The haze, PM 2.5, medical science and water

Hello everyone, I thought I'd talk about something the vast majority of my friends in Singapore are talking about - the haze. The students got a haze holiday on Friday and perhaps that is a sign of things to come, with the problem seemingly getting worse every year and the Indonesian government being totally unwilling and/or unable to do anything about the situation. Whilst Singaporeans panic as the PSI creeps near 400, do you know that in parts of Indonesia, the PSI is as high as 2000? So if you think Singaporeans are already suffering, think about what the people in Indonesia are going through now.  But let me be practical here, allow me to deal with a myth that has been going around in Singapore during the haze season: that you must drink more water during the haze season. Now the rationale behind this myth is that somehow you will be able to flush out the toxins that you have breathed in through your lungs by urinating more. Does it work like that? Can you flush out the toxins breathed in through your lungs?

Hazy Singapore

Now firstly, I want to deal with the issue of PM 2.5 - these are the tiny suspended particles of pollutants in the air (a by-product of the burning process) and they are called PM 2.5 because they are no larger than 2.5 microns, or just a thirtieth the diameter of a human hair. These can become trapped deep in the your lungs and some of it can make its way into your bloodstream. You should be particularly concerned about PM 2.5 readings as studies have shown these pollutants to be carcinogenic (that means they cause cancer - that's right, cancer). I just want to jump to the punch line here (sorry I can't wait) to say that it is just plain wrong to imagine that somehow you can piss out (or shit out) the PM 2.5 that you have breathed in through your lungs - no, your body's respiratory, circulatory and digestive system just doesn't work like that. Aiyoh. I'm afraid that a lot of you have fallen prey to old Singaporean housewives who don't understand medical science well enough and a lot of the medical advice that has been going around has been no more than old wives' tales. Please allow me to refer you to a 2013 SPH razor piece (hosted by my friend Dawn Tan) to explain how it works and why you simply cannot piss out the most toxic PM 2.5 that you have been breathing in:

Yes your body is quite efficient when it comes to dealing with the haze - firstly, your nostrils have both nose hairs which act as a filter and is lined with layer of mucus, this traps a lot of undesirable particles in the air as you inhale. If you are breathing in smoky or dusty air, your body reacts instantly by producing more sticky mucus to trap the suspended particles in the air you inhale, Coughing or sneezing is a way for your body to try to expel unwanted irritants in your airways. Your eyes naturally produce more tears to try to immediately flush out the irritants. So yes, our bodies are remarkably well designed to cope in terms of our immediate reflexes, but when you have been breathing in these PM 2.5 pollutants for an extended period (and that includes everyone who has been in Singapore for the last few months), I'm afraid your body does not expel these toxins through digestive system. That's just not how your body's digestive system works - do you guys really not understand how your bodies work?

Now, nobody would argue that smoking causes cancer and is particularly bad for your lungs. Every time you buy a packet of cigarettes, there are stark warnings about the effects smoking will have on your health. Nobody would tell smokers, "oh just drink more water, drink an extra glass of water for every cigarette you smoke to flush out the toxins from your body." Why would that kind of advice sound particularly stupid? This is because it is based entirely on the assumption that the toxins absorbed through the lungs into the bloodstream can somehow be expelled through one's urine. Whilst the kidneys perform a complex range of functions, one should not assume that they have an infinite ability to expel all forms of toxins, such as those absorbed during smoking. Indeed, humans experience all kinds of kidney ailments, diseases, even kidney failure. Our kidneys are not machines so why should anyone expect them to automatically be able to expel the pollutants in the haze we inhale by simply drinking a few more glasses of water? You simply cannot alter or manipulate the way our kidneys work by drinking more water - that's just the facts people.

That's me in hazy Singapore a few weeks ago

The fact is our kidneys perform their functions without us giving any thought to it - the same way our lungs, heart, brain, liver, stomach and other organs function without any prompting or action on our part. Simply drinking more water does not make your kidneys operate more efficiently, in fact the extra amount of toxins you actually expel through your urine is marginal. When one drinks a lot of water, your urine is very pale yellow or even completely clear; but when you drink very little water, the urine is then a dark yellow colour. Why is this so? This is because the kidneys are still expelling the same waste products through the urine - the hue of the colour depends on how much water the waste products are dissolved in. Thus whilst you may be going to the toilet and peeing a lot more often when you drink more water, the amount of waste you are expelling doesn't substantially increase. You are simply urinating urine that is a lot more dilute, with a lower waste content dissolved in a lot more water. Not drinking enough water can cause all kinds of medical problems, but that doesn't mean that drinking a lot more water than normal can somehow cure your body of ailments or flush out your toxins - that's just not the way the human body works. Water performs a function in our bodies, but it is not some kind of magical medicine. In fact scientists have proven that all these modern fads associated with fancy, trendy 'detox' therapies and diets don't work - it is just a fad to make people think they have more control over their bodies than they actually do. 

There are all kinds of PM 2.5 particles in the air we breath during the haze season - some of them are water soluble (and thus can make their way into our bloodstream) but some of them are not. What happens to those which are not water soluble then?  If they are not water soluble, they remain in the alveolar portion of the lungs for a long time - a very long time and over a prolonged period of exposure to the haze, you Singaporeans are building up a lot of crap in your lungs from these PM 2.5 particles which are not water soluble. And no, drinking more water isn't going to help with the situation in your lungs because your respiratory system and your digestive system are separate. Water may help if you have ingested some toxins, but when it is trapped in your lungs, it is going to make no difference. I'm afraid that there is really no solution for this problem of accumulating non water-soluble PM 2.5 particles in your lungs.

So why do humans still default to these old wives tales then, despite the fact that we live in a modern society where people are generally very well educated and have a much better understanding of medical science? Simple: we want to feel as if we are doing something useful. It is bloody depressing and frustrating for a Singaporean to wake up each morning, to look out of the window and see the neighbourhood shrouded in a blanket of thick, smoky haze. Parents feel particularly helpless when they see their young children badly affected by the haze, coughing and wheezing - they want to feel like they can do something to help. Short of literally going over to Indonesia to put out the forest fires themselves, well, there's literally nothing they can do to stop the haze situation in the region. However, if they tell themselves that drinking more water can literally flush out the harmful toxins and all the nasty pollutants in the air they are inhaling, then they feel like they are doing something that is helpful. Being able to think that they can do something constructive or useful is psychologically very important for people in a difficult situation because it gives them hope - the alternative is to throw ones hands up and say, "well we can't stop breathing - we're doomed."

People have suggested so many things - from eating more foods rich in anti-oxidants (such as broccoli, blueberries, tomatoes) to drinking mint tea to watermelon to help expel the toxins from our systems during the haze. Whilst all of these healthy food items are undoubtedly good for you, you should never be under the impression that they will somehow magically 'cure' you after breathing in weeks of smoky, hazy polluted air. In fact any marginal improvements that these healthy foods will give you is negligible, compared to the harm that the hazy air is doing directly to your respiratory system. Anyone who has a half-decent grasp of the way medical science works will realize that eating a slice or watermelon or a handful of blueberries isn't going to somehow dislodge the PM 2.5 particles trapped deep in your lungs after breathing in so much hazy air, so why are people so naive or stupid, for want of a better word?

Will drinking more orange juice help?

This is because we live in a modern age where we demand a simple, instant solution to our problems. Headache? Take this Panadol and your headache will disappear in minutes. Heartburn? Take this Alka-Seltzer and you will feel better in moments. Blocked nose? Use this decongestant nasal spray and your airways will magically open up in seconds. Oh medical science has been so good to us modern humans - there are indeed plenty of (near) instant 'cures' for minor ailments that trouble us, so we demand to have an equally simple solution when we are suffering the effects of the haze. The fact is, when you are constantly breathing in heavily polluted air that is certified 'hazardous' by the government, you're not dealing with a simple problem here - there are no simple solutions and if you think that you can somehow solve the problem by drinking more water or eating a lot of fresh fruits, then you are only kidding yourself. It is not a question of not understanding the medical science behind the issue, rather it is the mindset of people faced with a problem they cannot solve. They would rather live in ignorance, believing in old wives' tales, rather than confront the truth that there are no simple solutions, no instant cures.

The really only sensible option to mitigate the situation is to try to minimize one's exposure to the polluted air. Note that I used the word 'mitigate', not 'solve' as these only go some way to reduce the ill-effects of the haze. So for example, a common advice is to avoid going outdoors and staying indoors when the haze is particularly bad. Well, unless you have air-conditioning which filters the air of PM 2.5 particles, the air you are breathing indoors is still polluted - think about it, there's nothing to 'clean the air' the moment you shut your doors and windows. So the air inside your house isn't that pure or clean, it is probably just marginally less polluted. And even if you do have air-conditioning to filter the air, a lot of the nasty pollutants in the haze like sulphur dioxide, oxone, carbon monoxide and nitrogen dioxide (all of which are measured to calculate the PSI) are gases which will pass through any filter. Air ionisers and purifiers help, but they can only do so much and you can't hide away in a sealed room until the haze is over - you have to at some point venture out into the haze and when you do, at least try to wear a mask though again, that only does so much.

Has the haze affected your health?

In fact the only complete solution is to move away from Singapore to a part of the world where pollution simply isn't a problem. There are a few major causes of air pollution: in Indonesia, it is a result of the slash-and-burn method of clearing forests for agriculture, in China and India, the culprits are heavy industry (with little or no regulation) and extremely congested big cities, where the pollution is from a mix of traffic and industry. If you are after clean and green places to live, I suggest countries like Canada, Sweden, Norway, Finland and New Zealand. I live in London which is considered one of the more polluted places in the UK as it is a big city, but even that is relative: pollution isn't a major problem here - there are hardly any heavy industries (and thanks to tight regulation, they are not allowed to spew out toxic black smoke), the emissions of the traffic are tight regulated and monitored and slash-and-burn is strictly illegal here. In short, whilst the situation isn't perfect, the government here does give a damn about air quality, unlike the corrupt and inefficient Indonesian government who really don't give a shit as their people suffer.

So that's it from me on this issue.Do you understand the science behind the health issues? What steps are you taking to protect your health during the haze season? Has your health been affected by the haze? Many thanks for reading.