Gout

Let’s Talk About Gout Written by: Consultant Dietitian Megan Ang What is gout? Gout is a common form of inflammatory arthritis that affects the joints. In fact, it is one of the most prevalent forms of arthritis in Malaysia [1]. For many, symptoms such as pain and swelling often begin in the big toe but may also affect other joints in the lower limbs [2,3]. There are three stages of gout [4,5]: Asymptomatic hyperuricemia: High uric acid levels without any symptoms. Acute gout: Sudden and severe gout attacks that cause intense pain, often within 24 hours of onset. Chronic tophaceous gout: Formation of densely packed crystals called tophi due to frequent gout attacks, leading to permanent joint damage. As the condition progresses, it can cause extreme pain and significantly impact daily activities. How do I get gout? Gout develops due to a buildup of a substance called uric acid in the body. While uric acid plays an essential role as a powerful antioxidant, an excess can lead to problems [7]. This buildup may result from either overproduction or poor excretion, causing crystals to form in the joints, which in turn leads to pain and swelling. What is uric acid?  Uric acid is a by-product formed when the body breaks down purines [5,6,7]. These purines can come from the body’s own cells or from purine-rich foods in the diet. The more purine-rich foods consumed, the more uric acid is produced. As mentioned, uric acid itself is not harmful. It becomes a problem only when levels are excessively high. Persistently elevated levels can lead to crystal formation and accumulation in the joints [1]. However, not everyone with high uric acid levels will develop gout. Am I at risk of getting gout? [1,2,3] Risk factors include: Gender (more common in men) Age (risk increases with age) Family history of gout Health conditions such as obesity, high blood pressure, congestive heart failure, diabetes, kidney disease, and kidney stones Diets high in purines, alcohol, and fructose Certain medications (e.g., diuretics, low-dose aspirin, excessive B3, cyclosporine) How can I manage my gout? [6,9] Medical Management Medical treatments aim to reduce the pain of gout flares and lower uric acid levels. Medications used during gout attacks include: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Colchicine Medications used to lower uric acid levels include: Allopurinol Febuxostat Probenecid Note: Some medications may have side effects. Always consult your doctor to find a treatment that suits you best. Dietary and Lifestyle ModificationsWith proper dietary and lifestyle changes, future gout attacks can be prevented by reducing uric acid levels in the body. Maintaining a Healthy WeightMaintaining a healthy weight can significantly reduce the risk of gout [2,3,5,6]. Body Mass Index (BMI) can serve as a general guideline. If overweight, losing weight through healthy eating and regular exercise can help lower uric acid and reduce joint stress, particularly in the lower limbs. Physical ActivityAim for 30 minutes of exercise daily, or 150 minutes per week, to help manage weight and lower the risk of gout [2,6]. Start with low-intensity activities like walking and gradually increase as your fitness improves. Exercising with friends or family can make it more enjoyable. DietChoose lower purine foods: [3,5,7,8,9] Tart cherries (fresh, frozen, juice, or powdered) Low-fat dairy (milk, yogurt, cheese) Fruits and vegetables Eggs Grains and cereals (rice, noodles, bread) Reduce intake of: [3,5,7,8,9] Organ meats (liver, kidney) Red meats (beef, lamb) and poultry (chicken) Certain seafood (sardines, anchovies, tuna, mackerel, mussels, cockles) Alcohol (all types – limit to 1–2 standard drinks) High-fructose beverages While some vegetables such as mushrooms, asparagus, cauliflower, and spinach are higher in purines, research shows they don’t significantly raise uric acid levels. Therefore, focus more on reducing purine-rich animal products rather than plant-based foods [8,5]. Hydration is key. Drinking plenty of fluids, especially water, helps promote the excretion of uric acid through urine [5]. Summary Gout is a well-researched and manageable condition. Effective strategies, including medication, diet, and lifestyle changes, can help prevent painful flares and support joint health. By working with healthcare professionals and making informed decisions, those with gout can live well and stay pain-free. Reference List Wan Rohani WT, Mahfudzah A, Nazihah MY, Tan HL, Wan Syamimee WG, Amanda Jane PG, et al. Association of solute carrier family 2, member 9 (SLC2A9) genetic variant rs3733591 with gout in a Malay sample set. Med J Malaysia. 2018;73(5):307-10. Gout [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2022Nov5]. Available from: https://www.cdc.gov/arthritis/basics/gout.html#:~:text=quality%20of%20life%3F-,What%20is%20gout%3F,no%20symptoms%2C%20known%20as%20remission.  Gout [Internet]. National Institute of Arthritis and Musculoskeletal and Skin Diseases. U.S. Department of Health and Human Services; 2021 [cited 2022Nov5]. Available from: https://www.niams.nih.gov/health-topics/gout  Doherty M, Jansen TL, Nuki G, Pascual E, Perez-Ruiz F, Punzi L, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012;71(11):1765-70. Gandy J. Manual of Dietetic Practice. Chichester: Wiley Blackwell; 2019.   Department of Health & Human Services. Gout [Internet]. Better Health Channel. Department of Health & Human Services; 2000 [cited 2022Nov5]. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gout  Jakše B, Jakše B, Pajek M, Pajek J. Uric Acid and Plant-Based Nutrition. Nutrients. 2019;11(8). Aihemaitijiang S, Zhang Y, Zhang L, Yang J, Ye C, Halimulati M, et al. The Association between Purine-Rich Food Intake and Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents. Nutrients. 2020;12(12). Pillinger MH, Mandell BF. Therapeutic approaches in the treatment of gout. Seminars in Arthritis and Rheumatism. 2020;50(3, Supplement):S24-S30.

Snacking

Let’s Talk About Snacking, And How To Snack Healthily Written by: Consultant Dietitian from Global Precision Wellness Why do you snack so much?  Have you ever finished off an entire pack of potato chips in just one sitting? Are snacks good or bad? Snacks are generally defined as small bites consumed between meals [1]. Since the Covid-19 pandemic, Malaysians have experienced significant changes in traditional food purchasing patterns and dietary habits. One noticeable shift is an increased reliance on snacking, which has become a source of comfort for many. According to the Mondelez International (Malaysia) Consumer Survey 2021, which aimed to gather insights on snacking habits and mindful eating, nearly three-quarters of participants reported snacking to de-stress and unwind. Meanwhile, 42% said they snacked to satisfy hunger between meals. Interestingly, only 3 out of 10 Malaysians consider the nutritional content of their snacks to be important. When it comes to the concept of mindful snacking, just 58% of respondents defined it as a positive approach to eating with intention, reason, and attention [2]. Snacks can absolutely be a regular and beneficial part of a healthy diet, but they can also lead to health concerns. What differentiates the two outcomes is a person’s snacking behavior — including what you snack on, why you snack, how often, and how snacks fit into your overall eating plan [1,3]. So, how can we snack more healthily and mindfully? Snacking Tips 1. Focus First on Nourishing MealsIt’s essential to establish balanced meals before adjusting your snacking habits. Excessive snacking can reduce appetite during mealtimes or even lead to skipping meals altogether, increasing the risk of missing out on important nutrients [4]. The number of snacks you need varies based on your activity level and meal sizes. For example, active individuals may prefer 2–3 snacks per day, while a more sedentary person may do well with one or none [2]. 2. Snack Mindfully, Not Mindlessly“Mindful snacking” is a behavioral approach that emphasizes eating with intention and attention [5]. It’s important to stay aware of your body’s internal cues and accurately identify hunger versus thirst. Many people confuse thirst for hunger, which leads to unnecessary eating and dehydration. Dehydration, in turn, can make you feel tired and sluggish — prompting you to reach for sugary snacks to perk up [5,6]. Take a moment to understand your intent before reaching for food. Avoid snacking while distracted. Instead, take a break, focus solely on your snack, and savor it. This practice promotes a healthier relationship with food, reduces overeating, and improves overall diet quality [5]. 3. Build Up a Stock of Healthy SnacksResearch shows you’re more likely to choose a healthy snack if it’s convenient and easily accessible. The best way to avoid unhealthy snacks is to not buy them in the first place — or at least store them out of sight. Keep healthier options, like fruits and nuts, in visible and accessible spots [3,7]. For instance, place a fruit bowl on the counter and store nutritious items such as yogurt (preferably unsweetened), cheese, dried fruits, and nuts at eye level. These nutrient-dense options are more satisfying and help establish long-term healthy eating habits. 4. The Combo SnackMany prepackaged snacks are loaded with added sugars, salt, and unhealthy fats, while being low in nutrients. Always check the nutrition label. Instead of relying on processed snacks, go for whole, fresh foods. Ideal snacks contain a mix of food groups like fruits, vegetables, proteins, grains, and dairy [7]. Balanced snacks keep you fuller for longer and help stabilize blood sugar levels. For example, pair a banana (carbohydrate) with a few nuts (protein and fat), or spread peanut butter (protein and fat) on whole-grain crackers (carbohydrate). Your snacks should be enjoyable, simple to prepare, filling, and nutritious. 5. Pay Attention to Portion SizesPortion size depends on your daily caloric needs. A snack should provide enough energy to hold you over without interfering with your main meals. Aim for about 150–250 calories per snack. This could be something like an apple with a tablespoon of peanut butter, or a small serving of yogurt with nuts and seeds. If you opt for packaged snacks like chips or dried fruit, be sure to check the Nutrition Information Panel to determine the serving size [8]. When you’re on the go, skip the candy bars — instead, prepare your own trail mix or pick up a fruit like an apple or banana from a nearby store. In Conclusion Gaining a deeper understanding of healthy snacking can empower us to plan ahead and align our choices with personal health goals. And remember — it’s perfectly okay to indulge in an unhealthy snack occasionally. The key lies in variety, balance, and moderation. Our Global Precision Wellness consultant dietitian team is here to support you on your health journey. Whether you’re looking for personalized advice or long-term strategies, we’re ready to help. Come connect with us today. Reference List Hess J, Jonnalagadda S, Slavin J. What Is a Snack, Why Do We Snack, and How Can We Choose Better Snacks? A Review of the Definitions of Snacking, Motivations to Snack, Contributions to Dietary Intake, and Recommendations for Improvement. Advances in Nutrition. 2016;7(3):466-475. [Internet]. Mondelezinternational.com. 2021 [cited 12 January 2022]. Available from: https://www.mondelezinternational.com/-/media/Mondelez/Country/Malaysia/Press-Releases/2021/Mondelz_International_Leads_the_Future_of_Snacking_Mar2021.pdf The Science of Snacking [Internet]. The Nutrition Source. [cited 12 January 2022]. Available from: https://www.hsph.harvard.edu/nutritionsource/snacking/ Smart Snacking for Adults and Teens [Internet]. Eatright.org. 2017 [cited 12 January 2022]. Available from: https://www.eatright.org/-/media/files/eatrightdocuments/nnm/smartsnackingforadultsandteens.pdf Mindful eating applied to snacking: a promising behavioral approach supported by research [Internet]. Mondelezinternationalnutritionscience.com. 2017 [cited 12 January 2022]. Available from: https://www.mondelezinternationalnutritionscience.com/~/media/mondeleznutritionscience/com/files/pdf/beneficial-carbohydrates/icn%202017_symposium%20book.pdf?la=en-us eMag D. Hunger vs thirst: know the difference [Internet]. Diabetes South Africa. [cited 12 January 2022]. Available from: https://www.diabetessa.org.za/hunger-vs-thirst-know-the-difference/ 7 ways to snack smarter – Harvard Health [Internet]. Harvard Health. 2019 [cited 12 January 2022]. Available from: https://www.health.harvard.edu/staying-healthy/7-ways-to-snack-smarter Serving and Portion Sizes: How Much Should I Eat? [Internet]. National Institute on Aging. [cited 12 January 2022]. Available from: https://www.nia.nih.gov/health/serving-and-portion-sizes-how-much-should-i-eat

Explaining Vegetarian / Vegan Diets

Here, we’ll be Explaining Vegetarian / Vegan Diets Written by: Consultant Dietitian Charity Chin Vegetarian diets focus on plant-derived foods including fruits, vegetables, legumes (such as dried beans, peas, lentils), whole grains, seeds, and nuts, and exclude some or all foods derived from animals [1]. There are many reasons people choose to follow a vegetarian or vegan diet. For some, it may be due to environmental concerns, humanitarian and ethical values, religious practices, avoidance of hormones in animal products, or overall health considerations [1, 2]. When people think about vegetarian diets, they often imagine a diet that excludes meat, poultry, and fish. However, vegetarian diets vary in terms of what foods they include and exclude. Common subcategories include: Vegan diets: Exclude meat, poultry, fish, eggs, dairy products, and any food containing these products [1]. Lacto-vegetarian diets: Exclude meat, fish, poultry, and eggs (including products that contain them), but include dairy products such as milk, cheese, yogurt, and butter [1]. Lacto-ovo vegetarian diets: Exclude meat, fish, and poultry, but include dairy and egg products [1]. Ovo-vegetarian diets: Exclude meat, poultry, seafood, and dairy products, but include eggs and egg products [1]. Benefits of a Vegetarian Diet People follow a vegetarian diet for various reasons, but one common motivation is the potential health benefits. These include reducing the risk of heart disease, obesity, hypertension, diabetes, and certain cancers. According to the Academy of Nutrition and Dietetics, vegetarian and vegan diets are “healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases” when nutritional needs are properly met [1]. Vegetarians generally demonstrate healthier dietary patterns and lower body fat compared to non-vegetarians. Their diets, which are typically lower in saturated fats and higher in dietary fiber and phytonutrients, contribute to lower total cholesterol, lower LDL cholesterol, and improved glucose control. These factors help prevent, reduce, and manage chronic diseases such as heart failure, stroke, obesity, type 2 diabetes, and metabolic syndrome [4, 6, 7]. Considerations for a Vegetarian Diet While vegetarian and vegan diets offer many benefits, they can also pose nutritional challenges if not well planned. Processed vegetarian foods may be high in calories, sugar, fat, and sodium. Additionally, restrictive diets can make it harder to obtain all essential nutrients. Key nutrients to monitor include: Calcium & Vitamin D: Often lacking due to limited intake of dairy products. Vegetarians and vegans can obtain these nutrients from dark green vegetables (e.g., turnip greens, collard greens, kale, broccoli), fortified plant-based drinks (e.g., rice, oat, soy), and fortified foods [2, 5]. Vitamin B12: Naturally found in animal products and only in trace amounts in fermented plant foods like nori (seaweed), spirulina, and nutritional yeast. Vegans should consume B12-fortified foods (e.g., yeast extracts like Marmite, fortified cereals, soy products, nutritional yeast) or take a B12 supplement [5]. Protein: Because plant-based proteins may lack some essential amino acids, vegetarians and vegans may require slightly higher protein intake. Key sources include beans, lentils, peas, nuts, seeds, tofu, tempeh, and edamame [2]. Omega-3 Fatty Acids (EPA and DHA): Found mostly in fish, and often low in vegetarian and vegan diets. ALA (from flaxseeds, chia seeds, walnuts, soybean oil) can convert to EPA and DHA, though the process is inefficient. Supplementation or regular intake of ALA-rich foods is important [3, 9]. Iron & Zinc: Absorption is hindered by phytates found in whole grains, legumes, and nuts. Other inhibitors include calcium supplements, coffee, tea, and soy protein [6, 11]. Enhancing iron absorption with vitamin C and incorporating foods like dried fruits, dark leafy greens, fortified cereals, and soaking/sprouting legumes and grains can help. Zinc bioavailability is also improved through fermented foods like tempeh, miso, and yeast-leavened bread [1, 5, 6]. Iodine: Low in plant-based diets due to low iodine content in soil and limited seafood intake. Sources include sea vegetables (nori, kelp, kombu, wakame), iodized salt, and fortified cereals or breads [4, 10]. Who Is a Vegetarian Diet Suitable For? Vegetarian and vegan diets are suitable for people of all ages, including during pregnancy, provided that the diet is well-planned to ensure adequate nutrient intake. It’s essential to assess each individual’s food preferences and lifestyle to help them meet nutritional needs, achieve energy balance, and include a wide variety of plant-based foods. Those following vegetarian or vegan diets should pay special attention to nutrients like protein, iron, calcium, vitamin D, omega-3 fatty acids, zinc, iodine, and vitamin B12 to maintain long-term health and well-being. Reference List Nutrition Care Manual. Academy of Nutrition and Dietetics. 2018 Becoming A Vegetarian. Harvard Health Publishing Harvard Medical School. 2020. Omega-3 fatty acids. Nih.gov. Krajcovicová-Kudlácková M, Bucková K, Klimes I, Seboková E. Iodine deficiency in vegetarians and vegans. Ann Nutr Metab. 2003;47(5):183–5.  Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian diets. J Acad Nutr Diet [Internet]. 2016;116(12):1970–80. Walczyk T, Muthayya S, Wegmüller R, Thankachan P, Sierksma A, Frenken LGJ, et al. Inhibition of iron absorption by calcium is modest in an iron-fortified, casein- and whey-based drink in Indian children and is easily compensated for by addition of ascorbic acid. J Nutr. 2014;144(11):1703–9.  Kahleova H, Levin S, Barnard ND. Vegetarian dietary patterns and cardiovascular disease. Prog Cardiovasc Dis. 2018;61(1):54–61.  Leitzmann C. Vegetarian diets: What are the advantages? In: Forum of Nutrition. S. Karger AG; 2005. p. 147–56. Greupner T, Kutzner L, Nolte F, Strangmann A, Kohrs H, Hahn A, et al. Effects of a 12-week high-α-linolenic acid intervention on EPA and DHA concentrations in red blood cells and plasma oxylipin pattern in subjects with a low EPA and DHA status. Food Funct. 2018;9(3):1587–600. Iodine. The Nutrition Source. Harvard School of Public Health. 2021. Maares M, Haase H. A guide to human zinc absorption: General overview and recent advances of in vitro intestinal models. Nutrients. 2020;12(3):762.

The Importance of Breakfast

Let’s Talk About The Importance of Breakfast Written by: Consultant Dietitian Charity Chin What is Breakfast? Before understanding the importance of breakfast, let’s define it. According to the Academy of Nutrition and Dietetics, breakfast is specifically defined as: “The first meal of the day that breaks the fast after the longest period of sleep and is consumed within 2 to 3 hours of waking; it is comprised of food or beverage from at least one food group and may be consumed at any location” [1]. We often hear the saying, “Breakfast is the most important meal of the day.” You might think that the recommendation to eat breakfast is just common advice, but is it really that important? Research has consistently shown that consuming breakfast within a few hours of waking offers significant health benefits, reinforcing its reputation as the “most important meal of the day” [2]. Many reputable nutrition and dietetics institutions in the US, UK, and Australia recommend a healthy breakfast as a vital component of a nutritionally balanced diet [2]. Various health surveys and cross-sectional studies have reported that eating a morning meal positively impacts memory recall, cognitive function, mood, work performance, and children’s academic performance. Additionally, breakfast plays a role in women’s health, including regulating menstrual cycles and reducing obesity risk [7]. Despite its benefits, many people around the world still skip breakfast for various reasons, including: Lack of time Preferring extra sleep Following certain fad diets Feeling too tired to prepare food Family environment or cultural reasons Not feeling hungry in the morning Lack of readily available breakfast foods Misconceptions, such as believing skipping breakfast aids weight loss [7,8]. Disadvantages of Skipping Breakfast There is significant interest in understanding the health risks associated with skipping breakfast, as studies have linked it to negative health outcomes [2]. Research, including longitudinal studies, has shown that individuals who regularly skip breakfast or consume fewer calories in the morning tend to have: Unhealthy eating behaviors and poor dietary habits Lower physical activity levels Increased risk of obesity, metabolic syndrome, and cardiovascular diseases Higher fasting insulin levels, elevated LDL (bad) cholesterol, and high blood pressure A greater likelihood of developing Type 2 diabetes and other cardiometabolic disorders due to increased oxidative stress and inflammation [3,4,5,6]. Skipping breakfast has also been linked to higher morning blood pressure due to stress-independent overactivity in the hypothalamic-pituitary-adrenal axis following prolonged fasting [6]. Additionally, studies suggest that individuals who skip breakfast tend to consume larger meals later in the day, disrupting their circadian rhythm and increasing postprandial blood glucose levels, which is associated with a higher risk of Type 2 diabetes and cardiovascular diseases [5,6]. Moreover, skipping breakfast may be a behavioral marker for an unhealthy lifestyle [6]. Benefits of Eating Breakfast Many studies highlight the health benefits of consuming breakfast. A well-balanced breakfast helps: ✅ Boost energy levels and alertness after an overnight fast✅ Contribute to daily nutrient intake, ensuring essential vitamins and minerals are consumed✅ Support better weight management by reducing hunger later in the day✅ Lower the risk of Type 2 diabetes and heart disease in the long term [8] One study on caloric distribution and weight loss found that individuals who consumed a high-calorie breakfast (e.g., 700 kcal) and a low-calorie dinner (e.g., 300 kcal) lost significantly more weight than those who did the opposite [3]. Additionally, eating breakfast has been shown to:🔹 Improve cardiovascular health, reducing morbidity and mortality risks🔹 Regulate appetite, preventing excessive calorie intake later in the day🔹 Improve insulin sensitivity and glycemic response [6]🔹 Help lower blood pressure, reducing the risk of clogged arteries, hemorrhages, and cardiovascular events [6] Breakfast Ideas Adelle Davis once said: “Eat breakfast like a king, lunch like a prince, and dinner like a pauper.” This aligns with current research on meal distribution and overall health [5]. Choosing a nutrient-rich breakfast is essential for maintaining energy levels throughout the day. Here are quick and healthy breakfast options for those on the go:🥣 High-fiber cereal with fresh fruit and low-fat milk, oat, or soy milk🥤 Breakfast shakes – Protein smoothies with fresh or frozen fruit🍞 Whole grain toast with peanut butter or tahini spread🍫 Protein bars, plain Greek yogurt, or a glass of milk🌾 Overnight oats with fruits and healthy toppings🥣 Oatmeal with berries, banana, walnuts, or flaxseeds ⚠️ Watch out for added sugars! Some protein bars and yogurts contain excessive sugar. Aim for products with less than 20g of added sugar, 6-10g of protein, and at least 3g of fiber per serving [4]. Conclusion Start your day with a nutrient-dense meal that keeps you full longer, prevents unhealthy snacking, and promotes overall well-being. Plan ahead—a little preparation goes a long way, both for your health and your schedule. If you need guidance on improving your diet, consider consulting a dietitian. They can provide personalized recommendations based on your health needs and food preferences. Reference List O’Neil CE, Byrd-Bredbenner C, Hayes D, Jana L, Klinger SE, Stephenson-Martin S. The role of breakfast in health: definition and criteria for a quality breakfast. J Acad Nutr Diet. 2014;114(12 Suppl): S8–26. Gibney MJ, Barr SI, Bellisle F, Drewnowski A, Fagt S, Livingstone B, et al. Breakfast in human nutrition: The International Breakfast Research Initiative. Nutrients. 2018;10(5):559.  Lopez-Minguez J, Gómez-Abellán P, Garaulet M. Timing of breakfast, lunch, and dinner. Effects on obesity and metabolic risk. Nutrients. 2019;11(11):2624.  Why you should eat breakfast. Rush.edu.  Santos HO, Genario R, Macedo RCO, Pareek M, Tinsley GM. Association of breakfast skipping with cardiovascular outcomes and cardiometabolic risk factors: an updated review of clinical evidence. Crit Rev Food Sci Nutr. 2022;62(2):466–74.  Rong S, Snetselaar LG, Xu G, Sun Y, Liu B, Wallace RB, et al. Association of skipping breakfast with cardiovascular and all-cause mortality. J Am Coll Cardiol. 2019;73(16):2025–32.  Rani R, Dharaiya CN, Singh B. Importance of not skipping breakfast: a review. Int J Food Sci Technol. 2021;56(1):28–38.  Breakfast. Gov.au. Available from: https://www.betterhealth.vic.gov.au/health/healthyliving/breakfast

Calcium & Vitamin D: Why They Matter for Your Health

Diet Series Calcium & Vitamin D: Why They Matter for Your Health Written by: Consultant Dietitian from Global Precision Wellness Calcium and vitamin D are essential nutrients that play key roles in supporting our health, especially when it comes to strong bones and muscles. Calcium is the most abundant mineral in the body. 99% of calcium is found in our bones and teeth, where it provides strength and structure [1,2]. The remaining 1% is found in our blood, where it is involved in several important functions like helping muscles move, sending signals between your brain and body, blood circulation, and the release of hormones that help control different processes in the body [1,2]. Vitamin D, on the other hand, is unique as it can be produced by the body when exposed to sunlight and can also be obtained from certain foods. Vitamin D helps the body absorb calcium, it is like the ‘key’ that unlocks calcium’s ability to strengthen our bones. Just like calcium, it also helps with muscle movement and sending signals between your brain and body [3]. It also plays an important role in supporting a strong immune system to protect against illnesses [3]. The Calcium – Vitamin D Connection Calcium and vitamin D are closely connected when it comes to bone health. Vitamin D helps your body absorb calcium more effectively. Without enough vitamin D, you may not get the full benefits of calcium, even if you’re eating calcium-rich foods. That’s why both nutrients are essential for developing and maintaining strong bones, and together, they help prevent conditions like osteoporosis (brittle bones), osteomalacia (soft bones), and fractures [4]. How Genetics Play a Role in Calcium & Vitamin D Ever wondered why you might struggle with calcium or vitamin D deficiency, even if you eat foods that contain them? Well, your genes could be a factor, as genes may affect how the body processes or absorbs certain nutrients. Some people are genetically predisposed to process or use these nutrients less efficiently. This is where nutrigenomics, the study of how our genes influence the way our body responds to nutrients, comes in. It sounds complicated, but don’t worry! This article will explain how certain genes may affect your calcium and vitamin D levels, and what you can do about it: 1. Calcium – Average Calcium Absorption The GC gene is a gene responsible for producing a protein that helps in regulating calcium levels by transporting vitamin D to where it’s needed [5].  If your GC gene functions normally, your body will absorb calcium from food as effectively as most people. This means you are likely to need the standard amount of calcium recommended for your age and gender to maintain bone health. 2. Calcium – Low Calcium Absorption Variations of the GC gene can lead to altered levels of this protein, potentially impairing vitamin D metabolism and consequently reducing calcium absorption [5]. This means that your body may struggle to get enough calcium from food, which can increase your risk of calcium deficiency. This could lead to symptoms like muscle cramps, dry skin, coarse hair, and brittle nails [6]. Over time, insufficient calcium can lead to more serious conditions, such as osteopenia or osteoporosis, which can increase your risk of fractures [1]. 3. Vitamin D – Average Vitamin D Status The CYP2R1 gene helps produce an enzyme that converts vitamin D into the most abundant form of vitamin D in the bloodstream [7]. Additionally, the GC gene helps transport vitamin D to the tissues where it’s needed, ensuring that it is processed and used efficiently [7]. If these genes function normally, your body will process vitamin D well. With adequate sunlight exposure and right foods, you’re likely to get enough vitamin D. 4. Vitamin D – Low Vitamin D Status Genetic variations in genes like DHCR7, CYP2R1, and GC can contribute to low vitamin D status by affecting its production or activation [7]. Even if you get enough sunlight or consume vitamin D-rich foods, your body may not use it as efficiently. Symptoms of vitamin D deficiency include muscle weakness and bone pain [8]. Long-term deficiency can lead to conditions such as rickets in children, osteomalacia, and osteoporosis [3]. However, keep in mind that genetic tests only indicate how your body may respond to nutrients; they do not reflect your current nutritional status. Therefore, it is recommended to  complement nutrigenomic testing with blood tests for a more comprehensive understanding of your nutritional status. Improving Calcium & Vitamin D Health: Simple Steps You Can Take Here are some simple steps you can take to improve your calcium and vitamin D health, especially if you have a genetically higher risk of deficiency: 1. Eat More Calcium-Rich Foods Calcium can be found in dairy products like milk, yogurt, and cheese, or plant-based sources like kale and bok choy [1]. For Malaysians, the Recommended Nutrient Intake (RNI) value for calcium is 800-1000 mg per day for adults [9]. Here’s the calcium content for some common calcium-rich foods: 1 glass of milk (250 ml): 270 mg calcium (~27-34% of RNI) 1 serving of yogurt (150ml): 190 mg calcium (~19-24% of RNI) 1 slice of cheese: 90 mg calcium (~9-11% of RNI) 1 cup of kale, chopped, uncooked (around 60 g): 110 mg calcium (~11-14% of RNI) 1 cup of bok choy, chopped, uncooked (around 90 g): 90 mg calcium (~9-11% of RNI) To meet the daily RNI for calcium, aim for at least 3 servings of calcium-rich foods per day, such as a combination of milk, yogurt, and plant-based sources. 2. Include More Vitamin D-Rich Foods Foods such as fatty fish (salmon, mackerel, and sardines), egg yolks, fortified dairy products, and fortified plant-based milks are good sources of vitamin D [3]. The RNI for vitamin D in Malaysia is 5-10 mcg per day for adults [9]. Here’s the vitamin D content for some common vitamin D-rich foods: Salmon, cooked (85 g): 14 mcg vitamin D (~140-280% of RNI) Egg yolk from 1 large

Paleolithic Diet

Diet Series Paleolithic Diet Written by: Consultant Dietitian Current Western diets have led to the emergence of more chronic diseases, including obesity, cardiovascular disease, type 2 diabetes, and non-alcoholic fatty liver disease, which negatively affect life expectancy. These diets are characterized by high calorie intake, high fat content, high glycemic load, increased meat consumption, and elevated fructose intake [5]. There has been an increase in the consumption of processed products with added additives, such as preservatives, colorants, emulsifiers, and flavor enhancers, which are commonly used in the food industry [10]. The reason for adopting the Paleo diet stems from modern farming practices that are genetically incompatible with the human body [2]. Our ancestors were lean, fit, and generally free from heart disease and other ailments. Their genes were well-adapted to foods that were hunted, gathered, or fished from the natural environment, a diet that no longer exists as people began farming and raising domestic livestock after civilization. The Paleolithic diet, or Paleo diet, also known as the Caveman or Stone-Age diet, reflects the dietary practices of the Paleolithic era, which lasted from 2.5 million to 10,000 years B.C. This diet was based on wild food consumption, including meat, insects, green vegetables, roots, organ meats, seasonal fruits, and nuts [1, 5]. It became popular among those looking to improve their body shape by avoiding processed foods [3]. It is also widely practiced by athletes and young adults [3, 4]. So, what is included in the Paleo diet? The Paleo diet is low in carbohydrates (24.5%), high in protein (29.6%), and contains polyunsaturated fatty acids (15.3%) and cholesterol (835 mg/day) [1]. Paleolithic people did not consume dairy, as milking wild animals was not feasible. They also rarely ate cereal grains, avoided salting their food, and consumed refined sugar only in the form of honey. The diet is protein-rich due to the dominance of wild, lean animal foods, and lower in carbohydrates. Non-starchy wild fruits and vegetables were their primary carbohydrate sources, resulting in a higher fiber intake compared to modern diets [6]. To summarize the foods to include and avoid, refer to the table below. Allowed Not Allowed Lean red meat (sirloin steak, tenderloin) , game meats (venison, rabbit, wild boar) , organ meats (liver, kidney, heart from animals such as cows, chickens, or lambs) Grains (cereals = barley, corn, oats, rice, rye and wheat) Poultry Beans (soy milk, tofu) Fish, Seafood Legumes (edamame, hummus) Eggs Dairy products (milk, yogurt, cheese, ice cream) Leafy, cruciferous vegetables Salt Root vegetables Refined sugars (jam, syrup, candy, cakes, cookies) Mushrooms Refined fats Fruits Canned or processed meat Nuts (almonds, walnuts, cashews, pecans, pistachios) *no peanuts Fatty meats Raw honey Bacon Seeds (pumpkin, sunflower) Soda and fruit juices The Paleo diet is often followed for weight loss, diabetes management, and general health. Studies support its benefits, including improved glucose tolerance and significant weight loss. Lindeberg S, et al. (2007) compared Mediterranean and Paleo diets in heart disease patients, finding the Paleo group had better glucose removal and greater waist reduction (5.6 cm vs. 2.9 cm) [7]. Boers I, et al. (2014) noted its impact on lowering lipids, blood pressure, and weight, though long-term evidence remains limited due to short study durations and small samples [8]. The Paleo diet can have side effects, as it eliminates many carbohydrates and dairy products. Initially, your body might struggle to adjust from a high-carb to a low-carb diet, leading to symptoms like fatigue, irritability, or digestive discomfort. These effects may resolve within a few days but can last 2–4 weeks in more severe cases [11]. Headache Fatigue Lack of energy Nausea Dizziness Body aches Cold sweats Constipation and/or diarrhea Another downside of the Paleo diet is the exclusion of dairy products, which may result in a lack of calcium necessary for healthy bones and teeth. Vegetarians might find it challenging to follow since beans, a vital protein source, are restricted. Additionally, the diet’s restriction on grains, which provide insoluble fiber, raises questions about its impact on gut health. If you’re considering the Paleo diet or any other dietary approach, consult a registered dietitian nutritionist to ensure your choices meet your nutritional needs effectively. Reference List Cambeses-Franco C, González-García S, Feijoo G, Moreira MT. Is the Paleo diet safe for health and the environment? Sci Total Environ [Internet]. 2021;781(146717):146717. Available from: http://dx.doi.org/10.1016/j.scitotenv.2021.146717 Turner BL, Thompson AL. Beyond the Paleolithic prescription: incorporating diversity and flexibility in the study of human diet evolution. Nutrition reviews. 2013 Aug 1;71(8):501-10. Stanton R. Popular diets and over-the-counter dietary aids and their effectiveness in managing obesity. Managing and Preventing Obesity: Behavioural Factors and Dietary Interventions. Waltham, MA; 2014. Patel S, Suleria HA. Ethnic and paleolithic diet: Where do they stand in inflammation alleviation? A discussion. Journal of Ethnic Foods. 2017 Dec 1;4(4):236-41. Tarantino G, Citro V, Finelli C. Hype or reality: should patients with metabolic syndrome-related NAFLD be on the hunter-gatherer (Paleo) diet to decrease morbidity. J Gastrointestin Liver Dis. 2015 Sep 1;24(3):359-68. Cordain L. AARP The paleo diet revised: Lose weight and get healthy by eating the foods you were designed to eat. John Wiley & Sons; 2012 May 7. Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjöström K, et al. A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia [Internet]. 2007;50(9):1795–807. Available from: http://dx.doi.org/10.1007/s00125-007-0716-y Boers I, Muskiet FA, Berkelaar E, Schut E, Penders R, Hoenderdos K, et al. Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrome: a randomized controlled pilot-study. Lipids Health Dis [Internet]. 2014;13(1):160. Available from: http://dx.doi.org/10.1186/1476-511X-13-160 Andrikopoulos S. The Paleo diet and diabetes. Med J Aust [Internet]. 2016 [cited 2022 Apr 1];205(4):151–2. Available from: https://www.mja.com.au/journal/2016/205/4/paleo-diet-and-diabetes Zopf Y, Reljic D, Dieterich W. Dietary effects on Microbiota-new trends with gluten-free or Paleo diet. Med Sci (Basel) [Internet]. 2018 [cited 2022 Apr 1];6(4):92. Available from: https://www.mdpi.com/2076-3271/6/4/92 Usman M, Davidson J. Paleo Diet – Side Effects. Mendon Cottage Books, editor. North Charleston, SC: Createspace Independent Publishing Platform; 2015.

Childhood Obesity

Let’s Talk About Childhood Obesity Written by: Apprentice Dietitian Chia Hui Ying Childhood obesity is a major global challenge in the 21st century. In Malaysia, up to 30% of children are classified as overweight or obese. [1] According to the World Health Organization (WHO), obesity is characterized by abnormal or excessive fat accumulation that increases health risks, including mortality. [2] Body Mass Index (BMI) is commonly used to assess weight status in children. Based on CDC growth charts, children at or above the 85th percentile are overweight, the 95th percentile obese, and the 99th percentile classified as having severe obesity. [3] Obesity can be categorized as exogenous or endogenous. Exogenous obesity is primarily due to external factors, such as an imbalance between energy intake and expenditure, while endogenous obesity arises from genetic, syndromic, or endocrine causes. [4] Although genetics play a role in body fatness, environmental factors like diet and physical activity have a much greater impact. Modern diets often consist of energy-dense, nutrient-poor foods, compounded by decreased physical activity due to urbanization and sedentary lifestyles. [2] Children who are overweight or obese are more likely to continue being overweight into adulthood, increasing their risk of developing non-communicable diseases like: Type 2 diabetes mellitus – Children as young as 8 years old might be at risk of getting type 2 diabetes mellitus. Children with obesity might consume high calories and sugar-rich foods, thus increasing T2DM risk. High blood pressure – As obesity becomes more severe, the risk of high blood pressure rises. Long-term high blood pressure puts stress on the heart. Liver diseases – Fatty liver disease (nonalcoholic steatohepatitis or NASH) is common among children with obesity and this can lead to liver failure. Heart diseases – Atherosclerosis (narrowing of blood vessels), is a common heart disease that people with obesity might suffer from. Childhood obesity and related non-communicable diseases are largely preventable. Prevention is widely recognized as the most practical approach to addressing the pediatric obesity crisis, as current treatments mainly manage symptoms rather than offer long-term solutions. Achieving and maintaining energy balance throughout life is key. To prevent childhood obesity, encourage healthy eating habits, promote physical activity, reduce sedentary behaviors, and foster a supportive environment that enables children to make healthier lifestyle choices. [1] Engaging in regular physical activity—at least an hour daily—helps children maintain a healthy weight, reduce obesity-related health risks, and strengthen their bones and muscles. Encourage a variety of enjoyable activities like team sports, swimming, yoga, biking, dance classes, or evening walks. A balanced fitness regimen should include stretching for flexibility and strength training for muscle growth. Outdoor activities, particularly for preschool-aged children, are highly beneficial for their physical and mental development. Encourage children to eat at least five servings of fruits and vegetables daily. Create appealing, colorful meals using ingredients like tomatoes, broccoli, corn, carrots, and green peas. Replace juices with fresh whole fruits such as oranges, starfruit, or watermelon. For picky eaters, incorporate vegetables into meals by blending them into meat patties or meatballs to ensure they receive essential nutrients. Reduce sedentary activities, such as watching videos, playing video games, or using the internet, to no more than two hours daily. Encourage simple habits like taking the stairs instead of elevators at malls or schools to increase physical activity levels. Parents should actively support and participate in their child’s activities. Set achievable goals based on the child’s interests and abilities. Track progress using a chart and celebrate milestones with positive reinforcement. Lead by example by making exercise a family activity to encourage healthy habits. Healthier Food Swaps Small, easy food swaps can significantly reduce sugar, salt, and fat intake for children. Even incorporating just one or two changes daily can lead to a healthier diet. The more adjustments made, the greater the benefits for overall health. Instead of Swap to Milk chocolate Dark chocolate Cordial drinks with added sugar Fresh fruit juices Sweetened / Flavored yogurt Natural yogurt with added fresh fruits Chips Nuts (almonds, walnuts) and seeds (sunflower seeds, pumpkin seeds) Fat cut of poultry / meat Lean cut of poultry / meat Reference List Childhood Obesity [Internet]. PORTAL MyHEALTH. 2013 [cited 2023 Jan 25]. Available from: http://www.myhealth.gov.my/en/childhood-obesity/ Noncommunicable diseases: Childhood overweight and obesity [Internet]. [cited 2023 Jan 25]. Available from: https://www.who.int/news-room/questions-and-answers/item/noncommunicable-diseases-childhood-overweight-and-obesity Calculate Your BMI – Standard BMI Calculator [Internet]. [cited 2023 Jan 25]. Available from: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm Aggarwal B, Jain V. Obesity in Children: Definition, Etiology and Approach. Indian J Pediatr. 2018 Jun;85(6):463–71. Lee YS. Consequences of Childhood Obesity. 2009;38(1).

Kidney Stone Disease (Nephrolithiasis)

Let’s Talk About Kidney Stone Disease (Nephrolithiasis)​ Written by: Apprentice Dietitian Chang Chiao Wei What is a kidney stone? A kidney stone is a hard deposit formed in the kidneys when certain minerals, like calcium, oxalate, and uric acid, bind together and crystallize due to high concentration in the urine. These stones can vary in size, from tiny grains to larger stones that block the urinary tract, causing severe pain. Types and Prevalence Kidney stones are categorized into four main types: Calcium Oxalate & Calcium Phosphate (70-80%) – The most common type. Uric Acid Stones (10%) – Formed due to excessive uric acid. Struvite Stones (10%) – Linked to urinary tract infections (UTIs). Cystine Stones (<1%) – Caused by a genetic disorder. Historically, kidney stones were more common in men, but the gender gap is narrowing as more women are being diagnosed. Prevalence rates vary across regions, with 10-20% in Asia and 15-18% in Western countries. Signs and Symptoms Common symptoms include: Severe pain in the back, side, lower abdomen, or groin. Burning or painful urination. Cloudy, foul-smelling, pink, red, or brown-colored urine. Nausea, vomiting, fever, or chills (in severe cases). Small kidney stones may pass on their own, causing mild or no symptoms, but larger stones may block the urinary tract and require medical attention. Pain relievers or surgery may be necessary depending on the size and location of the stone. Dietary Management Diet plays a crucial role in preventing and managing kidney stones. Here’s a breakdown of essential nutrients and guidelines: Nutrient Recommended Intake Sodium Less than 2,300 mg/day Calcium 800 – 1200 mg/day Oxalate 40 – 50 mg/day Protein 0.8 – 1.4 g/kg of body weight Fluids More than 2.5 L/day Vitamin C Less than 1000 mg/day Dietary Tips for Prevention 1. Reduce Sodium Intake Limit salt intake to less than 1 teaspoon (6g) daily. Replace salt with herbs and spices (e.g., garlic, ginger, cumin, turmeric). Avoid high-sodium foods like canned foods, fast food, sausages, and processed meats. 2. Control Oxalate Intake Limit consumption of oxalate-rich foods like spinach, sweet potatoes, beetroot, rhubarb, nuts, chocolate, and soy. Pair oxalate-rich foods with calcium-rich foods (e.g., chocolate + milk or peanuts + yogurt) to reduce oxalate absorption. 3. Get Adequate Calcium Intake Contrary to popular belief, reducing calcium does not prevent kidney stones. In fact, adequate calcium intake helps bind oxalate in the intestines, preventing its absorption. Include both dairy (milk, cheese, yogurt) and non-dairy (chia seeds, kale, broccoli) sources of calcium in your diet. Choose calcium-rich foods with low sodium or added sugar. 4. Moderate Protein Intake Limit animal proteins (red meat, organ meat, seafood) as they increase uric acid production, making urine more acidic, which promotes kidney stone formation. Opt for plant-based proteins (lentils, beans, peas) to avoid acidic urine. 5. Increase Fluid Intake Aim to drink at least 2.5L of water daily to dilute urine and prevent stone formation. Add lemon juice to water as citric acid may prevent stone formation. Avoid sugary drinks and sodas. 6. Avoid Excessive Vitamin C High doses of vitamin C supplements can increase oxalate production, raising the risk of stones. It’s better to consume vitamin C from fruits and vegetables rather than high-dose supplements. Dietary Tips for Other Types of Kidney Stones Calcium Stones: Reduce sodium, oxalate, and excessive vitamin C; maintain adequate calcium intake, moderate protein, and sufficient hydration. Uric Acid Stones: Limit purine-rich foods (red meat, organ meat, seafood) and alcohol; stay hydrated. Struvite Stones: Typically caused by UTIs and require medical or surgical intervention. Cystine Stones: Caused by a genetic disorder and also require medical treatment. Take-Home Message Dietary changes, such as reducing sodium, controlling oxalate, and ensuring adequate hydration, can help prevent kidney stones. While dietary changes can manage calcium and uric acid stones, struvite and cystine stones may require medical treatment. Caring for kidney health is essential, as the kidneys play a vital role in filtering blood and removing waste. Reference List Han, H., Segal, A. M., Seifter, J. L., & Dwyer, J. T. (2015, July). Nutritional management of kidney stones (nephrolithiasis). Clinical nutrition research. Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525130/   U.S. Department of Health and Human Services. (n.d.). Definition & Facts for Kidney Stones. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved February 8, 2023, from https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/definition-facts Gillams, K., Juliebø-Jones, P., Juliebø, S. Ø., & Somani, B. K. (2021, October 8). Gender differences in kidney stone disease (KSD): Findings from a systematic review. Current urology reports. Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497339/ Dottie. (2016, April 7). Urinary stones. PORTAL MyHEALTH. Retrieved February 8, 2023, from http://www.myhealth.gov.my/en/urinary-stones/  Kidney stones: Diet plan and prevention. National Kidney Foundation. (2022, November 4). Retrieved February 8, 2023, from https://www.kidney.org/atoz/content/diet#:~:text=To%20prevent%20uric%20acid%20stones,and%20low%2Dfat%20dairy%20products  Mitchell, T., Kumar, P., Reddy, T., Wood, K. D., Knight, J., Assimos, D. G., & Holmes, R. P. (2019, March 1). Dietary oxalate and Kidney Stone Formation. American journal of physiology. Renal physiology. Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459305/  Diet and Kidney Stones – Queensland Health. (n.d.). Retrieved February 24, 2023, from https://www.health.qld.gov.au/__data/assets/pdf_file/0024/151863/renal_kdnystones.pdf   NHS. (n.d.). Prevention of Kidney Stones. NHS choices. Retrieved February 8, 2023, from https://www.nhs.uk/conditions/kidney-stones/prevention/#:~:text=The%20best%20way%20to%20prevent,throughout%20the%20day%2C%20every%20day.    Pearle MS;Goldfarb DS;Assimos DG;Curhan G;Denu-Ciocca CJ;Matlaga BR;Monga M;Penniston KL;Preminger GM;Turk TM;White JR; ; (n.d.). Medical Management of Kidney Stones: AUA guideline. The Journal of urology. Retrieved February 8, 2023, from https://pubmed.ncbi.nlm.nih.gov/24857648/  Gul, Z., & Monga, M. (2014, November 28). Medical and dietary therapy for Kidney Stone Prevention. Korean Journal of Urology. Retrieved February 8, 2023, from https://synapse.koreamed.org/articles/1006212