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Posted: 23 Jul 2011 10:01 PM PDT

Preventing and reversing diabetes is vital as the number of people with diabetes is increasing at an alarming rate.

ABOUT five years ago, I wrote about the holistic approach to fighting diabetes (see Fighting diabetes the holistic way at www.superqigong.com/articlesmore.asp?id=112).

Since then, the latest statistics show that the situation has worsened. The National Health & Morbidity Survey 2006 showed that adult Malaysians (30 years and above) were in bad shape: about 44% were overweight (including about 15% who were obese or grossly overweight); 43% were hypertensive; and 15% were diabetic.

Now, five years later, probably 60% are overweight and obese, 60% hypertensive, and 20% are diabetic. If we are not careful, the prevalence of diabetes will reach 25% or more by 2016.

For diabetes, the trend has been as follows (as indicated by the various National Health & Morbidity Surveys): 1986 – 6%; 1996 – 8%; and 2006 – 15%.

In Malaysia, the average age at diagnosis is 45 years, and decreasing. The trend worldwide is that diagnosis for diabetes (heart disease and cancers too) is occurring at a progressively earlier age due to increasingly unhealthy diets, obesity, and lack of physical activity, even in children, in affluent societies.

I am writing again on diabetes because I am worried that so many more new patients are being diagnosed with the disease. This week, I received a desperate plea from a friend who was trying to save a family member from having to undergo leg amputation due to diabetic gangrene.

If you were to visit hospitals, you will find many who are waiting to have their toes, feet or legs amputated. And the number of patients needing kidney dialysis (most kidney failures here are due to diabetes) is rising so fast that the there are not enough dialysis centres to cope with the demand.

This is a sickening situation. The economic and social burden to society and the nation is enormous. Something is terribly wrong in the way we approach the problem. I am not seeing many "sick" patients now, as I have re-engineered my practice to anti-ageing medicine (making "healthy" people younger and healthier), but many who come to me thinking that they are healthy were shocked to find out that they were not.

The three most common "expected" problems are overweight/obesity, dyslipidemia (abnormal levels of cholesterol and triglycerides) and general lack of physical fitness (due to lack of exercise). The three most common "surprise" diagnoses are andropause ("male menopause" due testosterone deficiency in men, often in those even below 50), somatopause (growth hormone deficiency in men and women), and type 2 diabetes (due to insulin resistance).

Many also have problems with several other hormones that affect their overall health.

To prevent and reverse diabetes, please refer to the several articles I have written on the importance of the nutrient-dense low-calorie anti-diabetic diet; maintaining a normal weight; and exercise.

In these articles I have also explained about the glycaemic index (GI) – which indicates how fast the blood glucose level will rise; and glycaemic load (GL) – which adds the amount consumed as a factor; and their importance in diabetic management.

Just 30 minutes a day (five times a week) of moderate exercise, improved diet and a 5% to 10% reduction in body weight can reduce the risk by 58% (source – Persatuan Diabetes Malaysia).

While it is easy to know whether you are exercising enough or not, and to know if you are overweight or not, I suspect many have trouble improving their diet because they do not understand that sweet stuff are not the only foods that promote or worsen diabetes.

Many patients report that they are already avoiding sugar and sweet foods, and are puzzled why their blood glucose levels remain high. What they do not realise is that all carbohydrates (sweet or otherwise) will be digested and broken down to the monosaccharides (ie single "sugar" molecules, eg glucose, galactose and fructose) before they can be absorbed. The monosaccharides and the disaccharides (ie made of two "sugar" molecules, eg maltose, sucrose and lactose, which are easily digested to monosaccharides) are classified as "simple" sugars.

Glucose, fructose ("fruit sugar") and galactose all occur naturally in varying amounts in fruits, veggies and other plants. Sucrose is table sugar (glucose and fructose) and is commonly sourced from sugarcane and beet, lactose is milk sugar (glucose and galactose), and maltose is malt sugar (glucose and glucose).

Many get trapped in the belief that their diet is okay when in fact they are eating high glycaemic loads, although the food is not sweet. Remember, one bowl of rice is equivalent to 20 teaspoons of sugar, and it is not sweet at all.

Many who are conscious of diabetes will reduce the sugar in their "teh tarik" but have no qualms about having a second helping of rice. The net result is reducing a teaspoon of sugar while consuming 30 to 40 teaspoons of sugar-equivalent carbohydrate.

Although eating complex carbohydrates (large chains of sugar units arranged to form starches and fibre, eg vegetables, fruits, rice, pasta, potatoes, grains, legumes and beans) is better than eating simple sugars, the processed and refined forms we consume (eg polished white rice) are mostly devoid of much of the original nutrients, leaving only "empty" calories with little nutrient content left.

I believe this is the main reason why our people are becoming overweight/obese – they don't realise that they are eating too much calories, too much carbohydrates, and often too much unhealthy fats as well.

With the lack of exercise and a generally unhealthy lifestyle, it is no wonder that the chronic diseases are becoming pandemic. And diabetes will be a major crisis soon.

If you have a sweet tooth and want to avoid obesity and diabetes, you should know about the sweetness of the sugars.

In terms of sweetness, fructose is the sweetest, sucrose second, glucose third and maltose fourth, among the commonly consumed sugars.

For this reason, using fructose as a sweetener will mean less calories consumed since less is required as the energy (calorie) content of the sugars are the same (4 kcal per gm). However, those who want to lose weight should consider zero-calorie natural sweeteners like stevia.

I am not in favour of the artificial sweeteners as there are some controversies over their long-term safety. I hope this additional information will make it easier for you to cut down on your sugar and carbohydrate consumption, and reduce your chances of getting diabetes. If you are already a diabetic, hopefully this will help you have better control, or reduce your medication.

> Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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Be a PAL for life

Posted: 23 Jul 2011 04:53 PM PDT

Malaysian Aids Foundation unveils the PAL scheme to attract corporate funders and to generate public contributions.

THE Malaysian AIDS Foundation (MAF) unveiled its PAL Scheme recently, a medical assistance scheme aimed at providing access to second-line highly active anti-retroviral (HAART) medications for underprivileged Malaysians living with HIV.

The PAL Scheme launch ceremony, held at the Tesco Academy Kuala Lumpur in Bandar Manjalara, Kepong, was officiated by Professor Dr Adeeba Kamarulzaman, chairman of MAF, and Faizal Tahir, a Red Ribbon celebrity supporter and ambassador-spokesperson for the PAL Scheme, and witnessed by corporate associates from Maybank Berhad, Tesco Stores (M) Sdn Bhd, Abbott Laboratories (M) Sdn Bhd, officials from government ministries and agencies.

PAL, which stands for Positive Audacious Living, was conceived as a rebranding tool of the existing Medicine Assistance Scheme introduced by MAF in 1998.

Accessibility to HAART has helped Malaysians living with HIV prolong and improve their quality of life. To date, more than 50 underprivileged Malaysians have received aid from the existing Medicine Assistance Scheme, whose source of core funding has been solely from MAF.

According to a 2010 report by the Health Ministry, only 9,962 out of the estimated 26,722 or 37.3% Malaysians living with HIV who were eligible for HAART have sought treatment. In addition to stigma and discrimination towards Malaysians living with HIV being a potential barrier to greater access to treatment, the high cost of HAART has been acknowledged to also be a contributing factor.

"Through our long-term commitment and history of advocating for HIV and AIDS causes, we have pioneered initiatives aimed at improving the livelihoods of Malaysians living with HIV, particularly those who come from underprivileged backgrounds and members of marginalised communities.

"Due to the high costs in supporting second-line HAART, we believe that the only way forward for the PAL Scheme to achieve its goals is for its core funding to be self-sustained through strategic collaborations and partnerships with corporate organisations, with supplemental contributions from the general public.

"This move will, hopefully, enable more Malaysians living with HIV to benefit from this scheme and lead meaningful lives," said Prof Dr Adeeba in her speech.

Under the rebranded PAL Scheme, singer/songwriter and fervent Red Ribbon celebrity supporter, Faizal, will serve as the official ambassador spokesperson to create more synergy and publicity for the brand through his magnetic voice and charismatic presence in public service awareness campaigns through the mass media, social media platforms, corporate and public events, as well as via its dedicated website, www.saveyourpal.com.my.

Faizal is optimistic that it will generate greater interest in the HIV and AIDS cause among corporate organisations and the Malaysian public, which will aid in ensuring sustainability of its funding core.

In line with its corporate social responsibilities to support the HIV and AIDS cause, Abbott Laboratories has provided the initial financial assistance to facilitate the rebranding process of the PAL Scheme.

"There is a saying that if you are planning for a lifetime, educate people. Abbott is proud to be partnering with MAF to champion, in our mutual effort, educating people about HIV and the PAL Scheme.

"In Abbott, people are the centre of our universe, hence this is our chance to encourage people living with HIV to tell their stories through this campaign, and at the same time, appeal to the public to extend their hands and hearts for this noble cause," explained Muru Annmalai, general manager of Abbott Laboratories.

MAF will continue to intensify its fundraising activities to improve access to treatment, care and support services for underprivileged Malaysians living with HIV.

It is hoped that the rebranded PAL Scheme will revitalise the interest of the corporate sector to invest in the social responsibility of creating an enabling environment, free of the negative impact of HIV and AIDS for Malaysians living with HIV.

For more information, log on to the official PAL Scheme website, www.saveyourpal.com.my.

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Recalcitrant men

Posted: 23 Jul 2011 04:53 PM PDT

Is going for a health check-up that difficult for men?

HAVE you gone to see your doctor?" the wife asks. "Why should I? I know how to take care of myself," the husband replies.

This is a commonly heard household conversation. Men are notorious for delaying health checkups and presenting late to doctors when contracting illnesses. Many men put their health at risk by ignoring health check-ups. The reasons for not giving priority to health check-ups are many.

However, most of the reasons boil down to the need to maintain the image of masculinity. Traditionally, men are expected to be stoic, tough, able to withstand stress, able to take care of themselves and earn for the family. They are taught not to cry easily; minor cuts and scars are to be seen as badges of masculinity. Therefore, medical check-ups are certainly not on their agenda.

A check-up is traditionally viewed as something for kids and pregnant mothers. Hence, health check-ups are viewed by men as something feminine. Once a boy has grown up to become a teenager, clinic visits are important only when he is sick enough to call for help, and not even if there is only a minor ailment.

However, this trend is slowly changing after years of campaigns on the importance of health check-ups and healthy lifestyles by various authorities and non-governmental organisations. Now, more men are interested in going for health check-ups.

However, we now face another problem with health check-ups – "overdoing" health check-ups by having many inappropriate screening tests carried out.

Common misunderstandings about health check-ups

Below are some of the more common myths about men's health check-ups.

·Health check-ups are feminine. Contrary to this belief, a health check-up is actually one of the ways to reaffirm a man's masculinity. The traditional role of a man in society is to protect and provide for his family. To be able to carry out these responsibilities, men have to be healthy. Hence, health check-ups should be seen as something expected of men to help them fufill their responsibilities.

·Health check-ups for men are not only about screening for erectile dysfunction or prostate problems, or even subscribing to a few blood testing packages.

The leading cause of death for men is heart disease. Hence, it is also about checking your risks for heart disease, which include smoking, weight problems, diabetes, high blood pressure and high cholesterol. Other important causes of death in men are strokes, injuries (including both accidental and intentional injuries) and cancers (mainly colorectal cancer and lung cancer).

On the issue of male-specific conditions such as sexual health and prostate problems, although they don't kill directly, it has been shown that erectile dysfunction is closely linked to heart disease and many other risk factors to heart disease.

Premature ejaculation adversely affects men's quality of life, as well as spousal relationship. Lower urinary tract symptoms (which are commonly associated with prostate disorders) also affect men's quality of life.

Therefore, going for health check-ups is about checking your possibility of having all the conditions listed above.

·A health check-up is not about having a standard screening package. Health check-ups might differ for different individuals, depending on inherited risk factors and social circumstances.

For example, men whose parents died of heart disease early in life have substantial risk of heart disease and therefore need earlier assessment of their cholesterol level; men who smoke and have diabetes may need cholesterol treatment at a lower threshold than men who don't; men who have erectile dysfunction may have undiagnosed hypertension which needs intervention, and so on and so forth.

Hence, it is important for you to visit your doctor for a comprehensive health check-up and determine what tests are needed.

·A health check-up is not a one-off situation. It is not a "Touch 'n Go" process. It has to be done systematically at regular intervals.

Besides presenting for the initial health check-up, a follow-up with your doctors will be important as our chances for contracting an illness changes as we age. For example, the risk of hypertension and diabetes increase with age.

Also, the chances of prostate problems and cancer also increase with age. Having a normal a health check-up result does not mean we may not contract any illness in the future.

·Screening tests are not diagnostic. This misunderstanding might be a little difficult to explain, but I'll try. A screening test is performed to identify people who might have a particular disease. It merely identifies those who have high risk (or chances) of contracting a disease.

To be more specific, a good screening test should be able to differentiate whether we are at higher risk or lower risk of a disease from our own baseline risk. If our baseline risk of a disease is negligible, a screening test result would not be informative; and worse still, it may cause unnecessary anxiety.

Therefore, it is meaningless to have a screening test done before even knowing our own baseline risk.

For example, if a man has a history of unprotected sex with prostitutes, he already has a higher risk of HIV infection. A positive HIV screening test will put him at a very high chance of having true HIV infection. (Yet this is still not confirmatory.)

On the other hand, for a man who has no risk behaviour at all in contracting HIV infection, a positive HIV screening test (which should not be carried out in the first place!) would likely be a false alarm.

Therefore, to accurately interpret your screening test results or even decide which tests to undertake, you should not only see your doctor or qualified healthcare provider, but also have a good understanding of the reasons for undertaking those tests.

The word "good" has been highlighted because many so-called screening tests offered are not good screening tests for healthy men, such as urine examination and serum CEA (a cancer marker); and some are not even screening tests at all, such as annual blood group check.

Lastly, almost all positive results from screening will need to be followed up by another diagnostic test.You should be aware of the possibility of having a diagnostic test even before undertaking a screening test.

Therefore, for screening tests, it is not the more the better.

Health check-ups should be of benefit to us by identifying our health risks or undiagnosed diseases that need attention, like acknowledging our risk for diabetes, heart disease or even erectile dysfunction.

You may not know what to look for but your doctor should be able to help you. It commonly involves asking a few questions about your health status, family members with illness, health behaviours and symptoms of common illnesses such as diabetes and sexual health problems.

This is often followed by a few physical tests like measuring blood pressure, weight and height.

Some screening tests may be offered after the initial assessment, depending on your baseline risk. You will need to keep in mind that there may be other assessments required depending on your status.

After receiving your screening test results, do not forget to discuss what the results mean. They are not as simple as high or low readings.

As mentioned above, it might be a false positive or even a false negative reading.

Having interpreted the results, and hopefully some plan of action to be taken, you are still not done yet. You need to arrange for your next health check-up.

So, is a health check-up that difficult? Only you can answer this question.

> This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information 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. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

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Kredit: www.thestar.com.my

Ahad, 24 Julai 2011

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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