Advanced glycation end products

Lately, I've been attending more health talks than ever before. Whether this is a good thing or not, I don't know lah. Maybe it's a sign of getting older when health becomes a more frequent topic of conversation. On Friday night, I was at The Old Frees' Association for a session that included constipation and hernia. Yesterday, I was at the Adventist Church in Bukit Mertajam for a talk on kidney health. Some of the slides certainly opened my eyes to a few things.

This wasn't my first visit to the church. In fact, I go there quite often, even though I'm a Buddhist. The church members have been very accommodating to both my wife and me, and we've taken part in some of their activities as well. Religion aside, I've always felt comfortable joining in. I don't see why we shouldn't be able to take part in one another's activities. 

The talk included something called Advanced Glycation End Products, or AGEs for short. These are compounds that can form when food is cooked at high temperatures, especially when meat is fried, grilled or roasted. The slides explained how AGEs are associated with inflammation and oxidative stress, which can affect our health, including our kidneys.

We all know that too much fried food isn't good for us, but how often do we think about the way our food is cooked? Dr Kuan suggested steaming, boiling and stewing instead, as these methods generally produce fewer AGEs than high-temperature cooking. Nobody is asking us to give up our favourite fried chicken or roast meat altogether, of course. But perhaps we can make a few changes to the way we prepare our food.

The other advice was very familiar enough: eat more vegetables, fruits, whole grains and beans, and pay attention to our diet. Unfortunately for me, these things are easier said than done. I know that as someone who has to keep an eye on his health, understanding what we should do and actually doing it are two different things.

Anyway, that's another health talk attended and another bit of information picked up along the way. I've certainly been going to more of these talks lately. Whether I'm becoming more health-conscious or simply more aware of the things that can go wrong as we grow older, I'll leave that to my wife to decide.

Constipated

I quite enjoyed a medical talk which The Old Frees' Association organised last Friday. Found it quite practical with easy-to-understand information on some common health issues. About 50 to 60 people attended, and we listened to four doctors from Aptus Surgery & Specialist Centre, namely, Dr Ong Hean Teik, Dr Lim Su Sian, Dr Cathy Heng and Dr Sabrina Jane Dass.

One of the segments was Dr Cathy Heng's presentation on the colon, particularly constipation. She began by asking how many people in the audience were constipated and invited us to raise our hands. Only one person responded. I suspect there were others who weren't quite prepared to own up, given that this isn't exactly the sort of subject we normally discuss in public.

But Dr Cathy made the point that constipation isn't simply about whether we pass motion every day. Some people go more than once a day while others may go only a few times a week. What matters is whether this is normal for us and whether we experience difficulty or discomfort. She also reminded us to pay attention to persistent changes in our bowel habits, particularly if accompanied by blood in the stool, unexplained weight loss or other worrying symptoms. These shouldn't be dismissed, as they could be signs of something more serious, including colorectal cancer.

Another point she made was about keeping our colon healthy through sensible eating and regular exercise. Eating more fibre, drinking enough water and staying active are simple measures, but they are easy to neglect in our daily lives. I particularly liked her comparison of exercise to putting money into a savings account. We save for a rainy day, and in much the same way, maintaining our muscles gives us a reserve to draw on when we grow older or when illness or an accident leaves us less active.

It was a useful reminder that looking after our health doesn't always require complicated measures. Sometimes, it begins with paying attention to what our bodies are telling us and doing the ordinary things consistently.

A shot in the arm

I had been dilly-dallying for years, but finally decided to go for my pneumonia jab yesterday. I first became aware of the pneumonia vaccine during the Covid-19 pandemic. At the time, I was encouraging my friends to get their annual influenza jabs. While the flu vaccine doesn't protect against Covid-19 itself, I felt that keeping the body's defences up against one infectious disease couldn't be a bad thing when dealing with another.

That's when one of my friends brought up the pneumonia vaccine, pointing out that it was just as important, especially for older people. He reminded me that pneumonia is one of the leading causes of hospitalisation among senior citizens and can be particularly dangerous for those with chronic conditions such as diabetes, heart disease and lung disease. Although the vaccine doesn't prevent every case of pneumonia, it greatly reduces the risk of severe illness and serious complications.

It certainly sounded like something worth having. Unfortunately, the price at the time was rather steep, so I shelved the idea. As often happens, one year became two, and before I knew it, several years had slipped by. Then about a week ago, something just clicked. I realised I had procrastinated long enough. We insure our homes, service our cars and go for regular medical check-ups, yet we sometimes hesitate over a vaccination that could help keep us out of hospital. The older we get, the less sense it makes to keep putting these things off.

So yesterday, Saw See and I, together with two other friends, kept appointments with a doctor friend who had kindly arranged for our vaccinations at cost price. I won't mention who he is or where we had the injections, just to respect everyone's privacy.

The vaccine we received was Prevnar 20, one of the newer pneumococcal vaccines that protects against 20 strains of the bacteria responsible for pneumonia and other serious infections. Unlike the influenza vaccine, which needs to be taken every year, this is generally a one-off vaccination for most older adults.

The whole thing was over in a matter of minutes. Just a tiny prick in the arm and a much lighter wallet, but also the comforting feeling that I'd finally crossed another important item off my health checklist. Come to think of it, the hardest part wasn't the injection at all. It was taking so many years to make up my mind.

SG Lim's run for cancer

There was a huge charity event at Penang Free School yesterday and, much as I would have liked to be there, I had to give it a regrettable miss. Not through any lack of interest, but because several weeks earlier, long before details of the event had been finalised, my brother-in-law from Singapore had already arranged to return home with his family for a visit. Family took priority as rare reunions, like this particular one, are not something I can postpone lightly.

Still, I followed developments from afar because this was no ordinary event. It marked the conclusion of Old Free Lim Shyang Guey's remarkable Run for Gold journey, which was a 2,200-kilometre run (actual distance covered was 2,390 kilometres) across Peninsular Malaysia to raise awareness and funds for children battling cancer.

Better known now as SG Lim, the Class of 1975 (Form Five) alumnus began his journey on the 28th of March from the National Cancer Society Malaysia's Home of Hope in Penang. Over the next 86 days, he ran north to Perlis, crossed to Kelantan, travelled down the east coast to Johor and then turned north again along the west coast before returning home to Penang.

The final stage took him on an 82-kilometre route around the island, passing through Teluk Bahang, Balik Pulau, Batu Maung, Jelutong and George Town before he crossed the finish line at his alma mater, Penang Free School, one day before his 67th birthday.

There was something fitting about that ending. The journey had begun in Penang and it ended where another journey had started many years earlier at the school that helped shape him.

More than 150 teachers and present pupils of the school were among the several hundreds gathered to welcome him home, alongside family members, former schoolmates, supporters, volunteers and well-wishers that included Penang Chief Minister Chow Kon Yeow and Penang Island City Council Mayor Rajendran P Anthony. Standing before the crowd at the finish line, SG Lim looked skyward and spoke words that had carried him through the entire journey. "Firstly, my darling, we made it." 

The tribute was to his late wife, Goh Joo Lee, who passed away from gallbladder cancer in August 2024 at the age of 63. The couple had once dreamed of travelling around Peninsular Malaysia together on foot after retirement. After losing her, Lim transformed that shared dream into a mission with a different purpose.

"We had wanted to walk around Malaysia together, every state," he said. "But I did not get to do it with my wife. She was there all along with me. Yes, we made it."

At its heart, Run for Gold was never really about running. The name itself comes from the gold ribbon, the international symbol of childhood cancer awareness. As Lim explained, "It's for the children. Children with cancer. That's why it's Run for Gold. I am running for the children. I don't need any more gold." 

Along the way, he covered between 25 and 35 kilometres a day, staying mostly in homestays and shared accommodation, meeting families affected by cancer and listening to their stories. The journey also formed part of the torch relay for Relay for Life Malaysia 2026 which carried a message of hope and solidarity from community to community.

The campaign had initially aimed to raise RM600,000 for the National Cancer Society Malaysia. By the time he crossed the finish line, donations had already exceeded RM775,000, with funds earmarked for childhood cancer support services, including the Home of Hope programme, psychosocial care and survivorship initiatives.

Penang Chief Minister Chow Kon Yeow, who welcomed SG Lim home at Penang Free School and announced a further RM50,000 contribution from the state government, perhaps summed up the significance of the occasion best.

"SG Lim's 2,200km Run for Gold journey across Peninsular Malaysia is far more than an extraordinary feat of endurance; it is a powerful story of love, resilience and hope. Every step he took carried a message of encouragement for children battling cancer and their families, inspiring Malaysians from all walks of life to come together for a meaningful cause."

The Chief Minister also spoke movingly of the personal sacrifice behind the journey. "Dedicated to the memory of his late wife, Joo Lee, SG Lim transformed grief into hope, raising more than RM700,000 for the National Cancer Society Malaysia and proving that one person can make a profound difference."

What SG Lim accomplished over those 86 days was not measured simply in kilometres covered or funds raised. It was measured in something less tangible but perhaps more important: one person's determination and compassion that brought people together.

As Old Frees, we often speak about the values our school tries to instil: service, perseverance and concern for others. SG Lim embodied all of these qualities. In recognition of his remarkable achievement and service to the community, he was presented with Life Memberships of the The Old Frees' Association and the Old Frees' Association Kuala Lumpur & Selangor.

And there is something more. While grief has a way of turning people inward, here was a man who chose to transform personal loss into an act of generosity that will help children and families facing challenges far greater than his own.

Staircase danger

A recent unfortunate incident brought back a memory that I had not thought about for quite some time. Four years ago, I had a close call falling down. I was standing on a collapsible ladder, only on the first step, when the whole thing suddenly slid backwards. It happened so quickly that there was no time to react. Fortunately, as the steps shot away beneath me, I fell sideways onto my right rather than backwards. The only injury was a bruise on my thigh. Over the next few days it grew impressively black and blue, spreading much further than I would have imagined, before gradually fading away and healing completely. At the time, I regarded it as an unpleasant but ultimately minor incident. After all, nothing was broken and life went on as normal.

Recently, however, I learnt of a far more tragic accident involving someone I was acquainted with. He fell down the staircase at his home and never recovered from the injuries. The news affected me more than I expected. Perhaps it was because the circumstances sounded so ordinary. Stairs are among the most familiar features of any house. We climb them and descend them every day without giving them a second thought. Yet a staircase can become dangerous when something goes wrong.

As we grow older, we become more vulnerable. When we are young, a fall often results in embarrassment, a few bruises and perhaps a story to tell later. Age changes everything. Bones become more fragile. Reflexes slow down. Balance is no longer quite what it once was. A fall that a younger person might shrug off can become a life-changing event for an older adult.

Medical studies have shown that the direction of a fall can make a tremendous difference. Falling backwards is often especially dangerous because there is little opportunity to protect oneself. A person may strike the back of the head, neck or spine with considerable force. Falling forwards is not necessarily safer. The instinctive attempt to break the fall can result in fractured wrists, broken shoulders or facial injuries.

Then there is the question of height. One might assume that only a tumble from the top of a staircase is dangerous, but even a fall from the bottom few steps can have devastating consequences. A sideways landing can fracture a hip. For many elderly people, a broken hip becomes the beginning of a long and difficult decline involving surgery, rehabilitation and a loss of mobility.

What is particularly sobering is that the danger does not end with the initial injury. A serious fall can trigger a chain of consequences. Reduced mobility leads to muscle loss. Confidence disappears. Some people become fearful of moving about independently lest they fall again. Ironically, that reduced activity can weaken the body further and increase the likelihood of another fall.

As I thought about my acquaintance's passing, I found myself thinking not only about the fragility of the human body but also about how Buddhism approaches impermanence. We often associate impermanence with grand events: aging, illness and death. Yet there's also impermanence in the smallest moments. A misplaced step. A stumble from uneven floors of even one millimetre apart. A momentary loss of balance. An ordinary staircase climbed a thousand times before without incident.

We tend to imagine that major changes in life arrive with warning signs and dramatic announcements. More often, they arrive unexpectedly. One moment everything is normal. The next, circumstances have changed completely.

When I look back on my own accident, I realise how fortunate I was. Had I fallen differently, the outcome might have been very different. It was a reminder, one that I perhaps did not fully appreciate at the time, that we should never take safety for granted. These days when I climb a staircase, I find myself paying more attention. When I step onto a ladder, I ask someone to hold it. Not out of fear, but out of respect for the simple fact that our bodies are not indestructible. The older we become, the more we learn that life often hangs on small things: a secure handrail, a dry floor, a firm footing and perhaps a little good fortune. The loss of my acquaintance is a sad reminder of that truth. May he rest in peace.

Cataract landmark

Another landmark reached today in my cataract journey. It’s been a calendar month since the operation. I’m only due to see my surgeon for the final follow-up next Wednesday, and I expect he’ll take me off the eye drops then. I’ve been on a steady routine of Nevanac, Maxidex and Vigamox, each with its own timing and purpose, so the day has been punctuated by little reminders on my mobile phone to tilt the head back and squeeze in a drop or two. Not a moment too soon, as one of them contains a steroid, which isn’t meant for long-term use.

I suppose the one lesson I’ve taken away from all this is how important it is to diligently follow the doctor’s instructions on the eye drops. They’re prescribed for a reason. In the past, keeping to such a schedule might have been a bit of a challenge, but with the timer function on the mobile phone, it has been quite straightforward. I’ve had no real difficulty keeping to the schedule once the alarms go off.

Cataract routine

It’s been almost two weeks since the cataract operation on my left eye. I’ve already gone back twice for follow-up sessions with the surgeon and, according to him, everything is progressing well. So far, I haven’t experienced any of the warning signs he mentioned earlier, no pain, no discharge, nothing out of the ordinary, so that in itself is already something to be thankful for. There’s one more follow-up scheduled towards the end of next month, just to make sure everything continues on track.

So how do I feel with this artificial lens sitting inside the eye? From the very first day, the difference was quite striking. Vision suddenly became very bright and very clear. Almost too clear, if that makes sense. The best way I can describe it is with the Penang Hokkien expression, Cheng Beng. It's the same term used for this time of the year when we Chinese make our way to the cemeteries to spring clean the graves of our ancestors and especially, to remember and fulfil our duties to those that came before us. Cheng and Beng, clear and bright. That same sense of clarity in the air, as if everything has been washed clean. That’s exactly how things look now. Colours appear more vivid, whites look whiter and there’s a certain crispness to everything that I don’t remember having for quite some time.

But of course, it’s not all perfectly balanced yet. The left eye is now long-sighted, while the right eye is still short-sighted. So when I look at something, the left eye sees it sharp and clear, while the right eye comes in slightly behind, blurred and struggling to catch up. It’s a strange sensation, like the two eyes are not quite in agreement with each other. At times I find myself unconsciously favouring the left eye, letting it take the lead.

I suppose this is part of the adjustment period. The brain probably needs time to sort things out and decide how to combine the two different images into something workable. For now, I just carry on as usual, reading, moving about, letting the eyes and the mind slowly get used to this new arrangement. How long that will take, I really don’t know. But at least for now, things are heading in the right direction, and that’s good enough for me. 

Of course, there are all the little routines that now come with it. Whenever I’m outdoors in the daytime, I have to wear sunglasses. “Protect your eyes from the ultraviolet light,” the surgeon warned. For how long, I asked. “As long as necessary,” he said. I suppose that means quite indefinitely.

At night, I have to put on an eye shield before going to bed. It’s quite a ritual, sticking it on with surgical tape. For afternoon naps, it’s much simpler, just the sunglasses will do. Both are really there to stop me from accidentally touching or rubbing the eye when I’m not fully aware of what I’m doing.

Then there are the eye drops. Three different types, several times a day. And this, not counting my glaucoma eyedrops too! By now I’ve more or less settled into the routine. Life goes on. I’ve even resumed driving, although with the difference in vision between the two eyes, I do have to be more careful and alert. Night driving I’ve not attempted yet, leaving that to my wife for the time being.

On the hygiene side, showering is not a problem, although I’ve avoided shampooing my hair these past two weeks. Instead, I give the scalp a good wipe with a damp cloth. Surprisingly refreshing. The eyelid too gets a daily clean with damp cotton puffs, just to remove any accumulated dirt. But that’s as far as I go when it comes to getting water near the eye.

As for food, the surgeon more or less dismissed any need for restrictions. But my wife, after listening to various well-meaning friends, has taken a different view. So for now, anything involving prawns, shrimp, hehbee or belachan is off the menu. Pantang for three weeks, she decided. Thus, no Hokkien mee, no char koay teow. She is the "She Who Must Be Obeyed", as the character Rumpole in Rumpole of the Bailey would say of his wife. Woe is me.

As a postscript, perhaps I should say that inevitably, in the longer term, I shall need another operation on the right eye to balance up my vision. That is something for another day. For now, I’ll just let things settle and take it as it comes.

#chengbeng

Cataract done

So I had my cataract procedure done on my left eye yesterday and I got through it okay. Many thanks to my doctor, Teoh Hian Jin, from Bagan Specialist Centre in Butterworth. I must admit that before the procedure I was mighty anxious and nervous because he had warned me that my iris was rather small and that he might have to use some alternatives to get it to open wider. And true enough, despite several attempts to dilate the eye, he eventually had to use hooks.

I probably wasn’t the perfect patient either. Several times he had to remind me to relax and unclench my jaw and turn my head slightly towards him. In the end, I attempted some basic techniques to calm myself down. 

Maybe I should also explain why I chose to go to him in the first place. I discovered that he is also an Old Free but seven years my junior at Penang Free School, although he isn’t a member of The Old Frees’ Association. Still, that information was good enough for me. I would trust an Old Free any time and in this case my trust certainly wasn’t misplaced. Hian Jin did an exemplary job on me. Now I just have to wait for the world to look a little brighter through that eye!

Cataract

Today's the day. Left eye. Wish me well.

Ultra-processed

Yesterday, I wrote about having attended a health talk on aflatoxins—those invisible toxins that can grow on grains, nuts and spices when they’re improperly stored in humid conditions—and food safety, and it left me thinking about what really goes into our daily meals. It’s quite concerning how some of the things we eat, which we think are okay for us, can turn out to be more complicated than they appear.  For example, the dangers that come from consuming deep-fried food too often. It was eye-opening to learn how burnt food could quietly damage the liver or, over time, lead to serious diseases.

But what caught my attention even more was something closer to home: the food products that line supermarket shelves and health stores, all neatly labelled “nutritional,” “balanced” or “scientifically formulated.” Products like Glucerna and Nutren, for example. They’re popular among older folks and people with diabetes, and they’re certainly convenient. Just flip open the lid, mix the powder in warm water and drink. But convenience often hides complexity.

I learned that these so-called meal replacements fall under what nutrition experts now call “ultra-processed foods.” They’re made from refined carbohydrates, isolated proteins, sweeteners, vegetable oils and a cocktail of stabilisers and artificial flavours: all carefully engineered to provide complete nutrition. In theory, they contain everything the body needs. But in practice, they’re still industrial formulations, far removed from the natural foods we grew up eating.

There’s nothing immediately dangerous about them, of course. Used sensibly, they can be a helpful supplement. The problem begins when they start to replace real meals altogether. They lack the living texture of food, such as fibre, the subtle nutrients and the natural balance that fresh ingredients bring. Over time, the body feels the difference, even if blood tests don’t show it right away.

I suppose this is one of the ironies of modern living. We’ve made great progress in medicine and nutrition, yet we’ve drifted farther from the simplicity of natural food. I’ve often thought back to how our parents and grandparents cooked with patience, simple ingredients and little waste. They didn’t have to read labels or worry about emulsifiers and trans fats.

So perhaps the lesson is not to be fearful, but to be aware. There’s no harm in occasionally reaching for a bottle of Glucerna or Nutren, especially when health or appetite falters. But they should stay as the exception, not the rule. Nothing replaces the goodness of a meal that’s cooked, shared and enjoyed fresh. And if we can manage that most days, I think our bodies will thank us in ways that no supplement ever could.

Aflatoxin

We attended a talk earlier this month that left quite an impression on me. It was about the food we eat every day. The speaker, Dr Steve Kuan, spoke about two hidden dangers that most of us probably don’t think about: aflatoxins and the harmful compounds that form when food is deep-fried, especially with reused oil. I must admit, I’d heard of food contamination before, but never realised how quietly these things creep into our lives.

Aflatoxins, we were told, are among the most potent natural toxins known. They come from certain types of mould, Aspergillus flavus and Aspergillus parasiticus, that grow easily in warm, humid places like ours. Once they infect crops such as peanuts, corn, rice, chillies, sesame or even spices, they produce an invisible toxin that stays behind even when the food looks and smells fine. It’s not just a minor health issue; long-term exposure can damage the liver, and in severe cases, lead to liver cancer. The talk mentioned that aflatoxin B1 is classified as a Group 1 carcinogen by the World Health Organization, meaning it’s a confirmed cause of cancer in humans. Children, too, are especially vulnerable; chronic exposure has been linked to stunted growth and developmental problems.

Listening to all this, I found myself thinking about the simple things we take for granted, for example, a jar of ground peanuts, a bag of rice or a packet of spices from the market. So much depends on how these foods are dried, stored and transported. Moisture and warmth can turn a harvest into a hazard, yet the problem remains invisible until it’s too late.

The second part of the talk turned to something far more familiar: deep-fried food. That one hit home instantly. Who among us doesn’t love something fried: a crispy snack at tea-time, a plate of char koay teow or fried fritters from a roadside stall? Yet frying at high heat, especially when the same oil is reused, can produce toxic compounds called Advanced Glycation End Products (AGEs) and trans fats. They may sound harmless enough, but these compounds quietly promote inflammation, harden our blood vessels and raise the risks of diabetes and heart disease.

It made me think of all those times I’ve seen stalls with oil that’s clearly been used over and over again. The golden crispness comes at a price we don’t see right away. It’s not about avoiding fried food altogether, but being mindful of how it’s prepared, and perhaps choosing steaming, boiling or poaching a little more often. I was also surprised to learn that a splash of lemon juice or vinegar in cooking can reduce the formation of those harmful AGEs. Small things, really, but they make a difference.

What stayed with me after the talk was how fragile our food chain really is, from the fields where crops are harvested to the kitchens where we cook our meals. Clean storage, careful cooking and a bit of knowledge can make all the difference. It’s not about becoming fearful or fussy, but about being a little more aware of what goes into our food. Most of the time, the danger isn’t what we can see but the quiet, invisible things that build up over time. If we can make small changes here and there, whether it’s drying our grains properly, choosing fresher oil or going easy on the deep-fried treats, then perhaps we’re already doing enough to keep ourselves and our families safe.