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Wednesday, December 7, 2022

Gaining lean muscle mass

 

Tips for men who want to build muscle effectively and gain lean muscle mass

 

In order to grow your muscles, you must apply enough stress for them to become fatigued. — 123rf.com

For most males, hitting the gym is a way to get healthy, look good and feel more confident.

To get the most out of a workout session, a good understanding of health and nutrition can help maximise results.

However, if you were to ask most men what it takes to build muscle, they’d probably say that you just need to eat protein, protein and more protein.

Sure, protein is important.

After all, your muscles are made of protein, and your body requires adequate protein in the diet in order to have the building blocks it needs to build muscle mass.

But protein alone won’t do.

You also need to pay attention to the rest of your diet and exercise routine.

To help men start off on the right track, here are some tips on how to build muscle effectively.

Strike the right balance

A lot of people who are trying to bulk up are also trying to lose body fat at the same time.

But sometimes, the approaches they use to meet those goals are at odds with each other.

They’ll take in plenty of protein, which, when coupled with a strength training routine, should lead to more lean mass.

But they may also cut their total calories back too far in an effort to get “shredded.”

That can be a problem.

If you cut your calories too much, some of the protein that you eat is going to be burned for fuel rather than being used to support muscle development.

So, to effectively build muscle mass, you want to ensure that you have enough calories to support your activity and the right balance of nutrients.

Don’t shy away from healthy fats, as they are a vital structural component of every cell membrane, including muscle cells. — Photos: Herbalife Nutrition 
Don’t shy away from healthy fats, as they are a vital structural component of every cell membrane, including muscle cells. — Photos: Herbalife Nutrition

Fuel up with carbohydrates

Many bodybuilders see carbohydrates as the enemy, and that can be a mistake.

Yes, highly refined carbohydrates and snacks hardly do the body good.

But the right carbohydrates help to fuel activity, including working muscles.

Good sources can be found in whole grains, beans, fruits and vegetables.

Without adequate carbohydrates to fuel your exercise, some of the protein you’re eating might get burned for fuel.

So, to avoid “burning the candle at both ends,” make sure to include enough high-quality carbs in your diet.

Get some healthy fats

Dietary fat is sometimes underappreciated by some athletes. Like carbohydrates, fats may have an undeserved bad reputation.

Small amounts of the right kinds of fats are very important.

That’s because certain fatty acids, the building blocks of dietary fats, are essential as the body can’t make them.

Fatty acids are a vital structural component of every cell membrane, including muscle cells.

The body relies on fat to fuel moderate intensity, longer-term exercise.

That’s just the type of exercise that might be coupled with a strength training regimen to build mass and lose body fat.

Good sources of fatty acids include nuts. seeds, fatty fish, olive oil and avocado.

Protein intake and timing are key

Protein is crucial for muscle development, but instead of simply focusing on the amount of protein you take in, you should also pay attention to the timing of your intake.

The process of muscle protein synthesis (MPS) is stimulated by strength training activity, but it’s also stimulated when you eat protein.

This is one reason why those looking to bulk up should aim to spread their protein intake evenly over meals and snacks throughout the day.

MPS is greater under these conditions than it is under a more typical pattern in which little protein is consumed in the morning, a bit more at lunch, and then a large amount at dinner.

And, a bedtime snack containing about 25g of protein can help to stimulate MPS during the night.

Both plant-based and animal- based protein sources provide the necessary building blocks for MPS, but different proteins are digested and absorbed at different rates, so taking in a variety of protein sources could allow a prolonged release of amino acids into the system.

For example, dairy products contain two proteins: whey and casein.

Whey is considered a “fast-acting” protein, while casein takes longer for the body to process.

It’s the reason why many athletes turn to dairy proteins since they provide a sustained release of amino acids over a longer period of time.

However, animal proteins aren’t necessary in order to build muscle.

With careful planning and attention to total intake, even vegetarians and vegans can consume enough protein to support muscle development.

A fruit and milk/soy smoothie or yoghurt is a good recovery food option after a strength training session. 
A fruit and milk/soy smoothie or yoghurt is a good recovery food option after a strength training session.

Best diet tips

> How to spread your protein intake, and how often should you eat?

Ideally, you’ll want to time your eating so that it works with your workout, but also aim for three regular meals and a couple of snacks – making sure that they are balanced with both carbohydrates and protein.

That way, you can provide your body with the fuel it needs from the carbohydrate, as well as a steady supply of protein to stimulate MPS.

> What to eat before a workout?

You want to start your workout well-hydrated and well-fuelled.

For fluids, drink about two cups of water two to three hours beforehand, then have another cup about 15-20 minutes before.

The length of time between the time you eat your meal and the time you work out will dictate the type of meal you have:

If you have a few hours to digest, then a balanced breakfast that might include foods like eggs, yoghurt, whole-grain toast or cereals, milk/soy milk, and fruit would be appropriate.

If you’ll be eating fairly close to the time you work out, then something like a protein shake will take less time to digest.

Just be sure your shake includes not just protein but a source of carbohydrates, too.

So, in addition to a protein powder and/or milk or milk alternatives, include foods such as fruits and vegetables (such as carrots or sweet potato); you can even toss in some rolled oats.

> What to eat after a workout?

After you exercise, your muscles need some healthy carbohydrates and about 10-20g of high-quality protein to help them repair and recover.

A tub of yoghurt, a turkey or nut butter sandwich, a smoothie made with fruit and milk or soy milk, or a bowl of cereal and fruit are all good recovery foods after a session of strength training.

> What are good snacks in between meals?

Snacks should include the same healthy balance of protein and carbohydrates.

Some snack bars have a good balance of protein and carbohydrates and are convenient to carry with you.

Other quick snacks include a hard-boiled egg with whole grain crackers, yoghurt with fruit, or raw vegetables and hummus.

> How to gain muscle without putting on fat?

In order to build muscle, your body does require additional nutrients and calories, but that doesn’t give you licence to eat as much as you want.

If you take in more calories than you burn – whether from unhealthy, fatty, sugary foods or from a healthy well-balanced diet – those calories will get stored as body fat.

Choosing lean proteins, such as fish, poultry, low-fat dairy products, beans and tempeh, will help ensure that your body gets the protein it needs without excess calories.

Similarly, choose healthy carbohydrates – fruits, vegetables, whole grains – over sugars and refined starches, so you can reap the benefits without the extra calories.

Left: Muscle growth happens with rest, so give yourself a day off to recover from your workout session. — dpa 
Left: Muscle growth happens with rest, so give yourself a day off to recover from your workout session. — dpa

Designing a plan

You need more than just protein in your diet to get the nutrients you need to build muscle.

The same applies to your exercise routine – doing the right workouts will help you reach this goal faster and more effectively.

Sports performance and fitness specialist, Denise Cervantes, shares her favourite tips for strength training.

Strength training, also known as resistance training, is the main form of exercise you want to focus on to build muscle.

These exercises include weightlifting or bodyweight training (without weights) to improve your strength and strength endurance.

When you are training to increase strength or gain muscle, there are two things you need to make sure you are doing in your training to initiate the physiological change for hypertrophy (muscle growth in size).

First, you need to make sure you are creating mechanical tension, meaning you are using a heavy enough weight to challenge the muscle through a full range of motion.

Secondly, your training must also cause metabolic stress.

You will know you have done so when your muscle becomes fatigued, because it has used all of its stored energy to fuel its contractions to complete the repetitions.

This is a good thing!

These stresses you apply to the muscle will cause damage to the muscle fibres, causing “micro-tears,” which then send signals for the cells to regrow stronger and bigger.

And remember, growth happens with rest, so make sure to follow a well-designed programme that gives you a day to rest the muscle you just worked so it has a chance to recover and grow.

To see continual improvements from strength training, you should gradually increase the weight and number of repetitions.

Pretty soon, you’ll be a lot stronger physically and attracting a lot of attention!

By SUSAN BOWERMAN 

Susan Bowerman is senior director, Worldwide Nutrition Education and Training, Herbalife Nutrition. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. 

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Tuesday, December 6, 2022

PM: No salary for me at all, Cabinet ministers to take 20% pay cut


– BernamaAll eyes and ears: Anwar chairing the first special Cabinet meeting of the Unity Government at Perdana Putra.

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PUTRAJAYA: Datuk Seri Anwar Ibrahim will not receive any salary, both as Prime Minister and as Finance Minister, he has clarified.

Cabinet ministers have also agreed to a 20% pay cut until Malaysia reaches economic recovery, he said.

ALSO READ: Zahid and Fadillah have role in bridging economic gap

Rubbishing talk that he would be paid as Finance Minister although he had declined the salary for the top job, Anwar announced he would not be taking any form of government salary.

This was in line with his promise made during the election campaign, he said.

During the campaign, Anwar had said he would not take a salary if he was appointed as prime minister because the people themselves were struggling to cope with rising costs.

“Some people say I’m not taking the Prime Minister’s salary because I am the Finance Minister. That’s not true. There is only one salary,” he said, laughing off such claims during a press conference here yesterday.

ALSO READ:Budget to be enhanced with MOF, Cabinet views

The Members of Parliament Act (Act 347) only allows one salary for ministers, deputy ministers or political secretaries.

On the Cabinet ministers’ pay cut, he said this was their way of acknowledging the tough times faced by the people.

“The pay cut will be implemented as long as Malaysia continues to recover economically.

“It shows the ministers are also concerned about the livelihood of the public,” he said.

Asked if the pay cut would be carried out throughout the government’s five-year tenure, he simply said that it could range from three to five years, depending on the situation. 

Cabinet to take 20% pay cut

Prime Minister Anwar Ibrahim thanks his ministers “for their willingness to make some sacrifices” and said this was to show the government’s concern for Malaysians.

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Sunday, December 4, 2022

Political factor was crucial, kindness and graciousness of DAP

 

 

 

PETALING JAYA: A wide range of views has emerged on the Cabinet line-up but most analysts agree on one thing – it reflects the current political set-up and the need to appease all the parties involved.

“I think it does reflect the strength and number of seats that each party has,” said senior fellow from Nusantara Academy for Strategic Research, Dr Azmi Hassan.

He described the appointments as “fair”, adding that they were made in tandem with the ratio of parliamentary seats held by each party.

The main factor in determining the line-up of Prime Minister Datuk Seri Anwar Ibrahim’s Cabinet was the need to please the political parties involved, he added.

This, he said, was to ensure that Anwar would have the support of the parties in the unity government.

“The political factor was crucial in determining the Cabinet appointments,” he added.

Azmi said the ministerial appointments might not please everyone.

DAP, he noted, has been relatively quiet since the Cabinet list was unveiled.

“I would understand why – they (Pakatan Harapan) needed to appease Barisan Nasional and thwart the advance of PAS,” he said.

The 28-member Cabinet includes 15 Pakatan ministers comprising four from DAP, eight from PKR, two from Amanah and one from Upko.

There are six Barisan Nasional ministers, five from Gabungan Parti Sarawak, one from Gabungan Rakyat Sabah and one without a political party – Datuk Mohd Na’im Mokhtar, a Syariah court chief judge who was appointed Religious Affairs Minister.

Presently, Anwar has the support of Pakatan’s 82 MPs, Barisan (30 MPs), GPS (23), GRS (six), Warisan (three), Muda (one), KDM (one), Parti Bangsa Malaysia (one) and two independent MPs.

International Islamic University Malaysia’s Dr Tunku Mohar Tunku Mohd Mokhtar said the Cabinet line-up was a result of negotiations between the Prime Minister and the component coalitions of the unity government.

“It reflects the proportionality of the components and party hierarchies,” he said.

He added that parties such as Muda and Warisan were not given ministerial positions, “but I think they would not protest about it”.

However, Tunku Mohar noted that Barisan chairman Datuk Seri Dr Ahmad Zahid Hamidi’s appointment as Deputy Prime Minister had compromised Pakatan’s pledge for good governance.

Ahmad Zahid is facing 47 charges involving criminal breach of trust, corruption and money laundering.

Universiti Sains Malaysia senior lecturer Dr Azmil Mohd Tayeb said the Cabinet was one which Anwar could cobble up based on the current political arrangement.

“It’s much slimmer and appeases almost everyone,” he said.

However, he was of the view that Anwar should not have assumed the Finance Minister’s post.

The last prime minister to hold both portfolios was Datuk Seri Najib Razak from 2008 to 2018.

Back then, this had come under criticism with Pakatan pledging in its 2018 general election manifesto that the prime minister would not hold the finance portfolio.Azmil also had reservations about the appointment of Tengku Datuk Seri Zafrul Tengku Abdul Aziz (International Trade and Industry Minister).

“I don’t think it is a good idea, while excluding someone like Datuk Seri Dr Dzulkefly Ahmad,” he said.

Dr Dzulkefly, the health minister in the Pakatan-led administration from 2018 to 2020, had defeated Tengku Zafrul in the battle for the Kuala Selangor seat.

Political analyst Oh Ei Sun, a senior fellow at the Singapore Institute of International Affairs, said the Cabinet appointments could appease those supporting the unity government “for a while, perhaps”.

He said the political parties would be “temporarily satisfied” with their allocated representation in the Cabinet.

“But politics nowadays is so fluid that anything could change rapidly,” he added.

Oh, however, conceded that the ministerial appointments reflected the proportion of the various parties in the administration.

“It is, in essence, a coalition government,” he added. 

 By TARRENCE TANRAGANANTHINI VETHASALAM

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Saturday, December 3, 2022

A unifying PM is what we need , Rebooting the economy

  


 
 



New Prime Minister Datuk Seri Anwar Ibrahim has been welcomed by many like a breath of fresh air. But can he cleanse the nation of the many ills it now suffers? It remains to be seen.

MY retired brother called from Penang the other day. He had yet to get his pension and needed some cash. Why? I asked. “Anwar has won and I want to celebrate with my friends,” he cheered. He is just one of many who are anamoured of our new Prime Minister.

There is also this man in Bukit Mertajam, Datuk Seri Anwar Ibrahim’s hometown, who is buying everyone meals at restaurants around town.

Elsewhere, a large non-Muslim crowd gathered outside a mosque as Anwar prayed inside. And they mobbed him when he came out. Everywhere he goes, the PM is being cheered.

He’s probably the most welcomed Malaysian chief executive in living memory. It’s all quite exciting, but I think the celebrations are also a bit premature.

Yes, it has been a long wait for him, his supporters and those who have been rooting for him all these years. He has been the underdog, facing failure after failure, falling every time he believed he had reached the pinnacle.

It’s the kind of story that would touch any heart.

But it’s only the beginning. Now is not the time to put him on a pedestal. He has much to prove, and he could fall off that high horse any time, just as the last three prime ministers did.

The plotting is going on. Those who do not like the idea of him being PM will do their best to bring about his downfall.

It happened before in 2020 with the Sheraton Move; and even days after Anwar’s appointment, there was talk of a Tropicana Move.

That has been denied, but his performance will be under intense scrutiny. There will be little room for relaxation.

His first task just got done. He has named his full Cabinet, obviously done with much juggling, putting together a unity government that will keep everyone happy and yet meet his promise of a small Cabinet.

If that was hard, the really herculean task awaits now.

There is so much wrong with our country now – an economy in the doldrums, a ringgit that’s floundering, an education system that’s well off the mark, and a population that’s deeply divided.

There’s so much to do – or undo.

I say undo because Anwar himself may be responsible for some of those maladies. He was once Education Minister – way back in 1986 – and started a revolution in the system.

He is the man credited with Islamisation of our schools, and the growth of religious schools, while working with then Prime Minister Tun Dr Mahathir Mohamad.

Those actions have come back to bite him, say analysts. Two weeks ago, his daughter lost the Permatang Pauh seat, held by members of his family since 1980, to a tahfiz teacher.

Anwar, and his Angkatan Belia Islam Malaysia (Abim), were the driving force behind such schools.

The children in many of these schools are being taught to only vote for a certain party, and with Undi18 now law, there was a flood of such voters, the analysts say.

With the mushrooming of religious schools, the days when children of all races laughed, played and mixed in schools seem to be long gone.

Now, schools are divisive. Even the syllabus has been questioned with Malays themselves asking why there are so many religious classes and too few teaching modern-day living skills like English, science and technology, computer know-how and things like that. 

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The Chinese and Indians are flocking to vernacular schools, leaving the national school system largely to the majority Malays. So many Malays are also migrating to these vernacular schools.

Already, there is a call for one stream of education for all. I think it’s too early for that too. We first need to make the national school system the one of choice. For that, a good Education Minister is needed, as is a revamp of the school syllabus. Fadhlina Sidek and Datuk Seri Khaled Noordin have a lot to do.

We have heard the perennial complaints – discrimination in matriculation places, the closure of canteens during Ramadan, children forced to eat in the toilet and odd corners, non-Muslim children being left to their own devices during agama classes ... the list is long.

Public universities too need to be places where a Malaysian identity can be forged, not where differences are reinforced.

A National Unity Minister who sincerely believes in his job could be a big help. Aaron Ago Dagang, a man from Sarawak, could be the right choice.

There is a lot we can learn from the Borneo states, which have retained much of the old-world charm that places like George Town, Klang, Johor and even Kuala Lumpur once had; the days when Chinese coffee shops housed nasi kandar stalls and people of all races sat together at the same table, eating and drinking together.

Even my mee jawa man had prawn and beef broth for his different clientele, each with a different wok.

Then there’s the minister for Religion. We have all heard about the one from Indonesia; his mantra is that he is a minister for all religions – Islam, Christianity, Hinduism or Buddhism.

It was not so the last time for the minister in Malaysia. He believed his job was only to cater to the religion of the federation.

What we need is a minister who looks at the similarities among religions, all of which preach peace and unity, not one who considers his religion superior and therefore untenable with the others.

The Rulers have got it right. They have called for an end to all extremism, religious or racist, and for unity to be the main consideration. It is important that the government works towards bringing the bitterness to an end.

“I hope there are no more leaders who will raise racial or religious issues to provoke the people,” said Negri Sembilan’s Tuanku Muhriz ibni Almarhum Tuanku Munawir.

They also want the Rukun Negara, whose first tenet is “Belief in God”. It does not say which religion. The supremacy of the Constitution and the rule of law are also important.

Now, it is up to the new PM. He has his job cut out for him. The honeymoon with the voters and adulation of the supporters will be over real soon.

The work – and it’s a lot of hard work – will have to begin. The pitfalls and booby traps are many. His supporters have faith that he will make it.

Five years from now – if Anwar succeeds as a unifying PM – we can celebrate as a nation. For now, though, I am holding that champagne, or non-alcoholic beer as the case may be. 

 by Dorairaj Nadason  

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Rebooting the economy 

 Anwar says he took Finance Ministry to bring new policies 


PUTRAJAYA: Prime Minister Datuk Seri Anwar Ibrahim, who appointed himself Finance Minister in his new Cabinet, is hoping to restore economic confidence through new policy approaches.

“I was not inclined (to take on the post), but I want to embark on new policy approaches and restore economic confidence among local traders as well as foreign investors.

“I will be assisted by a strong team that isn’t only civil servants, but also a group of advisers who will not burden the government’s coffers,” he said in announcing his Cabinet at Perdana Putra here yesterday.

In the follow-up press conference, Anwar said the Finance Ministry will be assisted by several advisers led by former PETRONAS president and chief executive officer Tan Sri Mohd Hassan Marican.

Meanwhile, Anwar said the new Cabinet members will be sworn in at 3pm today.

“I will have a special meeting with the ministers so I can convey several matters to them, such as new rules, direction, and new methods,” he said.

Anwar said ministers should begin their duties soon and he advised them to avoid wastage, bribes and power abuse.

“I have made it clear to the Cabinet that the unity government prioritises good governance and the need to reduce the people’s burden, as well as stimulating the economy,” he said.

The Prime Minister said his Cabinet, which comprises 28 ministers, is a clear signal to the people that the unity government, together with the civil service, will ensure its promises to the people are fulfilled.

The last prime minister who also served as a finance minister was Datuk Seri Najib Razak.

Anwar had served as finance minister and deputy prime minister to then premier Tun Dr Mahathir Mohamad before being sacked in 1998.

By TARRENCE TAN   Source link

 

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. Malaysia's newly appointed Prime Minister Anwar Ibrahim, right, and his wife Wan Azizah take part in the swearing-in ceremony at the Nat.

 

Friday, December 2, 2022

PM Anwar Ibrahim announced Malaysian new cabinet


 

 

CLICK HERE TO VIEW THE LIST 

CLICK HERE TO VIEW THE LIST


PETALING JAYA: Datuk Seri Anwar Ibrahim has named Datuk Seri Dr Ahmad Zahid Hamidi from Barisan Nasional and Datuk Seri Fadillah Yusof from Gabungan Parti Sarawak (GPS) as Deputy Prime Ministers in his Cabinet line-up.

Anwar will also be the Finance Minister, and Fadillah will also be the Plantations and Commodities Minister.

The Pakatan-led unity government will see Datuk Seri Saifuddin Nasution Ismail helming the Home Ministry, while Anthony Loke will be the new Transport Minister.

Dr Zaliha Mustafa will be the new Health Minister.

The other names and positions in the newly-formed Cabinet line-up are:

Economy – Pandan MP Rafizi Ramli

Local Government – Teluk Intan MP Nga Kor Ming

Defence – Rembau MP Datuk Seri Mohamad Hasan

Works – Kapit MP Datuk Seri Alexander Nanta Linggi

Home – PKR secretary-general Datuk Seri Saifuddin Nasution Ismail

Digital Communications: Fahmi Fadzil

International Trade and Industry – Datuk Seri Tengku Zafrul Tengku Abdul Aziz

Higher Education – Kota Tinggi MP Datuk Seri Mohamed Khaled Nordin

Science and Technology – Tg Malim MP Chang Lih Kang

Women, Family, and Community Development – Batang Sadong MP Datuk Seri Nancy Shukri

Domestic Trade and Cost of Living – Pulai MP Datuk Seri Salahuddin Ayub

Law and Institutional Reforms (PM’s Department) – Pengerang MP Datuk Seri Azalina Othman Said

Natural Resources, Environment, and Climate Change – Setiawangsa MP Nik Nazmi Nik Ahmad

Foreign Affairs – Barisan Nasional secretary-general Datuk Seri Zambry Abdul Kadir

Entrepreneur Development and Cooperatives - Datuk Ewon Benedick

Tourism - Datuk Seri Tiong King Sing

Education - Fadhlina Sidek

Unity - Datuk Aaron Ago Dagang

Religous Affairs - Datuk Seri Mohd Na’im Mokhtar

Youth and Sports - Hannah Yeoh

Health Minister: Dr Zaliha Mustafa

Sabah and Sarawak (PM's Department) - Datuk Armizan Mohd Ali

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Thursday, December 1, 2022

Inflammatory bowel disease can significantly disrupt a person's daily life

 

IBD comprises of two conditions: CD, which is inflammation of one or more parts of the intestines (left), and UC, which is inflammation of the large intestine. — Images: Prof IDA NORMIHA HILMI

 

Getting the occasional abdominal pain and diarrhoea is common for all of us, but if these symptoms consistently recur, do get yourself checked.

You could have inflammatory bowel disease (IBD) – a term used to describe two conditions: ulcerative colitis (UC) and Crohn’s disease (CD).

Like its name suggests, IBD patients have an inflamed gut, and present with pain at the site that is inflamed.

UC only affects the colon (large intestine), while CD can affect any or several parts of the digestive tract.

Other symptoms may include bloody stools and loss of appetite.

As the symptoms are non-specific, patients are normally treated for acute gastroenteritis or misdiagnosed as having irritable bowel syndrome (IBS) – a functional gastrointestinal disorder characterised by abdominal pain and altered bowel habits.

“IBD is an autoimmune disorder, where your immune cells attack your bowel.

“Our prevalence is low compared to Caucasian or East Asian populations, with less than 10 per 100,000 population; Australia has 125 per 100,000 population.

“But it is still a concern, in line with other growing autoimmune disorders,” says Universiti Malaya Medical Centre professor of medicine Dr Ida Normiha Hilmi.

The senior consultant gastroenterologist adds: “We don’t know why it happens or what triggers it, although there are many postulations.

“These include something in our environment, something we’re doing, changes in our diet that has become more Westernised, one too many courses of antibiotics, stress, smoking, pollution, lack of breastfeeding or a childhood virus.

“Or it could be related to the hygiene hypothesis.

“Your immune system is meant to be exposed to a lot of bacterial pathogens at an early age, but if the environment has been sterile, then it doesn’t know how to process all these things later on and processes them in an abnormal way.

“Once that occurs, it doesn’t switch itself off and there’s no way to reset it.”

One of Prof Ida’s colleagues in India has performed mobile colonoscopies in rural areas of that country and found no cases of IBD; however, the locals there had a lot of worms in their guts.

“Worms are protective against IBD – they sort of modulate the immune system and there is a symbiotic relationship,” she points out.

Late diagnosis

IBD a disease that is diagnosed in the young (ages 15 to 40), with a median age of 29; however, there is an increasing trend in the paediatric population.

An endoscopic image of a normal, healthy colon..An endoscopic image of a normal, healthy colon.>>

It’s not always easy to identify whether the patient has CD or UC, although UC is more common than CD.

“If the doctors don’t know, these patients are placed in the IBDU (IBD unclassified) category,” says Prof Ida, whose youngest IBD patient is 12 years old.

“You’ll be surprised at how many people wait for a year or two before getting treated – the inconsistent pattern of pain often confuses patients and it is normal for them to lose up to 20kg.

“They may go to the general practitioner, get some antibiotics and don’t seek further help.

“Or after several episodes, they finally decide to go to a specialist – maybe all diseases are like that in Malaysia – hence, awareness is very important.

“What they don’t realise is that if the disease is not treated, there is an increased risk of developing colon cancer.”

UC patients can also experience back and knee pain, skin rashes, and liver abnormality – every system can be affected – while CD patients tend to have specific areas affected.

The IBD specialist explains: “The whole gastrointestinal tract is very long, and in a lot of cases, when a CD flare-up happens, it tends to be in the predominant location, i.e. the common location, which is the lower right side (terminal portion of the ileum) – almost the same area as the appendix, which initially raises the suspicion of appendicitis.”

She adds: “There is some old data that shows patterns where if you get IBD once, you will never get it again, but from my experience, it’s rare.

“The disease will recur without treatment.

“It’s not a cure, but with treatment, you can remain in remission.”

Therapy for life

Treatment involves two therapies: induction and maintenance.

This endoscopic image shows deep longitudinal ulcers in the colon of someone with CD.This endoscopic image shows deep longitudinal ulcers in the colon of someone with CD >>

The induction therapy is intended to act fast to provide symptomatic relief, with the mainstay being steroids.

Prof Ida says: “It’s cheap, it works and it works fast, but there are long-term side effects – it thins your bones and causes obesity.”

She notes that the energy boost from the steroids also makes some patients feel better.

However, she adds: “Your adrenal glands that are producing your own steroids are suppressed with chronic steroid use and we have seen patients with Addison’s crisis, where the body is not able to produce steroids any more.

“We never want to give steroids as long-term therapy – we try to stop it within three months.

“If you taper it down and don’t give time for the other immunosuppressive drugs to work, especially slower-acting ones, the symptoms will return, so it’s a balancing act.”

For maintenance, a new group of drugs called biologics work well and have a good safety profile.

The drawback: they’re expensive and range from RM20,000 to RM50,000 annually.

“That’s the difficulty I face with my IBD patients,” Prof Ida laments, “because I’ve to think of costs all the time, especially for the ones without insurance.

“For this reason, I take part in a lot of clinical trials as that allows me to put patients on free drugs.

“Usually, when we get the drugs, we’re already on phase three trials and there are not many concerns as we are not guinea pigs.

“Or we seek funds from charities, non-governmental organisations, etc – that’s the reality.

“The Health Ministry hospitals also have their own free quota, e.g. five patients a year – the rest have to pay.”

For those on clinical trials, the good news is that they can get free drugs for quite a long while.

One of Prof Ida’s patients took part in a landmark IBD study and got free drugs worth about RM48,000 a year for a decade.

Most clinical trials entail a three-month induction and 12-month maintenance timeline.

Every patient usually wants to know when he or she can stop treatment; they think the diarrhoea should resolve with a course of antibiotics.

“The concept of long-term treatment is difficult for them to understand.

“I guess it’s hard when you’re young and have to be on drugs forever, but older people are more accepting,” she says.

“The patient’s function is very much affected as IBD occurs amongst young professionals in high-performing jobs, hence I try to normalise their lives as much as possible.”

For those who don’t succeed with medical therapy, they have to undergo surgery to resect their bowel.

In the past, the figure was 70%, but with better medications these days, the figure has gone down to about 20-30%.

What about foods?

“Before, we didn’t really know what to tell our patients in terms of diet, except to have a low-fibre diet, because when your colon is inflamed, the bowel is narrowed, and if you take too much fibre, it may block your passage.

“Now, we’re looking at anti-inflammatory diets, although we’re still far from anything concrete.

“My paediatric colleagues practise entero-nutrition (delivered into the digestive system as a liquid) for six weeks, but maintenance is difficult as you can’t be on liquid nutrition for the rest of your life,” says Prof Ida.

She suggests, however, that patients try to reduce pro-inflammatory foods, such as those with high fat content.

When it comes to herbs, she says turmeric might help, but the dose has to be right.

“If you have a bad case of UC, you still need biologics as turmeric is not going to save you.

“Everyone is also asking about probiotics.

“Not all probiotics in the market are medical grade, but if my patients want to take it and it makes them feel better, I don’t stop them.

“Our gut consists of trillions of gut microorganisms and taking a tablet or two a day is not going to touch the diversity or repopulate the microbiome.

ALSO READ: Think you know all about probiotics? Then take this quiz

“When the colon is inflamed, the pathogenesis is very complex – we think something is happening at the gut level, maybe a breach of some bacteria into your gut wall – and sometimes, the immune system goes awry.

“But there is also something else that is causing this and we can’t quite pinpoint it.”

The inheritance pattern of this condition is unclear, although some studies show that having a family member with IBD increases the risk of developing the condition.

However, Prof Ida has two sets of identical twin patients.

In one set, only one twin has UC, and in the other, only one twin has CD.

They grew up in the same environment, ate the same foods, and have the same genes, which indicates that some other factor is playing a role in the disease.

Our gut microbiome is developed by the time we’re one-year-old and that’s the one we keep, with minor alterations over the years.

She says: “When you go to another country, it may change a bit, but when you go back to your own country, it generally goes back to your original gut microbiome.”

ALSO READ: The good gut bacteria in our microbiome might be disappearing

Storing and transferring poo

Stool samples being processed for screening during the gut microbiome donation process. — Amili 
Stool samples being processed for screening during the gut microbiome donation process. — Amili

Faecal microbiota transplantation (FMT) is the transfer of faecal material from a healthy individual to another person with the aim of treating a disease.

It can be described as a form of probiotics as it pumps in a much greater number and diversity of bacterial strains than any available probiotic.

The concept is not new and the use of FMT was first described in China in the 4th century by Ge Hong when “yellow soup” – a faecal slurry – was administered for the treatment of severe food poisoning and diarrhoea.

And in fact, this was a practice that continued for centuries.

Bedouin groups also consumed the stools of their camels as a remedy for dysentery.

“FMT is an option for patients with recurrent or refractory Clostridium difficile (an overgrowth of this bacteria, also known as C. diff) as it has a cure rate of over 90% and can repopulate the good bacteria.

“Sometimes, C. diff can be difficult to kill, especially in older patients – it causes inflammation, and in bad cases, even death.

“FMT can also be used as a therapy for IBD, but because it is unable to be sustained long term as your own gut microbiome returns after a while, the disease comes back,” explains Prof Ida.

FMT preparations can be delivered via capsules, colonoscopies, nasoenteric tubes and enemas.

In this region, Singapore is the only country that has a gut microbiome banking service, provided by a company called Amili.

According to Amili’s head of clinical affairs, product lead, Dr Saishreyas Sundarajoo, stool donors must undergo rigorous screening, which includes a lifestyle/health survey, interview with a clinician, blood testing and stool testing.

“In the final stool test, we screen for potential gastrointestinal bacteria, viruses and parasites.

“These include MRSA (methicillin-resistant Staphylococcus aureus), C. diff, SARS-CoV-2 and more.

“The good bacteria we screen for include Bifidobacterium longum, which helps break down food, absorb nutrients and fight off bad organisms that might cause diseases, and Bifidobacterium breve, as studies have linked its shortage to antibiotic-associated diarrhoea, allergies, gas and IBS,” he says.

Applicants who pass the stool testing are qualified FMT donors for a span of eight weeks.

The samples are periodically tested in between the eight-week cycle for quality assurance,

The donor stools are then cryopreserved in Amili’s partner company Cordlife’s facility and shipped to other countries when there is a request.

Once the stool arrives at its destination, the doctor will thaw it out just before administering it into the patient via colonoscopy.

Prof Ida concludes: “Patients need to understand that disease control is important, and if all therapies fail, surgery, despite its drawbacks, is the only option.” - By Revathi Murugappan

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