Kiwifruit as part of a healthy Singaporean Diet

I recently delivered a talk on Kiwifruit as part of a healthy Singaporean diet. This was conducted during the launch of the Zespri Kiwifruit season which will last till the end of the year. In general we Singaporeans do not eat enough fruits and vegetables. Just look at a plate of Char Kway Teow, Chicken Rice and Fishball Noodles. There is hardly enough veggies in each dish to make up even one serving!

Here are the salient points of the speech I delivered. Remember that you need at least 2 servings of vegetables and 2 servings of fruits everyday and one serving is equal to around 100gms or one cupful. So remember to eat more fruits and veggies!



Children and adolescents are not eating enough fruits and vegetables

Children are unable to eat as much as adults, yet their nutritional requirements are higher than adults. Adolescents are eating lots of junk food and snacks which are high in sodium, saturated fats and low in nutritional value.

According to a study by LaChance(1), Kiwifruit was ranked #1 amongst a list of 27 popular fruits in terms of nutrient density. That means that for children especially, every mouthful of kiwifruit carries more nutritional value than if he was eating other fruits.

Since an apple a day keeps the doctor away, let’s compare Kiwifruit with Apple to get a sense of the nutritional density of the fruit.


Table 1: Kiwifruit vs Apple in terms of nutrition density

It is not easy to get kids to eat fruits and vegetables, so we want to make sure that every mouthful counts. Eating Kiwifruit is a practical way of getting as much nutrients into kids as you can.

Eating fruits and vegetables need to be cultivated from young.

In Singapore, it has been shown that amongst the Chinese adults, those who were eating the recommended number of servings of fruits and vegetables were three times more likely to have cultivated the habit during childhood. (2)

An adequate intake of fruit during childhood may protect the person from getting cancer in adulthood. It has been shown that childhood intake of fruit and vegetables were inversely associated with the risk of cancer in adulthood. (3)

Children are finicky eaters especially when it comes to fruits and vegetables. But it is often easier for them to enjoy fruits as they are often sweet and tasty. My kids love Zespri Gold Kiwi. It is so easy to eat, you just need to cut in half and scoop it out. I don’t have to force them to eat it, in fact, they have to ask for permission to eat the last one in the fridge.
Childhood asthma in Singapore and Kiwifruits

Asthma affects one in five children in Singapore and is a growing problem. Kiwifruits are very high in Vitamin C and it has been shown that children with a diet high in Vit C have less wheezing episodes. Vit C is also very important to keep the body’s immune system healthy which can help lower the risk of getting infections like the H1N1 flu.(4)


Table 2: Nutrients in Kiwifruit
Source www.whfoods.com

Cancer and Cardiovascular Disease

Cancer, heart disease and stroke are the principle causes of death in Singapore, accounting for almost 60% of all deaths in 2007.5 Heart Disease

Heart Disease accounts for 28.5% deaths in 2007.(5) It is clear in the studies that consumption of fruit and vegetables can protect against coronary artery disease. (6)

Kiwifruit is high in folate which possibly lowers blood levels of homocysteine, which is a risk factor in coronary heart disease. The high levels of potassium contained in Kiwifruit is beneficial for lowering blood pressure. It is also high in antioxidants, phytochemicals and Vitamin E. These have all be suggested to be cardio-protective. However, it Is interesting to note that Vit E supplements by themselves has not been shown to lower the risk of coronary disease.(7) However, taken together with the other nutrients in the fruit like the antioxidants and phytochemicals, it exerts its protective effect. So in other words, it is still better to take a good diet of fruits and vegetables rather than swallowing supplements if you want to protect your heart!

Cancer

Cancer accounted for 27.7% of deaths in 2007.(8) WHO expert panel estimated that low fruit and vegetable intake contributes to 5 to 12 percent of all cancers, and up to 20 to 30 percent of gastrointestinal cancers that may otherwise be preventable.(9) The protective effect of fruits and vegetables has been noted especially in relation to cancers of the gastrointestinal tract. In Singapore, cancer of the colon and stomach account for 25.1%.

It has been reported that the low intake of vegetables is associated with the increase risk of colorectal cancer in Chinese adults. (10) The protective effect of fruits and vegetables comes from a combination of antioxidants, phytochemicals and dietary fibre found in fruits and vegetables. Kiwifruit is very high in soluble fibre. It is shown that regular intake of Kiwifruit can promote regular bowel movement.11 The combination of high dietary fibre, together with the antioxidative properties of Vit E, Vit C and phytochemicals found in Kiwifruit can contribute significantly to a healthy cancer prevention diet.

References:

1. Lachance P, 1997, Journal of the American College of nutrition

2. Ling AM et al. Defining and measuring stages of change for dietary behaviors: readiness to meet fruit, vegetable, and grain guidelines among Chinese Singaporeans. J Am Diet Assoc 2000; 100:898-904

3. Maynard M et al. Fruit, vegetables, and antioxidants in childhood and risk of adult cancer: the Boyd Orr cohort. J Epidemiol Community Health 2003; 57: 218-25

4. Francesco F et al, Consumption of fresh fruits rich in vit C and wheezing symptoms in children, Thorax 2000:

5. Source: MOH http://www.moh.gov.sg/mohcorp/statistics.aspx?id=5526

6. Ness AR et al. Fruit and vegetables, and cardiovascular disease: a review. Int J Epidemiol 1997;26:1-13

7. Yusuf S et al. Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study investigators. N Eng J Med 2000; 342: 154-60

8. Source: http://www.nccs.com.sg/pbcation/canhelp/Dec05/focus1.htm

9. International Agency for Research on Cancer (IARC) Handbook of Cancer prevention. Lyon IARC, 2003

10. Seow A et al, Food groups and the risk of colorectal carcinoma in an Asian population. Cancer 2002;95:2390-96 11. Rush E. C. et al. Asia Pac J Clin Nutr. 2002, 11;164-8

Acknowledgments

This article is based on materials presented in the Dietary Guidelines for Children and Adolescents for the Healthcare Professional, Health Promotion Board 2007

The H1N1 Flu is here but don't need to Panic!

Several patients have walked into the clinic this morning asking about the implications of the H1N1 flu in Singapore.

At this point in time, do not panic. This H1N1 strain does not seem to be deadly and the three people are doing well. In terms of severity, it is like the normal seasonal flu that we experience year round.

So just go about your normal life, keep a good level of hygiene, eat plenty of fruits like Kiwifruit, oranges and papaya which are high in Vitamin C to keep your body's immune system in good shape.

Of course if you just came back from US, Mexico or other affected countries and you are experiencing flu symptoms of high fever, cough, runny nose and sorethroat then seek medical advise immediately.

Those Fever Pads can give Parents a false sense of security!

I saw two kids yesterday who came into the clinic with fever pads on their heads. I get really concerned when I see fever pads, because invariably when I take their temperature, it is going to be really high. And just as I predicted, both kids were having temperatures approaching 40 degrees.

I don't use fever pads for my own kids. When they get a fever, I feed them with paracetamol and use a wet towel to wipe them from the top of their head to the waistline and I keep doing it until the fever becomes manageable. The problem with the fever pads is that parents feel that just by putting on the fever pad, they have already done their job and neglect giving medication and sponging.

So what happens is, when the fever pad absorbs all the heat it can, it stops doing anything and consequently, the child's fever continues to escalate.

If you are a mom or dad, please don't be lulled by the clever marketing tactics of the fever pad companies. It is much cheaper and more environmentally friendly to use a wet towel and it works much better. The only thing the fever pad does is to lull you into a false sense of security.

The Flu Shot: New Stocks have just arrived

Our stock of the latest season Flu vaccines have just arrived! If you are planning to take your flu jabs, please call us to reserve yours because stocks are limited.

Clinic will be opened on Vesak Day

Our clinic will remain opened for consultation from 8.30am to 12.30pm.

We wish all our Buddhist patients a meaningful Vesak Day.

Swine Flu: Influenza A (H1N1) not as devastating as originally thought

It seems that the Swine Flu or Influenza A (H1N1) virus was not as virulent as was feared.

It was initially thought that the fatality rate from Swine Flu was as high as 6% but after some reclassification and taking into account the underreporting of milder cases, it would seem that the fatality rate is not that high.

Our Ministry of Health will progressively downgrade our DORSCON Status from Orange to Yellow by 11 May. What that means is that when you visit the clinic on 11 May, everything should be much the same as before. That a big relief as I often have to show our younger patients how to stick out their tongues by demonstrating it myself!

However, parents are still adviced to be vigilant and to observe a good level of hygiene. Please do not send your child to school if they are having a fever. Everyone can do their part to control the spread of highly infectious diseases like Swine Flu.

We have managed to put in an order of Flu vaccinations which should be coming in next week. As there are limited stock, please call the clinic to reserve your vaccine and we will inform you when the stock gets in.

Swine Flu: Safety precautions at the clinic

With the impending arrival of Swine flu on our shores, our clinic has implemented the necessary precautions to protect our patients.

If you are having a fever and flu symptoms, please let our staff know. You will have your temperature taken and if it is elevated, you will be required to sit outside the clinic. All this is necessary to prevent the spread of the disease.

So far there has not been any Swine Flu cases in Singapore, but it is only a matter of time before we get our first case. The global community is much better prepared after SARS and Bird Flu which might explain why this time round the impact of Swine Flu is not has devastating as expected. But we still need to be on our guard and look after ourselves and our family as well as the community around us by doing the necessary things to prevent the virus from spreading.

For a list of FAQ on Swine Flu, please click here

Do write in the comments if you have any pressing questions about Swine Flu.

Help! My child has difficulty sleeping!

Insomnia is a very common problem which we see often in the clinic. Most of the time it is caused by psychological problems caused by stress and anxiety. In general, kids have little problems falling asleep since there is relatively little stress in their lives. They don't have to worry about bosses, spouses, how to pay the bills and what is happening with their careers.

For young children, their world revolves primarily around their parents. I don't know whether you have come across the situation where the child gets upset when he see his parents quarelling. The child's survival instinct tells him that his parents are the source for everything, from food to shelter to love and affection. So, built into each child is a "Parental Bliss" alarm system which sounds off whenever the child feels that something is not right with Daddy and Mommy.

So it is vitally important for the child to know that everything is well between Daddy and Mommy and impetus is really up to us as parents to "Market" that to the child. Don't just take for granted that the child knows that you and your spouse are still in a loving relationship. You really do need to demonstrate it openly to the child. One of the things that you can do is to set aside some time each week for you and your spouse to be seen just talking to each other. This special "Togetherness Time" is a time when you and your spouse sit down and chat for maybe 10 or 15 mins and has to be a place where your child can see you but not interrupt. When the child sees that his parents are in a loving relationship, he will feel that his whole world is secure and life is good. That added sense of security might just solve that sleep problem!

My wife and I have been attending an excellent parenting course at a local church and this is just one of the many things that we learnt. So we have made a concerted effort to implement some of the things at home. It does make a difference for your child and for your family life as a whole.

If you have problems with your kids, maybe it is not your kids that need training, but you! The course I attend is conducted by Growing Kids Int'l and you can find more information at their webiste here.

Happy Parenting!

First Malaysian-Singaporean Expert Group Meeting on Pneumococcal Vaccination

I just returned from an Expert meeting on Pneumococcal diesease over the weekend. This meeting comprised of a small group of Doctors from Malaysia and Singapore whose main goal is to provide a forum to enable experts from both countries to share and exchange knowledege, clinical experience and insights in order to improve the management of pneumococcal disease and vaccination.

Chairing the meeting was Assoc Prof Daniel Goh, Chief of Paediatrics from NUH's University Children's Medical Institute and in attendence were specialists from both countries in Microbiology, Epidemiology and Paediatrics. I was one of two GPs who have been invited to be part of the expert panel to share our experience of pneumococcal vaccination in the general practice setting.

This meeting emphasized the need for more children to be vaccinated from the pneumococcal disease. Prof Daniel shared that the importance of vaccinating children from birth was important because by 6 months of age, a significant proportion of children will already have developed carrier status. That means that they carry the bacteria in their nose and throat where it might one day be activated and cause infections such as meningitis and pneumonia. By vaccinating the baby at 2 month, you reduce the risk of the child becoming a carrier.

A lot of information has been shared and these will be used in subsequent campaigns to educate the public on the importance of vaccinating kids with the pneumococcal vaccine.

Click here to read my last post on pneumococcal disease.

Karri Family Clinic 4th Anniversary

Karri Family Clinic is four years old! We had our staff and family lunch today to celebrate our fourth anniversary.

We wouldn't be here if not for the support of all our patients. So a big THANK YOU for choosing Karri Family Clinic. We will do our best to continue to serve you and your family better.

Good Friday: Clinic will be closed

We wish all our Christian patients a very meaningful Good Friday.

Our Clinic will be closed on Good Friday.

We will remain opened on Saturday 8.30am to 12.30pm and Sunday 6.30pm to 9.30pm.

Woman dies from eating Rojak at Geylang Serai Temporary Market

In case you still haven't heard, it has been reported that a woman had died from eating rojak at Geylang Serai Temporary Market.

At the point in time, MOH/NEA has not informed us of the cause of death, but it does appear that only one stall was responsible for the outbreak and that is the Indian Rojak stall no. 320.

What I think might have happened is that somehow the rojak was contaminated by some bacteria and because the rojak is prepared beforehand and left to sit in the display cabinate for a length of time, the bacteria has time to grow and produce its toxins.

The lesson to be learnt here is to be careful when eating food that have been lying around for a long time. The safest food to eat are those which have been freshly prepared.

If you have recently eaten at the Indian Rojak Stall in Geylang Serai and are experiencing diarrhoea, vomiting or stomach cramps, please consult your family doctor immediately.

The story can be read here.

The 938live Body and Soul Interview

In case you did not catch it on 938live, here are the podcasts of the interview I did with Daniel Martin last week on Body and Soul.

Dr Tay on 938live Body and Soul

Just in case you are interested to tune in, I will be speaking to Daniel Martin on 938live Body and Soul program on 2 Apr 2009 at 3.45pm. We will be talking about Chickenpox and why you should consider vaccinating your kids and yourself if you have not done so.

The Pneumoccocal bug is not to be trifled with!

I have been very affected by an email which I received from a distraught parent last week. She recounted that she had just lost her 2 year old son who succumbed to pneumococcal infection.

This pneumococcus bug can affect different parts of the body. Most commonly it can infect the brain, causing meningitis, the lungs (pneumonia), the ears (otitis media) or enter the bloodstream and cause widespread infection.

Having heard about this unfortunate case, I have been strongly urging every parent that comes to the clinic to consider vaccinating their kids from this disease. It was then that one parent also told me of another recent case of a pre-schooler who also died from the infection.

In retrospect, these tragedies might have been prevented if the kids had been given the pneumoccocal vaccination which has been available for the last few years. In Singapore it is not part of the list of compulsory vaccinations that all babies need to be given. So a lot of the time it is up to the doctors to inform their patients. In other countries like Australia for instance, all babies are required to be vaccinated from birth. I hope it is only a matter of time before the MOH adds this vaccine to the list of necessary vaccines for newborns.

In the meantime, it is up to you as parents to be aware and informed of the availability of the vaccine. A lot of information is already online, so I will not elaborate on the condition. However, I would like to let you know that these series of incidents has affect the way I look at this disease and so here are some of the things that I do now which I did not in the past:

1. Encourage parents to give the pneumoccocal vaccine from birth rather than let them wait till the age of two. The pneumoccoal vaccine is expensive, so at birth you need four jabs, but as the baby gets older, the number of jabs reduces till at two years of age, you only need one jab. I used to sympathize with parents concerning the cost of these jabs and so some parents decide to give later. However, I am now redoubling my efforts to educate and encourage parents to give it from birth.

2. In order to do this, I have decided to reduce the price of the vaccine to encourage parents to give it in the first year of life. So I have started to offer a package of 4 vaccines for $620 which works out to be $155 each. The normal price of the vaccine is $170. This price is nett so there is no GST or consultation charge if you only come to do the vaccination.

3. I am also now being extra vigilant in younger children who present with fever. There are some parents who are very resistant to the use of antibiotics and I agree that too much antibiotic use is not good. But we should also not go to the other extreme and let our children suffer from a prolonged fever. Pneumoccocal disease does respond to antibiotics, so a course of antibiotics given on suspicion of pneumoccocal disease does save lives and prevent severe disabilities. There was one instance of a 6 year old girl who did not present to the doctor until after 1 week of fever. By that time, the pneumococal bug had already got into the bloodstream and affected the kidneys. The girl is left with only 10% of kidney function and will need dialysis in the future. So as parents, a good general rule of thumb is to bring your kids to see the doctor if the fever lasts for more than three days or earlier if the child is really unwell.

So parents, if your child has not been vaccinated, please read up and be informed of the dangers of pneumoccocal disease and do let your friends know about it.

More info on pneumoccocal disease can be found here.

For info on other available vaccines, please click here.