The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
- Resolving gluten sensitivity: Fodmaps and your gut
- Talk to your doctor to better understand your health issues
- Palliative care: Care that comforts
| Resolving gluten sensitivity: Fodmaps and your gut Posted: 19 Apr 2014 09:00 AM PDT Those sensitive to gluten may improve their symptoms by avoiding the carbohydrates known by their acronym, Fodmaps. Coeliac disease, which is basically the result of the body's inability to digest gluten, and gluten sensitivity are gaining more and more attention. But, for many with symptoms – gas, pain, bloating, cramping, constipation or diarrhoea – gluten may not be the issue, or may only be part of the problem. In true coeliac disease, a person cannot digest gluten – a protein found in wheat, rye and barley. Lifelong adherence to a gluten-free diet is the only management for this condition. For those with gluten sensitivity, irritable bowel syndrome or functional gut disorders, eliminating gluten may not resolve the symptoms completely. These individuals may be responding to fermentable, oligo-di-monosaccharides and polyols (Fodmaps). Okay, now that you have swallowed that mouthful, let's break it down. Fodmaps are short-chain carbohydrates, actually sugar molecules, which are poorly absorbed in the intestine. They are osmotic, which means that they pull water into the intestinal tract that in turn, leads to bloating and diarrhoea. They may also be fermented by bacteria in the gut, which also leads to gas and bloating. The response to Fodmaps is very individual, and it requires some effort to determine individual triggers. So, what exactly are Fodmaps? They can be categorised as the following: ·Fructose – found in high amounts in some fruits (watermelon, pineapple, oranges, honeydew melon, peaches, starfruit, mango, apples and pears), honey and high-fructose corn syrup. ·Lactose – milk sugar found in most dairy products (all types of milk, ice cream, custard, yoghurt and soft cheese such as ricotta and cottage cheese). ·Fructans – also known as inulin and found in wheat, onions, garlic, zucchini, mango, persimmon and watermelon. ·Galactans – found in beans, baked beans, green beans, lentils, cabbage and brussels sprouts. ·Polyols – found in low-calorie sweeteners such as sorbitol, mannitol, isomalt and xylitol, and in some fruits such as apples, pears, apricots, cherries, nectarines, peaches and plums. Resolving gluten sensitivity A low Fodmaps diet may help to resolve symptoms that have not been resolved by simply eliminating foods containing gluten. To try this approach, you need to avoid all Fodmaps food for at least six weeks. This is not easy because so many foods are restricted. It would be wise to do this elimination diet with the help of a registered dietitian or gastroenterologist. Those who are sensitive to Fodmaps usually see resolution of symptoms in one to two weeks. The next step is to slowly reintroduce Fodmaps foods one category at a time to see if symptoms reappear. Many hesitate doing this step once they are feeling better. But it is important because not everyone responds to every Fodmap. In many cases, a person simply needs to limit, rather than eliminate foods. Symptoms are often due to a dose response. In many cases, a person can eat a reasonable portion (half a cup) of a food, but eating more may trigger symptoms. Although it may appear complicated, once triggers are found, it is easy to avoid them. Following a low Fodmaps diet, once individual triggers are determined, is quite safe. There are many gluten-free options currently on the market, as well as many alternative choices for foods that must be avoided. Important to the success of implementing a low Fodmaps diet is the education you receive from a dietitian or doctor. It takes considerable time to examine a person's diet and identify potential triggers. It is also important that you understand and can identify alternative foods that are allowed. Compliance with the diet and its ultimate success will be spotty without a qualified health care provider for support. – HealthNewsDigest.com >> Jo-Ann Heslin is a registered dietitian from the United States. |
| Talk to your doctor to better understand your health issues Posted: 19 Apr 2014 09:00 AM PDT Managing health is a shared responsibility between doctor and patient. Maintaining good health is key to our success and happiness. When things go wrong with our health, we will be alerted through the symptoms we experience. This is when we try to find a solution by seeing a doctor. Good communication in the doctor-patient relationship is important to ensure that you get the best care. Being able to communicate well with your doctor will help him or her make a diagnosis and help you understand your illness, so that you know what you can do to get better and maintain your health. Information will be shared between the doctor and you, so it is important that you take an active role in understanding your illness and the treatment. For the doctor, empowering patients to take responsibility in managing their health is the key to a good doctor-patient relationship and successful treatment. There are various factors that need to be communicated during a visit with your doctor. In addition to how you are feeling, you may need to discuss with the doctor various issues relating to the treatment; for example, the cost, how long the treatment requires, how many times each day the medicine must be taken (Does your job permit you to take medicine at the required times?), etc. For both caregivers and recipients of healthcare, it is essential to be able to feel comfortable and build a rapport – developing trust between the caregiver (doctor) and the recipient of the care (patient). Thus, it is essential that the patient feels they can be open with their doctor and discuss their problems without feeling uncomfortable. This trust is important in a doctor-patient relationship so as to ensure success in the provision of care. The role of the doctor is to listen to the patient's problems, comfort and reassure them, make a diagnosis, and provide treatment and advice. Effective communication is a two-way process; the doctor and patient must interact. The doctor needs to educate the patient about their illness, ensuring the information given is in a language that is comprehensible to the patient, and that the patient's understanding of the problem is correct. At the same time, the responsibility of the patient is to ensure that they understand both the information given and how they should implement the steps they need to take to ensure that their health is taken care of. The manner in which the doctor speaks to the patient, from the moment of first meeting the patient, should be sincere, polite and show empathy. The doctor can educate the patient about various health matters, encouraging the patient to have a healthy lifestyle. Empowerment of the patient and the patient's understanding of their role in maintaining their health is key to a good doctor-patient relationship, which is based on understanding, trust, respect and openness between the caregiver and the patient. In order to stay healthy and have a good quality of life, the role of the doctor is to provide accurate information and ensure that the patient understands his illness and how to manage it. The responsibility of the patient is to ensure that he clarifies all doubts about his illness, takes the advice given, and implements the treatment as prescribed. Thus, in order for our society to stay healthy and productive, the responsibility of healthcare is shared between the patient and his caregiver. > 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. |
| Palliative care: Care that comforts Posted: 19 Apr 2014 09:00 AM PDT Palliative care is not just for the old or cancer patients, but also for those with life-limiting illnesses to improve their quality of life. At age 14, Nami is not a typical palliative care recipient. He is young and he does not have cancer. Nami was diagnosed with spinal muscular atrophy, a genetic condition that renders his body unable to maintain and support the growth of nerve cells that govern the body's movements. There is no cure for this condition, but Nami continues to be the kind of child who makes his parents smile with pride at his excellent academic results, strong extra-curricular activities, and love for math and science. He is a scout and an avid chess player who won a gold medal for Malaysia at the 2013 Asian Youth Para Games held in Kuala Lumpur. He even taught himself how to play blindfolded shortly after witnessing a blind chess game. For the past four years, Nami has been receiving palliative care from a healthcare team at Hospis Malaysia, a community-based palliative care provider, as his condition has made it necessary to have closer monitoring of his mental and physical well-being. The team also supports his parents, Nizam and Midah, in caring for him. Making patients comfortable Nami's story dispels two of the most common myths about palliative care: that it is needed only by people who are old or have cancer. There are many illnesses for which palliative care is appropriate, says Hospis Malaysia deputy medical director Dr Sylvia McCarthy.  Dr McCarthy shows off a promotional photo of Yasmin Yusuff with Hospis Malaysia¿s new palliative care symbol. - Lim Wey Wen People with life-limiting illnesses such as chronic obstructive pulmonary disease, multiple sclerosis, AIDS, liver failure, renal failure, heart failure or neurological diseases like Nami's motor neuron disease, can receive help to make them feel and function better, even while they are still receiving treatment to slow down the progression of their illness. Life-limiting illnesses are diseases that shorten a person's life significantly and impact their quality of life. Full recovery from the illness is also highly unlikely. "It is important to recognise that palliative care is not end-of-life care; it is about helping people live in a difficult situation, and the goal of care is about improving people's quality of life," says Dr McCarthy. Palliative care ranges from medical services designed to help patients control symptoms such as pain and nausea, to counselling and spiritual support to help them adjust to changes in their quality of life. The care needed and wanted by each patient is different, and so are the desired outcomes. "The goal of care is not necessarily to cure, but is instead, the person's wellbeing, to enable them to live the kind of life they want to live," the doctor says. Getting palliative care As palliative care is relatively young in Malaysia, there are less than 10 palliative care physicians in the country, and specialised palliative care offered by hospice organisations is available mostly in major cities. Patients usually need a referral from their attending doctors to access these services. However, not everyone requires specialised palliative care, says Dr McCarthy. "The model in most countries is that generalist palliative care can be provided by general practitioners and general physicians… but we still have to develop more specialised palliative care to support that," she says. Family members can ask doctors about things like symptom control or psychological support for their loved ones, to make their journey with a life-limiting illness more comfortable. Information on this kind of support is available online on the Hospis Malaysia website (www.hospismalaysia.org) or palliativecare.my, a new website that will be launched this Friday. It helps to remember that palliative care usually complements a person's treatment, rather than replacing it. A 2010 study at the Massachu-setts General Hospital, United States, found that patients given palliative care on top of standard treatment for advanced non-small cell lung cancer lived as long as 2.7 months longer than those who didn't receive palliative care. "Palliative care is about the recognition that it is not enough to treat the disease," says Dr McCarthy. "You need to treat the side effects of the disease, the side effects of the treatment of the disease, and deal with the impact of illness on somebody's life. "Sometimes medicine is seen as only for cure, whereas I prefer to see it as for healing. "And healing can be in the sense of making someone well. It doesn't necessarily mean curing the disease." > Hospis Malaysia will be launching a new symbol to raise awareness about palliative care nationwide on April 25 at Publika, Kuala Lumpur. A photo exhibition featuring the stories of palliative care recipients will also be held from April 25-29 at Publika. A public lecture on euthanasia by Cardiff University, United Kingdom, palliative medicine professor Baroness Ilora Finlay will be held at JW Marriott Hotel, Kuala Lumpur, at 5pm on April 25. To register, kindly email pr@hospismalaysia.org. |
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