The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 24 Sep 2011 08:30 PM PDT Next week, Fit4life introduces a new column on eye health called You & Eye. Here, we introduce the writers to you. HE is an eye specialist with a bright red personality (decisive, goal-oriented, achievement-driven). She is a consultant dietitian with a green personality (compassionate, intuitive, orderly). Both returned to Malaysia from the UK two years ago, having studied and worked there, with two young children in tow. They're now thriving in their respective fields, and rediscovering their love for all things Malaysian. The husband and wife team of Dr Fong Choong Sian and Goo Chui Hoong are now embarking on a new career path – writing and publishing a recipe book, with a difference. "I've noticed since my return that food is an integral part of the lives of Asians," observes Dr Fong. "In my practice, I've often been asked questions like, 'I've got this eye condition, so should there be foods that I should abstain from?' or 'What foods should I take to improve my cataracts?'. "So one day, I returned from work and asked my wife whether food can help with various eye conditions ... what food should be taken, what food shouldn't be." Food for thought It was through such conversations that =husband and wife hit on the idea of a recipe book for healthy eyes. "There are certainly some foods that can be taken to help with certain eye conditions, especially macular degeneration. There's research that has indicated that high-dose antioxidants and zinc can reduce the risk of developing advanced age-related macular degeneration (AMD)," explains Dr Fong. AMD is an eye condition that affects a tiny part of the retina at the back of the eye called the macula. It causes problems with central vision, especially when you're looking directly at something, for example, when you're reading, looking at photos or watching television. AMD may make central vision distorted or blurry and, over a period of time, it may cause a blank patch in the centre of your vision. The research that Dr Fong referred to is the Age-Related Eye Disease Study (AREDS), sponsored by the US government's National Eye Institute. This major clinical trial closely followed about 3,600 participants with varying stages of AMD. The results showed that the AREDS formulation (a combination of antioxidants and minerals), while not a cure for AMD, may play a key role in helping people at high risk for developing advanced AMD keep their remaining vision. The specific daily amounts of antioxidants and zinc used by the study researchers were 500mg of vitamin C; 400 International Units of vitamin E; 15mg of beta-carotene (often labeled as equivalent to 25,000 International Units of vitamin A); 80mg of zinc as zinc oxide; and 2mg of copper as cupric oxide. Copper was added to the AREDS formulations containing zinc to prevent copper deficiency anaemia, a condition associated with high levels of zinc intake. "The column will also help us address some issues related to health in general. For example, supplements is big business, not only in Malaysia, but all over the world. "We can help dispel some of the myths associated with supplements through this column," says Dr Fong. Serendipity Dr Fong studied and worked in the UK, while Goo, after completing her dietetics degree in Univesiti Kebangsaan Malaysia, proceeded to do her Masters in the UK and subsequently worked there. The story of how Dr Fong and Goo met might as well have come from the fertile mind of a Hollywood script writer, only in this instance, it's all true. "We first met through The Star's Quiz Quest contest in 1991," recalls Goo. "We were in different teams. I was with Convent, Seremban, while Choong Sian was with Bukit Bintang Boy's School. Our respective teams advanced to the semis, where my team beat his, and we advanced to the finals." "Yes, I was actually captain of my team," says Dr Fong. "And it just so happened that my future wife and I were sitting alongside each other!" They have now been married for 11 years, and have two girls, aged six and three years. The happy couple is expecting a third child next year. The couple came back primarily because of their families. "We've adjusted to the pace of life in Malaysia, and are enjoying our time back home," they note. Dr Fong is now busy with his practice, while Goo also teaches cooking in her spare time. Occasionally, Goo tries out her cooking creations on her family. The verdict? "It's good," says Dr Fong, with a smile. |
| Posted: 24 Sep 2011 08:29 PM PDT Pain is an unpleasant experience, and one that all of us would want to avoid. THE 17th century French philosopher René Descartes (for the mathematicians among the readers, yes, this is the same Descartes who developed Cartesian geometry) first described a theory on how pain is felt based on a mechanical concept of how the body works. He hypothesised that there was a specific pain pathway, a single channel from the skin to a particular area of the brain, that carried messages from a peripheral pain receptor to a pain centre in the brain. To Descartes, all this would happen in a mechanical manner. Descartes thus had a similar concept as Aristotle, that is, pain is "bad" and to be avoided, and our bodies had these pathways that would help us avoid painful stimuli. Amazingly, despite no evidence to back it up, this theory was accepted until the early 20th century. The evidence backing Descartes' theory began to emerge from the 1890s, when the structure of nerve cells and fibres were discovered in the body. Neurotransmitters that transmitted the pain sensation along the nerve cells (neurons) were described in 1921, which re-enforced the idea of a pain pathway. However, there were real-life situations that the theory could not explain. For example, based on this model, once a nerve was cut, the pain should disappear. In real life, this did not happen; in fact, at times, more pain was felt once a nerve was damaged. An extreme example of this phenomenon is phantom pain, in which pain is felt from a part of the body that has been lost or from which the brain no longer receives signals, commonly happening to limb amputees. In addition, observations from soldiers seemed to suggest that they did not feel pain from their severe injuries while they were in the midst of fighting. Gate Control Theory of Pain From these and other observations, it would seem that emotions also play a part in pain perception. The Gate Control Theory of Pain was proposed by Melzack and Wall in 1965 to try to include the psychological component in the perception of pain. Their idea was that the perception of physical pain is not only a direct result of the activation of pain receptor neurons and the transmitter cells (opens the gate), but also that its perception is modulated by interaction between the transmitter and inhibitor cells (closes the gate) signalling from the brain. The intensity of the pain perceived would depend on the balance between the opened and closed "gates" or pathways, ie between the strength of transmission of the painful stimuli and its inhibition by a descending pathway from the brain. Definition of pain The International Association for the Study of Pain in 1994 merged the physical and psychological aspects of pain and defined it as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". There is no doubt that the ability to experience pain is essential for protection from injury, to detect the presence of injury, and to avoid similar situations in the future, all of which is beneficial for the survival of our species. However, if pain becomes prolonged, it may be less evolutionarily useful. For example, persistent pain from arthritis would not be regarded as "useful" pain. There are several ways to classify pain. The simplest would be based on time. Acute pain is short-term pain that lasts less than 12 weeks. Chronic pain is continuous, long-term pain of more than 12 weeks, or "pain that extends beyond the expected period of healing". This is somewhat arbitrary as arthritic pain would start off as acute pain and then become chronic over time, as there is no "healing" that can occur. Pain can be classified according to its location in the body, as in headache, low back pain and pelvic pain; or according to the body system involved, such as rheumatic pain (emanating from the joints and surrounding tissue), neuropathic pain (caused by damage or illness affecting the nerves), or vascular (pain from blood vessels). The characteristics of the pain can also give a clue as to where it may be coming from. For example, aching or pain around the joint area would suggest an arthritic problem, whereas "burning" or numbness would suggest nerve pain or "throbbing" for vascular pain. Characteristics of pain In the case of joint pain, a further important distinction is whether the pain is mechanical or inflammatory in character. Mechanical pain could suggest joint pain from "wear and tear" or the ageing process. Acute mechanical-type pain could suggest an injury. In contrast, inflammatory pain is less common and would suggest significant joint pathology. An example of an arthritis with mechanical pain would be osteoarthritis, where the cartilage has thinned with associated bone changes. Rheumatoid arthritis, an inflammatory arthritis, with its painful, warm and swollen joints, gives rise to pain with inflammatory characteristics. Gout is another example of an inflammatory arthritis leading to severe joint pain, swelling and redness due to excess uric acid in the body. Thus, the characteristics of pain felt in arthritis are qualitatively distinct due to the different underlying pathologies. Typical characteristics of mechanical and inflammatory pain include: Mechanical pain ● Morning stiffness of less than 30 minutes. ● Occurs primarily with activity and relieved by rest. ● Can be associated with swelling that is bony in nature. ● Reduction in the range of motion of the joint – if sudden, would suggest structural damage, eg torn ligament. Inflammatory pain ● Morning stiffness of greater than 30 minutes. ● Present at rest but worse with movement or in some cases, it can improve exercise. ● Often associated with joint swelling with warmth. ● Usually has an insidious onset of restricted joint movements. In essence, the perception of pain is a complex phenomenon, an integration of inputs from multiple pathways. The treatment of pain should therefore encompass a multimodal approach. Look out for the next article which will discuss the different types of arthritis and the correspondingly different treatments. References: 1. Benini A, DeLeo JA. Rene´ Descartes' Physiology of Pain. Spine 1999; 24(20): 2115–2119 2. Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971-79 3. Merskey H, Bogduk N. Classification of chronic pain. Seattle: International Association for the Study of Pain Press, 1994: 210. ■ This article is a collaborative effort by Dr Yeap Swan Sim together with MSD and is supported by the Arthritis Foundation of Malaysia. This article is for educational purposes only. The Year Against Acute Pain is the theme of 'Anticipate, Assess, Alleviate', an initiative that aims to improve acute pain management worldwide. |
| Posted: 24 Sep 2011 08:28 PM PDT Eating right during pregnancy is important for both mother and baby. GOOD nutrition for you and your baby starts long before you are pregnant, or before your baby is born. A balanced and healthy diet is especially important in the few months before your pregnancy, as well as throughout the entire pregnancy, to ensure that your baby gets all the nutrients he requires. This is because your baby's source of nutrition comes solely from you! The best time to begin eating healthily is before you actually get pregnant. This ensures that you have all the nutrients needed for a healthy pregnancy and baby. When you and your spouse finally decide to expand your family of two into three or more, it is a good idea to pay a visit to your health professional. Your doctor will ask you a few personal questions to learn more about your personal and family life, your work, your own lifestyle, as well as your diet. This will help your physician to determine and discuss with you on how to look after yourself before and during pregnancy. Fundamental nutrients Whether pregnant or otherwise, young or old, man or woman, all diets should consist of the following nutrients: proteins, carbohydrates, fats, vitamins and minerals. These are essential nutrients, and should be consumed based on the recommended nutrient intake (RNI) for each individual. For pregnant women, the RNI values are usually higher for many of the nutrients. Carbohydrates provide energy to the body. Sources include grains, cereals, potatoes, bread, rice, and legumes. Protein helps build red blood cells and antibodies, as well as repair and replace body tissue. Sources include eggs, milk, meat, bananas, dates, nuts, and beans. Calcium helps build strong bones and teeth. Sources include milk, cheese, yoghurt, green leafy vegetables, and sardines. Iron helps red blood cells deliver oxygen to your baby. Sources include liver, lean red meat, chicken, fish, egg yolk, and green leafy vegetables. Vitamin A promotes healthy skin and eyesight. Sources include carrots, dark leafy greens, and sweet potatoes. Vitamin C promotes healthy gums, teeth, and bones, and helps in iron absorption. Sources include guava, citrus fruit, broccoli, tomatoes, and green leafy vegetables. Vitamin D helps build baby's bones and teeth. Sources include sunlight exposure, fatty fish (salmon), and fortified milk. Vitamin B6 helps form red blood cells, and helps the body use protein, fat and carbohydrates. Sources include beef, liver, whole-grain cereals, and bananas. Vitamin B12 maintains the health of the nervous system and is needed for red blood cell formation. Sources include liver, meat, fish, poultry, and milk. Folate is required for blood and protein production and helps the functioning of some enzymes. Sources include green leafy vegetables, liver, orange juice, legumes and nuts. DHA (Omega-3 fatty acids) and AA (Omega-6 fatty acids) are involved in the formation of foetal plasma, grey matter and retinas. Sources include oily fish, walnuts, and eggs. Additional nutrients In general, pregnant women need more of all the nutrients listed above. However, iron and folic acid (folate) are two very important nutrients, and pregnant women require more of them. Some women take a prenatal vitamin supplement to get these extra nutrients. These supplements have all the recommended daily vitamins and minerals needed during pregnancy, including vitamins A, C, and D; folic acid; as well as minerals such as zinc and copper. Do discuss with your physician if you have been already taking vitamin supplements before taking a prenatal supplement. Excessive amounts of certain vitamins and minerals can be harmful to your baby. Keeping your weight in check Watching how much you eat is just as important as watching what you eat. Extra energy and nutrients are essential for healthy weight gain, and to further support the growth and development of your baby. However, opposed to the famous rumour, this does not mean you have to eat double of everything to gain those nutrients and energy! If you were of normal weight before pregnancy, then most women only need an average of 300 extra calories daily to support baby's growth and to keep healthy during pregnancy. During the first trimester, it will be slightly less than 300 calories, and during the third trimester, you will need slightly more than 300 calories. Excessive weight gain during pregnancy can lead to health problems or other complications for you and your baby. Obesity during pregnancy has been found to be an independent risk factor for neural tube defects, foetal mortality, and pre-term delivery. Thus, women who are already overweight or obese before pregnancy should pay close attention to how much they eat during pregnancy to avoid gaining unnecessary weight. Pregnant women should try to eat a well-balanced diet and adhere to the Malaysian Food Pyramid as a guide – balance, moderation and variety are the key points. Daily challenges Many women may find it a struggle to juggle between work, family, personal life, and looking after herself, to ensure that she stays healthy during this time. Hence, maintaining good nutrition can be quite a challenge. Not only are some women too busy, causing them to skip meals or not eat nutritious and healthy food, morning sickness and food cravings may also cause them to avoid a certain type of food, or to eat more of a particular one. In such cases, taking additional nutritional supplements may be an option. Milk has been said to be an almost complete meal, full of essential nutrients that benefit both mother and unborn child. There are many different types of milk for mothers-to-be available in the market today, which are fortified with additional amounts of essential nutrients to meet the demands of pregnancy. Most importantly, these milk are fortified with DHA, folic acid, iron, as well as calcium, all vital nutrients that are needed to help support the growth and development of the baby. Pregnant women who are sometimes too busy too take a full and complete meal may drink a glass of milk to ensure that she still obtains the essential nutrients, until she can eat a proper meal. But remember, never substitute healthy and balanced meals with just milk! A good diet, which is varied, balanced and in moderation, is very important for both mother and baby. However, the need for some nutrients, such as iron and folic acid, may not be achieved through diet alone. To ensure the proper growth and development of your baby, supplements that can meet these needs are therefore helpful. ■ Prof Dr Norimah A.Karim is a nutritionist. This article is courtesy of the Positive Parenting Programme by the Malaysian Paediatric Association (MPA) and supported by an educational grant from Abbott Nutrition International. For more information, please visit www.mypositiveparenting.org |
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