Monday, April 8, 2013 C11
HEALTH Ask the doctors ................................................ Dr Durai Raj Subramaniam healthpost@scmp.com Q: Antioxidants: what are they and do they really benefit me?
Dermatologists discover fresh hope for acne sufferers, writes Sunory Dutt
Illustration: Corbis
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n a society obsessed with appearances, acne often influences a person’s quality of life, leading to social withdrawal, anxiety, and sometimes depression. Treatment of the skin problem is therefore essential, and new research suggests that diet could play a bigger part than was thought. A recent study published in the Journal of the Academy of Nutrition and Dietetics has determined that there is increasing evidence of a connection between diet and acne, particularly from high glycemic load diets and dairy products, and that medical nutrition therapy (MNT) can play a role in acne treatment. Since the late 1800s, research has linked diet to this common disease, identifying chocolate, sugar, and fat as particular culprits. But in the 1960s, studies began to refute the link between diet and acne. “Recently, dermatologists and registered dietitians have revisited the diet-acne relationship and become increasingly interested in the role of medical nutritional therapy in acne treatment,” says one of the study authors, dietitian Jennifer Burris of the Department of Nutrition, Food Studies, and Public Health at New York University. Her team culled information from studies between 1960 and 2012 that investigated diet and acne. Acne occurs when hair follicles get plugged with oil and dead skin cells, creating an environment for bacteria to thrive. They may appear in the form of whiteheads, blackheads or pimples. Diet aside, the condition can be triggered or aggravated by many factors: a family history of acne, hormonal changes, certain medications, stress, sweatiness, certain cosmetics and skincare products, improper cleansing methods, and aesthetic treatments. In Hong Kong, acne affects 80 per cent of adolescents and young adults aged 11 to 30 years. “Developed countries have more acne sufferers, as often more development leads to increased ingestion of refined carbohydrates,” says Dr Suseela Narra, a dermatologist at Narra Dermatology and Aesthetics in Washington. The US alone has 17 million acne sufferers. “I advise my patients to avoid processed foods and refined carbohydrates, including white bread, white pasta and white rice, as well as anything that is pre-packaged,” Narra adds. “I tell them to concentrate on eating whole fruits,
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vegetables, whole grains, and good fats like avocados and olive oil. They often see improvement after reducing sugar and refined food consumption. I have to say dietary control has more of an effect on mild to moderate acne than on severe acne.” The Glycemic Index is a scale from 0 to 100 that ranks carbohydrate-rich foods by how much they raise blood glucose levels. Pure glucose serves as a reference point with a GI of 100. High GI foods (70 or more) include white bread, baked potato and pretzels. Low GI foods include pumpernickel, yam and legumes.
Maintain a food diary and review it regularly to pin down foods that are giving skin problems CHARMAIN TAN, DIETITIAN
High GI foods increase insulin levels, causing the stimulation of sebaceous glands, which then produce increased sebum, resulting in the clogging of pores and acne. In general, high fibre foods tend to have a relatively lower GI. Dairy’s contribution to acne is controversial. The hormones in dairy products are thought to stimulate sebaceous glands, much like our endogenous hormones do. Some studies show more of a connection between acne and skim milk than with whole milk. If you avoid dairy, Karen Chong, registered dietitian at Matilda International Hospital, cautions that it is important to replace the calcium from other high calcium food sources such as dark green leafy vegetables, calcium fortified soy products such as tofu, calcium fortified orange juice, almonds, beans, and sardines with edible bone. Hippocrates said, “Let food be your medicine and let medicine be your food.” Skin is constantly under construction and needs nutrients to repair and rebuild. Charmain Tan, a registered
dietitian at Seventeen Nutrition Consultants, suggests eating a well-balanced diet rich in fruits, vegetables, fish rich in omega-3, and low GI foods. A healthy diet might keep blood sugar steady and fight inflammation and oxidative damage that link to skin problems. “Maintain a food diary and regularly review it to pin down what sort of foods are giving you skin problems,” Tan suggests. Medical reviews so far contain very little objective data, and studies have been inconclusive on the relation between diet and acne, says Dr Georgia Lee, aesthetics physician and pioneer of DrGL skincare products in Singapore. This is due to methodological limitations, such as small sample size, lack of appropriate controls, incomplete reported results or failure to clearly define the changes in acne. But Lee believes there is a link between diet and acne, “as many dietary factors influence a variety of hormones and growth factors, which in turn influence sebaceous gland biology and production of sebum. “I find that acne associated
Medical tourism: buyer beware However, slick websites displaying advanced medical cells to grow cells in the dying set-ups and listing impressive heart muscles of patients facing panels of staff can be cardiac failure three years ago. misleading. As Monica “Stem cell treatment is still in discovered after paying a the experimental stages but we deposit, the Indian facility she are very selective and careful. signed with wasn’t even a Only four companies are hospital. licensed by the Ministry of “After paying the deposit, I Health to provide stem cell kept telling them I was diabetic. services here,” says HSC Because of the scale of the chairman Dr Lim Yin Chow. operation, there’s a possibility of me going into shock and there’s a death risk. I have to stay in a hospital because I need the equipment in case something goes wrong. I kept asking whether they were a hospital and they just kept stalling ... After I arrived, I found out it was just a clinic with an operating theatre.” At the Hong Kong Sanatorium & Hospital, Dr John Chang SoAdvertisements for a medical tourism expo min, director of its in Seoul, one of the plastic surgery capitals Guy Hugh Chan of the world. Photo: AFP Refractive Surgery > CONTINUED FROM C9
Centre, says language differences can affect treatment, noting that local ophthalmologists have treated a number of Hongkongers for botched eye surgeries on the mainland and in Thailand. Procedures to correct sight problems using Lasik machines are done while the patient is conscious, he says. “The doctor needs to tell the patient which light to look at during surgery. Some patients get frightened and we need to calm them and keep reminding them to keep their eye still. Such back-andforth should be conducted in the mother tongue.” Chang adds that quality of treatment may suffer when centres pursue more international patients to make up for lower fees. For instance, some places are able to charge less for laser eye surgeries because they run their equipment at full capacity to treat more patients. “Running machines at full capacity is not a good thing, as doctors need to personally tune the machines between patient sessions,” Chang says. Sterile conditions can also be a concern. Chang says: “They might reuse medical equipment that is meant to be disposed of instantly after use, and this can lead to inflammation in
patients.” Monica, too, found her wounds became infected after her return. “All stitches were rejected by my body. It ended up being really messy. It’s quite scary. I thought I would be scarred for life as the wounds were really deep.” She eventually sought help from St Paul’s Hospital here. Doctors traced the infection to a bacterium although they could not be sure if it was picked up during her surgery or something already existing in her body. And the extended course of antibiotics added up to “a huge bill”. Despite higher risks and some horror stories, the significant savings are likely to lure more Hong Kong patients overseas. Monica, for one, still plans to go back to India to remove the excess skin on her legs. She paid about HK$70,000 for her two procedures in India, but it would have been much more expensive if she had them done in Hong Kong. What’s more, the stomach bypass she had in 2008 was not available here at the time. “I may not go back to that hospital, but I might go to another one in India,” she says. elaine.yau@scmp.com
with seborrhoeic dermatitis seems to do very well with a low glycemic, minimal bread and alcohol diet. Abstinence, if adhered to, should lead to the condition improving in three months.” To keep zits at bay involves learning how to manage stress, reduce caffeine, alcohol, unhealthy fats and sugar, drink more water and engage in regular exercise. The dermatologists’ arsenal of anti-acne medications – benzoyl peroxide, antibiotics and Accutane – hasn’t expanded in decades. Recent studies have suggested other treatment possibilities, from viruses present on human skin, to herbal tinctures of thyme, marigold and myrrh. Burris and colleagues say the medical community should not dismiss the possibility of diet therapy as an adjunct treatment for acne. “At this time, the best approach is to address each acne patient individually, carefully considering the possibility of dietary counselling,” she says. life@scmp.com
A: The word “antioxidant” is found on many food products these days. An antioxidant is basically a mop that cleans up a vital yet potentially damaging substance – oxygen. During certain metabolic processes in our body, an unstable form of oxygen is released. This belongs to a class of molecules called reactive oxygen species (ROS). ROS is like fire: useful and even vital in controlled situations, but damages cells in excess. The natural antioxidant mechanisms in our body keep ROS from doing too much harm. The theory is that certain unhealthy activities are prooxidant, such as smoking, an unhealthy diet, exposure to environmental pollutants and even excessive exercise. Antioxidants are said to help counter these effects. Unfortunately, the truth may not be so simple. It is difficult to prove how much of a particular antioxidant is required to combat a certain condition, and for how long. For example, a study conducted in India on Western Nepalese smokers who were suffering from lung cancer found that smokers had low total antioxidant activity in their
bodies. Each puff of a cigarette contains 10 to the 16th power of ROS, according to the authors. Adding to this, the smokers had poor diets with low levels of antioxidants. The study said further work was required to determine the relationship between smoking and oxidative stress (pro-oxidant activity). So will taking a whole lot of supplements actually help reduce the risk of any disease? A consensus has not yet been reached, but here’s some good old advice: eating plenty of fresh fruit,
vegetables and fish; having a moderate exercise programme; and learning to manage stress are more sensible ways than pills to optimise natural antioxidant levels. Also, don’t smoke and avoid processed foods. If you must take supplements to treat a serious condition, seek the advice of a nutritional therapies expert and balance with mainstream wisdom. Dr Durai Raj Subramaniam is a resident physician at the 24-hour walk-in clinic/A&E department of Gleneagles Hospital in Singapore
LAB REPORT Droplets of hope Oxford University scientists have custom-built a 3-D printer that can create a new type of material with the properties of living tissues. These printed networks of tens of thousands of connected water droplets, encapsulated within lipid films, can perform some cell functions. This could form the building blocks of a new drug-
found that (over six years) the same energy used for moderate intensity walking and vigorous intensity running resulted in similar reductions in risk for high blood pressure, high cholesterol, diabetes, and possibly coronary heart disease.
A fresh twist on chocolate Scientists at the University of Warwick have developed “fruit juice-infused chocolate”. They claim chocolate can be healthier by using fruit juice, vitamin C water, or diet cola to replace up delivery technology, and to 50 per potentially one day replace or interface with damaged human cent of fat. tissue. The networks stay stable The juice is for weeks. The findings were in in the form of microlast week’s Science. bubbles that help A walk in the park Walking briskly can lower your chocolate risk of heart-related conditions retain its velvety feel. as much as running can, The overall according to a report in the sugar American Heart Association content is journal Arteriosclerosis, also Thrombosis and Vascular reduced. Biology. Researchers analysed The team more than 33,000 runners has made chocolate with apple, and over 15,000 walkers aged orange and cranberry juice. 18 to 80, and their energy jeanette.wang@scmp.com expenditure by distance. They