WHAT IS GUT AND GUT MICRIOBIOTA?

Gut refers to the gastrointestinal or in simpler terms, the digestive system which starts from the mouth and ends at the rectum. It contains a number of microorganisms which are not visible to naked eye. Microbiota refers to all the microorganisms living in the same environment, while microbiome refers to all genes of these microbes. So, the gut microbiota refers to the large community of microbes that reside in the gut.

WHAT IS THE FUNCTION OF GUT MICROBIOTA?

The gut microbiota plays an important role in digestion, absorption and metabolism of food. On the other hand, the gut bacteria are thought to play an important role in obesity, immune function and minimally responsible in influencing mood. In fact, our gut bacteria is said to have an impact on most of our physiological functions, directly or indirectly. While the research around the gut microbiota is still ongoing, it is clear that it is a key factor in several aspects of the body’s optimal functioning.

WHAT ARE THE COMMON GUT RELATED DISORDERS AND WHY DOES IT OCCUR?

In certain situations, such as a disease, the microbes that reside in your gut can be disrupted. This will be different from the microbe community that was present when your body was healthy. This is termed as dysbiosis. Dysbiosis can be caused by change in eating habits, bowel movements and even medications taken when one is ill. However, it is to note that whether these changes in the microbiota are helpful or not is still under research. Some of the most common gut related disorders you would have come across are constipation, indigestion and diarrhea. In addition, conditions such as irritable bowel syndrome (IBS), Crohn’s disease, Celiac disease, lactose intolerance and colitis are also gut related.

WHAT CAN I DO TO MAINTAIN A HEALTHY GUT?

The following tips can be incorporated into your daily life to ensure the gut microbes are functioning well in order to support your body to function optimally;

DIVERSE DIET:

A large and diverse community of microbes resides in our gut. So, to support these microbes, our diet needs to be equally varied. Our food serves as substrates for these microbes to thrive. It is clear that the diversity of our diet determines the diversity and richness of the gut microbiota. The increasing number of fad diets is also an issue of concern as it encourages elimination of food groups, which in turn affect the diversity of the gut microbiota.

Fiber intake and polyphenols also play key role in shaping the microbiome. Low intake of fiber paired with high fat and sugar intake may reduce certain microbe groups in the gut. Polyphenols are found in foods like tea, chocolate, spice, seasonings, herbs and even fruits and vegetables. Interactions between polyphenols and the gut microbes can also impact health.

WHAT CAN YOU DO?

Ensure your diet is diverse by varying the foods you eat on a daily basis. Consume fiber rich food such as whole grains, lentils/legumes, fruits and vegetables. Aim for at least 25-30g of fiber a day. It is important to note that fruits and vegetable are rich in polyphenols thus are able to provide much additional benefits.

FERMENTED FOODS

Fermentation is a natural process by which bacteria break down substances into simpler forms. Examples of fermented food are kimchi, yoghurt and kefir among several others. These are commonly termed as ‘probiotics’ since they contain live cultures of microorganisms. While the research on probiotics is still ongoing, they do seem to show promising effects on enriching the existing gut flora.

STRESS

This is something that affects each one of us on a day-to-day basis. While everyone knows that extreme stress is unhealthy, we never expect stress to also affect the diversity of microbes in our gut. Hence, get enough sleep and limit your involvement in anxiety inducing environment as much as possible to avoid disrupting your gut microbiota and maintain a healthy body.

Conclusion

In conclusion, gut health is a growing area of research. While there are still a number of questions left unanswered, the field seems vast and promising. It is clear that the gut plays an important role in several aspects of human health. Thus, it is necessary for us to understand this and nourish the gut by practicing a healthy lifestyle.

REFERENCES:

• Ursell L, Metcalf J, Parfrey L, Knight R. Defining the human microbiome. Nutrition Reviews. 2012;70(Suppl 1):S38-S44.
• Shreiner AB, Kao, JY, Young, VB. The gut microbiome in health and disease. Current Opinion Gastroentology. 2015;31(1):69-75
• Makki K, Deehan E, Walter J, Bäckhed F. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host & Microbe. 2018;23(6):705-715. 
• Sonnenburg E, Sonnenburg J. Starving our Microbial Self: The Deleterious Consequences of a Diet Deficient in Microbiota-Accessible Carbohydrates. Cell Metabolism. 2014;20(5):779-786.
• Ozdal T, Sela D, Xiao J, Boyacioglu D, Chen F, Capanoglu E. The Reciprocal Interactions between Polyphenols and Gut Microbiota and Effects on Bioaccessibility. Nutrients. 2016;8(2):78.
• Konturek PC,Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. Journal of Physiology and Pharmacology. 2011;62(6):591-599.

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).

Confinement​​​ is a period to allow a mother to recuperate and recover after childbirth. The idea of confinement is familiar to Asians but foreign to Westerners. In the past when infant and maternal mortality rates were high, it was a practice to keep both the baby and mother indoors during the period of confinement to protect them from ill health. However, many of these practises originated from Asian culture and hence, possess no scientific basis at all.

Myth #1: I cannot drink plain water at all during confinement

Fact: Adequate fluid consumption is advised especially if the mother is breastfeeding. In case one drinks less water, it could be hazardous as it may lead to the formation of blood clots in your body. New mothers tend to sweat a lot, and they are also producing milk. It is therefore even more important for them to stay hydrated. The kidneys will produce more urine in the first few weeks after the baby is born to remove the excess fluid that has accumulated during the course of the pregnancy.​

Myth #2: I am not allowed to bathe or touch water for fear of ‘wi​​​nd’ entering the body

Fact: There is no basis to these beliefs. In fact, bathing regularly ensures good personal hygiene and comfort. It also reduces the chance of skin and wound infections.

Myth #3: I must not consume cold food (fruits and vegetables)

Fact: In fact, half of a recovering mother’s diet should consist of fruits and vegetables to help her restore important nutrients and source of fiber. Fiber is important to help avoid constipation among postpartum mothers and prevent hemorroids to happen.

Myth #4: I cannot eat chicken

Fact: It is important to have a well-balanced diet during confinement to replenish the body’s stores rather than avoiding specific food types. Other than consuming fibers, the other half diet portion of a postpartum mother should include whole grains such as brown rice and whole-grain bread. Overall, following the food pyramid is still the way to go. In the case of vegetarians or vegans, iron or vitamin supplements may be taken to fulfill these nutritional needs. However, there are some foods that you should avoid, such as raw food, caffeine and alcohol.

Myth #5: I have been told not to read or cry

Fact: According to traditional Chinese beliefs, childbirth is thought to weaken the liver which is linked to the eyes. During confinement, it is believed that mothers should not read or cry to avoid exerting stress on the eyes. However, there is no scientific proof to back up this belief. While prolonged reading of fine print may cause eye strain, there is no evidence to suggest that it can directly cause damage to the eyes. The same can be said for crying. In fact, crying can be a way of relieving stress and dealing with the emotions that come with being a new mum.

Myth #6: I must not expose myself and my baby to any wind drafts or air-conditioning

Fact: For personal comfort, there is definitely no harm in switching on the air-conditioner or fan, as long as it makes you and your baby comfortable. It may even help prevent heat rash from developing under hot and humid climate.

Myth #7: I shouldn’t walk or move about

Fact: While it’s true that mothers who have just given birth especially those who gave birth via C-section need to rest, they should not be restricted to just lying in bed. Experts recommend new mothers to walk and move around once they feel comfortable as it can help decrease the risk of blood clots (deep vein thrombosis).

Postpartum care

Get plenty of rest
Get as much sleep as possible to cope with tiredness and fatigue. Your baby may wake up every two to three hours for feeding. It is advised that postpartum mothers should get enough rest, sleep when your baby sleeps.

Eat healthy meals
Eat healthy diet to promote healing. Increase your intake of whole grains, vegetables, fruits, and protein. You should also increase your fluid intake, especially if you are breast-feeding.

Seek help
Don’t hesitate to accept help from family and friends during the postpartum period, as well as after this period. Your body needs to heal, and practical help around the house hold can help you get much-needed rest. Friends or family can prepare meals, run errands, or help care for other children in the house hold.

Exercise
Your doctor will let you know when it’s OK to exercise. The activity should not be strenuous. Try taking a walk near your house. The change of scenery is refreshing and can increase your energy level.

References:

8 Confinement Myths Debunked [Internet]. Gleneagles Hospital. [cited 2023 Apr 19]. Available from: https://www.gleneagles.com.sg/healthplus/article/confinement-myths-debunked
Confinement After Pregnancy: 12 Myths and Facts – HealthXchange [Internet]. [cited 2023 Apr 19]. Available from: https://www.healthxchange.sg:443/women/post-pregnancy/confinement-after-pregnancy-myths-facts
Confinement Food in Chinese, Malay and Indian Cultures – HealthXchange [Internet]. [cited 2023 Apr 19]. Available from: https://www.healthxchange.sg:443/women/post-pregnancy/confinement-food-chinese-malay-indian
Myths About Postpartum Care – Healthcare Wellness Blogs – Ovum Hospital [Internet]. 2022 [cited 2023 Apr 19]. Available from: https://ovumhospitals.com/blog/myths-about-postpartum-care/
Confinement Practices and Myths: Part 1 [Internet]. [cited 2023 Apr 19]. Available from: https://www.healthhub.sg/live-healthy/1068/pregnancy-confinement-practices-and-myths
Postpartum Care: Tips for the Recovery Process [Internet]. Healthline. 2016 [cited 2023 Apr 19]. Available from: https://www.healthline.com/health/postpartum-care

What is nappy rash?

Nappy rash is a skin irritation around the area covered by the baby’s nappy. It can look like a mild pink or red rash just covering some of their skin, or across their whole nappy area. If left untreated, nappy rash can develop blisters and even open sores.

Some babies have skin conditions that make them particularly sensitive. Eczema, psoriasis and impetigo can make nappy rash worse because of a breakdown in the skin.

Nappy rash will affect 1 in 3 babies before the age of 2. There are things we can do to help avoid these rashes and to treat them if and when they do occur. 

Signs and symptoms of nappy rash

The skin on the child’s bottom and genitals will look inflamed and sore. On children with darker skin, the inflammation might look brown, purple or grey. On children with lighter skin, the inflammation might look red. Some areas of skin might be raised or swollen, and there might be breaks in the skin. These breaks are called ulcers. Skin folds aren’t usually affected because wee doesn’t get into them. But nappy rash might sometimes go up onto the child’s tummy or spread up towards the baby’s back.

The rash can be uncomfortable and even painful, which can make the child irritable.

4types of nappy rash

1. BACTERIAL 

Most rashes are an irritation of the skin caused or aggravated by contact with the wee and poo. The rash starts with a slight reddening of the skin in the nappy area and can progress to soreness and discomfort.

• The most common type of nappy rash is a mild bacterial rash.
• The skin looks red and sore and can almost appear shiny.
• This is usually caused when the baby’s bottom is in contact with a wet or dirty nappy for a long period of time.
• A normal disposable nappy is made of plastic and traps heat and moisture inside. This combined with the wee or poo, makes a perfect breeding ground for bacteria.

2. FRICTION 

Nappy rash can be caused by chaffing or rubbing if skin is very sensitive or the nappy is the wrong size.

• A common cause of nappy rash is friction caused by the nappy rubbing against the baby’s delicate skin.
• Whether the parents use disposables or reusable do check the fit of the nappy.
• It should be snug around the tummy but not too tight – parents should be able to fit their finger inside the waist band.
• The tabs should come around the sides and sit on the frontal sticky tape without having to cross over or meet – Most brands have a logo on their tape. Parents should sit be able to see this once the nappy is fastened.
• The leg ruching should not leave deep red indents in the babies’ skin. If it does, it is too tight.
• Conversely a too loose nappy can cause chafing between the thighs.
• Check the size chart on the nappies but remember every baby is different, so it may be a case of using the parents’ intuition. 

3. FUNGAL

A bright red, moist rash with white or red pimples which spreads to the folds of the skin, may indicate that the baby has a thrush infection and requires a prescribed cream.

• This kind of rash can sometimes happen if the baby is on antibiotics or if they have thrush.
• A fungal rash shows as tiny red spots and the genitals can appear slightly swollen.
• This needs to be treated using an anti-fungal cream, available on prescription from the GP.
• This should be applied thinly to the affected area.
• If the nappy rash is fungal it is important that we avoid our usual barrier cream as this can make the condition worse.

4. ALLERGY 

Occasionally nappy rash can become persistent and can be related to other skin conditions like eczema or allergies.

Some babies have sensitivities or allergies to the various components of their nappies or wet wipes.

Normal nappies are made using:

• Polypropylene     
• Polyester
• Polyethylene
• Latex or PVC
• Chlorine bleached pulp
• Adhesives
• Dyes
• Perfumes
• Lotions

Prevention of baby’s nappy rash

Prevention is always better than treatment.

Parents can reduce the chance of their child getting nappy rash by keeping their nappy area clean and dry. Change the child’s nappy frequently and give their bottom air as often as we can. Parents also can :

• use good quality, disposable nappies
• try to leave the baby’s nappy off whenever possible. This will keep the baby’s skin dry and away from any contact with wee or poo. Try laying the baby on a towel during tummy time or any floor play. Parents should always watch that they have not wet or soiled the towel so that they are not left on a damp towel
• only use warm water to clean the rash area
• avoid soaps and perfumed baby wipes as these can irritate the skin
• use soft towels or cotton wool when drying the skin, and dab the area gently
• apply a barrier cream after changing every nappy. Products containing zinc cream, zinc oxide ointment and petroleum jelly are all suitable. You can also ask your pharmacist about nappy rash creams
• do not use talcum powder or antiseptics

When should the parents or caretaker see a doctor?

See a doctor if:

• the rash doesn’t clear up in one week
• there are blisters, crusts or pimples
• the baby has a fever
• the rash is spreading
• the baby is very upset
• if the parents have a son, the end of his penis is red and swollen or has a scab

The doctor or pharmacist may need to give patients a medicated cream to treat the nappy rash. If it is caused by eczema or a skin infection, the doctor will need to give the patients the right treatment.

References

1. https://www.johnsonsbabyarabia.com/en/nappy-rash
2. https://raisingchildren.net.au/newborns/health-daily-care/poos-wees-nappies/nappy-rash
3. https://www.healthdirect.gov.au/nappy-rash
4. https://www.pregnancybirthbaby.org.au/nappy-rash#what
5. https://www.mamabamboo.com/blogs/news/nappy-rash

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.

What exactly is a stretch mark?

A stretch mark is a type of scar that develops when our skin stretches or shrinks quickly. The abrupt change causes the collagen and elastin, which support our skin, to rupture. As the skin heals, stretch marks may appear. (1)
They’re common during puberty or pregnancy, in which they usually form during the last trimester. (2) The indented streaks (stretch marks) normally appear on the abdomen, breasts, hips, buttocks, thighs or other places on the body.(3) Stretch marks may also be influenced by the hormonal changes associated with puberty, pregnancy, bodybuilding, or hormone replacement therapy.(2)
Over time stretch marks may diminish, but will not disappear completely.(2) They aren’t painful or harmful, but some people don’t like the way they make their skin look.

How stretch mark looks like?

Stretch marks don’t all look alike. They vary depending on how long you’ve had them, what caused them, where they are on your body and the type of skin you have.(3)
When stretch marks first appear, they tend to be red, purple, pink, reddish-brown, or dark brown, depending on your skin color. Early stretch marks may feel slightly raised and can be itchy.
In time, the color fades and the narrow bands sink beneath your skin. If you run your finger over a mature stretch mark, you often feel a slight depression.(1)

Who are more prone to getting stretch marks?

Anyone can develop stretch marks, but some factors increase your likelihood of getting them, including:

• Being female
• Having a personal or family history of stretch marks
• Being pregnant, especially if you’re young
• Rapid growth in adolescence
• Rapidly gaining or losing weight
• Using corticosteroids
• Having breast enlargement surgery
• Exercising and using anabolic steroids
• Having a genetic disorder such as Cushing’s syndrome or Marfan syndrome(3)

How to treat stretch marks?

Stretch marks are harmless and often fade over time. Treatment can make them fade, but they may never completely disappear.
The following treatments are among those available to help improve the appearance and texture of stretch marks. None has been proved to be more consistently successful than the others.

1. Retinoid cream. Derived from vitamin A, retinoids — such as tretinoin (Retin-A, Renova, Avita) — that you apply to your skin may improve the appearance of stretch marks less than a few months old. Tretinoin, when it works, helps to rebuild a protein in the skin called collagen, making the stretch marks look more like your normal skin. Tretinoin can irritate your skin.
   If you’re pregnant or nursing, talk with your doctor about other treatment options, because possible side effects of retinoid cream may affect the baby.
2. Light and laser therapies. A variety of light and laser therapies are available that might stimulate growth of collagen or promote elasticity. Your doctor can help you determine which technique is appropriate for you.
3. Microneedling. This type of treatment involves a hand-held device with tiny needles that stimulate collagen growth. This technique has less risk of pigmentation changes than does laser therapy so is the preferred initial approach for people with darker skin.(3)
4. Stretch mark creams, lotions, and gels. Researchers have studied many of the creams, lotions, and gels sold to treat stretch marks. While no one product seems to help all of the time — and some don’t seem to help at all — researchers have discovered some helpful hacks.
   If you want to try one of these creams, lotions, or gels to fade stretch marks, be sure to use the product on early stretch marks. Treatment seems to have little effect on mature stretch marks. You should massage the product into your stretch marks. Taking time to massage the product gently into your skin may make it more effective. Applying the product every day for weeks may also increase effectiveness of the products. If you see results, they take weeks to appear.(1)

Work with your doctor to choose the most appropriate treatment or combination of treatments for you. Factors to consider include:

• How long you’ve had the stretch marks
• Your skin type
• Convenience, as some therapies require repeated doctor visits
• Cost
• Your expectations

How to prevent formation of a stretch mark?

Collagen and elastin are proteins in the skin that contribute to the skin’s strength, resilience, flexibility, and help skin that has been stretched to recover to its original state. Boosting the production of collagen and elastin helps prevent stretch marks from occurring.Stretch marks can also derive from nutritional deficiencies. Consuming foods that contribute to the skin’s health, such as zinc-rich foods, foods high in vitamin A, C, D, and protein rich foods, can help suppress stretch marks. (4)

References

1. Stretch marks: Why they appear and how to get rid of them. (n.d.). https://www.aad.org/public/cosmetic/scars-stretch-marks/stretch-marks-why-appear
2. Wikipedia contributors. (2022, December 22). Stretch marks. Wikipedia. https://en.wikipedia.org/wiki/Stretch_marks
3. Stretch marks – Symptoms and causes. (2022, August 23). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/stretch-marks/symptoms-causes/syc-20351139
4. Skin: Layers, Structure and Function. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/10978-skin

N-acetylcysteine, also known as Acetylcysteine, NAC or N-acetyl-cysteine, is a derivative of an amino acid called cysteine which is important in the production of glutathione, a potent antioxidant in human body.

Benefits of N-acetylcysteine

1. Antioxidative function

When consumed, N-acetylcysteine gets converted into L-cysteine, an amino acid that is the direct precursor to glutathione in human body. Glutathione is a potent antioxidant that can neutralize free radicals and thus protect your body cells and tissues from oxidative damage.1 Therefore, N-acetylcysteine acts as an antioxidant by replenishing the glutathione pool in body cells that becomes depleted with increased level of inflammation and oxidative stress in human body.2 This antioxidant property can help improve illnesses caused by oxidative stress, such as heart disease and infertility as well as help maintaining healthy function of immune system.3, 4, 5

2. Liver-protective function

N-acetylcysteine has been used for long as the mainstay treatment and antidote for paracetamol overdose to prevent or reduce liver damage.6 When given intravenously within 8 hours after the ingestion of paracetamol, the treatment is highly effective.6 N-acetylcysteine is also found to improve liver function in patients with non-paracetamol induced liver failure and non-alcoholic fatty liver disease thanks to its antioxidative and anti-inflammatory effect.7, 8

3. Helps relieve symptoms of respiratory condition

N-acetylcysteine is also commonly used to reduce phlegm in respiratory system. It achieves this effect by acting as mucolytic agent that reduces mucus viscosity and as a muco-regulatory agent which reduces airway mucus secretion.2 These effects, along with the anti-inflammatory and antioxidant properties of N-acetylcysteine helps to improve breathing and lung function in lung disorders such as chronic obstructive pulmonary disease, chronic bronchitis and many others.2, 9

4. Kidney-protective function

N-acetylcysteine has been speculated to be able to slow down the progress of chronic kidney disease by reducing serum creatinine and improving the structure of some of the cells in kidneys.10, 11

5. May improve mental health condition and substance use disorder

In recent years, there has been increasing interest in the use of N-acetylcysteine in helping to manage mental health conditions and substance use disorder. N-acetylcysteine has been discovered to be able to regulate the level of glutamate, an important neurotransmitter in human brain. 12 While glutamate is needed for normal brain activity, excess glutamate in brain has been found to be associated with mental illnesses such as schizophrenia or depression. 13, 14 When used in patient with substance use disorders, especially to treat young individuals addicted to cocaine and cannabis, N-acetylcysteine is effective in reducing the craving for the substances and can help abstinent individuals to prevent relapsing.13 There are also promising evidence for the use of N-acetylcysteine in treating obsessive-compulsive disorders and mood disorders, but better designed studies are required to further investigate its clinical effectiveness. 13

6. May improve fertility

N-acetylcysteine has been yielding positive results in studies that look into fertility improvement in recent years. It was found that N-acetylcysteine can be helpful in polycystic ovarian syndrome(PCOS)-related and unexplained female infertility, especially in women with high BMI, insulin resistance, and oxidative stress15 N-acetylcysteine is also discovered to have ovulation induction properties and thus can be an effective adjuvant to improves pregnancy rate in patients receiving intrauterine insemination.16 However, more well-controlled studies still need to be done to further confirm and establish the findings.

Risks and side effects of N-acetylcysteine

N-acetylcysteine on its own has very good tolerability and safety profile even at high dose.8, 13, 14 The most common side effects that are associated with it are mainly gastrointestinal disorders such as diarrhea, gastric reflux, bloating. 14, 17

However, N-acetylcysteine can potentiate the vasodilation effect of Nitroglycerin, an antianginal medication which can lead to higher incidence of side effects such as headache and severe hypotension.18, 19

People who are taking blood thinning medication, have bleeding disorders or for those who are about to undergo major surgery also need to be cautious with the use of N-acetylcysteine because N-acetylcysteine has anticoagulant and platelet-inhibiting properties, thus can increase bleeding risk.20

References

1. Ershad M, Naji A, Vearrie D. National Center for Biotechnology Information [Internet]. N Acetylcysteine. National Library of Medicine; 2023 [cited 2023Apr22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537183/
2. Sadowska AM. N-Acetylcysteine mucolysis in the management of chronic obstructive pulmonary disease. Therapeutic Advances in Respiratory Disease. 2012;6(3):127-135. 
3. Shackebaei D, King N, Shukla B, Suleiman MS. Mechanisms underlying the cardioprotective effect of L-cysteine. Mol Cell Biochem. 2005;277(1-2):27-31.
4. Adeoye O, Olawumi J, Opeyemi A, Christiania O. Review on the role of glutathione on oxidative stress and infertility. JBRA Assist Reprod. 2018;22(1):61-66.
5. Dröge W, Breitkreutz R. Glutathione and immune function. Proc Nutr Soc. 2000;59(4):595-600.
6. Daly, F. F., Fountain, J. S., Murray, L., Graudins, A., & Buckley, N. A. (2008). Guidelines for the management of paracetamol poisoning in Australia and New Zealand-explanation and elaboration. Medical journal of Australia, 188(5), 296.
7. Dludla PV, Nkambule BB, Mazibuko-Mbeje SE, et al. N-Acetyl Cysteine Targets Hepatic Lipid Accumulation to Curb Oxidative Stress and Inflammation in NAFLD: A Comprehensive Analysis of the Literature. Antioxidants (Basel). 2020;9(12):1283. Published 2020 Dec 16.
8. Nabi T, Nabi S, Rafiq N, Shah A. Role of N-acetylcysteine treatment in non-acetaminophen-induced acute liver failure: A prospective study. Saudi J Gastroenterol. 2017;23(3):169-175.
9. Cazzola M, Calzetta L, Page C, et al. Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. Eur Respir Rev. 2015;24(137):451-461.
10. Tian N, Rose R, Jordan S, Dwyer TM, Hughson MD, Manning RD Jr. N-acetylcysteine improves renal dysfunction, ameliorates kidney damage and decreases blood pressure in salt-sensitive hypertension. J Hypertens. 2006;24:2263–2270.
11. Ye M, Lin W, Zheng J, Lin S. N-acetylcysteine for chronic kidney disease: a systematic review and meta-analysis. Am J Transl Res. 2021;13(4):2472-2485.
12. Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001. Glutamate. Available from: https://www.ncbi.nlm.nih.gov/books/NBK10807/
13. McQueen G, Lally J, Collier T, et al. Effects of N-acetylcysteine on brain glutamate levels and resting perfusion in schizophrenia. Psychopharmacology (Berl). 2018;235(10):3045-3054. doi:10.1007/s00213-018-4997-2
14. Onaolapo AY, Onaolapo OJ. Glutamate and depression: Reflecting a deepening knowledge of the gut and brain effects of a ubiquitous molecule. World J Psychiatry. 2021;11(7):297-315.
15. Devi N, Boya C, Chhabra M, Bansal D. N-acetyl-cysteine as adjuvant therapy in female infertility: a systematic review and meta-analysis. J Basic Clin Physiol Pharmacol. 2020;32(5):899-910.
16. Bedaiwy, M.A., RezkH. Al Inany, A. and Falcone, T. (2004) “N-acetyl Cystein improves pregnancy rate in long standing unexplained infertility: A novel mechanism of ovulation induction,” Fertility and Sterility, 82.
17. Calverley P, Rogliani P, Papi A. Safety of N-Acetylcysteine at High Doses in Chronic Respiratory Diseases: A Review. Drug Saf. 2021;44(3):273-290.
18. Horowitz JD, Henry CA, Syrjanen ML, et al. Nitroglycerine/N-acetylcysteine in the management of unstable angina pectoris. Eur Heart J. 1988;9 Suppl A:95-100.
19. Ardissino D, Merlini PA, Savonitto S, et al. Effect of transdermal nitroglycerin or N-acetylcysteine, or both, in the long-term treatment of unstable angina pectoris. J Am Coll Cardiol. 1997;29(5):941-947.
20. Niemi TT, Munsterhjelm E, Pöyhiä R, Hynninen MS, Salmenperä MT. The effect of N-acetylcysteine on blood coagulation and platelet function in patients undergoing open repair of abdominal aortic aneurysm. Blood Coagul Fibrinolysis. 2006;17(1):29-34.

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.

The kidneys are important organs that filter waste and maintain our body’s fluid balance. They also release hormones that help to regulate blood pressure at a normal level, and they play an important role in producing red blood cells in our body. Besides that, they are vital in producing the active form of vitamin D which is essential to promote strong and healthy bones.

In this article, we will discuss some common medications that will affect the kidney’s function. It’s important to understand and be aware of which medications may be harmful to the kidneys and precautions shall be taken to protect our kidneys.

Pain Relievers (Non-Steroidal Anti-Inflammatory Drugs-NSAIDs)

Some pain relievers, for example ibuprofen and naproxen, can harm the kidneys if taken frequently or in large doses. These medications relieve pain and help with inflammation.

However, it can be dangerous for those who have existing kidney problems or those who are dehydrated. Thus, we shall not take too much of pain relievers but to take them cautiously according to the dosage recommended by doctors.

Certain Antibiotics

Certain antibiotics can hurt the kidneys through a variety of mechanisms. For example, some antibiotics can block the urine flow by producing crystals that cannot be broken down. Some antibiotics have substances that can damage certain kidney cells when they are excreted from the kidneys. There are also cases where some people develop allergic reactions towards antibiotics that will adversely affect their kidneys.

When antibiotics are used for a short period of time, they are generally safe. The risk of damage to kidneys is increased when antibiotics are used in high dosage or for a prolonged period. So, bear in mind that we should only take antibiotics when prescribed by doctors and we should strictly follow their medical advices.

Diuretics/Water Pills

Diuretics, or water pills, are usually prescribed by doctors to treat high blood pressure and swelling. They work by helping to excrete extra fluid in the body. However, some diuretics, like furosemide, can affect kidney function. This is because sometimes diuretics will dehydrate the body, disturbing the balance of electrolytes in the body and the blood flow to the kidneys which can be bad for the kidneys.

Thus, it is crucial for people taking diuretics to have regular monitoring of kidney function and electrolyte levels.

Contrast Dyes

In many cases, the use of a contrast dye is necessary while carrying out diagnostic tests such as CT scans, angiograms and MRIs to help doctors see certain body tissues or blood vessels better. However, it is important to know that sometimes these dyes can be harmful to the kidneys and will either cause kidney problems, or cause problems in patients with existing kidney disease. Thus, it is important to inform doctors if you have any kidney diseases before undergoing any imaging tests involving contrast dyes.

Certain Antiviral Medications

Some antiviral medications, such as acyclovir and tenofovir, used to treat viral infections, can damage the kidneys. These medications can cause harms to the kidneys or reduce kidney function, especially when taken at high doses or for a long period. Antiviral medications can cause renal failure in many ways such as through crystal deposition in the kidneys as well as causing injury on the renal transporters and renal cells. Thus, it is imperative to have regular monitoring of kidney function if taking these antiviral medications.

Take away messages

While medications can be beneficial, it is crucial to understand the potential risks they pose to the kidneys. Be aware of which medications will affect kidney function and take necessary precautions to protect our kidneys. We shall always take medications according to the recommended dosage so as to reduce the risk of developing medication-related kidney problems and always talk to your doctors if you have any existing kidney diseases.

Reference:

1.    National Kidney Foundation. (n.d.). Pain Medicines (Analgesics). Retrieved from https://www.kidney.org/atoz/content/painmeds_analgesics

2.   American Association of Kidney Patients. (n.d.). Understanding Diuretics. Retrieved from https://aakp.org/dialysis/understanding-diuretics/

3.    Radiological Society of North America. (2020). Contrast Materials. Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=contrast-ct

4.     National Kidney Foundation. (n.d.). Common Medicines Used for People with Kidney Disease. Retrieved from https://www.kidney.org/atoz/content/medications-kidney-disease

5.     WebMD. (2022). What Meds Might Hurt My Kidneys? Retrieved from https://www.webmd.com/a-to-z-guides/medicine-hurt-kidneys

6.     National Kidney Foundation. (n.d.). Contrast Dye and the Kidneys. Retrieved from https://www.kidney.org/atoz/content/Contrast-Dye-and-Kidneys#:~:text=Contrast dyes are often used,the way they normally should.

7.     National Library of Medicine. (2005). Retrieved from https://pubmed.ncbi.nlm.nih.gov/15861345/#:~:text=Antiviral drugs cause renal failure,epithelial cells of the kidney.

A slipped disc happens when one of the rubbery cushions (discs) that sit between the bones (vertebrae) that stack up spine pushes out from its position. The disc protects the bones by absorbing the shocks from daily activities like walking, lifting, and twisting.

Each disc has two parts: a soft, gelatinous inner portion and a tough outer ring. A slipped disc happens when the inner “jelly” substance pushes through the crack. This is also known as a herniated or prolapsed disc.

Causes

Several factors can contribute to a disc rupture, including:

• Aging – Disc becomes less flexible as people age and becomes more prone to tearing or rupturing
• Gender – Men between the ages of 20 and 50 are most likely to have a slipped disc
• Obesity – Excess body weight causes extra stress on the discs in the lower back
• Occupation – People with physically demanding jobs have a greater risk of back problems
• Sedentary lifestyle – Driving or working at a desk job for long time can increase the risk of a slipped disc
• Smoking – Less oxygen is supplied to the disc and it may lead to rapid degeneration of the discs

Slipped discs can happen anywhere along the spine, but slipped discs most often occur in the lower back or the neck. It’s rare for a slipped disc to be in the mid-back. However, not all slipped discs cause symptoms. Many people will never know that they have slipped a disc.

Slipped disc at the lower back
It’s common for a slipped disc at the lower back to cause “sciatic nerve” pain. This sharp pain usually radiates from the buttock to the leg and sometimes to the foot. Other symptoms of a slipped disc at the lower back include:

• Back pain
• Tingling or numbness in the legs and/or feet
• Muscle weakness

Slipped disc at the neck
Symptoms of a slipped disc at the neck include:

• Pain near or between shoulder blades
• Pain that travels to shoulder, arm and sometimes hand and fingers
• Neck pain, especially in the back and on the sides of the neck
• Pain that increases when bending or turning the neck
• Numbness or tingling in the arms

Treatment

In most cases, slipped discs do not require surgery. With time, the symptoms of a slipped disc will improve in approximately 9 out of 10 people. However, time taken to improve varies, ranging from a few days to a few weeks.

Nonsurgical treatment
Initial treatment for a herniated disc is usually nonsurgical. Nonsurgical treatment may include:

• Applying heat or cold. Initially, cold packs can be used to relieve pain and inflammation. After a few days, might switch to gentle heat to give relief and comfort.
• Rest. Take rest breaks throughout the day but avoid sitting for long periods. Try to avoid activities that worsen the pain.
• Resuming activity slowly. Make sure movements are slow and controlled, especially bending forward and lifting.

Medication

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory drugs such as ibuprofen or naproxen can help relieve pain by treating inflammation in the nerves and soft tissues surrounding the disc.
• Neuropathic drugs. These drugs affect nerve impulses to decrease the pain. They include gabapentin (Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta), or venlafaxine (Effexor XR).
• Muscle relaxants. These medications can calm spasms and ease pain. Sedation and dizziness are common side effects.
• Steroid injection. An injection of a cortisone-like medicine into the space around the nerve may provide short-term pain relief by reducing inflammation.

Physical therapy

Strengthening the core—the muscles in the back, abdomen, upper thighs, and buttocks—is an important part of therapy to treat symptoms of a slipped disc. If these muscles are weak, the spine bears more weight. This added pressure could cause instability or worsen an existing spine problem. A physical therapist can recommend a series of exercises for strengthening these core muscle groups, which can improve posture, relieve pressure on the nerves affected by a slipped disc, and alleviate pain.

Surgical treatment

A doctor may recommend surgery if conservative treatment options, such as physical therapy and medications, do not reduce or end the pain altogether. The benefits of surgery should be weighed carefully against its risks. Although a large percentage of patients with herniated discs report significant pain relief after surgery, there is no guarantee that surgery will help.
A patient may be considered a candidate for spinal surgery if:

• Pain limits normal activity or impairs quality of life
• Progressive neurological deficits develop, such as leg weakness and/or numbness
• Loss of normal bowel and bladder functions
• Difficulty standing or walking
• Medication and physical therapy are ineffective
• The patient is in reasonably good health

Complications

Left untreated, a slipped disc may lead to complications such as:

• Worsening symptoms, such as increased pain, numbness or weakness that can affect daily routine
• Loss of bladder control or bowel control, which may lead to incontinence or difficulty urinating
• Saddle anesthesia, where the slipped disc compresses the nerves and leads to loss of sensation in the inner thighs, back of the legs and around the rectum
• Permanent nerve damage, which may lead to permanent weakness or paralysis

Prevention

• Using proper lifting techniques
  Position your feet shoulder-width apart
  Bend your knees and keep your back straight
  Use your legs to lift you up
  Keep the object close to the center of your body

• Practicing good posture
  When standing, keep your shoulders aligned over your hips
  Avoid slouching, especially while sitting at your computer
  Sit with your feet flat on the floor and your knees bent at 90-degree angles

• Exercising regularly
• Focus on workouts that strengthen back and abdomen muscles to support your spine
  Avoid exercises such as squats, sit-ups, and high impact aerobics activities

• Maintain a healthy weight
  Being overweight or obese puts excessive pressure and strain on the back and knees. It also may contribute to poor posture

• Quit smoking
  Smoking deprives healthy tissue of nutrients and oxygen, increasing the risk of developing spinal disc degeneration and osteoporosis. A smoker’s heavy coughing bouts can also increase pressure on the spine

References

Cleveland Clinic (2021). Herniated Disk (Slipped, Ruptured or Bulging Disk). Retrieved 10 June 2023, from https://my.clevelandclinic.org/health/diseases/12768-herniated-disk .
Mayo Clinic (2022). Herniated disk. Retrieved 10 June 2023, from https://www.mayoclinic.org/diseases-conditions/herniated-disk/symptoms-causes/syc-20354095 .
Nall, R. (2017). Slipped (Herniated) Disc. Retrieved 10 June 2023, from https://www.healthline.com/health/herniated-disk .
Park, D. K. (2022). Herniated Disk in the Lower Back. Retrieved 10 June 2023, from https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/ .
Portal Rasmi MyHEALTH (2019). Slipped Disc of Spine. Retrieved 10 June 2023, from http://www.myhealth.gov.my/en/slipped-disc-spine/ .

Aging is an inevitable process that all people experience. The progress of aging depends heavily on diet. Therefore, diet that rich in adequate nutrients and antioxidants play significant roles in delaying skin aging process. They can protect the skin from UV-induced skin aging, fight against oxidative stress, neutralize free radicals and scavenge reactive oxygen species.

Figure 1.0: Comparison of the Changes between Healthy skin and Aging skin.

Table 1.0: Comparison of Young Skin and Aging Skin

Vitamin C (Ascorbic Acid)

Vitamin C is a water-soluble, powerful antioxidant that protects skin from oxidative stress and repairs UV-induced skin aging. Besides, it also promotes the productions of collagen and elastin. This results in decrease in wrinkles, and increase in skin’s elasticity. According to a study conducted by Abdullah et al. (2019), both enzymes lysyl hydroxylase and proyly hydroxylase are crucial in Types I and III Collagen production. They rely on Vitamin C as an essential co-factor. Examples of foods that rich in Vitamin C are kiwi, strawberry, lemon, orange, guava, papaya, green peppers, red peppers, etc.

Vitamin E (Tocopherol)

Vitamin E is a fat-soluble potent antioxidant. It delays skin aging by fighting against oxidative stress and moisturizing the skin. A study from Keen et al. (2016) showed that the skincare products with the range between 2% to 20% of topical Vitamin E are able to minimize lipid peroxidation, thus delaying skin aging. It works by reducing wrinkles and enhancing the stratum corneum’s capacity to retain moisture and promote skin antioxidant protection. Examples of foods that rich in Vitamin E are broccoli, corn oil, sunflower seeds, mango, nuts (almond, hazelnuts and peanuts), etc.

Alpha Lipoic Acid (ALA)

ALA is a very potent antioxidant. ALA and its reduced form Dihydrolipoic Acid play significant roles in producing intracellular antioxidants and removing free radicals (Isaac et al., 2015). Examples of foods and supplements are broccoli, internal organs, potato, red meat, spinach, tomato, ALA supplements, etc.

Astaxanthin

It is a reddish-orange pigment that present in a wide variety of aquatic creatures. Examples included marine fishes, shrimps, crustaceans, etc. It is a potent antioxidant that plays a significant role in delaying skin aging by fighting against oxidative stress. In a study by Tominaga et al. (2017), long-term intake of astaxanthin may prevent age-related skin degeneration and preserve skin disorders resulting from environmental exposure. Examples of foods and supplements are algae, crayfish, krill, shrimp, salmon, trout, yeast, astaxanthin supplements, etc.

Coenzyme Q10 (CoQ10)

It is a well-known free radical scavenger. It helps to neutralizes reactive oxygen species, thus protecting cells from oxidative stress. According to a study conducted by Zhao et al. (2019), CoQ10 are able to shield astrocytes (cells) from UVB-induced oxidative stress by regulating PKA-ERK 1/2 signalling pathway. Examples of foods and supplements are fatty and oily fishes (salmon and tuna), internal organs, soybean, spinach, whole grains, CoQ10 supplements, etc.

Protein

Protein is needed to preserve the firmness, shape and integrity of the skin. Besides, it plays a crucial role in boosting cell regeneration. Diet high in protein promotes collagen production that results in smooth, radiant, moisturized and healthy skin. Examples of foods that rich in protein are lean meats (beef, lamb and pork), poultry (chicken, duck, goose and turkey), egg, fatty fishes, prawn, crab, lobster, mussels, oysters, scallops, tofu, etc.

Collagen Supplement

It helps to improve skin texture, retain moisture, and slow down the aging process. It has a variety of formulations and a broad range of origins like porcine, bovine and marine fishes, etc. In a study conducted by Czajka et al. (2018), oral administration of fish-derived collagen hydrolysate low-molecular-weight collagen peptide (LMWCP) promotes the regeneration of collagen fibers and elastic tissues in the skin. At a dose of 1000 mg once daily, it can significantly improve skin moisture, suppleness and wrinkles.

Water

Water helps our body stays hydrated and revitalized, and assists in maintaining the suppleness of skin. Individuals who drink plenty of water are less likely to get marks, creases compared to those who don’t. This helps to slow skin aging. In a study that conducted by Palma et al. (2015), consuming more than 2 L water daily encourages both superficial and deep hydration of the skin. As a result, skin looks moisturized, younger and healthier.

Conclusion

In conclusion, diet and nutrition that are adequate, balanced, moderate and diversified plays a crucial role in delaying skin aging. Besides, individuals should also consume at least five servings of fruits and vegetables daily, and avoid overconsumption to maintain healthy, radiant skin.

References

1. Abdullah. M & Attia, F.N. 2019. Vitamin C (Ascorbic Acid). In: StatPearls
2. Keen, M.A. & Hassan, I. 2016. Vitamin E in dermatology; Indian Dermatology Online Journal, 7(4):311-315.
3. Tominaga, K., Hongo, N., Fujishita, M., Takahashi, Y & Adachi, Y. 2017. Protective effects of astaxanthin on skin deterioration; Journal of Clinical Biochemistry and Nutrition; 61(1):33-39
4. Zhao, Q., Ma, Y.M., Jing, L., Zheng, T.X., Jiang, H.F., Li, P.A. & Zhang, J.Z. 2019. Coenzyme Q10 Protects Astrocytes from Ultraviolet B-Induced Damage Through Inhibition of ERK 1/2 Pathway Overexpression; Neurochemical Research; 44(7):1755-1763.
5. Isaac, V.L., Chiari-Andréo, B.G., Marto, J.M., Moraes, J.D., Leone, B.A., Corrêa, M.A. & Ribeiro, H.M. 2015. Rheology as a Tool to Predict the Release of Alpha-Lipoic Acid from Emulsions Used for the Prevention of Skin Aging; Biomed Research International.
6. Czajka, A., Kania, E.M., Genovese, L., Corbo, A., Merone, G., Luci, C. & Sibilla, S. 2018. Daily oral supplementation with collagen peptides combined with vitamins and other bioactive compounds improves skin elasticity and has a beneficial effect on joint and general wellbeing; Nutrition Research. 57:97-108.
7. Palma, L., Marques, L.T., Bujan, J. & Rodrigues, L.M. 2015. Dietary water affects human skin hydration and biomechanics. Clinics in Cosmetic Investigation Dermatology. 8, 413

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/.

What is diabetes?

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood glucose. Hyperglycemia also known as high blood sugar is a common effect of uncontrolled diabetes and if continued over time will leads to deterioration of various body’s systems, especially the nerves and blood vessels.

What are the symptoms of diabetic patient?

Symptoms of diabetes may occur suddenly. In type 2 diabetes, the symptoms can be mild and may take years to be noticed. Symptoms of diabetes include:

Over time, diabetes can damage blood vessels in the heart, eyes and kidneys. People with diabetes have a higher risk of health problems including heart attack, stroke and kidney failure. Diabetes can cause permanent vision loss by damaging blood vessels in the eyes. Many people with diabetes develop problems with their feet due to nerve damage and poor blood flow. This can cause foot ulcers and may lead to amputation.

What is Therapeutic Diet?

A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients. It is part of the treatment of a medical condition and are normally prescribed by a physician and planned by a dietician. A therapeutic diet is usually a modification of a regular diet. It is modified or tailored to fit the nutrition needs of a particular person.

Purpose of Therapeutic Diet:

Type of Therapeutic Diet:

Diabetic or calorie-controlled diet (ADA)

These diets control calories, carbohydrates, protein, and fat intake in balanced amounts to meet nutritional needs, control blood sugar levels, and control weight. The purpose of the diet is to keep the patient in good health, to keep blood sugar level within normal level and to keep urine free from sugar. Portion control is used at mealtimes as outlined in ADA “Exchange List for Meal Planning.  The diet planning will be balanced but have restriction on carbohydrates like rice, biscuits, sugar, jams, sweets, honey and sweet potatoes. Most commonly used calorie levels are 1,200, 1,500, 1,800 and 2,000.  Moreover, this diet used healthy fats that come from fish oils, olive oil, nuts, flaxseeds, avocados and high-fiber cereals made from whole grains, fresh fruits and veggies.

What are lifestyle approaches for prevention and management of diabetes?

Exercise

Physical activity is another important part of diabetes management plan. During workout, our muscles use sugar (glucose) for energy. Regular physical activity also helps our body use insulin more efficiently. These factors work together to lower the blood sugar level. The more strenuous the workout, the longer the effect lasts. However, even light activities such as housework, gardening or being on the feet for extended periods can improve blood sugar.

Management of stress

Stress may induce your body to release hormone cortisol which in turn triggers liver to release glucose. Thus, prolonged stress may cause a rise in blood sugar level. Additionally, it may be harder to closely follow usual diabetes management routine if an individual is under a lot of extra pressure. Patient with diabetic should learn relaxation techniques and avoid common stressors. Exercise can often help relieve stress and lower blood sugar level.

Monitoring of blood sugar

Diabetic patients, even healthy individual should monitor blood sugar levels regularly. This action can help everyone to maintain their sugar levels under normal range. Most importantly patient with diabetes should have their sugar levels recorded to ensure that their health is in optimal condition. Otherwise, patient with diabetes might not be aware whether their sugar level is in an acceptable range or have passed a dangerous level.

Take medication on time

Alongside lifestyle modification such as nutrient-dense diet and regular exercise, a person with type 2 diabetes might need to manage their blood sugar levels through medication that was prescribed by a doctor. In order to ensure their blood glucose is always under control, diabetic patient must take precaution to always consume their medication on time.

Conclusion

In conclusion, appropriate diet and lifestyle approach is important in preventing and managing diabetes. Diet which are rich is fibers, low carbohydrates and healthy fats helps in management of normal blood sugar level. Together with this, physically active, good management of stress and regular monitoring of sugar level gives more benefits in the prevention and management of diabetes. So let’s live healthy!!

References

Ghosh, Amrita. (2018). Therapeutic Diet: What We Need to Consider. Bengal Physician Journal. 5. 25-27. 10.5005/jp-journals-10070-5209.

Tarigan, Rinawati. (2022). hubungan gaya hidup dengan terjadinya penyakit diabetes melitus di rsu daerah dr r.m djoelham. Jurnal Keperawatan Priority. 5. 94-102. 10.34012/jukep.v5i1.2105.

Superfood?

In a world constantly on the move, maintaining a healthy body is profound as it could put a halt to everyday requirement including work and social life. Therefore, the choices we make about the food we consume are perhaps the most influential decisions we make daily, as it doesn’t just shape our individual health but also the collective vitality of generations to come. Superfoods, packed with essential nutrients, can play a significant role in promoting health and preventing various diseases. However not a single food can provide all the nutrients, health benefits and energy we need for our body. According to 2015–2020 US Dietary Guidelines, “a healthy eating pattern is combining healthy choices from across all food groups while paying attention to calorie limits.”  This article aims to highlight a list of essential superfoods that should be included in your diet to ensure optimal health and vitality.

List of Superfoods

1. BERRIES

Berries are considered beneficial to our health due to its high antioxidant content, particularly anthocyanin. These compounds have been linked to the abilities that may help protect the body from heart disease and reduce inflammation. Some of the most well-known berries are Strawberries, Blueberries, Blackberries and Cranberries. Cheatham et al. (2023) found that regularly eating blueberries may improve memory and delay age-related cognitive decline. The result proved that the potential consumption of blueberries has supported neural functioning.  Besides, eating berries can also be effective in treating various digestive and immune-related disorders combined with established treatment or therapies (Govers et al., 2018). There is various ways to enjoy berries as it can be part of your breakfast plate, a smoothie or a dessert.  

2. FATTY FISHES

Fatty fishes contain Omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are essential for cardiovascular health and brain function.  Furthermore, these fatty acids help in reducing inflammation, preventing fat deposited in the arteries, improving blood flow and reducing triglyceride levels (Shahidi & Ambigaipalan, 2018). Our body cannot produce omega 3 fatty acids naturally. Therefore, it must be obtained through diet. Fatty fish such as salmon, sardine and mackerel are excellent sources of omega 3 and it is highly nutritious packed with `healthy fats’, protein, vitamin B, and minerals such as potassium and selenium. It is one of the best source to reduce inflammation and may help reduce the risk of cardiovascular issues (Zivkovic et al. 2011).

!! the serving of fatty fish is limited to one to two servings weekly due to the risk of heavy metal contamination in larger fish.

3. QUINOA

Quinoa is one of the many varieties of whole grain. Whole grains are made up of all three components of the grain. There are numerous varieties, such as whole wheat and whole corn, oats, brown rice and quinoa. Seal (2006) stated that whole grains provide a variety of essential elements such as vitamins, minerals, protein, fiber, and other beneficial plant compounds. Fiber content in whole grains helps to reduce bad cholesterol levels (LDL), blood pressure and aids in weight loss as it can create a feeling of fullness. For instance, Quinoa is a complete protein and is a great alternative to traditional grains. It contains high fiber, vitamins, and minerals, making it a great addition to any balanced diet (Carreiro et al. 2016). A combination of quinoa with high protein food in a daily diet provides you with a variety of health benefits to support your gut health and body weight management.

4. DARK LEAFY VEGETABLES

Dark leafy vegetables are a crucial part in every diet as they are packed with a bunch of nutrients such as vitamins, minerals and fibre. According to Malaysian Food Pyramid 2020, the recommended intakes for vegetables are more than 3 servings in a daily food intake. There are some examples of dark leafy vegetables that you can add in your diet such as Kale. Kale is a nutrient powerhouse, rich in vitamins A, C, and K, as well as calcium and fibre. It contains antioxidants and compounds that may help protect against certain types of cancer (Ortega et al. 2021). Besides, spinach is also one of the vegetables that are often on the list of the healthiest foods. Spinach is filled with nutrients such as vitamins, minerals, and antioxidants. It is also an excellent source of iron and folate, crucial for increasing hemoglobin in blood and preventing anemia symptoms.

5. YOGURT

Yogurt is a superfood that should be included in your healthy diet list.  It is not only diverse, but has numerous health benefits and abundant with nutrients such as protein and calcium. It is a good source of probiotic equipped with detoxifying properties making it ideal for weight loss and beneficial to your skin. Furthermore, yoghurt is packed with healthy bacteria, which can aid digestion, promote gut health and protect from colon cancer (Kim CE et al. 2022). In addition, consumption of dairy products such as yogurt helps in strengthening body’s immunity and prevention from viral infections due to their beneficial effect that has been mainly attributed to its probiotic.

6. SWEET POTATOES

Sweet potatoes scientifically known as Ipomoea batatas, are a versatile and nutritious root vegetable that has captured the palates and hearts of people around the world. With their vibrant colours, rich flavours, and numerous health benefits, sweet potatoes have earned their place not only on dinner plates but also in culinary traditions and discussions about wellness. One of the most striking features of sweet potatoes is their spectrum of colors, which ranges from pale yellows to deep oranges and even purples. This diverse color palette is indicative of the variety of nutrients and antioxidants they contain. The vibrant orange hue, for instance, is a sign of their high beta-carotene content, a precursor to vitamin A that supports vision, immune function, and skin health (Johra FT et al. 2020).

Conclusion

Incorporating a variety of superfoods into your diet can have a profound impact on your overall health and well-being. These nutrient-dense foods provide a wide array of vitamins, minerals, antioxidants, and other beneficial compounds that support various bodily functions and help protect against chronic diseases. By including superfoods like berries, quinoa, fatty fishes, green leafy vegetables, yogurt, and sweet potatoes, you can create a foundation for a balanced and nutritious diet that promotes long-term health. Remember, a diverse and colorful plate is key to reap the full benefits of these incredible superfoods!

References

1. Cheatham CL, Canipe LG 3rd, Millsap G, Stegall JM, Chai SC, Sheppard KW, Lila MA. Six-month intervention with wild blueberries improved speed of processing in mild cognitive decline: a double-blind, placebo-controlled, randomized clinical trial. Nutr Neurosci. 2023 Oct;26(10):1019-1033. doi: 10.1080/1028415X.2022.2117475. Epub 2022 Sep 6. PMID: 36066009.

2. Govers C, Berkel Kasikci M, van der Sluis AA, Mes JJ. Review of the health effects of berries and their phytochemicals on the digestive and immune systems. Nutr Rev. 2018 Jan 1;76(1):29-46. doi: 10.1093/nutrit/nux039. PMID: 29087531.

3. Zivkovic AM, Telis N, German JB, Hammock BD. Dietary omega-3 fatty acids aid in the modulation of inflammation and metabolic health. Calif Agric (Berkeley). 2011 Jul;65(3):106-111. doi: 10.3733/ca.v065n03p106. PMID: 24860193; PMCID: PMC4030645.

4. Shahidi F, Ambigaipalan P. Omega-3 Polyunsaturated Fatty Acids and Their Health Benefits. Annu Rev Food Sci Technol. 2018 Mar 25;9:345-381. doi: 10.1146/annurev-food-111317-095850. PMID: 29350557.

5. Seal CJ. Whole grains and CVD risk. Proc Nutr Soc. 2006 Feb;65(1):24-34. doi: 10.1079/pns2005482. PMID: 16441941.

6. Carreiro AL, Dhillon J, Gordon S, Higgins KA, Jacobs AG, McArthur BM, Redan BW, Rivera RL, Schmidt LR, Mattes RD. The Macronutrients, Appetite, and Energy Intake. Annu Rev Nutr. 2016 Jul 17;36:73-103. doi: 10.1146/annurev-nutr-121415-112624. PMID: 27431364; PMCID: PMC4960974.

7. Ortega-Hernández E, Antunes-Ricardo M, Jacobo-Velázquez DA. Improving the Health-Benefits of Kales (Brassica oleracea L. var. acephala DC) through the Application of Controlled Abiotic Stresses: A Review. Plants (Basel). 2021 Nov 29;10(12):2629. doi: 10.3390/plants10122629. PMID: 34961097; PMCID: PMC8706317.

8. Kim CE, Yoon LS, Michels KB, Tranfield W, Jacobs JP, May FP. The Impact of Prebiotic, Probiotic, and Synbiotic Supplements and Yogurt Consumption on the Risk of Colorectal Neoplasia among Adults: A Systematic Review. Nutrients. 2022 Nov 21;14(22):4937. doi: 10.3390/nu14224937. PMID: 36432622; PMCID: PMC9697560.

9. Johra FT, Bepari AK, Bristy AT, Reza HM. A Mechanistic Review of β-Carotene, Lutein, and Zeaxanthin in Eye Health and Disease. Antioxidants (Basel). 2020 Oct 26;9(11):1046. doi: 10.3390/antiox9111046. PMID: 33114699; PMCID: PMC7692753.

Aging is an inevitable process that all people experience. The progress of aging depends heavily on diet. Therefore, diet that rich in adequate nutrients and antioxidants play significant roles in delaying skin aging process. They can protect the skin from UV-induced skin aging, fight against oxidative stress, neutralize free radicals and scavenge reactive oxygen species.

Figure 1.0: Comparison of the Changes between Healthy skin and Aging skin.

Table 1.0: Comparison of Young Skin and Aging Skin

Vitamin C is a water-soluble, powerful antioxidant that protects skin from oxidative stress and repairs UV-induced skin aging. Besides, it also promotes the productions of collagen and elastin. This results in decrease in wrinkles, and increase in skin’s elasticity. According to a study conducted by Abdullah et al. (2019), both enzymes lysyl hydroxylase and proyly hydroxylase are crucial in Types I and III Collagen production. They rely on Vitamin C as an essential co-factor. Examples of foods that rich in Vitamin C are kiwi, strawberry, lemon, orange, guava, papaya, green peppers, red peppers, etc.

Vitamin E (Tocopherol)

Vitamin E is a fat-soluble potent antioxidant. It delays skin aging by fighting against oxidative stress and moisturizing the skin. A study from Keen et al. (2016) showed that the skincare products with the range between 2% to 20% of topical Vitamin E are able to minimize lipid peroxidation, thus delaying skin aging. It works by reducing wrinkles and enhancing the stratum corneum’s capacity to retain moisture and promote skin antioxidant protection. Examples of foods that rich in Vitamin E are broccoli, corn oil, sunflower seeds, mango, nuts (almond, hazelnuts and peanuts), etc.

Alpha Lipoic Acid (ALA)

ALA is a very potent antioxidant. ALA and its reduced form Dihydrolipoic Acid play significant roles in producing intracellular antioxidants and removing free radicals (Isaac et al., 2015). Examples of foods and supplements are broccoli, internal organs, potato, red meat, spinach, tomato, ALA supplements, etc.

Astaxanthin

It is a reddish-orange pigment that present in a wide variety of aquatic creatures. Examples included marine fishes, shrimps, crustaceans, etc. It is a potent antioxidant that plays a significant role in delaying skin aging by fighting against oxidative stress. In a study by Tominaga et al. (2017), long-term intake of astaxanthin may prevent age-related skin degeneration and preserve skin disorders resulting from environmental exposure. Examples of foods and supplements are algae, crayfish, krill, shrimp, salmon, trout, yeast, astaxanthin supplements, etc.

Coenzyme Q10 (CoQ10)

It is a well-known free radical scavenger. It helps to neutralizes reactive oxygen species, thus protecting cells from oxidative stress. According to a study conducted by Zhao et al. (2019), CoQ10 are able to shield astrocytes (cells) from UVB-induced oxidative stress by regulating PKA-ERK 1/2 signalling pathway. Examples of foods and supplements are fatty and oily fishes (salmon and tuna), internal organs, soybean, spinach, whole grains, CoQ10 supplements, etc.

Protein

Protein is needed to preserve the firmness, shape and integrity of the skin. Besides, it plays a crucial role in boosting cell regeneration. Diet high in protein promotes collagen production that results in smooth, radiant, moisturized and healthy skin. Examples of foods that rich in protein are lean meats (beef, lamb and pork), poultry (chicken, duck, goose and turkey), egg, fatty fishes, prawn, crab, lobster, mussels, oysters, scallops, tofu, etc.

Collagen Supplement

It helps to improve skin texture, retain moisture, and slow down the aging process. It has a variety of formulations and a broad range of origins like porcine, bovine and marine fishes, etc. In a study conducted by Czajka et al. (2018), oral administration of fish-derived collagen hydrolysate low-molecular-weight collagen peptide (LMWCP) promotes the regeneration of collagen fibers and elastic tissues in the skin. At a dose of 1000 mg once daily, it can significantly improve skin moisture, suppleness and wrinkles.

Water

Water helps our body stays hydrated and revitalized, and assists in maintaining the suppleness of skin. Individuals who drink plenty of water are less likely to get marks, creases compared to those who don’t. This helps to slow skin aging. In a study that conducted by Palma et al. (2015), consuming more than 2 L water daily encourages both superficial and deep hydration of the skin. As a result, skin looks moisturized, younger and healthier.

Conclusion

In conclusion, diet and nutrition that are adequate, balanced, moderate and diversified plays a crucial role in delaying skin aging. Besides, individuals should also consume at least five servings of fruits and vegetables daily, and avoid overconsumption to maintain healthy, radiant skin.

References

1. Abdullah. M & Attia, F.N. 2019. Vitamin C (Ascorbic Acid). In: StatPearls
2. Keen, M.A. & Hassan, I. 2016. Vitamin E in dermatology; Indian Dermatology Online Journal, 7(4):311-315.
3. Tominaga, K., Hongo, N., Fujishita, M., Takahashi, Y & Adachi, Y. 2017. Protective effects of astaxanthin on skin deterioration; Journal of Clinical Biochemistry and Nutrition; 61(1):33-39
4. Zhao, Q., Ma, Y.M., Jing, L., Zheng, T.X., Jiang, H.F., Li, P.A. & Zhang, J.Z. 2019. Coenzyme Q10 Protects Astrocytes from Ultraviolet B-Induced Damage Through Inhibition of ERK 1/2 Pathway Overexpression; Neurochemical Research; 44(7):1755-1763.
5. Isaac, V.L., Chiari-Andréo, B.G., Marto, J.M., Moraes, J.D., Leone, B.A., Corrêa, M.A. & Ribeiro, H.M. 2015. Rheology as a Tool to Predict the Release of Alpha-Lipoic Acid from Emulsions Used for the Prevention of Skin Aging; Biomed Research International.
6. Czajka, A., Kania, E.M., Genovese, L., Corbo, A., Merone, G., Luci, C. & Sibilla, S. 2018. Daily oral supplementation with collagen peptides combined with vitamins and other bioactive compounds improves skin elasticity and has a beneficial effect on joint and general wellbeing; Nutrition Research. 57:97-108.
7. Palma, L., Marques, L.T., Bujan, J. & Rodrigues, L.M. 2015. Dietary water affects human skin hydration and biomechanics. Clinics in Cosmetic Investigation Dermatology. 8, 413

Magnesium, one of the abundant minerals in the body, is found naturally in foods, added to food products, available as a dietary supplement, and present in some medicines. Energy synthesis, oxidative phosphorylation, and glycolysis all require magnesium. It is necessary for the production of DNA, RNA, and antioxidant glutathione besides helping in the structural development of bone. Magnesium is also involved in the active transport of calcium and potassium ions across cell membranes, which is important for nerve impulse transmission, muscle contraction, and appropriate heart rhythm.

Magnesium deficiency is not very common in children. However, as more children consume more processed foods, magnesium deficiency is becoming more common nowadays. Magnesium deficiency can also occur in children with digestive disorders such as celiac disease, chronic diarrhea, or type 2 diabetes. Loss of appetite, nausea, vomiting, fatigue, and weakness are the first signs of deficiency in children. When it becomes severe, it may lead to numbness, tingling, and muscle cramps. Magnesium deficiency in children can also cause sadness, difficulties in focusing, insomnia, and anxiety (NIH, 2022).

HEALTH BENEFITS OF MAGNESIUM

Magnesium is one of the important minerals needed for children as it plays a vital part in wide range of enzymatic functions in the body. As the body requires magnesium for numerous biological functions,  its deficiency can have a significant effect. This is especially important for infants, toddlers and teenagers, who rely on these processes to grow and function normally.

Magnesium has a wide range of benefits for children, which include promoting restful sleep. Sleep issues can affect people of any age, but children are more prone to suffer from them. Lack of magnesium are linked to sleeplessness as magnesium is thought to promote and regulate GABA, a neurotransmitter that promotes sleep. Thus, increasing child’s magnesium levels in tiny amount can help to promote sleep (Doherty et al., 2019).

Magnesium also acts as a guide that direct calcium to the bones. Calcium and magnesium work together to promote bone density and growth. Calcium is not effectively absorbed into the bones without magnesium. Furthermore, there is a higher risk of weakened bones if the magnesium level falls too low (Ciosek et al., 2021).

Commonly, children are still unable to manage their emotions and moods, thus taking magnesium can help to create calm and peaceful feeling. It can help to relieve stress and increase children’s mood. As such, magnesium-rich diet is also advised for children with attention-deficit hyperactivity disorder (ADHD) in order to reduce hyperactivity and agitation (Robberecht et al., 2020).

Additionally, magnesium provides constipation relief by working as a natural stool softener. Magnesium aids with bowel movement, which help to soften the stool by increasing water in the intestines. The increase in water stimulates bowel movement, besides softening the stool, making the stool easier to pass (Terri, 2021).

SOURCES OF MAGNESIUM

Magnesium is important for the proper functioning of hundreds of enzymes and aids to promote healthy bones. Deficiency of magnesium might cause development issues in children. Thus, it is important to know what are the best sources to get magnesium from your diet (Patwal, 2023). Magnesium is abundantly present in plant and animal-sourced foods. Green leafy vegetables, legumes, nuts, seeds, and whole grain are all good sources of magnesium. In general, magnesium can be found in foods containing dietary fiber. Magnesium is also added into some breakfast cereals and other fortified foods (NIH, 2022).

Some examples of magnesium-rich foods that can be included in daily diet are soy products, such as tofu, soy milk, and soybeans. Other than that, legumes and seeds also good source of magnesium besides nuts such as almonds and cashews. Consuming almond butter and almond milk can be a good alternative too. Whole grain breads and breakfast cereals can be a good option too as magnesium is also fortified into them. Bananas, potatoes, and dried apricots are some of the sources other than green leafy vegetables, such as avocados and spinach (Golisano Children’s Hospital, 2023).

Healthy foods usually offer all the nutrients needed by our body. However, given today’s children’s eating habits, supplement containing magnesium can be considered to fulfil the daily recommended intake.

RECOMMENDED INTAKE OF MAGNESIUM

The amount of magnesium needed by the body usually depend on the age and sex. For infants aged zero to six months, it is recommended to take 30mg/day, while for infants aged seven to twelve months, it is recommended to take 75mg/day. Children aged between one to three years old, on the other hand, need 80mg/day. While, for those aged four to eight years old need 130mg/day. For adolescent aged nine to thirteen years old, they may need 240mg/day, while for boys and girls aged between fourteen to eighteen years old, need 410mg/day and 360mg/day of magnesium, respectively (RNI, 2017).

CONCLUSION

In conclusion, magnesium serves as an important mineral needed by the body for various functions. It is considered as one of the essential mineral children need for healthy growth and development. In children, magnesium may offer benefits such as to promote sleep, support neurological function, improve mood, and aid in the muscle development. Lack of magnesium in children may lead to fatigue, muscle weakness, irritability, and delayed growth and development. Thus, it is important to take healthy diet in order to make sure magnesium are taken according to the recommendation. When the intake cannot meet the recommendation, magnesium supplements may be a good idea to combat the insufficiency.

REFERENCES

Ciosek, A., Kot, K., Kosik-Bogacka, D., Łanocha-Arendarczyk, N., & Rotter, I. (2021, March 28). The Effects of Calcium, Magnesium, Phosphorus, Fluoride, and Lead on Bone Tissue. Biomolecules; Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/biom11040506

Doherty, R., Madigan, S. M., Warrington, G. D., & Ellis, J. (2019, April 11). Sleep and Nutrition Interactions: Implications for Athletes. Nutrients; Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/nu11040822

Golisano Children’s Hospital. (2023). Magnesium-Rich Foods – Pediatric Nutrition. Galisano Children’s Hospital. Retrieved October 7, 2023, from https://www.urmc.rochester.edu/childrens-hospital/nutrition/magnesium-foods.aspx

NIH. (2022, June 2). Magnesium – Fact Sheet for Health Professionals. National Institutes of Health (NIH). Retrieved October 7, 2023, from https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#:~:text=Magnesium%20is%20a%20cofactor%20in,%2C%20oxidative%20phosphorylation%2C%20and%20glycolysis.

Patwal, S. (2023, July 18). Magnesium For Kids: Importance, Best Sources And Supplements. MomJunction. https://www.momjunction.com/articles/magnesium-rich-foods-for-your-kids_00104129/

Robberecht, H., Verlaet, A. A. J., Breynaert, A., De Bruyne, T., & Hermans, N. (2020, September 27). Magnesium, Iron, Zinc, Copper and Selenium Status in Attention-Deficit/Hyperactivity Disorder (ADHD). Molecules; Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/molecules25194440

RNI. (2017). Recommended Nutrient Intakes for Malaysia 2017. Ministry of Health (MoH). Retrieved October 7, 2023, from https://hq.moh.gov.my/nutrition/wp-content/uploads/2017/05/FA-Buku-RNI.pdf

Terri. (2021, March). Magnesium for Constipation. Michigan Medicine, University of Michigan. Retrieved October 7, 2023, from https://www.med.umich.edu/1libr/MBCP/Magnesium.pdf

INTRODUCTION

Periods of voluntary moderation from food and drink (i.e., intermittent fasting) has been practiced since earliest ancient times by peoples around the globe. Books on ethnology and religion describe a remarkable variety of fasting forms and practices. Renewed interest in fasting regimens is evidenced by an excess of popular press publications and diet recommendations (Brongers,1997).

Intermittent Fasting vs Calories Restriction

While entering the discussion about intermittent fasting, it is important to understand the difference between caloric restriction and intermittent fasting. Calorie restriction (CR) is a reduction in total caloric intake that does not result in malnutrition. This has consistently been found to result in decreased body weight and increased longevity in many species, including non-human primates. Among overweight humans, short-term CR (6-months) has been shown to significantly improve multiple cardiovascular risk factors, insulin sensitivity, and mitochondrial function. Likely due to these physiological changes, clinical trials indicate CR may have several beneficial effects among overweight adults, in addition to weight loss. However, over the past several decades, obesity intervention trials have revealed that most individuals experience difficulties sustaining daily CR for extended periods of time.

Types of Intermittent Fasting

More studies are needed to evaluate mechanisms, efficacy in humans, target populations, and safety of intermittent fasting. There are numerous intermittent fasting regimens ranging from 12- to 16-hour daily fasts to 5:2 strategy, and it remains uncertain which strategy is the best for cardiovascular health, especially with evidence suggesting that intermittent fasting regimens should follow circadian rhythms. Some of the most common ways are:

The 16:8 method

16:8 intermittent fasting method is a form of time-restricted fasting. It works by allowing consumption of foods during an 8-hour window and avoiding food or fasting for the remaining 16 hours each day. People who follows the 16:8 method abstain from taking food at night and for part of the morning and evening. During the middle of the day, they tend to consume their daily calories (NA, 2020). This method of intermittent fasting can be repeated as often as you’d like or even done once or twice. Finding the right eating and fasting windows for this method might take a few days to figure out, especially if you’re very active or if you wake up hungry for breakfast.

The 5:2 method

This approach to intermittent fasting focuses on capping your calories at 500 for two days a week. During the other five days of the week, you maintain a healthy and normal diet. On fasting days, this approach usually includes a 200-calorie meal and a 300-calorie meal. It’s important to focus on high-fiber and high-protein foods to help fill you up and keep calories low when fasting (menshealth.com, 2019)

The eat-stop-eat method

It’s a method of intermittent fasting which involves two, non-consecutive, 24 hour fasts per week. That means that two days a week, you’ll eat just one meal. Whether that’s breakfast, lunch, or dinner is up to you, and you can vary it as you wish. An example week might look like this:

Benefit of Intermittent Fasting

Help weight loss                                 

Trepanowski et al., 2017, compared the effects of alternate-day fasting vs. daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease. This was a randomized clinical trial of obese adults (18 to 64 years of age; mean body mass index, 34) at a single-centre academic institution in Chicago. Participating individuals were randomized to one of three groups for one year: alternate-day fasting (25% of energy needs on fast days; 125% of energy needs on alternating “feast days”), calorie restriction (75% of energy needs every day), or a no-intervention control. The primary outcome was a change in body weight.

Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease. Over the course of 12 months, the control group maintained their weight around the baseline weight, while the alternate-day fasting and daily caloric restriction groups, by 6 months, both exhibited a lowest point in weight 7% below the baseline weight (not significantly different from each other before exhibiting some later weight gain, ending at 12 months approximately 4.5% below starting weight. There was a 38% dropout in the alternate-day fasting group compared to 29% in the daily calorie restriction group and 26% in the control group. Overall, the authors concluded that alternate-day fasting did not improve health beyond calorie restriction.

Help in blood sugar

There are several proposed mechanisms regarding the development of insulin resistance. One prominent theory relates to associations between increased adiposity and subsequent chronic inflammation, leading to the development of insulin resistance in tissues. Intermittent fasting can decrease adiposity and related insulin resistance through reduced caloric intake and metabolic reprogramming. Another hypothesis is that decreased energy intake, such as that achieved through intermittent fasting, will cause a prolonged decrease in insulin production and increased levels of AMPK, which likely plays a role in the improvements in insulin sensitivity and glucose homeostasis.

CONCLUSION

In summary, intermittent fasting has shown positive effects on weight loss, in addition to reducing insulin resistance and favourably shifting the levels of leptin and adiponectin. Pre-clinical and clinical studies have demonstrated that intermittent fasting has a wide range of benefits for many diseases, including obesity, T2DM, and hypertension, and in improving cardiovascular risk factors. One argument against intermittent fasting is that, despite extensive animal data, many clinical trials have failed to show as significant improvements of intermittent fasting over caloric restriction.

REFERENCES

1. Brongers HA. Instruction and Interpretation: Studies in Hebrew Language, Palestinian Archaeology and Biblical Exegesis. Belgium: Brill Academic Pub.; 1997.
2.  Kerndt P.R., Naughton J.L., Driscoll C.E., Loxterkamp D.A. Fasting: The history, pathophysiology and complications. West. J. Med. 1982;137:379–399. 
3.  Moro T, Tinsley G, Bianco A, et al. Effects of eight weeks of timerestricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males. J Transl Med 2016;14:290
4. Nowosad K., Sujka M. Effect of Various Types of Intermittent Fasting (IF) on Weight Loss and Improvement of Diabetic Parameters in Human. Curr. Nutr. Rep. 2021;10:146–154. doi: 10.1007/s13668-021-00353-5. 
5. https://www.healthline.com/nutrition/16-8-intermittent-fasting
6. https://simple.life/blog/eat-stop-eat-plan/
7. Trepanowski J.F., Kroeger C.M., Barnosky A., Klempel M.C., Bhutani S., Hoddy K.K., Gabel K., Freels S., Rigdon J., Rood J., et al. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Intern. Med. 2017;177:930–938. doi: 10.1001/jamainternmed.2017.0936
8. Albosta M., Bakke J. Intermittent fasting: Is there a role in the treatment of diabetes? A review of the literature and guide for primary care physicians. Clin. Diabetes Endocrinol. 2021;7:3. doi: 10.1186/s40842-020-00116-
9. NA (2020), A Guide To 16:8 Intermittent Fasting. https://www.medicalnewstoday.com/articles/324882#summary

Introduction

Magnesium (Mg2+), is an abundant mineral in the body, plays a key role in many essential cellular processes such as:

• intermediary metabolism,
• DNA replication and repair,
• transporting potassium and calcium ions,
• cell proliferation together with signaling transduction

For children, magnesium is crucial as it helps in muscle relaxation and activation of vitamin D and calcium to help keep bones strong. In addition, magnesium plays an important role in helping:

• to regulate heartbeat
• preventing tooth decay and
• supporting the immune system when the body is under stress.

Factors that contribute to magnesium deficiency

Magnesium deficiency can be caused by a variety of circumstances, but the main cause in children is usually a poor diet management.

Magnesium is known to be depleted by stress, strenuous activity, and a diet high in refined sugar and carbs. It’s crucial to note that anxiety and stress affect children too, which causes them to regularly consume a diet high in sugar and refined carbohydrates.

Other than that, factors that can reduce the absorption of magnesium include a low protein diet, a high saturated fat diet, a prevalent western diet which leads to vitamin D deficiency, a lack of sunlight exposure and medications commonly given to children, such as antibiotics, inhaled corticosteroids, antihistamines and antacids (Magnesium: A Vital Nutrient for Children, n.d.).

Symptoms and complications of magnesium deficiency

Symptomatic magnesium deficiency in children is not very common. However, habitually low intakes or excessive losses of magnesium due to certain health conditions, and/or the use of certain medications can lead to magnesium deficiency.

Symptoms of worsened magnesium deficiency can include:

• numbness
• tingling
• muscle spasms or cramps
• severe symptoms related to irregular heartbeats and seizures (Signs and Consequences When Children Lack Magnesium | Vinmec, n.d.).

• Severe magnesium deficiency can result in hypocalcemia or hypokalemia (low serum calcium or potassium levels, respectively) because mineral homeostasis is disrupted.

• A magnesium deficiency can also affect a child’s behavior such as sadness (irritability or hyperactivity), difficulty concentrating, insomnia, and anxiety (“Diet. Ref. Intakes Calcium, Phosphorus, Magnesium, Vitam. D, Fluoride,” 1997).

When a child’s body lacks magnesium, it may affect their growth rate causing them to be underdeveloped in height and have small skeletal muscles. Besides, children with magnesium deficiency often have behavioural disorders such as aggression, depression and anxiety. Children who are deficient in magnesium are more likely to have weak muscles, experience muscle spasms, and are more prone to cramps because magnesium is involved in the process of relaxation of muscles.

Recommended intake of magnesium and source of magnesium

The amount of magnesium the body needs depends on age and gender. Based on the Recommended Nutrient Intake for Malaysia (RNI), the average recommended amount of magnesium per day according to age is as follows:

The Dietary Guidelines for Americans describe a healthy dietary pattern as one that includes a variety of vegetables; fruits; grains (at least half whole grains); fat-free and low-fat milk, yogurt, and cheese; and oils.

Whole grains and dark-green leafy vegetables are good sources of magnesium. Low-fat milk and yogurt contain magnesium as well.

Some ready-to-eat breakfast cereals are fortified with magnesium. Also, dried beans, legumes (such as soybeans, baked beans, lentils, and peanuts) and nuts (such as almonds and cashews) also provide magnesium (Magnesium – Health Professional Fact Sheet, n.d.).

Conclusion

In children, symptomatic magnesium deficiency is uncommon, but it can be triggered by habitual low intake, excessive losses due to specific health conditions, and certain medications. Early signs include loss of appetite, nausea, vomiting, fatigue and weakness. If ignored, these symptoms could become more severe and show up as tingling, numbness, muscle spasms, or even convulsions. This deficit may result in diseases like hypocalcemia or hypokalemia, which disturb the balance of minerals in the body and prevent children from growing and developing their muscles properly.

References

Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. (1997). Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. https://doi.org/10.17226/5776

Magnesium: A Vital Nutrient for Children. (n.d.). Retrieved September 14, 2023, from https://www.printfriendly.com/p/g/pcGdNy

Magnesium – Health Professional Fact Sheet. (n.d.).

Ministry of Health Malaysia. (2005). Recommended Nutrient Intakes for Malaysia 2005. In Ministry of Health Malaysia.

SARAVANAMUTTO, K. (n.d.). MAGNESIUM DEFICIENCY IN KIDS. https://www.nourishedbeginnings.ca/blog1/magnesium-deficiency-in-kids-what-you-should-know#:~:text=Yes%2C deficiency can also impact,the behaviours above (7)

Signs and consequences when children lack magnesium | Vinmec. (n.d.).