Study: Asians unable to produce enough insulin

Recently the news reported on a study which suggested that one reason why Asians are more prone to diabetes is due to inadequate insulin production.

Study: Asians unable to produce enough insulin

Local researchers from the National University Hospital (NUH), in collaboration with Janssen Pharmaceuticals, have found that the inability to produce enough insulin could be why Asians are more prone to Type 2 diabetes than their Western counterparts.

The breakthrough finding, based on a study of 140 mostly Chinese participants, will pave the way for better diabetes management for people here and in the region. This includes tailoring dietary advice and a better selection of drugs to treat diabetes, doctors believe.

Another interesting finding from a separate study is that Chinese people are more prone to diabetes at lower BMIs than Caucasians.

According to a previous study, 8 per cent of people of Chinese descent with a Body Mass Index (BMI) of 23 (just outside the healthy weight range) have diabetes. This is four times more than their European counterparts. A BMI of 23 is within the normal weight range for Caucasians.

As I have mentioned in my previous blog post, Caucasians tend to have lower body fat than Asians despite having the same BMI.

Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements.

Although Asians had lower BMI, they were fatter than whites of both sexes. The correlations between fat% and BMI varied by BMI and sex and race. Comparisons in anthropometry show that Asians had more subcutaneous fat than did whites and had different fat distributions from whites. Asians had more upper-body subcutaneous fat than did whites. The magnitude of differences between the two races was greater in females than in males.

My theory is that the impaired insulin production is due to the higher body fat percentage that Asians seem to have. A higher body fat percentage translates to a lower fat free mass. Which in turn reduces insulin production. Hence in comparison to Caucasians with the same BMI but lower body fat percentage, Asians will produce less insulin.

This news outlet reported on the same article, but I disagree with something they added.

Most Asians don’t produce enough insulin, more prone to diabetes

In a separate study, it was also discovered that 8 per cent of Chinese participants with a Body Mass Index (BMI) of 23 (this means they’re just outside the healthy range) have diabetes, four times more than those of European descent.

The reason for this? Caucasians generally have more body fat and therefore, a BMI of 23 is considered normal for them.

The part that is in bold is incorrect. The opposite is true, Asians in general have MORE body fat. That is the reason why WHO recommended a LOWER BMI cutoff for Asians.

WHO Expert Consultation: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.


On the basis of the available data in Asia, the WHO expert consultation concluded that Asians generally have a higher percentage of body fat than white people of the same age, sex, and BMI. Also, the proportion of Asian people with risk factors for type 2 diabetes and cardiovascular disease is substantial even below the existing WHO BMI cut-off point of 25 kg/m2. Thus, current WHO cut-off points do not provide an adequate basis for taking action on risks related to overweight and obesity in many populations in Asia.


Is BMI a good measure of health?

Recently, my government has increased it’s focus on its citizens adopting a healthy lifestyle. Today, I decided to look into one metric that is commonly used to determine a population’s health.

What is BMI?

Body Mass Index (BMI) is a person’s weight in kilograms divided by the square of height in meters. A high BMI can be an indicator of high body fatness. BMI can be used to screen for weight categories that may lead to health problems but it is not diagnostic of the body fatness or health of an individual.

What is it used for?

BMI is mainly used to assess weight status of a population. It is a simple screening tool to estimate a person’s body fat, but should be used in conjunction with other body composition tests before a diagnosis is to be made. This is because BMI is unable to discern between body fat percentage and lean mass.

How accurate is it?

This is a tricky question to answer. It’s accuracy differs between populations.

For example, in the USA and Singapore, the use of BMI actually under-diagnoses the prevalence of obesity.

In this study, it was observed that the use of BMI underdiagnosed obesity by 30%!
Accuracy of Body Mass Index to Diagnose Obesity In the US Adult Population

BMI-defined obesity (≥ 30 kg/m2) was present in 21% of men and 31% of women, while BF %-defined obesity was present in 50% and 62%, respectively.

Our findings also suggest that the magnitude of the obesity epidemic may be greatly underestimated by the use of BMI as the marker of obesity 35. In our results, BMI showed an unacceptable low sensitivity for detecting body fatness, with more than half of obese subjects (by body fat measurement) being labeled as normal or overweight by BMI. The true prevalence of obesity might be strikingly higher than that estimated by BMI.

In Singapore, it was observed that the accuracy of BMI differs between ethnic groups.
The paradox of low body mass index and high body fat percentage among Chinese, Malays and Indians in Singapore

RESULTS: Compared with body fat percentage (BF%) obtained using the reference method, BF% for the Singaporean Chinese, Malays and Indians were under-predicted by BMI, sex and age when an equation developed in a Caucasian population was used. The mean prediction error ranged from 2.7% to 5.6% body fat. The BMI/BF% relationship was also different among the three Singaporean groups, with Indians having the highest BF% and Chinese the lowest for the same BMI. These differences could be ascribed to differences in body build. It was also found that for the same amount of body fat as Caucasians who have a body mass index (BMI) of 30 kg/m2 (cut-off for obesity as defined by WHO), the BMI cut-off points for obesity would have to be about 27 kg/m2 for Chinese and Malays and 26 kg/m2 for Indians.

If obesity is defined as excess body fat rather than excess weight, the obesity cut-off point for Singaporeans should be 27 kg/m2 instead of 30 kg/m2. The lowering of the cut-off point for obesity would more than double the prevalence figures in Singapore.

In addition, the study authors also noted that the use of BMI underdiagnosed the prevalence of obesity in Singapore by at least 10%.

Generally, if the cut-off point for obesity in Singapore were lowered to 27 kg/m2, this would have immense impact on the prevalence of obesity among the adult Singapore population. Compared to a BMI cut-off point of 30 kg/m2 the prevalence would increase in females from 6.5% to 15.4% and in males from 5.2% to 17.3%.

Interestingly, it is the opposite for Korea. The use of BMI actually over-diagnosed obesity.

Diagnostic Performance of Body Mass Index Using the Western Pacific Regional Office of World Health Organization Reference Standards for Body Fat Percentage

In the present study, obesity was identified in 38.7% of men and 28.1% of women using body mass index (≥25 kg/m2) and in 25.2% of men and 31.1% of women using body fat percentage. A body mass index cut-off ≥25 kg/m2 had high specificity (89%, men; 84%, women) but poor sensitivity (56%, men; 72%, women).

On the basis of BF%, 25.2% of men and 31.1% of women were classified as obese in the present study compared to 50% of men and 62% of women in American populations (10). Thus, BF% better reflects the current status than population-specific cut-off points for BMI for international comparisons of the prevalence of obesity. The prevalence of BF%-defined obesity was higher in women than in men in Korea, which suggests that Korean women have less lean mass than do Korean men.

What is the significance of BMI?

As mentioned earlier it is mainly used a health indicator of a population but not an individual.

High and low BMI have been correlated with increased mortality rates. However, the increased risk of mortality observed in underweight people could at least partly be caused by residual confounding from prediagnostic disease. i.e. It’s a reverse causation, people are underweight due to their pre-existing conditions (eg. cancer).

An increase in BMI has been correlated with an increased risk for a myriad of diseases such as heart disease and diabetes.

Is “Less Sugar” Always Better?

Healthier food costs more because slow demand leads to inadequate economies of scale: Chee Hong Tat

During a parliament session Senior Minister of State (SMS) for Health Chee Hong Tat attributed the increased cost of “heathier” food options to lack of demand.

“During the initial phase when the healthier products are being introduced, they will have to go through this phase where consumers are getting used to it and the demand is not quite picking up,” he said.

“So when you produce it and there’s inadequate economies of scale, the merchant finds it difficult to price it at a very competitive level.”

Mr Chee was responding to Member of Parliament for Bishan-Toa Payoh GRC Chong Kee Hiong, who asked why healthier foods tend to be more expensive than less healthy options.

As for his question on the price disparity, Mr Chong clarified that he was referring to two variations of the same brand of kaya. The low sugar option costs S$1 more, he said.

Out of interest, I went to take a look at the two types of kaya from Fairprice private label:
Fairprice Nonya Kaya – Less Sugar 400G – $3.95
FairPrice Nonya Kaya 410G – $2.65

Below I have made a comparison table of the macronutrients.

Normal Less Sugar
Serving(g) 16 16
Calories(kcal) 48 49
Protein(g) 0.8 0.6
Total Fat(g) 1.4 0.8
Carbohydrate(g) 8 9.9

Not only does the less sugar version contain more calories, it also contains MORE carbohydrates and LESS protein.

To reduce the sugar, they added maltitol, a cheap sugar alcohol that has half the calories of sugar per gram and actually cost less than sugar for the same unit of sweetness

So is the “heathier” option always healthier?

Best to be a smart consumer and always remember to always check the nutrition label! Caveat emptor.



I read an article recently, titled “Running Is Stupid, So Why Do I Do It?”

And it reminded me of this passage from “The Curse of Lono” by Hunter S. Thompson

There are 30,000 of them now and they all are running for their own reasons. And this is the angle — this is the story: Why do these buggers run? What kind of sick instinct, stroked by countless hours of brutal training, would cause intelligent people to get up at 4 in the morning and stagger through the streets of Honolulu for 26 ball-busting miles in a race that less than a dozen of them have any chance of winning? This is the question we have come to Hawaii to answer — again. They do not enter to win. They enter to survive, and go home with a T-shirt. That was the test and the only ones who failed were those who dropped out.

Most people grapple with the fact that I run as a hobby. For leisure and not punishment. They often ask what am I training for and I answer nothing. I’m essentially a hobby yogger.

I don’t post my runs on social media and neither do I talk about it unless prompted to. I feel that running is a private activity and try to keep it that way. Yes, I do run in public places, but at same time I am by myself. The only participant in this impromptu race to nowhere. Challenging myself to be better.. for no apparent purpose.

I usually run by time or direction and see where my feet take me. I do get lost often and usually have to ask for directions. But I love that. The people I meet are always so helpful, which is a refreshing change from the barbaric hordes you battle with during rush hour.

So if running is stupid and hard, why do I do it?  I honestly don’t know. But I do know not running is harder.


In American Beauty (1999), Kevin Spacey stars as a depressed middle-aged man who suffers a midlife crisis after falling in love with his daughter’s best friend. This movie helped popularize many of the iconic images we now associate with the midlife crisis – buying a flashy car, vanity and trying to be relevant again.

It is believed that the midlife crisis is brought about when one starts to examine one’s life circumstances. Their health, career and relationships. How satisfied are they with their current condition and how to improve or rework them. And it seems that even apes experience midlife crisis.

The midlife crisis is usually triggered by a period of stress or depression. And women  might be more susceptible to it due to life experiences which are unique to women such as pregnancy and menopause.

According to the National Alliance on Mental Illness, most life experiences attributed to depression are unique to women, such as post-partum changes, infertility, and hormonal fluctuation. Evidence has shown that people suffering from depression have different brain chemistry which is altered by hormones that control emotions and mood. These hormones are particularly heightened during certain times in a women’s life, including postpartum period and menopause.

In addition, it seems that most people experience a lull in their 40s-50s. When scholars started studying the “science” of happiness, they noticed a recurrent pattern that is now known as the U-curve:

“Whatever sets of data you looked at,” Blanchflower told me in a recent interview, “you got the same things”: life satisfaction would decline with age for the first couple of decades of adulthood, bottom out somewhere in the 40s or early 50s, and then, until the very last years, increase with age, often (though not always) reaching a higher level than in young adulthood. The pattern came to be known as the happiness U-curve.

However, although most people seem to experience this nadir in their lives, how badly their happiness dips is dependent on a slew of other factors besides age such as income, marital status, employment. For example, it appears that people in wealthier countries tend to be more dis-satisfied and experience a greater deal of “unhappiness”.

And then there’s the quarter life crisis. But I’ll save that for another post.

Why does one arm pit stink worst than the other?

I’ve been wondering about this for a while and decided to research it.


  • Asymmetrical sweat glands distribution
  • Arm pits have different sets of microbes
  • The side which is more active is usually less stinky

Asymmetrical sweat glands distribution

One arm pit will usually have more sweat glands than the other and this will lead to you sweat more on one side. Although sweat itself has no smell, it reacts with the bacteria under your arm and produces an odor. Since one side is sweatier than the other, the stink will be more noticeable on that pit.

But — here’s a real shocker — sweat and other secretions don’t actually smell. Sweat, sebaceous, and apocrine glands secrete volatile organic compounds, and odors arise when these “VOCs” interact with bacteria on the skin, in hair follicles, and in the mouth.

Arm pits have different sets of microbes

What are microbes?

Microbe is a term for tiny creatures that individually are too small to be seen with the unaided eye. Microbes include bacteria (back-tear-ee-uh), archaea (are-key-uh), fungi (fun-jeye) and protists (pro-tists). actually did a informal study to find out how does one’s lifestyle affect their armpits’ microbiome.

The picture below is a comparison between one of the participant’s left and right pits

It indicates that there is more microbes in the left pit. Since odor is produced only when sweat interacts with the microbes, having a different set of microbes (eg. different types of bacteria or amount) will give each of your pit an unique bouquet.

The side which is more active is usually less stinky

This is a personal theory of mine. When I had surgery on my right shoulder and had it in a sling for about a month, my right pit produced some serious funk. I think that the more active your arms are, the more the pits are able to “breathe” or air themselves out, thus helping to mitigate some of the stink.

The Curious Case of Manuka Honey

Manuka Honey is produced by Western honey bees feeding on the nectar of Manuka bushes that can only be found in New Zealand and Australia.

western honey bee
Manuka honey is coveted for its anitbacterial properties discovered by Peter Molan.

Then Molan discovered there was something special about manuka honey. It appears to have antibacterial properties, unlike other honeys in the world, and some studies suggested it could heal wounds and help boost the immune system. (Specifically, the antibacterial property found in other honeys comes from hydrogen peroxide, which is broken down quickly in the body, whereas the non-peroxide form found in manuka honey isn’t.)

The manuka honey industry is highly lucrative. In New Zealand alone, manuka honey exports are worth NZ$315 million (~USD230million). The intense interest has led to a “manuka crime wave”, as warring beekeepers resort to beehive heists and massacres to edge out the competition.

The biggest consumers are the UK and China. 1,800 tonnes a year of the honey are now consumed in the UK each year, with prices ranging from £40 to £50 for 500g. China imports 1,500 tonnes a year and it sells for up to 1,789RMB ($279) for a 500g jar.

In total, 10,000 tonnes of manuka honey are sold worldwide, whereas only 2-3000 tonnes are produced each year. The New Zealand government has implemented measures to safeguard the authenticity of their prized export. However these tests seem to be ineffective in reducing the volume of fake manuka honey in circulation and major honey producers have called for a revision of these standards.

There is no single standard for manuka honey, instead there are various grading systems being used by different brands and countries which leads to much consumer confusion.

So how do you tell if your manuka honey is the real stuff?
I honestly don’t know.