Sleep - A healthy snooze

By Dr MILTON LUM

Sleep is needed for the body to rest and repair.

SLEEP is something none of us can do without. However, the reason why everyone needs sleep is not well-elucidated. During sleep, the brain is more responsive to internal stimuli than external stimuli like sound and light. The metabolic demand of the brain is also reduced and this is reflected in a general decrease in the blood flow to the brain.

Most of the knowledge about sleep has come from sleep deprivation experiments. It is generally accepted that good sleep is crucial for optimal intellectual performance and helps in realising a person’s mental potential.

Normal sleep comprises of cycles of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep consists of progressively deeper stages of sleep. As NREM sleep progresses, stronger stimuli are needed for awakening. REM sleep, which is also known as “dream sleep”, has tonic and phasic components.

There are no rapid eye movements in the former. There are rapid eye movements, muscle twitches, pupil dilatation, increased heart rate variability and increased breathing rate in the latter. The muscle tone is decreased throughout REM sleep. The length of REM sleep and the intensity of the eye movements increase throughout the sleep cycle.

NREM sleep is followed by REM sleep, which occurs four to five times during the usual eight hour sleep period. The first REM period of the night may be last less than 10 minutes, while the last may exceed an hour. The NREM and REM cycles vary in length from 70 to 100 minutes initially to 90 to 120 minutes later in the night.

During the first third of the night, deep NREM sleep is present more whereas REM sleep predominates in the last third of the night. REM sleep takes up 20 to 25% of total sleep time. Light NREM sleep is the transition between sleep and awakening.

Infants sleep more than any other age group. The newborn baby can sleep 14 to 16 hours in a day. As the baby grows, the sleep time decreases so that by about six months of age, there is usually an overnight sleep period with at least a nap during the day. There is more REM sleep in an infant.

Senior citizens take a longer time to fall asleep and have more frequent awakenings. This sleep fragmentation may be aggravated by medical problems. There is less deep sleep and the total time in bed may increase leading to complaints of insomnia.

How much sleep?

The need for sleep varies with age. A newborn may sleep 16 to 20 hours throughout a day and an infant 12 to 14 hours with most of the sleep at night. Toddlers may sleep 10 hours or more. Primary school children need nine to 10 hours of sleep. Normal adults need six to 10 hours of sleep. It usually takes an adult about 10 to 20 minutes to fall asleep. Most of those who have less than five to six hours of sleep are probably not getting enough sleep.

After a good sleep, a person would feel refreshed on waking and is able to be alert throughout the day, without the need for naps or sleeping in on weekends.

The body has a “biological clock” called the circadian rhythm which is set by the hypothalamus in the brain. It is set at about 24.2 hours and the body is used to a regular routine of light and darkness at certain times. Light is called zeitgeber, a German word meaning time-giver, because it sets the clock in the hypothalamus.

A practical explanation for the circadian rhythm is that the brain is analogous to a battery charging during sleep and discharging during the time a person is awake.

It is believed there is a downswing in the circadian rhythm from evening till it reaches the lowest point (nadir) in the early morning.This makes it possible for a person to remain asleep overnight by preventing premature awakening, which is facilitated by the morning upswing. The upswing peaks in the early evening after which there is a downswing. This explains the stable cognitive function during the time a person is awake.

The body temperature is controlled by the hypothalamus. It is increased during the daylight hours and decreased at night, thus mirroring the sleep rhythm. Melatonin, prolactin, testosterone and growth hormone also have a circadian rhythm with maximal secretion during the night.

Sleep deprivation

Much knowledge about sleep has come from sleep deprivation experiments. Studies of individuals deprived of sleep for more than 24 hours have shown that there is a decrease in the brain’s metabolic activity by up to 6% for the whole brain and 11% for specific areas in the brain. There is also a decrease in body temperature, release of growth hormone and immunity as well as an increase in heart rate variability.

As sleep has a restorative function, deprivation leads to short and long term serious consequences. There are significant effects of sleep deprivation on brain functions like memory, concentration and mood.

Higher order cognitive function like language and numerical skills is affected early and disproportionately. There may be memory lapses, blurring of vision, slurring of speech, disorientation and poor co-ordination of body movements. Mood changes like depression are common.

Short term sleep deprivation has been reported to contribute to obesity and poor control of type II diabetes. Chronic partial sleep deprivation is the commonest cause of daytime sleepiness, which can impair performance at school or work and increases the risk of accidents especially when driving or operating machinery.

Long term sleep deprivation decreases the quality of life and leads to increased morbidity and mortality. There are effects on cardiovascular, respiratory and endocrine function. Coronary events have been found to be more common in those who have less than seven hours sleep compared to those with eight hours or more.

The subtle cognitive changes with small amounts of sleep loss (less than an hour each night for many nights) may not be recognised by the affected individual. Sleep loss for a week leads to marked cognitive deficits which may also be unrecognised by the affected individual. Research and education is ongoing to address this lack of recognition of the effects of sleep deprivation.

Sleeping well

Getting a good night’s sleep is vital for everyone. There are several ways of achieving this and they include:

* Having a routine facilitates sound sleep. This means going to bed and getting up at about the same time every day.

* Having an early dinner is helpful. The digestive system goes to sleep at about 7pm. A light dinner is helpful.

* Avoiding caffeine after lunch is helpful as caffeine keeps one awake.

* Avoiding alcohol is helpful as its breakdown produces chemicals that stimulate the individual. It also increases the likelihood of snoring as it relaxes the muscles. This leads to lighter and less refreshing sleep.

* Avoiding naps. The afternoon nap may be what keeps one awake at night.

* Avoiding light can be helpful. Not going to bed immediately after turning off the television. This is because melatonin, which is the hormone that helps a person sleep, is produced in the dark.

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The fats of life

By Dr NORIMAH A KARIM

Despite its reputation, we have to realise that not all fats are bad.

OVER the years, the media has done a fair bit in highlighting the dangers of fat, but quite rarely its benefits. Hence, the misconception and common belief that “Fat is bad, so stay away!” The fact, however, is that fats are an important component in our diet, more so in our children’s diet.

Why is fat important in your child’s diet?

Fats have many functions in the body, and these include:

·Important for providing energy and maintaining body temperature.

·Insulates and acts as a shock absorber for bones and organs.

·Helps the body absorb the fat-soluble vitamins A, D, E and K.

·Is a structural component of myelin, the fatty insulating sheath surrounding each nerve fibre, enabling it to carry messages faster.

Fat deficiency is rarely seen in our society. However, the dangers of not giving your child fats can be severe, resulting in weight loss, dryness of the skin, atopic eczema and others.

What are the types of fat?

In general, there are two types of fats: the good fats and the harmful fats. It is crucial that you understand the roles of these fats and how they may benefit or harm your child’s wellbeing.

Good fats are categorised into two basic groups: polyunsaturated fats (PUFAs) and monounsaturated fats (MUFAs).

Polyunsaturated fats: The two types of PUFAs are omega-3 and omega-6 essential fatty acids. These fats are crucial to help your child in areas such as:

·Better quality cell membrane – Every cell in the human body is held together by a thin membrane that is composed of fats, primarily the essential fats. These essential fats contribute to a better quality cell membrane, which allows nutrients and oxygen to get into cells more easily, and helps carbon dioxide and other waste products leave the cells efficiently. Because the composition of fats in this membrane is determined by the composition of the fats that your child eats, it is vital that you keep an eye on the amount and the type of fats your child consumes.

·Supports brain development – The brain has almost 20 billion cells that are in a state of non-stop action, which enables us to think, make connections, solve problems and other such activities.

It has been found that nearly 60% of the brain is made up of long-chain polyunsaturated fatty acids (LCPs) such as arachidonic acid (AA) and docosahexaenoic acid (DHA). A study on the relationship of intellectual function and the intake of essential fatty acids in the University of Dundee, Scotland, showed that children who are fed with DHA, an omega-3 essential fatty acid, had better problem-solving skills than those who didn’t.

·Reduces inflammatory reactions – Essential fats are processed by the body into eicosanoids. These are special molecules that act as messengers in the central nervous system and are involved in many bodily processes. According to the European Heart Journal, the quantity of essential fats such as omega-3 and omega-6 in the diet can affect inflammatory processes in the body and work to stop inflammation as these fats are generally anti-inflammatory.

·Smoother hair and skin – The essential fats can also give your child healthy hair and skin because they help build soft flexible cell walls, resulting in smoother hair and skin. The cells in our bodies use these good fats to regenerate and build new tissues.

Monounsaturated fats – Monounsaturated fatty acids are largely neutral. You may include these fats in your child’s diet. However, do take note that excessive or extreme intake of these fats should be avoided.

Harmful fats can generally be divided into saturated fats and trans fats.

·Saturated fats – Saturated fats are mostly found in food from animal sources, such as meat, dairy products and eggs. Children, in particular, need some of this fat in their daily diet, partly for use as energy, and partly to be incorporated into their bodies as they grow. However, technically, this fat is not essential in the diet because the body can manufacture what it needs from the essential fats, but it shouldn’t be avoided altogether.

·Trans fats – These fats are harmful fats. They rarely occur in natural foods, and when they do, they are relatively harmless and the amounts are small. Trans fats are created when food is fried, especially when deep-fried, and often in the processing of food. The ideal amount of trans fats in your child’s diet is zero.

Fat watch

Now that you know there are two types of fats – the good fats and the harmful fats, it is important that you watch your child’s fat intake. Do ensure your little one gets a variety of the good fats in adequate amounts. Keep in mind also that too much fat will lead to obesity and health problems. Focus on reducing foods high in saturated fats and trans fats and select more foods containing unsaturated fats.

To learn more about how proper early nutrition can benefit your child, join us and our team of experts in a series of Positive Parenting Child Nutrition Seminars that will be held throughout Malaysia in the coming months. The upcoming seminar will be conducted in the Klang Valley on June 20, 2009. For more details, please call (03) 5621 1408 or (03) 5621 1691.

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Kiwifruit - Packed with goodness

Kiwifruit is not just loaded with vitamin C, it is a powerhouse of nutrients.

It is kiwifruit season from May to December. Zespri, a kiwifruit brand from New Zealand, wants to get Malaysians to eat two kiwifruits a day. In its six-month Extreme Nutrition, Extreme Vitality campaign, it is promoting the goodness of the fuzzy brown fruit.

Zespri International, which represents 2,700 growers in New Zealand, exports kiwifruit to 70 countries and has 23% of the world’s kiwifruit market.

New Zealand first exported its Green kiwifruit to Britain in 1952. The first Gold kiwifruit which took 20 years to develop from natural cross-breeding was exported in 1998.

Nowadays, the Gold kiwifruit is grown outside New Zealand by Zespri contract growers in eight countries.

The Green, Gold and organic kiwifruits are mainly imported by Malaysia, says Daniel Mathieson, Zespri International (Asia) market manager.

He claims that Zespri has “the best- tasting kiwifruit in the world” and “consistency in quality”.

“The Gold kiwifruit (with bright golden flesh) is growing popular because of its tropical sweet taste. The more popular Green kiwifruit has a sweet sour taste and bright green flesh,” he says.

“The Green kiwifruit has more fibre – 3.4g per 100g compared to the Gold kiwifruit which has 1.4g.”

Mathieson explains why the Gold kiwifruit costs more: “It takes more experience to grow the vines which are harder to control. Growers also have to be more careful when harvesting and packing the fruits to prevent injury to the fruits because the Gold kiwifruit has ‘a beak’.”

Red kiwifruit is still being developed. It is slightly smaller than the Green kiwifruit and has a sweet taste.

The research team is working to improve its taste, colour, appearance and export characteristics.

Nutritional powerhouse

Kiwifruit is one of the superfruits (which includes oranges, cranberries, blueberries, pomegranates, bananas and apples) owing to its many health benefits.

Zespri has invested over RM25mil in a scientific programme that demonstrated the positive effects of kiwifruit on digestive health, immune support, cell damage and repair, cardiovascular health and interaction with other food to enhance its nutritional status, says Mathieson.

In its promotional flyer, Zespri claims that kiwifruit has immune-boosting qualities; it contains twice the amount of vitamin C in an orange and as such “provides a shield against colds and flu”.

“Kiwifruit is nutrient-rich and its vitamin C is a blast,” says Lynley Drummond, Zespri International’s health science manager, who bemoans that “many foods today are loaded with carbohydrates and calories”.

“For your cells and antibodies functions, you need your vitamin C every day. One kiwifruit gives you vitamin C for the whole day. The Gold kiwifruit has 110mg vitamin C (the recommended dietary intake is 75 mg per day for an adult).”

An avocado and kiwifruit grower, Drummond goes on to give a quick rundown on the health benefits of eating kiwifruit.

Kiwifruit is “fibre fabulous”, she exclaims, adding that it helps to ease bloatedness after a heavy meal. At a dinner party, Drummond never fails to serve kiwifruit salsa with salmon.

Mathieson also has an antidote for indigestion for durian aficionados. “Try eating kiwifruits with durian,” he suggests. “It helps to ease bloatedness.”

Babies from six months onwards can take kiwifruit, he says, adding that he had given his then six-month old son, Keanu, soft slices of kiwifruit to suck on. “Now, at four, he wants only the Gold kiwifruit!”

Zespri Ambassador Dr Norzita Mohd Yusof says the kiwifruit is wholesome and loaded with many health benefits.

“Kiwifruit has phytochemical compounds which are important to prevent cancer. The more colourful fruits you eat, the more phytonutrients you have and the more they reduce your risks of cancer.”

Fibre-rich kiwifruit is essential to help cleanse and improve one’s digestive system and promote a healthy heart and body.

“It has a mild laxative effect unlike some fruits which send you ‘flying’ to the loo soon after eating them,” says Dr Norzita.

More benefits

Kiwifruit supposedly has almost the same amount of potassium as a mango. Potassium is said to be helpful in reducing high blood pressure and helps to regenerate nerves and muscles quickly.

Kiwifruit also has four peaches’ worth of folate, which is crucial before and during pregnancy for healthy development of the baby and also for healthy skin and blood cells.

It is also loaded with antioxidants such as polyphenols and carotenoids to offer protection from damaging free radicals. One kiwifruit boasts the vitamin E of three apples, and vitamin E is claimed to lower cholesterol and soothe and heal damaged skin tissue.

Weight watchers and diabetics will be happy to know that kiwifruit, particularly the Green kiwifruit, has a low glycemic index and has as much dietary fibre as a serving of bran flakes.

This month, Zespri will partner gym chain Fitness First to host a series of sampling activities to highlight the goodness of kiwifruit.

It will also visit Real Kids kindergartens to promote kiwifruit consumption to 2,000 preschoolers.

- THE STAR

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Reasons to stop smoking

By LIM WEY WEN

Thanks to anti-smoking campaigns, many smokers know of the common health hazards that come with cigarette smoking. However, before the damage culminates into a major, life-threatening event, health concerns are not strong motivators for quitting.

AFTER 24 years living of with his daily pack of cigarettes, it took S. Vigay-indran a mild stroke, lots of encouragement from his family and frequent thoughts of his two children to stop.

“It was midnight on Sept 21, 1999, when I suddenly woke up and realised that I could not speak,” says Vigay-indran, who is now a senior sales executive in The Star. “I couldn’t raise my hand. I couldn’t even walk straight.

“My speech was slurred and part of my face was paralysed,” he says.

His wife, who is a nursing sister, recognised the signs of stroke and brought him to a hospital where he was treated. “One of the first questions the doctor asked my wife was, ‘is your husband a smoker?’” he recalled. “When she told the doctor I was an occasional smoker (I seldom smoked in the house), the doctor showed her my x-ray and said I already had smoker’s lungs.”

It was upon the realisation that smoking may have been one of the major causes of his stroke that he resolved to quit.

“It is not easy, and sometimes there is the temptation to go for a puff or two. But whenever I think of my health and my two young children, I don’t want to smoke anymore because I want to live longer and see them grow up. My family, especially my wife and my sisters, have also encouraged me a lot.”

Better late than never

While it often takes a life-changing experience to strengthen a smoker’s resolve to stop, Vigay-indran reckons that it is better late than never.

One of the problems we face in the field of smoking cessation is that although we are looking at very shocking numbers – for instance, one billion people die from smoking in a year – smokers don’t think they are going to die, says Dr Alaster Allum, Pfizer’s regional medical affairs director.

And although smokers do know that they are at increased risk of developing heart disease and cancer, they think that it is always someone else’s risk.

“The way I look at it,” says Dr Allum, “is that I’m 39 and I’ve got a five-year-old boy. He’s going to do his degree, and I’m going to see him graduating from college. But if I’m a smoker, I probably won’t see my grandkids, because I’ll die 10 years younger.

And that is really what smoking cessation is about – that we’re going to lose 10 years of life. “If you have two relatives who smoke, you will lose one,” he adds. “It actually touches every one of us.”

In her years of experience in nursing, and recently, her two months experience in the new National Heart Institute (IJN) Quit Smoking Clinic, patient counsellor Khoo Soon Gaik noticed a trend among smokers that are trying to quit.

“Those who are self-referred tend to do better than those who are referred by the doctors. Once they decide they want to quit, most of them could,” she says. “But if they still have doubts, it will be a quite difficult.”

To Dr Allum, people like Vigay-indran – those who quit cold turkey – are extremely rare. To some extent, if a smoker has enough willpower, they will quit, he says. But if they are addicted to smoking, they would probably need some assistance.

“You could really ramp up quit rates if you get some help – whether it is nicotine replacement therapy, non-nicotine drugs or counselling – just get some help,” he says.

It is best not to start smoking at all, but if you already are, the benefits of quitting are immediate, says consultant cardiologist Datuk Dr Aizai Azan Abdul Rahim. “Within 20 minutes of quitting smoking, your blood pressure and heart rate will normalise. And in about 12 hours, the carbon monoxide and nicotine levels in your blood will reduce by half.

“By 24 hours, the oxygen levels in your blood will normalise and your immediate risk of heart attacks falls,” he said. But to reduce your immediate risk of heart attacks similar to that of non-smokers, it will take another 14 years.

Your choices

“Drugs certainly play a role, but they do not play the only role,” says Dr Aizai. “The most successful programmes are those that combine some form of counselling or behavioural therapy with the support of drug therapy,” he adds.

According to the American Cancer Society guide to quitting smoking, there are a few ways you could go about quitting.

There is the nicotine replacement therapy, where you replace the nicotine you normally get from cigarettes with patches, chewing gums, sprays and inhalers to help you through withdrawal symptoms. The dose of nicotine will be reduced over time until you do not need or crave it anymore.

There are also the non-nicotine medications to choose from. Bupropion is a prescription anti-depressant that reduces symptoms of nicotine withdrawal, while varenicline is a newer drug that lessens the pleasurable physical effects a person gets from smoking and reduces the symptoms of nicotine withdrawal by attaching itself to the nicotine receptors in the brain.

Other methods, like hypnotherapy and acupuncture, may also help some people, although there is no strong evidence they can improve your chances of quitting.

“If you looked at the National Health Morbidity Surveys, one-third of the many smokers we interviewed have made an attempt to quit smoking,” says Dr Aizai.

On average, most smokers have attempted to quit at least twice a year. And although they may have failed, 71% still had intentions to quit within the next six months, Dr Aizai notes. “That is why it is clear, we need to help them quit,” he says.

So, if you are ready to quit smoking, here are some of the ways that could help you.

Quit smoking clinics

Abdullah Mat Ali, 39, has been off his 20-year-old habit for two months since he started his quit attempt with nicotine replacement therapy at the IJN quit clinic. “I was referred to the clinic by my doctor because of my health problems, but economic concerns are also part of the reason why I decided to quit. Cigarettes don’t come cheap these days,” he says.

However, quitting was not easy – even with help. “The first week was difficult as I felt anxious and uncomfortable. Now, I still have cravings for cigarettes but I can control it better,” he says. “But I would advise smokers who want to quit to get help because quitting on your own is difficult,” he adds.

In Malaysia, the first government quit smoking clinic was set up in Hospital Ipoh, Perak, in 1996. Now, there are about 336 government clinics nationwide as well as some private quit smoking outlets that could help smokers quit. IJN has just started their in-house quit smoking clinic two months ago.

These clinics combine pharmacotherapy (nicotine replacement therapy and non-nicotine medications) with counselling and the average success rate hovers at about 30 to 40%, according to a health official.

If you are interested in quitting this way, you could call the IJN Quit Clinic at 03- 2617 8585 or the Ministry of Health Stop Smoking info-line at 03-8883 4400. You will be directed to the nearest quit clinic.

Hypnotherapy

Hypnotherapy to quit smoking is a one-off session that works by reinforcing smokers’ will to quit in their subconscious mind, says clinical hypnotherapist Joyce Hue.

“We are also creating in the subconscious mind an image of our clients as non-smokers,” adds Sheila Menon, who is a clinical hypnotherapist and principal of the London College of Clinical Hypnosis.

As some of them have been smoking for a very long time, they could not remember or imagine themselves as non-smokers again, she says. And so, what hypnosis does is create an image – that of a non-smoker – which smokers can better associate with compared to memories of their smoking days, she adds.

James Lim is pleasantly surprised when he went off cigarettes for 10 days after a session of hypnotherapy. “I didn’t think I would go off cigarettes after nine years of smoking a pack a day. Even when I tried to quit several times before over the last two years, I still needed two to three cigarettes a day to get by.

“But now, when I have cravings for cigarettes – it usually lasts just about five seconds – I don’t even think of lighting up.”

While there are clients who slip up after hypnotherapy, Hue says they encourage their clients to come back and work with their hypnotherapists to find out the reasons for the recurrence.

“Sometimes they come because their spouses or family asked them to. But if the client really wants to quit, they can usually succeed,” says Hue.

Those interested in knowing more about the therapy, you could visit the London College of Clinical Hypnosis website at www.hypnosis-malaysia.com.

Acupuncture

Acupuncture helps detoxify your body and changes the way your body experiences tobacco, says acupuncturist and associate professor at the Kuala Lumpur Academy of Traditional Chinese Medicine Tan Poh Choon. “Smoke will start to taste unpleasant to the smoker, and his or her desire to smoke will be reduced,” he adds.

“It usually takes three to five sessions for it to be effective. But sometimes it is difficult to get clients to come back regularly for follow-up,” he says.

French acupuncturist Nadege Lubrano’s interest in using acupuncture to help smokers quit stemmed from her personal experience in quitting smoking through acupuncture.

After many attempts to stop over the 18 years she smoked, she did not succeed. “I tried acupuncture, which is quite widely practised in France, together with counselling. And I have stopped ever since,” she said.

But like other therapies, she notes, acupuncture is often not enough. Smokers must be given enough psychological and moral support to follow through. “I believe that acupuncture is not enough. You need the counselling to help smokers understand their situation and motivate them,” she adds.

Never too early, or too late to stop

There is no guarantee that a treatment that works an individual will work for another. But even if your first few attempts did not work out, there is no reason to stop trying because you will never know when smoking will catch up to you, healthwise.

And if you have seen examples of people who smoke but do not appear to have any problems, Dr Allum says, “Some people smoke but don’t die, but you can see how many people do. We can’t pretend that everyone is alike.

The grandmother who smokes but lives to a ripe, old age may not be one of those who died of smoking, but the point is, she might have been, Dr Allum explained.

“When I had my stroke at age 43, I was already trying to cut down smoking due to health reasons. However, it was too late as I already had the attack before I could stop,” says Vigay-indran.

That is why it is better is you stop early. You never know when you’ll suffer the consequences, he adds.

- THE STAR

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Adult immunisation

A VACCINE induces immunity to a disease by stimulating the body’s production of antibodies.

Efficacy levels of vaccines range from 60% to 70%, to close to 100%.

According to the Malaysian Clinical Practice Guidelines on Adult Vaccination, the target groups for influenza vaccination are: residents of homes for the elderly; elderly folks with chronic conditions like cardiovascular, lung, metabolic, or kidney disease; adults and children (above six months old) who have chronic diseases; those at higher risk for complications; those who can transmit the disease to others, such as healthcare workers; and haj pilgrims.

Adults age 65 and above are at risk of serious diseases such as diphtheria, influenza, pneumococcus and tetanus (lockjaw). Certain sectors of society are more susceptible to particular infections.

Emeritus Professor Datuk Dr Lam Sai Kit said padi and pig farmers should get the Japanese encephalitis vaccine as they are at special risk of getting infected. The same goes for the typhoid vaccine for people involved in hawker businesses and food handlers.

“Adults who escape being infected by the chickenpox virus in childhood should consider immunisation against it. Quite often, they get much more severe infection, usually caught from their own children. The meningococcal meningitis vaccine and influenza vaccine are recommended for those going for the Haj.

One of the latest vaccines in the market is the human papillomavirus (HPV) immunisation for girls and women up to the age of 26. The HPV vaccine protects against four types of HPV that cause most cases of cervical cancer and genital warts.

Lam, who is senior research fellow at Universiti Malaya, said many young adults in the country have benefited from the Expanded Programme of Immunisation (EPI) implemented in 1989 and have been immunised against diseases like MMR and Hepatitis B.

“The EPI programme in Malaysia has successfully brought down the morbidity and mortality of these vaccine-preventable diseases, especially those of childhood,” said Lam, adding that Hepatitis A and B are two such vaccines under the EPI.

“Adults who have not been vaccinated against some of these diseases because they were born after the implementation of the EPI programme should consider doing so,” he said, adding that older persons have also received vaccines against BCG and smallpox.

He said adults who missed certain childhood infections such as chicken pox and measles should consider immunisation since the diseases in adulthood tend to be more severe.

“Smallpox is an excellent vaccine and used to eradicate the disease globally. Polio is the next disease for eradication, to be followed by measles.

“These diseases are ideal targets for eradication because the vaccines are good, easy to deliver, and there are no animal hosts.”

Some adults incorrectly assume that the vaccines they received as children will protect them for the rest of their lives. This is generally true but there are some caveats – some adults were never vaccinated as children, newer vaccines were not available when some adults were children, immunity can fade over time, and as we age, one becomes more susceptible to serious disease caused by common infections such as flu and pneumococcus.

“Many adults think that they are naturally immune to infectious diseases until they are struck down with dengue, chickenpox, mumps, rubella or influenza. It is also not true that the elderly and immuno-compromised adults do not respond well to immunisation,” said Lam.

Vaccine-preventable adult diseases include: cholera, diphtheria, Haemophilus influenzae type b (Hib), Hepatitis A, Hepatitis B, herpes zoster (shingles), human papillomavirus (HPV), influenza (flu), Japanese encephalitis, measles, meningococcal, mumps, pertussis (whooping cough), Pneumococcal, polio, rubella (German measles), tetanus (lockjaw), varicella (chickenpox) and yellow fever. –

Source: US Centre for Disease Control and Prevention / Malaysia’s Clinical Practice Guideline on Adult Vaccination

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A flu for all seasons

By DR ONG CHUN CHIANG

Seasonal flu is very common around this time of the year when the inter-monsoon weather changes rapidly. Seasonal flu is caused by the influenza virus, the main ones being Influenza A (H1N1 and H3N2) and Influenza B viruses.

Seasonal flu that commonly afflicts Europeans and North Americans every winter can be traced to East Asia and South-East Asia. Malaysia is one of the countries listed as a point of origin of seasonal flu. The problem with these viruses is their ability to mutate as they travel around the globe. This gives rise to new strains every year. Vaccines produced by scientists against these have to be revised yearly.

The latest flu outbreak that started in Mexico is spread by an influenza virus from the Orthomyxoviridae family. It is endemic in swine populations. Known strains of “swine” influenza viruses are classified as either Influenza C or one of the subtypes of Influenza A. These strains can mutate into a form that can pass from human to human.

There have been many outbreaks of “swine” flu in the past. The 1918 flu pandemic that took the lives of millions of people worldwide was associated with a H1N1 virus that was transmitted from swine to humans or from humans to swine. There is insufficient data from then to provide us with detailed information.

Avian influenza virus H3N2 is endemic in pigs in China and has been detected in pigs in Vietnam. These pigs can carry human influenza virus, which can combine with H5N1 (bird flu virus), passing genes between to mutate into a form that can pass easily among humans.

According to the US Centers for Disease Control and Prevention (CDC), A/H1N1 flu symptoms are similar to those of influenza and influenza-like illnesses. Symptoms include runny nose, sore throat, cough, fever, body aches, headache, chills, and fatigue. Some patients also report having diarrhoea and vomiting.

As these symptoms are so common and general, the patient’s contact history is of paramount importance. Patients with the above symptoms who have travelled to Mexico, the US or other endemic areas over the past seven days must be tested for A/H1N1 flu. Confirmation of this requires laboratory testing of a simple nose and throat swab. However, conclusive results may take some time.

The CDC reports that the transmission of A/H1N1 flu among humans is very much like that of seasonal flu. It is believed to spread through coughing or sneezing of infected people and touching something with the virus on it before touching your own nose or mouth.

The virus is not transmitted through food as it is destroyed by simple cooking. A/H1N1 flu in humans is most contagious during the first five days of illness and can remain contagious for up to 10 days. It can be treated using two drugs licensed in the US, namely oseltamivir and zanamivir. It is recommended that confirmed cases be treated under strict medical supervision.

The vaccine for human seasonal H1N1 flu does not protect against the “swine” A/H1N1 flu as they are antigenically different. Prevention of spread of A/H1N1 flu is the same as prevention against other influenza virus. This includes frequent handwashing with soap and water or with hand sanitizers. You should avoid touching your mouth, nose or eyes with your hands unless you have washed them. If you cough, cough into a tissue and throw away immediately, or cough into your elbow or hand, then wash them immediately.

The Malaysian government is taking the threat of A/H1N1 flu very seriously. As reported in the media, Asian countries are more prepared this time round. All necessary precautionary facilities from the recent SARS outbreak are still in place. These have been activated to prevent the spread of A/H1N1 flu. Already, people arriving from endemic countries are being medically screened.

Unfortunately, some travellers may be inconvenienced by delays and confinement but these steps are essential. The Health Ministry has advised Malaysians against travelling to endemic countries, especially Mexico and the US, unless travel is of utmost necessity. Travellers should take every precaution so as not to be exposed to the A/H1N1 flu virus.

Medical personnel play very important roles in times like these. Any patient who presents with flu-like symptoms and has been to endemic areas over the past one week or so should be tested for A/H1N1 flu. If the suspicion is high, the Health Ministry should be informed so that the patient receives urgent treatment while awaiting test results.

We all have a duty to act sensibly to prevent another worrying flu pandemic. There is no reason to panic as this virus has yet to be reported in Malaysia, but every precaution should be taken to prevent it from entering our country.

- THE STAR

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Malaysia confirms first case of A(H1N1) flu

Malaysia on Friday confirmed its first case of the A(H1N1) flu in a 21-year-old student who returned from the United States on Wednesday morning.

All the 192 passengers on the Malaysia Airlines flight MH091 from Newark on Wednesday are urged to contact the Health Ministry by calling 03-88810200 or 03-88810300

Health Minister Datuk Seri Liow Tiong Lai said the case made Malaysia the 36th country to be affected by the virus.

“Malaysia is now on high alert,” said Liow, who is in London now, enroute to Geneva, for a World Health Organisation meeting. He added he would return earlier than his scheduled return next Friday.

Meanwhile, A statement by the Health Ministry's director-general, Dr. Ismail Merican, said the young man was hospitalised on Thursday for fever, sore throat and body aches.

Tests confirmed that he was infected with the A(H1N1) virus, the statement said. He is receiving anti-viral treatment and was in stable condition, it said.

Ismail said the ministry had contacted members of his family but they have not been placed under quarantine.

Ismail said his department was taking steps to protect public health and that there was no reason to panic.

Meanwhile, in Putrajaya, acting Health Minister Datuk Seri Kong Cho Ha said later Friday that the fact that Malaysia’s first A(H1N1) patient managed to pass through the scanners at the Kuala Lumpur International Airport (KLIA) undetected was in no way indicative of scanners’ failure.

Kong said the scanners installed since the start of the global alert on the disease traced elevated body temperature levels in travellers coming into the country and did not pick out the 21-year-old student flying in from the United States as the symptoms were not showing yet.

He said the virus had a two to three day incubation period during which none of the symptoms linked to the disease were visible and that was why he passed undetected by the scanner after his flight landed at 7.15am on Wednesday.

He said the Health Ministry would continue to use the scanners at entry points and continue with all the precautionary measures it had taken since the global alert was first issued and there were no plans to tighten measures further.

“The ministry has taken all the possible precautionary measures to control and contain the disease after the WHO (World Health Organisation) issued a level five alert so we are calling on the public not to panic as the situation is under control.

“I also want to assure the people that we will make public any information related to the disease that we have just as we did with our first case confirmed today,” he said.

Meanwhile, Bernama reported that a man from Bukit Mertajam held under observation at the isolation ward of the Penang Hospital has been declared free of Influenza A (H1N1).

"We just got a report that the blood test on the 26-year-old man was negative," State Health, Welfare, Caring Society and Environment Committee chairman Phee Boon Poh said when contacted by Bernama Friday.

A test on a sample of his blood had been sent to Kuala Lumpur.

The man was kept for observation Thursday after he was found to have fever and symptoms similar to those of Influenza A (H1N1) on his return from the United States.

Two weeks ago, a New Zealand tourist was admitted to the isolation ward of the hospital for suspected Influenza A (H1N1) but a blood test also showed up negative.

- THE STAR

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Dirt from dry-cleaning

The chemical used to dry-clean our clothes, if improperly used and disposed of, can threaten the health of both humans and the environment.

You know that characteristic sickly-sweet odour that lingers on your clothes after they’ve returned from the dry-cleaners? It may be a reassuring sign that your garments were indeed cleaned thoroughly, but that smell is also an indication of all the processes and chemicals that go into dry-cleaning – chemicals that can cause serious environmental damage if not handled properly.

Not many people realise that something as ubiquitous as dry-cleaning may have far-reaching and potentially serious effects on the environment. The main cause for concern is the cleansing agent commonly used around the world, a solvent called perchloroethylene (perc).

Perc is used in place of water or detergent, and is classified as a chlorocarbon. In the dry-cleaning process, dirty garments are immersed in perc, which is continuously pumped through a filter and recirculated.

The clothes are then circulated in hot air in a dryer to vaporise the solvent remaining in them. The vaporised perc itself is distilled and sent back into the main tank for reuse. This entire process is carried out inside a dry-cleaning machine (see infographic, right). Therefore, the perc supply can actually be recycled for quite a while, though there will usually be some perc residue, or sludge, left behind after each cycle.

Clean clothes, dirty environment

According to Dr Mohamad Pauzi Zakaria, associate professor and co-ordinator of the Centre of Excellence in Environmental Forensics in Universiti Putra Malaysia, perc falls into the category of chlorofluorocarbons (CFCs), which are acknowledged as having a destructive effect on the ozone layer. “CFCs (such as perc) are released into the environment as they are volatile and readily evaporate. These CFCs are transported to the upper stratosphere where they will react with ozone and cause a depletion of the ozone layer.

“This has very serious environmental and health implications. The ozone layer protects humans from exposure to harmful ultraviolet radiation,” says Pauzi.

And like carbon dioxide and methane, CFCs are also greenhouse gases. Many CFCs are banned globally under the Montreal Protocol on Substances That Deplete the Ozone Layer (enforced in 1989) but perc is not of them. Pauzi says perc is less potent than those CFCs with fluorine atoms in the compound, but can nevertheless destroy the ozone layer. “We have to totally ban CFCs to protect the ozone layer,” he stresses.

There are many ways in which perc can be released into the environment during the dry-cleaning cycle. Dr Catherine Yule, deputy head of the School of Science in Monash University Malaysia, says perc that escapes during the dry-cleaning process can pollute buildings, the air, groundwater and soil.

“Perc is highly volatile and so it is difficult to contain and recycle. It can be released during cleaning, purification and waste disposal,” she says.

She explains that this happens in several ways. Firstly, perc is released into the air when it is added to the dry-cleaning machines, and also evaporates from open drums and dry-cleaned clothes. It can further evaporate from clothes that are being transferred from the washer to the dryer, or it can be discharged by the dryer exhaust. Perc can also be released through accidental spills or from leaky tanks and pipes.

“Most of the evaporated perc exits buildings through windows, vents and air-conditioning ducts, but the vapour can also pass through the floors, walls and ceilings of dry-cleaning establishments,” adds Yule. “Perc can remain in the air for nearly a month, after which it breaks down into other chemicals, some of which are also toxic.”

Another source of contamination is when the dry-cleaning process is over, and the solvent is removed to be reused. Yule says that sometimes, the liquid isn’t recycled but simply thrown down the drain. Solid wastes remaining after the cleaning can also be a source of pollution.

Perc is also used in textile mills, metal cleaning operations and rubber coatings factories. It is reported to be the chemical most widely found in groundwater contamination in the United States. Some states there have set target dates to phase out perc, replacing it with less toxic dry-cleaning substances which are now in the market.

The real dirt

Those in the dry-cleaning industry acknowledge that perc is damaging to the environment. The product handbook by Dowper, a leading global supplier of perc, for example, emphasises that special care should be taken to prevent the entry of perc into soil, surface water or groundwater, and that failure to do so would result in environmental contamination.

Some of the ways to ensure this is to keep dry-cleaning machines in pristine condition and to properly dispose of used perc. It is also important to store and transfer the solvent in a safe way to minimise its release into the surroundings. The onus of enforcing this in Malaysia, however, seems to be in the hands of the individual business owners.

Big laundry chains here seem to practice self-regulation for the most part, complying with international standards set by their parent companies.

Pressto Asia director Tan Ling Swee says they minimise the release of perc by using the newest available machines and advanced programmes.

“It isn’t prevented 100%, but it is minimised greatly. The machines also minimise the amount of perc going into the garment at every cycle,” he says.

Rajeswaran Muniandi, general manager of Crisp-N-Clean, agrees that the machines and programmes used are very important.

“If there isn’t proper maintenance of the machine, then there is definitely a higher chance of the perc leaking during the process, as well as perc remaining on the customers’ garments. However, we are aware that it can cause environmental and health problems, so we have very strict guidelines to follow.”

Both Tan and Rajeswaran stress that their companies hire contractors who are licensed to dispose of chemical wastes.

Crisp-N-Clean employs Yozai, a company dealing with scheduled wastes (particularly solvent wastes) to handle their used perc. A spokesperson for Yozai explains that the company’s job is to recycle as much of these wastes into usable condition. “A lot of solvent is recoverable, so we distil it and extract the usable amount,” the person says.

After this process, any remaining waste is sent by Yozai to Kualiti Alam (which operates the country’s main hazardous waste treatment and disposal facility in Bukit Nenas, Negeri Sembilan) for disposal.

The spokesperson says Kualiti Alam either incinerates the waste or places it in their landfill.

Tan shares, however, that there is no specific organisation that monitors dry-cleaners in Malaysia. Pressto is monitored by their parent company in Spain while Crisp-N-Clean adheres to the guidelines of the Drycleaning and Laundry Institute International.

This begs the question: who ensures that the many smaller dry-cleaners in the country adhere to the proper usage and disposal of perc?

As it is classified as scheduled waste, perc residue falls under the jurisdiction of the Department of Environment. As licensed businesses, however, laundries and dry-cleaners come under the purview of local authorities.

Therefore, it remains unclear which government agency is responsible for monitoring the usage of perc. Repeated attempts to obtain comments on the issue from the Department of Environment were unsuccessful.

Tellingly, a survey of several laundries in the Klang Valley showed that the owners were quite casual with using this solvent (see sidebar).

Are your clothes making you sick?

Besides the environmental effects, perc is also associated with a host of health-related issues. These occur in two circumstances: firstly, the effect on dry-cleaning workers who are exposed to the solvent daily and secondly, the effect on the consumer, whose dry-cleaned clothes contain and release traces of perc even after they’ve been brought home.

“Perc is toxic to humans, as well as animals and plants. It enters the body when it is breathed in or via contaminated food or water. It does not usually pass through the skin. It can be stored in fat tissue and has been associated with cancers, liver and kidney damage, and respiratory failure,” says Yule. “It has also been implicated in birth defects. People who work in dry-cleaning establishments are most likely to be affected, particularly if the machines are old and not well-maintained and cleaned.”

While there isn’t conclusive evidence linking perc to medical problems, there are numerous studies that suggest this. In the early 1980s, the United States Environmental Protection Agency stated that perc posed a risk to the environment and in 1985, classified it as a possible human carcinogen – a fact the International Association for Research on Cancer concurs with.

The US National Institute of Environmental Health Sciences further states that short-term exposure to perc can cause adverse health effects on the nervous system that include dizziness, fatigue, headaches, sweating, incoordination and unconsciousness, while long-term exposure can cause liver and kidney damage.

The effects seem most pronounced on workers in the industry. A Danish study by Kolstad, Brandt and Rasmussen showed that pregnant dry-cleaning workers are twice as likely to have a miscarriage in comparison to pregnant women in other jobs. Another study by the University of California at Berkeley discovered that male dry-cleaning employees have more sperm abnormalities and a significantly lower sperm count.

Again, companies like Dowper provide ample warning of the effects of over-exposure. The company’s handbook states that perc is hazardous if handled without engineering controls, ventilation equipment and personal protection such as gloves, goggles and respirators.

The guide further says: “When it is used properly by trained personnel and stored carefully in accordance with accepted practice, perchloroethylene should present little or no practical risk to workers. Exposure above guideline levels, however, may cause adverse effects, including anaesthetic or narcotic effects and liver and/or kidney effects.”

Companies like Pressto and Crisp-N-Clean are aware of these risks, and ensure that their personnel are always in their protective gear when handling perc. Tan further says Pressto plants have air-quality testers to monitor the levels of perc in the working environment.

Small neighbourhood laundries and dry-cleaners, however, seem to rarely take such precautions. Here, workers often don’t wear any protective gear, and it isn’t unusual to see buckets or dippers filled with perc sitting out in the open near the machines.

Rajeswaran also explains that the quality of the dry-cleaning machine greatly affects whether perc residue is left on consumers’ clothing.

“The drying process, if done properly with a good machine and programme, ensures that all the perc on the garments is evaporated. When the machine is not well-maintained, however, there is a high chance of traces of solvent left on the clothes,” he says.

The problem, according to Pauzi, lies in murky legislation.

“Dry-cleaning chemicals may have escaped our monitoring activities due to unclear jurisdiction. Our country’s environmental law straddles a wide spectrum of agencies, making it very difficult to focus.

“It is time for us and the authorities to take a closer look at these chemicals, to try and understand their impact on the environment and us. Clear and unambiguous legislation will help.”

- THE STAR

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Cancer is not one disease

By Dr ALBERT LIM KOK HOOI

You have to understand that cancer is not one single entity, and neither are heart disease, hepatitis, arthritis or any other disease-complex.

IF I had to pick one lesson to teach about cancer and its treatment, it is this: cancer is not one disease. It is perhaps a hundred different diseases.

Because cancers are so different from each other, cancer patients can be divided into approximately 100 groups. This calls for a hundred different treatment approaches.

Take just one of these 100 groups. Advanced or metastatic breast cancer is common. It is more common in Malaysia than in the developed world. Patients here often present to the doctor late either because of ignorance or shame. There are also patients who originally present with early disease but who refuse chemotherapy and hormonal therapy after their breast surgery. Their cancer then recurs and spreads.

Advanced breast cancer can be divided into four subsets as a first approximation. The division is based on two molecular characteristics of the tumour: HER2 and ER. Both HER2 and ER are receptors or docking sites on the surface of the cancer cell which predict which cancer drug will work. HER2 and ER can be either positive or negative. Two variables each of which there can be two possibilities make four groups.

We now have four groups of patients with advanced breast cancer viz. i) HER2 positive ER positive, ii) HER2 positive ER negative, iii) HER2 negative ER positive, iv) HER2 negative ER negative. We approach each of the four groups differently. We use anti-HER2 treatment for the two HER2 positive groups. We use hormonal treatment for the two ER positive groups. In addition, we use chemotherapy for all four groups at some time during their illness.

Actually, advanced breast cancer (or any cancer) is more complicated than that. Not only are the four groups I spoke about important, we oncologists also take into account the tumour burden (how much cancer there is in the body) as well as the status of the patient’s internal organs. How well are her heart, bone marrow, liver and kidney functioning? All this will influence the treatment we prescribe.

Patients often (or is it always?) compare notes and wonder why their treatments differ even though they both have the “same” cancer. I hope there is less need to wonder after reading this article. Some patients demand the oral treatment their fellow sufferers are on because it is more convenient than injections.

They want the chemotherapy that does not cause hair loss. Sure, we can give convenient, tolerable treatment to them but it may not be the appropriate and effective one for their cancer.

Some cancer patients die within a few weeks of diagnosis. Many patients are cured and survive decades after cancer treatment. They lead meaningful, comfortable lives. Between the first and second scenario, everything else is possible. There is much variability even within each subset of cancer patients, let alone the whole cohort of cancer patients.

Once again, let me dispel the misconception that cancer is one disease that requires one therapeutic approach. It is not. It is a 100 different diseases with 100 different treatment approaches. Ozone therapy, Gerson therapy, cytotron therapy, herbal therapy and qi gong for cancer imply that cancer is one disease. Even if these alternative and complementary therapies are not meant to treat the cancer directly but to boost the immune system and palliate, it still does not make sense.

The immune system is a very complicated and heterogeneous system that is not so easily boosted. Palliative medicine has come a long way and is as much on a scientific footing as oncology. Similarly patients who need palliative care can be divided into 100 groups which required 100 different approaches.

The more we know about cancer, the more we find the need to split cancer patients into more and more groups. It is a generalist’s nightmare and a reductionist’s dream.

I hope other medical specialists will cheer me on. Heart disease is not one disease. Neither is arthritis, diabetes, stroke, hepatitis or tuberculosis.

My colleagues also dissect the disease complex of their speciality into smaller entities and treat each one differently.

They are also faced with patients who tend to “lump” (rather then “split”) and to compare notes. Cultural beliefs have engendered myths and legends about how the human body works, how it goes wrong and how good health can be restored.

Moreover our educational system may not have adequately prepared us to understand contemporary science-based and evidence-based medicine.

Not only should science and mathematics be taught in English, perhaps science and mathematics should also be taught in science and mathematics.

- THE STAR

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6 All-Natural Age-Defying Skin Recipes

By Dr. Maoshing Ni

Hundreds of expensive products and procedures exist for beautifying the skin and keeping it looking young and fresh, some of which may pose dangers to your health. Instead, try some of these all-natural, do-it-yourself beauty recipes you can use to keep your skin young and glowing—at a fraction of the cost.

1. A skin peel from nature

Probably one of the fastest ways to look younger is to have a skin peel. While the Retin-A, high-concentration glycolic acid, and harsh chemical peels that cosmetic dermatologists prescribe can decrease lines and result in a smooth skin finish, they also strip your skin's protective layer, increasing your chance of sun damage, skin aging, and skin cancer. In fact, the FDA warns that a high concentration of various skin-peel agents may thin the skin.

The alternative? Simply make a natural skin peel right from your refrigerator. You can use eggplant, tomatoes, pineapple or any other fruits and veggies that contain other natural acids. Thinly slice the ingredients and place them on your face, covering the skin thoroughly. Leave on for 20 minutes, remove the fruit and veggie pieces and wash with warm water. For the first few minutes, your skin may look red, but this should clear up quickly. Follow with a natural moisturizer.

2. Cucumber to remedy rosacea
Rosacea is a chronic skin problem that reddens the forehead, nose, cheeks, and sometimes the chin. Some of the outbreak triggers include alcohol, sunlight, temperature extremes, caffeine, spicy food, among other culprits. In my treatment of rosacea, I focus on soothing the spirit, clearing heat, and using natural remedies to remove skin blockages. A perfect natural remedy is a cucumber mask. Peel the skin off of a fresh cucumber and puree the insides in a blender with one egg white. Coat your face with this mixture, leave on for 30 minutes. And then wash off with cold water. Use this mask daily and you should notice improvement within a month.

3. Yogurt for a smooth skin texture
Yogurt is a traditional ingredient for healthy skin. It contains lactic acid, a naturally occurring alpha-hydroxy acid that gently peels off the dead skin layer, giving you a smooth skin texture. For sensitive skin that cannot withstand commercial alpha-hydroxy acid preparations, yogurt is especially beneficial. Over time, yogurt can also lighten spots and even out a patchy skin tone. To get these results, wash your face and apply organic plain yogurt as a facial cream. Leave on for 15 minutes, wash off with cold water, and finish with a moisturizer. Afterwards, to reduce any redness, apply a cold pack for 10 minutes.

4. Tone with apple cider vinegar
Apple cider vinegar can be used as a natural and effective toner for your skin. The malic acid in vinegar helps renew your skin by ridding the epidermis of dead skin cells. Dilute one part cider vinegar in two parts distilled water. After washing your skin, apply the diluted vinegar solution with a cotton pad to your face and neck. Follow with a natural moisturizing lotion.

5. Nature's "facelift"
One of the secrets of Chinese women's youthful looks is the acupuncture face-lift. We have been treating patients with facial-toning acupuncture at our wellness center for over 25 years. Research has shown that acupuncture increases blood flow in the tiny capillaries of the skin and muscles and stimulates collagen production in the dermis layer, which increases skin elasticity. Consult an acupuncturist for a natural face-lift or...

Try this do-it-yourself "facelift":
Using your fingers, you can tone your facial muscles and stimulate the natural production of collagen in the skin. Press firmly with your fingers, working your way methodically along the following points:

Point 1: GB 14 to relax the forehead

Point 2: Yintang to ease furrow between the brows

Point 3: Taiyang to get rid of crows feet around the eyes

Point 4 and 5: LI 20 and ST 3 for minimizing smile lines

Stimulate these points in the morning and at night for beautiful skin tone. For more age-defying tips and techniques, check out my new book Second Spring: Hundreds of Natural Secrets for Women to Revitalize and Regenerate at Any Age.

6. Tasty super skin foods
While many of the tips above use super foods directly on the skin, some good eats also treat your skin. Super skin foods include cherries, peanuts, black soybeans, walnuts, and jujube dates. Citrus fruits are packed with antioxidants that benefit your skin's health. For dry skin, eat flaxseed oil, sesame oil, olive oil, and virgin coconut oil and avocado every day. And eat a daily handful of nuts and seeds, especially pine nuts, hazelnuts, walnuts, and sunflower seeds.

Peaches, an excellent source of potassium and vitamins A and C, have been used in beauty tonics throughout Chinese history. One beauty recipe recommends baked peaches with honey and lavender.

A nutrient found in anchovies and sardines, DMAE (dimethyl-amino-ethanol), is a powerful membrane stabilizer that can reverse age spots on your skin.

To lighten dark circles and minimize skin damage from free radicals, try Asian pear. Asian (or Fuji) pears are packed with copper and vitamin C, antioxidant nutrients that help protect you from cellular damage caused by free radicals, preserving your skin's beauty and vitality.

These natural recipes will bring you beautiful skin well into your late years!

May you live long, live strong, and live happy!

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Boosting bone density

By DR MILTON LUM

Taking vitamins, minerals and hormonal therapy are some of the ways to prevent brittle bones.

The treatment goal in the management of osteoporosis is to increase bone density. The medicines available include vitamins, minerals, calcitriol, hormone therapy (HT), selective oestrogen receptor modulators (SERMS), bisphosphonates and recombinant parathyroid hormone.

A high calcium intake plays a crucial role as an adjunct to the other treatment options. Calcium intake has a synergistic bone protective effect along with hormone therapay in post-menopausal women, allowing a doubling or even tripling of the effect of the therapy.

Supplements

Hormones by themselves do not provide substances to form bone – they need to come from the diet. As such, the first step is to ensure that an adequate amount of calcium and vitamin is consumed daily.

Most people, particularly women, should get sufficient vitamins and minerals in their diet. A recent study found that 49% of post-menopausal Malaysian women have vitamin D levels below the normal range, despite the fact the sun is shining throughout the year. This, together with lower rates of calcium absorption and increased bone loss in post-menopausal women, contribute to the development of osteoporosis.

The daily requirement of vitamin D is 400 IU. If one is never in the sun, 800 IU of vitamin D is recommended. This has been shown to reduce fracture in the elderly who are vitamin D deficient. If calcium cannot be obtained from the diet, a calcium supplement may be required to attain the recommended daily requirement of 1,000 to 1,500mg of elemental calcium.

The risk of urinary tract stones is not increased if the calcium consumed does not exceed 1,500mg per day. It is advisable to drink plenty of water. Calcium should not be taken with fibre or iron supplements.

Calcitriol is a synthetic form of vitamin D used to treat osteoporosis. It is one of the most important active metabolites of vitamin D, which is needed for calcium absorption. Calcitriol increases intestinal calcium absorption, regulates bone mineralisation and the production of bone proteins. It prevents bone loss and increases bone mass thereby reducing fractures.

Alfacalcidol is converted in the liver to a metabolite of vitamin D3. It has a rapid onset of action and is safe and effective. It increases bone mineral density, improves biochemical markers and is effective in preventing osteoporotic fractures in the spine and those with mild to moderate osteoporosis.

Hormones

The oestrogen levels in a post-menopausal woman are about 10% that in the reproductive age group and progesterone is almost absent. Post-menopausal oestrogen is produced by the adrenal glands and fat.

Hormone therapy usually involves treatment with either oestrogen alone or in combination with progestogen to help compensate for the decrease in natural hormones. Its use only doubles the oestrogen level of a post-menopausal woman. Hence, even with hormone therapy, the oestrogen and progesterone levels of a post-menopausal woman do not reach the natural levels of a pre-menopausal woman.

The medicines used in hormone therapy are similar in certain aspects yet different in others, with different modes of action, side effects and adverse events. Hormone therapy is the only effective method for the management of menopausal symptoms..

The long-term use of hormone therapy, like all other medicines, has risks as well as benefits. It is beneficial in the prevention and treatment of osteoporosis but it is not the first line medicine as alternatives are available.

When hormone therapy is used for the treatment of menopausal symptoms, it will also decrease bone loss and prevent osteoporosis. Hence, during its intake, the alternatives need not be taken. Hormone therapy is also recommended in women who have premature menopause, that is, menopause below 40 years.

Hormone therapy is an effective method to prevent post-menopausal osteoporosis. It increases bone density at the spine, hip and peripheral sites, and reduces the risk of fractures. The beneficial effects of hormone therapy have been consistently reported in many studies. The potential risks must be weighed against the benefits.

As breast tissue is sensitive to hormones, there has been concern about breast cancer risk among hormone therapy users. Short-term use of less than five years does not appear to increase the risk of breast cancer.

There is some evidence that long-term hormone therapy use may be associated with a small increase in the incidence of breast cancer (with best evidence for combination of oestrogen and progestogen).

The Collaborative Group on Hormonal Factors in Breast Cancer, in an analysis of over 90% of breast cancer studies worldwide, estimate that there are 45 cases of breast cancer in 1,000 women at aged 50 in non-hormone therapy users.

It is estimated five years of hormone therapy use will result in two extra cases per 1,000 users; after 10 years of use, six extra cases per 1,000 users; and after 15 years of use, 12 extra cases per 1,000 users. The extra risk of developing breast cancer on hormone therapy does not persist beyond about five years after stopping its use.

There is good evidence that hormone therapy increases the risk of blood clots (venous thromboembolism) from one in 10,000 people a year to three. Most people who get a blood clot make a complete recovery with treatment. There is fair evidence that hormone therapy use is associated with a small increase in stroke incidence due mainly to an increase in thromboembolic stroke.

Unopposed oestrogen increases the development of endometrial hyperplasia and the risk of endometrial cancer. The addition of progestogen reduces the risk of endometrial cancer.

Oestrogen-only products are prescribed for women who have had a hysterectomy. All other women on hormone therapy will be prescribed an oestrogen-progestogen combination.

Prior to the commencement of hormone therapy, one needs to be assessed by the doctor particularly for conditions which would make hormone therapy unsuitable: current pregnancy, hormone dependent cancers, endometrium, venous thromboembolic disease, pulmonary embolism, severe liver disease, undiagnosed breast lump and uninvestigated abnormal vaginal bleeding.

Oestrogen is usually taken in hormone therapy unless there are contraindications. Various types of progestogens are added for endometrial protection in women with an intact uterus.

Tibolone is a synthetic steroid with mixed oestrogenic, progestogenic and androgenic actions. It is a prescribed for postmenopausal women and has to be taken continuously. It is used to treat vasomotor, psychological and libido problems, and also possesses bone protection.

Hormone therapy should be used under medical supervision. Long term use, such as more than five years, require close monitoring and a regular evaluation (at least annually).

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Swine Flu: 5 Things You Need to Know About the Outbreak

Right now health officials around the world are trying to take precautions without inciting panic. Here are just a few of the questions facing them - and ultimately, us as well:

1. Is this a flu pandemic?

The influenza virus is constantly mutating. That's why we can't get full immunity to the flu, the way we can to diseases like chicken pox, because there are multiple strains of the flu virus and they change from year to year. However, even though the virus makes us sick, our immune systems can usually muster enough of a response so that the flu is rarely fatal for healthy people.

But every once in awhile, the virus shifts its genetic structure so much that our immune systems offer no protection whatsoever. (This usually happens when a flu virus found in animals - like the avian flu still circulating in Asia - swaps genes with other viruses in a process called reassortment, and jumps to human beings.) A flu pandemic occurs when a new flu virus emerges for which humans have little or no immunity and then spreads easily from person to person around the world. In the 20th century we had two mild flu pandemics, in 1968 and 1957, and the severe "Spanish flu" pandemic of 1918, which killed an estimated 40 to 50 million people worldwide.

The WHO has the responsibility of declaring when a new flu pandemic is underway, and to simplify the process, the U.N. body has established six pandemic phases. Thanks to H5N1 avian flu, which has killed 257 people since 2003 but doesn't spread very well from one human to another, we're currently at phase 3. If the WHO upgraded that status to phase 4, which is marked by a new virus that begins to pass easily enough from person to person that we can detect community-sized outbreaks, such a move would effectively mean that we've got a pandemic on our hands.

The H1N1 swine flu virus has already been identified as a new virus, with genes from human and avian flus as well as the swine variety. And since it is apparently causing large-scale outbreaks in Mexico, along with separate confirmed cases in the U.S. and Canada and suspected cases in other countries, it would seem that we've already met the criteria for phase 4. But though an emergency committee met on April 25 to evaluate the situation, the WHO hasn't made the pandemic declaration yet. Keiji Fukuda, the WHO's interim assistant director-general for health, security and environment, said on Sunday that its experts "would like a little bit more information and a little bit more time to consider this." The committee is set to meet again by April 28 at the latest.

As health officials have repeatedly emphasized, with good reason, the swine flu situation is evolving rapidly, and more lab tests are needed to ascertain exactly what is going on in Mexico and elsewhere. "We want to make sure we're on solid ground," said Fukuda, a highly respected former CDC official and flu expert.

2. What will happen if this outbreak gets classified as a pandemic?

Moving the world to pandemic phase 4 would be the signal for serious containment actions to be taken on the national and international level. Given that these actions would have major implications for the global economy, not to mention the effects of the public fear that would ensue, there is concern that the WHO may be considering politics along with science. "What the WHO did makes no sense," says Osterholm. "In a potential pandemic, you need to have the WHO be beyond question, and (April 25) was not a good day for them."

Of course, declaring a pandemic isn't a decision that should be taken lightly. For the WHO, phase 4 might trigger an attempt to keep the virus from spreading by instituting strict quarantines and blanketing infected areas with antivirals. But we appear to have missed the opportunity to contain the disease at its source since the virus is already crossing borders with ease. "We cannot stop this at the border," said Anne Schuchat, the CDC's interim director for science and public health. "We don't think that we can quench this in Mexico if it's in many communities now."

That would leave the WHO and individual countries to fall back on damage control, using antivirals and old-fashioned infection control - like closing schools, limiting public gatherings and even restricting travel - to slow the spread of the virus. But such efforts would likely inflict serious damage on an already faltering global economy - and the truth is, we don't know how well those methods will work.

3. Why have the U.S. cases been so much milder than the ones in Mexico?

This is the question that has health officials from Geneva to Washington puzzled. In Mexico, swine flu has caused severe respiratory disease in a number of patients - and even more worryingly, has killed the sort of young and healthy people who can normally shrug off the flu. (Fueling such concerns is the fact that similar age groups died in unusually high numbers during the 1918 pandemic.) Yet the cases in the U.S. have all been mild and likely wouldn't have even garnered much attention if doctors hadn't begun actively looking for swine flu in recent days. "What we're seeing in this country so far is not anywhere near the severity of what we're hearing about in Mexico," said the CDC's Besser. "We need to understand that."

Some of the difference may be due to the fact that Mexico has apparently been grappling with swine flu for weeks longer than the U.S. As doctors across the U.S. begin checking patients with respiratory symptoms for swine flu, CDC officials expect to see more severe cases in the U.S. as well - and as better epidemiological work is done in Mexico, we'll probably hear about more mild cases there too. Right now, however, the true severity of the H1N1 swine flu virus is still an open question, whose answer could change over time. The 1918 Spanish flu pandemic began with a fairly mild wave of infections in the spring, but the virus returned a few months later in a far more virulent form. That could happen with the current swine flu as well. "It's quite possible for this virus to evolve," said Fukuda. "When viruses evolve, clearly they can become more dangerous to people."

4. How ready is the U.S. - and the world - to respond to a flu pandemic?

In some ways, the world is better prepared for a flu pandemic today than it has ever been. Thanks to concerns over H5N1 avian flu, the WHO, the U.S. and countries around the world have stockpiled millions of doses of antivirals that can help fight swine flu as well as other strains of influenza. The U.S. has a detailed pandemic preparation plan that was drafted under former President George W. Bush. Many other countries have similar plans. SARS and bird flu have given international health officials useful practice runs for dealing with a real pandemic. We can identify new viruses faster than ever before, and we have life-saving technologies - like artificial respirators and antivirals - that weren't available back in 1918. "I believe that the world is much, much better prepared than we have ever been for dealing with this kind of situation," said Fukuda.

At the same time, the very nature of globalization puts us at greater risk. International air travel means that infections can spread very quickly. And while the WHO can prepare a new swine flu vaccine strain in fairly short order, we still use a laborious, decades-old process to manufacture vaccines, meaning it would take months before the pharmaceutical industry could produce its full capacity of doses - and even then, there wouldn't be enough for everyone on the planet. The U.S. could be particularly vulnerable; only one plant, in Stillwater, Penn., makes flu vaccine in America. In a pandemic, that could produce some ugly political debates. "Do you really think the E.U. is going to release pandemic vaccine to the U.S. when its own people need it?" asks Osterholm.

Indeed, the greatest risk from a pandemic might not turn out to be from the swine flu virus itself - especially if it ends up being relatively mild - but what Osterholm calls "collateral damage" if governments respond to the emergency by instituting border controls and disrupting world trade. Not only would the global recession worsen - a 2008 World Bank report estimated that a severe pandemic could reduce the world's GDP by 4.8% - but we depend on international trade now for countless necessities, from generic medicines to surgical gloves. The just-in-time production systems embraced by companies like Wal-Mart - where inventories are kept as low as possible to cut waste and boost profit - mean that we don't have stockpiles of most things. Supply chains for food, medicines and even the coal that generates half our electricity are easily disruptable, with potentially catastrophic results. Though we'll likely hear calls to close the border with Mexico, Osterholm points out that a key component used in artificial respirators comes from Mexico. "We are more vulnerable to a pandemic now than at any other time over the past 100 years," he says. "We can't depend on ourselves."

5. So how scared should we be?

That depends on whom you ask. Officials at the CDC and the WHO have emphasized that while the swine flu situation is serious, they're responding with an abundance of precautions. Even Osterholm, who has been highly critical of the U.S. government's long-term failures to better prepare for a pandemic, gives the CDC a 9 out of 10 for its response so far. Outside of Mexico, the swine flu hasn't looked too serious yet - unlike during the SARS outbreaks of 2003, when an entirely new virus with no obvious treatment took the world by surprise. In the U.S., the normal flu season is winding down, which should make it easier for public-health officials to pick out swine flu cases from run-of-the-mill respiratory disease. And there are simple things that people can do to protect themselves, like practicing better hygiene (wash hands frequently and cover mouth and nose when sneezing) and staying away from public places or traveling if they feel sick. "There's a role for everyone to play when an outbreak is ongoing," said Besser.

But the truth is that every outbreak is unpredictable, and there's a lot we don't know yet about the new swine flu. There hasn't been a flu pandemic for more than a generation, and there hasn't been a truly virulent pandemic since long before the arrival of mass air transit. We're in terra incognito here. Panic would be counterproductive - especially if it results in knee-jerk reactions like closing international borders, which would only complicate the public-health response. But neither should we downplay our very real vulnerabilities. As Napolitano put it: "This will be a marathon, not a sprint." Be prepared.

- TIME

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What is Docosahexaenoic acid (DHA)?

By Dr NOR ASHIKIN MOKHTAR

What women need to know about docosahexaenoic acid (DHA)

DHA – you might have seen those three letters on an increasing number of food products in the supermarket. They appear on egg cartons, supplements and, especially, on milk products.

You may also have heard that DHA has something to do with the brains and eyes. Does it make us smarter or able to see better?

As DHA is increasingly being added to the foods that women consume every day, it is important to know what it is and how it helps them.

What is DHA?

DHA stands for docosahexaenoic acid, an omega-3 essential fatty acid. DHA is one of several types of essential fatty acids that the body needs for important physiological processes (hence the term “essential”), such as maintaining the integrity of skin and cell membranes and synthesising prostaglandins and leukotrienes.

DHA is the most abundant fatty acid found in our brains and retinas (in our eyes). Hence, this fatty acid is very important for the proper functioning of our brains as adults. Scientists have also discovered that DHA is essential for the development of babies’ nervous systems and visual abilities during the first six months of life.

In addition, omega-3 fatty acids are part of a healthy diet that helps lower risk of heart disease. Omega-3 fatty acids found in fish oil help to lower triglycerides (fats in the blood), lower blood pressure, reduce the risk of blood clots, improve the health of arteries and reduce the amount of arterial plaque (which narrows arteries and causes heart disease).

Why is DHA important during pregnancy?

A baby’s brain, eyes and nervous system develop while in the womb and during the early years of childhood. During these years, particularly during pregnancy and lactation, a woman needs to ensure that she consumes adequate amounts of DHA so that her baby will also have enough DHA for development.

What does DHA do for the baby in the womb? DHA is important during pregnancy, especially during the last three months, when the baby’s brain grows at a rapid pace. DHA intake is also crucial when a mother is breastfeeding, particularly in the first three months of life, as the DHA content of a baby’s brain triples during this period.

There is a lot of research to suggest that sufficient amounts of DHA may help increase a baby’s cognitive functioning, such as learning ability and mental development, as he/she grows up.

Some studies have tried to make a link between DHA and intelligence. One study in 2003, published in the journal Pediatrics, showed that children whose mothers took a DHA supplement during pregnancy scored higher on intelligence tests at four years of age than children of mothers not taking DHA supplements.

Other studies suggest that breastfed babies have IQs of six to 10 points higher than formula-fed babies – making a link to DHA, as breast milk naturally contains essential fatty acids like DHA.

How to get more of it

As more and more people realise the importance of getting adequate amounts of DHA, they are starting to ask the question: how do I get more DHA in my diet?

Our bodies naturally produce small amounts of DHA, but most of our DHA intake comes from our diet.

DHA is found in most abundance in cold water fatty fish, including salmon, tuna (bluefin tuna have up to five times more DHA than other types of tuna), mackerel, sardines, shellfish, and herring.

Although some of these fish contain low levels of mercury, the US Food and Drug Administration has found that consuming several servings of fish each week poses no risk to healthy people and conveys many health benefits.

However, women who are pregnant or are planning to have a baby should avoid Atlantic Mackerel, shark, swordfish and tilefish, due to the mercury risk.

Other foods that indirectly provide DHA are plant food sources rich in ALA (alpha-linolenic acid), such as flax, canola oil and walnuts. The body will then convert ALA to DHA combined with another fatty acid called EPA. However, this metabolic conversion is very limited in the human body and does not result in high levels of DHA.

So how can mothers ensure that their babies get enough DHA for development? By breastfeeding, for one. Breast milk from a well-nourished mother contains just the right proportion of essential fatty acids for a baby’s growth and development.

During pregnancy, a woman can get DHA intake from foods fortified with DHA or from DHA supplements, such as fish oil capsules and algae supplements. Fish oil capsules contain both DHA and EPA, while algae supplements only contain DHA.

Be sure to ask your doctor or pharmacist for advice before taking DHA supplements, especially if you are pregnant or planning to be pregnant. Take only high-quality fish oil supplements made by manufacturers who test for mercury and other toxins, to prevent mercury contamination. Read the labels carefully and ask about the purity of the supplement.

As you can see, some fats are good for us and our babies. So the next time you go shopping, read the labels to see which fortified foods suit your needs best.

- THE STAR

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Strong bones

By DR MILTON LUM

Eat right to maintain healthy bones.

Keeping healthy with a positive lifestyle has a significant impact on health. As bone mass peaks in our 30s, the higher the bone mineral density (BMD) attained at this time, the less likely is the risk of osteoporotic fractures. So we should try to get as high a BMD as we possibly can in the first three decades of our lives.

Many women have no hesitation about taking a healthy diet when pregnant but may not do so after the baby is born. They can do themselves a lot of good if they continue taking a healthy diet, whether pregnant or not.

Lifestyle changes will lower their risk of health problems as they get older. The perimenopause is a good time to pay more attention to health if one has not been doing so.

It is essential to remember that prevention is better than treatment – it is easier to prevent loss of bone density than to restore it once it is lost.

Healthy diet

A balanced diet high in grains, fruits and vegetables, with adequate water, vitamins and minerals but low in fat contributes to good bone health. The intake of sweet and fatty food should be limited. Fat intake should be less than 30% of daily calorie requirement.

Women at the perimenopause and beyond should pay attention to their diet as cardiovascular disease and osteoporosis are affected by diet.

There is a positive relationship between calcium consumption and bone mass at all ages. When calcium intake is consistently high in childhood and adolescence, bone mass achieved in the 30s would be higher. An increased calcium intake enhances the effects of other treatments like vitamin D and hormone therapy.

The recommended daily consumption of elemental calcium varies at different ages. It is important that these levels be achieved so that there is maximum impact on bone health. The recommended intakes are:

* Infant – 300mg in breast-fed and 400mg in bottle-fed

* Children – 500mg (one to three years), 600mg (four to six) and 700mg (seven to 10)

* Adolescents (10 to 18) – 1,000mg

* Adults – 800mg (up to 49) and 1,000mg (above 50)

* Pregnant and during breast- feeding – 1,000mg.

Calcium is found in leafy green vegetables, calcium-rich dairy products, tofu, dhal, mussels, ikan bilis, sardine, baked beans, and calcium-fortified foods and juices. If this is insufficient, calcium supplements (calcium carbonate, citrate, calcium lactate and calcium gluconate) may be used.

Calcium absorption is increased by vitamin D, which can be found with 15 minutes or more of daily exposure to the sun and in fortified foods like milk, tuna and liver or vitamin D supplements. If one does not go outdoors, is immobile or has a deficient diet, a daily intake of 800IU of vitamin D supplement is necessary. This is particularly relevant to women, as a recent study found that 49% of postmenopausal Malaysian women were vitamin D-deficient. An adequate intake of protein and energy is important particularly in children and senior citizens.

Exercise

Physical inactivity is a risk factor for many conditions. Exercise can help one lose weight and protects against cardiovascular disease and prevents osteoporosis as it maximises peak bone mass, decreases age-related bone loss as well as maintains muscle strength and balance.

If one is not used to strenuous activity, it would be prudent to check with the doctor before commencing an exercise programme, especially if one is above 40 years or overweight.

In a good workout, one needs to exercise at the target heart rate for at least 30 minutes three times a week. The doctor will be able to provide advice on the target heart rate, which is dependent on age.

If there is difficulty in fitting exercise into one’s schedule, there are things that can be done to be more active, such as walking (rather than driving) and taking the stairs (instead of the lift).

Excessive dieting and a low body weight (body mass index less than 19kg per sqm) are associated with low bone mass and increased risk of fracture. Weight gain is not due to menopause. As one ages, metabolism slows so that the body takes a longer time to burn up the food taken. This means that taking the same amount of food like what one did when younger would increase the weight.

It would be best not to exceed the weight for one’s height. If one has to lose weight, discuss the matter with the doctor and dietitian. A healthy rate of weight loss is 0.5 to 1kg per week. Do not go on crash diets.

Alcohol exerts a greater impact on women than men as their bodies contain less water to dilute the alcohol and the enzyme that digests alcohol is less in women. Alcohol interferes with calcium absorption and bone growth. A drink or two a day may be all right. Larger amounts have been associated with many health problems.

Preventing falls

It is important to eliminate factors in the environment that can result in falls, thereby reducing the risk of fractures. Various conditions can increase the chances of falling. They include poor eyesight and/or balance, decreased muscle strength, excessive alcohol intake, diseases of the nervous system, muscles and the skeleton, certain medicines like anti-hypertensives, sedatives, and home conditions like slippery floors, steps and poor lighting. In general, falls can be avoided by regular exercise, reducing alcohol intake, avoiding sedatives and correcting eyesight problems.

There is ample evidence that hip protectors reduce the risk of hip fractures due to falls. To avoid falls indoors, keep rooms free of clutter, keep floors smooth but not slippery, install grab bars and use a rubber bath mat in the tub or shower. To avoid falls outdoors, wear rubber-soled shoes, avoid walking on slippery surfaces and use a walker or cane for added stability.

Hormone therapy, bisphosphonates and other medicines have proven effective in the prevention of osteoporosis. A healthy lifestyle and regular clinical examinations are important in maintaining health. Routine examinations can detect problems early and give the patient and doctor an opportunity to discuss ways to avoid problems later in life.

Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

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Miracle of green tea

Tea, especially green tea, has a host of beneficial health properties.

The practice of drinking tea is believed to have originated in China some 4,000 years ago although there is archaeological evidence to suggest people consumed tea leaves steeped in boiling water as far back as 500,000 years ago.

People in Asian countries more commonly consume green or oolong tea, while black tea is more popular in the United States and Europe. In fact, tea is second only to water in terms of global consumption.

Green, black and oolong teas are all derived from the leaves of the Camellia sinensis plant. Originally cultivated in East Asia, this plant grows as large as a shrub or tree. Today, Camellia sinensis grows throughout Asia and in parts of the Middle East and Africa.

Green tea is prepared from unfermented leaves, while the leaves of oolong tea are partially fermented, and black tea is fully fermented. The more the leaves are fermented, the lower the polyphenol content and the higher the caffeine content. Green tea has the highest polyphenol content while black tea has roughly two to three times the caffeine content of green tea.

The healthy properties of green tea are largely attributed to polyphenols, chemicals with potent antioxidant properties. In fact, the antioxidant effects of polyphenols appear to be greater than that of vitamin C.

Antioxidants are substances that scavenge free radicals – damaging compounds in the body that alter cells, tamper with DNA (genetic material) and even cause cell death.

Free radicals occur naturally in the body, but environmental toxins (including ultraviolet rays from the sun, radiation, cigarette smoke and air pollution) also give rise to these damaging particles. Many scientists believe that free radicals contribute to the ageing process as well as the development of a number of health problems, including cancer and heart disease. Antioxidants such as polyphenols in green tea can neutralise free radicals and may reduce or even help prevent some of the damage they cause.

Polyphenols contained in teas are classified as catechins. Green tea contains six primary catechin compounds: catechin, gallaogatechin, epicatechin, epigallocatechin, epicatechin gallate and apigallocatechin gallate (also known as EGCG). EGCG is the most active and the most studied polyphenol component in green tea.

Green tea also contains alkaloids including caffeine, theobromine and theophylline. These alkaloids provide its stimulant effects. L-theanine, an amino acid compound found in green tea, has been studied for its calming effects on the nervous system.

Ancient superfood

Practitioners of traditional Chinese and Indian medicine use green tea as a stimulant, diuretic, astringent and to improve heart health. Other traditional uses of green tea include treating flatulence, regulating body temperature and blood sugar, promoting digestion and improving mental processes.

Green tea has been extensively studied in people, animals and laboratory experiments. The results from these studies suggest that green tea may be useful for the following health conditions:

·High cholesterol – Research shows that green tea lowers total cholesterol and raises HDL (“good”) cholesterol in animals and people. In a small study of smokers, researchers found that green tea significantly reduced blood levels of harmful LDL cholesterol.

·Cancer – Emerging clinical studies suggest that the polyphenols in green tea may play an important role in the prevention of cancer. Researchers also believe that polyphenols help kill cancerous cells and stop their progression.

·Diabetes – Green tea is traditionally used to control blood sugar in the body. Animal studies suggest that green tea may help prevent the development of Type 1 diabetes and slow the progression once it has developed, as it may help regulate glucose in the body.

Some small clinical studies have found that daily supplementation of the diet with green tea-extract powder lowers the haemoglobin A1c level in individuals with borderline diabetes.

·Liver disease – Population-based clinical studies have shown that those who drink more than 10 cups of green tea per day are less likely to develop disorders of the liver. Green tea also seems to protect the liver from the damaging effects of toxic substances such as alcohol.

Results from several animal and human studies suggest that catechin in green tea may help treat viral hepatitis (inflammation of the liver from a virus) although it should be noted that in these studies, catechin was isolated from green tea and used in very high concentrations.

·Weight loss – Clinical studies suggest that green tea extract may boost metabolism and help burn fat. One study confirmed that the combination of green tea and caffeine improved weight loss and maintenance in overweight and moderately obese individuals.

·Other uses – Drinking green tea has been found to be effective in a small clinical study for dental caries or tooth decay. Research also indicates that green tea may benefit arthritis sufferers by reducing inflammation and slowing cartilage breakdown. In addition, chemicals found in green tea may be effective in treating genital warts and preventing symptoms of colds and influenza.

How about a cuppa?

Producing the perfect cup of green tea is a tricky process. If not brewed properly, those same polyphenols that provide health benefits can ruin the flavour, making the tea taste “gassy”. But with the variety of quality products fortified with green tea extract available in the market, it’s easy to have the perfect cuppa.

The health benefits of green tea are overwhelmingly stacked in its favour, so maybe it’s time to let its unique health benefits grow on you! – Article courtesy of Dutch Lady

- THE STAR

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