Category Archives: Medicine & Health 疗池

THE LOW-FODMAP DIET

by Dr. Mecherl Lim 

MD (MA) Naturopath (ND), Holistic Kinesiology

In 2006, researchers Dr Sue Shepherd & Professor Peter Gibson from Monash Uni, linked several highly fermentable but poorly absorbed short chain carbohydrates and polyols to symptoms associated with IBS, including wind & diarrhoea, as well as to the increased intestinal permeability associated with Crohn’s disease.

These fermentable aligo-di-and monosaccharides and polyols are now known collectively as FODMAPs. They comprise oligosaccharides (fructans and galactans), disaccharides (lactose), monosaccharides (fructose) and polyols, which is the technical word for sweetener. In the 2006 study, 74 per cent of patients with IBS and fructose/fructan diet such as the FODMAP diet.

HOW DOES THE LOW-FODMAP DIET WORK?

Research shows that FODMAPS in meals are poorly absorbed in the small intestine and increase the delivery of water to the colon-suggesting the catalyst for diarrhoea in some people. Breath test show that eating a low-FODMAP diet reduces hydrogen production (in both healthy volunteers and patients with IBS), linking the short chain carbohydrates with bloating, abdominal distension and pain and excessive flatulence. 

Since the first study, research has consistently tied global restriction of FODMAPs (rather than restriction of individual components) with reduced symptoms of IBS. In a challenge trial (in which participants restricted fructose/fructans-containing foods and then restored the foods to the diet) showed a return of symptoms after the foods were reintroduced.

In those with Crohn’s disease, sweeteners such as sorbitol, maltitol and isomalt are absorbed, but the digestibility of the other nutrients in the foods is reduced because these polyols cause an osmotic load, meaning that more water remains in the intestine, leading to watery stool.

FODMAP group had reduced bloating, 87 per cent enjoyed less flatulence and 85 per cent experience a reduction in abdominal pain.

The researchers concluded that the low-FODMAP diet is more effective than standard dietary guidelines for symptom control of IBS.

FODMAPS AFFECT HEALTHY PEOPLE TOO

It’s interesting to note the research has also uncovered information about how FODMAPS are digested by healthy participants. We know, for example, that fructans (polymers of fructose found in asparagus, leeks, garlic, onions and onions and wheat) and galacto-oligosaccharides (lactose from cows milk) are always fermented by intestinal flora, and cause wind production and flatulence in healthy people too. The effects are merely worsened in those with hypersensitivity and motility disorders as found in IBS.

READY TO TRY IT

The low FOD-MAP diet eliminates sugars that can’t be fully digested and absorbed in the small intestine. When following this diet, journal ling is critical. Be sure to keep accurate records of what you eat, when and how your body responds.

After following the diet until all of your symptoms have disappeared, the goal is to reintroduce foods to determine whether they are a trigger for your symptoms. When doing so, add one food back at a time and wait 72 hours to determine that symptoms haven’t re-appeared before moving on to the next food. 

FODMAP DIETThis way of eating is not as restrictive as some other prescription diets, but if you are interested in following it, you are wise to get nutritional guidance from an expert so you are sure to get all of your health-supportive nutrients. You may have to use vitamin and mineral supplementation to be sure to meet nutrient requirements, particularly in the elimination and re-challenge phases. 

Dr Mecherl Lim

An Intuitive Medical Practitioner in Alternative Medicine (MD) (MA), Naturopath (ND), Holistic Kinesiology (HK), and Functional Medicine (FM)

Visit : www.drmecherlherbs.com

Email : drmecherherbs@gmail.com

FACEBOOK : drmecherlherbs for further enquiries.

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STEM CELL THERAPY IN ORTHOPAEDICS

by Dr. Tan Boon Cheong

MBBS (MU),. MS Ortho (MU)

Many issues ago I did very briefly mentioned about stem cell treatment in orthopaedics, but only in a few sentences. Stem Cell Therapy has gained increasing popularity in orthopaedic treatment especially in knee osteoarthritis in the last few years. Stem cells are not only used for articular cartilage regeneration, but also used for osteonecrosis, fracture healing, osteochondral defects and tendinopathies.

The two most common sources of adult stem cells for clinical application in orthopaedics are the bone marrow and adipose tissue. Bone marrow aspirate is first harvested and centrifuged, Bone Marrow Aspirate Concentrate (BMAC) which contains Mesenchymal Stem Cells (MSCs) will then be produced. When lipoaspirate has been treated by enzymes and has undergone differential centrifugation, a layer of Stromal Vascular Fraction (SVF) which contains MSCs will be obtained. With the advancement of technology today, industry players have managed to obtain better stem cell count with each centrifugation; Thus, making the cultivation of stem cells easier and faster. 

Although stem cells have been widely used in orthopaedic treatment, stem cell usage in knee osteoarthritis has interested patients more than others. With recent advancement, more research articles have been able to show the regeneration of articular cartilage in knee osteoarthritis with stem cell treatment. Even though most of these studies were small-scaled, but they have shown promising results.

Stem cell application in knee osteoarthritis can be in two ways. The first will involve a minor operation through arthroscopy of the knee. During the arthroscopy procedure, the cartilage defect on the joint surface will be identified and prepared. The stem cells will then be used to fill up the defect (implantation). The second method which is much simpler is direct intra-articular injection into the knee joint. This usually goes together with hyaluronic acid (gel).

Having said about the use of stem cells in the treatment of knee osteoarthritis, not every patient with knee osteoarthritis is suitable to be treated with stem cell as the patient must be well selected. Knees with severe osteoarthritis should not have Stem Cell Therapy performed on them as this will result in poor outcomes, for them knee replacement surgery is their only option. Do bear in mind, Stem Cell Therapy in knee osteoarthritis is not permanent. Several studies have shown that the effects only last a range of 2 to 5 years. 

One major drawback of stem cells  being widely used in knee osteoarthritis is the cost. The cost of stem cell treatment can range from RM12000 to RM 20000 (USD 3000 to 5000) per knee per treatment. Moreover, this cost will not be covered by medical insurance.

I believe that the usage of stem cells in knee osteoarthritis treatment in the years to come as more studies are conducted will be able to provide us with better evidence on the outcomes of Stem Cell Therapy. Therefore, before one decides to have this treatment, it would be great to first have a consultation with an orthopaedic surgeon as every patient differs. 

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The New Food Map For Digestive Disorders

by Dr. Mecherl Lim 

MD (MA) Naturopath (ND), Holistic Kinesiology

There’s a new acronym in the dieting world: FODMAP. It’s  an acronym that makes life easier for anyone discussing this particular diet, because the words represented by the acronym are so difficult to remember, let alone pronounce.  FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.

IBS RELIEF

One of the reasons this new diet is getting so much attention is that it seems to help those who experience the symptoms of irritable bowel syndrome (IBS). Millions of people suffer from digestive disorders, and up to 20 per cent suffers at some time with IBS

WHAT IS IBS?

While the word “bowel” is built into the name, IBS involves pain and discomfort anywhere in the abdomen, and includes such varied symptoms as diarrhoea, constipation, painful wind, belching, flatulence and bloating. If left untreated, over time it can lead to dehydration, nutrient deficiencies, social discomfort and could contribute to some forms of cancer.

WHAT CAUSE IBS?

Experts believe that IBS is the result of dysfunction in the muscles or nerves controlling the  organs of the gastrointestinal tract, which is  a lot more complex than it might first appear. A system of nerves runs the length of the digestive tract starting at the oesophagus and ending at the anus.  In fact, the number of nerves in the gastrointestinal  tract is exceeded only by the number  present in the spinal cord and brain!

WHAT ROLE DOES DIET PLAY?

While some experts ponder the source of the dysfunction, others are focusing on the role of diet in producing the symptoms associated with IBS. Poor digestion, malabsorption of dietary sugars (lactose from dairy and fructose from fruits) and food chemicals have often been considered triggers for IBS symptoms. 

Similarly, while dietary fat helps food and wind to move slowly through the stomach and small intestine of healthy individuals, it seems to really slow down food and wind transit in those with IBS. New research also suggests non coeliac gluten intolerance may play a role in those who suffer with irritable bowels.

One of the major complaints associated with IBS involves wind production. For example, IBS sufferers report more  wind, as well as wind that takes longer to dissipate from the small intestine that those without IBS.

As a result of the wind build up, bloating causes an increased abdominal size throughout the day, leading to discomfort and possible embarrasment- not to mention a wardrobe full of unattractive clothing with elasticized waistbands! 

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