Dr K.K.Tan Specialist Clinic

18/06/2025

"When is the best time for dinner?"

Put your fork down at least three hours before bed, say the experts – but don’t stress if it’s your biggest meal of the day.

Few lifestyle choices come with as much cultural baggage as the best time to eat dinner.

There are all the national/ethnic stereotypes – Americans/Chinese eat early; Italians/Indians eat late; Spaniards/Malays eat even later – and in certain countries like Britain, the issue comes weighted with class too. (The later you eat, the posher you are, supposedly.)

An early dinner opens up the evening to do stuff with; a late dinner, conversely, can be a thrilling event in itself.

But is there a best time to eat dinner from a health perspective? Sort of.

What you certainly want to be doing is finishing your food at least three hours before you plan to go to sleep. If your usual bedtime is midnight, for example, you’ve got a 9 pm deadline.

This is because eating too late can disrupt the circadian rhythms, which govern how our body transitions from day to night and back again.

If you push your dinner later and later, the message to your system is that you should still be active. It might negatively affect your sleep – in the same way as being exposed to bright light before going to bed – and how efficiently you burn calories.

This is what “time-restricted eating” – a type of intermittent fasting that involves keeping all your day’s meals in a window of 12 hours or less – is concerned with.

If you extend your overnight fast between dinner and breakfast, then you’re allowing your body to go into the more catabolic phase, where you’re shifting to oxidising fats. You’re training the body to do what it’s designed to do: burn carbs when you’re eating carbs, and then burn fat when you’re not.

This can help with weight loss and is generally good for your metabolic health.

Should eating in a restricted window mean making your breakfast later or your dinner earlier?

The most common evening meal habit of long-lived centenarians is a “light dinner” early enough to then allow 12 hours before breakfast the following day.

Eating less later in the day sounds healthy too, at least if we believe the old saying instructing us to “eat breakfast like a king, lunch like a prince, and dinner like a pauper”.

This isn’t always realistic.

It’s quite difficult to eat a big breakfast because you just haven’t got the hunger, partly because your body has “started to export glucose out into the blood” as you wake up, so your energy levels are already high. And given people typically just have sandwiches for lunch, it’s inevitable that most of us “calorie load in the evening”.

Don’t stress about this, though, it’s fine as long as you give your body a “period of rest” by following it with a low-carb breakfast the next day.

If an early time-restricted eating window is unrealistic, then a later one is still better than letting your mealtimes sprawl across the entire day.

And if you’re doing exercise in the day – particularly the resistance-based kind, like weightlifting – then a big, carb, and protein-rich dinner can be just the thing to help your muscles recover.

Ultimately, the key thing is to keep your meals in a 12-hour window and finish dinner three hours before you go to bed.

If you do have a bigger dinner, and you’re sleeping well, your cholesterol and blood pressure are fine, then you’re good.

But if you’re sleeping poorly, and you have health problems, maybe you should move to have a bigger breakfast, a bigger lunch and a smaller dinner, which usually seems to be the healthiest pattern of all.

17/03/2025

"Let's talk about love & betrayals.."

A patient/friend visited me a week ago with a broken heart and emotionally drained. With an unstable vital signs, he is at the verge of suicidal after weeks of unrelenting mental anguish. He was betrayed by his loved ones.

So why people betray? It is a very complicated topic and sometimes it is very personal. It also can be illogical and senseless. Therefore, only general advice and direction can be offered, but the final decision is still need to be made by himself.

According to expert in this field, a distinct pattern is becoming more obvious in sequential events that follow suit.

If someone has betrayed your trust once, there’s a strong likelihood that they will repeat that behavior—time and time again.

Trust is fragile, and once it’s broken, it’s difficult to repair. Forgiving disloyalty is not an act of love; it's an invitation for more disrespect.

It’s not a “mistake” they made—it’s a conscious decision. And when you allow that betrayal to go unaddressed, it signals that there are no real consequences for their actions. They know they can hurt you again, without fear of losing you.

True respect isn’t earned through forgiveness of harmful actions, but by setting clear boundaries and maintaining your own strength.

People, regardless of gender, respect those who hold firm to their principles and are not afraid to walk away when necessary. Tolerating betrayal only leads to the erosion of respect and trust.

Be the person who values loyalty above all else, who holds onto self-respect even when emotions pull you in a different direction.

Those who betray your trust once will never truly be yours—no matter how much they may say otherwise.

15/10/2024

‘’Could fasting make you live longer?"

Restricting calories could be the best way to slow your rate of ageing – as long as you have the right genes.

When it comes to slowing down ageing, we’ve tried everything under the Sun. But until there’s an anti-ageing pill breakthrough, scientists are trying to make headway with changes we can make in our everyday lives – including what we eat.

Now, a major new study claims to finally provide some answers to how your diet could help you live longer, but also what the downsides are.

The short answer? They say that dietary restriction (reducing your overall daily calories) has a bigger impact on expending your lifespan than doing an intermittent fasting diet.

Published in the journal Nature, the team tracked the health of 960 mice on different diets. They made sure there was a good range of genetic diversity across the group of mice to mimic the human population – though experts say we can’t assume the results apply to us.

This is a fascinating and counterintuitive result, but mice aren't just tiny people so we need to be very careful extrapolating these results to humans said by some longevity experts.

Nevertheless, one reason these findings are relevant is because we can't wait the necessary decades to perform a dietary restriction or fasting experiment in humans to see if it makes us live longer, so scientists have been looking for proxy measures to see if people get healthier in the short term.

During the much shorter lifespans of the mice, the researchers performed regular blood tests and other health evaluations. The mice were assigned one of five diets:

1. Eating freely
2. Only given 60 per cent of their baseline calories a day
3. Only given 80 per cent of their baseline calories
4. No food for one day per week (but eating freely the rest of the week)
5. The same as group 4, but fasting for two consecutive days a week.

The researchers discovered that the free-eating mice (group 1) lived an average of 25 months, while those on the intermittent fasting diets (groups 4 and 5) lived about 28 months.

But those in the low-calorie groups lived, on average, even longer: 30 months for the mice eating 80 per cent of their baseline calories, and a whopping 34 months for those on 60 per cent.

In fact, the very-low-calorie diets consistently extended the mice’s lifespans regardless of their body fat and glucose levels – which are usually considered good indicators of health and ageing.

Surprisingly, the mice who lived the longest lost the least weight overall. On the other side, the mice that lost the most weight had little energy, compromised immune and reproductive systems, and shorter lives.

The study really points to the importance of resilience. The most robust animals keep their weight on even in the face of stress and caloric restriction, and they are the ones that live the longest.

So what does this mean?

Essentially, if you’re wanting to extend your lifespan, you may want to hold back on extreme levels of weight loss to get there.

According to longevity expert, a more moderate level of calorie restriction may be a better approach to your long-term health.

Your genetics may get in the way. As always, it’s not as simple as it sounds.

Firstly, there was huge variation between individuals: even in the calorie-restriction groups, the mice’s lifespans ranged from a few months to four and a half years.

Secondly, the resilience to weight loss changed across individuals. In every group, the mice that lived the longest were the ones who were able to keep their immune cell health during periods of food stress, as well as those who didn’t lose body fat later in life.

The researchers think that genetic factors in your DNA that we are yet to identify could be behind the different impacts of diets on different people.

The study also reveals that metabolic markers like weight, body fat and glucose are perhaps not as useful as we thought when it comes to measuring whether calorie restriction is working in people – even if they remain very important indicators of health overall.

In summary, if you want to live a long time, there are things you can control within your lifetime, such as diet.

If you need to lose weight and you find fasting works better for you than dietary restriction, then go for it! We know that being overweight is bad for our healthy life expectancy.

Whether people whose weight is in the healthy range should be cutting back further, or fasting one or two days a week, is less clear – and, while fascinating, I don't think this study is going to put that incredibly long-lived debate to rest just yet.

So, Just eat less, be happy and live life. 🙂

02/09/2024

‘’When is the best time to take your high blood pressure medication?"

This is a common question asked by many patients. Now we have a more definite and scientific answer.

About one in three adults in the Malaysia has high blood pressure, also known as hypertension. It is also the third biggest risk factor for all disease in Malaysia after smoking and poor diet.

Although a high blood pressure does not cause symptoms, taking medicines can help prevent complications like heart disease, stroke, and kidney problems.

But questions remain around the timing of taking the blood pressure medication, with some experts saying people should take their medicine in the evening because night-time blood pressure is a better predictor of heart disease outcomes than daytime blood pressure.

We know that effective treatment with blood pressure lowering medication is vital to reduce people’s risk.

However expert found that previous studies looking at the impact of taking BP medications at night have shown mixed or confusing results.

To find out more, the researchers analysed the data from five trials, comparing night-time and morning administration of all BP-lowering medications.

The team concluded that "the timing of dosing does not affect outcomes”.

The timing of BP medication had no impact on secondary events including strokes, heart attacks and events related to uncontrolled hypertension, the researchers said.

Therefore the final conclusion made now is should let the patients take their once-daily BP-lowering medications at whatever time best suits their preferences and circumstances.

By bringing together large amounts of data from tens of thousands of trial participants, these important results should now put the question of when is best to take blood pressure medication to rest.

These results reinforce a key message that patients should take their blood pressure tablets at a time when they are most likely to REMEMBER, irrespective of the time of the day.

#高血壓

05/05/2024

"SALT & KIDNEY DISEASE"

Salt is a great one for adding flavour to a meal, it is also an electrolyte, an important nutrient for our body, however, it is often demonised in kidney disease.

Salt is an essential nutrient, but it is seen as a contributing factor in developing hypertension. If you already have kidney disease, in addition to contributing to hypertension, it can add to an increase in glomerular pressure, which lead to more kidney trouble.

Glomeruli are tiny clusters of blood vessels within the kidneys, and they play an important role in filtering waste and fluid from the blood to produce urine. Glomerular pressure refers to the pressure seen in these blood vessels. Changes in this pressure can impact kidney function and blood pressure regulation.

If you consume processed, packaged foods, you may consume more salt than you realise.

19/01/2024

Read food labels...

18/11/2023

Again.. about our food..

10/10/2023

"Jews & Arabs Share Common Ancestry"

As fighting continues in the Middle East, a new genetic study shows that many Arabs and Jews are closely related.

More than 70% of Jewish men and half of the Arab men whose DNA was studied inherited their Y chromosomes from the same paternal ancestors who lived in the region within the last few thousand years.

The results match historical accounts that some Moslem Arabs are descended from Christians and Jews who lived in the southern Levant, a region that includes Israel and the Sinai. They were descendants of a core population that lived in the area since prehistoric times.

And in a recent study of 1371 men from around the world, geneticist Michael Hammer of the University of Arizona in Tucson found that the Y chromosome in Middle Eastern Arabs was almost indistinguishable from that of Jews.

Intrigued by the genetic similarities between the two populations, geneticist Ariella Oppenheim of Hebrew University in Jerusalem, who collaborated on the earlier study, focused on Arab and Jewish men. Her team examined the Y chromosomes of 119 Ashkenazi and Sephardic Jews and 143 Israeli and Palestinian Arabs.

Many of the Jewish subjects were descended from ancestors who presumably originated in the Levant but dispersed throughout the world before returning to Israel in the past few generations; most of the Arab subjects could trace their ancestry to men who had lived in the region for centuries or longer.

The Y chromosomes of many of the men had key segments of DNA that were so similar that they clustered into just three of many groups known as haplogroups. Other short segments of DNA called microsatellites were similar enough to reveal that the men must have had common ancestors within the past several thousand years. The study, reported here at a Human Origins and Disease conference, will appear in an upcoming issue of Human Genetics.

Hammer praises the new study for "focusing in detail on the Jewish and Palestinian populations." Oppenheim's team found, for example, that Jews have mixed more with European populations, which makes sense because some of them lived in Europe during the last millennium.

30/09/2023

"How to Spot a Potential Liar?"

Trust is an important aspect of any relationship, whether it be personal or professional. However, it can be difficult to determine if someone is trustworthy or not. Luckily, research has identified several red flags that can indicate that someone may not be trustworthy. Here are some of the most common red flags, according to science.

1. Inadequate eye contact

One of the most common red flags of untrustworthiness is a lack of eye contact. Studies have found that individuals who avoid eye contact are seen as less trustworthy than those who maintain eye contact. This may be because eye contact is associated with honesty and openness.

2. Inconsistent behavior

Another red flag is inconsistency in behavior. If someone behaves differently depending on who they are around or the situation, it may be a sign that they are not being honest or genuine.

3. Negative body language

Body language can also be a clue whether someone is trustworthy. Negative body language, such as crossed arms or a lack of smiles, can indicate that someone is defensive or hiding something.

4. Dishonesty

Perhaps the most obvious red flag of untrustworthiness is dishonesty. If someone lies or withholds information, it can be difficult to trust them.

5. Lack of empathy

Another sign that someone may not be trustworthy is a lack of empathy. People who are unable to understand or connect with others’ emotions may be more likely to engage in unethical behavior.

6. Selfish behavior

Self-centered behavior can also be a red flag of untrustworthiness. Individuals who are primarily focused on their own needs and desires may be less concerned about the needs of others and more likely to engage in behavior that is detrimental to others.

7. Excessive bragging

Excessive bragging or self-promotion can also be a sign that someone is not trustworthy. People who constantly talk about their accomplishments or skills may be more concerned with impressing others than being honest.

8. Unreliability

If someone is consistently unreliable, it can be a sign that they are not trustworthy. Individuals who make promises but fail to follow through may be more likely to engage in behavior that is dishonest or harmful.

9. Gossiping

Gossiping or talking behind someone’s back can also be a red flag of untrustworthiness. Individuals who engage in gossip may be more likely to spread rumors or information that is not true.

10. Lack of accountability

Finally, a lack of accountability can be a sign that someone is not trustworthy. If someone is unwilling to take responsibility for their actions or apologize when they have done something wrong, it can be difficult to trust them.

In conclusion, there are several red flags that can indicate that someone may not be trustworthy. These include a lack of eye contact, inconsistent behavior, negative body language, dishonesty, lack of empathy, self-centered behavior, excessive bragging, unreliability, gossiping, and lack of accountability. However, it is important to note that not all individuals who exhibit these behaviours are untrustworthy, and it is important to consider the context of the situation before making a judgment.

29/09/2023

Happy Mid Autumn Festival !

19/07/2023

Salam Maal Hijrah 1445H/2023
- Awal Muharram

18/04/2023

"8 Essential Factors for Healthy Aging"

A interesting recent report by the American Heart Association (AHA) Life's Essential 8 metric and its association with both life expectancy and health span or life expectancy free of chronic diseases such as cardiovascular disease (CVD), cancer, diabetes, and dementia.

This study leveraged the UK Biobank and included more than 135,000 UK adults with a mean age of 55. The AHA metric was defined as including the following lifestyle behavioural factors:

1. Not smoking;

2. Regular physical activity;

3. Healthy weight;

4. Healthy diet;

5. Healthy sleep (defined as an average of 7-9 hours nightly);

6. Blood pressure in a healthy range:

7. Blood glucose in a healthy range; and

8. Non-HDL cholesterol in a healthy range.

This study was just published in JAMA Internal Medicine.

They divided the study population into three groups: those with low, moderate, and high scores on the Life's Essential 8 metric.

Overall, the average life expectancy free of chronic disease was estimated (at age 50) to be 25 additional years in men and 30 additional years in women.

A large differences was observed across the Life's Essential 8 metric group.

Men with high cardiovascular health scores tended to have an additional 7 years of life expectancy free of chronic disease compared with those who had lower scores. In women, the difference was about 9.5 years between high scores and lower scores.

Also, the number of years lived with chronic disease was compressed in those with high cardiovascular health scores. They tended to have fewer years living with those chronic diseases but more years living free of chronic diseases.

It is interesting how these results might differ by socioeconomic status, educational level, and income level, as well as the Townsend deprivation index.

The researchers were intrigued by the finding that the gain in life expectancy free of chronic disease was very similar across all socioeconomic strata. Even those with lower education and income gained as much chronic disease–free life expectancy as those who were in the higher socioeconomic strata.

Overall, the findings make a compelling case for the importance of lifestyle factors in extending health span and years free of chronic disease. It can be motivating to tell our patients that a healthy lifestyle not only extends life expectancy but also extends years of health free of chronic disease.

Nonetheless, we do have many disparities in life expectancy and health span. So it will be very important to population health to narrow those health disparities through education about the importance of lifestyle factors, more research on implementation of lifestyle factors and behaviors, and public policy to make a healthy lifestyle both affordable and accessible to all people across all of these socioeconomic groups.

Internal Medicine and Kidney Specialist, Clinical Hypnotherapist, Anti Ageing, Aesthetic and Stem Ce