• A Day In Beijing Is Like Smoking Only One Sixth Of A Cigarette? It’s Almost…Disappointing! – this was one of my most fun projects, and still very controversial.
• Official School Air Pollution Action Plan: You’re Not Going To Like It – another very controversial post, I detail why Beijing schools should enact no-outdoor-activity cutoffs when the AQI reaches 200.
• Alen Air Purifiers Battle IQAir and Blueair – I had geeky fun running around my apartment for 3 days with 4 purifiers, one particle monitor and a spreadsheet. And the winner is…the consumer!
• Happy Birthday, Dad. You Died Far Too Young – the most painful article I’ve ever written, I offer this as a homage to my father, who died of alcoholic cirrhosis.
• Hey Laowai: Now You Can Use Weibo In English. Here’s How – not medical but important and also very popular, I give step-by-step instructions on using China’s coolest website, Weibo (you can always follow my Weibo at weibo.com/daniudaifu). Also non-medical but culturally important was my article helping people use group-buying websites in China (tuangou), which have saved me tens of thousands of RMB on everyday purchases in just two years
• High Cholesterol Hits Home… – another very personal article, I describe my brother’s efforts to control his dangerously high triglycerides
• Radiation Hits China — In “Harmless” Amounts. What Level Actually is “Harmless”? – this was enormously popular all over the world, not just in China, during last spring’s radiation scare in Japan.
• Air Pollution Masks: Buy Them Now! Here’s Where — And Why – I detail why I think N95 masks should be the new Beijing accessory.
• Welcome To Beijing! Here’s What You Need To Know To Stay Healthy – I detail my top ten wellness tips for Beijing’s newcomers
• Diabetes: What Natural Medicines Work — Or Don’t Work? and Diabetes: What’s The #1 Way To Prevent It? – this one-two punch offers practical tips on both avoiding and treating the global lifestyle epidemic of diabetes

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Metro’s Fish and Produce — My wife and I finally discovered Metro, the German hypermarket chain, this summer, and we’re really glad we did. It’s instantly become our favorite place to buy groceries. I’m especially impressed with their standards on two important food safety concerns: their frozen fish section, and their organic and traceable produce.

Water filters for shower and drinking – Every winter in Beijing, I have seriously itchy, dry skin mostly around the shins which drives me nuts. I’ve survived on thick moisturizers and baby oil — until this winter, when I’ve had zero problems with itchy skin. Not just a slight improvement; my shins have been completely itch-free, and I’m usually not even using any oils at all. What’s the big improvement? I’m happy to say that my theory about Beijing’s shower water having skin-irritating chemicals may actually be true! Last spring I bought and installed an Aquasana Shower Filter, and I’m actually shocked that I now have zero itchiness. Perhaps those of you who also complain of thinning hair in China may benefit? (This is obviously not a scientific study, just anecdotal, I just thought I’d share…)

Also, we installed an under-the-sink drinking water filter in our kitchen and we really love this as well. I never liked the water bottle idea, and I previously had used those 1 liter Brita-style countertop jugs which constantly needed refilling. But this installed version filters much more efficiently and is also extremely convenient.

Elderberry & Zinc lozenges for the common cold — In my desperate search for evidence-based treatments for the common cold, I’ve discovered some fairly strong evidence that both elderberry and zinc help to decrease the severity and length of the common cold. So I now take a chewable elderberry/zinc combo pill three times a day whenever I feel a regular cold starting, and I must admit that my colds last year were much shorter and less severe. I’m sure there are multiple products to buy, including syrups for kids: one great website to research and to order and deliver is at another of my 2011 discoveries: iherb.com.

An 18-Speed Bicycle — Yes, people, I have now started to practice what I relentlessly preach: exercise! For the first time since coming to Beijing, I am getting routine exercise. And the best part is that it’s not purposeful “exercise” — it’s simply  real-life commuting 25 minutes a day on my new Giant Hunter 2.0 urban bicycle instead of my fun-but-lazy electric bike. I am now getting 250 minutes a week of moderate, cardio-burning exercise. The air pollution has been relatively good lately, but I have my N95 mask in my bag just in case. And of course, I usually wear my bike helmet — although it didn’t prevent my backside from throbbing after this morning’s tumble on black ice…ouch…

Men’s sunscreen face creams — Women have been far ahead than men when it comes to availability of daily facial moisturizers which also have built-in sunscreen. Finally this year, Watsons and all other major stores started to carry my favorite men’s version, Neutrogena Triple Protect face lotion. This has SPF20 and also is great post-shave, especially for acne-prone sensitive skin types like mine.

What were your major health breakthroughs in 2011?

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I’m very skeptical of the common practice in Chinese “health check” centers to do multiple screening tests for cancers. Many of these tests are neither specific nor sensitive enough for cost-effective screening, and most patients end up spending a lot of money on follow-up tests which prove benign. I’m not saying the concept is bad, I’m saying that many blood biomarkers are not ready for prime time. It’s really a shame, as many cancers including liver cancer are usually diagnosed too late to help the patient survive for a long time. Perhaps there’s now some hope with liver cancer, as a Chinese team has designed a blood test which may be more accurate than the common AFP test. This hopefully will turn out to be truly effective, especially for China, as liver cancer from hepatitis B is extremely common. I discuss this issue in my weekly radio broadcast on Beijing Hour; you can listen to the podcast with the above links.

Paul James and I also discuss recent news stories about the questionable nutritional value of many popular milk beverages, including Wahaha’s Nutri-Express line of milk+juice combinations. I’ve never tried them so cannot comment on the taste (milk with juice?), but in general the vast majority of this class of drinks are never as nutritious as the real deal. In other words, pure milk is usually a lot better than the super-sweetened mixes, and juices in boxes are almost always super-sweetened and also have less of the original nutrients. Your grandma was right: an apple a day keeps the doctor away.

More Podcast Information

You can always listen live to my radio interview each Wednesday around 7:35am Beijing time, on the Beijing Hour program on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the China Radio International network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.

You can listen to all my previous podcasts at the podcast archive.

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I’ve simplified my supplements this year and now only take vitamin D and fish oil. Both of these made the news again last week, and both stories reinforced my belief that they both are uniquely powerful supplements for almost anyone, at any age.

In last week’s weekly radio interview with Paul James, we first discuss a Xinhuanet article about vitamin D and diabetes. They discuss a new study in obese children which showed that obese children with lower vitamin D levels had higher degrees of insulin resistance:

…”Although our study cannot prove causation, it does suggest that low vitamin D levels may play a role in the development of type 2 diabetes.”…”Poor dietary habits such as skipping breakfast and increased soda and juice intake were associated with the lower vitamin D levels seen in obese children,”…

It’s not a terrific study as the connection may be chicken-and-egg; in other words, is low vitamin D leading to diabetes, or is it just a marker of people that have diabetes? Stay tuned for more research, but in the meantime, I’ve always been a big fan of vitamin D, and kids are supposed to be taking supplements anyway (it’s the official position of the AAP). I and other docs at BJU have also found quite a few Beijingers with low blood levels of vitamin D, at all times of the year.

We also discuss yet another Xinhuanet story discussing a powerful research study of one of fatty fish’s major ingredients, omega-3 fatty acids. This study specifically looked at healthy younger women (50,000 Danish women), and found an astonishing 50% increase in heart disease in the women who ate zero fish when compared to those who ate the most fish. In other words, even for healthy young people at any age with no previous heart troubles, eating fatty fish can still lower your risk of heart attacks and strokes by a major amount. Powerful stuff, and certainly not the first study to show this dose-dependent cardioprotective effect:

“To our knowledge this is the first study of this size to focus exclusively on women of childbearing age,” said Marin Strom, lead researcher and post doctoral fellow at the Center for Fetal Programming, at Statens Serum Institute in Copenhagen, Denmark. ” We saw a strong association with cardiovascular disease in the women who were still in their late 30′s.”

The most common fish consumed by women in the study were cod, salmon, herring, and mackerel.

“Our study shows that for younger women, eating fish is very important for overall health, and even though we found cardio- protective effects at relatively modest dietary levels, higher levels may yield additional benefits,” Strom said.

More Podcast Information

You can always listen live to my radio interview each Wednesday around 7:35am Beijing time, on the Beijing Hour program on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the China Radio International network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.

You can listen to all my previous podcasts at the podcast archive.

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These are two of a handful of necessities I use to survive Beijing’s long winters. Here are my other favorites:

Use baby oil for smooth skin: Beijing’s winters are dry, dry dry. Get yourself a hygrometer to monitor for yourself; indoor air is most comfortable at 40-60%, but in winter is usually 15-20%. That’s almost airplane-cabin dry, and you instantly feel it on your skin and lips. The best way to prevent dry, itchy skin is a good moisturizer after your shower. I like Neutrogena, but this year I discovered an even better therapy for me: baby oil.

Put an ec0-fireplace in any room. There truly is nothing like coming home to a warm fire. And yes, you can have a real fire in any apartment complex, inany room, if you use a special metal box that burns clean 95% alcohol without any special needs for ventilation due to its clean burn. I bought these Ecosmart bioethanol fireplaces from L’art Et La Matiere in Beijing, and we installed it into a custom fireplace in our living room. The flame is smallish but it’s real, and it’s lovely and warming.

Use a foot soak every night. Now that you’re in front of your real fire, go to the next level and buy yourself one of the dozens of Chinese-made foot soaking machines. They are sold everywhere: Carrefour, Walmart, Suning, Taobao etc etc. It’s a treat to come home and soak a bit.

Turn on the humidifier. This is even more crucial than the daily baby oil, since a good humidifier can pump up the humidity to nice indoor levels of 40-60%, which will instantly help your skin, your throat, your sleeping, and your wood furniture. I’ve always preferred the Yadu brand.

Put up the Christmas tree now. Why wait for December? Just put it up now! And don’t take it down early; we keep ours up until after Chinese new years in January/February. I always love that Christmassy glow of the lights and decorations. You can buy live Christmas trees at the Liangma flower market (the smaller one, behind the Kempinski) or you can get a fake tree on their second floor winter wonderland, stacked with holiday decorations at amazing prices.

Eat lots of warm chestnuts and yams. This tradition is one of downtown Beijing’s charms: the multiple vendors selling delicious warm yams for 2RMB from their big metal barrels, as well as the many stores roasting fresh chestnuts. Get in line, pay 10-15RMB a bag and enjoy!

Go to a local hot spring resort. Beijing’s suburbs are blessed with some excellent hot springs resorts, and I love to check them out every few weeks, especially on those bitter cold days. The one just across from Ikea is also very nice.

Snuggle with your true love. All of the above tips are nice to follow, but if I came home to my foot soak and my fireplace –  and if my house was empty of my wife, then I would feel an enormous, cold empty hole inside me. I truly feel lucky to have her in my life, and that love is what warms my days more than anything else. I hope all of you have someone special like that. If not, keep looking — everyone deserves it!

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I said this last year because of a large meta-analysis from the esteemed Cochrane group, which found only about a 73% reduced risk of the flu — in the most ideal situation. Plus, it barely seemed effective for kids under 2 years of age. Now, just this week, an even more specific meta-analysis just published in the Lancet Infectious Diseases shows an even less effective prevention: 59%. During the recent H1N1 years, it was a bit better at 69%. Here’s a bit from their abstract:

Interpretation: Influenza vaccines can provide moderate protection against virologically confirmed influenza, but such protection is greatly reduced or absent in some seasons. Evidence for protection in adults aged 65 years or older is lacking. LAIVs consistently show highest efficacy in young children (aged 6 months to 7 years). New vaccines with improved clinical efficacy and effectiveness are needed to further reduce influenza-related morbidity and mortality.

So there you have it. So the question is; do you like those odds? No, it’s not 100% but it’s still darn good, in my opinion. We all hope a better vaccine is just around the corner with new technology, but let’s just get to the point:

• I definitely plan to get the vaccine, as I am surrounded by sick adults and kids and I don’t want to give the flu to them.
• In the same vein, any person in close contact to our most vulnerable patients (kids under 2; the very old; and people with chronic diseases) should really consider getting the vaccine, again to prevent you from giving it to your vulnerable loved one.
• Pregnant women should definitely get the vaccine
• Anyone who wants it should get it.

For those of you who don’t have people coming to your office or school, you can drop by our Beijing clinics (United Family Healthcare) anytime and get it for 99 RMB total, no other fees added.  All international clinics now offer similar services.

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Well, that certainly perked up my ears. My oldest brother had cholesterol problems at such dangerously high levels (normal TG is under 150) that he was a “walking heart attack risk” before the age of 50. Needless to say, I picked up my jaw off the floor and had a long brother/doctor heart-to-heart discussion with him about how serious this was. I even showed him his cardiovascular risk score (from myhealthcheckup.com) and showed him how he has a 12% risk of having a heart attack or a stroke in the next 10 years (normal risk is ~5%; mine is 1.5%; anything over 10% worries us docs). I’m not exactly sure how that doctor last year let him get out of his office without medicines or strong warnings, but it doesn’t really matter now; I have no intention of letting my only older brother depart from this world prematurely.

One important point for my readers is that for many of you, as well as for my brother, lifestyle changes only take you so far. Honestly, even if my brother spent 3-6 months losing 10 kilograms and having a hardcore low-fat diet, his levels still would be higher than normal, certainly still high enough to be laying down that artery-clogging cholesterol plaque in his heart and brain. Many people cling to this noble idea that lifestyle changes will help a lot, and they absolutely do and should be a part of anyone’s treatment, including when on prescription meds. But for a great many of us, medicines are inevitable. That’s not a bad thing at all! It’s just the hard draw of our genetic makeup. This idea is called epigenetics, a very trendy and exciting research term: our genetic makeup determines a lot about which diseases we get, but our environment can dramatically effect how severe, or how quickly, we develop those pre-programmed diseases. In my brother’s case, he likely has a genetic weakness for cholesterol, especially triglycerides, but his decades of a typical American diet clearly makes his condition worse than it could be.

That’s why cholesterol-lowering medicines for many of us are not only inevitable but essential. The prescription statins such as Lipitor have been remarkably effective for tens of millions of people, and they literally can cut your risk of heart attacks and strokes more than 50%. But another take-home message is that a few natural medicines can also really help many of us. The best evidence is for omega-3 fatty acids as well as niacin, but fiber and other natural products also help a bit.

I’ve written a lot about omega-3, a natural fatty acid which is found in all the fatty fish, especially salmon, mackerel and sardines. The healthiest way to get this is to eat those fish as often as possible, at least twice a week. If that’s not too practical, all pharmacies carry fish oil supplements.
If you do decide to take it, and if you can tolerate the fishy aftertaste, there are some key facts:

• LOOK CLOSELY AT THE FINE PRINT. Sure, it may say “1000mg fish oil”, but we’re not interested in that. We want to know the TOTAL AMOUNT OF OMEGA 3 (DHA and EPA) – which is usually only a third of the total oil amount! So the key is to look at the nutrition label to see how much TOTAL omega 3 it has — again a combination of DHA and EPA. Usually, your 1,000mg of fish oil only has about 360mg of omega-3. That means, if you need to take 1 gram a day of omega 3, you need to take 3 capsules. (Shoppers tip: in the US, the megastores Costco and Sam’s Club have big bottles of higher-strength, and enteric-coated, softgel capsules. I always stock up at Costco when I go home).
• For general low cholesterol issues, people should usually take 1 gram a day of the omega 3.
• For more severe cholesterol problems (such as my brother), usually 2-3 grams a day of omega 3 is recommended. That means some of you may need to take ~8 pills a day, if you can tolerate them.
• Don’t forget that omega-3 is mostly beneficial for triglycerides; it can lower TGs by 23-45%. It is NOT very effective for lowering total cholesterol, and it actually raises LDL a bit, which may surprise many of you. But it also raises HDL, the “good cholesterol”, by a similar amount – thus canceling out the bad effect on LDL (we think). To be most effective in my brother’s case, he would need to take a lot, at least 2 grams – but 4 grams is even better, if he can tolerate it.

Another natural treatment for cholesterol, niacin, is actually a simple over-the-counter mineral which is quite cheap. Niacin is quite effective for some types of high cholesterol but isn’t commonly used – mostly due to the side effects and liver problems. Here are some important points:

• Niacin is great for lowering triglycerides, at high doses >1,500mg daily. It lowers triglycerides by 20% to 50%.
• Niacin decreases LDL-C by about 5% to 25%.
• It’s excellent for increasing HDL-C. It increases HDL-C by up to 35%.

But side effects of niacin are very common, and many people cannot tolerate this for too long. The most common problem is headaches and a flushing reaction people get after taking their medicines, almost like a hot flash. This can range from barely noticeable to intolerable. Some tricks to avoid the side effects are to take a baby aspirin 1/2 hour before your niacin, and also to buy the extended-release and not the immediate-release niacin. The most concerning — but rarer — side effect is liver toxicity; you should not start niacin by yourself without first getting your liver function tested by your doctor. And your doctor can help you choose which niacin is best. The extended-release pills have less flushing and headache effects but they also increase the risk of liver toxicity.
Niacin can also increase glucose levels, so diabetic or pre-diabetic persons should discuss this issue with their doctor before starting niacin.
One great thing about niacin is price – the OTC versions can be as cheap at $10 a month. But then you also cannot guarantee that the doses are totally accurate; in some cases, it’s still better to get the prescription versions. If you have insurance, it’s probably best to get it from your doctor, or at least get their recommendation as to which, if any niacin, you should take.

As for prescription medicine, my brother’s triglycerides are best treated with prescription fenofibrate, usually called Tricor in most countries. This medicine has a long track record and is, by far, the top choice that doctors would use in this case – much more than niacin, for example. Fenofibrate lowers TGs over 50%, and it also lowers LDL and raises HDL. Thus, it’s a potent triple-benefit for people with seriously high triglycerides. But since he’s currently waiting for his health insurance to kick in (welcome to America!), there’s nothing at all wrong with now starting omega-3 supplements right now, and perhaps niacin if he gets his liver tests first. There’s also a bunch of fiber supplements and others that work a bit: here’s a nice graph from the Natural Medicines Database article on natural ways to lower cholesterol:

natural medicines to lower cholesterol

So I’m now heading back to China, at least feeling a bit better that I could help my brother out. The hardest part – lifestyle changes and weight loss – will be up to him.

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OK, let’s get the really bad news out of the way first: a major study this week which followed 39,000 women over 19 years showed that not only is there no major health benefit to taking a general multivitamin, but actually there was a 2.4% increase in deaths. In particular, as the New York Times summarizes:

Use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper were all associated with increased risk of death. The findings translate to a 2.4 percent increase in absolute risk for multivitamin users, a 4 percent increase associated with vitamin B6, a 5.9 percent increase for folic acid, and increases of 3 to 4 percent in risk for those taking supplements of iron, folic acid, magnesium and zinc.

This is not a surprising finding to me, as I already stopped taking a multivitamin last year after reviewing other recent large studies which also find essentially no major benefit, and some risks, in a multivitamin. The main issue is that most healthy adults get plenty of these compounds from their diet, and excess amounts of iron, beta carotene, vitamin A, vitamin E and others can actually hurt a lot more than help. In fact, another major study this week showed how vitamin E supplements increase the risk of prostate cancer. How many of you take a multivitamin?

The second news story this week on my podcast discusses the bad news around Steve Jobs’ death, which is bringing the spotlight upon pancreatic cancer. Pancreatic cancer is one of the most deadly cancers, unfortunately, as most people are diagnosed late into the disease, and it’s extremely difficult to treat. Can lifestyle help? The data on a super-healthy diet is actually not convincing; the strongest risk factors are smoking and obesity, both which raise the risk almost twice the norm.

More Podcast Information

You can always listen live to my radio interview each Wednesday around 7:35am Beijing time, on the Beijing Hour program on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the China Radio International network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.

You can listen to all my previous podcasts at the podcast archive.

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We doctors now always need be on alert to counter the many anti-vaccine arguments, and now we have a major reinforcement in a new evidence-based  review of the 8 most common vaccines. This very important report is from the US Institute of Medicine, which is considered the gold-standard of objective, evidence-based reviews upon which many countries base their medical care. Or to put it another way — many lawsuits regarding vaccines would use IOM reports as their top evidence. (Here is the link to the IOM report, called “Adverse Effects of Vaccines: Evidence and Causality”.)

The most important take-home message from this study was that “the M.M.R. vaccine doesn’t cause autism, and the evidence is overwhelming that it doesn’t,” according to Dr. Ellen Wright Clayton, the chairwoman of the IOM panel. To put it more dryly, the IOM states, “evidence favors rejection of five vaccine-adverse event relationships, including MMR vaccine and autism and inactivated influenza vaccine and asthma episodes.” This certainly isn’t the first time scientists have found no link, but hopefully this IOM report can be the final nail in the coffin of the MMR-autism allegations.

So that’s the good news; the less good news is that there are some adverse reactions, sometimes severe, which vaccines can cause. The most concise review of the report’s pros and cons is from a Medscape report:

The IOM group decided that the evidence “convincingly” supports a link between

• anaphylaxis and MMR, varicella, influenza, hepatitis B, meningococcal, and tetanus toxoid vaccines;
• febrile seizures and MMR vaccine (such seizures almost always have no long-term consequences);
• syncope and the injection of any vaccine;
• deltoid bursitis and the injection of any vaccine;
• disseminated Oka-strain varicella zoster virus, along with Oka-strain varicella zoster virus viral reactivation (both with and without other organ involvement) and varicella vaccine; and
• measles inclusion body encephalitis and MMR vaccine in individuals with severe immune system deficiencies.

According to another set of committee conclusions with a lower certainty level, scientific evidence favorsaccepting a causal relationship between

• anaphylaxis and HPV vaccine,
• transient arthralgia in adult women and MMR vaccine,
• transient arthralgia in children and MMR vaccine, and
• a mild and temporary oculorespiratory syndrome and certain trivalent influenza vaccines in Canada.

Conversely, the committee stated that the evidence favors rejecting a causal relationship between

• type 1 diabetes and MMR vaccine;
• type 1 diabetes and diphtheria, tetanus, and pertussis vaccine;
• Bell’s palsy and inactivated influenza vaccine;
• asthma exacerbation or reactive airway disease episodes and inactivated influenza vaccine; and
• autism and MMR vaccine.

In its deliberation on MMR vaccine and autism, the committee stated that it reviewed 22 studies for epidemiologic evidence but relied only on 5 that, unlike the others, were “reasonably valid” overall. Each of the 5 studies asserted that there is no causal relationship between the vaccine and autism.

The committee also reviewed 4 articles and weighed evidence for the biological mechanisms by which MMR vaccine could possibly trigger autism. Its report noted that one of those articles, authored by the controversial Andrew Wakefield, was retracted last year by its publisher, The Lancet. Earlier this year, a series of articles and editorials in the British Medical Journal called Wakefield’s article an “elaborate fraud.”

“The committee assesses the mechanistic evidence regarding an association between MMR vaccine and autism as lacking,” the report stated.

There was also a good review of this important research by the The New York Times, which mentioned how the chicken pox (varicella) vaccine can sometimes cause problems as adults:

The panel did conclude, however, that there are risks to getting the chickenpox vaccine that can arise years after vaccination. People who have had the vaccine can develop pneumonia, meningitis or hepatitis years later if the virus used in the vaccine reawakens because an unrelated health problem, like cancer, has compromised their immune systems.

The same problems are far more likely in patients who are infected naturally at some point in their lives with chickenpox, since varicella zoster, the virus that causes chickenpox, can live dormant in nerve cells for decades. Shingles, a painful eruption of skin blisters that usually affects the aged, is generally caused by this Lazarus-like ability of varicella zoster.

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Here’s a quick 3-minute video from the American Heart Association (with Chinese subtitles) which may save someone’s life. If you cannot see the video below, please click here.

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