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Posted: 29 Oct 2011 05:12 PM PDT

Making a small change to your diet might help slow down the advent of blindness caused by age-related macular degeneration.

AGE-RELATED macular degeneration (AMD) is the leading cause of blindness in people aged above 60 years in the developed world.

AMD gradually affects central vision and the macula, which is the most sensitive part of the retina.

There are two forms of AMD: wet and dry.

Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile, and often leak blood and fluid.

With wet AMD, loss of central vision can occur quickly. Wet AMD is also known as advanced AMD and is a cause of severe blindness in our senior population.

Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye.

As dry AMD gets worse, you may see a blurred spot in the centre of your vision. Over time, as less of the macula functions, central vision is gradually lost in the affected eye.

Patients with dry AMD are at higher risk of getting wet AMD. The three major risk factors for developing AMD are: age, family history of AMD, and smoking.

There are now effective treatments available for wet AMD with injections of anti-VEGF antibody drugs into the eye.

In Malaysia, however, patients often present late to their ophthalmologists, and their visual recovery is limited, even with treatment.

There is no treatment available for dry AMD.

There is a huge interest in looking at ways to prevent AMD in the general public and delay progression of disease in AMD patients.

Diet and nutrient supplementation especially have been the focus of intense research in the past 10 years.

Looking at supplements

The Age Related Eye Diseases Study (AREDS) was a landmark trial done in the United States and completed in 2006.

It looked at the effect of nutrient supplementation in preventing and delaying progression of AMD in over 4,000 patients.

The exact contents of the supplements were 500 milligrams of vitamin C, 400 International Units of vitamin E, 15 mg of beta-carotene (equivalent to 25,000 IU of vitamin A), 80 mg of zinc as zinc oxide, and two mg of copper as cupric oxide.

The study found that patients at high risk of developing wet AMD benefited from taking these supplements as it reduced their risk of getting the condition, compared to patients who did not take the supplements.

Patients at high risk of developing wet AMD were those with intermediate or advanced dry AMD, or those who already had wet AMD in one eye.

An eye doctor will be able to tell you what stage of dry AMD you have and whether or not you will need to take these supplements.

We should be cautious in supplementing our diets with the nutrients and doses used in the AREDS as many older people take prescription medications, over-the-counter drugs, dietary supplements, and herbal medicines.

High dose nutrients can interfere with medications and interact with other nutrients to decrease their absorption into the body.

For example, the zinc concentration in the AREDS formulation is at a very high dose and could cause copper deficiency anaemia. To prevent this, copper was added to the AREDS formulation.

People who are being treated for chronic diseases such as cancer, heart disease and diabetes, should not take high dose nutrients without consulting their doctors.

Self-medication with high doses of vitamins and minerals is not recommended!

The results of the AREDS raised many more questions, like whether zinc and beta-carotene can be eliminated from the formulation as both these supplements can have side-effects.

Many people were also interested in looking at the possible beneficial effect of adding dietary carotenoids like lutein and zeaxanthin, and omega-3 fatty acids to the formulation.

As such, AREDS 2 was started in 2008, and will hopefully refine the findings of the original study by adding the above supplements to the study formulation.

The main objective is to determine if these nutrients will decrease a person's risk of progression to advanced AMD. Previous observational studies have suggested that these nutrients may protect vision.

The results of the study are expected to be released in 2013.

More on diet

Carotenoids are the natural pigments that give colour to egg yolks, tomatoes, green leaves, fruits, and flowers. They cannot be made internally in the body, and therefore, must be obtained from the diet.

Lutein and zeaxanthin are members of the carotenoid family. Beta-carotene is another type of carotenoid.

They serve as light-gathering pigments and protect against the toxic effects of ultra-violet radiation and oxygen. They also appear to protect humans against phototoxic damage.

Lutein and zeaxanthin are found in the macula, as well as the lens of our eye.

When taking orally, lutein and zeaxanthin are far more effective in penetrating the retina than beta-carotene.

However, AREDS did not include them and used beta-carotene, because lutein and zeaxanthin were not commercially available 10 years ago.

Another interesting finding of the AREDS involved the diet of the participants.

The participants were given either a placebo or the actual supplements, had their eyes checked annually, and were also required to inform investigators about their diet.

In terms of eating oily fish (rich in omega-3 oils), the effect on the progression of early AMD was found to vary depending on what supplements the participants were taking.

The researchers found that consuming higher levels of oily fish was associated with a reduced risk of progression of early AMD in people taking the placebo, but there was no significant effect of eating more oily fish on the progression of early AMD when participants used the supplements.

They also found that eating a low glycaemic index (GI) diet reduced the risk of progressing to advanced AMD, regardless of what supplements were being taken. Low GI foods release their sugars into the blood more slowly than foods with a high GI.

So, there is clearly a complex interaction between diet and supplements in the prevention of AMD.

My opinion on this is that a low GI diet with two to three servings of oily fish a week can help prevent AMD, and is probably more useful than taking supplements alone.

I apologize for the excessive medical jargon used today, but I wanted to share these key findings of this very important study with you.

Prevention of AMD is a complex area, and I don't believe that taking supplements alone will help.

Apart from the supplements I have mentioned earlier, there are many other supplements that are commercially available that claim to prevent AMD like bilberry, gingko, acai berry, turmeric, selenium, and bioflavinoids.

It is very difficult to assess these claims, and currently, the most convincing evidence still comes from the AREDS, which found that high dose antioxidants and zinc supplementation reduced the risk of developing wet AMD in patients who already had dry AMD.

Please also bear in mind that the AREDS was done on a predominantly white North American population, and their findings cannot be directly extrapolated to our Asian population.

As a general guide to AMD prevention, here are my top five tips:

1. Eat plenty of fruits and vegetables like spinach, carrots, broccoli, guava and papaya. Choose different coloured fruits/vegetables to ensure you get a good variety of nutrients.

2. Eat oily fish like tuna, salmon, mackerel or sardines at least twice a week.

3. Exercise regularly.

4. Avoid a high fat diet.

5. Avoid smoking.

> Dr Fong Choong Sian is a consultant ophthalmologist while Goo Chui Hoong is a consultant dietitian. They are publishing a book on eye health and diet next year. 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. 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.

Here is a recipe you can try to apply some of the dietary principles:

Vietnamese spring roll

This is my version of Vietnamese spring roll.

I have substituted brown rice vermicelli for the normal rice vermicelli to take advantage of its lower glycaemic index.

These spring rolls are packed with fresh salads and herbs to give it a lovely fresh taste and to retain most of its antioxidants.

You can substitute the vegetables with your favourite ones. Try shredded guava, blanched choy sum or shredded courgettes!

Prawns are a source of omega-3 fatty acid and zinc. Alternatively, you could use smoked salmon or canned tuna in place of prawns.

Serves four

Preparation & cooking time: 35 minutes

Ingredients:

300 g prawns

100 g (1 cup) brown rice vermicelli, soaked in water for 20 minutes

40 g (8 sheets) rice paper

80 g (8) fresh lettuce leaves, washed and drained dry

100 g (1 cup) bean sprouts, blanched in boiling water

110 g (1) carrot, shredded

20 g (½ cup) mint leaves

20 g (½ cup) coriander leaves

20 g (2) spring onion, cut into slivers

Nuoc Cham sauce:

4 tablespoons (tbsp) fresh lime juice

4 tbsp fish sauce

4 tbsp water

2 teaspoons sugar

10 g (2 cloves) garlic, minced

10 g (2) birds eye chilli, minced

Method:

First, devein the prawns. With the shell intact, hold the prawn backside up. Run your knife down the length of the prawn to expose the vein. Use your finger or the tip of your knife to remove the vein. Repeat until all the prawns are deveined.

Bring a pot of water to boil. Cook the deveined prawns for 1-2 minutes, or until it floats to the top. Drain the prawns from the pot and leave to cool.

Peel off the shell and slice the cooked prawns in half. Peeling the prawn shells is left until after the prawns are cooked to prevent them from shrinking too much.

Bring the water to boil. Boil the rice vermicelli for 3 to 5 minutes, or until al dente, and drain.

Dip the rice paper in a large bowl of warm water. It will become soft and pliable.

Place the rice paper on a flat area and line with a lettuce leaf. Scoop a tablespoon each of rice vermicelli, sprouts, carrots, coriander, mint leaves, spring onion and prawn halves onto it.

Roll the rice paper and fold over the ends to seal in the filling. Cover with a damp cloth and continue to make the rest of the rice paper rolls.

Nuoc Cham sauce:

In a small bowl, mix all the ingredients together.

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A little pick-me-up

Posted: 29 Oct 2011 05:10 PM PDT

Giving your mind and body a small treat every day will only help improve your quality of life.

AS WOMEN, we've got a lot in our lives to deal with. Whether at home or at work, we're often the problem-solvers and decision-makers, putting other people's concerns ahead of ours.

At the end of the day, when we're at home, we're too exhausted to do anything but crash on the bed and fall asleep.

If you keep going on like this without a break, you will eventually burn out, and experience mental and emotional distress, as well as physical symptoms.

Every so often, it is important to do something to indulge and pamper yourself. It gives you emotional and mental relief, and sometimes, even physical relaxation as well.

In other words, you need to do something that is good for your body, mind and soul.

Indulgence is not necessarily about doing something that is bad for you – you can indulge yourself in healthy and meaningful ways too.

Here are a few ways to treat yourself, without costing too much or taking up a lot of time in your busy schedule.

Laugh at something funny

When was the last time you had a good, hearty belly laugh?

It was probably too long ago for you to remember. What with having to deal with naughty kids, cranky colleagues, difficult customers and a dozen other problems, who has time to laugh?

You should make time, though.

Laughing is the best way to release all the stress that has built up inside you. It even strengthens your immune system, improves blood flow, stabilises blood pressure and keeps blood glucose levels down.

The easiest way to get a good laugh is to watch a funny movie. Pick something that will not only make you smile or chuckle, but laugh out loud.

Have a cuppa

Much has been said about tea's healthful, antioxidant properties. So start channelling those benefits into your "me-time" by taking a break with a cup of tea.

Studies show that people who drink four cups of black tea a day for six weeks release fewer stress hormones after a difficult task, compared to those who drank a caffeinated fruit drink.

Green tea is also a good choice, if you want some variety.

Go dark

After all the years of secretly eating chocolate, we have finally been told that chocolate is good for us... but only dark chocolate.

While being low in sugar and fat, dark chocolate is also a good source of flavonoids. These are compounds found in plants, which are believed to have strong health properties.

Some of the health benefits associated with flavonoid-rich foods are: reduced risk of cardiovascular disease, neurodegenerative disease, cancer and other chronic diseases.

Now, this is not a license for you to eat loads of chocolates every day. Have only a little piece a day, and truly savour it as it melts in your mouth.

Get a massage and manicure

These aren't just for the rich and famous, but for any woman who works herself to the bone 24 hours a day, seven days a week.

We submit our bodies to a great physical toll, whether we are doing housework and manual labour, or sitting hunched in front of a computer all day long.

A manicure, pedicure and massage all offer one great benefit – human touch, which has been shown to reduce stress and boost self-confidence.

A massage releases endorphins in the body, which lowers anxiety and increases your immunity.

Many reflexology places offer simple back, neck, shoulder or foot massages at affordable prices. You can also get a chair massage at some malls or office buildings.

Be intimate

If you have a significant other in your life, don't neglect your relationship in your busy schedule. Physical intimacy is something that you should take time to indulge in.

Give your spouse a proper kiss every day when you leave for work and when you come home. You will be surprised at how much it improves your spirit and helps your worries melt away.

And when you're feeling very stressed and drained, don't crash straight onto the bed or in front of the television – try sex instead. Research has shown that sex lowers blood pressure, increases immunity and improves self-esteem.

A healthy physical connection with your partner will also strengthen your relationship emotionally, which gives you one less reason to be stressed during the day!

Streeeeetch

Can stretching be an indulgence?

It can, when you take your time at it and give every little muscle in your body a tweak (watch a cat the next time it stretches).

Stretching helps ease tired muscles, increases flexibility, improves your range of motion, gets the blood circulating and soothes away the stress.

It's always a good idea to stop in the middle of the workday and give yourself a good stretch.

Get out of your chair and do a slow stretch across all the major parts of your bodies, holding each pose for 10 seconds. You can also do it again when you are at home, while watching TV.

Call a good friend

When was the last time you had a proper chat with one of your dear friends?

You may see them at gatherings, drop them an email sometimes or read their status updates on Facebook, but nothing beats a good conversation about the things that really matter in life (or even just chatting about trivial, fun things).

The power of friendship in nurturing good mental and emotional health is not negligible. Everyone needs to have emotional attachments to people around them, as it gives us a sense of belonging, purpose and self-worth.

So treat yourself to a good long conversation with your friend, either over the phone or a simple meal.

Get moving

Get your blood flowing with some physical movements in your daily life.

It's not necessarily exercise (which is something else you should do regularly). Instead, this is just a chance to get some fresh air, relax your mind and boost your energy levels.

You could try taking a walk around your neighbourhood, do some simple gardening or play around with the kids outside.

Just 10 minutes will make you feel the difference!

Get some zzz's

Indulgence or necessity? It's certainly the latter, but you also need to indulge in good quality, restful sleep each night.

The amount of sleep we need differs between individuals, but generally, six to eight hours every night is the recommended amount.

Quality sleep refreshes your mind, helping you to retain information that you have learnt during the day and make memories.

Sleep may also play a crucial role in preventing cardiovascular disease, cancer and Alzheimer's disease.

I have previously written about ways to improve the quality of sleep, such as by ensuring that the bedroom is properly dark and quiet, the mattress and pillows are comfortable, and the temperature is not too warm or too cold.

Lavender is another good trick to help you sleep and also ease your anxiety. Spritz a little lavender water on your pillow, or put a little sachet with lavender oil next to your bed.

These tips above are simple ways to take time out in a day and indulge in a little pick-me-up. Try not to go a day without at least one of these healthy treats.

> Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit www.primanora.com. 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. 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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‘Shock’ therapy for ED

Posted: 29 Oct 2011 05:08 PM PDT

A treatment originally meant for urinary stones is now being utilised to help men with erectile dysfunction.

EXTRACORPOREAL Shockwave Lithotripsy (ESWL) for the treatment of urinary stones was pioneered by urologists in Germany in the mid-1980s. It was arguably recognized as the greatest invention in medicine at that time!

ESWL was brought to Malaysia in early 1988, and within a short period, all urinary stone treatments were done without open surgery, albeit with the support of endourological procedures in a certain number of cases.

In recent years, ESWL has been used in the treatment of shoulder stiffness/pain and Peyronie's disease with limited success.

Today, ESWL is being used successfully in many centres to treat men suffering from erectile dysfunction (ED).

Painless shockwaves delivered to the penis in stages over six weeks have been found to increase the blood flow to the penis significantly.

Over the past one year, well-conducted studies have confirmed that ESWL treatment is highly effective in treating men suffering from ED.

The results in these centres have shown that in the short term (up to a year), its efficacy is similar, if not better than, the current oral phosphodiesterase type 5 inhibitors (PDE5i) used to treat ED.

In a few series, patients who initially failed to respond to PDE5i, responded to ESWL, and a number of them subsequently become responsive to PDE5i.

A novel treatment

ED shockwave therapy (EDSWT) is currently recognised as a novel innovative approach to treat vasculogenic ED (ie ED caused by disorder of the blood vessels). Apparently, all vasculogenic ED patients will benefit from EDSWT in varying degrees.

In the recent Annual Congress of the International Society of Men's Health held early this month, Prof Y. Vardi reported a series of studies dating back to 2009.

The first pilot study involved 20 middle-aged patients with moderate to severe ED (mean International Index of Erectile Function-ED score of 13.5 out of 25). He excluded men with ED from neurogenic (caused by nerve problems), psychogenic (caused by mental problems) or post-pelvic surgical causes.

Low intensity shockwaves were applied to the penile shaft and crus (base of penis) for three minutes in five different penile sites (300 shocks per site) without any painkillers.

The treatment included two sessions per week for three weeks, and was repeated after a three week no-treatment interval.

At the end of the nine week treatment regime, 15 patients (75%) responded to the therapy. Prior to the intervention, all the patients were on PDE5i therapy — five with poor response and 15 with good response.

Overall, 12 patients did not require PDE5i therapy three months after completing the shockwave treatment.

At one year, nine subjects showed improvement from an average of 14.4 to 23.3 in the IIEF-Erectile Function score (max score 15 of 25). None of the patients reported pain or any other side effects from the study.

This first pilot study was followed by a randomised sham controlled double blind study involving 60 vasculogenic ED patients who, at screening, were responders to PDE5i therapy (IIEF-EF score of >21).

The results showed clearly that 65% (26/40) of the treated group, compared to 20% of the sham group (p=0.0007), increased their IIEF-EF score by ≥5 points.

The treated patients also reported significantly higher satisfaction rate and increased flow-mediated dilatation parameters compared to the sham group.

Prof Vardi went on to present a study involving 24 patients with severe ED, who were not responding to oral medication.

At the end of the 12 week study, 80% of the patients achieved a rigidity score of ≥3 out of 5 (p21) with the use of PDE5i.

Prof Vardi concluded that EDSWT is a new modality that can be used to effectively treat a subgroup of ED patients who fail PDE5i therapy, and this study confirmed the potential clinical benefits of this novel shockwave therapy in restoring erectile function.

Currently, patients with severe vasculogenic ED who fail oral therapies often resort to vacuum pumps, injection therapies or penile implants if they want to resume sexual activities.

The experience with shockwaves (EDSWT) has shown that up to 70% of these difficult-to-treat cases can be salvaged, and become responsive to PDE5i.

Prof Vardi's study results have been duplicated by many centres in Europe, Japan, Korea and India.

Going beyond ED

EDSWT utilizes low-intensity extracorporeal shockwaves focusing on penile blood vessels, resulting in development of numerous tiny vessels (neovascularization) in the shaft and crus (base) of the penis.

This technology has been used successfully in cardiology to bring about revascularization of ischaemic tissues.

Low intensity shockwaves are also currently being experimented on in the treatment of chronic pelvic pain syndrome, and in aesthetics medicine to treat cellulite.

The discovery of sildenafil (Viagra), a PDE5i, revolutionised the management of ED in the 1990s. Four of six PDE5i are available in Malaysia, and they have been used very successfully in an on-demand basis in treating men with ED.

Lately, modification of the treatment regime using daily low dose PDE5i is preferred by men who cannot tolerate the side effects (headache, backache or flushing) of on-demand dosages. A proportion of men who desire spontaneity in their sex life also favour using daily dose PDE5i.

Recently, the US Food & Drug Administra-tion (FDA) approved the use of daily PDE5i in treating men with lower urinary tract symptoms secondary to prostate enlargement. This is certainly another milestone in the expanding usage of PDE5i.

Daily high doses of sildenafil taken two to three times per day has already been proven and approved to treat patients (including children) who suffer from debilitating life-threatening pulmonary arterial hypertension.

We have certainly come full circle with therapies for ED that continue to evolve and marvel medical science with their ever-expanding applications.

ESWL, which dramatically changed the treatment of urinary stones, is certainly on the verge of changing the treatment of men suffering from erectile dysfunction.

It is unimaginable that ESWL, a powerful but safe energy that has been used by urologists to crush nearly all stones in the urinary system, can be harnessed to deliver painless, controlled shock energy to bring new blood supply to the penis.

Urologists are certainly living in exciting times. We have literally grown up with the lithotripter. The powerful energy which we unleash to crush stones safely can also be controlled and tamed to caress the penis back to 'life'.

Urologists are also helping researchers in other fields of medicine to innovate the use of shockwave energy in the treatment of other medical conditions.

> 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, 30 Oktober 2011

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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