Healing A Hurt Heel

Healing A Hurt Heel

May 8, 2022   Return

Words Dr Au Yong Pui San

The plantar fascia is a thick fibrous band of tissue that stretches from the inner underside of the heel bone to the base of the toes. It provides support to the arch of the foot.

When there is too much stress to the plantar fascia, it can become inflamed, thickened and swollen, causing pain on the heel or along the arch of the foot. This condition is called plantar fasciitis (pronounced fash-ee-ai-tis). 

The condition is commonly associated with overuse and usually occurs slowly. Typically, the usual complaint will be pain at the heel, especially upon waking up in the morning and taking the first step out of bed. Similarly, there will be pain in the heel during the first step after a period of prolonged immobilization (for eg, sitting in a car for a long journey or after a movie marathon). 

Early in this condition, the pain eases after walking around but if it is left untreated, the pain worsens and lingers throughout the day. 


Some people are more prone to developing this condition, such as those with high body mass index, are flat footed, have overpronation of the feet and very tight calves (typical of people who do not stretch on a regular basis and people who love wearing high heels). 

In the more athletic population, especially runners, common predisposing factors that may lead to the road of prolonged pain and (most times debilitating) discomfort of plantar fasciitis are: 

  1. Poor running biomechanics (or running form), where there is over pronation of feet and/or too much heel strike during running gait. This places a lot of stress onto the plantar fascia leading to irritation and inflammation.
  2. Poor choice of footwear, where a person uses the wrong type of footwear for his or her foot type or body type, or there is inadequate support from the footwear. For larger sized runners who are just starting to enter the fascinating world of running and road racing, picking a pair of shoes with enough cushioning and support is important. With the minimalist types of running shoes still in vogue, a sudden change to shoes with low heel-to-toe drop without adequate adaptation to the shoes will place a high amount of stress to the plantar fascia. 
  3. Tight calves from inadequate stretching (or none!). Stretching post run is highly recommended if not pivotal to the prevention of many overuse injuries, including plantar fasciitis. 
  4. Weak calves, just like tight calves, are also contributing factors to developing plantar fasciitis. A lot of runners feel that running is the only exercise necessary to build muscles in the legs, thus forgoing strengthening exercises. 
  5. Running surfaces also play a role. Running on tar roads and cemented sidewalks (which unfortunately most runners do) leads to high impact on foot strike landing which leads in turn to higher stress on the plantar fascia. 
  6. The dreaded “too’s”, which is too much, too soon, too often. Sudden increment in mileage without adequate rest will most often lead to unwanted aches and pains. One of them very likely could be plantar fasciitis. 
  7. Speedwork and hill repeats. Related to “too much, too soon and too often”, adding on too much speedwork and hill repeats can also lead to heel pain. 



If you experience such heel pain and it is causing you much grievance when you run, there are a few things that you can do to ease the discomfort and return to running in a timely fashion. 

First, you need to make sure it really is plantar fasciitis. There are other ailments that can mimic plantar fasciitis, especially in the non athletic population. The best way to confirm the diagnosis (after your doctor goes through your medical history and physical examination) is to do an ultrasound scan of the plantar fascia, which should show that the fascia is visibly thickened and swollen. An x-ray may show heel spurs but that rarely is the cause of heel pain. There are many people with heel spurs that do nat have heel pain, just as there are many people with heel pain that do not have heel spurs.

If you are a runner and had committed the above causal factors that may have led to plantar fasciitis, then correcting them is the first step to reducing your likelihood of heel pain.

  • Icing after a run, walk or even prolonged standing. 
  • Using proper footwear with adequate cushioning and support. You may consider inserting silicone insoles to reduce the pressure on the heels or insoles that help reduce flat footedness. 
  • Stretching of both the plantar fascia and your calves. Rolling the painful foot over a tennis ball or a golf ball helps to stretch the plantar fascia and may provide a lot of relief upon your first step out of bed. Ideally, this is done the moment you wake up. 
  • Strengthening of intrinsic foot muscles and calf muscles. The stronger the muscles, the better you are at preventing re-injury.
  • Adding softer running surfaces such as a rubberized track, grassy field or less technical trail to your routine.
  • Pulling back on the mileage up to 50 percent and taking a break on speedwork and hill repeats, while letting the pain ease off. Once the pain resolves, you can add the mileage back slowly (key word: slowly). Cross training (for eg, cycling, swimming, aqua-running) can be a great option to maintain cardiovascular fitness while easing off pressure on the foot.

Other treatments that can be done include: 

  • Soft tissue therapy (or myofascial release therapy) can be performed on the plantar fascia, calf muscles, hamstrings and glute muscles.
  •  Night splint worn during sleep to keep the plantar fascia (and calf muscles, to some degree) stretched throughout the night.
  • Taping of the plantar fascia and the calf muscles.
  • Topical and/or oral analgesia. (However, these are not recommended to be taken when exercising.)

If all the above conservative management does not help, your options are:

  • Corticosteroid injection, ideally done under ultrasound guidance to prevent injecting directly into the plantar fascia. Corticosteroid, while useful in reducing inflammation quickly, can weaken the plantar fascia and may cause it to tear or rupture especiallyin the athletic population. With ultrasound guidance, the corticosteroid will be injected along the surface of the fascia.
  • Surgery, only in stubborn or difficult cases where there is still pain but all conservative management efforts have been tried to no avail. Note that surgery is not ideal for the athletic population. HT

What Are The Latest Updates On Diabetes?

What Are The Latest Updates On Diabetes?

May 8, 2022   Return


Think you have heard everything there is to know about type 2 diabetes? Given the ongoing research on this disease, it is very likely that there is some latest news that you may have missed out on. Last November 2018, medical experts from all over the world gathered in Kuala Lumpur for the 12th International Diabetes Federation Western Pacific Region (IDF-WPR) Congress and 10th Asian Association for the Study of Diabetes (AASD) Scientific Meeting. We are fortunate to be among the attendees, and we are pleased to share with you four important updates that were discussed during these events.

Dr Martalena br Purba




Plant-based proteins  and a balanced diet can help in diabetes management.

The increase in consumption of calorie-dense foods which include fast foods, meats and other animal fats, as well as highly-refined grains and drinks loaded with refined sugar, are dietary choices contributing to the rising rates of obesity around the world.

As most people know by now, diabetes is closely linked to obesity and type 2 diabetes is more prevalent among people who eat more fat and animal-based foods.


Didn’t your parents tell you to eat your vegetables? They may not have told you the reasons, but studies have shown that populations eating a plant-heavy, low-fat diet have less risk of heart disease, hypertension, type 2 diabetes, osteoporosis, kidney stones and gallstones; lower death rates from heart conditions, fewer intestinal disorders, and less incidence of certain cancers.

Not necessarily vegetarian

Plant-based diets here are not necessarily vegan or vegetarian in nature, but rather rich in plant- based foods. Animal proteins can be replaced with plant proteins such as tempeh and other soy- based products and legumes. Carbohydrates can come from fruits, vegetables and nuts while calcium and other nutrients can be sourced from dairy and eggs.


The American Diabetes Association (ADA) and the US Academy of Nutrition and Dietetics (AND) recently recommended a well- balanced, plant-based diet as part of diabetes nutrition. These guidelines recommend carbohydrates intake from legumes, whole grains, vegetables and dairy products, with an emphasis on nutrient-dense, high-fiber, low-glycaemic load foods. In short, plant-based diets are consistent with these diets.

Plant-based diets are indirectly beneficial for blood sugar control because they contain less saturated fatty acids. When taken over a long term, plant- based diets result in lower free- fatty acid levels and lesser fat accumulation thus leading to a reduction in diseases associated with free fatty acids, which includes heart failure, metabolic syndrome, and more.

Professor Lee In-Kyu

President of Korean Diabetic Association Department of Internal Medicine Kyungpook National University Daegu, South Korea



According to current scientific research, it seems to be true. Type 2 diabetes is closely linked to obesity and obesity increases the risk for cardiovascular diseases (which includes mainly heart disease and stroke), muscle and bone diseases; and cancers. Obesity related cancers include breast, endometrial, ovarian, colorectal, pancreatic, renal, liver and gallbladder cancer.

Although the reasons for this link have not been thoroughly identified, it is thought to be related to hyperinsulinaemia (excess insulin), hyperglycaemia (high blood sugar) and inflammation. On a more scientific note, there’s a link between energy metabolism of our cell’s powerhouse, the mitochondria, and how it’s altered in cancer cells. This alteration is induced by starvation, nutrient deficiency, long-term high-fat diets and can be found in patients with obesity and diabetes.

According to the American Institute for Cancer Research, after smoking avoidance, maintaining a healthy weight is the most important thing we can do to prevent cancer. Our National Health and Morbidity Survey states that as of 2016, 30 percent of Malaysians are overweight and 17.7 percent of them are obese. This means 30 percent of the population are at increased risk of the cancers listed above.


The answer seems quite universal. A healthy diet, physical activity and weight management – the core of a healthy lifestyle – not only improve type 2 iabetes outcomes, but also reduce the risk of cancer.

Some diabetes drugs are associated with reduction in cancer risk. Metformin, for example, is a first-line drug in the treatment of type 2 diabetes. The drug has been around for many years and is widely used on its own or in combination with other antidiabetic medications. Metformin use has been linked to lower risks of cancer, and a study in 2010 revealed that it could lower the risk by up to 30 percent.

Insulin, on the other hand, has a somewhat volatile reputation, with some studies linking it to an increased risk of cancer while some claim it does not raise any cancer risks. However, the benefits of insulin use in type 2 diabetes far outweigh its cancer risk, which is minimal, if any. Cancer risk should not be a major factor in choosing between available diabetes therapies for the average patient. Only for selected patients with very high risk of cancer occurrence or for recurrence of specific cancer types, should these issues require more careful consideration.

Patients should seek appropriate cancer screenings as recommended for their age and sex ie, colon and prostate cancer for men above 50.

Dr Andrea Ban Yu-Lin

Consultant Respiratory Specialist Head of Respiratory Unit

Universiti Kebangsaan Malaysia Medical Centre




Obstructive Sleep Apnoea (OSA) is a dangerous condition which is expected to affect more people in the near future, in tandem with the obesity epidemic. This makes it necessary for effective and acceptable treatment options to be available.

OSA is a condition where a person stops breathing frequently during his or her sleep. This results in interrupted sleep and subsequently a host of other diseases. Diagnosis is a challenge as the current criteria requires overnight monitoring of sleep-disordered breathing. This means a person suspected of OSA will need to register to a sleep clinic and have special monitoring equipment (a polysomnography) fixed on him or her. As can be expected, the diagnosis itself can be expensive.

Lack of sleep is associated with excessive daytime sleepiness and an increase in workplace and driving accidents. Sleep fragmentation also affects glucose balance in the body and in rats, this leads to increased fat deposition, insulin resistance and hyperglycaemia via increased cortisol and oxidative stress.

There’s more! OSA is also associated with increased risk of hypertension (high blood pressure), atrial fibrillation (uneven heartbeat) and even stroke! In other words, OSA is a recognized independent risk factor for cardiovascular and metabolic disorders.


OSA is more common in males with a prevalence of 24% versus only 9% in women. It is thought that men tend to store more fat around the neck, hence the increased likelihood of airway blockage which is responsible for snoring and intermittent stoppage of breathing.



Sleep on your sideAs the soft tissue at the back of the throat is responsible for blocking one’s airway, sleeping on the side or belly may help alleviate sleep apnoea. Lose weight! As obesity is one of the main causes of snoring and OSA, it makes sense that by losing weight, one would be able to rectify the problem. A 10% weight loss predicts a 26% reduction in apnoea-hypopnoea index (a measurement of the severity of sleep apnoea). Conversely, a 10% increase in weight is associated with a six-fold increase in chances of developing moderate-to-severe OSA.

There’s a machine called the continuous positive airway pressure (CPAP) which forces low pressure air into the nose at night to help with breathing and to prevent hypoxia. The downside of this treatment is some persons may not like the discomfort of having a mask over their face as they sleep. A newer version called the bilevel positive airway pressure (BiPAP) machine works in the same fashion.

Should all else fail, surgery is also an option. Various surgical therapies are available, and these should be discussed with a specialist. Among available procedures are radiofrequency ablation, mandibular advancement, palatal implants and tracheostomy.



Associate Professor Barakatun Nisak Mohd Yusof

Department of Nutrition and Dietetics Universiti Putra Malaysia




Carbohydrates in the diet raise blood sugar levels, and because diabetes is defined by high blood sugar levels, it makes sense to minimize carbohydrates in the diet.

A high-carbohydrate diet leads to constantly high blood sugar levels, which in turn leads to a constant high demand of insulin. As a result, cells in the body become insulin resistant. The positive feedback loop creates an environment in the body where high glucose and high insulin levels circulate in the blood but due to insulin resistance, the person is still hungry.

What’s high and what’s low?

  • Low-fat diets are usually synonymous with high carbohydrate content, while a very-low-carbohydrate diet is synonymous with high-fat or high-protein (ketogenic) content.
  • A very-low-carbohydrate or ketogenic diet only allows for 5% to 10% of daily energy intake to come from carbohydrates.
  • A low-carbohydrate diet consists of less than 26% carbohydrates.
  • Moderate carbohydrate diets range from 26% to 45% carbohydrates.
  • A typical Asian diet consists of 45% to 60% carbohydrates. In the Asian context, a high-carbohydrate diet is one that consists of more than 65% carbohydrate intake.

We’ve heard many people talk about the benefits of low-carbohydrate diets. The evidence seems to swing from one end to another. BUT DO LOW-CARB DIETS REALLY WORK?

According to a study named PURE, which was published in 2017, the intake of high  carbohydrate was associated with a higher risk of mortality. The study found that fat intake had no effect on cardiovascular disease or death.

Later in 2018, the Atherosclerosis Risk in Communities (ARIC) study revealed a U-shaped association between percentage of energy from carbohydrate and all-cause mortality. What this means is if too little (less than 40%) or too much (more than 70%) of our daily diet is from carbohydrates, the risk of death increases.


Yes, balance is the key. The ARIC study found that carbohydrate intake of between 50% and 55% of daily energy intake pose the least risk in terms of deaths. Also, definitions of moderate intake differ in Asian and Western settings, as Asians take more carbs in general.

But wait! The type of protein and fat plays a role, too. The type of non-carbohydrates ie, the fats and proteins consumed as part of the daily dietary intake also plays a big role in determining the risk of death. For instance, if the bulk of protein and fats come from animal sources then there is an increased risk of death.

Conversely, if the bulk of protein and fats are derived from plant and unsaturated sources then they become beneficial for health, and thus, result in a reduced risk of death. HT 

What goes in, must come out in due time

What goes in, must come out in due time

May 8, 2022   Return

Words Jennifer F. Netto

Gut as the second brain

Constipation arises because of improper colonic transit also known as the emptying of the bowels and is due to hard and dry stool. Bowel movement is dependent on the efficiency of the enteric nervous system (ENS) which lies within the walls of the gut. The gut is also known as the second brain because of its gut-brain connection which activates ENS under healthy conditions and allows the colon to efficiently aid in bowel movement through transmission of neuron signals to the brain, affecting the intestinal transit time.

What is Intestinal Transit Time?

The intestinal transit time is a digestive health indicator. It is described as the time between eating food and excreting stool. The gut is more than a mere food processing system and it needs time to do its work effectively, therefore it takes between six and eight hours on average for food to pass into the large intestine (colon) where it would spend close to 40 hours on average before being excreted. The exact time of excretion depends on one’s metabolic rate, the complexity of food that was eaten and the activeness of the ENS system.

According to food nutritionist Despina Kamper, an ideal transit time is about 12-48 hours. If excretion happens sooner, optimal absorption of nutrients can be hindered, whereas if delayed, can cause constipation. Since the colon is the main section in the gastrointestinal tract for water and electrolytes absorption, the longer stool stays in the colon, the more water is absorbed, leaving stool dry and hard.

Tackling Constipation, intestinal transit time and the functionality of the second brain

If your child suffers from constipation and has a long intestinal transit time, you could consider improving your child’s diet by increasing fluid and dietary fibre intake. Rule out intolerances and allergies by identifying which types of food causes an onset of constipation (meat, fish, eggs, lentils, etc). Increasing physical activities, is also known to speed up this transit time as exercising increases the body’s metabolic rate, regulates hormones and aids the ENS in performing more effectively and efficiently to help prevent constipation in your child.


1. Müller, M., et al. (2018). Gastrointestinal Transit Time, Glucose Homeostasis and Metabolic Health: Modulation by Dietary Fibers. Nutrients;10(3):275.

2. The Daily Telegraph. Gut transit time can be big indicator of your digestive health. Retrieved from: https://www.dailytelegraph.com.au/lifestyle/health/body-soul-daily/gut-transit-time-can-be-big-indicator-of-your-digestive-health/news-story/badc481cb67bc3bcb508e4ad93671132.

3. Medical News Today. What are the different types of poop? Retrieved from: https://www.medicalnewstoday.com/articles/320938.php.

4. Scientific American. Think Twice: How the Gut’s “Second Brain” Influences Mood and Well-Being. Retrieved from: https://www.scientificamerican.com/article/gut-second-brain/.

5. GI Society: Canadian Society of Intestinal Research. Constipation Overview. Retrieved from: https://www.badgut.org/information-centre/a-z-digestive-topics/constipation/.

6. Eisenhofer, G., et al. (1997). Substantial production of dopamine in the human gastrointestinal tract. J Clin Endocrinol Metab;82(11):3864–3871.

7. Spencer, N.J., et al. Identification of a Rhythmic Firing Pattern in the Enteric Nervous System That Generates Rhythmic Electrical Activity in Smooth Muscle. Journal of Neuroscience;38(24):5507–5522.

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When NSAIDs Cause Pain

When NSAIDs Cause Pain

May 8, 2022   Return


Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of medications that can help reduce inflammation, pain and fever. As a result, they are commonly used as painkillers. However, NSAIDs can, somewhat ironically, also bring pain and discomfort as they can cause ulcers to form in the stomach and small intestines as a side effect. This month, gastroenterologist and hepatologist Dr Chieng Jin Yu will give us a closer look at these NSAID- induced ulcers, and what we can do about these ulcers.

NSAIDS: Friends To Most People

Dr Chieng Jin Yu

Consultant Physician, Gastroenterologist & Hepatologist

Pantai Hospital Ampang


Most NSAIDs work by inhibiting the production of COX-1 and COX-2, leading to a reduction in inflammation and pain.

“Non-steroidal anti-inflammatory drugs, or NSAIDS, are among the most commonly prescribed medications in the world,” Dr Chieng says. “They are used to reduce pain and inflammation.”

 NSAIDs are available by prescription as well as over the counter at a pharmacy. See Table A for some common examples of NSAIDs.

Table A. The following are some of the more common examples of NSAIDs.
  • Aspirin
  • Naproxen
  • Ibuprofen
  • Indomethacin
  • Ketoprofen
  • Voltaren

Because of their usefulness, NSAIDs are commonly prescribed to patients who experience pain due to surgery, bone or muscle issues, rheumatoid diseases (diseases involving the bone, joints and muscles such as rheumatoid arthritis) and more. Aspirin has an additional benefit – it helps to reduce the chances of blood clot formation – so it is also prescribed to people recovering from heart attacks and strokes.

Unfortunately, inhibition of COX-1 in our body has an unfortunate side effect: COX-1 is needed to produce a fatty substance called prostaglandin. Prostaglandin plays a role in many key functions of the body, and one of these functions is to protect the lining of our gastrointestinal tract (see Figure A).

Therefore, some people may experience damage in their gastrointestinal tract lining after prolonged use of NSAIDs. People who take high dosage of NSAIDs may also experience this issue.

Dr Chieng explains that the reason behind the widespread of NSAIDs is pretty simple: they work very well. However, the mechanism by which these medications offer their users benefits may also end up causing an uncomfortable and even painful side effect among some people.

Let’s take a closer look at this mechanism to understand how the side effect comes about.

The Link Between Nsaids And Our Gastrointestinal Tract

Present in our body is a group of enzymes called cyclooxygenase or COX. When it comes to NSAIDs, two forms or isozymes of COX share the spotlight: COX-1 and COX-2.

Most NSAIDs work by inhibiting the production of COX-1 and COX-2, leading to a reduction in inflammation and pain.

Unfortunately, inhibition of COX-1 in our body has an unfortunate side effect: COX-1 is needed to produce a fatty substance called prostaglandin. Prostaglandin plays a role in many key functions of the body, and one of these functions is to protect the lining of our gastrointestinal tract (see Figure A). Therefore, some people may experience damage in their gastrointestinal tract lining after prolonged use of NSAIDs. People who take high dosage of NSAIDs may also experience this issue.

Figure A. Our gastrointestinal tract comprises our mouth (not pictured here), the oesophagus, the stomach, the small and large intestines all the way down to our anus. It makes up an organ system that allows us to consume food, digest it to obtain energy and nutrients and expel undigested waste from our body.

How Do Nsaids Affect The Gastrointestinal Tract Lining?

With a reduction in the protective benefits of prostaglandin, the gastrointestinal tract becomes irritated and more prone to damage.

Oesophagus. Damage to its lining can cause ulcers to form. Over time, constant ulceration can cause scars, which in turn can lead to the narrowing of the oesophageal tube. This narrowing, called oesophageal stricture, can make swallowing difficult.

Stomach and duodenum (the first section of the small intestine).

The stomach contains gastric acids that help with its digestive function. These same acids can also damage the stomach lining and cause ulcer formation. The duodenum, as the first stop for digested foods mixed with gastric acids, also has its lining vulnerable to damage and ulcer formation.

Dr Chieng shares that studies suggest about 10- 40% of people taking NSAIDs experience stomach ulcers within the frst 3 months of use, the prevalence for duodenal ulcers is about 4-15%. He adds that, sometimes, there are no symptoms; these ulcers are only discovered during an endoscopy.

Small intestine. Dr Chieng points out that NSAID-induced damage to the small bowel lining can lead to narrowing or strictures, inflammation (enteropathy) and even serious complications such as perforation.

To date, we still have not found the exact mechanism that leads to small bowel damage, but some researchers believe that increased intestinal permeability and/or disruption of the mucosal lining structure could be involved.

Dr Chieng points out that a study in 1992 suggests that the prevalence of ulcers in the small intestine is about 8.3% among people with rheumatoid arthritis who are on NSAIDs.

Colon. According to Dr Chieng, injuries to the colon from NSAID use are less appreciated and diagnosed compared to those affecting the above mentioned parts of the gastrointestinal tract.

Who Are More At Risk?

Dr Chieng shares that the following groups of people are more at risk of serious NSAID-induced gastrointestinal complications:

  • Those older than 65.
  • People who also take corticosteroids.
  • Those with a history of stomach or small intestinal ulcers.
  • Those taking NSAIDs at high dosage.
  • People who also have Helicobacter pylori infection.
  • People who take aspirin daily (including low-dose aspirin for cardioprotective purposes).
  • Those who are also on blood thinners or anti-platelet drugs such as heparin and warfarin.

Figure B. NSAIDs may make it easier for ulcers to form in the stomach and duodenum.

What Are The Signs To Watch Out For?

Common signs and symptoms of ulcers include:

  • Abdominal pain. This pain may improve after eating, drinking or taking antacids.
  • Unusual weight loss.
  • Nausea or vomiting. The vomit is often bloody with particles that resemble coffee grounds.
  • Bloating.
  • Easily feeling full during a meal.
  • Burping or acid reflux.
  • Heartburn.
  • Bleeding from ulceration may lead to anaemia, hence one may also experience tiredness, shortness of breath, pale skin and other symptoms of anaemia.
  • Dark, tarry stools.

If we fall into any of the high-risk categories, and we experience any of the above symptoms after taking NSAIDs, we should inform our doctor as soon as possible.

Nsaids Seem Dangerous! Should I Just Avoid Taking Them?

If reading the previous pages has caused you to believe that NSAIDs are a “dangerous” type of medication, don’t worry. NSAIDs continue to be used these days because, like many medications, the benefits outweigh the risk of side effects. It is possible that you may not experience any side effect at all if you take NSAIDs. For most people, even if side effects were to occur, these side effects are usually manageable.

What is important is to let your doctor know early if you fall under a high-risk group, so that your doctor can advise you on how to take NSAIDs without increasing your risk of side effects.

Another thing we should keep in mind is that NSAIDs are rarely taken on a long-term basis, so not everyone will be subjected to high dosage that is often the cause of side effects. If long- term medication with NSAIDs is necessary, doctors can also prescribe proton-pump inhibitors (PPI), a type of medication that can help reduce the risk of NSAID- induced ulceration.

Dr Chieng also shares a few other useful tips when it comes to getting the most benefits out of this group of medications.

  • Don’t self-medicate when it comes to NSAIDs. We should follow our doctor’s advice, which is typically to take the lowest dose possible for the shortest time needed.
  • Take NSAIDs at the end of a full meal or with an antacid. This helps to reduce stomach irritation and ulcer formation. NSAIDs should never be taken on an empty stomach!
  • Limit alcohol intake, as alcohol also irritates the mucosal lining of the gastrointestinal tract.
  • Stop smoking – this habit will only worsen the irritation caused by NSAIDs. HT

It’s not the end of the world if we cannot take NSAIDs for pain relief. As useful and effective as these medications are, there are alternatives such as paracetamol. Dr Chieng also shares that we can consider other therapies to relieve pain, such as hot or cold packs as well as physical therapy.



May 8, 2022   Return

The COVID-19 is spread through small droplets. When a person infected with the virus coughs or sneezes, these droplets land on objects and surfaces in the surrounding area. The virus spreads when other people touch these objects or surfaces and subsequently touch their eyes, nose or mouth.

Though it is still unclear how long exactly the virus can survive on surfaces, some preliminary studies have found that the virus can survive from a few hours, up to a few days depending on conditions such as the type of surface (soft or hard material), temperature and humidity of the environment. One of the most touched surfaces is your phone screen. Hence, it’s of utmost importance we keep the screen clean.

However, the world’s top phone companies warn against using products such as bleach, hand sanitizers, aerosol spray cleaners, window or household cleaners, or any type of abrasive material as these may damage yourdevice.

So, what can you do? Well, do this!


  •  Lint-free microfibre cloth
  •  Small spray bottle
  •  ½ cup water
  •  ½ cup isopropyl alcohol, 70%
  •  Cotton swab


  1. Turn off your phone. Take your phone out of its cover and unplug ear buds or chargers—these should be cleaned separately).
  2. Mix water with 70% isopropyl alcohol (1:1) and pour the mixture into a spray bottle. Shake well.
  3. Lightly spray a lint-free microfibre cloth with the mixture. Do not soak the cloth completely as too much moisture might damage your phone.
  4. Wipe down your phone with the damp cloth, and don’t forget to clean the back of your phone.
  5. You can use a cotton swab to clean small areas like the camera lens, charging port or buttons.
  6. Allow your phone to air dry.

References: 1. World Health Organization. Q&A on coronaviruses (COVID-19). Retrieved on March 18, 2020 from https://www.who.int/news-room/q-a-detail/q-a-coronaviruses 2. The Spruce. The right way to clean your cell phone. Retrieved on March 18, 2020 from: https://www.thespruce.com/how-to-clean-your-cell-phone-4163609



May 8, 2022   Return


The coronavirus disease 2019 – COVID-19 for short—is caused by a virus called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Because a virus, not bacteria, is responsible for the disease, what normally works to kill bacteria MAY NOT WORK this time around.


Washing your hands regularly with soap and water (even when they don’t seem dirty). Doing so helps to break down the protective fatty outer layer of the virus, killing it.

Sanitizers work, but only if the alcohol content is 70% or higher. Alcohol-free sanitizers is not effective in this situation.


  1. Hot or cold baths. It’s best to instead clean your hands regularly with soap and water as well as sanitizer.
  2. Antibiotics. These only work on bacteria.
  3. Spraying alcohol or bleach onto your entire body. This can hurt your skin, mouth and eyes.
  4. Hand dryers. Best to stick to soap and water as well as sanitizers.
  5. UV lamps. These can harm your skin.
  6. Saline nasal spray. Rinsing the nose has never been proven to protect anyone from respiratory infections.


  1. Getting vaccinated against influenza,pneumococcal disease and Haemophilus influenza type B. These vaccines protect you from these specific diseases, but we haven’t developed a vaccine against COVID-19 yet.
  2. Loading up on vitamin C, garlic, curry, etc. Certain foods may help boost your immune system, but diet alone is not shown to be effective to protect you against infection.


  1. Wearing a face mask alone is not enough to protect you from COVID-19. You need to also wash your hands with soap and water, as well as use a sanitizer, regularly.
  2. If you are healthy, you need to wear a face mask only when you are tending to someone who has or is suspected to have COVID-19.
  3. Clean your hands before wearing the mask.
  4. Avoid touching the mask once you’ve worn it. If you do this, wash your hands with soap and water or use a sanitizer.
  5. To remove a mask, do it from behind (don’t grab the front to pull it off) and discard the used mask into a closed bin. Clean your hands afterwards.


With the restrictive movement order in place, being cooped at home can be an isolating and even lonely experience, especially when you’re already anxious about the outbreak and its impact on your life. Try these to help you feel better.

  1. Try to contact 5 people every day—other family members, friends, etc— via Whatsapp, FaceTime and other communication apps.
  2. Offer to help obtain groceries and medications for those who are unable to leave their homes.
  3. Talk a short stroll within your house compounds, or spend some time looking outside the window—this helps to remind you that there is a beautiful world outside your home that you can get back out into once the order is lifted. HT



May 8, 2022   Return

We’re all blessed to live in a land where the sun shines all year round. But on the flip side, when it gets too hot, the extreme heat can really work against your complexion and makeup. Luckily, there are some things you can do to keep your skin looking fresh all day while protecting it from sun damage.


Put on your sunscreen 15 minutes before going outdoors, even on cloudy days. Ideally, use one with SPF30 protection or higher. Don’t forget to reapply approximately every 2 hours when you’re outdoors.


If you have oily skin, your skin may get a little shiny as the day goes by. Use oil blotting paper to remove this excess oil off your skin. Alternatively, keep a clean handkerchief handy to dab away the excess oil and sweat.


On casual days, wear a little less makeup. The less makeup you wear, the less likely your pores clog up. Also, stay away from thick and oily moisturizers on hot days, as they tend to cause makeup to slide right off the skin. Opt instead for a lightweight tinted moisturiser with SPF sun protection.


Drink plenty of water throughout the day, especially if you are physically active. This is also good for our overall health and has beauty benefits too! Water nourishes and plumps up the skin, making you look more youthful. HT

Reference: American Academy of Dermatology. Sunscreen FAQs. Retrieved on March 3, 2020 from https://www.aad.org/public/everyday-care/sun protection/sunscreen-patients/sunscreen-faqs

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May 8, 2022   Return

Our brain can only store a finite amount of information. Hence, it is just as important for us to forget trivial details as it is to remember important ones. Removing unnecessary memories allows our brain to continuously collect new, useful information.

Researchers recently learned that cells called microglia play a role in determining which memory is kept and which is forgotten. These cells remove synapses— structures in the nervous system that allow transmission of information from one nerve cell to another—and in the process cause memories linked to these synapses to be lost.

This discovery could be important in the search for a treatment for Alzheimer’s disease, as synapse destruction is linked to this disease. Who knows, it may also one day allow us to have a means to remove traumatic memories from our mind—something that could be useful in treating people with post-traumatic stress
disorder. HT

Reference: Wang, C., et al. (2020). Microglia mediate forgetting via complement-dependent synaptic elimination. Science;367(6478):688–694.



May 8, 2022   Return



According to Dr Kok Chin Yong, many studies have shown that poor sleep can lead to or accelerate cognitive decline. Elderly people suffering from insomnia face a higher risk of developing Alzheimer’s disease, while too little as well as too much sleep have been linked to migraines. 

Dr Kok advises us to avoid light-emitting devices 1 to 2 hours before sleep, caffeine after 3 pm and large meals or high intensity exercises at night.


The World Health Organisation has stated that an active lifestyle plays a beneficial role in reducing the risk of dementia and stroke. Dr Kok recommends physical exercise for at least 40 minutes each time, three times a week.


If we have high blood pressure, our risk of developing a stroke as well as dementia is higher. Likewise, people with diabetes face higher risk of developing hypertension and high cholesterol. If we have any of these diseases, we should work closely with our healthcare team to practice good control of the disease.


Dr Kok explains that MIND stands for Mediterranean-DASH for Neurodegenerative Delay; it is a hybrid of both the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. Such a diet consists of green, leafy vegetables, whole grain, berries, olive oil, poultry, and fish. 

Dr Kok further reveals that, based on data from epidemiological studies, this diet may be able to slow brain ageing by approximately 7.5 years and reduce the risk of Alzheimer’s disease. 

On the other hand, poor dietary habits such as high salt intake and low consumption of fruits and vegetables can increase the risk of disabilities stemming from cardiovascular diseases and stroke.



May 8, 2022   Return


Kundursalaiparangidhupshallaki, cunnampu… depending on which part of Asia you’re in, Indian frankincense is known by many names. Prized as incense in religious ceremonies, as perfume, and as a healing herb, this sweet-smelling resin from an ancient tree species has caught the eye of researchers as a possible answer to painful joints.

Besides Boswellia serrata, a few other closely related tree species also produce frankincense. Boswellia carterii grows throughout the Arabian Peninsula, and traditional Chinese medicine makes use of its resin, known as ru xiang (‘fragrant milk’). Boswellia frereana or Coptic frankincense is more local to Somalia and parts of Northeast Africa.

Boswellic acids—a solution for anti-inflammation?

The key component seems to be what scientists have named boswellic acids. For one thing, they’ve been shown to slow down the production of cytokines in the human body.

Cytokines are little bits of protein that normally tell the body to cause inflammation in a particular spot; while this is normally meant to help heal the body, cytokines can sometimes go overboard, causing too much inflammation and hurting the body instead.

More than 12 different kinds of boswellic acids have been found, but two in particular: acetyl-11-keto-β-boswellic acid and 11-keto-β-boswellic acid (abbreviated to AKBA and KBA, respectively) seem to have the strongest anti-inflammatory effects so far.

Helps with joint pain?

It seems to! According to a team of scientists from the Cochrane Network—one of the largest independent reviewers of published scientific research—there’s a moderate level of evidence to suggest that Boswellia serrata extract, taken orally, can help with osteoarthritis symptoms.

They took a look at three different studies and found that groups of people with osteoarthritis who took 100 mg of Boswellia serrata extract daily seemed to report reduced pain and improved joint function after a 90-day period, compared to a parallel group who were taking placebos.

As a caveat, though, they noted that the studies they looked at involved only a few dozen participants, and there were multiple other studies that couldn’t quite prove the same level of benefit. Still, it’s an area of research that “warrants further investigation, in light of the fact that the risk of adverse events appears low.”

Safe to use?

Boswellia is generally believed to be safe, though there haven’t been extensive studies into its safety and toxicity. So far, the most frequent side effects have been mild nausea and gastric reflux, so caution is advised if you’re taking it while gut troubles are around.

Some small studies in India have also noted that the resin might be capable of inducing abortion—an effect also noted in traditional literature—so it’s not advised for pregnant women.

References: 1. Siddiqui, M. Z. (2011). Boswellia serrata, a potential antiinflammatory agent: an overview. Indian J Pharm Sci. 73(3):255-261. 2. Ammon, H. P. T. (2016). Boswellic acids and their role in chronic inflammatory diseases. Adv Exp Med Biol.;928:291-327.  3. Ammon, H. P. T. (2006). Boswellic acids in chronic inflammatory diseases. Planta Med.;72(12):1100-1116. 4. Cameron, M., & Chrubasik, S. (2014). Oral herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev;5:CD002947. 5. Basch, E., et al. (2004). Boswellia: an evidence-based systematic review by the Natural Standard Research Collaboration. J Herb Pharmacother;4:63-83.