There’s no sugar-coating it

Food is a national pastime.

We all scream for ice cream!

CNN Travel names chicken rice, char kway teow, wantan mee, chai tow kuay, and chill crab as the top 5 foods locals can’t live without (surprisingly, katong laksa didn’t make it to the top 5; it’s listed at #14). According to a 2012 Mastercard survey, locals spend as much as $262 in US dollars dining out each month. There are more local food blogs than supermarkets and more than just a few food apps (e.g., Hungrygowhere, BurpplePicky). With almost every other person a foodie, that’s quite a lot for a place less than half the size of Greater London and nearly double in its population density.

It’s not the problem of junk food here. Rather, if the National Nutrition Survey in 2010 is anything to go by, nearly half the nation dines out at their local friendly hawker centre more than four times a week (up from 40% in 2004: National Nutrition Survey by HPB). In addition to the problem of too much salt from eating out, which increases the risk of high blood pressure and vascular illness, the most recent data reveal a disturbing trend of overeating. As many as 6 in 10 locals consume too many calories, leaving them vulnerable to the risk of obesity and diabetes, and heart disease.

But there’s a bit more to the story than that. In reality, stress has a bit of a starring role, while sugar plays a vital supporting role.

We typically respond to a stressful situation at work with cortisol (since we can neither fight our co-workers nor flee from our emails, much as we try to sometimes), which encourages our appetite and desire for high energy foods — simple carbohydrates (find the science explained herehere and here). We often think of these as just sugar and honey. But in reality, they often wear clever disguises from white rice, breads, cake, muffins, cupcakes, doughnuts, and biscuits, to hot and cold desserts. And an overconsumption of these lovely, fragrant, heart-warming energy-dense foods increases the risk of impaired insulin function (read this to understand the link between overeating and diabetes).

And while prolonged exposure to stress leads to chronic inflammation, it should be recognized that sugar also contributes to inflammation. In fact, it is sugar in all its various nefarious disguises which is responsible for populating the blood stream with small, dense LDL cholesterol particles. And it’s these small, dense LDL particles which raise our risk of coronary heart disease (read this for a full review of the factors for cardiovascular disease).

So yes, stress and sugar are the bad guys (here’s an earlier blog entry on thwarting the ill intentions of sugar). But there is a simple solution. It’s called exercise.

Why we eat what we eat

Recent reports about the increasing number of people with diabetes mellitus in Singapore and who need kidney dialysis (and here’s the science behind it) are a timely reminder about the evils of simple carbohydrates. Like white bread and white rice.

Saturated fat used to be the bad guy. Now we point fingers at sugar. But refined sugar (white or brown, does it matter? it’s still sugar) is not entirely to blame. Rather, simple carbohydrates are the reason why obesity is on the rise. They’re the real villains for specific individuals, such as people who have diabetes (here’s why).

Simple carbs are the bad guy?

But knowing that fries, chips, crisps, cinnamon raisin buns swirled with icing, cupcakes, and chocolate croissants are not what you should eat regularly is one thing. Actually not eating them is quite another.

One would think that if people told you that you were large (for want of a better label: see this article for ideas), you would stop eating things responsible for your size. But in fact, it does the opposite (this Dr Oz episode is a good illustration). It has unintended consequences: We’re motivated to eat more of those sorts of things people keep telling us not to eat (presumably for our own good).

Emotional eating is the tendency for us to overeat when we’re faced with negative emotions. It’s when we eat to make ourselves feel better. Research indicates that we are inclined to eat when we feel sad. But less so when we experience positive emotions such as when we’re being included as part of a social group. Eating is also often a strategy for dealing with stress.

It could be worse. We could have non-hostile acquaintances who sabotage our good intentions not to eat things we’re not allowed to have and who put us down for making an effort (read these articles on how to questionidentify, and fix toxic friendships). So apart from putting to good use your assertive communication skills (i.e., saying no), it can be useful to have these strategies in your pocket:

1. Keep a food diary
Tracking what you eat and how you felt when you ate it, can make you aware of whether you’re guilty of emotional eating. Instead of a pen-and-paper diary, take pictures of your meals and snacks for a blog or daily facebook post to save time and handbag (or trouser pocket) space.

2. Cook your own meals
Research indicates that doing our own cooking encourages healthy dietary habits. Make a batch on the weekend and bring a portion for lunch. Or bring the constituents of a sandwich, assemble it at the office, and stick it in the toaster for a few minutes.

3. Get your RDA of fruits and veggies
Stash crunchy fruits like jambu, guava, and apples on your desk. Snack on Japanese rice crackers instead of biscuits, and stock your desk with only a few at a time. Keep a facebook diary of healthy snacks and meals to inspire others around you.

4. Make instant oats in a cup
Irish and steel-cut oats retain the whole grain benefits of rolled oats but provide a time-saving convenient snack, as long as your office pantry has a microwave. Add honey, dried cranberries, flax seeds, almonds, and normal cornflakes for crunchy texture.

5. Drink water
Buy disposable tea filters from Daiso and make your own tea bags from loose tea. Keep a stack nearby at work so you can add a tea bag to hot water, if you don’t like drinking plain water. It’s a quick fix for the “itchy mouth” syndrome. Get into the habit of saying “o sosong” or homemade barley at the coffee shop. Soon, you can order unsugared hot drinks on autopilot.

6. Sharing is caring
Share your dessert and cake with others, instead of having the whole thing to yourself. Or bring your tupperware so you can keep half of it for another day. Birthday at the office and leftover cake is calling out your name? Box it up and offer it to a colleague with many little ones to feed at home or offer it to another department!

Don’t just stand there gawking at the cake (and eat it). Do something about it!

Time out!

That chronic stress is responsible for poor immune functioning has been long established. The literature as early as 1990s provides much evidence to support this view (O’Leary, 1990; see Khansari, Murgo, & Faith, 1990 for a review), while more recent research indicates a role for moderating factors such as the ageing process or physical illness, which increase our vulnerability to immune suppression in the face of chronic stress (Segerstrom & Miller, 2004).

The finding that chronic stress has long-lasting negative consequences for our cognitive abilities is also not new. It’s been well-established that prolonged exposure to stress damages our hippocampus – a brain structure responsible for consolidating short-term memory to long-term memory (McEwen, 2004Sapolsky, Krey, & McEwen, 1986).

It follows that efforts to manage chronic stress should be equated with improvements in mental wellbeing measures such as life satisfaction and psychological mood. Apart from specific interventions targeted at alleviating the symptoms of depression, research points to exercise as an effective strategy for managing stress. Various studies demonstrate that exercise improves mood and anxiety levels (Craft and Perner 2004Ströhle, 2009; see also Atlantis, Chow, Kirby, & Singh, 2004Bhui, Dinos, Stansfeld, & White, 2008Coulson & McKenna, 2008Daley & Parfitt, 2011). Additionally, there is some evidence that participation or passive appreciation of creative cultural activities can also have a positive effect on mental wellbeing, specifically psychological mood (Cuypers, Krokstad, Holmen, Knudtsen, Bygren, & Holmen, 2011).

So if you’re stressed and need some time out, here are some ideas to take home and share with your family and friends:

1. Get up and get going!

  • Walk down Orchard Road in the evening for some physical exercise. Enjoying the Christmas lights are an optional add-on.
  • Jostle the crowd at Sitex 2013 held at Singapore Expo. 28 Nov to 1 Dec. Playing the game of walking quickly through the throng, visiting every booth, and avoiding contact with other people earns you extra physical activity points.
  • Join the dots and map out all the hip and cool cafes and historical landmarks on this National Heritage Trail in Tiong Bahru, which has recently received new media attention.

2. Take time out and enjoy what’s out there!

3. Do it as a family activity

  • The Singapore Zoo celebrates its 40th birthday by giving their macques and chimps enrichment gifts (read: a puzzle containing delicious food). On weekends till 22 Dec 2013, at 80 Mandai Road.
  • Visit the ice sculptures exhibiting as part of the International Ice and Snow Sculpture Festival, at Sheares Link. 30 Nov to 4 Dec 2013. $26-32. Don’t forget to wear your coat, scarf, and gloves!
  • Sleep over with your little (and not-so-little) ones at the SEA Acquarium on 17-18, 23-24 Nov, 6-7 and 14-15 Dec. $135-158 for non-members.

Food for Thought

At least one in ten persons aged 18 to 69 years has diabetes mellitus in Singapore, according to the 2010 Singapore Burden Of Disease Study (MOH), while prevalence for older adults is one in three persons (“1m diabetes by 2050 as Singaporeans get older, fatter”, Straits Times, 2 Oct 2012). This is relatively higher than the global prevalence which the International Diabetes Federation puts at 8.3% in 2011. Metabolic syndrome, which is closely associated with diabetes, has a relatively high prevalence in Singapore, particularly when body mass indices (BMIs) relevant to Asian body build are applied (read this IDF report).

A local report on diabetes from the Health Promotion Board reveals a relatively high proportion of residents with undiagnosed diabetes. And not surprisingly, a local study of 43,176 adults aged 45 to 74 years revealed that among non-smokers, a greater intake of fruits, vegetables, and soy foods was associated with a lower risk of type II diabetes (Odegaard et al., 2011).

There’s also much hoo-ha at the moment about soda tax and sugar tax. While more fingers are being pointed at sugar as the villain in the landscape of obesity, metabolic syndrome and diabetes, saturated fat isn’t entirely off the hook. True, fructose contributes to insulin resistance while not providing adequate satiation (“Sweet poison: Why sugar is ruining our health”, Telegraph, 12 April 2013; read also “Sugar, not fat, exposed as deadly villain in obesity epidemic”, The Guardian, 20 Mar 2013). But, intake of saturated fat is still associated with higher risks of heart disease (“Fat, Sugar or Carbs: Which Is the Bad Guy?”, Huffington Post, 25 Oct 2013). The good news about soda and sugar taxes is the expectation that obesity would be reduced in the states and cities they’re being applied, even though the debate rages on, and on, and on.

On World Diabetes Day (14 Nov 2013), there’s no time like the present to think about healthy eating. Here’s some thoughts about food:

1. Less is more. 

Here’s one diet to aspire to. Studies indicate that the diet structure of Okinawans is responsible for their successful ageing: They eat lots of fruits, vegetables, and soy products (“The Okinawan diet – could it help you live to 100?”, The Guardian, 19 June 2013). But more importantly, it may be their habit of eating until they feel 80% full: It’s their caloric restriction which may be making the big contribution (for details Willcox et al., 2006; 2007). If you’re not convinced, watch this TED talk.

2. Is there something worse than fructose? Yes, artificial sweeteners. 

Having a sugar substitute when we desire sugar seems to have the opposite desired effect. As neatly pointed out in a Harvard Health Blog, “Artificial sweeteners: sugar-free, but at what cost?”, there are at least two problems with artificial sweeteners. One is that we are tempted to eat other foods in place of the calories which we didn’t consume. The other is that sugar substitutes don’t provide the endorphins that sugar does and we continue to crave sugar. As a result, we still eat cake after a sugar-free drink. More disturbing facts are easily available at the eloquent Dr Oz website and videos which might help you switch off the “zero-sugar” option.

3. Eat like a caveman. But only if you’re prepared to cook like one?

The paleo diet. It’s the new black. There are apparently benefits to this diet (“5 reasons to follow a caveman diet”, Discovery; “6 health lessons from the paleo diet”, Huffington Post, 13 Sept 2013), and scientific evidence that this diet may have benefits for type 2 diabetes (Klonoff, 2009), possibly because it is more satiating than mediterranean diets (Jonsson et al., 2010). Well, at least it is a proponent of a “whole grains, fruits, and vegetables” diet. And to be a caveman, it would be preferable if one would also grow one’s own herbs, whip up pancakes without electricity, and knead one’s bread too. Not difficult to achieve at all.

4. Breakfast is the most important meal of the day.

The old adage isn’t wrong. A recent report (“Breakfast is the most important meal of the day”, Daily Mail, 23 July 2013) suggested that those who skip breakfast tend to have larger meals during the day, which predisposes them to heart attacks. Another recent study (by Odegaard and colleagues) indicated that eating breakfast frequently lowers the risk of obesity, metabolic syndrome, and diabetes mellitus (“The most important meal?”, press release, UM Minnesota, 16 Sept 2013). More importantly, there’s evidence that a low glycaemic index breakfast (like oats) helps children maintain their attention on cognitive tasks through the morning (Ingwersen et al., 2007; Wesnes et al., 2003).

5. We’re more likely to eat it if we’ve tried it before.

There’s a reason why healthy cooking demonstrations are part of a healthy eating programme at the workplace. One study which asked 205 participants to sample a chicken-and-whole-grain pasta dish and gave them the opportunity to try it at home with a receipe provided to them, found that they were more likely to perceive whole grains positively and to report more confidence about consuming them, compared to controls (Yao et al., 2013). Time for you to try out the recommended roasted brussel sprouts on the Food Network channel and the latest recipes on the Dr Oz show (like sweet potato peanut cookies!).