The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 22 Oct 2011 07:29 PM PDT When you eat excessively and then try to purge the food through various means, you're suffering from bulimia. BULIMIA nervosa is an eating disorder that is characterized by cycles of eating large amounts of food (binge eating) followed by the sufferer taking measures to get rid of it (purging) by stimulating vomiting, use of laxatives, or excessive exercising. The cause of eating disorders is unknown. However, it is believed to be due to a complex interaction between biological, family, psychological, and social factors. The causative factors include: ·Family history of parents or siblings with an eating disorder suggests a biological factor. ·Psychological factors like poor self-esteem, perfectionism, disturbed relationships and family conflicts may be contributing factors. ·Social factors like media focus on body shapes and peer pressure may be contributing factors in teenage girls. The factors that increase the risk of an eating disorder include: ·Teenage girls and young women. ·Teenage girls whose parents and siblings place an undue emphasis on physical appearance and body weight. ·People suffering from depression, anxiety disorders and obsessive-compulsive disorder. ·Stressful situations like discontinuation of relationship(s). ·Occupations like athletes, dancers, models, ballerinas, gymnasts. Bulimia nervosa and anorexia nervosa are similar in that there is an inaccurate perception of body weight, size or shape and/or marked over-concern about body weight, size or shape. However, there are differences. Bulimia nervosa is characterised by inappropriate weight reducing behaviour (vomiting, laxative or diuretic abuse, excessive exercise, fasting) at least twice a week and large uncontrolled binge eating at least twice a week. Anorexia nervosa is characterised by voluntary maintenance of unhealthy low weight (less than 85% of expected), cessation of menstrual periods for at least three cycles (amenorrhoea), and an intense fear of weight gain or becoming fat. Eating disorders usually affect young females, with a female to male ratio of 10-20 to one. The average prevalence of bulimia nervosa and anorexia nervosa in young females in developed countries is 1% and 0.3% respectively. Although there is no local data, it is believed the prevalence in Malaysia is not very far off these rates. Characteristics of bulimia The clinical features of bulimia nervosa include repeated episodes of binge eating and purging. During the binge eating, the sufferer experiences loss of control and eats beyond comfortable fullness. The binge eating is followed by purging of the food consumed, typically with self-induced vomiting, laxative abuse, medicines that increase passage of urine (diuretics) and use or abuse of medicines used for dieting. There are frequent attempts at dieting, which include over-exercising. It is common for sufferers to have abdominal fullness and constipation because of delayed gastric emptying, laxative abuse, and decreased intestinal motility. The vomiting may be associated with electrolyte disturbances from the loss of the body's sodium, potassium and chloride, swelling of the parotid salivary gland behind the cheek, erosion of the enamel of the teeth, sores in the mouth and throat, and callous swellings on the dorsum of the fingers consequent to the abutment of the teeth in self-induced vomiting. There may be bruises on the chest or abdomen that are shaped like the contours of the toilet bowl. Laxative abuse can lead to electrolyte disturbances and changes in the body's chemistry. Electrolyte and/or pH disturbances lead to low blood pressure, heart rate abnormalities, electrocardiogram (ECG) changes, muscle weakness, fits and kidney failure. Serious and even fatal consequences may result. Like anorexia nervosa, there is an association of bulimia nervosa with other mental health conditions like depression, anxiety disorders, obsessive compulsive disorders, personality disorders, and addictive disorders. The presence of these mental health disorders in a young woman would raise suspicions of an eating disorder. Bulimia nervosa sufferers are more likely to have problems controlling their impulses, leading to self-harm, sexual promiscuity, and shoplifting. Managing the condition There are three main components in the management of bulimia nervosa, just like in anorexia nervosa, ie assessment, correction of physical abnormalities, and restoration of weight; development of regular meals and normal eating patterns, and cessation of purging; and psychological therapy and prevention of relapse. Prior to commencement of treatment, an assessment of the patient's medical and social needs, risks and severity of the condition will have to be made. An assessment of the patient's physical, psychosocial and familial functioning is the basis of good treatment. Most patients with bulimia nervosa will consult a doctor willingly. This makes engagement and the development of rapport easier. This is unlike the person with anorexia nervosa, who is often a defiant adolescent and denies that there is anything wrong with them. Significant abnormalities have to be corrected first. As the weight is not usually critically low in bulimia nervosa, unlike anorexia nervosa, emphasis is placed on regular meals and the elimination of bingeing and purging. The onset of self-induced vomiting often heralds an increase in the frequency and amount of binge eating. Depending on the severity of the condition, treatment can be done as an outpatient (this is most common), or in a day unit, or as in inpatient in hospital. The psychological treatment involves cognitive analytic therapy (CAT), cognitive behavioural therapy (CBT), interpersonal therapy (IPT), focal psychodynamic therapy (FPT), and family therapy (FT). CAT is based on the theory that bulimia is due to unhealthy patterns of behaviour and thinking, which the patient has developed in the past, usually in childhood. It involves reformulation, ie looking for past events that may explain why the unhealthy patterns developed, recognition of how these patterns are contributing towards the bulimia, and revision, ie identifying the changes to break these unhealthy patterns. CBT is based on the theory that thoughts about a situation affect a person's actions. Similarly, actions impact on how one thinks and feels. Hence, it is necessary to change the act of thinking and behaviour concomitantly. IPT is based on the theory that relationships with other people have a significant effect on a person's mental health. FPT is based on the theory that bulimia nervosa may be associated with unresolved past conflicts, usually in childhood, which are being re-enacted in adult life. FT involves the patient and close family members discussing how bulimia nervosa has affected them, and the positive changes the patient and family can make. CBT and IPT have been found to be effective in the management of bulimia nervosa. The type of treatment chosen may be based on personal preference and the availability of the services. Medication is usually prescribed for associated depression. The antidepressants, fluoxetine, desimipramine and imipramine, have been found effective. In addition to professional management, bulimia nervosa sufferers can develop coping skills like boosting self-esteem by learning new skills, developing a hobby, or involvement in social group activities; being realistic and not succumbing to hype frm the media or friends; refraining from dieting or omitting meals; and emulating healthy role models. Bulimia nervosa sufferers can recover, but it may take a long time. They have to change the way they think about food, change their eating habits, and if necessary, gain weight safely. The longer a person has had bulimia nervosa, the more difficult it is to recover. The recovery process in most sufferers goes through many stages in which progress involve forward and backward steps. n Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with. For further information, e-mail starhealth@thestar.com.my. Full content generated by Get Full RSS. |
| Posted: 22 Oct 2011 07:29 PM PDT The amount of total fat and types of fatty acids in the body have important health effects. I HAVE heard people say that we should not eat too much fatty foods. However, much to my dismay, I do not see this knowledge being put into practice. I do believe that we need to further reinforce the message to the public to be more careful of their fat intake. We need to emphasise that excessive fat intake causes excessive weight gain and obesity. The public needs to take action to prevent getting obese, so as to reduce the risk of heart disease, diabetes, and cancer. Today, I will highlight recommendations of the Malaysian Dietary Guidelines (MDG) 2010 in relation to reducing excessive fat intake. Watch out for total fat A small amount of fat in the diet is essential for health. It contributes to the energy needs of the person; it provides the essential fatty acids (EFA) that cannot be made by the body; and fat promotes the absorption of fat-soluble vitamins (A, D, E, and K). Fat also improves the taste and flavour of food, thereby enhancing their palatability. However, excess fat consumption can result in too much calorie intake. Remember that 1 gram of fat is "burned" to give 9 kcal whereas it is only 4 kcal for carbohydrates. Foods with higher content of fats and oils are therefore more energy dense foods. Excessive intake of energy-dense foods increases the likelihood of overweight and obesity. Fat and oils are therefore placed at the tip of the food pyramid of the Malaysian Dietary Guidelines. They are to be consumed the least, relative to the other food groups at the lower levels of the pyramid. Only small amounts are generally needed. It is important to pay particular attention to the amount of total fat and oil in our daily diet. There are two aspects to this. Firstly, choose foods that are lower in fat, eg lean meat. Limit intake of fried foods such as fried fish, chicken, and meat to no more than once or twice a week. When eating out, order dishes with less oil. The second aspect to this is to use less oil when preparing meals. For example, instead of frying, use alternative methods such as steaming; use less santan (which is actually fat from coconut) in cooking; when eating out, request the chef or hawker to use less oil in your meals. Types of fatty acids are important The fat molecule, known as triglyceride, is made up of two components: the glycerol backbone, and fatty acids attached to this. There are different types of fatty acids, and this determines the properties of the fat molecule, eg whether the fat is a solid or a liquid and their effects on human health. Fatty acids are composed of varying numbers of carbon and hydrogen atoms. The fatty acid could therefore be a short chain, comprising 10 carbon atoms, or a long chain type, made up of 22 carbon atoms. When all the bonds joining the carbon atoms in a fatty acid molecule are single (saturated) bonds, the fatty acid is known as a saturated fatty acid (SFA). On the other hand, when one or more double (unsaturated) bonds occur in the fatty acid chain, it is known as an unsaturated fatty acid. A fatty acid with one double bond is known as a monounsaturated fatty acid (MUFA); a fatty acid with more than one double bond is known as polyunsaturated fatty acid (PUFA). The latter include the omega-3 and omega-6 fatty acids. Examples of fats that are high in SFA content are animal fats such as tallow (beef or mutton fat) and lard (pork fat), and they are solids. Coconut oil is also very high in saturated fatty acids. Olive and soya bean oils are examples of MUFAs and PUFAs and are oily. Palm oil is a mixture of these three main types of fatty acids. The MDG 2010 has recommended to limit intake of saturated fat and to increase intake of MUFA and PUFA. Specific mention must be made of two fatty acids that are known as "essential fatty acids", namely linoleic acid (an omega-6 fatty acid), and alpha-linolenic acid (an omega-3 fatty acid). These are PUFAs and cannot be made in the body and must therefore be obtained from the diet. They are found in seed oils, fish, nuts and vegetables, as well as smaller amounts in meat, eggs, and dairy products. Avoid trans fatty acids Hydrogenation is a chemical process whereby hydrogen is added to the double bonds found in polyunsaturated oils. It is actually an artificial way to "saturate" an unsaturated oil so that the oil formed is harder. Such resulting oils can be used in solid applications, especially in the fat spread industry, eg in margarine manufacture. During this process, unsaturated fatty acids with their natural cis-configuration may be converted into the trans-configuration at one or more carbon-carbon double bonds. Trans fatty acids (TFAs) or trans fats are thereby formed. Palm oil, with its semi-solid properties, does not need to be hydrogenated prior to use in food applications. It does not contain trans fats. TFAs have been shown to have harmful effects on human health, especially in increasing risk of coronary heart disease. The MDG 2010 has given clear recommendations to limit the intake of foods containing trans fatty acids. Proper understanding of cholesterol Cholesterol is a waxy-like fatty substance. You may have heard bad things about cholesterol. It is actually required in the human body, for example for cell membranes, and for the manufacture of bile acids, steroid hormones and vitamin D. However, high levels of cholesterol in the blood are to be avoided as this can increase the risk of heart disease. The MDG 2010 has therefore recommended to limit intake of foods high in cholesterol. Remember that cholesterol is found only in foods of animal origin, such as egg yolk, brain, organ foods, butter, meat, and seafood. It should be pointed out that cholesterol from the diet plays only a minor role in increasing blood cholesterol level. Unless a person has high blood cholesterol, there is no need to be overly concerned about cholesterol from the diet. Especially for children, there is no need to stop giving your children milk and eggs because they contain cholesterol. These are nutritious foods and should be made available to children. It is important to remember that most of the cholesterol in the body is manufactured in our own liver. We must therefore pay close attention to reducing the making of cholesterol by practising healthy eating in general, particularly reducing intake of SFA (particularly from animal sources) and increasing intake of PUFA and dietary fibre. MDG key message 8 MDG 2010 has provided six key recommendations for this key message. Within each of the following key recommendations, the MDG has provided several tips on how to achieve these recommendations. 1. Limit the intake of saturated fats to less than 10% of total daily calorie intake. a. Limit the use of oils and fats such as coconut oil, coconut milk (santan), palm kernel oil and animal fat (ghee or butter). b. Trim the fat from meat or poultry before cooking. c. Remove skin of poultry before cooking. d. Use low fat or skimmed dairy products 2. Increase the intake of unsaturated fats (MUFA and PUFA). a. Palm oil is a good source of MUFA, while corn oil, soya bean and sunflower oils are good sources of PUFA. Using these vegetable oils in cooking will improve the intake of MUFA and PUFA. For example, mix one part of palm olein with one part of soya bean oil as a cooking oil blend. b. Increase consumption of foods such as nuts (groundnuts, cashew nuts, almonds and pistachios) and seeds (sesame and sunflower seeds) and legumes (chickpeas and soya bean). c. Increase consumption of fresh fish such as siakap, cencaru, selar kuning, bawal hitam, senangin, tongkol, kembung, tenggiri or sardines. Canned sources of fish such as tuna and sardines can also be consumed. 3. Limit intake of foods high in cholesterol. a. Limit organ meats (especially brain, heart, kidney and liver) and fish roe to less than twice a month. b. Remove the head of ikan bilis and prawns before cooking. c. Consume eggs in moderate amount, up to an average (whole or in dishes) of one egg a day. For individuals with hypercholesterolaemia, limit eggs to three per week. 4. Limit foods containing trans fatty acids (TFAs). a. Limit intake of margarines and shortenings made from hydrogenated or ''hardened'' fats. b. Limit intake of foods prepared with partially hydrogenated or "hardened" fats such as french fries, doughnuts and bakery products. c. Look for words such as ''partially hydrogenated" fats or oils or "hardened" fats or oils on the food label of processed foods as these contain TFAs. 5. Minimise the use of fat in food preparation in order to keep total daily fat intake between 20% and 30% of total energy. a. Limit deep frying, shallow frying and batter frying when cooking. b. Modify recipes which use excessive oils and fats such as sambal tumis, goreng berlada and nasi minyak. 6. When eating out, choose low fat foods. a. Choose dishes using minimal oil, fat or santan in the preparation. b. Choose high fat foods less frequently. c. Include vegetables and fruits in your meal choices. d. Eat at places which provide a wider variety of healthy meal options. e. Request for less fat and oil when ordering food. 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). n Dr Tee E Siong pens his thoughts as a nutritionist with over 30 years of experience in the research and public health arena. Full content generated by Get Full RSS. |
| Posted: 22 Oct 2011 07:28 PM PDT Study reveals that less than half of patients in Malaysia fail to achieve cholesterol treatment goals and remain at risk for heart disease. ASTRAZENECA recently published findings of the Centralized Pan-Asian survey on the Undertreatment of Hypercholesterolemia Study, or simply known as the CEPHEUS study. The CEPHEUS study is the largest survey conducted on the current treatment status of high blood cholesterol levels (hypercholesterolemia) in Asia Pacific. This study involved more than 7,000 patients from eight countries, including Malaysia. CEPHEUS looked at the treatment situation for high cholesterol in high-risk individuals, trying to establish the percentage of patients who achieve target cholesterol goals based on the Adult Treatment Panel III guidelines of the National Cholesterol Education Program (NCEP ATP III). It also aimed to identify and understand physician and patient characteristics that may influence or contribute to the treatment situation. Data gathered will help both physicians and patients to better manage their treatment, therefore reducing the main risk factor for cardiovascular diseases – high cholesterol. According to Datuk Dr Khoo Kah Lin, lead investigator of the CEPHEUS study, approximately half (overall CEPHEUS population 50.9%, Malaysia 54.9%) of the patients in Malaysia failed to reach their LDL-C (low density lipoprotein cholesterol) goals, even with existing treatment. This could be due to one of two reasons, which is either non-compliance by the patient, or non-aggressive treatment. "Results from the study showed that many patients failed to take their medication diligently, as more than half (54%) of the patients thought that missing a tablet once every two weeks or more would not have any effect on their cholesterol levels. This would suggest that many patients remain ignorant about the role of drugs in their cholesterol management, which in turn may have contributed to their attitude in regards to compliance with drug treatment regimens," he noted. Physicians play a role in explaining how these cholesterol-lowering drugs actually work. This will help patients understand better the necessity of taking their medication regularly, and on time. "Despite more effective treatments available, both physicians and patients were also found to dislike switching their current method of treatment. About 64.1% from the total number of patients are still on the same lipid-lowering drug they were prescribed the first time!" added Dr Khoo. Patients often do not schedule regular check-ups with their physician and many fail to see the necessity of this in the first place. Physicians should ensure that their patients come in for regular screening and monitor their progress regularly too. This will help, especially when prescribing new drugs or different dosages. Medical treatment should be sought early on for anyone who has been tested and diagnosed with high LDL-C levels. With diagnosis, it is then important for a patient to understand his/her condition well and ensure that any treatment prescribed is always adhered to, regardless of whether their cholesterol levels are controlled, unless otherwise advised by their doctor. Physicians should also consider prescribing a more aggressive form of treatment early on, eg more effective statins. Treatment that is both effective and aggressive is crucial for a patient to reach his/her LDL-C goals. Patients who suffer from high cholesterol should change their lifestyle routines, especially if they smoke, or do not follow a healthy diet. It is best to quit smoking, exercise regularly, eat healthily and maintain a healthy weight. "Compliance has a strong correlation to achieving LDL-C goals, and it is therefore crucial that patients take their medication diligently. Physicians too play an important role for a patient to reach his/her LDL-C goals, as successful outcomes start with an aggressive and effective treatment regime," said Dr Khoo. According to Professor Dr Wan Azman bin Wan Ahmad, a consultant cardiologist, having high cholesterol puts us at a higher risk for cardiovascular diseases, which has been the number one killer in Malaysia for the past three decades. "Although the risk for cardiovascular diseases increases with age, in recent years, it has now become more common for younger people to suffer from heart disease. High cholesterol is an especially serious risk factor; however, it is often taken lightly, and does not ring alarm bells. Often, it is only when their health is at stake that people start realising the dangers and consequences of high cholesterol," said Prof Wan Azman. The CEPHEUS Study is the first of its kind, as there has never been a large-scale study conducted in a region whereby almost half of the world's CVD burden has been predicted to occur. Publishing this first centralised Pan-Asian survey on the under-treatment of high cholesterol is a way to increase awareness among the public, and bring down the escalating numbers of patients who are under-treated, therefore reducing the prevalence of heart disease in Malaysia. Full content generated by Get Full RSS. |
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