Expert Advice for Moms That Are Juggling Breastfeeding and Work

WORDS MAS AMIRAH MOHMAD AZHAR & DR HASLINA ABDUL HAMID

FEATURED EXPERTS

MAS AMIRAH MOHMAD AZHAR
Student of Master’s in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DR HASLINA ABDUL HAMID
Lecturer and Registered Dietitian Nutritionist
Centre for Community Health Studies (ReaCH)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

Exclusive breastfeeding is recommended for infants from birth until at least 6 months of age.

This is defined as providing an infant with just breast milk—no other foods or liquids.

For the first six months of life, the World Health Organization (WHO) and other health organizations highly advise this practice, as it can contribute to many advantages for both mother and baby.

THE BENEFITS OF BREASTFEEDING

In addition to its balanced nutritional composition, breast milk contains important substances such as immunoglobulin A or Ig A, lactoferrin, cytokines, enzymes, growth factors and leucocytes. These substances provide the baby with protection against infections while also promoting intestinal adaptation and maturation.

Breast milk also contains numerous prebiotic substances such as human milk oligosaccharides (HMO), which support the growth of non-pathogenic probiotic microorganisms, primarily lactobacilli and bifidobacteria, while removing the potentially pathogenic bacteria. This high concentration of HMO is unique to humans, and studies have shown that breastfed infant has a more stable and constant population of oligosaccharides compared with infants fed with formula milk.

Furthermore, the composition of breast milk is unique, as the concentration of both energy and protein in expressed breast milk is highly variable throughout lactation stages, between mothers, and even from the same mother.

Breast milk feeding also has been linked to improved long-term neurocognitive development and cardiovascular health outcomes.

Additionally, numerous studies have demonstrated the effectiveness of breast milk in offering protection even to preterm infants in the Neonatal Intensive Care Unit (NICU).

THE JUGGLE BETWEEN BABY AND BRIEFCASE

For many working mothers, balancing work and breastfeeding can be challenging.

If you’re one of these mothers, you can choose to breastfeed exclusively or partially once you go back to work.

If you choose to exclusively breastfeed, you should express your milk while you’re on your work breaks. You can use this expressed milk to build up a supply for the feeding of your infant by a caregiver while you’re at work or for moments when you face a shortage of breast milk.

TIPS & ADVICE

The following may be useful for working mothers that still wish to breastfeed as well as to support needs of their infants.

Don’t stress yourself out!

While it’s always ideal to aim to complete your breastfeeding journey until 2 years, you and your health matters too.

Studies have shown that the benefits of breast milk on babies are dose-dependent, so the more and the longer you give, the better the beneficial effects are.

With that said, it also means that some breast milk is better than none.

Every drop matter, so while you are trying your best to pump your milk within your capacity, do not be discouraged by the amount. You might get to express more in some days and just a little in other days, and it’s totally fine.

Seek help whenever necessary.

Being a new mother is overwhelming with both love and new responsibilities, so it is very important for you to prioritise your mental and physical well-being.

Also, go for consistent health check-ups and give yourself ample time to rest.

Know your employment policies.

Nowadays, many companies provide reasonable breaks for breastfeeding employees to express breast milk. Certain companies even provide special rooms or areas for pumping the breastmilk, which comes with a refrigerator to store breast milk as well as a wash area. These venues are kept out of sight and away from public or coworker intrusion.

You can request for such an area at your workplace if such a space is not available.

The location to express your breast milk, the number of breaks available for you, and the length of each break likely differ from company to company. You should get a better understanding on your employer’s company’s policy when it comes to expressing breast milk at the workplace. This way, you can incorporate breast milk expression into your work schedule without negatively affecting your work performance or your ability to get enough rest.

You have the right to ask for permission, explain about your timetable routines to express milk, and enquire about any accommodations to improve your ability express milk more conveniently, so don’t hesitate to talk to your supervisor or human resource department.

You can do this early, such as before your delivery date, so that you can transition from your maternity leave to back to work more seamlessly.

Manage your expectations.

Know how much you need to pump, how many sessions you need to spare your time for, and how much breast milk your baby needs.

How much does your baby need? While it is quite difficult to estimate how much a baby receives from direct breastfeeding, Recommended Nutrient Intake for Malaysia 2017 states that:

  • Babies need around 500 to 600 kcal/day during their first year of life.
  • This amount increases to around 900 to 980 kcal/day at the age of 1 to 3 years.

The number of breastfeeding sessions is reduced as the baby ages, but the amount of milk needed by the baby is increased, from 6 to 8 sessions and 60 to 150 ml.

So, the number of pumping sessions and amount of milk needed to be expressed could be tailored to that.

The amount of milk consumed by your baby is usually reduced once you start them on complementary feeding, but they can still be breastfed on demand, with direct breastfeeding done at home.

Estimated daily milk requirements of babies from 0 to 6 months old. Click image for a larger, clearer version.


The recommended nutrient intake for infants from 0 to 3 years old. Click on the image for a larger, clearer version.

Invest in a good breast pump and breast milk storage.

There are many innovations and developments in the design of breast pumps and related accessories.

Hence, before purchasing a breast pump, take time to research by reading reviews or talking to your healthcare about the necessary equipment to meet your breastfeeding needs. You can also opt for trial or rental period to determine whether a breast pump is suitable for you.

Don’t just choose based on design and brand—you must also choose based on your needs also your budget. Local brands are usually more economical while still having comparable good quality to imported brands.

If you have a busy schedule, there are certain brands that offer quiet, wearable, or hands-free option which could accommodate your routine.

You will also need specialised storage bags made specifically to hold breast milk for safe transportation and storage.

  • Look for BPA-free bags that are strong enough to be kept in the freezer or refrigerator.
  • Consider bags with double zipper seal, the ability to stand alone for simple pouring, and a write-on section to record the time and date you expressed the milk.

Also, after each use of the breast pump, you should clean every area that came into contact with your breast milk or breast tissue. It is not always possible to use soap and water, particularly at work when you might not have access to a sink or have limited time. Cleansing wipes prevail for these instances!

Breastfeeding sanitizer spray is another useful consideration for quick or last-minute cleaning.

To make breast pump cleaning easier when you are on the go, make sure the supplies you buy fit compactly inside your pump bag.

Maintain proper hydration.

Have a bottle of water ready every time you pump your breast milk as well as every time you breastfeed your baby.

Water is essential, but it’s especially critical for working breastfeeding moms to stay focused and energised throughout the day.

Studies have shown that consuming more fluids than normal does not result in an increase in milk production. However, drinking too little water can lead to dehydration, which can harm your health and the quality of your breast milk.

Therefore, to ensure that your body is functioning at its best, it is crucial to consume enough fluids as to stay hydrated, which can range from 1.5 to 2.5 litres per day.

Some mothers rely on coffee to stay awake— which makes sense when your baby decided to play at 3 am! —so consuming low to moderate amounts (around 2 to 3 cups per day, or less than 300 mg of caffeine) is still considered acceptable.

Balanced meals are always key!

Recommended Nutrient Intake for Malaysia 2017 recommends that lactating mothers should consume about 2,400 kcal/day in the first 6 months of lactation, which is approximately 500 kcal more than normal adult women (1,800 to 1,900 kcal for a moderately active individual).

For mothers that want to lose some of their pregnancy weight, make sure to have adequate calories and protein according to your needs. Schedule an appointment with a dietitian if you need help to plan your meal.

Make sure to include plenty of fruits and vegetables in your meals as they are a great supply of important vitamins and minerals. Carbohydrates, especially from whole grains, is a great source of energy and fibre that can support the ability to feel full for longer.

Healthy snacking is encouraged in between meals. Go for fruit smoothies, toast, crackers, yogurt, and nuts.

TO SUM THINGS UP

Exclusive breastfeeding is one of the essential components of early childhood nutrition, but every breastfeeding mother’s circumstances are different. Therefore, it’s critical to identify a schedule and strategy that are most effective for you and your baby.

Furthermore, practice self-compassion while you manage this delicate balancing act, and don’t be afraid to seek for help and advice from your loved ones, coworkers, family members, and friends.

An Expert Discusses What Happened to the Generational Endgame Bill of Malaysia

WORDS MUHAMMAD ZAID ZAINUDDIN

FEATURED EXPERT
MUHAMMAD ZAID ZAINUDDIN
Lecturer (Anatomy)
Centre of Preclinical Science Studies
Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
IN RECENT NEWS

In November 2023, the Dewan Rakyat passed the Control of Smoking Products and Public Health Bill.

The Bill aims to regulate the sale and purchase of tobacco products, smoking materials, tobacco substitute products, and smoking devices, which includes smoking products such as electronic cigarettes or vape.

Though the passing of the bill is a positive step for the country’s public healthcare system and future generations, it has left members of the parliament and public health experts outraged.

WHY THE OUTRAGE?

The passed Control of Smoking Products and Public Health Bill is a watered-down version of the ambitious proposal initiated by our former Minister of Health, Khairy Jamaluddin.

The previous bill, dubbed the “Generational Endgame Bill”, proposed to prohibit persons born on or after 1 January 2007 from purchasing and smoking tobacco products, substitute tobacco products and smoking substances which includes e-cigarettes and vapes.

The bill passed in November 2023 removed this bold clause that would give rise to a smoke-free Malaysian generation in the future.

WHAT WOULD HAPPEN IF THE GENERATIONAL ENDGAME BILL WAS PASSED IN ITS ORIGINAL PROPOSED FORM?

In terms of impact on healthcare, the proposed Generational Endgame policy would ban smoking and vaping for those born in 2007 and onwards for the rest of their lives.

Ideally, this will create a smoke-free generation in the coming decades and save north of RM6 billion ringgit per year in terms of healthcare expenditure in the years to come.

This is stipulated by 2020 data, whereby the country had spent RM6.2 billion to treat three major diseases caused by smoking; lung cancer, heart disease, and chronic obstructive pulmonary disease. This cost was estimated to increase to RM8.8 billion by 2030 and will increase further if smoking had not been curbed.

THEN, WHY WAS THE GENERATIONAL ENDGAME CLAUSE DROPPED?

The Generational Endgame clause was dropped after considering the views from the Attorney-General’s Chambers, who claimed potential constitutional arguments.

The clause is unconstitutional.

In brief, the passing of the bill would create unequal treatment under the law between persons born before 1 January 2007, and individuals born after.

This is contradictory to Article 8 (1) of the Federal Constitution, which states that every person shall be equal under the law and have equal protection of the law.

The proposed bill would be unconstitutional as it would create two sets of laws for two different groups of citizens based on age.

Socio-economic impact on Malaysians.

An assessment of Malaysia’s Generational Endgame Policy by Oxford Economics, published in September 2023, states that the policy would be unlikely to deliver a reduction in healthcare costs. This is because future smokers would switch to illicit products.

This is on the basis that Malaysia has one of the largest illicit tobacco problems globally, with an estimated 57% of all cigarette sales in 2022 occurring through illicit channels.

An argument against the bill claims that a total ban of tobacco products would just expand the illicit tobacco market.

Impact on the economy.

The report also estimates that the legal tobacco industry in Malaysia currently supports a RM983 million contribution to the country’s GDP, RM3.3 billion in tax receipts, and 7,940 jobs.

A total ban of tobacco products would decrease these economic benefits on top of having to sustain an expensive expenditure on policy implementation, public communication, and enforcement programmes in addition to efforts needed to control the expanding of illicit markets.

IS THIS THE END OF THE GENERATIONAL ENDGAME POLICY?

Absolutely not!

The passing of the current bill is a small step forward toward achieving the Generational Endgame policy.

Though not banning the selling of tobacco products in its entirety, the Control of Smoking Products and Public Health Bill protects the younger generation from modern smoking devices, a rampant disease amongst our teenage youths.

The bill prohibits the sale and purchase of tobacco products, smoking materials, or substitute tobacco products as well as the provision of any services for smoking to under 18-year-olds, ultimately curbing the increase of smoking and vaping habit amongst children and teenagers.

IN CONCLUSION

Though our healthcare workers and policy makers are working hard to curb the rise of smoking and vaping, it is of the highest importance to maintain public awareness of the dangers of smoking and vaping. Such public awareness should be promoted and reiterated from generation to generation.

References:

  1. Bernama. (2023, December 7). Experts: Anti-smoking bill first step towards a smoke-free generation. NST Online. https://www.nst.com.my/news/government-public-policy/2023/12/987431/experts-anti-smoking-bill-first-step-towards-smoke-free
  2. Choy, N.Y. (2023, November 23). Health minister pledges to table Generational Endgame bill on tobacco before the end of Parliament sitting. The Edge Malaysia. https://theedgemalaysia.com/node/690959
  3. Harun, H. N. (2023, November 28). GEG dropped due to constitutional arguments – Dr Zaliha. NST Online. https://www.nst.com.my/news/government-public-policy/2023/11/984010/geg-dropped-due-constitutional-arguments-dr-zaliha
  4. Cabello, K. (2023, October 6). An assessment of Malaysia’s ‘Generational Endgame Policy’. Oxford Economics. https://www.oxfordeconomics.com/resource/gegmalaysia/

Autoimmune Encephalitis: When Your Own Immune System Attacks Your Brain

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ELLIE KOK HUEY TEAN
Consultant Neurologist and Internal Medicine Physician
Sunway Medical Centre Velocity

Autoimmune encephalitis, often abbreviated as AE, is a relatively new and hence frequently misdiagnosed group of related conditions in which the body’s own immune system attacks the brain.

According to Dr Ellie Kok Huey Tean, autoimmune encephalitis can affect people of all ages, even those with no family history of this condition.

COMMON POSSIBLE SYMPTOMS OF AUTOIMMUNE ENCEPHALITIS 
  • Frequent headaches.
  • Personality and behavioural changes.
  • Decline in cognitive function (thinking, learning, memory, decision-making, etc).
  • Seizures.
  • Abnormal, slow, and/or involuntary movement (movement disorders).
  • Hallucination and/or delusion.

If left untreated, someone with this condition may experience permanent brain injury and even death.

However, Dr Ellie shares that, because the symptoms of autoimmune encephalitis overlap with those of psychiatric disorders, this condition is often misdiagnosed.

WHAT ARE THE COMMON CAUSES AUTOIMMUNE ENCEPHALITIS?

Dr Ellie explains that there are many different possible causes, such as exposure to viruses such as herpes simplex virus and the presence of certain cancers.

ARE CERTAIN GROUPS OF PEOPLE MORE AT RISK?

“Research indicates that AE predominantly impacts individuals from their early teenage years to age 50, with women being more susceptible than men,” she added.

Furthermore, while this condition can develop in people of all ages, certain age or gender groups may exhibit higher prevalence of certain traits linked to autoimmune encephalitis.

For example, N-methyl-D-aspartate receptor (NMDAR) encephalitis tend to be more commonly observed in adolescents and young adults. It is also more prevalent among young women with tumours in their reproductive organs.

Another example is araneoplastic encephalitis, which affects elderly persons with occult cancer. Occult cancer is a term for cancer cases in which cancer cells are detected in the person’s body, but the doctors can’t locate the tumour from which these cancer cells originate from.

WHAT CAN WE DO ABOUT AUTOIMMUNE ENCEPHALITIS?

Dr Ellie advises that family members or caretakers of the elderly should be vigilant for symptoms, especially given that the elderly are more vulnerable to infections, one of the primary causes of autoimmune encephalitis.

“It is also crucial to monitor for symptoms such as memory decline, behavioural changes, seizures, and gait problems, such as loss of balance while walking,” she elaborates.

IS THERE A CURE FOR AUTOIMMUNE ENCEPHALITIS?

Dr Ellie reveals that most people with this condition can be cured after receiving proper diagnosis and the appropriate immunotherapy treatment.

Immunotherapy typically involves the use of immunoglobulin injected into the patient’s bloodstream as well as plasma exchange and the use of immunosuppression agents. The purpose of this treatment is to eliminate the antibodies that direct the immune cells to attack the patient’s brain.

“However, a small number of patients may experience a relapse within 5 years after treatment,” says Dr Ellie, adding that this is the reason why it is important for people that have completed treatment to go for medical follow-ups. These follow-ups will allow the doctor to detect and take steps to prevent the chances of recurrence.

What Kind of Sleeping Position Is Best for a Pregnant Mom and Safest for Her Baby? Let’s Find Out!

WORDS LIM TECK CHOON

When it comes to pregnancy, the mom will have to generate enough energy for her well-being and for the growth and development of her baby. This includes eating for two (or more if she is carrying more than one baby!) as well as getting enough sleep to meet the physical demands of pregnancy.

Of course, the mom may have to adopt a different sleeping position during the pregnancy. This brings us to the question of which sleeping position is best when it comes to keeping the baby safe while allowing mom to get the most out of her sleep.

THE ACCEPTED CONVENTIONAL WISDOM OUT THERE

It is generally assumed that sleeping on the left side is better for a pregnant woman, as it’s more comfortable and helps to maintain proper blood flow between the mom and the baby she is carrying. This better blood flow also decreases the chances of swelling around the mom’s ankles and in her legs.

Sleeping on the right side is said to put pressure on the mom’s liver, so many advise a pregnant woman to sleep on her right side only for short naps.

How true are all these assumptions, though?

THE UK NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) REVIEWED AVAILABLE EVIDENCE

They stated that the purpose of their review was to determine whether there is any link between the mom’s sleeping position and the incidence of either stillbirth or the baby being born smaller in size than typical normal, healthy babies of the same age (small for gestational age or SGA).

In their findings, published in 2021, they stated that:

There is high quality evidence linking supine going-to-sleep position—that is, the mom sleeps lying on her back—and stillbirth.

NICE noted that the overall incidence of stillbirth is generally low (1 in every 244 births in the UK based on 2018 statistics), but they feel that there is enough evidence for doctors to advise pregnant moms to avoid sleeping in this position.

HOW ABOUT SLEEPING ON THE LEFT SIDE THAT IS GENERALLY SAID TO BE GOOD FOR MOM & BABY? ANY EVIDENCE FOR THAT?

Well, NICE noted that the evidence for this, as well as for sleeping on the right side, ranged from low quality to very low quality. They concluded, therefore, that more research would be needed to look into this matter.

One thing is for sure, though—they noted that sleeping on mom’s back is definitely something to be avoided!

THE TAKE HOME MESSAGE

Pregnancy may also give rise to other sleeping issues, such as problems falling asleep, and special care is often needed for pregnant women that also have obstructive sleep apneoa (OSA) and other health conditions that could affect her sleep or her breathing while she is asleep.

Hence, it’s always sensible for a couple expecting a baby to discuss mom’s sleep matters further with their obstetrician and gynaecologist. They should do this as early as possible—don’t wait for the sleeping issues to arise first!

Reference: National Guideline Alliance (UK). (2021). Maternal sleep position during pregnancy: Antenatal care. National Institute for Health and Care Excellence (NICE). https://www.ncbi.nlm.nih.gov/books/NBK573947/

Can Parkinson’s Disease Be Prevented with the Mediterranean Diet?

WORDS OH YAN TING, DR MUNIRAH ISMAIL & PROFESSOR DATO’ DR ROSLEE RAJIKAN

FEATURED EXPERTS

OH YAN TING
Dietitian and Student of MHSc in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
DR MUNIRAH ISMAIL (PhD)
Lecturer and Dietitian
Dietetics Program
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
PROFESSOR DATO’ DR ROSLEE RAJIKAN
Professor in Clinical Nutrition and Dietetics
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

Parkinson’s disease is a degenerative neurological disorder affecting movement.

It occurs when there is damage to brain cells that results in a reduction of dopamine, a chemical in the brain that controls movement, mood, concentration, and others. A lack of dopamine will result in the brain’s nerves being unable to effectively regulate the activities as mentioned earlier.

Individuals with Parkinson’s disease usually experience motor symptoms such as tremors, slower body movements, limb stiffness, postural instability, and uncoordinated body movements. In addition, they may also suffer from depression, behavioural changes, sleep disorders, constipation as well as smell disorders.

PARKINSON’S DISEASE IN MALAYSIA

To date, approximately 15,000 to 20,000 Malaysians have been diagnosed with Parkinson’s disease, and this number is expected to increase by five times in the year 2040.

CAUSES & CURE

Various factors can contribute to the development of this disease, including genetic predisposition and environmental factors such as diet and physical activity as well as exposure to toxic agents such as heavy metals and pesticides.

Although the cause of Parkinson’s disease is not fully understood, there is evidence to suggest a link between oxidative damage, chronic neuroinflammation, and mitochondrial dysfunction, which can result in the development of this disease.

Currently, there isn’t a cure for Parkinson’s disease. Therefore, preventive measures must be implemented to reduce one’s risk of developing this disease.

NUTRITION & PARKINSON’S DISEASE

Nutrition is one of the environmental factors found to influence one’s risk of developing Parkinson’s disease.

A high intake of vegetables as well as fish and legumes are moderately associated to a reduced risk of Parkinson’s disease.

Meanwhile, high consumption of meat, processed meat, sugary foods, and carbonated drinks is associated to an increased risk.

THE MEDITERRANEAN DIET

The Mediterranean diet is practiced widely in Greece, Spain, and Italy.

Many previous studies found that this diet confers benefits for health and longevity.

It is associated with a reduced risk of type 2 diabetes, heart disease, and stroke.

In addition, the Mediterranean diet is also widely recognized for its role in reducing oxidation and inflammation in the body. Since the onset and progression of Parkinson’s disease involve neuroinflammation and oxidative stress, the Mediterranean diet can therefore play an important role in the prevention of this disease.

Two large cohort studies have shown that a high level of adherence to the Mediterranean diet is associated with a lower risk of Parkinson’s disease. Whereas a lower level of adherence to this diet is associated with an earlier onset of Parkinson’s disease.

In addition, short-term adherence to the Mediterranean diet has also been found to reduce constipation, which is one of the signs and symptoms of Parkinson’s disease.

Characteristics of the Mediterranean diet.

This diet emphasizes the following 4 components:

High intake of fresh fruits and vegetables, as well as whole grains. According to the Greek Dietary Guidelines 1999, it recommends the following:

  • Vegetables: 6 servings a day.
  • Fruits: 3 servings a day.
  • Whole grains: 8 servings a day.

These foods contain high dietary fibre, vitamins, and polyphenols. Vitamins A, C, and E and polyphenols contain antioxidant and anti-inflammatory properties that are likely to reduce the risk of Parkinson’s disease. In addition, the high dietary fibre content can also help to reduce occurrences of constipation.

Consistent use of olive oil. This oil contains monounsaturated fatty acids and polyphenols that can reduce oxidative stress and inflammation.

Consumption of milk, dairy products, potatoes, chicken eggs, fish, nuts, legumes, seeds and red wine in moderation.

  • Milk and dairy products: 2 servings a day.
  • Nuts and legumes: 3 to 4 servings a week.
  • Fish or seafood: 5 to 6 servings a week.
  • Chicken or duck: 4 servings a week.
  • Eggs: 3 servings a week.
  • Red wine: no more than 2 glasses a day for men and 1 glass a day for women.

Foods such as nuts, legumes, fish, chicken, and eggs are important sources of protein for building and repairing body cells and tissues.

For fish, go for deep-sea fish that contain high levels of omega-3 fatty acids. Omega-3 fatty acids can maintain brain function and reduce inflammation and oxidation.

As for red wine, it contains high amounts of polyphenols.

Low intake of red meat, sweet foods, and saturated fat.

  • Red meat: 4 servings a month.
  • Sweet foods: 3 servings a week.

High intake of red meat has been linked to an increased risk of Parkinson’s disease. There are several possibilities that contribute to this. The high haem content in red meat can act as a toxin when this substance is not digested properly. Secondly, the high content of saturated fat in red meat is associated with increased oxidative stress.

RECONCILING THE MEDITERRANEAN DIET WITH OUR MALAYSIAN DIET

Although this diet is practiced by the people in Mediterranean countries that have a different dietary culture from Malaysians, it is possible to include their recommendations into our Malaysian diet.

In fact, there is a high similarity between the Mediterranean Diet Pyramid and the Malaysian Food Pyramid.

Image 1 shows the Mediterranean Diet Pyramid while Image 2 shows the latest Malaysian Food Pyramid. Click on these images for larger, clearer versions.

  • Both the Mediterranean diet and the Malaysian Food Pyramid encourage the consumption of fruits and vegetables, followed by the consumption of various grain products, especially whole grains.
  • In line with the recommendations of the Mediterranean diet, the Malaysian Food Pyramid also recommends the selection of lean meat and the incorporation of plant protein sources such as legumes in a simple daily diet.
  • Both of these pyramids also emphasize limiting the intake of fat, oil, sugar, and salt.

However, a slight difference is that the Mediterranean diet emphasizes the consistent use of olive oil.

The Mediterranean diet also encourages moderate wine consumption, but individuals may make decisions on whether to include this into their diet, based on their own personal religion and beliefs.

HOW TO USE THE MALAYSIAN FOOD PYRAMID AS A FOUNDATION TO INCORPORATE MEDITERRANEAN DIET IN OUR LIVES

One simple way is to follow the Malaysian Healthy Plate concept.

The Malaysian Healthy Plate concept. Click on the image for a larger, clearer version.

  • The first quarter of the plate is allocated for carbohydrate food sources such as rice, bread, grains, and others.
  • The second quarter is allocated for protein sources such as legumes, fish, chicken, and meat.
  • The remaining half is allocated for fresh vegetables and fruits.

The “Suku Suku Separuh” (“Quarter Quarter Half”) concept emphasizes portion control and balanced meals. Following it allows us to adhere to the recommendations of the Malaysian Food Pyramid.

Additionally, the cooking methods used in meal preparation also play a key role in enabling the incorporation of the Mediterranean diet into our Malaysian diet. We can use olive oil in the grilling, baking, and roasting of meat, fish, and vegetables. It can also be used as drizzle for our salads and ulams.

References:

  1. Chu, C., Yu, L., Chen, W., Tian, F., & Zhai, Q. (2021). Dietary patterns affect Parkinson’s disease via the microbiota-gut-brain axis. Trends in food science and technology, 116, 90–101. https://doi.org/10.1016/j.tifs.2021.07.004
  2. Bexci, M.S. & Subramani, R. (2018). Decoding Parkinson’s associated health messages in social media pages by Malaysian service administrators. Malaysian journal of medical research (MJMR), 2(4), 64-72.
    3. Torti, M., Fossati, C., Casali, M., De Pandis, M. F., Grassini, P., Radicati, F. G., Stirpe, P., Vacca, L., Iavicoli, I., Leso, V., Ceppi, M., Bruzzone, M., Bonassi, S., & Stocchi, F. (2020). Effect of family history, occupation and diet on the risk of Parkinson disease: A case-control study. PLoS one, 15(12), e0243612. https://doi.org/10.1371/journal.pone.0243612
  3. Molsberry, S., Bjornevik, K., Hughes, K. C., Healy, B., Schwarzschild, M., & Ascherio, A. (2020). Diet pattern and prodromal features of Parkinson disease. Neurology, 95(15), e2095–e2108. https://doi.org/10.1212/WNL.0000000000010523
  4. Georgiou, A., Demetriou, C. A., Christou, Y. P., Heraclides, A., Leonidou, E., Loukaides, P., Yiasoumi, E., Pantziaris, M., Kleopa, K. A., Papacostas, S. S., Loizidou, M. A., Hadjisavvas, A., & Zamba-Papanicolaou, E. (2019). Genetic and environmental factors contributing to Parkinson’s disease: A case-control study in the Cypriot population. Frontiers in neurology, 10, 1047. https://doi.org/10.3389/fneur.2019.01047
  5. Gao, X., Chen, H., Fung, T. T., Logroscino, G., Schwarzschild, M. A., Hu, F. B., & Ascherio, A. (2007). Prospective study of dietary pattern and risk of Parkinson disease. The American journal of clinical nutrition, 86(5), 1486–1494. https://doi.org/10.1093/ajcn/86.5.1486
  6. Yin, W., Löf, M., Pedersen, N. L., Sandin, S., & Fang, F. (2021). Mediterranean dietary pattern at middle age and risk of Parkinson’s disease: A Swedish cohort study. Movement disorders : official journal of the Movement Disorder Society, 36(1), 255–260. https://doi.org/10.1002/mds.28314
  7. Alcalay, R. N., Gu, Y., Mejia-Santana, H., Cote, L., Marder, K. S., & Scarmeas, N. (2012). The association between Mediterranean diet adherence and Parkinson’s disease. Movement disorders : official journal of the Movement Disorder Society, 27(6), 771–774. https://doi.org/10.1002/mds.24918
  8. Rusch, C., Beke, M., Tucciarone, L., Dixon, K., Nieves, C., Jr, Mai, V., Stiep, T., Tholanikunnel, T., Ramirez-Zamora, A., Hess, C. W., & Langkamp-Henken, B. (2021). Effect of a Mediterranean diet intervention on gastrointestinal function in Parkinson’s disease (the MEDI-PD study): Study protocol for a randomised controlled trial. BMJ open, 11(9), e053336. https://doi.org/10.1136/bmjopen-2021-053336
  9. Rusch, C., Beke, M., Tucciarone, L., Nieves, C., Jr, Ukhanova, M., Tagliamonte, M. S., Mai, V., Suh, J. H., Wang, Y., Chiu, S., Patel, B., Ramirez-Zamora, A., & Langkamp-Henken, B. (2021). Mediterranean diet adherence in people with Parkinson’s disease reduces constipation symptoms and changes fecal microbiota after a 5-week single-arm pilot study. Frontiers in neurology, 12, 794640. https://doi.org/10.3389/fneur.2021.794640
  10. Calder P. C. (2006). n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. The American journal of clinical nutrition, 83(6 Suppl), 1505S–1519S. https://doi.org/10.1093/ajcn/83.6.1505S
  11. The Hellenic Health Foundation. (n.d.). Dietary guidelines for adults in Greece. https://www.hhf-greece.gr/hydria-nhns.gr/adultdietarytext_eng.html
  12. Bisaglia, M. (2022). Mediterranean diet and Parkinson’s disease. International journal of molecular sciences, 24(1), 42. https://doi.org/10.3390/ijms24010042
  13. Lange, K. W., Nakamura, Y., Chen, N., Guo, J., Kanaya, S., Lange, K., & Li, S. (2019). Diet and medical foods in Parkinson’s disease. Food science and human wellness, 8(2), 83–95. https://doi.org/10.1016/j.fshw.2019.03.006
  14. Foo Chung, C., Pazim, K., & Mansur, K. (2020). Ageing population: Policies and programmes for older people in Malaysia. Asian journal of research in education and social sciences, 2(2), 92-96.  https://myjms.mohe.gov.my/index.php/ajress/article/view/10227

New Year, Healthier You? An Expert Shares a Health Screening Strategy to Help You Get Started

WORDS LIM TECK CHOON

FEATURED EXPERT
DR MURALITHARAN GANESALINGAM
Head of Department
Obstetrics and Gynaecology
School of Medicine
International Medical University (IMU)
FIRST, LET’S REFLECT: DO YOU NEED HEALTH SCREENING? 

Health screening benefits us, even when we believe and feel that we are healthy.

Dr Muralitharan Ganesalingam tells us: “The goal of screening tests is to detect changes in the body before they become unmanageable. In this way, you have the chance to modify your lifestyle and steer away from a particular illness.”

GO FOR HEALTH SCREENING FROM EARLY ADULTHOOD (SUCH AS WHEN YOU START WORKING) AND DO IT TWICE A YEAR AFTER YOU TURN 45

As Dr Murali puts it:

  • Generally, women between 19-24 years of age are considered to be at the peak of health.
  • From the age of 25, fat begins to accumulate, especially in the hips, thighs and abdomen, while muscle mass deteriorates.
  • From the age of 35, bone mass depletes at a rate of 0.5% to 1% each year.

There will be variations to this trend, as people are difference and hence their bodies age differently too. However, these changes with ageing prompt the recommendation given by Dr Murali, as health screening can help in detecting early the health issues that can arise alongside these changes.

Furthermore, health screening can be helpful in detecting the development of certain diseases that may not show obvious symptoms at the early stage.

PRIORITISE THESE HEALTH SCREENING TESTS
  • Blood pressure to check for hypertension. “This disease, known as the ‘silent killer’, progresses without noticeable symptoms and affects 3 in 10 Malaysians (approximately 6.4 million people), and increases the risk of stroke and heart attack,” explains Dr Murali.
  • Blood count to detect conditions like anaemia. On average, anaemia affects 3 in 10 women aged 15 to 49 years and can cause complications during pregnancy such as miscarriage and premature birth.
  • Blood glucose test to check for diabetes.
  • Body mass index (BMI) to monitor weight gain and help prevent obesity. Dr Murali points out that our national statistics show that 1 in 2 adults are overweight or obese, and 1 in 2 have abdominal obesity, of which women accounted for 54.7% and 64.8% respectively.
  • Lipids test to check for elevated levels of cholesterol, which can lead to heart disease. Around 4 in 10 Malaysians, approximately 8 million people, have raised cholesterol levels, with women being more likely to have higher levels than men. In spite of this, 1 in 4 people are unaware they have high cholesterol.
  • Kidney function and liver profile, as chronic kidney disease affects 1 in 7 Malaysians, and diabetes is a significant risk factor for this disease.

Dr Murali also recommends going for annual eye checks, hearing tests, and dental check-ups as we age.

Just for women
  • Pap smears to check for cervical cancer. “Because we have an efficient screening programme through the use of Pap smears, we have been able to reduce the incidence of cervical cancer substantially,” says Dr Murali. “It is the most significant advancement in the control of cancer, hence annual screening for cervical cancer is something I emphatically encourage.”
  • Breast examinations (see below) to check for breast cancer. Dr Murali points out that it is essential for all women to be disciplined about performing their own breast examinations as well as to go for an annual check by a doctor, who will advise if a mammogram is needed.
  • Bone mineral density scans to detect osteoporosis. Dr Murali explains that one’s bone mineral density decreases with age and the risk of fractures increases, hence postmenopausal women 50 years and older should be screened. “Women aged 65 years and older should be screened at least once a year, according to Malaysian guidelines,” he adds.

An overview of how to perform breast self-examination at home. Click on the image for a larger, clearer version. If you are unsure or you have concerns, you can consult your doctor for more information.

FINAL ADVICE

“It is important for you to speak to your regular doctor about any health concerns and discuss what health screenings may be beneficial for you, based on your age, lifestyle and family history,” Dr Murali emphasizes.

An Expert Spills the Bean on Lactose Intolerance & Your Kids

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ONG SIK YONG
Consultant Paediatric Gastroenterologist and Hepatologist
Sunway Medical Centre

According to Dr Ong Sik Yong, lactose intolerance is a common gastrointestinal condition caused by the inability to digest and absorb dietary lactose.

Lactose intolerance is the result of your small intestine not producing enough of an enzyme called lactase. Lactase helps to break down lactose or milk sugars into simple sugars for absorption by your body.

BLAME IT ON DECLINING LEVELS OF LACTASE

Dr Ong shares that newborns can digest about 1 litre of breast milk every day.

However, the enzyme lactase, which digests lactose, usually declines in levels once the child stops breastfeeding, a circumstance known as lactase non-persistence.

“Approximately 70% of the world population are affected by lactase non-persistence, which causes the condition called primary lactose intolerance,” Dr Ong reveals.

He adds that generally a child shows symptoms of primary lactose intolerance after they turn 5. However, some children may exhibit symptoms as early as 2 years old.

CAN ALSO BE DUE TO OTHER GUT ISSUES

In young children, lactose intolerance may also be caused by underlying gut issues such as:

  • Gut infection.
  • Cow’s milk allergy.
  • Celiac disease.
  • Inflammatory bowel disease.

Dr Ong further shares that sometimes a child may temporarily lose the ability to digest lactose during an episode of acute gastroenteritis. Once the child recovers, however, they can continue to consume milk without further issues.

SYMPTOMS OF LACTOSE INTOLERANCE

“Usually, symptoms begin about 30 minutes to two hours after consumption,” says Dr Ong.

He adds that the common symptoms are:

  • Abdominal discomfort.
  • Bloating.
  • Farting.
  • Diarrhoea.
  • Perianal skin irritations with raw lesions surrounding the anus, due to low faecal pH in the child’s stools.
MANAGING THE DIET OF A LACTOSE INTOLERANT CHILD

Dr Ong advises parents to feed dairy products with naturally lower lactose content to children that show signs of lactose intolerance.

“After a period of limiting food with lactose, the child can consume back small amounts of foods and drinks containing lactose,” he adds.

The child’s symptoms should be observed throughout this trial period and over time, the parents or even the child would be able to tell how much of lactose the child can take.

“Besides that, parents can also consider using lactase enzyme, which can be taken by the child prior to consumption of dairy products to reduce unwanted consequences from consuming lactose,” advises Dr Ong.

NUTRITIONAL CONSIDERATION FOR THE LACTOSE-INTOLERANT CHILD

Milk and other various dairy products are a major source of calcium and vitamin D.

“Hence, it is important to make sure children who has limited dairy product intake to have other non-dairy food which are rich in these nutrients, like fish with soft edible bones, such as salmon and sardines, as well as green leafy vegetables. They may also require calcium or vitamin D supplement for their growing bones,” Dr Ong says.

A Tips-Filled Bumper Article to Help You Sleep Better Featuring Four Experts

WORDS LIM TECK CHOON

FEATURED EXPERT
CELESTE LAU
Chief Dietitian
Sunway Medical Centre
ADD MAGNESIUM-RICH FOODS IN YOUR DIET

“Magnesium plays a crucial role in various bodily functions, such as muscle and nerve operation, protein synthesis, glycolysis, and blood pressure regulation,” says Celeste Lau.

She explains further that this mineral aids in the conversion of protein into chemicals that induce sleepiness, promote muscle relaxation, and maintain gamma-aminobutyric acid (GABA), a neurotransmitter responsible for promoting restfulness.

You should consume between 100 and 350 mg of magnesium daily for optimal sleep support.

Celeste recommends adding sources of magnesium such as walnuts, almonds, flaxseeds, salmon, and mackerel into your meals. It is recommended to consume between 100-350mg of magnesium daily for optimal sleep support.

“Additionally, refrain from consuming a heavy meal in the evening. It is recommended to have dinner 2 to 3 hours prior to your bedtime,” she adds.

FEATURED EXPERT
MICHELLE CHONG HUI YEE
Clinical Psychologist
Sunway Medical Centre
PRACTICE RESTFULNESS

Michelle Chong explains that restfulness is a deliberate act of nurturing yourself—physically, mentally, and emotionally.

It is characterized by a feeling of peacefulness and contentment, often accompanied by a sense of relief from stress, worries, tension, or fatigue.

Mentally, restfulness means quieting the mind, letting go of worries, and embracing a sense of mental stillness.

  • Learn to embrace mindfulness and relaxation techniques.
  • Grounding yourself in the present moment. This heightened awareness allows you to detach from worries about the past and anxieties regarding the future as well as to foster a sense of presence that can alleviate stress and enhance your awareness of immediate experiences.
  • Practice deep breathing exercises and progressive muscle relaxation (PMR) methods to heighten your body awareness and release muscle tension, focusing on achieving a state of ‘physical rest’.
  • Prioritize relaxation techniques that calm the mind before bedtime. “Activities such as mindfulness meditation and journaling can effectively declutter the mind and reduce stress hormones, creating a more seamless transition into sleep,” Michelle says.
FEATURED EXPERT
DR NURUL YAQEEN
Consultant Respiratory, Sleep & Internal Medicine Physician
Sunway Medical Centre Velocity
START SLEEPTIME RITUALS 
  • “Do not use your bed as an office to answer calls, respond to emails and avoid watching television in bed,” advises Dr Nurul Yaqeen.
  • Instead, reserve your bed for sleep. Remove electronic devices (televisions, computers, smartphones, etc), from the bedroom.
  • Try to start a sleep ritual as rituals help signal the body and mind that it is time to sleep. Some suggestions from Dr Nurul Yaqeen are drinking a glass of warm milk, taking a bath, or listening to calming music to unwind before bed.
  • “There is also the 10-3-2-1 method to help you rest better at night,” she says, “which is no caffeine 10 hours before bed, no food or alcohol 3 hours before bed, no work 2 hours before bed, and no screen time 1 hour before bed.” 
FEATURED EXPERT
Effendy Nadzri
Interior Designer
ENDO
Website
GET THE AMBIENCE RIGHT
  • “Keep your room cool at night,” says Effendy Nadzri. “The ideal temperature in the bedroom should be between 20º and 23º Celsius.”
  • If you have an air conditioner at home, he recommends switching it on at night to signal to your body that it is time for sleep.
  • Set the perfect ambience with dimmable or mood lighting to enhance your bedroom space and create the desired mood for a restful evening before you retire to sleep.
  • “You may want to have aromatherapy or essential oils that can help you relax at night,” Effendy adds.

 

Tuberculosis Cases Are Rising in Malaysia. An Expert Shares What You Should Know & Do About This

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ROSMADI ISMAIL
Consultant Interventional Pulmonologist and Internal Medicine Specialist
Sunway Medical Centre

Quite recently, our Minister of Health Dr Zaliha Mustafa revealed at the United Nations General Assembly High-Level Meeting that there was a concerning increase of 17% in tuberculosis cases in 2022 compared to 2021, along with a 12% increase in tuberculosis-related deaths during that time period.

In light of this development, Dr Rosmadi Ismail shares his thoughts with us about tuberculosis, its detection, treatment, and prevention.

Tuberculosis is an infectious disease that is caused by the bacteria Mycobacterium tuberculosis (MTB) infecting the lungs as well as certain other parts of the body.

An overview of the symptoms and preventive measures of tuberculosis. Click on the image for a larger, clearer view.

IS DETECTION OF TUBERCULOSIS GETTING BETTER?

Dr Rosmadi reveals that there are several innovative techniques currently undergoing clinical trials in a few countries.

These techniques, which include biosensing technologies and nano-diagnostics, promise quicker and more accurate results.

He shares: “Ongoing research focuses on innovative methods like computer-aided detection (CAD) through artificial intelligence, aerosol capture technologies, and antigen-based skin tests. They are poised to revolutionise TB diagnosis, enhancing efficiency and effectiveness in the future.”

In Malaysia, there are diverse methods employed to ensure accurate and timely detection of tuberculosis, such as:

  • Sputum smear microscopy, typically the first test for tuberculosis.
  • Culture and sensitivity testing to diagnose tuberculosis.
  • Nucleic acid amplification tests (NAATs) to facilitate the identification of tuberculosis cases.
  • Chest radiography and clinical tests like the Tuberculin Skin Test (TST) to confirming the infection.
TREATMENT OF TUBERCULOSIS

Treatment of tuberculosis in Malaysia follows the World Health Organization guidelines, which is the global standard.

Dr Rosmadi tells us, “The standard treatment for drug-susceptible tuberculosis in Malaysia involves a combination of four drugs administered for a duration of 6 to 8 months.”

Treatment utilizes the Directly Observed Treatment (DOT) strategy, which sees the patients receiving close supervision from healthcare workers to ensure that they complete their medication intake.

Currently, there are no new medications or treatments that show superior results over current ones when it comes to treating tuberculosis. Dr Rosmadi notes that treatment for drug-resistant TB involves a distinct medication regimen and extended treatment duration.

“This tailored approach has proven effective even in cases of drug-resistant TB, reinforcing our commitment to comprehensive patient care,” he says.

DR ROSMADI’S TUBERCULOSIS TIPS 
  • Stay clear of crowded places. It’s best to avoid crowds, especially if they’re poorly ventilated.
  • If you’re experiencing a persistent cough, fever, or unexpected weight loss, seek medical help promptly. This will help you get better and stop the disease from spreading.
  • Get checked if you’re at risk. If you have a weak immune system or have been around people with tuberculosis, consider getting tested. It’s a simple step that can catch the disease early if exposed.
  • If you’re diagnosed with tuberculosis, completing your treatment is essential. P
  • Preventive measures such as wearing a mask, covering your mouth and nose when you cough or sneeze, and disposing of tissues properly can help protect yourself and those around you.
  • If your job puts you in contact with many people, wear the proper protective gear as an added layer of safety.
  • Think about getting vaccinated. The current vaccine, Bacillus Calmette Guérin (BCG), offers partial protection to infants and young children against severe forms of tuberculosis. It doesn’t protect adolescents and adults that are the primary carriers of the tuberculosis bacteria, but it could help in the long run.