Investigating Anaemia, High Cholesterol and Singaporean Diet/Lifestyle Comparison

In the previous post, I wrote about how my lab results showed that I was still anaemic and had abnormally high cholesterol levels after going “carnivore” for 40 days.

This post will cover a follow up lab investigation on the anaemia, high cholesterol and how I felt being back on a regular ‘Singaporean’ diet and lifestyle for the past 60+ days.


At a glance:

  • Tests show that the anaemia is not a B12 or Folate deficiency, nor is it genetic. Confirming my suspicions that it is probably due to a history of autoimmunity + the past 3 years of vegetarian, vegan and chronic caloric restriction.
    It should correct itself soon since I’ve started eating meat again.
  • My LDL levels dropped by almost a quarter in just 5 weeks back on a regular Singapore diet with significantly more carbs, less fats and more ‘junk’ food than before.
  • In Singapore, my family eats very frequently but we have smaller portions and eat home cooked food most of the time. Overall we still have lots of snacks/treats. I think our saving grace is our relatively high physical activity levels (particularly walking) due to the need to commute without a car.

Anaemia

As mentioned in the previous post, I have been anaemic for almost 5 years now. It started with the autoimmune disorder as chronically high levels of inflammation in the system tends to do that to your haemoglobin.

Then I went a few years going vegetarian with a few months just eating 1 meal a day. Next, I experimented with a vegan diet for 4 months with iron supplements. And finally, I tried a “nose-to-tail” carnivore diet for 40 days before flying back to SG for some tests which revealed that I am still borderline anaemic.

About 5 weeks (43 days) later, I did another set of tests to investigate if the anaemia was a lack of vitamins or a genetic condition. Here are the results:

Typed out on a spreadsheet this time 🙂

In summary, it shows that I am not iron deficient, nor is the cause of my anaemia related to B12 or B9 (Folate) deficiency.

These next set of results also show that I do not have any genetic abnormalities.

Hence I still stand by my initial theory that I was anaemic before starting the carnivore diet simply from the result of years being vegetarian/vegan + chronic caloric restriction and that it takes about 90 days (turnaround time of a RBC) before the anaemia can be resolved through including more absorbable forms of haem like animal foods.

High Cholesterol

40 days on a ‘Carnivore Diet‘ really affected my cholesterol readings. More specifically, my LDL (the ‘bad cholesterol’) shot up so high that I couldn’t believe that was even possible!

I attributed this to a change in metabolic dependency to a more ketogenic state where fats are primarily burnt for fuel. Increased cholesterol readings often result from low carb diets simply because the body requires more transport vessels to transport the fats you eat for energy. These vessels are the lipoproteins – LDL transports fats & cholesterol from the liver to the rest of the body and HDL transports it back. (more detailed explanation in the previous post)

Here is my second lipid panel after 43 days off the ‘carnivore diet’ and back on a high carb, low-to-moderate protein ‘Singaporean diet’.

As you can see, it is still high but in a just 5 weeks, my LDL dropped by 4 points!

A graph might show it better! This is the trend of LDL against time.

So this kinda proves the theory that what you eat can drastically alter your biochemistry haha.

In this case, reintroducing a relatively high carbohydrate diet with much lower overall fats has almost QUARTERED my LDL in 5 weeks!

And as mentioned in more detail in the previous post, I am totally unworried about the likelihood of a cardiovascular event because my inflammatory markers like CRP are low and I am very insulin sensitive.

Singaporean Diet/Lifestyle Comparison

Here’s a summary of the many major differences since returning to a Singaporean (SG) diet.

1. EATING FREQUENCY:
We eat many meals/snacks throughout the day but our portions are very little compared to Westerners (and my previous diet).

From eating about 2x/day… I sometimes ate up to five!

Besides breakfast, lunch and dinner, my family would have afternoon tea-break and some ‘dessert’ after dinner

Having practiced intermittent fasting for years and skipping breakfast first thing in the morning, eating so often felt very strange to me. I thought I would gain weight and fats, but it was the contrary. I ended up losing weight and getting skinnier! Probably due to a number of other reasons outlined below.

I also felt my metabolism significantly increase due to the increased eating frequency and more physical activity (walking) throughout the day.

From having a daily fasting window of about 14 hours between dinner and breakfast, I ended up with less than 12 hours.

A typical day might look like this:

9am: Breakfast – 3 eggs, some kueh / bazhang / oats / sourdough bread
1pm: Lunch – chicken organs (heart, liver, gizzard) or tempeh (if vegetarian day) with some veggies stirfry
3/4/5pm: Tea break – some keuh / cakes / CNY snacks / fruits, nibbles here and there
7pm: Dinner – steamed fish, rice, some veggie stirfy or if vegetarian day, spelt with chickpea mushroom veggie broth (always some grains with legumes for protein)
8-9pm: dessert – fruits (pineapple/papaya) most days but about once a week we might have some traditional SG dessert if we tabao-ed home like LaoBan beacurd/grassjelly / red bean soup / cheng teng / chendol

Despite eating so often, we would never eat to the point of feeling so full/bloated that you’d feel sick. Breakfast is very small (for my family, not me), lunch and dinner slightly bigger. Often there would be leftovers that we’d save for another day.

I soon began to take pride in being able to realize when I had enough to eat and not overeat like I used to previously in NZ. Somehow I think the state of living alone or self-reliance might have conditioned myself into thinking I was in a state of food scarcity and so I developed a bad habit of eating till I was beyond full.

2. NUTRIENT COMPOSITION

A typical SG diet is mostly ‘high-carb, moderate protein and low fat’. We would also have at least one vegetable dish per meal.

So I ended up eating a lot more plants and carbs than the previous diet.

Despite this, I realized that I started to lean out significantly when I went back to eating more rice/carbs and much less fats. Similarly, another mystery for me is how my dad eats so much rice yet still stays skeleton thin!

Hence I’ve come to another theory that it is the mixture of high-carbs AND high-fats that results in easy weight gain.

A diet that is primarily just high-carbs OR high-fats alone will not promote weight gain.

For example:

The ratio of carbs to fats in 100 ml of breast milk is 4.2/7.0 = 0.6 [1]

Whereas in 100 g of cooked rice it is 28.3/0.3 = 94.3 [2]

Huge difference! This means much more carbs than fats in rice compared to a higher ratio of fats to carbs in milk. Hence milk’s ability to promote weight gain and growth.

Of course there are many other factors that promote unhealthy weight gain but this is one common dietary factor that I’ve come to realize through my own research and experiments. A high carb-fat ratio is common in processed foods that are inflammatory and addictive because such a ratio also ‘short-circuits’ our brain’s pleasure centres. Even worse if it is refined carbohydrates with high glycemic load and processed oils and deep fried foods. [9]

3. HOME-COOKING VS EATING OUT

I felt this makes one of the biggest difference in my health.

My autoimmunity and inflammation symptoms would often return whenever we ate out too often. And we did several times a week.

Especially if it was something oily, fried and/or too spicy. Culprits include processed vegetable oils, inflammatory cooking methods, ingredients and additives in sauces, MSG and overwhelming spices.

4. LACK OF PROTEIN

Another major difference.

When we eat out, most of the time our meals have only the bare minimum protein content. Even less if it is vegetarian.

Throughout the course of the past year, I have come to realize that protein is probably the most important macronutrient we should prioritize in our meals. Followed by healthy fats and lastly, carbs (which are actually non-essential).

I realized most people don’t know how much protein they need to maintain muscle mass and prevent muscle loss (sarcopenia) as they age:

1.2 grams per kg of body weight per day.

Source [3]

If you weigh 50kg, that is about 60 grams per day or 20 grams per meal.

However, 20 grams of protein is NOT equivalent to 20 grams of meat or beans.

Here are some examples of the amount of protein as a percentage of TOTAL WEIGHT of some foods:

  • Red Meat and poultry: 27-35% [4]
    • Cooked Lamb shoulder roast, 35.5%
    • Braised beef, 32.4%
    • Cooked lean chicken breast, 32.1%
    • Pork spare ribs 29.1%
    • Roasted Turkey Breast, 30.1%
  • Fish & Seafood: 20~30% [5]
    • Smoked Salmon, 18.3%
    • Cooked Sockeye Salmon, 26.5%
    • Cooked shrimp, 22.8%
    • Cooked Bluefin Tuna, 29.9%
    • Cooked Blue Mussels, 23.8%
  • Nuts & Seeds: 8~30% [6]
    • Macadamia nuts, 8%
    • Pumpkin & Squash seeds, 30%
    • Dried black walnuts, 24.1%
    • Almonds, 21.2%
    • Cashews raw, 18.2%
  • Beans and Lentils: 5~25% [7]
    • Raw peanuts, 25.8%
    • Smooth peanut butter, 21.9%
    • Firm Tofu, 17.3%
    • Chickpeas (Garbanzo beans) cooked, 8.9%
    • Commercial Hummus, 7.9%
  • Grains: 2~17% [8]
    • Cooked Oatmeal, 2.5%
    • Cooked Couscous, 3.8%
    • Cooked Brown Rice, 2.3%
    • Cooked Quinoa, 4.4%
    • Cooked Pasta (unenriched), 5.8%

So as a general rule, about a palm size of animal protein is required per meal.

However when it comes to plants, often much more than you think is required because they:

  1. Absorb a lot of water and so the protein content is much lesser. Example – 100g of dry kidney beans has about 25g of protein but when soaked and cooked, only about 9g
  2. Beans or grains alone are incomplete amino acid sources so often a grain and bean is required to get the full range of essential amino acids required for health

5. TREATS

Our Achilles heels… I often found myself repeating this phrase in my head: “That’s not so healthy…”

As a family, we each have so many favourite indulgences!

Breakfast kuehs

My mum loves to buy kuehs for breakfast – small cakes that can be high in sugar/starch/flours.

We also love making our own tapioca cakes and sourdough breads.

Homemade Tapioca cake
Home-baked sourdough

Then there are our favourite drinks like teh o bing sui dai, Kopi o siu dai and my mum’s lemon aiyu jelly bubble tea, etc. Occasionally the durian, ice-creams, and hawker foods several times a week. Worse still, all the Chinese New Year snacks just sitting there staring at us to eat them!

Traditional Singaporean ice cream!

Stepping back and looking at our diet as a whole, there are so many things we consume mostly for their momentary pleasures. Not exactly for health promotion. Sometimes I wonder how we still stay healthy!

Their effects on our health now may be subtle such as increased mucus/phlegm, acne, tooth sensitivity, bad breath/farts, fatigue, lack of mental acuity/sharpness, etc. However, if left unchecked, these can progress to full blown chronic illnesses like autoimmunity, cardiovascular disease or neurodegeneration!

6. PHYSICAL ACTIVITY: We walk a LOT!

Since we don’t own a car, we rely on our legs a lot for commuting.

On average each day I can easily hit 10,000 steps and walk about 5km. I also live on the 6th floor and have developed the habit of climbing up the stairs instead of taking the lift.

Screenshot from my phone

With all that walking on top of my own physical training, no wonder I loss weight! On top of that, the perpetual summer weather here means we sweat quite a bit. This helps with detoxing too.

7. Autoimmunity and inflammation

However one thing I must note is that all the snacks/treats and eating out is not doing my condition any good.

Some symptoms that have not bothered me for months have come back in such a short time.

I guess once your system tips off balance, it will always be more susceptible to tipping again if one is not vigilant. Therefore I will always need to be more strict than others, since I cannot afford to slip too far down my slippery (autoimmune) slope again. 👊🏻

Conclusion

I’m not worried about anaemia or the high cholesterol as long as I don’t have excessive inflammation and/or insulin resistance. Our family may not eat the most typical Singaporean diet and this is by no means reflective of what everyone else is eating. However, as long as we don’t eat out too often, or indulge in too much refined/processed snacks and keep up our activity levels, we should hopefully be healthy till our last breath!

More importantly, so many factors intertwine to affect our health and everyone is different. Diet is just one part of it.

Having gone through so many dietary extremes from keto to vegan, vegetarian and carnivore, my main conclusions are that most diets work simply because they make ordinary people cut out most of the processed and refined foods. Eating more WHOLE, natural foods the way nature intended is the most important change that one can make at the start.

After that, maybe having a WHOLISTIC diet with a moderate amount of everything is okay for most people.

My next few posts will focus more on Education. Starting with what Naturopathy is and going back to the basics of health from a naturopathic holistic standpoint.

References mentioned:

  1. Breast milk nutritional data
  2. Rice nutritional data
  3. Rondanelli, M., Faliva, M., Monteferrario, F., Peroni, G., Repaci, E., Allieri, F., & Perna, S. (2017). Novel insights on nutrient management of sarcopenia in elderly. In Clinical Nutrition and Aging (pp. 35-66). Apple Academic Press.
  4. Meats Highest in Protein, Ranked by a 100 gram Serving Size, 50g Protein = 100% DV 
  5. Fish Highest in Protein, Ranked by a 100 gram Serving Size, 50g Protein = 100% DV 
  6. Nuts and Seeds Highest in Protein, Ranked by a 100 gram Serving Size, 50g Protein = 100% DV
  7. Beans and Lentils Highest in Protein, Ranked by a 100 gram Serving Size, 50g Protein = 100% DV
  8. Grains and Pasta Highest in Protein, Ranked by a 100 gram Serving Size, 50g Protein = 100% DV
  9. Schulte, E. M., Avena, N. M., & Gearhardt, A. N. (2015). Which foods may be addictive? The roles of processing, fat content, and glycemic loadPloS one10(2), e0117959. doi:10.1371/journal.pone.0117959

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