Answers by James Lau Guan Ho for a Magazine

1. What illness have you been diagnosed with, when were you diagnosed, and what treatments have you undergone?
   A. I have over 22 years of experience with primary liver cancer (HCC) starting in year 1999. In all, I had 12 liver cancer recurrences, with 25 lesions in 7 segments, some recurring 2- 4 times in the same segment. I have done two resections, one treatment of radioactive nuclear medicine, 7 Radio Frequency Ablations (RFA), one alcohol ablation, two mapping procedures for SIRT, two insertion of nuclear medicine Y-90, 4 Transarterial Chemoembolization (TACE), 6 sessions of immunotherapy and 16 MRI.

In addition, I have to see various other doctors for type 2 diabetes, a Lung doctor for chronic dry cough, another for hypothyroid, n also doctors for hyper-tension, gum and teeth problems, sleep apnea, a colorectal doctor for my constipation, the gastroenterologist for Hepatitis B, C, E and gastric varices. In all it was a very trying period visiting and waiting at the hospitals!!!

Q. What has been most challenging and difficult for you as a patient?
A. My over 22 years battling with primary liver cancer experience is the most challenging and difficult for me.

Q. Is there anything that a patient or non-patients may not understand?
A. My Type 2 Diabetes is something that I and most patients and non-patients will not understand. Why? Because of the way the fasting glucose level is currently presented. It is presented in a silo manner that is not understandable to a patient or non-patient. The laboratory just states that the fasting glucose of 3 – 6 mmol/l as Normal and anything above 6.0 mmol/l as High. No patient or non-patient will know what High means!

A better way to state clearly for the patient to understand is:
3 – 6 mmol/l is normal
6.1 – 6.9 mmol/l indicates pre-diabetes
>7.0 mmol/l indicates Type 2 Diabetes

Furthermore, a pamphlet explaining the long-term dire consequences of T2D and the various treatment options available can be given to patients with prediabetes or T2D.

More importantly, the hospitals need to be open to the challenge of recommending LCHF diet as an alternative treatment option for T2D! This LCHF diet has been proven to be able to Reverse Diabetes. For example, Dr Richard Bernstein has reversed his T1D for some 75 years and Dennis Pollock has reversed his T2D by more than 20 years and I have reversed my T2D for the last 2 years (see https://jameslau88blog.wordpress.com/2021/07u/27/dennis-pollock-on-sharing-testimonies-of-patients-reversing-their-diabetes-with-lchf-diet/).

Q. Could you share a couple of examples?
A. Do you know that there are 1.7 Million Singaporeans already at risk of Obesity-related Diseases as on 15 March 2014?
https://www.hpb.gov.sg/article/1.7-million-singaporeans-already-at-risk-of-obesity-related-diseases
Today in August 2021, this could be close to 2 million Singaporeans. This is a vast number. We could be talking about 40 to 45 % of Singaporeans having obesity related diseases.

• The Standard Recommendation of “Eat Less and Exercise More” will not work in the long term. Why?
• Singapore will not be able to defeat this Added Sugar problem if it still recommends HCLF Diet. The enemy is the HC which is the Added Sugar. The Added Sugar cannot be defeated for it has come in through the Trojan horse!!! The Trojan horse is already inside the gate. Sugar causes belly fat n fructose contributes to fatty liver
• Added Sugar consumption is the main contributor to belly fat, overweight, obesity and Type 2 Diabetes (FOOD).
• Singapore has to change to a LCHF Diet if Singapore wants to defeat the Type 2 Diabetes problem like Sweden does. See the article in my https://linktr.ee/jameslau8888 account under Dr Andreas Enfeldt on how Sweden is able to Reverse its T2D problem.
Please click on https://youtu.be/l55OjWS9pEc

As I see from a patient or a non-patient point of view, the Government is trying desperately to reduce these Obesity-related Diseases by recently introducing such initiatives as:

1. Singapore Health Promotion Board wanting to help manage diabetes because Singapore is also having an epidemic growth in T2D. https://www.healthxchange.sg/diabetes/living-well-diabetes/manage-diabetes-better-with-glimpse
2. CHAS Clinics for Diabetes, according to Health Promotion Board, is giving subsidies to Singaporeans, who need to pay only $0 – $5 per screening. https://www.facebook.com/135254099825195/posts/4488800354470526/?d=n

From a patient’s perspective, both SGH and NUH should do their part in making their laboratory data available in a layman language so that the patient or non-patient will know clearly and immediately whether they have prediabetes or T2D. If the patient has prediabetes or T2D, they should give him a pamphlet listing the dire consequences of T2D and the treatment options including a LCHF Diet that are available.

For instance, see how Singapore is trying to get only 200,000 elderly Singaporeans to take the Covid-19 injection. What is being done is that The Ministers including The Straits Times have emphasised this necessity daily in layman language to get the elderly Singaporeans to understand and respond by taking the Covid-19 injection.

Similarly, this is a challenge for SGH Health Magazine, which can help enormously by publishing the necessary information in a way that a patient or a non-patient can understand. This will enable the patient to do his part in helping himself to reverse his T2D. This is so vital with an on-going epidemic of Obesity-related Diseases involving some 2,000,000 Singaporeans.

To give another example where I and most patients and non-patients will not understand is:

• The Carbs that I or a patient eat are normally measured in glycaemic index or glycaemic load or grams or total grams or fixed grams or net grams or calories in and calories out. These units of measurement are very difficult for us to grasp. I don’t understand them. They don’t gel with me. They don’t click with me. What does it mean in practical terms for me? What will work for me? It is a teaspoonful of sugar!!!
• It easier for me to understand when these carbs are converted or calculated as equivalent teaspoonfuls of sugar. I can easily visualize one teaspoonful of sugar. Everyone can understand one teaspoonful of sugar, which is a cube of sugar. I have weighed a cube of sugar and it is about 4.5gm.

• Dr David Unwin is the doctor that helped me to understand what I should eat and what I should not eat.
• Dr David Unwin has calculated and tabulated “How many teaspoonfuls of sugar are present in various kinds of carb food” in https://youtu.be/sa7ggkDatps or https://phcuk.org/sugar/
• This list, in around 2017, contains information regarding the equivalent teaspoonful of sugar found in each kind of Carb food I eat.
• This gives me the option to decide what not to eat and what to eat.

• Why is it vitally important for me to know how many teaspoonfuls of sugar in each food I eat? Why? Then it gives me the choice to select Which food to eat or not to eat.

• Why do I also need to know how many teaspoonfuls of Sugar there is in the entire bloodstream of a healthy person?
• Dr Eric Westman in “The Science Behind Low Carb High Fat” https://www.youtube.com/watch?v=SCGDAwp-y0o stated that the entire bloodstream of an adult contains only about 5 – 7 litres of blood. Out of this 5–7 litres there is 5.5 mmol/l (100 mg/dL) of sugar. This can be calculated mathematically to be 5 – 7 gm of sugar in the entire blood stream. This 5-7 gm is roughly equivalent to one teaspoonful of sugar. One cube of sugar!!
• Therefore, a healthy individual needs only one teaspoonful of sugar in his entire bloodstream.

• Now I can see clearly that the normal blood glucose test of 4 – 6 mmol/l is equivalent to one teaspoonful of sugar. A cube of sugar in his entire bloodstream!!

• A person is medically considered to have T2D if his blood glucose is above 7.0mmol/l.
• But a blood glucose test of above 7.0mmol/l (roughly 1.5 times of 5.5mmol/l), is equivalent to about 1.5 teaspoonfuls of sugar.
• Thus I now understand Why—when I have 1.5 teaspoonfuls of sugar in my entire bloodstream—I am medically considered to have Type 2 Diabetes!! Can we see this???

• Once we grasp this concept, we must then ask ourselves: Why do we need to add so many more teaspoonfuls of sugar in our diet daily? Should we not cut down on our sugar intake?
o A 150gm of brown rice contains 10.1 teaspoonfuls of sugar. Avoid it.
o A can of Coca-Cola contains 10 teaspoonfuls of sugar. Avoid it.
o A 150gm of boiled potatoes contain 9.1 teaspoonfuls of sugar. Avoid it.
o A 60gm of Raisins contains 10.3 teaspoonfuls of sugar—whereas 120gm of Grapes contains 4.0 teaspoonfuls of sugar. So avoid dry fruits.
o A glass of apple juice contains 8.6 teaspoonfuls of sugar but one apple contains 2.3 teaspoonfuls of sugar. The fibre reduces the sugar absorption. So avoid fruit juices.
o A slice of white bread contains 3.7 teaspoonfuls of sugar. I normally take 2 slices = 7.4 teaspoonfuls of sugar. Avoid it.

• This is the most important concept to grasp!!! A patient and I must get this concept right and perfectly clear in our mind. When I have 1.5 teaspoonfuls of sugar in my entire bloodstream—I am medically considered to have Type 2 Diabetes!! Why then should I add more amount of sugar than necessary in my diet?
• What do you think will happen to our body, if we do NOT avoid the high amount of sugar in the carb items we eat? What it means is that we attack or bombard our body with high amounts of sugar in our breakfast, lunch and dinner daily for years continuously. We clog our bloodstream with sugar! This causes Type 2 Diabetes!
• Fortunately, it is a blessing that our body is endowed with an opportunity of some 15 to 20 years to reverse our T2D.
• Sadly, it is also a curse that—many people are easily lulled into not taking any preventive action because the complications of T2D takes 15-20 years to develop.

• But the long-term complications of T2D will definitely strike—suddenly and unexpectedly. And people will be surprised when they or their loved ones are stricken with the dire consequences of T2D like amputation of toes or legs, heart attack, stroke, blindness, kidney dialysis or kidney transplant. These complications are terrible. They are horrible. They are tragic.

3. What convinced you to be a member of LPSG?
   A. We are not alone in our suffering. By sharing our own experience as a patient, we can help each other to go through our fight against cancer.
   The enormous help from Dr Peter Mack, Sis Julianah Bee and their team have made the LPSG come into existence. Without their constant support the LPSG would not be what it is today—vibrant and of great help to us patients. We as patients have an access to them with our health problems and also hep each other with our health concern.
4. What activities do you participate in? Which has been the most memorable or meaningful?
   A. Mainly talks to further my understanding of my cancer problems.
5. How has the group helped you? Could you share specific details, including particularly low points in your health journey, what happened, how you felt, and how the group helped you pull through?
   A. Yes, the group has helped me.
   The low point was when I had to go for my immunotherapy treatment as it was entirely new to me. I asked whether anyone has immunotherapy treatment, and someone from the LPSG related his experience to me. It gives me hope.
6. Would you say this group has been more essential for your well-being during the COVID-19 pandemic, especially because of social distancing restrictions?
   A. Yes, definitely so.
7. Were there any unexpected personal takeaways from your health journey and from being a member of the support group? Have you made any personal discoveries, been inspired, forged deep friendships, or changed in the process? Could you elaborate.
   A. The LPSG asked me to share my Y-90 experience on 8 August 2020. I gave a Zoom talk to the LPSG. (See https://drive.google.com/file/d/1U72GOPADABsUyaZ92ZVpV9Tu48oAEj6e/view?usp=sharing)

I was also asked to by LPSG to share and give two Zoom talks on how I managed to reverse my T2D. There were various questions raised by the attendees. (See https://youtu.be/K0xvqiPcuJ4 and https://youtu.be/JiL5LGpJwpE)

8. Do you have any words of advice to share with other patients on why a support group may help them?
   A. It is always good to share patient experiences with each other as they see things from a perspective that is different from that of a doctor. The patients remind all to be strong, supportive and pray for each other.