Sedap atau sihat

Oleh NORLAILA HAMIMA JAMALUDDIN
norlaila@hmetro.com.my

“BERALIHLAH daripada makanan sedap kepada makanan sihat. Kebanyakan makanan sedap boleh menjadi makanan sihat jika kena caranya iaitu bermula daripada pemilihan bahan, penyediaan, kaedah memasak dan makan. Makanan harian sebenarnya boleh menjadi ubat atau pelindung daripada pelbagai penyakit.

“Banyak individu dan keluarga menderita kerana penyakit. Malah yang menyedihkan ialah, semakin ramai golongan muda menghidap penyakit kronik seperti obesiti, kencing manis, tekanan darah tinggi dan sesetengah jenis kanser, sedangkan ia boleh dicegah melalui penjagaan pemakanan harian,” kata aktivis kesihatan sosial yang juga Pegawai Penyelidikan Pusat Penyelidikan Perhutanan Malaysia (FRIM), Dr Lim Hin Fui.

Kajian membuktikan banyak penyakit hari ini disebabkan gaya hidup dan tabiat pemakanan tidak sihat. Dianggarkan 15 hingga 25 peratus rakyat Malaysia mungkin mendapat kanser dan setiap jam kira-kira enam orang diserang angin ahmar atau strok.

Lebih 50 peratus golongan dewasa berumur 40 tahun ke atas menghidapi sekurang-kurangnya satu penyakit dan antara penyakit kronik paling lazim ialah kencing manis dan tekanan darah tinggi.

Meskipun jumlah pesakit kronik bertambah setiap tahun, ia belum dapat menimbulkan kesedaran masyarakat untuk berubah kerana ramai menganggap penyakit berbahaya itu hanya berlaku kepada orang lain dan tidak akan menimpa mereka.

Bahkan kita juga bangga dengan budaya menjamu yang semakin kukuh dalam masyarakat kita. Dalam sebarang aktiviti, termasuk perjumpaan mahu pun mesyuarat kecil, pasti dilengkapi dengan makanan; sekurang-kurangnya teh tarik serta kuih muih walaupun ia diadakan sejurus selepas waktu makan tengah hari.

Menurut Dr Lim, makanan mempunyai dua ciri iaitu positif (menyihatkan badan dan memulihkan penyakit) atau negatif (menyebabkan penyakit).

Sama ada membawa faedah atau padah, jangan salahkan makanan kerana kuasa memilih ada di tangan kita dan kita yang bertanggungjawab terhadap tahap kesihatan diri.

Kegemukan adalah hasil pertama daripada amalan pemakanan tidak sihat yang menjadi pencetus kepada pelbagai masalah kesihatan lain kerana mengandungi banyak toksik.

Beliau berpendapat, makanan tidak sihat ini mengandungi banyak bahan toksik yang akhirnya merosakkan badan dengan mengakibatkan masalah obesiti, kencing manis, tekanan darah tinggi, angin ahmar, sakit jantung, kanser dan lemah tulang.

Katanya, penyakit tidak menyerang mendadak tetapi datang perlahan-lahan dalam tiga peringkat iaitu badan menjadi kurang selesa, mengalami gangguan pada bahagian tertentu dan akhirnya menyebabkan masalah pada seluruh badan hinggalah ia disahkan doktor.

Kira-kira 90 peratus masalah kesihatan berpunca daripada makanan yang mengakibatkan sistem pertahanan badan menjadi lemah.

Badan kita membabitkan kira-kira 60 trilion sel kecil termasuk sel darah, lemak, otot dan kulit. Pengumpulan toksik menyebabkan sel ‘demam’ dan akhirnya berlaku pelbagai masalah kesihatan.

Antara sumber bahan toksik ini ialah:

Makanan berasid Terlalu banyak mengambil ubat moden Terlalu banyak lemak Kolesterol Pencemaran alam sekitar “Apabila ditimpa penyakit, orang berbeza pendapat. Ada yang menganggap ia disebabkan faktor cuaca atau genetik, daya ketahanan badan yang lemah, tekanan, konflik, kurang bersenam, tidak cukup tidur dan rehat atau pencemaran alam sekitar. Bahkan ada yang menerimanya sebagai takdir, sedangkan kita boleh berusaha mengurangkan risiko mendapat penyakit. “Banyak jenis makanan boleh dikaitkan dengan penyakit, umpamanya makanan berlemak dan kolesterol tinggi menyebabkan penyakit jantung dan strok, manakala makanan mengandungi banyak garam boleh merangsang kenaikan tekanan darah yang akhirnya membawa kepada pelbagai masalah lain,” katanya ketika menyampaikan ceramah sempena sambutan Bulan Kesihatan anjuran FRIM. Formula untuk sihat Untuk menjadi sihat, Dr Lim menyarankan enam panduan iaitu: Bertukar kepada jenis makanan yang menyihatkan Buat perubahan secara perlahan-lahan; satu persatu Fahami kesan detoksifikasi (penyingkiran toksik dari badan) Laksanakan amalan pemakanan yang baru ini dengan yakin Mulakan bersenam Kuatkan pegangan rohani (keagamaan) Untuk sihat, pemakanan kita harus mengandungi 80 peratus makanan bersifat alkali dan 20 peratus lagi makanan bersifat asid bagi meningkatkan daya ketahanan badan. Namun apa yang berlaku kini adalah sebaliknya iaitu 80 peratus makanan bersifat asid dan hanya 20 peratus makanan beralkali. “Semua makanan yang dihadam dipecahkan kepada partikel kecil yang boleh bersifat asid, alkali atau neutral. Ia bergantung kepada kandungan galian di dalam makanan berkenaan. “Individu yang mengambil banyak makanan bersifat asid lebih mudah jatuh sakit berbanding individu yang melebihkan makanan beralkali,” katanya. Komposisi makanan yang disarankan ialah 60 peratus sayur-sayuran, 20 peratus buah-buahan, 10 peratus sumber karbohidrat dan 10 peratus lagi protein (lebih baik jika protein tumbuh-tumbuhan). Walaupun tahu sayur dan buah itu penting, pengambilan serat harian kebanyakan rakyat Malaysia sekitar lima gram sehari. Komposisi ini membolehkan kita mencapai saranan pengambilan serat harian oleh sebanyak 20 gram sehari. Makanan yang dianggap beralkali: Sayur-sayuran segar Buah-buahan segar Bijirin (milet) Kekacang dan produk kekacang Jus buah segar Makanan yang dianggap berasid: Bijirin (beras perang, beras putih, gandum, oat) Daging Makanan laut Ayam Telur Sayur-sayuran dan buah-buahan awet Makanan dihasilkan daripada karbohidrat (roti, mi, biskut) Makanan yang banyak menggunakan gula putih (ais krim, coklat, makanan dalam tin, sos) Minuman contohnya susu diproses, dadih, kopi, minuman ringan dan berkarbonat Susu dan produk tenusu Bahan masak (bawang merah dan putih, halia, minyak haiwan dan lada) Perubatan semula jadi Bapa pakar perubatan moden, Hippocrates pernah berkata ‘makanan sihat adalah ubat paling baik’. Bagi Dr Lim, kata-kata ini terbukti apabila bapa mentuanya kini disahkan sembuh daripada kanser prostat selepas mereka sekeluarga mengubah corak pemakanan dengan melebihkan makanan beralkali dan mengurangkan semua jenis makanan mengandungi banyak bahan toksik. Mereka sekeluarga juga lebih berhati-hati ketika memilih sayur di pasar. Pilihan mereka ialah sayur organik kerana kebanyakan sayur yang dijual di pasar menggunakan baja kimia dan racun serangga bagi memastikan ia kelihatan cantik dan bebas daripada dimakan serangga atau ulat. Katanya, dua bahan ini boleh menambah beban pada badan, terutama hati yang berfungsi sebagai penapis bahan toksik. Memahami kesan negatif daripada makanan yang dikelaskan sebagai berasid, Dr Lim berkata, secara perlahan-lahan mereka mengeluarkan daging, ayam, telur, makanan dalam tin dan semua makanan sejuk beku berproses daripada menu harian. Ia digantikan dengan sayur-sayuran dan buah-buahan segar. Dia sekeluarga juga memilih beras perang yang terbukti kaya khasiat dan ada banyak kelebihan berbanding beras putih. “Menjaga makanan saja tidak cukup kerana perubatan semula jadi memerlukan pendekatan menyeluruh atau holistik yang membabitkan pembersihan badan, ketenangan minda dan rohani. “Biasanya pendekatan holistik diambil apabila ubat moden tidak lagi berkesan atau tidak mahu mendapat kesan sampingan ubat moden. Namun kebanyakan orang menggabungkan rawatan moden dan tradisional. “Pendekatan agama seperti bersembahyang juga penting untuk menenangkan fikiran dan jiwa. Ia secara tidak langsung mengurangkan tekanan dan meningkatkan tahap kesihatan seseorang,” katanya. Kenali kesan detoksifikasi Selepas tempoh tertentu mengamalkan pemakanan sihat, anda mungkin mengalami kesan detoksifikasi iaitu pengeluaran toksik dari badan. Namun jangan panik kerana ia bukan tanda penyakit, sebaliknya permulaan kepada kesihatan lebih baik. Detoksifikasi boleh dilakukan dengan mengamalkan pemakanan sihat, minum teh hijau atau herba atau menggunakan kaedah penyingkiran toksik lain. Menurutnya, kesan dialami mereka sekeluarga termasuk demam, hidung berair, batuk, sembap, perut terasa senak, sakit kepala (sedikit), najis menjadi cair dan badan menyingkirkan banyak lendir atau mukus. Namun dalam tempoh ini anda tidak digalakkan mengambil ubat moden kerana ubat moden menghentikan proses detoksifikasi. Sebagai permulaan untuk menyingkir toksik dari badan ialah meminum jus buah atau sayur (bersama seratnya) yang disediakan sendiri di rumah. Permulaan pemakanan sihat Dr Lim berkata, pemakanan sihat boleh dilakukan secara perlahan-lahan dan berperingkat. Antara perubahan mudah yang boleh dilakukan ialah: Makan beras perang menggantikan beras putih. Bukan semua orang boleh menerima rasa beras perang. Jadi, anda boleh memasukkan sedikit (segenggam) beras perang ke dalam beras putih. Tambah kuantiti beras perang selepas satu tempoh tertentu. Kaedah ini bertujuan membiasakan lidah anda sekeluarga dengan rasa beras perang. Ganti roti putih dengan roti gandum mil penuh (berserat) Guna garam laut untuk menggantikan garam putih Guna gula perang, madu atau molases bagi menggantikan gula putih. Gula putih dikatakan antara penyebab utama yang boleh melemahkan daya ketahanan badan. Elak penggunaan monosodium glutamat (MSG) Kurangkan penggunaan sos soya dan sebarang sos lain kerana ia mengandungi banyak garam Kurangkan pengambilan daging, ayam dan telur; lebihkan sayur-sayuran dan buah-buahan segar. Ini kerana ayam dan daging mengandungi terlalu banyak protein dan lemak. Ayam pula mengandungi banyak antibiotik dan hormon pembesaran supaya anak ayam yang diternak boleh dipasarkan dalam tempoh 32 hari saja! Hentikan mengambil makanan yang mempunyai pewarna dan perasa tiruan “Orang Melayu sangat beruntung kerana secara tradisionalnya mereka mengambil banyak ulam. Ulam sangat baik kerana ia bukan saja kaya vitamin dan mineral (kalsium, fosforus, zat besi dan kalium) tetapi ia juga mengandungi antioksidan untuk melawan kesan radikal bebas yang merosakkan sel. “Antara ulam yang kaya antioksidan ialah pegaga, selom dan ulam raja yang murah dan mudah diperoleh. Ia juga mengandungi enzim untuk menyihatkan sel. “Selain itu banyak jenis sayur-sayuran kampung dan herba yang boleh membantu meningkatkan kesihatan seperti misai kucing, bunga kantan, daun kari, gajus dan jantung pisang. “Amalan ini menjadikan kami sekeluarga jarang sakit dan tanpa disedari, berat badan kami turun perlahan-lahan tanpa perlu berdiet atau mengambil ubat. Lebih penting, ayah mentua saya sembuh walaupun tidak menjalani rawatan kemoterapi,” katanya. Cari langkah pertama Kita tidak perlu menjadi vegetarian, sebaliknya lakukan apa yang anda mampu untuk meningkatkan kesihatan. Anda masih boleh mengambil makanan kegemaran tetapi kurangkan kuantitinya dan lebihkan sayur dan buah. Selain itu ambil langkah pertama yang sesuai dengan anda seperti: Minum jus buah atau sayur sekurang-kurangnya segelas sehari. Sebaiknya sediakan jus tanpa gula, jika mahu masukkan gula perang atau madu Guna beras perang (campurkan segenggam beras perang setiap kali anda masak nasi. Ini untuk membiasakan lidah menerima rasa beras perang sebelum beralih sepenuhnya kepada beras perang) Kurangkan penggunaan sos, kicap, garam dan gula dalam masakan; gantikan dengan rempah dan herba Kurangkan daging, ayam dan telur Kurangkan makanan bergoreng dan berlemak Guna kaedah memasak yang lebih sihat seperti mereneh, kukus atau bakar berbanding goreng Gantikan roti putih dengan roti gandum mil penuh (berserat) Makan buah-buahan sebagai pembuka selera atau pencuci mulut. Hidangkan ia selepas makan bersama keluarga untuk membiasakan anak dengan corak pemakanan ini Jadikan buah-buahan sebagai snek Jadikan ulam atau sayur-sayuran sebagai bahan yang wajib ada dalam pinggan anda setiap kali makan

It’s a hormone thing

A woman can suffer a variety of symptoms directly linked to the level of oestrogen in her body

FEELING hot, flush and your temper on edge all the time? Your once flawless skin beginning to feel dry and showing signs of wrinkles? Millions of women around the world would be able to identify with these symptoms.

What they are unaware of is that these symptoms could be closely linked to the level of hormones in their bodies.

The demands and stress from today’s modern lifestyle can affect the production of the female hormone, oestrogen, which is crucial to a woman’s physical development.

It plays a role in her ability to bear children, and has bearings on her overall health. It is also responsible for the woman’s menstrual cycle, breast formation and manages her libido.

Therefore, any imbalance to the level of oestrogen in the body can cause severe repercussions to a woman’s health, resulting in symptoms like those above. So it is imperative that the level of oestrogen in a woman’s body be maintained at an acceptable level.

In a clinical study conducted on genistein, Dr Francesco Squadrito discovered that women who took 54mg of genistein a day (equivalent to two gallons of soy milk per day) have far denser bones than those who did not.

Genistein is one of the most active ingredients contained in soy isoflavones, which refers to a group of natural compounds extracted from soy. Another name for genistein is ‘phytoestrogen’.

The combination of ‘phyto’ (which means plant) and ‘oestrogen’ (the female hormone) implies that genistein has the ability to mimic the functions of oestrogen in the body, which enables it to modulate any imbalance.

The benefits of genistein include:

» Radiant, flawless and supple skin

Any fluctuations in the oestrogen level caused by everyday stresses can greatly reduce the ability of the cells in our skin to manufacture collagen and hyaluronic acid, which are the two key components for healthy, radiant skin. Therefore, balancing the fluctuation is important to maintain good skin health.

» Moisturising skin from the inside

Hyaluronic acid is a natural moisturiser contained within our skin cells. However, when the skin is exposed to environmental pollutants and stress for a long period of time, the production of hyaluronic acid reduce progressively. This will then cause our skin to become dry and wrinkled.

One of the most important discoveries about genistein is its ability to stimulate skin cells to increase the production of hyaluronic acid, which keeps the skin moisturised. Thus, it is advisable to drink at least eight glasses of water when consuming genistein.

» Alleviating menopausal symptoms

Hot flushes, irregular periods, night sweats, interrupted sleep, mood swings and vaginal thinning are some of the common symptoms of menopause. The more severe symptoms lead to an increased risk of osteoporosis (brittle bones) and heart problems. All these symptoms are directly linked to the decline of oestrogen in the body.

Genistein is a natural and safe alternative to increase the level of oestrogen in the body, hence alleviating the symptoms.

» Keeps calcium ‘locked in’ bones

Bones are dynamic living tissues that continuously ‘dissolve’ and ‘reform’ at an average of 10% annually. An adult skeleton is estimated to experience a complete cycle once in every 10 years.

The level of oestrogen in the body controls the process of bone reformation. A drop in the oestrogen level will result in the process of bone dissolving at a faster rate compared to the ability of the bone to reform.

As calcium – which is a mineral responsible for keeping bones strong and healthy – is stored in the bone, the increased rate of bones dissolving also indicates a loss of calcium. This will then lead to an increased risk from osteoporosis, or commonly known as brittle bones.

Genistein mimics the action of oestrogen, therefore, slowing down the process of calcium-loss in bones. This keeps bones stronger and denser over time.

It is advisable to include a variety of dairy products or calcium supplements in our daily diet to facilitate the cells to form stronger bones.

Choosing a good source of genistein is important as not all genistein supplements are the same. Here are some tips to identifying a good genistein supplement:

• Ensure that it contains a fixed and standard amount of genistein required by the body.

• Ensure that it is in tablet or capsule form. Genistein in powdered form may contain additional flavouring or proteins that may interfere with its absorption.

• Ensure that it is extracted from organic soy beans.

• Ensure that it has a low protein content. This is especially important when consumed by individuals with a history of gout.

• Ensure that it is sugar and flavour free. This is important for diabetics and those who are weight conscious.

• Ensure that it is made from non-genetically modified (non-GMO) soy beans.

• Ensure that it is individually packed in aluminium blister to maintain freshness and effectiveness.

Guide to a woman’s heart

By LIM WEY WEN

Clinical Practice Guidelines for the prevention of cardiovascular disease in women.

TO medical professionals, drawing up a typical patient profile for various diseases has its virtues – it allows them to make quick clinical decisions on a daily basis. But this kind of stereotyping has its flaws. Patients with atypical symptoms may be overlooked or misdiagnosed. Preventative measures preached to high-risk groups may fall on deaf ears for others who do not fit the profile.

Such is the case with cardiovascular disease (CVD).

Initially thought of as a disease that affects mostly men, the manifestation of the disease in women has been overlooked until recently, as statistics have begun to show that women are equally at risk.

Health Ministry director-general Tan Sri Dr Ismail Merican stressed the need to address this disparity in his message for the 2008 Clinical Practise Guidelines (CPG) on the prevention of CVD in women. “With increasing and longer life expectancy of 76.4 years in the Malaysian woman, CVD will become the most common cause of morbidity and mortality for women in Malaysia ...” he wrote.

Unfortunately, many women and healthcare professionals have not been able to shake the perception of CVD as a men’s disease. To address this issue, the new CPG aims to increase the awareness of healthcare providers about CVD in women by addressing five clinical questions.

1. Are there gender specific differences in the epidemiology of CVD?

CHD

·In general, women develop coronary heart disease (CHD) about 10 years later than men.

·Due to certain cultural norms, such as a passive nature and a tendency towards denial, women with CHD symptoms are less likely to be referred for appropriate investigations. The presence of other diseases or conditions such as arthritis and obesity may also cause physicians to overlook the possibility of CHD.

Stroke

·Stroke is now the second leading cause of death in women worldwide after CHD.

·Data from the United States National Health and Nutrition Examination Survey (NHANES) showed that women in the age group 45-54 were twice as likely as men in the same age group to suffer strokes.

2. Do women with CVD present in the same manner as men?

CHD

·When CVD is present in women, early symptoms are often atypical ones such as shortness of breath, sleep disturbances and fatigue. However, during a heart attack, women are as likely as men to present with typical chest pains associated with sweating.

·Conventional stress tests have a lower diagnostic accuracy in women. However, a normal stress ECG at an adequate workload is a good indication that there is no significant blocks in the coronary arteries.

Stroke

·Women are more likely to report vague sensations not classical of stroke, such as changes in consciousness or disorientation. They could also experience non-neurological symptoms such as shortness of breath and chest pain.

3. Are there gender differences in the management of CVD?

·Although data on the management of CHD in women are limited, those available suggest most of the benefits seen in men can be extrapolated to women.

·Women with CHD should be treated in the same manner and as aggressively as men.

4. Are the risk factors for cardiovascular disease different in women?

Generally speaking, obesity, diabetes, sedentary lifestyles and smoking are CVD risk factors for both men and women, but their impact may differ.

CHD

·Elderly hypertensive women and young female smokers are especially at risk of CHD.

·Women who smoke or consume alcohol are more at risk of CVD than their male counterparts. This risk is greatly increased if a woman smoker is also on combination oral contraceptives.

Stroke

·Women and men share many common risk factors for stroke, which includes a family history of premature stroke and a previous history of stroke.

·Women also face additional gender-specific risk factors such as certain low-dose oral contraceptive use, combined hormone therapy for postmenopausal women, complications in pregnancy (pre-eclampsia) and migraine.

5. How do you prevent cardiovascular disease in women?

Even without overt symptoms, women should have their cardiovascular risk assessed. Assessment of CVD risk involves:

1. History: Look for symptoms of CHD, family history of premature CHD (CHD at an early age), smoking status, and physical activity.

2. Physical examination: BMI, waist circumference, pulse and blood pressure.

3. Laboratory investigations: Blood sugar levels, and lipid profile.

The prevention of CVD involves:

1. Those with high risk: Intensive risk factor reduction with lifestyle changes and medication to achieve target levels.

2. Those at risk: Non-pharmacological intervention with diet and physical activity. If the targets are not achieved, the use of medication may be considered.

3. Those with optimal risk: Continue with healthy lifestyle measures.

This article is a summary of the 2008 Clinical Practise Guidelines on the Prevention of Cardiovascular Disease in Women. The full version of the guidelines can be downloaded from the Ministry of Health website, www.moh.gov.my.

Our fat livers

By WIN-SON YING

In last week’s article, we discussed the two different types of fatty liver – alcoholic fatty liver, and non-alcoholic fatty liver, as well as the risk factors that increase an individual’s chances of getting the condition. This week, we look at how common fatty liver is and explore the different approaches used in the management of this condition.

ALCOHOLIC liver disease, which is due to excessive alcohol consumption, includes alcoholic fatty liver, alcoholic hepatitis, and cirrhosis. The number of people dying from alcoholic cirrhosis (characterised by scarring of the liver) is usually used as an indicator of the prevalence of alcoholic liver disease in a population.

In the UK, death rates from alcoholic cirrhosis have shot up drastically – an 88% increase between 1974 and 1994. The highest increase was recorded in young men aged 35 to 44. Every year, seven out of 100,000 individuals in the UK die of alcoholic cirrhosis.

Essential phospholipids (EPL), which is isolated from soy bean, has been found to have protective, curative and regenerative effects on the membranes of liver cell. Basically, EPLs are incorporated into the cell membrane of damaged liver cells, replacing the lost phospholipids in the structure of the cell membrane.

In this part of the world, studies have been more focused on the other type of fatty liver – fatty liver which is non-alcohol induced.

Non-alcoholic fatty liver disease (NAFLD) is probably the most common liver disorder worldwide and has emerged as the most frequent cause of abnormal liver enzymes within the US. In our region, the Asia-Pacific Working Party for the study of NAFLD (APWP-NAFLD) has discovered that the incidence of the major risk factors for NAFLD is increasing dramatically in the Asia-Pacific region.

These risk factors include type 2 diabetes, obesity, glucose intolerance, as well as abnormal levels of lipids and cholesterol in the blood. Surveys show that the percentage of people with NAFLD in the general population across Asia varies from 5% to 40%.

Japan in the late 80s had a NAFLD prevalence of around 9 to 14%. This figure has increased to 30% over the last two decades due to lifestyle changes, which sees more obese and diabetic individuals in the Japanese population.

In our own country, 17 out of every 100 individuals are diagnosed with NAFLD. The chances of being diagnosed with NAFLD are even greater for individuals with concomitant risk factors such as diabetes, obesity, and unfavourable levels of cholesterol.

In a recent study carried out by the University Malaya Medical Centre (UMMC) on patients with fatty liver, it was found that 84% of them had the more severe form of fatty liver known as non-alcoholic steatohepatitis (NASH), and 11% of them had already developed cirrhosis.

The close association between risk factors such as obesity and diabetes with fatty liver was also shown in that same study, with more than half of the patients (59%) found to be either diabetic or have impaired glucose tolerance, and 77% of them found to be obese.

Lifestyle modification

Diet control and increased physical activity play an important role in the management of fatty liver. Lifestyle-mediated weight loss by reducing calorie intake and increasing activity is generally recommended to reduce liver fat content. Aerobic exercise reduces weight by preferentially decreasing visceral obesity while maintaining muscle mass.

Weight loss, diet and exercise have all been shown to improve liver enzymes, which in most instances are the first signs which warn you that something is not too right about your liver.

If you have fatty liver and find yourself gulping down a few pints of beer every night, it may be wise to give up alcohol. Your fatty liver is most probably alcohol-induced. The foundation of therapy for alcoholic liver disease is abstinence, which remains the cornerstone of treatment for this disease till today.

Treatments

The treatment of NAFLD patients usually focuses on the management of associated conditions such as obesity, diabetes mellitus, and high lipid levels.

Two classes of anti-diabetic drugs commonly used to correct insulin resistance are the biguanides (eg metformin) and thiazolidinediones (eg rosiglitazone and pioglitazone). The latter generally work by redistributing fat away from sites where it is not supposed to accumulate, in particular the liver.

Bariatric surgery is carried out only in cases where the patient is severely obese and fails to respond to lifestyle measures. The basic idea of this procedure is to reduce the size of the stomach in order to reduce the amount of food a person consumes.

Nutritional support such as essential phospholipids (EPL), which are isolated from soy beans, has also been studied in the management of fatty liver. During the reign of Emperor Sheng Nung (2838 BC), the soy bean plant was one of the five “holy cereals” and considered essential for human life.

In modern science, EPL administration is found to have protective, curative and regenerative effects on the membranes of liver cells.

Basically, EPLs are incorporated into the cell membrane of damaged liver cells, replacing the lost phospholipids in the structure of the cell membrane.

Some of the beneficial effects of EPL include:

·Formation and regeneration of the cell membrane, which helps maintain the structure and function of the cells

·As a component of bile, which aids in the digestion of fat

·Increases cholesterol solubility, which decreases the risk of stroke

·Antioxidant protection

The effects of EPLs have been found to be more pronounced the earlier they are given. Other nutritional support which contains silymarin (extracted from milk thistle) and betaine are also widely used.

Expected rise in Malaysia

The majority of fatty liver patients in Malaysia have concomittant conditions such as obesity and diabetes. With the prevalence of diabetes increasing globally, the number of fatty liver cases in Malaysia will also be expected to increase. The knowledge that more and more of us are indulging in sedentary lifestyles is not comforting either.

The prevalence of NAFLD in obese people has been reported to be as high as 80% in this region, which translates to eight NAFLD cases out of every 10 obese individuals.

A multimodal treatment plan which targets the underlying risk factors for fatty liver may be the best option to manage this condition.

To quote Paracelsus (1493-1541), “…because the liver is a source of many diseases, and is a noble organ that serves many organs, almost all of them: so it suffers, it is not a small suffering, but a great and manifold one”.

It is time for us to take our liver seriously and the onus is on us to keep it healthy.

References:

1. Amarapurkar, D.N. et al. 2007 “How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences?”, Journal of Gastroenterology and Hepatology; 22: 788 – 793.

2. Chan, H.L.Y. et al 2007 “How should we manage patients with NAFLD in 2007?”, Journal of Gastroenterology and Hepatology; 22: 801 - 808.

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This article is courtesy of sanofi-aventis.

Gagal rancang beri tekanan kepada warga tua

Oleh SHANIKA ABDULLATIB

KESIHATAN fizikal dan mental mesti dijaga seiring dengan peningkatan usia.

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DR. ANG KIM TENG

TIDAK dinafikan, kesedaran terhadap kesihatan fizikal semakin meningkat di kalangan warga emas. Malah, di mana-mana saja, warga emas dilihat semakin menitikberatkan aspek pemakanan serta melakukan senaman secara konsisten bagi menghindari penyakit seperti jantung, darah tinggi dan kencing manis.

Namun tidak begitu apabila bercakap tentang kesihatan mental.

Menurut Presiden Persatuan Kesihatan Mental Malaysia (MMHA), Dr. Ang Kim Teng, kegagalan menyiapkan benteng pertahanan mental sebelum bersara adalah antara faktor utama warga emas kerapkali mengalami tekanan dan terdedah kepada kemurungan.

“Kesilapan utama ialah selepas bersara baru hendak merancang. Malah menerusi pemerhatian dan kajian saya, ramai yang hanya mengambil berat mengenai kesihatan fizikal berbanding mental,” katanya.

Ujar Kim Teng, sudah tiba masanya kesihatan mental bagi mereka yang menuju ke usia emas ini dititikberatkan. Jelasnya, perkara ini bukan sukar untuk dilakukan walaupun sudah mencecah umur 70 tahun.

Jelasnya lagi, kesihatan mental yang tidak dijaga akan membawa kepada gangguan emosi yang parah berikutan usia mereka yang semakin lanjut.

“Dengan menanam pemikiran positif, secara tidak langsung, warga emas ini menguatkan sistem imunisasi, menjadi lebih gembira dan kuat dalam menghadapi hari tua,” ujarnya pada pelancaran program Golden Third Age (G3A).

Bukan sekadar itu, kurang kesedaran mengenai kekuatan kuasa emosi turut menjadi punca mengapa ramai warga emas di Malaysia mudah menghadapi tekanan serta berasa kesunyian.

Kim Teng juga menambah, jangan terkejut sekiranya idea membunuh diri juga wujud dalam pemikiran warga emas akibat gangguan emosi yang tidak dirawat dari awal.

“Dengan jumlah warga emas yang mencecah dua juta orang, jelas sekali Malaysia sedang menuju ke arah penuaan penduduk yang dijangka melebihi 10 peratus menjelang tahun 2025.

“Justeru, tanpa kekuatan emosi dan fizikal, nescaya kita tidak dapat mengharungi usia emas dengan sempurna,” tegasnya yang berpendapat tiada kerja yang khusus, anak-anak yang telah besar serta berpindah ke persekitaran baru juga menjadi sebahagian faktor kepada kemurungan dan gangguan emosi lain yang dihadapi oleh golongan ini.