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Posted: 02 Jul 2011 06:34 PM PDT

Fish, meat, poultry, egg, legumes and nuts provide nutrients that are vital for health and maintenance of the body.

MOST people know that fish, meat and poultry are good sources of protein. Protein is required for building tissues in the body, and for repair and maintenance of such tissues.

Less well known is that legumes, nuts and seeds are also valuable sources of protein and a number of other important nutrients. In addition, they also contain several healthful bioactive substances. These foods are grouped together with the meat proteins in the fifth key message of the Malaysian Dietary Guidelines (MDG) 2010.

The MDG 2010 is a set of advisory statements aimed at promoting appropriate dietary patterns and active living. I have summarised the 14 key messages contained in the MDG 2010 and dealt in detail four of the key messages in previous articles.

This fifth key message recommends the consumption of moderate amounts of fish, meat, poultry, egg, legumes and nuts. Actually, these foods are more than just body-building foods. They provide nutrients that are vital for health and maintenance of the body, including protein, B vitamins, iron, zinc and magnesium.

This message in the MDG explains the nutritional goodness of these foods and the rationale for its recommendations. Several tips on how to achieve the recommendations are provided.

Fish

Fish is recommended to be consumed frequently, if possible daily. This strong recommendation is based on the positive nutritional value of fish.

·Protein in fish is similar to that found in meat and poultry.

·The fat content of fish is variable and is generally lower than meat and poultry. The cholesterol content of fish is marginally lower than that in meat and poultry.

·Some fish (such as salmon, trout and herring) are high in a type of polyunsaturated fatty acids (PUFA) called omega-3 fatty acids. These fatty acids have been shown to provide specific health benefits, notably in relation to cardiovascular health.

·The amount of iron and zinc in fish is lower than those in meat, but they are more easily available to the body. In contrast, the vitamin B12 level of fish is similar to that of meat or even higher, depending on the species. Fish are also a valuable source of iodine.

·Small fish consumed with edible bones such as ikan bilis are good sources of calcium, especially for individuals who do not consume milk.

·Shellfish such as clams, crabs, lobsters, mussels, oysters, scallops and shrimp are all generally low in fat and provide essential nutrients. Cholesterol content is variable, with prawns and squid having relatively higher levels compared to the others. In prawns, removing the head removes most of the cholesterol in it.

Meat and poultry

The recommendation is to consume meat and poultry in moderate amounts. The main nutritional value of meat and poultry include the following:

·Meat and poultry are a valuable source of dietary protein.

·They are also valuable sources of iron that is easily absorbed and utilised by the body. They also provide substantial amounts of zinc and vitamin B12.

·To reduce saturated fat intake, it is advisable to select only lean meat and, for chicken, with the skin removed.

·Offal or organ meats such as liver and kidneys, heart, gizzard and visceral organs are not encouraged to be consumed regularly as they are somewhat high in cholesterol.

Eggs

Eggs have high nutritional value and hence are recommended for consumption by all healthy persons. They can be eaten in various forms, up to one egg every day. Eggs can become an important source of protein for children. They are also relatively less expensive compared to other animal-derived foods.

The important nutrients in eggs include the following:

·Protein in eggs is of excellent quality, and the amount present is just slightly lower than in meat.

·They are good sources of vitamin B12 and provide substantial amounts of iron and zinc.

·Egg yolk contains substantial amounts of cholesterol but unlike dairy products and meat, does not provide saturated fatty acids. Thus, for adults with high blood cholesterol, consumption of egg yolks should be limited, eg to three eggs per week.

Legumes

A variety of legumes and their products should be consumed daily by everyone in the family, including people who eat meat, poultry and fish regularly. These plant foods are generally recognised as alternatives to animal foods and have important nutritional factors.

·The protein content of legumes is generally similar to that of meat and poultry. However, they usually lack one or two amino acids (building blocks of proteins). Mixing two or more plant proteins are encouraged, such as legumes and grains or legumes and nuts or seeds so as to produce a complete protein from two incomplete ones.

·Legumes can also be considered as starchy foods that can serve as excellent sources of dietary fibre.

·Legumes also provide other nutrients such as iron and zinc. However, the iron and zinc from plant sources are less bioavailable than from animal sources.

·Legumes are also very good sources of the B-complex group of vitamins, with the exception of vitamin B2.

·These plant foods do not contain saturated fat and cholesterol which are found in meat and poultry.

·Legumes (as well as nuts and certain seeds), also contain a wide variety of phytochemicals. These bioactive substances possess potential health benefits for various chronic diseases.

Soya bean and its products (eg tauhu, tempe, soya bean sprout, miso) are some of the most widely consumed legumes.

Nuts and seeds

Nuts and seeds can be included in the diet, several times a week. They provide a range of nutrients and are generally pleasantly flavoured. Many types of nuts are appropriate for consumption, eg almond, pecans, pistachios and walnuts. There are also different types of seeds such as sunflower, pumpkin, sesame, poppy or flax seeds.

The main nutritional value of nuts and seeds include the following:

·Nuts and seeds are a tasty source of protein and other nutrients. Nuts are also high in fibre and rich in a wide range of vitamins and minerals.

·Nuts are a good source of monounsaturated fat and also contain polyunsaturated essential fatty acids, which the body needs for a number of vital processes.

·However, nuts are also high in fat. Hence, they should not be consumed too much. Intake of salted nuts should also be reduced as they are high in sodium.

·Seeds contain protein, fibre and vitamins and minerals. They also add extra texture and flavour to various dishes and can be used to coat breads. They make a healthy snack and can be added to salads, casseroles and breakfast cereals.

The consumption of these plant-based alternatives to meat, fish and poultry is encouraged for everyone. They are particularly valuable in a vegetarian diet as an alternative source of protein and other important nutrients.

For vegetarians, these foods, together with cereal foods, can provide most (but not all) of the nutrients provided by meats, fish and poultry.

Excessive intake is to be avoided

The recommendation is to consume "moderate" amounts of these foods. This is because although they are high in many nutrients, some foods in this group, namely those from animal sources, are high in saturated fat, while others are high in cholesterol.

Foods that are high in saturated fat include fatty cuts of beef, pork and lamb; sausages, hotdogs and bacon; some processed meats such as regular bologna and salami; and some poultry such as duck. Some foods from this group such as egg yolk (egg white is cholesterol-free) and organ meats such as liver and kidney are high in cholesterol.

MDG 2010 has highlighted the nutritional value of these foods and the importance of consuming them. These are placed at the third level of the food pyramid, and are recommended to be consumed in moderate amounts.

There are six key recommendations within this key message.

1. Consume fish more frequently, if possible daily.

2. Consume meat, poultry and egg moderately.

3. Practise healthier cooking methods for fish, meat poultry and egg dishes.

4. Choose meat and poultry that are low in fat and cholesterol.

5. Consume legumes daily.

6. Include nuts and seeds in weekly diet.

Let the MDG 2010 guide you and your family members in adopting healthy eating habits and an active lifestyle. The complete MDG is obtainable from the Ministry of Health website: www.moh.gov.my/v/diet. The Nutrition Society of Malaysia has also made available leaflets of these MDG suitable for the public (www.nutriweb.org.my).

> Dr Tee E Siong pens his thoughts as a nutritionist with over 30 years of experience in the research and public health arena. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care.

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Feeding the eyes

Posted: 02 Jul 2011 06:33 PM PDT

The important role diet can play in preventing vision problems.

WE all know that carrots are good for sight. Our mums drummed that into us when we were growing up; we're probably still drumming this fact to our kids or grandkids.

What exactly is in carrots or spinach that is good for our eyesight? What other foods are good for the eyes?

In 2009, a study published in Opthamology found that proper diet, especially a low glycaemic index diet, can be very helpful in preventing age-related macular degeneration (AMD) and other sight-robbing diseases. The nutrients that have been found to be most protective are lutein, zeaxanthin, beta carotene, vitamins C and E, zinc, and the omega-3 fatty acids DHA and EPA.

Some of the foods that are known to foster good eyesight and eye health include:

Spinach, kale and green leafy vegetables – These foods are rich in carotenoids, especially lutein and zeaxanthin. Lutein, a yellow pigment, protects the macula from the damaging effects of the sun's ultraviolet rays. Lutein and zeaxanthin are the only two primary plant pigments contained within the macula and retina of the eye.

Eggs – Eggs are rich in sulphur, cysteine, lecithin, amino acids and lutein. Sulphur-containing compounds protect the lens of the eye from cataract formation. Sulphur is also necessary for the production of glutathione, an important antioxidant for the lens of the eye and the whole body.

Cold water fish (sardines, cod, mackerel, tuna) – These are excellent sources of DHA, a compound which provides structural support to cell membranes and is recommended for dry eyes. DHA is also used as a treatment for macular degeneration and for sight preservation.

Carrots – Carrots are rich in beta carotene. Beta carotene is a provitamin A carotenoid that is converted to retinol (vitamin A) by the body after the food is ingested. Vitamin A is an antioxidant that protects the eyes from free radicals and also helps the surface of the eye, mucous membranes and skin be effective barriers to bacteria and viruses, reducing the risk of eye infections, respiratory problems and other infectious diseases.

Blueberries, blackberries, bilberries – These are high in flavonoids and contain anthocyanins, which help improve night vision.

Nuts – They are excellent sources of vitamin E and minerals such as zinc that help keep your eyes healthy and may decrease your risk of cataracts and age-related macular degeneration.

Presbyopia and cataract

The lens is also subject to the ageing process, and the resulting conditions – cataracts and presbyopia – will eventually affect just about everyone. When we are born, our lenses are crystal clear, meaning that the image entering the eye is not degraded by any opacity. They are also very pliable, meaning that the lens can change its shape to help focus images that are very far away as well as very close.

Unfortunately, as we grow older, two things happen to the lens: it clouds up and it becomes less pliable. The clouding of the lens – or cataract – forces an image to travel through a distorted medium, resulting in diminished vision.

Cataracts are the leading cause of impaired vision and blindness worldwide, affecting up to 40% of people over 75.

They are most often caused by overexposure to intense light (sunlight) but other factors can contribute to them: cigarette smoking, hereditary factors, injury, diabetes, and some medications.

Cataracts usually develop slowly, starting with blurred vision, spots, and the impression that a film is covering the eyes.

Similarly, when the lens loses its pliability, it also loses its ability to focus over a wide range of distances. A hardened lens becomes more fixed on distant objects and cannot focus as well on nearby objects or vice versa. This hardening often occurs in middle age, when people notice the need to hold the newspaper farther away in order to read the print – presbyopia.

Age-related macular degeneration (AMD)

Age-related macular degeneration (AMD) is a disease affecting the elderly that gradually destroys the macula, resulting in loss of sharp, central vision. The retina is the light-sensitive tissue at the back of the eye. The centre of this retina is called the macula. It is the macula that is responsible for the sharp central vision needed for activities like reading, writing, driving and even recognising faces. It enables us to see fine detail and differentiate colour.

Macular degeneration causes no pain. Macular degeneration affects one-third of adults over the age of 75, and is the principal cause of visual disability in people over 65 years of age.

Age is by far the greatest risk factor.

Lutein and zeaxanthin declines with age

Like many other important nutrients, lutein and zeaxanthin are not manufactured in the body. The only way to consume it is by eating food rich in these antioxidants or by supplementing with lutein and zeaxanthin.

Unfortunately, as we age, the concentration of lutein and zeaxanthin in the eyes decline. Increasing one's dietary intake of lutein and zeaxanthin increases the density in the macula.

Lutein and zeaxanthin belong to the xanthophyll family of carotenoids and are the two major components of the macular pigment of the retina. The macula lutea or "yellow spot" in the retina is responsible for central vision and visual acuity.

Of the more than 600 plant pigments called carotenoids found in nature, lutein and zeaxanthin are the only carotenoids found in the macula, retina and lens of the human eye, and have dual functions in these tissues – to act as powerful antioxidants and to filter high-energy blue light.

Lutein and zeaxanthin offer protection against the two most common causes of vision loss: cataracts and age-related macular degeneration (AMD). In addition to its role in preventing cataracts, lutein and zeaxanthin may improve vision in people who already have cataracts.

Lutein is found in high amounts in human serum. In the diet, it is found in highest concentrations in dark green, leafy vegetables (spinach, kale, collard greens, and others), corn, and egg yolks. Zeaxanthin is the major carotenoid found in corn, orange peppers, oranges, and tangerines.

Zeaxanthin is the dominant component in the centre of the macula, while lutein dominates at the outer edges. The eye is selective and preferentially places dietary zeaxanthin in the very centre of the macula, the most critical area for central vision with the greatest need for protection.

Concentrated in the lenses and retina, these two carotenoids fulfil two essential functions:

·Protect the eyes from damaging UV light by acting as a filter to shield against harmful blue light.

·Act as antioxidants to protect the lenses, retina and macula against free radical damage due to exposure to sunrays, computer screens and other harmful form of lights.

Both lutein and zeaxanthin absorb the very high-energy and most damaging portions of the light spectrum (ultraviolet blue). The absorption of the high-energy light spectrum is critical for the protection of the lens, retina and macula portions of the eye. High-energy blue light also generates "free radicals" that cause damage to the tissues of the eye.

> This article is courtesy of Live-well Nutraceuticals, for more information, please consult your pharmacist or call Live-wellINFOline: 03-6140 7605 or e-mail info@live-well.com.my.

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Regulating traditional medicine

Posted: 02 Jul 2011 06:31 PM PDT

In view of the lack of enforcement in alternative treatments, the Traditional & Complementary Medicine Bill is a much anticipated one.

TRADITIONAL and complementary therapies have mushroomed in recent decades and the Health Ministry's Traditional and Complementary Medicine Division estimates that there are 15,000 traditional and complementary medicine (TCM) practitioners in the country.

Despite the numbers, there is no specific law governing these fields.

Last year, the Division received more than 30 complaints relating to unethical practises, overcharging, and cheating, but the numbers are likely to be more because people are too embarrassed to complain, says the Division's director Dr Ramli Abd Ghani.

"Practitioners may claim that this or that herb can cure cancer, for instance, with no scientific proof," he notes.

Dr Ramli says for cancer patients, it is better to get modern medical treatment because there is no alternative or traditional treatment that has been scientifically proven to cure cancer, for now. "They should go to a hospital and get themselves examined first, and if they want to go for traditional treatment, they can add that as an adjunct treatment, which must be monitored by qualified medical personnel," he says.

Currently, the Health Ministry accepts TCM as adjunct treatment, not alternative treatment.

A total of 85 types of herbs imported from China are used in the Health Ministry's Hospital Putrajaya, Hospital Sultan Ismail in Johor Baru and Hospital Kepala Batas in Penang in their TCM divisions. These herbs are not for cancer treatment. Instead, they are used to overcome chemotherapy side effects.

"When patients do not suffer from side effects, they are more likely to complete their chemotherapy. "That's the best we can get out of herbs for now," he says.

Private hospitals providing similar integrated services are the Lam Wah Ee in Penang, Tungshin in Kuala Lumpur and Hospital Putra in Malacca.

Government hospitals incorporating traditional treatments such as massage, acupuncture and Malay post-natal care include Hospital Sandakan, Hospital Sarawak and Hospital Sultanah Nur Zahirah in Trengganu.

Challenges in TCM

Many people who use TCM tend to think that the approach uses natural ingredients, and hence, there is no toxicity. Contrary to the perception, naturally occurring heavy metals as well as bacteria are found in herbs.

"Before they take it, they have to check if their liver and kidneys are all right, because if these are damaged, the use of these herbs will worsen the condition," says Dr Ramli.

The concern is that there are more than 600 medical halls and they are not run by people who can monitor these conditions, he says.

On top of that, there are also concerns about steroids and adulterated drugs or chemicals added into the herbs, he says.

Former Malaysian Medical Association president Dr David Quek says that people should be cautious when using TCM.

"They tend to go for it because it sounds more promising. For example, on the verge of losing one's leg, they tend to opt not to lose their legs if they can and will try other treatments instead of amputation because it's catastrophic and frightening," he says.

On patients who claim that they recover from diseases due to such treatments, Dr Quek says it can be due to the placebo effect, or even the fact that in a small number of cases, they recover no matter what they do or not do. Even in modern medicine, in rare cases, someone with a terrible heart condition, for instance, can live for years despite a poor prognosis, he observes.

While he says he will not object if patients want to try out some supplements, they should consult their doctors first to prevent any drug interaction.

Consultant breast surgeon and associate professor at Universiti Malaya Dr Nur Aishah Mohd Taib says some TCM researchers claim that certain products are anti-cancer based on tests in laboratories, but no clinical trials are carried out to prove the efficacy of the herbal products on humans.

"This is unacceptable," she says.

Dr Nur Aishah urges the authorities to monitor all claims on cancer cures without proper clinical trials done on humans because it may not be effective and can be unsafe.

While the scientific community does not accept TCM as evidence-based or standard treatment, the TCM industry does not necessarily believe that TCM is only for complementing modern treatment as per the Government's stance.

Federation of Complementary & Natural Medical Associations honorary secretary Tunku Badli Tunku Ibrahim says they usually ask the patient if he or she has seen the doctor and what the doctor's advice is. "We take the case history and give our views, but the choice is the client's and they can discuss with their family members," he says.

He says traditional and Chinese medicine (T&CM) are recognised in many Western countries, and they are decades ahead of Malaysia when it comes to established qualifications. The level of practice in Malaysia needs a boost in terms of professionalism and stringent monitoring.

He says the problem is, there are many who attend courses (for a few days) and claim themselves to be practitioners while others may deceive customers with fake credentials.

Professionalism in practice

Dr Ramli says the Ministry hopes that the Traditional and Complementary Bill will be tabled very soon, since it did not get to be tabled in March, so that they can take disciplinary action against those who flout the law.

"Currently, our hands are tied because there is no specific law governing the activities or to compel practitioners to adhere to guidelines," he says.

When the Act is in place, the Traditional & Complementary Medicine Council will be set up to look into the rules and regulations and matters pertaining to certification, he says.

Dr Ramli says that many TCM practitioners also misuse the title "Dr", especially in homeopathy therapies, and this will not be allowed unless approved by the council.

Dr Ramli says the division is promoting voluntary registration of TCM practitioners in the country and 3,000 practitioners have registered themselves online.

"We urge all practitioners to register now because once the bill is passed in Parliament, we will vet through the registration and issue a certificate on a first-come-first-serve basis," he says.

The Act will also ensure that those who wish to pursue TCM must have diplomas or degrees before they are allowed to practise.

Dr Ramli says they are collaborating with universities and the Malaysian Qualifications Agency (MQA) on proper places for the studies and also collaborating with the Human Resources Ministry's Skills Development Department on getting spa therapists qualified.

As for bomoh practices, they will be guided based on Islamic principles and be given diplomas, he says.

Under the proposed law, practitioners have to adhere to a code of ethics, put patient safety first, refer them to the doctor if it is not their area of expertise, and ensure patient confidentiality, Dr Ramli explains.

The Division has categorised traditional medicine into Malay, Chinese, Indian and homeopathy, while complementary medicine has been divided into four groups – mind and body (music therapy), biological, energy medicine and manipulative therapy.

A therapy is considered a wellness programme if it is not evidence-based treatment, such as a spa programme, but if it is evidence-based, such as acupuncture or certain herbs that help with certain health problems, they are considered therapeutic, says Dr Ramli.

The Government is also collaborating with the government of China and India on traditional treatments, he says.

Every year, 10 to 20 Malaysian students study in three recognised TCM universities in China – Beijing, Shanghai and Nanjing, he says, adding that in China, a traditional medicine pharmacy degree course requires four years of study.

Malaysia has also signed a memorandum of understanding with India and the latter has offered short-term courses to Malaysians, he says.

Dr Ramli says the Ministry hopes that with the introduction of proper studies, more will move towards evidence-based research. "We want to promote clinical trials," he says.

Since there is currently no law on TCM practices, patients going for these treatments do so at their own risk. For this reason, if they still want to use TCM, they should be properly monitored by qualified professionals or in hospital settings approved by the Health Ministry.

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Ahad, 3 Julai 2011

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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