Pandemic COVID-19

The outbreak of Coronavirus disease began at Wuhan, China in December 2019, thus far it has infected more that 46 million of individual all around the world and has caused more than 1.2 million of deaths. The symptoms of COVID-19 include fever, cough, dyspnoea, and myalgia. Some proportion of confirmed cases also developed severe diseases which involves acute lung injury and acute respiratory distress syndrome (ARDS) which can precipitated into multiple organ failure and death. This is also one of the reasons why infection occur to the high-risk individuals are more likely be getting serious or lead to complications as compared to healthy individuals.

It has been reported that the condition is called ‘cytokine storm’, a condition where the host immune response becomes dysfunction due to the attack from the virus to body’s immune system. In the absence of approved vaccine to prevent this from happening, management of critically ill COVID19 patients include administration of azithromycin (antibiotic) and hydroxychloroquine (malaria medicine), this is due to that there is no specific medication yet for COVID-19.

However, growing study interest is seen on the administration of COVID-19 recently, where even in Malaysia, Ministry of Health has conducted few studies to see whether the usage of vitamin C among critically ill COVID-19 patients is beneficial. The first study was conducted among 17 patients, the critically ill patients were given 1g of vitamin C in every 8 hour for three days. Although the findings are promising, but according to Deputy Health Minister, Datuk Dr, Noor Azmi Ghazali, it cannot still be used as management of critically ill COVID-19 patients as the sample size of the studies is too small for the result to be used.

Another study involving critically ill COVID-19 patients, divide between two groups of critically ill patients, the one administered with Vitamin C and the one without administration of vitamin C. The result found out that group with vitamin C administration has 57% lower on mortality rate, 9 days shorter of hospital stay, 5.6 days faster in successful extubating, and 7.5 days faster in weaning off oxygen support.

There is another unpublished study that was conducted among critically ill COVID-19 patients in two different tertiary hospital in Malaysia comparing individual treated with vitamin C against those who are not treated with vitamin C. Both groups show similar clinical background, comorbidity, illness severity, and severity score on admission. The finding shows that the vitamin C group has lower mortality rate (14.3%) as compared to the group without vitamin C (71.4%). Duration of days on the ventilator were also shorter in vitamin C groups compared to non-vitamin C group (14 vs 19.6 days). Similarly, the duration to complete weaning of oxygen therapy was also shorter in vitamin C group (16 vs 23.5 days). Since the result is very promising currently, a multicenter randomized controlled trial is underway in evaluating the effectiveness of high dosage of intravenous vitamin C for the treatment for severe COVID-19 patients.

Usage of Vitamin C as prophylaxis to COVID-19 for general population

Apart from vitamin C is a water-soluble vitamin it is also a potent antioxidant. It acts as free radical scavenger and has its anti-inflammatory properties, which influence cellular immunity and vascular integrity. Which explain why it is being studied as one of the treatments for COVID-19. As for general population, National Health Service (NHS) U.K. treatment guideline stated that for non critically ill COVID-19 individuals and for non-COVID19 individuals there is insufficient data to recommend usage of high dosage of vitamin C in combating COVID-19. This being stated because, in critically ill COVID-19 individuals they experience high oxidative stress and severe inflammation, which may be helpful with the administration of vitamin C but unlike non COVID19 and non critical COVID19 individuals.

In general, sufficient consumption of vitamin C and healthy eating habit may helps with combating COVID-19 pandemic. A proper diet can help to ensure that the body is in the strongest possible state to battle the virus. Certain precaution with regards to food safety as well may helps in combating the virus although researchers have found that there is no source of virus contamination via food packaging or food. However, good food practices are always recommended to minimize the risk of contamination and to ensure that there is no window for the virus to weaken immune system.

• Eat plenty of fruits daily ( such as guava, apple, banana, strawberry, cantaloupe melon, grapefruit, pineapple, papaya, orange, Longman fruit, blackcurrant, pumelo) these are fruits have high vitamin C.
• Eat plenty of fresh vegetables daily (such as green bell peppers, garlic, ginger, kale, lime, coriander, broccoli, green chili pepper). Do not overcook vegetables as it leads to the loss of important nutrients such as vitamins and minerals.
• Eat whole grains and nuts, which have high amount of good fats! Limit intake of red meat, processed and fast foods.
• For snacks, choose fresh fruits and raw vegetables rather than foods that are high in sugar, salt or fat.
• Limit the salt intake to less than 6g/day.
• Drink 8–10 glasses of water every day. It helps to transport nutrients in the blood, gets rid of waste, and regulates the body temperature.
• Maintain a healthy lifestyle of exercise, meditation, and regular sleep. Adequate sleep will help to support immune function.
• Eat at home to avoid contact with other people and try to reduce the chance of being exposed to COVID-19.
• Wash vegetables and fruits before eating.
• Wash, rinse, and disinfect objects and surfaces every time before and after use.
• Keep cooked and raw foods separate, as it would prevent the harmful microbes from raw foods spreading to cooked foods. Use different chopping boards and utensils for cooked and raw foods to prevent cross-contamination.

References

1. Ministry of Health Malaysia (MOH). Kajian dan Penyelidikan MahTAS COVID-19 rapid evidence update. Intravenous Vitamin C for COVID-19. Based on the availa le evidence up to 16 November 2020. http://covid-19.moh.gov.my/kajian-dan-penyelidikan/mahtas-covid-19-rapid-evidence-updates/12_INTRAVENOUS_VITAMIN_C_FOR_COVID-19_editted.pdf (Access on Feb 2, 2021).
2. New Straits Times (NST). Vitamin C injections not used in COVID-19 treatment in Malaysia. https://www.nst.com.my/news/nation/2020/11/637714/vitamin-c-injection-not-used-covid-19-treatment-malaysia (Accessed on Feb 2, 2021).
3. National Institute of Health (NIH). Vitamin C usage and COVID-19. https://www.covid19treatmentguidelines.nih.gov/adjunctive-therapy/vitamin-c/ (Accessed on Feb 2, 2021).
4. Feyaerts, A. F., & Luyten, W. (2020). Vitamin C as prophylaxis and adjunctive medical treatment for COVID-19? Nutrition (Burbank, Los Angeles County, Calif.), 79-80, 110948. https://doi.org/10.1016/j.nut.2020.110948
5. Aman, F., & Masood, S. (2020). How Nutrition can help to fight against COVID-19 Pandemic. Pakistan journal of medical sciences, 36(COVID19-S4), S121–S123. https://doi.org/10.12669/pjms.36.COVID19-S4.2776

Unsaturated fats can be classified into two main categories: Monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA). MUFA-rich foods include olive oil, canola oil, cashews, and groundnuts. On the other hand, PUFA can be further divided into Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), also known as omega-3 fatty acids. EPA and DHA are commonly found in fatty fish and algae.

Benefits of EPA and DHA
 

EPA and DHA offer a range of benefits, with one well-studied area being their connection to cardiovascular health. Multiple studies indicate that incorporating EPA and DHA-rich foods or supplements into the diet can lower triglyceride levels. Consequently, the American Heart Association (AHA) recommends a daily intake of about 1g of EPA plus DHA for individuals at high risk of heart disease. Joseph C. Maroon, MD, a professor in the Department of Neurological Surgery at the University of Pittsburgh School of Medicine and author of "Fish Oil: The Natural Anti-Inflammatory," emphasizes that sufficient omega-3 intake can reduce the inflammatory processes linked to various chronic conditions. This anti-inflammatory effect could potentially extend to diseases like arthritis, dry eyes, age-related macular degeneration (AMD), dementia, Alzheimer's, and cognitive issues. However, what about its relevance to COVID-19?



EPA & DHA in the Context of COVID-19

COVID-19 remains a novel disease, with many aspects still unknown to scientists. Among the potential management and treatment avenues being explored is the relationship between EPA and DHA and COVID-19. Numerous well-documented studies suggest that EPA and DHA's anti-inflammatory properties could have potential benefits for COVID-19 patients.
 

COVID-19 primarily targets the body's immune system, triggering an immune response to combat the disease. During this battle, the body releases cytokines, a phenomenon referred to as a "cytokine storm." Studies on sepsis patients have shown that administering EPA and DHA leads to the release of resolvins, which aid in restoring cellular function post-inflammation and tissue injury. This insight underlines why the administration and consumption of EPA and DHA-rich diets are being examined as potential mechanisms against COVID-19. Furthermore, a meta-analysis indicates that high EPA and DHA supplementation through parenteral and enteral nutrition can significantly reduce ventilator-free days, organ failures, ICU stays, and mortality rates among individuals with acute respiratory distress syndrome (ARDS). Given that ARDS is a common complication of critically ill COVID-19 patients, these findings suggest a potential positive impact.
 

Another critical parameter in assessing COVID-19 severity, particularly in critically ill patients, is coagulation ability. Non-survivors of COVID-19 are often those with heightened platelet aggregation and activation, resulting in a higher risk of life-threatening blood clotting. A study involving a moderate intake of three omega-3-rich fish species over 18 days showed improved bleeding time and reduced platelet aggregation, potentially decreasing thrombosis risk among COVID-19 patients. Similarly, a study supplementing healthy subjects with EPA for four weeks demonstrated decreased platelet activation, an early step in platelet aggregation.
 

In conclusion, the administration or consumption of EPA and DHA could potentially aid critically ill COVID-19 patients. However, using EPA and DHA as a prophylactic among healthy individuals requires further investigation due to the limited understanding of the virus's pathology and its interaction with patients' characteristics during recovery. Therefore, it's advisable to conduct randomized controlled trials that consider supplementation type, dosage, individual characteristics, adverse effects, and potential combinations with medication and antioxidants.
 

References
 

1. National Institute of Health (NIH). Office of Dietary Supplements. Fact sheet for consumer. Omega 3 Fatty Acids. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/ (Accessed on Feb 4, 2021).

2. National Institute of Health (NIH). Office of Dietary Supplements. Fact sheet for Health Professionals. Omega 3 Fatty Acids. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/ (Accessed on Feb 4, 2021).

3. Nourish by WebMD. What to know about Omega 3 and fish? Annie Stuart. https://www.webmd.com/diet/features/what-to-know-about-omega-3s-and-fish#1 (Accessed on Feb 4, 2021).

4. Rogero, M. M., Leão, M. D. C., Santana, T. M., de MB Pimentel, M. V., Carlini, G. C., da Silveira, T. F.& Castro, I. A. (2020). Potential benefits and risks of omega-3 fatty acids supplementation to patients with COVID-19. Free Radical Biology and Medicine.

Grape seed extract (GSE) is derived naturally from grape seed and is commonly used in dietary supplements for a variety of purposes. It is created by removing, drying, and pulverising the bitter tasting grape seeds. It contains a lot of antioxidants like phenolic acids, anthocyanins, flavonoids, and oligomeric proanthocyanidins complexes (OPC). Grape seed extract, in fact, is regarded as one of the best sources of proanthocyanidins. As a result, grape seed extract provides numerous benefits to the human body, including disease prevention, protection against oxidative stress, tissue damage, inflammation, and many more. In this article, we will look in depth at the potential health benefits of grape seed extract (GSE) based on studies:

Wound healing activity and antioxidant properties. 

Numerous studies have shown that grape seed extract contains a high level of antioxidants. Using punctured wounded mice, researchers discovered that mice treated with GSE in the wound affected area grew tissue faster than mice treated with only normal saline. Another difference between GSE-treated mice and placebo-treated mice was more organized tissue formation and a higher rate of collagen deposition.

Topical application of 2% GSE cream in the area of a post-surgery surgical wound heals the wound completely in an average of 8 days, compared to 14 days for placebo. This is due to GSE's vascular endothelial growth factor (VEGF) properties, which promote the regeneration of damaged blood vessels while increasing the amount of free radicals present at the wound site. Free radicals aid in the killing and removal of pathogenic bacteria and endotoxin from the site, as well as in the healing of wounds

Apart from wound healing and skin health properties, it also has anti-ageing properties. GSE proanthocyanidins delay skin ageing by reducing lipid oxidation on the skin structure.

Cardiovascular and antihypertensive properties. 

Cardiovascular disorders (CVD) are among the major problems that arise due to modern, unhealthy lifestyles, which are the primary cause of death worldwide. It is a disorder that affects the condition and function of the heart and blood vessels in general. Changes in these two can result in cardiac arrest, heart stroke, hypertension, chest pain, and other complications. Studies show that GSE may prevent atherosclerosis (a condition where there is a build-up of fats, cholesterol, etc. in the blood vessel walls, which can restrict blood flow), inhibit or limit the oxidation of LDL (bad cholesterol), reduce inflammation, inhibit platelet aggregation, and lower blood pressure. It lowers blood pressure by suppressing oxidative stress and inhibiting the angiotensin-converting enzyme (ACE) and nitric oxide, which mediate vasodilation, hence making the constricted blood vessels dilate and improving blood pressure.

Vitamin C can be said to be the most popular micronutrient of all. It serves various functions, from immune health to skin health. As of late, many skin care products have incorporated vitamin C as one of the ingredients, or it stands alone in skincare products. Many studies found that topical application of vitamin C showed positive skin changes in improving skin complexion, improving skin hydration, fading out hyperpigmentation, and reducing the appearance of under-eye circles.

 But, according to the study, there are various hindrances to the absorption of vitamin C applied topically, such as skin pH, penetration of vitamin C into skin layers, oxidation due to exposure to harsh environments before the skincare is even applied to the skin, and many more.

Which is why people started to dig? What about the consumption of vitamin C? Will it help with skin health even better?

A study on the roles of vitamin C in skin found that the consumption of vitamin C helps with skin health via various pathways.

1. The promotion of collagen formation

Vitamin C acts as a co-factor for the proline and lysine hydroxylase enzymes that stabilise the collagen structure in skin. In the skin, collagen formation is carried out mostly in the dermis; it requires the enzyme lysine hydroxylase to form collagen, which is dependent on vitamin C. Which is why consumption of a sufficient amount of vitamin C helps with intact-looking skin due to the formation of collagen.

2.  The ability to scavenge free radicals and dispose of toxic oxidants

Another important role of vitamin C is that it acts as a potent antioxidant, which can neutralise and remove oxidants from environmental pollutants and after exposure to ultraviolet (UV) radiation. But most intervention studies are carried out to see the effect or prevention of the damage using a cocktail of other ingredients as well (such as glutathione and vitamin E). Which is why it is said that vitamin C is particularly effective when it is used in conjunction with vitamin E.

3.  Inhibition of melanogenesis.

Vitamin C and its derivates, including the weak one (magnesium phosphate ascorbyl derivatives), have been shown to treat skin hyperpigmentation in conditions such as melasma, better known as age spots. This is due to the fact that it has been shown that it reduces melanin synthesis in the skin by interfering with the action of tyrosinase (the rate-limiting enzyme in the production of melanin).

These are all pathways through which vitamin C could help with skin health. During the course of life, the skin is exposed to various challenges that affect its structure, function, and appearance, including:

1. Ageing: loss of elasticity and wrinkle formation

2. Exposure to elements leading to discoloration, dryness, and accelerated wrinkles.

3. Chemical insults such as soaps, hair dyes, and detergents

4. Direct injury, such as wounding or bleeding.

With all the factors from internal and external being addressed, it is thought that it can make things clear that the consumption of vitamin C is able to help with the prevention of further skin damage but at the same time must limit or reduce external factors that cause harm to skin; after all, prevention is better than cure, right?

Apart from this, 16 studies that investigate the consumption of vitamin C supplements or foods show that it improves skin appearance by improving skin elasticity, facial wrinkling, roughness, and discoloration.

Another double-blind nutrition intervention using cocktails of supplementation such as that high in antioxidants such as 10mg trans resveratrol, 60 mcg selenium, 10 mg vitamin E, and 50 mg vitamin C in papaya extraction among populations between 40 and 65 years old shows improved skin surface, brown spots, evenness, moisture, and elasticity after 90 days of supplementation.

Based on all these data, the study stated that the efficacy of consumption of vitamin C is better at improving skin health as compared to topical application only. As the efficacy of topical application is based on the prior skin condition. In one study, it was suggested that when the health status is already optimal, meaning there is enough vitamin C, the topical application of vitamin C will not be absorbed into the skin. Hence, ‘beauty from the inside" via nutrition may be more effective than topical application.

References

1. Pullar, J. M., Carr, A. C., & Vissers, M. (2017). The Roles of Vitamin C in Skin Health. Nutrients, 9(8), 866. https://doi.org/10.3390/nu9080866.

2. Radiance by WebMD. Benefits of Vitamin For Your Skin Health. https://www.webmd.com/beauty/ss/slideshow-benefits-of-vitamin-c-for-skin (Retrieved on May 3rd, 2021).

3. 11 Reasons to add vitamin C serum to your skincare routine. https://www.healthline.com/health/beauty-skin-care/vitamin-c-serum-benefits#how-to-use (Retrieved on May 3rd, 2021).

As we age, the production of collagen in the body decreases, it causes skin to become wrinkled. For certain people, even when they are still young due to exposure of skin to various harsh environments and conditions both internally and externally, collagen level in skin tend to diminish even quickly.

Collagen and skin

Collagen is the central element in the dermis layer (one of the skin layer), it comprises about 70%-80% of skin. Whenever skin is wounded, collagen helps in wound healing through providing an ideal environment for cells to proliferate, which will help with the healing process. It also plays a significant role in all phases of wound healing, including haemostasis, inflammation, proliferation, and remodelling.

Studies shows that application of collagen in wounded skin is very beneficial since the collagen is highly porous and have interconnected pore structure. It is said that collagen is beneficial to wound healing to the extent of, there is study noted that collagen potentially can be used for skin substitute in full thickness wound healing.

Collagen and hair

Building block of hair is protein keratin, by consuming collagen rich food and/or collagen supplement, it will then be break down into variety types of amino acids compound.

There are 11 types of non- essential amino acids, which body can produce itself, and there are 9 types of essential amino acids which need to be consumed from diet since body cannot produced it. Collagen is made up from three types of essential amino acids, which is why it is best to consume collagen, collagen rich foods, or variety of protein rich foods, so you may get different types of amino acids compound especially the essential amino acids compound which body cannot synthesized, so that we can improve level of collagen in the body.

Collagen helps to fight damage to hair follicles by functioning as antioxidants which helps to fight free radical. Free radical could develop due to stress, smoking, dietary habits and many more. These are all factors that we are at risk of everyday, by consuming collagen it helps to reduce damage in the hair follicles thus lead to a healthier hair growth. It may also help to prevent thinning due to ageing and slow down the appearance of greying.

Collagen and nails

A study that was conducted among men and women who experience brittle nail syndrome, where their nail exhibits rough surface, raggedness, and peeling, noted that consumption of collagen promoted an increase of 12% nail growth rate and a decrease of 42% in the frequency of broken nails. Additionally, 64% of participants experienced an improvement 4-week post treatment. Most participants (80%) agreed that the use of collagen help with their brittle nail syndrome.

In conclusion, collagen consumption may helps with hair, nails, and skin condition since it is the building block of it. So, apart from practicing ‘prevention is better than cure’ measure once you have seen the symptoms in your hair, skin and nails, it is still not too late to help it with collagen.

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

Coenzyme Q-10 (CoQ-10) is a naturally occurring quinone found in all organisms, from bacteria to mammals. It was discovered in 1940 and isolated in 1957 from the mitochondria of the beef heart. Coenzyme Q10, also known as Coenzyme Q, CoQ, CoQ10, Ubiquinone, Ubiquinone-Q10, Ubidecarenone, or Vitamin Q10, is a type of coenzyme. The number of side chains distinguishes the different types of coenzyme Q. CoQ10 is the most common coenzyme Q. CoQ10 is present in all human tissues, though its level varies.

 Why do we need CoQ10?

CoQ10's main function is to act as an energy transfer molecule, where it is a co-factor in the production of energy. Essentially, all cellular functions are dependent on an adequate supply of energy, which explains why coq10 is vital for all tissues and organs. CoQ10 is also one of the most significant lipid antioxidants that prevents the generation of harmful substances in the body, such as free radicals, which can lead to the modification of proteins, lipids, and DNA.

Antioxidant is defined as a substance that inhibits the oxidation process or is a scavenger of free radicals that are produced by normal body processes, hence making the body more stable.

Due to its function as antioxidants, not only can it help neutralize free radicals and prevent the damage caused by free radicals, but it can also improve energy and augment the immune system.

 Who needs CoQ10?

There are certain individuals who need to consume more CoQ10 as the amount in their bodies is diminishing.

1. Individual who is consuming or on statin medication (medicine used to lower high blood levels of cholesterol or triglycerides to prevent heart problems). This is because studies show that statins interfere with the production of mevalonic acid, which is used to form CoQ10. Thus, individuals who consume statins have low levels of CoQ10 in their bodies.
2. Individuals with heart conditions, such as heart failure and angina, may benefit from taking a CoQ10 supplement. A review of 13 studies in people with heart failure found that 100 mg of CoQ10 per day for 12 weeks improved blood flow from the heart.
3. As CoQ10 is involved in the production of energy, it can be used by athletes and those who would like to boost physical performance. A 6-week study in 100 German athletes found that those who supplemented with CoQ10 daily experienced significant improvements in physical performance, measured as power output, compared to a placebo group. CoQ10 supplements help reduce the inflammation associated with heavy exercise and may even speed recovery.

How much do we need CoQ10? 

A typical CoQ10 dosage is about 30–90 mg per day, taken in divided doses, but the recommended amount can be as high as 200 mg per day. CoQ10 is a fat-soluble antioxidant, so it is better absorbed when taken with a meal that contains oil or fat. The clinical effect of CoQ10 may take up to eight weeks.

Food source with CoQ10?

Primary dietary sources of CoQ10 include oily fish (such as salmon and tuna), organ meats (such as liver), and whole grains. Most individuals obtain sufficient amounts of CoQ10 through a balanced diet, but supplementation may be useful for individuals with particular health conditions. CoQ10 is available as a supplement in several forms, including soft gel capsules, oral spray, hard shell capsules, and tablets.

Safety precautions

Consumption of CoQ10 might not really be suitable for individuals who consume warfarin medication, pregnant women, or breastfeeding mothers. 

References

1. Saini R. (2011). Coenzyme Q10: The essential nutrient. Journal of pharmacy & bioallied sciences, 3(3), 466–467. https://doi.org/10.4103/0975-7406.84471
2. National Institute Health (NIH). National Centre for Complementary and Integrative Health. Coenzyme Q10. https://www.nccih.nih.gov/health/coenzyme-q10
3. CoQ10 dosage: How much you should consume per day? https://www.healthline.com/nutrition/coq10-dosage

Coenzyme Q10 (CoQ10) is a substance that is naturally present in the human body, with the highest levels in the heart, liver, kidneys, and pancreas. It is also naturally present in the foods that we eat, such as cold-water fish like tuna, salmon, mackerel, and sardines, vegetable oils, and meats. Other than these types of foods, individuals can consume CoQ10 through supplementation. Here are some of the benefits of consuming CoQ10 for your heart's health:

Therapeutic benefit in hypertension.

Hypertension, also known as high blood pressure, is a condition in which the blood pressure rises above 120/80. CoQ10 has been shown in animal model studies to significantly reduce blood pressure levels while having no effect on other hypertension-related parameters such as plasma renin, serum/urine sodium and potassium, or urinary aldosterone. It is also suggested that varying COQ10 dosage results in a reduced need for medication. In a human study, taking 60 mg of CoQ10 twice daily for 8 weeks reduced blood pressure, plasma inulin, glucose, and several lipid compounds. Other human studies have ranged from 100 to 225mg/day for 4.4 to 10 months.

Therapeutic benefit in coronary artery disease.

Coronary heart disease (CHD) occurs when the coronary arteries that supply oxygen-rich blood to your muscles become narrowed due to a gradual buildup of fatty material within their walls. The condition is also referred to as atherosclerosis. Pretreatment with CoQ10 has been shown in animal studies to reduce myocardial ischemia (occurs when blood flow to the heart muscle is obstructed by a partial or complete blockage of plaque buildup (atherosclerosis)) and cardiac dysfunction. In human studies, a dose of 300 mg/day for 7 days straight improves heart efficiency as measured by oxygen consumption per energy formed. Another study on humans using a 150mg dose of CoQ10 found that the supplement increased treadmill exercise tolerance. However, because these two studies involved a small number of subjects, they are not statistically significant.

Therapeutic benefit of congestive heart failure 

A small study of 17 patients with congestive heart failure discovered that using 30 mg/day of coenzyme Q10 improved the patients' condition, with 53% of the patients becoming asymptomatic after four weeks of treatment (no symptoms). Another large-scale study involving 2664 patients who took 50-100mg/day of coenzyme Q10 for three months found that 54% of patients improved in their symptoms of insomnia, nocturia, and vertigo. 

Is CoQ10 recommended for heart health prevention and treatment?

In conclusion, it appears that CoQ10 may be beneficial for heart health prevention and treatment, particularly for people with coronary heart disease, hypertension, and congestive heart failure. This is due to its ability to prevent LDL oxidation. It also appears that the majority of patients with heart disease are deficient in coenzyme Q10, which can lead to a variety of heart-related complications later on.

References

1.     Sarter, B. (2002). Coenzyme Q10 and cardiovascular disease: a review. Journal of Cardiovascular Nursing, 16(4), 9-20.

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).

Calories are a unit of measurement for the amount of energy in food and beverages.

We put energy into our bodies when we eat and drink. This energy will then be used in our daily activities, such as breathing, sleeping, and running.

To maintain a stable weight, we must balance the energy we put into our bodies with the energy we use through normal body functions and daily activities. Simply put, the more calories you put into your body, the more activities you need to do to burn them off, and vice versa.

General calories intake

Men on average need about 2500 kcal per day, while women need about 2000 kcal per day. However, as mentioned above, the amount of recommended nutrient intake varies from person to person based on their daily activities, occupation, frequency of exercise, lifestyle habits, and also body metabolism.

The more vigorously you engage in an activity, the more calories you will expend. Fast walking, for example, burns more calories than moderate walking. If you're gaining weight, it could be because you've been eating and drinking more calories than you've been burning. To lose weight, you must expend more energy than you consume; this can be accomplished by eating less or exercising more vigorously. Doing this consistently over time will get you to your desired weight.

When people try to lose weight, they tend to restrict their food intake and often do not enjoy their diet changes. A healthy diet should also be a sustainable diet, which means gradually but consistently reducing unhealthy food consumption, consuming more healthier food options, and being mindful of the amount of food consumed.

Calorie counter

Nowadays, there are various apps that can be used on a mobile phone to track not only your calorie intake but also your steps, exercise, and the energy that you burn. Using all these apps and gadgets is helpful in making sure that you are on track with your diet and exercise.

One of the apps developed by the Ministry of Health Malaysia that is compatible with the Malaysian variety of foods is My Nutri Diary 2.0. The app is helpful in monitoring your calorie intake and your weight progress. Often, when we use calorie tracking apps, it frustrates users that the app does not know how many calories a nasi lemak has (or any local food), but with my nutri diary, it covers a variety of Malaysian food options, which can be helpful for our daily food consumption.

Gap between unhealthy diet and body needs

While trying to lose, put on, or maintain weight, imbalanced consumption of foods may lead to the loss of some essential nutrients. Hence, to bridge the gap between the lack of nutrients in food and what the body needs, consumption of multivitamins and multiminerals is helpful.

Other conditions include denture problems, loss of appetite, a hectic lifestyle, and many more.

Iron is a mineral found in many proteins and enzymes that the body needs in order to stay healthy. Most of the iron in the body is found in haemoglobin, the pigment of red blood cells. Haemoglobin transports oxygen to all of the tissues and organs in the body. If there is an insufficient amount of iron in the blood, the amount of haemoglobin in the blood decreases too. This will reduce the oxygen supply to cells and organs.

During pregnancy, a haemoglobin level of 11 g/dl or above is considered normal. Between 3 to 6 months of pregnancy, a small drop of 10.5 g/dl is also considered normal. Lower levels of haemoglobin are usually due to a lack of iron (iron deficiency). Usually, the level of iron in the blood is measured in order to find out whether a low haemoglobin level is due to a lack of iron.

Lignosus rhinoceros, or its common name, Tiger Milk Mushroom, has been used since ancient times. It is very precious due to its rarity, since it grows in isolation. Within the same 5km radius, you will not find another stalk of Tiger Milk Mushroom. Another reason is that the medicinal properties of Tiger Milk Mushroom are only found in the underground tuber; if you find it at the stage where it has already sprouted out from the ground with a stem and cap, the active compound inside it may have already diminished. Tiger Milk Mushroom, also known as ‘Cendawan Susu Harimau, got famous after the former Prime Minister, Tun Dr. Mahathir Mohamad, said his chronic cough stopped after he consumed Chinese medicine derived from Tiger’s Milk Mushroom at the opening of the International Convention on Biotechnology in 2002 in Kuala Lumpur (1, 2).

Frequently, we perform thousands of breaths each day, often without contemplating the significance and benefits this fundamental bodily function affords us. In contrast to the indispensability of breathing, research regarding breathing techniques remains relatively limited. Nevertheless, there are specific breathing techniques recommended for enhancing various aspects of our health.

Stress and Belly Breathing

One of the most common techniques is breathing exercises aimed at managing stress. Numerous studies have conclusively demonstrated the efficacy of breathing exercises in alleviating anxiety disorders, panic attacks, and general stress. The United Kingdom's National Health Service (NHS) recommends the use of belly breathing for individuals grappling with stress, anxiety, and panic (1). In today's context, where mental health issues have become increasingly prevalent due to the ongoing COVID-19 pandemic and other stressors, it's crucial to educate ourselves and our loved ones on how to respond when confronted with situations that trigger panic, anxiety, or stress (2).

The lungs are a pair of organs in your chest. When you inhale (breathe in), air enters your lungs, and oxygen from the air moves from the lungs to the blood. At the same time, carbon dioxide (a waste gas) moves from the blood to the lung and is exhaled (breathed out). This whole process is known as gas exchange. It is essential to life, despite the very short microsecond period that it takes to complete the cycle (1).

Apart from the lung, the brain also plays a vital role in this whole system. The brain is the one that controls your breathing rate (how fast or slowly you breathe) by sensing your body’s need for oxygen and its need to get rid of carbon dioxide (1).

Exercise and breathing

Exercise is vital to maintaining a healthy body. The benefits of exercise include the well-being of your physical and mental health. As for physical health, studies found that exercise is not only good for individuals with chronic diseases such as obesity, diabetes, hypertension, and many others, but it is also good for lung health (2, 3).

During exercise, the lungs bring oxygen into the body to provide energy and, at the same time, remove carbon dioxide. while the heart pumps oxygen to the muscles that are exercising (2).

When you exercise, your muscles work harder, and your body uses more oxygen and produces more carbon dioxide. To cope with this extra demand, your breathing has to increase from about 15 times a minute (12 litres of air) when you are resting to about 40–60 times a minute (100 litres of air) during exercise. Your circulation also speeds up to take oxygen to the muscles so that they can keep moving (2).

When your lungs are healthy, you have a large breathing reserve. You may feel ‘out of breath’ after exercise, but you will not be ‘short of breath’. When you have reduced lung function, you may use a large part of your breathing reserve. This may make you feel ‘out of breath’, which can be an unpleasant feeling, but it is not generally dangerous (2).

In fact, all these processes, if practised regularly, will improve lung health. How? By improving lung capacity. Even for people with lung problems such as chronic obstructive pulmonary disorder (COPD), it is also recommended to exercise frequently and to practise breathing techniques that can help with them, such as the diaphragmatic breathing technique (3, 4).

Cordyceps is a genus of parasitic fungi that grows on the larvae of insects. When these fungi attack their host, they replace its tissue with long sprouts and slender stems that grow outside the host’s body. The remains of the insects and fungi have been hand-collected, dried, and used in Traditional Chinese Medicine for centuries to treat fatigue, sickness, kidney disease, and low sexual drive (3).

Since there is now an increased shift of attention from synthetic drugs to natural herbal products, not only to treat the common cold and flu but also to prevent chronic diseases, people start to consume various kinds of traditional medicine in an effort to prevent or control diseases (2).

Since cordyceps live only on certain caterpillars in the high mountain regions of China, natural cordyceps are hard to get and are expansive. Most supplements are made with cordyceps grown in the laboratory, which is also known as Cordyceps CS-4. People start to market products containing cordyceps in supplement form or as functional foods since many studies start to dig into their benefits. From more than 400 species of cordyceps discovered, only two types of cordyceps are commonly used, which are Cordyceps sinensis and Cordyceps militaris (3).

Traditionally, people used cordyceps for various purposes; until now, certain people who were able to get wild cordyceps still used this in their daily lives. Some people mix it with milk; it is said to improve sexual drive. It is also sometimes mixed with alcohol, which is referred to as ‘chang', in which people drink it in the morning as tonic (5).

As for modern studies, apart from the usage of cordyceps in cough syrup, cordyceps also have various other health benefits, such as antihyperglycemic. A study on diabetic rats found that the 4g/kg/day that is administered to diabetic rats does not affect their fasting insulin level. When oral administration of cordyceps at 150 mg/kg/day and 500mg/kg/day is ingested by mice for 4 weeks, it significantly prolongs the swimming time of mice by about 20 to 24 minutes, respectively, thus showing that consumption of cordyceps also improves fatigue conditions. It is the involvement of cordyceps in adenosine triphosphate (ATP) (energy) production that accounts for a decrease in physical fatigue when it is administered. Apart from that, the administration of cordyceps decreased the airway inflammation in ovalbumin-induced mice, thus easing breathing for individuals with cough and flu (6).

However, most studies with regards to cordyceps are conducted on mice, not humans, so the findings are considered to have insufficient evidence (1, 3, 4).

However, it is safe to consume cordyceps supplements with other medications if you have any other medical condition since the government of China uses cordyceps as a natural drug in their hospitals to treat patients (1, 3, 4).

References

Foods are supposed to be the best source of nutrients readily available to be absorbed by the body; unfortunately, with our current advancement of food technology, it does not only make our food less perishable, which is a good thing, but it also, through the process, makes it lose the vital nutrients inside the food. Not only that, the advancement in the culinary field makes our taste buds somehow lose its palatability towards healthy food. During the hunting and gathering time, our senses used to tell us what was good or not through smelling and the taste of it (whether it was rotten or dangerous to be consumed), but nowadays people seem to be losing all those. We are only able to tell based on the looks of the food; if it has lots of greens, then it must not be good, but if it has lots of chocolate or cheesy things on it, then it must be tasty. Especially in Malaysia, that is what seems to happen.