Experts Talk About How to Best Care for and Feed a Child with Autism

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NUR HANA HAMZAID

FEATURED EXPERTS

AINUL SYAFIQAH MOHD AZAHARI
Nutritionist and Student of Master’s in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DR NUR HANA HAMZAID
Senior Lecturer
Center for Rehabilitation & Special Needs Studies (iCaRehab)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

Autism spectrum disorder (ASD), also known as autism, is a developmental disability caused by neurodevelopmental disorders that affect how the brain functions and alter the development of the nervous system.

As a result, someone with autism typically experiences difficulties in their social, cognitive, and emotional functioning.

Among the main characteristics of people with autism are significant social communication and behavioural challenges that can be seen as early as when they are 18 months old.

Additionally, people with autism would also exhibit a high degree of repetitive behavioural patterns.

AUTISM CAN GIVE RISE OF PROBLEMS AFFECTING THE CHILD’S GASTROINTESTINAL SYSTEM

These problems, called gastrointestinal issues (GI), are common among with children with autism.

A 2019 review of 13 studies found out that 80% of children with autism experience gastrointestinal issues.

These children typically experience:

  • Constipation
  • Diarrhoea
  • Abdominal bloating
  • Abdominal pain

The same review also found out that there is an association between poor gut health and the children’s behavioural response, due to the impaired function of the gut and disruptions to the population of bacteria in the gut (the gut microbiome).

ISSUES IN THE GUT CAN CAUSE THE CHILD WITH AUTISM TO ACCEPT ONLY A SMALL SELECTION OF FOODS 

The affected gut-brain axis results in neurological imbalance that gives rise to the child’s tendency toward repetitive behaviour and sensitivity.

This repetitive behaviour can restrict the variety of foods accepted by the child, or food selectivity, based on their taste and sensory requirements. A hypersensitive child with autism, for instance, usually prefer foods with less texture and milder tastes, while a hyposensitive child with autism—one with lower-than-normal sensitivity to sensory input—may prefer instead foods with more textures and stronger tastes.

THESE ISSUES CAN PUT A CHILD WITH AUTISM AT RISK OF NUTRITIONAL DEFICIENCY

Food selectivity as well as gut issues in children with autism can put their nutritional status at stake. Here are some common issues related to this.

Reduced absorption efficiency of nutrients in the gut during digestion

This is due to abnormalities in gut functions.

Reduced digestion of carbohydrates

Some studies mentioned that children with autism lack the enzymes needed for a better carbohydrate digestion.

Preference for carbohydrate-rich and often sweet foods

One 2004 study found out that children with autism prefer foods high in carbohydrates, which are generally sweet, while commonly rejecting foods that are bitter and sour.  High consumption of carbohydrate-rich foods can impact the child’s glucose tolerance and sensitivity, which over time would lead to overweight and obesity, diabetes, and dental caries.

Food selectivity keeps children with autism from obtaining the types and amounts of nutrients to meet their daily nutritional intake

Rejection of certain tastes and food textures may restrict the child from obtaining essential micronutrients such as vitamin D, vitamin B12, vitamin C, calcium, and zinc.

The child may also have a lower consumption of dairy products.

Furthermore, parents of some children with autism put these children under dietary restrictions protocols, such as casein- and/or gluten-free diets. However, to date there is no evidence that these dietary restrictions can improve the child’s behavioural and gastrointestinal issues. On the other hand, it is likely that such dietary restrictions only further narrow the window of opportunity for proper nutrient intake.

HOW TO PROVIDE OPTIMAL NUTRITION & CARE TO A CHILD WITH AUTISM

Providing optimal care to a child with autism involves a multidisciplinary team, which comprises of paediatricians, psychiatrists, occupational therapists, speech-language therapists, dietitians, and social workers.

  • The paediatrician and psychiatrists work to recognize the early symptoms of and conduct assessments for autism.
  • Occupational therapists evaluate the current developmental levels of emotional self- regulation and participation in social interactions.
  • Speech-language therapists provide interventions to help the child improve their communication skills.
  • Dietitians consult with carer or the child themselves to understand the child’s dietary and eating behaviours, in order to identify the child’s food aversion and/or nutritional deficiencies and to advise the child’s carers on how to best manage these issues.
  • Social workers link parents and families with agencies and autism-related community programmes.
HOW PARENTS CAN MANAGE THE FOOD SELECTIVITY OF A CHILD WITH AUTISM
Explore various food textures and tastes 
  • A hyposensitive child requires more triggers in order to stimulate their senses, so offer crunchy and chewy foods with strong aromas. Use herbs and spices, instead of salt and sugar, to enhance the flavours of these foods.
  •  For hypersensitive children, introduce softer, mushier foods with less intense flavours such as porridge, yoghurt, and mashed foods. Parents and caregivers should also incorporate desensitization techniques into playtime and other activities with these children outside of eating time.
Roleplay with the child during mealtimes

For example, pretend to be a cook or feed the child’s favourite toy. You can also use the foods that your child likes and accepts to spin a story about other foods that your child may also enjoy.

Such imaginative games can help switch on the child’s imaginative skills, make mealtimes for enjoyable, and reduce the child’s reluctance to eat.

Food challenge

For example, if your child accepts a certain sauces, dips, or gravy, try dipping new foods into them to get your child to try these foods.

Food chaining

Food chaining helps to encourage a child with food selectivity to try new foods.

If your child like apple sauce, for example, you can try introducing the apple fruit into their meals.

Food chaining involves trial and error, and parents/caregivers may experience some degree of frustration when the child rejects the new foods that are introduced into their meals.

However, be patient and don’t give up! Perseverance and consistency are essential when it comes to success in helping a child with autism to adopt healthier eating habits.

References:

  1. Lefter, R., Ciobica, A., Timofte, D., Stanciu, C., & Trifan, A. (2019). A descriptive review on the prevalence of gastrointestinal disturbances and their multiple associations in autism spectrum disorder. Medicina (Kaunas, Lithuania), 56(1), 11. https://doi.org/10.3390/medicina56010011
  2. Narzisi, A., Masi, G., & Grossi, E. (2021). Nutrition and autism spectrum disorder: Between false myths and real research-based opportunities. Nutrients, 13(6), 2068. https://doi.org/10.3390/nu13062068
  3. Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of eating behaviors between children with and without autism. Journal of autism and developmental disorders, 34(4), 433–438. https://doi.org/10.1023/b:jadd.0000037419.78531.86
  4. Williams, B. L., Hornig, M., Buie, T., Bauman, M. L., Cho Paik, M., Wick, I., Bennett, A., Jabado, O., Hirschberg, D. L., & Lipkin, W. I. (2011). Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal disturbances. PloS one, 6(9), e24585. https://doi.org/10.1371/journal.pone.0024585
  5. Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M. S., Saxena, S., Yusuf, A., Shih, A., & Elsabbagh, M. (2022). Global prevalence of autism: A systematic review update. Autism research : official journal of the International Society for Autism Research, 15(5), 778–790. https://doi.org/10.1002/aur.2696

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

If You Have Diabetes, Here’s What You Need to Know About Muscle Loss

WORDS DR NIZAR ABDUL MAJEED KUTTY

FEATURED EXPERT
DR NIZAR ABDUL MAJEED KUTTY
Senior Lecturer
Department of Physiotherapy
Universiti Tunku Abdul Rahman (UTAR)

People with diabetes are living longer now, which is incredibly exciting. Still, they are vulnerable to accelerated muscle loss or sarcopenia, an often-overlooked condition that occurs in people with type 2 diabetes.

MUSCLE LOSS IS NORMAL WHEN WE AGE

It is normal for individuals to lose 3% to 8% of their muscle mass per decade beginning at age 30, and the rate of decline is even higher after the about age 60. Muscle strength declines even more rapidly; at a rate of 3% to 4% per year in men and 2.5% to 3% per year in women by the age of 75.

HOWEVER, PEOPLE WITH TYPE 2 DIABETES ARE LIKELY TO EXPERIENCE ACCELERATED MUSCLE LOSS OR SARCOPENIA

While some muscle loss is typical, sarcopenia refers to a condition of accelerated muscle loss.

An overview of sarcopenia compared to healthy muscle mass. Click on the image to get a larger, clearer version.

Earlier definitions of sarcopenia focused exclusively on loss of muscle mass as the key determinant of the condition, but more recent definitions have recognized that muscle strength and function are equally important for predicting adverse outcomes.

Thus, newer definitions for sarcopenia have included low walking speed and grip strength alongside low muscle mass.

Sarcopenia is associated with an increased risk of falls, functional decline, frailty, and mortality.

THE LINK BETWEEN SARCOPENIA AND TYPE 2 DIABETES

The link is well established.

In a study of Korean adults, 15.7% of participants with diabetes were found to have sarcopenia, compared with just 6.9% of participants without diabetes.

A later study led by the same author, also in Korea, produced similar findings: in a sample of 414 adults aged 65 or older, participants with type 2 diabetes had significantly lower muscle mass.

A link between low muscle mass and diabetes has been found in several other populations as well.

Multiple studies have also linked diabetes to reduced muscle strength. The effect sizes were smaller in women, but the trend was the same for both genders.

This association between sarcopenia and diabetes has led some researchers to argue that sarcopenia is probably one of the underlying mechanisms that explains the reduced functional ability and mobility that is often seen in older patients with type 2 diabetes.

HOW TYPE 2 DIABETES LEADS TO SARCOPENIA

While diabetes accelerates the process of muscle loss, the mechanisms aren’t yet thoroughly understood.

The presence of insulin resistance, which is the key feature of type 2 diabetes, appears to be a major pathway.

Inability to make new proteins at a rapid pace to replace muscles that have been degraded naturally

One of the key roles of insulin is to drive nutrients, such as glucose, from the blood into skeletal muscle tissues and stimulate protein synthesis.

In type 2 diabetes, however, insulin signaling is impaired; insulin is not able to effectively drive glucose into the muscle tissues, and the muscles cannot synthesize new protein rapidly enough to keep pace with natural muscle degradation.

Decreased function of mitochondria

The mitochondrion is the ‘energy plant’ structure in most cells of the body.

Individuals with diabetes frequently have decreased mitochondrial function, which appears to contribute to the impairment of muscle function.

Type 2 diabetes can damage the nerves outside of the brain and spinal cord, usually at the hands and feet (peripheral neuropathy)

Diabetes can promote sarcopenia via peripheral neuropathy. This condition can affect nerves that control proper muscle contraction.

Approximately 30% to 50% of diabetes mellitus patients experience peripheral neuropathy, and the condition has been shown to be an independent risk factor for sarcopenia in individuals with diabetes.

Other possible factors?

Still, other factors also may play a role in causing muscle loss in the context of diabetes.

Thus, a wide variety of factors likely contribute to the connection between diabetes and sarcopenia. Some data suggest that these varying mechanisms come into play even in individuals who are comparatively young or who are comparatively early in the disease process.

CAN LOWERING BLOOD GLUCOSE HELP PREVENT MUSCLE LOSS?

The growing body of research on the connection between diabetes and sarcopenia has raised an important question of whether lowering blood glucose help preserve muscle mass.

There’s currently little research on that question, but diabetes medications that control blood glucose levels likely do have a role to play in treating and preventing muscle loss among older adults with diabetes.

However, key clinical trials on which clinical management guidelines for blood glucose have been based on unfortunately often exclude the participation of older adults, so there’s no way to know at present.

Hence, future research is needed to better understand the effects of glucose-lowering on muscle mass in older adults.

THE ROLE OF EXERCISE

While diabetes medications may have a role to play in lowering blood glucose and in staving off muscle loss, no medication is as beneficial for treating sarcopenia as physical activity.

Physical activity is always recommended to promote fat loss and maintain muscle mass, both of which can improve glucose levels in people with type 2 diabetes.

This recommendation applies equally to both younger and older adults.

Researchers especially recommend muscle strengthening exercise and resistance activities.

Progressive resistance training is the proven method for the prevention and improvement of sarcopenia.

Resistance exercises in more detail

Resistance training doesn’t require more than your own body weight.

Using resistance to engage the muscles causes a surge in growth-promoting hormones that signal the body to produce more muscle tissues.

Not only do these signals encourage the growth of new muscle tissue, but they also help to reinforce existing muscle tissues by making them stronger.

Some body weight resistance exercises that you can try include:

  • Push-ups; try an easier version with your knees on the ground, if you need to.
  • Planks.
  • Squats.
  • Lunges.

With progressive resistance training, you need to exercise your muscles against an increasing external force 2 to 3 times a week for at least 8 to 12 weeks.

This is progressive, meaning that the number of repetitions, sets, or load should be increased gradually over time based on your capabilities and progress.

As the resistance exercises programme develops, more advanced resistance exercises that can be done include barbells, kettlebells, and medicine balls or floor-based exercises.

In terms of exercise order, the American College of Sports Medicine (ACSM) recommends multi-joint exercises to be performed before single-joint exercises for a particular muscle group, and that within each session the larger muscle groups be exercised before smaller muscle groups.

As older adults with sarcopenia are also likely to be at an increased risk for falls and display reduced cardiorespiratory fitness, exercise programmes for them often involve a combination of exercise modes that includes resistance exercises, balance training and aerobic training.

For older adults with sarcopenia

Consider:

  • Walking around the block 4 to 5 times.
  • Do some weight lifting.
  • Sit on and get up from a chair as fast as possible and do this 10 times in a row and getting up ten times in a row as fast as possible.
If you are not used to being physically active, or you have health conditions that can affect your ability to exercise, consider consulting a physiotherapist or a personal trainer to advice. They can help you develop an exercise programme tailored to your needs, health status, and personal enjoyment.

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

WORDS DR DAVID TEO

FEATURED EXPERT
DR DAVID TEO
Regional Medical Director
International SOS

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

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

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

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

Tip 1
DO NOT SKIMP ON REST AND SLEEP

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

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

Tip 2
STAGGER YOUR HYDRATION

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

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

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

Tip 3
EAT HEALTHY & NUTRITIOUS MEALS

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

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

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

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

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

Tip 4
DO MORE IN THE MORNING

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

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

Tip 5
DON’T STOP EXERCISING

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

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

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

Food for All: Modifying Food Texture for People With Dysphagia

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NURUL HUDA RAZALLI

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

DYSPHAGIA: IT MEANS DIFFICULTIES IN SWALLOWING FOODS & LIQUIDS

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

Choking and lung infection

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

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

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

Also, be alert to any unexplained weight loss, hair loss, feeling of coldness and fatigue—these could be early symptoms of malnutrition.
IF YOU ARE WORRIED THAT YOU OR SOMEONE CLOSE TO YOU HAVE DYSPHAGIA

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

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

TIPS FOR INDIVIDUALS WITH DYSPHAGIA TO ACHIEVE GOOD NUTRITION

Understand the extent of one’s dysphagia

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

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

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

Click to view a larger and clearer image.

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

Modify foods into certain textures 

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

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

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

References:

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