Sleep hygiene refers to a healthy routine sleep habit that helps one sleep throughout the night or get enough quality sleep. These habits are the cornerstone of cognitive behavioural therapy, the most effective long-term treatment for people with chronic insomnia.

There are certain habits that should be cultivated if you are experiencing poor sleeping habits before you opt to take medication or any remedies. You should consider practising good sleeping hygiene, such as going to bed at the same time every night and being consistent with it. Make sure the bedroom is quiet, dark, relaxing, and at a comfortable temperature. Remove electronic devices, such as TVs, computers, and smartphones, from the bedroom. Avoid large, heavy meals, caffeine, and alcohol before bedtime. Regular exercise during the day is able to make one fall asleep easily at night.

How can all these habits help you get good-quality sleep? (3)

Behaviour during the day and before bedtime has a major impact on sleep. Either it can promote healthy sleep or contribute to sleeplessness.

The daily routines that include what we consume, the medication that we take, how we schedule our days, and how we spend our evenings can significantly affect the quality of sleep. Sometimes, for a person who is experiencing trouble sleeping, it takes only a slight adjustment in their daily routines, or in some cases, they are required to write a two-week diary to help them understand their routines that affect their sleep quality.

Why is good-quality sleep important? (3,4)

Insufficient sleep has major health consequences for adults, adolescents, and young children. Strong evidence found that adults who have insufficient sleep develop numerous health complications, including an increased incidence of chronic disease. Those who have short sleep duration (less than 7 hours per night) and poor sleep quality are associated with cardiovascular morbidity and metabolic disorders such as glucose intolerance, which will also lead to obesity, diabetes, heart disease, and hypertension. Individuals who experience shorter sleep duration are at 1.48 times greater risk of developing and dying of coronary heart disease than those who have sufficient sleep, and they are 1.15 times more likely to have a stroke.

Adults who sleep less than 7 hours per night also have greater difficulty concentrating, remembering, and performing daily activities than those who sleep 7 to 9 hours per night.

When it comes to children, those who experience shorter sleep durations are more likely to become obese than those who do not. Insufficient sleep also affects immunologic function and the development of mood disorders and is associated with depression, deficits in cognition, memory, and learning, and reduced quality of life.

One major consequence of insufficient sleep is daytime sleepiness, which reduces alertness and causes slow reaction times, leading to occupational and medical errors, workplace injuries, impaired driving, and motor vehicle accidents. In 2009, almost 5% of adults in 12 states reported that during the previous 30 days they had nodded off or fallen asleep while driving. In 2005, drowsy driving contributed to 100,000 motor vehicle accidents and 15,000 deaths.

 What needs to be done? (4)

As medical practitioners such as doctors, nurses, pharmacists, nutritionists, etc., one must consider the sleeping factor when advising lifestyle modification. One must also ensure that patients or customers are well informed regarding the medication or supplement that they are taking, which will induce symptoms that hinder them from sleeping, such as tachycardia (irregular heart rate), etc. Thus, they need to adjust the timing of medication consumption, sleeping time, and daily activities. One must also consider the sleep factor in finding the diagnosis or underlying cause of one’s health condition.

At this point, the public must be reminded that sleep is an essential factor in maintaining health, especially for diseases like hypertension. There are various factors that can hinder sleep or cause trouble sleeping, so adjustments in lifestyle sometimes need to be made for the improvement of life quality.

References

1. Centre for Disease Control and Prevention (CDC). Tips for better sleep (2016). https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html (Accessed on September 4, 2020).

2. American Academy of Sleep Medicine (AASM). Healthy Sleep Habits (2017). http://sleepeducation.org/essentials-in-sleep/healthy-sleep-habits (Accessed on September 4, 2020).

3. Sleep Foundation. Nilong Vyas. Sleep Hygiene (2020). https://www.sleepfoundation.org/articles/sleep-hygiene (Accessed on September, 2020).

4. Irish, L.A., et al. (2015). The Role of Sleeping Hygiene in Promoting Public Health: A Review of Empirical Evidence. Sleep Medicine Reviews. Volume 22, Pages 23-36. https://doi.org/10.1016/j.smrv.2014.10.001

Sleep is always less likely to be linked with chronic diseases, since many people think that it is something that is not related. However, sleep disturbance might be caused by symptoms of chronic diseases, or the other way around, where sleep disorders can eventually lead to chronic diseases. That is to describe how tight the cycle is between sleep and chronic diseases (1).

Chronic disease is the kind of disease that lasts for a long time, such as Diabetes and Cardiovascular diseases. It usually cannot be cured, so it needs to be managed (1, 2).

Two elements that contribute to sleep disorders are the chronic fatigue and pain that people with chronic illnesses experience on a daily basis. They struggle to get to sleep at night and are sleepy all day as a result of this condition. The depression or anxiety that people with chronic diseases experience in relation to their illness can also be a cause of their nighttime sleep disturbances. Certain medications taken by people with chronic illnesses can occasionally cause conditions that prevent them from falling asleep (1, 2).  

Sleep, diabetes, obesity, and cardiovascular diseases.

Diabetes and sleep problems often go hand in hand. Diabetes can cause sleep loss, and not sleeping well can cause diabetes due to frequently eating at night, which will then lead to obesity and various underlying factors (3, 4).

Individuals with diabetes who experience a spike in blood sugar will not have good quality sleep since the kidney is trying hard to excrete the sugar by urinating, so individuals with a spike in blood sugar level will usually experience getting up and going to the toilet all night long (3, 4). Thus, the only solution to this is to control blood glucose levels, eat well during the day, and eventually experience a good sleep at night.

Touching on the fact that not sleeping well can cause diabetes due to frequently eating at night, one study, found that people who get less sleep tend to be heavier than those who sleep well, since being overweight is a risk factor for the development of diabetes (3, 4).

Obese individuals also experience sleep apnea, a condition of sleep disorder indicated by loud snoring and paused breathing when you sleep. The culprit behind this may be the weight gain, which causes fat to deposit around the upper airway and obstruct breathing (3, 4).

There are many effective treatments for sleep apnea. These include lifestyle changes such as weight loss for mild cases and devices to open-up blocked airways for more significant cases (3, 4). 

As for sleep and cardiovascular diseases, when we sleep, our blood pressure goes down. This makes our body and mind relax and be calm. However, for individuals with sleep problems, their blood pressure level will stay higher for a long time since it does not get the chance to rest. Thus, prolonged high blood pressure can lead to various heart disease problems, such as stroke (5).

Conclusion

Sleep is as important as eating. It acts as the reset button for the whole-body function. It allows the body's systems to realign, grow, and slow down before it kicks off another day. Thus, do yourself a favour today by getting sufficient quality sleep.

But if you already have trouble sleeping, find out ways to improve it either by managing your underlying health condition that hinders you from getting good sleep or by following some sleeping hygiene techniques in order to train your body and mind to fall asleep. It is not a one-day job; it requires many days, weeks, and perhaps months, but if you are consistent, it will surely have a fruitful result. Happy sleeping, and live your life to the fullest.

References

1. Centre of Disease Control and Prevention (CDC). Sleep and Sleep disorder. Sleep and Chronic Diseases. https://www.cdc.gov/sleep/about_sleep/chronic_disease.html#:~:text=Notably%2C%20insufficient%20sleep%20has%20been,disease%2C%20obesity%2C%20and%20depression. (Accessed on September 11, 2020).

2. Sleep and Chronic Illness. https://www.webmd.com/sleep-disorders/sleep-disorders-sleep-and-chronic-illness (Accessed on September 11, 2020).

3. The Sleep – Diabetes Connection. https://www.webmd.com/diabetes/features/diabetes-lack-of-sleep (Accessed on September 11,2020).

4. Deepak Khandelwal, Deep Dutta, Sachin Chittawar, and Sanjay Kalra (2017). Sleep Disorders in Type 2 Diabetes. Indian J Endocrinol Metab. 21(5): 758–761. DOI: 4103/ijem.IJEM_156_17

5. Centre of Disease Control and Prevention (CDC). How does sleep affects your heart health. https://www.cdc.gov/features/sleep-hearthealth/index.html#:~:text=Adults%20who%20sleep%20less%20than,attack%2C%20asthma%2C%20and%20depression.&text=Some%20of%20these%20health%20problems,High%20blood%20pressure. (Accessed on September 11, 2020).

Stress is a response to challenging circumstances that we are in; it is also a response to things that happen in our daily lives. Everything that happens, be it in our daily lives or not (to someone else), can somehow affect us emotionally, physically, and behaviorally. Stress is not all bad; the right amount of stress will act as a precursor to help us do our best and keep us alert and energetic. However, too much stress can make us tense and anxious and hinder our sleep quality (1, 2).

What is making you stressed might not make others stressed, and vice versa. When it comes to stress, there are just no standard parameters to measure. Since the amount of stress that individuals perceive differs from one another, even when it stems from the same source of stress (1, 2, 3).

Stress induces multiple body reactions in the brain, nervous system, endocrine system (hormones), and immune system. Research named it hyperarousal, which is a state when our body is in a stress state. In other words, our brain perceives the condition as being on alert (1, 2, 4).

The signs of a hyperarousal state include the fact that you cannot shut down your busy mind. Your mind seems to have no shut-down button. It keeps going over and over your stress, worries, and frustrations, which you contemplate from various angles. Which is also one of the reasons that hinder you from getting enough quality sleep. Secondly, when you are experiencing muscle tension for no reason, It can be aches in areas such as the neck and shoulders or a constant headache. Thirdly, when you are experiencing a heart race. This is particularly associated with the hormone cortisol (a stress hormone). This will then result in a condition where your body and brain are wide awake, making it difficult for you to fall asleep. This explains why individuals who are stressed experience sleep disturbance. (1)

It is unfair to discuss in the area that stress causes sleep disturbances without noting that there are other conditions that will make individuals who experience stress sleep excessively as well. It is somewhat a mystery to experts as well, though it is hypothesised due to the different kinds of stress that individuals experience and the different coping mechanisms they develop in adapting to different stressors (3).

What to do (4)

Fortunately, there are habits that, if you cultivate them diligently, will train your mind to ease stress and help you sleep. First, practise relaxation exercises such as progressive muscle relaxation or deep breathing techniques before turning in for the night. This technique can help you unwind. It will help your body and mind dial down the stress. It is also wise to actually have relaxing pre-sleep rituals, such as changing into comfortable clothing for sleep, dimming your bedroom light, being in a comfortable situation, taking a warm bath or drinking a cup of warm water or milk, avoiding caffeinated drinks like soda, tea, and coffee in the late afternoon, and slowly nesting yourself.

Of course, these are not tips that will work for everybody; anyhow, you've just got to do some trial and error. You just have to give it a try and adjust it accordingly so that it will suit your condition better.

Lastly, if you have anything in your mind that is stressing you out, think of it as just a phase that you have to endure. Whatever situation you are in, you know it better than anyone else since you have the key to getting yourself out of it. You are in masterful control of it; soon you will be out of this. Think positive thoughts and try to talk to someone you trust. If you think your condition is worsening, it may be a sign for you to seek medical help.

References

1. Sleep Foundation.org. National Sleep Foundation. Stress and Insomnia (July 2020). https://www.sleepfoundation.org/articles/stress-and-insomnia (Accessed on September 20, 2020).

2. Sleep Foundation.org. National Sleep Foundation. Relaxation Exercises for Falling Asleep (July 2020). https://www.sleepfoundation.org/shift-work-disorder/shift-work-you/relaxation-exercises-falling-asleep (Accessed on September 20, 2020).

3. Kim, E. J., & Dimsdale, J. E. (2007). The effect of psychosocial stress on sleep: a review of polysomnographic evidence. Behavioral sleep medicine, 5(4), 256-278.

4. Tips to reduce stress and Sleep better (2019). https://www.webmd.com/sleep-disorders/tips-reduce-stress (Accessed on September 20, 2020).

Sleep disorder is a group of condition that affects individuals’ ability to fall asleep on daily basis, in another word it is a disruption to sleep pattern. It is a wide spectrum of diseases, it refers to the alteration in the sleep quality, quantity, and pattern. It could be due to stress or it is an underlying problem to diseases. This condition can also persist in long term or short term. The recommended sleeping hour for normal adults are about 6-8 hours, whilst for children the sleeping hours is even longer (e.g: newborn up to 16 hours), however as for elderly usually it is shorter which is only about 4-5 hours of sleep.

Cause of sleep disorder?

Common cause of sleep disorders includes work in the shift hour, physical problems such as difficulty in breathing, frequent urination at night, pain (e.g: arthritis). It can also be due to psychological or psychiatric disorders such as schizophrenia, depression, anxiety disorders, and stress. Another condition that can lead to sleep disorder or sleep disruption includes drugs and alcohol abuse, or if individuals is exposed to environment that is not suitable for sleeping.

The interruptions or alterations in sleeping quality, quantity and pattern can affect body more than we think of, since sleep primary functions is to provide rest and restoring body’s energy levels.

Currently the problem with regards to sleeping has increase tremendously. If this condition prolonged individuals should quickly seek help from medical professionals.

Signs for sleep disorder?

The signs for sleep disorder is when individuals consistently taking more than 30 minutes to fall asleep, waking up several times in the middle of the night and remain awake for hours, easily irritate during the day (even after seven to eight hours of sleep at night), frequent and/or long nap during the day, difficult to concentrate at work or school, waking up too early in the morning, loud snoring while asleep, require stimulant such as caffeine to keep you awake during the day, sometimes certain people even experience irresistible urge to move legs, or a tingling or crawling feeling in the legs, particularly at bedtime.

Common sleep disorder is insomnia, it includes symptoms like, feeling not fresh in the morning even after you have sleep for 7 – 8 hours, waking up too early in the morning, and trouble falling asleep or staying asleep. The American College of Physicians (ACP) recommends cognitive behavioural therapy (CBT) as a first-line treatment for chronic insomnia in adults. Apart from this, sleep hygiene training is also recommended and should be introduce to individuals with insomnia. Sometimes, there are behaviour that interfere with difficulty in sleep thus by cultivating healthy sleeping habits it can help you to change some of these disruptive behaviours.

Apart from insomnia, sleep apnea is also one of the common sleep disorders. It is defined as interrupted sleep caused by periodic gasping or snorting noises, or the momentary suspension of breathing. A deviated septum or polyps in the sinuses can cause difficult breathing during sleep. Individuals with sleep apnea usually unable to get enough oxygen while sleeping thus causing sleep disturbance.

Other known sleep disorder includes, narcolepsy, a condition when a person cannot control when they fall asleep and they will have episodes of unwanted sleep. Circadian rhythm sleep disorder is a condition in which a person has trouble aligning their body natural inclination for sleep with the rising and setting of sun. Klein-Levin syndrome a.k.a sleeping beauty syndrome, a condition in which a person will sleep for period of two or more days at a time.

Conclusion

 References

1. Warning Signs of a Sleep Disorder. https://www.healthline.com/health/sleep-disorders-warning-signs (Accessed on September 18, 20).
2. Everything you need to know about insomnia. https://www.healthline.com/health/insomnia (Accessed on September 18, 20).
3. Fighting Insomnia with Therapy. https://www.healthline.com/health-news/fighting-insomnia-with-therapy#1 (Accessed on September 18, 20).
4. Ministry of Health Malaysia. MyHealth Portal. Sleep Disorder. http://www.myhealth.gov.my/en/sleep-disorder/ (Accessed on September 18, 20).

You’ve been told a hundred times that exercise is good for you, and it’s true, but to maintain or do it every day is a problem, right? Here are five very good tips to rock out during your next workout.

Tip 1: Make exercise goals that you can achieve.

Many people find that having a firm goal in mind motivates them to move ahead. Goals are most useful when they are specific, realistic, and important to you. So maybe you can try to exercise on three weekdays and one weekend day for 30 minutes to start, but if you can only do less but slowly increase the duration, that’s okay too. The point is to get moving and keep moving. You can also start with mini workouts for only 5 minutes. After you get comfortable, challenge yourself by increasing the duration until your exercise lasts 30 minutes (1).

Tip 2: Get a partner to work out together so both of you can support each other.

There will be someone to help motivate you. Doing it with your exercise partner, however, makes it a lot easier. Men and women have different intensity levels. People put more effort into their workout routine when they’re exercising with someone else. So you must realise your partner cannot always keep up with you if your partner is of a different gender. What feels like a good workout to one of you might be too much or too little for the other. The same goes for healthy eating. The identical meal may not be acceptable to both of you. You may get advice on tips for healthy eating from a nutritionist (2). Fact! Men lose weight faster than women. It is due to the fact that they have more muscle mass and can burn 30 to 40 percent more calories during the same workout. You cannot compare your results with those of your partner. It’s not realistic to expect the same results in the same time period (3).

Tip 3: Don’t stick to only one place or one exercise.

Head outside. Do a variety of exercises so you don’t get bored. One of the simplest reasons for working out in a variety of places and doing different exercises is that it will be more fun. Going to the gym day after day can start to feel routine, and the last thing you want is to dread your workouts. Instead, get some fresh air with a walk, run, bike ride, or hike (2).

Tip 4: Play Some Music to Keep Your Energy Up.

Music could be just what you really need to motivate you to push further. Research has found that playing music while exercising increases the duration of workouts without a perceived increase in effort. This effect occurs because music boosts mood and encourages rhythmic movement. When a song has a strong, steady beat, for example, you can pedal or run to the beat of that music, which tends to feel satisfying and may inspire you to exercise more. While any type of music is beneficial, some research suggests faster music is more effective than slow music.

Choosing music that you enjoy and that fits your exercise routine can help you get more out of your exercise experience. Since everyone has a different ideal workout pace and intensity (4).

Tip 5:Work Out in the Morning and Get It out of the Way.

Some people find it easy if they do it in the morning, getting it out of the way before an excuse comes up to skip it. By the end of the day, you’re often really tired; random things have come up, and there’s always something else to do instead of exercise.

Morning workouts have been shown to lower nighttime blood pressure and improve sleep quality, and physical activity also improves focus and concentration, regardless of when you do it. But if you have trouble focusing during the day, a morning workout might be just the ticket. The most important thing is to find a routine, schedule, and workout routine that you can stick with (5).

References

1. WebMD (n.d). Setting Your Goals on Fitness. https://www.webmd.com/fitness-exercise/features/setting-goals-fitness#

2. Sadie Trombetta. (2016). 12 Reasons To Exercise With A Partner, Because Everyone Should Have A Gym Buddy. https://www.bustle.com/articles/156775-12-reasons-to-exercise-with-a-partner-because-everyone-should-have-a-gym-buddy

3. Cari Nierenberg. (2018). Yes, Men Lose Weight Faster Than Women, Here’s Why. https://www.livescience.com/63324-men-women-weight-loss-difference.html

4. National Center for Health Research (n.d). Can Listening to Music Improve Your Workout?. http://www.center4research.org/can-listening-music-improve-workout/

5. Kirsten Nunez (n.d). 13 Benefits of Working Out in the Morning. https://www.healthline.com/health/exercise-fitness/working-out-in-the-morning

Function of Calcium?

Body needs calcium for strong bones and teeth. Calcium is also required to carry out important function such as for muscle to move, for nerves system to carry messages between brain and body parts, for blood vessels to move blood throughout the body, and for body to help release hormones and enzyme that affect almost every function in the human body (1,2,3).

How much calcium is needed?

Normal adult need about 1000 mg of calcium daily, however there are certain condition which require to consume up to 1300 mg of calcium daily such as for pregnant lady, lactating mother, post-menopausal women, and man who is above 70 years old of age (1,2,4).

Calcium and diet

Body does not produce calcium, so it needs to be consumed from foods. Luckily, calcium can be found in variety of foods such as dairy products, dark leafy vegetables, fish, and many other fortified food products (1,2,3).   As for our local food products sardine, anchovies, cencaluk, budu, tofu, tempeh, broccoli, kalian, and tapioca leaves are among food that is high with calcium (4).

It is also important to take note that in order to absorb calcium, body needs vitamin D. Only a few foods containing small amount of natural vitamin D, such as egg yolks and salmon with bones. Mostly, we rely on the exposure to sunlight in order to get enough vitamin D, of course in Malaysia the country with sun all year long have no problem with this! However, as currently we are still in the so to say the ‘lockdown’ phase thus it is very important to remind everyone to get the sunlight every day at least 20 minutes for its vitamin D and calcium absorption (1,2,4).

Though all the foods stated above are easily found, but there are conditions which hinder individuals from getting enough calcium from diet thus require it from calcium supplementation.

Condition for calcium supplementation

Before considering calcium supplement, individuals must understand how much calcium needs by the body (stated above). Then individuals must seek help from nutritionist, dietitian, pharmacist, or doctors, where they will assess your calcium consumption from your diet through diet recall. If the calcium intake falls short thus you need to top up calcium from supplement.

Hypertensive individuals and diet with large amounts of sodium.

Several literature reviews on topic of total calcium intake from food and supplements with regards to hypertension suggested that there is possible link to lowering high blood pressure. However, since most of the study design have small number of subjects, and were tested with people from different background, and not to mention possess various kind of biases thus making it difficult for scientist to draw conclusion (1,2).

However, a large study subject (Women’s Health Study), found out that calcium intake was inversely associated with risk of hypertension in middle-aged and older women, in terms of preventing hypertension (1,2).

The consumption of high sodium food lead to more calcium excretion through the urine, which will lead to constriction of blood vessels, which in the end resulting  in high blood pressure. Drinking large water after consuming salty food, is not enough, as it may be making blood pressure return to its slightly normal condition, but it is not helping with the loss of calcium (1,2,5).

Pregnant and lactating mother

Often times, pregnant women is being reminded of how important is folic acid for the baby, even from the trying to conceive period, healthcare providers already advise them to consume folic acid, in order to prevent spina bifida to the baby. However, calcium is as well very important for mothers throughout pregnancy and lactating period especially for mother who is lack of calcium from diet (1).

Several professional organizations recommend calcium supplements during pregnancy for women with low calcium intakes to reduce the risk of preeclampsia (a condition where gestational hypertension always occur). For example, the American College of Obstetrics and Gynaecology (ACOG) states that daily supplementation with 1,500–2,000 mg calcium may reduce the severity of preeclampsia in pregnant women who have calcium intakes less than 600 mg/day. Similarly, the World Health Organization (WHO) recommends 1,500–2,000 mg calcium for pregnant women with low dietary calcium intakes, particularly those at higher risk of gestational hypertension (1).

As for normal healthy mother, the consumption of calcium is especially important during lactating period, mother may notice symptoms such as cramps which indicates lack of calcium during pregnancy and lactation period. Also if a mother is on iron supplementation as well, it is advisable to not consume both at the same time, it is best to gap several prior the consumption of these two since it can interfere with the absorption (1,2).

Post-menopausal women and elderly

Throughout the lifespan, bones are constantly being broken down and built up in a process known as remodelling. Bone cells called osteoblasts build bone, while other bone cells called osteoclasts break down bone if calcium is needed. In healthy individuals who get enough calcium and physical activity, bone production exceeds bone destruction up to about age 30. After that, destruction typically exceeds production. This is sometimes called “negative calcium balance,” which can lead to bone loss. Women tend to experience greater bone loss than men later in life due to menopause, a condition that lowers the amount of hormones that help to build and preserve bone (5).

Getting enough dietary calcium at all ages may help to slow the degree of bone loss, but calcium intakes at any level are not known to completely prevent bone loss. Calcium is less easily absorbed at later ages, and therefore eating a very high amount of calcium will not always resolve the problem (5).

Studies on calcium intake and bone density in postmenopausal women have mixed results that could be due to various reasons. Because the results of some large trials found that higher calcium intakes (usually achieved with a supplement) was associated with improved bone density and slightly lower risk of hip fractures, the RDA for calcium for postmenopausal women is higher than at younger ages. Some studies suggest that frail elderly (80 years and older living in institutions) may benefit from supplementation more than “younger” elderly who live independently in the community (5).

Individuals with lactose intolerance and limit dairy products

Individuals with lactose intolerance usually, is unable to consume food that has high amount of calcium especially if it come from milk and dairy source of food. Thus, lactose intolerance individuals need to consume it form dark leafy vegetables and soy-based product. However, in most cases the consumption is not enough or individuals with lactose intolerance consume not enough vegetable rich with calcium or other food source rich with calcium, thus for this specific population calcium supplementation is needed either from fortified food product such as ready to eat cereals or from calcium supplementation tablet itself.

Individuals receiving treatment on certain medication in the long period

Well, there are certain medication which can influence the absorption of calcium. Medication such as to treat osteoporosis (bisphosphonates), antibiotics (fluroquinolone), medication to treat low thyroid problem (levothyroxine), anticonvulsant (phenytoin), diuretic medication (Lasix and bumex), antacids containing aluminium and magnesium and also glucocorticoids (prednisone). These are all either causing calcium loss in the urine or cause calcium depletion in the bone. Thus, if you are on these medication, it is advisable to take calcium rich foods four hours prior or after the intake of medication, so that it would not interfere with the absorption of calcium, it is also best if you consume calcium supplementation if you do have poor intake of calcium rich food as well (2).

In conclusion, in all these conditions, calcium supplements may help you meet your calcium requirements. Talk with your doctor or dietitian about whether calcium supplements are right for you.

References

1. National Institute of Health (NIH). Department of Health and Human Service. Calcium. Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/ (Accessed on November 18, 2020).
2. National Institute of Health (NIH). Department of Health and Human Service. Calcium. Fact Sheet for Consumers. https://ods.od.nih.gov/factsheets/Calcium-Consumer/ (Accessed on November 18, 2020).
3. Mayo Clinic. Nutrition and Healthy Eating. Healthy Lifestyle. Calcium and calcium supplements: Achieving the right balance. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/calcium-supplements/art-20047097 (Accessed on November 18, 2020).
4. Ministry of Health (MOH). National Coordinating Committee on Food and Nutrition. Recommended Nutrient Intake (RNI): A Report of the Technical Working Group on Nutritional Guidelines (2017).
5. Harvard T.H. Chan. School of Public Health. The Nutrition Source. Calcium. https://www.hsph.harvard.edu/nutritionsource/calcium/ (Accessed on November 18, 2020).

Milk is renowned as a nutritional powerhouse, often considered the food with the highest nutrient density, making it a natural dietary staple for infants from ancient times. This association continues to hold true, as milk is the preferred oral nutrition supplement for bedridden patients (1).
 

Nonetheless, the role of milk in adult diets remains a topic of debate. Some studies argue that daily milk consumption is unnecessary, while others advocate for its regular inclusion (1). Here, we present a breakdown of the considerations to help you decide whether daily milk intake is right for you.

Arthritis is not a single disease; it refers to joint pain or joint diseases. There are more than 100 types of arthritis and related conditions. It can be due to various reasons and require different kinds of treatment. Arthritis is more common among women, and it can affect just anyone, but more frequently older and overweight or obese individuals. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis (1, 2).

Osteoarthritis causes cartilage (the tissue that covers the bone end) to break down. While rheumatoid arthritis attacks the joint, beginning with the joint lining. Another condition that often occurs in individuals of younger age, unlike osteoarthritis and rheumatoid arthritis, is gout. The condition occurs when uric acid crystals form from too much uric acid in the blood (1, 2).

Symptoms of arthritis?

The symptoms of arthritis usually develop over time, but they may also appear suddenly. Common arthritis joint symptoms include swelling, pain, stiffness, redness, and decreased range of motion. Symptoms may come and go. They can be mild, moderate, or severe, but most often they are reported to be severe in the morning. The pain may stay about the same for years but can progress or get worse over time. Severe arthritis can result in chronic pain, an inability to do daily activities, and the inability to walk or climb stairs (2, 3).

Arthritis can also cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on an X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys, and skin, as well as the joints (2, 3).

What causes arthritis?

There are many causes of arthritis, and different types of arthritis have different causes. As an example, osteoarthritis (OA) occurs due to normal wear and tear, but an infection or injury to the joints can exacerbate this natural breakdown of cartilage tissue. Also, if you have a family history of OA, your risk of developing it is higher (2, 3).

While rheumatoid arthritis (RA) occurs when your body’s immune system attacks the tissues of the body, These attacks affect the synovium (a soft tissue in joints that functions to nourish cartilage and lubricate joints). RA is the kind of disease that invades and destroys joints. It can eventually lead to the destruction of both bone and cartilage inside the joint. The exact cause of the immune system’s attacks is unknown. But scientists have discovered genetic markers that increase your risk of developing RA nowadays (2, 3).

What to do?

When it comes to pain, if you notice some changes in your body, it is important for you to seek help so that you can get an accurate diagnosis. The earlier you seek help, the better. So talk to your doctor about your symptoms. You may be referred to a rheumatologist, orthopaedic surgeon, or other doctor who specialises in arthritis and related conditions. There are many things that can be done to preserve joint function, improve mobility, and improve quality of life. Learning about the options available for treatment will give you a higher chance of finding the best solution that fits you (3, 4).

However, apart from learning the best solution for your joint pain, it is also best if you try to reduce your weight if you are obese or overweight. Try to maintain weight since weight has some impact on joints, regardless of where the joint is. By maintaining weight, you will start putting nutritious foods in your body that can reduce inflammation in your joints. The main goals when you have arthritis are to reduce symptoms and improve your quality of life (3, 4).

References

1. Mayo Clinic. Arthritis. https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772#:~:text=Arthritis%20is%20the%20swelling%20and,are%20osteoarthritis%20and%20rheumatoid%20arthritis. (Accessed on December 4, 2020).
2. Arthritis. https://www.healthline.com/health/arthritis (Accessed on December 4, 2020).
3. Arthritis Foundation. What is arthritis? https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis/what-is-arthritis (Accessed on December 4, 2020).
4. Arthritis. https://www.webmd.com/arthritis/default.htm (Accessed on December 4, 2020).

The word collagen comes from the Greek word "kola,” which means glue, and that is basically the function of collagen, which is to hold protein and/or non-protein substances together. As an example, in the skin, the function of collagen is to hold all the skin structure together. Collagen is one of the major building blocks for many parts of the body, including bones, skin, tendons, and ligaments. It accounts for about one-third of the body's protein composition. It is also found in many other body parts, including blood vessels, corneas, and teeth.

Types of collagen

There are various types of collagen, but the main types are type I, type II, type III, and type IV.

Type I: Most of your body’s collagen is made of type I. It is a densely packed fibre that provides structure to skin, bones, tendons, fibrous cartilage, connective tissue, and teeth.

Type II: This type is made of more loosely packed fibres and is found in elastic cartilage, which cushions the joints.

Type III: This type supports the structure of muscles, organs, and arteries.

Type IV: This type helps with filtration and is found in the layers of your skin.

Collagen in Skin: Do We Need It?

Our body can produce its own collagen; however, the production of collagen gradually declined as we aged, which explains that among the signs of ageing are wrinkles, which come from skin that is less elastic, less supple, and unfirm.

Researchers also revealed that women lose collagen faster than men, causing women’s skin to age faster than men. Apart from gender, nutrition, and recreational drugs, environmental stress such as sun exposure, exposure to toxins such as pollutants, and cigarette smoke can also affect the level of collagen in the body.

Where can we get collagen from?

The good news is that collagen can be gotten from food. There are foods that can stimulate the production of collagen and break down collagen. The body makes collagen by combining proline and glycine (types of proteins). Thus, consuming foods high in proline and glycine will help restore collagen levels in the body.

According to Dr. Bradley from the Cleveland Clinic, your body cannot make them if it doesn’t have them, which means all the nutrients, such as glycine and proline, are essential to produce collagen, but if we do not acquire them from our diet, then our body might not be able to produce collagen. Foods that are high in collagen are mostly derived from protein-rich foods such as bone broth, pork, chicken, beef, eggs, and fish. Plant-based foods also have added benefits to collagen-rich food consumption since vegetables and fruits contain high levels of antioxidants that can protect against reducing collagen. Types of foods that can break down collagen are sugary foods and refined carbs.

As for supplements containing collagen, they are usually in the form of hydrolyzed collagen. The source of hydrolyzed collagen can be fish, marine seaweed, pork skin, or other food sources that have high collagen contents. It is also said that hydrolyzed collagen is much easier to absorb by the body as compared to collagen from food.

To date, studies that report whether consumption of collagen has benefits to skin, joint health, muscle mass, bone, and many more are inconsistent. It depends on various factors such as the source of collagen, the bioavailability of collagen, the frequency of consuming it, the severity of a skin condition or joint condition previously, and many more. Thus, it is advisable for individuals to check the supplement ingredients prior to consuming any kind of supplement.

Individuals with cyst problems and cancer problems must be careful with their consumption of collagen supplements, as they can be harmful. Hence, it is best to seek professional help before consuming any supplement. Certain supplements are contraindicated with the medicine that you are consuming, etc.

References

1. Top 6 Benefits of Taking Collagen Supplement. https://www.healthline.com/nutrition/collagen-benefits#_noHeaderPrefixedContent (Accessed on December 29, 2020)
2. (n.d). Collagen, what is it and what it is good for? https://www.healthline.com/nutrition/collagen (Accessed on December 29, 2020).
3. Atikah Khalim (2015). Ministry of Health Malaysia (MOH). My Health Portal. Collagen. http://www.myhealth.gov.my/en/collagen/
4. Fadzilah kahar (2015). Ministry of Health Malaysia (MOH). My Health Portal Collagen and its source. http://www.myhealth.gov.my/kolagen-dan-sumbernya/
5. Cleveland Clinic. The best way you can get more collagen. https://health.clevelandclinic.org/the-best-way-you-can-get-more-collagen/ (Accessed on December 29, 2020).
6. What is collagen.
   https://www.livescience.com/collagen.html#:~:text=Collagen%20refers%20to%20a%20family,in%20the%20body%20by%20mass(Accessed on December 29, 2020).

Consumption of fish is important as it is a good source of protein. It is recommended to consume one fish per day, according to the Malaysian food pyramid. This is because the consumption of fish in Malaysia is rarely equated with a risk of contamination with mercury, etc., unlike in western countries. This might be due to the types of fish and sizes of fish that we are consuming here as compared to other parts of the world. It is said that the bigger the fish, the more contamination it has; hence, there is a recommendation for pregnant mothers to consume small fish rather than big fish to avoid the risk of contamination.

Research on the benefits of fish oil supplementation also varies greatly, which is why in this article we are going to list out who might need a fish oil supplementation in their daily lives!

The benefits of ingesting fish oil can differ significantly between studies. A study found a connection between these omega-3 fatty acids and mental health disorders and that EPA and DHA can speed up brain development even in young children. Additionally, studies have demonstrated that it can help treat cardiovascular diseases, joint pain, and eczema. The question is, is it true that all of these effects can be obtained from fish oil consumption? (1)

Individual with mental health problems/disorders

In three lengthy studies spanning the years 1988 to 2008, researchers looked at the relationship between fatty acid intake and suicide risk among more than 205 000 participants. They discovered no proof that eating fish or fatty acids reduced the risk of suicide. "The vast majority of earlier research on whether fatty acid intake has any positive effects on mental health has been based on results from depression screening. The only time this relationship has been studied with concrete data on suicide mortality is in our study, which is also the largest of its kind.” (2)

While a study found that eating a balanced diet and exercising regularly are better for brain health than taking fish oil or omega-3 fatty acid supplements, A study of 3073 elderly people at risk of macular degeneration, an age-related cause of vision loss, found little benefit from omega-3 supplements on memory. Omega 3 supplements or a placebo were given to study participants at random for a five-year period.  According to the researcher, a healthy diet cannot be replaced by a supplement; therefore, if you eat a healthy diet rich in fruits, vegetables, and marine fish, you probably don't need to take a fish oil supplement. According to this study, the overall dietary pattern is more important than a single nutrient (2).

Individuals with cardiovascular disease

Recently, there have been many studies suggesting that Omega 3 will not lower the risk of heart problems. To answer this, Dariush Mozaffarian, cardiologist from Harvard Medical School, said that he gathered 20 previous studies involving more than 68, 000 patients since 1989 and found that, overall, fish oil supplements did neither harm nor good since they did not significantly reduce people’s risk of mortality, cardiac death, heart attack, or stroke. But according to him, the research link between fish oil supplementation and heart problems is rather complex since it does not only take fish oil to shield the heart from various problems and diseases; it also takes weight status, exercise frequency, cigarette or substance use, and many more (3,4,5).

Which is why, interpreting the study, we would still recommend customers and patients consume more fish as a first-line measure. But if you do not like fish, or you feel like your consumption of fish is not enough, or you simply want to be sure that your body is getting omega 3, there is no harm in taking fish oil; it will certainly help with the essential nutrient, since omega 3 is a nutrient that your body cannot produce and can only get from diet (3,4,5).

Individuals with skin problem

A systematic review for the treatment of atopic dermatitis or eczema using fish oil supplementation is very scarce; the studies available are all small-sample studies. Not only are these three studies small, but they are also described as poor methodological studies by the reviewer, as they have many confounding factors. However, the outcomes of these studies show positive outcomes for eczema and overall daily living as compared to placebo (6, 7).

Another convincing relationship between consumption of fish oil and skin health is that in a study where pregnant women were given fish oil during pregnancy and followed up for 6 years, it was found that consumption of fish oil during pregnancy led to a positive skin health outcome for babies skin. The study also concluded that maternal supplementation with fish oil might have prophylactic potential for long-term prevention of asthma in offspring (6, 7).

In conclusion, consumption of fish oil has mixed results in studies depending on what kind of problem we are looking to solve with fish oil. Since there are various factors influencing a particular health problem, There is no magic pill in this world, honey! You need to, however, eat healthily, consume a lot of vegetables and fruits, and exercise, but if you think that you do not get enough omega 3 from your diet because you dislike fish, are afraid to consume fish regularly due to contamination, etc., or simply would like to make sure that your body has enough omega 3, then there is no harm in taking fish oil supplementation. It's just that in order to make sure you get the right omega 3 for your body, buy it from a pharmacy, make sure the product has a Ministry of Health (MOH) notification number, and simply ask a healthcare professional which omega 3 supplementation suits you, simply for the dosage and perhaps current medication that you are on, and you are good to go!

References

1. Harvard T.H Chan. School of Public Health. Fish: Friend or Foe? https://www.hsph.harvard.edu/nutritionsource/fish/

2. Harvard T.H. Chan. School of Public Health. No mental health benefit from fish oil. https://www.hsph.harvard.edu/news/hsph-in-the-news/no-mental-health-benefit-from-fish-oil/\

3. Harvard T.H. Chan. School of Public Health. https://www.hsph.harvard.edu/news/hsph-in-the-news/fish-stroke-risk-mozaffarian/

4. Harvard T.H Chan. School of Public Health. Major Meta Analysis in Clinical Trial Omega 3 Supplemeny link with lower risk of CVD.  https://www.hsph.harvard.edu/news/press-releases/in-major-meta-analysis-of-clinical-trials-omega-3-fish-oil-supplements-linked-with-lower-cardiovascular-disease-risk/

5. Harvard T.H. Chan. School of Public Health. Fish Oil Supplementation and Heart Health. https://www.hsph.harvard.edu/news/hsph-in-the-news/mozaffarian-fish-oil-supplements-heart-health/

6. Schlichte, M. J., Vandersall, A., & Katta, R. (2016). Diet and eczema: a review of dietary supplements for the treatment of atopic dermatitis. Dermatology practical & conceptual, 6(3), 23–29. https://doi.org/10.5826/dpc.0603a06

7. Huang, T. H., Wang, P. W., Yang, S. C., Chou, W. L., & Fang, J. Y. (2018). Cosmetic and Therapeutic Applications of Fish Oil’s Fatty Acids on the Skin. Marine drugs, 16(8), 256. https://doi.org/10.3390/md16080256

Collagen is a fibre-like structure that is used to make connective tissue, which connects other tissues together. It is a major component of bone, skin, muscles, tendons, and cartilage. Collagen is a component that helps make tissue strong, resilient, and able to withstand stretching (1).

Although the saying that our bodies make less collagen as we age is true, the production of collagen drops most not only because of this but also due to excessive exposure to the sun, smoking, including secondhand smoke, excessive consumption of alcohol, lack of sleep, and lack of exercise. As the collagen levels in our skin diminish, the deep skin layers change from a tightly organised network of fibres to an unorganised maze. Environmental exposure to the skin, such as harsh weather, can also damage collagen fibres by reducing their thickness and strength, which can lead to wrinkles on the skin surface (1).

Since 1970, vitamin C has been widely used to fight and prevent the common cold. Nowadays, everyone knows that taking vitamin C can help prevent and fight the common cold (1).