The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 01 Sep 2012 06:52 PM PDT Find out more about the heart benefits of vitamin D. ACCORDING to the US-based Vitamin D Council, a non-profit organisation responsible for spreading reliable information on vitamin D, sun exposure, and the vitamin D deficiency pandemic, vitamin D deficiency is estimated to affect a third to half of the adult population worldwide. Living in tropical Malaysia does not mean we are getting enough of the sunshine nutrient – vitamin D3. Factors affecting vitamin D production from sunlight range from the angle of the sun's rays, the time of the day, skin type, etc. Vitamin D3 is known for helping with calcium absorption, and for building strong bones, which is why milk has been fortified with it. But there is growing evidence to show that vitamin D deficiency is linked with numerous other health conditions and diseases, from cancer to heart disease, high blood pressure and diabetes. The heart health connection Getting enough vitamin D3 may help your heart, according to a study published in the January 2008 publication of the Journal of American Heart Association. Researchers found that people with the lowest levels of vitamin D were more likely to have a heart attack, stroke, angina or heart failure, than those who started with higher vitamin D levels. In a randomised controlled trial consisting of 77 overweight and obese women carried out in Tehran, Iran, vitamin D supplementation has shown potential in regards to improving blood lipid profiles. Based on a study focusing on the effects of vitamin D on heart health, conducted at the Intermountain Medical Centre based in Salt Lake City in the US, involving 27,686 patients, those with the lowest vitamin D levels were 77% more likely to die during the follow-up, 78% more likely to have a stroke and 45% more likely to develop coronary artery disease than those with normal levels. They were twice as likely to develop heart failure compared to those with normal levels. And even those who had moderate deficiencies were at higher risk, the researchers said. People who were vitamin D deficient were also twice as likely to have diabetes, and tended to have high blood pressure. But being vitamin D deficient was an independent risk factor for poor outcomes, regardless of other risk factors like diabetes, said Dr Joseph B. Muhlestein, cardiologist and researcher with Intermountain Medical Centre, and one of the authors of the new study. He adds: "What we were taught in medical school about vitamin D is that it's associated with rickets and calcium metabolism." That, however, is changing. "What's been discovered in the last few years is a significantly greater role for vitamin D," Dr Muhlestein said. "There are perhaps 200 different important metabolic processes that use vitamin D as a co-factor." How do you get your vitamin D? There are only two ways to receive vitamin D in the amounts necessary for proper health: ultraviolet B (UVB) exposure and vitamin D supplementation. Diet should not be considered a satisfactory source of vitamin D. The few foods that do contain vitamin D, contain too little to have any noticeable benefit. Vitamin D3 (cholecalciferol) is the type of vitamin D the body naturally produces in the skin in response to sun exposure. Vitamin D2 is produced naturally when fungi (yeast or mushrooms) are exposed to ultraviolet light from the sun, or to artificial UV light. There is evidence that the body has preference for D3 over D2, showing in these studies that the body more readily uses D3 when it has both forms in the body, and that D3 is more potent than D2 for producing 25(OH)D. The safety limit for vitamin D is much higher than commonly believed. Based on the latest evidence, it is determined that 10,000 I.U. a day is non-toxic. After all, your body can easily make 20,000 I.U. after 30 minutes at the beach between 10am and 2pm. Published cases of toxicity, for which serum levels and doses are known, all involve intake of over 40,000 IU (1,000 mcg) per day. Many health experts recommend 1,000 I.U. to 2,000 I.U. of vitamin D3 supplements a day for the prevention of many heart-related conditions. When taking a vitamin D supplement, try to choose a supplement made with natural vitamin D3 (cholecalciferol). References: 1. Chan J., Jaceldo-Siegl K., Fraser G.E. Serum 25-hydroxyvitamin D status of vegetarians, partial vegetarians, and nonvegetarians: the Adventist Health Study-2. Am J Clin Nutr. 2009 May; 89 (5): 1686S-1692S. 2. Välimäki VV, Löyttyniemi E, Välimäki MJ Vitamin D fortification of milk products does not resolve hypovitaminosis D in young Finnish men. Eur J Clin Nutr. 2007 Apr; 61 (4): 493-7. 3. Reinhold Vieth. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety- Am J Clin Nutr May 1999 vol. 69 no. 5 842-856 4. Vieth, R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999 May; 69 (5): 842-56. 5. Edvardsen K, Brustad M, Engelsen O, Aksnes L The solar UV radiation level needed for cutaneous production of vitamin D3 in the face. A study conducted among subjects living at a high latitude (68 degrees N). Photochemical and Photobiological Sciences. 2007 Jan; 6 (1): 57-62. ■ This article is courtesy of Live-well Nutraceuticals, for more information, please consult your pharmacist or call Live-well INFOline: 03-6142 6570 or e-mail info@livewell2u.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. |
| Posted: 01 Sep 2012 06:48 PM PDT By nine years of age, the visual system is fully developed in a child. Detect problems earlier before it's too late. THE moment I was told to pen down some words on paediatric eye care, I did not have to crack my head to understand the problem faced by most parents when it comes to children's vision care these days. I see my son Danish, who is four-and-a-half years old, sitting in front of the TV, watching his favourite programmes: cartoons – Spiderman, Transformers, Ultraman, and what not. Also, with one hand holding an iPad, he plays games and has fun with interactive lessons available online provided by the App store. If he is bored with all that, he will start amusing himself with colouring books. Occasionally, he will jump on his tricycle and cycle around the living hall within its four walls. I'm sure this is a common scenario with children nowadays. Because these activities affect their vision, parents will have to address any problems for the betterment of the child's visual development. When vision develops Even at a newborn stage, infants are able to see. Their vision improves as they continue to grow. During their early childhood years, the visual system changes quickly, and if the child complains of visual clarity, it could be that his/her vision is not developing properly. In fact, visual development may even decrease. Through a thorough eye exam, the doctor can detect reduced visual acuity, squint or misalignment of the eyes, amblyopia (lazy eyes), glaucoma (high eye pressure), cataract and blocked tear ducts, to name a few. If diagnosed early, the child will have better chances of gaining back good vision. By nine years of age, the visual system is fully developed, and usually cannot be changed. This means a child has only up to nine years of his/her life to correct any pathology in the visual system. After that, it may be too late to consult the eye doctor for any treatment. Signs of poor vision Babies have poor vision at birth but can see faces at close range, even for newborns. At about six weeks old, a baby's eyes should follow objects, and by four months, he or she should have conjugate movements, where the movement of both eyes are synchronised with each other. Over the first year or two, vision develops rapidly. A two-year-old usually would have gained around 90-95% of their distant vision. Given all the facts above, parents should be aware of signs of poor vision in children. If one eye turns or crosses, that eye may not see as well as the other eye. If the child is disinterested in faces or age-appropriate toys, or if the eyes rove around or jiggle (nystagmus), poor vision may be the reason. Another sign to watch out for is when the child tilts his/her head and squints. Unable to complain, babies and toddlers compensate for poor vision by showing the behaviours mentioned above. When to get an eye exam? The first recommended eye exam for your child is between the ages of three and five years. However, a complete eye exam can even be performed on a newborn child. Visual sharpness can be assessed on a child as young as three months to two years of age. Prescriptions for glasses can also be measured in even the youngest and most uncooperative child by using a special instrument called a retinoscope. It analyses light reflected through the pupil from the back of the eye. If you have any suspicion that your child is having visual problems, he/she should be examined right away. Towards healthier activities There must be some time allocated for parents to be with their children for at least a few hours a day. Encourage children to indulge more in outdoor activities like walking or jogging, under their parents' supervision. Throughout life, the eyes should be trained to look at any distance so that it does not develop significant refractive errors, be it for near or far distances. ■ Dr Asokumaran Thanaraj is a consultant ophthalmologist. This article is courtesy of Columbia Asia. 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. |
| Posted: 01 Sep 2012 06:47 PM PDT Aiming at a treatment target for rheumatoid arthritis leads to better outcomes compared to traditional follow-up care. IF you have high blood pressure (BP) or diabetes, you should be aware of what the doctor would like to achieve with treatment. In people with high blood pressure, the aim of treatment would be to reduce the BP to below 140/90, ie the target is to get the BP below 140/90. If there are additional medical problems such as diabetes, heart disease or previous heart attacks, then the target would be to lower the BP even further, to below 130/80. In diabetes, the aim is for the blood sugar to be as normal as possible. Thus, the target is for the fasting blood sugar to be below 5.5 mmol/l, or for the glycosylated haemoglobin (HbA1c) – the measure of diabetic control over the previous three months – to be below 7.0%. The doctor would discuss these "numbers" with you before treatment is started, and regular measurements are done to ensure that these targets are achieved during treatment. Achieving these targets leads to improved outcomes, with a reduction in organ damage/complications. Rheumatoid control Rheumatoid arthritis (RA) is chronic (ie long-term) arthritis leading to joint pain and swelling due to inflammation. Inflammation is the process in RA by which the joints get painful and swollen. Untreated RA leads to joint damage, and consequently, physical disability, with the attendant reduced quality of life. The need for early treatment in RA has been highlighted in many previous articles. Early treatment with disease-modifying anti-rheumatic drugs (DMARDs) has been shown to reduce joint damage, with ensuing better physical function. Apart from early treatment, once patients are onmedication, tight (or good) control of their RA would lead to a better outcome. However, in the past, there has been no consensus on such targets for RA patients. In 2008, an international Steering Group of rheumatologists (doctors treating arthritis) and patients met to develop a set of recommendations for the tight control of RA – "treat to target" (T2T). This was based on an extensive review of the research evidence available, followed by discussion amongst the international panel of over 60 doctors and some patients to achieve consensus. It was felt to be a timely initiative for several reasons. Firstly, there are now various methods commonly available to measure the amount of RA activity more reliably (rather like the HbA1c for diabetic patients) so that decisions on treatment changes can be made based on recognised and accepted activity scores. Secondly, medications have become available that can more effectively control RA compared to previously available drugs. Thirdly, research studies have shown that aiming at a treatment target for RA leads to better outcomes compared to traditional follow-up care. The resulting recommendations were then disseminated to rheumatologists worldwide. Overall, there was very good support from the rheumatologists, including those surveyed in Malaysia, with the recommendations. Patient recommendations The next step was completed earlier this year when the patient version of the recommendations was published. This was based on discussions with a few of the doctors involved in the initial T2T recommendations and nine RA patients from various parts of Europe. The patient recommendations and its main concepts are discussed further below. It is hoped that if patients are aware of the recommendations for the treatment of RA, they can start to understand why treatment is important, and have a dialogue with their rheumatologist about the treatment aims for their disease and how it can be achieved. The over-riding principle of T2T is that there is discussion between the doctor and patient about their treatment of RA and the goal of their treatment. Ideally, there should be agreement on the goal to maximise long-term quality of life by controlling the disease to stop joint inflammation. There is no doubt that uncontrolled inflammation in RA leads to joint damage. So it is important that RA disease activity/inflammation is measured regularly, and the treatment adjusted if the target is not achieved. This is an important concept – patients with RA are typically on several types of medication, and there can be a reluctance on their part to adjust medication, especially if they are already feeling better and can cope with the few swollen joints that are still present. In addition, some RA patients are concerned that the potential benefits do not outweigh the potential harm of the treatment, which makes adjustment of, and compliance with, treatment difficult. The recommendations that follow explain what the aim of treatment should be, and how to get there. The best target for patients with RA would be to get to a state of clinical remission. This means that there are no swollen or tender joints, and the markers of inflammation in the blood, such as the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), are within normal limits. If remission is not possible, then a state of "low disease activity" may be an acceptable alternative. In this state, there may be still some signs of inflammation, such as one or two swollen joints, or a slightly raised ESR or CRP. Both remission and low disease activity states significantly reduce the chances of progressive joint damage in RA, in contrast to patients with moderate to high disease activity. It is suggested that patients with moderate or high disease activity be seen in clinics more frequently, so that treatment can be adjusted until the RA goes into remission. Once under control, the frequency of the visits can be reduced. However, the recommendations do recognise that the process should be individualised; recommendation 9 states that, "Selecting the appropriate measurement of disease activity and target may be influenced by the individual situation: the presence of other diseases, patient-related factors or drug-related safety risks". Of course, these recommendations suggest what should happen in the ideal situation, where both doctor and patient have enough time and resources to achieve the optimum outcomes in RA. Nevertheless, as in the other medical conditions where doctors are encouraged to treat to a target, doctors treating RA should behave no differently in treating to a target. Even if resources are limited, there is no reason why we should not be trying to aim for the ideal and achieve as much as possible. Therefore, to all the patients with RA reading this, talk to your doctor about T2T! Overreaching T2T principles ·Decisions regarding the treatment of RA must be made by the patient and rheumatologist together. ·The most important goal of treatment is to maximise long-term health-related quality of life. This can be achieved through: (i) Control of disease symptoms like pain, inflammation, stiffness and fatigue. (ii) Prevention of damage to joints and bones. (iii) Regaining normal function and participation in daily activities. ·The most important way to achieve these goals is to stop joint inflammation. ·Treatment toward a clear target of disease activity gives the best results in RA. This can be achieved by measuring disease activity and adjusting therapy if the target is not achieved. Recommendations 1. The primary target of treatment of RA should be clinical remission. 2. Clinical remission means that significant signs and symptoms of the disease that are caused by inflammation are absent. 3. Although remission should be the target, it is not possible for some patients, in particular, those with long disease duration. Therefore, low disease activity may be an acceptable alternative. 4. Until the desired treatment target is reached, drug therapy should be adjusted at least every three months. 5. Disease activity must be measured and documented regularly. For patients with high or moderate disease activity, this must be done every month. For patients in a sustained low disease activity state or remission, this can be done less frequently (eg every three to six months). 6. Combined disease activity measurements, which include joint examinations, are needed in routine clinical practice to guide treatment decisions. 7. Besides disease activity, treatment decisions in clinical practice should also consider damage to the joints and restrictions in activities of daily living. 8. The desired treatment target should be maintained throughout the remaining course of the disease. 9. Selecting the appropriate measurement of disease activity and target may be influenced by the individual situation: presence of other diseases, patient-related factors or drug-related safety risks. 10. The patient has to be appropriately informed about the treatment target and the strategy planned to reach this target under the supervision of the rheumatologist. References: 1. Smolen JS, Aletaha D, Bijlsma JWJ et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 2010; 69: 631-7. doi:10.1136/ard.2009.123919. 2. De Wit MPT, Smolen JS, Gossec L, van der Heijde DMFM. Treating rheumatoid arthritis to target: the patient version of the international recommendations. Ann Rheum Dis 2011; 70: 891-5. doi:10.1136/ard.2010.146662. ■ Dr Yeap Swan Sim, Dr Gun Suk Chyn and Dr Heselynn Hussein are part of the Malaysian T2T Steering Committee. 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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