Yuen Kah Hay Professor, School of Pharmaceutical Sciences, Universiti Sains Malaysia
Our brain is a complex organ, and we still have much to learn about how it works. What we do know, however, is that our brain undergoes changes as we age, changes that can affect its ability to function normally.
While some of these changes are due to the natural consequences of ageing, we may develop conditions that can also affect our brain. According to Prof Yuen Kah Hay, our brain consumes more energy than any other organ in the body, roughly 20% of our total energy requirements. Our brain is nourished by a massive network of blood vessels. “Therefore, any damage to the blood vessels can lead to degeneration of brain tissues, possibly leading to neurodegenerative disorders such as cognitive dysfunction, dementia and Alzheimer’s disease,” he says. He adds that hypertension, hyperlipidaemia and diabetes are just some of the conditions that can damage the fine blood vessels in our brain.
Controlling the risk factors of such conditions would be very helpful to maintain our brain health, and thus, Prof Yuen recommends living a healthy lifestyle comprising a balanced diet and regular physical activity. If we need a little extra help, neuroprotective supplements such as tocotrienols can be helpful.
How can tocotrienols help?
Prof Yuen mentions that tocotrienol is a member of the vitamin E family essential for maintaining the health and functions of our nervous system. Thus, tocotrienol supplementation will benefit the elderly as well as those who are younger but have risk factors that can lead to neurological problems such as stroke and dementia.
White matter lesions
The benefits of tocotrienol can be seen in studies on white matter lesions (WMLs). These are lesions that are formed in the white matter region of the brain, often due to small blood vessel disease and other conditions that can cause degeneration of nerve fibres in that region.
Prof Yuen mentions a recent study on 121 human volunteers with WMLs. It is found that, in patients who were not given tocotrienol supplements, the mean lesion volume of the WMLs increased after 1 year, and further increased after 2 years. Those given tocotrienol supplements do not show any significant changes in their lesions, suggesting that tocotrienols are neuroprotective in nature.
Recent studies have shown that WMLs are closely associated with cognitive decline and dementia. Hence, tocotrienols have the potential to be used in the preventive treatment of such neurodegenerative disorders. Moreover, their neuroprotective activity may help reduce injury of the brain tissues during an ischaemic stroke.
Did you know?
Our very own palm oil is one of the richest sources of tocotrienols. Tocotrienols from our palm oil are extracted in a concentrated form and formulated into soft gelatin capsules with specified dose strengths (50, 100 or 200 mg per capsule), to provide optimal benefits when taken as a supplement.
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Arthritis does not recognise age or origins; it causes disability and morbidity in millions across the world. Statistics show that more women are at risk of this disorder, and there are also more women who suffer from arthritis compared to men. There are many types of arthritis with varying causes and symptoms, but the one thing that they all have in common is pain.
Arthritis has been and is being extensively researched for a better understanding of its root causes and elimination strategies. While there is no absolute cure for arthritic conditions, some treatments and measures do help provide symptomatic relief. One such measure that can help to provide temporary and timely relief is massage therapy.
Massage has been in existence since centuries and has been one of the oldest techniques of pain management. It has traditionally been used for improving circulation and flexibility, reducing inflammation, pain stress and anxiety. It can slow down the degeneration process, ease the pain, increase the level of comfort and improve mobility. Therefore, it can be a great complement to any arthritic pain management and lifestyle improvement programs.
The compression, friction, kneading and vibration motions in massage therapy provide much needed positive support and comfort arthritis patients such as:
Massage therapy improves blood circulation and flow to the affected areas. This helps to provide much needed nutrition and oxygen to the arthritic joint or muscle. It also helps to clean the affected area’s tissues of the arthritic inflammation’s by-products (e.g. lactic acid). All these effects result in better mobility and reduced inflammation.
Muscles around an arthritic joint or bone usually tighten in order to provide protection to the affected tissue, resulting in muscle stiffness. Massage therapy aids in release the muscular tension and relaxing them, leading to improved mobility.
Massage therapy also releases endorphins, which are natural pain killers produced by our body.
Due to its effects on reduction of inflammation and pain, massage therapy enables the arthritic patient to have improved mobility, leading to a slower rate of tissue degeneration.
Massage therapy can trigger our body to produce less cortisol ( “the stress hormone”) and more serotonin ( “the feel-good” or “happiness” neurotransmitter). Massage therapy also lowers the level of Substance P (commonly known as “the pain neurotransmitter”), thus reducing pain and improving sleep.
There are various types of massages that can be used. It ultimately dependson the type and degree of discomfort or pain experienced. Some common types are:
- Swedish massage, which incorporates long strokes of muscles and tissues.
- Hot stone massage involves the placement of hot smooth rounded stones on the back as one lies on her stomach.
- Ayurvedic massage, involving the use of certain medicinal oils.
- Deep tissue massage. The therapist places additional pressure deep into the tissues of affected areas.
- Anma is the Japanese-style kneading action on muscles without the use of oils.
- Lomilomi, a Hawaiian technique combining diet and meditation along with massage.
- Thai massage is carried out in various yoga-like body positions.
- Myofascial release massages and relaxes the fascia, a band of connective fibers (mainly collagen) that is located under the skin to join and stabilize internal organs, muscles and tissues.
- Shiatsu is a Japanese massage that applies pressure to specific points of the body using fingers and palms in a continuous rhythmic motion.
- Trigger point massage applies a combination of pressure and vibration on certain points on the body .
When deciding on the massage therapy that is most suited to you, remember that arthritic joints are extremely sensitive to pressure and touch. Talk to your doctor and a qualified message therapist for more information.
Arthritis Foundation. Available at www.arthritis.org
American Massage Therapy Association (AMTA); Available at www.amtamassage.org
Lorig K., Holman H., Sobel D., Laurent D., Gonzalez V. and Minor M. (2013). Understanding and Managing Common Symptoms, Living a Healthy Life with Chronic Conditions: For Ongoing Physical and Mental Health Conditions (4th ed.). Canada: Bull Publishing Company.
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Dr Peter Ch’ng Wee Beng Consultant Dermatologist, Peter Skin Specialist, Gleneagles Kuala Lumpur
People with psoriasis know that this condition is no mere skin disease. Their skin forms red patches with thick, silvery scales, and these plaques are accompanied by itch, irritation and even joint pain. The joint pain may prevent the person from working or going to school, and the negative reaction of others to their appearance can hurt their self-esteem.
Psoriasis is actually an auto-immune disease, caused by the immune system attacking healthy skin cells under the assumption that these skin cells are the ‘enemies’.
Consultant dermatologist Dr Peter Ch’ng explains that, in addition to the symptoms described above, about 30% of patients with psoriasis may develop psoriatic arthritis. Just like rheumatoid arthritis, psoriatic arthritis causes inflammation of the joints, making movement difficult and even painful. Sometimes, the affected joints may become permanently deformed.
Treating psoriasis can be challenging
“The most challenging part of treating patients with psoriasis,” says Dr Peter Ch’ng, “is how some patients, especially those with severe psoriasis, may not respond adequately to treatment. There are also patients who cannot tolerate the current conventional therapy due to side effects, or they suffer from health conditions that make these available treatments unsuitable or even dangerous for them (contraindication).”
Therefore, there are always people living with psoriasis who find that current available treatments still cannot help them achieve symptom-free outcomes.
A new option for clear skin
More treatment options are always better when it comes to psoriasis, and the dream of having clear skin is more achievable than ever, thanks to the introduction of secukinumab in Malaysia this year.
Secukinumab is the bioengineered version of an antibody that binds specifically to a protein in the body called IL-17A. IL-17A is thought to play a role in the development of symptoms in both psoriasis and psoriatic arthritis. Secukinumab stops the activity of IL-17A, thus helping to reduce the symptoms as well as inflammation to a very effective degree.
Dr Peter Ch’ng explains, “Secukinumab has demonstrated superior efficacy outcome compared to current treatments.” He elaborates that eight out of 10 patients are able to achieve clear or almost clear skin after receiving this treatment. Furthermore, more than 80% of patients with psoriatic arthritis found that secukinumab managed to stop the progression of their joint damage.
But is the drug safe? Dr Ch’ng says, “This drug was studied in clinical trials involving more than 4,000 patients, and the safety profile was found to be similar to other biologic treatments in the market.”
He also says that the most common side effects are upper respiratory tract infections, with symptoms such as sore throat and stuffy nose (nasopharyngitis, rhinitis). However, patients should not worry: if their physician deems that they are suitable to receive secukinumab, there would be a thorough discussion on the safety and precautions before treatment is initiated.
- NHS Choices. Psoriasis. Retrieved on July 19, 2016 from http://www.nhs.uk/Conditions/Psoriasis/Pages/Introduction.aspx.
- Gladman, D.D., et al. (2005). Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis; 64:ii14-ii17 doi:10.1136/ard.2004.032482
- Papp, K.A., et al. (2013). Efficacy and safety of secukinumab in the treatment of moderate-to-severe plaque psoriasis: a randomized, double-blind, placebo-controlled phase II dose-ranging study. Br J Dermatol.; 168(2):412-21. doi: 10.1111/bjd.12110. Epub 2013 Jan 18.
- Novartis International AG. (2015). Novartis presents new data showing that the majority of patients are able to maintain clear or almost clear skin with Cosentyx across 3 years. Retrieved on July 19, 2016 from https://www.novartis.com/news/media-releases/novartis-presents-new-data-showing-majority-patients-are-able-maintain-clear-or
- Novartis International AG. (2015). Novartis reports landmark Phase III results for AIN457 (secukinumab) showing rapid and significant efficacy in psoriatic arthritis patients. Retrieved on July 19, 2016 from https://www.novartis.com/news/media-releases/novartis-reports-landmark-phase-iii-results-ain457-secukinumab-showing-rapid-and
- PI RD 09 DEC 2015; APPR 28 APR 2016
- Drugs.com. Secukinumab side effects. Retrieved on July 19 from https://www.drugs.com/sfx/secukinumab-side-effects.html
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Michaela Dinboeck recently participated in a small experiment. The General Manager and President of Novartis Corporation Malaysia had a make-up artist apply on her neck area patches that resembled the reddish scaly skin of a person with psoriasis. Her colleagues and friends were not notified of this experiment, so they were taken aback when they saw her.
Wearing the patch was not a pleasant experience. “By the time afternoon rolled in, I wanted to just tear the patch off,” she recalls.
Perhaps just as hard to swallow was the reaction of the people she met on that day. Colleagues and friends who know her well still kept a distance from her, conversations became hesitant and cold, and there were looks on their faces to suggest strongly that they did not want to come too close in fear of catching her ‘disease’.
Even her children hesitated to approach her when she came home. “Mommy, you look horrible!” they cried when they saw the patches. Despite her coaxing, her children refused to hug her until she removed the patch.
She did, and they finally gave her a hug. But as Ms Dinboeck embraced her children, her single day of walking in the shoes of someone with psoriasis revealed with heartbreaking surety that there are people with psoriasis out there, somewhere, who face such reactions daily. And these people have no easy means to remove the signs of their affliction. Psoriasis causes not only physical discomfort and pain – it can slowly eat away at the soul.
But, there is more hope for these people now. This Mini-Report will give you an insight into psoriasis as well as a common complication of that affliction, psoriatic arthritis, and how improved treatment options can change lives for the better.
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