The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Functional foods health claims Posted: 24 Dec 2011 03:47 PM PST The beneficial effects of functional foods must be scientifically substantiated. A GREAT deal of attention is now given to the potential health significance of components other than nutrients that are found in foods. These bioactive components have been found to be able to serve physiological roles beyond provisions of simple nutrient requirements, and even reduce risk to chronic diseases. Foods containing such components have been termed "functional foods". Consumers are now more health conscious, especially in view of the increase in diet-related chronic diseases. There would certainly be a great deal of interest to see if some functional foods or ingredients can indeed help in reducing the risk of these diseases. However, there must be adequate scientific proof that these functional foods do indeed provide beneficial health effects. All over the world, there are specific regulations that govern the types of health claims that are permitted to be made on functional foods. I would like to share with readers two recent scientific meetings on functional foods that I participated in. The first was an International Life Sciences Institute (ILSI) Europe regional conference on functional foods. The second was a conference organised by Universiti Putra Malaysia. In both meetings, I spoke on the global regulatory aspects of health claims on functional foods. Other healthful components in food Two main functions of food have conventionally been recognised. The primary function is to provide a variety of macro- and micro-nutrients to nourish the body. The secondary function is sensory functions, eg to provide tastes, flavours and texture to food. There is now thought to be a third or tertiary function of food. This function pertains to regulating the physiological processes of the body, and even promoting health. In this new dimension in the relationship between food and health, this function is not performed by nutrients in foods, but rather by other components in food. It is now generally recognised that foods do not merely provide nutrients. It has been shown that there is a large variety of bioactive or functional components in foods that are capable of promoting health. Many of these bioactive components have been shown to be able to serve physiological roles beyond those provided by "classical" nutrients such as protein, carbohydrate, fat, vitamins and minerals. Characteristics of functional foods To date, there is no unanimously accepted global definition of functional foods among the scientific community. Nevertheless, a generally accepted understanding is that functional foods are foods that provide health benefits beyond basic nutrition. This is by virtue of physiologically active (or bioactive) food components (functional ingredients) present in these foods. Functional foods are similar in appearance to conventional foods and are intended to be consumed as part of a normal diet. They possess sensory characteristics including appearance, colour, texture, consistencies and flavours, and are not in the form of capsules and tablets. These are traditionally recognised as food, and are unlike herbs and other botanicals. In recent years, the bioactive components in functional foods have been extracted, purified and added to various other food products. For example, plant sterol has been extracted from soya bean and added to milk powder. Another example is the addition of oligosaccharides such as inulin to various beverages. In this way, the functional properties of these components are made available to the consumer through various vehicles that do not naturally possess such components. The bioactive components have also been isolated and presented to the consumer in medicinal forms, eg capsules and tablets. In such forms, not associated with food, these products are appropriately known as nutraceuticals or health supplements. Functional foods have featured prominently in food and nutrition scene internationally. The various regional branches of ILSI have been the main drivers of scientific activities in functional foods. There has been active research and development in function food products. Numerous conferences and other scientific meetings have been organised, and volumes have been published on the matter. Functional foods have been traded internationally and are huge businesses. Common examples of functional foods Soya beans contain a number of phytochemicals, and several of these have been studied for their anticarcinogenic activity. Isoflavones have been studied for their oestrogen properties and in relation to lowering blood cholesterol. Soya protein and phytosterols have been demonstrated to lower blood cholesterol. High soya intake is associated with lowered risk for breast cancer and prostate cancer, whereas high soya and/or isoflavone intake has been reported to be positively associated with bone mineral density. Flavonoids are a diverse group of polyphenol compounds found in various plant foods. The most important flavonoids in tea are flavanols and flavonols, eg catechins, many of which have been studied for their antioxidant properties. The possible effects of these bioactive compounds in lowering risk for cardiovascular disease have been investigated, eg via lowering of blood cholesterol and blood pressure, protection against LDL cholesterol oxidation and reduction in platelet aggregation. Broccoli and other cruciferous vegetables (including cabbage, kailan and cauliflower) contain glucosinolates which are capable of being converted to a variety of hydrolysis products including isothiocyanates and indoles. These compounds have been studied for their capability in reducing risk to some cancers. Another group of bioactive compounds found in many fruits and vegetables is carotenoids. Carotenoids give the bright orange colour to these plant foods. Lycopene in tomato and papaya is an example of a carotenoid. It is not converted into vitamin A but may possess other physiological properties, eg as antioxidants. Several undigestible carbohydrates have been demonstrated to be able to impart beneficial effects on human health. As dietary fibre, these carbohydrates have lower energy value ( Several studies have also demonstrated the ability of several dietary fibres to lower blood cholesterol and blood sugar levels, and to improve calcium bioavailability and immune function. Several examples of these are the non-digestible oligosaccharides and polysaccharides, eg oligofructose, inulin, polydextrose, resistant starch. Related to gut health is the role of another group of functional components, namely probiotics. Common examples of these beneficial bacteria are Lactobacillus and Bifidobacteria that have been demonstrated to improve gut health and possibly reduce the incidence of colon cancers. Probiotics are now added to yoghurt, fermented milk and milk drinks. Health claims on functional foods The term "functional foods" is currently not used in any of the relevant regulatory or legal systems. The approach by regulatory agencies towards these foods is therefore focused on health claims and their scientific substantiation. There have been major worldwide regulatory developments in health claims, specifically "other function claims" and "disease risk reduction claims". Other function claim describe specific beneficial effects of the consumption of a food bioactive or functional constituent in improving or modifying a physiological function, eg plant sterols help in lowering blood cholesterol. Reduction of disease risk claims relate to the consumption of a food or food constituent to the reduced risk of developing a disease or health-related condition, eg soya protein reduces risk to heart disease. In Malaysia, the term functional food is also not used. Nevertheless, other function claims for bioactive components are permitted in the current food regulations. A "positive list" approach is adopted by the authorities, meaning only claims on this list are permitted to be made by a food product. A total of 29 "other function claims" for food components (non-nutrients) are permitted (as of December 2010)*. A large number of these bioactive components with approved function claims are non-digestible carbohydrates or dietary fibres. These include inulin, galactooligosaccharide (GOS), fructooligosaccharide (FOS), GOS:FOS (90:10) mixture, oligofructose-inulin mixture, beta-glucan, polydextrose, resistant dextrin and High Amylose Maize Resistant Starch. Other components include sialic acid, isomaltulose, soya protein, plant sterols/sterol esters, a patented cooking oil blend, Bifidobacterium, lutein, docosahexaenoic acid/arachidonic acid. Some of the permitted function claims include reducing or lowering cholesterol; maintaining a good intestinal environment; increasing intestinal bifidobacteria; lowering rise in blood glucose; improving intestinal immune system of babies; contributing to visual development. For each of the approved function claims, specific conditions are required. One condition that is required for all claims is that a minimum amount of the relevant "food component" must be present. Additional labelling requirements may be required for some components, eg caution for some population groups. In some cases, the claim is restricted to selected foods. It is to be noted that disease reduction claims are not permitted in Malaysia. A clear distinction is to be made between function claims and disease risk reduction claims. Two examples of function claims would be that beta-glucan from oat helps lower blood cholesterol and that calcium is important for bone and teeth formation. Disease risk reduction claims for these two components, which are not permitted in Malaysia, would be: beta-glucan from oat helps reduce risk to heart disease and calcium reduces risk to osteoporosis. All of the function claims related to bioactive food components have resulted from applications from the food industry. Indeed, there is continuing interest among the food industry to apply for new function claims. A framework has been established by the Food Safety and Quality Division of the Health Ministry to review applications. More research on local functional ingredients It can be noted that only a few of the permitted functional ingredients with health claims in Malaysia are of local origin. There is actually a rich flora and fauna in the country which are potential sources of a large variety of functional foods or bioactive components that may be beneficial in promoting health. However, the safety and health benefits of these local ingredients should be clearly demonstrated before being marketed to the consumer. Marketing of functional foods often runs ahead of scientific substantiation. There are various claims of beneficial effects of specific ingredients or foods without proper scientific proof. To be accepted in the world market, intended claims must be scientifically substantiated. The local scientific community could carry out research on this topic, to gather the required scientific data to support efforts to develop and market these functional foods and ingredients. Collaborations between the industry and academia will be most essential for the future development and advancement of local functional foods. Advice to consumers Some functional foods and ingredients may indeed possess beneficial effects on health. Consumers should indeed consume a variety of foods (particularly plant foods) so as to obtain a variety of nutrients as well as functional ingredients. It must, however, be emphasised that these foods alone are not going to prevent chronic diseases. Functional foods must be consumed as part of a daily diet. There is no such thing as a magic bullet or super food to prevent or cure chronic diseases; indeed, foods do not cure diseases. The best advice for consumers is to: ·Enjoy a variety of foods; ·Eat balanced meals; ·Eat in moderation, and ·Be physically active! *Details of all the health claims permitted by the Food Safety and Quality Division of the Ministry of Health Malaysia can be viewed from: > 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. Full content generated by Get Full RSS. |
| Posted: 24 Dec 2011 03:46 PM PST We all talk about chemistry or spark in a romance, but what is it and by what is it defined? I ANSWER viewer questions for Fox 26 each week on my segments, "Mind, Body, Soul with Mary Jo". I didn't have time to answer this letter from Jane, so I decided to write the answer in my blog. "Dear Mary Jo, When you are starting to date someone and you enjoy their company, but do not have any real desire for them ... how do you know if you should give it time to grow? Is it foolish to date where there is no 'spark', hoping that will come with time? (In my experience, it has never grown, if not there to begin with). How much time is fair to avoid hurting the other person if you know they are into you, but you don't return the same level of attraction? Thank you, Jane." The answer to these types of questions is difficult, and there are no right or wrong answers. Some of the best marriages I have ever seen were arranged, and some of the worse relationships I have ever seen consisted of people who had an abundance of spark, but nothing else in common. We all talk about chemistry or spark, but what is it and by what is it defined? For some, chemistry means the other person is "cute" or "hot"; for others, it may mean they are an intellect and share career interests. Dating usually implies that you are meeting people you want to see again. I cannot imagine getting dressed and ready to go to a play or an event with someone for whom I felt no interest or with whom I didn't want to be. As you read my answer you may think of other things that would be helpful to share with Jane. Your comments are appreciated, so long as you consider "helping and encouraging her," because she is stuck right now, and trying to do the right thing. Dear Jane, I want to thank you for trusting me with your question and I am hoping I can offer things to think about and question within yourself, to help you find your answers. Dating should be fun and it allows you to get to know people in an intimate setting. Like any relationship, it should be done as honestly as possible. When you are transparent, you allow the other person to know you, and free yourself from trying to be what you aren't. If you pretend to like this guy and keep it going when you really aren't interested, that is deception. Being honest doesn't have to be mean, something as simple as, "I think you are a really neat person (if he is), but I have some things I need to work out in my own head right now, and I need to take a break from seeing you anymore." Of course that is my script ... you can change it however you wish as long as you stay honest with your own part (spark happens; it's not something anyone is to blame for or feel badly about). You also asked if spark ever comes when it isn't there initially. There is no one answer to that question, Jane. In a healthy marriage, couples may experience their spark growing and dimming only to repeat this cycle. A relationship also grows, but with dating, there has to be something there to keep you wanting to continue the dates. That leads us to the last portion of your question. When the other person does feel a spark and you don't, how long should you continue the relationship? This is where you have to become very honest with yourself by asking yourself these questions. What am I afraid of if I let this one go? What specifically (write them down) makes this person void of spark? What specific combination makes me feel a spark? Many women who like bad boys were raised with dads who didn't treat their mums very nice. These women may say they would never marry or date a guy like their dad, but the unfinished business in their heads attracts them to a bad boy like a moth to a flame. Many mums who were bored with their partners couldn't hide their boredom from their daughters. When their daughters meet nice guys, they get cast aside due to the daughters' fear they will end up bored like their mothers were. Chemistry is the sum total of what we grew up with, what we saw mentored in our own homes and our personal wiring. When it attracts, it is strong, and there is a spark. Can a relationship grow to spark? Yes. Will it ever feel as intense as a natural first meeting spark? No, probably not. Can you build a healthy marriage or life with someone you don't feel that spark for? YES. Is it easy? NO, but then again, creating a healthy marriage takes work, and I doubt anyone would say it was easy. I could not say that about life in general as life is about learning all aspects of one's self and some of those are painful. Good luck, Jane. – HealthNewsDigest.com > Mary Jo Rapini is a relationship counsellor in the US. Full content generated by Get Full RSS. |
| Posted: 24 Dec 2011 03:45 PM PST Monitoring outcomes in breast cancer. BREAST cancer is the most common cancer in women in Malaysia, and one third of women with breast cancer are aged 40-49 years old. This is the age when a career woman would be at the height of her career, and a woman at this age would have children who are still in school. It is devastating for any woman to be told that she has breast cancer. The family dynamics is disturbed, and her role as a wife, a daughter and a mother is threatened. As a breast surgeon, every time I have to break the bad news to a woman, the usual reaction I get is, "Am I going to die?" Well, the good news is, breast cancer is the most curable cancer if detected and treated early. Five-year survival rates of more than 90% are achievable when diagnosed in the first stage. Even in the second stage, cure rates of over 80% are possible with the newer treatments available. Treatment of breast cancer involves a multidisciplinary team approach. The surgeon, pathologist and radiologist are the main team to diagnose the breast cancer, through a process of "triple assessment", which involves a clinical examination, mammogram and ultrasound, and a biopsy of the breast lump. After that, the treatment team involves the surgeon and the oncologist, together with the pathologist who is required to report on the breast specimen (and axillary lymph nodes) that is removed. Throughout this process, a breast care nurse to coordinate the woman's appointments, and to navigate her through the healthcare system is also important. A plastic surgeon is also an important member of the team if a woman needs a mastectomy and wants to consider an immediate breast reconstruction. Counseling and help in decision-making is essential at this point. But how many women in Malaysia will have access to this "multidisciplinary" management? Shortage of specialist manpower in the Health Ministry is a perpetual problem. Another common question is, "How much will it cost?" For those with insurance or who are well-to-do, they can get almost immediate access to a surgeon in a private hospital. Although the Health Ministry provides treatment for breast cancer to all Malaysian citizens practically free of charge, most women do have problems getting an early appointment to see a surgeon in a government hospital. Although most of the large general hospitals will have a breast clinic with facilities for mammogram and biopsy the same day, the waiting time to get to this clinic can take a month or so. However, it is important to emphasise to women that the same treatment that will cost thousands of ringgit in the private sector is available in government hospitals at minimal cost. Most women seem to think that the more they pay, the higher the chance of cure. This need not be true, because although there may be some delay, eventually the woman with breast cancer will receive the care that is needed. The ultimate outcome of any treatment is survival, that is, the time interval between diagnosis and death. In breast cancer, the two most important determinants of this outcome is stage at diagnosis and optimal treatment. Optimal treatment means access to quality care as well as timely care. Whether the delays which are associated with a busy government hospital will impact on survival should be studied, although studies overseas have shown that a delay of three months or less will not have an impact on survival. Survival in breast cancer is measured in terms of five- and 10-year survival, hence it will take some time to be able to prospectively measure how well the healthcare system is performing. An early indicator of performance is to measure the delay in instituting treatment, ie the time taken from the first patient visit to the first treatment, whether surgery or chemotherapy. This "systems delay" does not take into account patient delay, that is, the time taken by the patient to present to a doctor after first finding a lump in her breast. To measure outcome from breast cancer treatment, a study called the Healthcare Performance and Management Report System (HPRMS) was started in Jan 2011 with support from Roche Malaysia, and involves the Health Ministry, universities as well as private hospitals. The indices measured in this study are: 1. Stage of breast cancer at diagnosis. 2. The time taken from the first time a woman visits the clinic to diagnosis, and from diagnosis to the first treatment, whether surgery or chemotherapy. 3. Five-year survival rate of breast cancer. Besides these indices, the HPRMS also measures the pathological features of breast cancer, that is, size, grade of cancer (which is different from the stage at diagnosis), lymph node involvement, and also important biomarkers that will determine the type of treatment, such as the oestrogen receptor (ER) status, the progesterone receptor (PR) status and the human epidermal receptor 2 (HER2) status. No two woman will have exactly the same combination of these pathological features. These features will determine the prognosis, that is, the chance of cure. A woman with a 1cm Grade 1 breast cancer with no lymph nodes involved will have a much better chance of cure than a woman who has a 5cm Grade 3 cancer which has spread to 10 lymph nodes. In the same way, a woman who has ER positive, PR positive and HER2 negative status will have a better prognosis than those who are ER and PR negative and HER2 positive. The HPRMS also records the type of treatment the woman receives. For example, a woman who is node positive should have chemotherapy, those who are ER or PR positive should be given hormonal therapy, and those who are HER2 positive should have access to herceptin (an anti-HER2 drug). Optimal treatment will lead to the best outcome. Hence, the HPRMS also measures access to optimal care, timeliness of optimal care, as well as patient compliance to treatment. A six-monthly report will be generated by the HPRMS study to look at the early indices such as patient delay and systems delay. It will also look at the adequacy of pathology reporting, since the pathological features will have an impact on the type of treatment given. Ultimately, over time, the goal of the HPRMS will be to: 1. Reduce the number of patients presenting with advanced late stage disease. 2. Improve access to optimal care, as well as timeliness of care. 3. Reduce mortality from breast cancer. It is important that we monitor the results of treatment, not only in breast cancer, but also in other cancers. Only if we measure the performance indicators that are considered important in outcomes will we be able to determine if our breast cancer survival is equal to other countries. If we find that our five-year survival (adjusted for stage) is lower than that seen in other countries, we should then review our treatment strategies and look towards improving access to quality optimal care and timeliness of care. Full content generated by Get Full RSS. |
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