Toothbrushes: Manual Or Electric?

Toothbrushes: Manual Or Electric?

March 19, 2020   Return


If you are like everyone else who practices good dental hygiene, you’ve probably brushed your teeth this morning. Which toothbrush did you use? It is safe to assume most of us use a manual toothbrush. I recently went for a regular dental checkup and was told my gums were receding. My dentist advised me to get an electric toothbrush as it would prevent my gums from receding further. Having recently seen a video of how manual toothbrushes were better at removing dirt than electric ones, I was somewhat confused. So, what does a good writer do? We do some research. Here’s what I found.


Electric may be better
According to a scientific review, which looked at 51 studies with about 4,600 participants, electric toothbrushes are capable of significantly reducing plaque over short- and long-term use.1 Similarly, electric toothbrushes reduce the risk of gingivitis more than manual toothbrushes in the short and long term.1 However, as it is a review of existing studies, the strength of the review was considered to be of moderate quality. This means it isn’t a foregone conclusion and further research may change the situation. For now, it looks like electric toothbrushes are better than manual ones.

It can get a little confusing though, as not all electric toothbrushes are equal. There is a difference even within electric toothbrushes. It appears that electric toothbrushes that oscillate and rotate (makes circular motions) are better at cleaning plaque than those that create side-to-side movements.

I asked Dr Catherine Chong, a dentist in private practice, on how to determine which toothbrush is better. According to Dr Catherine, electric toothbrushes are indeed better. However, some people do just as well with manual toothbrushes. She recommends the use of plaque disclosing tablets to determine which toothbrush is more effective for an individual person. She says a person can perform a simple test of using a manual toothbrush to clean their teeth and then using the tablet to check for plaque remnants. Then the next day, the person can try brushing their teeth with an electric toothbrush and testing with the plaque disclosing tablet again to see the amount of plaque left after brushing. The difference will allow the person to decide which is best for him or her.

Plaque disclosing tablets are chewable tablets that stains plaque on teeth. It is usually made of vegetable dye that makes the plaque stand out and is either red or blue in colour. Although it isn’t a common item, these tablets can easily be purchased online.

Manual Toothbrushes
Manual toothbrushes are much cheaper than electric toothbrushes. They usually range from a few ringgit to tens of ringgit, depending on their unique selling points. Generally, toothbrushes are divided into soft, medium and firm bristle types. But within these three types are the numerous designs, angles, and materials that go into the bristle production.

How about the measurements of the toothbrush and bristles? A Korean study says the length of the bristle head should be 2.14 to 3.05 cm for men and 2.09 to 2.96 cm for women. The length of bristles should be 1.07 cm for men and 1.03 cm for women. The width of the toothbrush head should be 7.7 mm. Finally, the neck of the toothbrush should be 3.13 cm for men and 3.0 cm for women.2 While the study was done on Koreans, they should not stray too far from our measurements as they are also Asian in terms of size.

While this may sound confusing, the best advice would be to test out a few types of toothbrushes and find out which one fits you the best.

Electric toothbrushes
Electric toothbrushes are less common but are seeing better uptake in recent years. As mentioned earlier, some models oscillate and rotate while others only move in a singular side-toside motion. While the hard work of manual brushing is already done by the motor of the toothbrush, the highspeed movement and vibration of the device can still cause damage to gums and teeth if the user is not careful.3



Specific types of toothbrushes
Beyond the usual round or oblong toothbrush heads we are used to, there are some uncommon types in the market. First is the interdental toothbrush, which is good for cleaning between teeth and dental braces.

We also have end-tufted toothbrushes which are specially made to clean the wisdom tooth area and also crooked teeth with odd angles that are hard to reach using normal toothbrushes.

Whichever toothbrush you choose, remember it doesn’t negate the recommended twice-yearly visit to your dentist. Regular visits to the dentist not only ensure your teeth and mouth are in good condition, it will also help doctors detect abnormalities early. These includes receding gums, oral cancers, dry mouth, fungal infections, and taste impairment.

A dentist also trained to look at the muscles of the head, neck, jaw, tongue, salivary glands, and the nervous systems of the head and neck. They can quickly refer the patient to a specialist if they suspect there is something serious going on. HT

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References:References: 1. Yaacob, M., et al. (2014). Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev;(6):CD002281. 2. Chun, J.A., et al. (2014). The Standardization of Toothbrush Form for Korean Adult. Int J Clin Prev Dent;10(4):227-235. 3. University Health Service – The University of Hong Kong. Types of Toothbrushes. Retrieved from


‘ACTing’ Mindfully On Anxiety

‘ACTing’ Mindfully On Anxiety

March 19, 2020   Return


Dr Phang Cheng Kar
CPsychiatrist Sunway Medical Centre

A psychiatrist and mindfulness-based therapist expands on the topic of anxiety, a crippling yet common mental health issue. He also explains how Acceptance and Commitment Therapy (ACT) can work as a treatment option for those with anxiety disorder.


How would you define anxiety disorder?
Anxiety symptoms are part and parcel of life. For example, it’s normal to feel anxious when you have a deadline for an assignment approaching. Having anxiety disorder on the other hand, means to have anxiety symptoms (fears, worries, and psychosomatic symptoms) that are more intense and frequent, to the extent that it interferes with a person’s daily activities such as job performance, school work, and relationships.

What are the more common causes of anxiety disorder?
The common mental disorders under the anxiety category that I encounter in my adult psychiatric clinic are: panic disorder, agoraphobia, generalized anxiety disorder, and social anxiety disorder. It’s also common for anxiety to occur with depression. The causes of these are multifactorial— it could be biological (caused by hormonal disorders such as thyroid problems, or stress from a physical illness like cancer); psychological (such as traumatic childhood experiences, stressful life events like unemployment, etc.); environmental (natural disasters, haze), or social (political instability such as riots or demonstrations that are prolonged).

Can anxiety disorder run in the family?
If yes, does this mean that there is a genetic component to the disorder? Yes, that’s one of the biological causes of anxiety disorder. I have a strong family history of anxiety disorders. I know the condition inside out. The genetic risk factor partly contributes to my particular interest in anxiety education and treatment.

When should someone with a possible anxiety disorder see a mental health professional?
Someone with a possible anxiety disorder should see a health professional when:

  • It interferes with his or her daily activity at school, work, or home.
  • He or she makes excessive or unnecessary visits to doctors due to psychosomatic symptoms (a physical illness or other bodily conditions caused or aggravated by a mental factor) or is frequently absent from work due to poor physical health.
  • The anxiety leads to depression symptoms such as: loss of interest in daily activities; feeling hopeless or helpless; experiencing changes in sleep, appetite, or weight patterns; having irrational guilt, anger or irritability; or having suicidal thoughts.
  • Loved ones can’t tolerate the negativity of the person with anxiety disorder, giving rise to interpersonal challenges eg, marital and parenting issues.
  • A person copes with anxiety using unhealthy or harmful methods eg, excessive alcohol consumption, illicit drug abuse, self-harm, or binge eating.

What could happen if the disorder is not properly controlled or treated?
The following complications could occur:

  • The affected person could continue to have frequent psychosomatic complaints which could lead to excessive use of medical services—these people tend to “doctor shop”. Due to their weakened immunity, they are also more prone to getting various physical illnesses.
  • The person could develop other anxiety disorders (eg, generalized anxiety disorder combined with panic attacks and social anxiety), depression, or suicidal thoughts.
  • The person could also turn to alcohol or substance abuse. It can also lead to behavioural addictions like gambling, pornography, or computer gaming addictions.

What is Acceptance and Commitment Therapy(ACT)?
Acceptance and Commitment Therapy (ACT, typically pronounced as the word ‘act’) is an action-oriented and scientifically supported approach to psychotherapy for conditions such as anxiety disorders, major depressive disorder, and substance-use disorders.

Please tell us more about ACT.
ACT teaches various mindfulness and acceptance-based skills (such as present moment awareness, thought defusion, emotional acceptance, and observing mind) in therapy sessions. These methods are intended to help people befriend anxiety symptoms rather than fight or feel bad about them. ACT also uses a set of exercises that help patients identify and commit to their meaningful goals and values in life.

What is the goal of ACT?
To act towards our value-based goals. In ACT, we don’t aim to get rid of anxiety symptoms (such as panic attacks); it’s to embrace anxiety and move towards meaningful goals in life.

Aside from ACT, what other common therapies are recommended for anxiety disorders?

  • Cognitive Behavioural Therapy (CBT) eg, challenging thoughts, exposure therapy, and social skills training.
  • Antidepressant and anti-anxiety medications may be prescribed by a qualified doctor.
  • Relaxation training eg, progressive muscle relaxation, pleasant imagery, and deep breathing. • Emotional Freedom Technique (EFT).
  • Eye Movement Desensitization and Reprocessing (EMDR).
  • Exercise, meditation, hypnosis, and prayer.

Can one’s anxiety disorder truly go away?
It’s normal to have some anxiety in daily life. It’s also not uncommon that anxiety disorder does not truly go away. Therefore, the aim of ACT is not to eliminate anxiety. It’s to learn to cope with anxiety and move on with life to achieve what is meaningful to us.

What is your advice to people who decide to self-diagnose and “DIY” their own ACT using information found online or in a book?
If it works well for you, good; if not, get guidance from a mental health professional who is familiar with ACT. There is no one-sizefits-all or best treatment plan. Most importantly, do not give up; explore with a therapist on methods or combinations of treatments that suit you. HT

Breaking The Chains Of ‘Bacne’

Breaking The Chains Of ‘Bacne’

March 19, 2020   Return


Dr Ch’ng Chin Chwen
Consultant Dermatologist

It’s certainly no fun when it seems only pimples have got your back. Want to get rid of them? Take the advice of a dermatologist.

Having acne can really ruin one’s confidence and having them on your back is no less embarrassing. Back acne or ‘bacne’ is particularly frustrating as they appear in places that are hard to reach. Thankfully, according to consultant dermatologist Dr Ch’ng Chin Chwen, there are things you can do to alleviate back acne. In this article, Dr Ch’ng debunks some common myths about back acne and gives us helpful dermatologist-approved tips on how to get rid of them the right way.

What causes back acne and why do only some of us get them?
Acne, no matter which part of the body it appears in, is mostly triggered by genetic and hormonal factors. There is some recent evidence pointing to high sugar foods and milk/dairy products as key contributing factors to acne breakouts as well.

A variety of medications are known to be associated with acne breakouts. These include oral corticosteroids, hormones (such as anabolic steroids, certain contraceptive pills, and testosterone), certain antiepileptic medications, antibiotics or antidepressants, and some chemotherapeutic medications.

Why is the skin on our back particularly prone to acne?
This area has more sebaceous glands. The formation of acne on our skin involves sebaceous glands, which are more abundant over our face, upper chest and back. Areas without sebaceous glands don’t develop acne (for example, the palms).

What worsens back acne?

  • Using harsh skin care items like antibacterial soaps, astringents and abrasive scrubs can disrupt the skin’s natural protection layer, irritate the skin, and worsen acne. Hence, excessive washing, scrubbing or use of drying skin care products can also exacerbate back acne.
  • Use of oily/thick textured skin care products that clog the pores can worsen back acne. For people with acne-prone skin, it’s best to stick to oil-free or non-comedogenic skin care products.
  • Back acne may be more common in our country because of our hot and humid weather. Sweating, wearing thick or tight clothing, or working in an oily environment can clog pores and worsen back acne.
  • Stress has long been known to be a contributing factor to acne breakouts.

What should we do to get clear skin on our backs? Any medication or topical treatment options available?

  • Avoid trigger factors as mentioned earlier in this article.
  • Practice good skin care habits: no excessive washing/ cleansing, diligently use sun protection, avoid hot and humid places, shower immediately after sweating, wear loose and airy clothing made of cotton, and regularly moisturize your skin.
  • Topical acne medicines (similar to those that treat facial acne) are available in most pharmacies. Perhaps look for products that can cover large surface areas easily, such as products specifically formulated for body acne or spray-on products.
  • Your dermatologist may prescribe oral medicines such as antibiotics, spironolactone, and isotretinoin to treat your acne.
  • Light and laser treatments provided by your dermatologist may also help treat back acne. Do you recommend those with back acne to use a loofah/ back scrubber? Gentle scrubs can help clear clogged pores, but harsh scrubs can disrupt skin barrier and cause more inflammation—the balance may be difficult to strike. If you want to use loofah, use it softly, and remember to wash and dry the loofah properly after each use for hygiene reasons.

It’s easier to opt for a chemical exfoliator rather than physical scrubs for a gentler effect. Use products with AHA (alpha hydroxy acid), BHA (beta hydroxy acid) or salicylic acid. Note that salicylic acid is stronger and may not be suitable for those with dry skin to use regularly.

Are those ‘special acne body wash’ the best option for those with back acne?
Yes. Body washes that contain AHA, BHA or salicylic acid may help with back acne.

When should we see a dermatologist?
If you have tried changing your diet, lifestyle, skin care products, and have regularly used over-the-counter acne gels but still have uncontrolled acne, you should see your dermatologist.

It’s hard to care for our backs as some areas are hard to reach. Are there any products that can help us solve this problem?
Some products come in a spray form for difficult-to-reach areas. HT

A Fascinating Story Of Vaping, Popcorns & Lung Troubles

A Fascinating Story Of Vaping, Popcorns & Lung Troubles

March 19, 2020   Return


In 2019, many news outlets featured the story of a 17-year-old in Canada who was treated for a condition called popcorn lung disease, which can be life threatening. It was alleged that his condition was due to his regular vaping and marijuana habit.

The incident actually happened a while back, and it became news only after the medical team published a paper on the case in the Canadian Medical Association Journal. The case was considered noteworthy because of two reasons:

  • popcorn lung disease itself is a rare disease, and
  • this is a case that indicates a link between vaping and popcorn lung disease.
    Before we go on, first let’s review the incident based on the medical team’s account in the paper.1

The teenager suffered from severe and prolonged coughing fits. His coughs are wet (there is phlegm produced) and he also suffers from fever and prolonged, laboured breathing (dyspnoea).

He was first admitted into the emergency department when he developed pneumonia. Five days after he was discharged, he was back again, this time for severe dyspnoea, malaise, and nausea.

The healthcare team diagnosed his condition as bronchiolitis obliterans, also called obliterative or constrictive bronchiolitis. This rare condition is more popularly known as popcorn lung disease.


What’s that?
What happens is that the smallest airways in the lungs, called the bronchioles, become inflamed and even damaged. This causes constant irritation to the lung tissues, hence the chronic coughs and phlegm formation.2

Furthermore, when the areas of damage heal, scar tissues can form at those areas. Extensive formation of such scars can cause the air passages to become narrow or even completely blocked altogether.2

As a result, over time, the affected person will find it increasingly harder to breathe, and their body becomes deprived of much-needed oxygen. If this condition is left unchecked, death will eventually follow.2

Can this be treated? Unfortunately, to date we don’t have any treatment that can reverse the damage in the lungs.

However, the progress of the disease can be kept in check with medications such as antibiotics, corticosteroids, and immunosuppressants.2

Additionally, cough suppressants may be useful to manage coughing fits, and oxygen therapy can help those affected by this disease to breathe more comfortably.2

As for the teenager, the report shares that, at the time of its publication, he still had issues with movement and carrying out physical activities, but the medical team was optimistic about his chances of recovery.

Wait, so despite its name, the disease has nothing to do with popcorns?
Illustrations of the alveolus in the lung may resemble a popcorn at times, but the term ‘popcorn lung’ stems from how this disease affected a significant number of workers in American popcorn factories.

When it comes to popcorns, most Malaysians consider it a delicious snack to be enjoyed at the movies. In the US, it is big business—the country, in fact, is the top producer of ready-to-eat or microwave popcorns in the world, with the average US citizen consuming 45 quarts (about 1.4 kilogram) of popcorns every year!3

I can’t believe it’s not butter! To cut costs, many microwave popcorn manufacturers use artificial flavouring instead of butter. A commonly used ingredient in artificial butter flavouring is the alpha-diketone, 2,3-butanedione or diacetyl. 4,5

In 2000, it was reported in the US that eight former microwave-popcorn factory workers had developed bronchiolitis obliterans. Of the eight, four were very sick, awaiting lung transplant. Researchers of the US National Institute of Occupational Safety and Health (NIOSH) eventually identified the culprit to be vapours that were produced when butter flavourings were added to the popcorn. More specifically—diacetyl. The fact that the same disease was also observed among workers in coffee plants and in plants that manufacture diacetyl corroborated this finding.5,6

Out with diacetyl! A flurry of lawsuits from ex- and current workers were quickly filed against manufacturers of microwave popcorns in the US. As it always happens when it hit where it hurts the most (their pockets), the popcorn industry was pretty quick to take action. Today, diacetyl is no longer used in the manufacture of microwave popcorns.



“The teenager in the study had been vaping regularly in the past 5 months. He regularly added tetrahydrocannabinol (THC) to his vape juices. THC is an extract obtained from marijuana; it can trigger a ‘high’ similar to that of taking marijuana itself. The teenager also occasionally inhaled marijuana via a bong.”

Hence, it is understandable that people begin linking his vaping habit to his popcorn lung disease.

Well, it’s not so straightforward …
It is very important to note that the medical team that published the paper made the following conclusion:1

This case of acute, life-threatening bronchiolitis resulting in fixed, chronic airflow obstruction in a previously healthy youth highlights the need for further research on the epidemiology of e-cigarette use, its addictive potential, and the short- and long-term risks and mechanisms of injury associated with vaping.

Wait, the paper said ‘further research’—does this mean we still aren’t sure about the link?
A study conducted by Harvard, published in 2016, found that diacetyl was present in 47 out of the 51 e-cigarette flavours studied.7

However, various research to date has still not found any conclusive evidence that the levels of diacetyl present in vape juices can indeed cause popcorn lung disease.8

Now, science is all about making evidence-based conclusions, so without the conclusive evidence, researchers will hesitate to give absolute statements about this link.

Does this mean that we can vape in peace?
Well, it’s not so simple. We should keep in mind that, unlike cigarettes which have decades of research demonstrating conclusively how bad they are for our health, e-cigarettes are comparatively new. It may take a while to get confirmation as to how they can affect our health.

Not that we have been complacently sitting on our thumbs waiting for research to uncover the evidence, though!

In the US. The US Food and Drug Administration (FDA) would require e-cigarette companies to submit their product ingredients for review from 2022. For the time being, therefore, there is a likelihood of vape juices produced in the US that still contain potentially harmful amounts of diacetyl.8

In the EU. The EU Tobacco Products Directive (TPD) banned the use of diacetyl in e-cigarette liquids in 2016.9 Hence, all vape juices originating from EU countries should be free of that substance.

What does this mean for us?
Well, one thing most health authorities all over the world agree on is that vaping is not a positive alternative to smoking. There are many red flags to suggest that vaping may have negative long-term effects on our health. Quitting smoking by taking up vaping is like leaping from the fire into a deep sea—who knows what is lurking beneath that sea?

Why take chances? Don’t vape, and if you are vaping, talk to your doctor or pharmacist on how you can successfully quit the habit! HT

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References: 1. Landman, S.T., et al. (2019). Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth. CMAJ.;191(48):E1321— E1331. 2. Genetic and Rare Diseases Information Center (US). Bronchiolitis obliterans. Retrieved on 27 December 2019 from gov/diseases/9551/bronchiolitis-obliterans. 3. The Popcorn Board. Industry Facts. Retrieved on 27 December 2019 from 4. Centers for Disease Control and Prevention (US). Flavorings-Related Lung Disease. Retrieved on 27 December 2019 from topics/flavorings/exposure.html. 5. Krishna, R., et al. (2019). Bronchiolitis Obliterans (Obliterative Bronchiolitis, Constrictive Bronchiolitis) [Updated 11 November 2019]. Retrieved on 27 December 2019 from NBK441865/. 6. Centers for Disease Control and Prevention (US). “We Were There” – Diacetyl and Popcorn Lung Disease. Retrieved on 27 December 2019 from 7. Allen, J.G., et al. (2016). Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a Sample of 51 Products, Including Fruit-, Candy-, and CocktailFlavored E-Cigarettes. Environ Health Perspect;124(6):733–739. 8. American Lung Association. (2016, July 7). Popcorn Lung: A Dangerous Risk of Flavored E-Cigarettes. Retrieved on 27 December 2019 from blog/2016/07/popcorn-lung-risk-ecigs.html. 9. Medicines and Healthcare Products Regulatory Agency (UK). Advice on Ingredients in Nicotine-Containing Liquids in Electronic Cigarettes and Refill Containers. In: Discussion Paper on Submission of Notifications Under Article 20 of Directive 2014/40/EU. Retrieved on 27 December 2019 from

I Have A Pine. I Have An Apple. I Have A Pineapple!

I Have A Pine. I Have An Apple. I Have A Pineapple!

March 13, 2020   Return


Pineapples (Ananas comosus) are as synonymous with the tropics as coconuts are. Thanks to our classic movies such as Hawaii Five-O and Fantasy Island, the fruit is always seen as a must have in tropical settings. It can be bewildering to think how our ancestors decided to eat the fruit. Similar to the durian, it has spines and ‘eyes’ which are hard to remove. Our older folk may remember being forced by their parents to manually peel and remove the eyes in a spiral cutting motion. Nowadays, we can get them pre-cut at lunch places and supermarkets. As well as being delicious, pineapples contain a long list of nutrients and enzymes which are healthy for us.


What is a pineapple?

Well, guess what? The pineapple, as you may already know, isn’t related to the pine nor the apple. It is actually a type of bromeliad. Bromeliads are plants with thick waxy leaves that spread out in a bowl-like fashion and catch rainwater at the centre. They produce beautiful flowers that last a long time. The pineapple first took the leap into worldwide fame when Christopher Columbus brought the plant to Spain when he returned from the New World in 1493.

Nutrition-wise, the fruit may not be ranked as a ‘superfood’ by today’s standards but the utility of pineapple lies in its enzymes. Take a look at what a typical 100-g portion of pineapple contains. (Table 1)

The main component that contributes to the sweetness of pineapples is sucrose while the main acid component is citric and ascorbic acids.2 The table does not list vitamins, of which pineapple has loads of. It has vitamin C (in the form of ascorbic acid), thiamin, riboflavin, niacin, pyridoxine, cobalamin, vitamin A, folate, and trace amounts of vitamin E.1

Table 1: Nutrition Facts— fight off oxidative stress.”Pineapple, raw, all varieties.

Serving Size: 100 g
Water [g]
Energy [kcal]
Protein [g]
Total lipid (fat) [g]
Carbohydrate, by difference [g]
Fibre, total dietary [g]
Sugars, total [g]
Calcium, Ca [mg]
Iron, Fe [mg]
Magnesium, Mg [mg]
Phosphorus, P [mg]
Potassium, K [mg]
Sodium, Na [mg]



Pineapples contain a lot of flavonoids, which help the body fight off oxidative stress. Vitamin C, another potent antioxidant and immune booster, is helpful in reducing the duration of illness by stimulating the immune system.3


Bromelain, a protein dissolving enzyme, is found mostly at the centre of the pineapple fruit. It is the same enzyme responsible for the itchy tongue and lips some people face when eating pineapples. The enzymes attack the skin in our tongue, cheek and lips thus causing it to hurt. Some sensitive folk may even develop ulcers. There’s really no way to avoid the enzymes if you want to eat fresh pineapple. Preserved pineapples, on the other hand, won’t have that effect as it has to be heated before being canned. The heating process destroys all the enzymes. Some people suggest soaking the pineapple in salt water to reduce the itchy effect. It is doubtful that salt does anything to the enzyme; instead, it is probably the water dissolving the enzymes and flushing it away. But don’t forget, you’re also flushing the water-soluble nutrients away.

Are you allergic to pineapple?

One thing to watch out for is genuine pineapple allergy. Some may mistake the pain and itching from pineapple as a reaction to the bromelain when in effect it could be allergy to the fruit.

Allergic reactions are usually more severe compared to normal reactions. You may have swelling or other symptoms such as sneezing or difficulty in breathing. If that happens, drop the pineapple and head to your nearest clinic.

Due to the bromelain and other enzymes, pineapples are a great aid for digestion. Many digestive enzyme tablets contain bromelain as one of the key components to help in reducing discomfort and bloating after meals.


Some pineapples may be fibrous if left to ripen for too long. Organic and vegan consumers are also resorting to fabric made from pineapple fibre. The source of the fibre comes from the entire plant, from the crown, leaf, stem, and even the fruit itself.4

Every 100 g of pineapple contains about 1.4 g of dietary fibre. This is by no means a large amount of fibre, so any improvement in bowel habit is due to the enzymes and juices of the fruit. The combined action of digestive enzymes and fibre in pineapple helps food to be properly digested as it travels through the gut.

Can I plant my own pineapples?

Unless you have a lot of space and patience, planting your own pineapple may be an exercise in futility. For one, it takes anywhere from 9 months to 2 years to mature, and only then will it flower and fruit.5 From the flower, a single fruit forms and this fruit takes about 6 months to grow to maturity. As the fruit juts out, birds, squirrels and bats will be eyeing it even before it fully ripens.

One good thing about the pineapple is that it is extremely hardy and even novice gardeners can’t really kill it. Belonging to the bromeliad family, the pineapple can absorb water through its leaves. It can also survive in a small pot as the root system is small and weak (because the leaves do a good job in sucking up water and preventing water loss). They do well with foliar fertilizers. One thing to watch out for when it comes to plants in the bromeliad group is their tendency to store water at the centre of the plant during the raining season. If you have only a few plants, then it may be worth checking them out periodically and pouring any excess water stored at its centre to prevent mosquitoes from breeding.

Pineapples are particularly choosy about the soil they grow in. In certain soils, they choose to grow leaves instead of flowers even when mature.In such an instance, you will need to induce flowering by chemical or physical means. Even then, it isn’t a foolproof method.

Pineapples, like bananas, only fruit once. Baby plantlets grow from the base of the plant and a new plant can be grown from the crown of each pineapple fruit. The local pineapple market is familiar with three main cultivars: Smooth Cayenne, Queen and Red Spanish. All local varieties are derived from these cultivars. The all-time favourite known as Nanas Sarawak is derived from the Red Spanish group. Nanas Sarawak can tip the scale at 2 to 4 kg for each fruit.

Most consumers are familiar with the Josephine variety, which is the result of a cross between the Nanas Johor and Nanas Sarawak. Nanas Maspine is derived from the Red Spanish cultivar and is about 1.8 kg when ripe.

The newer varieties such as the MD-2 are super sweet. However, a word of caution on all these super sweet new varieties—they aren’t exactly good for health. Already zoo animals are suffering from our continued obsession with breeding sweeter fruits and vegetables.6 If they are too sweet for animals who are active all day long, I’m guessing they are probably too sweet for us ie, mostly sedentary humans.

Just remember to ration our fruit intake and perhaps choose a variety which is less sweet but has higher fibre content. For the super sweet varieties, it is best to limit the intake for each sitting. Keep in mind that one serving size is 2 slices, 3” diameter, ¾” thick, and weighs 112 g.7 Most of all, don’t forget to appreciate our pineapple farmers! It’s hard work to grow pineapples. HT

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References: 1. U.S. Department of Agriculture. Pineapple, raw, all varieties. Retrieved from Lu, X.H., et al. (2014). Physico-chemicalproperties, antioxidant activity and mineral
contents of pineapple genotypes grown in China. Molecules.;19(6):8518–8532. 3. Nagy, S. (1980). Vitamin C contents of citrus fruit and their products: a review. J Agric Food Chem.;28(1):8–18. 4. SFGate. The Dietary Fiber in Raw Pineapple. Retrieved from 5. SFGate. What Is theLife Cycle of a Pineapple Plant? Retrievedfrom 6.The Sydney Morning Herald. Zoo won’t panda to taste, says fruit’s too sweet for its monkey menu.Retrieved from 7. U.S. FDA. Fruits: NutritionFacts. Retrieved from

5 Facts About Obstructive Sleep

5 Facts About Obstructive Sleep

March 13, 2020   Return


Dr Mangayarkarasi M Ramanathan
Consultant Physician & Respiratory Physician Assunta Hospital


#1 Obstructive sleep apnoea (OSA) is NOT a snoring problem.
Like its name would suggest, OSA is a condition in which there is an obstruction in your airway that interrupts your breathing while you are asleep. Possible obstructions include tonsils and adenoids in children or muscles at the back of the throat that can become too relaxed during sleep, narrowing the airway as a result.

When you have OSA, your body interrupts your sleep to get you to breathe each time oxygen levels fall below normal. As a result, you never truly reach deep sleep, and you wake up still feeling very tired.

Snoring is one possible sign of someone with OSA, but someone who snores may not necessarily have OSA.

OSA can also be ‘silent’—the person with OSA may not snore at all. Dr Mangayarkarasi shares that people with ‘silent’ OSA often have high blood pressure because of their condition; often their OSA is detected only after the doctor begins investigating the cause of their high blood pressure.

#2 OSA is linked to many serious issues and poor quality of life.
Additionally, lack of proper sleep can lead to daytime sleepiness, which in turn puts you at risk of reduced workplace productivity and/or academic performance as well as accidents. Accidentally falling asleep while driving due to OSA is a main cause of road accidents.

#3 Among children, hyperactivity may be a symptom of OSA.
Studies found that children with OSA are more likely to have problems paying attention or concentrating, and they also tend to develop attention deficit hyperactivity disorder (ADHD). As a result, their academic performance will suffer, and they will also have behavioural problems.

Children with OSA are also at increased risk of health problems listed in the previous point.

#4 OSA can be managed for better daily sleep and quality of life.
There is no cure for OSA. Dr Mangayarkarasi points out that, fortunately, it can be managed using continuous positive airway pressure (CPAP) therapy.

If you have OSA, your doctor may advise you to use a CPAP device each time you sleep. You need to wear a sleep mask attached to the device via a rubber tube, and once you’ve switched on the machine and go to sleep, the device will continuously deliver air via a steady, constant pressure. That way, your body will never be deprived of oxygen and you can achieve true sleep.

What about surgery? While surgery to widen the airway is certainly possible, Dr Mangayarkarasi reveals that among adults, this option is considered only after CPAP therapy fails to yield the desired positive results. This is because there is still a high possibility of someone developing OSA again some time in the future after a surgery.

For children with OSA, however, surgery is often the first option. Such surgery typically involves the removal of the tonsils to make more room in the airway.

#5 CPAP therapy is more convenient than before.
Don’t be put off by the above photo— that’s a typical image associated with the use of a CPAP device, but it’s an old school one!

These days, the device is smaller, lighter, and sleeker, thanks to improved technology. There are even portable versions that will be most suitable for people who travel often,and these portable versions may even come with slots to charge your mobile phone! Furthermore, the rubber tubes are thinner, longer, and more flexible to allow for more mobility, while the masks are also smaller and more comfortable to wear.

Aren’t CPAP devices expensive?
They do cost quite a bit, but in Malaysia, you can withdraw from your EPF funds to purchase the device. Furthermore, you may be able to pay in installments. Some government hospitals may offer CPAP devices at a subsidized cost as well. Therefore, don’t immediately assume that you cannot afford a CPAP device.Talk to your ENT specialist—they can advise you on how you can best afford CPAP therapy within your budget. HT