Crack Tooth Syndrome

Crack tooth syndrome.

The diagnosis of the above condition and its management of the tooth is one of the most perplexing issue a dentist can often face with. Many a times it leads to serious contention between the patient either with his dentist or even the endodontist. That's the reason it has such a unique sounding name.

Simply put, the tooth structure has cracked and through this crack bacteria can reach the inner sanctum of the tooth. This results in an infection of the  pulpal tissue..The inflammation of the pulp causes severe pain and what we commonly call toothache. This pain is the most common reason why a patient seeks treatment. As we all know this pain does not come suddenly. Unlike severe trauma to teeth such as a big blow to the tooth, cracks must have started off as very fine failures in the tooth surface, With time and continuous abuse  these cracks will slowly enlarge and deepen  allowing the ingress of bacteria. At different stages of the  crack, the patient will feel varying degrees of pain. To make matters worse human beings have very different pain thresholds. So some can come in early and some come in late. The treatment rendered and the resultant outcome is highly dependent on the right diagnosis as to which stage the crack has occurred.

Rationale for treating a crack tooth.

Functions of teeth

Our teeth exist for many functions. These include chewing, speech and also facial profiles. This are all very important functions for human beings.

Chewing. Eating well is one of the great pleasures in life. The ability to chew food properly not only enhances the taste but also aid in its digestion. This gives us the nutrition we need for good health.

Speech. Without teeth or wearing loose dentures can cause speech difficulties and a source of embarrassment.

Facial profiles. Whenever teeth is lost the bone that is holding to the teeth is also lost. This results in the face losing its support and the person now looks much older than their age.

For all the above reasons patients would want  to keep their teeth for life.

Potential trauma from Extractions

Not all dental extractions go smoothly. Some can go terribly wrong. Pain from extractions and its associated complications are not only feared but definitely want to be avoided by the patient.

Inconvenience and costs of replacements

Any loss of teeth will result in many inconveniences for the patient. All forms of tooth replacement involves loss of time, in some cases further pain and definitely can be very costly . This can be in the form of dentures , bridges and implants. All these replacements have their own lifespan and thus sooner or later they will have to be replaced. That would result in even further loss of tooth. If a crack tooth is well treated it should be able to survive at least for another 10 years or more. It is a good way of buying time.

Timely treatment

As with any dental condition the earlier it is diagnosed and treated the better the survival rate of the tooth. At the early stages, the pulpal inflammation is reversible.If the patient has turned early and the dentist correctly diagnosed the condition, just a crown will be sufficient to protect the tooth. Once a toothache has occur a root canal treatment becomes necessary to stop the pain.

As the ageing population increases there is a proportional increase in the number of crack tooth.

Root canal treatment and its problems

The idea behind root canal treatment is very basic. The patient is having a toothache and wants the pain removed. The nerves in the tooth is inflamed and the technical term is pulpitis. There is a great buildup in pressure inside the pulp that causes this pain.  Hot drinks will precipitate severe pain. Worse of all when one lies down to sleep at night the ache seems to get worse and with the silence of the night this really becomes unbearable. All the painkillers does not seem to work or at best effective only for a short time.

To save the tooth from pain all you have to do is remove the nerves in the pulp cavity and the root canals. Then you seal up all these spaces so that bacteria cannot live in them and thus there will be no further infection. The tooth then is restored with a crown and become functional again.

This is easier said than done. It is a blind technique, that is you cannot see what you are cleaning more so than able to see where you are sealing. Till today not all endodontist can agree on the perfect technique. Even with the best results the longevity of a root treated tooth is significantly shortened.

Usually in severe pulpitis it is very difficult to achieve sufficient numbness to treat the tooth. So patient can be uncooperative. At this phase this is the bane of dentists who performs extractions. The patient will complain of severe pain during the extraction and in later life will have a dreaded fear of dentistry.

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Why do teeth crack?

There are many reasons for teeth to crack. The causes can work alone or in tandem.

Most dental schools suggests that the most frequent reason for a tooth to crack is due to abnormal function e.g. bruxism. Such patients gnash or bite  hard on the teeth resulting in severe wear and concomitant cracks. Generally most people are really normal.

Caries is still the most frequent cause of weakening of tooth structure. To stop the caries from spreading and later affecting the health of the pulp , the cavity is cleansed and a filling is done.  Very often caries are detected very late and a lot of tooth structure has been destroyed. . Caries can spread like wildfire in dentine. Caries itself can transmit bacteria into the pulp with resultant pulpal inflammation. As the dentine is destroyed or weakened the enamel is unsupported and it will crack. Fillings cannot replace the manner in which dentine support enamel.

Increasingly patients come into the surgery free of caries and fillings also without any parafunction to the extent that the tooth is structurally untouched with just some sign of wear.

So what is the new cause of crack tooth.It is definitely the ageing process.

The ageing process and its effect on dentine.

If you ask most dentist what is the function of dentine , they will say it is a hard tissue that contains nerve tissue that is connected to the pulp. As such it acts as an early warning system to indicate that bacteria is penetrating into the pulp.  This reason does not make sense as if one looks back more than a hundred years ago when dentists do not exist , even if the dentine can warn you of a potential threat  there is no way one can find a dentist to solve it.

To solve this dilemma all we need is to look at the structure of dentine. Dentine is made up of tubules with a nerve in each tubule. One end of the tubule is at the pulp while the other ends at the enamel. Enamel is made up of prism like crystals and completely free of nerve tissue. It is like glass. The enamel sits on the dentine layer. The dentine tubule being connected to the pulp has also dentinal fluid. If you look at the way the whole system is set up then you can see the function of dentine. Tubular structures can flex and the dentinal fluid provide even greater flexibility to the system. Through this unique structural combination the dentine acts as a flexible support to the enamel enabling the enamel to function like hard glass but does not crack in the process.

As one grow older secondary dentine is deposited at the pulpal end of the tubule. In teeth where fillings have been done or severe wear is seen, a thick layer of secondary dentine is seen. This can  act as a barrier to irritants from reaching the pulp. Secondary dentine is an amorphous mass and as they are deposited they block the renewal of dentinal fluid from the pulp. Without this renewal of dentinal fluid the dentine layer loses its flexibility.

If we use the rational of ageing bamboo we can come out with the most likely cause of crack tooth. As we all know young bamboo is green in colour with great flexural strength. It has a lot of fluid in its structure. As bamboo aged, they dry up and turn brown. Brown bamboo cracks much more easily. If you apply this rationale to the dentine , we can deduce that when there is an absence of secondary dentine i.e in a young tooth or tooth that has not have any wear or damage, the enamel is well  supported by the dentine’s ability to flex to absorb all the stresses. As ageing progress or the tooth suffers from wear or injury, the secondary dentine formed now blocks the dentinal fluid from the pulp. The dentine now acts like brown bamboo and as it has lost its flexural strength , it no longer can support the forces acting on the enamel leading to cracks developing in the enamel.

To make things worst cracks do not just appear in the enamel. It extends into the dentine. These cracks then become the pathway for bacteria to reach the pulp causing inflammation and eventually pulpal death. Cracks now not only can exist in the coronal part of the tooth but propagates into the neck and eventually the root of the tooth. At this stage a split tooth is seen.

Is there any other natural factor that cause people to have a higher rate of crack-tooth?

It may come as  a surprise to you that the dental profession does not know that the jaw relationship plays a major role in crack teeth. Commonly human being’s teeth are classified into three relationship i.e how the upper jaw come to contact the lower jaw.

These are namely Class I, II and III.

People with Class II Division II jaws has the highest frequency of crack teeth. (I will dwell into it in another chapter)

Management of the crack tooth.

Once you can understand the anatomy of the tooth and nature’s way of using this anatomical setup, you can see there are varying stages of cracks developing in the tooth. At each of stage they not only present with different symptoms they also call for different methods of treatment with the resultant outcome. Ironically the diagnosis is not as simple as just detecting the extent of the crack.

Factors affecting the correct diagnosis of the stages of a cracked tooth

The patient’s experience of a cracked tooth.

The majority of patients have no experience of a cracked tooth and thus is not aware that a tooth has cracked until they notice significant symptoms. If the dentist are not aware of the the signs and symptoms of crack tooth early sufferers are usually not treated.

Most people still associate dental sensitivity with caries or expose roots. Exposed roots is the culprit in modern society as there are plenty of advertisements by manufacturers of desensitising toothpastes highlighting their efficacy against such an irritation to one’s comfort.

In the average person there is always a certain degree of exposed roots. In people with chronic gum disease the surface area exposed is increased significantly. The roots of teeth have no enamel cover and the dentine tubules are exposed to the oral environment and its stimuli of temperature, touch and pH changes. Our modern diet can change from an ice cold drink to some very hot food. Food can be sweet, saltish, sour and bitter with its different pH. When it comes to brushing teeth some people brush too hard while others will use very abrasive toothpastes to the detriment of the exposed roots.

So people and dentists are usually fixated with these causes and overlook the initial cracks.

The symptoms associated with cracked tooth

These can be divided into early, intermediate and late symptoms.

Each patient has a different pain threshold, thus it is utmost importance that the patient’s story is correctly heard.

Early symptoms.

The first inkling of a crack tooth is when the patient comes into surgery usually on their routine dental  check up, complaining that there is occasional pain on biting. Some patient may even tell you that recently on biting something hard,  they had heard a crack sound in one of their teeth. Usually they cannot tell for sure which tooth is involved. To make matters worse the nature of the trigeminal nerve and its interpretation of the source of pain complicates the diagnosis of which tooth is involved.  A fair number of patients will point to the opposite or the next tooth as the source of pain. In the absence of clear cut pathology such as deep fillings, it is very difficult to confirm the cause.

X-ray films are of little help as the crack is usually at right angle to the x-ray beam and thus does not show up at all.

In some cases they don’t even mention of the pain but on examination one can see that the patient had avoided biting on the side. Only on detailed questioning will they tell of the symptoms. The pain is fleeting and once the patient avoids biting on that side, it no longer bothers the patient. The tooth is usually not affected by temperature changes.

Examination can reveal one or more cracks in one tooth or on its neighbouring teeth. Some of the cracks are fine and can  be seen only by refracted light.  This is useful as it can be use to differentiate between cuspal fracture or a midline fracture.  The tooth involved may not have any restorations but usually show some wear facets. When the patient is asked to bite on a woodstick, the location of the crack can often be confirmed.

X-ray usually is not helpful at this stage but is important to rule out any inter-dental caries that was not seen.

This is the stage where the best results are obtained. Since there is no response to temperature stimuli, the pulp is still healthy and when the tooth is restored properly  it will heal uneventfully.  However the x-ray film must also rule out that there is no periapical lesion which would indicate that the tooth is already non vital and so patient does not respond to temperature stimuli.

A crown is the treatment of choice in restoring the tooth. It is usually a difficult recommendation as the patient may be taken aback that a perfectly sound looking  tooth requires such an expensive treatment. To make matters worse  he make seek a second opinion in which the other dentist lacking experience may rule against your diagnosis. The age of the patient, presence of severe wear facets, a lone tooth and a class 2 division 2 bite  can guide you to push for the crown treatment.  When in doubt and when the patient show reluctance ,explain to the patient that if symptoms persist or gets worse, he should return for treatment.

Even at this very early stage, the dentist may recommend a crown without root treatment. Very soon after the crowned has been cemented the tooth becomes painful and needs a root canal treatment That highlights the difficulty in the right diagnosis.

The intermediate stage.

At this stage the patient has had suffered from pain on biting for some time. This can be a little as a few weeks or more than a year. Now the patient seeks treatment because he is bothered by the irritation when having cold drinks even though he has avoided chewing on the causative tooth. Frequently he may have consulted one or more dentists who could not find any pathology. The usual treatment they have received is an application of a desensitising paste and even a filling at the exposed root of the tooth. By now the causative tooth can be usually be pinpointed easily. When asked they probably cannot recall any episode of a crack sound on biting.

One can see the crack clearly. However in some cases it can be masked by amalgam or other restorations. In non restored teeth the amount of stains in the crack can give one the degree of severity and duration of the crack. As mentioned earlier the crack is the path of bacteria ingression. Darkly stained cracks would indicate that the crack has been around for a long time. Refracted light will show an obvious crack even in the absence of stains. The most important observation is if both mesial and distal cracks are seen, then the condition is fairly advanced.  The tooth should be immediately restored. X-rays is taken to rule out any other pathology. In some cases one can see that the pulp is shrunk from the crack area. This is due to the deposition of secondary dentine.

This is a troublesome stage of affairs. If the patient’s history point to an early appearance of the symptoms to cold, no root treatment is recommended. If they have a long history of sensitiveness and if you can see some fillings around the cervical part of the tooth, it is best to complete the root treatment prior to the restoration. Some patients may resist a root treatment. They may have heard that root canal treatment is painful and maybe they would not like to put with additional cost. Such patients must be informed that the need for root treatment later. The bad news is some patients may come back complaining of pulpitis soon after you have restored the tooth. Also it is imperative you rule out the presence of other crack teeth. The prognosis is now guarded.  Due to the difficulty in pinpointing the extent of the crack, it is advisable to inform the patient that the whole treatment may fail many years down the road as cracks reaching the root can progress further down resulting in abscesses even with no obvious split in the root.

The Late stage.

This is the most obvious stage. The tooth is a hot tooth and is giving the patient a lot of pain. The diagnosis is very easy and the patient usually reacts even with a slight tap. Patient will complain of severe pain when having a hot drink. Most of the time they will also tell you that cold drinks relieve the pain. Now all you need is to rule out if the pain is a result of a crack tooth or due to a deep restoration. With a crack tooth the information the patient receives is very important as at this stage the crack may have gone so far down the the crown that it has reach the root of the tooth.

The following observations are very important.

Visual  and physical examination.

At this stage the crack is clearly seen. It is  mesio-distal in nature or involves two sides of a cusp. Some are stained deeply. When you run a probe across the crack it catches the tip. If you can place the probe tip into the crack, the tooth is best extracted. The tooth maybe be slightly mobile which is indicative of some sort of abscess. Do check for any gingival pockets as it may show up an endo-perio lesion. This only occurs in molars as only one of the root is already necrotic but the other roots may still have some nerve tissue.

The tooth may or may not show any mobility.  Mobility is usually a bad sign.

X-ray will show up many issues. An enlarged periodontal space is not a good sign. This is an indication that the crack has reached the root of the tooth.

Management of the crack tooth at the late stage

In the absence of any of the above negative issues, a root treatment must be instituted immediately. Previously it was advocated that a band be placed around the tooth to prevent it from splitting up. However placing a smooth fitting band is extremely difficult. Many a times it may result in more aggravation of the patient. It is easier to grind the tooth completely out of occlusion and use a composite as a temporary restoration. If the tooth actually cracks during the interim period it may be a blessing in disguise.

Then it should be extracted immediately.

Many problems associated with treatment arise at this stage. This is all due to the difficulty of diagnosing if the crack has reached the root. Sometimes when using a tool called apex locator, when it gives a funny reading you can conclude the crack tooth is beyond redemption.

When root canal treatment is completed and the tooth absent from any symptoms it is best to crown the tooth immediately.

It is obvious that the patient is cautioned that the tooth has a high possibility of it being extracted if all fails.

The end stage of the crack tooth.

Failure of the whole treatment can come anytime. Those that come very early i.e less than a year is always a point of contention between the patient and the dentist. This due to the high cost and amount of time already expended. Even at the very early stage, the dentist may have recommended a crown without root treatment. Very soon after the crowned has been cemented the tooth becomes painful and needs a root canal treatment Whose fault is it?

Sometimes there can a be swelling of the gums or an abscess. Other times it just presents with a very small swelling followed by what we called a sinus tract. X-ray will show changes to the bone on the side of one of the roots.

This is the end stage and the tooth should be extracted.

Dry Socket. Pain and Treatment. How to cure the excruciating pain of Dry Socket.

Dry Socket. Pain and Treatment .How to cure the excruciating pain of Dry Socket.

Dr Seow Onn Choong

As a dentist it is inevitable to end up with a conversation over problems of dental care when you meet strangers and they found out that you are a dentist.

Last Sunday I manage to squeeze myself into a flight of three golfers to play a round of golf. At the  end of game we always sit down for drinks.The usual conversation popped up.

One of them shared with us his bad experience of dry socket after a wisdom tooth surgery four years ago. His description of the surgery was already bad enough.

But his statement really caught me. “ I do not wish upon others the excruciating pain from a dry socket. The pain was so bad that I cried. The whole episode lasted for nearly ten days and I was suffering throughout that period.”

Obviously he had returned to the dental clinic for treatment but it was to no avail. I looked at him. He is around my age and of fairly big built. For him to said that the pain had caused him to cry must be pretty significant.

Well this is not the first time I have heard of such an outcome. Just last year a patient turn up at my clinic to fix up a chipped incisor. Just as he was sitting down he shed a tear.He said he had another problem. He showed me a healing socket on his right lower jaw where his first molar had been. It still looked raw. This patient had seen me twice  for extractions of his upper molars.

He does not see me for other work as he is a regular patient of the national dental centre. Three weeks ago he went for his routine scaling. The young dentist suggested to him to take a set of x-rays. Lo and behold he found a cavity below a crown. His treatment option was to extract the tooth. Seems drastic but after some persuasion he agreed to it. Then his regret started. One hour into the procedure the tooth was broken down but still in his mouth. The nurse advice the young dentist to ask for help. Well with a more  experienced person it was done in ten minutes. Now the pain has started. It was subdued with analgesics. However on the third day  it became quite unbearable. So he returned to the centre. They proceeded to clean the wound without anaesthetic and his remarks was the same as the golfer, he was crying. They asked him to bite a piece of gauze and he told them off.He told them over the last two years he had come to see me for two extractions. Each time he was surprised that the tooth had been removed without him feeling any discomfort. Both times healing was so asymptomatic that he did not felt that he had an extraction. How is that their method was so painful and different. I told him they have not change their technique of extracting difficult tooth resulting in a Dry Socket . The method of managing the wound is very classical and textbook method.

I prescribed him an antibiotic and a pain killer, asking him to return the next day with the X-ray so that I may know the reason for the extraction. He came back the next day and told me the medication was like magic.

Dry Socket

The term Dry Socket is really a misnomer. It is the name describing a very painful condition involving the bone socket two to three days after a dental extraction. It is usually associated with the extraction of a lower molar especially the wisdom tooth . As no one knows the cause of this problem, thus here is no prevention and worst of all the whole dental world has no good solution to managing the problem.

Usually the patient can suffer for around 7 to 10 days. Some sort of relief can be obtained through analgesics but  usually is inadequate.

The condition is fairly common. Some articles quote around 4% of extractions will result in some sort of dry socket.

The worst case is when a dentist tries to clean the socket to speed up healing. The socket is ultra sensitive and usually most people will shed tears of pain during the procedure. Ironically this procedure does not work at all.

Some dentist will place some foul smelling paste known as alvogel  or cotton soak medicament (eugenol) into the socket hopefully to ameliorate the pain. Not only it does not work , it makes the patient have this horrible tasting  mouth for days. It also contravenes surgical principle by placing a foreign body to expose bone.

I do not want to elaborate more of this condition as on the internet it is already very well written and documented.

https://www.animated-teeth.com/dry-sockets/a1-dry-sockets.htm

This site gives you a very good understanding of the condition.

When I was a young dentist this condition had baffled me. I would follow the procedures as outlined in textbooks and taught to me by the dental school. The results are the same suffering of the patient. Without fail that is also the last time he or she will use me as their dentist.

In the early eighties extractions were fairly common daily procedures and with this condition occurring I felt it was not good for business.

One day I had lunch with a prominent orthopaedic surgeon. So I outlined to him my problem of managing dry socket.

He laughed and said it was such a small matter as he has to deal with much more serious bone infection  especially in cases involving road traffic accidents.

He was kind enough to tell me the answer.

That year was 1982

From that day on wards no dental infections were beyond my control and dry sockets was just a temporary irritation.

Many times I have tried to share with my dental colleagues this information and many times I have been rebutted by the oral surgeons.

One of them told me the golden rule in managing dry socket is curettage follow by a course of Amoxycillin and Flagyll.

I am sure  he knows Amoxycillin has many resistant strains.

Worst of all Flagyl is a terrible gastric irritating drug and in the oral cavity its ability to eliminate anaerobes is really doubtful

Have you heard of mega doses of Penicillin. I am not too sure whether it is still used today. I dread the risk of seeing the patient going into anaphylactic shock

Let me share my trade secret with the whole world.

From all the literature we know Dry Socket is a very localised bone infection because the bone in the extraction site is exposed to bacteria.

So all we need is an antibiotic that can reach the site and also effective against the bacteria involved.

And that antibiotic is Clindamycin

Clindamycin is used primarily to treat anaerobic infections caused by susceptible anaerobic bacteria, including dental infections and infections of the respiratory tract, skin, and soft tissue, and

peritonitis. In people with hypersensitivity to penicillins, clindamycin may be used to treat infections caused by susceptible aerobic bacteria, as well. It is also used to treat bone and joint infections, particularly those caused by staphylococcus aureus

This was a fairly expensive antibiotic back in the 80’s but now the generic version is widely available.

In severe cases the Injection version known as Lincomycin is needed. In fact the injection version is very effective against all severe dental infections as most of them are anaerobic in nature. In Brunei because of my ability to treat dental infections I was like a local hero.

Painkiller is also needed to overcome the pain. Nowadays we are very lucky to have so many variety of good painkillers. I used to experiment with lots of them and the one of the most effective was Feldene. You can hardly find it today.

Nowadays the drug of my choice is Arcoxia.

To my patients they really think I am a magician. This combination is very effective as the pain will disappear in as little as two to three hours. When I call my patients they will tell me they feel much better already.

Well if you are suffering from Dry Socket now please contact your doctor for the above prescriptions.

If you are a dentist try using it on the next dry socket that turns up. It will save you a lot of your precious clinical time and also the angst of your patients.

As dentists there are many things we can do for our patients and one of them is definitely not to make them suffer.
Many dentists will not believe what I have written. I hope the original manufacturer Pfizer will undertake a study to prove my claim. Then this method will be taught in dental schools and accepted by the dental profession.

To the whole world I sincerely apologise for those who had suffered the excruciating pain of dry socket by keeping this knowledge to myself. ( actually I had tried sharing. The few dentists I demonstrated to in Cambodia agrees) I can assure you I have no shares in the drug companies that sells the above drugs.

I wish nobody in the world will suffer from the excruciating pain of Dry Socket again.

Teach your body to burn fat and lose weight forever

Teach your body to burn fat and lose weight forever.

Overweight is one of the biggest problem facing mankind today. This is more so in the developed countries but it is fast catching up in the developing places too. The list of issues associated with overweight is so long that I would not list it out. However the reason why I went on a weight loss diet  was my cholesterol level have crept up over the years and my GP  wants me to start on statins. As all those males above forty will know, the fear of  a cardiovascular incident will drive one to improve your health. Most will seriously work out at the gym, going on serious diets to the extend of not eating any food that contains cholesterol. I think they have the same experience as me. It does not seem to work.

The easy way out is actually to take your GP’s advice. Just start taking statins and you will be fine. Afterall there is so much information outside about the effectiveness of this wonder drug that some doctors are advocating you to take it like a vitamin supplement even though you don’t have a cholesterol problem yet. Also when you check around you will find many of your friends already on the medication and they don’t seem to have a problem with it.

I choose to differ. I have high blood pressure since my forties. I have tried all the remedies known be it oil ,salt free, vegetarian diet to  no avail. Yes the medication had side effects but by changing them and fine tuning the dosage it is almost no trouble at all.

However I think one medication is enough and I need to do something about it.

I love watching TV especially documentaries. One night I happened to watch the BBC series Trust me I am a doctor. In it Dr Michael Mosley who had similar problems of health. He went on to interview many schools of dietary ideas. The problem with any dietary regime is the effect on our daily life habits not just personal but with the social interactions with people around us. Afterall our immediate family members and all your friends don’t have your health issue.

Food and its consumption is also the time we interact with people the most. Take for example when I was on my vegetarian and oil free diet my family complained terribly about the tasteless and bland food they were having daily. Also I have to give excuses to friends during social gatherings. Finally it  did not work.

Five and  Two diet

What Dr Mosley discovered and practiced on himself is known as the Five and Two diet. Whether he is still on it , I am not sure but it seemed he did well to reach his targets. Basically this diet advocates you fast on two days limiting your calorie intake to 600 calories for men and 500 calories of ladies. On other days you can eat normally but must not be a glutton. As there are already many articles on the internet that you can find I won’t dwell into it. This diet came about from  observations in America that during the  Great Depression era of the 1930;s many of these  so call health diseases were greatly reduced. The conclusion was this phenomenon was due to reduction in calorie intake. Many people loss their jobs during this period. With a loss in income people had less food available.

Advantages of this diet.

Life goes on as normal as far as social interactions are concern. One does not have to avoid any types of food or cook it differently.You can still partake food or drinks with your social circle albeit on a reduce amount. You choose the two days you have to reduce the calories. Thus literally speaking there is little change in your life.

**** GOAL***  

Once you reach your health targets you no longer have to fast on the two days i.e you no longer have to diet. You have mastered the technique of burning fat and thus you don’t have to worry about the issues associated with overweight.

How to get through the diet.

Obviously as with any diets one must stick to it. The first two or three weeks can be daunting but once you overcome that period it will be easy. This is where I can share my experience with you.

At the beginning.

To start of measure your weight and height so that you have an idea of your BMI. Also keep notes of your previous medical reports as a reference.

The two fasting days.

As I have mentioned there are already a lot of resources available, so do  refer to them.

My personal regime.

Breakfast

My usual day starts with fruits. I would use a blender, throw in juicy fruits and vegetables such as oranges, starfruit, cucumbers etc. Use fruits that have a high fibre content. Add water to the blending. Thus you get your vitamins, fiber and water to start your day. In addition I will just have  two tablespoon of muesli type of cereals with skimmed milk.  

Lunch

It can be hard boiled egg, sardines and some fruits such as apple, carrots, celery. I like fruits and vegetables that has low starch content, not sweet and has  a lot of bulk.

Tip. Divide the lunch into small portions and eat it over time. Drink lots of water to acoomapny  the food so you feel bulk up.

Dinner.

Clear soup, lots of vegetables, a small piece of meat.

Things to avoid.

Sugar and carbohydrates are the biggest contributor to weight gain. So I avoid it completely on the two days. As a dentist I am very well aware of the effects of sugars on our health, thus I hardly consume any soft drinks and generally do not drink any beverages with sugars. I have leant to appreciate tea and coffee in their natural state.  

Fats. As you can see fats are important but in this diet it just comes along with the food.

Tip

To distract my hunger pangs on the first two weeks I took time for walks when I feel hungry and not time yet for the next meal. All I needed was a bottle of water and the distraction of the surroundings.

The Science behind this diet.

I am sure most people have tried some or all the diets in their lifetime. Some will find it works but others cannot keep it up for life. The good thing about this diet is it is easy and you can do it for life. The best of all it cost you nothing.

Exercising and weight loss,

Many discipline people will push themselves to burn off the calories. This is very well written subject. However one has to work out the maths to see it is difficult to achieve one’s goal.

When you run or walk 1 km, the energy you burn up is only about 65  kcal. To lose

1 kilo of your weight you have to burn up 7000 kcal. Thus effectively you will have to run 100 kms to do that. Imagine the time consumed, the wear and tear on your body and the extreme discipline to finish it. Worst of all , the impact on your joints when you start exercising as an overweight person.To make matters worse if you drink a rehydrating drink after the exercise then you  have zero calories lost.

Effectively to run a marathon you only burn up in the region of a day’s routine calorie intake. If you look at the African world marathon champions they hardly have any fat.

So isn’t it easier just not to take in the calories in the first place.

So the moral of the story is exercise for health and fun so there is no need to stress your body.

Where is our fat and cholesterol coming from in our diet?

In our good life, food has become plentiful. Not just in amount, variety but also very conveniently available. Firstly we have been conditioned from young by our parents as they gave us as much food a we wanted so that we grow up healthy. Asians who are traditionally non milk drinkers have a pint of it daily. The food industry is the worst culprit. The more they sell the more money they make. So not only do they upsize the meal they add a lot of sugars to hook you. Worse of all when the food arrives on the table in order not to waste any, you finish all of it thus conditioning your body to the next big meal.

Carbohydrate is the real culprit.

In human evolution, our main building blocks are protein and fats. Once agriculture was developed carbohydrates as a source of energy was easier to obtain than hunting for food.

However our body is tuned to the early days. When food comes into our system our body is geared  towards the absorption and storage of the protein and fat as they are the basic building blocks. In the past man has to do more physical work thus any intake of carbohydrate is welcome.

Now the story has changed. Not only is food abundant, with the help of machines we are doing much less physical work. The nett result is an abundance of carbohydrate and thus calorie intake.

Everything will be fine if excess carbohydrates excreted out just like water as urine.

Now comes the big Ouch.

All the excess carbohydrate is converted to Triglyceride. Yes you did not see wrongly and what does triglyceride end up as? Yes you guessed it. Fats.

So now you can understand why the hype about eating low cholesterol food did not achieve an inch of success!.

We have all being conned.

What else?

As we know the building blocks of cholesterol is triglycerides, you will not have a problem of having a high cholesterol if you just take in the right amount of calories. Simple isn’t it? Now you can return the statins to your GP.

 

My own personal experience.

As usual when one starts of on any project there is always a lot of scepticism.

My starting weight 71 kilos

                  Height 168 cm

Trousers waist measurement 34

As can be seen I am not really overweight. However for the sake of my high cholesterol problem I embarked on this journey. I gave myself seven weeks as I was going on a overseas holiday. As usual I am not able to resist the variety and new types of food on such trips.  

Results were dramatic.

I loss 6 kilos in 7 weeks.

My blood test results were really rewarding. My cholesterol numbers have improved significantly.

I can now wear trousers with waist measurement of 31.

Pretty dramatic changes in the cholesterol readings.

Ketones in the urine.

The  urine test indicated ketones in the urine. I checked my previous test and there was no such thing. Came as a surprised. To my happiness I found out that when your body burns fat, ketones are formed and excreted in the urine.

Hallelujah I can burn fat now.

The biggest benefit I found was my ability to run again. I used to run a lot to the tune of 8 to 10 km regularly. I am also an avid squash player. They go hand in hand. You don’t play squash to be fit but you must be fit to play squash. So you need to run to build up stamina. Over the years i find it increasing difficult to finish 8 km without stopping. It became a case of running and walking.

During the third week I went for my run. I felt I had lots of new found energy  and before I knew it I manage to run the whole 8km. That was 5 months ago, now I can run 10 km. Not bad for a 63 year old man.

The Best unintended result.

My blood pressure has come down. I now take only  half the dosage of the medication. Hopefully one day I can get on with life free of medication.

Most important now is I never really feel hungry at all. Even if I don’t eat the whole day I can still go running. Amazing.

My weight now still hovers around 64 kg. This was my weight when I was a university student, then the fittest period in my life. Alas the good life had slowly added kilos without be being aware.

I am sure the diet I undertook is not for everyone.However I want to share this with people who have the same problems I had an easy and successful way to claim back your health without medication. Think of the amount of money you can save from not having to pay for all those medications but also the food bill you saved. You are also contributing to a greener world as we know the growth, transport, preparation,sale and consumption of food  uses a lot of resources.

Still have the energy and mental strength to win a golf tournament. The tournament was played over four days. 

Follow through of the diet.

Once you have achieved your goal, it is just a matter of maintenance. The trick is very simple. If you know you are going to have a heavy meal with family or friends, make your other meals very light. In reality even if you don't eat you no longer feel hungry. So now you can really eat for fun.

Now you really can have the cake and eat it.