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

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

FEATURED EXPERTS

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

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

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

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

PARKINSON’S DISEASE IN MALAYSIA

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

CAUSES & CURE

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

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

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

NUTRITION & PARKINSON’S DISEASE

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

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

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

THE MEDITERRANEAN DIET

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

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

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

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

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

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

Characteristics of the Mediterranean diet.

This diet emphasizes the following 4 components:

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

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

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

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

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

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

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

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

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

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

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

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

RECONCILING THE MEDITERRANEAN DIET WITH OUR MALAYSIAN DIET

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

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

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

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

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

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

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

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

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

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

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

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

References:

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

Georgen Thye Explains the Differences between Various Milks in the Market

WORDS GEORGEN THYE

FEATURED EXPERT
GEORGEN THYE
Consultant Dietitian and Coach
Founder of Georgen Cooking
Instagram | Facebook | TikTok | YouTube | Linkedin

Milk comes in various forms, and it’s important to know the differences, including how they’re processed in the factory, and their nutrition content. Let’s break down the variations:

UHT MILK

Ultra-high temperature (UHT) milk is heat-treated to extend shelf life.

It undergoes pasteurization at an ultra-high temperature, a process to kill harmful bacteria, and is packed in a sterile environment.

It’s convenient and doesn’t require refrigeration until opened.

However, some nutrients may be reduced during the manufacturing process.

FULL CREAM MILK

This milk contains the highest fat content, approximately 3.25–3.5% fat, giving it a rich, creamy flavour.

It also goes through pasteurization and is homogenized to ensure an even distribution of fat.

LOW FAT MILK

Low fat milk first undergoes pasteurization, similar to full cream milk.

Then, it undergoes a skimming process to remove much of the fat, reducing its overall fat content to around 1–2%.

It’s still homogenized, ensuring a consistent texture while providing essential nutrients with reduced fat.

FRESH MILK

Straight from the farm to your fridge, fresh milk is minimally processed to preserve its natural flavour and nutrients.

It typically undergoes pasteurization but minimal homogenization, keeping it close to its farm-fresh state and containing around 3.25–3.5% fat.

FLAVOURED MILK

Whether it’s chocolate or strawberry, flavoured milk adds a tasty spin to regular milk.

However, be cautious of added sugars, which can increase calorie levels.

Choose options with lower sugar content and enjoy in moderation.

Note that despite its sweetness, flavored milk still provides essential nutrients like calcium and protein.

WHICH MILK IS RIGHT FOR YOU?

Your milk choice depends on your goals and taste.

Low-fat is great for reducing fat and sugar.

Fresh milk is minimally processed and ideal for those who love its natural taste.

Enjoy flavoured milk in moderation, choosing lower-sugar options.

Regardless of your pick, milk is rich in vital nutrients like calcium and protein for good health so enjoy!

A Dietitian Exposes 3 Common Misconceptions about Detox Diets & Products

WORDS GEORGEN THYE

FEATURED EXPERT
GEORGEN THYE
Consultant Dietitian and Coach
Founder of Georgen Cooking
Instagram | Facebook | TikTok | YouTube | Linkedin

It’s a common belief that detox diets and products can cleanse your body of toxins, but let’s unravel the truth.

MYTH 1: DETOXING CLEARS YOUR TOXINS

Fact: Your body has its own built-in detox system. Your liver, kidneys, and digestive system work around the clock to eliminate waste and toxins.


An overview of the detox system of our body. Click on the image for a larger, clearer version.

MYTH 2: DETOX DIETS ARE EFFECTIVE

Fact: Most detox diets are restrictive and low in essential nutrients. They may lead to temporary weight loss, but it’s mostly water weight, not toxins.

MYTH 3: DETOX PRODUCTS WORK MIRACLES

Fact: Detox teas, supplements, and wraps often lack scientific evidence and can have side effects. They’re not a magic solution.

SO, HOW CAN YOU SUPPORT YOUR BODY’S NATURAL DETOX PROCESSES?

Eat a balanced diet, stay hydrated, and get enough sleep. Your body has the detox game covered!

LOOKING FOR AUTHENTIC DIETARY FACTS & ADVICE?

Visit Georgen’s social media, links above, for more fun educational advice, facts, and more.

Drop him a note if you are interested in his services:

  • Corporate Wellness Programme
  • Health Talks
  • Cooking Workshop
  • Virtual Diet Consultations

IMU Opens the First Free Student-Led Dietetics & Wellness Clinic in Malaysia

WORDS LIM TECK CHOON

The International Medical University (IMU) recently opened the doors of the IMU Student Dietetics and Wellness Clinic. It had its official launch on 19 September 2023.

HIGHLIGHTS OF THE LAUNCH

HealthToday had the opportunity to meet the staff of the clinic as well as Professor Dr Winnie Chee, the Pro Vice-Chancellor Academic of IMU, to find out more about the clinic.

We are greatly indebted to them for their time and their willingness to provide answers to the following questions!

WHAT SERVICES ARE AVAILABLE AT THE CLINIC?

It offers many services comparable to other dietetics clinics. However, the clinic offers these services free of charge.

Individualized Meal Planning

It can be challenging to navigate through various foods to plan the right meals for one’s optimal health and maintenance of one’s ideal body weight.

 The staff of this clinic can meet with an individual and their loved ones to help design personalized daily meals based on the individual’s health status, their food preferences, and other factors.

Given that a healthy, balanced diet is key to good management of chronic diseases such as type 2 diabetes, high blood pressure, and more, this service will be especially helpful to those with these conditions.

YOU MAY FIND INIVIDUALIZED MEAL PLANNING HELPFUL IF YOU HAVE THE FOLLOWING:
  • Overweight or obesity
  • Gout
  • Diabetes
  • High blood pressure
  • High blood cholesterol
  • Chronic kidney disease
  • Anaemia
  • Irritable bowel syndrome (IBS)
  • Gastroesophageal reflux disease (GERD)
  • Chronic or long-term gastritis
Body Composition Analyzer

This is a series of non-invasive tests to measure a person’s fat mass and muscle mass.

These tests are also a good way to find out whether the person is at risk of not getting enough nutrients to maintain good health and proper functioning of the body (malnutrition).

A student dietitian can advise the individual accordingly based on the test results.

To register for your free session, click here. The link opens in a new tab.

Public Talks and Workshops

Members of the public can attend educational talks, cooking demonstrations, and more—free, of course!

They can follow the social media of the clinic (see below) to stay updated on upcoming talks and other public events.

WHERE IS THIS CLINIC?

It’s located at the International Medical University building at the following address:

Student Dietetics & Wellness Clinic
Level LG at the International Medical University
126 Jalan Jalil Perkasa
57000 Bukit Jalil
Kuala Lumpur

Opening hours: Monday to Thursday, 10.00 am to 4.00 pm during the final year dietetics practicum semesters.
Check the social media of the clinic (see below) for the latest updates.

Find the clinic on Google Maps

Do I Have to Travel to the Clinic Personally to Obtain Its Services?

Since the clinic has just opened its doors, for the time being only face-to-face consultation is available.

There are plans for telehealth services in the future, however. Interested parties can follow the social media of this clinic (see below) for future updates.

SO, IT’S A CLINIC STAFFED BY STUDENTS?

Yes, it’s a student-led diet clinic is a clinic managed and run by final year dietetics students.

These students are supervised by registered dietitians that are part of the IMU staff and they work in close collaboration with the public and communities in the surrounding area in Bukit Jalil and beyond.

Professor Dr Winnie Chee proudly tells us that while the clinic was conceptualized by the IMU School of Health Sciences, the enthusiastic students were responsible for all the planning, resources, programmes, and marketing of the services, as well as quality monitoring and management of the day-to-day operations of the clinic.

Wait, So Are These Students ‘Real’ Dietitians?

Don’t worry, these are final year dietetic students under the Bachelor of Science (Hons) Dietetics with Nutrition programme under the School of Health Sciences at IMU.

Therefore, they possess the necessary knowledge to help their clients.

What they lack is real world experience, which will be provided by this clinic. It will give these students training and experience on how to set up and manage a dietetics clinic as well as to instill in them an entrepreneurial mindset—thus making them more well-rounded dietitians when they graduate!

Throughout it all, every session will be supervised by a clinical educator, who is a registered dietitian.

If a medical emergency were to occur, the person will be directed to relevant healthcare professionals at IMU Health that are just nearby.

Hence, you don’t have to worry about receiving ‘inferior’ advice and help from this clinic!

HOW DO I MAKE AN APPOINTMENT?

Just fill in the online form found on their Facebook page.

HOW LONG IS EACH SESSION?

It can vary on a case-by-case basis.

Typically, the first session may take up to 1 hour. During this session, you may be asked to go through some simple, non-invasive tests and be asked about your medical history, current dietary preferences, etc.

Subsequent sessions—also free—may take about 30 minutes. The clinic will follow-up with you during these sessions to monitor your progress. If you’re having difficulties following your new meal plan, the staff will offer advice and help to get you back on track.

STAY CONNECTED WITH THE CLINIC
Facebook | Instagram

Here’s Why You Really Should NOT Extreme Diet & Severely Restrict Your Calories

WORDS LIE JIE YEE

FEATURED EXPERT
LEE JIE YEE
Dietitian and Student of Master’s in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

Over-restricting calories has become a concerning weight-loss trend in today’s society, driven by the impact of social media and influencers.

These influencers on social media promise a speedy weight loss by extreme dieting and severely restricting the amounts of calories consumed. These extreme strategies usually lure people who want to lose weight quickly to achieve their desired body shape.

But do these strategies really deliver the magical results you once believed in?

3 REASONS WHY EATING TOO FEW CALORIES CAN UNDERMINE YOUE EFFORTS TO LOSE WEIGHT
Reason 1
THE YOYO EFFECT

A successful weight loss is defined as when an individual voluntarily loses weight and keeps the weight loss for 1 year or more.

Unfortunately, most individuals fail to maintain their weight due to the yoyo effect.

Like the toy that inspires its name, the yoyo effect is a kind of weight loss phenomenon that goes up and down just like a yoyo.

Imagine that a long holiday is approaching. You think, “Beach vacay, I should get in shape!” You start a new diet, and the weight starts to come off.

But then, you get tired of the restrictive diet and bounce back to your old eating habits: desserts, fried foods, snacks…

Eventually, the kilos that you have lost start to creep back on, and you’re back where you started. You struggle to fit into your pants and decide to diet again.

This, the yoyo effect, is like a rollercoaster for your weight, but not a fun one.

Reason 2
YOUR BODY’S METABOLIC RATE GOES LOWER

Extremely cutting down on calories is basically subjecting your body to a starvation state.

Starvation is essentially a prolonged deprivation of nutrition—a state that our bodies naturally perceive as an existential threat to our survival.

To ensure that the body’s energy storage is used efficiently, the body will slow down its metabolism rate.

A lowered metabolism also delays other processes such as fatty acid oxidation, which makes weight loss harder.

Reason 3
YOUR MUSCLES BREAK DOWN AND YOUR HORMONES ARE AFFECTED TOO!

While people aiming for weight loss usually strive to increase muscle mass and reduce fat, this aftermath might not be appealing to you.

Similar to the mechanism above, our body needs to provide sufficient energy for survival during starvation.

Therefore, when the glucose reservoir is depleted, this is where our muscles start to break down to provide us with the energy we need.

This could lead to severe muscle loss as well as hormonal changes, which could affect our mood or menstrual cycle.

SO, WHAT SHOULD YOU DO INSTEAD TO LOSE WEIGHT?

It is important to keep in mind that a long-term weight loss journey should be slow, steady, and determined.

A reasonable calorie deficit targeting 500 to 1,000 kcal would allow one to lose 0.5 to 1 kg per week.

Do seek advice from a nutritionist or dietitian for an effective and personalized weight loss regime.

References:

  1. Contreras, R. E., Schriever, S. C., & Pfluger, P. T. (2019). Physiological and epigenetic features of yoyo dieting and weight control. Frontiers in genetics, 10, 1015. https://doi.org/10.3389/fgene.2019.01015
  2. Farhana, A., & Rehman, A. (2023). Metabolic consequences of weight reduction. In StatPearls. StatPearls Publishing.
  3. Olson, B., Marks, D. L., & Grossberg, A. J. (2020). Diverging metabolic programmes and behaviours during states of starvation, protein malnutrition, and cachexia. Journal of cachexia, sarcopenia and muscle, 11(6), 1429–1446. https://doi.org/10.1002/jcsm.12630

Getting the Timing Right: Sleep and Meal Strategies for Weight Management

WORDS VOON SUK CHEN & DR FATIN HANANI MAZRI

FEATURED EXPERTS

VOON SUK CHEN
Nutritionist and Student of Master’s in Clinical Nutrition
Universiti Kebangsaan Malaysia (UKM)
DR FATIN HANANI MAZRI
Lecturer of Dietetic Programme
School of Healthcare Sciences
Universiti Kebangsaan Malaysia (UKM)

When it comes to managing one’s weight, most people tend to think about watching their calories. But do you know that the timing of your sleep and meals is just as important?

Your body follow a natural rhythm that controls all sorts of stuff happening inside you. It’s time to uncover the secrets of your body clock and how they can help you keep your weight in check.

WHY TIMING MATTERS

Have you ever wondered why you consistently feel sleepy as night approaches and your stomach starts growling around the same time each day?

It’s all thanks to your body’s internal clock, known as circadian rhythm.

Our internal clock

The term ‘circadian’ originates from ‘circa’ meaning ‘cycle’ and ‘diem’ meaning ‘day.

It represents the daily oscillation of various molecular, physiological and behavioural processes, including the sleep-wake cycle.

This helps to induce and promote sleep, ensuring that your sleep patterns align with the 24-hour day-night cycle.

How does the internal clock work?

Your internal body clock synchronizes with the day-night cycle through light signals.

During the day, it receives light signals, like sunlight, through retina receptors in your eyes. This stimulates metabolism and physiological processes that promote wakefulness.

As night falls, the body clock detects weaker light stimuli, triggering night-time activities and inducing sleepiness, aided by the release of melatonin.

By aligning your circadian rhythms with the day-night cycle, your internal clock ensures sufficient rest for daytime productivity.

How the internal clock affects our eating-fasting cycle

The eating-fasting cycle is also orchestrated by the internal body clock.

During the daytime, digestive system is optimized for efficient nutrient absorption and energy utilization, while hunger hormones are regulated to promote appetite and energy intake.

Whereas at night, your physiology is geared towards rest, and your digestive system slows down.

Ideally, based on the internal clock, you are meant to be physically active and eating during the day, and sleeping and fasting at night.

However, your internal body clock cycle can be disrupted by erratic 24-hour day-night activities, such as:

  • The modernization of our lives.
  • Exposure to artificial light around the clock.
  • High calorie food being accessible 24-hours.

This disruption can have adverse effects on your efforts to maintain our health, which includes weight management.

THE LINK BETWEEN THE TIMING OF OUR SLEEP & EATING AND OBESITY

Sleep-wake and eating-fasting cycles are 2 vital physiological and behavioural activities that are regulated by internal body clock, and they influence one another.

Staying up late can lead to late-night snacks and weight gain

Eating closer to bedtime, when your internal body clock is telling us that it’s rest time, it can mess with the normal rhythm of internal body clock and eventually promote weight gain.

Picture this: you had dinner at 7.00 pm, and you’re still awake at 1.00 am. That’s a long stretch to feel hungry and be tempted to snack. Staying up late gives you a large window of opportunity to eat, especially if there’s a big gap until bedtime.

Those late-night munchies can easily lead to unwanted weight gain.

Eating 2 to 3 hours before bedtime can lead to weight gain

Your internal body clock will stimulate the production of melatonin, a hormone that make you feel sleepy, 2 to 3 hours prior to usual bedtime.

Eating close to the onset of melatonin production has been associated with insulin resistance as well as greater body fat percent and waist circumference.

Eating more later in the day can lead to more weight gain

Several studies reported that your body burns less calorie (diet-induced thermogenesis, DIT) during dinner compared to breakfast.

The decrease in DIT reflects a reduction in energy expenditure from digestion, absorption, and metabolism of the nutrients ingested.

Therefore, if you eat more of calories towards later in the day, you are more likely to gain more weight compared to those that eat earlier in the day.

Lack of sleep can make us hungry and eat more than we should

Not getting enough sleep due to late sleep can mess with important hunger hormones like leptin and ghrelin, which can leave you feeling hungrier and more likely to overeat.

On top of that, it affects your brain’s ability to make healthy choices and control cravings.

Studies have shown that sleep-deprived individuals have poor food choices, and they tend to go for high calorie and unhealthy foods.

5 WAYS TO ALIGN YOUR BEHAVIOURS WITH YOUR INTERNAL CLOCK & OPTIMIZE YOUR WEIGHT MANAGEMENT EFFORTS 
  1. Sleep early. Don’t let late nights tempt you into reaching for those late-night snacks. Aim for an early bedtime, ideally aligning with the natural day-night cycle.
  2. Have an adequate amount of sleep. The National Sleep Foundation and the Sleep Health Foundation recommend 7 to 9 hours of sleep for adults.
  3. Maintain a consistent sleep schedule. Stick to a routine, even on weekends, to keep your circadian rhythm on track and promote better sleep quality.
  4. Have regular meals and avoid late-night eating. Establish regular mealtimes and try to avoid eating close to bedtime. Give yourself at least a three-hour gap between your last meal and sleep.
  5. Eat more calories earlier in the day. Follow the age-old wisdom of “eat breakfast like a king, lunch like a prince, and dine like a pauper.” Focus on consuming a substantial portion of your daily caloric intake during breakfast and lunch.

Aligning your sleep and eating patterns with circadian rhythms is important for effective weight management. So, the next time you find yourself struggling with your weight, remember that it’s not just about calories.

Take a moment to listen to your body’s natural rhythm, prioritize adequate and quality sleep, stick to consistent sleep and meal schedules, and avoid late-night eating.

These small adjustments can help maintain a healthy weight and achieve a healthier you. Your body and waistline will thank you for it!

References:

  1. Al Khatib, H. K., Harding, S. V., Darzi, J., & Pot, G. K. (2017). The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. European journal of clinical nutrition, 71(5), 614–624. https://doi.org/10.1038/ejcn.2016.201
  2. Bacaro, V., Ballesio, A., Cerolini, S., Vacca, M., Poggiogalle, E., Donini, L. M., Lucidi, F., & Lombardo, C. (2020). Sleep duration and obesity in adulthood: An updated systematic review and meta-analysis. Obesity research & clinical practice, 14(4), 301–309. https://doi.org/10.1016/j.orcp.2020.03.004
  3. Boege, H. L., Bhatti, M. Z., & St-Onge, M. P. (2021). Circadian rhythms and meal timing: impact on energy balance and body weight. Current opinion in biotechnology, 70, 1–6. https://doi.org/10.1016/j.copbio.2020.08.009
  4. Chaput, J. P., McHill, A. W., Cox, R. C., Broussard, J. L., Dutil, C., da Costa, B. G. G., Sampasa-Kanyinga, H., & Wright, K. P., Jr (2023). The role of insufficient sleep and circadian misalignment in obesity. Nature reviews. Endocrinology, 19(2), 82–97. https://doi.org/10.1038/s41574-022-00747-7
  5. Dashti, H. S., Gómez-Abellán, P., Qian, J., Esteban, A., Morales, E., Scheer, F. A. J. L., & Garaulet, M. (2021). Late eating is associated with cardiometabolic risk traits, obesogenic behaviors, and impaired weight loss. The American journal of clinical nutrition, 113(1), 154–161. https://doi.org/10.1093/ajcn/nqaa264
  6. Mazri, F. H., Manaf, Z. A., Shahar, S., Mat Ludin, A. F., & Abdul Basir, S. M. (2022). Development and evaluation of integrated chrono-nutrition weight reduction program among overweight/obese with morning and evening chronotypes. International journal of environmental research and public health, 19(8), 4469. https://doi.org/10.3390/ijerph19084469
  7. Richter, J., Herzog, N., Janka, S., Baumann, T., Kistenmacher, A., & Oltmanns, K. M. (2020). Twice as high diet-induced thermogenesis after breakfast vs dinner on high-calorie as well as low-calorie meals. The Journal of clinical endocrinology and metabolism, 105(3), dgz311. https://doi.org/10.1210/clinem/dgz311

5 Healthy To-Do Things for a Fulfilling & Rewarding Fasting This Ramadan

WORDS DR DAVID TEO

FEATURED EXPERT
DR DAVID TEO
Regional Medical Director
International SOS

Ramadan is a very significant and special observation that is shared by many Malaysians every year, which is why we created our top five tips to hopefully help make it easier for those observing the fast.

For many, the long hours of fasting can lead to dehydration, fatigue, low blood sugar, and headaches, especially if not enough water and nutritious food are consumed during the non-fasting hours. Therefore, it is essential for those fasting to ensure adequate hydration and a balanced diet during Sahur and Iftar.

Individuals suffering from chronic illnesses should consult their doctors on how to manage regular medication and to ensure it is safe for them to fast. People who are COVID-19 positive or have any symptoms of COVID-19 should consider staying at home and avoid contact with other people to prevent the risk of transmission. As COVID-19 continues to evolve around the world, it is important for Malaysians to be mindful when gathering and take measures to ensure a safe experience during Ramadan when with family, friends and co-workers.

We would also like to wish everyone a blessed and safe Ramadan month!

Tip 1
DO NOT SKIMP ON REST AND SLEEP

Ramadan is a time of increased prayer. Though it may be tempting to stay up late for sahur and only sleep after imsak, you should still aim to get at least 8 hours of sleep daily even if this is accumulated over several separate periods of rest.

A well-rested body and mind will make it easier for you to concentrate at work and have more energy throughout the day.

Tip 2
STAGGER YOUR HYDRATION

Thirst can be one of the most challenging symptoms of fasting, leading us to drink plenty of water and liquids very fast as soon as we break our fast and then just before Imsak. However, rehydration should be a cumulative process.

The best way to rehydrate fasting bodies and maintain this hydration for longer is to pace your liquid intake by consuming at least 2 litres of water—1 or 2 glasses at a time—between iftar and imsak.

It also helps to cut down on caffeinated drinks at night, and to top up your liquid intake with soups, fruits and vegetables rich in water, such as cucumbers and watermelon.

Tip 3
EAT HEALTHY & NUTRITIOUS MEALS

Fasting will cause a change of habit in eating and your food intake frequency.

Hence, it is vital to fulfil your vitamin and mineral needs and to be mindful of your salt and sugar intake.

After a full day of fasting, avoid satisfying cravings with soda and energy drinks which are high in sugar. Instead, opt for unprocessed foods such as fruits, and consume complex carbohydrates such as rice, bread and wholegrains alongside vegetables, which will keep you fuller for longer.

As for salt intake, it is worth keeping in mind that having moderately savoury foods with water can help you retain some hydration for longer.

Avoid consuming too much salt as this can affect blood pressure and contribute to thirst and dehydration during the day.

Tip 4
DO MORE IN THE MORNING

Wherever possible, schedule more difficult tasks requiring greater concentration or physical effort in the morning.

Schedule important meetings during the first half of the day, when your energy levels will be higher and you are better able to retain new information.

Tip 5
DON’T STOP EXERCISING

Although you may feel more tired and, understandably, less active while fasting, skipping regular exercise for a full month is unhealthy, particularly as most of your food intake will be consumed at night.

Moderate exercise is advisable and will also help you feel less sluggish.

Just remember to wait a couple of hours after iftar before doing an activity.

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