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

You Aren’t Alone When It Comes to Infertility, Experts Say, So Here’s What You Can Do About It

WORDS DR KHINE PWINT PHYU & ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN

FEATURED EXPERTS

DR KHINE PWINT PHYU
Senior Lecturer in Obstetrics and Gynaecology
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN
Head of School
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
THE INCIDENCE OF INFERTILITY IS ON AN UPWARD TREND WORLDWIDE
  • Infertility is defined as not being able to conceive after 1 year of unprotected sexual intercourse.
  • In women above 35, this duration is sometimes shortened to 6 months.
  • The World Health Organization estimates that 1 in 6 people are affected by infertility.
  • In Malaysia, there is a drop in fertility rates from 4.9 children per woman of childbearing age in 1970 to 1.7 in 2021.
CAUSES ARE VARIED, INVOLVING ISSUES IN EITHER PARTNER OR BOTH AND IN SOME CASES, THE CAUSES ARE DIFFICULT TO IDENTIFY

Female factors of infertility

  • Anovulation, or ovulation disorders, are situations where no eggs are released from the ovaries during the menstrual cycle. These disorders can be caused by:
    • Hormonal imbalances such as seen in polycystic ovary syndrome (PCOS) and excessive prolactin secretion.
    • Eating disorders.
    • Extremes of body weight.
    • Strenuous exercises.
    • Stress.
    • Chronic illnesses.
  • Blockage of fallopian tubes, caused by previous pelvic infections, inflammation of tubes, and pelvic adhesions which may be related to past surgery at the abdomen and pelvis. When the tubes are blocked, it will affect the transport of sperm to meet the eggs to achieve successful implantation and pregnancy.
  • Endometriosis, which is the presence of tissue that is normally found in the inner lining of the uterus, outside the uterine cavity, which may affect the function of the ovaries, uterus, and fallopian tubes.
  • Congenital abnormalities (malformations that develop before birth) of the uterus.
  • Uterine fibroids (non-cancerous growths which develop in and around the womb).

Male factors of infertility

  • Low sperm count, which can be seen in men with genetic defects, chronic health problems such as diabetes, liver or kidney diseases, or sexually transmitted infections like gonorrhoea. Abnormalities such as undescended testis and varicoceles (swollen veins within the scrotum) can also be causes.
  • Premature ejaculation.
  • Blockage or injury to the reproductive organs.
  • Usage of certain medications can affect sperm movement, quality, or lead to coital dysfunction.
  • Environmental and lifestyle factors such as use of tobacco, heavy alcohol, marijuana or steroids, exposure to toxins and exposure of the external genitalia to high temperatures.
BOTH PARTNERS NEED TO BE INVOLVED WHEN IT COMES TO FERTILITY TREATMENT

To support health education and increase awareness regarding numerous infertility issues faced by couples across the globe, World Infertility Awareness Month is observed every year in June. Many couples are not even aware they are infertile; hence this month serves to alert them of issues that may affect them as well as their available solutions.

While the causes of infertility are varied and can affect both partners, the burden and stigma are often shouldered by the female partner. In our part of the world, both issues are particularly pronounced.

Couples with fertility issues should therefore see a doctor in a timely manner to receive a proper assessment and effective treatment. As age is an important factor in conceiving, early medical intervention often leads to positive outcomes in a couple’s fertility journey.

Both partners should be involved in fertility consultation and management. The primary issues to address include if the woman is ovulating regularly, if the sperm cells in semen are healthy, if there are coital issues and any problems with fertilization and implantation, and if the woman is able to maintain the pregnancy.

To answer these questions, thorough evaluation should be done through taking a detailed medical and personal history, sexual history and performing a physical examination for both partners. The next steps would then be to test the couple with baseline investigations as well as specific evaluations.

Some common assessments include tests to ensure the fallopian tubes are patent (open and lacking blockage), tests to confirm ovulation, sperm counts, and ultrasound to look for abnormalities in the uterus, fallopian tubes, and ovaries.

MANAGING & TREATING INFERTILITY

Sometimes, simple lifestyle modification measures such as weight management, adequate exercise, cessation of smoking, and the limitation on alcohol consumption can solve infertility.

As for natural methods, frequency of sexual intercourse can be an issue and it is recommended that at least 3 times a week increases the probability of conceiving.

Timed intercourse during a women’s fertile period may be a strategy as well. Women usually ovulate about 12 to 14 days before the start of a next menstrual cycle and the fertile period is the five days before ovulation, the day of ovulation, and the day after ovulation.

The treatment for fertility issues depends on the cause. For women who experience problems with ovulation, medications to induce ovulation may be employed. As for women with endometriosis, fibroids, or other tubal diseases, surgery may also improve outcomes. For men, prescribing medications to improve sperm quality may help and surgery may be employed for men with structural abnormalities in their reproductive system.

When more simple methods are not successful, more complex procedures may be employed such as intra-uterine insemination (IUI), gamete intra-fallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI). For couples with unexplained infertility, increasing coital frequency in combination with IUI often results in successful pregnancies.

References:

  1. Ferlin, A., Raicu, F., Gatta, V., Zuccarello, D., Palka, G., & Foresta, C. (2007). Male infertility: role of genetic background. Reproductive biomedicine online, 14(6), 734–745. https://doi.org/10.1016/s1472-6483(10)60677-3
  2. Lipshultz, L. I., Howards, S. S., & Niederberger, C. (2009). Infertility in the male (4th ed.). Cambridge University Press. http://dlib.sbmu.ac.ir/site/catalogue/134959
  3. Krausz C. (2011). Male infertility: pathogenesis and clinical diagnosis. Best practice & research. Clinical endocrinology & metabolism, 25(2), 271–285. https://doi.org/10.1016/j.beem.2010.08.006
  4. Poongothai, J., Gopenath, T. S., & Manonayaki, S. (2009). Genetics of human male infertility. Singapore medical journal, 50(4), 336–347.

Here’s EVERYTHING That Mom and Dad Should Know About Hand, Foot & Mouth Disease

WORDS LIM TECK CHOON

FEATURED EXPERT
ASSOCIATE PROFESSOR DR ERWIN J KHOO
Consultant Paediatrician and Head of Paediatrics Department
International Medical University (IMU)
WHY KIDS ARE VULNERABLE TO HAND, FOOT, AND MOUTH DISEASE

It’s hard to avoid hand, foot, and mouth disease recently, as it’s either affecting children in the country or appearing in the news.

Simply put, young kids are at risk of catching this disease because they are active, mobile, and curious.

According to Associate Professor Dr Erwin Khoo, toddlers tend to have a messy habit of touching and putting everything they come across into their mouths. This puts them at risk of the disease.

THE CULPRITS RESPONSIBLE FOR THE DISEASE

That will be viruses, the most common ones being Coxsackie A16 and Enterovirus 71.

According to Dr Erwin:

  • These viruses can be found in the respiratory tract and faeces, as well as in the fluid-filled blisters that form on the hands and feet of someone with hand, foot, and mouth disease.
  • The usual incubation period—the time period from infection to the first appearances of symptoms— is between 3 and 7 days, but it can also be and can go up to 2 weeks.
  • The virus can remain contagious for several days, even when it’s on hard surfaces.
  • As a result, the virus can spread easily amongst those in close contact with the infected child. One can also catch the virus from touching toys, eating utensils, and other objects that had been handled by the infected child.
  • One can also catch the virus from not properly washing their hands after performing routine childcare tasks on the infected child, such as changing diapers.
COMMON SYMPTOMS OF HAND, FOOT, AND MOUTH DISEASE
  • Fever
  • Sores around the mouth
  • Rashes
Rashes on the feet. Click for larger, clearer image.

Widespread rashes across the body are commonly seen on children with this disease, which may lead some people to confuse it with chickenpox.

Dr Erwin shares that unlike chickenpox, however, the rashes of a child with hand, foot, and mouth disease typically form at the hands and feet (hence the name of the disease) as well as sometimes on the knees, elbows, and buttocks.

IT CAN ALSO AFFECT ADULTS

This disease commonly affects children under the age of 6, but adults can also get infected and develop the disease.

Research has suggested that adults usually experience milder symptoms when compared to children.

Hence, it is possible for adults to pass the virus on to children under their care.

ONE CAN GET THIS DISEASE MORE THAN ONCE

Dr Erwin explains that this is because there are different strains of viruses that cause this disease. Because of this, any immunity developed by the body after an infection is only temporary.

HOW IS HAND, FOOT, AND MOUTH DISEASE TREATED?

“There is no cure or specific treatment for this disease,” Dr Erwin shares.

Currently, treatment revolves around managing the symptoms and making the child as comfortable as possible.

Dr Erwin points out that the disease typically goes away on its own between 7 and 10 days.

OKAY, BUT CAN WE PREVENT THE DISEASE FROM AFFECTING US OR OUR CHILDREN, THEN?

Unfortunately, we currently have no means to fully prevent hand, foot, and mouth disease from happening to us or our children.

SOMEONE AT HOME HAS THIS DISEASE. WHAT SHOULD WE DO?

Dr Erwin advises the following:

  • Be extra careful and limit contact with the infected individual.
  • Practice good hand hygiene. Wash or disinfect hands regularly, especially after caring for an infected child. It’s also good to wipe down common areas, such as the living and dining areas, as well as commonly handled objects such as toys, doorknobs, etc with disinfectant.
  • Don’t share food and eating utensils.
  • Avoid touching the eyes or nose.

Do the above up to 10 days after the infected individual started showing symptoms.

If your child is confirmed by a doctor to have hand, foot, and mouth disease, it is prudent to have the child stay at home to avoid passing the infection on to others.

WHAT CAN PARENTS DO TO HELP PROVIDE THE BEST TLC TO A CHILD WITH HAND, FOOT, AND MOUTH DISEASE?

Dr Erwin advises the following:

  • The paediatrician will prescribe appropriate medications for fever, pain relief, and reduction of inflammation of mouth ulcers. Parents wishing to use medications outside of the doctor’s prescription should consult the paediatrician first.
  • Give the child easy-to-swallow foods, such as soups and porridges.
  • Have the child drink plenty of fluids to avoid getting dehydrated. Offer them their favourite drinks or juices.
  • For painful mouth ulcers, consider using cold treats such as ice cream, jelly, and yoghurt to provide soothing pain relief. Parents can also consider alcohol-free mouth rinses and oral gels for the child.
  • Have the child shower or bathe regularly, as this will help soothe their sores. Avoid using harsh soaps and body scrubs on the child, as these may irritate their skin further.
  • Afterward, apply a towel gently to dry the child, to avoid breaking the blisters on the child’s skin. harsh soaps and scrubs that further irritate the skin.
  • If the child’s sleeping area has air-conditioning, switch it off at night. This is because air conditioning can create a dry environment that will reduce the child’s saliva production. This can cause the child’s mouth ulcers to hurt more.
  • If cooling is needed, such as due to hot weather, a humidifier or even just leaving a bowl of water in the room can prevent an excessively dry environment from forming.
  • If the child can’t sleep or rest due to pain, consult the paediatrician about the use of a pain reliever at night.

Dr Erwin points out that there are many “home remedies” being passed around, such as using coarse salts or enzyme water on a child with this disease. There is no evidence that such “remedies” actually work, and in most cases, they only irritate the skin and cause more pain and discomfort!

WHAT ABOUT COMPLICATIONS? ARE THERE ANY?

Usually, plenty of rest at home can help a child with hand, foot, and mouse disease recover, with over-the-counter treatments sufficient to relieve symptoms such as fever, rashes, and/or red spots.

However, in some cases, painful ulcers in the mouth can prevent a child from eating, drinking, and swallowing normally.

“This can lead to dehydration. Serious cases of dehydration require medical attention,” Dr Erwin states.

To keep an eye out for signs of dehydration, parents can do the following:

Take note of poor urine output, dry mouth, and lack of tears when they cry.

These are possible signs of severe dehydration.

Seek immediate medical attention when your child experiences the following:
  • Rapid breathing
  • Disorientation
  • Drowsiness
  • Giddiness
  • Stiff neck
  • Seizures
  • Fever for more than 3 days
  • Not eating and drinking
IT MAY SEEM OVERWHELMING WHEN YOUR CHILD HAS HAND, FOOT, AND MOUTH DISEASE, BUT TAKE A DEEP BREATH

Dr Erwin encourages parents to take a different outlook.

“If you can arrange to take some time off from work, maybe with a doctor’s letter for your employer, just stay home and spend this time with your kids. It is easy to overlook how quickly they grow up!” he says.

Everything You Need to Know About Managing Disruptive Menopause Symptoms

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR DR NAZIMAH IDRIS
Medical Director
IMU Healthcare

I’m still young. Should I be concerned about menopause at this point in time?
“We should speak to women long before they reach menopause, so that, when it happens, they are more prepared and less anxious about it,” says Professor Dr Nazimah Idris.

She adds: “Many women I see wish they had known earlier what they could have done to prepare themselves. As every woman will go through this experience, you should enter this life phase empowered with knowledge.”

What’s menopause, exactly?
According to Prof Dr Nazimah, menopause is when a woman’s ovaries stop producing eggs and she stops menstruating.

Medically, menopause is confirmed when a woman has not experienced menstruation after one year.

Generally, this takes place when a woman is between 45 and 55 years old.

About 5% of women worldwide, however, experience early menopause between the ages of 40 and 45.

It’s also possible to experience menopause after undergoing a hysterectomy, chemotherapy, and other medical procedures that can damage the ovaries and affect menstruation.

Common symptoms of menopause. Click on the image for a larger, clearer version.

Why do some women experience symptoms of menopause even when they are still menstruating?

Prof Dr Nazimah explains that this is likely because the woman is experiencing perimenopausal stage (often called perimenopause for short), which can occur even before a woman enters menopause.

This stage usually lasts 4 to 5 years.

“During this time, it is normal to have irregular menstruation that may include heavier bleeding as well as infrequent or skipped cycles,” she elaborates.

Perimenopause can occur due to changes in a woman’s endocrine system. These changes can cause a reduction in the levels of oestrogen, the female sex hormone.

Because of this reduction in levels, a woman may experience symptoms of menopause such as hot flashes, fluctuating emotional states, difficulty sleeping and vaginal dryness.

She may also experience forgetfulness, low energy levels and reduced libido which, combined with vaginal dryness, can lead to less interest in sex and intimacy.

Once the woman enters menopause, the symptoms can become more severe and last up to another 5 years.

That sounds uncomfortable. Can anything be done about it?

Prof Dr Nazimah admits that a woman going through perimenopause and later menopause may experience around 10 years of symptoms. “This is a long time to be coping with symptoms if they are disrupting your daily life.”

Hormone therapy can help to manage severe and disruptive symptoms.

Tell me more about hormone therapy. Does it work, and how does it work?

“Hormone therapy can be very helpful in relieving hot flashes and improving sleep quality, vaginal dryness and urinary incontinence, among others,” she says.

There are different types of hormone therapy: tablets, topical creams, vaginal ring, and more. Medications may also be prescribed when necessary, such as to reduce the risk of osteoporosis due to low levels of oestrogen in the body.

The doctor will recommend the most suitable option based on a woman’s needs, family history, and other factors.

This sounds intriguing. Is hormone therapy an option for every woman experiencing symptoms of menopause?

Well, for one thing, Prof Dr Nazimah points out that hormone therapy is generally well-tolerated.

Hence, it is an option available to most women even when they have chronic diseases such as type 2 diabetes and high blood pressure.

However, hormone therapy may not be suitable for women that have certain diseases and conditions such as breast cancer, liver disease, thromboembolism, and heart disease.

If you have a health condition and are interested in hormone therapy, Prof Dr Nazimah recommends consulting a doctor for more information.

FEATURED EXPERT
SIN YEN SUAN
Certified Chinese Medicine Practitioner
IMU Healthcare

How about natural remedies for menopause symptoms? Do they work?

According to Sin Yen Suan, a certified Chinese medical practitioner, natural remedies such as evening primrose and black cohosh are traditionally turned to for perimenopause and menopause.

However, research on the efficacy on these remedies has yet to uncover any conclusive evidence on their efficacy in relieving the symptoms of perimenopause and menopause.

“However, Chinese medicine may be able to help,” Yen Suan offers.

She explains that the effectiveness of Chinese medicine can be seen by about 3 cycles of treatment, although the whole treatment process for menopause symptoms may last 1 to 2 years.

How exactly can Chinese medicine help?

Yen Suan further elaborates that Chinese medicine treat health problems by addressing imbalances in the body through individualized therapies, based on each person’s health status, needs, and other factoers.

“Many women come to me for help with symptoms such as persistent or heavy vaginal bleeding especially, heavy sweating, hot flashes, and disturbed sleep,” she says. “To help, we use several different treatments such as herbal medications to balance their qi or acupuncture to stimulate blood flow at the meridian points. These methods help to ease their emotional state, so they are able to feel better and sleep better at night.”

Chinese medicine can complement a person’s current Western medicine regime. If you are considering Chinese medicine to complement your current medical treatments, she recommends keeping both your doctor and Chinese medicine practitioner updated on your current forms of treatment.

PROF DR NAZIMAH’S TO-DO CHECKLIST FOR WOMEN EXPERIENCING MENOPAUSE
  • Menopause is not the end of life as you know it. Embrace new experiences, learn new things, take up a new hobby, make new friendships and rekindle old ones—the list goes on and on.
  • Speak to your doctor about health screenings such as Pap smear, mammograms, and colonoscopy, which are useful in detecting early stages of cancer and other health issues.
  • Also consider tests such as blood tests for anaemia and diabetes as well as bone density scans for osteoporosis.
  • Women over 51 should increase their calcium intake to 1,200 mg a day and consume vitamin D3 to keep their bones healthy and reduce their risk of osteoporosis.
  • Do regular Kegel or pelvic floor exercises, weight bearing exercises, and strength training to keep your body in good working condition.
  • Quit unhealthy habits such as smoking.

“Don’t Let Diabetes Ruin Your Eyesight!” Warns Expert

WORDS LIM TECK CHOON

FEATURED EXPERT
DR PEH KHAIK KEE
Consultant Ophthalmologist and Vitreoretinal Surgeon
Sunway Medical Centre
DIABETES IS THE MOST COMMON CAUSE OF BLINDNESS AMONG WORKING-AGE ADULTS

“1 in 5 Malaysians is diabetic, which equals to an estimated 4.6 million Malaysians, and diabetic eye disease affects 1 in 3 diabetics. That means about 500,000 of these people will experience vision-threatening eye disease,” says Dr Peh Khaik Kee.

DIABETIC RETINOPATHY IS A DIABETES-LINKED EYE DISEASE THAT CAN LEAD TO VISION LOSS

According to Dr Peh, diabetes affects the eye in several ways:

  • It causes changes to the lens, leading to blurry vision.
  • Increased pressure in the eye can lead to glaucoma.
  • Damages the nerves that control the eye muscles, giving rise double vision.
  • Damages the blood vessels in the retina, leading to diabetic retinopathy.
Overview of diabetic retinopathy. Click on the image for a larger, clearer version.

Dr Peh shares: “Diabetic retinopathy has become of epidemic proportions. A large part of this issue is due to poor awareness. Many people with diabetes do not undergo regular eye exams to check for signs of the condition.”

REGULAR EYE EXAMS ARE IMPORTANT BECAUSE EARLY STAGE DIABETIC RETINOPATHY DOES NOT SHOW ANY SYMPTOMS

Vision loss occurs at late-stage diabetic retinopathy—this is when most people affected by this disease seeks medical help.

Dark spots floating around in the person’s vision (floaters) are a possible symptom of diabetic retinopathy.

Unfortunately, the vision loss is permanent, and at that stage, there is little to be done to improve the person’s eyesight.

On the other hand, should diabetic retinopathy be detected at its early stages, treatment can be prescribed to help slow down or stop the vision loss over time.

“That is where the importance of screening comes in,” Dr Peh said.

EYE SCREENING FOR DIABETIC RETINOPATHY IS MORE COMFORTABLE THESE DAYS

In the past, such screening can involve staring at a bright light for up to 5 minutes for each eye, which can be very uncomfortable for some people.

Dr Peh shares that the eye screening process has improved since. “These days we have ultra-widefield fundus cameras that can capture a single, 150-degree field view of the retina; 3 times more field view than a standard camera.”

He adds that the camera captures images in under 1 minute, with up to 98% accuracy in detecting and grading retina disease when combined with targeted slit-lamp examination.

Thus, the screening process is faster and hence the person undergoing screening will have a more comfortable experience, while at the same time offering a high accuracy rate in detecting diabetic retinopathy.

EYE SCREENING MAKES A DIFFERENCE

“Diabetic eye screening was formally initiated in the UK in 2009, and by 2014, diabetes is no longer the commonest cause of blindness in working adults in the UK. That is the difference that screening makes,” says Dr Peh.

WHO SHOULD GO FOR EYE SCREENING?

Dr Peh encourages those with a family history of diabetes to have their blood sugar screened, and those diagnosed with diabetes should see an ophthalmologist to have their retina examined.

IMU Counsellors Open Up About Mental Health Issues Among University Students

WORDS LIM TECK CHOON

The 2015 Malaysian National Health and Morbidity Survey found the prevalence of mental health problems has increased from 10.6% in 1996 to 29.2% in 2015.

The prevalence is highest among those aged 16 to 19, with 18.3% having depression and 10% having suicidal thoughts.

Some of the factors associated with this increase include:

  • Unemployment
  • Financial difficulties
  • Family and relationship problems
  • Poor coping skills
  • Insufficient social support
WHAT IS KEEPING OUR YOUTH FROM SEEKING HELP?

Barriers that are keeping young adults from seeking help include:

  • Poor understanding of mental health problems
  • Fear of social stigma or embarrassment
  • Lack of social support
  • Difficulty in accessing professional services

Counsellors of the International Medical University (IMU) recently issued a statement that mental health issues can be even more prevalent among tertiary students that study abroad.

To circumvent this issue, International Medical University (IMU) and other tertiary education institutes often work closely with their partner schools to ensure full support and care for the wellbeing of their students, and to provide benchmarks on how their students are actually coping overseas.

Such support can come in the form of student-led initiatives such as peer-to-peer support—when students effectively reach out to one another—as well as counselling sessions with academic leads, senior tutors, and/or professional advisers.

WATCH OUT FOR THESE SIGNS

According to the IMU Self-Development Unit counsellors, we should watch out for these signs

  • Disturbed sleep patterns, such as difficulties falling asleep or waking up, waking up in the middle of the night, or excessive sleep.
  • Emotional outbursts, such as being very sensitive and easily irritated or angry.
  • Persistent fatigue.
  • Poor concentration, such as losing track of conversations.
  • Significant changes in eating habits and/or weight change that is not caused by a health issue.
  • Withdrawal from social activities—not making eye contact, being less active or significantly quieter or not participating when in social groups.

The IMU Self-Development Unit notes that some of these warning signs can be easily misunderstood or misconstrued in different social contexts. Hence, it is important to have patience in understanding a person’s behaviours when these could indicate possible mental health risk.

OFFER SUPPORT & HELP

The next step is to offer support to someone who is struggling, and the IMU Self-Development Unit counsellors says that listening to our intuition is very important.

Very often, the signs are there that tell us something is wrong, but we may turn a blind eye and ignore them. In some instances, we may even feel concerned about our own safety.

Here is their advice, based on the NEC model:

  1. Notice. Tell the person what you’ve observed that has worried you, such as “I noticed that you haven’t been eating/sleeping much lately.”
  2. Express concern. Let them know that you are worried about them and offer them space and privacy to listen to them and support them in any way such.
  3. Connect them to someone who can help. Suggest a person or resource where they can get the help they need or offer to accompany them when they are ready to seek professional help.
For a more comprehensive list of mental health resources across Malaysia, check out https://sites.google.com/view/psymalaysia/ (link opens in a new tab).

Expert Dishes on Staying Safe & Comfy During This HOT HOT Heat Wave

WORDS LIM TECK CHOON

FEATURED EXPERT
DR CHAN YANJUN
Medical Director
International SOS
HEAT WAVE AT A GLACE
  • The official definition of a heat wave in Malaysia is a period when the daily maximum temperature is higher than 37ºC for 3 consecutive days.
  • As of 12 May 2023, the Ministry of Health has recorded a total of 14 cases of heat-related illnesses such as heat stroke (4 cases), heat exhaustion (4 cases) and heat cramps (6 cases).
  • The Ministry expects the number of such cases to increase until August 2023!
Heat awareness at a glance, courtesy of International SOS. Click for a larger, clearer version.

Dr Chan Yanjun tells us: “Heat waves can lead to heat exhaustion and heatstroke, which can have severe consequences on health. It is crucial to prioritize personal well-being and take necessary precautions to prevent heat-related illnesses.”

COMMON HEAT-RELATED ILLNESSES
  • Heat stroke occurs when your body overheats—your body temperature goes over 40ºC—and it can quickly damage your brain, heart, kidneys, and muscles if you didn’t receive prompt treatment. This is considered a medical emergency.
  • Heat exhaustion is the result of excessive sweating in high temperatures, which leads to enormous amount of loss of water and salt. Symptoms include heavy sweating, dizziness, thirst, decreased urine output nausea, and vomiting. Without prompt medical attention, this can lead to heatstroke.
  • Heat cramps occur in your muscles due to depletion of water and salt as a result of excessive sweating.  These cramps, which can be painful, usually occur in muscles of the calves, thighs, and shoulders.
DR CHAN’S 5 TIPS TO STAY HEALTHY & COMFY DURING A HEAT WAVE
TIP 1: STAY HYDRATED
  • Drink plenty of fluids, especially water, regularly (about every 20 minutes) even before you feel thirsty.
  • Avoid excessive consumption of caffeine, alcohol, and very sugary drinks, as they can contribute to dehydration.
TIP 2: DRESS APPROPRIATELY
  • Wear loose-fitting, lightweight, and light-coloured clothing to allow your body to breathe and stay cool.
  • Protect your head and face with a hat and use sunscreen to prevent sunburn.
TIP 3: SEEK SHADE
  • Avoid direct exposure to the sun, particularly during peak heat hours.
  • If possible, stay indoors or find shaded areas when the sun is at its strongest, typically between 10 am and 4 pm.
TIP 4: TAKE REGULAR BREAKS
  • If engaging in outdoor activities, schedule frequent breaks to rest and cool down in shaded areas.
  • Listen to your body and do not overexert yourself.
TIP 5: MONITOR HIGH-RISK INDIVIDUALS
  • Keep a close eye on children, elderly individuals, and those with pre-existing medical conditions, as they are more susceptible to heat-related illnesses.
  • Ensure they have access to cool environments and sufficient hydration.

Planning to Have a ‘Dragon Baby’ in 2024? Here’s How to Start on a Right Note!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR CHONG KUOH REN
Consultant Obstetrician & Gynaecologist and Fertility Specialist
TMC Fertility

To the Chinese, 2024 marks the auspicious Year of the Dragon. The dragon symbolizes courage, wisdom, and success—qualities that most couples would like to hope for their child. Hence, many would plan to have a ‘dragon baby’ come the next year!

“Planning for parenthood however, requires a lot more than just jumping into the process of baby-making,” says Dr Chong Kuoh Ren with a laugh.

As it is never too early to plan, he offers some tips for parents to have a healthy pregnancy and baby in 2024.

START WITH A PRE-PREGNANCY HEALTH CHECK

“A preconception checkup is a good idea, even if this isn’t your first pregnancy,” Dr Chong states.

Such a checkup typically involves a health review of the aspiring parents, with the doctor screening them for the presence of chronic conditions such as diabetes, hypertension, and more.

“According to the Malaysian Ministry of Health, these health screenings should be carried out at least 3 months before you’re planning to conceive,” he adds.

Dr Chong further adds that couples can further opt for genetic counselling if they are concerned about potentially passing on genetic disorders to their future offspring.

“Genes that cause genetic medical conditions such as thalassemia can be identified with a simple blood test. Having this knowledge can help you make better decisions about your pregnancy,” he elaborates.

GET YOUR BODY ‘BABY-READY’

Dr Chong mentions that there is no foolproof diet or exercise plan that will help one conceive.

“Nonetheless, a well-rounded diet and ideal body weight can have an impact on your pregnancy,” he says.

Such a diet should be balanced and filled with fruits, vegetables, lean proteins, and whole grains in order to provide essential nourishment for both mom and the future baby.

“Multivitamins are also a great way of providing this nourishment, especially folic acid,” he adds.

Folic acid aids in the formation of red blood cells and helps tissues grow. In pregnancy, folic acid is crucial in preventing neural tube defects, which refer to birth defects of the brain, spine, and spinal cord.

Dr Chong also highlights vitamin D, which is important for improving the quality of both egg and sperms. In pregnant women, vitamin D can prevent premature delivery.

Meanwhile, regular exercise will not only strengthen your body, but also help you manage your body weight sustainably. “You don’t have to do anything extreme, just focus on having some physical activity throughout the week. Simply doing 30 minutes of moderate exercise, such as brisk walking or gardening, can go a long way in helping you stay fit,” says Dr Chong.

DITCH UNHEALTHY HABITS

Don’t wait until one is pregnant to quit habits such as smoking and excessive drinking of alcohol.

“Smoking, especially, can adversely impact your chances of conceiving as it is linked to fertility issues in both men and women,” says Dr Chong. “Newer research has shown that secondhand smoke can increase foetal risk factors too.”

Excessive drinking is linked to lowered sperm counts and abnormal eggs.

TRACK THE MENSTRUAL CYCLE

This helps to identify the woman’s most fertile period — and in turn, help her to get pregnant faster.

Overview of the menstrual cycle. Click for a larger, clearer version.

“Start recording when your period starts and ends from month to month.” Dr Chong advises.

This will give one an idea of how long her cycles are.

While the average menstrual cycle is around 28 days, many doctors say the healthy range can be anywhere from 21 to 35 days.

“Cycle tracking can be trickier for women who have irregular periods in the first place,” Dr Chong concedes. “Broadly speaking, the general advice is to keep having sex every 2 to 3 days, so you don’t have to do all these calculations. I’d strongly advise consulting a specialist in these cases though, as irregular bleeding might be a symptom of more serious underlying issues.”

CAN’T CONCEIVE NATURALLY? DON’T DESPAIR, SEEK HELP

Dr Chong adds that couples should also not shy away from communicating with health professionals — and each other — if they continue to have problems conceiving.

Experts Detail the Hidden Threat of Microplastics in Our Environment

WORDS PROFESSOR DR CHRIS GIBBINS & PROFESSOR TING KANG-NEE

FEATURED EXPERTS
PROFESSOR DR CHRIS GIBBINS
Vice Provost
Research and Knowledge Exchange
University of Nottingham Malaysia (UNM)
PROFESSOR TING KANG-NEE
Head of the School of Pharmacy
University of Nottingham Malaysia (UNM)

On Earth Day, observed on 22 April and themed ‘Invest In Our Planet’, we would like to call your attention to the pressing matter of microplastic pollution.

Did you know that Malaysia is ranked third (after The Philippines and India) in the list of countries contributing most to marine plastic pollution? Dutch academic Lourens JJ Meijer highlighted these rankings in a paper published in 2021, and the position of Malaysia should be enough to cause us to reflect on our contribution to the global problem of plastic waste.

WHAT ARE MICROPLASTICS?

When we think of plastic waste we tend to think of plastic bottles and bags, but once these everyday items break down, they cause a more insidious threat to the environment – microplastic.

Microplastics are microscopic pieces of plastic that are often invisible to the naked eye, with the very smallest pieces being within the nano-size range (less than 1 µm, which is 0.001 mm).

In fact, some plastics are deliberately manufactured at this microscopic size range—for example, beads used in toothpaste and other personal care products, or used in industrial processes.

THE MICROPLASTICS THREAT ON HUMAN HEALTH
  • There is mounting evidence that it causes respiratory problems, especially for those with existing conditions.
  • There are also increasing reports associating inflammatory bowel disease with the presence of microplastics in stool.
  • Although there is no direct evidence to link microplastics and cancer, its presence can lead to tissue inflammation which may result in DNA damage, the initial stage of cancer development.
HOW MICROPLASTICS FIND THEIR WAY INTO OUR BODY
How microplastics can end up in our body. Click on the image for a larger, clearer version.

For the past four years, our research team from the University of Nottingham Malaysia has been looking at microplastics in the Langat River in Selangor, as well as in the bodies of animals that live in the river.

We have found microplastic particles in every one of the hundreds of river water samples we have collected, in concentrations ranging from two to more than 80 pieces per litre of water.

We have also found very high concentrations on the riverbed, with up to 150,000 pieces of microplastic sitting on the riverbed surface per square meter.

Most alarmingly, we have found microplastic in the body of almost every single animal we collected, including aquatic insects, mussels and fish. Fish were the most highly contaminated, and our latest work suggests that microplastic is not only present on the gills and in the guts of fish, but in their flesh.

This is very worrying, as it means that people who consume fish caught from our rivers are likely to be routinely ingesting microplastic. The same applies to fish caught from oceans, where microplastic contamination is also very high.

WE NEED TO URGENTLY DO SOMETHING ABOUT THIS

The human health risks posed by microplastics mean that urgent action is needed.

Reduce exposure to microplastics

This can be extremely challenging as microplastics are already in the air we breathe and the water we drink, and very likely in much of the food we eat.

Some good places to start:

  • Use filters on tap water
  • Avoid eating hot food or drinking hot drinks from plastic containers
  • Avoiding eating bottom feeders like shellfish and prawns 
Reduce the use of single-use plastics and hence the amount of plastics added to the environment

Removing the microplastics already present in the environment will be difficult, but we can take action to reduce how much more we add. This can only be achieved with concerted efforts on multiple fronts.

Individually we should be mindful of how much plastic we use, and especially how we dispose of it.

  • Bring our own stainless-steel containers to pack food bought from food stalls
  • Use glass or metal bottles to refill instead of buying bottled water go a long way in reducing the amount of single-use plastics that may end up in the environment.
Improve and adopt recycling habits

This needs to be supported by better waste management facilities and recycling options being made available by local councils.

Taxes or other fiscal incentives could be introduced to help reduce plastic use and increase the use of recyclable plastics.

Government funding for research to help find new ways of removing plastics and microplastics from our marine and freshwater ecosystems, and to help develop new biodegradable plastics, is greatly needed.

LET’S TAKE ACTION!

Malaysia has T-minus seven years to fulfil its Roadmap Towards Zero Single-use Plastics 2018-2030. Time is ticking. The attitudes and behaviours of everyone, from the authorities and industry to the public at large, need to change for the sake of both current and future generations.

Let’s all try to use less plastic between now and next year’s Earth Day.