Blog | gutCARE - Part 2

What Should I Do If I Am Tested Positive For Hepatitis B?


March 17, 2021 Blog

Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). At times, hepatitis B infection can become chronic and increase a person’s risk of developing liver failure, liver cancer, or cirrhosis, which can eventually lead to death. This can be prevented by early detection and treatment.

If you or anyone close has been diagnosed with hepatitis B, remember that you are not alone. In Singapore, about 1 in 25 persons of the population have chronic hepatitis B infection. It can be confusing and overwhelming when someone receives their diagnosis of hepatitis B. Here is what you should do if you are tested positive for hepatitis B.

1. Understanding your test results

Understanding the hepatitis B test results can sometimes be confusing. To understand your test results and your hepatitis status, it is important to consult with your healthcare provider and clear any doubts. Are you infected? Are you at risk? Is it an acute or chronic infection? A simple blood test called an abnormal liver function test can help answer some of those questions.

You can get infected with viral hepatitis B through sexual transmission from your partner or exposure to blood from an infected person. For example, drug abusers can get infected by sharing contaminated needles. Majority of healthy patients who have an acute infection can leave the body to get rid of the infection itself with ample rest and hydration. However, if a person still tests positive for hepatitis B even after 6 months, it is called a chronic infection. In Singapore, most people get the infection from mother to child transmission during pregnancy. In that situation, most infections will end up as chronic infections. Understanding the severity of your hepatitis B condition can allow you and your doctor to assess your next move.

2. Discuss treatment options

When diagnosed with chronic hepatitis B, it is essential to consult a doctor who has experience treating liver disease to discuss your treatment options. Most patients with chronic infection do not need antiviral medication as they are just a carrier of the virus without any evidence of the virus causing damage to the liver. In the situation that antiviral medication is needed to treat chronic hepatitis B and help fight the virus, several antiviral medications such as entecavir (Baraclude), tenofovir TDF (Viread), and tenofovir TAF (vemlidy) are commonly used. They can also reduce the risk of future liver complications. With multiple prescription combinations available, your doctor can advise you on an effective and suitable drug regimen depending on the type of infection you have, your liver function, and any other medical conditions you may have.

For certain cases, a liver transplant may be needed if a person’s liver has been severely damaged. During the liver transplant, a surgeon will remove your liver and replace it with a healthy donor liver. Most transplanted livers come from deceased donors, while a small percentage of them come from living donors.

3. Make lifestyle changes

Patients diagnosed with hepatitis B should avoid consuming alcohol and other medications that further cause damage to the liver. Discuss with your doctor about your prescribed medications, herbs, and supplements you can take. Consuming a more balanced and nutritious diet can rid the body of toxins and help cope with chronic hepatitis. Exercising regularly and getting plenty of rest can help improve the immune system, helping the body naturally remove the virus and heal the liver.

It is important to note that hepatitis B can be transmitted through blood and bodily fluids. Patients should be aware of how to protect others and avoid passing the infection to their close contacts.


It is important to educate yourself on the facts about hepatitis B. Here at gutCARE, we are here to help you through this challenging time and answer the questions you have.


March 10, 2021 Blog

Before you cook a plate of fried rice, pause to think, will Uncle Roger approve? You might not have used a colander to drain the rice, but how did you prepare it?

In September 2017, there was a case of Fried Rice Syndrome in a school canteen, where 14 students fell sick after their meal of fried rice. While typically mild in its impact, this syndrome can also be fatal and should not be easily dismissed.

As the name goes, this syndrome has been proven to be closely associated to the dish of fried rice. As ordinary as the dish sounds, improper preparation methods can cause dangerous effects. This is due to the presence of Bacillus cereus, a bacterium that multiplies in cooked food left at room temperature.

With fried rice as a typical Asian dish, it is crucial to know more about the Fried Rice Syndrome to care for our gut health. Here are some insights into the context of the bacteria, the symptoms of the syndrome and, of course, crucial tips to avoid contracting it!

What is Bacillus cereus?

Bacillus cereus is a bacterium that produces toxins in the form of spores. Although typically found in soil, vegetables, raw and processed food, it can remain and even multiply in cooked food at room temperature.

Moreover, heat is not able to remove this infectious bacteria. Hence, even after food previously left at room temperature is reheated, the bacteria continue to thrive and becomes a culprit for food poisoning.

Fried Rice Syndrome

This type of food poisoning has been coined as such because it often happens after the consumption of contaminated fried rice.

To understand how a plate of fried rice becomes contaminated, you would need to understand the process of cooking it. The crux of Fried Rice Syndrome lies in how the dish is prepared.

A standard process of preparing fried rice goes like this: rice is first pre-cooked and then either left to cool at room temperature or kept overnight, a step that is crucial to remove moisture and let the grains firm up. After that, the cooled rice grains are fried with other ingredients to complete the dish.

In this whole process, the heat-resistant Bacillus cereus survives past both the cooling and frying stages. As such, the bacteria remain on the plate of fried rice up until it is served.

Symptoms of the syndrome

Fried Rice Syndrome can show itself almost immediately. The development of symptoms is dependent on the time of toxin release by the bacteria. The bacteria either releases toxins in the food or releases toxins into the body after the food has been consumed.

If the toxins have already been released into the food before consumption, nausea and vomiting symptoms might be experienced almost immediately. If toxins are released directly into the body, after consumption of bacteria-containing food, you might contract diarrhoea, cramps and nausea after an average of six hours.

How to treat Fried Rice Syndrome

Mild cases can be treated by hydrating the body, leaving it to fight the infection. However, the more severe Fried Rice Syndrome cases would require treatment using antibiotics.

Like with any type of food poisoning that results in prolonged diarrhoea, vomiting or abdominal cramps, seeking a professional for proper diagnosis and treatment is advised.


To prevent the Fried Rice Syndrome, cooked food should either be refrigerated at 4 °C and below or kept warm above 60 °C.

Storing food well is crucial as bacteria can persist and thrive at room temperature. Specifically, to prevent the occurrence of Fried Rice Syndrome, food should not be left at room temperature to cool for more than two hours.


March 8, 2021 Blog0














March 1, 2021 Blog

Stools are a normal part of the digestive process, and it consists of waste products that are being removed from the body. On some days, you may notice a change in the colour or texture of your stools. But what does this mean?

Different coloured stools can mean many different things, mostly affected by what you have eaten. These variations are usually harmless and considered normal. After all, we don’t eat the same thing every day.

But sometimes, a change in colour can be a sign of a health issue. In rare cases, it could also mean a serious issue with your digestive system. Read on to find out what the colour of your stools may be revealing about your digestive health!


The natural colour of stool is brown, due to a substance called bilirubin which is present in bile. As bile passes through the intestines and gets broken down by enzymes, the colour changes from a light yellow-brown to dark brown colour. If your stools are any shade of light to dark brown, you have no reason to worry!


If you are having green stools, think about what you ate recently. Eating excessive amounts of green foods such as leafy vegetables or green food colouring can result in green stools. (Interestingly, some purple food colourings cause green stools too!) Green stools from food pigments are not usually a cause for worry.

However, having loose, green stools could mean that food may be moving through the large intestine too quickly, giving greenish bile insufficient time to be broken down. If this happens chronically, it may lead to malabsorption and malnutrition. It could also indicate an underlying problem in the intestine.


Yellow stools are normal for many people, especially for babies. But if the yellow or pale stools are accompanied with a bad smell, look greasy, and they float on water, it could be a sign that the stools contain too much fat. This may be the result of diseases of the pancreas that reduce delivery of fat-digesting enzymes to the intestines. Some pancreatic disorders that lead to yellow stools include pancreatitis,  pancreatic cancer, and cystic fibrosis. If the colour persists, visit a doctor to get it checked out.  

Bright red

Bright red or maroon-coloured stools can be the result of consuming scarlet-coloured foods such as beetroot or dragon fruit. But occasionally, it could be a sign of bleeding. This happens when blood gets mixed with or covers the stools as it passes through the large intestine or rectum. Some of the possible causes are haemorrhoids, colon polyps, or colon cancer. If you realise the red stools are probably not caused by your diet, visit a doctor immediately. 

Black or tar-coloured

Black stools can occur when you eat something very dark coloured or take a supplement that causes it. Foods and supplements that cause black stools include blueberries, black liquorice, or iron supplements.

However, black stools can be a sign of a more serious problem. It could result from bleeding in the upper part of the digestive tract which can be caused by stomach ulcers, noncancerous tumours, or cancer. It is best to get checked and talk to a doctor if you notice dark-coloured stools that are not caused by food. 

Pale or clay-coloured

Whitish, pale, or clay-coloured stools could be a result of causes ranging from certain medications you have taken, to certain nutritional deficiencies. If you’ve recently had a barium test, you may also pass out chalky looking stools.

However, if the clay-coloured stools are accompanied by jaundice, a liver or bile problem is usually suspected, which could be bile duct obstruction, hepatitis, or liver cirrhosis.


Often, day-to-day variations the appearance of your stools is normal and isn’t something to worry about. Your diet plays an important part! However, if any changes persist without any known cause – like foods in your diet, then you shouldn’t hesitate to head down to your doctor for an examination.


February 23, 2021 Blog

Many of us wish there was an easy way to detect cancer early enough. What about cancer markers, you ask?

As its name suggests, cancer markers can indicate the presence of cancer in a person. However, they are not as widely used for cancer diagnosis as you might think, because most cancer markers are not specific enough. The high number of false positives from cancer marker tests makes them not ideal for diagnosis at the moment. Conversely, patients with cancer can have normal levels of cancer markers too.

But why may your doctor still recommend taking a cancer marker test? What are they useful for? Here are some answers to your questions about cancer markers.

What are cancer markers?

Cancer markers, sometimes also called tumour markers, are substances present in the body due to cancer. They could be a compound associated with the tumour cells itself, or a chemical produced by the body in response to cancer. In other cases, these may be certain mutations in particular cells, or an abnormal level of a compound that’s normally already present in the body.

There are different markers for different cancers, but not all markers are specific to just one cancer. For example, the test for alpha fetoprotein can be indicative of liver cancer or some types of testicular cancer. Another marker, CA 19-9, could be used to study the presence of pancreatic cancer, pancreatitis, colon cancer, stomach cancer, or bile duct cancers.

As you might have noticed, cancer markers do not just indicate the presence of cancer. Some may be associated with other non-cancerous health conditions as well. For example, CA 125 is a cancer marker for ovarian cancer, but it can be raised in patients who has fluid accumulation in the abdominal space. And that is the reason why cancer markers are not usually conclusive as cancer diagnostic tests.

Why screen for cancer markers?

Testing for cancer markers can be highly useful in a variety of scenarios, not limited to diagnosis.

Cancer detection

In suspected cases of cancer, doctors may recommend a test for cancer markers as part of the diagnosis process. While cancer markers alone are not conclusive of cancer, their detection can be useful at giving information about the nature of the patient’s condition. Most doctors will follow-up a positive cancer marker test with more conclusive tests like an MRI, CT scan, or biopsy.

During diagnosis

Recently diagnosed cancer patients may also be recommended a cancer marker test to give information about the nature of the cancer – for example, the extent of its spread, how aggressive it is, and so on. This will aid the cancer specialist in coming up with suitable treatment programmes for the patient.

During treatment

Cancer marker tests may be performed regularly on patients undergoing cancer treatment. This helps the doctor monitor the progress of treatment, and how well the disease is reacting to treatment. Stubbornly high or rising cancer marker levels can be clues that the treatment is not effective, or that the cancer is turning more aggressive.

During recovery

For some cancers, cancer markers can be used to detect the recurrence of cancer. That is why these tests are also performed routinely on patients after successful treatment.

How do doctors check for cancer markers?

Most commonly, cancer markers are tested for through blood tests. Once the doctor has obtained the sample, they will send it to the laboratory for testing.

Various methods of testing are used to detect and measure the level of the cancer marker, depending on the specific marker in question.

For cancer marker measurements taken to monitor treatment progress, the test is repeated at intervals before, during, and after the treatment programme. This offers a more detailed view of how the marker levels change over time.

Doctors have detected raised cancer markers. What should I do?

Raised cancer markers may indicate many things: cancer, recurring cancer, or certain other medical issues.

Before you panic, consult your doctor about what other tests they can recommend to you. Raised cancer markers are not a firm diagnosis. You should accompany it with other tests such as a comprehensive physical examination, CT, MRI or PET scans, and biopsies to have a better indication.

If you are taking cancer marker tests as part of monitoring for ongoing cancer treatment, raised cancer markers are often signify that the treatment is not effective. You might require a stronger treatment or different type of treatment altogether. Speak to your cancer specialist about what changes they can recommend.


While cancer markers today are not yet a definitive diagnostic tool for cancer, they are still useful in a myriad of other ways in the diagnosis, treatment, and monitoring of cancer. Meanwhile, cancer researchers are working hard to explore how these biomarkers can help to diagnose early cancers and predict treatment effectiveness. Hopefully, we will be able to see more efficient and reliable cancer screening methods in the near future!



February 15, 2021 Blog

If diarrhoea is a frequent occurrence for you, it’s natural to be worried about what underlying health condition may be causing it. From irritable bowel syndrome to cancers, diarrhoea is a very common symptom. In this article, we shine the spotlight on celiac disease, an autoimmune disease in which consumption of gluten causes the body to attack the small intestine.

Celiac disease affects an estimated 1% of the worldwide population, and it is on an upward trend. This can also be seen by the rise in awareness of gluten-free food alternatives, and gluten-free-friendly eateries. As celiac disease is a serious condition that comes with a host of uncomfortable symptoms – including diarrhoea, it is important to watch out for the signs of it, so that it can be managed effectively for a better quality of life.

Does diarrhoea mean I have celiac disease?

As mentioned, diarrhoea doesn’t necessarily point to celiac disease. Diarrhoea is a symptom of a huge spectrum of diseases, or it could just be a one-off result of eating something wrong.

However, chronic diarrhoea could definitely be a sign of celiac disease. In fact, diarrhoea is one of the most common symptoms amongst celiac disease sufferers. One study found that diarrhoea was a symptom experienced by almost 80% of untreated celiac cases. The good news is, the percentage of patients who continued to experience chronic diarrhoea after treatment dropped significantly to 17%.

Diarrhoea in celiac disease is typically caused by impaired absorptive functions of the small intestine. It can manifest as watery stools, loose stools, or more frequent urges to go to the bathroom.

What other symptoms point to celiac disease?

Diarrhoea is only one of the many symptoms related to celiac disease. People with celiac disease may also experience the following symptoms:

  • Bloating & gas: Inflammation in the small intestine can contribute to excessive gas and bloating. One study found that 73% of celiac disease sufferers experienced bloated stomach symptoms before diagnosis.
  • Fatigue: Low energy levels are common in those with celiac disease. This is contributed by a higher incidence of sleep disorders in celiac patients, and nutrient deficiencies due to malabsorption.

Apart from the above, symptoms like stomach pain, unintended weight loss, and anaemia may also accompany celiac disease. If you are unsure if your diarrhoea is related to celiac disease, you can observe for these symptoms and observe if they worsen with increased gluten consumption.

How is celiac disease diagnosed?

If you suspect that you have celiac disease, your doctor can confirm the diagnosis using a few methods:

  • Blood tests: Two types of blood tests can help to diagnose celiac disease. One tests for the presence of certain antibodies, which are compounds produced by the body as an immune response to gluten. The other tests for certain antigens linked to celiac disease.
  • Biopsy: A small sample of tissue from the small intestine can help the doctor ascertain if you have celiac disease. In this case, the biopsy is usually obtained via an upper endoscopy, in which a long, flexible tube is inserted into the mouth, reaching past the throat into the small intestine.

How is celiac disease treated?

There is no direct cure for celiac disease, but most people manage their symptoms very well with a gluten-free diet. Going gluten-free gives your small intestine time to heal, and prevents additional damage to it.

Generally, you will have to avoid foods containing:

  • Wheat
  • Rye
  • Barley
  • Malt
  • Semolina

Additionally, it will require extra vigilance to identify and avoid gluten in processed foods and even medications, health supplements, and non-oral health products like toothpaste, mouthwash, and lipstick.

If celiac disease had caused significant deficiencies or anaemia, your doctor might also recommend certain supplements to maintain healthy levels of essential minerals in your body.


Although celiac disease can cause serious impacts on one’s health and quality of life, these symptoms are often well-managed with a conscientious diet.

However, if your diarrhoea turns out not to be celiac disease, it will be worthwhile to check up some other conditions to rule out other causes. A gastroenterologist can also advise you on the steps and tests you can take.


February 10, 2021 Blog0

Looking forward to feasting on sumptuous steamboat and snacks this weekend, but not looking forward to the bloat, sluggishness, and indigestion afterwards? You’re not alone.

Every Lunar New Year (LNY) sees the resurgence of articles telling us once again how sinful that piece of pineapple tart or bakkwa is in in terms of calorie count. But apart from weight gain, how much exactly do we know about the havoc this yearly period of feasting does to our bodies?

Spoiler alert: The occasional feast probably won’t cause lasting damage to your body. But if you have existing medical conditions, or are overeating at a regular frequency, it’s better that you watch your intake this LNY.

What happens in the body when we overeat?

Most experts agree that the body is able to withstand the occasional binge-session without making a dent in one’s overall health. Symptoms that occur after overeating are typically acute, and the body gets back to normal within a day or two.

  • Sluggishness

To process all that extra calories, sugar, and fats from your hearty family potluck, your body needs to dedicate a little more attention and energy towards digesting them. This leads to that familiar groggy and lethargic feeling you get after a heavy meal. However, remaining sedentary for too long may just amplify this feeling. If possible, work in a post-lunch walk or keep your body moving by helping out with clearing away the dishes.

  • Bloating

Your belly feels like it has grown double in size – and it’s not all just food. Part of the bloating is caused by gases produced during the digestion process. With an increased volume of food, you can expect even more bloating, and even more so if you have been drinking carbonated drinks. Ease off this bubbling feeling in your tummy with a comforting cup of ginger or chamomile tea.

  • Heartburn

Some people may feel a burning pain at the back of their throat or in the upper chest area. Most likely, these heartburn symptoms are caused by acid reflux, which happens due to the large amounts of acid that needs to be produced to digest all that food. Frequent overeating can also weaken the lower esophageal sphincter (LES, the valve that keeps the stomach acids from flowing up to the esophagus and throat), contributing to gastroesophageal reflux disease (GERD). As tempting as it may be, abstain from lying down right after eating, as doing so would encourage the backflow of stomach acids, worsening your heartburn if you have a loose LES.

What happens if overeating becomes too frequent?

If this weekend’s LNY meals make up just a portion of your binge marathons taking place once a week or more, then you have more to worry about. Frequently eating more than your body needs can increase your risk for a number of health conditions.

  • Weight gain

Weight gain happens when your calorie and fat intake is more than what your body burns. The excess is converted and stored as fat. If weight gain is a concern for you, fill your plate and tummy with more protein and greens before heading for the high-fat and high-calorie dishes.

  • Increased risk of metabolic diseases

Obesity and overeating go hand in hand, and these contribute to a higher risk of metabolic diseases like heart disease and diabetes. When fats accumulate in the body, it is more difficult for the heart to pump blood around the body. This also increases the risk for high blood pressure, high blood sugar, and high cholesterol levels.

  • Liver disease

Frequent overeating of high-fat, high-calorie meals can cause unhealthy levels of fat to accumulate in the liver. Overconsumption of alcoholic drinks can also cause this. A fatty liver impedes its functions, and may lead to inflammation, liver damage, liver cancer, or even liver failure.

How can I prevent overeating?

There’s no doubt that overeating doesn’t do much good to the body. But controlling one’s intake is easier said than done. After all, no one really wants to be counting calories in between their games of mahjong or yearly family gossip sessions.

For an easier way to control your consumption this LNY, some suggestions include using a smaller plate to control your portions, drinking water before and during your meal, and consuming more proteins rather than carbs or fat-heavy food.

Making it a point to clock in some physical activity will also help boost your energy levels and burn off some of that extra calories. However, experts warn against going for a total detox after the festivities – as the drastic change could wreak more damage to your already taxed body.


February 4, 2021 Blog0

In Singapore, the number of patients diagnosed with cancer has been rising over the years. However, with early diagnosis and treatment, patients can look forward to a higher chance of recovery, while avoiding further complications. This is why regular cancer screenings are so important to identify early diseases, even before any signs or symptoms emerge.

Persons with additional risks like family history all the more should not neglect this crucial step in their healthcare regimen. Additionally, your doctor will be able to advise you on which cancer screenings they recommend based on your health history.

As a general guide, we’ve also compiled a list of the 3 most common cancers you can get screened for in Singapore.

Colorectal cancer

Colorectal cancer is the most common cancer diagnosed in Singapore, with approximately 1,200 new cases each year. Men generally have a higher risk of contracting colorectal cancer, but an early diagnosis can increase the likelihood of complete recovery.

Some symptoms associated with colon cancer include a change in bowel habits, changes in stool colour and shape, abdominal pain, and presence of blood in stools. However, most of these symptoms only show up in the later stages of the disease, hence early detection through regular screenings like colonoscopies is crucial.

You can also obtain kits for the faecal immunochemical test (FIT) from the Singapore Cancer Society and participating pharmacies in Singapore.

Breast cancer

Breast cancer is the most common cancer amongst women in Singapore. Each year, 1000 women are diagnosed with breast cancer, and 1 out of 13 develop the condition some time in their life.

Early breast cancer usually does not have any symptoms. However, some signs you can look out for include a lump or thickening in the breast, bleeding or discharge from the nipple, and a persistent rash. Although breast cancer screening cannot prevent breast cancer, finding the cancer early makes it easier to treat.

The mammogram is the most common screening test for breast cancer in Singapore, and this may be complemented with other imaging scan like ultrasound. Consult your doctor to find out which screening test is most suitable for you.

Cervical cancer

Cervical cancer is a type of cancer that happens in the cells of the neck of the womb, called the cervix. Human Papillomavirus (HPV), a sexually transmitted infection, is a common virus that can lead to cervical cancer. In about 90% of the infected cases, the virus clears on its own, and the cells return to normal. Only in some cases, the infection persists and the cells grow abnormally, resulting in cervical cancer.

This cancer is a slow-progressing condition that usually takes years to develop. Therefore, it is vital to go for regular screenings so that it can be detected and treated early. Screening tests for cervical cancer includes Pap tests (also called Pap smears) and human papillomavirus (HPV) tests. These tests can detect cervical cells that are abnormal or infected with HPV, even before they turn into cancer.


As most cancers do not have symptoms at the early stage, early detection is the most important strategy to lessen the impact of cancer. Remember, prevention is the best cure!

Worried about going to a clinic amidst the pandemic? Even with the COVID-19 pandemic ongoing, many clinics are open for routine cancer screenings and can make arrangements for safe and controlled testing. Call ahead to make your appointments or ask your doctor about the screening tests you need.


February 2, 2021 Blog0




  1. 鸡蛋



  1. 浆果类



  1. 蒜米


  1. 深色绿叶蔬菜



  1. 克非尔(也称牛奶酒)


  1. 坚果和种子







January 28, 2021 Blog0








  • 控制进食发酵食品、汽水及含有高果糖的饮料。这种食品只会“喂食”肠道里的细菌进而产生更多气体。每天记得要补充水分。
  • 避免狼吞虎咽。因为这会导致您在进食时吞入更多空气。当您选择细嚼慢咽时,更多的唾液将会与食物混合在一起,有助于分泌胃酸来分解食物。
  • 定期运动。运动有助于肠道内的气体排出体外。您可以尝试一些增强腹部的运动,这种运动能促使肠胃道的蠕动。为自己指定一天至少30分钟的运动,一个星期3至4次。
  • 控制进食善于产生气体的食物如十字花科蔬菜、乳制品及特定的水果如梨子和苹果。这些食物含有果糖、乳糖及不可溶性纤维,会在大肠发酵时大量产气。然而,这些食物还是富含身体所需的营养,所以就别完全把这类型食物从您的饮食习惯中排除。
  • 留意一些引起您食物不耐症与食物过敏的症状。不同的人会对于不同的食物产生过敏。通常这些食物过敏的症状包括腹泻、腹胀和恶心。进行排除饮食能够帮助改善气体过量的症状。排除生产大量气体的食物,再慢慢一个一个引进您的饮食习惯中,就能够帮助您确认哪类食物是导致您胀气的。



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