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Expat Living October 2023: In Good Health

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Plant Power

The Rise of Flexitarianism. Here is how Singapore has been stepping up its game in the global meat-reduction movement - and what you can do, too.

Choosing whether to eat meat has increasingly become more than just a matter of one's personal health concerns or even an individual's ethical stance - it's a matter of actually saving our planet. With meat production accounting for 14.5 percent of greenhouse gas emissions globally (more than all transportation combined worldwide!), and reports that the global temperature rises are unlikely to keep below two degrees Celsius without a shift in global meat and dairy consumption, scientists are encouraging people to embrace more plant-based diets to mitigate environmental disasters and natural resource depletion. But this doesn't necessarily mean to give up meat completely. Adopting a "flexitarian" diet, they say, is at least a step in the right direction toward promoting sustainability.

What is Flexitarianism?

Eating meat doesn't have to be an all or nothing thing. Instead of quitting cold turkey, there's an alternative: flexitarianism - following a mostly vegetarian diet but occasionally consuming seafood or meat. Also known as semi-vegetarianism, this type of diet (much like pescetarian and pollotarian diets) allows you some flexibility while still being mindful of food choices, and the ethical and environmental impacts of those choices. Unlike veganism, which promotes the complete abstinence of animal products, including eggs and dairy, a flexitarian diet might mean abstaining from meat six days a week to one person, but going meatless only once a week to another.
No matter how you decide to interpret it, the goal is to minimise animal-based protein intake, thus reducing your carbon footprint, even just a little. And the appeal of this type of diet, for many, is not having to label themselves one way or the other, or feel the pressure of committing to a permanent lifestyle choice.
The concept may draw eye-rolls from some who see it as "cheating" or "vegetarianism with benefits", but the fact is that cutting back on the meat rather than refraining completely could be the practical compromise that's needed in order to help the environment. It can have a positive impact on one's health, too.

Several studies have shown that frequent red meat consumption and the mode of its preparation are associated with an increased risk of development of colon cancer, says gastroenterologist DR ANDREA RAJNAKOVA. Which is why, she says, removing meat from the diet even at least once a week can be beneficial.

Thanks to their high intake of plant-based foods, vegetarians have lesser risk for development of certain types of cancer and other diseases." At the same time, she adds, strict vegetarian diets without any animal proteins may cause various nutritional deficiencies - of iron, calcium, vitamin D and vitamin B12, for example along with protein deficiencies.

As for amino acids, Dr Andrea says because animal protein contains all the essential amino acids in the correct proportions, it's considered to be of a high biological value, while vegetables can have an incomplete amino acid profile.

For this reason, the combination of grains and legumes in the same dish (rice and lentils, for example) represents a better substitute of a slice of meat then legumes on their own, as grains contain an amino acid missing in the legumes,

she says. In all, Dr Andrea feels that a flexitarian diet is a great compromise, as combining animal proteins with vegetable proteins a few times a week can provide a better variety of vitamins and minerals that might otherwise be lacking in a purely vegetarian diet.

DR ANDREA'S TIPS FOR EATING A FLEXITARIAN DIET

Eat at least five portions of fruit and vegetables a day (more vegetables than fruit).
Include whole grain in at least one main meal per day.
Include different sources of iron that may be lacking due to a low intake of red meat. Good sources include dark green, leafy vegetables such as spinach, cabbage, kale, and broccoli.
Use foods rich in vitamin C to increase the absorption of iron from vegetable sources: small glass (150ml) of freshly squeezed orange juice, lemon sauce as a dressing, bell peppers, lettuce, tomatoes, and kiwifruit, for example.
Include animal protein a few times a week, such as salmon, eggs, low-fat dairy and chicken.
Improve your ability to digest the legumes (and reduce flatulence) by soaking them for a long time, then changing the water before cooking; and, when possible, remove the skin.

Healthy Lunch and Snack Choices

Nutritious, healthy and balanced packed lunch for a child or young adolescent that can be prepared at home and taken to school in an environmentally friendly package.

Adolescence is a critical period of growth and development, so good nutrition is essential. The body demands more calories and nutrients during early adolescence than at any other time of life. Calories are the measurement used to express the energy delivered by food. On average, boys require about 2,800 calories per day; and girls, 2,200 calories per day. If they are active in sports, their requirements are even higher.

Nutrients and Energy

The nutrients protein, carbohydrates, and fats in food serve as the body’s energy sources. Each gram of protein and carbohydrate supplies four calories, or units of energy, whereas fat contributes more than twice as much: nine calories per gram.

Protein

Protein is an important nutrient needed for the growth and repair of cells. 50% percent of body weight is made up of protein. Protein can also be used for energy, especially if not enough carbohydrate foods are eaten. Protein needs are increased during times of cell growth and repair such as during childhood and adolescence.

Protein can come from animal or plant foods such as:

Meat, chicken, fish
Eggs
Nuts and seeds
Dried beans and lentils
Dairy products such as milk, yogurt and cheese

Too Much Protein

Some people use protein supplements in an effort to build muscle. The best way to build muscle is to do exercise that uses muscle strength. Although muscle is made of protein, the preferred fuel for working muscles is carbohydrate.

It can be dangerous and harmful to adolescents, children and adults to follow diets high in protein or protein shakes and low in other nutrients. It can damage the kidneys and create a serious impact on their health. It is important that diet is well balanced and provides all nutrients essential for good health.

Carbohydrates

Carbohydrate is an important nutrient found in many foods. Carbohydrate is an important source of energy for the body. They are divided into complex and simple carbohydrates. Many complex carbohydrate-containing foods are high in dietary fiber and are healthy food choices. Complex carbohydrate-containing foods provide the body with energy throughout the day.

The rate at which carbohydrate-containing foods are digested varies greatly. Complex carbohydrate-containing foods are digested slowly and therefore provide a longer-lasting release of energy with a low glycaemic index (GI). It is often labeled on the food that we buy in the supermarket.

Simplex carbohydrates such as sweets, cakes, candies, chocolate, cupcakes, desserts etc provide high surge of blood sugar, fast and short release of energy with high GI index and their consumption leads to obesity and diabetes.

Low GI foods include wholegrain bread, pasta, oats, apples, banana, apricots and oranges, yogurt and milk, dried beans and lentils.

High GI foods include white bread, processed cereals, short-grain rice, potato, most cracker biscuits, watermelon.

Complex carbohydrate foods like breads and cereals are also fuel to the probiotic (healthy and beneficial) bacteria in our gut and which are essential for a healthy digestive tract. For good health, eat a variety of low GI, high fibre complex carbohydrate-containing foods each day.

Examples include:

Fresh, canned or dried fruits

Rice (preferably brown), bread (wholemeal), quinoa (also rich in protein), noodles and pasta (preferably brown/whole grain varieties)

Low-fat milk and yogurt
Whole grain breakfast cereals
Legumes such as beans, chickpeas and lentils
Starchy vegetables such as potato, sweet potato, carrots, corn

Fats

Fat is an essential part of our diet and is important for good health. There are different types of fats, with some fats being healthier than others. It is important to eat healthy fats in moderation as part of a balanced diet.

Unsaturated fats

Unsaturated fats are healthy fats and are an important part of a healthy diet. These fats help reduce the risk of heart disease and lower cholesterol levels.

Polyunsaturated fats:

Omega-3 fats which are found in oily fish such as salmon, sardines and anchovies, walnuts, canola oil, soy, chia seeds, flaxseeds
Omega-6 fats which are found in safflower and soybean oil, some nuts, including brazil nuts.

Monounsaturated fats:

Found in olive and canola oil, avocados and some nuts, such as cashews and almonds.

Saturated fats

Saturated fats are unhealthy fats, which may increase the risk of heart disease and high cholesterol levels. These fats are solid at room temperature and are found in:

Animal-based products:

Dairy foods – such as butter, cream, ice-cream
Meat – such as fatty cuts of beef, pork and lamb, processed meats like salami, and chicken skin

Some plant-derived products:

Palm oil
Coconut oil
Cooking margarine

Saturated fats are also commonly found in many processed food::

Fatty snack foods
Deep-fried take away foods e.g. french fries, chicken nuggets, spring rolls, battered/crumbed fish
Packaged cakes and biscuits
Pastries and pies.

Vitamins

Vitamins are important building blocks in our diet. They are vitally important for function of different organs (vitamin A for eyes and vision), enzymes (vitamin B) and neuronal cells (vitamin B12 and folic acid), production of blood cells (iron, vitamin B12 and folic acid), wound healing (vitamin C), bones and teeth (calcium and vitamin D), for production of blood clotting factors (vitamin K) etc.

Diet for children growing adolescents is very important to be rich in vitamins and minerals. Vitamins are divided into oil-soluble vitamins (A, D, E, K) and the rest are water-soluble vitamins.

Best sources of vitamins

Vitamin A: Dairy products, eggs, liver, fish, fortified cereals, darkly colored fruits, and leafy vegetables
B1 (Thiamin): Whole grains, pork, beans, seafood
B2 (Riboflavin): Milk, whole grains, dairy, beef, lamb, eggs, green leafy vegetables
B3 (Niacin): Meat, fish, wholemeal breads and cereals, beans, peas, nuts
B6 (Pyridoxine): Fish, poultry, lean meat, whole grains, potatoes
B9 (Folate): Dried beans, green leafy vegetables, oranges, beans, poultry, fortified cereals, nuts
B12 (Cobalamin): Fish, red meat, poultry, dairy products, eggs
Pantothenic acid: Sunflower seeds, mushrooms, peanuts, yeast, yogurt
Biotin: Peanut butter, hard-boiled eggs, wheat germ
Vitamin C: Berries, kiwi, bell peppers, tomatoes, melons, citrus fruits, oranges
Vitamin D: Egg yolk, fatty fish, and milk. Also made by the skin when exposed to sunlight
Vitamin E: Vegetable oils, nuts, dark green vegetables, avocados, and whole grains

Minerals

Calcium: Dairy products (milk, yogurt, cheese, etc.), calcium-fortified juice, or soy milk
Iron: Red meat, pork, fish, chicken, beans, soy foods, green veggies, and raisins
Magnesium: Whole grains, whole-grain breads, nuts and seeds, potatoes, milk, and bananas
Phosphorus: Dairy products, meat, and fish
Potassium: Banana, dry fruits, beans, broccoli, potatoes (with skins), citrus fruits, peas, and other legumes
Zinc: Red meat, chicken, seafood, soy foods, dairy products, whole grains, nuts
Sodium: Usually used as a food additive or kitchen salt. Many processed food contain high amount of salt (NaCl). It's recommended that we eat less than 2,300 mg of sodium a day because it will lead to high blood pressure and water retention and headache.

Water

Adequate intake of fluids during the adolescent years is important because it supports many body functions. Fluid requirements depend on size, age, and level of physical activity. Male adolescents should get 2.4 to 3.3 liters of water per day and female adolescents need at least 2.1 to 2.3 liters per day.

Water and other fluids keep tissues moist, regulates body temperature, lubricates joints, prevents constipation, supports kidneys and liver function and make nutrients available to the body. Dehydration can occur if an adolescent doesn't get enough fluids throughout the day and may result in kidney problems, developing kidney stones, skin conditions, including acne, allergy and asthma, fatigue, headaches, weight gain, and diabetes.

Not all fluids are suitable for hydration. Water is the best way to keep hydration. Many foods are high in water content and contribute to an overall fluid intake, including melons, citrus fruits, grapes, strawberries, carrots, lettuce, tomatoes, celery, and squash. Some sports drinks are good water alternatives for athletes, particularly ones who play hard for long periods of time.

Sodas and other soft drinks which contain caffeine, sugar, and other coloring artificial ingredients are not hydrating and create extra load of sugar which may lead to obesity and diabetes.

Cereal Killers

As food intolerances and allergies become increasingly common, consultant gastroenterologist DR ANDREA RAJNAKOVA's clinic has developed a new speciality with holistic approach to food-related gastrointestinal problems such as gluten intolerance and coeliac disease.

For many of the millions who suffer from digestive disorder, it's merely a source of irritation and discomfort; for those with coeliac disease, however, it can be a lot more serious.
Cutely described as the body's "food processor", the long, muscular tube that is our gastrointestinal (GI) tract has the ability to sense and react to whatever passes through it.

And to maintain a healthy digestive system, each of us needs to choose the right food to match our individual GI tract's capacity, says Dr Rajnakova.

Food intolerance or allergy is a primary cause of GI tract problems such as reflu, bloating, dyspepsia, diarrhoea, constipation, diverticulosis, gallstones, fatty liver and even GI cancer. It's no wonder these problems are on the rise, she says, when you look at the modern diet: centred on concentrated proteins from meat and dairy products, preferring simple to complex carbohydrates, and laced with harmful additives.

How do you screen fro gluten intolerance and coeliac disease?

We do a physical examination and take a detailed medical history, plus an evaluation of dietary habits. GI tract prbolems show symptoms that may include nausea and vomiting, bloating, abdominal pain, constipation and diarrhoea. Coeliac disease can be detected by a blood test, after which we would do a gastroscopy do confirm the diagnosis.

Tell us about coeliac disease.

It's an immune-based inflammatory reaction in the small intestine to dietary gluten (the storage protein for wheat, barley, and rye), and it affects those who are genetically predisposed to it.
It's a serious condition: the inflammation caused by the body's reaction to gluten damages the lining of the small intestine, reducing it's absorptive surface area, reducing its digestive enzymes and impairing the absorption of important micronutrients. Apart from abdominal pain and bloating, this causes chronic malabsorption, malnutrition, and unhealthy weight-loss.
In cases of lactose intolerance or coeliac disease, bloating is linked to a failure of the digestive tract to break down nutrients into small, absorbable molecules. Other GI symptoms of coeliac disease include diarrhea, oily stools and flatulence; it can also lead to liver disease, anemia, bone disease and skin disorders. Some coeliac sufferers surprisingly, may have no symptoms at all!

What is the cure?

Excluding gluten from the diet completely resolves the problem. But this is not always straightforward - it often requires detailed patient education, proper motivation, and ongoing follow-up.

Any advice on going gluten-free?

This is interesting! An increasing number of people are going gluten-free, mainly because of the huge misconception that gluten-free food is in and of itself "healthier". In fact, there is no evidence that avoiding gluten is beneficial for people who do not have coeliac disease.
My patients with coeliac disease know that most commercially made gluten-free food is highly processed, low in nutrients and loaded with harmful additives. Instead, I advise them to focus their diet on whole foods that are naturally free from gluten.

I advise anyone who suspects that they or a family member may have a food intolerance or allergy to go for proper medical evaluation and testing.

Heart Burn: Dos and Donts

Ever get that awfully uncomfortable burning sensation in your chest and throat? You’re not alone.

About 60 percent of all adults experience some type of acid reflux, and irritation of the esophagus caused by the acid that comes up from the stomach. Here, DR ANDREA RAJNAKOVA of Andrea’s Digestive, Colon, Liver and Gallbladder Clinic explains the causes and symptoms of reflux, and what we can do about it.

Causes and Symptoms of Heart Burn

“Acid reflux usually happens when the junction between the gullet and the stomach doesn’t function normally,” says Dr Andrea. “During swallowing, food passes down the throat, through the oesophagus and into the stomach. Normally, a muscle valve at the end of the oesophagus, called the lower oesophageal sphincter, opens to allow food into the stomach, then closes again. When this muscle doesn’t close tightly enough, stomach acid can reflux, or wash back, into the oesophagus causing damage to its lining.”

This irritation creates troublesome symptoms including a burning sensation in the gullet, which is the most typically experienced symptom of reflux. However, Dr Andrea notes that, while most people experience heartburn pain during reflux, others feel nothing at all – it just depends on the person. Other symptoms of reflux can include burping, belching, sour or bitter tastes in the mouth, coughing at night, dry throat, sore throat, hoarseness in the morning, or worsening asthma.

Longstanding reflux can result in complications such as oesophagitis, an inflammation of the esophagus that may be associated with ulcers (breaks in the lining of the esophagus) and stricture, the narrowing of the swallowing tube as a result of long-lasting inflammation. Another possible complication is Barrett’s Oesophagus, which may occur when longstanding inflammation leads to changes in the cells of the lower esophagus. “Patients with Barrett’s Oesophagus have higher risk of oesophageal cancer compared to the general population,” notes Dr Andrea.

Heart Burn Detection and Diagnosis

“In the simplest case, when the duration of symptoms is short and reflux improves after medication, no diagnostic tests are required,” says Dr Andrea. “However, if the symptoms are longstanding and don’t improve with medication, further investigation is mandatory.”

A gastroscopy allows for the inspection of the gullet and stomach, and can detect inflammation in the lower esophagus. During the procedure, tissue samples can be obtained for further testing to assess the severity of reflux and rule out Barrett’s esophagus. Another assessment is 24-hour pH monitoring, which tests the acidity of the esophagus; it’s a complementary test for gastroscopy but it cannot replace the procedure.

Treatment Options

Luckily, reflux is a condition that can be resolved. Dr Andrea says that medications like proton pump inhibitors can be prescribed to reduce acid secretion in the stomach, while antacids, many of which are available over-the-counter, can neutralize gastric acid. In addition to medication, Dr Andrea says that lifestyle and dietary modifications are key to the treatment and prevention of acid reflux.

Lifestyle Habits

“In today’s hectic lifestyle, many of us are affected by stress and stress-related health problems, which can manifest in different ways”, says Dr Andrea. “One of the most common ways stress manifests is by causing digestive problems – affecting the stomach, oesophagus and bowel. The problems may be brought about by stress itself, irregular meals, inappropriate food selection or gulping the food due to lack of time”.

In addition to avoiding stress, Dr Andrea suggests adopting the following lifestyle habits, whenever possible, to help minimize the amount of acid refluxing from the stomach:

Eat five small meals rather than three large meals a day
Eat meals slowly, while chewing properly
Avoid oily foods, fried foods, heavy meals and overeating
Refrain from eating two to three hours before bedtime
Lose weight (if you’re overweight)
Quit smoking
Elevate the head of your bed by 15 to 20 centimeters

Dietary Changes

It’s also important to avoid the very foods that are known to worsen acid reflux, as they relax the muscle responsible for stomach closure, allowing stomach acid to reflux into the esophagus.

Foods and beverages to be avoided during reflux episodes include:

Chocolate Sweet desserts
High-fat foods
Curry and other spicy foods
Citrus fruits and citrus juices
Garlic and spring onions
Tomatoes or tomato-based products
Alcohol, especially on an empty stomach
Coffee and tea on an empty stomach

Why is reflux especially common during pregnancy?

Acid reflux is experienced by 45 to 80 percent of pregnant women due to hormonal and mechanical changes – after all, a growing baby in the uterus causes pressure on the stomach. According to some statistics and epidemiological studies, 52 percent of pregnant women first experience reflux in the first trimester, 24 to 40 percent in the second trimester, and nine percent experienced in the third trimester.

Dr Andrea says that making lifestyle changes is important for pregnant women with reflux. “I’d advise pregnant patients to elevate the heads of their beds, avoid getting into bent or stooped positions, eating small, frequent meals, and refraining from ingesting foods within three hours of bedtime.” She adds that, while the outcome for pregnant patients with acid reflux is positive, the condition tends to recur with subsequent pregnancies.