Dr.Tanatip, this centre has three major sections. The first section is for sick children, who need treatment for cold and coughing or diarrhea or any other acute illness. The second part of this centre is for well children who need vaccinations and other services. They are separate to prevent infection and other problems.

The third section is aimed at child development issues, which have become more important due to the rising number of medical issues affecting kids during their early years.

Among the top issues are Attention Deficit Hyperactivity Disorder (ADHD), child obesity and Obsessive Compulsive Disorder, or Nomophobia (no mobile phone phobia) or computer game addiction or slow reading development.

What are the major changes over the past 30-40 years regarding medical issues among kids? In my opinion, there are two big changes. First, medical problems which were previously not widely recognized have become more apparent. For example, our generation  had some friends in school who probably suffered from the attention deficit and hyperactivity problem (30-40 years ago). There were neither diagnosis nor treatment back then.

However, we’re now better equipped to deal with this kind of problems. The class’s teacher would have reported to parents any kids who are suspected to have this problem. Parents are often advised to see the pediatrician.

Another change is that we have observed some relatively new medical issues such as child obesity or even obsessive compulsive disorder. In the older days, overweight kids, for example,  were rare as more kids had suffered from malnutrition. So back then we talked about better nourishment. Now, the opposite is true, over-eating as well as insufficient physical activity are the problems.

Medical issue among kids in Thailand when compared to those in other countries, are there any significant differences? Dr Tanatip, the world has become smaller due to technology advances. Developed and developing countries mostly have the same digital gadgets such as Internet and smart phones or Ipads or more ready-to-eat meals at convenient stores next door.

The current generation are less physically active and some stay in smaller places such as condominium units with no or little space for an active lifestyle, while both parents usually work so they have less time for kids.

Next, we will talk to specialist doctors covering each of the medical issues mentioned earlier. First is the Attention Deficit Hyperactivity Disorder (ADHD).

Here is Dr Chalermphol, the pediatrician, what’s the definition of this medical issue. Dr Chalermphol, parents usually tell me that their kids might be hyperactive from a very young age as they could play around non-stop without being exhausted.

In the older days, some people thought hyper-active kids were probably smart kids but some of these so-called smart kids were in fact suffering from the attention deficit problem.

Since they are hyperactive, they also disturb the class and teachers may not be able to handle them. Some also abuse their classmates.

Teachers should report such as a problem to parents so that they may see the doctors. Parents who have multiple children may notice that one of them is rather hyperactive compared to the rest or the teachers would in some cases ask the parents to see the doctors before having the kids back to the classroom.

What is the definition of ADHD and its diagnosis? Dr Chalermphol, ADHD in very young kids is obvious when kids have little or no self control largely due to a chemical imbalance in the brain where concentration is managed.

There are varying degrees of ADHD patients, starting from mildness to a serious level. Symptoms are consistent hyperactivity, restlessness, impulsiveness, lack of a focus. Some kids have problems at school in terms of inability to follow the lessons or play too hard with classmates.

In these cases, parents should bring their kids to specialists on child development. In serious cases, these kids could not act normally in class, or they have to walk around or they would just physically abuse other kids due to the lack of self-control.

Many of these kids also perform badly in class with low grades due to the inability to focus for an extended period. Their attention span is very short so learning is a big challenge for them. In short, kids who can focus for a reasonable amount of time can learn better.

What is the treatment plan for those diagnosed with ADHD? Dr Chaelermphol says parents should be cautious especially when their kids have problems at school.

In some cases, kids may have some inclinations such as they may like maths more than other lessons that need a lot of reciting or they may like some teacher characters and hate the others.

As a result, we have to find out if they are really ADHD sufferers or they are affected by other factors as mentioned. If the kids are confirmed to be ADHD, parents and teachers need to be involved in helping the kids. Basically, we try to help kids manage their weaknesses while strengthening their positive behaviors so they can adapt and lead a more normal lifestyle at home and at school.

In some cases, we also need medication to tackle the brain chemical imbalance.

What is the heredity factor? Dr Chalermphol, we could say that this is a major factor as we often learn that parents who are ADHD usually have a higher probability that one of their kids could also suffer from ADHD.

As a result, we often ask parents if they used to experience some forms of ADHD when they were young. However, the body of ADHD knowledge is quite new so we are still learning about this medical issue. Many parents told me that they faced a lot of difficulties at learning during their school years. Some said when they grow up they still have some of these symptoms or tend to make impulsive decisions.

Sometimes, they find it hard to stick to a long-term plan.

What is the timeline of ADHD from a young age to adulthood? Dr Chalermphon says we can expect the brain function to improve when kids get older as can observe from previous generations. When you get older, you tend to have less problems with ADHD.

For ADHD in adults, they are more obvious in terms of emotional rather than physical areas.

Besides heredity, ADHD has other causes. For example, kids who are born significantly prematurely could suffer from ADHD or kids who have brain damage.

In fact, brain function development started long before kids are born. As a result, a pregnant mother who smokes or drinks alcohol would hurt their unborn baby who will likely suffer from ADHD.

As a result, pregnant women are advised to refrain from smoking and alcoholic consumption while fathers are also advised to stop smoking since second-hand smoking has similar adverse effects on unborn babies.

What is the ratio of ADHD cases in Thailand? The findings show that over 10 per cent. The sooner we diagnose ADHD cases, the less severe consequences are found among kid patients. However, if left untreated for a long time, the consequences could be more serious.

Just imagine if ADHD kids are not treated, they could face psychological effects from their inability to focus such as punishment from adults. These are good kids but they don’t follow instructions due to the inability to focus and listen attentively.

So the kids are under constant pressure to conform leading to problematic relationship with their parents or teachers and later on emotional problems as well as aggression.

It’s the duty of parents to observe their kids’ behavior closely, especially when they start school or around kindergarten level 3. More serious ADHD cases could be seen at an even younger age.

Digital technology has a significant impact on people’s lifestyle. Dr Chalermphol, please explain Nomo-phobia or the so-called no mobile phone phobia. This means people are anxious when their mobile phones are not around.

Due to the current lifestyle, you and me are often worried if personal smartphones are not handy. In many cases, people feel lonely when they do not have smartphones with them. In serious cases, they suffer from acute moodiness when there is no Internet connectivity or their phones are lost or batteries are out. Some also have headaches or stomach pain.

The suffering is obvious among those who use smartphones many hours a day. Teenagers are most vulnerable to this Nomo-phobia, aged 18-24. About 70 per cent of this age group are found to have suffered some degree of this Nomo-phobia.

Some adults also have suffered such as an anxiety. We think this stems from the lack of self-confidence when their smartphones are not around and usable.

Some people are worried that if they are in trouble they could not ask for help. Another factor is the rise of social media. People want to know what happens instantly or learn the latest about their friends or their communities so when they don’t have smartphones or connectivity they suffer.

They feel they are left out if unable to check Facebook or Instagram as often as they like.  That’s a new phenomenal.

And bubble tea has now found its way to Europe and America – known as the Blue Ocean market –with The Alley opening 300 branches around the world and more planned for Germany and England.

Anol Thanesworakul, chairman of Millary, which owns the franchise in Thailand, said the global bubble tea market is expected to reach more than Bt100 billion in 2023 from Bt62 billion in 2018.

According to GrabFood statistics, the bubble tea market in Thailand enjoyed a 3,000-per-cent growth rate in 2017-2018 with 1,500 bubble tea brands and around 4,000 shops.

Thailand has seen a growth rate of at least 40 per cent in the last 3 years valued at Bt2.5-Bt3 billion. It is forecast to reach a value of Bt5 billion in the next few years. However, the market will turn into a ‘red ocean’ market and without any flagship product or new gimmicks, could drop by 20-25 per cent causing some brands to leave the market.

Middle-quality bubble tea prices are around Bt40-75 and hold 60 per cent of the market while the mass market price of Bt40 or less has 30 per cent.

According to The Alley record, the main customers are female (79 per cent) with males making up the remaining 21 per cent. Most consumers are young adults between the ages of 24 and 35 (50 per cent) and workers aged 35 to 44 years (25 per cent).

Today, we’ll talk about anti-ageing medicine and wellness tips. Dr Tanatip, wellness has become a buzzword over the last decade, but I think I will focus on the quality of life (as you get older) rather than other aspects of the wellness definition. For instance, many people have the difficulty to touch their upper back with one of their hands when they are getting old.

Maybe a trivial thing for some, but this problem is not ordinary, especially when you occasionally have an itchy back. When you are younger you could touch and or scratch your upper back with ease. That’s not possible any longer due to the tightening shoulder muscles. But there is a solution to this problem. Senior citizens may need a physical therapist’s session over a period of six months or one year to loosen the muscles. In other words, wellness in this context is to extend the quality of life as you age.

Other issues faced by the ageing population include increased tiredness. You used to get upstairs a couple of floors with ease, then it’s no longer the case. Then there’s the generational factor. Your parents’ generation, those who are now in their late 70s or 80s, have a different frame of reference when it comes to the definition of wellness. Based on my clinical experience, they prefer to be left alone.

Then, there are those baby boomers aged from 55 to 70. They are well educated with a lot of savings and financial resources so they want to maintain the quality of life after retirement. They want to travel the world in good shape, even on their own, or can still drive with ease for 3-4 hours for a domestic holiday trip without having to depend on their children.

If the baby boomers want to achieve this goal, when they need to start the preparation? In my opinion, they may start as early as 35 or 40 years old. For females, there is also the child-bearing factor affecting their hormones, weight control and physical exercise. For males, many have had alcoholic drinks or smoked when they are younger so it’s time for more discipline.

Those who stop drinking and smoking when they reach 40, they may expect a big improvement in the general health. If they don’t, they will likely face a significant health issue in advanced age. So a decent lifestyle is a big deal post-40-years of age. It’s the turning point for you to start the anti-ageing effort before it’s too late.

What’s about diet? Yes, it’s another key factor and there have been many bad guys when it comes to food. However, the good guys in terms of food definitely include fresh fruits vegetables. Citrus and turmeric powders (in some Thai curries and other dishes) are among those backed by research which shows they have health-beneficial properties. They can help prevent Alzheimer’s disease, for example.

On the other hand, sugary and salty foods are bad for health, with people in Southeast Asia, including Thailand, among heavy consumers of sweet and salty food. For oily and fatty food, it’s not yet a big problem in Thailand, but it may be a more obvious problem for Indian and Middle Eastern people.

Red meat and highly processed meat products are not good either so are liquid oil turned into artificial butter and other processed stuffs. However, there are both good and bad fats and oils so we have to differentiate.

More importantly, many Thai and Southeast Asian people have consumed too much starch and carbohydrates. (Due to the improved economic well-being and less manual work,) over-consumption leads to more bad fats and cholesterols, which can cause heart disease, stroke and diabetes etc.

There is an old saying that the less you eat the longer you may live. You can also use the body mass index (BMI) or a simple formula that you minus your height with 100 for male and with 110 for female. I am 182 cm tall so my ideal weight is 82 kg. I am currently 3 kg overweight. A proper ratio of height to  weight has a direct correlation to good health, especially as you age.

After diet, the next key factor for good health is physical exercise, especially when you’re 40 or older. Yes, it’s necessary to exercise at least every other day. You may start with the aerobic workout which is good for your heart and physical flexibility as well as balance. You should do aerobic for at least half an hour with a peak performance after 15 minutes, then slow and cool down. For me at 53, my heart rate should reach 130-140 beats per minute while doing the aerobic exercise to prevent an overloading. Good balance is also essential since it helps prevent injuries in old age.

In terms of the anti-aging medicine, what is the latest development? Dr Tanatip, there are now many new screening methods such as those to measure your cognitive capacity for the probability of Alzheimer’s disease. Or the genome tests for genetic probabilities of some diseases. However, only 180 genes are known in relation to some diseases so there is a limit at this stage.

The datasets are expanding with more people around the world taking more tests to help artificial intelligence (AI) software improve the capability to diagnose with predictive analytics. We can expect more accuracy in this technology over the next decade.

In anti-aging medicine, I also like to talk about the psychological factor or attitudes. When I see my patients, I often say there are two major groups of senior citizens, the active ones and the lazy ones. For example, my father in his 80s is still very active and he drives to see doctors twice a week by himself, one trip for the eye doctor another for prostate treatment. He follows the doctors’ instructions strictly.

On the other hand, my mother is in the opposite camp as she likes to lie down the whole day watching TV. She only gets up for meals and prefers a sedentary lifestyle. So we need to approach the two groups differently from the psychological perspective. In general, both groups, including the active group,  should not over-do and the middle way is probably better.

Regarding the Generation Y who are 40 or younger, they appear to be more in control of their lifestyle and forecasts show that this generation’s life expectancy will likely reach 100. Generation X or those who are now over 50 may live until 90. However, Gen Y are more health-conscious and better at diet management.

Overall, anti-aging medicine has become more tailor-made with specific targets and behavior therapies plus vitamins, supplements and lifestyle changes etc. For those who are 40 you should start to look after yourself.

Time is up for the Health Talk programme. Good Bye.  Episode 7–Anti-ageing medicine and wellness tips

Welcome to the Health Talk programme with Dr Tanatip of Thonburi Healthcare Group. The programme is online every Monday at 8 am on the websites of Nation Thailand and Bangkokbiznews. We discuss the latest healthcare trends in Thailand and other Asian countries.

Today, we’ll talk about anti-ageing medicine and wellness tips. Dr Tanatip, wellness has become a buzzword over the last decade, but I think I will focus on the quality of life (as you get older) rather than other aspects of the wellness definition. For instance, many people have the difficulty to touch their upper back with one of their hands when they are getting old.

Maybe a trivial thing for some, but this problem is not ordinary, especially when you occasionally have an itchy back. When you are younger you could touch and or scratch your upper back with ease. That’s not possible any longer due to the tightening shoulder muscles. But there is a solution to this problem. Senior citizens may need a physical therapist’s session over a period of six months or one year to loosen the muscles. In other words, wellness in this context is to extend the quality of life as you age.

Other issues faced by the ageing population include increased tiredness. You used to get upstairs a couple of floors with ease, then it’s no longer the case. Then there’s the generational factor. Your parents’ generation, those who are now in their late 70s or 80s, have a different frame of reference when it comes to the definition of wellness. Based on my clinical experience, they prefer to be left alone.

Then, there are those baby boomers aged from 55 to 70. They are well educated with a lot of savings and financial resources so they want to maintain the quality of life after retirement. They want to travel the world in good shape, even on their own, or can still drive with ease for 3-4 hours for a domestic holiday trip without having to depend on their children.

If the baby boomers want to achieve this goal, when they need to start the preparation? In my opinion, they may start as early as 35 or 40 years old. For females, there is also the child-bearing factor affecting their hormones, weight control and physical exercise. For males, many have had alcoholic drinks or smoked when they are younger so it’s time for more discipline.

Those who stop drinking and smoking when they reach 40, they may expect a big improvement in the general health. If they don’t, they will likely face a significant health issue in advanced age. So a decent lifestyle is a big deal post-40-years of age. It’s the turning point for you to start the anti-ageing effort before it’s too late.

What’s about diet? Yes, it’s another key factor and there have been many bad guys when it comes to food. However, the good guys in terms of food definitely include fresh fruits vegetables. Citrus and turmeric powders (in some Thai curries and other dishes) are among those backed by research which shows they have health-beneficial properties. They can help prevent Alzheimer’s disease, for example.

“Coffee is a regular beverage for many people. But there is much concern if drinking too much will affect the body,” says Kritsada. “Too much caffeine can cause headache, dizziness, palpitations, insomnia, restlessness and diarrhoea. And if one experiences chest pain, one must see a doctor as muscle twitching or twitching may be caused by caffeine poisoning.

Kritsada said a number of patients who come to consult about ageing want to continue drinking coffee. “Actually it is not a taboo at all because coffee is a part of the anti-ageing programme,” he said.

Enumerating the benefits of coffee, Kritsada said: “The caffeine in coffee stimulates the body and wakes up the brain, because there are other neurotransmitters like norepinephrine and dopamine, which stimulate the brain.”

He said caffeine helps burn fat because this black drink helps to increase the metabolic rate of our body by 3 to 11 per cent, according to research by Wageningen Agricultural University in the Netherlands. A study published in the American Journal Clinical Nutrition states that coffee can increase fat burning by 10 per cent in obese people, while in general people who have lean bodies it can burn up to 29 per cent. However, long-term use of coffee may reduce the results of the burning.

Among the other benefits Kritsada outlined were:

➤ It increases exercise potential. Caffeine stimulates the nervous system to signal to the lump of fat cells to break down fat. In addition, it also increases the adrenaline levels circulating in the blood, making the body ready to go into muscle-ready mode, causing caffeine to increase exercise power by 11-12 per cent on average, according to a study in the journal International Journal Sport Nutrition Exercise Metabolism.

➤ Coffee has vitamins and minerals. One cup of coffee reportedly contains vitamins B2, B3, B5 and the minerals manganese and potassium.

➤ Caffeine may help reduce diabetes risk, especially Type 2 diabetes. Many studies show that coffee drinkers have a lower risk of diabetes by 23-50 per cent. Researchers from the Faculty of Public Health of the University of Oklahoma concluded that three glasses of coffee per day can reduce the risk by 67 per cent.

➤ Caffeine protects us from Alzheimer’s disease that is common in humans aged 65 years and above, although it also depends on eating and exercising. According to a study by the University of Lisbon Neurology, caffeine consumption is associated with a significantly reduced risk of Alzheimer’s disease. Another important work from Portugal, published in the journal Alzheimer’s disease, also studied “Caffeine intake and dementia: systemic review and meta-analysis”.

➤ It is reported that people who drink four cups of coffee a day may reduce the risk of cirrhosis from alcohol. A study by the Medical Research Department Kaiser Permanente Medical Care Programme revealed that this property is derived from substances in coffee. A study by the Department of Statistics and Epidemiology, University of Milan-Bicocca, found that coffee may suspend the occurrence of cirrhosis from alcohol and not from alcohol which does not include other caffeine beverages.

Dr Kritsada said drinking coffee has some health benefits that should be known, whether it affects the brain, fat, metabolism, diabetes or weight loss. But not everyone needs to drink coffee on a regular basis to reap its benefits as they can be obtained by eating other foods, too.