what happens in yishun, a district of singapore? · public enemies . the u.s. government is poised...

What happens in Yishun, a district of Singapore?

a classic population pyramid

17.4 years

64.5 years

547,000

age median:

life expectancy:

age 60+ Total population: https://populationpyramid.net (United Nations)

https://populationpyramid.net/

What will happen to Malaysian population pyramid?

2010

28,334,000

26 years

74 years

2,250,000

100,000

The senior population was multiplied by 3 in 3 decades

year

population census

age median:

life expectancy

seniors (60+)

seniors (85+)

1980

13,136,000

17 years

72 years

745,000

67,000

Total population: https://populationpyramid.net (United Nations). Population census 1980, 2010

https://populationpyramid.net/

A huge population of seniors will have to be taken care of

60+

0.7Millions (6%)

60+

2.3Millions (8%)

60+

6.3Millions (16%)

There is no timeless & universal

rules of nutrition

Nutritionists have to adapt to

the local age pyramid

Nutrition

nutritionists have to adapt to the local age pyramid

nutritionists priority:

• Providing the young generation

with proper nutrients for healthy growth



•cardio-vascular diseases

•obesity

•diabetes



•age-related diseases very much linked with

•cardio-vascular diseases

•obesity

•diabetes

statistically 1.4 senior 60+ out of 10 suffer from dementia

Simple question:

is it going to be a proportional number in 2040?

Simple Calculation:

Senior population: 6.3 million

Dementia: 0.88 million

90+ 1 out of 2

75+ 1 out of 4 to 5

average 1.4 out of 10

rare incidence

Unfortunately:

it does not work that way!

It will be probably much more because we have

two associated factors

-the population is aging

&

-the life expectancy is increasing

The prevalence of dementia increase exponentially with

oldest ages

Dementia incidence increases exponentially with age

Finland 2014

With a fast aging population, the Dementia will become epidemic:

what will be the cost to society?

There is no medical treatment to age-related dementia,

the main cost is nursing

This cost explodes with a fast aging population coupled with longer

life expectancy.

the USA example, as a modern nation

the cost for the US Government alone

& only for Alzheimer cares:

represents

TODAY

the whole 2015 GDP of one country

like Portugal or New Zealand




represents

TODAY



IN 2030

more than 2015 GDP of one country

like Singapore or Malaysia




represents

TODAY



IN 2030

more than 2015 GDP of one country

like Singapore or Malaysia

IN 2050

close to 2015 GDP of one country

like Australia, Spain or Russia

on top of that, you have to add the costs

funded by the families…


The cost of dementia per patient today was estimated in Malaysia

close to Rm 2,700/month (in 2005) with

a fast aging population an increasing life expectancy

Family could end up to support several parents & grand-parents at various periods of time, but also for many years.

Today, there is no medical treatment to age-related dementia

but

a proper lifestyle, especially a proper nutrition, can prevent,

if not delay, but mitigate age-related diseases

What to Do?

3 important points

Public policies and nutritionists will play a key role

in the prevention of age-related diseases

it is necessary

• to get rid of misconceptions inherited from the 80’s • to have « brain feeding » guidelines, not only for babies and pregnant women, but also for general population and for seniors • to rehabilitate fats and to declare « sugars » and « smoking » public enemies

The U.S. government is poised to withdraw

longstanding warnings about cholesterol

The nation’s top nutrition advisory panel has decided to drop its caution about eating

cholesterol-laden food, a move that could undo almost 40 years of government warnings about

its consumption.

The group’s finding that cholesterol in the diet need no longer be considered a “nutrient of

concern” stands in contrast to the committee’s findings five years ago, the last time it convened.

…

Walter Willett, chair of the nutrition department at the Harvard School of Public Health, also

called the turnaround on cholesterol a “reasonable move.”

“There’s been a shift of thinking,” he said.

… January 2015

What was the consequences of this misconception that dated 1961?

Based on the archaic belief that the

fats we store in our body are the fats

we eat (ignoring the complex

chemistry of digestion), the

americans turned away for decades

on eggs: a great source of nutrients.

And the rest of the world followed.

Cholesterol in foods is just a clear and

stunning example.

but the biggest misconception,

originated in the 80’s, is probably the

food pyramid.

in June 2011, USDA

announced the end of the Food

Pyramid, created in the 80’s.

but many countries never

received the notification of

replacement.

What were the consequences of the Food

Pyramid on many nutrition guidelines?

Promoted an excess intake of carbohydrates

Demonized all types of fats for many years,

despite the latest scientific findings

Promoted inefficient, if not damaging, no-fat

diets and low-fat diets

Push the whole industry to substitute fats by

sugars

Heavily used refined carbohydrates

In Singapore, you can find industrial bread

with 30% sugar

to give more taste, while French bread

recipe adds no sugar to the bread.

The Food Pyramid created a habit of carbs

and a world addiction to sugar.

the bad consequences of the application

of the food pyramid on public health are

incalculable.

Food Pyramid & Public heath in USA.

Since the application of the guidelines, US

citizens have reduced the percentage of fats

from 43% to 33%.

Ironically, what happened was contrary to what

was expected.

in 1960, only 1 in 100 Americans had type 2

diabetes, now it is 1 in 10 people.

In 1960, 1 in 7 Americans were obese,

now it is 1 in 3 people.

Three decades ago, type 2 diabetes was

generally limited to adults.

Now, 1 out of 3 new diabetes cases is among

patients under 18 with type 2 diabetes.

More than 1 in 10 kids are pre-diabetic or have

diabetes.

Figure 2. Number (in Millions) of Civilian,

Non-Institutionalized Persons with

Diagnosed Diabetes, United States, 1980-20144 4Centers for Disease Control and Prevention. (2015). Number (in Millions) of Civilian, Non-Institutionalized Persons with Diagnosed Diabetes, United States, 1980-2014. [Graph]. Retrieved from

http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm



the Food Pyramid was inefficient

the no-fat and low-fat diets were damaging.

so what were the inconveniences of low-fats diets?

inefficient: the weight lost is often temporary

unsatisfying: during the diet, the patient is starving and may suffer from fatigue

and mood disorder

damaging: no-fat and low-fat diets are not innocuous

> Low-fats diets decrease brain cell function

> Low-fats diets damage the body cells

> Low-fats diets may impair the digestive system

> Low-fats diets imbalance the immune system

repeated and uncontrolled low-fat diets

could eventually make you fat or sick, or both.

During this 3 decades of Food Pyramid,

numerous scientific findings

were published and demonstrated.

the various types of fats and the incredible benefits on many of them, like Omega 3

the complexity of the chemistry of digestion and the role of bacteria

the role of fruits and vegetables, for antioxidants and fibers

the needs of non-refined and more complex carbohydrates, like wholemeal or

brown rice

the devastating effects of sugar and tobacco

the benefits of high-fats diet versus low fat diet

To add on this new scientific knowledge, the population shape also changes from

pyramid to kite, making the misconceptions of the 80’s even more problematic on an

aging population.

Our body is designed for higher-fat diet.

In the Paleolithic Period, the macronutrient ratio of a day’s diet was about 75% fat, 20%

proteins, and 5% carbohydrates. Before the development of agriculture, our ancestors ate

fish, wild meat and nuts on a daily basis. Our body systems have not changed

substantially since then.

In 2009, researchers led by Dr. Hession and Dr. Rolland from the Centre for Obesity

Research and Epidemiology (CORE) in the UK, have conducted a meta-analysis on

metabolic syndrome and proved that high-fat diets outperformed low-fat diets when it

comes to weight loss, as well as when it comes to lowering heart disease risks, diabetes,

inflammation and hypertension.

It now becomes quite clear for scientists that general population who decrease the ratio of

carbs, cut on sugars, eat more fruits and vegetable and increase the ratio of fats, within the

limit of their daily calorie needs, are healthier and tends to lose weight easily and without

efforts.

Among all nutrients explored by scientists on the last two

decades

a combination of 3 elements is very promising to prevent,

delay or mitigate age-related diseases, especially

dementia

omega-3, especially DHA and EPA

Medium-Chain Fatty Acids (MCFAs or MCTs)

antioxidants in fruits, vegetables and spices

Omega-3

it is an essential nutrient. For omega-3 fatty acids, it has two meanings:

our body can not produce them: we have to get them from our diet.

to make things worse, we do not get enough in our diet.

it is difficult for our body to transform ALA into the most interesting forms of

DHA and EPA.

to make things worse, our enzymes have the strong competition of omega-6

Omega 3, especially DHA/EPA, are the last general nutrient deficiency in the

modern world

It have been largely demonstrated

that omega-3 is protective on heart

and cardio-vascular system.

As such, omega-3 plays a key role in

the prevention, delay and mitigation of

age-related disease

It is now a large consensus amongst

scientific community.

it is now obvious that omega-3

fatty acids, especially

DHA/EPA, play a key role, not

only in the development of the

brain and the nerves system,

but also in their protection and

their proper functioning during

all the life.

Omega-3 fatty acids are incorporated into

neuronal membrane, making membrane fluidity

and lipid raft domain.

the benefits of DHA/EPA in the formation

and development of brain is not a surprise:

there are many recommandations in all

public policies for pregnant women and

babies.

breast milk is the best natural source of DHA

for babies.

but scientists are still discovering how far

these benefits can go, even to school

performances

because of all these proven and undebatable benefits, many advanced countries

have published during the last 6 years, recommended intakes for general

population for omega-3 ALA, DHA and EPA, with functional and even health

claims.

the recommendations clearly specify the level for ALA and the level for DHA-EPA.

the level of DHA-EPA is certainly the most important as the conversion from ALA

is not easy.

Codex is also on the verge of publishing recommended intakes for general

population for omega-3 DHA and EPA ( CX/NFSDU 15/37/7).

in the next few years, it will be inconceivable for a modern country

not to implement recommended daily intakes for DHA-EPA

where to get your omega-3 from?

As the general population is so much in deficiency, I

could recommend Omega-3 from any sources:

supplements, supplement food (eggs),…

but the best source is fatty fish as it contains already our

needs in DHA-EPA

besides, the natural source is always the best choice for

human as we are not yet fully aware how the nutrients

work together in the complex chemistry of digestion.

As a proof, fish lovers tends to live longer.

Besides omega-3, a clear anti-aging best practice is

to use proper oils and fats in the local general

population diet

the first move is to reduce significantly omega-6

consumption

the second step is to use local oils and fats with

anti-aging properties

Omega 6 has two problems:

it competes with omega-3 as the enzymes needed for

the digestion of omega-3 prefer omega-6

omega-6 has proven inflammatory properties

general population gets too much omega-6 in their diet,

especially with cooking oils & fried foods

Once we have removed omega-6

sources, we have to replace them by

the local proper good fats rich in

anti-aging nutrients.

coconut oil is 55% MCFAs and coconut milk fats 45% MCFAs

it is now clearly demonstrated that Medium Chain Fatty Acids

are « good » saturated fats

MCFAs rapidly metabolize into energy in the liver. It is thought that unlike other

saturated fats. The shortcuts that MCFAs take through our digestive system

means that it is able to fight diseases, especially inflammatory conditions.

MCFAs are transported across the intestinal wall and into the portal vein where

they are sent directly to the liver. In the liver, MCFAs are used to produce energy

in the form of ketone bodies.

on top of that MCFAs in coconut is dairy free, an advantage for most of asian who

are lactose intolerant

the recents findings about MFCAs benefits are

their role in delaying or mitigating

neurodegenerative diseases, especially

Alzheimer’s disease.

Alzheimer’s Brain cannot utilize

the glucose

52

Alzheimer’s Disease is brain type Diabetes

(Type 3 Diabetes)

Amyloid

Beta Glucose

Ketone

53

Ketone Body improves Cognitive

Function of Alzheimer’s Disease

0.5 mM Ketone

54

What are the intake recommendations

for omega-3 and MCTs?

for omega-3 DHA-EPA, it is easy to

find levels with all public policies

250 to 500 mg/day

for MCT,

There is not yet undebatable figures like for omega-3 DHA-EPA

Europeans are encouraged to find them in coconut milk

and Asians in coconut oil.

Based on my medical experience, I would recommend

for general population: 60ml of coconut oil or coconut milk daily

for Alzheimer and dementia patients: 120ml daily

Thank you,

Feel free to contact:

Takuji Shirasawa, M.D., Ph.D.

Director Professor

Shirasawa Anti-Aging Physiology

Medical Institute School of Medicine

Tokyo, Japan Dokkyo Medical University

[email protected]

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