Category Archives: Hall of Fame

Here is my personal selection of my favorite articles.

My Amazon China Wish List

The winter holidays are here, and it’s time for my favorite tradition — buying gifts for myself. OK, family comes first, of course. This year I am overjoyed to play Santa for the first time, and it’s pure pleasure to give gifts to my family. I now do a lot of my shopping online, both for gifts as well as daily staples of life. I’m not a pro with Chinese, but when I use Google Chrome’s browser and the incredible Zhongwen popup translator, I can now easily get around major shopping websites such as Taobao, Tmall, and the newer Jingdong — but my favorite remains Amazon China. I’m still quite comfortable with Amazon’s familiar, simple interface; higher quality selection (usually) and same day/next day deliveries — usually for free! Below is my top list of essentials. Take a look — and there’s still time for delivery by Christmas!

Winter warmers — If you’re stuck in Beijing’s winter, or even worse, in Shanghai without any indoor heating, you simply must try most of these. For starters, just pick up a radiator or infrared heater 取暖器. But I strongly recommend you buy a foot soak machine 足浴盆, as they are wonderful on a cold night! I was told the Kanglida brand 康立达足浴盆 was good, and ours has been working fine for years. All the good machines keep the water warm at specified temperatures forever, with vibration modes which will lull you into a glorious stupor. Another necessity is an ultrasonic humidifier 超声波加湿器 to keep Beijing’s bone dry air to a more comfy 30-50%. Also, don’t forget about nuan bao bao 暖宝宝  — these small heating pads stick to your clothes, and they radiate glorious muscle-relaxing heat for over 12 hours. They sell a lot of brands of 暖宝宝 but my favorite quality brand is Kobayashi from Japan. They carry a big line of warming products for the back, shoulders, toes — even your pet!

Food — We love to wake up to fresh soy milk, which literally takes only 20 minutes. There are many brands of these soy milk machines 豆浆机 available, and a major brand is Joyoung 九阳豆浆机. If you’re worried about milk in China (and who isn’t?), then anyone anywhere in China could just order imported UHT milk. Oldenburger, from Germany, is an especially good value. And did you know it’s incredibly easy to make your own yogurt? Just buy a yogurt maker, such as from the Bear brand 小熊 of 酸奶机 (click here to read more details on DIY yogurt).  And don’t forget to pamper yourself with luxuries like Kirkland truffles — or any other Kirkland food item. How about some very economical honey imported from France?

Air pollution — They may not have some of the most familiar expat brands, but they carry a big list of  air purifiers 空气净化器 for sale. Daikin, Sharp, etc — including the Philips AC4074, which did very well against PM2.5 and formaldehyde in tests from Shanghai (read the report here). They also have a bunch of PM2.5 masks here at pm2.5口罩, but I would usually stick with 3MWant to make your own purifier with a HEPA filter (HEPA过滤网) and a fan? You can then test its effectiveness with your own PM2.5 particle monitor (PM2.5空气质量检测仪). One of the cheaper plug-in models is from Dylos. Their cheaper 1100 model is available here, but at much higher cost than in the USA.

Kid stuff — You could order more Merries diapers and get by the end of the day.  How about Megabloks? Once they get a bit older and can ride a bike, don’t forget a bike helmet 自行车头盔.

Vitamins — they carry a good supply from American-imported Nature’s Bounty 自然之宝, as well as GNC 健安喜.

Happy shopping — and happy holidays!

Multivitamins: Again, Studies Show They Are Useless For Most of Us

I’ve blogged a couple of times about this, and now a trio of studies seriously underscores what I previously mentioned: a multivitamin is a waste of money for the vast majority of people taking them. Including myself.

I actually had stopped taking them a couple of years ago but recently restarted — not for any particularly good reason, I admit. But now we have three very strong, enormous research studies involving over 450,000 persons which may indeed warrant the blunt editorial title: Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.

To recap these studies, published in the new issue of the Annals of Internal Medicine:

  • A large literature search aimed to find out if long-term use of a multivitamin helped to prevent deaths from heart disease or cancers. They analyzed data from over 400,000 persons and concluded that “limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or cardiovascular disease. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on cardiovascular disease.” This last comment refers to the tiny decrease in cancers in older men, when used for over 10 years. But this relative risk of 0.93 is debatably insignificant — and how does it make sense for men only, and not women?
  • The second study tested multivitamins in people who had recently suffered from a heart attack, following them for over five years and measuring how many died or had more heart attacks or other cardiovascular problems. This study showed no statistically significant improvement, but so many people stopped taking the multivitamins (46%) that it’s difficult to be truly definitive here.
  • The third study tested over 5,000 doctors for more than 12 years, assessing whether the group taking a daily multivitamin had less problems with age-related memory loss and cognitive decline than the placebo group. Again, there was no difference in mental ability between these two groups.

I have to admit that these studies, especially the first study, are quite conclusive, and now I think I’ll just stop taking my daily pill (again). There really isn’t any reason why any reasonably healthy person, eating basically normal food, in any developed country, should take a daily multivitamin. But does this new evidence convince you at all? A huge and growing percentage of people all over the world are taking daily multivitamins, despite all of these increasingly broadcast studies. Why? Why are so many of us simply ignoring science? Read their final statement:

“The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries.”

Are you really not going to change your habits?

Aww, How Cute…Baby’s First Air Pollution Mask!

PM2.5 air pollution masks children
Ready for the great outdoors

Have many of my readers tried the new pollution masks for your kids? I’d love to hear your stories! The big news over the last couple months was the new collection from Vogmask, which has (as far as I know) the first official fit test results, in a real world setting on a child’s face, showing much better than 95% filtration against PM2.5 (even smaller, actually, as the test looks for PM0.3). You can view the test result below or on their site.

Totobobo also claims a smaller size mask, and also the ability to custom-cut down to size. That’s a great option, but as I like hard data I would have to say that Vogmask goes to top of my list for kids, due again to their independent test results on a child’s smaller faces. I believe the results are from an 8-year old, which isn’t a 2-year old — but their younger test subjects couldn’t sit still long enough during the test! And again, it’s better data than anyone else on the market.

Another good thing about Vogmask is that they look “normal”, like a winter facemask which most people wear already. Plus, they come in fun colors, and also different sizes. Some also have an exhalation valve, which I always like on masks to help prevent fogging. My nine-month old son is wearing the baby size in the photo here, which he doesn’t seem to mind too much, especially as daddy has the same fun pattern.

You can buy Vogmask right here at our hospital’s gift shop, or also from the Vogmask Taobao website as well as some local stores, such as Torana Air in Beijing. Always call ahead as they may be out of stock. If you want more information on masks, you can read a few key earlier articles (herehere and here) as well as wander around my air pollution archives.

How about you? Are you having luck getting your kids to wear any of these?

vogmask child fit test PM2.5 N95

Half of China Has Prediabetes

World Diabetes Day 世界糖尿病日
World Diabetes Day 世界糖尿病日

My family medicine colleagues and I recently have noticed an alarming increase in our patients’ blood sugar levels testing high for diabetes and prediabetes, so much so that we figured it must be a lab error. But our lab confirmed these indeed were accurate, and now a recent paper published in the esteemed Journal of the American Medical Association confirms the frightening reality in China: more than half of all persons in China now are prediabetic. Even worse, 11.2% have diabetes, giving China the dubious and unwanted distinction of having the highest prevalence of diabetes in the world. This is now higher than in the USA, an extraordinary statement given the far higher rate of obesity in the USA. As November 14th is World Diabetes Day, I felt a timely urgency to share my advice on how to avoid this disease – or at least to slow it down.

It helps to think of diabetes as a modern lifestyle disease, mostly caused by all developing countries’ gains in weight, less physical activity, and changes in diet. Diabetes now is a global pandemic. Tens of millions of people have diabetes, and many people are undiagnosed because they’ve never been tested. There are two types of diabetes, and type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes in adults.

Diabetes is a disease caused by your body losing the ability to properly digest and use sugars and starches in your foods, thus leading to high levels in your blood. Too much glucose floating around your bloodstream for many years can cause many toxic problems to your organs if not treated — especially with your eyes, kidneys and lower legs. For example, diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputation and new cases of blindness among adults in much of the world. Diabetes also raises your risk of heart disease and some cancers.

Prediabetes concerns us doctors because it means you are at extremely high risk of developing diabetes in the next few years. Studies show that a prediabetic person has a 25% risk of developing diabetes within three years, and a majority within ten years. The greatest risk factor by far is overweight and obesity. Having a BMI under 23 is ideal, and a BMI of 25 increases your lifetime risk of diabetes by 600%. A BMI of 30 increases your risk by 4,000% — that’s 40 times the risk!

The crucially important message for everyone is that you have great control over whether or not you develop full diabetes. You should think of prediabetes as an early warning sign by your body, a major wake up call that whatever you’ve been doing to your body isn’t too healthy. Most people with prediabetes fit one or more of these three major risk factors: body mass index (BMI) over 25; lack of enough exercise; and unhealthy food choices as well as portion sizes.

So let’s say that you’re one of the half of China who has prediabetes: what can you do right now to help? If you follow the three lifestyle steps below, you can lower your risk more than half! One of the most important public health research studies ever, the Diabetes Prevention Program, proved that lifestyle changes worked better than pills. Lifestyle changes lowered a prediabetic person’s risk by 58% over three years — much better than the 31% improvement with a daily pill. The three most important lifestyle tips are:

  1. Lose weight. Weight gain and obesity are the top causes of type 2 diabetes, and losing weight is now proven to be the most effective prevention. In the DPP study, the goal was to lose at least 7% of your body weight. Your goal should be to lose 5-10% of your body weight.
  2. Exercise. Exercise may not directly cause much weight loss, but exercising muscles absorb sugars much more effectively. This is why exercising is crucial to help control sugars, both in a prediabetic as well as in diabetics. How much exercise is enough? We usually recommend 150 minutes a week of moderate exercise, but any amount is better than nothing. Also, as I mentioned in an earlier New York Times column, shorter, more intense workouts also can help.
  3. Proper diet. Healthy food choices also are crucial to control your sugars. One of the most common misperceptions about diabetes and prediabetes is that it’s “a sugar problem” and you must cut down on sweets and desserts. The bigger culprit are total starches — pastas, breads, rice and potatoes. In all these cases, processed versions are never as healthy as the originals.

Here are a few quick tips on nutrition:

  • Brown is always better than white: Processed white bread and flour have lost all the nutritious fiber which helps regulate your bowels as well as your sugar spikes after a meal. If you love your carbs, at least try to switch to whole wheat pastas, breads and rice.
  • Portion control: Total calories are also important, as most likely you are taking in a bit more than you realize. These extra calories will get deposited as fat, which leads to more risk of diabetes.
  • Cut back on sodas, beer and juices: All of these are empty calories, full of processed sugars which stress out your liver and pancreas. These unhealthy carbs, especially in sodas, are a major cause of obesity and diabetes in both children and adults.

Type 2 diabetes is partly genetic, so no matter how healthy you are, it still may be inevitable. But these above steps are always good advice for all of us. Another great thing about these healthy life changes is that they also dramatically reduce your risk of heart disease, many cancers, and early deaths from all causes.

Don’t get discouraged with this prediabetes diagnosis — you have control over the next steps! Even if you already have diabetes, you could maybe avoid that second or third medicine, especially insulin injections, if you followed those above lifestyle steps and especially lost 5-10% of your weight.

 


This is a revised update from my recent article; a Chinese version will be published in my regular column in the New York Times Chinese edition

Air Pollution Masks: A Review of the Best

Update November 2014: After new data in 2014 (please read my personal mask test and a review of three independent tests of masks) I now only strongly recommend truly N95-certified masks such as 3M, and Vogmask as second choice (KN95 certification in June 2014).

What’s the best air pollution mask for China? There are quite a few brands out there, and you now can find them at convenience stores and pharmacies. But which ones really work? Many masks have proven that their material is over 99% effective in blocking PM2.5, which is an important first step. But this test is not nearly as important as real world test results, called quantitative fit tests. Even a great fabric is useless if the mask’s fit isn’t snug on your face, and any air leaking around the edges makes your mask worthless, no matter how expensive or trendy it is. Since air pollution is a truly serious problem here in China, you really shouldn’t mess around with inadequate masks when there are a handful which have proven both 99% fabric effectiveness and 95% or higher efficiency in fit tests. This article offers my personal and professional opinions of the four best reviewed masks, all with proven results: 3M, Totobobo, Vogmask, and I Can Breathe.

3M N95 Masks

The 3M company has a large range of disposable N95 certified masks which they have made for decades as protective gear for construction and heavy industries worldwide. These 3M masks are considered the gold standard of masks as they have the longest track record by far, and all major research studies have used these in their testing of air pollution. Quite a few models are available here, and some have special exhalation valves, useful during sports or preventing fogging up of eyeglasses. Comfort: These are usually very comfortable on the face. But their straps go behind the head and not around the ears, which is less practical for many users. Air Leaking: There is very little leaking if the metal nose bridge is pinched together just right. Exercising: I found it very comfortable to breathe while biking, especially if the model has an exhalation valve. Fog Factor: I had very little fogging of my glasses with a good seal around the nose Stinky Factor: After a few days these do tend to look grey and haggard Hipness: Not very consumer-friendly, usually with big black writing, bright yellow elastic strap and an imposing exhalation valve Reusable filters: These don’t take replacement filters; each mask can be used for at least a few days until they get dirty or you can’t breathe as easily through it Kid Friendly: They only have one model for younger faces, the 1860S child size. But this isn’t easily found in China. Longevity: Each mask can last at least a few days of use before losing effectiveness Cost: Each mask should be around 7-15 RMB each, depending on volume. Bottom Line: 3M will always be the gold standard, is available everywhere, and is useful at all times. You should always have a few available in a pinch. But it’s not the most user friendly or attractive, and you may prefer reusable ones to cut down on waste.

Vogmask

Vogmask was started by a group in the super-green enclave of Santa Cruz, California.  They carry two types of fabrics, with their flagship models made of a high-tech non-woven microfiber. They are making a big splash this summer with the first consumer line of pollution masks specifically designed for children’s faces. Comfort: Their mask is extremely comfortable for most users. Air Leaking: It’s not quite as snug as some others and I did occasionally smell street odors. Exercising: The fabric gets soggy during exercise, as it rests on the lips. I also found it harder to take deeper breaths. Fog Factor: It sometimes takes a bit of fine tuning the metal nose clip for a good seal, but overall wasn’t a big deal Stinky Factor: This rests on the lips so gets soggy very quickly, which may be uncomfortable for some. Hipness: They have a wide assortment of colors and patterns. Also, since they look exactly like the winter kouzhao facemasks that many Beijingers use, you can blend in without getting stares. Filters: No need, as the fabric itself is the filter Kid Friendly: Yes, they offer two sizes for children from all ages, including infants. Longevity: Each mask is washable many times with no loss of filtration effectiveness Cost: 120-150 RMB, depending on the size Bottom Line: Vogmask is extremely comfortable and has a wide selection of patterns, and they are first on the market with children’s sizes which actually are proven to work. It’s not my first choice when exercising.

Totobobo

totoboto mask CBD clinic N95 air pollutionTotobobo is the more well known reusable, consumer friendly mask as they have been around for a few years. Originally from Singapore, they have a few models for adults and kids, with differing levels of filtration from 92 to 96% — but in China there’s no reason not to use the strongest, at 96%.  Comfort: This is usually very comfortable but the plastic edges can leave skin indentations which last longer than other softer masks. Straps can go either around the head or just the ears, depending on the model. Air Leaking: The general fit is usually excellent, and you can cut edges off for an even better fit. Exercising: I had no problems during biking or jogging and still felt able to catch a breath. Fog Factor: Sometimes the nose fit isn’t perfect and my eyeglasses fog up, but this is rare Stinky Factor: It’s easy to steam up inside the plastic and takes a while to dry. Otherwise, cleaning off is easy. Hipness: The mask is clear and the small white filters are very unobtrusive. But it only comes in one style. Filters: It’s very easy to replace their small filters. Kid Friendly: Many, but not all, parents have had success cutting the masks down for children’s size. And some kids don’t mind this style compared to others. Reusability: The mask itself can last for years, and you just pop in a new filter every few days. The thin straps slowly stretch out and may eventually need replacing. Cost: 2oo RMB for the mask frame and 25 RMB for each pair of replacement 96% filters Bottom Line: Totobobo is an excellent choice with a growing track record, and also can be used for older kids if you cut it down properly.

I Can Breathe!

The I Can Breathe! reusable masks come from the USA. They have many models and styles available, and their Active Sports Mask has the best proof of effectiveness. Comfort: Their mesh fabric is very comfortable, and their adjustable straps go around the ears. Air Leaking: There is a bit of leaking and odor from the streets. Exercising: It was generally fine but not the best I’ve tried. Breathing rates were adequate. The exhalation valve helps prevent steaming up. Fog Factor: I had very little fogging of my glasses. Stinky Factor: They did well here; it dries quickly and your mouth isn’t resting on the fabric. Hipness: Not bad at all, as they have many different colors and models. Filters: The replaceable filter is a bit difficult to switch out, but it’s not a serious problem. Kid Friendly: They do not have specific children’s sizes. Longevity: The outer mesh is washable many times, and you buy filter inserts. Cost: 245 RMB for the mask, and 50 RMB for the replaceable filter Bottom Line: This is a very good, comfortable mask for adults during leisure and sports.


This article was originally printed in the 2013-4 BeijingKids Health Guide — click here to read it online