Tip 1: Make an exercise goals that you can achieve.

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

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

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

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

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

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

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

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

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

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

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

References

1. WebMD (n.d). Setting Your Goals on Fitness. https://www.webmd.com/fitness-exercise/features/setting-goals-fitness#
2. Sadie Trombetta. (2016). 12 Reasons To Exercise With A Partner, Because Everyone Should Have A Gym Buddy. https://www.bustle.com/articles/156775-12-reasons-to-exercise-with-a-partner-because-everyone-should-have-a-gym-buddy
3. Cari Nierenberg. (2018). Yes, Men Lose Weight Faster Than Women, Here’s Why. https://www.livescience.com/63324-men-women-weight-loss-difference.html
4. National Center for Health Research (n.d). Can Listening to Music Improve Your Workout?. http://www.center4research.org/can-listening-music-improve-workout/
5. Kirsten Nunez (n.d). 13 Benefits of Working Out in the Morning. https://www.healthline.com/health/exercise-fitness/working-out-in-the-morning

Function of Calcium?

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

How much calcium is needed?

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

Calcium and diet

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

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

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

Condition for calcium supplementation

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

Hypertensive individuals and diet with large amounts of sodium.

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

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

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

Pregnant and lactating mother

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

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

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

Post-menopausal women and elderly

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

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

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

Individuals with lactose intolerance and limit dairy products

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

Individuals receiving treatment on certain medication in the long period

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

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

References

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

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

Benefits of fish oil consumption vary greatly from one study to another, there is study link between mental health and disorder with omega, as it said that EPA and DHA can improve brain development ability, even in young children, there are also study noted that it can help with cardiovascular diseases, joint pain, and skin problem such as eczema. The question is, is true that fish oil consumption can help with these all? ?(1)

Individual with mental health problem/disorder

Researchers examined link between suicide and consumption of fatty acids intake among more than 205, 000 participants in three long term studies from 1988 to 2008 found out that there is no evidence that intake of fatty acids or fish lowered the risk of suicide. “The vast majority of previous literature on whether there is a mental health benefit from fatty acid intake has been based on depression screening data. Our study represents one of the few times—and it is certainly the largest of its kind—that this relationship has been studied with hard data on suicide mortality.” (2)

Whilst for brain health,  study noted that it is better to eat nutritious diet and be physically active than to take omega 3 fatty acids supplements or fish oil, Study showed little benefit of omega 3 supplements on memory of a 3073 elderly people at risk of macular degeneration (an age related cause of vision loss). The participants of the study were randomly assigned to take omega 3 pills or placebo for five years.  The researcher concluded that supplement cannot replace a healthy dietary pattern, if you eat a healthy diet with high amounts of fruits, vegetables, and marine fish, you probably don’t need to take fish oil supplement. The overall dietary pattern is more important than a single nutrient (2).

Individual with cardiovascular disease

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

Which is why interpreting the study, we would still recommend customers and patients to consume fish more 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 nutrient essential nutrient, since omega 3 is a nutrient that your body cannot produce can only get form diet (3,4,5).

Individual 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 only small sample size studies. Not only these three studies are small, it is also described as poor methodological studies from reviewer, as it has many confounding factors, but the outcomes of these studies shows positive outcome from eczema condition and overall daily living as compared to placebo (6,7).

Another convinced relationship between consumption of fish oil and skin health is that in a study where pregnant lady were given fish oil during pregnancy and follow up to 6 years found out that, consumption of fish oil during pregnancy lead to positive skin health outcome on babies skin health. 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 mixing result in studies depending on what kind of problem that we are looking at 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 diet, as you dislike fish, or you are afraid to consume fish regularly due to contamination etc, or you simply would like to make sure that your body has enough omega 3, then there is no harm in taking fish oil supplementation. It just that in order to make sure you get the right omega 3 for your body, buy it from pharmacy, make sure the product has Ministry of Health (MOH) notification number, and simply ask healthcare professional on 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

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

Soluble fiber

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

Insoluble fiber

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

 Facts About Fiber (3,4)

#1 Fiber aids in achieving healthy weight.

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

#3 Fiber helps to lower cholesterol.

#4 Fiber helps to regulate blood glucose.

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

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

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

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

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

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

#11 Fiber cannot be cooked out.

Tips to Increase fiber intake (5,7)

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

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

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

Eat unpeeled whole fruit and vegetables not juice.

Snack on fruits and vegetables

Take a fiber supplement (e.g psyllium)

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

References

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

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).

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).

In this article we are going to focus solely on slimming products that people consume like functional foods, pills, beverages, not for external use like ointment, lotion, or other types of slimming products since different kind of product has different method on how they give effect to the body.

Slimming pills on the market is either from drug, or drug combination or from herbal supplement. As for drugs at the moment, in Malaysia we only use two types of drugs which is anti-obesity medicine (AOM) that act on gastrointestinal tracts (GIT) or better known as orlistat (brand name Xenical) and drugs which is used to suppress appetite or better known as Sibutramine or phentermine. The consumption of all these drugs must be prescribed and monitored by doctors.

There are certain criteria for doctors to consider in order to prescribed slimming pills such as when individual has BMI more than 30, but most importantly is when the individual have tried to loss weight like eat healthily and exercise. Once individual have achieved certain weight loss then the doctor can no longer prescribed the medication, which is why, the consumption of such drugs needs to be monitored by doctors only. Also, to note that there have been cases previously where the prescription of slimming drugs which harm individual health, the drug is called Fen-Phen, it was phenomenal back then, it was a combination from Phentermine and Fenfluramine, but Foods and Drugs Administration (FDA) already take it back from the market as it can harm human health specifically heart valve. When prescribing slimming drugs doctors will usually conduct full body examination and blood test from time to time thus whatever things that is not suitable for body may be detected early, unlike consuming slimming pills without prescription.

As for herbal supplement slimming pills, the ingredients can be from various ingredients, either plant-based ingredients or animal-based ingredient. Since it does not consider as drugs thus it is not put under the strict and effectiveness requirement that drugs are in.

In Malaysia, all these supplement products need to be notified to Ministry of Health (MOH) under the National Pharmaceutical Regulatory Agency (NPRA) for its safety. Once it is being notified, NPRA will provide the supplement products with notification number. Many product founders use this as their marketing strategy as to promote that their product is approved by MOH. However, products with notification number does not means that they are safe. It means that they are confident that their product is safe so that MOH can come and spot check anytime to make sure that their products is safe. Of course, before NPRA provide the product with the notification number they already go through the product ingredients and all that, but different batches of supplement are produce over the time, which can be different from the one sent for checking initially.

Among common ingredients that are in slimming pills supplement are chitosan (from shrimp shell), caffeine, bitter orange, green tea, beta gluten, carnitine, raspberry ketone, white kidney bean, yohimbe, guar gum, garcinia cambogia, fucoxanthin and many more. All these ingredients usually do not have conclusive study findings but rather mixing or promising study findings.

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