Critical to improve health literacy

People must learn to modify diets to prevent lifestyle diseases such as diabetes

Image Credit: Created with the assistance of DALL·E 3

 

PRIME Minister Datuk Seri Anwar Ibrahim’s reminder to the people to take health knowledge seriously is timely.

At the launch of the 2024 National Wellness Month celebration last weekend, he reminded people to understand the dangers of excessive sugar consumption, saying that campaigns on health literacy or sugar reduction, as well as health literacy policies, would only be effective if people began changing their eating habits now.

For a start, let’s recall what we ate and drank in the past 24 hours, just to have a perspective of our sugar consumption.

From roti canai to teh tarik and the myriad of kuih, these foods all contain sugar.

When people say that they have cut sugar from their diets, I wonder if they realise that their bodies convert the carbohydrates they consume into sugar.

Staples like rice, bread, noodles and fruits are also high in carbohydrates, so maybe we need to take a good look at our food portions too.

Not long ago, the Health Ministry introduced the Malaysian Healthy Plate campaign with the hashtag #sukusukuseparuh

My friends were talking about it and I thought it was a clever way of introducing the concept of meal portions to the public.

The campaign encourages the public to limit their carbohydrate intake to fit a quarter segment of the plate. Another quarter of the plate should be filled with protein and the remaining half, with fruits and vegetables.

Now the key is making this meal formula part of our lifestyle.

Growing up, I watched my paternal grandmother suffering from diabetes.

She had her first stroke a day before I turned one. She must have been about 53 years old then.

However, I remember my paternal grandmother having a healthy diet. She took me along for her evening walks, took her medications on time and never skipped doctor’s appointments.

Over time, she became bedridden, before she passed away at the age of 70 in 1994.

She was an attractive woman in her youth but everything went downhill when she became sick.

After the stroke, her mobility was limited, preventing her from maintaining her active lifestyle.

My maternal grandmother also suffered from diabetes and her mobility, too, was limited after a stroke.

She had never cared about her diet and was a teh tarik addict. There was always an unlimited supply of condensed milk from my grandfather’s grocery store.

I dare say her enjoyment of this popular drink and her eventual poor physical mobility contributed to her eventual death.

As a child, I watched my grandmothers become weak, lose their speech and become bedridden before their deaths.

They were both diabetics and would have had poor health literacy in their younger days.

Thankfully, both my parents are healthy and my dad just turned 80. I believe this can be attributed to their balanced diets.

I’m also conscious of my own family’s consumption and manage this through my cooking.

Besides food, physical exercise is also necessary. It is no longer an option to say that we have no time to exercise.

A walk in the park may be possible depending on the weather.

However, I believe it is time that more public gyms are created. These gyms could be open from morning to midnight and made accessible to the public for a minimal fee.

The Bangsar Sports Complex at in Bangsar, Kuala Lumpur, has a public gym and it is managed by Kuala Lumpur City Hall. The entrance fee is just RM2.

I hope local councils, especially the ones with city status, will create public gyms with cardio and weight-training equipment.

Cardio activities such as Zumba could also be held at public spaces and should be promoted to the community.

More community-based sports for children, such as football and netball, should also be spearheaded by elected representatives.

Prevention of non-communicable diseases such as diabetes, hypertension and high cholesterol will reduce taxpayers’ funding of the nation’s healthcare services.

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Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood glucose.

Diabetes and insulin

Summary

Read the full fact sheet

• People with type 1 diabetes must inject insulin every day, often up to 4 or 5 times per day.
• There are different ways to inject insulin ranging from a syringe and needle, to an insulin delivery pen, to an insulin pump.
• Your doctor or diabetes nurse educator will teach you about how, where and when to inject insulin, and how to store it safely.
• Even with the help of your doctor and diabetes nurse educator, it may take a while to find the right insulin dose to reduce your blood glucose to your target levels.
• What is Type 2 Diabetes?

Type 2 diabetes is a common metabolic condition that develops when the body fails to produce enough insulin or when insulin fails to work properly, which is referred to as insulin resistance. Insulin is the hormone that stimulates cells to uptake glucose from the blood to use for energy.

Image Credit: Created with the assistance of DALL·E 3

When this is the case, cells are not instructed by insulin to take up glucose from the blood, meaning the blood sugar level rises (hyperglycemia).

Prevalence and Risk Factors

People usually develop type 2 diabetes after the age of 40 years. However, people of South Asian origin are at an increased risk of the condition and may develop diabetes from age 25 onwards. The condition is also becoming increasingly common among children and adolescents across all populations. Type 2 diabetes often develops due to overweight, obesity, and lack of physical activity, and diabetes prevalence is on the rise worldwide as these problems become more widespread.

Heterogeneity and Genetic Factors

Type 2 diabetes is a heterogeneous disorder characterized by varying degrees of beta cell dysfunction in concert with insulin resistance. The strong association between obesity and type 2 diabetes involves pathways regulated by the central nervous system governing food intake and energy expenditure, integrating inputs from peripheral organs and the environment. Genetic susceptibility and environmental factors, including the availability of nutritious food and other social determinants of health, play significant roles in the development of diabetes and its complications.

Global Impact In 2021, the global prevalence of diabetes mellitus was estimated to be 6.1%, representing 529 million people, with prevalence estimates in certain regions as high as 12.3%. Type 2 diabetes accounts for 96% of cases, and greater than 50% of type 2 diabetes is attributable to obesity. The trajectory of the diabetes pandemic is concerning, with an estimated 1.31 billion individuals projected to have diabetes by 2050.

Types of Diabetes

Also known as juvenile diabetes, type 1 diabetes usually occurs in childhood or adolescence. In type 1 diabetes, the body fails to produce insulin, so patients have to be given the hormone. This is why the condition is also known as insulin-dependent diabetes mellitus (IDDM).

Type 2 diabetes mellitus is also called non-insulin-dependent diabetes mellitus (NIDDM) since it can be treated with lifestyle changes and types of medication other than insulin therapy. Type 2 diabetes is significantly more common than type 1 diabetes.

Symptoms of Type 2 Diabetes

The increased blood glucose level seen in diabetes can eventually damage a person’s blood vessels, nerves, and organs. The body attempts to remove the excess glucose through urination, and the most common symptoms of type 2 diabetes include the following:

• Polydipsia (increased thirst)
• Polyphagia (increased hunger)
• Polyuria (increased frequency of urination), especially during the night
• Extreme fatigue, weight loss, and sudden loss of muscle bulk.

Some of these symptoms are also seen in type 1 diabetes, but type 2 diabetes symptoms tend to develop more gradually and can take months or years to manifest. This can make it more difficult for people to tell they have an underlying health condition, and often, people have had type 2 diabetes for a long time before it is finally diagnosed.

Risk Factors

Several factors can increase a person’s risk of developing diabetes. Examples include:

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• Overweight or obesity
• Unhealthy diet
• A waist measurement of 31.5 inches or more among women
• A waist measurement of more than 37 inches among men
• Low levels of physical activity
• Raised cholesterol
• High blood pressure
• South Asian ethnicity
• Smoking

A family history of diabetes also increases a person’s risk of developing the condition. Studies have shown that the offspring of families where one parent has diabetes have a 15% increased risk of developing the condition and that offspring born to two parents with diabetes have a 75% increased risk.

Complications of Type 2 Diabetes

The high blood glucose seen in diabetes can damage blood vessels, nerves, and organs, leading to a number of potential complications. Some examples of the complications caused by diabetes include the following:

Cardiovascular Disease

Persistently high blood glucose levels can lead to atherosclerosis, increasing the risk of heart disease and stroke. This includes narrowing and clogging of blood vessels with fatty plaques, which can disrupt blood flow to the heart and brain.

Nervous System Damage

Excess glucose in the blood can damage small blood vessels in the nerves, causing a tingling sensation or pain in the fingers, toes, and limbs. Nerves outside of the central nervous system may also be damaged, a condition known as peripheral neuropathy. If nerves of the gastrointestinal tract are affected, vomiting, constipation, and diarrhea may occur.

Diabetic Retinopathy

Damage to the retina may occur if tiny vessels in this tissue layer become blocked or leak. The light then fails to pass through the retina properly, which can cause vision loss.

Kidney Disease

Blockage and leakage of vessels in the kidneys can affect kidney function. This usually happens due to high blood pressure, and blood pressure management is an integral part of managing type 2 diabetes.

Foot Ulceration

Nerve damage in the feet can mean minor cuts are not felt or treated, leading to a foot ulcer developing. This happens to around 10% of people with diabetes.

Prevention, Treatment, and Care

Blood sugar should be regularly monitored to detect and treat any problems early. Treatment involves lifestyle changes such as eating a healthy and balanced diet and regular physical exercise. If lifestyle changes alone are not enough to regulate the blood glucose level, anti-diabetic medication in the form of tablets or injections may be prescribed. In some cases, people who have had type 2 diabetes for many years are eventually prescribed insulin injections.

Maintaining a healthy blood glucose level, blood pressure, and cholesterol is essential to preventing the complications of type 2 diabetes. Overweight or obese individuals with diabetes often significantly reduce the extent of their symptoms by making adjustments to their lifestyle.

Recent Therapeutic Advances

Maintaining a healthy blood glucose level, blood pressure, and cholesterol is essential to preventing the complications of type 2 diabetes. Recent advances in therapy include the use of GLP-1 receptor agonists, which have shown positive effects beyond glycemic control, such as weight loss and reduced cardiovascular mortality. These therapies represent a new era in diabetes treatment, impacting both metabolic control and cardiorenal complications.

Gut Microbiota and Type 2 Diabetes

The gut microbiota (GM), comprising trillions of microorganisms in the gastrointestinal tract, plays a crucial role in the development of obesity and related metabolic disorders, such as type 2 diabetes. Studies show that GM dysbiosis is linked to increased energy extraction, altered metabolic pathways, and inflammation, contributing to obesity, metabolic syndrome, and type 2 diabetes. The GM influences nutrient absorption, immune regulation, and energy metabolism.

Impact of Diet and Lifestyle

Dietary habits significantly influence GM composition and microbial metabolites that regulate host metabolism. A Western diet, rich in fat and sugar but low in fiber, is associated with GM dysbiosis. Conversely, adherence to a Mediterranean diet increases short-chain fatty acid (SCFA) levels, promoting metabolic health.

Microbial Diversity and Health

The human GM consists of approximately 100 trillion cells, with the highest diversity found in the colon. A diverse GM is rich in number and variety, playing a key role in maintaining metabolic health. Disruptions to GM diversity due to diet or medication can lead to metabolic diseases.

Emerging Therapies Targeting GM

Potential therapies targeting GM include dietary modification, prebiotics, probiotics, and fecal microbiota transplantation (FMT). These interventions aim to restore a healthy GM composition, improving metabolic health and reducing the risk of type 2 diabetes and obesity.

Sources

1. NHS. “What Is Type 2 Diabetes?” NHS, NHS, 18 Aug. 2020, www.nhs.uk/conditions/type-2-diabetes/.
2. National Institute for Health and Care Excellence. (2022, June 29). Overview | Type 2 diabetes in adults: management | Guidance | NICE. Nice.org.uk; NICE. https://www.nice.org.uk/guidance/ng28
3. http://www.diabetes.ca/files/Prediabetes-Fact-Sheet_CPG08.pdf (no longer active)
4. Diabetes UK. “Type 2 Diabetes.” Diabetes UK, Diabetes UK, 18 May 2023, www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-2.
5. “Type 2 Diabetes - Symptoms and Causes.” Mayo Clinic, www.mayoclinic.org/diseases-conditions/type-2-diabetes/home/ovc-20169860.
6. Sasidharan Pillai, S., Gagnon, C. A., Foster, C., & Ashraf, A. P. Exploring the Gut Microbiota: Key Insights into Its Role in Obesity, Metabolic Syndrome, and Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism. DOI:10.1210/clinem/dgae499, academic.oup.com/.../7718329?login=false
7. Diabetes mellitus—Progress and opportunities in the evolving epidemic Abel, E. Dale et al. Cell, Volume 187, Issue 15, 3789 - 3820, https://www.cell.com/cell/fulltext/S0092-8674(24)00703-7

Further Reading

• All Type 2 Diabetes Content
• Diabetes Mellitus Type 2 Pathophysiology
• Type 2 Diabetes Symptoms
• Type 2 Diabetes Diagnosis
• Type 2 Diabetes Screening and Prevention

More...

WADA statement on Reuters story exposing USADA scheme in contravention of World Anti-Doping Code

WADA Exposes USADA's Prolonged Doping Scheme ...

WADA Exposes USADA's Prolonged Doping Scheme ...

The World Anti-Doping Agency (WADA) responds to a Reuters story of 7 August 2024 exposing a scheme whereby the U.S. Anti-Doping Agency (USADA) allowed athletes who had doped, to compete for years, in at least one case without ever publishing or sanctioning their anti-doping rule violations, in direct contravention of the World Anti-Doping Code and USADA’s own rules. 

This USADA scheme threatened the integrity of sporting competition, which the Code seeks to protect. By operating it, USADA was in clear breach of the rules. Contrary to the claims made by USADA, WADA did not sign off on this practice of permitting drug cheats to compete for years on the promise that they would try to obtain incriminating evidence against others. 

Within the Code there is a provision whereby an athlete who provides substantial assistance can subsequently apply to have a proportion of their period of ineligibility suspended. However, there is a clear process for that, which does not involve allowing those who have cheated to continue to compete while they may or may not gather incriminating evidence against others and while they could retain a performance-enhancement effect from the substances they took. When WADA eventually found out about this non-compliant practice in 2021, many years after it had started, it immediately instructed USADA to desist. 

WADA is now aware of at least three cases where athletes who had committed serious anti-doping rule violations were allowed to continue to compete for years while they acted as undercover agents for USADA, without it notifying WADA and without there being any provision allowing such a practice under the Code or USADA’s own rules. 

In one case, an elite level athlete, who competed at Olympic qualifier and international events in the United States, admitted to taking steroids and EPO yet was permitted to continue competing all the way up to retirement. Their case was never published, results never disqualified, prize money never returned, and no suspension ever served. The athlete was allowed to line up against their unknowing competitors as if they had never cheated. In that case, when USADA eventually admitted to WADA what had been going on, it advised that any publication of consequences or disqualification of results would put the athlete’s security at risk and asked WADA to agree to non-publication. Being put in this impossible position, WADA had no choice but to agree (after verifying with its Intelligence and Investigations Department that the security threat was credible). The athlete’s doping was therefore never made public. 

In another case of a high-level athlete, USADA never notified WADA of its decision to lift an athlete’s provisional suspension, which is an appealable decision, despite being required to do so under the Code. Had WADA been notified, it would never have allowed this. 

How must other athletes feel knowing they were competing in good faith against those who were known by USADA to have cheated? It is ironic and hypocritical that USADA cries foul when it suspects other Anti-Doping Organizations are not following the rules to the letter while it did not announce doping cases for years and allowed cheats to carry on competing, on the off chance they might help them catch other possible violators. WADA wonders if the USADA Board of Directors, which governs USADA, or U.S. Congress, which funds it, knew about this non-compliant practice that not only undermined the integrity of sporting competition but also put the co-operating athletes’ security at risk.  

WADA statement following comments by CEO of United ...

WADA statement following comments by CEO of United States Anti-Doping Agency

The World Anti-Doping Agency (WADA) is astonished by the outrageous, completely false and defamatory remarks made by the CEO of the United States Anti-Doping Agency (USADA), Travis Tygart, who has made very serious accusations against WADA in connection with the case of 23 swimmers from China that was reported upon by the media earlier today.

Mr. Tygart’s allegations are politically motivated and delivered with the intention of undermining WADA’s work to protect clean sport around the world. WADA notes that the damaging comments have been delivered without any supporting evidence whatsoever.

The truth of this matter is that according to all available scientific evidence and intelligence, thoroughly gathered, assessed and tested by leading anti-doping experts, WADA had no basis to challenge the explanation of environmental contamination. At all times, WADA acted in good faith, according to due process and following advice from external counsel when it decided not to appeal this case. In the absence of any other evidence WADA, still today, stands by the results of its rigorous scientific investigation as well as the approach of its Intelligence and Investigations Department. WADA’s statement of 20 April outlines the Agency’s position on this file in more detail.

It is implicit in his statement that Mr. Tygart does not accept the finding of environmental contamination in this case although he cannot say why. Yet, it is true that in the United States, WADA has also accepted USADA’s similar conclusions of contamination involving a number of U.S. athletes. Mr. Tygart should realize that it is not only American athletes who can fall victim to situations of no-fault contamination.

USADA contacted WADA in early 2023 based on a tip it had received about an alleged cover-up involving these cases but unfortunately was unable to provide any evidence whatsoever.

It should be noted that following Mr. Tygart’s false allegations, WADA has no choice but to refer this matter to its legal counsel for further action

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The financial impact of having a stroke

 

 

Managing Money After a Stroke

One way to alleviate some of the costs incurred after a stroke is to review your health insurance to ensure you are getting all the benefits you are entitled to. — Freepik

A big financial impact

The aftermath of a strokr can be expensive with medicines, assistive devices, home modifications, and caregiver costs, coupled with potential loss of income. 

The financial impact of a stroke can be overwhelming and unpredictable.

The lifetime cost of ischaemic strokes – which comprise over 80% of strokes and are caused by blockage of blood vessels supplying part of the brain – were estimated at US$140,481 (RM659,698).

This includes the cost of inpatient care, rehabilitation and follow-up care.

A study that looked at the cost of post-stroke outpatient care in Malaysia in 2015, found that the average total cost incurred was US$547.10 (RM2,569.18).

Of this figure, 36.6% was spent on attendant care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and 8.5% on out-of-pocket expenses.

The main factor in the cost of post-stroke outpatient care was the severity of the stroke.

Increased costs was also associated with a haemorrhagic stroke – the other main type of stroke, which is caused by the bleeding, or haemorrhage, of a blood vessel in the brain.

Leading a safe and cost-effective life post-stroke requires a combination of self-care, medical management and lifestyle adjustments.

Here are some steps that can help:

> Follow medical advice

It’s important to follow your healthcare provider’s advice on medication, rehabilitation and lifestyle modifications.

This may include taking medication as prescribed, attending rehabilitation sessions, and making changes to your diet and exercise routine.

> Manage chronic health conditions

If you have other chronic health conditions such as high blood pressure or diabetes, it’s important to manage these conditions to reduce the risk of future strokes and other health complications.

> Make home modifications

Consider making modifications to your home to reduce the risk of falls and improve your safety.

This may include installing grab bars, non-slip mats and handrails.

> Use assistive devices 

Assistive devices such as canes, walkers and wheelchairs, can help you maintain your mobility and independence.

> Adopt healthy habits

Adopting healthy habits such as eating a balanced diet, exercising regularly and getting enough sleep, can help you maintain your overall health and reduce the risk of future strokes.

> Stay socially active

Staying socially active and engaged can help reduce the risk of depression and improve your overall quality of life.

Consider joining a social group or doing volunteer work.

> Manage finances

Stroke can have a significant financial impact on the family, especially if the stroke patient is the sole breadwinner.

So it’s important to manage your finances carefully.

By following these steps and working closely with your healthcare team, you can lead a safe and cost-effective life post-stroke.

Managing the financial impact

As mentioned above, no doubt, one of the biggest challenges post-stroke would be the financial impact on the patient and their dependents.

Financial burdens following a stroke may be due to medical expenses and decreased income because of the inability to work, whether it is the patient themself or a family member who has to quit their job to become a full-time caregiver to the patient.

Addressing financial needs post-stroke can be challenging, but here are some strategies that can help:

> Review your insurance coverage

Examine your insurance coverage to make sure it includes all the necessary benefits and services, such as rehabilitation and home healthcare.

Consider speaking with an insurance specialist to ensure you are getting the most out of your coverage.

> Explore disability benefits

If you are unable to work because of stroke, you may be eligible for disability benefits.

Socso provides a range of benefits for employees, including medical treatment, rehabilitation and financial assistance.

There are also many NGOs (non-governmental organisations) that offer financial assistance to stroke patients and their families, including the National Stroke Association of Malaysia (Nasam), Stroke Care Malaysia, etc.

These organisations can help with medical bills, transportation costs and other expenses related to stroke care.

> Create a budget

You and your dependents should review your daily expenses and financial commitments to see what can be adjusted to compensate for the decrease in income and increase in stroke-related expenses.

A leaner budget might have to be created for the family to follow, to ensure that you don’t go into unsustainable debt, or even bankruptcy.

What’s good for yourself

It is also important, though challenging, to develop a sense of what is good for oneself after a stroke.

Here are some methods that can help:

> Listen to your body

Pay attention to your body and how it responds to different activities and situations.

Take note of what makes you feel better or worse. and adjust your routine accordingly.

> Set realistic goals

Set achievable goals that are tailored to your abilities and interests.

This can help you build confidence and a sense of accomplishment, which can improve your overall well-being.

> Prioritise self-care

Make self-care a priority, including getting enough rest, eating a healthy diet, and engaging in physical activity, as recommended by your healthcare providers.

> Seek support

Connect with others who have experienced stroke or other health challenges.

Consider joining a support group or seeking individual therapy to help you process your emotions and develop coping skills.

> Practice mindfulness

Mindfulness practices such as meditation, yoga or deep breathing, can help you become more aware of your thoughts and feelings, and develop a greater sense of inner calm and well-being.

> Experiment and adjust

Be willing to experiment with different approaches to self-care and self-discovery, and be open to adjusting your routine as needed.

By focusing on self-care, seeking support, and staying open to new experiences and perspectives, stroke patients can develop a greater sense of what is good for themselves and their overall well-being.

In a nutshell, it is not impossible for a person to regain a normal life after a stroke.

The real challenge lies in how stroke survivors can manage their post-stroke life and deal with the challenges from then on effectively.

Remember, there will always be light at the end of the tunnel for stroke survivors!

Dr Lee Tze Yan is a senior lecturer in molecular medicine at Perdana University. Matthew Teo Yong Chang is an occupational therapist specialising in stroke rehabilitation and senior lecturer at Manipal University College Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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Life after a stroke, post-stroke care crucial