Category Archives: EZ 47 – Medicines & Sciences

What Is The Difference Between Food Allergy And Food Intolerence

by Dr Mecherl Lim

MD (MA) Naturopath (ND), Holistic Kinesiology


ALLERGY AND FOOD INTOLERANCE :

It is well known that deficient intake of protein, calories, vitamins, or minerals leads to a variety of nutritional disorders.  It is known that food contaminated with toxic materials or bacteria may cause illness if consumed.  It is also known that certain foods contain non-nutrient poisonous substances that may cause illness and in some cases death. Nevertheless, it is not generally realised that the nutrient components of foods, in themselves may be toxic for certain people, causing illness or aggravating pre-existing illness.

THEORETICAL CONSIDERATIONS :

Food Intolerance may be defined as any illness or biochemical or metabolic abnormality that is causally connected to the ingestion of any food or dietary component. An illness that is causally connected to non-nutritive dietary component may be referred to as food poisoning or food toxicity. The term food intolerance is usually applied to illness resulting from the ingestion of substances that have nutritive value such as carbohydrate, fat, proteins and amino acids, and accessory factors such as purines (purines are responsible for gout in some sensitive individuals).

There may be an obvious connection between food ingestion and the production of acute illness or a less obvious connection so that a patient may fail to recognise

the relationship between his disease and the offending dietary component.

Under special circumstances certain combinations or amounts of food substances may cause illness in otherwise healthy individuals. For example, fasting followed by refeeding may result in stomach and intestinal distress or fluid retention. Another example is in illnesses that cause anorexia where feeding may be associated with nausea and vomiting. This type of Food Intolerance may be considered to be secondary type since the food is non toxic but illness or fasting has so altered the normal physiology that the patient becomes intolerant to many types of food.

REVIEWING SOME COMMON NUTRIENT FOOD INTOLERANCES :

Carbohydrate Induced Food Intolerances

  • Lactose Intolerance is the most common. Most people around the world are deficient in the intestinal enzyme lactase and thus have an inability to digest lactose-containing foods (eg.milk). Symptoms associated with lactase deficiency are bloatedness, wind and diarrhea. Lactose Intolerance may occur of various ages, it may occur at birth or at a latter age to different people. Treatment requires the avoidance of lactose by restricting dietary milk and milk-containing products. Lactose Intolerance should not be confused with milk allergy which is related to milk proteins.
  • High refined carbohydrate diet, in general, may be related to a number of medical problems. For example-low blood sugar (hypoglycaemia) which associated with variety of symptoms including fatigue, weakness, irritability, headaches and sugar craving may classified as diabetic.
  • For the sake of complete example of carbohydrate induced food intolerance are as listed : Glucose-galactose intolerance, sucrose-starch intolerance, sucrose-fruit intolerance, fructose-glycerol intolerance, lactose intolerance, pyruvate dehydrogenase deficiency.
  • All intolerances are due to lack of specific enzymes required for the metabolism of the particular sugar.

Protein Induced Food Intolerance

  • Coeliac disease results from a sensitivity to the protein, gluten, contained in wheat, rye, oats and barley. The disease manifests in most individuals as gastro-intestinal discomfort, wind and diarrhoea. However gastrointestinal symptoms need not be present and the disease may manifest as eczema, or arthritis. Strict avoidance of gluten is necessary in the treatment of this disease.
  • Cow’s milk (casein) allergy or more particular allergy or intolerance to a protein component of milk. It is associated with vomiting, chronic diarrhoea, eczema and failure to thrive. 
  • Other common food sensitivities are to egg protein, soy protein and shell fish. Symptoms may vary from hives to gastrointestinal symptoms, asthma to neurological disturbances (poor concentration, irritability, behaviour disturbances). Avoidance of these food results in remission of symptoms.
  • Individuals suffering from liver failure, cirrhosis of liver, kidney failure or pancreatic insufficiency all show intolerance to most proteins. The intolerance is due to the ailing body’s inability to either digest, metabolise or excrete proteins, amino acids or their waste products. So limiting the intake of protein until the body recovers its health or reduce symptoms.

Lipid Or Fat Induced Food Intolerance

  • Symptoms of diarrhoea (Steatorrhoea) wind, fatty motions occurs whenever fat is malabsorbed.  Steatorrhoe represents an intolerance to dietary fat or lipid. Fat malabsorption occurs in pancreatic insufficiency, various disease of the small bowel (cystic fibrosis, coeliac disease, liver disease, gall bladder disease and diabetes. Obviously a restriction of dietary fats or supplementation with digestive enzymes must be incorporated in the treatment of the above diseases.
  • Very high blood fat concentration due to a deficiency in lipoprotein lipase is associated with severe fasting, pronounced elevation in plasma triglyceride, eruptive xanthomas (fatty nodules in the skin) and recurrent episodes of abdominal pain due to pancreatitis. A low fat diet can control the disease process.
  • High blood cholesterol and altered lipoprotein profile can be viewed as a fat intolerant disease. Treatment in most cases requires the introduction of a low fat diet or supplementation with chromium and essential fatty acids.
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Common Questions From Couples Desiring IVF Programme

Mr. Sim Seng Keat

Obstetrician & Gynaecologist / Fertility Specialist


1. Do you really need IVF programme to get pregnant?

Though it is also equally important that IVF should not be attempted without good justification, it should not be delayed very long either. Unfortunately the public’s idea that IVF to be tried as the last resort has delayed the decision making of many couples and hence most of them have reached their late thirties and even late forties before trying for IVF- assisted pregnancy.

Attempting to try for IVF must be a timely decision by the couples. Incorporating fertility status into annual checkup early in your married life will give a perspective idea about your fertility status. Then it will be more realistic to decide on when to enlist for fertility assistance and /or when to have a timely attempt for IVF amidst your busy daily routine. 

The following time proven approaches still stand true:

  • It is better to have the first child early
  • Couple should decide to go for a checkup with Fertility specialist when there is failure of pregnancy after actively attempting for one year in women less than 35 years old and half a year of active attempt in women more than 35 years old.
  • It is strongly recommended to have early fertility consultation in couple with preexisting gynecological or male fertility related disorders.

2. How long is the duration of IVF injections and is it easy to self-administer injections?

Though earlier IVF injection schedules were longer & lasted for 4-5 weeks, with the advent of recent methodologies, newer injection schedules are shorter lasting which is less than two weeks. It has been proven that the chance of having successful IVF pregnancy has been equally good even in couple adopting shorter injection schedule!

This has not only reduced the stress and time spent in keeping to the schedule but also the number of injections. Moreover, the shorter injection schedules tend to be equally flexible to plan for egg-retrieval procedures and better in reducing the risk of ovarian hyper stimulation.

With the development of newer user friendly injection pens, self-administration of injections deliver dosages precisely and are also easier to use reducing the likelihood of errors and mistakes. 

3. Is it possible to plan / prefix earlier for all appointment dates for couples adopting to go for attempt of IVF pregnancy?

Yes, all the appointment dates from the first day of the injection to the end of IVF procedure including the dates of blood tests could be planned and fixed much in advance and can be made known to the couple even during their first day of consultation. This usually helps the couple to plan their leave or allocate time and be available for all appointments in the midst of their busy work commitments, holiday plans and family obligations.

Treatment plan includes 6 appointments, first three are for collection of medications after pelvic ultrasound examinations. Fourth appointment is for semen collection from husband and day case admission for wife for egg retrieval. Fifth appointment is for admission as day case for wife to have the embryo transfer and sixth appointment is for wife to have the blood test to detect pregnancy status. 

Hence husband must be present for the fourth appointment unless he has already preserved frozen sperms to be used for IVF procedures. It is needless to say wife must be present for all appointments. It is highly recommended to have the presence of an accompanying adult with the wife for day-care admissions for fourth and fifth appointments since these admissions are for the wife to undergo minor procedures.

Schedule of appointments depend on the day of onset of menstruation and hence for women with regular menstrual cycles, appointment dates are very much predictable and easier to fix. 

Women with irregular menstrual cycles require oral contraceptives or progesterone-only pills to induce menstruation to get the date of onset of menstruation to plan for all future appointments.

4. How is the egg retrieval procedure performed? How true are hear-says about pain during and after undergoing egg retrieval procedures?

From the feedback from many patients, egg retrieval procedures are relatively painless though very few of them might experience minor lower abdominal discomfort for a shorter duration after the procedure.

Most egg retrieval procedures are performed easily with minor sedation though some of them might need light general anaesthesia or spinal anaesthesia.

Newer well designed needle tips are very small in diameter with finer needles causing lesser trauma and as such these procedures are relatively painless. Hence most of them do not even require paracetamol for pain relief though very few patients require paracetamol for a day or two.

5.  Are these dreadful stories of Ovarian Hyper Stimulation (OHSS) true?

5 to 20% of women undergoing IVF procedures with longer injection schedules develop OHSS while chances of developing OHSS is much lesser in women with shorter injection schedules. OHSS developing after egg retrieval in women produces a bloated abdomen, poor oral intake, shortness of breath, abdominal pain, reduced urine output, nausea and vomiting.

Occurrence of  OHSS can be reduced to less than 1% by the introduction of deliberate efforts such as use of agonist medications  as triggers and with the approach of new technique of freeze-all embryos.

With the advent of well researched methodologies the incidence of OHSS has reduced significantly while the success rate of IVF pregnancy has increased satisfactorily.

6. What are the factors to be considered before deciding the chances for getting successful pregnancy after IVF procedures?

Everyone would like to know the chances of getting pregnant through IVF procedures though there are many factors that decide the success after such procedures.

Basically in sub fertile women of less than 35 years, transfer of two good quality embryos in fresh IVF attempt confers more than half the chance of getting pregnant. In established IVF centre with good “Freezing and Thawing Program”, transfer of 2 good quality thawed embryos also provides good outcome.

80% of fertile couple conceive naturally through active attempts within a period of 12 months.

Direct comparison of chances of getting pregnant of sub fertile and fertile couple might not be appropriate. It is very encouraging and overwhelming to note the uptrend in the increasing pregnancy rates after fertility techniques, with the advent of research proven technologies and procedures.

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Knee Osteoarthritis

Dr. Tan Boon Cheong

MBBS (MU), MS Ortho (MU)


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One of the most common causes of knee pain, especially when oneself is approaching middle age, is usually links to degenerative joint disease (age as risk factor), but it is more complex as some young people have it too and for some it may be hereditary.

By definition knee osteoarthritis is defined as chronic joint disorder in which there is progressive softening and disintegration of joint cartilage, accompanied by new growth of cartilage and bone at the joint margins and capsular fibrosis. The prevalence of knee osteoarthritis increase with age (>45 years) and females have a higher incidence compare to male.

Knee pain is one of the most common chief complaints for knee osteoarthritis. The knee pain usually takes place with prolonged walking or standing. Resting the joint will relieve the pain. Stiffness is another common complaint. The stiffness happens after prolonged immobilization especially when getting up from a sitting position or early morning when oneself tries to get out from the bed to walk. The patient will need to stand for a brief second before he/she can start to walk. After a few steps, the patient will feel easier to walk.  Frequently, the patient may have episodic attack of knee swelling due to inflammatory process that takes place. When the knee osteoarthritis become more advance, the patient will have deformity, which most of the time the leg appear to curve inward, and if the patient’s both knees are involved, then the deformity would appear like an ‘O’ shape (in most of the patients). Knee osteoarthritis has no immediate threat to one’s life, but it reduces the quality of life due to persistent pain and immobility.

The management of knee osteoarthritis starts with the establishment of its diagnosis. Beside a good history given above, an examination by a doctor will help to come to this diagnosis and exclude other causes of knee pain. A plain X-ray of the knee with the patient standing will be good enough to tell the grading of the knee osteoarthritis. Kellgren and Lawrence classification system (Grade 0 to 4) are usually in use.

The treatment of knee osteoarthritis will depends on the severity of it and how much the symptoms affect the patient’s on daily basis. Joint supplements such as glucosamine sulphate and chondroitin have been used widely for knee osteoarthritis. Analgesia (pain killer) can be used but will give grieve side effects if abused. Intra-articular injection of hyaluronic acid (gel), PRP (blood) and stem cells have been widely introduced but their effectiveness and cost should always  be taken into consideration. Surgical intervention such as total knee replacement surgery will be the last resort when everything fails and the pain is tremendously affecting the quality of life. Beside all the above medical treatment, the lifestyle of the patient should also be modified such as exercising and weight management.