So, I’ve decided to turn this humiliation (please don’t tell my wife) into a teaching moment; let’s all rummage through our medicines this week and throw out anything expired! Most of us return to China from our home countries with big econo-jars of pain pills, allergy pills, vitamins, etc. But any medicine more than a few months past expiration date likely is much less effective, especially if those pills have been exposed to the open air. I’ve often had patients tell me they’ve been taking home medicines which they’ve been keeping for a couple of years, and it’s very possible that those medicines had expired and had degraded to the point of uselessness. So maybe their cold symptoms or back pains are lingering only because their medicine is too old.

Let’s all take the time to clean out those medicine cabinets this week. And feel free to share your horror stories below! I doubt anyone can beat 2004…

Share this:

---

Check Out These Related Articles:
Do-It-Yourself Travel Kits: Is Yours Ready?	Pain Control: Double or Nothing	Malaria Pills: Which One To Take (If Any)?

---

In case you don’t know, Sina Weibo is China’s version of Twitter — only much, much better, in my opinion. It’s a cross between Facebook and Twitter and it’s used by over 300 million Chinese. It’s the social media place to be — but the interface is in Chinese. Here are instructions for accessing the site without knowing Chinese; you can also download the free apps Weibo or Weico for smartphones and change the language to English.

Welcome to Weibo! By the way, I definitely will be keeping this blog going; it continues to grow in popularity and now attracts visitors from over 100 countries each month.

Share this:

---

Check Out These Related Articles:
Follow Me On Sina Weibo (China's Twitter)	Hey Laowai: Now You Can Use Weibo In English. Here’s How.	My Top Computer Tips For China Expats

---

My initial response is that you shouldn’t drink straight from the tap, as while many central water systems are clean, there may be heavy metals and bacteria collected along the way in the piping. But I would be generally saying this in almost any city in the world, so the same idea applies here. Actually, in New York City the tap water is famously clean, but even while living in San Francisco I always used a Brita table-top water filter and kept refilling it all day. I probably didn’t need to, but I always felt safer.

I think the same concept applies to the major cities in China: a recent Global Times headline “Half of Tap Water Undrinkable” certainly didn’t dissuade me from my caution. And how many remember the 2007 Beijing Times expose that half of Beijing’s bottled water jugs were counterfeit, using tap water or fake Watsons stickers? Or last year’s China Daily expose discussing the dangers of cheap water jugs? How many of you realize that many of those big blue jugs you get delivered to your homes and offices aren’t as safe as you think? I strongly recommend that anyone buying those blue water jugs read that above article from China Daily. One very concerning stat was a July 2011 survey which showed that 31 water brands had failed inspection due to high levels of bacteria in them. Here are some more disturbing quotes:

Li said it is no secret in the industry that about half of these large bottles do not meet appropriate standards.

While doing research in Hebei province, Li said, he saw workers from small illegal workhouses smash waste DVDs and small plastic bottles into granules and sell them to factories that make the big water bottles.

“Water is contaminated if it is kept in vessels like this. People may feel a stomach ache or get dizzy if they drink this water for a long time,” Li said.

“Price competition is hot in the industry, and the bottles account for the biggest portion of the total cost.” Li said bottles that meet standards cost at least 30 yuan.

Forged bottles are hard to identify, Li said, even by professionals.

If you lift a standard bottle and a substandard one together against the sun, he said, it’s clear that the ”good” bottle is a transparent light blue, with no impurities. The substandard bottle is darker and rougher, with low transparency and more scratches.

When such a comparison isn’t possible, Li said, it’s hard to make a distinction.

Distribution

The biggest risks occur after the filled bottles leave the production plant.

Few companies in the industry have retail operations. Instead they rely on dealers and distributors to sell and deliver their water, and that’s when they lose control of their products.

“Some distributors simply pump tap water into the bottles that are labeled as famous brands.Some replace qualified bottles with substandard ones,” Li said. “The authorities care most about the producers. There is hardly any supervision in this segment.”

Even when the water reaches the customer, risks remain.

The large jugs require the use of a water dispenser. Li said many people think the dispensers are convenient and safe but don’t think to clean them often enough. They also should consume the water within a week, he said.

“What they usually don’t know,” he said, “is that once the barrel is loaded onto the dispenser,air and dust start to come inside, making it a comfortable reproduction site for germs.”

This brings up one of my major survival tips in China: have as much control over your environment as possible. That’s why I recommend you use a water filter system at home and not get those water jugs delivered. You can read a lot of good consumer information about water filter systems at Consumersearch.com. When I first came to China, we used our table-top filter for a couple years, but now we have “upgraded” to an installed water filter under the kitchen sink. I bought an American brand, Aquasana, which is consistently rated by Consumer Reports as top quality, but other brands are also highly rated. These under-the-sink versions also are more efficient filters than those table-top versions. But they are more expensive and also a bit difficult to install. If price is an issue, then a table-top version is ok.

Please Stop Delivering Your Water

I think water filter systems at your home or office are far better solutions than bottled water, as long as you are replacing the filters as scheduled. I think environmental cost should also be considered, and it’s obvious that the environmental impact of the plastics and the gas needed from delivering water jugs is far more severe than the environmental cost of installed filters at home and office. And heaven forbid that you’d continuously buy small plastic bottles of water — what an astoundingly wasteful and expensive solution! That assumes, of course, that you’re using a local “trusted” water such as Nongfu instead of the incredibly wasteful imported water such as Fuji and others. What a crazy industry! Don’t get me started…

But back to the point: are you absolutely sure that your delivered water jugs are 100% safe? Are you sure that your Watsons brand actually is from Watsons? Are you sure the jugs are properly made plastic, or that the water is actually from its source? With all the environmental exposures we deal with, why not have some control over this one aspect and get a filter instead?

Share this:

---

Check Out These Related Articles:
China's Water Pollution Census Consensus: Dirty	Here Are My Favorite Health Finds For 2011. What Are Yours?	Ultrasonic Humidifiers in Beijing – An Unnecessary Risk?

---

So the first choice is to try to continue normal eating habits and get some official ORS packets or pre-made solutions (Pedialyte) at your local pharmacy or clinic. But what about all those sports drinks, sodas or juice? After all, don’t the Gatorade-type brands specifically advertise they can replenish your essential nutrients? What’s the actual data showing if these are helpful — or harmful?

The general consensus is that none of the above options are ideal. Juice, especially apple juice, also can make diarrhea worse. This is because there’s so much sugar and other ingredients in many of these drinks that their osmolality is much higher than a normal body can handle, and this higher osmolality actually pulls more liquid from your cells — making your dehydration and watery diarrhea worse, not better. Here’s a neat table from a good review article which shows the data from ORS compared to Coke, Pocari, Gatorade and other common brands:

An important column is the far right, showing osmolarity. Notice how much higher is Coke and energy drinks when compared to official ORS. Pocari Sweat is closer but still has much more glucose and much less sodium. I have another graph below from another review article which details why juices and chicken broth also are not ideal. Notice how apple juice is too concentrated, and chicken broth has too much salt:

Let’s hear from the experts

The take-home message, especially for parents, is that you should not reach for Gatorade, Coke, apple juice or many other drinks when you or your child are throwing up and having diarrhea. But don’t just take it from me; let’s hear from some experts. Here’s a nice synopsis from my Academy of Family Practice, from their article on management of acute gastroenteritis in children;

The time-honored “clear liquids” most often used by parents or recommended by physicians in the past are not appropriate for use in oral rehydration therapy. Drinks such as colas, ginger ale, apple juice and even commercial sports drinks (e.g., Gatorade) are inappropriately high in carbohydrates and osmolality(Table 7).¹¹ They can cause osmotic worsening of diarrhea, and their low sodium content may contribute to the development of hyponatremia. Tea should not be used because of its low sodium content, and chicken broth is contraindicated because of its high sodium content.^5,11 Furthermore, food should not be arbitrarily withheld because continued feeding or the early resumption of feeding improves outcome.

So you all get the idea now. As an aside, I think that sports drinks in general are a lot more hurtful than helpful, especially with childhood obesity rising so quickly. Here’s some helpful advice from the American Academy of Pediatrics:

Specific AAP recommendations regarding use of sports drinks and energy drinks in children and adolescents include the following:

• Pediatricians should educate patients and their parents regarding the potential health risks of energy drinks and sports drinks and explain the significant differences between these types of drinks. The terms should not be used interchangeably.
• Energy drinks should never be consumed by children or adolescents, because the stimulants they contain pose potential health risks.
• Children and adolescents should avoid and restrict routine consumption of carbohydrate-containing sports drinks, which can increase the risk for overweight, obesity, and dental erosion.
• For pediatric athletes, sports drinks should be consumed in combination with water during prolonged, vigorous physical activity, when rapid replenishment of carbohydrates and/or electrolytes is needed.
• For children and adolescents, water, not sports drinks, should be the principal source of hydration.

Share this:

---

Check Out These Related Articles:
Schools & Air Quality: Here's A Sample Action Plan	Do You Know Your BMI?	The Top Supplements of 2009

---

• No antibiotics for acute sinusitis infections
• No x-rays of the low back during the first 6 weeks of an injury
  (unless there are obvious “red flag” danger signs)
• No routine ECG during any annual physical for a healthy person
• No DEXA bone scan in healthy women under 65
• No Pap smears for women under 21

These are very common tests and treatments all over the world, but the fact remains that there truly is little proof that these tests help more than hurt most patients. I think this Choosing Wisely campaign is a very important new program that really sheds some evidence-based prudence on what were previously considered de-facto tests. This is a wake-up call for all doctors everywhere, and I welcome the discussion.

Share this:

---

Check Out These Related Articles:
Cervical Cancer Screening: New Guidelines	Physical Exams 1, Genetic Tests 0	Mammograms & PSA: To Screen or Not to Screen?

---

Pistachios are a wonderfully healthy nut, full of healthy, cholesterol-lowering oils and antioxidants. But one uniquely Chinese trait is to bleach the majority of pistachios on the market, as many consumers believe the cleaner, whiter look is more appealing than the original. While the hydrogen peroxide bleach may not by itself be unhealthy, the bleaching certainly removes some of the vitamins such as B1, as well as antioxidant phytochemicals. So please do your body a favor and don’t buy the pure white pistachios with the dull colors; pay a bit more for the slightly darker shell which has the original green nut and deep red/purplish skin.

The same concept applies to mushrooms; local markets are filled with preternaturally, almost luminescent white mushrooms, which again are an obvious sign of unneeded whitening. A mushroom should not naturally be shiny white, like a piece of printer paper; it should be ivory or darker. Some of you may remember the entertaining story in 2010 about a Chinese primary care student who tested store-bought mushrooms and found that 90% had used a fluorescent whitening agent which was considered “not edible”. Maybe not dangerous, but certainly not needed — and given the chronic uncertainties of food safety, why take the risk at all?

Share this:

---

Check Out These Related Articles:
Preventing Diabetes: Brown is Aways Better Than White	White Rice May Cause Diabetes	My Favorite Wellness Tips of 2010

---

I mention all this because I am concerned that we all are bombarded in our daily environment with potentially toxic chemicals from what we eat, breathe and drink; and I feel we should do everything we can to minimize the potential risks. Plastics, especially BPA, are a clear example of ubiquitous objects which research suggests may carry unintended health effects such as infertility, cancers, heart disease and diabetes. The research isn’t conclusive but I feel it is concerning enough to take action, based on the “precautionary principle”, which states that there is a responsibility to intervene and protect the public from exposure to harm where scientific investigation discovers a plausible risk in the course of having screened for other suspected causes. Also, there is an official position paper from 2009 by the US Endocrine Society which recommends much less exposure to BPA and other “endocrine-disrupting agents”.

With this in mind, some simple things we all can do at home include:

• Switch all your plastic food containers to glass
• Only use plastic cling wrap that says PE on the label.
• With any type of plastic cling wrap, always minimize contact of the plastic with the food to minimize leaching of chemicals, and try not to microwave with the plastic on it. Especially don’t let the plastic sit on top of liquids.
• Always immediately transfer your restaurant leftovers into glass containers at home; many takeaway plastic containers leach dangerous chemicals into the foods. Vinegar, especially, can eat away at the plastic.
• Never reheat your leftovers or eat directly from the takeaway plastic containers, as the leaching effect is dramatically higher.
• If you choose to keep your leftovers in plastic, look closely at the Plastic Coding System (that triangle on the bottom with a number from 1-7 in the middle). It’s better to avoid numbers 3, 6 and 7 and safer to use numbers 1,2,4 or 5
• Try to minimize eating canned food, as the plastic linings also could leach into the food.

Chopsticks hygiene is another big issue in China, both from food safety and environmental angles. When choosing a restaurant, plastic or metal chopsticks are much safer than the reuseable wooden ones, which are very difficult to completely wash of all bacteria and viruses (the same goes for your home’s wooden cutting boards and cooking utensils). Disposable wood chopsticks are far more hygenic but they carry an enormous burden on the environment. My favorite preference is to use my own portable metal chopsticks which unscrew in the middle and collapse into a nice small box to carry around. I now use this exclusively with my lunches at work. I got mine at Muji, but you can find these at many stores.

To sum up, these environmental precautions can be healthy for yourself and your family as well as the environment.

(This article was originally printed in the April 2012 edition of Beijing Kids magazine, in my monthly The Doc is In column)

Share this:

---

Check Out These Related Articles:
Are Plastics Causing Cancer & Infertility?	What Health Changes Did You Make In 2010? Here Are Mine…	Food Safety Scandal, Take 258…259…260…

---

The key concept for diabetics is limiting carbohydrates — and that doesn’t only mean sugar. I see many diabetics who think they’re doing well because they’re “cutting back on sweets and dessert”, when the main diabetic culprit in their diet is the starch carbs from rice, pastas and breads.

One popular method of monitoring carbs is the glycemic index. This index is a ranking from 0-100 of how high a carbohydrate raises blood sugar levels after eating. Here’s a graph below showing the basic concept: a healthy food has a low glycemic index, which means the sugar levels in your body peak lower and slower, thus not stressing out your insulin-secreting pancreas. Unhealthy foods have a high glycemic index, where the sugar levels peak very high and very quickly. This stresses out your pancreas to make insulin, and it’s this chronic repeated stress of your pancreas that partly causes it to slowly fail, producing less insulin — and thus causing diabetes.

Glycemic index

Think Brown

Following this GI list of foods, and tracking your foods, can honestly be quite cumbersome. Many believe that patients’ counting their carbs is a more effective tool. But in either case, I have an easy clue for everyone: think brown. Brown food is always better than the equivalent white food. What do I mean? I mean that white foods are quite unnatural; white rice and breads and pastas are finely processed versions of the original grains. And these original grains have the “brown” husks full of vitamins, oils, magnesium, fibers and other nutrients. In other words, brown rice is much healthier than white rice for many more reasons than just lowering risk of diabetes. The glycemic index of brown rice is 55, a bit lower than the 72 for short-grain white rice, which is the most common rice in China. Here’s more data which may convince you: a huge 2010 cohort study showed that switching from white to brown rice can lower your risk of diabetes by 16%. Switching to whole grains lowered risk even better, by 36%. That’s an enormous benefit!

Bread & Pastas: The Same Benefit

The same concept applies to white bread, which is made of finely processed flour and thus has lost its husk of nutrients and fiber. The GI of white bread is 70 (a GI over 70 is considered unhealthy), while whole grain breads have a GI of 51. Pasta, on the other hand, has a much better glycemic index than breads or rices, with a GI range from 43 to 61.

Share this:

---

Check Out These Related Articles:
White Rice May Cause Diabetes	Mushrooms and Pistachios Should Not Be White!	My Favorite Wellness Tips of 2010

---