XTRA Health+ March 2016 Issue 04

Battling obesity

www.healthplus.com.my

Growing problem has earned Malaysia the inglorious title of ‘fattest’ nation in Asia

... pages 02-09

The Pulse of the Nation

March | 2016

LOVING OUR KIDNEYS Our kidneys are amazing organs that do many essential tasks to keep us healthy.

Hence, we need to take good care of them.

However, the sad reality is many people don’t – in fact some abuse these precious organs until they’re finally injured beyond repair... pages 10-17

SOCSO steps ahead with dialysis support

Scheme provides dialysis facilities for contributors suffering from end-stage kidney failure

... pages 14-15

Taking HIV by the horns

Andrew Tan, living with HIV for 20 years, finds peace helping others with similar condition

... page 18

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Battling obesity Growing problem has earned Malaysia inglorious title of ‘fattest’ nation in Asia

H

By Norman Hussaini

umans are fascinating beings. We can fit in different types of situations – we can live in cold climates by building shelters and heaters, or in hot climates by building electric fans and air conditioners.

Buildings, bridges, highways and dams are what make us live comfortably and with ease. And

with all these technological and social developments come various technological and social problems to boot.

Riding in cars and living in comfortable homes with tons of entertainment mediums have made us less active. As a result, we’re plagued by one of the biggest, oversized lifestyle diseases – OBESITY. Being overweight or obese is no laughing matter. The mere mention of the word “obese” can sometimes spark off debates about political correctness – or incorrectness – as the case may be.

The growing – no pun intended – number of overweight Malaysians has earned Malaysia the inglorious title of the “fattest” nation in Asia, in a survey by British medical journal, The Lancet.

Health Minister Datuk Dr S Subramaniam had reportedly said “almost half the population of Malaysia are either overweight or obese”. This means that 15 million of the 30 million Malaysians are overweight or obese.

Subramaniam added that “the prevalence of obesity has increased drastically from 4.4% in 1996 to 14% in 2006. Then it increased to 15.1% in 2011 and continued to increase to 17.7% in 2015.” To say obesity is a problem now is an understatement.

Recent email correspondence with the Health Ministry provides Health+ with some interesting statistics. The findings of the latest National Health and Morbidity Survey (NHMS) 2015 had estimated 3.3 million adult Malaysians are obese.

Looking at a nutritional

From flab to fab

“I believe that determination is the key for me.

We should continue fighting to be better individuals as best as we can.”

How Jom Kurus 1 Malaysia transformed the lives of two overweight and unhealthy individuals

By Norman Hussaini

O

besity is a buzzword in our society these days given the amount of unhealthy food we eat day in and day out. Though the weighty problem continues to affect our population, we have seen encouraging changes in the general awareness of healthier eating and increased physical activity in recent years.

More and more people leading unhealthy

lifestyle are stepping forth to try to change, ultimately becoming healthier and breaking free from the clutches of obesity.

Of the many weight loss programmes available, Jom Kurus 1 Malaysia (JK1M) has transformed the lives of many since its inception a few years ago. And for two inspiring individuals Health+ spoke to recently, the impact of the programme on them is nothing short of spectacular.

Nur Farhiyah Ahmad Fadli Bank officer Farhiyah had never felt the need to lead a healthy lifestyle as she was so used to eating unhealthily as was the habit of most of the people around her. “I had been overweight all my life.

My family and I were all big sized so I never felt out of place and was comfortable,” she says.

However, her unhealthy habit of overeating and inactivity took a heavy toll on her health. “I realised that I started having awful skin conditions and my legs were always swollen because of my weight. That was when I felt that something needed to change.”

Farhiyah decided to join JK1M after her sister told her about the popular weight loss programme.

“We thought it would be a great

idea to join the programme together as a way for us to support each other. We wanted to change – we wanted to lose weight.”

Her experience “I was surprised to see that JK1M was so much more than just a weight loss programme where you exercise to lose weight. It offered educational materials to help us lose weight and also eat healthier.”

She also had the opportunity to explore new things with diets and exercise through the programme.

The programme caters to each individual’s ability and is not meant to torture participants. “I started doing exercise for beginners and gradually worked up to more advanced exercise regime

NEW JOY: Farhiyah found happiness after leading a healthier lifestyle.

point of view, findings from the Malaysian Adult Nutrition Survey (MANS) 2014 showed that more than 90% of Malaysian adults were taking all the recommended three main meals daily. However, it also reported a high prevalence (31.9%) of them taking heavy meals after dinner or supper.

Moreover, MANS found that daily intake of fruit and vegetables was greatly lacking. The survey showed 1.4 and 1.5 servings of fruit and vegetable consumed respectively, undermining the recommended guideline of two and three servings.

Unhealthy lifestyle is the keyword in most cases of obesity.

Malaysia is well known for an incredible amount of delicious food, and many Malaysians have abused its abundance for the worst. The unhealthy lifestyle and habits we practise bleed down to our children as well, resulting in growing childhood obesity.

Obesity is not a disease on its own but a gateway for a plethora of other diseases to conquer

– Farhiyah

over time.” She never felt that the exercise was overly strenuous.

However, it was not easy for her to follow a new diet and exercise as she often found herself wanting to quit and slip back to her old habits again. “It was during the last season of JK1M when I found myself cheating on my diet and eating like I used to,” she admits.

“I was able to lose a lot of weight and because of that, I started to overeat again.” Eventually, she realised the effort she had put in FITTER IMAGE: Aizat admits he is more fashionable and comfortable with his image now.

for months to get where she was had meant nothing if she went back to her old eating habits.

“I received my wake-up call after about two weeks of slipping back to my old habits. Then I started my healthier diet and exercise as usual.”

A valiant effort to make a better person of herself, Farhiyah faithfully continues her diet and exercise till today. She now mostly cooks her own food daily and exercises three to four times a week for an hour.

“I believe that determination is the key for me. We should continue fighting to be better individuals as best as we can,” she says with much conviction.

Muhammad Aizat Abdul Razak Another familiar face in JK1M is Aizat who joined the programme in 2014, after hitting the scales at a whopping 230kg. Like Farhiyah, he used to overeat and did little to none exercise.

“I was similar to Farhiyah in a

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our wellbeing. Obesity can be described as a condition where a person has accumulated so much body fat that it might perpetuate negative effect on his health.

Diseases like heart diseases, stroke, high blood pressure, diabetes, some types of cancer, gallbladder diseases, osteoarthritis, gout, sleep apnoea and asthma can all be the result of being obese.

Prevention of all these illnesses can be achieved by practising a healthier and more active lifestyle.

Yet the prevalence of obesity among us proves otherwise.

There have been numerous ongoing attempts to tackle our obesity problem. Countless campaigns, marathons, seminars and events had been organised to address this disease. Many people had defeated obesity and emerged victorious, and they should be our shining examples to do likewise.

There is growing awareness of healthy lifestyle among Malaysians too. Healthy food restaurants and takeaways are trending, gyms are mushrooming

lot of ways. I was very big and was always demotivated when it came to doing something active.” His condition affected his emotions quite often.

After years of leading an unhealthy lifestyle, Aizat finally found his turning point in his mother’s words. “I remember her asking me how long I will be fat.

Who will take care of me when she is no more? Those words jolted me to look for ways to improve my unhealthy lifestyle.”

Aizat was one of the first participants to join JK1M in 2014 when it was initiated by Kevin Zahri.

His experience Aizat is seen as the poster boy for the programme because of his achievement to lose more than 135kg through it. “I was ready to change. I wanted to become a better person than I was, physically and emotionally.”

Members of his training group helped him a lot to go through the programme. “I received continuous support from the trainers as well my peers during the programme.

We were all aiming for the same goal – losing weight – so all of us had each other’s backs.”

Aizat admits it is good to share feelings and emotions because we tend to lose our confidence from time to time.

He says the most important factor in losing weight is to control your eating habits. “We must have discipline in controlling what we eat. Working out and exercising always come second.” He followed a very strict diet during his first six months in the programme and gradually became more lenient over time.

everywhere, jogging and cycling are getting widely accepted as family activities and more people are coming forward for health screenings now than ever before.

Campaigns such as Jom Kurus 1 Malaysia had recorded immense success in terms of number of participants who had lost weight. Doctors and experts are also coming forward to educate and inform the public on various subjects relating to obesity.

However, the change in awareness and efforts is gradual and slow, and still miniscule compared with the growing rate of obesity.

However, a million-mile journey always starts with a single step.

Battling obesity is a continuous uphill fight with no sure win in sight, but the most important thing to do is to persevere and keep at it. Practising healthier eating habits and less sedentary activities is a lifestyle to adopt, not a trend to follow. It is to ensure a healthier future for ourselves and our future generations.

Body Mass Index (BMI) chart

What is obesity and how to determine it Obesity is defined as a condition where a person has accumulated so much body fat (or adipose tissue) that it might have a negative effect on his health. There are many ways to determine excess body fat in a person, with the most common one being the Body Mass Index (BMI).

It is an international standard to determine ideal body weight.

BMI is calculated by dividing a person’s body weight in kilogrammes (kg) by his height in metres squared (m2). According to the rule set up by the World Health Organisation (WHO), a BMI between 25 and 29.9kg/m2 is considered pre-obese, and anything above is obese.

The use of BMI to determine

“We must have discipline in controlling what we eat.

Working out and exercising always come second.”

– Aizat He says a good eating habit is to eat many times a day but in smaller portions. “As I was accustomed to eat a lot, I often had cravings going through the programme. So eating smaller portions helped me to fight off my cravings,” he says.

“As for exercising, I never did more than three times a week.

Obviously I did light exercises when I was overweight and did heavier exercises when I started losing weight.”

Aizat now enjoys life as a healthier and fashionable individual while continuing to eat healthy and exercise regularly.

obesity, however, has fluctuating factors. This is because BMI determines only body weight but not the percentage of body fat.

Therefore, athletes or bodybuilders are exempted from using BMI to determine obesity as they have an increased level of muscle tissue, making them heavier in a sense.

Another way to determine obesity is by measuring the waist circumference. This measurement determines the amount of abdominal fat proportional to total body fat and is used to predict risk of obesity. The generallyaccepted risky waist measurement is 40 inches (102cm) and above for men and 35 inches (89cm) for women.

Classification of weight by BMI (Evidence level c) Classification BMI (kg/m2)

Risk of co-morbidities

Underweight

< 18.5

Low (but increased risk of other clinical problems)

Normal range

18.5 – 22.9

Increasing but acceptable risk

Overweight

≥ 23

Pre-obese

23.0 – 27.4

Increased

Obese I

27.5 – 34.9

High

Obese II

35.0 – 39.9

Very high

Obese III

> 40.0

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Fit for the better

L

By Norman Hussaini

osing weight is like climbing a wall which many people are engaged in as a way to become better, both physically and mentally. With the growing concern of obesity among Malaysians, that wall seems to be getting larger and taller than ever before.

Although a new, healthier eating and living trend is slowly emerging among Malaysians, being overweight is still an oversized concern. Health+ met up with Kevin Zahri, one of the country’s best-known trainers and health consultants, to talk about how the Jom Kurus 1 Malaysia (JK1M) programme is helping people live fitter and healthier lives.

JK1M, which started out as an educational seminar programme at Prince Court Medical Centre in Kuala Lumpur, is a nationwide phenomenon with thousands already part of it and enjoying a healthier lifestyle.

“The programme started about

Jom Kurus 1 Malaysia programme is tailored to help people live fitter and healthier lives

INSPIRING: Kevin’s programme has helped many people take control of their bad habits and lead a healthier lifestyle.

four or five years ago. The seminar was done as a way to structure the best weight loss plan for participants. It was aimed at the public to join and was done to inform how weight loss works and how the participants can lose weight, either with more exercise, with better diet, or both.”

“The seminar,” he adds, “acts as a guidance and empowers the participants to lose weight.”

However, as a simple educational seminar, most participants felt the need to receive more guidance in terms of actually executing the practices taught.

With a growing number of participants wanting to receive instructions, the programme evolved to become a six-week educational programme complete

Key causes of obesity

Training to fight obesity takes commitment If at first you don’t succeed, try doing what your trainer told you to do the first time

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By Ali-Azmin Hassan

ecoming a personal trainer is a noble cause.

To commit one’s time and energy every day for the sake of others to become healthy is true commitment. There’s no career quite like it and it is far from the usual one-size-fits-all option.

Health+ met up with Raja Faisal Raja Aziz, a personal trainer for seven years and now training at Fitness First, to give us the low

down on what a personal trainer does and his efforts to promote healthy lifestyle and help people beat obesity.

He thinks having the right mentality is critical if someone wants to lose weight. “I go through my clients’ mindset and attitude first to train them and make sure they always come on time. That is my personal touch and style on how I motivate my clients.”

On training to overcome obesity, he says it all depends on the person’s motivation level and consistency in training. “There is a big difference one can make between coming once a week and five times a week. You really need

FOOD GUARD: The key challenge in losing weight is food, says Faisal

to slot your gym time into your daily routine.

“The key challenge that one can face in losing weight is food. When you are on training to lose weight, you have to restrict high calorie and fried foods, soda drinks and many other sweet foods. But we’re human and sometimes we lose control. The price of restriction is rejection. Your body and mind are going to react to your cravings.

And that’s why your mentality and commitment to lose weight are important,” he says.

Training for obese people

is different from those who are not. “They need longer resting time. For each round they do, they need at least a two-minute break to reregulate their heart rate. If they were to push more than they could, they would feel dizzy and possibly, even black out. There are restrictions and limits to their workout routine for their own good and safety,” says Faisal.

Obesity is at a dire level in Malaysia as a 2013 study by The Lancet, a weekly peer-reviewed general medical journal, showed

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with education and practical training.

“There had been many success stories from the six-week programme. Once we published those stories online, the demand for it increased substantially,” says Kevin. unique programme Kevin tells Health+ the programme is a unique take on the traditional trainer-trainee relationship. He explains that because the programme is conducted simultaneously in different parts of the country, it must also be suitable to each environment.

“It is never a fixed programme because fitness can come anywhere, be it indoor, outdoor, working out in the gym, playing sports or running. Each trainer – also called a team leader – who trains the participants in each area is given the flexibility to set the type of programme. “We empower team leaders to use their speciality to the fullest. So their job is not just to train the participants, but to also arrange the programme.”

Kevin says the trainers take into account what the participants want to do as well, so the programme is tailored to the

that we are the most obese country in Asia. Faisal says most people only train to lose weight and be healthy when they realise their health is at a critical level.

“Back in the day, obesity was not a major problem in Malaysia.

People farmed, gardened and did a lot of physical work. Our bodies are designed to do many things, but with our current lifestyle, we sit a lot, especially in the office.

We have snack bars and pantries in the office, and all these create an unhealthy culture. And to counter all these, one should take

participants’ wants and needs. programme’s success “The success of the programme didn’t come from only myself. I think the biggest factor the programme is successful is the sense of community it creates. With the programme, participants are surrounded by their own peers working together for a common goal – to lose weight. So it helps tremendously and gives them great motivation,” says Kevin.

The programme’s ability to become a nationwide phenomenon, however, is due to the many success stories seen on various social media platforms. All of them provoke the question of “they have done it, why can’t you?”

“All the success stories came from the people who had gone through the journey and were successful. So they bring about more impact to others than I could ever do.”

Additionally, individuals who participate in JK1M are also entitled to various educational materials like e-books and videos as part of the programme. “These materials are a good way to learn whenever and wherever you are,” says Kevin.

a few minutes to walk outside the office, stretch and even standing is good enough. You might even get weird looks from your colleagues but you know what you got to do,” he says.

As a personal trainer, Faisal’s biggest achievement is to get gym members to change their lifestyles. “When they see the benefit of changing their lifestyles, you can see their consistency. It is not going to be just a one-time thing for them anymore. The healthy lifestyle will stick with them for the rest of their lives.”

How to definitely lose weight and stay slim Mal aysia is the most obese country in Asia with an obesity rate of more than 45.3% (BMI more than 25), according to British medical journal, The Lancet. This clearly shows Malaysia is hit by an obesity epidemic with no cure in sight.

This growing problem which has adverse effects on children and adolescents have threatened to roll back much of the country’s progress made in living healthy and independent lives as well as in creating social harmony and economic productivity.

Being overweight or obese puts you at risk for a number of diseases, including heart disease, diabetes, high blood pressure, cancer, stroke, gallbladder disease, osteoarthritis and respiratory disorders.

This is evident in Malaysia’s rising rates of diabetes and high cholesterol cases which have increased in tandem with the rise in obesity rates to 17.7% and 42.1% respectively, according to the Health Ministry.

Also, risk of developing these diseases is even higher when weight is concentrated near the waist – most commonly known as belly fat.

Despite continuing research on obesity, there are no medicines, herbs or supplements that can help you lose a significant amount of weight, without side effects.

An individual must take a comprehensive approach to losing weight, which involves three lifestyle changes: Appetite control – eating less harmful food Firming the body – increase lean mass (muscles, skin and inner organs) Reduce weight – reduce fat mass Appetite Control Our hormones work together to tell us when to eat and when to stop. However, for many people who are obese or overweight, this system is off balance. Hence, maintaining a healthy routine is the key element to appetite control. The routine consists of: Sufficient sleep Drinking more water Eat slowly by chewing more Make healthy choices for your meals – avoid fast foods, eat more fish, fruits and vegetables, and avoid foods high in carbohydrates or fats.

Take appetite-reducers – nutrients and hormones Reduce stress, frustration and anxiety level Increase energy Sleep and weight reduction Timing your sleep is like timing an investment in the stock market – it doesn’t matter how much you invest, it matters when you invest. Sleep is an

important modulator of neuroendocrine function and glucose metabolism. Sleepdeprived individuals have been found to experience metabolic and endocrine alterations, due to increased levels of ghrelin, decreased levels of leptin, and increased hunger and appetite, especially carbohydrates and sweet food, according to the University of Chicago.

Growing evidence revealed in both laboratory and epidemiological studies points to short-sleep duration as a new risk factor for the development of obesity and its complications. The obesity epidemic in the US is associated with sleep deprivation among its people, as selfreported sleep duration recorded there has reduced by two hours. The link between obesity and sleep deprivation is further established by studies conducted by the University of Chicago, which concluded total sleep deprivation in humans leads to hyperphagia.

To tackle the issue of obesity and appetite control, we must look at the causes of sleep deprivation. Today, individuals are watching TV and surfing the internet late into the night and even early morning, and getting poor quality sleep due to excessive stress or other causes, which deprive them of the required seven or eight hours of sleep needed for a normal appetite. Studies also found that watching TV for more than two hours a day and eating while indulging in the habit, have been linked to a factor causing bad appetite control among women.

An individual is recommended to sleep daily latest by 11.00pm to allow rapid eye movement (REM) phase of sleep to be concentrated at 1am to 3am. These are the peak hours of liver function whereby it undergoes detoxification and regenerative process, and this process should ideally be done in a deep sleep state.

If you are facing issues resetting your sleep cycle, limit watching TV and surfing the internet before going to sleep to avoid the common causes of sleep deprivation.

Both activities are stimulating to the mind and significantly impair the secretion of melatonin due to the strong light they emit. Also, to ensure better quality sleep, you can take sleep-improving nutrients and hormones.

Hence, you should examine your sleep schedule. Are you getting at least seven hours of sleep each night? Do you wake up feeling refreshed or lethargic? Do you wake up frequently during the night?

Are you underweight, overweight or just right?

This article is contributed by Dr Alice Prethima, head of aesthetic physician at Dr Alice Total Wellness Center.

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Correcting misconceptions about liposuction Procedure is for contouring purposes only, not to help you control and lose weight

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By Norman Hussaini

at-removing procedures such as liposuction – a surgical fat removal procedure that first became popular in the 1980s – are known the world over as easier for people to shed excess and unwanted fat off certain parts of the body. This form of cosmetic surgery has become so vogue that it has subconsciously created misconceptions among the public.

Dr Mohamad Nasir Zahari, medical director and consultant plastic, reconstructive and cosmetic surgeon at Beverly Wilshire Medical Centre, says the term “cosmetic” essentially means making things look better, and liposuction does just that. Yet because of its ability to remove fat, people feel the surgery is a shortcut to become thinner and actually beat obesity.

“There are two things about liposuction we always tell our patients, and they must understand these very clearly,” he tells Health+. “The first thing is that the procedure is for contouring purposes only. Secondly, it is not a procedure to control and lose weight.”

He says some people have asked whether the procedure can take a significant amount of weight off their bodies so that they may not be overweight anymore. “That is not how liposuction works.

Removing that much fat with surgery will endanger your life.”

WHAT’S LIPOSUCTION? So what is liposuction actually, if it is not for overweight people

to become thinner? And what is contouring?

“Liposuction is basically a surgery where we remove a certain amount of fat in a particular part of the body, per the patient’s request. It can be done pretty much on every part of the body except for a few,” says Dr Nasir.

Contouring, on the other hand, is a term used to describe an adjustment of a particular part of the body which the patient is dissatisfied with.

“For example, let’s say one feels the shape of the thighs is unsatisfactory and is making it hard to fit into a particular outfit.

Liposuction can help that person ‘adjust’ the shape by removing some fat on that particular area.”

Any kind of surgery comes with its own set of risks, and liposuction is no different. However, the risks are very minimal, says Dr Nasir.

“The procedure is very straight forward. Provided that the person is healthy and fit for surgery, risks of complications will be below 5%.”

“Risks like bleeding and infections are quite rare. In comparison, there is higher risk of you getting injured when crossing the road than to have infections and bleeding from liposuction,” he says.

VERY PAINFUL PROCEDURE However, he says the procedure is very painful. “I am not trying to scare anyone, but it is important to know that the procedure will cause quite a pain during the recovery period. A full recovery usually takes about six weeks.”

That is why Dr Nasir feels that it is important for someone seeking to go for liposuction must be ready physically and mentally.

“Cosmetic surgery is not a 100% guarantee success – it never

ORDEAL: The procedure is very painful, warns Dr Nasir.

Cosmetic surgery is not a 100% guarantee success – it never is. We are careful to project that clearly to our patients before they take the dive. We opt for a few consultations if required so that they understand the procedure and its possible results as best as possible.”

95% of patients are reasonably happy with the results of their surgery.

– Dr Nasir is. We are careful to project that clearly to our patients before they take the dive. We opt for a few consultations if required so that they understand the procedure and its possible results as best as possible.” He adds that about 95% of

his patients are reasonably happy with the results of their surgeries.

So at the end of the day, liposuction is just a procedure to improve the aesthetics and to help people look better than they do before. Or is it?

Practical aspect Dr Nasir says the procedure does have a practical aspect to it as well. “Take for example a person who works as a cabin attendant. He is required to fit into a particular size before he is qualified. Or even for a normal person, a bit of fat off the tummy or thighs can make it easier for him or her to exercise and lose

weight.” The procedure can help certain people perform better at their jobs and daily activities.

So does Dr Nasir feel that there is a substantial amount of misconception towards liposuction? He answers with a resounding yes.

“There definitely is. That is why it is important for me to stress that the first point I made earlier. The procedure is for contouring purposes only, not to control weight. Although it can be a tool to help people exercise better, it is not a way to fight obesity.”

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I

By Ali-Azmin Hassan

ndividuals who are severely obese are unaffected by conventional therapies such as consuming fewer calories and increasing exercise, says the National Institutes of Health (NIH). Severe obesity is one the most serious stages of obesity, and those affected may feel trapped in a weight gain cycle, making conventional means pointless.

NIH, one of the world’s foremost medical research centres, recognises gastric bypass surgery as the best solution to combat severe obesity and maintain weight loss in the long term. As it appears, gastric bypass surgery is an effective shortcut to overcome obesity.

Being obese is different from being overweight. One can be overweight from muscle, bone, fat and body water. Obesity, on the other hand, is having excess body fat around the abdomen, hips, thighs, waist and buttocks.

Most people have the misconception that obesity surgery is similar to cosmetic surgery such as liposuction and tummy tucks which are superficial enhancements at best. The purpose of gastric bypass surgery focuses mainly on health reasons and not a superficial one.

When every possible option to lose weight has been exhausted, many view gastric bypass surgery as their last option. Choosing this option is a difficult decision because weight loss surgery is a life-altering decision and it involves discussing with medical experts.

Dr Andrea Ooi, a dedicated surgeon with more than 17 years of medical experience and also an expert in obesity and metabolic management at Andrea Bariatric Surgery, shares her insight with

Bariatric surgeries to overcome obesity Although patients enjoy many benefits, there’s 5% chance they will regain weight Health+, concerning obesity issues and the varieties of procedures for the purpose of weight loss to maintain or regain health.

“Bariatric surgeries such as gastric bypass, gastric sleeve, and laparoscopic adjustable gastric banding, work by changing the anatomy of one’s gastrointestinal tracts” says Dr Ooi. Surgery causes different physiologic changes in one’s body that alter his energy balance and fat metabolism.

“Bariatric surgery has been shown to help improve or resolve many obesity-related conditions such as type 2 diabetes, high blood pressure, heart disease, hypertension, and more,” says Dr Ooi. Despite the many benefits of a gastric bypass surgery, there are risks and complications involved.

For example, there’s a 5% chance for a patient to regain weight.

In dietary weight loss, energy expenditure is reduced to levels lower than would be predicted by weight loss and changes in body composition. This change in energy can often lead to weight regain.

Dr Ooi classifies the types of bariatric surgery as restrictive and mild absorption. Restrictive surgery is by reducing the size of the stomach to reduce the amount of food intake. Hence, with this

Some people can become overweight due to depression which makes them eat a lot, says Dr Ooi.

process, it helps to mobilise other parts of the fat to reduce the body size. Basically, this surgery helps one to control his appetite so that he eats less. Mild absorption, on the other hand, is decreasing the amount of nutrient when one is eating to help in weight loss.

Dr Ooi explains the restriction of diet after one had undergone surgery. During the first week after surgery, it is imperative for the patients to consume clear fluid foods such as water, broth and clear juices. Gradually, after each week, patients can consume thicker fluids, and eventually, soft and solid foods. This is because the patients need time for the cuts in the stomach to be healed. Strenuous activities are also restricted.

The only instance where one is rejected from getting a bariatric

surgery is mental instability.

“Clients need to go through a psychological assessment. Some people can become overweight due to depression which makes them eat a lot. The patients need to follow a diet plan for them to recover after the surgery. If this is a certain factor, then it’s dangerous if we conduct the surgery for them,” says Dr Ooi. It is important to remember that bariatric surgery is a “tool” to help one lose weight. The total success of weight loss depends on many other important factors such as nutrition, exercise and behaviour modification. Bariatric surgery can result in long-term weight-loss success, and besides improvements in health and longevity, it can improve overall quality of life.

Surgery last resort if diet and exercise don’t work There’re many types of bariatric surgery, and choosing the right one will depend on a patient’s condition, says obesity surgeon Dr Haron Ahmad

By Ali-Azmin Hassan

W

eight-loss surgery is an option for those who are severely obese and are unable to lose weight through diet and exercise. “We only do this surgery as a final option when dieting and exercising do not work,” says Datuk Dr Haron

Ahmad, an advanced laparoscopic and obesity surgeon at KPJ Damansara Specialist Hospital in Petaling Jaya.

“Weight-loss surgery is very risky as obese people have diseases such as diabetes, hypertension, hyper cholesterol, anemia, sleep apnea and liver problem. These are metabolic diseases that can pose risks to the operation,” continue on page 08

BENEFITS GALORE: Losing enough weight after the surgery can improve many medical conditions such as asthma, high blood pressure, high cholesterol, obstructive sleep apnea, hypertension and type 2 diabetes.

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Losing weight through detoxification Loads of detox programmes and products claim to help weight watchers shed those unsightly flabs

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By Ali-Azmin Hassan

e toxific at ion programmes and products are gaining popularity everywhere. Some might consider this trend a new diet fad which will eventually fizzle out just like any other new diet fads. You may think you exercise enough and maintain a balanced diet, and you’re set and well, that’s enough. Okay, sure, but what about supplementing that with detox – or short for detoxification?

Despite the hype and publicity onslaught, it’s important to know that detox is no magic to help you lose weight without exercising or dieting. It’s meant to clean your body from the inside, making exercising and dieting easier – hence making you healthy.

Detox products help to cleanse, purify and detoxify your organs.

Sharon Wong, general manager of Total Image Regional (M) Sdn Bhd, a company that provides detox products, among others, explains to Health+ the benefits of detox and how it can help one to lose weight and live healthy.

She says the reason detox can work to help you lose weight is the plethora of raw fruits and

vegetables in its ingredients. These ingredients help remove toxins and extra body fat, in addition to exercising and maintaining a well-balanced diet. Raw fruits and vegetables have more nutrients than cooked produce simply because they’re still in raw state.

Blocking body’s ability to make fat Wong says one of the ingredients used for Total Image products is garcinia cambogia, which is known to be very effective for weight loss.

Garcinia cambogia, a tropical fruit also known as malabar tamarind, supposedly blocks your body’s ability to make fat and puts the brakes on your appetite. It also keeps blood sugar and cholesterol levels in check too.

“A lot of people are chasing products that contain garcinia cambogia. In fact, this ingredient has been around 10 years ago, but only quite recently it has gained popularity,” says Wong.

“Every day we eat different kinds of things and we always overeat. So we need to detox our body. So for people to lose weight, I think you need to detox first to get better result.

“Detox happens when you sweat. When you detox, it’s easier for you to lose weight effectively.

Detox also helps to improve your digestion to make you feel lighter and less bloated.”

Wonder of garcinia cambogia Garcinia cambogia is used in many slimming products. The active ingredient is hydroxycitric acid found in the fruit skin which is said to boost fat-burning and cut back appetite. It appears to block an enzyme called citrate lyase which is used by the body to make fat. It also raises the serotonin level in your brain, which makes you feel less hungry.

Although many slimming products contain garcinia cambogia that is said to help one lose weight, the actual weight loss results are not that impressive. Studies have found that people who took garcinia cambogia lost about two pounds more than those who didn’t take it.

Reviewers couldn’t say for sure whether that weight loss was due to garcinia cambogia, or simply due to other reasons such as exercising or lower-calorie diet.

Nevertheless, garcinia cambogia is still beneficial to one’s health and although its effectiveness to help one lose weight is still being researched and at times questioned too, it seems there’re more benefits to take it rather than not.

Detox for how long?

How long should one undergo detox to lose weight? “It all depends. For our products you do not require meal replacement or special diet.

We recommend at least 1-3 months of detoxification,” says Wong.

As mentioned earlier, detox is no magic to make you lose weight.

“You need to combine it with exercise and balanced diet. Even for myself, I use the products and even go for exercise and maintain my diet. We always advise our customers to live healthy and exercise and use the products for faster results,” she advises.

“We’ve been in the market for 32 years, we always try to source for other products such as hair care, but we focus mainly on slimming and beauty. A lot of people have the mindset that Total Image relates to this industry only. In fact, we want to have more beauty and slimming products. Most of our customers are women. We want to keep them beautiful and healthy so they can have more confidence. This is what keeps us going,” says Wong, adding that Total Image detox products are approved by the Health Ministry.

Many types of bariatric surgery from page 07

he tells Health+.

There are many types of bariatric surgery, and choosing the right one will depend on each patient’s condition. In all types of bariatric surgery, patients will be under general anaesthesia to induce sleep and ensure a pain-free procedure.

LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING Laparoscopic gastric banding is a surgery whereby the surgeon places a band and constricts the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat and this will go down slowly to the stomach.

“We can adjust how tight the band is by putting in fluid inside the port that is placed beneath the skin. This surgery has been done for many years but it’s slowly losing its popularity. This is because after many years we have found there are many complications. After a month, the band will loosen because the fluid that tightens it gets dissipated. Patients then have to go for check-up regularly to recalibrate. So we have found that it’s difficult to follow up,” says Dr Haron.

“Other than that, there’re also some complications related to the band. For example, ulceration, gastritis, heartburn and the gastric band may even slip partly out of place. The surgery does not involve any cutting or stapling inside the belly.”

GASTRIC BYPASS SURGERY Gastric bypass is a surgery that helps you lose weight by changing how your stomach

and small intestine handle the food you eat.

“The procedure involves creating a stomach pouch out of the portion of the stomach and attaching it to the small intestine. The bigger portion of the stomach is still necessary because it produces enzymes and acid for digestion. So when the food is flowing through the small pouch of the stomach that is connected to the small intestine, the enzymes and acid from the stomach flow through the duodenum which will also be connected to the lower part of the small intestine through surgery,” says Dr Haron.

“So the absorption of vitamins from the food doesn’t happen in the stomach because as the food goes straight through the small intestine and so do the enzymes and acid.

That’s why it’s called a bypass.”

Gastric bypass is a major surgery and hence has many risks. Just like laparoscopic adjustable gastric banding, it can cause gastritis, heartburn or stomach ulcers.

“Despite the risks of complications, the benefits of this surgery outweigh the risks.

Losing enough weight after the surgery can improve many medical conditions such as asthma, high blood pressure, high cholesterol, obstructive sleep apnea, hypertension and type 2 diabetes. You won’t feel tired as much, you’ll walk well, there’s no knee pain and you feel more confident,” says Dr Haron.

Does a patient regain weight after the surgery? Yes, you can, says Dr Haron, if you don’t control or take care of yourself.

“After the surgery, you need to be with us for check-ups at least for one-and-a-half years, so I can change your behaviour.

Weight-loss surgery also involves forced

• 09

2016 | march

Obese children at risk to bone, joint problems

plate. It usually affects older children in their adolescent years. Like Blount’s disease, most children diagnosed with the condition are usually overweight.

Signs of SUFE can be detected when a child becomes less active or develops a limp. Sometimes, the child cannot even walk due to the pain. Previous injuries from a fall might also aggravate the slip.

OVERWEIGHT CHILDREN AT RISK “The theory dictates that SUFE and Blount’s develop in overweight children because of their still tender growth plates. They can’t function normally because of the unusual weight of the body.

It doesn’t affect adults as adults have reached bone maturity,” adds Dr Razak.

The severely overweight are more prone to Blount’s disease, slipped upper femoral epiphysis

W

hen talking about bone and joint health, most people will straight away think about conditions that come with old age or after being involved in traumatic accidents.

However, there is a certain condition that occurs in children which greatly affects their ability to physically develop properly.

Health+ spoke to Dr Abd Razak Muhamad, a paediatric orthopaedic surgeon at Gleneagles Kuala

Lumpur, to find out why and how obese children are at risk of developing Blount’s disease or slipped upper femoral epiphysis (SUFE).

BLOUNT’S DISEASE Blount’s disease is an abnormal or asymmetrical growth disturbance at the medial (inner part) of proximal leg growth plate derived from excessive stress due to overweight.

This causes asymmetrical growth at the upper part of the leg and progressive bowing deformity.

Dr Razak says most children

ANTI-SLIP: Surgery involves inserting a screw in the hip joint to prevent further slip.

change of behaviour.

It’s about changing you to become a new person. We want to modify the way you eat. Even when drinking, you’ll be sipping instead of gulping.

This is all for the benefit of your health,” he explains.

VERTICAL SLEEVE GASTRECTOMY Sleeve gastrectomy is a surgical weight-loss procedure in which a large portion of your stomach is removed. The new, smaller stomach is about the size of a banana. “It limits the amount of food you can eat by making you feel full after eating small amounts of food. This one has no bypass – it only makes your stomach smaller,” says Dr Haron.

Weight-loss surgery is not a quick fix for obesity, but it helps to change your lifestyle. After the surgery, it forces you to want to eat less than you regularly do.

With a control diet and exercise, you’ll soon see changes to your body.

Before deciding whether you should go for a weight-loss surgery, Dr Haron will ask a few questions. “Firstly, have you tried to lose weight? Secondly, are you obese? In Malaysia, someone is obese if his or her body mass index (BMI) is 28 and above.

SUFE: A typical slipped upper femoral epiphysis in children.

“When you come and see me, you’ll meet the whole team.

My team consists of surgeons, physicians, a psychologist and a dietician. You will be assessed by all these people. If you’re a drug addict or an alcoholic, or have mental illness, I will not treat you. It’s because I need to trust people to follow instructions after the surgery.”

Is weight-loss surgery covered by health insurance?

Generally no, says Dr Haron.

“Bariatric surgery in Malaysia is considered a lifestyle classic surgery, which is wrong. Being fat is considered a lifestyle problem, but when you’re obese, it’s a disease. But right now, obesity is declared by the World Health Organisation as a disease and epidemic. The best thing the government can do is to tell people not to get fat and promote healthy lifestyle.”

BOWLEGS: Bowing of the legs is caused by Blount’s disease.

NATURAL: Dr Razak says most children are born naturally with mild bowing of the legs. are born naturally with mild bowing of the legs. This, he adds, is normal and is caused by the baby’s position in the mother’s womb. This natural occurrence makes babies under two years of age to have bowlegs, which will eventually straighten as the bones develop.

However, a child with Blount’s disease may not grow out of bowlegs after this age with the condition getting worse rather than better. “Progressive bowing will alter the normal alignment of the lower limbs and the resulting malalignment will cause an abnormal stress to the inner part of the knee joint leading to chronic pain and in a long term, premature arthritis of the knees,” says Dr Razak.

THREE INSTANCES He says there are three instances when the disease occurs in children. The first, which occurs when children are between two and four years old, is known as infantile Blount’s. The second is called juvenile Blount’s which occurs in children between four and seven years of age.

The third is called adolescent Blount’s which occurs in children in their adolescent years. “What is peculiar about adolescent Blount’s is that it is usually occurs quite progressively in a short period of time, usually involving children between the ages of 10 and 12.

This particular type of Blount’s is said to be strongly caused by childhood obesity,” says Dr Razak.

SUFE SUFE, on the other hand, is an unusual slipping of the adolescent hip. It is a caused by the separation of the upper part of the femoral head from the neck causing a deformity of the hip joint. This is due to weakness of the growth

TREATMENTS There are two types of treatment for Blount’s disease – non-operative and operative. Non-operative treatment, which includes the use of braces, is usually for children below three years old. Bracing usually takes about two years for maximum effectiveness. However, due to compliance issues, bracing has limited indication and poor success rate.

Operative treatment, on the other hand, includes surgery, which is usually needed if braces do not work, or if the deformities are progressive after the age of two.

For SUFE, treatment should be immediate. The goal of treatment, which requires surgery, is to prevent further slipping of the femoral head until the growth plate closes. If the head is allowed to slip farther, hip motion could be limited, and premature osteoarthritis could develop.

Dr Razak says early diagnosis of SUFE provides the best chance to achieve the treatment goal of stabilising the hip. Fixing the femoral head with pins or screws has been the treatment of choice for decades.

EARLY DETECTION IS ALWAYS BETTER As a paediatric orthopaedic surgeon, Dr Razak deals exclusively with children with various bone and joint problems, mainly treating congenital conditions. He says Blount’s disease and SUFE are some conditions that can be prevented if detected early.

“It is therefore important for parents to take necessary actions if they notice their children limping or when they complain of pain of the lower limbs. It is easy for parents to detect such conditions as they make their children less active,” he explains.

As childhood obesity becomes more prevalent, these conditions are likely to occur in more children and parents should be vigilant and watchful to detect potential cases of Blount’s disease and SUFE.

10 •

march | 2016

Losing weight can affect your health Two studies show over-the-counter slimming supplements are ineffective

F

rom slimming supplements to prescription drugs, pharmacies are full of products destined to help lose weight, but their use can come at great expense, both financially and health-wise.

At the 11th International Congress on Obesity hosted in Stockholm, experts were clear when it came to over-the-counter slimming supplements: “save your money, the only thing you are going to lose is your money,” said Judith Stern, a professor in the Departments of Nutrition and Internal Medicine at the University of California Davis.

Two studies presented at the congress showed supplements were ineffective.

Thomas Ellrott, a professor at the University of Goettingen in Germany, presented a study in which nine popular supplements, proposing nine different weight loss solutions, were tested against placebo pills in a controlled trial.

“There are scores of slimming supplements out there claiming weight-loss effects through all sorts of mechanisms of action... the market for these is huge, but unlike for regulated drugs, effectiveness does not have to be proven for these to be sold,” he said.

The participants in his study

that took weight loss supplements lost between 1-2kg, while those taking the placebo lost 1.2 kg on average.

“Not a single product was any more effective than placebo pills in producing weight loss over the two months of the study, regardless of how it claims to work,” he said.

Despite their proven lack of effectiveness, the market for supplements ranging from cabbage powder to fibre pills to plant extracts generates a whopping US$13 billion (RM53 billion) per year, said Igho Onakpoya of the Universities of Exeter and Plymouth in Britain.

“People think these supplements are a short cut to weight loss and may spend huge sums of money on them, but they may end up disappointed, frustrated and depressed,” he said.

For a more effective chance at tackling weight loss, experts recommend turning to prescription drugs, but these are not free from side effects.

An anti-obesity drug that targeted the cannabinoid receptor CB1 had received all regulatory approvals but was then withdrawn from the European market after widespread use showed it carried a risk of psychiatric side effects.

“Depression is not an acceptable trade-off for weight loss,” said Christian Elling, vice-president of the Danish pharmaceutical laboratory 7TM Pharma.

His team is working to develop a new drug based on a molecule that acts the same way on organs and muscles linked to metabolism as the withdrawn drug, with the important difference that it does not penetrate the brain. “ The lack of significant exposure in the brain seen in our pre-clinical experiments provides optimism that blockade of the CB1 receptor may still be an effective and safe approach to treat obesity and related diseases,” he said when presenting his laboratory’s findings at the conference, adding more trials were still needed before commercialising the drug.

Other prescription drugs have been proven effective, allowing to shed up to 10% of total body weight, or 8-9kg per year.

And even these are not health

If the patient is not happy because he’s not losing weight fast enough or he wants to lose more, he starts experimenting, doubling doses... and then, (prescription drugs) become a health risk.”

– Luc van Gaal

US$13b market for supplements ranging from cabbage powder to fibre pills to plant extracts

risk free, because of the psychological aspect of fighting against a weight surplus.

“Patients are often victims of their expectations,” said Luc van Gaal, of the University of Antwerp in Belgium.

“If the patient is not happy because he’s not losing weight fast enough or he wants to lose more, he starts experimenting, doubling doses... and then, (prescription drugs) become a health risk,” he said, hinting that patients blinded by an obsession to slim down could manage to get their hands on medicine illegally.

– AFPRelaxnews

• 11

2016 | march

and monitor your blood pressure level regularly. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and cardiovascular diseases.

Eat healthy and keep weight in check This can help prevent diabetes, heart disease and other conditions associated with chronic kidney disease. Reduce your salt intake – the recommended intake is 5-6gm per day (around a teaspoon). Limit the amount of processed and restaurant food and do not add salt to food. It is easier to control your intake if you prepare the food yourself with fresh ingredients.

STAY HEALTHY: Keeping fit helps to reduce our blood pressure and therefore reduces the risk of chronic kidney disease.

Loving our kidneys Take good care of those precious organs for they are vital to our overall health

and obesity. This will also translate to better kidney health for Malaysians.”

ur kidneys are complicated and amazing organs that do many essential tasks to keep us healthy.

Their main job is to remove toxins and excess water from our blood.

They also help control our blood pressure, produce red blood cells and keep our bones healthy.

Each roughly the size of our fist, and located deep in the abdomen, beneath the rib cage, these vital organs control blood stream levels of many minerals and molecules, including sodium and potassium, and help to control blood acidity.

Every day our kidneys carefully control the salt and water in our body system so that our blood pressure remains the same.

Since our kidneys are vital to our overall health, it’s important to look after them. However, the sad reality is many people don’t – in fact some abuse these precious organs until they’re finally injured beyond repair.

According to the World Kidney Day website, kidney diseases affect millions of people worldwide, including many children who may be at risk at an early age.

It is therefore crucial that we encourage and facilitate education, early detection and a healthy

REDUCING RISK Kidney diseases are silent killers.

There are however several easy ways to reduce the risk of developing kidney diseases.

O

life style in children, to fight the increase of preventable kidney diseases and to treat children with inborn and acquired disorders of the kidneys worldwide.

In Peninsular Malaysia, the overall prevalence of chronic kidney disease is 9.07% based on a published sub-study of the National Health and Morbidity Survey 2011. Only 4% of respondents were aware that they had chronic kidney disease.

According to Director-General of Health Datuk Dr Noor Hisham Abdullah, the number of Malaysians diagnosed with end-stage kidney renal failure and requiring dialysis treatment is increasing every year.

“Over a 10-year period, the number of new patients requiring dialysis had increased from 3,134 in 2005 to 7,055 in 2014. Similarly, the prevalence of patients on dialysis had increased from 13,332 in 2005 to 34,767 in 2014. The leading cause of end-stage kidney failure is diabetes,” he says.

“Sixty-one percent of all new patients requiring dialysis treatment in 2014 developed end-stage kidney failure due to diabetes.

Malaysians need to do more in terms of practising a healthy lifestyle to prevent and better control diabetes, hypertension

1.5 to 2 litres of water is the minimum per day.

61%

of all new patients requiring dialysis treatment in 2014 developed end-stage kidney failure due to diabetes.

Keep fit and active Keeping fit helps to reduce our blood pressure and therefore reduces the risk of chronic kidney disease.

Keep regular control of blood sugar level About half of people who have diabetes develop kidney damage, so it is important for those with diabetes to have regular tests to check their kidney functions.

Kidney damage from diabetes can be reduced or prevented if detected early. It is important to control our blood sugar levels.

Monitor blood pressure Although many people may be aware that high blood pressure can lead to stroke or heart attack, few are aware it is also the most common cause of kidney damage.

The normal blood pressure level is 120/80 mm Hg. Between this level and 139/89, you’re considered prehypertensive and should adopt lifestyle and dietary changes. At 140/90 and above, you should discuss the risks with your doctor

Maintain healthy fluid intake Although clinical studies have not reached an agreement on the ideal quantity of water and other fluids we should consume daily to maintain good health, traditional wisdom has long suggested drinking 1.5 to 2 litres (3-4 pints) of water per day.

Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing chronic kidney disease, according to researchers in Australia and Canada.

The findings, the researchers said, do not advocate “aggressive fluid loading”, which can cause side effects, but they do provide evidence that moderately increased water intake, around two litres daily, may reduce the risk of decline in kidney function.

It’s important to keep in mind that the right level of fluid intake for any individual depends on many factors including gender, exercise, climate, health conditions, pregnancy and breast feeding.

In addition, people who have already had a kidney stone are advised to drink 2 to 3 litres of water daily to lessen the risk of forming a new stone.

Stop smoking Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it impairs their ability to function properly.

Smoking also increases the risk of kidney cancer by about 50%.

Stop taking over-the-counter pills on a regular basis Common drugs such non-steroidal anti-inflammatory drugs are known to cause kidney damage and disease if taken regularly.

Such medications probably do not pose significant danger if your kidneys are relatively healthy and you use them for emergencies only, but if you are dealing with chronic pain, such as arthritis or back pain, work with your doctor to find a way to control your pain without putting your kidneys at risk.

12 •

march | 2016

In the dark about medical condition Only 4% of respondents in a study were aware that they had chronic kidney disease

W

ith the growing prevalence of diabetes, there is an increasing need for greater public awareness of kidney-related disease, particularly on the risks involved. Director-General of Health Datuk Dr Noor Hisham Abdullah shares his thoughts with Health+ on the state of kidneyrelated diseases in the country.

Q: How prevalent is kidneyrelated diseases in Malaysia?

A: The overall prevalence of chronic kidney disease in Peninsular Malaysia is 9.07%. This is based on a published sub-study of the National Health and Morbidity Survey 2011. Only 4% of the respondents in this study were aware that they had chronic kidney disease.

(Reference: A population-based study measuring the prevalence of chronic kidney disease among adults

in West Malaysia. Lai Seong Hooi et al. Kidney International (2013) 84, 1054-1040) Q: How prevalent is kidneyrelated disease stemming from obesity?

A: There is presently no local data on chronic kidney disease stemming from obesity. However, obesity is a major risk factor for diabetes and hypertension. Diabetes and hypertension are the two leading causes of chronic kidney diseases.

HEAVY RISK: Dr Noor Hisham says obesity is a major risk factor for diabetes and hypertension.

unable to afford the treatment are given a subsidy of RM50 per haemodialysis treatment and their treatment with erythropoietin injections are also paid for by the Health Ministry.

Q: We see a lot of dialysis centres in the country. Are there any dialysis centres that are fully supported by the Health Ministry besides those in government hospitals?

A: Only dialysis centres at the Health Ministry hospitals and health clinics are fully supported by the ministry. However, patients at NGO dialysis centres who are

Q: The cost of medication for dialysis is not cheap. Is there a subsidised rate for patients?

A: At the Health Ministry centres, drugs are highly subsidised and patients on dialysis do not usually

Treating and preventing kidney diseases National Kidney Foundation aims to treat, prevent and spread awareness of kidney diseases among Malaysians

T

By Norman Hussaini

he incidence of kidney diseases among Malaysians is growing yearly, indicating that we are putting our kidneys at risk due to unhealthy lifestyle.

Although the reported number of patients with kidney failure is quite low, the trend is worrying, says Datuk Dr Zaki Morad, chairman of the National Kidney Foundation (NKF) and consultant

nephrologist at KPJ Ampang Puteri.

“If we look at all aspects of kidney diseases from the mild to the more severe one, 9.6% of the overall Malaysian population is reported to have them, according to a survey done by the Health Ministry. If we are looking at kidney failure cases, NKF receives about 300 cases annually,” he tells Health+.

NKF has 26 dialysis centres, a fraction of the total in the country.

And the growing need for more dialysis centres indicates that the number of patients with kidney failure is ever increasing.

NOBLE CAUSE: NKF, chaired by Dr Zaki, is dedicated to help people with kidney diseases access better treatment and support.

NKF’S ROLE NKF is a non-government organisation dedicated to all things kidney.

According to Dr Zaki, the foundation’s main roles relate specifically to kidney health. “Our main role as an organisation is to educate the public on early detection and prevention of kidney diseases.

This involves knowing the types of kidney diseases and the symptoms to look out for,” he says.

Besides that, the foundation also provides affordable haemodialysis treatment to patients

have to pay for their medications.

The majority of patients who are receiving dialysis treatment at NGOs and private centres still come to the Health Ministry hospitals and health clinics to get their highly-subsidised oral medications.

Q: We understand some patients receive free treatments. What are the criteria to be eligible for free treatments?

A: At the Health Ministry facilities,

with kidney failure. “We do this to complement the government’s programme. We know the government provides dialysis facilities throughout the country but these are not enough,” says Dr Zaki. NKF’s facilities which offer subsidised rates are for patients who cannot afford to go to private hospitals for treatment, he adds.

Apart from promoting greater awareness on early detection and prevention of kidney diseases, as well as providing dialysis treatment, NKF also provides training to nurses to take care of kidney patients undergoing dialysis treatment. “As a foundation, we also do not shy away from giving support to any kidney health related research to be done in Malaysia,” he adds.

KIDNEY DISEASES AMONG DIABETICS Some 6,000 cases of kidney failure are reported annually in Malaysia, and the worrying part is the growing incidence among diabetic patients.

“The most common kidney disease catalyst among the adult population is diabetes. It accounts for about 60% of patients taken into dialysis. It is very important

• 13

2016 | march

patients are required to pay RM13 for each haemodialysis treatment.

In the event they are unable to pay, and confirmed by an evaluation by a medical social worker, then the fee is waived.

Q: We understand the Health Ministry had stopped transplant surgery in private hospitals last year because of unwarranted fatalities. Are any private hospitals allowed to do transplant now?

A: At this point in time that is true.

However, a private hospital is in the process of fulfilling the required conditions and will be reapplying for approval.

Q: What is the overall success rate of kidney transplants in Malaysia over the years?

A: The overall success rate of kidney transplants in Malaysia is comparable with that of other more developed countries. In addition to improving a patient’s quality of life, receiving a kidney transplant will still be better in terms of survival than continuing on dialysis.

The patient and kidney graft outcomes are as below:

Q: At which stage of a patient’s condition before he/she needs a kidney transplant?

A: A patient who has been diagnosed which chronic kidney disease (CKD) stage 5, i.e. at a stage when his/her kidney function has deteriorated to a point that his/her life may be in danger if he/she does not undergo renal replacement therapy such as renal transplant or dialysis.

Kidney transplants may be done after dialysis treatment has been initiated or pre-emptively just before the patient needs to be put on dialysis.

Number of patients on waiting list for kidney transplants from deceased donors: 19,932 Number of Malaysians who have pledged to donate their organs after death: 326,738 (this is slightly more than 1% of the Malaysian population)

Statistics from 1975 till now: Total number of living kidney donors (donation to their relatives): 1,274

Living Donor

Deceased Donor

1 year

98%

92%

5 years

95%

85%

10 years

80%

80%

WHO NEED TO GO FOR DIALYSIS A person with kidney disease will lose the functions of the organ, sometimes quickly but mostly gradually. When the kidney function drops to below 10%, the patient will have major symptoms such as fatigue and loss of appetite.

“As a common practice,

Total number of deceased donors (donation after death): 513

Q: Are there many kidney donors in Malaysia?

A: The number of kidney donation after death has increased in recent years due to greater public awareness. However the numbers are still low when compared to other more developed countries.

Patient Survival (Patients Alive)

to know that correlation,” Dr Zaki stresses. “Diabetes is something that can be prevented and controlled, which can subsequently prevent kidney failure as well.” He says while diabetes affects every organ in the body, the kidneys are affected first. Hence, preventing diabetes is crucial to prevent kidney diseases.

Dr Zaki says although diabetes can be inherited, in most cases, people with diabetes are those who fail to lead a healthy lifestyle.

Obesity, he adds, is also another key factor that causes diabetes, besides other severe conditions.

He says there are also other kidney diseases that are not connected to diabetes such as kidney stones, glomerulonephritis (inflammation of the kidney) and polycystic kidney disease, which account for 40% of kidney patients.

The leading cause of end-stage kidney failure is diabetes.

patients whose kidney function has dropped to about 15% are to start haemodialysis treatment.

However, a patient can only undergo haemodialysis after a few months because certain procedures must be carried out prior to treatment.”

Dr Zaki advises the public to go for regular health screenings, particularly so if any family members have kidney diseases. “We always encourage the public to know about their state of health and to go for screenings on a regular basis.

As with any type of conditions and illnesses, prevention is always better than cure.”

SPREADING LOVE FOR KIDNEYS NKF organised an event at Taman Metropolitan Kepong on March 12 to commemorate World Kidney Day 2016, an annual global awareness and education event dedicated to spread the importance of kidney health. The event, with the slogan “Kidney Disease and Children”, was to create awareness about kidney health among the younger generation and their parents. Fun and educational activities included diet counselling, free screenings and colouring contests.

19,932

patients on waiting list for kidney transplants from deceased donors

Q: Is the Health Ministry planning any programmes in conjunction with World Diabetes Day 2016?

A: World Health Day 2016 will be dedicated to diabetes and will be observed by the Health Ministry (tentative date is April 7, 2016) and various activities have been planned, including health promotion activities and diabetes awareness campaigns.

Q: Will the Health Ministry support any NGOs for the World Diabetes Day 2016 celebration?

A: The Health Ministry aims to work together with various NGOs, including Diabetes Malaysia.

Q: Has there been any new development in kidneyrelated disease treatments in

recent years?

A: There have been some new drugs that can improve the management of dialysis and transplant patients. Innovations in home-automated peritoneal dialysis machines now allow remote monitoring of home therapy by doctors and nurses.

The “artificial wearable kidney”, a small portable wearable dialysis machine, is now undergoing trials in a number of countries. Hopefully this technology will become a reality in the next 5-10 years.

Q: What is your opinion on the state of kidney health among Malaysians?

A: We are very concerned that the number of people diagnosed with end-stage kidney renal failure and requiring dialysis treatment is increasing every year. Over a 10-year period, the number of new patients requiring dialysis had increased from 3,134 in 2005 to 7,055 in 2014. Similarly, the prevalence, i.e. the number of patients on dialysis, had increased from 13,332 in 2005 to 34,767 in 2014. The leading cause of endstage kidney failure is diabetes.

Sixty-one percent of all new patients requiring dialysis treatment in 2014 developed end-stage kidney failure due to diabetes.

Malaysians need to do more in terms of practising a healthy lifestyle to prevent and better control diabetes, hypertension and obesity. This will also translate to better kidney health for Malaysians.

Types of dialysis treatments A patient with kidney failure generally has to undergo treatment known as renal replacement therapy. The therapy is mostly known as dialysis treatments and functions as replacement kidneys, so to speak. There are two types of treatments:

HAEMODIALYSIS

It is a process of purifying the blood of a person whose kidneys are not working properly. The treatment makes use of an “artificial kidney” in a form of a haemodialysis machine. It basically replaces the function of the kidneys which is to remove unwanted wastage in the blood.

The treatment can be an outpatient or inpatient therapy, depending on the patient’s circumstances. A prescription for dialysis from a nephrologist will specify various parameters for the treatment. These include the frequency, length of each treatment and the blood and dialysis solution flow rates.

The treatment will usually be prescribed only after a certain procedure has been done prior to starting treatment.

Usually, a patient need to undergo surgery to make his veins bigger so that treatment can be carried out. The process

is called arteriovenous fistula.

PERITONEAL DIALYSIS

This is a treatment for patients with severe chronic kidney disease. It is done by inserting a tube into the patient’s stomach by minor surgery. This surgery uses the patient’s peritoneum – the membrane lining the abdominal cavity – as a membrane across which fluids and other dissolved substances are exchanged from the blood.

Fluid is introduced through a permanent tube in the abdomen and is flushed out every few hours. Patients are trained to run the treatment at home, instead of going to a dialysis centre.

Peritoneal dialysis offers more mobility for the patients as they can continue working or travelling while receiving treatment. Another version of the treatment, known as automatic peritoneal dialysis, allows a patient to change the fluids only before going to sleep as the process runs through the night.

The automatic peritoneal dialysis is not as popular among the public as it is still new and costs a lot more than regular peritoneal dialysis.

14 •

march | 2016

SOCSO steps ahead with dialysis support Scheme provides dialysis facilities for contributors suffering from end-stage kidney failure

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By PRASAD CHANDRA SEGARAN

ecogni sing the rising cost of dialysis treatment, the Social Security Organisation (SOCSO) has put in place a scheme to help insured dialysis patients. The scheme provides dialysis facilities to support contributors suffering from severe chronic kidney disease – end-stage renal failure (ESRF).

Haemodialysis is a process where machines are used to filter out waste fluids in the kidney.

Without life sustenance, once a person with kidney disease reaches ESRF, toxin build-up in the body and death usually comes within a few weeks.

SOCSO is one of the main bodies that create awareness

among workers on the importance of caring for their kidneys. As a caring organisation and leader in social security, SOCSO looks after the wellbeing and welfare of its contributors affected by kidney diseases.

SOCSO started the scheme in early 1999 after the then minister of labour and manpower Datuk (now Tan Sri) Lim Ah Lek mooted the idea to provide haemodialysis treatment for its contributors affected by ESRF. The dialysis treatment is extended to all eligible members for life when they are unable to work and certified invalid by the SOCSO medical board.

In 2005, the service was extended to include eligible SOCSO contributors claiming for Invalidity Pension Scheme subject to recommendation by the medical board. SOCSO came up with subsidised peritoneal dialysis treatment to help those who are medically prescribed by its nephrologist.

SOCSO also started subsidising

The public should know what is happening to the money they have contributed to SOCSO. The awareness is not just about providing services to the patients or the public; it is more about how we prevent them from getting these diseases.”

– Dr Azman

Ayurveda possible cure for kidney diseases Indian traditional treatment can be used to treat, and sometimes even cure such chronic ailments

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hen it comes to treating kidney diseases – or for that matter any diseases – most people will first think of mainstream or western medicine. But then, like almost everything else,

there are always alternatives to consider – from natural cures to home remedies and many other types of alternative treatments.

Of all the alternative choices to treat diseases, Ayurvedic treatment is probably one of the oldest whole body – or holistic – healing

systems. Ayurveda originated in India more than 5,000 years ago and remains one of the country’s traditional health care systems.

One of the foremost practitioners of Ayurveda in Malaysia is Vaidya CD Siby, who has a Bachelor in Ayurvedic Medicine and Surgery (BAMS) from India.

For close to 28 years, he has been treating people who come to him suffering from various ailments from kidney diseases and cancers to diabetes and hypertension.

Today, he is the chief Ayurveda physician of Ayur Centre, a premier Ayurveda centre set up in 2000. It has a branch in Petaling Jaya and another in Seremban.

The basis of Ayurveda is the need to balance the mind, spirit and body. Ayurvedic medicines are primarily aimed at promoting good health, and in certain cases, Ayurveda can provide a cure.

“Every system of medicine has a role to play in health management and no system is complete,” says Siby. “Modern conventional

system is a progressive science with advanced technology, while Ayurveda is based on a traditional approach. Also, surgery is a branch of Ayurveda that is no longer in practice today.”

Siby says the effectiveness and duration of treatment for any disease depends on various factors, including the patient’s age and the stage of the disease. In the case of kidney disease, the first step is to identify the type. Is it related to other diseases such as hypertension, diabetes or cancer? Are there lifestyle changes that can be made to help the patient? Siby believes that when a patient is suffering from a very early stage of kidney disease, there are times when the condition can be reversed with proper diet and medication.

“However, when the kidney is damaged, and if the patient is suffering from other chronic diseases, the best we can do is help the patient’s quality of life with proper diet, medicines and other supplements.

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erythropoietin (EPO) injection in 2009 to treat and improve the health of those suffering from anaemia due to chronic kidney diseases. It also provides assistance to subsidise immunosuppressant drugs to contributors who have undergone kidney transplant.

Treatment at private, government dialysis centres The haemodialysis treatment for SOCSO contributors is available at 471 private sector and non-governmental organisation (NGO) dialysis centres and 125 government hospitals nationwide.

A total of 11,025 contributors are receiving haemodialysis treatment at private dialysis centres and another 1,086 at government health facilities. The total number of SOCSO contributors receiving dialysis treatment under the scheme is almost a third of the total number of patients nationwide.

SOCSO CEO Datuk Dr Mohammed Azman Aziz Mohammed says the number of kidney patients in the country is increasing due to kidney failure caused by kidney disease complications. “SOCSO has two main schemes. The first is Employment Injury Insurance Scheme which covers accidents that happen to contributors during or at work. The second is the Invalidity Pension Scheme.

This 24-hour coverage is basically not related to injury or accidents, but due to any kind of physical diseases like heart disease, stroke or even kidney failure, for which you can come forward to claim the pension,” explains Dr Azman.

A contributor is eligible to claim for the pension under the Invalidity Pension Scheme after

being certified invalid by the medical board.

“Looking at the facts, every year the number of cases increases by about 15-20%, which is quite serious,” says Dr Azman. He says diabetes is the main cause of kidney failure and for such cases, contributors can apply for invalidity.

Alarming number of kidney failures SOCSO says the risk of kidney failure is high because obesity statistics are about 72%, high cholesterol is about 61%, high blood pressure is about 41%, and diabetes is 9%. This is based on health screening carried out by SOCSO. “It’s alarming that the number of cases has doubled over the last five years. The number of kidney disease cases in Malaysia is increasing compared to developed countries. Over the years, SOCSO has provided more than 500 haemodialysis machines to NGO dialysis centres and government health facilities to ensure accessibility to eligible patients and when we do this, we make sure the press covers the event so that the public and stakeholders are aware of it,” says Dr Azman.

“The public should know what is happening to the money they have contributed to SOCSO. The awareness is not just about providing services to the patients or the public; it is more about how we prevent them from getting these diseases.”

Dr Azman says SOCSO started the awareness programme in January 2013 through the health screening programme. Twenty percent of contributors who are

Risk of kidney failure obesity is about

72% high cholesterol is about

61%

high blood pressure is about

41%

Training for jobless patients Dr Azman says some patients

SELF LOVE: When you start loving yourself, that’s when the body system won’t cheat you, says Siby When someone is at the terminal stage of any disease, there is very little Ayurveda can do to reverse the situation. The best that it can do is to help manage the condition and improve the quality of the patient’s life.

In most cases, patients are encouraged to stay at Ayur Centre

for two weeks to allow Siby and his team of therapists to monitor their diet. “We will be very strict and they will be allowed to eat only certain vegetarian food,” says Siby.

The patient will also be administered suitable herbal medication which he says are sometimes manufactured locally. “However,

eligible for the SOCSO health screening programme had undergone the screening.

Previously, the dialysis facilities were only for those on the pension scheme. Recognising the growing need, SOCSO has relaxed the conditions to include contributors who are still working and have made at least 12 contributions.

SOCSO extends its facilities to contributors who require such services even though they are not certified invalid by the medical board.

Besides the high cost, haemodialysis treatment also takes up a lot of the patients’ time. Hence, SOCSO also provides peritoneal dialysis which is more convenient as it allows the patients to carry out their normal daily routine.

some medicines are produced by us in India and imported to Malaysia.”

The patient may also be required to undergo external oil massages.

In all, Siby’s message is clear: “In Ayurveda, we call upon one’s own body’s energy to combat any disease. It won’t be easy to do this if the body is unhealthy. It is difficult to maintain a healthy body, and you won’t get a healthy body when you are exposed to all kinds of environmental poisons including water, the air we breathe and the place we live in

had lost their jobs because their employers don’t accept workers with health problems.

“In such cases, SOCSO provides training and get them other jobs or even encourage them to be entrepreneurs. Regarding the peritoneal dialysis, SOCSO provides the patients with its equipments and accessories such as the catheter in the stomach and the solution that costs around RM2, 000 per month,” he adds.

“We don’t want dialysis patients to just sit at home. SOCSO believes dialysis patients can also be very productive.”

Azman advises contributors to make use of SOCSO’s health screening as prevention should be everybody’s ultimate goal. “There is no cure for kidney disease, unless if you go for kidney transplant, but that requires you to be under medication for life,” he says.

which is a challenge to our body system.”

His advice, therefore, is to start loving your body. “When you start loving yourself, that’s when the body system won’t cheat you.

Pretend as though your body is a car and you’re the driver. To make sure your car runs well, you have to maintain it well. Similarly, if you maintain your body well, it will function well too. Don’t take your system for granted as prevention is always the better than cure.”

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Staying positive and accepting life Dialysis patient Ramzy can’t do many things he did before, but has learned to live with his condition

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By Norman Hussaini

he number of kidney patients is increasing every year, resulting in many of them in need of dialysis treatment.

According to the Health Ministry, the number of kidney patients in need of dialysis treatment increased from 13,332 in 2005 to 34,767 in 2014.

To support patients requiring dialysis treatments, the ministry provides comfortable dialysis centres in major hospitals nationwide as well as subsidising medicine and treatment costs. In addition, organisations like the Social Security Organisation (SOCSO) also provide support for workers in need of dialysis treatments.

The support given by the ministry and SOCSO, among others, has impacted many Malaysians who otherwise might not be

able to receive ample treatment for their conditions. One of them is Ramzy Hashim who is undergoing dialysis treatment at Hospital Sungai Buloh as part of the SOCSO’s health scheme. His is a story of hardship, determination and acceptance. It’s a powerful testimony of how SOCSO’s support has brought light into the life of a man coping with kidney failure.

Ramzy was a hardworking member of the society, living his days on the factory floor with vigour. After years of service, he was given the opportunity to work in Langkawi and was all set to take on the job. However, his luck turned when he was diagnosed with kidney failure during his stay in Langkawi following his job offer.

“I was diagnosed with kidney failure in 2012. The condition wasn’t at a critical point yet, so I was going back and forth to the hospital every month for the doctor to keep track on my condition,” he tells Health+. Due to his condition, he was no longer

Dialysis patients increased from

13,332 in 2005 to

34,767 in 2014

qualified for the job and had to opt for early retirement.

He never struggled while going in and out of the hospital and living off his retirement from SOCSO, and neither was he happy.

“I was living with the condition for three years before it came to a point where I needed to undergo dialysis.” His kidney functions had deteriorated over 15% and his doctor told him to go for dialysis treatment.

Challenging life Ramzy is pleasant and soft spoken, and talking to him reflects how strong he is in dealing with his condition. He earnestly laments his first experience undergoing dialysis treatment. “The first time was the hardest. I was uncomfortable with the needle and the pain was daunting. The amount of time I had to stay for the treatment also made me very uncomfortable.”

Ramzy is on four-hour dialysis treatment three times a week. He started his treatment in July last year and is now more comfortable and used to the process. “Thinking positively of the treatment has helped me get used to it over time,” he says.

The down side of living with kidney failure, says Ramzy, is that he gets tired and exhausted rather quickly. “I was very active before this. I used to climb hills and go jungle trekking all the time as it was my hobby. But now I am unable to do any of these as I would be at the risk of collapsing.”

A great sacrifice to make, Ramzy now finds himself unable to even drive a car for an extended period of time as he would get exhausted. “I can drive but I have limits on how long I can drive. I can’t go too fast either because it would require me to be more

Looking back, I’ve never felt regret having this condition.

Sure I may no longer be able to climb hills, jungle trek or eat whatever I want, but I believe there is a reason for me to be what (my condition) I am now. I’ve learned to live with it and to think positively.”

– Ramzy

focused which makes me tired quicker.”

Helping hand Hospital Sungai Buloh is one of the pioneering hospitals to set up a dialysis centre to provide treatments to patients. Health+ also spoke to the hospital’s medical assistant Ahmad Nizam Mat Yunos during the interview with Ramzy.

Ahmad Nizam was the pioneering staff of the dialysis unit and has been serving there for 10 years.

“My primary role is to manage patients’ admissions to the centre.

I also oversee the staff and nurses to ensure (everything is) smooth sailing,” he explains. Nizam keeps a tight ship managing the centre, and is responsible for the comfort of Ramzy and other patients throughout their treatment.

Ramzy is fortunate to get SOCSO’s help and the treatment at Hospital Sungai Buloh. “Because of my background as a factory worker, it was never a hassle to get the help from SOCSO to cover the expenses for my treatment.

The process to apply for insurance from them was simple once I had all the necessary documents.”

Positive acceptance Ramzy says it has been tough adjusting to the changes, abstaining from enjoying his hobbies and going for dialysis treatment three times a week for the rest of his life.

However, he has accepted his fate and found that it is all in the hands of God. “Looking back, I’ve never felt regret having this condition. Sure I may no longer be able to climb hills, jungle trek or eat whatever I want, but I believe there is a reason for me to be what (my condition) I am now. I’ve learned to live with it and to think positively.”

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Filtering out the negatives through dialysis

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IN GOOD HANDS: Nizam keeps the dialysis unit running smoothly.

KPJ Selangor treats hepatitis C patients KPJ Selangor is one of few hospitals equipped to treat hepatitis C patients.

Hepatitis C is transmitted when the blood of an infected person contaminates the blood of someone who is not.

One of the known ways of spreading hepatitis C is sharing needles or other drug injection equipment to administer drug which process is similar to the treatment of dialysis.

KPJ Selangor senior state nurse Natalia Thamil Selvi Perumal (pic) says most government centres are not equipped to treat patients with hepatitis C condition due to the travelling nature of the sickness. “Patients with hepatitis C require different care. While treating them,

the centre has to take extra precautions to contain the condition,” she tells Health+.

KPJ Selangor’s dialysis centre is equipped with a cubicle for those with hepatitis C. The law requires patients with such conditions to be isolated from other patients to restrain the virus.

“The room has to be well taken care of. We pay attention to the smallest details down to the piping system,” she adds.

After about a month of feeling sad, I accepted my fate.

I’m sure God has a plan for me and I was ready to live again” – Zainy

By Syed Zaid Syed Osman

arly every morning, Zainy @ Ahmad Zainy Che Agus wakes up to perform morning prayers, then heads down for a nice breakfast with his family before going about his daily routine. The Kelantan-born father of five spends most of his mornings at home before leaving his house on his old Kembara en route to Jalan Pahang in the heart of Kuala Lumpur.

For the past seven years, he has been on dialysis at KPJ Tawakkal Specialist Hospital. He was 28 when the first complication showed up. He noticed that his urine output had decreased every now and then; he sensed his breath was getting shorter and he felt drowsy most of the time.

Back then, Zainy considered himself fit. He was active in sports, focusing on his football games before he was admitted to hospital for the first time. The doctor told him the creatinine level in his blood was slightly higher than the amount in his urine, indicating his kidneys weren’t working properly.

As time passed, his condition got from bad to worse, and finally, he was required to undergo long-term dialysis.

“The dialysis centre is basically my second home now” he tells Health+. He commutes from his house in Putrajaya to the hospital every Monday, Wednesday and Friday at 1.35pm for his appointment.

CHEERFUL: Zainy is still able to keep his smile despite what he is going through.

Zainy took his time adjusting to the treatment. “I remember the time when I felt death was so near to me,” he recalls. “My breath was out of rhythm and in shorter pace while I felt my strength leaving my body.”

He was rushed to the hospital and was given anti-depressants by the attending doctor. He was later told that his symptoms came from the stress that originated from the changes around him. “After about a month of feeling sad, I accepted my fate. I’m sure God has a plan for me and I was ready to live again,” he vocalises in a positive tone. Now he treats his four-hour dialysis as one of his daily tasks. “Get it done and move on to the next thing in my to-do list for the day,” he says with a smile.

Like other dialysis patients, Zainy has to adjust to major changes. He says the changes were initially difficult but slowly he has managed to change his lifestyle and diet. “Humans are creatures of adaptation. That is for certain.”

Zainy has completely stopped playing any sort of sports because of the treatment. Despite the hardship, he shares the joy from the support of his family and close friends. Filled with positive energies around him, he says his wife has remained strong and persevering throughout his illness.

“I still do wish that this illness can be cured someday,” Zainy says with much hope. Despite being chair-bound for the next few hours, he is filled with optimism. His parting words were very encouraging: “Whatever predicament you are in, be patience. That is always the key”.

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Taking HIV by the horns Andrew Tan, living with HIV for 22 years, finds peace helping others with similar condition

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By Norman Hussaini

ndrew Tan grew up in a normal neighbourhood, went to a normal school, had normal friends and lived with his normal, loving family. Yet his life was never actually normal.

Andrew’s story on discovering his condition and living with it is far from boring. He now serves as an Exco member of the Malaysian AIDS Council (MAC) and is part of the Kuala Lumpur AIDS Support Services Society (KLASS), a society providing peer support to HIV patients.

Andrew fell terribly ill one day in 1994 when he was just 34, and decided to go to the doctor after a nudge from his mother. After some tests, the doctor told him he had a viral infection, though it was not known specifically what type. He was reluctant to leave the hospital without knowing everything.

“Of all the tests the doctor had done, some were left out and the HIV test was one of them,” he says. He didn’t know much about HIV as public awareness was limited then.

Sure enough, after the tests, he was declared HIV positive.

The sad part was that he was sent home after the diagnosis. “The doctor told me that I could go home after I was told I had HIV. Back then, medication for HIV was still uncommon in Malaysia.

Even the ones available were very expensive and were not subsidised by the government.”

The doctor’s response to his condition solidified his feeling of finality to his life. “It was like there was nothing I could do but to wait for death. It all happened on my birthday – no less, great birthday present,” he jokingly says.

AGAINST ALL ODDS “I felt that I had transformed from someone who felt indestructible to someone who was to face death anytime.” He found the experience harrowing. “I must admit that I had thought about suicide at one point in time, yet I never had the courage to commit such an act.”

He lived a full year without going to the doctor and became ill day by day. His condition transgressed to a level where he actually had AIDS. “After a year of living with the sickness, I finally found the courage to seek help. I confided with a trusted friend who volunteered with PT Foundation and was referred to a doctor at the University of Malaya Medical Centre (UMMC) to consult with.”

He started his medication and sought support from the foundation through its support groups.

Even then though, he found new challenges. “Back then there was only one type of medicine to control HIV in Malaysia called zidovudine. It was very expensive and I had to spend most of my salary just for the drug.”

Being a person with a different sexual orientation and living with HIV caused serious self-stigma and self-discrimination. “I had known from a young age that I was different, and that I was gravitating more towards men than women.” Homosexuality was such an alien idea then and that made it more challenging for him as a young lad.

I think my spirit of never giving up was from my father. He was always a high-spirited person and had enjoyed helping other people.”

– Andrew

RESILIENT: Living with HIV is no small feat for Andrew, but he prevailed while helping others in the process.

SERVING THE HIV COMMUNITY Andrew was very fortunate. Even when his health had fallen to a critical level, he had the courage and tenacity to keep surviving and living his life.

“I think my spirit of never giving up was from my father. He was always a high-spirited person and had enjoyed helping other people. I also set my personal goals, shifting the goal posts a bit every time I made some progress.

My partner encouraged me every step of the way,” he says.

As a member of KLASS, he loves helping and supporting people who are going through what he had gone through. His previous doctor was the one who wanted him to join KLASS. “My doctor said my condition had transcended so well that I can be an example for other people

who are diagnosed with HIV,” he says.

Andrew found KLASS to be a safe place. He joined its support groups and has since started helping to support others. “My duties usually involve me going to hospitals and visiting people who had recently been diagnosed with HIV. I will go in after visiting hours right before their bedtime as I find it to be the perfect moment.”

He feels very lucky to have the opportunity to touch other people’s lives and empower them to face any personal challenges they have. “I think the general perspective towards HIV is still in need of changing. And I feel that a very good way of doing that is to present the success stories of people living with HIV to a wider audience.” With KLASS and its dedicated members, it will certainly go far.

KLASS lends a helping hand The Kuala Lumpur AIDS Support Services Society (KLASS) was set up in 2001 to focus on filling the gaps in HIV support services in the country.

It is committed to complement the available services already set up by the Health Ministry and various other organisations.

Its main target is the Chinese and Indian-speaking communities, where

the level of comprehension and support is still poor. As part of its services, KLASS, which is located next to the Malaysian AIDS Council office, provides counselling to people with HIV by giving them ample information on HIV prevention, treatment and management. It also provides comfortable meeting place for them to share and meet by way of support

groups.

KLASS members are also active volunteers carrying out HIV and AIDS related projects, especially those which disseminate information. As an organisation dedicated to complement the already established support for HIV, it also works regularly with other NGOs to carry out projects for the community.

KLASS is conducting a pilot project funded by the Global Fund to engage the key affected population of the MSM community (men who have sex with men) via social apps. The project aims to encourage greater acceptance for MSM to “Know Your Status” with free anonymous test in an effort to reduce the fear of testing for HIV within the community.

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CREATIVE COMMONS

GENETICALLY SPEAKING: To reduce risk of heart attack, the benefits of a healthy lifestyle are clear, but genetics can still stack the deck.

Genetic errors may prevent heart attacks Findings of new study may guide design of new drugs, similar to how statins lower ‘bad’ cholesterol

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o reduce risk of heart attack, the benefits of a healthy lifestyle are clear. But genetics can still stack the deck.

Some people’s genes bestow a natural advantage – or disadvantage – in protecting against heart disease, the leading cause of death worldwide.

Now, a new study led by Washington University School of Medicine in St. Louis that included genetic data from more than 190,000 people has identified two genes that, when altered in specific ways, either promote or undermine cardiovascular health.

In a press release announcing the findings, the university says this may reduce risk of heart attacks and serve as a basis for developing new drugs designed to prevent heart disease.

The findings may help guide efforts to design new preventive drugs, similar to the way statins are prescribed to lower “bad” cholesterol to reduce the risk of heart disease.

The research, from Washington University School of Medicine in St. Louis, the Broad Institute at Massachusetts Institute of Technology and Harvard, and

numerous other institutions, was published online in The New England Journal of Medicine. “ We identified genetic variation in several genes that associated with protection from coronary heart disease,” says first author Nathan O Stitziel, a Washington University cardiologist and assistant professor of medicine and genetics. “Our findings support the idea that therapies focused on a major pathway regulating triglycerides should help prevent the build-up of plaque in the heart’s coronary arteries and protect against heart attacks.”

DNA data To identify genes that might be relevant for drug discovery, the investigators plumbed DNA data from patients with coronary disease and from healthy controls.

They searched across more than 220,000 genetic variants that altered proteins to identify those that appeared to influence heart disease risk. Errors in proteins can have major physiologic consequences.

As part of the study, the researchers confirmed past work identifying genes already shown to confer an advantage

35%

reduction in triglyceride levels in the blood of people with a disabled copy of ANGPTL4 compared with people with two working copies of the gene.

or a vulnerability in protecting against heart disease risk, and they implicated two new ones — ANGPTL4 and SVEP1.

Rare errors in ANGPTL4 were associated with reduced risk of coronary artery disease. The reduction varied from 14% for a small error in the gene to cutting risk by about 50% when an entire copy of the gene was disabled. The other gene, SVEP1, showed the opposite correlation – a rare error increased risk of coronary artery disease by about 14%.

Mystery While ANGPTL4 has been the subject of much study, the other gene newly implicated in cardiovascular health is a bit of a mystery. In the new study, Stitziel and his colleagues showed that the error in SVEP1also was linked to higher blood pressure in their study populations, but beyond that there are few clues to what it’s doing.

In contrast, ANGPTL4 has long been known to play a role in processing triglycerides, a type of fat that circulates in the bloodstream. Doctors measure levels of triglycerides as a marker of heart disease risk, though whether these fats play a role in causing plaque to build up in arteries historically has been a matter of debate. ANGPTL4’s role in processing triglycerides is part of a system called the

lipoprotein lipase (LPL) pathway.

Blocking ANGPTL4 actually opens up this pathway, allowing the body to process triglycerides from the diet and get them out of the bloodstream.

“The gene’s association with lower triglycerides has been known for a while,” says Stitziel, who also sees patients at Barnes-Jewish Hospital. “But for a long time it was not clear that high triglycerides were a cause of coronary disease rather than a marker of it. Now we know that errors in ANGPTL4 associate with both reduced triglycerides and lower risk of coronary disease. This is another piece of the puzzle that points to a causal role for triglycerides in coronary disease.”

“If that’s correct, strategies to lower triglycerides should help,” he adds. “Our study indicates that those strategies could include blocking ANGPTL4 or manipulating other elements of the LPL pathway.”

Lower triglyceride levels In people with a disabled copy of ANGPTL4, triglyceride levels in the blood are reduced by about 35% compared with people who have two working copies of the gene. Stitziel also pointed out that variations in the gene were not associated with changes in levels of “bad” LDL cholesterol. So any drug that impacts this pathway would, in theory, work independently of statins as well as PCSK9 inhibitors, a new and potent cholesterol-lowering therapy that was approved in 2015 by the Food and Drug Administration. Stitziel notes that these recently approved therapeutics that inhibit PCSK9 were developed after similar genetic studies showed an association with LDL cholesterol levels.

“The poster child for human genetic studies leading to new therapies is PCSK9,” Stitziel says.

“Rare errors in PCSK9 were first found to cause high LDL cholesterol and different errors were later associated with low LDL cholesterol and protection from coronary disease. And within 12 years of those findings there are now new therapies. The key insight from human genetic studies is the ability to identify biological pathways that are relevant to human disease.”

With future therapeutics in mind, Stitziel points out that early versions of inhibitors targeting ANGPTL4 and other members of the LPL pathway are in development. While none of these are clinically approved therapies, the new study linking these genes to reduced coronary disease and lower triglycerides suggests the line of investigation is worth pursuing, he adds.

As for the mystery gene implicated in the new study, Stitziel says he and researchers in his lab are working to unravel the role of SVEP1 in coronary disease risk.

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