Joint pain can be a common issue for many people, especially as they age. Natural remedies are becoming increasingly popular for their gentle and holistic approach to pain relief. Here are some natural remedies that may help reduce joint pain and improve mobility:

1. Turmeric 

Turmeric contains curcumin, a powerful anti-inflammatory compound. It can help reduce swelling and relieve pain. You can add turmeric to your meals or take it as a supplement to enjoy its benefits.

2. Ginger 

Ginger has been used for centuries as a natural remedy for pain and inflammation. It can be consumed fresh, in tea, or as a supplement to help reduce joint pain caused by inflammation.

3. Epsom Salt 

Soaking in a warm bath with Epsom salt can soothe aching joints. The magnesium in the salt is absorbed through the skin and may help reduce inflammation and relieve pain.

4. Fish Oil 

Rich in omega-3 fatty acids, fish oil can help reduce joint stiffness and inflammation. Regular consumption of fish oil may support joint health and reduce the discomfort caused by conditions like arthritis.

5. Massage and Stretching 

Gentle massage and stretching exercises can improve circulation, reduce stiffness, and promote flexibility in the joints. Consider incorporating yoga or other low-impact exercises into your routine for long-term joint health.

6. Hot and Cold Therapy 

Alternating between hot and cold treatments can help manage joint pain. Cold packs reduce swelling, while heat promotes blood flow and relaxes muscles around the joints.

7. Apple Cider Vinegar 

Apple cider vinegar contains acetic acid, which may help break down minerals and toxins that can build up in the joints. A tablespoon of apple cider vinegar in warm water may ease discomfort when taken daily.

Natural remedies for joint pain can complement traditional treatments and may offer relief without the side effects of medications. As always, it's important to consult with a healthcare provider before starting any new treatment.

Rushing for work and no time to do your make up? Spending too much money on cosmetics? Don’t worry, you still can pamper yourself. Nutritious food and a healthy lifestyle can help to enhance your beauty. 

1. Vitamins and Minerals for Skin Health

Certain nutrients are essential for maintaining healthy skin:

• Vitamin C: Found in citrus fruits and berries such as kiwi, strawberries and oranges. Vitamin C is a powerful antioxidant which can protect against radical damage and boost collagen production. 

• Vitamin E: Mostly found in avocados, almond and sunflower seeds. Vitamin E is a good oil that helps reduce UV damage to our skin. Also, it helps in scar and wound healing.

• Zinc. Reduce inflammation and protect against UV radiation

Majority of vitamins and minerals can be gained from fruits and vegetables. Try to incorporate green leafy vegetables in every meal and consume at least one serving of fruits after main meals to help fulfill your daily dose of vitamins. 

2. Protein for Strong Hair and Nails

Protein provides us an important material to produce strong hair and nails which is keratin. If we consume inadequate protein, our hair becomes brittle and might be unable to grow to desired length. Include protein sources such as mackerel, salmon, tuna or chicken inside your meal. The recommended serving size is one slice of any of them. 

3. Good Microbial Health in The Gut 

Prebiotics and probiotics help provide a good environment for our gut. Good source of probiotics includes yoghurt, kefir, tempeh and kombucha; while prebiotics may be found in foods rich in fiber such as fruits and vegetables. Studies found that probiotics restored the balance of good bacteria in the gut, thus helping to reduce skin conditions such as acne and eczema.

4. Limit Sugary and Processed Food 

Excessive intake of sugary and processed food can trigger various skin problems such as inflammation, acne and speed up aging. Besides, excessive sugar intake might lead to obesity that might cause insecurity regarding one’s appearance.

5. Hydration is Important

Water is important to us. It maintains our skin elasticity, reduces dryness and provides moisture for our skin. On the other hand, water flushes out toxins and provides a clean environment for the gut. Drink at least 6-8 glasses of plain water per day to help maintain skin hydration.

Remember, true beauty radiates from within. By making mindful choices in your diet and lifestyle, you can achieve a healthier, more vibrant appearance. Take charge of your beauty journey today—one nutritious meal at a time!

Ramadan is a sacred month of fasting for Muslims worldwide. While fasting from dawn (Suhoor) to sunset (Iftar) is obligatory, managing medication during this period can be challenging, especially for those with chronic conditions or illnesses. Here are some practical tips to ensure that your health remains a priority while observing your fast :

1. Consult Your Doctor or Pharmacist

Before Ramadan begins, consult your doctor to adjust your medication schedule if needed. Some medicines can be taken at Suhoor and Iftar instead of during the day. Never alter your dosage or schedule without professional advice.

2. Plan Your Medication Schedule

• Once Daily Medicines: Take the dose at Iftar or Suhoor as recommended.

• Twice Daily Medicines: Adjust to take one dose at Iftar and the second dose at Suhoor.

• Thrice or More Daily Medicines: Discuss with your doctor for alternatives or modified schedules.

3. Use Long-Acting Medications

For some conditions, long-acting or extended-release medications can be prescribed. 

These provide a consistent effect throughout the day, reducing the need for frequent doses.

4. Stay Hydrated 

Although you can only drink water during non-fasting hours, ensure you hydrate well between Iftar and Suhoor. 

This is especially important for those taking diuretics or medicines that increase water loss.

5. Set Reminders

The change in routine during Ramadan can make it easy to forget your medication. 

Use alarms or phone reminders to ensure you take your medicine on time.

6. Be Mindful of Food Interactions

Certain medications need to be taken with food or on an empty stomach. 

Pay attention to these instructions and adjust your Suhoor and Iftar meals accordingly.

7. Inhalers and Topical Medications 

Inhalers, creams, and eye/ear drops generally do not break the fast according to many Islamic scholars. However, confirm this with your local religious authority and your healthcare provider.

8. Monitor Your Health

Watch for symptoms like dizziness, fatigue, or worsening of your condition. 

If fasting impacts your health significantly, Islamic teachings allow for exceptions in cases of illness.

9. Consider Alternate Dosage Forms

If swallowing pills is difficult during Suhoor or Iftar, ask your doctor about alternatives. 

Example: syrups, dissolvable tablets, or injections.

10. Exemptions for Health Reasons

Islam permits individuals who are sick or have chronic conditions to skip fasting and compensate by feeding the needy (Fidyah) or fasting later if possible. Prioritize your health and consult your religious leader for guidance.

Final Thoughts

Balancing fasting and medication requires careful planning and communication with healthcare professionals. Always prioritize your health while observing Ramadan. With the right approach, you can maintain your well-being and spiritual commitments during this holy month.

Magnesium is often overshadowed by other nutrients like calcium and vitamin D, but this humble mineral deserves a spotlight of its own. Essential for more than 300 biochemical reactions in the body, magnesium plays a vital role in maintaining overall health and well-being. Let’s explore why magnesium is known as the “wonder mineral.”

1. It promotes sleep

- Magnesium supplements improve sleep issues such as insomnia,  including sleep efficiency, sleep time and onset latency, early morning awakening.

2. May combat anxiety/depression

- Magnesium plays a critical role in brain function and mood; low levels are linked to risk of depression. Magnesium could help you handle stress better.

3. Relief Migraine and Headaches

- Research finds that people who frequently experience headaches and migraines tend to have lower magnesium levels than people who don’t.

4. Bone Health

- Magnesium is important for bone health. Some studies tie a higher intake to a lower risk of osteoporosis, fractures, and bone loss.

5. May promote heart health

- Studies show that increasing magnesium levels can benefit high blood pressure, helping to reduce both systolic and diastolic blood pressure.

6.  Prevent Migraine

- Several studies suggest that magnesium supplements may even prevent and treat migraine headache.

7. Reduce symptoms of PMS

- Studies show that magnesium can help manage PMS symptoms by relax the smooth muscle of the uterus and reduce prostaglandins that cause menstrual pain.

Why Is Magnesium Bisglycinate Considered the Superior Supplemental Form?

Magnesium bisglycinate is widely regarded as the superior form of magnesium supplement due to its exceptional bioavailability and gentle effects on the digestive system. This chelated form of magnesium, bound to the amino acid glycine, ensures efficient absorption and optimal utilization by the body. Unlike other magnesium supplements, it is less likely to cause gastrointestinal discomfort, such as diarrhea, making it particularly suitable for individuals with sensitive stomach. 

Don’t wait—grab your magnesium supplement today and take the first step toward a healthier, better life!

Our bodies require proper nourishment to maintain energy levels and live a quality life. Food plays a vital role in fueling our bodies, and its importance cannot be overstated. While all foods provide some form of energy, certain nutrient-dense options stand out for their ability to sustain energy longer and promote overall well-being.

Some quick fixes, like refined carbs found in white bread, pastries, cakes, and pasta, provide a rapid energy boost due to their quick absorption. However, these foods often lead to energy crashes, leaving us feeling groggy and tired. In contrast, consuming nutrient-packed superfoods that digest slowly can provide steady and sustained energy without the unwanted side effects of a sugar spike.

When we feel fatigued, it's tempting to reach for energy drinks. However, these drinks typically contain 21 to 34 grams of sugar per ounce (30 ml). A standard 150 ml can of energy drink can have over 80 grams of sugar, leading to energy crashes and heightened lethargy. Instead, consider turning to natural, nutrient-rich superfoods to keep your energy levels stable. Here are some excellent options:

1. Legumes: A Fiber-Rich Energy Source

Legumes are a powerhouse of nutrition, offering high protein and fiber content. Green peas, almonds, and chickpeas are among the top choices. Green peas, for instance, are low-glycemic and contain complex carbohydrates and proteins, which help regulate blood sugar levels and sustain energy. Additionally, they are rich in vitamin B1 (thiamine), which aids in converting nutrients into energy. Incorporate green peas into stews and soups for an energy boost.

2. Almonds: A Convenient Energy Snack

Almonds are an excellent finger food packed with protein, healthy fats, and riboflavin. Riboflavin plays a crucial role in converting food into energy, making almonds a fatigue-fighting snack. Just a quarter cup of almonds provides seven grams of protein and 37% of your daily riboflavin needs. For a quick and nutritious snack, roast almonds in an air fryer or oven, pack them in a container, and take them to class, work, or the gym.

3. Dark Chocolate: A Tasty Energy Booster

Dark chocolate not only helps combat fatigue but also curbs sugar cravings. Opt for high-quality dark chocolate with 70–80% cocoa content, which is rich in fiber, iron, and magnesium. While moderation is key due to its fat and sugar content, enjoying a small portion of dark chocolate can boost energy and enhance mood.

4. Blueberries: Tiny Yet Mighty  

Blueberries are a popular superfood known for their high antioxidant content. A 100-gram serving contains 2.4 grams of fiber, 8.1 mg of vitamin C, and 12 mg of calcium, all while being low in calories. Blueberries help reduce inflammation, improve exercise performance, and aid recovery. Enjoy them on their own or as a topping for yogurt and fruit salads.

Conclusion

There is no single “miracle” food for boosting energy instantly without potential downsides. However, incorporating nutrient-rich superfoods like legumes, almonds, dark chocolate, and blueberries into your daily diet can provide a steady energy supply. Combine these with a healthy lifestyle to maintain optimal energy levels and enhance overall well-being.

Puasa Ramadan ertinya menahan diri daripada makan dan minum serta segala perbuatan yang boleh membatalkan puasa, mulai dari terbit fajar sehinggalah terbenam matahari pada bulan Ramadan.

Pada bulan Ramadan, umat Islam akan menahan lapar dan dahaga lebih daripada 12 jam sehari. Oleh itu, mereka yang berpuasa perlu menggunakan dua waktu makan yang dibenarkan sehari iaitu sahur dan iftar dengan sebaik mungkin.

Penghidratan adalah salah satu risiko yang dihadapi semasa berpuasa kerana cuaca yang panas dan lembap. Ramai yang mengalami sakit kepala dan masalah untuk menumpukan perhatian semasa berpuasa. Tabiat pemakanan yang berbeza dalam 30 hari berpuasa boleh mengakibatkan pelbagai masalah penghadaman, sakti gastrik dan sembelit. Ketidakhadaman juga boleh berlaku akibat makan terlalu banyak daripada biasa semasa berbuka.

Namun begitu, daripada menambahkan jumlah makanan semasa berbuka atau sahur, lebih baik bagi anda memilih jenis dan kualiti makanan yang sesuai dimakan supaya kesan-kesan negatif berpuasa di bulan Ramadan boleh dielakkan.
Mari lihat jenis makanan yang sesuai dimakan sewaktu sahur dan berbuka untuk meningkatkan tenaga anda.

1) Kekalkan Hidrasi dengan Makanan yang Mempunyai Kandungan Air yang Tinggi

Selain daripada minum air kosong, anda boleh mengambil makanan yang tinggi dengan kandungan air seperti tembikai merah, timun, tomato dan strawberi.
Elakkan minuman yang mengandungi kafein seperti kopi dan teh kerana kafein boleh menambah pembuangan air kencing dan menyebabkan air dalam badan kita kurang.

2) Makanan Tinggi Protein

Makanan tinggi protein boleh membantu anda kurang penat sepanjang hari. Protein mengambil masa lebih lama untuk hadam dan anda akan merasa kenyang untuk tempoh masa yang panjang. Telur, keju, ayam dan daging adalah pilihan yang baik.
Susu tepung seperti MK Nutrasure dan Ensure Gold Liquid sesuai untuk diambil semasa bulan puasa kerana kandungan protein yang lebih tinggi berbanding susu tepung yang lain.

3) Makanan yang Tinggi Kandungan Kanji dan Serat

Makanan berserat tinggi boleh membantu mengawal ketidakhadaman dan pedih ulu hati. Anda boleh cuba oat, bijirin tinggi serat dan roti gandum penuh kerana ia boleh membantu anda merasa kenyang untuk tempoh masa yang lebih panjang.
Karbohidrat kompleks dalam makanan berkanji seperti nasi perang, dan kentang adalah pilihan yang bagus untuk tenaga dan mampu meningkatkan tumpuan. 

4) Penghadaman yang Lancar dengan Buah-buahan dan Sayur-sayuran

Untuk mengatasi masalah sembelit, kurangkan pengambilan makanan yang berlemak, bergoreng dan pedas sewaktu sahur. Anda boleh meningkatkan pengambilan buah-buahan dan sayur-sayuran kerana ia kaya dengan serat dan boleh mengelakkan sembelit. Amalkan brokoli, sayur bayam, keledek, lentil dalam pemakanan.

5) Pilih Lemak dan Minyak yang Sesuai

Lemak yang baik memainkan peranan yang penting dalam diet seimbang. Makanan yang kaya dengan lemak sihat seperti salmon, zaitun dan kacang-kacang boleh dirangkumi dalam pemakanan anda. Selain itu, minyak yang digunakan untuk memasak juga sangat penting. Anda boleh menggunakan minyak kepala dara, minyak dedak beras dan lain-lain.

6) Berbuka Puasa dengan Kurma

Kurma secara tradisinya dimakan pada permulaan iftar kerana ia mengandungi gula semula jadi, serat dan mineral. Selain itu, kurma mudah dicerna, menjadikannya sumber tenaga dan nutrien yang cepat bagi individu yang berpuasa.

7) Supplemen

Selain pemakanan yang sihat, supplemen dan minuman sihat adalah sumber vitamin dan mineral yang bagus.
Individu yang mempunyai masalah gastrik atau ketidakhadaman boleh mengambil probiotik untuk mengurangkan senak dan kembung yang disebabkan oleh perubahan tabiat makan secara tiba-tiba. Probiotik boleh membantu menyeimbangkan semula mikroflora normal dalam sistem pencernaan dan megurangkan risiko gastrik.

Susu tepung seperti MK Glucerwin, MK Colostrum, Ensure Gold Liquid, Glucerna membekalkan nutrisi yang lengkap dan membekalkan makro- dan micro-nutrien yang diperlukan oleh badan kita. Susu tepung adalah pilihan alternatif yang sesuai untuk Muslim yang berpuasa sebagai makanan penggantian pada waktu sahur atau iftar.

Bagi individu yang tidak gemar susu tepung atau minuman sihat, multivitamin adalah pilihan terbaik semasa bulan puasa. Multivitamin bukan hanya membekalkan vitamin dan mineral yang lengkap, ia juga membantu membekalkan tenaga untuk badan kita sepanjang tempoh
berpuasa. Oleh itu, multivitamin adalah penting pada bulan puasa untuk menambahkan balik vitamin dan mineral yang diperlukan untuk seharian.

Perlu diingatkan bahawa kesederhanaan adalah kunci untuk pemakanan sihat. Selain itu, kita juga harus mengamalkan pergerakan fizikal yang aktif, contohnya, dengan berjalan-jalan atau berjoging setiap hari. Pemakanan yang sihat adalah penting dan harus diamalkan selalu bukan sahaja pada bulan puasa! Dengan ini, kami mengucapkan selamat berpuasa kepada semua orang!

Body weight is one of many determinants of health. Maintaining a healthy body weight can lower your risks towards many weight-related diseases and health issues. However, each person’s healthy weight range will vary and depend on factors such as age, gender, genetics, body frame, existing medical history and lifestyle habits. So, weight management is a process of adopting long-term lifestyle modification to maintain a healthy body weight on the basis of these factors.

You may assess your body weight status via two simple physical examination methods:

Body mass index (BMI)

BMI is a person’s weight in kilograms divided by the square of height in meters. A high BMI can indicate high body fatness, and a low BMI can indicate too low body fatness.

• If your BMI is less than 18.5, it falls within the underweight range.
• If your BMI is 18.5 to 24.9, it falls within the normal or healthy weight range.
• If your BMI is 25.0 to 29.9, it falls within the overweight range.
• If your BMI is 30.0 or higher, it falls within the obese range.

Waist Circumference

Another way to estimate your potential disease risk is to measure your waist circumference. It is also a good estimate of visceral fat, the dangerous internal fat that coats the organ. Waist circumference measurement correlates well with abdominal fat content irrespective of the BMI. It is most useful in individuals who are in the normal and overweight categories of BMI. Your waistline may be telling you that you have a higher risk of developing obesity-related conditions if you are:

• A man whose waist circumference is more than 40 inches
• A non-pregnant woman whose waist circumference is more than 35 inches

Being too thin (underweight) or obese (overweight), both may impact your health condition. Maintaining a healthy weight is not only important for improving your physical appearance but is also beneficial for your overall well-being. Prioritizing weight management not only lowers the health risks but can also lead to an improved quality of life.

Underweight is a condition when energy intake is less than energy expenditure, it may lead to health risks such as malnutrition, decreased immune function, osteoporosis, infertility, developmental delays, and increased risk of surgical complications 2. A person may be underweight due to genetics, improper metabolism, lack of appetite, over-exercising, certain medicines, and underlying medical problems such as overactive thyroid, anorexia, etc 3.

Overweight and obesity are consequence of an energy imbalance where energy intake has exceeded energy expenditure over a considerable period of time, lead to abnormal or excessive fat accumulation that presents a risk to health. Obesity is one side of the double burden of malnutrition, and today more people are obese than underweight in every region. It once considered a problem only in high-income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings. The World Health Organization (WHO) reported one in five Malaysian adults will be obese by 2025 4. Obese and overweight people are more prone to illnesses and conditions such as diabetes, hypertension, heart diseases, gall bladder diseases and osteoarthritis. Obesity may influence the risk of cancers of the colon, rectum, prostate, gall bladder, cervix, endometrium and ovary. Obesity also affects mobility, physical endurance and other functional measures. Obese people may also have low self-esteem 5.

Factors Weight Gain

Poor diet and overeating

Poor eating habits are probably the leading cause of obesity among all others. More often than not, people are likely to gain weight when they consume more calories than they burn through physical activity. Examples of unhealthy eating choices that directly lead to weight gain include:

• Eating more portions than your body needs
• Eating excessive amounts of processed or fast food
• Consuming beverages with too much sugar content
• Drinking too much alcohol 6

Physical inactivity

Another important factor is the lack of physical exercise. Nowadays, most people’s work desk jobs that consist of sitting and staring at a computer for long hours every day. When it comes to leisure activities, many of us prefer to lounge around and binge-watch or scroll endlessly on our phones instead of heading out to exercise. If you fail to incorporate exercise into your daily lives, the energy provided by the food you eat will only be stored by the body to become fat, which can lead to excessive weight gain 6.

Stress, emotional factors, and poor sleep

Some people eat more than usual when they are bored, angry, upset, or stressed. This “stress eating” are due to secretion of stress hormone called cortisol in our body. It increases appetite and may ramp up desire to eat fatty, salty or sugary “comfort foods” 7.  Studies also have found that the less people sleep, the more likely they are to have overweight or obesity. This is partly because hormones that are released during sleep help control appetite and the body’s use of energy 8.

Health Conditions

On fairly rare occasions, obesity could be caused by certain health conditions. Examples of medical conditions that commonly contribute to weight gain include hormonal imbalance, hypothyroidism and Cushing’s syndrome. Other medical problems such as arthritis can hinder one from engaging in physical activity, which can ultimately result in weight gain as well. Certain medicines also may cause weight gain, including some corticosteroids, antidepressants, and seizure medicines 8.

Ways to Achieve Healthy Weight

Healthy eating

Healthy eating features a variety of healthy foods. Fad diets may promise fast results, but such diets limit your nutritional intake, can be unhealthy, and tend to fail in the long run. A healthy eating plan shall:

• Emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• Include a variety of protein foods such as seafood, lean meats and poultry, eggs, legumes (beans and peas), soy products, nuts, and seeds.
• Is low in added sugars, sodium, saturated fats, trans fats, and cholesterol.
• Stay within your daily calorie needs 9.

Exercise regularly and stay physically active

Engaging in physical activity is one of the simplest ways to get rid of excess weight on your body. The more you exercise, the more calories your body burns off. On top of burning fat, exercising also increases your metabolism significantly 6. The World Health Organization (WHO) recommended regular exercise 60 minutes per day for children and 150 minutes per week for adults, to lower the risk or overweight and obesity 4.

Set smart weight goals

Losing or gaining weight does not happen overnight. A good and healthy weight loss or weight gain should adopt the concept of energy balance as its guiding principle. Setting a SMART goal should be specific, measurable, achievable, relevant and timely. For example, if your BMI is 23 kg/m2 and above, losing 10% to 15% of your current body weight over 6 months at a rate of 0.5 kg to 1 kg a week is a healthy target 10.

Last but not least, a heathy and successful weight management include regular monitoring of your progress and maintenance of healthy weight in the long term. Making lifestyle modifications goes beyond the physical aspects, this requires you to tap into your mental stamina as well. Believe it or not, your outlook or mindset can play an essential role in your weight management journey.

Reference:

1. Assessing Your Weight. (2022, June 3). Centers for Disease Control and Prevention. Retrieved September 10, 2022, from https://www.cdc.gov/healthyweight/assessing/index.html
2. Marcin, A. (2017, May 15). 6 Health Risks of Being Underweight. Healthline. Retrieved September 10, 2022, from https://www.healthline.com/health/underweight-health-risks
3. Underweight | Office on Women’s Health. (n.d.). Retrieved September 10, 2022, from https://www.womenshealth.gov/healthy-weight/underweight
4. Obesity. (2020, February 21). Retrieved September 10, 2022, from https://www.who.int/health-topics/obesity#tab=tab_1
5. Surainee bt. Wahab. (2012, April 20). Weight Management. PORTAL MyHEALTH. Retrieved September 10, 2022, from https://www.cdc.gov/healthyweight/assessing/index.html
6. Homage. (2022, January 4). Weight Management Programmes by Doctors in Singapore. Retrieved September 10, 2022, from https://www.homage.sg/resources/weight-management/
7. Harvard Health. (2021, February 15). Why stress causes people to overeat. Retrieved September 10, 2022, from https://www.health.harvard.edu/staying-healthy/why-stress-causes-people-to-overeat
8. National Heart, Lung, and Blood Institute. (2012). What causes overweight and obesity? Retrieved September 10, 2012, from https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity
9. Physical Activity for a Healthy Weight. (2022, June 16). Centers for Disease Control and Prevention. Retrieved September 10, 2022, from https://www.cdc.gov/healthyweight/physical_activity/index.html
10. HealthHub. (n.d.). Retrieved September 10, 2022, from https://www.healthhub.sg/live-healthy/410/Healthy%20Weight

Intermittent fasting is a dietary approach that involves interspacing planned periods of fasting with regular eating. It is an eating pattern that cycle between periods of eating and    fasting. It focuses more on when to eat rather than what to eat.

Intermittent fasting works by prolonging the period when the body has burned through the calories consumed from the last meal and begins to burn fat. The body will use up its sugar stores and starts to burn fat after hours of fasting, this process is known as metabolic switching.

Benefits of Intermittent Fasting

Help Lose Weight and Visceral Fat

Intermittent fasting can support hormone function to facilitate weight loss. Lower insulin levels, higher Human Growth Hormone (HGH) levels, and increased amounts of noradrenaline can assist in the breakdown of body fat and facilitate its use for energy. Because of this, fasting actually increases the body metabolic rate and eventually help to burn more calories. According to a 2014 review of the scientific literature, intermittent fasting can cause weight loss of 3–8% over 3–24 weeks.

Lowering risk for Type II Diabetes

Intermittent fasting has been shown to have major benefits for insulin resistance, leading to an impressive reduction in blood sugar levels. In human studies on intermittent fasting, fasting blood sugar has been reduced by 3–6% over the course of 8–12 weeks in people with prediabetes. Fasting insulin has been reduced by 20–31%.

Beneficial for Heart Health

Intermittent fasting improves heart health by controlling the risk factors that lead to heart diseases. The risk factors include blood sugar levels, blood pressures, cholesterol levels and inflammatory markers.

Improve Sleep

Research suggests that intermittent fasting may improve sleeping quality by reinforcing the circadian rhythms.

Types of Intermittent Fasting

Time-Restricted Fasting (16/8 method)

The 16/8 method involves choosing of an eating window (about 8 hours) everyday and fast during the remaining 16 hours. It is also known as the Leangains protocol and can be very simple as we only have to skip our breakfast and not eating anything after dinner.

The easiest way to practice 16/8 method is to choose a 16-hours fasting period which include the time we spent sleeping. For example:

• 9 a.m. to 5 p.m.
• 10 a.m. to 6 p.m.
• 12 a.m. to 8 p.m.

Fast Diet (5:2 method)

It involves eating normal diet 5 days a week and restricting the calorie intake to 500 – 600 in the other 2 days. During the fast, the calorie intake is limited to 500 for women and 600 for men respectively.

For example, we may have normal diet every day of the week except Friday and Saturday. For those 2 days, we can eat 2 or 3 small meals with total calories not exceeding the limit.

Eat Stop Eat

Following this method, one has to practice a 24-hours fast once or twice per week. Important tip here is to eat responsibly after the fast. Eating responsibly refers to eating normal diet where we don’t binge because we just fasted, but we also don’t restrict ourselves with an extreme diet (eating more or less than we need).

For example, if we finish our dinner at 7p.m., then the next meal should be on 7.pm. the next day. By this, we have completed a 24-hours fast. Water, coffee, and zero-calories beverages are allowed during this period to help with the fast.

This method may be difficult for many people to follow. However, we can start with 14 hours fast and slowly increase to 24 hours.

Alternate Day Fasting

There are several different versions of this method. Some of them allow 500 calories (about 25% of calorie need) during the fast and eat normally during the non-fasting days. A full fast every other day can be rather extreme and is not recommended to beginners.

Fasting Tips

1. Drink cinnamon tea during the fast to help suppress the appetite.
2. Exercise just before or during the eating window.
3. Meditation during the fasting period to pass the hunger pangs.
4. Practice balance and healthy diet.
5. Always check with your primary care provider before starting any restrictive eating plan.

Who Should Avoid Intermittent Fasting

1. Teenagers under 18 years old.
2. Pregnant or breastfeeding women.
3. People with diabetes mellitus.
4. People with eating disorders such as anorexia.

References

1. Mosley M, Spencer M. The FastDiet: Lose Weight, Stay Healthy, and Live Longer with the Simple Secret of Intermittent Fasting. Atria Books. 2013
2. Williams KV, Mullen ML, Kelley DE, Wing RR. The effect of short periods of caloric restriction on weight loss and glycemic control in type 2 diabetes. Diabetes Care. 1998;21:2–8.
3. Varady KA, Bhutani S, Klempel MC, et al. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutr J. 2013;12:146.
4. LeCheminant JD, Christenson E, Bailey BW, Tucker LA. Restricting night-time eating reduces daily energy intake in healthy young men: a short-term cross-over study. Br J Nutr. 2013;110:2108–2113.
5. Ekmekcioglu C, Touitou Y. Chronobiological aspects of food intake and metabolism and their relevance on energy balance and weight regulation. Obesity Reviews. 2011;12:14– 25.

Superfood is a term that is commonly used to describe foods that offers multiple health benefits through its nutrient contents, beyond providing energy. Consumption of these foods is linked with disease prevention and improved quality of life.

The idea of superfoods offers longevity and vitality has long been described in various cultures. Recent findings on essential fatty acids, dietary fibers, essential micronutrients and antioxidants make them the main substances related to superfoods.

Superfood such as Omega-3 and Omega-6 fatty acids must be obtained in diet as the human body does not produce them naturally. Better known types of omega-3 fatty acids, Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are mainly associated with benefits for the heart. They reduce inflammation, improve blood flow, prevent formation of fat deposit in blood vessel, and reduce triglyceride levels. Consuming a diet enriched with EPA and DHA can lead to less frequent and milder headache in patients with migraine, while moderate intakes may also delay cognitive function decline in elderly men. Some studies suggest that dietary interventions combined with pharmacological treatments might have an additive benefit in prevention of such condition.

Micronutrients are vitamins and minerals which are consumed in small quantities but are nonetheless essential for physical and mental development. There is a long list of essential micronutrients, however the ones that are particularly deficient in diets include iron, zinc, calcium, iodine, vitamin A, B-vitamins, and vitamin C. Effects of these micronutrient deficiency includes night blindness, eyesight problems, anemia and stunted growth.

Some superfoods confer benefit to digestive health via dietary fibers. These includes soluble fibers (inulin) and non-digestible carbohydrates (oligosaccharides), better known as prebiotics that helps nourish microflora in the intestines. Insoluble fibers help with bowel movement, reduces risk of intestinal diseases and helps in weight control.

Phytochemicals found in plants provide their colors and characteristic smell. There are multiple different types of known phytochemicals which includes tannins, flavonoids, and saponins. These chemicals are produced by plants for their own benefit and do not have nutritional value for human. Yet, they have been found to provide multiple health benefits via antioxidant properties, hailed for preventing cancer, protecting cells from damage, and reducing signs of ageing.

One popular example of superfood would be the Goji berry, originating from China. Also known commonly as Wolfberry, they contain phytochemicals zeaxanthin dan carotene which are important in maintaining healthy eyesight. They can be taken as part of the diet, providing energy through complex sugar and protein contents. Carbohydrates betaine, cerebroside, beta-sitosterol in Goji berry help counter nerve damage in neurodegenerative diseases and protect the eyes from glaucoma –both are important especially in ageing populations.

A lot of wholegrains have also been discussed to have superfood property. An analysis of more than 3000 middle- and older-aged American adults over years indicates taking more whole grains in diet may protect against heart disease. Person who ate at least 3 servings of whole grains daily had smaller increases in blood sugar levels, blood pressure, and waist size compared with persons who ate less than one-half serving per day.

An excellent example of super grain is Quinoa. It provides a rich supply of protein, dietary fibers, several B vitamins, dietary minerals, magnesium, phosphorus, and manganese. Quinoa seeds also have low glycemic index, it provides energy source in small, lasting amount, which makes it a good staple food item. Raw quinoa seeds provide polyphenols at a higher level compared to many fruits and vegetables. Polyphenols are known to have powerful anti-inflammatory benefits for the body, and it is believed that they could help to reduce the risk of some cancers, cardiovascular disease and other illnesses too. Indigestible carbohydrate fibres called oligosaccharides found in the grain act as prebiotic, they provide nutrients for intestinal microflora.

Pumpkin, a fruit that is more nutritionally similar to vegetables, is a filling, nutrient-dense food with multiple health benefit. It’s very high in antioxidants, such as alpha-carotene, beta-carotene and beta-cryptoxanthin. These can neutralize free radicals, stopping them from damaging human cells. High content of vitamins A, C, and E, iron and folate help strengthen immunity. Pumpkins’ high vitamin A, lutein and zeaxanthin contents can protect the eyes against sight loss, which becomes more common with age. Pumpkin is also a good source of fiber and helps suppress appetite. It has mildly diuretic property, eating a lot of pumpkin may induce a “water pill”-like reaction, increasing the amount of water and salt the body expels through urine. This is particularly beneficial for people concerned with their blood pressure.

The beetroot is the taproot portion of a beet plant, one of several cultivated varieties of Beta vulgaris. Beetroot had been used as part of traditional remedy for multiple health benefits, particularly relating to blood and heart health. Studies have shown that beetroot juice can modestly help reduce blood pressure. Beetroot can be eaten raw, used for juice extraction, baked or boiled. Polyphenols and dietary fiber in red beetroot juice helps diminish blood cholesterol level by stimulating excretion of cholesterol in intestines. It has also been studied to stop weight gain and reduce cholesterol in obese individuals. Beetroot is rich in soluble dietary fiber that provide moderate increase in blood sugar level post-meal, and especially beneficial in pre-diabetic.  Regular consumption as part of diet also appears to positively influence physiological response to exercise. Therefore, beet root is an especially valuable super food for people concerned with their body weight and cardiovascular risks.

Although a lot of superfoods are from plant origin, fatty fishes are one of the exceptions. They provide essential proteins not commonly found in plants, which the human body use for energy production, growth, and repair. Fatty fishes found in cold water such as salmon, trout, and sardines contain higher level of omega-3 fatty acids compared to their warm-water counterparts. These benefits are however offset by risk of heavy metal contamination in larger fish. Thus, it is only recommended to take one to two servings of the fish weekly.

To get the best result from superfoods, is it best to consume them raw, cooked, or processed? The answer depends on which superfood one is referring to. In general, taking them as closely to their natural form is preferable to retain its nutrients. Juicing of beetroots, natural drying of goji berries, and removing the outermost shell of quinoa helps improve palatability and ease consumption. However, excessive consumption beyond dietary recommendation exposes to other risks. Red beet root, for example, accumulates oxalic acid responsible for causing kidney stones. Larger fatty fish may also have heavy metal content in their muscle tissue and may adversely affect some populations proportionately. In these cases, taking pre-processed food or supplements focusing on their benefit may be the wiser choice.

Most of the studies that display theoretical health benefits of these food products would use extracts in laboratory. In experimental studies, the method to gain the extract themselves are usually more vigorous than is possible in human digestive system. Therefore, a lot of the supporting studies may overestimate or underestimate the actual health benefit when we consume the food as part of our diet.

It is also important to note that phytochemical content may vary among species, cultivation method, and food handling prior to consumption. The magnitude of potential risks that may be associated with phytochemicals is still unclear, especially when taken in large doses as supplements. These extracted substances may have possible side effects or may interact with other substances in the body, e.g., medications. There are only few documented cases suggesting that certain phytochemicals may also be harmful. For instance, some studies have shown that overdosing on beta-carotene may increase the risk of lung cancer in smokers. Therefore, you should always speak to your healthcare provider before taking phytochemical supplements. Taking it as functional food in moderation is probably safer in the long run.

To quote the 2021 Dietary Guidance to Improve Cardiovascular Health scientific statement, developed under chair of the American Heart Association’s writing group, one can improve cardiovascular health and reduce cardiovascular risk with an emphasis on dietary patterns and food-based guidance beyond naming individual foods or nutrients. It is important to first emphasize on balanced diet, and to take superfoods strategically to enrich our nutrient consumption.

References

1. Quinoa – Wikipedia [Internet]. En.wikipedia.org. 2022 [cited 18 April 2022]. Available from: https://en.wikipedia.org/wiki/Quinoa
2. 9 Super Grains With Health Benefits You Need to Try [Internet]. HubPages. 2022 [cited 18 April 2022]. Available from: https://discover.hubpages.com/health/Super-Grains-Your-Guide-To-The-Newest-Hollywood-Superfoods
3. Superfoods or Superhype? [Internet]. The Nutrition Source. 2022 [cited 18 April 2022]. Available from: https://www.hsph.harvard.edu/nutritionsource/superfoods/
4. Barsby J, Cowley J, Leemaqz S, Grieger J, McKeating D, Perkins A et al. Nutritional properties of selected superfood extracts and their potential health benefits. PeerJ. 2021;9:e12525.
5. The Role of Proteins, Fats and Carbohydrates in Our Diet and Health [Internet]. Healthpedian.org. 2022 [cited 18 April 2022]. Available from: https://www.healthpedian.org/the-role-of-proteins-fats-and-carbohydrates-in-our-diet-and-health/
6. Omega-3-enriched diet cuts headache days | Latest news for Doctors, Nurses and Pharmacists | Pharmacy [Internet]. MIMS News. 2022 [cited 4 April 2022]. Available from: https://specialty.mims.com/topic/omega-3-enriched-diet-cuts-headache-days-in-migraine-
7. Kendall C, Esfahani A, Jenkins D. The link between dietary fibre and human health. Food Hydrocolloids. 2010;24(1):42-48.
8. Ritchie H, Roser M. Micronutrient Deficiency [Internet]. Our World in Data. 2022 [cited 3 February 2022]. Available from: https://ourworldindata.org/micronutrient-deficiency?utm_medium=syndication&utm_source=scribd#hidden-hunger-index
9. Goji berries a potential arsenal against age-related macular degeneration | Latest news for Doctors, Nurses and Pharmacists | Multidisciplinary [Internet]. MIMS News. 2022 [cited 18 April 2022]. Available from: https://specialty.mims.com/topic/goji-berries-a-potential-arsenal-against-age-related-macular-degeneration?channel=multi-specialty&utm_medium=email&_hsmi=202393192&_hsenc=p2ANqtz-9bZXdq_h6_uBQH5DFoIcHXH-iS6Za-A0TknP3rGbXfJvYHIX78OtHoVU4MvlP-E88nUmrjbXdxANrUdkqdI0dmHTgCVQ&utm_content=202393192&utm_source=hs_email
10. Phytochemicals and their Potential Health Benefits [Internet]. Healthpedian.org. 2022 [cited 18 April 2022]. Available from: https://www.healthpedian.org/phytochemicals-and-their-potential-health-benefits/
11. Sawicki C, Jacques P, Lichtenstein A, Rogers G, Ma J, Saltzman E et al. Whole- and Refined-Grain Consumption and Longitudinal Changes in Cardiometabolic Risk Factors in the Framingham Offspring Cohort. The Journal of Nutrition. 2021;151(9):2790-2799.
12. Barsby J, Cowley J, Leemaqz S, Grieger J, McKeating D, Perkins A et al. Nutritional properties of selected superfood extracts and their potential health benefits. PeerJ. 2021;9:e12525.
13. Saravanan V, Manokaran S. Physico-chemical studies and evaluation of diuretic activity of <i>Cucurbita maxima</i>. Bangladesh Journal of Pharmacology. 2012;7(4).
14. Beetroot – Wikipedia [Internet]. En.wikipedia.org. 2022 [cited 18 April 2022]. Available from: https://en.wikipedia.org/wiki/Beetroot
15. Siervo M, Lara J, Ogbonmwan I, Mathers J. Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis. The Journal of Nutrition. 2013;143(6):818-826.
16. Vega C. What Is a Heart-Healthy Diet? American Heart Association Weighs in With New Dietary Recommendations. Presentation presented at; 2021; Medscape.org.

According to National Health and Morbidity Survey (NHMS 2019), about 1.7 million individuals in Malaysia are at risk of suffering from 3Hs, namely hypertension, hyperlipidemia (high cholesterol) and hyperglycemia (diabetes) which leads to cardiovascular disease. It is well known that cardiovascular disease is the leading cause of death in Malaysia.

Plukenetia volubilis L. (family Euphorbiaceae), commonly known as Sacha Inchi, Inca peanut or mountain peanut has been adopted as a food source due to its high nutritional value and potential benefits for human health. Sacha Inchi is used as a traditional remedy and in recent years has been introduced to cosmetics and dietary supplementation markets successfully.

Content of Sacha Inchi

Medicinal applications of Sacha Inchi have been discussed for a variety of diseases. Besides its cholesterol and blood pressure lowering properties, it is presumed that Sacha Inchi may promotes health improvements in diabetic, arthritis, cancers (breast cancer, prostate carcinoma) and in certain cases of psychological disorders patients. Due to its recognized high content of essential fatty acids, phenolic compounds and vitamin E, Sacha Inchi provides antioxidant properties, hypolipidemic, immunomodulation and emollient activity, as well as capacity to remove heavy metals from aqueous solutions.

Sacha inchi has been known to be rich in unsaturated fatty acids. Its seed contains:

1. Polyunsaturated fatty acids like α-linolenic (ALA) and linoleic (LA), bases of ω-3 and -6, respectively, γ- and δ-tocopherols,
2. Natural forms of vitamin E, known for its antioxi­dant activity and antitumor potential.

Essential fatty acids in the form of omega 3 and omega 6 contained in sacha inchi oil are 50.5% and 34.1% respectively, while the protein content in Sacha Inchi is 22-30%. These biomolecules are involved in immune functions, where it helps in mediating inflamma­tory response. Intake of omega-3 fatty acids from other sources is widely used to lower high blood triglyceride levels which positively influence blood flow and blood clotting.  In this context, Sacha Inchi oil has been assumed to be an alternative to fish oil.

Studies on Sacha Inchi

Gonzales et al. conducted a study for four months on 15 males and 15 females without the history of hyperlipidaemia or any other disease likely to affect lipid me­tabolism showed that the permanent consumption of sacha inchi oil for four consecutive months showed 10 % increase in plasma HDL level. Other study also stated that consumption of 50 g of sacha inchi can significantly lower triglyceride levels. Although sacha inchi oil may have an unpleasant taste, it is believed that over time it can be accepted by consumers. Commercial sacha inchi oil is classified as extra virgin oil or virgin oil and has low oxidative stability thus should not be consumed hot.

Polyunsaturated fatty acids of Sacha Inchi is the main component that contributed to its beneficial function in variety of processes such as regulation of the inflammatory immune response, blood pres­sure, re­duction of triglyceride levels in the circulation, prevention of neurodegenerative and neuropsychiatric disorder, main­tenance of memory and visual function. Supplementation of yoghurt with sacha inchi seeds has been studied recently, revealing an increase of the levels of ALA and LA of 25- and 50-fold respectively, from an average PUFA content of 3.60 to 81.51% in the modified product compared to the control.

It is considered that fatty acids with higher fraction of PUFA in sacha inchi are beneficial to human health due to their antiatherogenic, antithrombogenic and hypocholester­olemic effects, besides having a high nutritional value.

Sources of sacha inci

Sources of sacha inchi can be varies in these modern days. Various brands has marketed sacha inchi in form of oil and softgels. Some people would simply enjoy sacha inchi by roasting the seed or mix with other nuts for snacking.

References

1. Cárdenas DM, Gómez Rave LJ, Soto JA. Biological Activity of Sacha Inchi (Plukenetia volubilis Linneo) and Potential Uses in Human Health: A Review. Food Technol Biotechnol. 2021 Sep;59(3):253-266.
2. Gonzales GF, Gonzales C. A randomized, double-blind pla­cebo-controlled study on acceptability, safety and efficacy of oral administration of sacha inchi oil (Plukenetia volubilis L.) in adult human subjects. Food Chem Toxicol. 2014;65: 168–76.
3. Hanssen, H.-P. and Schmitz-Hübsch, M. (2011) Nuts and Seeds in Health and Disease Prevention, Chapter 117 – Sacha Inchi (Plukenetia volubilis L.) Nut Oil and Its Therapeutic and Nutritional Uses. Academic Press. Available at: https://doi.org/10.1016/B978-0-12-375688-6.10117-3 (Accessed: April 14, 2023).

In this era of globalization, most people make caffeine their loyal company day in, day out to stay alert while working. Caffeine is also well-known among adolescents and young adults to burn the midnight oil or during their café hunting endeavors.

WHAT IS CAFFEINE?

Caffeine is a natural stimulant that is widely consumed all over the world. It mainly stimulates  our brain by blocking the effects of neurotransmitter adenosine that cause sleepiness and fatigue. As a result, it helps us to stay awake and prevent exhaustion.

Caffeine is usually found in plants including tea leaves and cocoa beans. There are also synthetically formed caffeine that has been added in some food, drinks, tablets  and supplements. Therefore, try to avoid these caffeinated foods and drinks six hours prior to sleep to prevent trouble sleeping.

As we all know, consumption of caffeine has often been related to sleep problems, increased case of heart palpitations and anxiety. Nonetheless, research found that it also has various health benefits.

BENEFITS OF CAFFEINE

·         Improves alertness and psychological health

A study reported that caffeine may improve alertness and decrease fatigue. Besides, caffeine has been linked to decrease risk of depression and suicide (Walter, 2022).

·         Boost metabolism and burn fat

Due to caffeine’s ability to stimulate the central nervous system, it may aid in boosting metabolism and promote fat burning. However, these effects are likely to remain small over the long term (Tabrizi et al. 2019). Another study also found that caffeine may decrease appetite which can slightly help in reducing weight gain (Walter, 2022).

·         Enhance exercise performance

It is reported that small amount of caffeine consumed before exercise can possibly show an acute increase in exercise performance (Diaz-Lara et al. 2022).

·         Reduced risk of chronic illnesses

Several studies reported that regular consumption of caffeine may decrease the risk of developing type 2 diabetes, endometrial cancer, liver cancer, gall-stones and gall-bladder cancers (Walter, 2022).

Note: The health benefits of caffeine are influenced by the amount of caffeine intake and physical condition of the consumer as well.

SIDE EFFECTS OF CAFFEINE

Excess consumption of caffeine is substantially associated with various side effects on our health.

Caffeine may also interact with calcium and iron absorption that may lead to calcium and iron deficiency. Besides, it can interact with some medications causing it to limit the effectiveness of certain medications. Thus, medications and caffeinated food and drinks should be taken separately.

Note: Caffeine affects individual differently. Some individual may experience the symptoms above with a small intake of caffeine within short period of time and vice versa.

RECOMMENDED DOSAGE

It is considered safe for healthy adults to consume 400 mg of caffeine a day (FDA 2018).

As for pregnant women, you are advised to limit your caffeine intake (≤ 200 mg per day) as it can easily cross the placenta which results in increased risk of miscarriage  and low birth weight.

A moderate amount of caffeine for Individual A may feel like a high dose for Individual B. In conclusion, every individual has different caffeine tolerance.

THE TAKEAWAY

Moderation is the key. Consume caffeine in moderation (≤400mg caffeine per day) so that you can enjoy the health benefits of caffeine without incurring it negative impact. You may also consider other ways to stay energized throughout the day by getting 7-8 hours of sleep per night and exercise regularly. If you have trouble staying awake and frequently feel tired, consult a doctor/physician for further assistance.

REFERENCES

Diaz-Lara, J., Grgic, J., Detanico, D., Botella, J., Jiménez, S. L. & Del Coso, J. 2022. Effects of acute caffeine intake on combat sports performance: A systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition: 1-16.

FDA. 2018. How much caffeine is too much? https://www.fda.gov/consumers- updates/spilling-beans-how-much-caffeine-too-much [3 May 2023].

Saimaiti, A., Zhou, D.D., Li, J., Xiong, R.G., Gan, R.Y., Huang, S.Y., Shang, A., Zhao, C.N., Li, H.Y. & Li, H.B. 2022. Dietary sources, health benefits, and risks of caffeine. Critical Reviews in Food Science and Nutrition: 1-19.

Saleem, A. R., Iftikhar, R., Kazmi, S. M. A. & Majeed, A. 2022. Effects of caffeine on mood, memory and attention. Pakistan Journal of Medical & Health Sciences 16(10): 541- 541.

Tabrizi, R., Saneei, P., Lankarani, K. B., Akbari, M., Kolahdooz, F., Esmaillzadeh, A., Nadi- Ravandi, S., Mazoochi, M. & Asemi, Z. 2019. The effects of caffeine intake on weight loss: a systematic review and dos-response meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition 59(16): 2688-2696.

Walter, K. 2022. Caffeine and health. JAMA 327(7): 693-693.

INTRODUCTION

Diabetic foot is one of the most devastating complications of diabetes, which is defined as infection, ulceration or destruction of tissues at the foot. It is usually the result of poor glycemic control, underlying nerve damage, peripheral vascular disease, or poor foot care.

According to World Health Organization, the global prevalence of diabetes among adults of > 18 years old has risen from 4.8% in 1980 to 8.5% in the year of 2014. As the numbers of newly diagnosed diabetics increase yearly, the incidences of foot ulcer also increase.

ETIOLOGY

The etiology of diabetic foot ulcer is multifactorial, however the common underlying causes are:

1. Poor blood sugar control
2. Formation of calluses
3. Foot deformities
4. Improper foot care
5. Underlying nerve damage / poor blood circulation of lower limbs
6. Dry skin

PRESENTATION OF THE WOUND

1. Well defined wound
2. Punch out-look
3. Surrounding skin will often be calloused
4. Depth of wound typically depending on the thickness of callous

The most common cause of ulceration is due to repetitive mechanical forces of gait, which lead to callus (pre-ulcerative lesion). When the callus becomes too thick, the callus will press on the soft tissues underneath which eventually lead to ulceration.

A layer of whitish, macerated, moist tissue found under the surface of the callus indicates that the foot is close to ulceration, and urgent removal of the callus is necessary.

Figure 1 showing diabetic ulcer revealed underneath of callus.

TREATMENT

PHARMACOLOGICAL TREATMENT

Oral Analgesic

Simple pain killer ( e.g. paracetamol or NSAIDs) should be considered in mild and moderate pain in diabetic foot ulcer patient.

• Topical antibiotic

Topical antibiotics are used to treat infected wound or to further prevent infection in uninfected wound.

• Oral Antibiotic

Oral antibiotic will be prescribed by physician when there are systemic symptoms of infection in diabetic foot ulcer patient.

NON PHARMACOLOGICAL TREATMENT

Wound care

Wound care is important in management of diabetic foot. There are different types of wound dressing which helps in reduce symptom, provide wound protection and improve wound healing. It has 3 important steps in diabetic wound management:

1. Debridement

Debridement is a process of removing debris and surrounding callus that will slow down wound healing and causes infection.

• Offloading

Offloading is the process of redistribution the pressure off the wound to the entire weight-bearing surface of the foot. It can be achieved by either wearing temporary footwear until ulcer heal or wearing pressure-relief devices

Mechanical loading of feet during daily activities, e.g. walking or standing which exposes pressure on plantar surface causing compression and shear stress. This pressure and stress will be aggravated by foot deformities ( e.g. hammer and claw toes) which are very common in diabetic patients. Therefore patients are advised on using footwear that fits, protects and accommodates the shape of feet (with socks). Patient who are at moderate or high-risk are usually prescribed with footwear with removable cast boots to decrease the pressure on affected area. It has to ensure that it fits, protects and supports the foot.

c. Appropriate wound dressing

• Dry wound needs topical application that add moisture to the wound
• Diabetic wound with heavy exudates needs a dressing to absorb moisture.
• Dressings need to be changed at least daily in order to apply clean wound covering & monitor infected wound.

Vitamin B12

Vitamin B12, which is also known as cobalamin is vital for proper functioning and development of nervous system. Nerve damage with symptoms of pain, tingling, numbness and loss of sensation is often associated with Vitamin B12 deficiency.

Metformin, which is one of the diabetic agent commonly used for diabetic patient has confirmed that its long term use has contributed to vitamin B12 deficiency in patient with diabetic disease. Metformin has been reported to lead to malabsorption of vitamin B12. Therefore, diabetic patient who is taking metformin is encouraged to consume vitamin B12 through diet or supplement. This is to prevent development of nerve damage which eventually leads to foot ulcer.

PREVENTION

Patients who are at high risk of developing diabetic foot ulcer need to know the basic care of foot, callus and nail, this should be done regularly to prevent foot problems. Diabetic foot prevention can be done by:

• Lifestyle modification
  • Having good glycemic and blood pressure control by taking medication, follow diet plan, exercise regularly, and monitor blood sugar regularly through HbA1c test is important to reduce the incidence of diabetic foot ulcer and subsequent risk of amputation.
• Smoke cessation
  • Do not smoke as it reduce blood flow in feet.
• Take good care of feet hygiene by washing them daily with mild soap. Use only lukewarm (below 37°C) and not hot water. Do not soak feet as it can cause dry skin.
• Use moisturizer daily to keep dry skin from itching or cracking. But do not moisturize between the toes as it could risk an infection to occur
• Cut toenails carefully after washing and drying the feet. Do not cut nails too short as this could lead to ingrown toenails.

• No self-treat corns or calluses.
• Wear clean and dry socks which are not too tight and are light coloured. Socks with extra cushioning, no elastic top, higher than ankle, made from fibers material are preferred.
• Never walk barefoot indoors or outdoors.
• Put feet up when sitting to ensure good blood circulation. Keep the blood flowing to feet by wiggling toes and moving ankles for five minutes, 2 – 3 times a day. Don’t cross legs for long periods of time.
• Seek for treatment if there is presence of pain, noticeably red or discolored areas, discharge, bad smell, ulcer, blister or if feeling generally unwell with difficulty controlling blood sugar level

REFERENCE

1. Ministry of Health Malaysia. Clinical practice guideline: Management of diabetic foot. 2nd ed. Ministry of Health Malaysia. http://www.moh.gov.my/. 2018.
2. Edmonds ME, Foster AV. ABC of wound healing: Diabetic foot ulcers. BMJ. 2006 May 1;332(Suppl S5).
3. MIMS Malaysia. Infectious Disease: Diabetic Foot Infection. https://specialty.mims.com/diabetic%20foot%20infection/signs%20and%20symptoms?channel=infectious-diseases.
4. Badedi M, Darraj H, Hummadi A, Solan Y, Zakri I, Khawaji A, Daghreeri M, Budaydi A. Vitamin b12 deficiency and foot ulcers in type 2 diabetes mellitus: A case–control study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2019 Dec 6:2589-96.

INTRODUCTION

Globally, the popularity of plant-based diets has increased, largely due to its positive impacts for human health and the environment. Plant based diet is when eating habits are largely plant-based or plant-forward emphasized. This diet includes whole grains, legumes, beans, nuts, seeds, and oils in addition to fruits and vegetables (McManus, 2018).

A plant-based diet can help athletes perform better by reducing weight, building slimmer bodies, and enhancing stamina, according to recent studies.  Athletes, who require weight control, speed, and endurance in particular should consider the benefits of practicing plant-based diets. As research indicates, reduction in meat-based foods and an increase in plant-based foods can contribute to a reduction in body fat percentage and, consequently, leaner body mass. Leaner body mass promotes improved athletic performance.

One of the earliest studies on the body composition of American Olympians revealed that they had more lean body mass and a lower body fat percentage than collegiate athletes.  More recent research has been done to look at the body composition of professional athletes.  Although body fat percentage and lean body mass varied by sport in various studies of collegiate athletes, athletes nevertheless had lower overall body fat percentages than other college students (Rizal, 2021).

However, there are few downsides of consuming a plant-based diet. Protein is present in plant-based diets, albeit in lower amounts than in animal-based foods, and they typically include a high concentration of one of the other macronutrients. A chicken breast, for instance, contains 80% protein and 20% fat, while raw chickpeas contain 22% protein and 65% carbohydrates. Plant proteins are more difficult to digest, frequently “incomplete” (lacking essential amino acids), and frequently poor in branched chain amino acids (BCAA), which are crucial for muscle synthesis.

Moreover, the presence of phytic acid reduces the bioavailability of nutrients such as zinc and iron in plant-based food products. Micronutrients such as vitamin B12, iron, calcium and zinc are least available in plant-based food and can be found mainly in animal based food products. The substitutes for these vitamins can only be obtained in supplements in order to fully obtain the benefits among athletes. Deficiency of iron causes anaemia which leads to muscle injury and fatigue during strenuous activities. Calcium inadequacy in a sportsperson causes reduced bone density that further leads to bone fragility (BioSteel US, 2023).

There are several ways to manage a healthy plant-based diet while being an athlete. Vitamin B12 deficiency can be overcome by consuming food rich in that specific nutrient such as nutritional yeast, fortified soy and almond milks. If there is no sufficient source in getting enough iron each day, they can consume more plant sources of the mineral, such as green vegetables, cereals, legumes, nuts, and seeds.

The main iron supply for vegans is non-haem iron, which is less accessible than the haem iron present in animal products. Consuming ascorbic acid (vitamin C) along with an iron-rich meal can, however, increase the bioavailability of non-haem iron. Citrus fruits, bell peppers, strawberries, and kiwifruit are just a few foods that contain vitamin C. In the event that the athlete avoids dairy products, plant sources of calcium include tofu, fortified plant milks and juices, broccoli, and leafy greens like kale. Beans, nuts, seeds, oats, and wheat germ are examples of plant sources of zinc (Harrington, 2020).

CONCLUSION

When it comes down to it, vegan athletes may face some additional dietary difficulties. While it can be challenging for many athletes to achieve nutritional requirements, those who follow a plant-based diet may be more susceptible to nutrient shortages, particularly when it comes to protein and several vitamins and minerals. However, all nutrient needs can be satisfied with careful meal planning, preparation, strategic replacement of animal foods with plant meals of comparable nutritional content, and supplementation. In conclusion, a plant-based diet should at least be given some thought by athletes who want to obtain a competitive edge in all areas of health that can positively affect their performance.

REFERENCES

BioSteel US. (2023). Are Vegan Athletes at a Disadvantage in Pro Sports? [online] Available at: https://biosteel.com/blogs/news/are-vegan-athletes-at-a-disadvantage-in-pro-sports

Harrington, J. (2020, April 22). 5 Tips for Creating a Plant Based Diet for Athletes | CSP Global. CSP Global. https://online.csp.edu/resources/blog/plant-based-diet-for-athletes/

McManus, K. (2018). What is a plant-based diet and why should you try it? [online] Harvard Health Blog. Available at: https://www.health.harvard.edu/blog/what-is-a-plant-based-diet-and-why-should-you-try-it-2018092614760.

Ostfeld, R.J. (2017). Definition of a plant-based diet and overview of this special issue. Journal of geriatric cardiology : JGC, [online] 14(5), p.315. doi:https://doi.org/10.11909/j.issn.1671-5411.2017.05.008.

‌Rizal, E. (2021). Benefits of Plant-Based Diets in Athletic… [online] Berkeley.edu. Available at:https://pha.berkeley.edu/2021/04/11/benefits-of-plant-based-diets-in-athletic-performance/.