On My Youngest Daughter Ai Hsing (Front) Graduation Day

On My Youngest Daughter Ai Hsing (Front) Graduation Day

Saturday, May 6, 2017

Cardiac protein as an early predictor of heart attack

Very late last night just as I was already retiring to bed at nearly 3 am, I received a WhatsApp message from Professor Dr Andrew Charles Gomez, a very prominent and famous ENT Specialist asking my opinion of a claim by a speaker at a conference on nutrition and aging he attended who said that a heart protein called cardiac myosin can be used as early detector of heart attack?

I instantly got up from my bed to type my personal opinion on this to Prof Gomez

Dear Prof Dr Andrew Gomez,

I am surprised you heard from one of the conference speakers on nutrition and anti-aging you attended that cardiac myosin is used as an early detection of heart attack?

Since I was not at the conference, I do not have the details of that claim. This is the first time I heard of using cardiac myosin as an early predictor of AMI (acute myocardial infraction).

As you are a reputable medical specialist yourself, let us argue this logically.

First of all, myosin is not something new to scientists. Even during my student days in the early 1960’s we already learn about this protein both in our physiology, and later in our nutrition lectures, that this protein (myosin) is present in all muscles for their contractile functions.

There are essentially two types of myosin expressed by three different types of genes; two for skeletal muscles – namely, one for slow skeletal muscles, and the other for fast muscles; both of which are actually responsible for the conversion of energy-rich phosphate bonds ATP (adenosine triphosphate) into ADP (adenosine diphosphate) with the release of energy like muscle contraction. We all know that even in biochemistry.

The remaining 3rd type of gene (MYBPC3) exclusively expresses cardiac myosin that is responsible for the continuous non-stop contraction of the heart.

This protein (cardiac myosin) remains in the cardiac muscles at stable and low levels. But they may increase by drugs such as cardiac myosin activators in the event of a heart failure.

But I have never heard of a heightened expression of this cardiac protein even BEFORE an acute cardiac event such as AMI. This does not seem scientifically logical to me. How do you expect a gene able to know or predict that an acute event is going to happen that requires it to increase its (protein) expression? This is like fortune-telling and putting a cart before a horse.

In medicine, doctors ought to know (unfortunate a lot don’t) that in most diseases, biochemical lesions starts to appear in the blood before the clinical presentations become apparent. But this can only happen if the pathology is already present without the clinical features manifesting themselves in the early stages of the disease.

Just to give you one or two examples will do - hydroxyproline and hydroxylysine for collagen formation is low before gingival lesions become apparent in scurvy.

Another example is erythrocyte transketolase activity in the RBC is affected even BEFORE a thiamine deficiency and beri-beri clinically manifest itself.

Yet another simple example is blood sugar levels is elevated for months or years before polyuria, polydipsia, polyphagia, weight loss, retinopathy, nephropathy and other complications are presented as complications in diabetic patients.

Another example is the elevation of various liver enzymes - alanine transaminase, aspartate aminotransferase (SGOT)… etc., even before signs and symptoms of liver diseases are apparent.

There are hundreds more such examples of biochemical and protein expressions appearing BEFORE a clinical presentation following the existence of already an active pathophysiology

However there are also a number of examples where the biochemical expressions are not sensitive enough for them to appear first before the clinical lesions manifest themselves.

One example are the tumor markers for cancer detection. These markers are neither specific nor sensitive enough to detect a lurking cancer already in existence in the body until the neoplasm are already very massive and in an advanced stage.

The reason is probably an existing malignant tumour requires billion of cancer cells to collectively express sufficient amounts of abnormal malignant proteins to be sensitive enough for chemical detection.

In the event of tiny amounts of cellular cancers lurking in the body all the time which we all have, but dealt with by the immune system, these small amounts of malignant cells cannot express sufficient amounts of abnormal proteins for chemical detection.

The only exception I can think of are the prostate-specific antigen (PSA) where its blood elevation is common for both prostate cancer and benign prostatic hyperplasia (BPH). The only choice for diagnostic differentiation between PSA in prostate cancer and BPH is to look at the velocity of the PSA increase over time, and also the free and combined PSA ratios.

In a total PSA level, there will be more free PSA in BPH than in the case prostate cancer. That ratio expressed should be taken into consideration short of performing a TRUS biopsy (transrectal ultrasound biopsy) for differential diagnosis.

PSA detection expressed by the prostate gland is quite specific for prostate anomaly. The rest of the other tumor markers are neither sensitive nor specific. This is the only example I can think of at the moment as I type this sentence.

In short, in most cases biochemical changes precede a clinical presentation. It is the presence of an asymptomatic pathophysiology preceding that causes protein expressions as changes in the blood chemistry.

This is because the pathology is already actively present as a trigger factor for the genes to express the specific proteins. This is so logical to understand.

However, there is only one exception I can think of at the moment in which an acute event comes first; after which then there is an expression of a protein (enzyme).

In this exceptional example, there is an increase in cardiac enzymes creatine kinase (CK-MB), and also the troponin levels which are released by the heart muscle within 3-12 hours of onset of chest pain, reach peak values within 24 hours, and return to baseline after 48-72 hours.

These cardiac enzymes are released only after an AMI. This is because the heart muscles already suffered a damage, and the enzymes expressed are only an after effect. But there is no way the heart knows when it is going to suffer a sudden coronary insufficiency for it to express the enzymes beforehand?

So the genes responsible for such enzyme (protein) release can express themselves only after a sudden acute event. AMI happens when the coronary vessels suffers a sudden ischemic episode, unlike chronic diseases. In an AMI there is no way of predicting this instant event. This is logical.

So, how can cardiac myosin be expressed beforehand and detected as an early predictor before the heart even knows of an imminent sudden cardiac event? This beats my all my basic understanding in medical sciences

As we can clearly see from the example of CK-MB and troponin being released ONLY after the cardiac event has happened, I see no way can the gene MYBPC3 ability to express the myosin-binding protein C (cardiac myosin) before the event?

In lighter vein, genes are not fortune-tellers or harbingers that can foretell a medical catastrophe yet to come for person to take the necessary precaution.

What you heard from the conference presenter on nutrition and aging does not make scientific sense to me to the best of my understanding.

Maybe I need to get hold of his published paper (if any) to read the study, the methodology, data and inference.

Thank you for asking

Lim ju boo

Tuesday, May 2, 2017

Peeling An Apple. Is It Wise?

Recently someone sent me a WhatsApp showing a mechanical apple peeler, and how it can peel many apples rapidly, efficiently and very cleanly.

I replied to tell him that the skin of an apple or any fruit especially highly coloured ones contain the core of their nutritive and even medicinal value, and such a device is doing injustice to Nature, the apple and the most of all, the consumer himself.

The Skin is Wholesome and The Best:

In fact a consumer of a cleanly peeled apple is throwing away the best part of the fruit.
The skin with its tens of dozens of phytochemicals, antioxidants, and phytonutrients of various molecular weights, many of which with low molecular weights below 400 are bioavailable through the human intestinal gut as Nature intended. They are meant for human consumption, but are lost through ignorance and fear of toxicity.

WhatsApp Ignorance:

Following that, a few in my WhatsApp group replied, the reason why they normally remove the skin of an apple is because of the wax. One said he tried to use hot water (I suppose he meant “blanching”), rub it with cloth and tissue paper, but the wax is still there.

Some even wrote using a combination of baking powder and vinegar and all sorts of de-waxing methods. But the wax is still there.

Unfortunately those with no knowledge of even simple inorganic chemistry do not realize that using a combination of baking powder (which is sodium bicarbonate), and vinegar (which is acetic acid) only result in production of carbon dioxide, sodium acetate and water in the reaction.

None of these resultant compounds can remove waxes, whether mineral wax or natural ones. But they believe in such “knowledge” taken from the Internet!!

Finally they found the best way is to skin off the apple, and consume only the white flesh beneath.
This prompts me to write a small explanation in this blog.

Perhaps most people who try to remove waxes on the surface of apples or from the skin of most fruits and vegetables do not know even simple food science, nutrition or chemistry.

I think they do not understand what wax is on the skin of an apple? I think most people think wax is toxic, and is harmful to health.

Simple Household Science:

Let me explain using with just a little organic chemistry, and a bit of physiology.
The wax on the skin of an apple is a natural fruit wax secreted by the apple itself for its own protection.

Most plants, fruits and vegetables such as apples, oranges, lemon, tomatoes, pumpkins, water melon…etc., etc , do secrete waxes and oils on their skin to protect themselves against water from outside, and internally against moisture loss and subsequently dehydration.

Even animals like ducks, birds, chicken do the same when they peen their features to keep them waterproofs and stay dry and warm.

Even the human skin secrete sebum with its sebaceous glands, and the body oils on our skin is about 26 % wax esters and about 12 % squalene, but mainly triglycerides and less of other free fatty acids.

Wax esters and squalene are unique chemical composition of the sebum on our skin, and are produced as a protective layer to keep the skin moist, and this secretion is not found anywhere else in the body.

So we may say these waxes are natural substances and are mainly made of esters. But then, what are esters?


Now in order to explain what esters are, we need to understand just a little bit of organic chemistry.
Let me explain this in simple language.

Esters are organic compounds formed by the reaction between alcohols and organic acids.
For instance, esters derived from carboxylic acids have the general formula RCOOR’ A simple example will do, such as ethyl ethanoate CH2COOC2H5, and methyl propanoate, C2H5COOCH3.

Esters containing simple hydrocarbon groups are volatile fragrant substances found in most fruits such as in apples, citrus fruits, mangoes, peaches…etc.

Esters as the Fragrance Fruits:

Because of their fragrance, food scientists and food technologists used them as flavouring agents in the food industry.

Similarly, like oils and sebaceous secretion on human skin or the oils from the uropygial gland (preen gland) in birds to preen their features, they are called triesters, meaning they are waxes or natural oil and fats molecules containing three ester groups.

Wax can be solid or semisolid substances. There are classified into two main types. The first type is mineral wax which is a mixture of hydrocarbons with higher molecular weights.
finitely not found naturally in apples or in any fruit or vegetable or rubbed into apples by the fruit producers.

The waxes found in apples and plants and in all animals, are actually esters of fatty acids to protect them from moisture, and these are edible and not toxic.

Do Not Peel an Apple:

So there is no need to scrape off the skin of an apple. Sometimes, apple and other fruit producers do rub in just a drop or two of natural waxes to the apples to preserve and to store their produce for a longer time and for better keeping qualities during handling, transport, and storage, but these are same wax esters they use as the apples themselves, and they are of food grade, not industrial or mineral waxes.
So there is no reason why health conscious consumers should peel away the skin of an apple.

A Holistic Natural Apple:

It is “An (whole and holistic) Apple a Day that Keeps the Doctor Away”
And that’s what Nature intents, not an un-holistic one with its best parts removed. What Nature puts in, let no man put asunder.

I hope I have explained clearly in reachable non-technical language to the ill-informed consumers, including the so-called “nutritionist”, “food toxicologist” and “health and food experts”

“Let the Whole Food be Thy Medicine” (my own quote)

Thursday, February 2, 2017

Alternative Medicine for Liver Disease

Dear Readers

(This is a temporary reply for a comment a gentleman posted into my Whatsapp chat group. But since it was sent into my smartphone, my reply to him was rather lengthy (below) it could not be fully inserted in Whatsapp on a smart phone which like SMS is actually meant only for short messages.

I therefore take this alternative media to answer his question through this blog instead which may be used for general education on health issues for my other gentle readers as well. Thank you for your understanding).


Dear Mr.......

This letter (answer) is for you (Mr.....to conceal his identity) . Read carefully. It is also a very useful medical education for the rest in this chat group.

First, I am sorry on your mother’s death due to a liver disease although you did not tell us exactly which disease of the liver?

There are over 100 different types of diseases of the liver such as cystic disease of the liver, fatty disease of the liver, viral A, B, C and autoimmune hepatitis, cirrhosis, alcohol-induced, alpha 1 anti-trypsin deficiency, Alagille syndrome, fatty liver disease, galactosemia, Gilbert’s syndrome, hemochromatosis Gilbert’s syndrome, hemochromatosis, sarcoidosis, liver cancer, lysosomal acid lipase deficiency, Wilson disease, haemochromatosis…etc, etc…down the long list. Which one did your mother suffered for ten long years?

However I suspect it was cirrhosis of the liver from the way you described “my mum has hardened liver” (where the liver becomes fibrotic and harden like a piece of leather). Am I right with my clinical suspicion?

You mentioned she was under a physician’s care for 10 years which makes me suspect cirrhosis, which is probably the only liver disease that takes such a long time to harden (fibrosis).
Cirrhosis itself has so many causes, and I shall mention a few later.

You also mentioned “I remember very well all the 10 years of treatment, no vitamin support was ever prescribed” Be careful of this also. I shall briefly explain later.

You also said you no longer trust conventional medicine, and that alternative medicine and vitamin should also be given to her? Also be careful on this note.

Not all alternative medicine can “care”. Same with conventional (allopathic) medicine.

However if you can give me her medical records on the investigations done, I may be able to tell if alternative medicine and vitamin support should be given that would have changed her prognosis (forecast outcome of a disease).

Ten years of treatment is a very long time. In that period your mother would have a lot, a lot of chances under a knowledgeable doctor who may take an alternative treatment pathway(s).

If that was actually cirrhosis (if my guess is not wrong from the two sentences clue you wrote), then a lot could have been done to brake, alter the course of cirrhosis (if that was the disease) or even reverse its pathology. But I do not know what her doctor did for her?

There are just 3 main causes for cirrhosis of the liver.

Chronic alcoholism

Viral infection, especially hepatitis B, A and C

Prolonged and low dose ingestion of toxic substances

Examples of liver toxins in foods are: aflatoxins or other mycotoxins, and in drugs and medications are (examples): indomethacin, ibuprofen, cimetidine, salicylates, ranitidine, nifedipine, antithyroid drugs…etc, etc…down the long list).

Hypervitaminosis: An excessive intake of vitamin A very much over the recommended daily allowances in foods may also injure the liver.

The liver already stores a lot of fat soluble vitamin A (retinol). Vitamin A in low doses is very protective against most liver diseases, but is toxic in very high doses over many years of intake (hypervitaminosis).

Even synthetic chemical inhalants like cleaning products, benzene, petrol vapours, pesticides, and hair sprays…etc, etc inhaled over long periods and exposures can injure the liver, and probably other organs as well.

Always remember all diseases including liver disorders have a single, butt in most cases multiple root causes.

In the event of early stages of the disease, her doctor should try to identify the root cause(s) as the first step, and then teach her how to remove or avoid the ROOT causes first.

This is the first and most important step in the practice of good and ethical medicine, not just give some medicine for 10 years to block the symptoms.

Once the root cause(s) has been removed through education, then a protective diet has to be instituted to assist the body (liver) to recover on its own.

Fortunately the body especially the liver has a great capacity to rejuvenate on its own.

In fact the liver is the only organ in the body that can regenerate most of it parenchyma (soft tissues and cells) even when almost severely damaged by infections or toxins, unless it is already very severely damaged to its end point over a very long period of exposures, leading to extensive scaring and fibrosis.

It is made worse due to neglect or inappropriate treatment using a lot of drugs that injure it even more. In the first place there is no drug treatment for cirrhosis of the liver.

Hence merely giving drugs for 10 years to manage cirrhosis is completely absurd without removing the root causes, something I have already briefly mentioned as the first line management.

This is to be followed by dietary intervention with appropriate protective nutrition to reverse its cellular chemistry and pathology.

I lot could have been done in that ten years for your mother if these steps were instituted by a knowledgeable doctor who is not blinded only by drug-based approach.

Vaccination against hepatitis B may be the only exception as a prophylaxis, but not for treatment.

A well-balanced, low-fat diet high in fruits and vegetables and rich in antioxidant content especially in vitamin C and broad-spectrum carotenes maybe the best approach in liver-disease prevention, as well as in early stages of the treatment.

But do not overdose with vitamin A, D, E, K and other fat-soluble vitamins as supplements. They just accumulated in the liver, being fat soluble, they cannot get out through the (water soluble) urine, and these causes toxicities in the liver and fat tissues.

Be very careful on this approach when you said in your Whatsapp chat “no vitamin support was ever prescribed” for your mother.

In small regulated doses, vitamin support is a positive yes, but not in toxic high doses especially with vitamins A, D, E and K. The chemistry and pharmacodynamics (mechanism of action) we shall leave out.

Another treatment adjunct is to get rid of excessive body fat as this can infiltrate into the parenchyma (soft cellular tissues) to cause fatty liver, and finally cirrhosis. This is the next step to hepatocellular carcinoma (liver cancer).

I have in the course of my career as a research nutritionist and medical researcher successfully treated about 6 or 7 cases (not very much) using a combination of dietary, natural therapeutics, and herbal medicine, combined with counseling and health education.

I did this completely free-of-charge for the patients who came to seek my help. I prescribed and educate (free), they buy the medication

But whether alternative medicine or vitamin support alone (as you believe in your Whatsapp comment) without integrating this with conventional medical approach that has supportive drugs in critical cases, this is a very risky question to answer.

Since I am using WhATAPP with limited space, it is not feasible for me to describe how I successfully managed to reverse all the 6 – 7 liver cases who sought my help.

There was one an accidental case I saw deep, deep in a village at the fringe of the jungle where there was not even basic medical facilities available. I was the only one there with my nurses and a team of medical lab technologist during our health surveys. The other doctors were stationed at the village Community Centre.

I was there in that district somewhere in Perak with the rest of my medical colleagues to conduct health surveys, and not to treat the community.

His case was so characteristics of an acute liver failure – jaundice, abdominal swelling (ascites), spider naevi, pedal edema (water retention on lower extremities), nausea and vomiting, malaise, loss of appetite, inability to answer questions as the classical clinical features.

It was a straight forward diagnosis based these clinical presentations even without the need for any further imaging, biochemical, or HPE (biopsy) as done in a major hospital.

Where can you get these sophisticated diagnostic facilities when you are working deep, deep into the jungle-villages. You just have to rely entirely on your training and clinical acumen, and nothing else.

Fortunately I happened to be trained also in natural medicine. So I just taught his family to boil some weeds (a medicinal herbs – P. amarus) available just outside his village hut, and give this to him 3 times a day.

That’s all I could do for him inside a jungle without any medical facility. It was a make-shift treatment using the best of my trained knowledge and in medical research.

To even my own surprised, he fully recovered after only a month. By then I was back to my comfortable office at the Institute for Medical Research (IMR) in KL, and forgotten his case.

One morning, a month later, I received a totally unexpected phone call from his son, a Malay gentleman who was working in Petronas.

To my surprise, he told me of his father’s total recovery, and ring me to thank me very profusely for my help.. I did not expect that myself as I have by then forgotten him, but busy analyzing my research data collected in the survey.

I have lots and lots to tell you about these few cases I met, but since I am using a smart phone (that always make a clown out of me with my English, grammar, spelling, omission of words, repetition of the same words, substituting some words or terms with its “smarter” auto-correct), it is not possible for me here to give you a detailed account, except through a few hours talk.

If you let me know specifically what liver disorder your mother succumbed to, and I shall be able to tell you if alternative medicine (as you believe) would have helped.

Please remember alternative medicine is not a miracle system of medicine. The same for conventional medicine.

It all depends on the disease. Many are not curable whichever the medical system. Some are even down right bogus and a cheat. Just be very careful.

I shall tell you later how I was incorporated into a powerful joint technical committee consisting of representatives from WHO-MOH-IMR in the early 1980 -90’s when I was working at the IMR to evaluate all these systems to be integrated into the mainstream health-care system of this country.

Our years of laborious efforts have bore fruits today, with many alternative systems of medicine now officially recognized for lawful practice through an Act of Parliament in this country. They should thank us for our years of meetings after meetings of evaluation.

I have lots and lots to tell you about these few cases I met about liver diseases, but since I am using a smart phone (that always make a clown out of me with my English, grammar, spelling, omission of words, repetition of the same words, substituting some words or terms with its “smarter” auto-correct words).

it is not possible for me here to give you a detailed account, except through a few hours talk.

Maybe I can continue later at another chat session.

Regards and take care on your health

Jb lim

Monday, December 26, 2016

A Poem for Christmas 2016 by me to me

Christmas for me 

Each morning I wake up is Christmas Day for me.
Unknowingly I have sinned the night before
Each morning I need Christ to be born again in me
To remove the sin the night before

Born again each day in me
A new life in Christ to lead

The multitude sings and dance
In the streets and shopping malls
Hailing Christ birth only once a year
They matter not to me

The path of least resistance
Surely is the easiest way 

For it is written
“Enter ye in at the strait gate:
For wide is the gate, and broad is the way
That leadeth to destruction
And many there be which go in”

So they sing and dance all through the night and year

Each morning till my breath of life stays
I shall take the hard and narrow way

In remembrance of Christ birth each day
Who came to Earth to suffer for me

Surely I shall follow Him
Carrying my own cross along with Him

Through life journey in Christ till the end

To be born again each day in Him

Till I reach home to Him

That’s Christmas each day for me – jb lim

Friday, November 25, 2016

Fukushima Disaster Radioactivity found in the Pacific Ocean?

 Radioactivity in the Ocean?

An Analysis by

lim ju boo

Wow!  I received yet another bogus circular inside my smart phone asking people to avoid eating fish because radioactive has been detected millions of times above normal in the Pacific Ocean.

Just remember, Japan and the surrounding waters in Japan  is over 5,000 km away from Malaysia.

What a joke for me.

Let me clearly put it this in a very simple easy to understand way for my Gentle Readers
Pu-241 decays into americium-241, with a half-life of 14 years. In short it becomes less and less radioactive over the years.

Plutonium (Pu-239) is a key nuclear material used in modern nuclear reactor like those in Fukushima
Plutonium-239 is also one of the three main isotopes demonstrated usable as fuel in thermal spectrum nuclear reactors, along with uranium-235 and uranium-233. Plutonium-239 has a half-life of 24,110 years. But I do not know which of the isotopes was implanted into the Fukushima reactors.

But it makes very insignificant difference in our argument here, and I shall explain why.

The fission of one atom of Pu-239 generates 207.1 MeV = 3.318 × 10−11 J, i.e. 19.98 TJ/mol = 83.61 TJ/kg or about 2 322 719 kilowatt hours/kg. 

Einstein used the CGS system of units (centimeters, grams, seconds, dynes, and ergs), but the formula is independent of the system of units.

Energy Equivalent:

In natural units, the numerical value of the speed of light is set to equal 1, and the formula expresses an equality of numerical values: E = m. In the SI system (expressing the ratio  E / m  in joules per kilogram using the value of c in meters per second).

E = mc2

E / m  =  c2 = (299792458 m/s)2 = 89875517873681764 J/kg (≈ 9.0 × 1016 joules per kilogram).

So the energy equivalent of one kilogram of any mass like Plutonium as long as it is totally fissionable able   is equivalent  to the above calculation.

Put it another way, 1 kg of Plutonium or 1 kg of any mass, theoretically yields an equivalent of
= 89.9 petajoules

= 25.0 million kilowatt-hours (approx. 25 GW·h)

= 21.5 trillion kilocalories (approx.  21 P cal)

= 85.2 trillion BTUs

= 0.0852 quads or the energy released by combustion of the following:

21 500 kilotons of TNT-equivalent energy (approx. 21 Mt), or

2,630,000,000 litres or 695,000,000 US gallons of car petrol

This amount of energy if put into a car (let’s say) would be able to push the car up to 31,771,200 km or 19, 857,000 miles (assuming the petrol consumption of an average car is  14.87 km per litre or 35 miles per gallon).

Round and Round the Earth Circumference:

This amount of energy from 1 kg of Plutonium is more than sufficient to power  a car up to 3.91081 x 1010 km  or 975,873 times round and round the equatorial circumference of Earth

(Earth’s equatorial circumference is = 40,075 km)

(1 US gallon = 3.78541 litres, and 1 mile = 1.60934 km )

That’s a horrendous amount of energy no nation can ever use up even for 10 years or more.

So I do not think Japan has ever used 1 kg of any form of isotopes of Plutonium.  It was probably just 200 gm. of highly purified fissionable Plutonium, whichever the isotope they selected.

But let us say  for academic argument between you and me in this Whatsapp  chat group for the sake of stimulating  our mind  and for fun sake.

 Let us see what happens if all the entire 1 kg of pure fissionable  Plutonium were released into all the oceans on this Planet, and not just a small part of the Pacific Ocean near Japan as claimed.

Well, let’s do some simple mathematics and see what happens.

How Much Water in the Oceans:

First, we need to know how much water are there in all the oceans of the world, including the ice caps, glaciers, & permanent snow, etc. , except inland waters like lakes and river, and water trapped in subterranean layers of the Earth and in the atmosphere, etc.  

Let us make our calculations simple.

The data I got from various sources puts the estimate at 1,362,145,400 cubic kilometres.
That’s equivalent to 1012 X 1,362,145,400 cubic km = 1.36 x 1021 litres of ocean waters which is an extremely modest estimate I should say.

Let us say, all the 1 kg of pure Plutonium has leaked into all the oceans and seas and thoroughly diluted by ocean currents of various sorts for another 1,000 years to come. What happens?

Since one kg = 1,000,000 mg of Fukushima Plutonium

Then the dilution factor is:

1.000,000 / 1.36 x 1021 litres = 7.35 X 10 – 16 mg = 0.000,000,000,000,000735 mg per litre only diluted into all the ocean and sea water by ocean drifts, convection and currents

Let me now tell you this. I am a qualified analytical food quality controller with an MSc degree in this specialty from the University of Reading in England besides being a nutritionist and doctor.

Level of Detection in Analytical Chemistry:

As an analytical chemist it is possible for us to detect any chemical substance down to the tune of several parts per billion or ppb (1 billion = 1,000,000,000, i.e. one thousand million, or 109). We use highly sophisticated instrumental and state-of-art i analytical procedure to bring it down to this analytical level.

But to ask me or any well-trained analytical chemist,  even with the most advanced and classy analytical instrumentation and procedure available to my disposal  to detect any chemical substance down to the level of just 0.000,000,000,000,0007mg per litre,  is like asking me to detect 30 – 40  molecules  inside the biggest lake in the world, let alone detect any radioactivity from a few million  molecules  of a radioactive substance thrown into the Amazon or Yangtze River.

Well mathematics does it, and has shown me the way to argue for argument sake.

My brain was sleeping when Ir. Hon sent me that faked car climbing up a vertical mountain of snow. Initially my hollow skull was sleeping into believing anything or any video from Google.

Localized Area

 Of course if we are only talking about a small area in the Pacific Ocean near, and around where the Fukushima earthquake catastrophe took place, then there may be a small concentration of radioactivity concentrated around that area only where the discharge flowed. Maybe a small strip of the North Pacific Ocean was affected.

Even then over time, water currents will wash away all contaminations well away from coastal regions where there is human habitation. By then any radioactive wastes from spent nuclear fuel will also be so diluted by the enormous volumes of the Pacific Ocean, that nothing can be detected chemically  or its radioactivity shown by the Geiger-Mueller (GM) tube. 

Furthermore, there is no need for fishing boats to go so near the coast or strip of waters where the Fukushima Daiichi nuclear disaster took place, or where the radioactive waters was found.  It is a normal practice for fishing boats to go far out at sea for deep sea fishing.  The fishing yield may not be big enough near coastal region to be commercially viable.

Minamata Disease

The Minamata disease due to the continuous industrial discharge of methyl mercury into the Minamata Bay of Japan between 1932 – 1868 by the Chissa Corporation, a chemical company is an example of localized chemical pollution that lead to severe neurological disorders such as   ataxia, paraesthesia (sensation of ‘pins and needles’), muscular weakness, loss of vision, hearing and speech impairment, deformity, birth anomaly, insanity, coma, and other clinical presentations, and eventual death,

It is one example how poisonous discharge into the rivers and seas can affect the health of a fishing community living around that area due to consumption of fish and shellfish that have accumulated mercury in their tissues.

The disease first recognized in 1956 has since disappeared. The reason is obvious. All the mercurial toxic waste has since disappeared around Minamata Bay and the Shiranui Sea due to enormous dilution by ocean waters that drifted them far out into the North Pacific Ocean. I believe not a trace of mercurial complex can be detected there now.

Dilution Factors

 The amount of toxic or radioactive molecules or any atoms, molecules or particles present in a volume will depend upon the concentration of a substance present.

In Chemistry, this is called Avogadro number or Avogadro constant (named after the Amedeo Avogadro) which is the number of molecular particles, or atoms present in the amount of substance given by one mole. It is related to the molar mass of a compound.

Avogadro's constant or (NA or L), has the value 6.022140857(74)×1023 mol−1

What would the Avogadro number of radioactive waste now in the localized part of sea near Fukushima disaster area? 

I believe it would be much less than 6.022140857(74)×1023 mol−1 due to its much less concentration  - number of molecules per mole as defined by Avogadro constant.

Uranium and Plutonium

Plutonium (Pu) is a transuranic radioactive chemical element and an atomic number 94. It is an actinide metal that is silvery-gray in color that tarnishes when exposed to air.  Plutonium is the heaviest element known in nature but in trace amounts.  

Its trace presence in Nature is  similar to its small amounts of production  from the neutron capture of natural uranium-238.

 Plutonium is much more common on Earth since 1945 as a product of neutron capture and beta decay, where some of the neutrons released by the fission process convert uranium-238 nuclei into plutonium-239.

Since it is derived from uranium, and since uranium is a  more common elements in the Earth's crust, than silver by 40 times and silver  is  500 times more common than gold, uranium  can be found almost everywhere in rock, soil, rivers, and oceans.

If uranium is quite a common ore on the Earth’s crust, and since it is already present naturally on this Planet with or with the Fukushima Daiichi nuclear reactors what then is the problem. 

The Fukushima reactors did not add more radioactive elements into the seas and environment.  Japan did not bring them from outer space. It came only from Planet Earth, and they merely put them inside their reactors.  

The total amount of radioactive substances on the entire surface of this Earth, whether inside reactors or outside in the natural environment is exactly the same.  Nothing extra was added by Man or Nature. 

They were already there 4.543 thousand million years ago even long before the beginning of any life form creeping on the surface of this Earth. What then is the problem?

In fact the reactors subtracted the amount by spending it to yield nuclear energy, except it left behind unspent fuel as wastes, which is the issue. Spent plutonium fuels are no longer fissionable. That, at least is my understanding how nuclear reactors work.

Total Amount is the Same Within and Without

Because the total amount of radioactive substances on Earth are the same, be they inside  reactors or outside in the natural environment , what then is  the fuss if the same natural uranium from outside which plutonium is derived decides to leak into the environment through rain,  storm,  dust winds  and the elements causing  natural erosion.

Would environmental and health activists make a fuss as though the disaster came from the damaged reactors at Fukushima?

Waking Up:

I woke up from my slumber,  and proved by calculation that no vehicle can ever climb up a vertical wall of loose snow where absolutely there was zero grip up a vertical  even on the concrete  floor, let alone on loose snow (short of a jet propulsion against gravity).

Now this rubbish  thing about radioactivity in the Pacific Ocean from the Fukushima disaster, and asking everyone not to eat fish which to me as a food scientist and research nutritionist, is one of  most laughable jokes of 2016 when fish is one of the best sources  of excellent protein quality,  and nourishment for the protein-hungry world.

Whom do you believe? Those health quacks who ask others not to eat fish, and makes all sorts of health and toxicological claims inside Google, or myself?  

You decide. The mathematical calculations are clearly shown

juboo lim 

Saturday, October 15, 2016

Magnetic Nano Particles to Open Gates to Brain-Blood Barrier

Dear Professor Dr.  Andrew Charles Gomes

Thank you for your question soliciting my coments on this website:

I am not an expert in this area of medicine – nano-medicine, or in nano-pharmacodynamics or its kinetics.  

But still,  I shall attempt in a simple, non-technical way to answer your question by  explaining  its mechanisms as a potential drug-delivery system especially in hard-to-access target areas such as the brain where concentrated drug dosage need to be delivered without compromising toxicity exceeding therapeutic index / therapeutic  windows to the rest of the body especially for cytotoxic agents in cancer treatment.

Brief Introduction:

The application of nanotechnology as a drug delivery system especially in cancer research and in other therapeutics is considered as nanomedicine. This  discipline is one of the most active and exciting areas of medicine scientists are actively working on today.

It applies nanotechnology to highly specific medical  and pharmacological interventions for the prevention, diagnosis and treatment of diseases. The haste in nanomedicine research over  the past few decades is now  recognized  as part of translational medicine  that may result in  considerable marketing efforts  by  bio-pharmaceutical companies throughout the world.

There are at present a significant number of products using nanotechnology  such as cosmetics on the market and an increasing numbers are  in the pipeline. Presently, nanomedicine is restrained to drug delivery systems, and the results of R & D in this areas has exceeded  75% of total nanotechnology sales.

However, the application of nanotechnology as an emerging drug delivery systems would depend on their safety and efficacy data, but I believe would fail to reach clinical development for other therapeutic regimens because of their poor biopharmacological properties, such as modest solubility or poor permeability across the brain-blood barrier or even through the intestinal epithelium, circumstances that translates into poor bioavailability and undesirable pharmacokinetic  end-points.   

Currently there exist various nanoforms that have been attempted as drug delivery systems. They vary from metallic-organic conjugates,  biological compounds, such as albumin, gelatin and phospholipids in liposomes complexes, to chemical compounds  such as various polymers and solid metal-congugated complexes.

Polymer–drug conjugates, which have high-small size spectrum are normally not considered as nanoparticles(NPs).  But since their size can still be structured within 100 nm, they have been  integrated into these nanodelivery systems. 

These nanodelivery systems can be designed to have drugs absorbed or conjugated onto the particle surface, encapsulated inside the polymer/lipid bonds or dissolved within the particle matrix including perhaps magnetic –sensitive NPs which is the question Professor Dr.  Andrew Charles Gomes, a Senior Consultant ENT Surgeon associated with Johns Hopkins Hospital was asking me to comment

Brain-Blood Barrier:

First, we must consider the existence of  blood–brain barrier (BBB) which is a highly selective permeability barrier that disconnects the circulating blood from the brain extracellular fluid in the central nervous system (CNS).

This blood–brain barrier is shaped out by the brain endothelial cells, which are then linked by tight junctions with an extremely high electrical resistivity.

Neurophysiologists know that the blood–brain barrier allows only the passage of water, some gases like oxygen and carbon dioxide,   and lipid-soluble molecules into the brain.  These molecules are transported by passive diffusion, as well as the selective transport of compounds such as glucose and amino acids that are critical for neurological function.

On the other end of the blood–brain barrier it may prevent the entry of lipophilic, potential neurotoxins by way of an active transport mechanism mediated by P-glycoprotein.

Astrocytes are essential in this barrier mechanism to create the blood–brain barricade. A small number of regions in the brain, including the circumventricular organs (CVOs), do not have a blood–brain barrier such as what Prof Dr. Andrew Gomes emailed me on the above website.

However, there  are  regions in the brain where there is an open gate, and where  certain “thermo-gates” are temporary opened  at certain temperatures.  It is here scientists take an advantage when the gates are opened and / or subjected to a magnetic field for drug-laced nanoparticles to gain entry.

Normally, the blood–brain barrier exists along all capillaries and consists of tight junctions around the capillaries, but do not exist in normal circulation. Endothelial cells restrict the diffusion of microscopic objects such as bacteria and pathogens, and large or hydrophilic molecules into the cerebrospinal fluid (CSF), but  allowing the diffusion of small or hydrophobic molecules  such as oxygen,  carbon dioxide and hormones.

It is in these regions of the brain t that actively transports nutrients such as glucose and specific range of proteins across the barricade which encompasses a thick basement membrane and astrocytic sheet.

This "bio-barricade” results from the selectivity of the tight junctions between endothelial cells in CNS vessels restricts the passage of even solutes which generally are not magnetic-sensitive

At the interface between blood and the brain, endothelial cells are sewed together by these tight junctions. These junctions are composed of smaller subunits, frequently biochemical dimers, that are trans-membrane proteins such as occludin, claudins, junctional adhesion molecules.

The units of these trans-membrane proteins are fastened into the endothelial cells by another protein complex that includes other associated proteins. None of these molecules to the best of my understanding can be subjected to magnetic induction.

As I have already explained, the blood-brain barrier is a highly selective semipermeable barrier running inside the majority of all the vessels in the brain, and they only that lets through water, some gases and a few other select molecules, while inhibiting potentially toxic elements in the blood from entering the brain.  

It is almost improbable for most drugs to get through excepts perhaps Levodopa, the drug  used in the management of Parkinson’s  disease.  Levodopa is probably  the best drug that mimic dopamine,  the natural neurochemical in the brain

No Entry:

Scientists currently tell us 98 percent of therapeutic molecules are also blocked by the brain-blood barrier.

However medical researchers have developed a technique using magnetic nanoparticles to open  the door for such molecules, and in so doing opening the gates  to new therapeutics  regimen for brain diseases.

"At the present time, surgery is the only way to treat patients with brain disorders," says Anne-Sophie Carret, a study senior author in this area of magnetic nano-therapeutics  

Currently surgery is the only option to remove certain kinds of tumors.  But some disorders are located in the brain stem, amongst nerves;  making surgery impossible says Anne-Sophie Carret.

By opening the blood-brain barrier to these therapeutic molecules, the researchers feel that  would provide an alternative to surgery for treating various brain diseases.

According to researchers the technique involves sending magnetic nanoparticles to the surface of the blood-brain barrier at the desired location in the brain. The researchers say this could be achieved using magnetic resonance imaging (MRI) technology, albeit a different method was used for their study.

Scientists in the study say that the drug-laced nanoparticles are directed to the desired location, the nanoparticles are then exposed to a radio-frequency field that caused them to dissipate heat.

This causes a small rise in temperature which in turn places mechanical stress on the barrier, thus opening  a localized gate  which allows therapeutic molecules to pass through. The opening is only temporary, remaining open for around two hours the researchers claimed.

"While other techniques have been developed for delivering drugs to the blood-brain barrier, they either open it too wide, exposing the brain to great risks, or they are not precise enough, leading to scattering of the drugs and possible unwanted side effect," says principal investigator Sylvain Martel.

Currently technique is experimental, and was developed using murine (rats and mice) models. It is yet to be tested on humans, but the researchers are optimistic that  one day it can be used  on humans.

"Although our current results are only proof of concept, we are on the way to achieving our goal of developing a local drug delivery mechanism that will be able to treat oncologic, psychiatric, neurological and neurodegenerative disorders, amongst others," says Carret.

To the best of my understanding at the time of writing this comment, this is a novel approach in breaking into the brain-blood barrier using magnetically-induced nano therapeutic molecules, but the question I  would like to  ask the researchers is, how then would these drug-tagged nanoparticles get out from the brain parenchyma once it has delivered its therapeutic molecules to the target region. Surely, the brain-blood barrier is only a one-way street.

One-Way Entry:

Drugs, especially metallic complexes and large molecules with high molecular weights cannot find their way into the general blood  circulation or cerebrospinal fluid (CSF) flow  even via active transport mechanisms,  let alone by diffusion especially if a one-way gate is closed once the nanoparticles get lodged inside the brain  This is the dilemma I need to ask my scientific-medical counterparts . I wonder what their answers would be as much as I like to direct this same question to  Professor Andrew Charles Gomez.

A Neuro-Scientist Opnion:

I had a discussion with Professor Dr. Ong Wei Yi, who is my nephew and a neuroscientist at Yong Loo Lin School of Medicine, National University of Singapore (NUS) at a family dinner on September 3, 2016.

I was talking about the use of nano-delivery cream in cosmetic application such as in sun screens,  and my nephew  cautioned me about the use of nanoparticles, depending on their size as they can lodge in the brain even by inhalation, but not by injection, probably because  of this brain-blood-barrier mechanisms,   and they can cause extensive neurodegeneration and wide spread tissue and organ damage according to Professor Ong Wei Yi.

This is my nephew’s professional opinion as a neuroscience expert at NUS.

Many Questions:

I too have many questions to ask on their biosafety that requires extensive and long-term toxicological evaluation and long-term clinical trials with safety and dose data clearly demonstrated -  right to the end of Phase Four of drug trials before magnetic  nano therapeutic molecules can find their way into clinical applications

Comments by ju boo lim (lim ju boo) 

Tuesday, October 13, 2015

Artemisinin and Malaria a Nobel Prize Recognition of TMC

Dear Dr Chan Boon Lye

Thank you for your further info about Artemisinin and Chinese researcher Tu Youyou who won the 2015 Nobel Prize in Physiology or Medicine

This, indeed is a very great honour for a Chinese, and a giant leap for a medical researcher in TMC from China for a female Chinese to win this very prestigious Nobel Prize in Medicine or in Physiology.

As far as I know, there are 12 Chinese so far world-wide, 3 from Mainland China, including Tu Youyou, one from SAR Hong Kong, and the rest who won this coveted Prize in Physics and Chemistry were Chinese working in the United States.

But Tu Youyou is the first female Chinese from People's Republic of China, and the only Chinese to win one in Physiology or Medicine. What a tremendous honour for the super-fast growing superpower of China and the Chinese race world-wide.

What is more glaring is that she won this much esteemed Prize not in conventional allopathic medicine, but in a 2000-year old Traditional Chinese Medicine (TMC).  This gives the practice of TMC such a tremendous boost in recognition against the fast declining popularity of allopathic drug-based mainstream medicine. 

My Awareness as a Medical Researcher:

In the 1980’s when I was working at the Institute for Medical Research (IMR) there were already much  talks among us researchers at international  conferences,  scientific meetings and medical updates  about the resistance of MP (malaria parasite)  - Plasmodium falciparum  to most anti-malarial drugs, notably chloroquine a drug that has long been used against malaria.

Malaria claims the lives of nearly one million people each year, mainly in Africa. Chloroquine was then the best anti-malaria drug available against the scourge  of this tropical disease.

It was about the time I returned from London after completing my PhD in natural medicines. I went to London and universities elsewhere in the UK 3 times over for my postgraduates

I remember one afternoon standing on the open wooden corridor of the old colonial building, the old section of IMR after completing my PhD  in this field of expertise, I had a long discussion with Prof Dr Mak Joon Wah, MD PhD who then was the Head of the Malaria Division at IMR.

His office was just next door to mine. I asked him if he knew about a plant called Artemisia, a specie called Artemisia annua  in which contains  a therepeutic principle called Artemisinin.  

 I told Prof Mak that artemisinin has been used in Traditional Chinese Medicine as a very effective treatment for malaria. That was the knowledge I brought home from the London School of Hygiene and Tropical Medicine, University of London.

The year when I suggested that to Dr Mak, was around 1988 or 1989? I then proposed to Prof Dr Mak, that he  should consider using  this naturally-occurring medicine instead of using the conventional chloroquine-resistant  synthetic agent  against  P. falciparum (malarial parasite) since  the parasite was already showing resistance to chloroquine,  first observed in Vietnam and in Thailand.

 Fortunately Prof Mak told me he was aware of artemisinin, but unfortunately he also told me the World Health Organization has recommended that artemisinin should be reserved as the last resort as the only last hope left for treating malaria since MP has already shown resistance to most anti-malarial drugs, the best then was chloroquine, the chemical analogue of quinine from the bark of the cinchona tree.

So it looks like artemisinin is now a reserved natural drug-of-choice against malaria

Spoke to a WHO Malariologist:

I also remember some years later I also spoke to a WHO Consultant Malariologist who was posted to IMR.

During our dialogue, he admitted we were losing our battle against malaria and that mosquitoes have existed even much earlier than the dinosaurs, maybe about 100 million years ago.

He told me he was sent by WHO to Malaysia from Assam in the south-eastern region of the Himalayas

He told me malaria existed even in Assam, it was not a huge problem there because the Assamese used traditional medicine to treat themselves. In the case of malaria or any form of fevers, they did this by chewing the bark of a tree (presumably, the bark of the cinchona tree) 

Then the fever and malaria were all gone within hours. It was not a problem for the Assam people because they rely on their good old traditional medicine.

But he said WHO had a “better” idea for them.  WHO then started introducing chloroquine and other synthetic anti-malarial drugs into Assam to fight the disease en masse

After WHO did that he said, malaria took revenge, and ravaged the population there uncontrollably.   That was why he escaped from Assam and came to Malaysia to do the same to this country to the loud laughter of both of us.

 Our Experience among Orang Asli in Malaysia:

The same thing we experienced here in Malaysia among the Orang Asli. When our malaria team from the IMR went into the jungles and the orang asli settlements to do a survey, we found almost all of them carry Plasmodium falciparum or other species of Plasmodium in their blood as seen in thick blood films on Giemsa stains

But they do not suffer from any of the classical clinical signs and symptoms of malaria. They merely walk about healthily with the malarial parasites in their blood.  It was a kind of symbiosis between their body and the parasites.

Despite that, we still dosed all of them with synthetic chloroquine with the hope of getting rid of all the MP (malarial parasites) in the blood.  Then naturally the MP count fell.   

We were very happy because we thought we were very clever, we have achieved our objectives. We also thought we were very clever and smart, smarter than Mother Nature.

We then returned to our sophisticated research laboratories at IMR in Kuala Lumpur and ‘bemused’ at our ‘victory’ because we thought we have solved their chronic sub-clinical malaria problems.

Then we returned to re-evaluate our findings and our prophylactic and therapeutic regimen a month later. What did we find? Well, this time the entire settlement there not only got back all the MP into their blood, but they all also came down with clinical malaria as well, which was never there before.

It only shows if we have not interfered with Mother Nature with our synthetic drugs, we would not have made the problem worse.

The Orang Asli have been living peacefully in the jungles in harmony with Nature, and the malaria parasites too have been living peacefully with them in their blood without attacking them. They were in harmony with Nature, some kind of natural symbiosis.  

We are not too sure about this biological phenomenon as the malarial parasites require at least 6 major steps in their life cycle for their development once the malarial parasites or other species of Plasmodium, such as P.  falciparum P. vivax, P. ovale, and P. malariae enters  the body from the bite of the Anopheles mosquito during which clinical manifestations of malaria will develop.

But most of the native people living in the jungles or in malarial infested regions have high loads of malarial parasites in the blood without suffering from the classical clinical presentations of the disease.  It is quite a  phenomena we cannot quite understand.

Perhaps they are immune to it with chronic and long exposures to the bit of the Anopheles mosquitoes till they do not respond clinically? It could be the exhaustion phase from an acute to the chronic phase a disease until the body fails to respond as postulated by the famous Canadian physician Dr Hans Seyle in his theory  of General Adaptation Syndrome when the body undergoes from acute to chronic stress.  This could be the best explanation.

Alternatively, they may have developed a symbiotic relationship with the parasites in their blood

Yet, once we interfere with this biological relationship we invite trouble. The parasites attack back.

Perhaps if we have used artemisinin or other natural medicines, the scenarios would have been entirely different.

As doctors and research scientists we have much to learn from other alternative systems of medicine such as traditional medicines, botanical and herbal medicines, naturopathic medicine, nutraceutical and nutritional medicines.

Allopathic Medicine vs Traditional and Complementary Medicines:

Doctors and practitioners of most  alternative systems of medicine learn their therapeutics from Mother Nature thousands of years ago. 

Conventional allopathic doctors use chemical drugs and surgery only less than 100 years ago compared with thousands of years of therapeutic experiences for traditional and other systems of medical practices. 

Conventional drug-based medicine handles chronic and degenerative diseases such as metabolic syndrome (diabetes and endocrine disorders), hypertension, CVA, cardiovascular disorders, cancers, renal and neurological disorders, etc  poorly using synthetic chemical drugs to control (not cure) the disease,  compared to the slower but more responsive therapies of botanical and natural medicines.

Traditional Chinese Medicine for instance has served the Chinese civilization very effectively for over 2000, while naturopathic medicine or natural medicine based on food, rest, physiological fasting, etc  has been around since the time of Greek Physician, Hippocrates of Kos, the Father of Medicine around   460 – c. 370 BC.  Hippocrates advocated

 "Let Food Be Your Medicine"

This is therapeutic nutrition or nutritional medicine. Food especially plant-based (fruits and vegetable) contains hundreds of phytochemicals including antioxidants. They are functional foods and also be nutraceuticals. Almost half the present generations of synthetic chemical drugs used in conventional medicine have their origin from herbs and medicinal plants.

Hippocrates only advised “let food be your medicine” not the other way round. How can that be using medicine and drugs as our daily food? This round about quote was put there into Hippocrates mouth by modern allopathic doctors and drug companies working hand-in-gloves to promote their chemical drugs as food. The root causes was never taken into account, but simply to supply the same medication month-to-month till the next routine appointment three months later comes round!  

Unfortunately this last claim by Hippocrates that "let medicine be your food" was repeatedly quoted by many, including health-care professionals like parrots who has not a clue what they are uttering.

They just follow the repeated quotation from others like parrots. They merely follow the crowd to be on the safe side, but has no clue what were they were uttering.

Food and herbs do contain medicinal principles besides their nutrient contents, and can be used as food as well as medicine. But we need to be selective

But how illogical is it to advise someone to take tablets, pills, drugs, injections, including herbal medicines as our daily food and bread?

This last quote is highly illogical and can only come from someone who has no knowledge on the difference between medicine, food and nutrition.

They merely blare out their ignorance by following what others have quoted.

Hippocrates, the Father of Medicine only advised physicians of his time to treat their patients with food, rest and exercise

Never did he advise taking natural medicine as food. Food and medicine are two different things

How illogical to take drugs and all kinds of medicines as our daily food and bread. The body must be terribly ill to be supported like that! 

Hippocrates, the Father of Medicine had never advised that! 

Lim juboo  BSc (Physiol) PG Dip Nutri  MSc  MD  PhD (Med)  FRSPH  FRSM