Diabetes Threatens Vision

The Singapore Epidemiology of Eye Diseases Study has released frightening data on the prevalence of sight threatening diabetic retinal disease. Five out of six persons with diabetic retinopathy are unaware that they have the condition.

The Sunday Times of 24 May 2015 carried a report on the findings of this study. The article may be read by clicking the mouse over the graphic on the right.






Selenium and the Thyroid Gland

Selenium is a mineral found in naturally in food, added to food or used as a supplement. Its role in thyroid disease has been the subject of considerable investigation. There is now evidence that selenium may benefit some patients with thyroid eye disease (Graves' ophthalmopathy) such as the patient on the right, and help in reducing the inflammation of autoimmune lymphocytic thyroiditis (Hashimoto's disease).

A recent review of the role of selenium in thyroid disease may be found in Medscape (www.medscape.com/viewarticle/777483_5) or by clicking on this link.




MOH of Health Disallows Bio-Identical Hormone Replacement Therapy

On 15 April 2014, Ministry of Health Singapore issued a circular stating that bio-identical hormone replacement therapy is "non-evidence based" and may only be prescribed in the context of a clinical trial. The full text of the circular is available by following this link.




Problems with A Large Thyroid Gland

Some patients present with really large thyroids. One such patient is shown on the right, who presented with a 2 kg thyroid gland. (Normal thyroids are about 20 grams in weight). This was a huge cosmetic embarassment as he was unable to wear clothes properly. The thyroid also had a detrimental effect on his growth and mentation. He looks 6 years of age but was actually 12 years and some months old.

Following surgery and supplemenation with thyroid hormone, he rapidly gained height and weight and is well today. Unfortunately Ministry of Health has determined that the post-treatment picture cannot be displayed as it contravenes the Ministry's Publicity Regulations



Researchers Claim Reversal of Diabetes by Calorie Restriction

The 9th June 2011 issue of Diabetologia (Journal of the European Association for the Study of Diabetes) carried a paper by Lim and his colleagues claiming that diabetes is not an inevitably progressive condition. The researchers subjected a small group of individuals to a severely restricted diet of 600 KCal daily, which they claim resulted in reversal of the abnormalities of diabetes mellitus. The scientific paper (175KB PDF) is freely available online. For your convenience, it is downloadable by clicking on the link provided.

The universally recognized Big Mac which contains 570 KCal gives you an idea what amount of food a 600 Kcal /day meal may comprise.




The Dangers of Porcupine Kidney Powder

In March 2007, this young man consulted me regarding weight gain of 9 kg (about 20 lbs) over a 2 week period. His mother had given him some pills obtained from a Chinese physician. He was told that the pills contained "porcupine kidney powder" and if taken, would significantly boost his immunity. He disliked the sudden increase in his girth, but was particularly distressed by the appearance of red striae (picture on right) on his abdomen and arms. It turns out that he was unknowingly given steroids, resulting in his frightful appearance typical of Cushing's syndrome. The lesson for all of us is not to unquestioningly accept treatments from anyone, no matter how well intentioned.



Tour de France Doping Controversy - July 29, 2006

The winner of this year's Tour de France was accused of having used anabolic agents to boost his performance. The basis of this accusation was an abnormal testosterone / epi-testosterone ratio. In 1982 the IOC ruled that a T/E ratio > 6 was evidence of illicit T use. The expected T / E ratio in healthy males is ~ 1.

In practice, there are many confounding factors. In the general male population, less than 0.8% of individuals not on T or anabolic steroids will show a T/E ratio of > 6. Therefore there is a false positive rate. The lowering of the T / E ratio to 4 by the Cycling Federation will result in significantly more false positive tests. It's also been shown that chronic use of androstenedione (an anabolic steroid) can be compatible with a T / E ratio of < 6. Without prior knowledge of an athlete's T / E ratio out of competition (where AS or T use is less likely), one would be foolish to level accusations regarding use of performance enhancing drugs. 

The question now is how much over the mark Landis's T / E ratio is. If it's between 4 and 6, reasonable doubt can be cast about steroid use.  If it is just over 6, doubt can still be cast about testosterone use. If it's exceedingly over 6, testosterone-assisted performance is highly likely. If you are interested in the science of dope testing, kindly view or download the 2 files T-E Ratio in Sport (143KB PDF) and Urinary Steroids after Chronic Androstenedione Ingestion (99KB PDF).