White cells in blood

One important component of the body’s defence system is the neutrophil, a type of white blood cell in the blood.

MY aunt, who has been on cancer chemotherapy, was recently admitted because of fever. She was told she has low white blood cell count. The doctor said this is neutropenia. What is neutropenia?

Neutropenia means an abnormally low number of neutrophils in your bloodstream. (Neutro for “neutrophils”, penia = low.)

A neutrophil is a particular type of white blood cell that specialises in fighting off infection.

Some drugs may lead to decreased levels
of neutrophils (a type of white blood cell)
in the blood. - Photos.com

What are white blood cells are how many types are there? I thought blood is of a red colour.

Your blood is red because of the haemoglobin in it. The cells in your blood are predominantly made of red blood cells, which carry oxygen, but there are a certain number of white blood cells (leukocytes) that must be present in your bloodstream. These are part of your body’s immune system.

The density of leukocytes in your bloodstream is 5,000 to 7,000 cells every square mm.

There are several types of white blood cells:

Neutrophils – these form 50% to 70% of all white blood cells. They literally “eat” bacteria in a process called phagocytosis, in which they surround the bacteria and take it into their own cellular material.

You can actually see them in wounds that have a lot of pus.

After ingesting a few bacteria, they die.

Eosinophils – these reddish cells specialise in phagocyting parasites. They form only 2% to 4% of white blood cells.

Basophils – these are the rarest of the white blood cells, present in only 0.5% to 1%. They secrete substances like anti-clotting factors and histamines. Their main function is in the hypersensitivity reaction.

Lymphocytes – these form 20% to 40% of the cells. They are also present in your spleen, lymph nodes, thymus, tonsils and other lymphoid tissues. They are the main aggressors of the immune system because they secrete antibodies that bind to viruses and bacteria to nullify them so the neutrophils can later ingest them easily.

Lymphocytes also have a “memory” of the bacteria and virus forever, so when the same bacteria or virus attacks you, the lymphocytes will be able to mount a rapid response.

This is called “being immune” to the disease.

Monocytes – these form 3% to 8%. They play a role in phaygocytosis as well as secreting interferons and other substances.

Neutrophils leave the blood stream after six to eight hours and enter the tissues, where they either stay in the cells or die.

Is neutropenia caused only by chemotherapy?

Neutropenia can exist in normal healthy populations. Certain black people and Yemenite Jews have it. But in most people, neutropenia is a bad sign.

Neutropenia can be caused by any disease that:

·Decreases the production of white blood cells by the bone marrow – these include drugs (for example, chemotherapy); diseases of the bone marrow (for example, leukaemia); infections which suppress the bone marrow (viral diseases, TB); vitamin deficiencies.

·Destroys the white blood cells quickly after they are produced and released – when antibodies attack the white blood cells (Felty’s Syndrome); certain drugs that stimulate antibodies to attack its own white blood cells.

·Causes the accumulation or pooling of white blood cells, which takes them out of the blood stream (with some overwhelming infections, during haemodialysis, during heart-lung bypass surgery.)

How low does your white blood cell count need to go to be classified as neutropenia?

The normal white blood cell count is 4,500 to 10,000 white blood cells per microlitre. Neutrophils will form 50% to 70% of that. When your absolute neutrophil count (ANC) is 1,000 to 1,500 cells per mm3, it is mild neutropenia.

When your ANC is 500 to 1,000 cells per mm3, it is classified as moderate neutropenia. When your ANC is less than 500 cells per mm3, it is severe neutropenia.

What happens if you have neutropenia?

Because neutrophils are needed for your immune system and body defence, if you have neutropenia, then you can have infections.

The most common site for infections due to neutropenia begin with your mucous membranes, such as your lips, mouth, and eyes. The second most common infection site is your skin. This presents as ulcers, abscesses, rashes and delay in wound healing.

You have to be especially vigilant to look out for these if you have neutropenia because the normal signs of infection like warmth and swelling may not be present. This is because neutrophils are needed to mount a normal response, and if you have neutropenia, you will not have a normal response.

Note that people with neutropenia are not at increased risk for viral or parasitic infections because these are taken care of by the lymphocytes and eosinophils.

Serious infections can result in fever. This condition is then called febrile neutropenia. This is a potentially dangerous condition that can result in widespread infection.

There are drugs called the granulocyte-colony-stimulating factors to help boost your neutrophil count.

# Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health advice, computers and entertainment. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Are your kidneys okay?

Studies in the US suggest that about 10% of adults have some form of kidney damage ... and do not know about it. Take a screening test to find out if you’re one of them.

YOU might have heard stories about people whose kidneys failed suddenly. In reality, their kidneys had been damaged for some time, but they just weren’t aware of it. They had chronic kidney disease (CKD), which often presents no signs in the initial (“silent”) phase, sometimes lasting for years!

However, a time will come when the disease will start to manifest symptoms. By then, the person’s condition is already serious. Irreparable damage has been done. Most of the tiny filters (called nephrons) in the kidneys have been damaged and there are just too few left to take on the extra load of filtering the blood.

Without treatment, all the nephrons will eventually be destroyed and end-stage kidney failure will result.

Aris bin Said, 53, is a dialysis patient at NKF. For years, he didn’t know he had high blood pressure and diabetes. It didn’t really bother him until, one day, both his kidneys failed.

Causes of CKD

“The kidneys are fragile and have to be protected,” says Dr Thiruventhiran Thilaganathan, consultant nephrologist and Hon Secretary on the Board of Managers, National Kidney Foundation (NKF).

He explains: “CKD can result from certain kidney diseases (for example, polycystic kidney disease), kidney infections, blockage of the renal artery (that supplies blood to the kidney), blockage in the urinary tract (due to kidney stones or tumours), long-term use of certain medicines, and inborn kidney deformities or disorders.

“The top three causes of CKD in Malaysia, however, are uncontrolled diabetes (57% of CKD cases), unknown causes (27%) and uncontrolled high blood pressure (6%).”

Diabetes is a disease characterised by constantly high concentrations of glucose in the blood. Prolonged exposure to such high glucose levels will damage the kidneys and cause a condition called diabetic nephropathy, which is the No 1 cause of kidney failure. Almost a third of people with diabetes develop diabetic nephropathy.

High blood pressure (or hypertension) refers to how hard the blood pushes against the walls of your arteries. Chronic high blood pressure can damage the blood vessels and filters in the kidney. This is especially bad news for people with diabetes because up to 60% of them will eventually develop high blood pressure.

Signs of advanced chronic kidney disease

• Abnormally frequent and voluminous urination (especially at night), which, over time, reverses to become less frequent and in smaller amounts.
• Water retention causing swollen legs, ankles or feet, and puffy eyes.
• Continual itch anywhere on the body for no apparent reason.
• Foamy urine (due to the presence of protein).
• Easily tired and always sleepy.
• Frequent headaches.
• Trouble sleeping.
• Poor appetite, accompanied by weight loss.
• Frequent feeling of wanting to vomit.
• Blood in the urine.

Time to get tested!

Dr Goh Bak Leong, consultant nephrologist and member of the NKF Board of Managers states that, in Malaysia, diabetes is estimated to affect 14% of adults while the prevalence of high blood pressure stands at a staggering 42.6% for adults 30 years and above.

He remarks: “Both diabetes and hypertension can be without symptoms; so many Malaysians out there are walking around totally unaware that their blood glucose or blood pressure may be abnormally high.

“It is also highly likely that they don’t know that they either already have CKD or are seriously at risk of developing it.”

Dr Tan Chwee Choon, 2nd Vice-Chairman of the NKF Board of Managers, adds: “Clearly, kidney damage has to be detected as early as possible. The sooner you know you’re in trouble, the sooner you can be treated to prevent further deterioration,” he says.

“You have to make the effort to care for your kidneys and prevent end-stage kidney failure. Taking a morning or afternoon off to see the doctor for a test is a small inconvenience compared with spending the rest of your life on dialysis,” he remarks.

Evidently, NKF is serious about making the public aware of their CKD risk. As it is, the NKF LifeCheck Mobile Health Screening Unit has already screened more than 4,000 people in Klang Valley since its launch in January 2008.

Dr S.S. Gill, Chairman of NKF Board of Managers, elaborates: “NKF LifeCheck is part of our Kidney Care community education programme. Our NKF LifeCheck bus visits companies and communities daily to offer tests to detect protein in the urine (one of the first signs of kidney damage), high blood glucose, high blood pressure and high blood cholesterol. Checks are also performed to measure body weight status.

“Participants are then counselled, based on their results, by qualified personnel. People with suspected kidney damage, diabetes or high blood pressure will be advised to visit their doctors for a more thorough diagnosis.

“The tests and counselling cost only RM2 per person. This practically-free service is made possible by the generosity of the Sunway Group and other companies who care enough about the community to underwrite the actual, much higher cost of NKF LifeCheck.”

CKD is a serious disease that is made worse by the ignorance and complacency of people. World Kidney Day 2008 has just passed, but hears the echo of its call: “Are your kidneys OK?” If you don’t know the answer, ask your doctor today.

Healthy values for healthy kidneys

• Blood glucose – Less than 5.6 mmol/L (fasting)
• Blood pressure – Less than 130/90 mm/Hg
• Urine tests – No trace of protein; no trace of glucose; no trace of blood
• Waist circumference – Less than 102 cm (men); less than 88 cm (women)
• Body mass index – Between 18.5 and 24.9 kg/m2

This article is courtesy of NKF KIDNEY CARE, a community education programme by National Kidney Foundation of Malaysia. NKF provides subsidised dialysis treatments and free medications, laboratory tests, follow-ups and welfare assistance to NKF patients besides ongoing public education initiatives.

NKF welcomes public donations to support its work. For more details, please contact NKF Hotline: 1300-88-3110; website: www.nkf.org.my.

Liver Part 1

Deliverance

By TERESA KOK MEY YIN

This is the first in a series of six monthly educational articles on maintaining a healthy liver.

PLACE your right hand over the area under the ribs on the right side of your body – this is where the largest organ in the body resides – the liver.

Essential phospholipids are isolated from soy.

Most of us are blessed with a healthy liver, which unfortunately we tend to take for granted. The liver, being the only organ that is able to regenerate itself, is able to care for itself to a certain extent.

If however, the damage becomes extensive, then the liver will not be able to repair itself and will start to show signs of damage.

The liver performs over 500 different functions including:

Processing digested food from the intestine

Controlling levels of fats, amino acids and glucose in the blood

Combating infections in the body

Clearing the blood of particles and infections, including bacteria

Neutralising and destroying drugs and toxins

Manufacturing bile

Storing iron, vitamins and other essential chemicals

Breaking down food and turning it into energy

Manufacturing, breaking down and regulating numerous hormones, including sex hormones

Making enzymes and proteins that are responsible for most chemical reactions in the body, for example those involved in blood clotting and repair of damaged tissues.

The importance of the liver cannot be overemphasised. If we can appreciate this fact, then we can appreciate the fact that the liver does need some amount of care.

Liver facts

More often than not, we tend to associate liver diseases with alcohol or drugs. However, the truth of the matter is that there are over 100 known forms of liver diseases caused by a variety of factors, from stressful lifestyles to infections and it can affect everyone from infants to older adults.

The more common liver diseases are as follows, but keep in mind that the list is not exhaustive: hepatitis (A, B, C, autoimmune), cirrhosis, fatty liver, gallstones, liver cancer, alcoholic liver disease and so on.

One of the common myths that people may have is that liver diseases are primarily caused by alcohol and therefore most people who have liver diseases must be alcoholics. However, this is not true; in reality, alcohol is only one of the causes of over 100 forms of liver disease.

It may be difficult to diagnose liver diseases because of its vague presentation of symptoms. Some people may experience no symptoms at all even though the liver may have significant damage.

Some of the signs of early liver damage include a loss of appetite and low grade fever.

Liver health

From a not-so-common disease to one that has emerged among the top 10 causes of death in Malaysia, liver diseases are definitely increasing in prevalence in Malaysia1. Here are some tips for caring for your liver:

Healthy eating can lead to a healthy liver

Choose a variety of foods from all four food groups

Eat at least two servings from the meat & alternatives food group (meat, fish, poultry, peanut butter, dried beans, peas, lentils).

Focus on lower fat choices within each food group.

Eat small regular meals. Do not skip meals or over-eat.

Drink six to eight glasses of fluids (preferably water) a day.

Avoid alcohol – or if you drink, do not have more than one to two drinks per occasion (and never on a daily basis).

Eating a balanced diet may help regenerate damaged liver cells, forming new liver cells. Nutrition can be an essential part of treatment.

For example, a cirrhotic patient requires a diet which is rich in protein and which provides 2000 to 3000 calories per day to help the liver rebuild itself.

Besides healthy eating, exercise and reducing stresses in life are also important factors contributing to a healthy liver. Exercise is important because it helps give the body energy, boosts the immune system and aids in liver health.

Exercise is especially important in weight management, therefore reducing the risks of developing a fatty liver, which can lead to fatty liver disease2.

Stress is also important because it can have a negative impact on both the mind and the body. Research has shown that stress can trigger slight impairment of the liver function3.

Essential phospholipids

Essential phospholipids are isolated from soy. There are many soya bean species and the contents of the seeds may vary.

Essential phospholipids are highly purified extracts containing a high proportion of phosphatidylcholine, which is an important constituent of cell membranes and is also involved in lipid metabolism in the liver.

The exact amount of course depends on the species of the soya bean, location and extraction method. The amount of phosphatidylcholines with highly unsaturated fatty acids is a decisive factor in determining membrane fluidity and thus also the biological membrane functions4.

Essential phospholipids have protective, curative and regenerative effects on the membranes of the liver cells and this has been demonstrated in numerous experiments in the lab4.

In liver damage, there is loss of phospholipids leading to an unstable cell membrane. Incorporation of essential phospholipids into the cell membrane helps to restore the damaged structure and therefore enhance regeneration of the liver cells.

Studies seem to suggest that essential phospholipids aid in healing in a variety of liver diseases4:

1. In toxic liver damage and fatty liver.

2. In acute viral hepatitis, acute intoxication and insufficiency.

3. As a supportive therapy in chronic viral hepatitis and cirrhosis.

With all these facts in your mind, place your right hand over your liver again. This time, think of all the abuse that we have subjected our liver to: alcohol, medications, unhealthy eating, lack of exercise and stressful lifestyle. Perhaps, it is time to take heed and start taking care of our liver.

“ ? because the liver is a source of many diseases, and is a noble organ that serves many organs, almost all of them: so it suffers, it is not a small suffering, but a great and manifold one” – Theophrastus Bombastus von Hohenheim, also known as Paracelsus (1493 – 1541).

References:

1. Malaysian Burden of Disease and Injury Study. Ministry of Health 2004.

2. Canadian Liver Foundation. http://www.liver.ca/Liver_Health/Diet_and_Exercise.aspx

3. HCSP Fact Sheet. www.hbadvocate.org

4. E. Kuntz and H.D. Kuntz. Hepatology: Principles and Practice, 2nd Edition. Springer 2006, Germany.

This article is courtesy of sanofi-aventis.

Don't turn a blind eye to diabetes

From The NST

By Kasmiah Mustapha

Diabetics need regular eye checkups.

Diabetics risk going blind if they do not control their illness, writes KASMIAH MUSTAPHA.

AS symptoms only manifest until it is too late, most diabetics do not know they are at risk of developing other serious illnesses related to their disease.

One such malady is diabetic retinopathy or diabetic eye disease, a highly specific vascular complication of both Type 1 and Type 2 diabetes.

Universiti Sains Malaysia Professor of Medicine Dr Mafauzy Mohamed says the condition, if untreated, will lead to vision deterioration and ultimately, blindness.

"Most diabetics are not aware they can become blind if they do not control their blood sugar level. As diabetes is often diagnosed late, when patients have been suffering from it for four to five years, they could already be at risk of diabetic retinopathy.
The disease is responsible for over 80 per cent of blindness in diabetics. It blinds 25,000 diabetics each year.

Blindness results from damaged blood vessels next to the retina. Swollen, leaking and bleeding capillaries are blocked, cutting off blood and oxygen supply to small sections of the retina.

In a study conducted on the effectiveness of diabetic treatment in local hospitals last year, Dr Mafauzy discovered that 27.3 per cent of the 1,099 patients surveyed suffered from retinopathy.

"One out of 100 of them are already in the early stages of blindness," he said.

Of the number of patients he surveyed, 27 per cent had eye damage, one per cent were blind, 10.8 per cent had eye problems that needed laser treatment, 16 per cent had cataracts, 11.1 per cent had early symptoms that if left untreated can cause serious retinopathy, and 5.4 per cent had advanced eye disease or severe visual impairment.

Dr Mafauzy says almost all diabetics will suffer from some form of eye damage if they do not control their blood sugar level.

"More than 60 per cent of Type 2 diabetic patients had eye diseases."

Besides controlling their blood sugar levels and hypertension, Type 2 diabetics need to go for eye checkups every year. Those with Type 1 diabetes should go for a checkup five years after they have been diagnosed.

Dr Mafauzy says laser treatment is used to prevent the eye from getting worse by repairing leaking and bleeding vessels with cauterisation.

"This treatment is to prevent blindness. It is not to restore vision. If the damage has set in, it is not reversible. Doctors can only prevent it from getting worst. That is why diabetics need to control their condition by eating healthy, exercising and taking their medication."

In a recent sub-study on Fenofibrate Intervention and Event Lowering in Diabetes (Field) it was revealed that fenofibrate, a lipid modifying agent is found to be effective to treat diabetic retinopathy.

With fenofibrate, the use of laser treatment therapy was reduced by 30 per cent. In addition there was also a significant reduction in the progression of the disease.

In the year 2000, there were 940,000 adult diabetics in the country, and it is estimated 2.48 million will suffer from it by 2030.

Diabetes is the sixth leading of death. It is also the leading cause cause of renal failure, new cases of blindness and non-traumatic amputations.

What comes out of the farm may be something else

From The NST

To enlarge picture (pdf), click here

THAT deep green and crunchy organically grown vegetable sporting a shiny certification logo on its package comes with an assurance.

Loke Siew Foong with a selection of organic foods the company distributes.

To enlarge picture (pdf), click here

It's a promise that those leaves, beans or gourds were grown at a farm with no nasty pesticides or chemicals, with respect for the earth, and fair treatment for workers.

But, in Malaysia, here's where the official assurance ends - at the farms which produce the organically grown fruits and vegetables.

This is because Malaysia's organic certification scheme covers only the farms, not processors, wholesalers or retailers who get the fresh produce to diners everywhere.

And in the organic way of thinking, that makes the chain incomplete and opens the door to doubt.
Why? Because between farm and store, no one keeps an eye on how those organic greens are handled.

If someone was keeping an eye on things, the requirements would be tough.

Inspectors scrutinise cold rooms to see if strictly organic produce is kept apart from other naturally grown items, how often the room was cleaned and with what, says Loke Siew Foong, who manages organic certified wholesaler Radiant Code.

"They'll have none of that Baygon or Ridsect (insecticide) or even mosquito coils in our stores," says the OAM co-founder.

Everything from lorries that transport the greens to packaging used would also have to be up to scratch.

"The whole idea is that the organic produce doesn't get mixed up with conventionally grown foods."

The certification is also crucial because it doesn't just mean the greens are free of agro-chemicals, explains Gurmit Singh, the executive director of Cetdem.

A certified organic product also gives consumers the assurance that there's been a minimal impact on nature and the produce has been grown in a socially just manner.

"That means no abuse of cheap foreign labour.

"No cutting corners and no cheap alternatives.

"This makes organic farming a demanding business. As a result, initial costs can be high."

Gurmit knows this first hand from Cetdem's own experience with its pioneering organic farm in Sungai Buloh, which the group operated for about a decade.

Often, there were times when Gurmit and his wife, Tan Siew Luang, worked the one-acre farm on their own because no workers were available.

But this level of care and concern is what consumers are really paying for.

How do you know it's organic?

Look for certification

The best assurance is a certification. Look for a logo.

In Malaysia, the Department of Agriculture is the only agency that certifies organic food. It uses the SOM label.

At present, there are only standards to certify organic vegetables and fruits. Retailers should display their certification and customers have a right to ask.

Read the labels

Some products could be certified by an agency in a foreign country like the National Association for Sustainable Agriculture, Australia (Naasa).
Look for the logo that also carries a licence number.
The agencies usually list certified products/companies on their websites. It’s a good way to double-check that no one’s faking a label.

Check out the farm/farmer

Some people buy organic food from farms they know are doing things right, although these may not yet be certified. So visit the source farm if you can. Ask for a recommendation from the store if you aren’t sure.

Trial and error

This isn’t fail-safe but the difference between organic and conventional produce is this:

Fresh organic food very rarely looks the same. It’s not made in a mould. So shapes and sizes are often irregular. A consignment this month will also likely look different from next month’s.

Also it’s full of flavour. It’s very rarely tastes standardised or bland. A tomato should taste like a tomato, not like water.

Tips from the Centre for Environment, Technology and Development Malaysia and Organic Alliance Malaysia.

More Health Tips

The United States FDA defines cosmetics as: "Intended to be applied to the human body for cleansing, beautifying, promoting attractiveness, or altering the appearance without affecting the body’s structure or functions.

The first archaeological evidence of cosmetics usage is found in Ancient Egypt around 4000 BC. The Ancient Greeks and Romans also used cosmetics. The Romans and Egyptians used cosmetics containing mercury and often lead.

In the Western world, the advent of cosmetics was in the Middle Ages, although restricted to use within the upper classes. Cosmetic use was frowned upon at some points in history. For example, in the 1800s, Queen Victoria publicly declared make-up improper. It was viewed as vulgar and acceptable only for use by actors.

By the middle of the 20th century, cosmetics were in widespread use in nearly all societies around the world. Today the cosmetic industry is a big and growing one. One report said that women could use more than 20 make-up products as part of her daily routine. Even the guys are getting into it.

Let us face one fact: Make-up is an entirely unnatural phenomenon. Hence, no cosmetic product can claim to be totally safe. Even those without carcinogens could have ingredients that cause allergy and irritation. Cosmetics may also have ingredients that are supposed to be "safe" simply only there are no safety data for them.

When it comes to looking good, you do not need to make unhealthy choices. If your lifestyle is relatively clean, the use of well-chosen make-up may not add much to your total toxic load.

When buying or using cosmetics, here are some simple tips:

• Start from the inside

"I know the power of make-up," a doctor friend once told me, "I get to see my wife in the morning." The truth is really very simple: true and lasting beauty comes from within. Beauty is deeper than you skin! It starts with a nutritious diet, adequate rest, good sleep, regular exercise and periodic stress-free breaks.

• Study the label

It makes sense, but it bears repeating: Carefully read the labels of the stuff that you are going to put on your face. Don’t rely on claims of ‘all natural’, ‘organic’ or ‘cruelty-free’. These claims are increasingly becoming meaningless. Check for independent third party endorsement and credibility. The true story of the product can only be found in the list of ingredients.

• Natural Products

Look for natural waxes like honey, beeswax and carnauba, plant oils, cocoa butter and more natural powders based on cornstarch, kaolin and silk. Make sure these are the main (if not only) ingredients, and not simply added to pay lip service to the idea of being a "natural" product.

• Beware the price hype

Price is no guarantee. It used to be. Not anymore. Sometimes, the cheaper brands use fewer toxic ingredients, but only the label will tell you for sure. Ask for and about independent tests on done on the products in accredited laboratories.

• Re-read the label every time you buy

Don’t just buy a product because it was safe the last time you looked. By the time you replace your eye shadow or lipstick, it may be made from completely different ingredients. Manufacturers are continually reformulating their products.

• Avoid cosmetics that are pearly, glittery or frosted

To achieve this effect, manufacturers add ingredients such as pure aluminium, mica and even fish scales. Used near the eye, these particles can flake off and cause corneal damage. Ingested aluminium is linked to Alzheimer’s disease.

• Choose lip gloss over lipstick for everyday wear

Conventional lip glosses contain less colour, but are high in phenol, a poisonous substance that is easily absorbed into the delicate tissue of the lips (aided by petrolatum, a petroleum-derived moisturiser along with other wetting agents).

• Seek "safe" colours

In cosmetics terms, a number beginning with "CI75 ..." is considered a "natural" colourant, even though some are highly synthesised. Anything else may be considered suspect. Those beginning with "CI77..." are inorganic substances used as colourings (such as iron oxides, natural carbon, and the more toxic aluminium and barium sulphates).

• No Perfumes. No Sweet

Avoid all perfumed cosmetics. Avoid lip products that taste sweet. Often, these use saccharin (a suspected carcinogen) and phthalic anhydride (made from another suspected carcinogen, naphthalene), an irritant which can cause headaches, nausea, vomiting, diarrhoea and confusion. It has been linked to kidney and brain damage in infants.

• No sunscreens

Make-up is for indoors anyway. Don’t be fooled by claims of natural sunscreens. The only effective sunscreens are synthetic chemi- cals that add to your toxic burden.

• Don’t need to makeup

Sadly, many women wear makeup for the most trivial occasions — shopping for groceries, weekends at home or even for walks in the park. Get used to the way you look without make-up. Give your skin and body a break. If you really must put something, stick to the basics — swipe of carefully chosen mascara and a bit of lipstick or lip gloss is fine for everyday use.

* Datuk Dr Rajen M. is a pharmacist with a doctorate in Holistic Medicine.

Simple Health Tips

The deadly duo — heart disease and diabetes — can be kept at bay making the proper changes to lifestyle, writes DR LIEW YIN MEI.

HEART disease and diabetes are indeed a deadly duo, and people with diabetes are two to four times more likely to develop cardiovascular disease (CVD) than those without diabetes.

This is because those with diabetes usually have associated CVD risk factors: High blood glucose, high blood pressure, abnormal blood fat levels and central obesity.

High blood glucose and high blood pressure levels can damage the inner lining of your blood vessels (arteries), making it easier for cholesterol and other fat substances to accumulate inside the artery walls.

This causes plaques (fatty deposits) to form. These plaques narrow your arteries, restrict blood supply and may also rupture, leading to the formation of blood clots.
If the blood clots travel to other parts of your body and partially or totally block blood flow to an organ, say for example, your heart, you may end up with a heart attack. If a plaque ruptures in the brain, you will suffer a stroke.



HEART DISEASE DOESN’T HAVE TO BE YOUR FATE

While diabetes and heart disease are indeed closely linked, having the former doesn’t mean that you will invariably succumb to the latter.

There are steps you can take to protect your heart and keep it healthy. The key here is good control of your diabetes.

This includes becoming more physically active, reducing excessive body weight and maintaining a healthy body weight and normal blood glucose levels.

In addition, good control of your lipids (blood fats), blood pressure and avoidance of smoking are equally important. What you consume also makes a world of difference.

Highlighted below are some easy-to-follow dietary tips that will help you maintain healthy levels of blood glucose, blood pressure and blood fats (lipids):



Keep blood glucose levels within normal range

Ideally, if you have diabetes, your blood glucose level targets should be between 3.8 and 6.1 mmol/L before meals and less than 7.8 mmol/L two hours after meals. This can be achieved by:

• Eating smaller but more frequent meals. Your body can handle only so much glucose at a time.

• Consuming sensible amounts of complex carbohydrates (e.g. rice, wholemeal or wholegrain bread, noodles and tubers) instead of refined ones at every meal, every day.

• Spacing out the carbohydrate intake evenly throughout the day and have a consistent amount at every meal. Don’t overload on carbohydrate foods (or any other types of foods, for that matter) at any one meal. This helps to avoid a spike in blood glucose.

• Eating more complex carbohydrate foods that contain higher amounts of fibre. There are two types of fibre — soluble and insoluble.

Soluble fibre (such as beta glucan, pectin, etc) can be found in high quantities in oats, barley, legumes and some fruits, like apples. Insoluble fibre is found in fruits, vegetables, seeds and whole grains.

Consume a mix of both types of fibre to make up the recommended total dietary intake of 20-30g per day, of which at least 6g should comprise of soluble fibre.

High fibre foods are digested at a slower rate. This means that glucose is absorbed into the blood stream at a slower rate, leading to a slower rise of blood glucose levels.

• Choosing low glycaemic index (GI) carbohydrate foods. Glycaemic Index (GI) is a measure of how quickly or slowly your body converts carbohydrates in a particular food into glucose and releases it into your bloodstream.

Foods with low-GI include barley, brown rice, specially-formulated bread, pasta (made from durum wheat) and muesli.

• Avoid sugar and highly sweetened food and drinks and go for processed edibles that are low or free of fat and sugar. Sweetened foodstuff causes your blood glucose levels to rise quickly.



Keep your blood pressure down

You should ask your doctor to check your blood pressure at your every visit. People with diabetes should aim for lower blood pressures of 130/80 mmHg or less (irrespective of age).

The following dietary tips may help you achieve your target:

• Too much sodium, a type of mineral that is vital for the healthy functioning of your body (especially the heart, muscles and nerves), can aggravate blood pressure, particularly if you have diabetes and are obese.

Minimise sodium or get rid of it entirely. Try not to add salt, soy sauce or monosodium glutamate (MSG) to your meals. Instead, season your food with natural herbs and spices.

• Avoid processed foods (e.g. sausages and burger patties), preserved foods (pickles, salted eggs and salted fish) and canned foods as these contain too much salt.

• Limit or stay away from alcohol. Alcohol increases blood pressure and makes your heart work harder. If you must drink, the recommendation for men is not more than two standard drinks a day, while women should not exceed one standard drink a day.



Eat right to maintain healthy fat levels

If you have diabetes, it is crucial to maintain healthy fat levels. Keep your total cholesterol level below 5.2 mmol/L.

Your LDL ("bad") cholesterol should be kept lower than 2.6 mmol/L and the HDL ("good") cholesterol higher than 1.03 mmol/L for men and 1.3 mmol/L for women.

You also need to keep your triglyceride level below 1.7mmol/L.

In addition to practising an active lifestyle, here are some diet tips that can help you achieve healthy fat levels:

• Avoid high cholesterol foods which raise LDL cholesterol levels, such as prawns, crabs, oysters, squids, egg yolk and offal (liver, kidney, intestines, brain).

You can eat about two to three eggs a week provided you keep your animal fat intake low.

• Minimise your intake of saturated fats, which tend to boost LDL cholesterol levels.

Saturated fats are found mostly in animal or animal-derived foods, which include whole fat dairy foodstuffs like ghee, lard, full cream milk, butter, cheese and mayonnaise.

Coconut milk should be avoided as they are high in saturated fat.

A healthier alternative would be to use low-fat milk in curries, desserts (cendol, bubur cha cha) and your favourite kuih-muih.

• Love your unsaturated fats. Polyunsaturated fats help lower LDL cholesterol levels but also decreases the HDL ("good") cholesterol levels while monounsaturated fats are neutral.

Monounsaturated fats sources include plant oils such as canola, olive and peanut while polyunsaturated fats are derived from vegetables, plant oils (corn, sunflower, soy) nuts (almonds, hazelnuts) and certain kinds of fish like salmon and tuna.

• Limit your total fat intake by reducing fat from all sources including cooking oils. Watch out also for hidden fats from pastries and cookies.

• Use as little oil as possible when cooking. Instead of deep-frying food, try stir-frying or shallow-frying and experiment with other low-fat cooking methods like steaming, boiling, grilling, baking or roasting.

• Avoid trans fatty acids, which are regularly found in commercially prepared baked goods, margarine, snack foods and processed foods.

Trans fats are damaging to cholesterol levels as they increase the bad LDL cholesterol and lower the good HDL cholesterol. Read food labels to find out if a particular treat contains trans fat.

• Consume more soluble fibre because it helps to lower LDL cholesterol levels in the blood.

Keeping your blood glucose levels, blood pressure, blood fats and body weight within the healthy range is critical for every person who has diabetes.

By following the advice given above, you can effectively reduce your risk of heart disease (as well as other complications of diabetes) and be rewarded with the freedom to enjoy life to the fullest.

Note: Datin Dr Liew is a consultant physician with the Heart Foundation of Malaysia