SUNDAY STAR, 3 JULY 2016

special

HEALTHY BONES

SUNDAY STAR, 3 JULY 2016

2 healthy bones

Living
strong longer
BONE health is often overlooked by
many Malaysians. It usually does
not become a concern until an
injury occurs or bone health
deteriorates with old age.
Although bones are tough but
lightweight structures, they are
often susceptible to injuries and
wear-and-tear such as bone
fractures.
However, bones have the ability
to repair and mend themselves.
The recovery period of a fracture
depends on the severity of the
damage and if necessary, surgical
intervention is necessary to aid in
proper healing.
Bones are also prone to
disorders and diseases that often
occur in later stages of life, but
some bone issues may present
themselves at a much younger age.
If these bone diseases are left
untreated for an extended period
of time, the effects can be
detrimental and cause a host of
other health problems. Some of the
most common bone-related
diseases among Malaysians are
osteoporosis and arthritis.

Fragile bones
Osteoporosis is defined as a
skeletal disorder where bones lose
critical density and become fragile.
Patients suffering from
osteoporosis are prone to serious
bone fractures and injuries that
can result in poor healing or
render patients with disabilities.
According to the Health Ministry,
the causes of osteoporosis can be
broken down to primary and
secondary classifications. Primary
classification includes women who
have reached menopause, old age
and idiopathic causes. These are
the most common causes of
osteoporosis.
In the secondary classification,
osteoporosis is caused by
endocrine disorders (diseases
caused by the dysfunction of
organs that produce hormones in
the body) such as Cushings
syndrome and hypogonadism, side

effects of certain drugs and chronic

diseases such as renal failure and
liver cirrhosis.
Individuals diagnosed with
anorexia nervosa or certain types
of leukaemia or have undergone
gastric bypass surgical procedures
are also at risk of osteoporosis.
Osteoporosis also affects
individuals who have been
diagnosed with osteogenesis
imperfecta (OI) or brittle bone
disease.
OI is an incredibly rare disorder
that occurs in six to seven out of
every 100,000 individuals. People
with OI are constantly prone to
fractures due to defective or the
lack of type 1 collagen in their
bones.
For the most part, osteoporosis is
a silent disease and is not usually
diagnosed until a bone injury or
fracture.
However, some common
symptoms of osteoporosis include
back pain, loss of height, low
trauma fracture and increasing
dorsal kyphosis, known as
Dowagers hump or hunching.
Osteoporosis can be diagnosed
through an X-ray test known as the
bone mineral density test, which
measures how much calcium and
other minerals are packed into a
segment of a bone.

Creaky hinges
Arthritis is another common
bone and joint issue faced by
many. It is usually categorised as
the inflammation of the joint
structures such as bone and
cartilage.
There are many types of arthritis
but, according to the Arthritis
Foundation Malaysia (AFM), the
two most prevalent arthritis
incidences in Malaysia are
osteoarthritis (OA) and rheumatoid
arthritis (RA).
OA is a degenerative form of
arthritis that is common among
the older population. OA can be
defined as joint failure and is cause
by repeated damage of the joint

Non-modifiable

Modifiable

Advancing age

Low calcium and/or vitamin D intake

Genetic predisposition

Sedentary lifestyle

Female gender

Smoking

Premature menopause (<45 years)

including surgical menopause

Excessive alcohol intake

(> three units per day)

Family history of osteoporotic hip

fracture in first-degree relatives

Excessive caffeine intake

(> three drinks per day)

Personal history of fracture as

an adult

Low body weight (BMI<18.2kg/m2)

Oestrogen deficiency
Impaired vision
Recurrent falls

Modifiable and non-modifiable risk factors for osteoporosis. (Source: Clinical

Guide on Management of Osteoporosis 2012, Ministry of Health Malaysia)

Characteristics

Rheumatoid arthritis

Osteoarthritis

Age at which
condition manifests

30 to 50 years of age but may also

exhibit later in life

Begins later in life

Speed of onset

Relatively rapid over weeks to months

Slow and worsens over the years

Joint symptoms

Joints are painful, swollen and stiff

Joints ache and are sensitive, but have

little or no swelling

Pattern of joints
that are affected

Affects small and large joints on both

sides of the body in a symmetrical
pattern pain in both hands, both
wrists or elbows, or balls of the feet

Symptoms begin on one side of the body and

may spread to the other side. Symptoms begin
gradually and are limited to one set of joints
such as joints closest to the fingernails, larger
weight-bearing joints (knees and hips) or the spine

Duration of stiffness

Stiffness occurs in the mornings

and lasts more than an hour

Stiffness occurs in the mornings, end of the day

or after periods of activity and lasts less than
an hour

Presence of symptoms
affecting the whole
body (systemic)

Feeling of fatigue and being ill

Symptoms only focused on affected joints

The differences between osteoarthritis (OA) and rheumatoid arthritis (RA).

where the cartilage which

provides a cushion for weight
bearing around the joints
degenerates and exposes the bony
surfaces of the joint-ends of the
bones to direct pressure.
OA is usually described as acute
pain at the joints and sometimes
associated with stiffness. Patients
with OA will often find it difficult
to keep their stability when
moving. The pain for OA can vary
for no apparent reason there may
be good days and bad days.
OA commonly occurs around the
hands between elbows, wrists and
fingers, and in the knees and hips.
Unlike osteoporosis, OA is easier to
diagnose due to the symptoms
being easier to recognise.
Patients who experience joint
pain for more than six months
should consult a doctor. Thorough
physical and X-ray examinations
should be sufficient for doctors to
make a diagnosis if the symptoms
are a result of OA or some other
disorder.
RA exhibits different symptoms
compared to OA. According to the
AFM, RA is a common form of
arthritis and affects about five in
1,000 Malaysians.

RA is a result of inflammation of
the synovium a membrane
surrounding joints that contains a
lubricant called synovial liquid.
The synovium is also enclosed in a
hard outer layer known as the
capsule.
The inflammation exhibits
symptoms such as redness,
swelling and pain. Redness is
caused by increased blood flow
while swelling and pain is caused
by local nerve irritation due to the
inflammation chemicals and the
stretching of the capsule.
Inflammation is the bodys
natural reaction to arrest an
infection by foreign bodies such
as bacteria.
Healthcare experts are still
studying the reasons an
inflammation reaction is set off on
some of the bodys local tissues
such as the joints that exhibit RA.
Continuous inflammation to
cartilage, bones and other joint
ligaments can cause irreversible
damage. It is because of this
reaction that RA is classified as an
autoimmune disease.
RA is most prevalent among
individuals aged between 30 and
50, where women are more

commonly affected by the disease

than men. Unfortunately, there is
no fixed pattern of the severity of
RA in different individuals. The
effects of RA vary from person to
person, where some individuals
may suffer more extensive damage
to their joints while others exhibit
mild symptoms.
Pain and discomfort in joints due
to RA are not continuous; they
might flare up at intermittent
periods, but there are no known
obvious triggers for these flare-ups.
Early detection of RA is key to
better recovery outcomes. Even
though there is no specific test to
diagnose RA, doctors perform
several tests and examinations to
come up with a clinical diagnosis
for it.
Doctors will usually call for a
blood test that will detect traces of
inflammation and the rheumatoid
factor blood protein that is
prevalent in 70% of people with
RA.
In addition to this, an X-ray
examination will also be carried
out to identify damage to the joints
caused by inflammation in RA.

> SEE NEXT PAGE

SUNDAY STAR, 3 JULY 2016

healthy bones 3

Prevention is better than intervention

> FROM PREVIOUS PAGE
Though osteoporosis and
arthritis are diseases that are
more common among older
individuals, necessary
precautions taken at a younger
age can help delay if not
completely prevent these
diseases.
According to Dr Gopinath
Mathavan, consultant
orthopaedic and trauma surgeon
at Oriental Melaka Straits
Medical Centre, to achieve
optimal bone mass by the time
an individual reaches his late
twenties, it is important to instil
healthy nutritional and lifestyle
habits with adequate physical
activities from a young age.
Building a childs bone bank
is very much like saving for their
education. Parents play a crucial
role in building their childs bone
bank. Parents should inculcate
the practice of eating a balance
diet with their children, he says.
To build strong and healthy
bones, children should get
adequate dietary supplement
from foods that are rich in
calcium and vitamin D, which
aids the body in calcium
absorption. Some examples of
food that are rich in these
nutrients are milk, soy, cheese,
salmon and yoghurt.
Another growing concern
among the young is the lack of
physical activity, especially with
the emergence of digital gadgets.
Hence, children these days are
drawn to a sedentary lifestyle
with minimum physical activity.
Being physically active means
spending less time sitting and
more time on their feet. The best
physical exercises that are ideal
for bone health are weightbearing activities such as
running, soccer, hiking,
basketball and gymnastics,
says Dr Gopinath.
Even as adults, bone health is
crucial to avoid premature onset
of osteoporosis and arthritis.
Necessary lifestyle modifications
also need to be done to ensure
long-term bone health.
Minimising bone loss can
be achieved by ensuring the
modifiable risk factors such as
lack of nutrition, physical
inactivity, smoking and alcohol
abuse are avoided, says
Dr Gopinath.
Continuous focus on a
balanced diet and engagement
in physical activity is important
to ensure optimum bone
health to reduce bone
loss and strengthen
joints as well.
Always discuss and

consult with a healthcare

physician about taking the right
supplements to improve bone
health, in case of a reduced
intake of necessary sources of
bone nutrition in your diet.
However, special
consideration must be taken
when pursuing extreme physical
activities and sports.
Most bone injuries and stress
on the joints that could lead to
future injuries occur during a
physical activity.
This affects athletes who
undergo advanced training to
regular individuals who strain
their bones in gyms due to poor
technique and posture.
Hence, it is important to
always consult with a certified
expert such as a coach or a
trainer when engaging in such
activities.
Schedule annual
appointments with your
physician to check your bones
and keep a firm eye on
symptoms that cause discomfort
and need immediate medical
attention. In most cases,
untreated bone diseases worsen
over time.
Managing weight is also
crucial to bone health.
Individuals are advised to
maintain a target body mass
index (BMI) of between 18.2 and
22.9 for both males and females.
Individuals with a higher BMI
risk straining their weightbearing joints such as their hips
and knees while individuals
with a BMI that is lower than
18.2 are at risk of developing
osteoporosis due to malnutrition.

Living but not limited

Patients with osteoporosis are
advised to not engage in heavy
physical activity or contact
sports. Physicians will focus on
helping to strengthen bones
through diet and dietary
supplements.
A daily 30-minute brisk walk
is a simple and low-impact
physical activity patients with
osteoporosis and arthritis can
carry out to not only stay active
but also exercise joints and
strengthen bones.
Patients with OA are
encouraged to exercise and
usually a consultant
physiotherapist will advise on
special exercise techniques to
strengthen thigh muscles.
For RA patients, exercise is
important as well but
special care must be
taken to reduce
impact on the joints.
Warm-up routines
and gentle stretches
Foods such as
milk, cheese and
salmon are rich
in calcium and
vitamin D, which
contribute to
bone health.

are great ways for RA patients to

stay active.
RA patients are also advised to
invest in appropriate shoes to
reduce shock and impact to joints
when exercising.
As a whole, swimming is a
great activity for patients with
osteoporosis or arthritis as it
conditions bone and muscle with
minimal impact on joints and risk
of contact injury.
The appropriate precaution
and management of both
osteoporosis and arthritis begin
with the awareness of the
diseases and how they affect an
individual.
It is important to start taking
care of bones and joints at an
early age to sustain the health of
your bones for later in life.
Regularly consult physicians and
make the necessary modifications
to ensure long-term bone health.

Hope for arthritis

Arthritis Foundation Malaysia
(AFM) offers support and
assistance for patients with
arthritis.
One way it does so is by
providing funds for joint
prostheses procedures, which can
cost between RM10,000 and
RM20,000.
A lot of these procedures are
beyond the financial scope of
most Malaysians. We provide
assistance either in part or in full
based on the internal assessment
committees consideration,
says Assoc Prof Dr Sargunan
Sockalingam, consultant
rheumatologist and president of
AFM.
AFM also aids in the

management of arthritis in
Malaysia through public
programmes, where healthcare
professionals who specialise in the
treatment of arthritis speak in
public forums and seminars and
disseminate advice to the public.
These healthcare professionals
work with us on a voluntary basis.
AFM is a platform where patients,
their relatives, and anyone
interested in arthritis can meet
experts in the treatment and
management of the disease.
Some of our members who are
healthcare professionals in various
fields also suffer from arthritis.
They bring an interesting
perspective to the disease and how
to manage it, says Dr Sargunan.

SUNDAY STAR, 3 JULY 2016

4 healthy bones

SCIENTISTS now recognise the

benefits of vitamin K2 for bone and
heart health. It is essential for the
many processes in the body,
including maintenance of the
skeleton.
Insufficient vitamin K2 in
your diet may lead to weaker
bones and an increased risk of
fractures.
Scientists have been studying the
relationship between vitamin K2
and bone health, investigating how
vitamin K2 supplements may
improve bone health in some
people.
The research, published in
Osteoporosis International in 2013,
studied women who have been
through menopause this group is
most at risk of developing
osteoporosis and suffering
fractures.
A study published in Yonsei
Medical Journal in 2013 shows that
vitamin K2 supplements:
l Slow down the rate of bone
weakening after menopause
l Increase bone strength and
may decrease the number of
fractures in women with
osteoporosis
l May boost the effectiveness of
osteoporosis medications
Vitamin K2 plays a central role
in calcium metabolism, the main
mineral found in bones.
Vitamin K2 activates the
calcium-binding activity of
two proteins called matrix Gla

Keep your bones strong with vitamin K2, which works synergistically with calcium and vitamin D3.

Staying fit with K2

protein (MGP) and osteocalcin,
which help to build and maintain
bones.
Osteocalcin is the protein that
binds to the calcium in our body
and converts it to bone tissue. It is
released around soft, growing
bones where it binds with calcium
to add to the layers of bone tissue
being made.
Osteocalcin only works if it is
first activated by vitamin K2,
making it a major player in

bone health.
While vitamin K2 contributes
calcium to the bones, it also keeps
it out of the hearts arterial vessels,
which could have potentially
led to arterial hardening or
calcification, increasing the risk of
cardiovascular disease.
The vitamin K-dependent MGP
regulates this potentially fatal
calcium accumulation.
A 2004 study on the relationship
between dietary intake of

menaquinone and reduced risk of

coronary hear disease undertaken
by Erasmus Medical Center
Rotterdam, among others, found
that those who had the highest
intake of vitamin K2 were 52%
less likely to develop calcification
of the arteries and had a 57%
lower risk of dying from heart
disease over a seven- to 10-year
period.
A similar 2009 study of 16,057
women published in the Nutrition,

Metabolism and Cardiovascular

Diseases journal found that
participants with the highest intake
of vitamin K2 had a much lower
risk of heart disease.
For every 10g of K2 they
consumed per day, the risk of heart
disease was reduced by 9%.
Ensure that you get plenty of
vitamin K2 if you are consuming
calcium and vitamin D for your
bones to achieve their synergistic
effects.
Calcium is linked to good bone
health and vitamin D3, a natural
form of vitamin D, helps your body
absorb calcium while vitamin K2
directs the calcium to your
skeleton.
Without the help of vitamin K2,
the calcium that vitamin D3 helps
absorb might work against you by
building up in your coronary
arteries rather than your bones.
Thus, calcium taken together
with vitamin D3 and vitamin K2
may be the necessary solution for
healthy bones.
For patients receiving oral
anticoagulant treatment, it is
recommended that they do not
take vitamin K2 supplements
without consulting their medical
doctor.
This article is brought to you by
Vitamode and Caring Pharmacy.

n For more information,

call 1300 800 228 or e-mail
enquiry@medispec.com.my.

Forestalling
osteoporosis
Sole
confident
CORNS and calluses are areas of thick hard
skin that can sometimes form on the outer
edges of your toes, ball of the foot and back
of the heel.
Caused by excessive pressure or friction,
these thickened areas of skin can result in
discomfort and even pain with every step.
With the PediSoft Express Electronic Foot
File by Guardian, you can forget about these
problems once and for all as it helps remove
tough, lifeless skin and calluses, leaving you
with a soft and gentle sole.
Buffing your feet has never been more
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The PediSoft
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and
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roller heads.

advanced buffing mechanism that operates

at 2,350 revolutions per minute.
Powered by two AA batteries, the
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simple touch of a button.
Slide the safe and easy-to-use power
button to get rid of hard dry skin, and have
beautiful and smooth feet in just three
minutes.
Designed to provide you with a
comfortable grip and to avoid any
unfortunate mishap, the foot file is
ergonomically shaped with a slim-fit handle.
In addition to the foot file, a cover and
mini brush are included in every PediSoft
Express Electronic Foot File package and
you can choose between two types of roller
heads to suit the condition of your skin.
Use the coarse mineral roller head for
stubborn, hard and dry skin areas or switch
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Head to the nearest Guardian pharmacy
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n This article is brought to you by your

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OSTEOPOROSIS can strike at any age and

affects both men and women. According to
the International Osteoporosis Foundation,
globally, one in three women and one in five
men over the age of 50 will experience
osteoporotic fractures during their lifetime.
Many are not aware that osteoporosis is
robbing them of their bone mass until a
fracture occurs, most commonly at the hip,
spine or wrist. It can lead to chronic pain,
reduced mobility, disability or even death.
Bones are living tissues that constantly
undergo remodelling. During childhood and
adolescence, bones are formed faster than
are broken down, so there is a net increase in
bone mass.
Bone mass continues to increase until it
reaches its maximum strength and density in
ones thirties.
Then, with advancing age, bone
breakdown slowly overtakes bone formation,
resulting in gradual bone loss. As the bones
become more porous, osteoporosis is likely to
occur.
You are at a higher risk if you are a
woman, aged over 50, menopausal or have a
family history of osteoporosis.
An inactive lifestyle, heavy smoking,
excessive alcohol consumption, poor diet and
insufficient calcium intake can also increase
your risk of osteoporotic fractures.
Osteoporosis is preventable with proper
nutrition and lifestyle habits. Calcium is the
key nutrient for optimum bone growth and
maintenance.
The recommended nutrient intake of
calcium is 800mg to 1,000mg per day for
Malaysian adults, which many fall short of in
their daily diet.
You can get adequate calcium intake by
eating a variety of calcium-rich foods and

An adequate intake of calcium will ensure that

your bones stay strong.

complementing them with calcium

supplements. Essential co-factors are also
required to help your body better absorb
and use calcium.
Magnesium plays an important role in
preventing unabsorbed calcium from
depositing in arteries, joints and tendons or
forming kidney stones. On the other hand,
vitamin D facilitates calcium absorption and
promotes bone formation.
Boron is increasingly recognised as a key
trace mineral for bone growth. It helps
activate vitamin D, which in turn improves
calcium absorption from the small intestine,
facilitates calcium deposition into the bones
and reduces urinary excretion of calcium.
It also helps increase joint comfort and
flexibility. A good source of boron is
FruiteX-B, a patented plant-based form of
boron with remarkable bioavailability.
Keeping your bones strong and healthy
well into your golden years needs more than
just calcium. Supply your body with all the
bone-building nutrients it needs so you can
enjoy an active, vibrant life.
This article is brought to you by
VitaHealth.

n For more information, call 1800 183 288.

SUNDAY STAR, 3 JULY 2016

healthy bones 5

Averting sports injuries

THE most common sports-related
injuries that doctors see are
knee and ankle injuries, says
Dr Thirukumaran Subramaniam,
resident consultant orthopaedic
and trauma surgeon at Mahkota
Medical Centre.
In Malaysia, people generally
develop ankle sprains, shoulder
strains or a tear of the anterior
cruciate ligament (ACL a ligament
in the knee joint) while playing
football, futsal and badminton.
It comes down to poor
preparation. Basically, people do
not warm up properly, do not have
proper training and their muscles
and joints have lost the ability to
endure strenuous exercise, says
Dr Thirukumaran.
These are weekend warriors,
who do little or no exercise during
the week and then try to perform
strenuous activities during the
weekend. Because their bodies are
not used to the strain, this can lead
to traumatic injuries in the joints,
he continues.

What to do
Sometimes, sports injuries are
beyond your control. However, it is
possible to prevent the most
common types of sports injuries

from occurring, especially those

that are caused because we are not
properly conditioned for the
activity.
The best thing is to know your
limit do not unduly strain your
joints and muscles. This will
minimise injuries caused by
overuse. You should learn to
recognise when to stop. A good
indication is when you feel tired.
It is also very important to
warm up before playing sports.
This increases your blood flow to
the muscles and makes you more
flexible, says Dr Thirukumaran.
Another injury-prevention factor
that many people are not aware of
is the use of appropriate gear.
Protective gear such as shin and
elbow pads can, of course, prevent
injuries, but it is also important to
wear proper shoes and use good
equipment.
Shoes that are made for the
specific game will offer your ankles
support, grip the ground so that
falls are minimised, and minimise
injuries to your toes and ankles in
sports such as football and futsal.

Treatment
Most sports injuries 80% to
90% do not require surgery.

Dr Thirukumaran Subramaniam,
resident consultant orthopaedic and
trauma surgeon at Mahkota Medical
Centre.

Instead, the PRICE method of

treatment is used.
PRICE stands for protection, rest,
ice, compression and elevation;
these are the most important
principles for a speedy recovery.
Protection simply means
protecting the injured area from
further trauma by using a sling,
bandage, splint or other types of
protection.
Next, you have to rest the
injured joint so that it can heal
and recover naturally without
unnecessary movement.

An ice pack can be applied to the

injured area to reduce swelling
and pain.
Once the ice pack is removed,
compression should be applied to
the injured area. This also helps to
minimise swelling.
Elevation of the injured area is
important immediately after the
injury occurs to reduce the blood
flow to the injured area and
further reduce swelling.
PRICE is the main method of
treatment for sports injuries.
Sometimes, however, six to eight
weeks of rehabilitation is required,
depending on the severity of the
injury, says Dr Thirukumaran.

Keeping fit
Maintaining bone health comes
down to a good diet and
reasonable amount of exercise.
If you are older, feel you are not
flexible or have less energy, choose
low-impact exercises such as yoga
or tai chi, says Dr Thirukumaran.
He reiterates the importance of
warming up and using proper
methods and equipment when
exercising. Regular exercise will
minimise injuries and keep you fit
and healthy for longer.

n For more information,

call 06-285 2999.

SUNDAY STAR, 3 JULY 2016

6 healthy bones

Hygiene and
balanced diet
LOCATED on the right side
under your rib cage, the liver is
the second largest organ in your
body.
As the liver functions to remove
harmful substances from your
blood and process your daily
consumption into nourishment for
your body to use, it is crucial to
keep your liver healthy and take
precautionary steps to stave off
liver diseases.
Among the more common liver
diseases are hepatitis A, B and C
that can cause the liver to swell
and perform inefficiently.
While the best way to prevent
the hepatitis A virus is by
vaccination, it is advisable to
always wash your hands with soap
and warm water after using the
bathroom or before preparing and
eating food.
Both hepatitis B and C viruses
can also lead to cirrhosis, which is
the scarring of the liver caused by
continuous, long-term liver
damage.
Protect yourself by avoiding

direct contact with infected

blood and ensuring you do
not share personal items
such as toothbrushes and
razors with people who have the
disease.
Limiting foods that have high
iron content and salt will also help
to reduce your chances of
developing hepatitis B.
As there is no vaccine to
prevent the hepatitis C virus,
seek immediate medical attention
if you are exposed to blood or
needles.
In addition to hepatitis A, B and
C, another cause for liver swelling
and cirrhosis is fatty liver disease,
which is the build-up of fat in liver
cells.
Make sure you limit your intake
of high-calorie foods and instead
have a daily diet with high-fibre
foods such as oats, wheat bran,
wholegrain and fruits.

n This article is brought to you by

your partner in health, Guardian
Health and Beauty Sdn Bhd.

Ensure your liver performs

efficiently by maintaining a
healthy lifestyle that
includes regular exercise.

Keeping healthy
JUST because your liver can
repair itself and create new
healthy tissue, it should not be
taken for granted.
Follow these three general
steps to ensure your liver is
functioning at its best:
Maintain a healthy lifestyle
and diet
l Exercise regularly
l Have a diet comprising
food from all food groups.
Opt for more food rich in fibre
such as fruits, vegetables,
wholegrains and beans, and
have a sufficient source of

protein every day

l Drink six to eight glasses of
water daily
l Choose organic vegetables
as they contain less pesticides
and chemicals
l Maximise your intake of
fruits and vegetables with high
sulphur content such as
broccoli, cabbage, cauliflower,
garlic and onions
l Follow a steady eating
regime to maintain your weight,
an important aspect of liver
care
l Limit your intake of salt
and food high in salt

l Consult your doctor on the

recommended amount of
protein you should consume
Avoid overexposure to toxins
(breathing or touching)
l Limit your contact with
cleaning and aerosol products,
insecticides and cigarettes
Limit alcohol consumption
l Too much alcohol can
damage and destroy liver cells
l Prolonged and
overconsumption of liquor can
cause the liver to perform less
efficiently and cause cirrhosis

SUNDAY STAR, 3 JULY 2016

healthy bones 7

Nourishment for all ages

AS the most abundant mineral in
our body, calcium is important for
the maintenance of healthy bones.
The daily intake of calcium
recommended by the Health
Ministry is 800mg per day for
adults and 1,000mg per day for
adolescents and adults above 50
years old.
As bone mass peaks during
adolescence, it is important to
ensure adolescents recommended
calcium intake is met.
As for adults, calcium is
important to fight against the onset
of osteoporosis.

Bone nutrition
There are a number of nutrients
that help the body use calcium
efficiently to maintain bone health.
Over the years, various studies
have shown that magnesium helps
with calcium absorption and
retention in the body.
Vitamin D plays an important
role in regulating calcium in the
body while vitamin K works
closely with calcium to form strong
bones.
How do we get all these
nutrients in our daily diet? Milk is
not only a main source of calcium

but also other important

minerals and vitamins that
help in maintaining bone
health.

Benefits of goats
milk
Goats milk naturally
contains high calcium just
three glasses of milk can
provide about 90% of an
adults reference intake of
calcium based on the
European Unions
regulations.
Your other sources of
calcium should be foods
such as dark green
vegetables and nuts to
make up for the daily
requirement.
An interesting property
of goats milk is the
globules of fats, which are
easy to digest in the
intestine while the protein
forms a softer curd. This
unique property helps in
digestive health and comfort.
A 1996 study by the University of
Tampere suggests that the high
calcium content in goats milk
helps lower blood pressure.

Moreover, as goats milk

naturally has lower cholesterol
than other types of milk, it is a
good alternative for those who
want to watch their cholesterol
levels.

Goats milk contains

higher levels of magnesium
that is vital in maintaining
healthy bones. It also
contains higher vitamins D
and K, which help in
regulating calcium and
formation of bones in the
body.
Now that we know the
goodness in goats milk,
how do we ensure that it is
easily available for our
bodys uptake?
Goats milk contains
casein phosphopeptides,
which increase solubility
and absorption of minerals
such as calcium,
magnesium, iron and zinc.
Karihome goats milk is
produced by Dairy Goat
Co-operative in New
Zealand, which is naturally
blessed with green pastures
and enforces strict
regulations to ensure
quality products are
exported.
Dairy Goat Co-operative supplies
goats milk to various markets such
as the United Kingdom, France,
Spain, Hong Kong, Singapore and
China.

Karihome goats milk is available

in Malaysia and is locally
distributed by Orient Europharma
(M) Sdn Bhd, which is a subsidiary
of Orient Europharma Pte Ltd from
Taiwan.
Karihome is available in all
ranges to cater to different age
groups.
Children can benefit from
Karihome Growing-Up Formula,
which is suitable for one- to
three-year-olds while children
above four years old can enjoy
Karihome Pre-School Formula.
Karihome Goat Whole Milk
Powder is available for adults.
Rich in nutrition that helps in
childrens and adults physical
development, goats milk
complements our daily diet for the
maintenance of good health.
Goats milk is highly nutritious as
it contains essential vitamins and
minerals for the maintenance of
not only healthy bones but a
healthy you. It is an ideal food for
the whole family to enjoy.
This article is brought to you by
Orient Europharma.

n For more information,

call 03-5569 5405.

SUNDAY STAR, 3 JULY 2016

8 healthy bones

Working out safely

Light
exercises
and
stretching
can go a
long way in
improving
mobility and
flexibility.

PEOPLE living with arthritis can

from time to time experience
mild to severe swelling, pain,
stiffness and a decreased range
of motion in their joints.
A severe case of arthritis can
result in chronic pain and the
inability to conduct daily
activities.
However, this does not mean
that people with arthritis should
abstain from exercise and
physical activities altogether.
While it may be logical to
believe that exercise can harm
the joints and cause more pain,
there are a number of exercises
that can actually improve ones
ability to move and function,
particularly among those with
osteoarthritis.
Regular physical activity will
produce endorphins that
contribute to your overall sense
of well-being, help you control
pain, improve overall health and
sleep easier at night.

Develop flexibility
If you are unable to move
your joints through the entire
range of motion they were
designed to achieve, gentle
stretching and regular
movements through the full
span of each joint can help to
maintain and possibly improve
flexibility.
Besides moving your
limbs in all directions, you can
also use dynamic or active
stretching as a warm-up
mimicking the movements used
in a sport such as lunges and
twists.
Stretching must be done
correctly, after a five- to
10-minute warm-up.
A warmed-up muscle can stretch
for longer and endure more.

Head to the pool

Aquatic exercises do not
necessarily involve swimming
countless laps in the pool. While
standing in roughly shoulder
height of water, go through the
full range of flexibility exercises.
The water helps to relieve
the pressure of your bodys
weight on the affected joints
while also providing resistance
for your muscles to grow
stronger.
Exercising in water is
particularly helpful for people
who are just beginning to
exercise, overweight or
living with hip and knee
osteoarthritis.
Regular exercise will also help
to strengthen your heart, make
your lungs more efficient,
reduce fatigue and enable
you to have more stamina
throughout the day.

Go for a walk
The best thing about
walking is that you can do it

anywhere, anytime.
Unlike jogging and running
that put additional pressure and
impact on the joints, walking is
less strenuous and you can
always decide to slow down or
speed up depending on your
physical level.
Walking helps one improve
circulation, ward off heart
disease, lower blood pressure
and, as an aerobic exercise,
strengthen the heart.
It also tones muscles that
support your joints and, by
stopping or slowing down the
loss of bone mass, lowers the
risks of fractures.
Cycling and elliptical trainers
are other low-impact exercises
that can help you regain
mobility without putting
excessive pressure on your
joints.

Know when to stop

Some mild pain or discomfort
is normal when you first start to
move, but it usually feels better
after a few repetitions.
Joints and muscle get
nutrition through movement
and you will improve the
lubrication and circulation
around that joint.
Progress to a more active
range of motion only if you feel
okay. Decrease the intensity or
stop if you begin to feel
moderate to severe pain in your
joints.
Experiencing pain while not
particularly doing a joint-taxing
workout may be a sign that you
have inflammation in the joint
or even joint damage that
requires treatment.
With the expert advice of
your doctor, learn the specific
exercises that are best for you
so that you may regain some
mobility and independence as
well as maintain an ideal weight
and good health.

Exercising dos and donts

Even with arthritis, it is
important to exercise
regularly to help reduce pain
and improve your range of
motion. However, there are
some simple dos and donts
while exercising.
Do:
Always wear well-fitting
shoes that provide
adequate support
Take note of joint pain
that persists hours after
your exercise
Avoid walking on an
incline be it on land,
treadmill or in the pool
Swim laps using gentle
kicks
Cycle only on the high
gears
Neck exercises, yoga and
tai chi
Always check with your

doctor or physical
therapist on appropriate
fitness regimes
Dont:
Attempt heavy weights
when doing squats or
other muscle-toning
exercises
Attempt vigorous
exercises and contact
sport that require
quick changes of
direction, jumping or
running
Ride a bicycle that
requires you to bend
over too far
Walk on uneven
surfaces such as gravel
or rocky terrain or
attempt hiking trails
Walk for long distances
without rest

SUNDAY STAR, 3 JULY 2016

MINIMALLY invasive (keyhole)

surgery uses a few small incisions
rather than one large incision and
has been associated with better
outcomes than open surgery,
including reduced risk of surgical
site infections and less postoperation pain, which translate to
faster recovery time and shorter
hospital stay.

healthy bones 9

Fixing ailing joints

navigation technology and
minimally invasive surgical
technique, this advancement has
resulted in better post-operation
results.
Patients can move the day after
their surgery and can usually be
discharged four days after the
procedure.
Early mobilisation reduces
hospital stay by reducing the
risk of post-operation
complications such as deep
vein thrombosis and this is
psychologically empowering for
the patient, which translates to
improved results during
rehabilitation after the operation.

Total knee replacement

Arthritis of the joints is very
common in Malaysia and often
involves the knees.
The goal for treatment is to
relieve pain and improve quality of
life.
When my patient complains of
severe knee pain, I know that it is
hard if not impossible for them to
perform their daily activities.
Medications and walking support
are often used first but when their
effectiveness has reached a limit,
knee replacement surgery can
become the answer, says Dr Lim
Li Aik, consultant orthopaedic and
trauma surgeon at Oriental Melaka
Straits Medical Centre.
Total knee replacement surgery
(TKR) is a safe and effective
procedure to relieve pain, restore
limb alignment with good range of
motion and improve overall
quality of life.
This procedure involves
removing all diseased portions of
bone and tissue on the ends and
replacing them with metal and

Dr Lim Li Aik.

Dr Gopinath Mathavan.

high-density polyethylene
implants.
These implants create a new
joint that approximates the
anatomical and physiological
function of a human knee joint.
In most cases, the replacement
knee can last for about 15 to 20
years.
The overall success of TKR
depends on appropriate patient
selection, proper implant choice,
meticulous and appropriate

surgical technique and postsurgery rehabilitation, says

Dr Lim.
The availability of computerassisted navigation in TKR surgery
helps orthopaedic surgeons
achieve proper soft tissue balance,
correction to within one to two
degrees of the neutral mechanical
axis and minimal or zero error
during the implant placement,
says Dr Lim.
With the combination of

Joint arthroscopy
Arthroscopy is a surgical
procedure where the surgeon
uses specialised cameras and
equipment to diagnose and treat
a variety of joint problems
through just a small incision in
the skin.
Arthroscopy can only be
undertaken after obtaining a
complete medical history and
examination of the affected joint,
often supplemented by further
investigations such as X-rays or
MRI scans.

Following this, a decision will

be made whether or not to proceed
with surgery, says Dr Gopinath
Mathavan, consultant orthopaedic
and trauma surgeon at Oriental
Melaka Straits Medical Centre.
Common problems within the
joint that can be dealt with using
arthroscopic methods include:
l Synovitis (inflammation of the
joint lining)
l Damaged joint surfaces
l Loose fragments of bone or
cartilage
l Bone spurs or impingement
l Ligament reconstruction
procedures
Arthroscopy is generally safe
and can often be performed as a
day procedure. Because of the
smaller incision needed, there is
less discomfort and risk, which
allows for quicker recovery. Most
patients can return to work and
resume sporting activity as early
as two to six weeks post-surgery,
says Dr Gopinath.
Furthermore, complications
from arthroscopy are rare.
These include pain, infection
and swelling of the joints.

n For more information,

call 06-315 8888.

SUNDAY STAR, 3 JULY 2016

10 healthy bones

GOOD movement is essential to

maintain an active lifestyle.
Healthy bones, joints and muscles
as well as good nutrition are
essential for good flexibility,
posture, balance, stamina and
strength.
Bone is dynamic living material
consisting of minerals (mainly
calcium and phosphate), collagen
and small amounts of other
proteins, cells and water.
Bones are in a state of constant
remodelling where new bone is
deposited and older bone is
removed. However, it happens less
efficiently in adult men and
women and this results in bone
mass loss, causing osteoporosis and
increasing the risk of fractures.
Healthy joints are also integral to
staying mobile. Specialised
cartilage called hyaline cartilage
pads and protects the ends of
bones, absorbing shock and
reducing friction to ensure smooth
joint movement.
Cartilage is an active, growing
tissue that requires continuous
regeneration to provide the
protection and strength that joints
require.
Cartilage is subject to continuous
regeneration through the
breakdown and formation
processes, which are in a state of
equilibrium. If imbalanced, this
will lead to loss of cartilage.
An overactive lifestyle, highimpact sports and ageing can also
wear down joint cartilage, leading

Feel young, move well

Dietary sources of calcium and vitamin D are essential in ensuring better

calcium balance and reduced bone loss.

to joint discomfort, cartilage

degeneration, and loss of joint
mobility and flexibility, which lead
to osteoarthritis.
A physically active lifestyle has
been shown to provide benefits in
a number of areas associated with
musculoskeletal health and quality
of life, including improved bone
and muscle strength, reduced risk
of falls and fractures, increased

energy and stamina, protection

against osteoarthritis and pain
relief.
Calcium is essential for bone
health as it is one of the main
bone-forming minerals and 99% of
the bodys calcium resides in bone
as reservoir to maintain blood
calcium levels.
When dietary intakes or
intestinal absorption of calcium are

too low to maintain blood calcium

levels at the correct level,
parathyroid hormone (PTH) is
released by the parathyroid glands.
PTH stimulates bone resorption
or breakdown to release calcium
and this may lead to a loss of bone
mass.
An increase in calcium intake
can lead to better calcium balance,
increased bone gain during growth
periods, reduced bone loss in later
life and reduced risk of fractures.
Vitamin D is a fat-soluble
vitamin that is crucial for bone
health. However, there are very
few foods that contain vitamin D
and hence the main source comes
from what the body makes on the
skin from sun exposure.
Vitamin Ds main function in the
body is to increase the efficiency of
calcium absorption and maintain
levels of calcium in the blood.
It does this by enhancing the
ability of the gut to absorb calcium
from diet. When calcium intake is
low, vitamin D and PTH stimulate
the breakdown of bone to
release calcium to maintain blood
calcium level.
Vitamin D also supports calcium
absorption by stimulating the
production of a transport protein
called calbindin, which actively

transports calcium from the gut

into the bloodstream. When the
body has the right amount of
vitamin D, up to 40% of dietary
calcium is absorbed.
When a diet is supplemented
with vitamin D and calcium in the
elderly, there is a decrease in bone
loss and fracture.
Furthermore, vitamin
D-fortified foods may play a useful
and cost-effective role in improving
the vitamin D status of target
population groups.
Anlene contains the MoveMax
nutrition bundle, a combination of
nutrients that work together to
help care for the health of your
bones, joints and muscles, which
support your overall movement as
you age so you can move like you
feel young again.
Anlene MoveMaxs blend of
nutrients that includes calcium,
vitamin D, magnesium, zinc,
protein, B-vitamins, collagen,
vitamin C and vitamin E.
This article is brought to you by
Anlene.

n For more information, call

1800 883 122 (Monday to Friday
from 8.30am to 5.30pm) or e-mail
consumerservice@fonterra.com.

SUNDAY STAR, 3 JULY 2016

healthy bones 11

Milk for nutritional value

Excercise and
a balanced
diet help to
prevent
osteoporosis.

A BALANCED diet along with

regular exercise helps optimise
bone health at all ages and
reduce the risk of osteoporosis.
The benefits of a healthy diet
for bones are:
l Children and adolescents
build maximum peak bone
mass
l Adults maintain healthy
bones and avoid premature
bone loss
l Seniors sustain mobility
and independence
The health and strength of
our bones rely on a balanced
diet and steady stream of
nutrients, most importantly
calcium and vitamin D.
Calcium is a mineral that people
need to build and maintain strong
bones and teeth. It is also
important for other physical
functions such as muscle control
and blood circulation.
Calcium is not made in the body.
It must be absorbed from the foods
we eat. To effectively absorb
calcium from food, our bodies
need vitamin D.
If we do not have enough
calcium in our diet to keep
functioning, calcium is removed
from its storage in the bones.

Over time, this causes our bones

to grow weaker and this may lead
to osteoporosis. Osteoporosis is a
progressive bone disease that is
characterised by a decrease in
bone mass and density that leads
to an increased risk of fractures.
Postmenopausal women are
most vulnerable to osteoporosis.
Although loss of oestrogen is the
primary reason for this, poor
lifelong calcium and vitamin D
intake as well as lack of exercise
play a role in the development of
osteoporosis.
Men are also at risk, although
they usually get affected later in
life than women. This means that it
is important for men to keep track
of their calcium intake as well.
Marigold HL Low Fat Milk is
Malaysias favourite milk since
1988 and is the No.1 Pasteurised
Low Fat Milk in Malaysia till
today.
Marigold HL Low Fat Milk
has also been awarded the
prestigious Putra Brand
Awards 2015 The Peoples
Choice in the category of
Beverage Dairy.
With every glass of
Marigold HL Low Fat Milk,
you will enjoy nutritious
goodness of wholesome

delicious milk. This milk has 25%

more calcium compared to
ordinary milk and is fortified with
vitamin D for better calcium
absorption.
It also contains 56% more
protein compared to ordinary milk
and is fortified with eight essential
vitamins A, B1, B3, B6, B12, C, E
and folic acid giving you all the
nutrients needed to stay healthy
and active.
Marigold HL Low Fat Milk is low
in fat and lactose. It has 74% less
fat compared to ordinary milk,
which keeps you healthy, slim and
trim and has 75% less lactose
compared to ordinary milk, which
eases your digestive system and is
suitable for people who are lactose
intolerant.

People who are lactoseintolerant may experience

digestive discomfort such as gas,
bloating and diarrhoea with
ordinary milk.
For those who are concerned
with high cholesterol levels,
Marigold HL Low Fat Milk with
Plant Sterols helps lower
cholesterol levels.
Plant sterols work by blocking
cholesterol absorption by your
body. Include two glasses of
Marigold HL Low Fat Milk with
Plant Sterols (with 1.6g of plant
sterol esters) daily as part of a
balanced diet that includes regular
consumption of fruits and
vegetables as well as exercise to
help maintain cholesterol levels at
a healthy range.
Marigold HL Low Fat Milk is
available in plain, chocolate and
strawberry flavours.

n For more information, visit

www.marigold.com.my.
Obtain adequate
calcium and
nutrients with
Marigold HL Low
Fat Milk.

SUNDAY STAR, 3 JULY 2016

12 healthy bones

Treating osteoarthritis
YOU may notice that people
nowadays often suffer from
arthritis, especially osteoarthritis,
which typically attacks hands,
knees, hips and the spine.
Osteoarthritis is a common joint
disease that results from wear and
tear on the cartilage that protects
and cushions your joints.
While many think that this
happens only to the elderly, it
affects younger adults as well.
Apart from the natural ageing
process, the progressive
degeneration of cartilage can
be caused by repeated motion,
which increases friction when
bones at the joints rub against
each other.
This leads to breakdown of
cartilage, bony change of joints,
deterioration of tendons and
ligaments, and various degrees of
inflammation of the joint lining.
Symptoms of osteoarthritis vary
from person to person and include
pain, stiffness, tenderness and loss
of flexibility.
There is no cure for
osteoarthritis. The goal of
treatment is to ease the pain,
maintain mobility and slow the
progression of joint deterioration.
Over-the-counter medications
such as non-steroidal anti-

inflammatory drugs or aspirin are

usually prescribed to treat pain
caused by osteoarthritis.
Nevertheless, long-term
medication might cause side
effects and put you at risk of
numerous health complications.
Glucosamine and chondroitin
are slow but effective compounds
that are studied extensively to
prevent the degradation of
cartilage.
Glucosamine and chondroitin
are natural components found in
cartilage. In a healthy joint,
cartilage serves as a cushion
between bones to facilitate the
movement.
It is a flexible connective tissue
that allows the bones to glide over
each other smoothly with little
friction during physical activities
such as walking or exercising.
However, repetitive straining of
the joints can cause the cartilage to
wear down prematurely. Hence,
glucosamine and chondroitin play
important roles in promoting joint
health.
Glucosamine is a type of amino
sugar normally produced by the
body and is the precursor for
production of glycosaminoglycan
(GAG), a fundamental building
block of cartilage.

It aids in stimulating the

formation of collagen and
proteoglycans, which serve as joint
lubricant to provide smooth and
low-friction movements.
Due to its powerful effect on
cartilage metabolism, glucosamine
is capable of repairing damaged or
eroded cartilage to prevent further
deterioration.
Meanwhile, chondroitin is the
most abundant GAG in cartilage.
Being a natural compound in
cartilage, chondroitin acts like a
water magnet, absorbing water
into connective tissues and
providing shock absorption.
This helps to promote water
retention and suppleness to
maintain nourishment and
lubrication in the cartilage.
Moreover, chondroitin helps to
protect cartilage from premature
breakdown by inhibiting the
destructive enzymes activity.
As we age, producing sufficient
glucosamine becomes more
challenging and this causes the
cartilage to start deteriorating,
resulting in stiffness and painful
joints.
Therefore, supplementation of
glucosamine and chondroitin can
be used to manage osteoarthritis.
A well-known clinical study, the

Glucosamine/
chondroitin
Arthritis
Intervention Trial
(Gait), was conducted
in the United States to
investigate the efficacy
and safety of glucosamine
and chondroitin as a
treatment for knee
osteoarthritis.
The study, published
in the New England
Journal of Medicine
in 2006, revealed
that a combination
of 500mg
glucosamine and
400mg chondroitin
three times daily boosts
effectiveness in treating moderateto-severe knee pain related to
osteoarthritis.
The Study on Osteoarthritis
Progression Prevention (Stopp)
was also carried out to establish
the efficacy of chondroitin as
treatment for osteoarthritis.
The study, published in Arthritis
and Rheumatism in 2009,
demonstrated that long-term
supplementation with chondroitin
sulphate (800mg daily) can
improve symptoms and delay
joint structure degradation in

Supplement
your body with
glucosamine
and chondroitin
to manage
osteoarthritis.

individuals with osteoarthritis.

Physical activities such as
walking and exercising put
tremendous stress on your
cartilage.
Accumulation of these acute
strain injuries over time can lead
to the degenerative disease of
joints, so it is important to act now.
This article is brought to you by
BiO-LiFE Marketing Sdn Bhd.

n For more information,

call 03-7882 8888 or e-mail
health@biolife.com.my.

Wholesome eats
BUILDING healthy bones and joints begins
with getting much-needed nutrients from
various food sources to prevent disorders
such as osteoporosis and arthritis.
Here are some easy-to-find and
cost-friendly food sources that are rich in
nutrients to build healthier bones and joints.
l Milk Milk has always been associated
with building strong bones and joints
especially among children and teenagers
because it is one of the best sources of
calcium and vitamin D. Milk is also rich in
other nutrients such as potassium,
magnesium, riboflavin, phosphorus and
vitamins D and B12, which are key
components in building healthy bones. Other
dairy products such as yoghurt and cheese
also have the same nutrients as milk and
make excellent alternatives for milk.

l Soy Soy is a great alternative for

people who are looking for dairy substitutes.
Soy and tofu are great sources of calcium as
well as other plant-based nutrients such as
isoflavones. Soy has been shown to have a
positive impact in preventing osteoporosis.
Last year, a research team led by the
University of Hull in the United Kingdom
found that women on a soy diet with
isoflavones had a lower rate of bone loss,
which reduces the risk of osteoporosis.
l Dark green vegetables Dairy and soy
products are not the only sources of calcium
that can supplement your bodys needs to
build strong bones. Dark, leafy vegetables
such as mustard greens, bak choy, Chinese
cabbage, spinach and turnip greens have
adequate amounts of calcium to meet dietary
needs. One cup of turnip greens has
approximately 197mg of calcium. Dark green
vegetables are also great in preventing
osteoporosis as they are rich in vitamin K.
l Prunes Prunes are known to contain

Soy is an
alternative
source of
calcium for
individuals
who cannot
consume
dairy
products.

necessary dietary fibre for good digestion

but a 2013 study has discovered that it also
benefits your bones. The results of the study
published in the British Journal of Nutrition
showed that women who ate prunes had
significantly higher bone mineral density in
the ulna (one of two long bones in the
forearm) and spine. Hence, due to their high
content in calcium and vitamin D, eating
prunes can help to lower the rate of bone
mineral loss in older individuals.

l Sardines Although sardines are

mostly known for their benefits in
maintaining a healthy brain as they are rich
in DHA and omega fatty acids, they are also
packed with calcium and vitamin D. They
can provide as much calcium and vitamin D
as milk and dairy products in a single
serving. Sardines can be eaten from the can
as a quick fix or incorporated into salads,
fried rice and sandwiches. The omega fatty
acids in sardines are also good for
preventing inflammation in joints.