Discover The Effects Of Obesity On Your Liver Health

It is well-known that excessive alcohol consumption is detrimental to liver health. However, obesity is also a significant contributor to liver conditions.

What is obesity?

Obesity is the condition of having excess fat in the body. A normal amount of body fat percentage is 25-30% in women and 18-23% in men – any body fat percentage over the normal range is an indication of obesity. Some people prefer using the body-mass index (BMI) as an indicator of body fat, as it is easier to measure without specialised equipment, although it is less accurate. As a general indication, a person with a BMI of 30 and above is considered to be obese.

For a while now, doctors over the world have been labelling obesity as an epidemic. Perpetuated by sedentary lifestyles and poor diets, the condition is affecting vast populations in developed nations around the world. Obesity is worrisome as it is a contributor to many types of health conditions, such as type 2 diabetes, coronary heart disease, high blood pressure, higher risk of strokes, gout, gallstones, colon cancer, and fatty liver disease.

How does obesity affect liver health?

A range of liver diseases under the name non-alcoholic fatty liver disease (NAFLD) is caused by obesity. Statistics place NAFLD as the most common liver disease worldwide, affecting 10-24% of the world’s population. While the exact mechanism by which obesity leads to liver disease is not known, it is commonly thought that obesity contributes to insulin resistance, which in turn causes the onset of these liver conditions.

NAFLD and obesity are also closely tied in terms of the degree of liver damage. This means that a higher obesity or higher BMI typically leads to greater liver damage. The range of conditions under NAFLD can be classified in varying stages of severity. These are listed in increasing order below:

  • Simple fatty liver (steatosis): Steatosis is a build-up of excess fat (more than 5%) in the liver. This condition usually shows no symptoms and is diagnosed incidentally when tests for other conditions are being conducted.
  • Non-alcoholic steatohepatitis (NASH): NASH is a more advanced form of NAFLD in which inflammation occurs in the liver. However, it is still relatively low-grade and many people live with it with little or no symptoms for years.
  • Fibrosis:When liver inflammation persists, scar tissue is repeatedly formed and builds up around the liver and surrounding blood vessels. Although the condition is more serious, the liver can still function at this stage.
  • Cirrhosis:After years of inflammation, the liver starts to shrink and becomes scarred and lumpy. At the most severe form of NAFLD, liver damage is permanent and can lead to failure of liver functions and liver cancer. Other condition,  such as infections of hepatitis B and hepatitis C, can also lead to cirrhosis.

How is NAFLD diagnosed?

NAFLD at its early stages does not show any symptoms. If any, the symptoms reported are non-specific, such as lethargy, nausea, or a dull ache at the right abdomen under the ribs. Thus, NAFLD is usually only spotted during other routine tests or examinations for other conditions. For example, routine blood tests may show up with elevated levels of liver enzymes, prompting a diagnosis for NAFLD. Ultrasound examination of the abdomen for other purposes can also detect fatty liver.

As the disease progresses in severity, more symptoms will start to show up. At the cirrhosis stage, symptoms can range from swelling of the legs, bleeding from esophagal veins, accumulation of fluid in the abdomen, and mental confusion.

Who is at risk of NAFLD?

Certain lifestyle factors and pre-existing health conditions can put one at higher risk of contracting NAFLD. These are:

  • Obesity, especially if fats are concentrated at the visceral area
  • Type 2 diabetes
  • High blood pressure
  • High cholesterol
  • Metabolic syndrome (a combination of diabetes, high blood pressure and obesity)
  • Age of 50 years and above
  • Smoking

What can you do to reduce the risk factors?

If you are already obese, you can reduce your chances of developing NAFLD by losing weight. You can do this through exercising and maintaining a healthy diet. Ideally, this means reducing your consumption of refined carbs, opting instead to eat wholegrain foods, and foods that are low in sugar and fat.

For those who are already diagnosed with NAFLD, losing weight is also the primary treatment method to prevent further deterioration and promote recovery. A 10% weight loss is enough to lead to a significant drop in liver enzyme levels. However, care should be taken not to undergo extreme diets that lead to a drastic reduction in weight, as this puts extra stress on the liver and other parts of the body.

As can be seen, obesity is a major contributor to liver disease. Take care of your liver health by taking steps to maintain a healthy weight and active lifestyle. To learn more about liver diseases, you may consult a gastroenterology specialist for a personalised consultation.

Fatty Liver: Here’s Why You Should Be Worried About It

Fatty liver is the umbrella term for the condition where liver cells contain more fats than is considered normal. Someone is considered to have fatty liver disease when the fat content in the liver exceeds 5-10% of the organ’s weight. Common risk factors for fatty liver are excessive alcohol intake and obesity.

At its early stages, fatty liver disease is a mild condition that often shows no symptoms. As such, many people live with fatty liver without having the condition diagnosed. Yet, fatty liver is not a disease to be simply glossed over. If left uncontrolled, fatty liver can escalate into serious and irreversible health problems down the road.

The potential complications of fatty liver disease are described below:

  • Liver inflammation and scarring: Direct effects of accumulated fats to the liver typically proceed in three stages – hepatitis, fibrosis, and cirrhosis.
    • Hepatitis is the inflammation of the liver caused by excess fats in the organ.
    • Fibros is refers to the scarring that occurs when the liver heals itself from the inflammation. If damage is persistent, the repeated healing process results in a thick buildup of fibrous scar tissue.
    • Cirrhosis is the later stage of fibrosis when the scarring has caused impeded functions in the liver.
  • Liver failure: When the liver has sustained enough damage to impair its functions, it is referred to as liver failure. Signs of a failing liver include jaundice, nausea, diarrhoea, fatigue, and hemorrhoids (piles), amongst others. In addition, more serious complications can arise due to liver failure, like internal bleeding and kidney failure.
  • Ascites: Referring to the buildup of fluid in the abdomen, ascites can occur due to liver scarring at the cirrhosis stage. As scar tissue builds up, it puts pressure on the walls of blood vessels, pushing liquid into the abdominal cavity. The swollen abdomen can lead to shortness of breath, restricted mobility, and a higher risk of infection and hernia.
  • Esophageal varices: These are swollen veins in the oesophagus that may arise from liver scarring. When scar tissue accumulates, blood flow to the liver is reduced, causing increased pressure in the blood vessels at the esophagus. It is considered a medical emergency if the esophageal varices rupture and bleed. Thus, patients with advanced liver disease should periodically be screened for the onset of swelling veins in the esophagus. Varices are usually diagnosed through endoscopy.
  • Increased risk of metabolic diseases: Fatty liver causes the overproduction of glucose and triglycerides, which are two key components of metabolic syndrome. With metabolic syndrome, there is also an increased risk of developing type 2 diabetes and heart diseases.
  • Increased risk of gastrointestinal cancers: Persons with fatty liver have shown a higher likelihood of developing cancers in the gastrointestinal tract, like liver cancer, pancreatic cancer, and colon cancer. Some studies estimate that the risk is 90% higher in fatty liver patients as compared to patients without the disease.

The good news is, fatty liver can be managed with some lifestyle changes before it compounds into a severe health issue. If you are at risk of developing fatty liver, or are already diagnosed with the condition, you can reduce the damage done to your liver by reducing your alcohol intake, adopting a healthier diet, and losing weight if you are overweight.

Why Obesity Is A Risk In Non-Alcoholic Fatty Liver Disease

Non-Alcoholic Fatty Liver Disease (NAFLD) is the single most prevalent cause of liver disease around the world and cases of affected adults are rising here in Singapore. As the name implies, NAFLD occurs when there is excessive fat build-up in the liver. While it is commonly believed that heavy alcohol use contributes to the damage of the liver, other lifestyle habits may also put you at risk of NAFLD.

In majority of patients, NAFLD is associated with the metabolic syndrome characterized by risk factors including diabetes mellitus, dyslipidemia and obesity. While the causes of the disease are uncertain, those with NAFLD tend to face obesity as well as hypertension and high cholesterol levels which raises the risk of having a fatty liver. Because it has no symptoms, it may also be difficult to detect since NAFLD is rarely discovered until much damage has been done.

How Does Obesity Play a Part in NAFLD?

There are two kinds of NAFLD:

  • Simple fatty liver – There is fat deposition in your liver but with little or no inflammation and liver cell damage. It is not typically severe enough to cause any liver damage problems or complications and the symptoms might not be noticed.
  • Nonalcoholic steatohepatitis (NASH) – Occurs when fat continues to build up and the liver becomes inflamed. The inflammation and swelling in the liver may lead to more serious problems of liver cirrhosis and liver cancer.

While NAFLD most commonly affects the middle-aged and elderly as risk factors increase with age, fatty liver disease can also occur at any age including in children who are especially overweight. NAFLD is closely associated with metabolic risk factors including obesity. As obesity rates are rising in Singapore, the prevalence of NAFLD has also increased.

Symptoms of NAFLD

NAFLD is a silent disease that is often asymptomatic. Fatty liver disease symptoms can be vague or there is few or no symptoms to indicate that one might have the disease. However, possible symptoms may include enlarged liver, fatigue, and pain in the upper abdominal area.

Prevention is Key 

There is no medication or medical treatment for fatty liver diseases, however patients should make concrete lifestyle modification and changes to help reduce the risk and possibly reverse the damage in early stages.

You can refer to the following dietary tips:

  • Moderate your alcohol intake. The recommended daily alcohol limit is 30g for males and 20g for females
  • Maintain a healthy weight with a BMI of 23 or lower
  • Replace trans fats and animal fats with monounsaturated and polyunsaturated fats such as flaxseed oil, olive oil, corn and safflower oils
  • Eat a well-balanced diet with fruits and vegetables, low in sugar and high in fiber.
  • Regular exercise two to three times a week for 30 to 60 minutes to lose weight and reduce fat in the liver

You should also go for regular health screenings as diagnosis usually happens due to a routine blood test or there are relevant risk factors. If NAFLD is suspected, your doctor will also feel the abdominal area for any swelling, discuss about your diet and lifestyle, and carry out tests to eliminate other conditions.

Head down to gutCARE clinic in Singapore and talk to one of our specialists today regarding any health concerns. Our gastroenterology clinic provides sub-specialized care services for digestive and liver disorders. gutCARE also conducts the Fibroscan liver health assessment, a state-of-the-art non-invasive tool used to provide a complete assessment of your liver health and check for liver diseases such as hepatitis B or fatty liver disease.

6 Food That improve you Gut Health

Sugar-rich and heavily processed foods can leave your gut inflamed and prone to diseases, while whole foods can support your digestive health.

Superfoods offer essential nutrients and vitamins that can promote good health, and go a long way toward repairing any damage and healing your gut. They are also synergistic and work together to benefit your whole body.

These are the food we recommend you to include into your meals and diet:

1. Eggs

Unlike previously reported, having moderate consumption of eggs will not give your high cholesterol. They are rich in nutrients such as vitamin A, choline, iron and phosphorus. They also contain two potent antioxidants, lutein and zeaxanthin known to support eye health and protect vision.

There are many ways to prepare and consume eggs, such as omelettes, poached and baked goods. You can also hard-boil a batch of eggs for a quick on-the-go snack.

2. Berries

High in fiber, berries are also rich in minerals, vitamins and antioxidants. They also have strong anti-inflammatory properties, which can help reduce sustained inflammation in the body caused by inadequate physical activity, unhealthy food choices and stress. Berries can be included in different types of diets and they are also low in calories.

Examples are strawberries, blackberries, raspberries, cranberries and blueberries. You can add them to cereals, smoothies, yoghurts or eat them plain for a snack.

3. Garlic

A popular culinary ingredient, garlic has also been used for centuries for its medicinal benefits. It is a good source of vitamin B5, manganese, fiber, vitamin C and selenium. Garlic also increases your body’s immune function by promoting the growth of white cells, which helps combat sickness and lowers harmful low-density lipoprotein (LDL) cholesterol and high blood pressure. In general, with its antioxidant, antibacterial and antivirus properties, garlic is good for keeping your body healthy.

4. Dark Leafy Greens

Dark green leafy vegetables such as spinach, turnip greens, kale and collard greens are an excellent source of nutrients including iron, fiber, zinc, magnesium, calcium and vitamin C. They also contain high levels of carotenoids, an anti-inflammatory compound that may protect against certain types of cancer. They have the potential to lower the risk of chronic illnesses such as type 2 diabetes and heart disease.

You can throw them in salads, or stir fry them with a little olive oil and herbs and seasonings for flavour. They can also be added to stews and soups.

5. Kefir

Fermented foods such as kefir are rich in probiotics and enzymes to promote a healthy bacterial balance for proper gut health. Probiotics are known to relieve symptoms of IBS (irritable bowel syndrome) and restore bacterial balance in the gut. Kefir also have several associated health benefits, such as anti-inflammatory effects, lowered blood pressure, reduced cholesterol and improved digestion, as they contain B vitamins, protein, potassium and more.

6. Nuts and Seeds

Nuts and seeds are packed in various plant compounds with antioxidant and anti-inflammatory properties, which can help protect against oxidative stress. They are also rich in fiber and heart-healthy fats that may reduce your risk of heart disease.

Some common nuts and seeds include chia seeds, almonds, cashews, walnuts, flax seeds, hemp seeds, macadamia nuts and pistachios. You can add a handful to your yoghurt, cereal or oatmeal, or have it on its own as a snack. They make a great accompaniment to cooked vegetables and salads as well.

The list of superfoods is exhaustive thus good health is best supported by consuming a variety of nutritious foods daily. Try incorporating some of the foods mentioned as part of a balanced diet that is key towards overall health and disease prevention.

Certain foods such as carbonated drinks, dairy products, dried fruits and high-fiber foods can also trigger symptoms like rectal pain, abdominal pain and weight loss if you are suffering from digestive illnesses like ulcerative colitis. This disease causes inflammation and ulcers (sores) in your digestive tract and will require colonoscopy treatment to reduce its signs and symptoms.

If you have dietary concerns or wish to learn more about the suitability of certain foods for your health condition, you can consult with a dietitian or gastroenterology doctor in Singapore.

A Close Up Look In Understanding: What Is Heartburn?

Spicy food isn’t the only thing that can make your insides feels like burning. Heartburn is a burning sensation that is felt from the top part of the stomach, going down the throat and chest. The sensation is caused by stomach acid travelling back up into the esophagus. It is usually a symptom of gastroesophageal reflux disease (GERD).

How and why does it happen?

The issue lies with the lower esophageal sphincter (LES), where the esophagus meets the stomach. When it is functioning well, the LES relaxes to allow food into your stomach or to let you burp, and then tightens or closes again. If the LES weakens or relaxes abnormally, stomach acid can back up into the esophagus and cause a burning discomfort in your upper stomach or lower breastbone also known as heartburn.

There are several causes to heartburn. Often, it is due to overeating. Being overweight or pregnant can also potentially increase your risk of experiencing heartburn as there is too much pressure on the stomach. Certain foods and beverages can also trigger heartburn such as coffee (caffeine), acidic juices (grapefruit, orange, pineapples), spicy foods, carbonated drinks and consuming alcohol that can relax your LES too much or increase stomach acid. Studies also show that smoking cigarettes relaxes the LES.

How serious is heartburn? 

Heartburn can be usually identified by feeling a burning pain in the chest especially after food or at night, pain that can worsen when you lie down or bend over, and experiencing an acidic or bitter taste in the mouth. If it occurs more than just occasionally, it is not just a small inconvenience. It can affect what you eat and keep you from doing your daily activities and how you sleep at night.

You can find relief with over-the-counter medications such as antacid or prescriptions like proton pump inhibitor which also helps to lower the acid in your stomach and heal the esophageal lining. Other remedies include drinking ginger tea, wearing loose clothing to avoid compressing your stomach, and elevating your upper body to put less pressure on your LES.

The severity of heartburn depends on how frequent it occurs. Too often and it is considered as GERD, where there may be a dysfunction of the LES and the amount of stomach acid brought up from the stomach. It can lead to serious problems such as laryngitis, ulcers or inflammation of the esophagus, narrowing or scarring of the esophagus and Barrett’s esophagus, a complication that increases your risk of developing esophageal cancer.

When to seek treatment for heartburn?

If you find yourself reaching for medication or antacids too often and you are not getting better, seek medical help and see a gastroenterologist in Singapore. This includes symptoms such as heartburn occurring more than twice a week, difficulties in swallowing, persistent nausea or vomiting, and weight loss due to poor appetite.

Your doctor will ask about your medical history and symptoms, and perform a physical examination. Diagnosis tests may also be carried to check for underlying conditions such as 24-hour pH study and gastroscopy, if GERD is suspected. There are specific medication or procedures for proper treatment.

Dietary changes and lifestyle modification can also be helpful when it comes to managing heartburn. Cut down on foods that trigger your heartburn incidents, avoid heavy meals and having a big meal within 2 hours of bedtime. Stress reduction, a modest weight loss and quitting smoking can have significant benefits in improving symptoms.

How much is too Much: The Definition of Excessive Drinking and Risks

Alcohol beverages is very common in our popular, most of the common beverages are – beers, wines and spirits. Studies shows that limited alcohol consumption usually do not pose any harm to body. However, to much alcohol can cause significant health risks. In general, more than or equal to 3 units for a male and 2 units for a female (a day) is too much on a long-term basis. Binge drinking is also not recommended due to high risk of alcoholic intoxication.

How many alcohol units are in each drink?

A shot of spirits (25ml): 1 unit

A standard glass of wine (175ml): 2.1 units

A large glass of wine (250ml): 3 units

A pint of 4% beer: 2.3 units

A pint of 8% strong cider: 4.5 units

What are the health risks?

Our liver is the main organ that metabolise the alcohol consumed. Under certain limit, our liver may be able to metabolise the alcohol. However, in the event of excessive drinking, the liver may not able to cope and this can lead to liver cell damage. Binge drinking can be defined as consuming 5 or more drinks within 2 hours for men, and 4 or more drinks within 2 hours for women.

Too much alcohol consumption also associated with other health issues such as:

  • Obesity
  • High blood pressure and diabetes
  • Cancers of the mouth, throat and esophagus, liver, colon, and breast
  • Digestive problems
  • Liver disease

Health impacts on different organs of our body

  • Pancreas

Heavy alcohol drinking is another big cause to chronic pancreatitis, a condition where the pancreases is severely inflammed. It occurs mostly after an episode of acute pancreatitis. The damage from heavy alcohol use to the pancreas may not develop symptoms for many years and one day, suddenly develop severe pancreatitis symptoms such as diarrhoea, constant upper abdominal pain, and weight loss caused by malabsorption of food. 

  • Brain

Chronic alcoholic consumption also cause neurological problem such as tremors and numbness of limbs. However, heavy drinkers may develop deficits in brain functioning and shrinkage of the frontal lobes of your brain over an extended period of time, that continue despite attaining sobriety.  Cognitive problems can persist due to the long-term alcohol abuse that negatively impact the brain’s “hard wiring”, such as poor decision-making, mild to moderate impairment of intellectual functioning, confused or abnormal thinking and loss of inhibitions.

  • Heart

Chronic alcohol consumption also increase cardiovascular risk. It can trigger arrhythmias (irregular heartbeats). Regularly drinking too much alcohol also raises your blood cholesterol level, this increase the chance of cholesterol plaque formation in blood vessels, thus increases your blood pressure, and over time high blood pressure (hypertension) can place a strain on the heart muscle, increasing your risk of heart attack, stroke and heart failure.

  • Stomach

Too much alcohol consumption can irritate your digestive system and over time, damage your intestines leading to bouts of diarrhoea or stomach pain. It can also cause stomach distress with symptoms like nausea, vomitting, bloating, gas and painful ulcers.

  • Liver

Chronic heavy drinking of alcohol can also lead to alcohol-related liver diseases such as fatty liver, cirrhosis and hepatitis. A person can have any of the conditions at a time, or all, if the disease is part of a progression.

Alcoholic fatty liver disease occurs as the early stage of liver damage induced by alcohol. It develops over time when too much alcohol consumption leads to a build-up of fat in the body’s liver cells, thus hindering liver function. This condition can be followed by inflammation in the liver (alcoholic hepatitis) and may progress to a build-up of scar tissues in the liver, leading to alcoholic cirrhosis.

Symptoms may not be present in the early stages. As you continue drinking alcohol over time, the performance and health of your liver declines and symptoms may begin to appear, which often can be too late.

They may develop gradually and include:

  • Jaundice
  • Abdominal pain and swelling
  • Encephalopathy or confusion
  • Severe itching of the skin
  • Wasting of muscles
  • Gastrointestinal bleeding

Moderation drinking habit

By drinking lightly and periodically, you can continue your drinking habits responsibly. It is also important to note long term alcohol is not recommended due to long term health risks.

For those taking prescription and medication, they should also ask their doctor if they can drink alcohol while taking them. Individuals with health conditions like heart failure, liver or pancreatic disease and uncontrolled high blood pressure should also check with their doctor about drinking as alcohol can worsen pre-existing health conditions.

Diagnosis and treatment

 Alcoholic liver cirrhosis can be diagnosed by gastroenterology specialists in singapore using blood tests and imaging procedures, including Fibroscan that will give a comprehensive assessment of a person’s liver health and determine disease severity. Patients in early stages of alcoholic hepatitis and fatty liver can reverse the condition, however, cirrhosis damage is irreversible and might require a liver transplant to survive.

You will need to abstain from drinking completely or gradually reduce your alcohol intake to see an improvement in your liver over time. Dietary and lifestyle modifications will be recommended to improve your well-being, and you can seek advice from a dietician for a balanced diet.

How Do You Know If You Have Iron-Deficiency Anaemia?

Iron deficiency occurs when the body lacks enough iron for the formation of haemoglobin, a protein in red blood cells that helps transport oxygen. This can happen in two ways:

  • absolute iron deficiency is said to occur when the body has abnormally low levels of iron; in contrast,
  • functional iron deficiency is when the body has sufficient iron supplies, but for some reason, the body cannot make use of iron at normal rates of efficiency.

When the body doesn’t have enough iron to form haemoglobin, it leads to a low red blood cell count, and insufficient oxygen in tissues and muscles. The lack of haemoglobin is termed anaemia, and this often results in adverse effects on one’s quality of life.

How do you know if you have iron-deficiency anaemia?

Some of the effects and symptoms of anaemia are described below. If you observe any of these signs in yourself, you might want to get checked out for iron-deficiency anaemia.

  • Constant tiredness

A lack of oxygen reaching the tissues and muscles in the body deprives them of energy. As a result, the heart has to work harder to deliver oxygen-rich blood to various parts of the body, leading to a feeling of tiredness. It might be difficult to pinpoint iron deficiency as the cause from fatigue alone, but if you are iron-deficient, you will most likely experience this persistent sluggishness along with weakness, crankiness, poor concentration, and low productivity.

  • Pale skin

Haemoglobin is what gives blood its red colour, and what gives colour to lips, the insides of the eyelids, and rosy cheeks. Hence, low levels of haemoglobin make people appear paler. People with iron deficiency may lose their healthy, rosy colour, or exhibit pale lips, inner eyelids, gums, or nails. Also known as pallor, paleness is more common in moderate to severe anaemia cases.

  • Shortness of breath

When the body is not receiving enough oxygen for energy, everyday activities like walking or climbing the stairs can feel more strenuous than usual. This leads to an increased breathing rate and shortness of breath as the body tries to inhale more oxygen. Less commonly, persons with iron-deficiency may experience heart palpitations due to the heart having to work harder to move oxygen-rich blood around.

  • Swollen, pale tongue

Myoglobin is another protein in the blood, and it helps to support the structure of the muscles. Apart from low haemoglobin levels causing the tongue to look pale, low myoglobin levels can cause the tongue to feel sore, abnormally smooth, and swollen. Having dry mouth, cracks in the mouth or on the tongue can also be a sign of iron deficiency.

  • Spoon-shaped fingernails

A rarer symptom of iron deficiency is koilonychia – brittle or spoon-shaped fingernails. You may first notice that your nails chip and crack more easily than usual. As koilonychia worsens, the nails’ contours dip from convex to concave, giving it a spoon-like appearance. Koilonychia is less common, and usually occurs only in more severe cases of anaemia.

What does it mean if you have iron deficiency?

Iron deficiency is an indicator that something is wrong in the body – it could be a diet with insufficient iron, or excessive bleeding from menstruation or internal injury. It is also often an indicator of other health conditions, some of which include cancer and gastrointestinal diseases.

In particular, people with iron-deficiency anaemia are across the board more likely to develop cancer, and the converse is true as well – people with cancer are more likely to get iron-deficiency anaemia. One study showed that iron deficiency was most often associated with patients of pancreatic cancer, colorectal cancer, and lung cancer. Another research found that 6% of iron-deficiency anaemia cases were linked to colorectal cancer (which is often accompanied by bleeding in the colon).

So, being alert to symptoms of iron deficiency is not enough – if you also notice additional signs like persistent diarrhoea or constipation, bloated stomach, blood in stools, nausea, vomiting, and stomach pain, it is highly recommended you get tested for cancer or other gastrointestinal conditions as well. Your general practitioner may refer you to a colon cancer specialist if your risk of contracting colorectal cancer is high.

Bloody in Stools: is it a Sign Of Cancer?

Bloody stools is an alarming feature requiring further investigation. This is especially for those with family history of colon cancer, age > 50 years old and history of colon polyps. If the bleeding occurs lower down the intestinal tract, the blood can be visible as red-coloured or stained stools. Other times, blood in the stools appears as dark-coloured or black stools if the source of blood is further up the gastrointestinal tract. A majority of cases of bloody stools are attributed to non-serious conditions like hemorrhoids. Yet, bloody stools can also be a sign of other severe situations like colon cancer. There are also other medical condition that can cause blood in stools including colonic diverticulosis and inflammatory bowel disease. Not knowing the cause of bloody stools can be greatly distressing, thus it is useful to be able to recognise the tell-tale signs of the common hemorrhoid versus a more worrying condition like colon cancer.

Common symptoms of hemorrhoids and colon cancer

Besides bloody stools, other common symptoms that hemorrhoids and colon cancer share can result in them being mixed up. These include:

  • Rectal bleeding
  • Feeling of incomplete bowel movement

Symptoms of hemorrhoids

Having a basic understanding of hemorrhoids is crucial to distinguishing it from cancer. Hemorrhoids (also called piles) is the condition of swollen veins in the anus, lower rectum or just outside the anal opening. As such, most of the symptoms are localised at the anal area – there should not be any symptoms affecting the digestive processes per se. Here are some symptoms of piles that should not be present in a cancer like colon cancer:

  • Itching of the anal area
  • Pain in the anal area, especially during bowel movement
  • Bright red blood in stools
  • Lump outside the anus (only for external hemorrhoid)

Symptoms of colon cancer

On the other hand, colon cancer or colorectal cancer is a condition where abnormal cell growth occurs in the colon (large intestine), forming a tumour. Due to its location in the intestine, the tumour often affects gastrointestinal functions. However, the symptoms of colon cancer may not arise until it has advanced to a later stage. The following are some signs you should look out for that commonly occur in colon cancer patients, but that don’t occur for hemorrhoids:

  • Changes to bowel movement, e.g. diarrhoea or constipation
  • Nausea, vomiting, or weight loss with no apparent cause
  • Abdominal distension (swelling of the belly) – a sign of bowel obstruction
  • Gastric pain symptoms

How can your doctor check the cause of your bloody stools?

Often, symptoms alone are not enough to give you a complete diagnosis. Doctors will combine your reported symptoms with your health history and risk factors to decide if further tests need to be conducted to rule out other health conditions. Sometimes, the situation is not so clear-cut, especially if the presence of one condition serves as an aggravating factor for the other, as it has been found to occur.

If you have been referred to a gastroenterologist, they may conduct one of several tests to find out more about the condition you have. These may include:

  • Colonoscopy: A type of endoscopy where a long thin tube with an attached camera is inserted through the rectum to examine the lower intestinal tract.
  • Blood test to evaluate if you have significant blood loss, infection or inflammation in your bowels.
  • Stool sample test: A series of tests performed on a sample of faeces.
  • Biopsy: Collection of a small tissue sample to test for cancer.

After diagnosing your condition, a consultation with your gastroenterologist can also offer you more information on piles treatment or the prospects of colon cancer in Singapore.

Common myth About Colorectal Cancer

How much do you know about colorectal cancer? Given that colorectal cancer is the most common cancer in Singapore, it will be worth your while to understand a little bit more about it so that you can better guard against it.

Unfortunately, many people have misconceptions about colorectal cancer, which could lead to unwarranted fear or misled complacency. Here, we address some of the most commonly heard misconceptions our doctors hear from patients regarding colorectal cancer, and correct them with the facts.

Myth: Only men get colorectal cancer.

Fact: Colorectal cancer can affect both men and women.

Colorectal cancer is top 3 cancers diagnosed in Singapore, affecting both genders. Based on Singapore Cancer Registry from 2011 to 2015, colorectal cancer makes up 1 in 7 of cancers diagnosed in women, making it second only to breast cancer, with lung cancer following closely behind.

In men, colorectal cancer makes up 1 in 6 cancers, making it the top cancer diagnosis amongst men in Singapore, followed by lung and prostate cancer.

Myth: People under 50 years of age don’t need to be worried about colorectal cancer.

Fact: Colorectal cancer can affect persons of any age.

The incidence of colorectal cancer in younger people is on the rise. 10 years ago, only about 1 in 10 cases of colorectal cancer were in persons below the age of 50, but in the years 2011 to 2015, this rate has increased to 1 out of 5.

While age is one risk factor, young people also need to be aware of other factors that put them in risk, like their family history, existing or history of bowel-related conditions, a diet high in red meats and/or processed foods, a sedentary lifestyle, smoking, and heavy alcohol consumption.

Myth: Persons without symptoms do not need colorectal cancer screening.

Fact: Screening can detect cancer before symptoms arise, and offers a higher chance for effective treatment.

As many as half of colorectal cancer patients don’t display the common symptoms like blood in stools, diarrhoea, constipation, bloated stomach or stomach pain before the cancer is discovered. Screening tests help to detect cancers before symptoms surface, and allows for early intervention, which increases the chances of effective treatment and full recovery.

Some screening tests also detect pre-cancerous growths like polyps. Colonoscopy is one screening method that also offers the possibility of removing small polyps before they develop into tumours.

Myth: I must get a colonoscopy to screen for colorectal cancer.

Fact: There are several tests available for colorectal screening.

Colonoscopy stands as the most reliable method for detecting colorectal cancer. However, for those who prefer not to undergo colonoscopy, there are various alternatives available as well.

  1. Faecal occult blood test : non-invasive methods to detect blood in the stool.
  2. CT virtual colonoscopy : Can detect polyps > 5mm in well prepared colon, sensitivity and specificity is comparable to colonoscopy.

While these tests are good for preliminary testing, it should be noted that any abnormal results are still best checked out through a colonoscopy. The advantage of colonoscopy is that if a polyps being detected during the scope, it can be removed in the same setting, while a positive CT virtual colonoscopy for colonic polyps requires patient to go for colonoscopy and polyp removal, which is a 2 steps process.

Being informed about your risks and options when it comes to your health is one of the best ways to guard against diseases like colorectal cancer. If you would like to know more about your risk for colorectal cancer, don’t hesitate to consult a colon cancer specialist in Singapore to walk you through a thorough health history examination and give you advice on screenings recommended for you.

Food that may cause acid reflux or heartburn

Heartburn or acid reflux is a very common digestive disease in Singapore. It is a form of indigestion that typically presents itself as that awful burning sensation in your throat or chest, which happens when stomach acid backs up into your esophagus. The feeling can worsen when your lie down or bend over. This condition often related to abnormal relaxation of the sphincter muscle that prevents acid from flowing back to your food pipe from stomach.

As heartburn usually occurs after a meal, we explore how the potential food triggers can be the primary cause of one’s digestive discomfort. These are some of the common food that can trigger acid reflux and you may consider to avoid them if you are experiencing the problem.

1. Onions, Garlic and Spicy Foods

While the spice tolerance for individuals varies, spicy and tangy foods including garlic and onions can trigger heartburn symptoms in many people. Chillies, spicy sauces and chilli powder may aggravate acid reflux. If you wish to seek for an alternative, you can use other flavour enhancers like ginger, cinnamon, sea salt and herbs in your meals.

2. High-Fat Foods

High-fatty foods can be a major contribute to acid reflux symptoms. Greasy, fried and processed foods with trans and saturated fats as well as fatty meats such as ham or bacon linger longer in the stomach. This may slow down overall digestive process and relax the lower esophageal sphincter (LES), which can prompt or precipitate reflux. As a result, the stomach pressure is increased and the muscles that keep stomach acid out from the esophagus are forced open, leading to heartburn. 

3. Chocolate and Dairy Products

An ingredient called methylxanthine is found in chocolate and has been shown to relax or weaken the stomach valve muscle. This makes it easier for the contents in your stomach to escape up to your throat, causing acid reflux and heartburn. Healthy, dairy products such as cheese and butter contain fats that exacerbate acid reflux. Milk also creates excessive secretion of acid and will cause further discomfort, especially if consumed when the stomach is full.

4. Citrus Fruits

Highly acidic fruits and juices, such as oranges, lemons, limes, pineapples and grapefruits, can cause or worsen acid reflux symptoms. This also includes tomatoes or tomato products such as sauces in pizza and salsa.

5. Caffeine and Alcohol

For those with acid reflux and wish to enjoy their morning coffee, the high levels of caffeine present in coffee can actually lead to a rise in the secretion of gastric acid in the stomach, causing symptoms like heartburn to act up. When you consume alcohol, it contributes to an increase in gastric acid as it relaxes the muscles in your body, including LES which allows more stomach acid to enter the esophagus.

Keep a Food Diary

Keeping track of your meals carefully can help you to identify your individual triggers and control painful, uncomfortable flare-ups. Jot down what foods you eat and the time of day you ate followed by the symptoms that you may experience. Some food and beverages can also help to soothe your discomfort by neutralising the stomach acid, such as ginger tea and oatmeal.

Prevent Heartburn After Meals

Sometimes it may not be practical to avoid these foods in your diet, but you can take note of the following measures to prevent heartburn after eating.

  • Avoid overeating. Instead of several large meals, eat 5 or 6 small meals each day
  • Avoid eating before bedtime. Allow 2 hours for your food to be digested before lying down. This provides sufficient time for the food to pass out of the stomach and into the intestine, instead of it risking it getting back up into the esophagus. When you lie down too soon after eating, it makes digestion difficult and increases the chance of having heartburn.

Heartburn is a symptom for GERD (gastroesophageal reflux disease), and its other symptoms may include nausea, tightness in the chest, persistent dry cough, a sour taste in the mouth and trouble swallowing. If symptoms persist despite taking over the counter medication, your GP may recommend a gastroscopy for further evaluation. If you need further advice, you can consider consult our doctor. We are a gastroenterology clinic in Singapore that provides a full spectrum of sub-specialized care and clinical services for liver and digestive disorders.