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).

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

Fiber comes in two varieties, both beneficial to health (3):

Soluble fiber

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

Insoluble fiber

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

 Facts About Fiber (3,4)

#1 Fiber aids in achieving healthy weight.

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

#3 Fiber helps to lower cholesterol.

#4 Fiber helps to regulate blood glucose.

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

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

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

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

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

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

#11 Fiber cannot be cooked out.

Tips to Increase fiber intake (5,7)

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

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

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

Eat unpeeled whole fruit and vegetables not juice.

Snack on fruits and vegetables

Take a fiber supplement (e.g psyllium)

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

References

1. Cleveland Clinic. 2019. Improving Your Health With Fiber. Available from https://my.clevelandclinic.org/health/articles/14400-improving-your-health-with-fiber [Accessed on 23 April 2020].

2. Danielle, D. 2018. How much fiber is too much. Medical New Today. Available from https://www.medicalnewstoday.com/articles/321286#treatment [Accessed on 23 April 2020].

3. Harvard University School of Public Health. (n.d.). Fiber. Available from https://www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber/ [Accessed on 23 April 2020].

4. Karin, L. 2016. 45 Interesting Facts about FIber. Fact Retriever. Available from https://www.factretriever.com/fiber-facts [Accessed on 23 April 2020].

5. Kerri, A., J. 2016. 16 Easy Ways to Eat More Fiber. Healthline. Available from https://www.healthline.com/nutrition/16-ways-to-eat-more-fiber [Accessed on 23 April 2020].

6. Mayo Clinic. 2018. Dietary fiber: Essential for a healthy diet. Available from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983 [Accessed on 23 April 2020].

7. My Health Ministry of Health. 2012. SERAT DAN KAWALAN DIABETES. Available from http://www.myhealth.gov.my/serat-dan-kawalan-diabetes/ [Accessed on 23 April 2020].

Worldwide, people are living longer. With the advancement of medical technology, people in this era are expected to live into their sixties and beyond. By 2050, China alone will have as many as 2 billion people in this age group, compared to about 120 million in the rest of the world. Today, 125 million people are aged 80 years old and older, worldwide. 

While in Malaysia, the number of Malaysians aged 60 years and above is estimated to be 1.4 million and is projected to increase to 3.3 million in the year 2020. The percentage of the population that is 60 years of age or older has also increased over the years: 5.2% in 1970, 5.7% in 1990, and 6.3% in 2000. In the year 2020, this percentage is expected to be 9.8% of the population. Between 1990 and 2020, the population of Malaysia is expected to increase from 18.4 million to 33.3 million, an increase of 80%. The aged population, however, is expected to increase from 1.05 million in 1990 to 3.26 million over the same period, an increase of 210% (2).

The population is ageing at a much faster rate than in the past. All countries face significant challenges in ensuring that people's health and social systems are prepared for this demographic shift. The healthcare system and technology must keep up with people's health and needs (1,2).

Many more literatures on the topic of geriatric (elderly) health must be discussed. According to research, the elderly face issues such as frailty, which is frequently exacerbated by issues such as urinary incontinence, instability, falls, and acute confusion states. Furthermore, as people get older, they are more likely to develop chronic diseases (2).

All these issues contribute to elderly malnutrition; in addition, poor dentition, changes in dietary habits, and the types of food available all play important roles in this situation. Thus, if you have an elderly person with a poor appetite, make sure to rule out all physical issues before attempting to improve the elderly person's appetite (2,3). 

Ways to stimulate the elderly's appetite as a carer or ways for the elderly to try it themselves (3,4):

• Share a meal with your loved one or encourage them to join others for a weekly lunch or dinner. According to studies, seniors who eat with others eat more and make healthier food choices.
• Keep in mind that your loved one's preferences may change. Make nutritious meals that are bright and colourful, as well as high in vitamins and minerals. However, do not overburden your loved ones with large portions, as a plate piled high with food may overwhelm them and discourage them from eating at all.
• Eating meals on a set schedule makes it a routine part of your loved one's day. Every day of the week, breakfast, lunch, dinner, and snacks should be served at the same time.
• Serve higher-nutrient foods in smaller portions. When they see a large amount of food in front of them, some seniors become overwhelmed. Serve smaller portions instead of a large plate. You could even implement a daily routine in which your senior consumes 5 small meals rather than 3 larger ones.
• You can still cook in larger batches to save time. Simply store it in smaller individual containers to make it easier to reheat.
• Put down your utensils. The frustration of not being able to use a spoon, fork, or knife may cause some elderly people to refuse to eat at all. Serve foods that can be eaten without utensils to make eating easier for them.
• Have plenty of easy-to-eat snacks on hand. Some seniors would rather graze throughout the day than eat full meals. That is also acceptable. Make sure you have plenty of healthy, delicious, and easy-to-eat snacks on hand.
• Whip up some milkshakes or smoothies. Consider serving more liquid-y foods if chewing is difficult or tiring, even with small pieces of food. You can also try making this liquid diet with different fruits and vegetables. Do not be concerned about fat or cholesterol unless your elderly relative has specific health issues. After all, the challenge is to get enough calories into them.
• Consumption of complete milk formula such as Nutrasure and multivitamins such as Ginviton can help bridge the gap between poor food consumption/highly nutritious food and their health needs!
• Keep track of what works for you. Take notes so you can remember what foods your senior likes, what they don't, and what might be bothering their stomach. You can also observe when they are more willing to eat or when they have a stronger appetite. Keeping track allows you to experiment more with what works and avoid what doesn't.

 References

1.   World Health Organization (WHO). Key Facts. Ageing and Health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

2.   Mafauzy M. (2000). The Problems and Challenges of the Ageing Population in Malaysia. The Malaysian Journal of Medical Sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406209/

3.   American Senior Communities. Is Loss of Appetite in Elderly is the Sign of Something Else? https://www.asccare.com/loss-appetite-elderly-sign-something-else/

4.   Daily Caring. 6 Ways for Seniors with No Appetite to Eat. https://dailycaring.com/6-ways-to-get-seniors-with-no-appetite-to-eat/

"Pills are not a shortcut to better health or the prevention of chronic diseases," says a nutritionist who is actively advocating for healthy eating, while another nutritionist suggests that you must take supplements to make up for the daily recommended nutrient intake (RNI) that is not met. Are you familiar with this situation? The question is, "How do we go about it?" Do we need supplementation, or do we not need supplementation?

MAYBE is the answer to these questions. Yes, perhaps you need supplementation, or perhaps you do not need supplementation. In this article, we are focusing on healthy adults (men and women), not on those with special needs who really need supplementation as per recommendations by medical professionals.

When it comes to nutrition supplements, there are various schools of thought. Here's the baseline: the MOST IMPORTANT thing for a healthy adult to do in order to maintain healthy health is to EAT HEALTHY. Now comes the question: how do I eat healthily when healthy food is so confusing? 

The bottom line for healthy food is easy: eat three servings of vegetables and two servings of fruits per day. Limit your fat and sugar intake, especially from sugary beverages. Make sure the cooking method is a healthy one such as blanching, steaming, or grilling, and lastly, the individual should exercise regularly for at least 150 minutes of exercise five times per week (1, 2).

Wait a minute, after reading the above and reflecting on our current living situation, you might think, "This is hardly possible; there are people who work in shift schedules; there are people who work from 7 AM to 6 PM with no time to prepare a meal on their own; there are people who have many other commitments to whom eating simply means shove food down their throat and be full!" 

Examples of healthy plate.

Of course, as a nutritionist, I prefer healthy eating to vitamin and supplementation, but in light of our current situation, we should instead educate people on how to choose supplements that are appropriate for them and how to determine whether they need supplements at all. 

There are a few guidelines set by the Harvard School of Public Health on how to know the kind of supplementation that we need to take and our body's signs of needing a supplement (3, 4).

• Say no to ‘high dosage.’

 By saying no to high, we mean that any supplements that provide high dosages of vitamins and minerals need to be taken off the list. Check your nutritionist's recommended nutrient intake (RNI) and only take supplements that are equivalent to that. (E.g., the RNI for vitamin C for adults, both male and female, is about 70 mg; thus, choose your vitamin C supplementation around this amount.) In order to identify the supplements that are right for your health, you need to identify your eating pattern. If you are a picky eater, you must identify the foods that you do not normally consume, such as vegetables, fruits, protein-based foods, and so on. A nutritionist will then identify the nutrients that you are likely missing from your eating pattern and recommend a vitamin intake that is appropriate for your eating pattern. Those who do not eat vegetables, for example, may be deficient in fibre and antioxidants, so taking a fibre supplement or probiotics may be beneficial. As for people who rarely eat protein-based foods such as fish, poultry, and meat, they are at risk of lacking the B-complex vitamin. As a result, a single multivitamin is not the answer to all; each eating pattern must be observed to determine the supplements required to compensate for any loss. 

•  Say no to ‘super.’

There are numerous supplements on the market that claim various health benefits, particularly those advertised on television and the internet. Most of these are only based on testimonials saying that they are ‘super’ vitamins, etc. for health. Do not be swayed by these wild health claims. If it sounds too good to be true, you can be sure it is! Save your money for something even more beneficial, like healthy food and a good vacation for your mental health!

•  Say no to ‘cure.’

Most of the vitamins or supplements are meant to compensate for what is lost and to alleviate some of the health problems. Once there is a strike of an illness, usually there is just no turning back, e.g., diabetes, which is a lifelong health problem where a patient with diabetes needs to control their sugar intake for life and thus take care of their diet. Thus, it is the management of the disease that is important to not make it even worse, so here is how diet, supplements, and physical activity play important roles. However, for some other illnesses, such as occasional joint pain, the intake of certain supplements might help, but then again, it is on a case-by-case basis.

•  Holistic Care

 Most people regard supplements as "super pills," where they think that if they consume these supplements, they do not have to eat healthily or even exercise. Oh, my goodness, that is completely incorrect! Every nutritionist must ensure their customers or patients understand that by taking supplements, they still need to eat healthily and exercise; supplements are just meant to make up for whatever vitamins they do not get from their poor eating habits. Which means if you are eating well, have a good range of weight, are not a picky eater, and have no problem understanding what consuming healthy food means, you do not have to consume supplements; just continue to eat healthily and exercise. But for those who are showing symptoms of lethargies, scurvy, severe weight loss, poor appetite, a hectic schedule, a poor eating habit, etc., these are the people who need to consume supplements!

To summarize, in today's hectic lifestyle, supplements are critical to maintaining good health. By all means, try to understand how to eat healthily, but if you frequently fail to do so, it may be time to consider taking supplements. However, before taking any supplements, consult with a health professional, such as a medical doctor or a nutritionist!   

References

1. Jennifer Warner (2012). WebMD. 30 Minutes of Daily Exercise is enough to shed pounds. https://www.webmd.com/fitness-exercise/news/20120824/30-minutes-daily-exercise-shed-pounds (Accessed on June 25, 2020)

2. Edward R. Lawoski (2019). Mayo Clinic. How Much Should The Average Adult Exercise Every day ? https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/exercise/faq-20057916#:~:text=For%20most%20healthy%20adults%2C%20the,of%20moderate%20and%20vigorous%20activity. (Accessed on June 25, 2020).

3. Harvard T.H Chan. School of Public Health. The Nutrition Source. Nutrition Insurance Policy: A Daily Multivitamin. https://www.hsph.harvard.edu/nutritionsource/multivitamin/ (Accessed on June 25, 2020).

4. Org. Vitamins: Hype or helps for healthy eating. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/vitamin-supplements-hype-or-help-for-healthy-eating#:~:text=%E2%80%9CA%20supplement%20will%20generally%20provide,healthy%20food%2Dbased%20diet.%E2%80%9D (Accessed on June 25, 2020).

Consumption of supplementation is meant to fill the gap between poor nutrition intake and the actual nutrients required by the body. With our current lifestyle practice, it is necessary for certain individuals to consume supplementation such as those who find healthy eating is not palatable, those who always busy in which food is just meant to be eaten on the go thus, fast food, processed food and junk food is always the option and to those who unable to grasp the concept of healthy eating.

When it comes to choosing the right supplementation for your body, always bear in mind to ask your dietitian, nutritionist, or doctors on the Required Nutrient Intake (RNI) by the body, usually the amount needed is small only.  If you unable to get that nutrient from food since you do not consume certain food, thus you might consider supplement taking.

As an example, if you do not eat vegetables you might consider consuming fiber, since people who do not consume vegetables usually will experience constipation. Apart from constipation, people who do not consume vegetables and/or fruits also lack of antioxidants, antioxidants is very important to fight free radicals which can cause cancer any many other chronic and metabolic diseases in the body, thus, consuming supplement product containing antioxidants might help.

There is also certain phase in life where you need supplementation such as women of childbearing age, especially if they are expecting for baby. They need to consume folic acid. Worldwide, study has been established that consuming about 0.4 mg of folic acid prior pregnancy may prevent spina bifida (a neural tube defect condition, where birth defect occur when the spine and spinal cord do not form properly).

Apart from folic acid, World Health Organization also suggest pregnant mother to consume iron supplementation. About 30 mg to 60 mg of elemental iron is recommended for pregnant women to prevent maternal anaemia, low birth weight and preterm birth. At this stage women who experience hyperemesis gravidarum (severe morning sickness) also is advised to drink oral nutrition supplement if they have difficulty in consuming food in general.

Oral nutrition supplement is not only suitable for women in such condition it is also suitable for elderly who have denture problem, in which consuming food and swallowing food is hard, elderly who is picky eater, elderly who is always lethargic.

People who has certain food preference or regime, such as those who fasting from animal-based product (usually for religion purposes) or vegan can also consider including vitamin B in their diet. This is due to, vitamin B can be found ubiquitously in animal-based food, thus people who do not consume it might be deficient of it.

In conclusion,

When it comes to filling your nutrition gap, it is much essential to talk to your medical professional, letting them know your food preference, your current full blood examination results, and health symptoms that you are experiencing might also helps in improving your nutrition needs. It is very essential to buy supplement products from the legitimate source such as from pharmacy, or as per recommended by health professional. Apart from you need to make sure that the supplement product is safe to be consumed (e.g: have Ministry of Health (MOH) notification number), you have to also talk to medical professional since, some of the herbal or botanical based supplement might interfere with your medicine consumption.

References

1. News in Health (NIH). Should you take dietary supplement? (2013). https://newsinhealth.nih.gov/2013/08/should-you-take-dietary-supplements
2. Dietary Supplements Fact Sheet. National Institute of Health (NIH). https://ods.od.nih.gov/factsheets/list-all/
3. National Service Health (NSH). Do I Need Vitamin Supplement? https://www.nhs.uk/common-health-questions/food-and-diet/do-i-need-vitamin-supplements/
4. World Health Organization (WHO). Daily iron and folic acid supplementation during pregnancy. https://www.who.int/elena/titles/guidance_summaries/daily_iron_pregnancy/en/#:~:text=Daily%20oral%20iron%20and%20folic,birth%20weight%2C%20and%20preterm%20birth.

With regards to COVID-19 pandemic, many people started wanting to boost their immune system thus making the demand for vitamin C supplementation and food products containing vitamin C is even higher. However, is it true that vitamin C can boost immune system and prevent or treat COVID19?

What is vitamin C and how does it improve immune system?(2)

Vitamin C or also known as ascorbic acid, is a water-soluble vitamin. It can also act as antioxidant, which helps in protecting cells against free radicals thus helps with various kind of diseases. Vitamin C improves our white blood cells  (WBC) which function in fighting the viruses, bacteria, and generally foreign materials in the body. There are various studies with regards to this, one of it is the study that compare the administration of vitamin C and vitamin E as antioxidant, finding of the study noted that vitamin C give greater effect on body immunity as compared to vitamin E.

Vitamin C supplementation (4,5,6,7)

Vitamin C is found abundantly in fruits and vegetables especially citrus food. Also, if you look closely on the food labelled, there are food that is fortified with vitamin C such as breakfast cereal, milk etc. Local fruit that is high with vitamin C is guava, the amount of vitamin C in guava is even higher than in the orange.

As for cold, vitamin C has been a long popular remedy for common cold, which is why many people started to consume it when the pandemic strikes. Research shows that vitamin C does not reduce risk of getting common cold. Well, being sick once in a while, or get common cold once in a while is a good thing actually, it helps  antibodies to fight against pathogen (bad bacteria and viruses) and improve the immune system naturally. However, the consumption of vitamin C can lead to  a shorter period of common cold with milder symptoms. But the consumption of vitamin C after the symptoms of common cold is showing does not appear to be helpful.

With the COVID-19 pandemic, it’s especially important to understand that no supplement, diet, or other lifestyle modification other than physical distancing, also known as social distancing, and proper hygiene practices can protect you from COVID-19. However, since the symptoms is the same as common cold thus it is thought that it can be used to alleviate the same symptoms present. Currently researchers and physicians are studying the effect of vitamin C via (high dose intravenous) (IV) and also on the effect of supplementation taking on the new COVID19.

In conclusion, it is safe to say that, there is no harm in consuming vitamin C with the purpose to boost immune system in this pandemic situation, but also it has to be hand in hand with the other safety precautions such as only go out when it is necessary, must always adhere to the one meter social distance measure, must always wear mask when you are outside, must wash hands frequently using soap or hand sanitizer.

References

1. Oregon State University. Pauling Recommendation (2004).https://lpi.oregonstate.edu/mic/vitamins/vitamin-C/pauling-recommendation (Accessed on November, 16, 2020).
2. Healthline. 7 Impressive ways Vitamin C benefits your body. https://www.healthline.com/nutrition/vitamin-c-benefits ( Accessed on Nov 16, 2020)
3. 8 Nutrients that will optimize your eye health. https://www.healthline.com/nutrition/8-nutrients-for-eyes. (Accessed on Aug 26, 2020)
4. All About Vision. Lutein and Zeaxanthin. Eye and vision benefits. https://www.allaboutvision.com/nutrition/lutein.htm (Accessed on Aug, 26, 2020)
5. Simonson W. (2020). Vitamin C and coronavirus. Geriatric nursing (New York, N.Y.), 41(3), 331–332. https://doi.org/10.1016/j.gerinurse.2020.05.002
6. Medical News Today (MNT). Can Vitamin C Prevent or Treat COVID19.  https://www.medicalnewstoday.com/articles/can-vitamin-c-prevent-or-treat-covid-19 (Accessed on November 16, 2020).
7. Healthline. Can Vitamin C Protect you from Vitamin C. https://www.healthline.com/nutrition/vitamin-c-coronavirus (Accessed on November 16, 2020)

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.

Conditions 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).

Conclusion

In these situations, 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).

Which is why when it comes to supplement consumption it is very much suggested to go through below guideline from MOH:

1. Check the products that you are going to buy whether it is registered with the regulatory authority.

2. Some of the products (including herbal) may also cause adverse effects. Make sure your medical condition is not affected by it if you would like to try these products. Seek advice from healthcare practitioner before consuming it.

3. Read label carefully and do not take more than the listed dose.

4. These products are licensed as either over the counter (OTC), traditional, or functional food, therefore it is not ethical for the founder to make claim such as ‘stops from being fat’ or ‘speeds up metabolism’.

5. Avoid slimming products which promote rapid weight loss, promise quick result, suggest that you do not need to exercise or diet, fail to recommend dietary advice or worse encourage that you can still consume anything you want

In conclusion, whether slimming pills work or not it is still depending on type of slimming pills itself whether it is considered as drugs (need doctor prescription) or herbal one which is over the counter pills. All in all, health experts agree that making lifestyle changes including following a healthy eating pattern, reducing calorie intake, and engage in physical activity is the basis for achieving long term weight loss. But since making lifestyle changes can be difficult to some people, even more nowadays that there are many temptations for unhealthy food around us, not to mention the processed food which is marketed as ready to eat or ready to cook food (microwaved) but contain high trans-fat. Thus, it is really suggested that if you are to consume any slimming pills, get advice from healthcare professionals and accompanied it with healthy eating habit and exercise.

References

1. Ministry of Health (MOH). MyHealth Portal. Slimming Pills. http://www.myhealth.gov.my/en/slimming-pills-2/

2. National Institute of Health (NIH). Dietary Supplements for Weight Loss. Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/

3. Lasting damage from Fen Phen. https://www.webmd.com/heart-disease/news/20081105/lasting-heart-damage-from-fen-phen#1

The placenta is an organ that connects the foetus to the mother. It transfers oxygen and nutrients to the foetus and removes foetal waste products to the mother. When the baby is born, the placenta will also be discharged from the mother’s body. There has been a growing interest in placenta extraction as it is said to have high nutritional value. The nutritional substance includes cytokines, hormones, bioactive peptides, enzymes, growth factors, vitamins, and minerals.

Culturally, humans rarely consume placenta, but recently there has been growing interest in consuming placenta, be it from humans or animals. Mammals have been consuming placenta since years ago; it is called placentophagia, while in humans it is called placentophagy. The placenta could be served raw, cooked, or encapsulated and taken as a supplement as it contains various nutritional benefits.

Rave on this started when many Hollywood celebrities started using placenta therapy as part of their skincare routine treatment. Celebrities like Kim Kardashian, Victoria Beckham, and even male celebrities like Harry Styles from One Direction have said they have been using this for their skin to get baby-soft skin.

Placenta consumption in Malaysia.

In Malaysia, it is rare for people to consume raw placenta. Usually, it comes in health supplement form and is derived from deer or sheep. Hence, as it is in health supplement form, any products containing placenta extract in a pharmaceutical dosage will require to be registered with the Drug Control Authority (DCA) before they are sold or used in Malaysia.

Benefits of placenta consumption.

Findings from research reported that nutrients that are delivered via the placenta could be retained even after the process of delivering the baby. The research also stated that the placenta contains collagen, elastin, laminin, and vitamins such as B1, B2, B3, B4, B5, B6, B7, and B12. All these vitamins, better known as B complex vitamins, play roles in cell metabolism, cell division, cell development, and energy production.

Due to this aspect as well, it is said that it gives a lot of benefits to skin health. Placenta is even used in clinical settings, such as for burn injuries and wound healing. In one study, researchers compared the efficacy of topical placental extract dressings versus povidone iodine dressings in diabetic wounds in a variety of patients. Placenta wound dressings could significantly accelerate the rate of wound healing when compared to povidone-iodine dressings as they contained amino acids, vitamins, and nucleotides, which accelerated wound healing recovery by seven to ten days.

Due to all these effects, many skincare products have recently incorporated placenta, be it from sheep or deer, in their skincare or supplement products.

Caution with regard to placenta in the supplement

When it comes to placenta consumption as a health supplement, it is evaluated based on its safety of use and product quality. To be safe, sheep placenta products must be hormone-free. Because placenta typically contains hormones such as testosterone, oestrogen, and progesterone, being hormone-free is much more important for a placenta-based supplement. To confirm whether the products you are considering or consuming have been notified by the Ministry of Health, you can conduct an online product search on the National Pharmaceutical Registration Agency (NPRA). However, if the product is not listed in the DCA, it is not recommended that you consume it because its safety and quality have not been evaluated, and it may pose a health risk.

References

1. Ministry of Health (MOH). MyHealth Portal. Sheep Placenta. http://www.myhealth.gov.my/en/sheep-placenta/ (Accessed on January 13, 2021)
2. Pan, S. Y., Chan, M. K., Wong, M. B., Klokol, D., & Chernykh, V. (2017). Placental Therapy: An insight to their biological and therapeutic properties. blood, 4(11), 12.

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.