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Posted: 29 Sep 2012 06:27 PM PDT

The perception that cardiovascular disease mainly affects males and the elderly is horribly inaccurate; women, as well as children, are not spared this deadly disease.

Rachel Low woke up one morning to a strange feeling: she was overly tired and had a nagging pain in her left arm, shoulder, neck and breast. Then, she began sweating profusely, as if 'I was having a major hot flush'.

She continued ignoring her symptoms, but incessant nagging from her husband led her to reluctantly pay a visit to the doctor. The doctor-in-charge diagnosed her as "an anxious new mother" and subsequently sent Low home with painkillers and muscle relaxants.

The symptoms persisted, and the next day, Low collapsed at the dinner table.

"I did not think that what was happening was a heart attack. At the hospital, I was shocked when the hospital staff told me I was having a heart attack."

On a bright sunny morning one month ago, 42-year-old Jason Tan didn't know his short drive to work would change his entire life. "I started to feel a burning sensation in my chest, as well as discomfort from arm to shoulder. I broke out into a sweat, felt nauseous, and my head was spinning."

He kept on driving, figuring he was just anxious. He had a big presentation to the company's president that morning, and he had pulled an all-nighter preparing for that.

"At the time, I was a smoker, so I lit up a cigarette, figuring that it would reduce my anxiety."

It didn't. He kept ignoring the symptoms, got to work, and felt worse.

"It felt like all my body functions were out of control. I experienced crushing chest pain, left arm numbness, pain in my left arm. It felt like an elephant was sitting on my chest.

"A colleague called an ambulance for me. I just remember sitting on the floor, and people gathering around and watching me have a heart attack," he recalls.

Low and Tan have both joined the largest club in the world, dubbed by American actor and comedian Robin Williams as the "brotherhood of the cracked chest".

According to the World Health Organization (WHO), in 2008, coronary heart disease was responsible for 7.3 million deaths. Over 80% of those deaths takes place in developing nations like Malaysia, and occur just about equally in both men and women.

In 2030, if the WHO's projection is right, 23.6 million people will die from heart disease. Not in the picture are the millions more who will suffer from the crippling effects of a "damaged" heart.

"I never added up the symptoms. Instead of saying I'm having a heart attack, I thought maybe it was indigestion or stress anxiety. It's like everything else; you just don't think it's going to happen to you. And I don't know if that's being ignorant or just really believing you're healthier than that," says Tan.

According to senior consultant cardiologist Datuk Dr Khoo Kah Lin, "Often, many patients think they just have heartburn. A lot of people think you're supposed to clutch your chest and collapse, much like a 'Hollywood heart attack'."

"Some people only get pain in their jaws, so they get a pressure, a heavy feeling, a tight feeling in their neck. Many people think it's pain, but actually, it's not pain. A heart attack is pressure, a heavy feeling. It's a tight feeling across the chest. This tight feeling is often misconstrued by patients, making them think that it can't be a heart attack because a heart attack has to really hurt. It doesn't have to hurt, it's a tight feeling," adds Prof Sim Kui Hian, head of the cardiac unit at Sarawak General Hospital.

Women have different symptoms

According to Low, "I suffered significant heart muscle damage as a result of my heart attack, partially because I waited so long to go to the hospital, and partially because once I got there, it took the hospital casualty staff over two hours to realise what was going on.

"I feel so lost and confused about the whole experience. I am a mother of three children, and I am not ready to die."

Experts say for every minute the heart artery remains closed, the greater the heart muscle damage.

"Women need to accept that the threat of heart disease and stroke is very real. Heart disease is not a male-only disease," stresses Tan Sri Dr Robaayah Zambahari, senior consultant cardiologist and Women's Heart Health Organization (WH2O) chairperson.

"Just as important is the fact that women who make lifestyle changes to improve their health can reduce their risk of premature heart disease and stroke by as much as 80%."

According to a report published by WH2O, one in every four Malaysian women die each year from heart disease and stroke. Yet, stop a woman on the street and she is unlikely to list heart disease as a concern. The signs and symptoms in women can be subtle – nearly two-thirds of women who die suddenly of a heart attack had no prior symptoms. As a result, about 50% of women who experience heart attacks die before they reach hospital.

Women are less likely to experience chest pain than men. Even if they do, the pain experienced is milder, and can be described as pressure, or an ache. This discomfort is usually felt in the centre of the chest, and lasts for more than a few minutes; the pain may come and go.

"Because women who develop heart attacks usually do not experience severe chest pains, they are often given lower priority than men, who would usually come in with chest pains at hospitals," notes Dr Robaayah. "Women with heart disease are often misdiagnosed or under-treated. Those who are correctly diagnosed often feel isolated and confused."

Markers for heart disease

Risk factors for coronary artery disease were not formally established until the initial findings of the Framingham Heart Study in the early 1960s.

It is now known that a number of protective lifestyle factors are associated with a marked decrease in risk of coronary heart disease, cerebrovascular disease, and overall mortality. Such lifestyle factors include dietary pattern, physical activity, alcohol intake, sleep, smoking status and body mass index.

Dr Khoo advises: "You have to keep an eye on your cholesterol level, so you'll need to be doing a lipid test every six months. Blood pressure is an issue, so watch your salt intake. Go on an exercise programme. And watch your stress, because we know stress is a really important risk factor."

Both Tan and Low know the drill. These days, lunch or dinner looks a lot different.

"I used to eat char kuay teow or mixed rice piled with meat. I'm not sure if there is anything worse for you," says Tan.

With a low-fat diet and medicine, his cholesterol level is now down.

For the first time in 10 years, Tan is exercising, and four days in the hospital helped him quit his pack-a-day habit. "It's all for the good. I'm still getting used to it."

He advises: "Stop smoking; that's the first and foremost thing. Along with diet and exercise, that's three things you have to do. It's key that you maintain a healthy diet, and you do get out and walk or run or swim or do some physical activity a few times a week."

For a guy who never thought he would have a heart attack, he now knows how to prevent another one. Tan knows he has a second chance, one he doesn't want to squander.

Being practical

Once Low was discharged from the hospital, she asked herself repeatedly: "What can save me from another heart attack?"

Her cardiologist has this plain reply: "Simple lifestyle changes."

These lifestyle changes mean increasing your physical activity, a healthy diet, and giving up unhealthy habits like smoking or drinking excessive amounts of alcohol.

But that is the only solution.

"I work almost 12 to 14 hours a day. Deadlines have to be met, bosses have to be cajoled and pleased. Often, it is an unimaginable struggle just to keep afloat. I barely have time for proper meals – one or two meals in a day suffice for me," says Low.

"There are plenty of snacks and instant meals in the pantry, plus coffee and tea for hunger pangs. Call me an emotional eater, but that's how I keep sane.

"Cheap, convenient and easily accessible, that's usually the type of food my family goes for. Of course, we know the importance of healthy eating. But we can only afford to do what we can, given the circumstances. We try as much as possible to ask the waiter to use less oil or salt, and even call for kurang manis at the mamak.

"We have two young children to feed, and my husband is also working full-time, but still, we can barely make ends meet.

"My schedule for the day is so tight that I can't find the time to exercise. By the time I finish work, I am so drained that sleeping is all I can think about."

Low knows she is living on borrowed time, but for her and many others today, this is just the reality we are saddled with. Of course, we recognise that healthy diets and regular, adequate physical activity are major factors in the maintenance of good health; mainstream media, our parents, in-laws, have incessantly pounded that fact into us.

"Walk 10,000 steps a day," says one source. "Stress is bad for you. You must stay calm and practise meditation like a yogi," and "Eat a rainbow of vegetables every meal," say others.

We are also told that cardiovascular disease is the world's most vicious killer. People who have high blood pressure, high levels of cholesterol and glucose, overweight and obese, those who smoke, and those who rarely engage in physical activity, are all at high risk of cardiovascular diseases such as heart diseases and stroke.

Heart disease is a "lifestyle" disease that can be mitigated by changes to behaviour. In other words, victims "brought it upon themselves".

However, many argue that unsafe outdoor space, exacerbated by rapid development and decreased availability of green space for exercise and recreation forces individuals to a more sedentary lifestyle.

Such restrictions and influences "nudge" individuals into behaviours that predispose them to heart disease; for them, there is no option for a healthier lifestyle.

However, as Prof Sim puts it, there is no such thing as "I can't do this". Simple practices such as packing a fruit or two in your bag so that you have something to munch on when you get hungry in between meals, or drinking a glass of water prior to meals, are practical examples we Malaysians can adopt.

If your office is on the 10th floor, why not take the lift up to the 7th floor, and walk up the remaining distance via the stairs?

States Dr Robaayah: "If you have not exercised for many years, we are not expecting you to turn into a buffed-up fitness enthusiast overnight. Take time to gradually build your stamina by adopting a consistent exercise routine."

In fact, studies have shown that even 15 minutes a day or 90 minutes a week of moderate-intensity exercise may be beneficial.

At the end of the day, it's all up to us – give excuses for the lifestyle we live, or take the challenge and make positive changes that will benefit you in the long run.

> This article is a courtesy of THE HEART 2012 Exhibition, organised by Institut Jantung Negara & Yayasan Jantung Malaysia with the support of AIA as the official partner. THE HEART Exhibition 2012 was organised in conjunction with World Heart Day 2012. As part of their efforts, a book entitled "The Heart" was published. This book has all the basic information about heart diseases and what you should know about them. For copies of the publication, email the programme secretariat through hsieng.loong@versa-group.com or meichieng@versa-group.com for details.

Therapy in cancer

Posted: 29 Sep 2012 05:17 PM PDT

Is nutritional therapy part of the future of cancer treatment?

THERE was a lively discussion at the recent International Conference on Holistic Healing for Breast Cancer in Kuala Lumpur organised by Cansurvive Malaysia. I was privileged to be involved in the event as session moderator, panellist as well as speaker.

Being a conference on holistic healing, there were speakers with a wide range of expertise and perspectives (from Ayurveda to modern medicine to Vasthu to yoga). What I would like to share here is something I did not have the opportunity to elaborate on during the panel discussion due to time constraints.

When it comes to cancer, the main worries include: What are the causes? Why is the incidence rising? What are the treatment options? And why do most cancer patients still die despite advancements in medical science and the trillions spent on cancer research?

We were fortunate to have Datuk Dr Suseela Nair as a speaker and panellist. She is a senior breast surgeon with much knowledge and experience in managing breast cancer patients, at least from the surgical perspective.

It would not have been a balanced discussion if only the complementary health practitioners were there. Even though I am a medical doctor, my interest in cancer management is in the role of nutritional therapy and qigong.

It would have been even better if we also had an oncologist on board. However, attempts to get an oncologist to be involved in the Cansurvive conferences in the last two years have been futile. We may be luckier next year.

I would like to invite readers to contemplate the dilemma of the overall failure of the gold-standard medical treatments in the management of cancer. Why do I say that it has been a failure? Let me refresh you with findings published in several of the top medical journals on the usefulness of chemotherapy for cancer:

Clinical Oncology (2004)16:549-560): Overall, chemotherapy contributes just over 2% to improved survival in cancer patients in Australia and the US. Currently, eight years later, this conclusion has not been refuted.

Journal of the National Cancer Institute of NIH (USA), Sept 1993: Chemotherapy helped only 7% of patients in terms of "durable response" and prolonging survival.

Lancet, 1991, Vol. 337, p. 901: "Many oncologists recommend chemotherapy for almost any type of cancer, with a faith that is unshaken by the almost constant failures." – Dr Albert Braverman, Medical Oncology in the 90s

Followers of this column would also know that I had a close-up experience of this failure when my own sister died of breast cancer last year after undergoing all the surgery, radiotherapy, chemotherapy, and smart-drug therapy her doctors recommended. It is one of many recurring stories of cancer patients dying,F despite the best of what modern medicine can offer.

I am not saying that there have been no success stories, but the statistics (as published in the medical journals and reported regularly by the authorities) tell us that overall, cancer treatment has failed. For example, last year there were about 230,000 new cases of lung cancer in the US (arguably the most advanced in medical science), with about 160,000 deaths. For breast cancer, it was 230,000 new cases with 40,000 deaths.

Understanding statistics

Why is this so when we always read fantastic reports on new chemo or smart drugs that show improved survival rates?

To understand the whole picture, you need to understand simple statistics and how results can be presented to look good.

For example, a new drug is claimed to give 25% longer survival rate than the current best drug. That sounds impressive indeed, until you look into the details and discover that the survival rate using the previous drug was four months, and the new drug gives five months (one month longer = 25% improvement).

There are also the potentially dangerous side effects that the new drug may cause, which may further make it unbeneficial. And the newer drugs are usually more expensive.

In fact, this has been the typical snail-paced advancement in the development of new drugs for cancer therapy. Of course, many small steps would eventually equal a big step, but the progress has been painfully slow, in spite of the trillions spent over many decades on research.

The bevacizumab story

In 2008, the "smart" drug bevacizumab received "fast-track" approval as a treatment for metastatic breast cancer from the US Food and Drug Administration (FDA) because of reported improved survival rates. It became the "hot" drug for those who could afford it (RM7,000-15,000 per month, depending on subsidy received), even though the side effects can sometimes be severe (eg hypertension, bleeding and intestinal perforations).

In November 2011, the FDA revoked the approval for its use in breast cancer because follow-up studies showed that women taking the drug did not live longer than those not taking it. Many oncologists refused to follow this, and continued prescribing it to their breast cancer patients.

Many patients also trusted their oncologists and willingly continued with the hope for better survival. In fact, because of this hope, there is a movement to demand that the FDA reverse its decision.

In July 2012, The Cochrane Database of Systemic Reviews (one of the most respected independent reviewers of research data) published results of their review of all the seven randomised controlled studies on bevacizumab. It found that bevacizumab neither prolongs the lives of breast cancer patients, nor improves their quality of life.

Researchers found that patients who took bevacizumab along with their chemotherapy treatments survived about two to six weeks longer than those who took a placebo with their chemotherapy – but the difference between the groups could have been due to chance or factors other than the drug, according to the study.

The drug is still approved as a treatment for colon cancer and certain types of lung cancer and brain cancer in the US, and still approved for breast cancer in UK. It is still used for breast cancer by many oncologists.

I relate this story to illustrate that the trust put on evidence-based medicine is very high, but when it proves contrary to their expectations, even doctors ignore the evidence.

There have been other drugs that were withdrawn after more comprehensive studies negated the initial studies that led to their approval.

The apigenin story

Apigenin is a bioflavonoid found in many fruits and veggies (eg celery, parsley). Since 2005, studies (on cancer cells and cancers grown in live rats) have shown that apigenin induces cancer cell death (apoptosis), and shrinks the tumours of several types of cancer with minimal or no side effects.

Earlier this year, a University of Missouri study on rats showed apigenin to be effective in shrinking aggressive human breast cancer tumours stimulated by a progestin ( medroxy progesterone acetate is a progestin or synthetic progestagen hormone commonly found in female hormone replacement therapy drugs).

However, unlike bevacizumab, which was relentlessly researched and received "fast-track" approval, the research on apigenin is likely to stop here, despite the encouraging results. The reasons, as stated by researcher Salman Hyder, are as follows: "Clinical trials of apigenin with humans could start tomorrow, but we have to wait for medical doctors to carry out that next step... but finding funding for clinical testing of apigenin in humans may be difficult... since apigenin is easily extracted from plants, pharmaceutical companies don't stand to profit from the treatment; hence, the industry won't put money into studying something you can grow in your garden."

The nutritional therapy story

Sadly, many potential nutritional therapies for cancer remain at the "unproven" stage because nobody is interested to proceed with expensive human clinical trials, even though lab and animal studies have proven them to be effective.

Until randomised controlled human trials are done, no valid claims/conclusions can be made, and the treatment method cannot be accepted widely. So many nutrients with good lab study results are abandoned without sufficient clinical trials, eg fucoidan (brown seaweed extract) and ß-glucan.

Smart drugs vs nutritional therapy

The basic difference in the approach to fighting cancer between the two contrasting methods is this:

Chemotherapy (and smart drugs) attempts to damage/kill cancer cells, but also damage/kill normal cells, including the defence/immune cells that are required to fight the cancer and infections.

The challenge is to reduce the "collateral damage", which is often severe, and even fatal.

Nutritional therapy has three aims:

·Provide general nutritional support in the situation of poor appetite and undernutrition/cachexia (especially if undergoing chemo/radiotherapy).

·Empower the defence/immune cells to fight the cancer.

·Directly damage/kill cancer cells (eg by causing apoptosis) just as the chemo drugs do, but without harming normal cells.

My opinion is that the concept of fighting cancer the chemotherapy way is wrong. That is why finding the perfect chemo drug (kills cancer effectively, with no or minimal side effects) will be a neverending story. We have better hope if we spend the trillions researching the nutritional therapies that have shown promising results thus far. In other words, we have been betting on the wrong horse.

It is my fervent belief that the definitive answer to cancer is in nutritional therapy, and not chemotherapy, and not even the so-called "smart" drugs.

> Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. 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.

Feeling tired and listless?

Posted: 29 Sep 2012 05:17 PM PDT

Energy is the currency of life, and when energy levels are low, many aspects of life can be affected. You can take steps to prevent this from happening.

JOE Lang, 53, has been a regular customer at a pharmacy in Klang for many years. He recently came in complaining that his energy levels were not what they used to be and that he feels lousy in general.

His wife told the pharmacist in confidence that her husband loses his temper easily these days, especially when she tells him that he is getting forgetful. Last week, he could not find his mobile phone – it had been left on the roof of his car.

Joe just started taking a cholesterol-lowering medication about two months ago.

If you think that Joe's condition is simply another unavoidable affliction brought about by age, then you are surely missing out on an opportunity to stay young even as you grow older. This is no fairytale, just smart science.

Keeping energy levels up

Many have undertaken the journey to discover the fountain of youth, and nutritionally, the most promising results have emerged from the study of co-enzyme Q10 (CoQ10).

Since one of the primary symptoms of ageing is declining energy levels, scientists began their search at the cellular level of human energy production. Every human cell relies on the cellular energy powerhouse (the mitochondria) to generate all our energy requirements.

CoQ10 was discovered in 1957 in the US by Dr Frederick Crane and his team, while its function was determined a year later.

However, a lot more hard work and millions of research hours went into finding out whether CoQ10 had any nutritional significance, and if it could be used in the treatment of disease.

After several false starts, the first successful use of CoQ10 for the treatment of heart failure was discovered in 1967. Since then, a vast number of studies have explored the effects of CoQ10 in a variety of conditions such as heart disease, diabetes, gum disease, cancer, Parkinson's disease and migraine headache.

Understanding CoQ10

CoQ10 is a co-factor which is required by every cell in the body. It helps in the production of 95% of the energy we need to live. It is also an antioxidant that can help prevent free radical damage to our cells.

The difference between a child and an elderly is the varied levels of CoQ10 in their bodies – ageing depletes natural CoQ10 levels and produces more free radicals.

CoQ10 is so critical that our body naturally produces it as soon as we are born. However, production stops around the age of 25, after which levels steadily decline. By the time we approach our 40s, our cells only have about 40% of CoQ10 left.

Ageing is not the only factor that causes the body to be short of CoQ10. Stress and exercise as well as drug interactions also deplete this energy nutrient.

Do you know that commonly prescribed medications "eat up" CoQ10? Blood-pressure lowering drugs (beta blockers) and cholesterol-lowering drugs (statins) block the production of CoQ10. In fact, statins can reduce blood levels of CoQ10 by up to 40%.

Other drugs that reduce CoQ10 levels in the body include hormone replacement therapy (HRT) and oral contraceptives. Patients on these types of drugs may find themselves unduly tired, irritable, unable to handle stress well and aggressive. They may also experience muscle weakness and feel downright depressed.

Symptoms such as these are not part of ageing but occur due to CoQ10 deficiency.

As CoQ10 is involved in so many processes that enable the body to function, it is hardly a good idea to shut down the energy supply to your body, what more when already stricken with high blood pressure or high cholesterol.

Correcting deficiencies

Restoring CoQ10 levels may help you "turn back the hands of time", so to speak, as more energy is channelled to all cells. You become more energised and alert, and your heart and immune system work better. Overall, a CoQ10 boost leads to you feeling better, younger and happier. In Japan and certain European countries, patients can receive government support for CoQ10 therapy. While this is not the case with Malaysia, it is interesting to note that the Ministry of Defence has included CoQ10 in its formulary list, where it is procured for military use.

With so many CoQ10 formulations out there, it is not unusual for consumers to be confused over which to choose. Here are some key pointers to help you select an ideal CoQ10 formulation for your needs.

CoQ10 is a large and oily molecule, which makes it difficult to be absorbed by the body. Therefore, hydro-solubility is crucial when making your choice. Hydro-soluble CoQ10 is a type of CoQ10 that has been rendered water-soluble through a patented technology.

A study published in The New Zealand Medical Journal reported that hydro-soluble CoQ10 was three times better absorbed than other CoQ10 formulations in whichever form, be it oil-suspension in capsules, tablets or powdered CoQ10 in capsules.

Understanding how CoQ10 is absorbed is also important. CoQ10 exhibits non-linear pharmacokinetics, which simply means that putting too large a dose actually hampers absorption, leading to greater wastage. Ideally, you should select a product that offers 30mg of CoQ10 enhanced with the patented hydro-soluble technology so that you benefit from an optimal dose.

Ask for proof that the CoQ10 you are buying actually works, especially if the CoQ10 is being used for treatment purposes. Clinical studies using hydro-soluble CoQ10 show that it improves heart performance in patients with heart failure, resulting in improvement in symptoms such as shortness of breath, palpations and weakness.

Hydro-soluble CoQ10 has also been shown in studies as an antioxidant capable of reducing cell death by up to 50% besides being able to recycle other antioxidants such as vitamins A, C and E, hence its reputation as a super antioxidant.

Now back to Joe. The pharmacist decided to put him and his wife on hydro-soluble CoQ10. For Joe, it was to help him overcome the CoQ10 deficiency which occurred due to ageing (and likely from his cholesterol medication). Apparently, Joe is back to his normal self and is much sprightlier.

References:

1. Kishi, T; Watanabe, T; Folkers, K (1977). Bioenergetics in clinical medicine XV. Inhibition of coenzyme Q10-enzymes by clinically used adrenergic blockers of beta-receptors, Research communications in chemical pathology and pharmacology 17 (1): 157–64.

2. Seehusen DA, Asplund CA, Johnson DR, et al; Primary evaluation and management of statin therapy complications.; South Med J. 2006 Mar;99(3):250-6.

3. Ghirlanda, G; Oradei, A; Manto, A; Lippa, S; Uccioli, L; Caputo, S; Greco, AV; Littarru, GP (1993), Evidence of plasma CoQ10-lowering effect by HMG-CoA reductase inhibitors: a double-blind, placebo-controlled study, Journal of clinical pharmacology 33 (3): 226–9.

4. Seema R. Lalani, MD; Georgirene D. Vladutiu, PhD; Katie Plunkett, MS; Timothy E. Lotze, MD; Adekunle M. Adesina, MD, PhD; Fernando Scaglia, MD. Arch Neurol. 2005;62:317-320.

5. Adarsh Kumar, N.S.,Kartikey, M.A. Niaz, R.B. Singh, Effect Of Q Gel (Coenzyme Q10) In Patients With Endstage Heart Failure Targeted For Heart Transplantation, Third Conference of the International Coenzyme Q10 Association London, 2002.

> This article is courtesy of Nuvanta. For more information, e-mail starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. 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.

Kredit: www.thestar.com.my

Ahad, 30 September 2012

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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