Penyakit Buah Pinggang

Ada forumer yang tanya berkenaan sakit buah pinggang jadi saya selitkan maklumat disini untuk kebaikan bersama.

Sedikit mengenai anatomi buah pinggang.
















Kita mempunyai dua buah pinggang yang terletak di bawah otot pernafasan utama iaitu diaphragm dan pada bahagian belakang ruang abdomen. Buah pinggnang kiri terletak dibelakang perut manakala buah pinggang kanan terletak di bawah hati. Lokasi buah pinggang boleh dikenal pasti dengan mencari tulang rusuk paling bawah dan mengikut perjalanannya ke belakang sehingga bertemu tulang belakang. Ruang dibawah pertemuan kedua2 garisan ini adalah tempat terletaknya buah pinggang.

Buah pinggang telah dicipta oleh Allah sebagai organ penapis yang begitu komplex dan efficient. buah pinggang akan membuang bahan bahan yang tidak diperlukan oleh badan sebagai air kencing dan menyerap semula bahan2 yang diperlukan oleh badan. Keseimbangan garam (elektrolit) dan acid-base yang sangat penting untuk memastikan badan berfungsi dengan baik semuanya dikawal oleh buah pinggang. Oleh kerana buah pinggang menapis darah, bahan2 toxic juga ditapis dan dibuang dari tubuh sebagai air kencing. Oleh kerana itu buah pinggang sentiasa bekerja keras dan sentiasa menghadapi serangan dari bahan-bahan toxic dalam darah.

Oleh kerana manusia dikurniakan dengan sepasang buah pinggang, seseorang itu masih dapat hidup dengan normal dengan satu buah pinggang yang berfungsi. Apabila kedua-dua buah pinggang rosak maka fungsi buah pinggang perlu dijalankan oleh mesin dialysis.

kerosakan buah pinggang boleh dibahagikan kepada:
1) kerosakan akut (acute renal failure atau ARF): jika dirawat awal mungkin boleh sembuh seratus peratus
2) kerosakan kronik (chronic Renal Failure atau CRF): dimana lama kelamaan pesakit akan memerlukan dialysis
3) Kerosakan akut diatas kerosakan yang telah kronik (acute on chronic renal failure)

Antara punca-punca utama kerosakan buah pinggang termasuk:
Kencing Manis,
Darah tinggi,
jangkitan kuman,
trauma
penyakit autoimmune (penyakit dimana antibodi seseorang menyerang organ sendiri),
Batu karang
Ubat2 samada diberi oleh doktor atau herba2 dan lain2 toxin
polycytic kidney/ketumbuhan lain


Simtom dan tanda penyakit buah pinggang:

Oleh kerana fungsi buah pinggang begitu efficient simtom penyakit buah pinggang selalunya dialami apabila penyakit telah advance (iaitu tahap yang teruk). Sebelum itu penyakit ini memang susah dikesan.
Sekiranya sakit disebabkan oleh jangkitan kuman simtom utama merupakan sakit berterusan pada bahagian buah pinggang, demam panas, sakit semasa kencing dan kencing berdarah. Batu karang juga menunjukkan simtom seperti jangkitan kuman tetapi selalunya sakit tidak berterusan tepati datang berulang-ulang dan selalunya tidak demam. Tanda paling awal kerosakan buah pinggang disebabkan kencing manis ialah microalbuminuria (kehadiran microalbumin dalam air kencing dan ini dapat dikesan melalui ujian air kencing.

Simtom-simtom CRF selalunya disebabkan oleh kandungan urea yang tinggi dalam darah (selalunya dikatakan darah kotor kerana urea merupakan bahan kumbahan yang perlu di buang). Antara simtom2 nya termasuk, kurang selera makan, loya dan muntah, gatal seluruh badan, mulut dan peluh berbau hancing, jumlah kencing seharian yang kurang dan pesakit kurang sedar. Doktor sering dapat mengenal pasti seseorang yang mengalami CRF dengan melihat wajah dan warna kulit seseorang kerana berlaku perubahan pada warna kulit dan juga kehadiran tekanan darah yang tinggi. Peringkat seperti ini selalunya memerlukan dialysis terutama jika seseorang tidak dapat menghasilkan air kencing kerana air yang berlebihan boleh melimpah ke paru paru apabila jantung tidak dapat menampung pertambahan air badan. Pada waktu ini orang tersebut akan mengalami sesak nafas dan merupakan kecemasan perubatan.

Untuk mengetahui fungsi buah pinggang saudara/saudari boleh melakukan ujian darah dan air kencing dan doktor dapat memastikan fungsi buah pinggang saudara terutamanya kandungan creatinine dan urea dlm darah. Ujian yang paling tepat merupakan creatinine clearance yang mengkaji bagaimana buah pinggang menapis creatinine dalam darah. Ujian-ujian seperti ultrasound dan CT scan dapat mengenal pasti samada terdapat masalah dari segi struktur iaitu samada saiz buah pinggang normal dan jika terdapat batu karang, cyst atau ketumbuhan. Jika seseorang menghidap CRF buah pinggang akan mengecut.

Cara-cara menjaga buah pingggang:
1) Elakkan penyakit kencing manis dan darah tinggi dengan pemakanan seimbang dan senaman
2) Elakkan pengambilan ubat tanpa rujukan doktor terutama pengambilan ubat tahan sakit yang mudah dibeli di farmasi/pasaraya
3) minum air yang telah ditapis sekurang-kurangnya lapan gelas sehari.
4)Mengelakkan toksin yang terdapat dipersekitaran terutama makanan seperti buah dan sayur yang disembur racun dengan memakan makanan organic

Mahathir

Weight Management Essentials

A fellow forumer asked about my weight loss program and even though we have gone over this in our previous blog, here is a run down of how I did it. Remember, no two people are the same but the principle is the same and you will obtain various degrees of weight loss.

Here was my answer:

Hi,

Sorry for the late reply. How are you? Are you planning to reduce your weight?

I'll tell you how I did it after many years of failed attempts.
The plan is actually quite simple but you have to stick to it no matter what.
First measure your weight in Kg, then your height in meters. Calculate your Body Mass Index by dividing your weight (kg) by the square of your height (m2): weight(kg)/heightXheight (m). Your BMI should be less then 25. BMI of 25 to 30 is overweight and 30 to 35 is obese. You can then calculate your ideal weight by substituting the numbers in the formula to get a BMI of 25.

OK, next measure your waist at the navel. Males should be less or equals to34, females less or equals to 28. Any more than this puts you at a greater risk for heart disease.

So now you have an idea of what you should aim for. Personally, I think the waist measurement is much more important. The BMI may be in the overweight area but may be normal especially if you have lost fat and gained more muscle (fat is lighter than muscle).

Next....get a blood test. You can do this through your GP or from some labs. The basic should include a full blood count, kidney/renal function, liver funtion, Cholesterol profile, fasting blood sugar, Urine analysis.
Hormone imbalances are the commonest cause of weight gain, inability to lose weight or weight loss plateau, and regaining the weight lost.

A thyroid profile is also important to know as inadequate thyroid function may cause weight gain. Get a TSH, Free T4 and Free T3 tested and morning serum cortisol.

BTW, if you are a woman, hormones play a major role in weight gain and loss especially a lack of progesterone. This is indicated by irregular menses, severe PMS symptoms, breast tenderness during menstruation, polycystic ovaries etc. In this case you should check your serum progesterone level on day 21 of your menstrual cycle. Men are also affected by hormone especially if a person is more than 35. There can be a reduction of growth hormone and testosterone which leads to obesity.

OK, got the results back. You can send me the results if you want me to have a look. Some results may seem normal but not optimal and will require correction.

Assuming all your results are normal, we can begin.... If not hormone deficiencies may have to be corrected.

Weight management is about life style change. If you don't change what you're doing it either won't go away or it will come back to haunt you.
The basic diet I follow now is zero or minimal simple carbs like sugar, sweets, chocolates. read labels..if the sugar is an ingredient don't buy it. potatoes are also high in simple carbs.
High complex or low glycemic carbs from fruits (epals, pears, guava-without asamboi, apricots, kiwi), vegetable, whole grain and nuts.
High Protein from fish and poultry, occasionally beef.

So, this is how I lost weight.....pay attention..

2 Weeks Intensive Phase:

Breakfast: Mee Hoon Soup with extra chicken and fish ball, less noodle-1bowl
Only drink plain or better still mineral or RO water.
Lunch: Meal replacement drink (make sure it is a complete meal: carbs,protein, fat, vitamins)- mix with water. (about 250 cal)
Dinner: Meal replacement drink

I drank lots of water for 2 reasons, 1) I thought I was hungry but in actual fact, I was thirsty. This was crucial to learn. After drinking water, I realized I was no longer hungry. 2) It keeps me well hydrated and flushes out all the toxins in my body.

I also took a good multivitamin, which is high in chromium, selenium, zinc and vitamin E. Important factors for optimal bodily enzyme funtions.

You see, most people who tried to do it my way failed within the first week. That's because they were not determined enough and they think it can't be that simple. I'm amazed that people seem to prefer complex solutions. It is this simple. Stick to this and you will be amazed at your own body. Some people argue that a low calorie diet is not good. studies show that reducing calories extends your lifespan. For people who are obese, this is the only way to overhaul that engine and start you metabolism working for you...optimally burning fat and building muscle.

You can change the food you take for breakfast to something else if you want but this is the best.

What next:
After the 2 weeks you will feel a new level of energy and determination as you see your weight reduce. So time for step 2.

Yahooo!! Now you can eat 2 nutritious meals...breakfast and lunch. again no simple sugar, high in protein . As Malaysians you may miss the rice. My advise to you is take a quarter of what you used to take. replace the rest with vegetable and fish or poultry. You may take low glycemic fruits 1 per meal e.g. 1 apple. Also, Remove the skin from the chicken.

Take the meal replacement for dinner so that your stomach does not have to work hard, digesting the food while you sleep. Also remember the vitamins.

At this stage start to exercise to build up muscle. I have the exercise recommendations at my blog. do both cardio and strength. Swimming is a good option as it is weightless, and it is both cardio and strength. Remember, you will be losing both fat and some muscle during the first phase and its time to replace the muscle. You do not want to have flabby skin hanging out do you. I did not exercise during the first stage. There were too many biologic changes to adjust to and you will feel weak the first week as the body detoxifies. All this will go away after 1 week.

Do the second stage till you are happy with your weight. This may take 4-6 months but you wouldn't want to lose any faster. You need time to build your muscle to avoid flab.Even by losing 5 kg, you would have added 5-8 years to a healthy life.

after 3-4 weeks of stage 2, and as your physical activity increases, add a snack of low glycemic fruit at 11am and 4 pm to stabilze your blood sugar and your hormones.

Occasinally you will need to add Liquid L-Carnitine to boost your fat buring if there is a plateau.

I promise you, you will feel so good about yourself. Imagine fitting into clothes when you were in secondary school!! You'll be digging your closet for these!hehehe. So time to go shopping. I did my shopping a bit to early...I lost more weight and had to go shopping again.

People you've not seen for a while will start commenting on how good you look and this is the ultimate self esteem boost I've had for a long time since I've always been known to be fat.

Once your desired weight is achieved, stick to you meal plan. Have the occasional cake or chocolate and see that the occasional treat will not touch your weight as your metabolism can now handle it.

I really hope this will inspire you and wish you all the best in achieving your goal. Contact me at any time and I'll try to help.

Best regards,

Mahathir Mohamed, M.D.
General Physician and Anti-aging Medicine Practitioner.

* Additionally, several substances have come into the spotlight recently, such as the addition of conjugated linoleic acid (CLA), co-enzyme Q10, Alpha Lipoic Acid which some patients will need to boost their fat burning. Amino acids such as L-Glutamine and L-arginine has its role in patients who are deficient in Growth Hormone.

Endometriosis

I will be including some discussions I've had regarding several illnesses with patients through a health forum. These individuals were kind enough to allow me to share their stories for the benefits of others. This first discussion is on endometriosis.

Hi DrM,

I've been suffering with endometriosis (endo) for more than 10 years. I have undergone 3 major surgery to remove cycst. :( . The cycst appeared on both of my ovaries. Luckily, the gynae managed to save them both from being removed. According to the gynae, the size was as big as an orange.

I'm 37 years old, married for 7 years but no kids and desperately trying to conceive...
my hubby and I have been trying to concieve but unfortunately it did not successful.... :'(
We have tried IUI ( 2 Times), IVF (4 times) but failed.

I have done ultrasound last month and the results shows that the cycst on my left ovary is 40mm and no cycst appear on the right ovary. I am planning to do IVF very soon and seek medical advice from several gynae. However, different gynae gives different opinion. One of them suggest to perform another surgery in ensuring that all cycst is cleared prior to perform IVF. While another gynae suggest to have the cycst aspirated vaginally i.e. using similar IVF method in retriving eggs. Currently, I am not sure what my decision will be... too afraid to go for another surgery. If possible I would swallow anything that can remove this cycst.

Currently, I'm not taking any meds. One of my gynae suggest to take planning pills but i have done that previously, it didn't work... the size of the cycst won't budge..

I have mild asthma and bad migrane. Recently, I have done blood screening test at BP lab and found out that my haematology examination havind slight problem in which MCV is 70fl, MCH is 21pg and MCHC is 30%. The doctor indicated that I probably having thalassaemia and suggest to perform Hgb electrophoresis. However,I have not done it yet.

My father has high blood presurre while my mother has diabetic and severe migraine.

Therefore, I am kindly seeking your advice on this matter.

Thanks...

REPLY:

Thank you for your enquiry. I read your story with great interest and sympathy. You have gone through a lot and you seem to be a very strong and determined person.

As you may not have much time with your doctor to go over things I am sure you must have read and know quite a lot about endometriosis. However, it may be helpful to go over it from a different perspective.

The symptoms you are exhibiting (including the migraine) are symptoms of estrogen dominance. Estrogen is essential for living but can lead to problems if it is unbalanced. The result of too much estrogen relative to progesterone is estrogen dominance. It is the chief cause of PMS, fibroids, endometriosis, Polycystic ovary syndrome and infertility. Under the influence of too much estrogen women feel bloated, irritable, fatigued and have sugar cravings. All these estrogenic effects are supposed to be balanced by progesterone but are often not.

Endometriosis is a very difficult condition to treat and even modern medical technology have not found the ultimate treatment for it. In actual fact we do not know why endometriosis occurs. We know that there is deposits of endometrial tissue in sites other than the uterine wall and there are many theories to speculate how it occurs. However, looking through the history of this illness, it was not mentioned in the olden days. We now believe that there is a relationship between endometriosis and environmental toxins especially from petrochemical products such as plastic, processed food, animal growth hormone and even contaminated water. Petrochemicals contain harmful substanses and many of which act like the hormone estrogen but in a bad way (Xeno-estrogens) and lead to aggravation of endometriosis.

Some studies have also shown that women with endometriosis have antibodies against their own tissue. I equate this state to a confused immune system which attacks its own tissue. Therefore a healthy immune system is also important to fight this illness.

With each monthly cycle, the endometriosis spots responds to ovarian hormones just as the endometrial cells do within the uterus- they increase in size, swell with blood and bleed into surrounding tissue during menstruation. The bleeding (no matter how small) into the surrounding tissue causes inflammation and is very painful, often disabling. Symptoms usually begin 7 to 12 days before menses and become excruciatingly painful during menstruation.

Women with endometriosis often have problems to conceive as a result of inflammation and scarring. We have found that in those who get pregnant, endometriosis is retarded and occasionally cured. This is a result of the high levels of the hormone progesterone. You may have received a progesteron-like medicine from you gyne (provera, norethisterone etc). however, these are progesterone-like (chemical form) and not natural progesterone. The body does not process this progesterone the same way.


My recommendations for management of your condition:

1. I feel that you may benefit from Natural Progesterne (in the form of a cream) in a cyclical manner to control the endometriosis. It is important to use natural, bioidentical progesterone instead of progestins.

2. On top of this, the Usana Vitamins will help you as follows:
i) USANA Essentials Multivitamin, Mineral and Antioxidant (1 tablet 3x/day)
Dian Mills, a nutritionist and former trustee of the British Endometriosis Society in London, reported a double-blind study of dietary supplements that resulted in a 98% improvement in symptoms over those not on supplement. The supplements used were thiamine, riboflavin, pyridoxine, zinc and magnesium. (D.Mills, "The Nutritional Status of the Endometriosis Patient", Endometriosis Association Newsletter, Vol.17, nos.5-6 (1996))

ii) USANA Proflavanol (1 Tablet 3x/day)
Proflavanol contains grape seed extract a potent antioxidant and a potent stimulator of the immune system.

iii) USANA Biomega (1 tablet 2-3 times/day)
Omega 3 fatty acids have been shown to reduce inflammation.

iv) USANA Active Calcium (2 tablets 3x/day - introduced gradually)
Calcium has muscle relaxing effects and have been shown to relieve menstrual cramps

Dr Ray Strand, Author of "What your Doctor doesn't know about nutritional medicine may be killing you" has had success in many patients using the USANA Vitamins.

3. Indole-3-carbinol or DIM
As mentioned previously, endometriosis is related to estrogen dominance or excess. Indole-3-carbinol/DIM is the active ingredient of cruciferous vegetables (broccoli, cabbage, cauliflower etc) which have been shown to modulate estrogen levels.

4. Increase intake of soy and soy products (tempeh, tofu, etc) which contain the substance genestien, another potent estrogen modulator. You may want to try Enerflex forte which is in powder form with the added benefit of blue green algae.

5. Eliminate caffeine

6. Eliminate red meat, dairy foods, and egg yolk for 2 weeks. You may then reintroduce these one by one and see if symptoms recur.
Dr Christiane Northrup M.D, reported patients who became free of endometriosis after eliminating dairy products.


With nutritional approaches, it's important to give them at least 3 months to achieve optimum results.

Other than these measures, keep yourself active with exercise which will also boost your immune system. You will find that your asthma and migraine will also be controlled.

Strength Training

Hi there,

Most of us know the benefits of exercise but how do we perform exercises for optimum result in the least amount of time and make it fun?

There are several important components of exercise which include:
1) endurance,
2) strength,
3) speed and reaction time,
4) balance and coordination
5) flexibility
6) neuromuscular relaxation.

In this article, I will focus on strength and resistance training and how to go about starting a program for yourself ( This is meant for a sedentary person just starting to take an interest in his or her own health and not for the advanced athelete so it should be simple enough).

Strength training, obviously increases strength but it also tones the body, burns fat and bulids muscle.

Here is a simple program anyone could try. I recommend that you have with you some light weights to start off say 2 canned foods, unopened bottled water or better still two dumbells.

Some basic principles:

1. Reps: Repetition for 1 single movement described. The number of reps you perform will depend on your fitness goals. If your aim is for strength or muscle size, perform between 6 - 10 reps
If your aim is for muscle tone or endurance, perform between 10 - 15 reps

2. Sets: No of times a set of exercises is performed

3. Optimum Weight required:
The heaviest weight you can lift to obtain the required no of reps for a particular movement. For example, if you plan to perform 6 reps choose a weight which you can only lift 6 times for that particular movement. For absolute beginners start with two 1 kg dumbells and either increase or decrease the weight accordingly.

4. Don't forget to Breathe.

Are you ready?

Start with a warm up session of stretching followed by walking for about 5 min (ideally it should be 10 to 15 min). Walking will increase the blood flow to the muscles which you will then put to work in this program. This is important to prevent injury. After the warm up session, start your work-up from the toes up.

For a start increase your muscle endurance by performing 15 reps of each of the following in sequence:
1. Heel lift :
With the weights in your hands, by your sides or held at shoulder height, raise yourself up on your tip toes and then come back down slowly to standing position. You will feel your calf muscles contracting.


2. dumbell squat-to-bench:
With the weights in each hand by your sides, inhale deeply, then exhale as you squat down until yor buttocks touches the bench. Do not take tension off your thighs by actually sitting on the bench. Return immediately to the starting position.

3. Front Lunge:
Stand erect with your hands on your hips. Inhale and step forward as far as possible until your leading leg is parallel with the floor and your trailing leg is extended as straight as possible. Push back to the starting position and exhale. Repeat with other leg.

4. Abdominal Crunch:
Lie on the floor with your legs bent, your feet flat on the floor. Place your hands on the back of your head, or if you prefer, cross them over your chest. Lift your shoulder blades off the ground moving your elbows towards your knees. Don't try to lift your whole back - just your shoulder blades. Squeeze your abs for a second. Slowly return to the starting position.

5. Dumbell Lateral Raise:
Holding dumbbells, stand slightly bent at the hips. Your knees should also be slightly bent. Your back should be straight, and your arms hanging down, elbows slightly bent.
Keeping your arms locked, slowly raise the dumbbells out to the sides until elbows are level with your shoulders.
Slowly return to the starting position.

6. Hammer Curl:
Stand straight, holding the dumbells at your sides, palms facing inwards.
Keeping your elbows at locked at your sides, slowly lift the dumbells until they almost touch your shoulders. Slowly lower the weights back.

7. One arm dumbell extension:
The one are dumbbell extension can be done either standing or seated, whichever is more comfortable. Take a dumbbell in your right hand then extend your arm up so that you're holding the dumbbell straight up with your palm facing forwards. Keeping your upper arm still and bending at the elbow slowly lower the dumbbell down behind your neck. Raise back to the starting position and repeat for desired reps.

I've chosen these exercises because these are relatively simple. As you gain experience you may add other movement targeted to specific muscle groups.

For a start, perform 1 set of exercise 2-3 times per week then increase gradually. As you gain strength and stamina you can increase the sets accordingly. Try and keep the exercise regular. The more often you exercise, the easier it gets and exercise won't tire you too much.......

Instead you will feel energized.....

Cool Down
Take 5 minutes to walk at a slow pace, swinging arms back and forth, and breathing deeply releasing everything from your mind.

I hope you will take the time to try these strength training exercises and reap its benefits.
Till next time,

Stay healthy.

Mahathir

Women's Health: Family Planning (Bahasa)

Kebanyakan wanita keliru dengan kaedah untuk merancang keluarga. Berikut, merupakan antara kaedah yang kerap digunakan. Sila pastikan anda memahami setiap kaedah dan risikonya sebelum membuat keputusan.

IMPLAN (IMPLANON)

Implan merupakan kaedah perancangan keluarga untuk jangka masa panjang. Ia berbentuk seperti lidi yang dipasang di bawah kulit pada lengan anda.

Implan (implanon) berkesan mencegah kehamilan selama 3 tahun.

Implan mengandungi hormon progesteron yang mengeluarkan hormon secara berterusan dan menghalang pengeluaran telur. Ia juga menghalang sperma memasuki rahim dengan menukar lendir pada serviks. Perlindungan kehamilan bermula dari hari pemasangan.

Bagaimana implan dipasang?
Doktor akan menjalankan ujian ginekologi termasuk pemeriksaan payudara, pap smear dan ujian kehamilan sebelum memasang implan. Ubat bius akan diberi di tempat pemasangan dan diikuti dengan pemasangan implan. Bahagian lengan akan dibalut untuk mengurangkan risiko lebam. Anda boleh membuka balutan selepas 24 jam. Kebiasaannya, implan akan dipasang antara hari pertama dan kelima haid.

Kesan sampingan implan
Antaranya ialah jerawat, pening kepala, pertambahan berat badan, sengal payudara. Kesan sampingan yang jarang berlaku termasuk rambut gugur, perubahan emosi, perubahan nafsu seks, sakit perut dan senggugut. Implan akan mempengaruhi kitaran haid; kitaran haid tidak menentu, tiada haid.

Pengeluaran implan
Sekiranya anda memasang implan di Klinik Lina, anda akan menerima SMS peringatan apabila implan telah tamat tempoh dan perlu dikeluarkan. Ubat dius akan diberi sebelum insisi dibuat. Selepas implan dikeluarkan, luka akan dibalut.

Sekiranya anda ingin hamil semula, implan akan dikeluarkan dan kesuburan akan kembali dalam bulan pertama.

Implan tidak memberi kesan ke atas penyusuan bayi.

Implan tidak melindungi anda dari jangkitan kelamin.

Untuk keterangan lanjut, sila datang ke Klinik Lina (FG 17, Blok 2A, Jalan PJS2/1, Apartmen Taman Medan Jaya, Selangor. Tel no: 77820005)

IUCD

IUCD atau intrauterine contraceptive device ialah alat yang dimasukkan ke dalam rahim untuk mencegah kehamilan. Alat ini tidak mengandungi sebarang hormon, dan merupakan segelung wayar kuprum yang bertali.

Waktu paling optima untuk memasukkan alat ini ialah hari terakhir haid. Ia juga boleh dimasukkan selepas keguguran atau bersalin.

Kelebihan IUCD
o Efektif, kesuburan boleh dikembalikan serta-merta selepas IUCD dikeluarkan, sesuai untuk jangkamasa yang panjang
o Tidak mengganggu penyusuan bayi
o Sesuai jika ada penyakit darah tinggi
o Tiada kesan negatif hormon seperti pertambahan berat badan, sakit kepala

Prosedur memasukkan IUCD
Sebelum IUCD dimasukkan, doktor akan melakukan pemeriksaan vagina untuk memastikan kedudukan rahim. Doktor akan memasukkan spekulum untuk melihat servik. Servik dan vagina akan dicuci dengan antiseptik. Doktor akan mengukur saiz rahim sebelum memasukkan IUCD. Anda mungkin akan merasa tidak selesa sewaktu IUCD dimasukkan. Selepas IUCD dimasukkan, doktor akan memotong benang 2-3cm daripada servik. Pemeriksaan ultrasound akan dilakukan untuk menentukan kedudukan IUCD.

Anda akan mengalami sedikit pendarahan selepas IUCD dimasukkan. Anda juga akan mengalami sakit pada bahagian ari-ari selepas IUCD dimasukkan.

Anda mesti berjumpa dengan doktor jika:
o Haid lambat 2 minggu atau tiada haid
o Tidak dapat merasa benang atau dapat merasa bahagian plastik yang keras di dalam faraj
o Pendarahan yang banyak atau pendarahan selepas melakukan hubungan seks
o Senggugut atau sakit sewaktu melakukan hubungan seks
o Sakit ari-ari, sakit di hujung bahu, demam melebihi 38 darjah Celsius, pening, pengsan, lelehan faraj yang tidak normal

Anda dinasihatkan menukar IUCD setiap 3 tahun (bagi Multiload Cu250) dan 5 tahun (bagi Multiload Cu375). Jika IUCD dimasukkan di Klinik Lina, anda akan menerima SMS peringatan jika sampai masa untuk mengeluarkan IUCD.

Prosedur mengeluarkan IUCD
Untuk mengeluarkan IUCD, anda mesti berjumpa dengan doktor. Prosedurnya seperti memasukkan IUCD. Jika benang IUCD tidak dapat dilihat di dalam faraj, anda akan dirujuk kepada pakar ginekologi untuk mengeluarkan IUCD selepas dibius.

Apabila menggunakan IUCD, risiko untuk mengandung masih ada. Jika anda disahkan mengandung, IUCD akan dikeluarkan dan boleh menyebabkan keguguran. Jika anda tidak mahu mengeluarkan IUCD, anda juga berisiko untuk mendapat jangkitan kuman pada bahagian pelvis.

Walaupun IUCD mampu mencegah kehamilan di dalam rahim, ia tidak dapat mencegah kehamilan di luar rahim.

Untuk maklumat lanjut, sila datang ke Klinik Lina (FG 17, No 2A, Jalan PJS 2/1, Apartmen Taman Medan Jaya, Selangor. Tel no: 77820005)

PIL PERANCANG NORIDAY

Noriday ialah pil perancang yang mengandungi hormon progestin sahaja.

Bagaimana kehamilan dicegah?
Pil perancang ini mencegah kehamilan dengan cara menukar lelehan di bahagian serviks supaya sperma tidak dapat melepasinya. Ia juga menukar dinding rahim supaya telur yang telah disenyawakan tidak dapat melekat pada dinding rahim.

Cara pengambilan pil Noriday
Mula makan Noriday pada hari pertama haid sehingga habis pek. Ambil pil pada masa yang sama setiap hari.
Pada permulaan mengambil pil Noriday, pencegahan kehamilan alternatif mesti diambil 14 hari yang pertama.
Selepas habis pek pertama, anda perlu meneruskan dengan pek kedua tanpa berhenti, tidak kira jika ada haid atau tidak.

Haid tidak teratur
Kemungkinan haid tidak teratur akan berlaku dengan pengambilan pil Noriday. Kebiasaannya ia berlaku pada bulan-bulan awal sahaja. Anda dinasihatkan supaya tidak berhenti pil tersebut. Sila berjumpa dengan doktor jika tiada haid selama 6 minggu.

Anda diingatkan supaya mengambil pil pada masa yang sama setiap hari. Jika terlupa, ambil pil sebaik sahaja teringat dan ambil juga pada masa yang sama pada hari tersebut. Ini bermakna anda akan mengambil 2 pil pada hari tersebut. Anda mesti menggunakan cara alternatif juga selama 14 hari.
Jika terlupa 2 atau lebih pil berturut-turut, anda dinasihatkan supaya berhenti mengambil pil perancang dan menggunakan cara alternatif sehingga datang haid.
Muntah dan cirit-birit akan mengurangkan penyerapan pil dalam perut. Anda dinasihatkan meneruskan pil perancang dan menggunakan cara alternatif selama 14 hari.
Pil perancang akan berinteraksi dengan antibiotik, ubat sawan, ubat tidur dan ubat arthritis. Pastikan anda memberitahu doktor jika anda mengambil pil perancang.

Anda tidak boleh mengambil pil perancang jika ada penyakit kuning, gatal atau kuning ketika mengandung, pendarahan vagina yang tidak normal, penyakit hati, penyakit darah beku (angin ahmar, serangan jantung, paru-paru).
Pil perancang boleh menyebabkan darah tinggi pada sesetengah wanita.

Amaran
Anda dinasihatkan supaya berhenti mengambil pil perancang serta-merta dan berjumpa dengan doktor jika:
o Sakit dada, batuk berdarah dan sesak nafas
o Sakit dan bengkak urat kaki
o Sakit dada yang melampau
o Sakit kepala, muntah, pening, pengsan, masalah penglihatan atau pertuturan, lemah tangan atau kaki
o Ketulan pada buah dada
o Sakit pada bahagian perut

Jika anda ingin mengandung semula, berhenti pil perancang dan gunakan cara mekanikal (seperti kondom) selama tiga bulan sebelum merancang untuk hamil.

Anda dinasihatkan supaya berjumpa dengan doktor untuk memastikan cara merancang keluarga yang sesuai untuk anda. Oleh kerana Pil Noriday boleh memudaratkan jika disalahgunakan, ia merupakan ubat preskripsi oleh doktor sahaja.
Sila pastikan anda melakukan pemeriksaan tekanan darah, buah dada setiap bulan dan pemeriksaan pangkal rahim (pap smear) setiap tahun.

Untuk keterangan lanjut, sila datang ke Klinik Lina (FG 17 Blok 2A, Jalan PJS2/1, Apartmen Taman Medan Jaya, Selangor. Tel no: 77820005)

SUNTIKAN DEPO

Salah satu cara untuk merancang keluarga ialah melalui suntikan depo. Suntikan depo mengandungi hormon progesteron sahaja. Suntikan depo menukar lendir pada serviks yang menghalang sperma menembusinya. Keadaan hormon yang tinggi juga menyebabkan tiada telur dikeluarkan.

Sebelum diberi suntikan, anda akan diperiksa terlebih dahulu, termasuk pemeriksaan ginekologi dan payudara. Selepas memastikan anda tidak hamil, suntikan akan diberi pada bahagian punggung.

Kekerapan suntikan
Suntikan pertama akan diberi pada hari pertama ke hari kelima haid. Selepas itu, anda akan diberi apoinmen untuk suntikan setiap 2 bulan selama 3 kali. Ini diikuti dengan suntikan setiap 3 bulan. Jika anda menerima suntikan di Klinik Lina, anda akan diberi SMS peringatan untuk suntikan seterusnya.

Suntikan depo boleh menyebabkan haid tidak menentu atau tiada haid. Ia juga boleh menyebabkan penambahan berat badan, sakit kepala dan mual.

Anda tidak boleh menggunakan suntikan depo jika ada penyakit seperti di bawah:
o Darah tinggi
o Penyakit hati
o Herpes sewaktu hamil
o Sakit kuning
o Gatal sewaktu hamil
o Angin ahmar
o Sakit jantung

Suntikan depo tidak akan mengganggu penyusuan bayi.

Untuk keterangan lanjut, sila datang ke Klinik Lina (FG 17 Blok 2A, Jalan PJS2/1, Apartmen Taman Medan Jaya, Selangor. Tel no: 77820005)

PIL PERANCANG SELAIN NORIDAY (masih dikemaskini)

Not All Carbohydrates are Created the Same

When we attempt to change our diet to a healthier one it would be useful to know the components of food that we take. Most of you know that the major components are carboydrates, protein and fat. Understanding the types of carbohydrate and changing the types of carbohydrate you consume can make a big difference in attaining your goal.

When carbohydrates are digested into glucose and absorbed into our blood, the body releases a hormone called insulin which is produced by the pancreas. Insulin basically pushes glucose into cells to be used as energy. As glucose is pushed into cells with the help of insulin, our blood glucose level starts to fall. If glucose is in excess, insulin promotes the storage of glucose as fat (lipogenesis).

Researchers have discovered that certain carbohydrates stimulate the release of more insulin than others and have created a ranking of carbohydrates according to how rapidly the blood glucose rises (glycemic index).

The Glycemic Index (GI) is categorized into low (GI of 0-55), moderate (56-69), and high (70 or more).

High glycemic index foods raises the blood sugar rapidly. We often experience this with intake of sweet foodstuff as a sudden burst of energy (sugar high). However, our body immediately releases a large amount of insulin, pushing the glucose into cells. The sudden surge of large amounts of insulin causes an overshoot effect resulting in a period of relatively low blood sugar (hypoglycemia) which causes lethargy and low energy. The diagram above illustrates this. Low glycemic food in contrast raises the blood sugar gradually and the glucose level is more sustained.

Low glycemic foods include: kidney beans, nuts, chick peas, soy(beware that some contain sugar),milk, apricot, cherries and berries.

Moderate Glycemic foods include: Oranges, peaches, plums, pears, apples, yam, peas.

High glycemic foods: White rice, bread, most cookies, all sweets (except those sweetened with fructose, xylitol and splenda), potatoes, bananas, pineapple, mango, and papaya.

Note: The glycemic index does not list foods such as vegetables, meat, seeds and dairy products because these foods have an extremely low insulin effect.

For a database of glycemic index for food kindly refer to www.glycemicindex.com

Weight Management

WEIGHT MANAGEMENT PROGRAMME
KLINIK LINA


Lina Then Lina Now


Mahathir Then Mahathir Now

This write-up is specially designed for my patients who are undergoing weight management in my clinic. Please read through the content for further understanding of what weight management is all about. Good Luck!

What many people are concerned about including yourself is how to be slim and have a body like a model. Is that achievable?? That is the question you have to ask yourself because weight management is nothing but self discipline. To begin the weight management programme, firstly you have to ask yourself, what is the aim or objective. What do you want as an outcome of this programme? Now, the best outcome is for sure a slim body with good muscle tone, not a flabby skin, and of course, long lasting. Most weight management programme will bring your weight down to ideal but will you be able to maintain the healthy weight forever?? That is why in our weight management programme, we stress on lifestyle modification which includes dietary changes, regular exercise routine and regular sleep patterns. Healthy lifestyle equals healthy body.

Dietary Changes

The main aim is to change what, how and when you eat. What to eat while on diet?" A common question asked by many of my patients. One thing you have to instill is that you are not on DIET. You are going to change what you eat forever. What we eat is what we are; so let's look at what we can eat first. The key to a healthy diet is low in simple carbohydrate (i.e no refined sugar), high protein, high complex carbohydrate and high fibre diet. Always calculate your calories when you eat. Always look at labels and ingredients of any products that you buy in store. Ensure the serving size before you eat so that you don't overeat. If sugar is the top three ingredients listed in the label, then the product is loaded with sugar; avoid this product. Be a smart consumer. Don't let the product rule you, you are the chef of your menu, so you decide what ingredients are in your food.

Drink a glass of purified water before you eat to avoid overeating.

Rice

Who is Malaysian without rice?? Rice contains carbohydrate in which too much of it is not good for a healthy weight. Aim to eat half portion of rice which is half a bowl, maximum twice a day. Switch to brown rice, or basmati rice. If you are not used to eating brown rice, try to mix 1/4 brown rice to 3/4 basmati rice for a week. Then slowly increase the amount of brown rice ratio to basmati rice. Aim for 100% brown unpolished rice.

Resist adding rice to your meal. Take more vegetable or meat to replace the rice. Avoid fried rice whenever possible.

Mee

Mee also contains carbohydrate. Aim to eat half a bowl of mee only with more vegetable or protein in the form of lean chicken or lean beef. Mee soup is preferable than mee curry. If you are eating mee curry, resist from taking a lot of the soup (2-5 spoons is enough). Avoid fried mee whenever possible. If you are cooking or eating spaghetti, opt for wholegrain range.

Bread

Bread is mainly carbohydrate. Avoid white bread. The best bread is a low glycemic index bread or multigrain/wholegrain bread (Gardenia Breakthrough or High 5 is easily available in most stores); not wholemeal bread. The heavier the bread the better it is. How many bread to eat? For breakfast, lunch or dinner, 2 multigrain bread is enough either in sandwich form with chicken slices, tuna with light mayonnaise (avoid mayonnaise whenever possible) or eggs (2 eggs with 1 yolk only) or with peanut butter, or thin layer of butter and jam. Choose jam that is 100% fruit base (eg. St Dalfour brand) or diabetic jam.

Butter or margerine?? Margerine is hydrogenated fat. Butter is a better choice.

Avoid buying bread from bakery as most ingredients are not labelled. Most bread in bakeries have sugar and marjerine added. Avoid danish, croissant, fruit/egg tart, biscuits and puffs as it is loaded with sugar and calories.

Vegetable

Vegetable is good. I would encourage everyone to eat more of vegetable. The more the merrier. Although it has some calories in it, but we Malaysians tend to eat less of it. So, by all means, eat more of vegetable, no limit but watch how you cook it. Raw as in salads with dressing at the side (choose vinaigrette not italian sauce or coleslaw). Eat raw salad (all types), spinach, tomatoes, broccoli, cauliflower, carrot, green pepper and cucumber. Other good vegetable to eat raw are daum selom, pucuk raja, daun jambu or quick boil of pucuk paku, pucuk ubi, pucuk betik. You may eat your vegetables with sambal belacan (chilli, belacan, salt, lime; no sugar). Vegetable cooked in soup form is also good but do not overcook. Let the soup boil first then put the vegetable last for 1 minute before you turn off the fire. Try not to fry the vegetable. If need to fry just spray the oil, and use olive oil.

Fruit

Fruits are good for you. Aim to eat at least a slice of fruit after each meal. If you are hungry in betweel meals, snack on fruits. Fruits contains vitamins and fibre. If you are a diabetics, do not eat too much of citrus fruits.

Snacks

In between meals, if you feel hungry, you can have snacks. The good snacks are nuts e.g. peanut, almond, cashew, pistachio; raisins or dried fruit e.g. prune or you can snack on biscuits e.g. wholegrain, low-salt, high fibre biscuits.

Water

Drink plenty of purified plain water. Aim 10-12 glasses of water a day. Avoid caffeinated beverages and carbonated drinks. You may drink tea or coffee a cup a day, but remember to replace each cup with 2 glasses of water. This is due to the diuretic effect of tea and coffee which means it promotes water loss from kidneys. Tea or coffee has antioxidant which is good for health. However, avoid drinking tea or coffee after 4pm or you might find it difficult to sleep at night. Green tea is preferable to the others. Avoid drinking cordials as it is loaded with sugar. Buy yourself a juicer and make fresh juices everyday, do not add any sugar, and drink a glass a day. You can make all kinds of juices such as apple, strawberry, mango, pineapple, honeydew, watermelon and keep it refrigerated.

Egg

There are different types of eggs in the market. Low cholesterol, omega 3 and the list goes on. Which one is the best?? Personally, I would buy a low cholesterol, omega 3 eggs with a reasonable price. The egg yolk is where the cholesterol is whereas the egg white is high in protein. Aim to eat a maximum of 3 eggs a week only.

Fibre

Fibre = anti-fat. Soluble fibre includes dried beans, oats, barley, apples, citrus fruits, and potatoes and insoluble fibre. Recommended intake of 25-30 grams of daily fiber a day.

What about the regular malaysian food??

I am sure you are wondering about what other food is healthy. What about roti canai?? If given a choice between roti canai and tosai, I would go for tosai. It is less oily compared to roti canai. If you must have roti canai, do not exceed one roti canai a week. Chapatti is also a good choice but watch the curry used as the dip.

What about curry puff, pisang goreng and other kuih? Mostly contain high sugar, high cholesterol especially if it is made of coconut milk (santan) or if it is fried e.g. curry puff or banana fritters. Avoid it whenever possible. Do not make it a routine tea time meal. If you must have have it, do not exceed two kuih at one time.

Nasi lemak....is the all time favourite. It is normally cooked with coconut milk. Practise half portion nasi lemak with extra cucumber or anchovies (ikan bilis) and only eat it once a week. If you are preparing the nasi lemak yourself, replace the coconut milk with low fat milk.

Nasi briyani or nasi tomato are loaded with carbohydrate and fat. It is not recommended as a regular meal, only on special occasions.

Chicken rice. Ensure that chicken rice is not cooked with chicken fat. Steam or roasted chicken is better than fried chicken. If you are cooking the chicken rice yourself, cook the rice with some chicken meat or bones instead of using the broth from chicken fat. Add more cucumber, tomatoes and salads in your chicken rice.

Yong tau foo is a good choice of food. However, make sure that you do not fry it. Have it boiled and prepared with soup. Do not pour the sauce on it, have the sauce on the side for you to dip only when necessary. This way, you don't overdo with the sauce. The sauce also contains a lot of sugar. Choose the vegetable yong tau foo as opposed to the others e.g. lady's finger, taufoo, kangkong, brinjal...

Fried rice, fried mee, fried meehoon are not recommended.

What to avoid?

Fried foods

Why do we need to avoid fried foods? All fried foods contain trans fat, formed when vegetable oils are hardened in the cooking process. Trans fat increases blood levels of bad cholesterol (LDL) and reduces the good cholesterol (HDL). Fried foods using vegetable oils that can become rancid and produce free radicals which can damage cells and probably increase risk of obesity.

Chocolates

The regular chocolates are loaded with sugar. The good chocolate that has antioxidant is dark chocolate with no sugar added.

Chips

Its best to avoid chips as it contains monosodium glutamate (msg), high salt content, food colouring and mostly fat.

Sugar

Avoid all kinds of sugar if possible. If you must have it, go for those sugar made for diabetics.

Preserved or cured meats

Avoid food such as sausages, bacon, preserved fish (ikan masin) and preserved fruits (jeruk) as it contains nitrosoamines, a powerful carcinogen for stomach cancer.

What about supplement?

Supplement such as vitamins, antioxidants, probiotics are highly recommended.

Vitamin A - antioxidant, boost immune system (Therapeutic daily dose:7000 to 10000 IU)

Vitamin C - antioxidant, raises good cholesterol (HDL), prevents oxidation of bad cholesterol (LDL) (Therapeutic daily dose: 1000-2000mg)

Vitamin E - antioxidant, lower risk of heart attack and stroke. Only natural vitamin E supplements (mixed natural tocopherols) are potent. (Therapeutic daily dose: 400-1200 IU)

Selenium - antioxidant, increase effectiveness of vitamin E. Prevent heart disease by increasing the good cholesterol, decreasing the bad cholesterol and decreasing the stickiness of the blood. Also protects against certain types of cancer. (Therapeutic daily dose:100-200mcg)

Omega 3 fish oil - lowers cholesterol and prevent blood clot

Multivitamin + multimineral

Folic acid - for childbearing age women

Coenzyme Q 10 - especially if you are on cholesterol lowering medications

Calcium plus Vitamin D

Exercise

There is no short cuts to weight management. You need to exercise to burn the extra calories. Aim for 2 to 3 times a week of about 20-30 minutes of cardio exercise. However, you can actually burn the extra calories by doing some easy lifestyle changes. If you walk to the bus stop to work, try to do it half the time you usually take. For good abdominal muscle tone, do the stomach crunch when you are lying in bed or watching tv. If you like to go to shopping malls, try to walk faster and fix some weight at your feet.

Sometimes you might wonder why your weight reduction is slow.....

Initially, when you start a weight management programme, the weight loss is rapid. This is due to water loss from your body. After a while, the weight loss slows down until you reach the ideal weight. However, do not despair. This is quite normal. Weight loss should be gradual, or you will end up with flabby muscles and skin.

How to start losing weight?

Before starting a weight management programme, it is best to prepare yourself. Be prepared that this is going to be permanent lifestyle changes, to lose weight and maintain an ideal weight and healthy lifestyle.

Start by preparing a 5 day menus of your current intake including weekends, as we tend to treat ourselves during weekend. Record all intakes including sweets or even a glass of coke. Review your diet preferably with your doctor. Make changes wherever you can, follow the suggestions above.

Day Breakfast Brunch Lunch Tea Dinner Supper

Friday

Saturday

Sunday

Monday

Tuesday

Remember low simple carbohydrate, high complex carbohydrates, high protein, high fibre, low sugar, low salt, low fat diet is ideal.

By listing down what we eat, then only can we see what is wrong with our diet. Start by changes the dietary intake or the way you prepare a meal.

What's next?

Get a reliable weighing machine and weigh yourself in kilogram. At the same time, measure your height in cm. Start calculating your BMI (body mass index). BMI = weight (kg)/height (m) x height (m)
A BMI over 25 is defined as overweight and a BMI of over 30 as obese. The healthy weight range for BMI is 18.5-22.9

BMI
<> or = 23 Overweight
25-29.9 Obese
> or = 30 Severely obese

Classification of weight by BMI in Asian Adults

Look at the chart, how far are you from the ideal weight. That should be your aim. If you are 5kg overweight, it is easier to shed that 5kg than if you are 20kg overweight. It may take up to 6 months or more if you have to lose more but persistence is the key in weight management. Remember, the aim is permanent lifestyle changes in order to maintain a healthy weight. Aim for a slow and steady weight reduction to avoid heart complication, dehydration or fatique.


Measure your waistline and record it down.

Next, get a complete blood test done from your doctor. The blood test should include full blood count, renal profile, lipid profile, liver function test, thyroid function test, fasting glucose level and urinalysis. You are advised to fast at least 10 hours before the blood test. Why do I need a blood test? The initial blood test is useful to find out any metabolic disease that may interfere with the weight management programme. If you have diabetes, high cholesterol or hyperthyroid condition, it needs to be addresssed first. You may need medications to treat those conditions first.



Weight Management Regime

How do we do it? In my clinic, we try to incorporate our regime into patient's lifestyle, budget and how much they need to lose. Take a look at the regimes and you may decide which is most suitable for you.

Regime A

Intensive phase (for 2 weeks only):

Meal replacement for 2 meals (breakfast, lunch or dinner)
Lecithin 1200mg per day
Vitamin E 400IU per day
Carbohydrate blocker with one meal (if you take meal high in carbohydrate)
Lots of water
Multivitamin
Exercise 3 times per week

Maintenance phase:

One meal replacement until ideal weight or able to control dietary intake
Lecithin
Vitamin E
Carbohydrate blocker with each meal
Lots of water
Multivitamin
Liquid carnitine
Exercise 3 times per week

Regime B

Enerflex-forte 2 sachets twice daily before meal
Lecithin 1200mg
Vitamin E 400IU per day
Lots of water
Multivitamin
Liquid carnitine
Carbohydrate blocker if necessary
Exercise 3 times per week

Regime C

Dietary changes only (900-1200kcal per day)
Lecithin 1200mg
Vitamin E 400IU per day
Multivitamin
Liquid carnitine
Carbohydrate blocker if necessary
Exercise 3 times per week

Why Lecithin and Vitamin E?

Lecithin is a fat emulsifier of fatty substances in the body, and vitamin E is a fat-soluble anti-oxidant which helps to reduce free radicals in the body.

Appetite suppressant

In some cases, whereby patients may have problem with increase appetite, they may need to be on appetite suppressant such as Duromine. Duromine is a prescription only medication, please get advise from your doctor before taking such medication. Side-effects of Duromine includes palpitation, insomnia.

Most patients are confused about their calorie intake.Your specific daily calorie requirement depends on your level of activity. The more active your lifestyle, the more energy you need. Calculate your daily calorie requirement using the formula below:

daily calorie requirement = ideal weight x energy requirement (refer below)

Energy requirement
Weight status Overweight Normal weight Underweight

Sedentary 25 kcal/kg 30 kcal/kg 35 kcal/kg
Moderate activity 35 kcal/kg 40 kcal/kg
Marked activity 40 kcal/kg 45 kcal/kg

Example:
Height = 150cm, current weight = 70kg
Classification = overweight, ideal BMI weight 49.5kg
Lifestyle = sedentary
Overweight person with a sedentary lifestyle requires 25 kcal/kg. Therefore, his daily calorie requirement nesessary to obtain and maintain the ideal weight of 49.5 kg is: 49.5 x 25 = 1237.5 kcal per day

Not that the daily calorie requirement is to maintain ideal weight and not for weight loss.


Most common complaint from my patients is what should I eat? Please give me some ideas of what I can eat. Here are some guidelines for menu plan. I have included the calculated calories.

Breakfast

1) 1/2 nasi lemak (195 kcal)

2) Fried mee hoon 1/2 plate (147 kcal)

3) Red bean pau (40 kcal)

4) Thosai 1 piece (147kcal)

5) Omelette 1 egg (107 kcal)

6) Bubur kacang merah 1/2 bowl (50.5 kcal)

7) 2 slices of wholegrain bread


Lunch or Dinner

1) 1/2 cup plain cooked rice (83.5 cal)
1 medium piece chicken kurma (175 cal)
4 tbsp long beans with tauchoo (74 cal)
1 slice watermelon (37 cal)

*calories can be reduced if you substitute coconut milk with low fat milk, fry the vegetables with spray of olive oil only and replace plain rice with brown rice

2) 1/2 cup plain cooked rice
Fried pomfret (bawal) (143 cal)
4 tbsp bean sprout (taugeh) (108 cal)
1 slice guava (41 cal)

*steam fish is a better choice

3) 1/2 cup plain cooked rice
1 piece chicken curry (195 cal)
5 tbsp spinach with anchovies (32.5 cal)
1 slice papaya (56 cal)

*replace coconut milk with low fat milk, use olive oil for frying (1 tbsp only), boil the spinach rather than fry

4) 1/2 cup plain cooked rice
1 serving of fried anchovies with chilli (126 cal)
4 tbsp kangkung belacan (96 cal)
1 red apple (63 cal)

5) Mee soup 1 bowl (383 cal)
1 medium size banana (76 cal)

6) Fried mee (281 cal)
Prune 7 pieces (100cal)

7) Chicken rice 1 plate (278 cal)
4 tbsp rojak (182 cal)

8) Nasi briyani 1/2 plate (112 kcal)
Fried chicken (255 kcal)
Mutton curry 1/2 cup (92 kcal)
Dates 5pcs (155 kcal)

Snack

1) Almonds 12 nuts (118 kcal)

2) Grapes 10 (75 kcal)

3) Red apple 1 fruit (small) (52 kcal)

4) Cream crackers 2 pieces (80 kcal)

5) Mandarin orange 1 fruit (medium) (38 kcal)

6) Dates 5 fruits (155 kcal)

7) Guava 1/2 fruit (51 kcal)

8) Papaya 1 slice (53 kcal)

9) Prune 5 fruits (78 kcal)

10) Watermelon 1 slice (31 kcal)

11) Pineapple 1 slice (36 kcal)

12) Plain low fat yoghurt 1 cup (112 kcal)

13) Cheese 1 slice (64 kcal)


I hope that this guide will inspire many people to lose weight healthily and maintain their weight permanently.

All the best.

Lina

Should You Consume Supplements?

Many people take vitamin supplements for health reasons but is there any evidence to support the intake of supplements?

The dietary guide suggests at least 3-5 servings of vegetables and 2-4 servings of fruit every day. However, this amount only meets the Daily Value (DV) (formerly known as Recommended Daily Allowances; RDA). This recommendation does not take into account the quality of nutrients. Processed food (e.g., frozen vegetables and canned fruits) have lost much of their nutritional values and potency during manufacture. Some foods also contain unwanted substances such as preservatives or dyes.

The DV estimates the amount of nutrient the average person needs to avoid problems of severe deficiencies such as scurvy (vitamin C deficiency), pellagra (Niacin deficinecy), and rickets (vitamin D deficiency) for example, plus a margin of error. This is less than the amount needed to achieve optimum health. Many scientific studies show that our bodies need vitamins A, C, E, lipoic acid, selenium and zinc in doses 2-5 times the DV!

Nunerous research publications support the use of supplements.

In February 2002 a study published by the American Journal of Clinical Nutrition found that acetyl-L-carnitine and the antioxidant alpha-lipoic acid fed to older rats improved memory and boosted overall energy. The study predicted that similar therapeutic benefits to "rejuvinate aging humans" would likely be found.

In April 2002, in the same journal, data obtained from multiple studies studying megavitamin treatment (vitamins at least 10 times RDA) were pooled. Their research found that more than 50 genetic diseases could be successfully treated with megavitamin therapy. The researchers submit that flooding the body with excess vitamins creates an ample supply of coenzymes required for optimal metabolic function.

In June 2002, Journal of the American Medical Association (JAMA) published a study by researchers from Harvard Medical school. The research team reviewed 36 years of scientific literature that investigated links between vitamin intake and diseases. They found many benefits and little risk and recommended that "everybody-regardless of age or health status -take a daily multivitamin".

In April 2003, the Annals of Internal Medicine published a research conducted on 130 adults over 45 and compared those who took a multivitamin and mineral supplement with those who took a placebo. The group that took the vitamins and minerals fell in to an infection far less that those that took placebo.

These evidence points out the need for supplementation for healthy individuals and even more for those with an illness. It is prudent, however, that one consumes a multivitamin and mineral which is potent and of the correct dosage. It is therefore important to take a high quality multivitamin produced in comformation to the pharmaceutical grade Good Manufacturing Practice to ensure potency and quality.

Mahathir

When, Why and How do we Age?

Did you know that we start to age at 30? Our bodies function at its prime at the age of 25. Beyond the age of 30 our bodily functions start to decline. With age, people have come to accept degenerative disease or diseases of wear and tear. Our joints start to creak, our memory becomes poor, our reflexes are slower, and our sex life goes down the drain. Besides this the incidence of heart attack and cancer also increases with age. However, we all have known people who don't appear their age (i.e., either younger or older than their stated age). This is the difference between chronological age (the actual age in years a person has lived) and biological age (the age at which the bodily functions are able to perform). A person could therefore be 50 years old chronologically but has a biological age of 35! Why does this happen?

There are many scientific theories of aging. One of the major theories is the free radical theory of aging. As our bodies use up oxygen to generate energy it produces a molecule with a free electron. This is called a free radical. The free radical reacts destructively with adjacent molecules in order to attain electrical equilibrium. As you can see, eventhough we need oxygen to sustain life, by using oxygen our bodies produce harmful substances which damage our body. This is the "oxygen paradox".Another way of looking at free radical damage is to think of it as oxidation or rusting. In a sense our aging process is analogous to the rusting of a piece of metal.

Our body has several defences against these threats namely the natural antioxidants catalase, glutathione peroxidase and superoxide dismutase. As we age these antioxidants are depleted or diminish in function and cellular damage becomes evident.

Based on this theory, the use of antioxidants have been advocated to combat free radical damage. Some of the well known antioxidants include Vitamin C, Vitamin E and Beta Carotene (a substance used to produce vitamin A). One less known antioxidant is Oligomeric proanthocyanidin complexes (OPC) or flavanoids. These occur naturally in plants and are not produced in the body. Flavanoids defend us against fungi, toxins and environmental stress. One of the richest sources of OPCs is found in grape seed extract. Grape seed extract have been shown to lower bad cholesterol, inhibit cancer cell growth while promoting growth of healthy cells, protect the nervous system and helps the immune system.

Wishing you good health always,

Mahathir