To answer this, it really is a very tricky one. There are always two sides to a story when it comes to this. One believes that juicing is unhealthy than eating whole fruits due to the loss of fibre throughout the process, which makes fructose (sugar in fruit) absorb even quicker as compared to when it is combined with fibre, thus making it less healthy (1).

Another belief is that juicing is better than eating whole fruits and vegetables because the body can absorb them better and let the digestive tract rest from digesting fibre. If one considers blending fruit, that is even better since the edible fibre in it makes us feel full, so it promotes satiety (1).

So should we consider juicing, blending, or just eating raw fruits and vegetables?

Three longitudinal prospective cohort studies found that greater consumption of fruits such as blueberries, grapes, apples, bananas, and grapefruit reduced the risk of type 2 diabetes, while greater consumption of fruit juice was associated with an increased risk of type 2 diabetes (2).

When fruit is squeezed for its juice, what is left inside is basically sugar, vitamins, and antioxidants such as carotenoids, etc.; thus, it is healthier in this aspect as compared to frizzy drinks (3). However, the amount of sugar inside both of these drinks is about the same, which is about 20–26 g of sugar per cup (3).

The reason why fruit juice contains a higher sugar content as compared to fresh fruit even when it is 100% fruit juice without the addition of anything else is because, for example, in order to make 250 ml of orange juice, two medium-sized oranges are needed, and that is only 250 ml. Since when it is in liquid form, people tend to consume it even more, thus more fruits are needed. As the number of fruits increases, so does the sugar in them, but not the fibre inside, which in turn makes them have loads of sugar (1, 3, 4, 7, 8).

According to the Singapore Health Promotion Board, many people may think that naturally occurring sugar is healthier than added sugar, but actually there is no chemical difference between the two, and they have the same impact on blood sugar levels when ingested (8).

The same case goes to smoothies, not only because they have a lot of sugar from a large number of fruits, but also because various protein-based foods like yoghurt, milk, almond milk, etc. that are mixed together with them will increase their calories as well (4).

The high sugar levels in both of these drinks make them high-calorie beverages and thus pose the same effect as high-calorie food, which can lead to weight gain. As we know, Malaysia is the fattest country in Southeast Asia, and one of the contributing factors is a lack of knowledge on what can increase weight and what cannot.

Weight gain is linked to many health problems, such as heart diseases, metabolic syndrome, cancer, bone and joint problems, kidney problems, etc. (3).

A study on the composition of grapefruits with different methods of household processing also found out that the composition of antioxidants in blended grapefruit has a higher concentration of the beneficial compound as compared to juicing or hand squeezing (5).

However, as for the absorption of beta carotene, a study found that fruit and vegetable juice makes beta carotene absorb better as compared to blending or eating raw fruit. This is due to the fact that fibre hinders the absorption of beta-carotene (6).

The takeaway message

Eating raw fruit, juicing, and blending all have their pros and cons. What is important is to always take into account the amount of sugar and fibre content. All in all, make sure that you have a balanced, nutritious, and moderate diet as suggested by the Ministry of Health: eat 3 servings of vegetables per day and 2 servings of fruits per day. Vary the way vegetables and fruit are cooked or served and eat them in moderation.

References

1. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/juicing/faq-20058020

2. MurakiIsao, ImamuraFumiaki, Manson JoAnn E, Hu Frank B, Willett Walter C, van Dam Rob M et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies BMJ 2013; 347 :f5001. https://www.bmj.com/content/347/bmj.f5001

3. Healthline (n.d). Is Fruit Juice is as Unhealthy as Sugary Soda? https://www.healthline.com/nutrition/fruit-juice-vs-soda#sugar-content

4. Healthline (n.d). Juicing vs Blending: Which one is better for me? https://www.healthline.com/health/food-nutrition/juicing-vs-blending

5. Ram M Uckoo1, Guddadarangavvanahally K Jayaprakasha, V M Balasubramaniam, Bhimanagouda S Patil. Grapefruit (Citrus Paradisi Macfad) Phytochemicals Composition Is Modulated by Household Processing Techniques.

6. Julia K Kolodziejczyk1, Shirley W Flatt, Loki Natarajan, Ruth Patterson, John P Pierce, Gregory J Norman. Associations of Soluble Fiber, Whole Fruits/Vegetables, and Juice With Plasma Beta-carotene Concentrations in a Free-Living Population of Breast Cancer Survivors. Women Health 52(8). DOI: 10.1080/03630242.2012.728189

7. How many orange does it take to make a cup of orange juice? (n.d). https://www.eatdifferentrd.com/blog/2016/8/12/how-many-oranges-does-it-take-to-make-a-cup-of-oj

8. Chanel News Asia (CNA) International (2019). That cup of fresh fruit juice could contain as much sugar as a soft drink. https://www.channelnewsasia.com/news/singapore/fruit-juice-sugar-diabetes-health-risks-soft-drink-11708652

“Eat more vegetables and fruits to get your fiber!” You may have heard these words. But what is fiber, really? How it works to improve our health? Let us take a closer look on it!

Fiber is a type of carbohydrate that our body cannot digest undigested. Though most carbohydrates are broken down into sugar molecules but fiber cannot be broken down into sugar and thus it will pass through our body. These carbohydrates often considered beneficial in which mostly come from fruits, vegetables and legumes (1, 3, 6).

Soluble fiber

Dissolves in water; absorb water to form a gel like substance that slow the digestion and cause you to feel full. They have been shown to decrease cholesterol and lower blood glucose. Common source of soluble fiber includes beans, oat bran, fruits and vegetables. It is also found in pysllium, a common fiber supplement.

Insoluble fiber

Does not dissolve in water; Increase fecal bulk and appear to help food pass more quickly through the digestive tract so it can be of benefit to those who struggle with constipation and irregular stools.

 Facts About Fiber (3,4)

#1 Fiber aids in achieving healthy weight.

#2 Fiber fight diseases. It appears to reduce risk of developing various health conditions including heart disease, diabetes, constipation and breast cancer.

#3 Fiber helps to lower cholesterol.

#4 Fiber helps to regulate blood glucose.

#5 Recommended dietary fiber intake per day for all age group is 20-30g/day. However, if a person is not currently eating enough of fiber, he or she should increase his or her fiber intake slowly  to avoid gas and bloating.

#6 More fiber needs more water. When eating a high fiber diet, be sure to drink at least eight or more glasses of water every day.

#7 Fiber aids in improving digestion by increasing stool bulk and regularity. A high-fiber diet may help reduce the risk of hemorrhoids and diverticulitis.

#8 Too much fiber is a bad thing. You may experience abdominal cramping, bloating, gas, constipation and even diarrhea.

#9 Fruit and vegetable peels are rich in several nutrients including fiber. Eating unpeeled fruits and vegetables keep you feel full longer due to its high fiber content. However, certain fruit and vegetable peels may be hard to consume or simply inedible. These peels are best removed and not eaten.

#10 Fruits and vegetable juice has less fiber than whole fruits and vegetable. This is because the skin is removed and thus it is more healthful to eat whole fruit and vegetable.

#11 Fiber cannot be cooked out.

Tips to Increase fiber intake (5,7)

Consume products that have whole grain listed as the first ingredients, high fiber content and low fat and sugar content.

Replace white rice, bread and pasta with brown rice and whole grain products.

Include legumes in your diet (beans, dried peas and lentils)

Eat unpeeled whole fruit and vegetables not juice.

Snack on fruits and vegetables

Take a fiber supplement (e.g psyllium)

In conclusion,

Fiber is an important dietary substance to your diet. This is because high fiber foods are also good sources of vitamins, mineral and antioxidants which offer many health benefits. Therefore, as one of the key ingredients to healthy eating, fiber is something you cannot skip.

References

1. Cleveland Clinic. 2019. Improving Your Health With Fiber. Available from https://my.clevelandclinic.org/health/articles/14400-improving-your-health-with-fiber [Accessed on 23 April 2020].
2. Danielle, D. 2018. How much fiber is too much. Medical New Today. Available from https://www.medicalnewstoday.com/articles/321286#treatment [Accessed on 23 April 2020].
3. Harvard University School of Public Health. (n.d.). Fiber. Available from https://www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber/ [Accessed on 23 April 2020].
4. Karin, L. 2016. 45 Interesting Facts about FIber. Fact Retriever. Available from https://www.factretriever.com/fiber-facts [Accessed on 23 April 2020].
5. Kerri, A., J. 2016. 16 Easy Ways to Eat More Fiber. Healthline. Available from https://www.healthline.com/nutrition/16-ways-to-eat-more-fiber [Accessed on 23 April 2020].
6. Mayo Clinic. 2018. Dietary fiber: Essential for a healthy diet. Available from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983 [Accessed on 23 April 2020].
7. My Health Ministry of Health. 2012. SERAT DAN KAWALAN DIABETES. Available from http://www.myhealth.gov.my/serat-dan-kawalan-diabetes/ [Accessed on 23 April 2020].

Blood glucose is the primary source of energy, and it is derived from the food that we eat. To convert this energy from food that we consume to cells, our bodies require a hormone called insulin, which is produced in the pancreas. With the help of this insulin hormone, energy from food is then converted into cells. When the body is unable to produce enough or any insulin, or when insulin is not used effectively, glucose or sugar remains in the blood and does not reach the cells (2).

Too much glucose in the blood can cause health problems over time. Although there is no cure for diabetes, individuals can take steps to manage their diabetes and stay healthy. Diabetes complications include cardiovascular disease, diabetes neuropathy (nerve damage), nephropathy (kidney damage), retinopathy (eye damage), and many others.

In this article, we will concentrate on the complication of nerve damage, also known as neuropathy. Excess sugar can cause damage to the walls of the tiny blood vessels (capillaries) that nourish nerves, particularly in the legs. This can cause tingling, numbness, burning, or pain, which usually starts at the tips of the toes or fingers and spreads upward. If left untreated, the individual may lose all feeling in the affected limbs (4).

Many studies are being conducted in an effort to reduce the risk of diabetic neuropathy complications, one of which is the use of Alpha Lipoic Acid (ALA). ALA is a type of antioxidant found in a variety of foods, but in very small amounts. Foods containing it include spinach, broccoli, yams, tomatoes, potatoes, carrots, beets, and rice bran. Whereas in animal-based food, the heart, liver, and kidney have higher concentrations of lipoic acid (LA) (5).

Lipoic acid (LA) can be synthesized by the human body in the liver. LA or ALA performs functions such as glucose and lipid metabolism, anti-inflammation, antioxidant property that can be used to regenerate other antioxidants, protein repair, and metal ion chelation. ALA, on the other hand, increases insulin sensitivity in people with diabetes (6).

As an antioxidant, ALA or LA aids in the fight against free radicals or oxidative stress caused by three pathways in the body of people with diabetes mellitus: mitochondrial, enzymatic, and non-enzymatic. Concerning the function of ALA in diabetes, several clinical trials have discovered that ALA may increase insulin sensitivity and help to reduce blood sugar and lipid levels.

There are two detailed studies involving this, in which ALA is administered for two weeks to 22 patients and improvements in fasting and average glucose levels, insulin sensitivity, LDL and HDL, and total cholesterol are seen, but the study is too short to measure the HBa1C level. So, another study related to this is the one that administered ALA orally to 74 patients for 4 weeks and discovered improvements in insulin resistance and fasting glucose (7).

Regarding the sole function of ALA on diabetic neuropathy, it is a possible alternative treatment for diabetic neuropathy. Diabetes causes neuropathy, or nerve damage, which is a permanent and common complication. However, ALA can help to alleviate the symptoms (8).

There are two types of neuropathy, the first of which is peripheral neuropathy, which most commonly occurs in the feet and legs but can also sometimes occur in the hands and arms. It can also cause numbness or the inability to feel changes in temperature, tingling or burning sensations, muscle weakness, a loss of balance, foot problems including ulcers or infections, sharp pain, or cramps. Whereas autonomic neuropathy can affect your autonomic nervous system, such as your heart, bladder, lungs, stomach, and intestines, this includes difficulty swallowing, constipation or uncontrollable diarrhea, bladder problems, erectile dysfunction, a decrease or increase in sweating, sharp drops in blood pressure, and many more (8).

In conclusion, studies show that ALA is able to help alleviate the symptoms of diabetes and diabetic neuropathy. However, the right management of diabetes, such as the intake of its medication, such as metformin, and diet control, together with physical activity, must be done side by side.

References

1. National Institute if Diabetes, Digestive and Kidney Disease (NIDDK). United States Department of Health and Human Services. What is Diabetes? https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes#:~:text=Diabetes%20is%20a%20disease%20that,to%20be%20used%20for%20energy. (Accessed on June 16, 2020).
2. National Diabetes Institute of Malaysia (NADI). https://www.diabetesmalaysia.com.my/article.php?aid=8#:~:text=Your%20target%20blood%20glucose%20levels,in%20the%20last%203%20months. (Accessed on June 16, 2020).
3. Clinical Practice Guideline (CPG) for Management of Diabetes Mellitus Type 2. 5th Ministry of Health Malaysia (MOH). https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Endocrine/3b.pdf (Accessed on June 16, 2020).
4. Mayo Clinic. Diabetes. https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444 (Accessed on June 16, 2020).
5. Alpha Lipoic Acid Supplement. https://www.webmd.com/diabetes/supplement-guide-alpha-lipoic-acid (Accesed on June 16, 2020).
6. Saeid Golbidi, Mohammad Badran and Ismail Laher. Diabetes and Alpha Lipoic Acid (2011). Frontiers in Pharmacology. Journal of Pharmacology.NCBI. DOI 10.3389/fphar.2011.00069
7. Diabetes Action. Alpha Lipoic Acid. https://diabetesaction.org/article-alpha-lipoic-acid#:~:text=While%20most%20of%20the%20research,of%20oxidative%20stress%20and%20inflammation. (Accessed on June 16, 2020).
8. Alpha Lipoic Acid (ALA) and Diabetic Neuropathy. https://www.healthline.com/health/alpha-lipoic-acid-and-diabetes (Accessed on June 16, 2020).

Durian or ‘King of fruit’ is a well-known fruit for its smell. Anthony Bourdain, the late renowned food critic describes durian as “It smelled like you buried someone holding a big wheel of Stilton (cheese) in his arms, then dug him few weeks later” (1). That is to describe how horrible the smell of durian is, but to certain people who like to eat durian the smell of durian to them is heaven!

Durian actually has more than 30 species but the one that people usually eat are about 8 species only, due to its exotic nature, people have started to commercialized durian even to the international level. The most common durian being exported and widely consumed is Durio Zibethinus (2).

Due to its popularity, people started to questioning about durian health benefits, whether it is good or bad for health? Unlike apple, orange, guava and many other common fruits where people always equate it to “an apple a day keeps the doctor away” which means, consuming all these fruits are going to make you healthier, since it is packed full with nutrients that is good for body. For durian, the opinion regarding its health effect is mixing, some people say that it is good for health and can even be used to alleviate infertility or PCOS, Polycystic Ovarian Syndrome  and some people say that it is heaty thus cannot be consumed too much etc. (3).

In general, durian is considered a safe fruit to eat just like any other fruit, but since durian has high calorie value, thus it is not advisable to consume in large amount unlike other fruits. Look at the infographic below to understand, calorie in durian in comparison with other fruits (4).

Here is the calorie of durian per seeds, surprisingly eating  5 seeds of durian is equivalent to a bowl of rice! ANDDDD IF A DURIAN CONSISTS OF 15 SEEDS IT IS EQUIVALENT TO 3 BOWL OF RICE! Thus, the recommended intake of durian is only 2-3 seeds, which is equivalent to about per serving of fruits or 90 kcal.

Though, it is crystal clear here that it is safe to eat durian within recommended amount, but there are people who should be even more cautious in consuming durian, that is people who are obese, people who have diabetes and people who have kidney problem. As for people who are obese and diabetes, it is due to its high calorie, high carbohydrate and high fats value thus should be extra careful on the consumption of durian. Whereas for people with kidney problem or undergoing dialysis, due to high potassium content in durian and it is difficult for their body to excrete potassium, thus, they must avoid eating TOO MUCH durian at all cost (4)!

Apart from its high calorie content durian has many benefits as well. It has high antioxidant effect, which makes it a potent fruit to fight against cancer. Durian contains high vitamins, nutrients and organic chemicals that function as antioxidant. All these antioxidants are vital in scavenging the free radicals, that potentially mutated and becoming cancer cells. Which is why it is very important to consume food that is high in antioxidant. It also contains high vitamin C, vitamin B complex and vitamin E, as well as phytonutrients that battle cancerous cells (2).

Durian also, is found to helps in maintaining healthy bones due to its high potassium content. It can help in alleviating depression and sleeping problem, for it contain tryptophan – a natural sleep-inducing compound, that can increase level of serotonin and melatonin for better sleep and emotion management. Durian also contain high fibre which can aids in digestion and helps in infertility for it has high estrogen hormone for conceiving (2).

Albeit durian has many health benefits, when it comes to its consumption with other foods and beverages such as alcohol, it is said that it can interfere with liver function. In detail, durian contain sulphur-containing volatiles which can inhibit the enzyme aldehyde dehydrogenase (enzyme that helps in process alcohol), thus explaining why consuming durian together with alcohol is a deadly mixed (4).

As for the consumption of durian with paracetamol, there is no study on human has been conducted, so far. But there is study on lab rat regarding this. The study shows that, rat that receive paracetamol and durian gives sign of hypothermic effect (significant drop in temperature) thus explain that the two mixture is toxic. However, the mechanism of toxicity is still unknown. To be safe, it is not safe to consume durian together with paracetamol (5).

In conclusion, for people who does not have any health concerns, consume durian within the recommended intake and consume it in moderation, is very much advisable. While for those who have health concerns, eat durian very minimally, it is advisable to eat other types of fruit that have lower calorie count as compared to durian, but since it is in the season thus consume it very minimally with caution towards calorie intake from other food types as well is recommended.

References

1. The Star. Benefits of eating durian? Its rich in antioxidant but its fattening (2019). https://www.thestar.com.my/lifestyle/health/2019/09/10/eating-durian-healthy-or-not/ (Accessed on June 17, 2020). 
2. Tan M.C & Shyamala A. (2018). Exploring the Nutritional Content and Benefits of Durian (Durio Zibethinus). Institute of Bioproduct Development, Universiti Teknologi Mara. https://www.utm.my/ibd/project/exploring-the-nutritional-contents-and-benefits-of-durian-durio zibethinus/#:~:text=Durian%20is%20widely%20celebrated%20for,and%20protect%20against%20cardiovascular%20diseases. (Accessed on June 17, 2020). 
3. Reshma M. Ansari (2016). Potential Use of Durian Fruit (Durio Zibenthinus linn) as an Adjunct to treat Infertility in Polycystic Ovarian Synrdome (PCOS). PubMed. https://pubmed.ncbi.nlm.nih.gov/26778225/ (Accessed on June 17, 2020). 
4. International Medical University (IMU). Can A Durian A Day Keep the Doctor Away? http://imunews.imu.edu.my/people/can-a-durian-a-day-keep-the-doctor-away/ (Accessed on June 17, 2020).
5. A. Chua., H. Nurhaslina., S.H. Gan. (2008). Hyperthermic Effect of Durio Zibethinnus and Its Interaction with Paracetamol. https://pubmed.ncbi.nlm.nih.gov/19271022/#:~:text=Because%20durian%20(Durio%20zibethinus)%2C,a%20risk%20of%20toxic%20effects 

L-Carnitine is an amino acid that the body produces. L-carnitine assists the body in converting fat into energy. In other words, L-carnitine aids the body's energy production. L-carnitine is essential for heart and brain function, muscle movement, and a variety of other processes in the body (1).

How does it work? 

Many studies have found that L-carnitine can improve insulin sensitivity. It improves insulin sensitivity, allowing the body to convert food into energy. Here's a general overview of how food is converted into energy or fat in the body.

Glycogen is created when food is consumed and stored in the body until it is needed again (2). Insulin is an enzyme that converts the glucose in the food into glycogen.

The Overall pathway

This is where L-carnitine plays its role. Mice fed a high-fat diet are able to lower their blood glucose levels when L-carnitine supplementation is given to them, as opposed to mice fed a high-fat diet without the supplement (3).

Another human study found the same result, which is that L-carnitine supplementation reduces insulin resistance and improves insulin sensitivity. The study also suggests that current diabetes patient management, which includes diet modification, medication administration, and physical activities, may be improved in the future with the consumption of supplements such as L-Carnitine (4). The study also suggests that consuming 3g of L-carnitine per day may improve diabetes symptoms, but this must be accompanied by medical professional consultation (4). However, some studies suggest that L-carnitine consumption may have some side effects, so the safe consumption level is less than 2g/day.

Due to the possibility that the general public might mistake it for a "magic pill" that would allow diabetes patients to eat whatever they wanted after taking it. The answer is no! A diabetes patient must still adhere to the diabetes diet, physical activity, and diabetes medication, but because diabetes is a progressive disease where the condition can worsen progressively, all actions, including supplement intake, may slow its progression (4).

Where can L-carnitine be found?

Apart from supplemented products, L-carnitines can be found naturally in foods such as beef and fish.

Beef: 81 mg/ 3 ounces

Pork: 24 mg/ 3 ounces

Fish: 5 mg/ 3 ounces

Chicken: 3 mg/ 3 ounces

Milk: 8 mg/ 3 ounces

References

1. WebMD. L – Carnitine. https://www.webmd.com/vitamins/ai/ingredientmono-1026/l-carnitine (Accessed on July 13, 2020).

2. Feedback Loop of Insulin and Glucagon. https://www.biologycorner.com/2017/08/22/feedback-loops-insulin-andglucagon/ (Accessed on July 13, 2020).

3. Randall L. Mynat (2009). Carnitine and Type 2 Diabetes. NCBI. PMC Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707127(Accessed on July 13, 2020). 

4. Mingroe, Graco et al., (1999). L- carnitine Improves Glucose Disposal in Type 2 Diabetes Patient.  https://pubmed.ncbi.nlm.nih.gov/10067662/#:~:text=Conclusions%3A%20L%2Dcarnitine%20constant%20infusion,also%20observed%20in%20normal%20subjects (Accessed on July 13, 2020).

5. Healthline. L – Carnitine: Benefits, Sides Effects, Sources and Dosage.https://www.healthline.com/nutrition/l-carnitine (Accessed on July 13,2020).

Diabetes is a type of chronic disease; it occurs when the glucose level in the blood is higher than normal. It is one of the leading causes of heart problems as well. In Malaysia, according to the National Health Morbidity Survey (NHMS) 2019, there are about 3.9 million people aged 18 years and older who have diabetes. Diabetes affects one out of every five adults, and the prevalence is higher in states such as Negeri Sembilan (33.2%), Perlis (32.6%), and Pahang (25.7%). The prevalence of people who have undiagnosed diabetes in Malaysia is high as well; undiagnosed diabetes occurs when people have never checked their blood glucose level in their entire life or check it rarely (1).

To understand diabetes better, it occurs when the pancreas in the body does not produce enough insulin anymore, or when the insulin is not working well anymore. Insulin is needed in order to transport glucose from the blood vessels to cells and tissues. When insulin is insufficient, glucose cannot be transported to the intended organ, thus causing a high glucose level in the blood vessels and causing damage to the organ and tissue that do not get sufficient glucose to function, and also causing damage to the blood vessels that are exposed to a high glucose level (2).

There are various complications due to diabetes, such as kidney problems, heart problems, diabetic food disease, nerve problems, and eye problems. A nerve problem is when a diabetic person starts to feel tingling and numbness in their peripherals (legs and hands), which is commonly referred to as diabetic neuropathy. Diabetic foot disease, or gangrene, occurs when a diabetic person is exposed to a wound. It must be handled with care since it can be dangerous to the extent of amputation. Eyes problem or diabetes retinopathy is the one that can lead to blindness, that we are going to discuss in detail in this article (2,3).

Diabetes retinopathy is the condition in which the retina is damaged, and it is a diabetic complication. When the glucose level in the blood is high, it causes a blockage in the blood vessels, causing the blood vessels to rupture easily. thus causing impaired vision and blindness (2, 3).

In the early stages, there are no significant symptoms associated with this problem; however, as things get more serious, people will experience seeing floaters or black dots in their vision. They will then start to experience obscure vision, night blindness, and diplopia (seeing a double image) (2, 3).

Risk factor to this problem includes those who have been diagnosed with diabetic in the long time (more than 5 years), those who have poor control of blood glucose level, cholesterol level, blood pressure level and low haemoglobin. Those who have gestational diabetes are also at high risk of getting diabetes retinopathy (2, 3).

There are two types of diabetic retinopathy (2,4);

Non – Proliferative Diabetic Retinopathy

Non-proliferative diabetic retinopathy (NPDR) is the early stage of the disease, in which symptoms will be mild or non-existent. In NPDR, the blood vessels in the retina are weakened. Tiny bulges in the blood vessels, called microaneurysms, may leak fluid into the retina. This leakage may lead to swelling of the macula.

Proliferative Diabetic Retinopathy

The more advanced form of the disease is proliferative diabetic retinopathy (PDR). Circulation issues deprive the retina of oxygen at this stage. As a result, new, vulnerable blood vessels can form in the retina and the vitreous, the gel-like fluid that fills the back of the eye. Blood from the new blood vessels may leak into the vitreous, clouding vision.

In order to prevent diabetic retinopathy from occurring, it is recommended for individuals with diabetes to control their blood sugar level, control their blood pressure level, stop smoking, regularly exercise, and maintain their ideal weight. Apart from these, people with diabetes may as well conduct yearly eye screenings. Eye screening for diabetics will be conducted using a fundus non-mydriatic camera, where an image of the eyes will be captured. Optometrist, eyes doctor, or eye specialist will then grade the image to see whether the eye's codition is normal or abnormal. Bleeding and swelling in the retina, an abnormal optic disk, a torn retina, and other abnormal conditions are examples of abnormal conditions. 

References

1. National Health Morbidity Survey (NHMS) 2019. Institute Kesihatan Umum (IKU), Kementerian Kesihatan Malaysia.
2. Fatanah Ismail. Diabetes Mellitus (2008). MyHealth Portal. Kementerian Kesihatan Malaysia. http://www.myhealth.gov.my/en/diabetes-mellitus-3/ (Accessed on August 21, 2020).
3. Ainayanti Adnan. Diabetis: Mesti Jalani Pemeriksaan Mata (2016). MyHealth Portal. Kementerian Kesihatan Malaysia. http://www.myhealth.gov.my/diabetes-mesti-jalani-pemeriksaan-mata/ (Accessed on August 21, 2020).
4. Diabetic Retinopathy (n.d). American Optometric Association (AOA). https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/diabetic-retinopathy?sso=y (Accessed on August 21, 2020).

Fiber is a type of carbohydrate that our body is unable to digest. Though most carbohydrates are broken down into sugar molecules, fiber cannot be broken down into sugar molecules, and instead it passes through the body undigested. Fiber helps regulate sugars in the body and helps keep hunger and blood sugar in check.

Children and adults need at least 20 to 30 grammes of fiber per day for good health. It can be obtained by consuming a diet rich in whole grains, vegetables, legumes, nuts, and fruits.

There are two types of fiber: soluble fiber and insoluble fibre.

• Soluble fiber is a type of fiber that dissolves in water and can help lower glucose levels and blood cholesterol levels. Foods with soluble fiber include oatmeal, nuts, beans, lentils, apples, and blueberries.

• Insoluble fiber is a type of fiber that does not dissolve in water. It can help food move through the digestive system, promoting regularity and helping to prevent constipation. Foods with insoluble fibers are wheat, whole wheat bread, whole grain couscous, brown rice, legumes, carrots, cucumbers, and tomatoes.

There are various studies confirming that consumption of a diet high in fiber helps to make the overall body function healthier.

Heart Health

In a Harvard study with over 40, 000 male health professionals, researchers found that consumption of a high-fiber diet reduced the risk of getting coronary heart disease by 40%. Another study conducted by Harvard among female nurses also found similar findings: a high-fiber diet lowers the risk of metabolic syndrome (a combination factor of heart disease and diabetes). These factors are high blood pressure, high insulin levels, excess weight, a high triglyceride level, and a low HDL level (good cholesterol level).