problem.

The treatment for floaters really depends on the cause.
If ageing is the cause of the floaters, then no treatment is needed in most cases.
The floaters do not necessarily go away, but they do become less noticeable with time.
However, if floaters are caused by more serious issues like retinal detachment and tear, then surgical procedures will need to be done to preserve your vision.

I Hope this video helped u gain more knowledge about floaters and how to differentiate between floaters caused by ageing and floaters caused by other serious causes.Remember that floaters caused by serious causes requires urgent treatment.

Till the next time, stay safe and stay healthy.

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Welcome back to Sg Dr Wellness. I am Dr Chen Yiming.
In the third video of this eye series, i will be talking about cataract.
I’m sure many of you have heard of this term cataract and maybe you have cataract yourself.

So what exactly is it?
A cataract is a condition when your eye’s natural lens becomes cloudy, preventing sufficient light from entering The Eye.
Proteins in your lens break down and cause things to look blurry, hazy or less colourful. The lens look hazy and cloudy. It’s as if you were looking through a foggy or dusty car windshield - things naturally look blurry, hazy or less colourful with a cataract.

Some other vision changes you may notice if you have cataract includes
- seeing double vision
- being extra sensitive to light ( especially when driving at night )
- having trouble reading well at night, requiring more light
- seeing bright colours as faded or yellow instead.
- frequent changes in glasses or contact lens prescription

So if you are experiencing any of these symptoms or vision changes, please see an eye doctor immediately.

The most common cause of cataract is ageing.
Other causes & risk factors includes
2) injury to The Eye
3) previous eye conditions and past eye surgery
4) other medical conditions like diabetes
5) Long term usage of medications like steroids
6) Prolonged UV or sunlight exposure
7) Smoking
8) Occasionally young children can get cataract too due to congenital causes.

There are no scientifically proven prevention methods, but these tips may be helpful to slow the progression
1) protect your eyes from UV light by wearing sunglasses regularly
2) Stop smoking
3) Have regular eye checks, especially if you are already over 65
4) Have good control over your pre-existing medical conditions like diabetes.

Cataracts are usually not dangerous to eye health unless they become completely white as it can caused raised eye pressure resulting in closed angle glaucoma.

Now, cataracts cannot be treated with medications.
For mild cases of cataract, lifestyle changes like using prescription glasses or improving the lighting at home can be adopted.
When even lifestyle changes can’t help to compensate the visual impairment, then surgery is the only way to treat cataract.

During a cataract surgery, your eye surgeon will remove the eye’s cloudy natural lens and replace it with an artificial lens. It Is a a small operation and highly effective and safe. In experienced hands, the surgery may take only 30 minutes!

Cataracts are very common reason people lose vision. However it is very treatable and should not be ignored.Like and subscribe to my channel.
Till the next time, stay safe and stay healthy.

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Have you heard of Glaucoma? What exactly is it? What are the risk factors?
What are the signs and symptoms and how is it treated.
Glaucoma is an eye condition that gradually steals your sight without warning.
It does that by damaging your eye’s optic nerve - the nerve that sends images your eye sees to the brain.It usually happens when fluid builds up in the front part of your eye - resulting in high pressure within the eye that pushes back on the optic nerve.

If the damage worsens, glaucoma can cause permanent vision loss or even total blindness. In Singapore, glaucoma affects about 3% of those aged over 40 and this risk increases with age. In 2020, about 80 million people worldwide have glaucoma and this number is expected to increase to over 111 million by 2040.

The Eye is like a ball filled with fluid which provides oxygen and nourishment to the rest of eye. The ciliary body produces the fluid which is then drained out of The Eye via the trabecular meshwork. In a normal functioning eye, the production must balance the drainage. When the production increases or if the drainage is blocked - then The Eye pressure will go up.

What are the risk factors for glaucoma?
1) Positive family history of glaucoma
2) Older age group - the risk increases once you are above 40
3) Ethnicity - Asians, africans and hispanics are at a higher risk
4) Co-existing medical conditions like diabetes, hypertension or migraine
5) Co-existing eye conditions like severe short-sightedness or previous eye injury
6) Use of steroids

There are three main types of glaucoma
1) open angle or wide angle glaucoma, which Is the most common
2) angle closure glaucoma which can either be sudden or longstanding
3) and three, normal tension glaucoma

In open angle or wide angle glaucoma - the drainage system of the fluid is structurally open but is draining fluid slower than it should.
In angle closure glaucoma - the drainage system is blocked when the space between the iris and the cornea becomes too narrow.
In normal tension glaucoma, individuals can develop optic nerve damage even when their eye pressures are normal.

So what are some of the symptoms you may experience when you have glaucoma?In most cases of open-angle glaucoma and long term angle-closure glaucoma, you may not notice any symptoms or visual loss till the advanced stage.Vision loss is gradual and peripheral vision is typically affected first.As the condition progresses, the visual field narrows till only a small central island of vision is left.

In acute angle-closure glaucoma, symptoms are typically sudden and severe.
You may experience
- sudden blurring of vision
- severe pain of The Eye or forehead
- redness of The Eye
- headache, nausea or vomitingSo if you experience any of the above symptoms, please go and see your family physician or eye specialist immediately.

Your eye specialist will go on to
1) measure your eye pressure
2) Inspect your eye’s drainage angle
3) Examine your optic nerve for damage
4) and assess your vision and visual field

When an accurate diagnosis has been made - treatment can then be started
Most people with glaucoma who follow their treatment plan and have regular eye exams are able to keep their vision.

Treatment may involve
- medical treatment by giving eyedrops and in some cases intravenous or oral anti-glaucoma medications
- surgical treatment when medical treatment fails
- even laser therapy in certain situations.

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Myopia, commonly known as short-sightedness is a very common condition where patients can see objects near to you but objects farther away are blurry. In 2050, a total of 4758 million people worldwide , which is almost 50% of the world’s population, are expected to be myopic.
Surveys done locally in singapore indicated that myopia affects one in four 7 year olds, 1/3 of 9 year olds and half of 12 year olds. By 2050, its projected that 80-90% of all singapore adults above 18 will be myopic.

I will share more on causes of myopia, signs and symptoms of identifying early myopia in your kids and lifestyle changes and medical treatments to prevent and delay onset of myopia

childhood myopia or short-sightedness is caused by a combination of genetic factors and environmental factors. what are some of the other environmental factors that can result in increased risk of myopia?

They include
1) prolonged periods of detailed or close work such as reading and writing or computer and tablet usage
2) Lack of time spent outdoors

What are some of the tell-tale signs that your young child may be suffering from early myopia?1) you may find them squinting all the time when looking at distance objects or images
2) You realise that they are sitting closer and closer to the TV or moving to the front of the classroom to get a better view
3) Blinking excessively
4) rubbing his or her eyes frequently
5) Seemingly unaware of distant objects

I will share a few ways to delay and slow down onset and progression of myopia
Firstly, practise good eye care habits.
1) While near works such as school work, working on computers or reading is unavoidable, ensuring that your child takes frequent breaks to rest his or her eyes. Take a break to rest the eyes every 30 to 40 minutes. Look out of the window at distance objects to relax the eyes.
2) Hold any reading material 30 cm away from the eyes and always read while sitting upright
3) Be seated at least 2 metres away when watching television
4) Computer screens or tablet should be placed 50cm away from eyes and adjusted for minimal glare
5) Lighting should be sufficient to illuminate the room when reading, watching television or using the computer and tablets

Secondly, more outdoor and physical activities.
the Singapore Cohort Study of the Risk Factors for Myopia revealed that outdoor activity could be protective against the development of myopia in children. The Sydney Myopia Study presented in 2006 found that the prevalence of myopia in 6 and 7 year old of Chinese ethnicity in Sydney was 3.3% as compared to that of 29.1% in SIngapore. And the main reason for the difference was that Children in Sydney spent about 4 times as much time outdoors than Singapore children and less or hardly any time on tuition. Regular outdoor time of 2 hours a day in young children prevents myopia and its progression by about 10-20%.

Thirdly, early detection.
that can be done through yearly eye examinations. This is because corrective visual aids like spectacles when used early and appropriately can actually help the eyes focus better.

There are also some interventions which can slow down the progression of myopia. Some examples includes atropine eyedrops and the use of special daily disposable contact lens.

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