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| Posted: 22 Sep 2012 11:51 PM PDT A bacteria now recognised as a carcinogen for stomach cancer has been found to be using mothers as a means of transmission. HELICOBACTER pylori (H. pylori) is a bacterium that causes chronic gastritis, a long-term inflammation of the stomach. H. pylori infection is one of the most widespread, affecting about 50% of the world's population (over three billion people). It commonly causes ulcers, and accounts for more than 90% of duodenal ulcers and up to 80% of gastric ulcers. Before the discovery of this bacterium in 1982, spicy food, acid, stress, and poor lifestyle choices were considered the major causes of ulcers. The majority of patients were given long-term medications, such as H2 blockers, and more recently, proton pump inhibitors, without a chance for a permanent cure. Unfortunately, prolonged use of these medicines (which were administered to suppress hyperacidity) had been linked to the increased rate of atrophy or weakening of the stomach lining. In 1994, the International Agency for Research on Cancer classified H. pylori as a carcinogen, or cancer-causing agent, in humans. Today, H. pylori infection is well established as an important cause of stomach cancer, the second most common cause of cancer-related deaths in the world today. Several research papers have also shown a link between H. pylori infections and diabetes. While the prevalence of H. pylori infection is comparable between men and women, data shows that infected mothers are likely the main source for childhood H. pylori infection. Studies have found that H. pylori infections are usually acquired in childhood by age 10. Infection is most likely through ingestion of contaminated food and water, and through person-to-person contact (saliva). As mothers are usually the primary caregivers in a household, they have close contact with everyone under the same roof. A study conducted in Malaysia in 2010 found that H. pylori infection rates differed amongst different ethnic groups. Research carried out at Universiti Kebangsaan Malaysia (UKM) found that the highest prevalence of H. pylori infection was among Indians (45%), followed by Chinese (37%), and Malays 18%. Researchers were unclear about the reasons for the difference, although varying socio-cultural practices particular to each race is probably a contributing factor. This includes communal eating habits, diet, and genetic predisposition. Most individuals infected with H. pylori have few or no symptoms. Symptoms that could signal a H. pylori infection include episodes of gastritis, minor belching, bloating, nausea, vomiting, abdominal discomfort, and even bad breath. Individuals with more serious infections could experience persistent abdominal pain, nausea, vomiting (occasionally with the presence of blood), fatigue, and a sense of fullness after consuming a small amount of food. Infected individuals usually carry the infection for life, unless they are treated to eradicate the bacterium. While medical practitioners agree that H. pylori infections must be treated in order to prevent gastritis from worsening into ulcers or becoming a breeding ground for cancer, the current regimens are wrought with challenges. Patients with H. pylori infection feel lousy because their stomachs aren't functioning well. When put on treatment with antibiotics and other gastritis medications, many may feel worse. Side effects such as worsening stomach upsets, nausea, headaches and a metallic taste in the mouth, has led many patients to shy away from treatment or drop out without completing their course of medication. With increasing antibiotic usage, the bacterium has developed defences to overcome their efficacy. A study published in the October 2010 issue of the Journal of Infection and Immunity indicated that H. pylori may replicate on the cell membrane, ultimately forming a microcolony that is difficult for the antibiotics currently being used, to penetrate. Not only that, after two or three unsuccessful eradication attempts by antibiotics, a high rate of H. pylori resistance (50-73%) was observed. This means that every unsuccessful attempt to kill H. pylori only makes the bacterium stronger. Education is key in tackling H. pylori infection. Practicing good hygiene such as the washing of hands before and after meals, brushing teeth, no sharing of plates, glasses and cutlery, and no bed-sharing between siblings, is a must. In order to circumvent further infection, mothers should be tested for infection, especially if symptoms are present. Natural alternatives to treat H. pylori such as black or green tea, garlic and red wine, have been expounded on by naturalists, although there have been few reliable studies to substantiate such claims. Probiotics have been used to create a healthy colony of gut flora that builds a stronger immune system to fight H. pylori. However, probiotics alone are not strong enough to kill H. pylori. A study conducted by Swedish researchers on children in Bangladesh suggested that breastfeeding can protect children against early infection. Breast milk contains antibodies that can bind onto foreign substances (eg bacteria), and help prevent infection. "Children who have received high levels of antibodies to the peptic ulcer bacteria from their mothers during breastfeeding, were infected later than the children who had not received such high levels of antibodies," says Dr Taufiqur Bhuiyan from Sahlgrenska Academy, Sweden. In the world of nutraceuticals (natural substances with clinically proven benefits), the most promising results against H. pylori came from the Pasteur Institute in St. Petersburg, Russia, using a conifer pine needle extract. In a randomised double-blind clinical study, it was found to not only treat H. pylori infection, but also help restore stomach functioning, and reduce pre-cancerous lesions of the stomach in patients with atrophic gastritis. The research programme for the compound has been going on for about 80 years. Although it has been listed in the Russian pharmacopoeia since the 1950s, this research was a closely guarded secret within the tightly regulated former Soviet Union. It was only through an inter-government scientific exchange programme with Australia, and the fall of the old political regime that the technology developed to extract the compound was successfully preserved and brought into the limelight. References: 1. Brown LM. Helicobacter pylori epidemiology and routes of transmission. Epidemiol Rev. 2000;22:283–97 2. NIH Consensus Development Conference. Helicobacter pylori in peptic ulcer disease. JAMA 272:65-69, 1994 3. Kuipers EJ, Perez-Perez GI, Meuwissedn SG. Blaser MJ, Helicobacter pylori and atrophic gastritis: Importance of the cagA status. J Natl Cancer Institute 1995; 345: 1525-8 4. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International Journal of Cancer 2010; 127(12):2893–2917 5. Mehmet Demir, Huseyin Savas Gokturk, Nevin Akcaer Ozturk, Mustafa Kulaksizoglu, Ender Serin and Ugur Yilmaz, Helicobacter pylori Prevalence in Diabetes Mellitus Patients with Dyspeptic Symptoms and its Relationship to Glycemic Control and Late Complications, Digestive Diseases and Sciences, Volume 53, Number 10 (2008), 2646-2649 6. Weyermann M, Rothenbacher D, Brenner H., Acquisition of Helicobacter pylori infection in early childhood: independent contributions of infected mothers, fathers, and siblings; Am J Gastroenterol. 2009 Jan;104(1):182-9 7. Wu ML, Lewin KJ. Understanding Helicobacter pylori (editorial). Hum Pathol 2001; 32: 247-8 8. Baylor College Of Medicine. "Helicobacter Pylori Infection Most Common In Early Childhood." ScienceDaily, 15 Mar. 2002 9. Alfizah H, and Rizal AM, and Isa MR, and Aminudin A, and Jasmi AY, and Ramelah M , Four years analysis of helicobacter pylori infection among patients with dyspepsia at Universiti Kebangsaan Malaysia Medical Centre. Medicine & Health, 5 (1). pp. 13-21 10. Toshihiro Nishizawa et al , Antimicrob. Agents Chemother, 2011 11. Vladimir G. Bespalov, Vagif S. Soultanov et al. Pre-cancerous Conditions and Changes of the Stomach and their Correction. Medline-Express No. 2-3 (202), 2009 n This article is brought to you by the Nuvaceuticals Division of Nuvanta Sdn Bhd. |
| Posted: 22 Sep 2012 11:49 PM PDT We are all familiar with the benefits of exercise, but overdoing it can yield some pretty debilitating results, especially on one's social life. This writer shares how her addiction to exercise nearly ruined her vacation. IT was freezing in peaceful Jeju island – a popular vacation spot in South Korea known for its natural sights and beaches – when this writer set foot there a few months ago. Drenched from the evening rain, I had been shaking like a leaf despite being wrapped up in a long black coat and shawl. It was so cold that my fingers were numb. Inside, however, I was seething with raging unease. It had been nearly a week since I hit the gym, and my body was threatening to explode from pent-up frustration. "I would rather not eat or sleep than to not exercise" – a recalcitrant, if silly stand I have reiterated on my Facebook timeline every now and again. Yet, eating and sleeping was all I did in between stopovers at commercial touristy destinations during my 11-day bus tour across the south of Korea. It was springtime when the boyfriend and I set out for our Korean retreat. We began our journey in Seoul, and had stayed in different hotels across the country for every night throughout our trip. That meant having to wake up at 6am every morning to pack and prepare for the day's trip. I had planned on going jogging at night, but was often too exhausted from the tour's activities, which typically ended at 10pm. Plus, the frigid cold in places like Mount Sorak and Jeju island left the prospect of running outdoors entirely out of the question. Most of the hotels we stayed in didn't have a gym either. I did bring a jump rope with me, but the cramped hotel facilities diminished whatever possibility of me having a good workout. It was around day five when I started to notice that my triceps were losing their definition. I was frantic. It was only a matter of time before the rest of me swelled into a big, blubbery balloon. I was getting fat, fat, fat, fat, fat, and I was losing it. I tried to make up for the lack of physical activity by eating as little as I possibly could throughout my trip, but for most of it, I was also moody, grumpy, and constantly lashing out at my boyfriend for no good reason. It wasn't until my usually mild-mannered other (and better) half threatened to buy me a ticket on the next flight home, halfway into our trip, that it hit me: maybe I was taking my preoccupation with exercise a little too far. I have been an avid gym-goer for years, but never have I imagined that exercise would start to take over my life. My fitness regime has taught me patience, perseverance, discipline and determination, and has since transformed me from a bumbling fat kid into a self-assured, confident woman – so how could something so good be bad for me? It turns out that even the sacred domain of exercise is not exempt from the "too much of a good thing" rationale. We are all familiar with the benefits of exercise – weight loss, better health, better sleep, and so on – but overdoing it can yield some pretty debilitating results. According to the American Running Association, when the commitment to exercise crosses the line to dependency and compulsion, it can create a physical, social and psychological quagmire for the avid exerciser. The phenomenon typically plagues runners. As Richard Benyo, an American journalist and veteran distance runner writes on the subject in the Road Runners Club of America: "The exercise addict has lost his balance: Exercise has become overvalued compared to elements widely recognised as giving meaning in a full life – work, friends, family, community involvement – in short, the fruits of our humanity." To the addict, more is always more – more training, more hours, more mileage, more intensity. Anything that comes in between them and exercise is immediately resented. Signs of addiction include withdrawal symptoms like anxiety, irritability and depression when one's circumstances prevents one from working out. Uh-oh. Sounds like we have a problem. Personally, I don't run and I am not one for outdoor adventures (I work out on the elliptical trainer and I cycle), but I have been known to miss out on dinner dates and movie nights with my boyfriend and friends just so I could have a good workout at the gym. But exercise addiction, like any other addiction, can cost you more than just a night out with popcorn. To quote Benyo again: "The obsession bites back in the form of chronic injuries, impaired relationships and other problems." Frankly, I am getting a little paranoid. Have I been overdoing it? I had after all, been a wet blanket for most of my trip in South Korea because I just couldn't stand NOT exercising (I usually exercise up to five times in a week). I am still in my 20s, and already, I have been experiencing knee problems due to my bad form while cycling and from attempting barbell squats. Osteoarthritis, the lesser-known but equally malignant cousin of osteoporosis, is another probable consequence of exercise addiction. Osteoarthritis is a common joint disorder, which is usually due to aging, and wear and tear on a joint. There are no conclusive findings on the correlation between osteoarthritis and exercising to date; what is clear, however, is that osteoarthritis can be caused by trauma to, or overuse of the joints. According to the Journal of the American Osteopathic Association, "People who engaged in sports or other physically demanding activities are known to be at an increased risk of osteoarthritis in the joints they use most (eg knees and hips in soccer players, and hands in boxers). "Part of this apparent correlation can be explained by increased risk of joint injury. It would also seem logical that these groups would be predisposed to osteoarthritis from overuse injuries, and not necessarily from trauma." My colleague and self-professed outdoor enthusiast Leong Siok Hui, relates how constant and strenous physical activities has resulted in the wearing-and-tearing of her knee cartilage. Leong is only 41, but she already requires knee surgery. Years of mountain climbing, running and cycling constantly have resulted in the deterioration of her knee joints, she shares. She also has patella maltracking, a condition in which the patella does not remain within the central groove of the femur (thigh bone), and that has exacerbated the wearing down of her knees. She is currently undergoing stem cell regeneration treatment for her knees. She misses the "runner's high", and still tries to fit in low-impact exercises, such as working out on the elliptical trainer, into her routine. "This," she says, pointing to her knees, "should not be a reason to stop exercising." So why push so hard? It is a question that exercise addicts get asked a lot. I am not an athlete. I have no performance goals. I don't even run marathons. So why try? I wish I knew. During a more recent trip to Shanghai, I woke up at 4am just to hit the hotel gym to burn off the chocolate cake I had for dessert. That session did leave me quite dizzy, and I am grateful that I didn't pass out. I recently took up CrossFit and the workouts-of-the-day (WODs) have not been kind to my body either. Movements like the "clean", the "snatch", and kettlebell swings have given me a sore back, a sore neck and bruises across the length of my legs, and I've only been at it for about a month. What's in it for me? I really don't know. I just want to be good at it, and I am far from giving up. For what it's worth, at least my pursuit for fitness has served as a rather effective anger management mechanism, and has kept me sane through many a bad day at work. Also, the world just seems a little less crappy when I'm working out, and I plan to continue doing this for as long as I breathe. The remedy for this addiction is pretty obvious – just cut back on exercise, d'oh. But try telling Homer Simpson to cut down on his doughnuts, and you'll see that it's easier said than done. The American Running Association suggests that exercise addicts should try to change the emphasis of their exercise from quantity (meaning that more isn't always better) to quality. For instance, you can try engaging in 30-minutes of interval training, rather than an hour of low-intensity training. Try talking to an experienced personal trainer, and get him or her to plan out your workouts on a weekly basis. Draw a seven-day schedule, planning frequency, intensity, time and type of exercise with specific, reasonable goals relative to your abilities. Very importantly, stick to your programme, and make sure that rest and recovery are given equal emphasis as they are essential in any well-balanced training programme. Again, the above is easier said than done. I often feel like biting the heads off imaginary puppies on days when I'm not working out, but it's better to be safe than sorry. If I have to force myself to take a day off exercise, so be it. I am currently working on cutting down exercising from five to four days a week. There is no point in pushing myself to exhaustion all the time, only to end up with a series of injuries. I want to be 60, and still rocking my six-pack abs. Being addicted to exercise is hard, especially when you're living in a population where 20% are reportedly obese. As if being addicted to exercise doesn't do enough to alienate me from family and friends, I have recently taken on the Paleo Diet, which is based on this simple premise – if the cavemen didn't eat it, then you shouldn't either. Essentially, the Paleo Diet cuts out processed foods like grain products, legumes and dairy, and comprises mostly of meat, poultry, fish and veggies. Understandably, I have been preparing most of my own meals since. My colleagues make faces at my steamed chicken breast and vegetables, and my McDonalds-loving boyfriend thinks I'm crazy, but I think it's worth it. I have gained nearly 3kg of muscle mass in just a few months and my skin feels less oily than before. I turn 21 (again!) this weekend and I have told my mum not to get me a cake. But perhaps I really ought to give this health and fitness thing a break. After all, it is my birthday, and surely a tiny slice (or five) of moist chocolate cake wouldn't hurt... And when it hits my thighs, I can always burn it off at the gym. n Fiona Ho is a fitness enthusiast and a newly certified personal trainer by the American Council on Exercise (ACE). Her current interests include CrossFit and RPM classes. |
| Posted: 22 Sep 2012 11:47 PM PDT Inflammatory bowel disease does not only affect adults – children are not spared too. ALTHOUGH inflammatory bowel disease (IBD) is more common in the West, it has been on the rise in Asia over the past four decades. Most cases usually occur in those aged 15 to 30 years old. In childhood, the peak incidence is between 11 and 13 years, but it can also occur in younger children. In general, this long-term disease leads to inflammation of the intestines and damages the intestinal lining. Ulcers may form, which result in bleeding. The various types of IBD are Crohn's disease (CD), ulcerative colitis (UC), and allergic colitis (AC). Sometimes, the term indeterminate colitis (IC) is used to refer to cases that are impossible to accurately categorise. In a worldwide context, however, it is important to note that infection, and not IBD, is the most common cause of gastrointestinal inflammation. In general, CD can affect any part of the gastrointestinal tract, from the mouth to the anus, whereas UC affects only the colon and rectum. UC is more common than CD in Asian countries, but the incidence of CD appears to be rising. CD is more common in men, while the incidence of UC is equal in both genders. In Malaysia, IBD affects Indians more than other ethnic groups. On the other hand, AC mostly occurs in infants and young children. It is due to allergies to foods like cow's milk, egg, soy or wheat. It usually occurs concurrently with other conditions such as asthma, eczema and hay fever, but children with minor immunodeficiency may also get it. Causes of IBD The underlying cause of IBD is still unknown despite a large amount of research into it, but experts believe that IBD is caused by a combination of factors such as: ·Genetics: Research suggests that for people with IBD, there is a gene which mutates, causing the body to react abnormally to microbes like bacteria, viruses or protein in food. If your child has a blood relative with IBD, he or she is at a slightly higher risk of developing the disease. ·Immune system: Many immunological abnormalities have been described in patients with IBD, but none have yet to be convincingly shown to be the main causative factor. ·Environment: Cigarette smoke or the spread of bacteria or viruses can trigger an ongoing immune system response, or aggravate the disease. These environmental factors can damage the intestinal lining directly, triggering the start of the disease or accelerate its development. ·Diet: An unhealthy diet can worsen symptoms. Does your child have IBD? Pay attention if he or she displays various combinations of these symptoms: ·Diarrhoea (can be as often as 20 times a day, or more) ·Abdominal pain ·Rectal bleeding (blood in the stools) ·Skin pallor (anaemia caused by blood loss through stools, or the intestinal inflammation itself) ·Loss of appetite ·Lethargy ·Weight loss ·Fever ·Recurrent mouth ulcers that are difficult to heal ·Inflammation in the eyes or skin Those with IBD do not necessarily experience symptoms all the time. A child may go through periods of flare-ups and periods of no symptoms. Nonetheless, proper treatment must be given, especially since IBD might delay puberty, or stunt a child's growth, due to nutrient loss. In some cases, complications from CD can develop, including: ·Fistulas (abnormal openings between parts of the intestine, or between the intestine and another organ, such as the bladder or skin) ·Obstruction or rupture in the small intestine or colon ·Skin rashes ·Arthritis If you think your child might have IBD, please consult a doctor. The doctor might perform several tests to determine the diagnosis, including blood tests, colonoscopy, gastroscopy, barium X-ray and tissue biopsy. Helping your child cope with IBD Because there is no telling when symptoms may resurface after remission, managing the disease can be difficult. Your child may feel tired, uncomfortable and irritable, so do your best to help your child receive the right treatment, and adopt a suitable diet for his or her needs. Here are some tips: ·If your child has been prescribed medication by his or her paediatrician, make sure he or she takes them as instructed. Usually, anti-inflammatory drugs and immunosuppressive drugs are prescribed for IBD. ·Talk to the doctor about any queries you might have. Discuss your child's symptoms. Don't be afraid to ask what you need to know from the doctor. ·Ask the doctor about foods to avoid giving your child. Over time, your child should also find out which foods in particular provoke their symptoms, and make a note to abstain from eating them. Discourage intake of junk food as these can exacerbate IBD symptoms. To help control symptoms, try giving your child smaller meals throughout the day. Prepare healthy lunches and snacks for him or her to bring to school. ·Encourage your child to exercise regularly as this helps to give him or her more energy and reduce stress. With proper treatment and management of IBD, there is no reason why a child cannot lead a normal, active life. ■ Prof Dr Christopher Boey Chiong Meng is a professor of paediatrics and consultant paediatric gastroenterologist. This article is courtesy of the Malaysian Paediatric Association's Positive Parenting Digestive Health Initiative For further information, please visit www.mypositiveparenting.org. 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. |
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