The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 22 Dec 2012 05:51 PM PST Are you overweight? Start now on lifestyle and nutritional therapies to help stave off diabetes. WITH the number of diabetics jumping from one in seven (2006) adult Malaysians to one in five (2011), there must be something terribly wrong in our diet and lifestyle that has caused this seemingly unstoppable problem. Perhaps a comment by a patient of mine who was living overseas for five years (2006-2011) gives the underlying clue. She said that upon returning, she was surprised to see that many of her friends had become fat or obese. Sure enough, the statistics did show that the prevalence of overweight/obese adults ballooned from 43% to 60% during that period. There is a direct correlation between overweight/obesity and diabetes, such that the risk of anyone with a BMI of 25 (overweight by World Health Organisation guidelines) is about 10%; a BMI of 30 (obese), 30%; and a BMI of 35 and above (severe obesity), 90%! So, if you are overweight or obese, this should be an incentive to slim down. While many doctors and the drug companies are busy talking about yet more "advanced" anti-diabetic drugs to "control" blood glucose, I would like to emphasize lifestyle, diet, nutritional and natural therapies to prevent and reverse the disease. I have already written about the improvement, and even reversal, of diabetes by a nutrient-dense, high-fibre, low saturated fat, whole-food (legumes, fruits, vegetables and whole grains) diet combined with exercise and weight loss. Studies on these have been published in medical journals, but very few are aware of them, compared to the awareness of drugs that control diabetes. For example, studies showed that the Pritikin Diet (one such low-fat, high-fibre, whole-food diet) dramatically lowered serum triglyceride, C-reactive protein (a marker for inflammation and heart disease), LDL-cholesterol and blood pressure, and promoted weight loss in most people observing the diet diligently. It improved insulin sensitivity and lowered serum insulin levels. In diabetics, it improved blood sugar regulation, and reduced or completely eliminated the need for anti-diabetic drugs (see References). Several large studies have also shown that it is possible to prevent diabetes by the same strategies. For example, in the DPP Trial involving over 3,000 subjects with impaired glucose tolerance (a precursor stage to overt diabetes), the diet and exercise method was able to reduce the progression to diabetes by 58% (compared to the controls), which was even higher than the 31% achieved by those who took the drug metformin, and continued with their usual diet and lifestyle. The study was done over a period of nearly three years. Insulin resistance The strategy to reverse or cure diabetes should be threefold. The first is to restore the body's sensitivity to insulin. Insulin resistance (the opposite of sensitivity) is the basic problem in type 2 diabetes. In the early stages of the condition, blood glucose levels are maintained by increasing the production of insulin. Doctors will not detect this unless they also monitor insulin levels as part of the routine evaluation of their patients. Then, glucose levels start rising despite the raised insulin levels. This is the pre-diabetic stage. Finally, the glucose levels become so high that the patient becomes overtly diabetic. The persistent high insulin levels unfortunately, also cause damage to the beta cells of the pancreas, which secrete insulin. This further compounds the problem, as insulin production is soon impaired. Many type 2 diabetics will ultimately require insulin injections, and they will require relatively high doses compared to normal insulin levels in healthy people because of insulin resistance. The first-line medication for type 2 diabetes is metformin, and its major action is improving insulin sensitivity. Exercise (especially building muscles), weight reduction and many nutrients also improve insulin sensitivity. Many nutrients have been shown in scientific studies to improve insulin sensitivity. These include almonds, alpha lipoic acid, chromium, cinnamon, curcumin (turmeric), grapefruit, oatmeal, omega-3 (polyunsaturated fatty acids), vitamins D and K, and many more. Unlike the refined carbohydrates, unrefined complex carbohydrates protect against insulin resistance. If you are healthy, ensuring your diet includes these foods/nutrients should help you stave off the metabolic syndrome and diabetes. If you already have the disease, you will need higher doses, and should consider supplementation. Reducing calorie intake The second strategy is to reduce glucose and fat intake. As the body has problems managing glucose (and fats), despite higher insulin levels, it is best to reduce the workload in order to help the body cope with this unhealthy situation. A nutrient-dense, low-calorie diet allows us to maintain good health, as has been shown in many studies. Very-low calorie diets (but not lacking in nutrients, ie only calorie restriction) have repeatedly been proven to extend the lifespan of animals of several studied species. It is reasonable to expect similar benefits in humans. Studies have shown that under controlled conditions where subjects consume an equal number of calories, a high-carbohydrate diet induces insulin resistance faster than a high-fat diet. However, when they are allowed to eat on their own (with no control over the amount of calories consumed), it was found that those who preferred high-fat diets fared worse. This was because those on high-fat diets usually consumed more calories. High-fat means calorie-dense (or energy-dense), as fat has double the calorie content of carbohydrates and proteins. The type of fat also matters, as saturated and trans-fats gave the worse results in these studies. Mono- and polyunsaturated fats are protective against harmful effects, but not if taken excessively (remember the calorie/energy factor). So, it is important to restrict both refined carbohydrates and unhealthy fats from your diet to prevent and reverse diabetes. By doing so, you will definitely cut down the calories. Unfortunately, the typical Malaysian diet is lacking in nutrients and fibre, but has plenty of refined carbohydrates (white rice, white bread, etc), unhealthy (saturated and trans/hydrogenated) fats, and unhealthy processed foods. You really have to be disciplined in choosing what you eat, if you are concerned about your health. Refined carbohydrates also tend to have a high glycaemic index (ie raises blood glucose rapidly), compared to the healthier, wholesome unrefined complex carbohydrates. The glycaemic load (index x amount consumed) determines the actual stress on your glucose management system. And don't forget that a bowl of polished white rice is equivalent (in calorie/glucose terms) to 20 teaspoons of refined sugar, even though the rice is not sweet! Protect your body The third strategy is to protect the body from the harmful effects of diabetes. Most are familiar with the dangers of having too much glucose circulating in the blood, but many do not realize that the damage also results from another problem – while the blood is flushed with glucose, the cells in diabetic patients are actually starving as they have become resistant to the instructions of insulin to take in glucose. Glucose is essential for energy production, and the cell's activities are slowed down or stopped because of the lack of energy. This explains why diabetics are in fact, less energetic compared to healthy people, even though their glucose levels are much higher. They are also prone to a myriad of health problems. Because of the doubly unhealthy situation (glucose flooding the blood while the cells are starving), cells, tissues and organs are functioning sub-optimally, and are unable to cope with the assault from free radicals (produced by normal metabolism, plus more from the toxic environment and drugs), and invading germs (viruses and bacteria), yeast, fungi and parasites. Diabetic patients require a lot of a wide range of vitamins, minerals, antioxidants, enzymes, co-enzymes, probiotics, amino acids, essential fatty acids, and possibly many others, if they want to remain healthy. Some of the nutrients that improve insulin sensitivity are also cell protectors. Many powerful antioxidants and anti-inflammatory nutrients like curcumin (turmeric) and berries (which contain many types of phenols that make them the most powerful fruits in terms of antioxidant content), can help protect the tissues and organs in diabetic patients. My experience in using these berries (in concentrated juice extract form) is that they also help in reducing blood glucose levels. Diabetics will also benefit from taking glutathione-boosting supplements, as glutathione is the most important intracellular antioxidant. They will also benefit from taking foods (eg kale, beetroot) or supplements that increase nitric oxide, which is important for good blood circulation, penile erection, immunity and many other functions. Diabetics have low levels of both glutathione and nitric oxide. Prevention! The Government has announced that over 1.4 million Socso members 40 years old and above are entitled to a free medical examination. This is an opportune time to screen a large portion of those at risk. I am sure this exercise will pick up many undiagnosed diabetics and hypertensives (and others suffering from "silent" diseases). The doctors should also give adequate advice to those who are overweight/obese, and those with pre-diabetes and pre-hypertension as well, as these problems are much easier to reverse at the early stages. The rest should also go for their checkup if they have neglected to do so. References: 1. Barnard RJ, Ugianskis EJ, Martin DA, Inkeles SB. Role of diet and exercise in the management of hyperinsulinemia and associated atherosclerotic risk factors. Am J Cardiol 1992;69:440-4 2. Barnard RJ. Effects of life-style modification on serum lipids. Arch Intern Med 1991;151:1389-94 3. Barnard RJ, Wen SJ. Exercise and diet in the prevention and control of the metabolic syndrome. Sprts Med 1994;18:218-28 4. Roberts CK, Vaziri ND, Barnard RJ. Effect of diet and exercise intervention on blood pressure, insulin, oxidative stress, and nitric oxide availibility. Circulation 2002;106:2530-2 5. Knowler WC, Barrett-Connor E, Fowler SE, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle interventions or metformin. N Engl J Med 2002;346:393-403 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. |
| Posted: 22 Dec 2012 05:50 PM PST The world did not end, but still, it's time to take stock of our own lives. PREDICTABLY, the world did not end a few days ago. If I were born when civilization started (about 13,000 years ago) and lived till now, I would have opposed every person who announced "The End Of The World". This has happened with regularity every ten to hundred years. But I am speaking with hindsight. We knew less about geology, astronomy and evolutionary biology in the past. However, in the scientific era we are in, I am flummoxed that "The End Of The World" pronouncements still make news. The world will not end for a few million or billion years to come. A narrow definition of the end of the world is the end of Homo sapiens. Even this is unlikely for a few thousands to perhaps millions of years more. One possibility of humans going extinct in the next one hundred to one thousand years is a very large undetected near-Earth object (over 20km in size) slamming into our planet at 100,000km per hour. In such an event, enough dust particles will be generated to block off sunlight from reaching Earth for months to perhaps a couple of years. Photosynthesis will be interrupted, and food chains will break down in key places. Man, being on top of many food chains, will have next to nothing to eat. Detection of near-Earth objects (asteroids are the most common) is good, and continues to improve, so it is most unlikely that a very huge object out there will be missed. Another scenario: all the world's nuclear weapons are exploded at one go with the cooperation of the declared and undeclared nuclear powers. Those of us who do not die in the immediate aftermath of this catastrophe will suffer a 'nuclear winter' – the same scenario as if a large asteroid had hit us. Even if all human beings do die in either scenario, the hardiest of all living things that survive a natural or man-made armageddon will repopulate earth and start a "republic of insects and grass" (The Fate Of The Earth by Jonathan Schell). Defining the end All humans constitute one species out of all extant species, which number over 30 million. Forty trillion species (dinosaurs, the mammoth and the dodo included) have emerged and become extinct since life started 3.8 billion years ago. So, why should Homo sapiens be the exception? We will go extinct, but it won't be for some time yet. But the world will be unpleasant for Homo sapiens in the near and mid-future, to put it mildly. The sea level will likely rise about 10cm by 2100 (and that's a conservative figure) because of global warming, and living conditions in the coastal and riverine areas will be unbearable. The Earth's population will likely be around nine billion by then. There will be insufficient potable water, increasing desertification, insufficient energy sources, and an environment polluted with carcinogens, greenhouse gases, parasites, bacteria and viruses. Fossil fuels will be depleted. Wars will be fought over limited resources. Not a pretty picture, but not the end of the world for sure. The world will not end as soon as the doomsayers have it. Not even for millions and billions of years to come. There won't be divine intervention, cosmic wrath or the revenge of unforgiving gods. We must be clear by what we mean when we speak of the end of the world. The end of all Homo sapiens is only one definition of the end of the world. Self-replicating DNA forms will go on inhabiting planet Earth, regardless of the presence of humans. The second definition of the end of the world could be the end of all life forms on Earth as we know it. Life is very hardy. Extremophiles live in the hottest undersea hydrothermal vents without oxygen or light. Some species of bacteria, algae and fungi have survived billions of years. It takes a lot to exterminate every single DNA replicator. The third way to conceive of the end of the world is the end of planet Earth when our sun uses up all its fuel and finally implodes about 13 billion years from now. Our sun is one of 200 to 400 billion stars in the Milky Way – our local galaxy, and billions of billions of billions of galaxies make up the known universe. There is then a fourth way to speak about the end of the world. That is when the entire universe becomes a very cold, large, dark and extremely diluted soup of undifferentiated matter and energy. And that would be trillions and trillions of years from now. Individual lives Which brings me to a sad, but common story on Earth in my clinic. A woman in her 50s had a partial gastrectomy. Two-thirds of her stomach was removed during surgery for gastric cancer. Within a few months, her cancer had spread extensively to her bones. Fortunately, palliative radiotherapy and morphine have made her comfortable. Unfortunately, food prohibitions (taboo, pantang, superstition, culture) imposed on her by her relatives and loved ones have made her life a misery. She pleaded with me: "Can't I have some bah kut teh and satay?" The few pleasures she yearns for in the remaining weeks or months of her life are denied her. Whatever she eats now will not make an iota of difference to her survival. Some questions we have to ask ourselves are: How much science do we want to permeate our lives and light it up? Do we want to go on believing that the world will end soon? Do we want to deny others earthly pleasures when we know it won't make a difference to their cancer survival time? We have to ask ourselves many more similar questions. The world will not end in the near or intermediate future. But our individual lives will. How do we want to live the rest of our lives? Logic, science and humanism as a guide would be a good way. Enough of this doom and gloom. Please join me in a toast for the New Year: "To Logic; to Science; to Free-thinking; to Love; and finally, to Life." Dr Albert Lim Kok Hooi is a consultant oncologist. For more information, email starhealth@thestar.com.my. |
| Posted: 22 Dec 2012 05:49 PM PST This hormonal phase of life may be the cause of that belly fat you've been accumulating. MANY of my middle-aged patients are afraid of their impending menopause for several reasons. Of course, they are anxious about the possibility of hot flushes, sleep problems and low libido, but weight gain is also uppermost among their concerns. Weight gain is a valid problem for women to be worried about, especially as they hit their fifties. Most women will find themselves putting on at least half a kilogram every year around this age. Women aren't just worried about weight gain because of vanity, but because many chronic conditions are linked to being overweight, including diabetes, heart disease, hypertension, knee and back problems, and even cancer. Some recent studies have discovered fascinating information about the real relationship between menopause and weight gain (it's not really the kilos, it's about where the fat is), and I will share these insights with you here. I will also shed some light on what this means for women who want to stay healthy throughout the menopausal and post-menopausal years. Female 'spare tyre' For a long time, women and their doctors believed that menopause was the cause of weight gain among women going through this crucial hormonal stage in their lives. However, a key study, published just this October, has overturned this thinking. This study, led by Prof Susan Davis of Monash University in Australia, reviewed available scientific findings on weight gain and menopause. The first significant finding was that weight gain among menopausal women was not due to the hormonal changes, but rather, lifestyle and environmental factors. But many of my patients insist that their clothes are tighter, especially around the waist, and their stomach has grown bigger, so they must have gained weight! They are not entirely mistaken. Prof Davis explains that the new "spare tyre" women complain of after menopause is real, as more body fat tends to be deposited around the abdomen, compared to anywhere else in the body. Why would the body suddenly start storing more fat in the stomach area, compared to, say, the thighs or the buttocks? After all, isn't the spare tyre the domain of ageing men? Oestrogen and testosterone This is where the hormone changes of menopause come into play. The body changes the way it stores fat due to the decrease of oestrogen caused by menopause. While younger women find that a lot of their weight is concentrated slightly lower, around their hips, the loss of oestrogen in the body changes all this. Suddenly, women in the menopause stage find something new to be concerned about – a flabby tummy, or what doctors call "visceral fat". A study back in 2009 looked at various factors that could possibly explain the increase of visceral fat during this period, including age, race, cardiovascular risk factors, and levels of testosterone and oestradiol (the main form of oestrogen) in the participants. From the study's findings, age, race and cardiovascular risk factors did not correlate significantly with the amount of visceral fat. Neither did oestradiol levels. Instead, it turns out that testosterone is the culprit. As the level of oestrogen in the body dips with menopause, the level of active (or bioavailable) testosterone increases. It is this active testosterone that is the strongest predictor of visceral fat. Visceral fat is a bad thing – and not just because it is fat. It turns out that there are different types of fat cells, and the fat located beneath the skin (subcutaneous fat) is different from the fat surrounding internal organs in the abdominal area. Depending on where the fat cells are found, they behave differently. Visceral fat isn't just made up of inert cells that cause weight gain; it is metabolically active and causes inflammation – contributing to premature atherosclerosis (narrowing of blood vessels) and risk of acute coronary syndrome. The presence of too much visceral fat, also known as abdominal obesity, is part of the metabolic syndrome, which severely increases the risk of heart disease and diabetes. This is why heart disease is the number one killer among post-menopausal women, although many people still mistakenly believe that only men are prone to heart disease. A menopause message While the hormone changes of menopause are inevitable, women can still be in control over their weight and health. The menopausal phase is actually sending women a message, telling them that it is not too late to pay attention to their health. For many women, the years leading up to menopause have been about their careers, families or social lives. Finally, at a time when their children have grown up, they have retired, and their lives are finally about them, they can concentrate on taking care of themselves. At this point, women should not only be talking to their doctors about addressing the symptoms of menopause, but also its effects. They should review their overall health status, and start looking seriously at their cardiovascular risk factors. This is also the time to grab the initiative and lead a much healthier lifestyle. To counter the hormonal effects of menopause on abdominal fat, women need to eat healthily and become much more active. They need to balance their hormones with natural hormones and nutritional therapies. Fortunately, there are many health centres and exercise classes that cater to women of all ages today. So, don't let menopause get you down. Instead, take it as a new step forward in staying healthy and trim! Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit www.primanora.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. |
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