Advice for People With Health Conditions That Will Be Fasting This Ramadan

WORDS LIM TECK CHOON

For the upcoming fasting month, we are pleased to share some important advice from the good people at Alpro Pharmacy.

WILL THE USE OF INHALERS INVALIDATE YOUR FASTING?
  • There are 2 types of inhalers: ‘preventer’ inhalers and ‘reliever’ inhalers. If you are unsure which of your inhalers is which, check with your doctor.
  • While fasting, you should continue to use your preventer inhalers, typically twice a day—before sahur and before you go to bed. It’s best to check with your doctor how often and when you should use your preventer inhaler.
  • Use your reliever inhalers when you have an asthma attack.
WILL FASTING PUT YOU AT RISK OF DEHYDRATION OR LOW BLOOD GLUCOSE (HYPOGLYCAEMIA)?
  • If you have diabetes, check your blood glucose 2 hours after sahur and when you experience symptoms such as dizziness, cold sweat, blurred vision, and shivering. Checking your blood glucose won’t invalidate your fasting.
  • If your blood glucose level is below 3.9 mmol/L, you will need to break your fast for the sake of your health.
  • People with diabetes shouldn’t delay breaking their fast. Keep some dates with you if you have diabetes and you’re fasting. That way, when you’re still stuck in traffic or at work during iftar, you can break your fast with 1 or 2 dates.
  • Eat foods rich in dietary fibre for optimal blood glucose control during the fasting month. Dietary fibre helps keep you feel full longer and stabilize your blood glucose levels.
HOW TO FAST WHEN YOU HAVE GASTRIC PROBLEMS
  • If you have gastric problems, break your fast by eating moderate amounts of foods.
  • Avoid eating fried foods and gassy drinks in too much amounts or too quickly.
  • Also, it’s best to avoid drinks that are high in caffeine, such as coffee.

Good Food, Good Mood: The Science Behind Nutrition and Mental Health

WORDS LEE JIE YEE & DR HASLINA ABDUL HAMID

FEATURED EXPERTS
LEE JIE YEE
Dietitian and Student of Master’s in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DR HASLINA ABDUL HAMID
Lecturer & Registered Dietitian and Nutritionist
Dietetics Programme
Centre for Community Health Studies (ReaCH)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DO YOU KNOW?

Your brain is always working hard 24/7.

It takes charge of almost every daily activity—your movement, body temperature, hunger, memory, and thoughts.

It can also affect your moods, emotions, and eventually your mental health.

HOW YOUR FOOD INTAKE CAN AFFECT YOUR MOODS & BRAIN 

Choosing the right food is important not only for physical health, as what the common nutrition research shows, but also for your mind.

Well-balanced, nutritious foods help your bodies (and brains) to function well

As a matter of fact, the brain accounts for about 20% of your total daily energy requirements. From macronutrients (carbohydrates, proteins, and fats) to micronutrients (the vitamins and minerals), all of these play a role in brain health and function.

A healthy diet promotes a healthy gut, which communicates with the brain through what is known as the gut-brain axis

In our gut, billions of microbiota profoundly affect this gut-brain relationship.

Don’t underestimate these tiny little organisms, as they take charge of producing mood-regulating chemical substances, namely serotonin and dopamine.

Serotonin and dopamine, our body’s natural ‘feel-good’ neurotransmitters, help us to regulate emotions, sleep, and appetite. They are connected to our brain’s reward system and help to produce a happy sensation.

Since more than 90% of serotonin resides in the gut, taking good care of our stomach with food can transmit a happy signal to our brain.

Too happy isn’t always good, though! Don’t get too carried away with comfort foods

In stress-inducing situations, people tend to reach for comfort foods. However, these foods are usually high in fats and sugars, which makes them addictive. Yes indeed, the sugar is creating a surge of dopamine and a short boost of happiness.

However, other than contributing an exceeding amount of calories, these comfort foods also lacks essential nutrients such as omega-3 and vitamin B fatty acids and vitamin D, which are beneficial for your nervous system that regulates emotions.

Besides, high consumption of these calorie-dense foods might result in obesity, which is known to stimulate proinflammatory status—a plausible way to increase depression risk.

WHAT ARE THE BEST TYPES OF DIET TO IMPROVE YOUR MENTAL WELL-BEING?

Studies found that following a healthy eating pattern is associated with better stress management, improved sleep quality, increased concentration, and better mental well-being in general.

However, an emerging field of research known as nutrition psychiatry looks into a more specific relationship between diet and mental health. A few types of diet have been identified to be likely helpful for mental well-being.

Mediterranean diet
  • The Mediterranean diet emphasizes fruits, vegetables, whole grains, nuts, legumes, and healthy fats (such as olive oil) while limiting dairy products, red meat, alcohol, and processed foods.
  • The reason why the Mediterranean diet is beneficial to mental health could be due to its anti-inflammatory effects of the food components and the high content of antioxidants.
  • This diet might be relatively helpful in reducing the risk of depression as well as improving cognitive function.
  • If you are already dealing with depression, the depressive symptoms might reduce over time while preventing its remission.
  • The Mediterranean diet is also rich in selenium, tryptophan, omega-3, and vitamin D, which can help to improve sleep quality.
DASH diet
  • The DASH diet is a dietary approach that initially was designed to reduce blood pressure.
  • Same as the Mediterranean diet, the DASH diet is also rich in whole grains, vegetables, fruits, and other low-fat products such as fish, poultry, and beans. Try to limit high saturated fat food such as fatty meat and tropical oil.
  • The DASH diet emphasizes choosing food that is high in protein, fiber, potassium, calcium, and magnesium while cutting down those high in saturated fats and sodium.
  • Following a DASH diet could help to reduce symptoms of depression, anxiety, and stress. Additionally, nutrients that can be found in the DASH diet, such as vitamin B, omega-3 fatty acids, and antioxidants, are linked to brain function and mental well-being.
MIND diet
  • The MIND diet is the combination of Mediterranean diet and DASH diet, which also emphasizes the intake of natural plant-based foods and limits on animal and high-fat food.
  • However, leafy green vegetables and berries are exclusively focused.
  • Similar to the Mediterranean diet and DASH diet, the MIND diet could be helpful in reducing depression risk and psychological distress due to its high concentration of antioxidants.

Psychological stress and eating habits are closely related. It doesn’t matter which diet plan you want to choose, the key is to eat a healthy and balanced diet in appropriate portion sizes.

However, bear in mind that nutrition is just one factor among many that could impact mental health. Don’t just rely on changing your diet—you should seek advice from a mental health professional for personalized treatment for your mental issues.

Food for All: Modifying Food Texture for People With Dysphagia

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NURUL HUDA RAZALLI

FEATURED EXPERTS
AINUL SYAFIQAH MOHD AZAHARI
Nutritionist and Student of Master Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
DR NURUL HUDA RAZALLI
Dietetic Programme
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

DYSPHAGIA: IT MEANS DIFFICULTIES IN SWALLOWING FOODS & LIQUIDS

  • Dysphagia comes from  Greek word ‘dys’, which means difficulties, and ‘phagia’, which means swallowing.
  • Medically, dysphagia is a term for swallowing difficulties. Someone with dysphagia takes more time and effort to move food or liquid from their mouth down to their stomach.
  • Episodes of dysphagia can be intermittent or progressive.
IT IS A SYMPTOM FOR MANY MEDICAL CONDITIONS
  • In adults, dysphagia is very common in adult that has a history of stroke, dementia, Alzheimer’s disease, neck cancers, and gastroesophageal reflux disease (GERD).
  • It could also be present in children with attention deficit hyperactivity disorder (ADHD), autism, Down syndrome, and cerebral palsy.
  • Dysphagia can also be a sign that there are some issues with the many nerves and muscles that are involved in swallowing activities.
YOU MAY HAVE DYSPHAGIA IF YOU EXPERIENCE THE FOLLOWING
  • Persistent drooling of saliva
  • Coughing or choking when eating or drinking
  • Bringing food back up, sometimes through the nose
  • Feeling as though food is stuck in your throat or chest
  • Being unable to chew food properly
PEOPLE WITH DYSPHAGIA FACE ISSUES THAT CAN JEOPARDIZE THEIR HEALTH & WELL-BEING

Choking and lung infection

Individuals with dysphagia are susceptible to choking. Due to difficulties in swallowing normally, consumed foods or liquids can accidentally enter the airway into the lungs. This could result in aspiration pneumonia, often known as a lung infection and can be fatal.

Poor nutrition intake
  • The prevalence of malnutrition among people with dysphagia is reported to be anywhere between 3% and 29%, which is quite a high number.
  • Malnutrition leaves people with dysphagia more vulnerable to diseases, should they not receive enough essential nutrients for optimal body function.
  • Muscle wasting, underweight, and stunting could be other issues that arise. Hence, people with dysphagia needs to be aware of any weight loss, hair loss, feeling of coldness, and fatigue as these are the early symptoms of malnutrition.
Loss of appetite and fear of mealtimes
  • People with dysphagia often lose their appetite in conjunction with their reduced swallowing ability.
  • They might develop some degree of “laziness” when it comes to drinking more often, which may lead to dehydration.
  • Because their eating experiences can be difficult, uncomfortable, and unpleasant, they may develop anxiety during mealtimes.
Inability to talk fluently
  • Dysphagia can hinder one’s ability to talk fluently and, combined with difficulties in eating, may cause the affected person to experience low self-esteem and lead to self-isolation.
  • The decrease in social engagement will give a negative impact in the person’s quality of life.
  • Thus, social support from their carer, family members, and close friends are crucial. A little extra kindness and help will give a huge impact in their life and sometimes even touch their heart.
Proper nutrition management for people with dysphagia involves providing adequate nutrients through modification of food texture and fluid consistency.

We need to also keep an eye out for symptoms of dehydration such as dry mouth or tongue, thirst, headache, and lethargy. 

Also, be alert to any unexplained weight loss, hair loss, feeling of coldness and fatigue—these could be early symptoms of malnutrition.

IF YOU ARE WORRIED THAT YOU OR SOMEONE CLOSE TO YOU HAVE DYSPHAGIA

Consult a speech language pathologist, a healthcare professional trained to diagnose dysphagia, for a proper diagnosis.

People with dysphagia can consult with dietitians for their nutritional concerns or if they want to assess their nutritional adequacy.

TIPS FOR INDIVIDUALS WITH DYSPHAGIA TO ACHIEVE GOOD NUTRITION

Understand the extent of one’s dysphagia

Discuss with the speech language pathologist and other relevant healthcare professionals on the degree of swallowing ability in the person with dysphagia.

Refer to the International Dysphagia Diet Standardization Initiative (IDDSI) Framework

This guideline has seven levels. Flow test, spoon tilt, and fork drips are used as measurement methods to determine each level.

Click to view a larger and clearer image.

Further information can be obtained from the IDDSI website (link opens in a new tab).

Modify foods into certain textures 

For more detailed information on how to modify the textures of various foods, you can refer to this page on the IDDSI website (link opens in a new tab).

  • While modifying the textures of foods into appropriate textures, take into consideration the nutritional content (carbohydrates, protein, fat, as well as vitamin and minerals). Daily meals should provide all the nutrients to improve the person’s nutritional status.
  • Always choose softer food options if texture modification is not possible. For example, choose papaya instead of apple, and ‘soften’ a dish with gravy.
  • Add special thickening powder to watery liquids. This thickening allows for easier swallowing.
Useful tips for eating
  • Have the person with dysphagia sit upright to prevent choking.
  • Have them tilt their heads to prevent liquids from going into their air passage.
  • Encourage the person to take smaller bites, and give enough time to chew the food thoroughly.
  • If small pieces of food or liquid are stuck, have them cough a little.

Dysphagia is a journey of eating experience that may switch an individual’s life 360 degree. Hence support and motivation play an important role in the management of one’s dysphagia.


References:

  1. O’Rourke, F., Vickers, K., Upton, C., & Chan, D. (2014). Swallowing and oropharyngeal dysphagia. Clinical medicine (London, England), 14(2), 196–199. https://doi.org/10.7861/clinmedicine.14-2-196
  2. Shaheen, N. A., Alqahtani, A. A., Assiri, H., Alkhodair, R., & Hussein, M. A. (2018). Public knowledge of dehydration and fluid intake practices: Variation by participants’ characteristics. BMC public health, 18(1), 1346. https://doi.org/10.1186/s12889-018-6252-5
  3. Ueshima, J., Momosaki, R., Shimizu, A., Motokawa, K., Sonoi, M., Shirai, Y., Uno, C., Kokura, Y., Shimizu, M., Nishiyama, A., Moriyama, D., Yamamoto, K., & Sakai, K. (2021). Nutritional assessment in adult patients with dysphagia: A scoping review. Nutrients, 13(3), 778. https://doi.org/10.3390/nu13030778
  4. World Health Organization. (n.d.). Fact sheets – malnutrition. https://www.who.int/news-room/fact-sheets/detail/malnutrition

Hoping for a Baby? These Multivitamins May Increase Your Odds of Success!

WORDS LIM TECK CHOON

Data from a recent study conducted by Singaporean researchers suggests that multivitamin supplements that contain folic acid and iodine may be beneficial to women that are planning and hoping to conceive a child.

WHAT THE STUDY DID

The investigators interviewed 908 women between 18 and 45 years old that were trying to conceive. These women were enrolled in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO).

As an aside, S-PRESTO is a large-scale study on the effects of nutrition, lifestyle, and maternal mood prior to and during pregnancy on the effects of the baby’s genetic materials and the presence clinically important outcomes of the pregnancy. This study is beyond the scope of this article, though!

Back to this study, the investigators were interested in 2 things:

  1. Fecundity, or the measure of the chances of successful pregnancy
  2. Time to pregnancy, or the time between the first moment when the woman tries to conceive and the time of successful conception
WHAT THE INVESTIGATORS FOUND
  1. Multivitamins containing folic acid and iodine improve the success rate of having a baby when compared to those that do not take these supplements.
  2. These multivitamins also are linked to shorter time to pregnancy.
  3. Vitamins D and E do not show any significant improvements to pregnancy success rate and time to pregnancy.
  4. On the other hand, consumption of evening primrose oil is linked to lower pregnancy success rate and slightly longer time to pregnancy, compared to those that do not take this supplement.
WHY FOLIC ACID?

Folic acid, or vitamin B9, plays a role in breaking down and reducing the levels of an amino acid called homocysteine in the body.

High levels of homocysteine can cause effects that can affect fertility, such as increasing the ageing rate of a woman’s eggs and triggering the death of trophoblasts, which are cells of the outer layer of the developing embryo that helps it to attach to the woman’s endometrium for further development, protect the embryo, and eventually form the placenta.

Hence, by reducing the effects of high levels of homocysteine, folic acid can help improve the chances of a successful pregnancy.

HOW ABOUT IODINE?

Past tests on animals suggested that iodine can help improve the regulation of ovulation, increase the odds of a successful fertilization of an egg by a sperm cell following sexual intercourse, and promote successful implantation of the fertilized egg into the endometrium of the woman for further development.

Iodine also plays an important role in the development of nerve and brain cells of the foetus.

HOWEVER, SOME POINTS TO NOTE BEFORE YOU RUSH TO THE PHARMACY!

The investigators noted that more research is needed before we can make any conclusive statements about the effects of folic acid and iodine on one’s hopes of a successful pregnancy.

For example, their study did not measure the exact amounts of these nutrients that will work best on a woman hoping to conceive, and more research would be needed to determine whether their results can be replicated.

However, they believed that women trying to conceive could potentially benefit from taking multivitamin supplements containing these two nutrients, when this is also done in conjunction with other beneficial lifestyle modifications such as being physically active and cutting down on smoking and alcohol intake.


Reference: Ku, C. W., Ku, C. O., Tay, L. P. C., Xing, H. K., Cheung, Y. B., Godfrey, K. M., Colega, M. T., Teo, C., Tan, K. M. L., Chong, Y. S., Shek, L. P., Tan, K. H., Chan, S. Y., Lim, S. X., Chong, M. F., Yap, F., Chan, J. K. Y., & Loy, S. L. (2022). Dietary supplement intake and fecundability in a Singapore preconception cohort study. Nutrients, 14(23), 5110. https://doi.org/10.3390/nu14235110

Healthy Meals Are Still Tasty for People with Diabetes, Thanks to This Book

WORDS LIM TECK CHOON

FEATURED EXPERT
CHUA KAI JIA
Dietitian
Alpro Pharmacy

Most of us have heard it by now: the 2019 National Health and Morbidity Survey from our Ministry of Health revealed that more than half of Malaysians are overweight or obese. Given that type 2 diabetes is closely linked to overweight and obesity, it’s therefore not surprising that the prevalence of this chronic disease in this country is high—the highest in Asia, in fact!

Furthermore, there is a misconception that, for people with diabetes, eating healthily means giving up all the foods and beverages they used to enjoy. This is not true, that the key to a healthy, balanced diet for people with diabetes lies with keeping count of one’s carb and calorie intake, so that these are within the recommended amount for the person.

Recognizing the prevalence of type 2 diabetes and the need to empower Malaysians with this condition to prepare healthy, diabetes-friendly meals that they will enjoy, Alpro Pharmacy together with sugO35, a personalized diabetes care service provider, has prepared a series of recipe books for people with diabetes.

Last November, Teroka FUN Resipi Diabetik was released in conjunction with World Diabetes Day.

This is the second volume in the series, following the first volume, U-Turn Diabetic the Fun Way.

“One of the most frequently asked questions from our diabetic patients is ‘What can I eat?’,” dietitian Chua Kai Jia shares with us.

5 GREAT THINGS ABOUT TEROKA FUN RESIPI DIABETIK
  1. It contains 25 diabetes-friendly recipes utilizing common ingredients used in Malaysian dishes. Each ingredient gets a chapter of its own, with fun facts and nutritional information about these ingredients.
  2. These recipes are prepared by nutritionists and dietitians.
  3. These dishes will appeal to Malaysians of all races, and they are also affordable to prepare and tasty to eat—proof that someone with diabetes can still enjoy delicious meals as long as they pay attention to what and how much they eat.
  4. Chua shares that this book will be useful to people with diabetes and their loved ones when it comes to adhering to a healthy, well-balanced (and tasty!) diet while keeping their blood glucose levels within a healthy range.
  5. The content is in Bahasa Malaysia and Chinese, making it accessible to a large majority of Malaysians.
HOW TO GET YOUR COPY
Digital
You can sign-up to get your free copies of the 2 recipe books using the links below. All links open in a new tab.
Print
The first volume is out of print. Volume 2, Teroka FUN Resipi Diabetik, is still available, however, for RM59.90. You can obtain a copy here (link opens in a new tab).
HealthToday is not associated with Alpro Pharmacy and sugO35. This article is presented for information purpose only, as we believe that these books can be of use to readers. We do not get any income from downloads or purchases through the links on this page.

Read This Before You Reach for Your Snacks This FIFA World Cup Season

WORDS LIM CHAIN YIN

FEATURED EXPERT
LIM CHAIN YIN
SEA Nutrition Lead
Mondelēz International
Tip 1
PORTION OUT YOUR SNACK
  1. Be sure to pace yourself throughout the equal halves.
  2. Once you’ve decided what you want to eat, portion it out. This can help you slow down, so that you enjoy your snack.
  3. Check in with yourself to see if you’re full and satisfied before having another portion.
  4. To keep tabs on how much you eat, always check the serving size per package on the label and put your snack in a bowl or on a plate.
Tip 2
ALTER YOUR CHOICES

If you’re watching the game late at night, you might have a craving for something to eat. Remember that your body works harder when it’s sleeping, so try to snack on something light that will give you energy to keep going, but won’t make it hard for your body to digest.

Tip 3
ENJOY EVERY BITE

Snacking while engaging in other activities—in this case, watching the game—can easily lead to unconsciously eating more than you should.

  1. Take a moment during the interval to savour your snack with all of your senses. To fully enjoy your snacking experience, pay attention to the smell, taste, texture, shape, and colour of your food.
  2. Take small bites and chew slowly and be sure to finish one bite before starting the next.
Tip 4
PUT YOUR SNACKS OUT OF REACH

When watching a game in your living room, make sure your snacks are beyond arm’s reach. That way, you will be less likely to keep going back for more and inadvertently grab more than you need.

Tip 5
DRINK WATER, LOTS OF IT!

Your brain tends to trick you into wanting to snack more, but you might just be thirsty. So, drink a glass of water and wait for a couple of minutes before deciding whether or not you’re hungry.


Snacking mindfully is a simple way to tune into your body’s needs. It can be practiced by anyone, anywhere, and at any age. It is a great habit in cultivating a positive relationship with food by making deliberate and conscious choices to promote your well-being as well as keeping a balanced lifestyle. But habits take time to build and change, so taking small steps is a good way to start out!

5 Ways to Eat Healthily and Merrily During Deepavali

WORDS GURSHARON KAUR GILL

FEATURED EXPERT
GURSHARON KAUR GILL
Dietitian

With Deepavali being around the corner, the thought of delicious, mouth watering dishes comes to mind for most Malaysians.

Be it the sweet delicacies or the main dishes, festive food is known to be a crowd favourite. It is during festive seasons, that most people let go of their healthy eating habits and indulge in more than their usual food portion. Because, who doesn’t love their mutton curry, chicken varuval or pineapple tarts?

However, the brunt of all the overindulging comes about after the festive season. You might start seeing some extra pounds in your weight and perhaps even spikes in your blood sugar level from all that over indulging. So, why not make your festive season this time a little healthier by following some of my simple tips below.

Tip 1
PREPARE YOUR OWN DISHES & SWEETS

This allows you to modify the recipe to make it a healthier version, such as by reducing the amount of ghee or oil used in the original recipe.

Alternatively, you may also switch from ghee, which contains high amount of saturated fats, to vegetable oil, which contains unsaturated fats and is hence more friendly for your heart health.

You can also reduce the amount of sugar or condensed milk by half from the original recipe for the sweet items. This method helps to reduce the overall calorie of the food items.

Tip 2
PRACTICE PORTION CONTROL

While it can be hard to resist the mouth watering festive food, it is still important to practice portion control.

When it comes to your favourite festive food like jalebi, kesari, pineapple tarts or muruku, practice sharing these food items with family or friends.

You can also practice portion control by limiting to only 1-2 pieces of these food items onto your plate, so that you avoid over indulging, more so if you have multiple houses to visit!

Another trick is to avoid eating cookies straight out of the cookie jars, as this usually causes one to lose track of how much they have eaten.

Tip 3
KEEP AWAY FROM SUGARY DRINKS

Sugary drinks like cordials or packet drinks are commonly served at open houses. However, these drinks are just loaded with sugar without providing your body with any nutrients.

Hence, it is advisable to limit your intake of sugar sweetened beverages to no more than 1 to 2 servings per day.

It is very easy to over consume these sugary drinks as you go about visiting from one house to the other or even while catching up with family and friends. Hence, for those hosting open houses this year, some healthier options to consider would be lower-calorie drinks. Great examples that are also simple to prepare are:

  • Ginger lemonade, with half the sugar from the original recipe
  • Infused water; you can always replace plain water with sparkling water for that extra fizziness in the drink

And for those visiting, if there is no other option of lower-calorie drinks, opt for plain water!

Tip 4
EAT MINDFULLY

Mindful eating helps you to listen to your body for hunger and satiety cues. This is important as it prevents you from mindless eating that adds up to your daily calorie intake.

Over-indulging is common, especially if you are busy catching up with family and friends, and unknowingly end up eating more than you need to. Hence, check in with yourself to identify your hunger and satiety cues is helpful.

Always remember to stop eating before you feel full, as your brain takes 20-30 minutes to register the feeling of fullness.

Tip 5
APPLY THE MALAYSIAN HEALTHY PLATE PRINCIPLES
The Malaysian Healthy Eating Plate. Click on the image to view a larger version.

It is always back to basics when it comes to eating healthily during festive season. The Malaysian Healthy Plate concept encourages the suku-suku-separuh (quarter-quarter-half) method, which helps to ensure a balanced meal with less sugar, salt and fat intake.

This concept simply means filling:

  • ¼ of your plate with grains (preferably whole grains)
  • ¼ of your plate with low fat protein sources (chicken, fish, mutton, eggs, prawns)
  • ½ of your plate with vegetables
HOW YOU CAN PRACTICE THE HEALTHY PLATE CONCEPT DURING DEEPAVALI 
Example 1
  • Grains: Idli (2 small pieces)
  • Protein sources: Chicken varuval (1 palm-sized lean chicken)
  • Vegetables: Stir-fried cabbage with turmeric (2 handfuls of veggies)
Example 2
  • Grains: Thosai (1 piece)
  • Protein sources: Mutton Curry (4 matchbox-sized pieces of lean mutton)
  • Vegetables: Stir-fried bhindi masala (2 handfuls of veggies)
Example 3
  • Grains: Jeera rice (2 to 3 flat rice scoops)
  • Protein sources: Chicken peratal (1 palm-sized lean chicken)
  • Vegetables: Stir-fried bittergourd with turmeric (2 handfuls of veggies)

The bottom line is, you can definitely enjoy the festive food that usually comes about only once a year. However, the key is to practice moderation when consuming them. That way, you get to enjoy the good food and yet not have to deal with untoward health problems after the festive season is over!

Sheep’s Milk vs Goat’s Milk: Is One Better Than the Other?

WORDS GURSHARON KAUR GILL

FEATURED EXPERT
GURSHARON KAUR GILL
Dietitian
IS GOAT’S MILK THE G.O.A.T?
EASIER TO DIGEST, COMPARED TO COW’S MILK
  • The lower levels of alpha-S1-casein protein in goat’s milk explain its easier digestibility and hypoallergenic properties.
  • The casein protein in goat’s milk also results in a smaller and softer curd formation in the stomach, which can be more easily digested by stomach enzymes compared to the harder curd formed by cow’s milk.
  • Goat’s milk has more medium-chain fatty acids than cow’s milk, which has more long-chain fatty acids. Long chain fatty acids are harder to digest, because they require bile salts from the liver as well as pancreatic enzymes to break them down before they can be absorbed by the intestine. On the other hand, medium chain fatty acids in goat’s milk do not require pancreatic enzymes to be broken down; they are more readily absorbed into the blood stream.
MORE CALCIUM, VITAMIN A & PROBIOTICS THAN COW’S MILK
  • 1 cup of goat’s milk contains 327 mg of calcium, while 1 cup of cow’s milk contains 276 mg of calcium. That equates to 51 mg more calcium in goat’s milk. However, this does not mean you have to switch to goat’s milk for that extra calcium. One is still able to achieve their calcium requirement through other calcium-rich foods like yoghurt, cheese, and some vegetables like spinach, bok choy, and broccoli in addition to milk intake.
  • 1 cup of goat’s milk contains 483 IU of Vitamin A while 1 cup of cow’s milk contains 114 IU. Vitamin A is essential for good vision, growth, fetal development, and a healthy immune system.
  • Goat’s milk contains a higher amount of prebiotics (oligosaccharides) compared to cow’s milk, which encourages the growth and proliferation of beneficial bacteria in the gut.
HOWEVER, SOME CAVEATS OF NOTE
  • Goat’s milk may not be suitable for people that are lactose intolerant as it still contains lactose. Some people find goat’s milk slightly easier to digest than cow’s milk, but other people may not have the same reaction. If you are lactose intolerant or have milk allergies and want to give goat’s milk a try, do consult your doctor beforehand.
  • Children above the age of 1 year can safely drink pasteurised goat’s milk, provided they do not have any allergy issues. Raw, unpasteurized goat’s milk is not encouraged as it may contain bacteria that can cause serious illness among children.
  • Children diagnosed with cow’s milk protein allergy (CMPA) are not recommended to consume goat’s milk or goat’s milk formulas. This is because there is evidence that this milk may still cause allergy reactions in children with CMPA, due to cross reactivity with cow’s milk.
  • Goat’s milk has more calories per serving, when compared to whole cow’s milk. This is due to the higher fat content in goat’s milk (10 g per serving) compared to 8 g per serving in cow’s milk. So, if you’re watching your weight, you may want to consider low fat cow’s milk or skim milk, especially if you drink more than 2 cups of milk per day.
HOW ABOUT SHEEP’S MILK?
IT’S ALSO EASIER TO DIGEST, COMPARED TO COW’S MILK
  • Based on a recent study in New Zealand, the protein in sheep’s milk is also more readily digested as compared to cow’s milk, which may be the reason it is better tolerated by adults that are unable to tolerate cow’s milk.
MORE CALCIUM, ZINC & PROTEIN THAN COW’S MILK
  • Sheep’s milk contains as much as 35% more calcium in 1 serving (1 cup) as compared to cow’s milk. Calcium is an essential mineral for strong bones and teeth, and is one of the important minerals in the prevention of osteoporosis.
  • Sheep’s milk contains a higher amount of zinc as compared to cow’s milk. Zinc is important for cell growth and division, wound healing, and supporting a healthy immune system.
  • Sheep’s milk is a high-protein beverage, containing 7 grams more protein per serving than cow’s milk. Protein plays an important role in the building and repairing of tissues and muscles as well as for a healthy immune system.
HOWEVER, SOME CAVEATS OF NOTE
  • Pasteurized sheep’s milk is fine for children after the age of 1 year, provided that they do not have allergy issues.
  • Children diagnosed with cow’s milk protein allergy (CMPA) are not recommended to consume sheep’s milk or sheep’s milk formulas. Just like with goat’s milk, there is evidence that sheep’s milk may still cause allergy reactions in children with CMPA, due to cross reactivity with cow’s milk.
  • Sheep’s milk has more calories per serving, when compared to whole cow’s milk. This is due to the higher fat content (17 g per serving) compared to 8 g per serving in cow’s milk. So, if you’re watching your weight, you may want to consider low fat cow’s milk or skim milk, especially if you drink more than 2 cups of milk per day.
SHEEP’S MILK VS GOAT’S MILK: IS ONE BETTER THAN THE OTHER?

Looking at the data and evidence that we have, there isn’t one “best milk” out of the cow’s milk, sheep’s milk, or goat’s milk.

All three types of milk have their pros and cons, and it really depends on the specific reason you choose a particular type of milk.

Barring any intolerance or allergy issues, it is absolutely okay to choose the milk that you like the most in terms of taste as well as your health status.


References:

  1. Alberta Health Services (2022, April). Nutrition guideline: Healthy infants and young children—milk. https://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-ng-healthy-infants-other-milks-fluids-milk.pdf
  2. Malaysian Paediatric Association and Malaysian Society of Allergy and Immunology. (2012). Guidelines for the management of cow’s milk children 2012 (CMPA in children). https://www.allergymsai.org/pdf/guideline-cows-milk.pdf
  3. Metzger, M. (2022, July 22). Goat milk versus cow milk: A comparison. Michigan State University Extension Sheep & Goats. https://www.canr.msu.edu/news/goat-milk-versus-cow-milk-a-comparison

Will Consuming Bak Kut Teh Soup Damage Your Liver?

WORDS DR CHIENG JIN YU

FEATURED EXPERT
DR CHIENG JIN YU
Consultant Physician, Gastroenterologist & Hepatologist
Pantai Hospital Ampang

Back in June, the journal Forensic Science, Medicine and Pathology published a paper titled ‘Could herbal soup be a potentially unrecognized cause of hepatotoxicity at autopsy?’.

WHAT DOES THE PAPER SAY?

You can read the paper here (link opens in a new tab), but here are the key points:

  1. One of the investigators had a patient that suffered liver damage after eating bak kut teh soup.
  2. These researchers added 4 different formulations of bak kut teh soup to cultures of liver cancer cells.
  3. All 4 formulations were seen to cause ‘significant’ toxicity to these cells.
THAT SOUNDS ALARMING!

Indeed, this paper generated some discussion in the media recently. After all, bak kut teh is a popular delicacy especially among the Chinese population in Malaysia and Singapore!

Let me point to the statement made by Professor Roger Byard, the lead author of the study, in an interview with ABC Radio Adelaide: he said that he didn’t feel that people should panic over the results of the study.

“Obviously, a lot of people have this soup and don’t have a problem,” Prof Bayard told the interviewer, adding that he personally loves bak kut teh and has enjoyed the dish for years.

WHY PANIC MAY BE PREMATURE

We still don’t know the direct cause the patient’s liver damage. Perhaps she had a previous liver disease that led to the observed liver damage, or perhaps her liver was damage after she took her lipid-lowering medication.

We haven’t identified the exact component(s) in bak kut teh soup that may lead to liver damage. Furthermore, to date, we are not informed of the concentrations of various ingredients in these soup bases, so we can’t make a definite conclusion about the toxicity of these ingredients to our liver cells.

The investigators conducted an in-vitro laboratory study. What this means is that it was done in a controlled environment such as a test tube or petri dish.

Hence, we don’t know yet whether a similar result will be seen if the test were performed on actual people. Our digestive system is far more complex than what is in a test tube or petri dish, so this study does not accurately replicate what will happen to our body after we’ve consumed bak kut teh.

They did not study drug-food interactions. Everything we ingest, whether it’s medicine, foods, and drinks, may have a favourable response or therapeutic effect. It may also have therapeutic side effects.

THE TAKE HOME MESSAGE FROM ALL OF THIS

This is why the title of the paper is framed as a question: ‘Could herbal soup be a potentially unrecognized cause of hepatotoxicity at autopsy?’

It is meant to be a starting point for more research into the matter.

Until we have more information, there’s no harm in enjoying bak kut teh so long as it’s in moderation and in line with our healthy eating principles!


Reference: Britza, S. M., Farrington, R., Musgrave, I. F., Aboltins, C., & Byard, R. W. (2022). Could herbal soup be a potentially unrecognized cause of hepatotoxicity at autopsy?. Forensic science, medicine, and pathology, 1–4. Advance online publication. https://doi.org/10.1007/s12024-022-00490-5

How to Spot Contaminated Food in Your Child’s Canteen?

How to Spot Contaminated Food in Your Child’s Canteen?

May 8, 2022   Return

WORDS JENNIFER F. NETTO

Every parent desires to have the entire day planned, to wake up early, prepare breakfast, pack lunch-boxes, get the kids ready for school and send them off (right at the front of the school gate if possible). While that’s an ultimate vision, most parents aren’t so lucky especially when other obligations tie them down. Perfect parenting or not, sending your child off to school with lunch money alone is not enough. When it comes to food, there should also be a responsible concern on what your child is eating in school. Apart from prioritizing a healthy diet, consuming uncontaminated food should top the priority list too.

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WHAT IS CONTAMINATED FOOD?

According to the Ministry of Health Malaysia, food contamination refers to food that has been corrupted with another substance – either physical, biological or chemical. Biological contamination refers to food that is contaminated by organisms or substances they produce. This includes biological matter produced by humans, rodents, insects and microorganisms. Bacteria and viruses are typically the two biggest causes of biological contamination and can result in some of the most common types of food poisoning including salmonella, E. coli, listeria and norovirus.

Physical contamination is when a foreign object contaminates food, objects such as steel wool, sponges and utensils. Chemical contamination refers to food that has been contaminated with a natural or artificial chemical substance. These contaminants are particularly dangerous as they expose people to any number of toxic substances, some of which can be fatal. Chemicals can also contaminate food at any time of the food process, whether by pesticides transferred from the soil the food is grown in or during the manufacturing process. Storing chemicals separately from food is essential to help protect against chemical contamination.

BEING SHERLOCK

Incidents of food poisoning in schools have happened a lot and we hear in the media of outbreaks almost annually. Detecting contaminated food can be tricky but there is a simple way to do this which is to be observant of various causal factors. Food vendors are hired to cater to children in schools, some of them are unable to adhere to safe practices and this will put the children in danger of food poisoning. Most cases can be avoided if food handlers practise proper measures when preparing food and it is every parent’s responsibility to play the social health inspector for the sake of the safety of every schoolgoing child.

“Food contamination refers to food that has been corrupted with another substance – either physical, biological or chemical.”

FOOD HANDLING AND STORAGE

A simple observation of how the canteen operates and handles food can give you a general picture of what to expect. Check if food is displayed properly, if they are covered and if they use thongs to serve unpacked food. Observe how they manage raw food and that it is not mixed with cooked food as this could cause cross- biological contamination. It is also important to observe the canteen’s food storage area – are the boxed items left on the floor and if they are accessible to rodents and pests?

Check also the condition of their refrigerator and what items are stored and not stored in it, if seafood, eggs and milk are stored at the right temperature and what are left unrefrigerated and exposed in the open. Note also if they reheat their food, and how quickly they refrigerate leftovers. This may seem like a trivial matter, but cooked food that are exposed to room temperature for more than 2 hours have the potential to attract biological contaminants onto them and therefore should sometimes not even be considered to be refrigerated as leftovers. Foods such as eggs, cheese, milk and coconut rice (nasi lemak) for instance can biologically degrade fast when left in room temperature and may be best discarded if not consumed after a long preparation time. Contaminated water can also be the main cause of food poisoning. Rightfully, water should be filtered and boiled when it is served to children, but this is most often not the case. In practice, vendors are more prone to preparing drinks from unboiled and unfiltered water due to convenience.

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CANTEEN FACILITIES

Some canteens can have poorly managed facilities, but cleanliness should never be compromised no matter how limited the resources may be. Eating utensils for instance can carry various contaminants if they are not washed properly, dried and stored well. The sink in which our children wash their hands is another matter of concern. Take note if children are provided with good hand soaps and if the sinks are regularly washed or not. A dirty sink can harbor billions of bacteria which thrives in such environment and they are easily spread through each kid who uses the sink. Trash bins too should be emptied regularly and kept closed to prevent flies from vectoring pathogens that can cross-contaminate well prepared food.

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EDUCATE FOR PREVENTION

While such observations in a canteen will give you a rough idea of how to evaluate the quality of food produced by the canteen vendor and the potential hazards your child could face consuming their meals, it is also important to teach the young ones to identify spoilt and soiled food, and to be vigilant in observing the cleanliness of their canteen vendor. Train them to purchase boxed or canned drinks instead, advise them to stay away from food which has too many flies around it and to use their sensory to detect food that has gone bad through smell and texture before consumption. Food safety is everyone’s responsibility and when canteens are poorly managed, as a parent, you could take the proactive measure to inform respective authorities to take necessary action. You could even start an awareness programme with the rest of the parents through your child’s school Parents Teachers Association (PTA, also known as PIBG) and get everyone involved in making changes for the better. HT

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