How are micro nutrients different from macro nutrients?

The food we eat provides us with energy as well as with essential ingredients necessary for the growth and maintenance of our body. All these nutrients can be divided into two main categories, micro and macro nutrients.

Micro Nutrients

These are present in our diets, but in very small amounts. These can be found in vitamins, minerals and trace elements. Micro nutrients, just like water do not provide energy; however they are still needed in adequate amounts to ensure that all our body cells function properly. Even though their presence is in minute amounts, these are very important to nutrition.

Most of the micro nutrients are known to be essential nutrients, meaning they are those which are indispensable to life processes, and what the body cannot make itself. In other words, this means these essential nutrients can only be obtained from the food we eat.
Micro nutrients can be found in;
· Vitamins
· Minerals
· Trace elements

Macro nutrients

These are present in our diets in large amounts, and make up the bulk of our diets.
They can be found in;
· Carbohydrates
· Fat
· Protein

And water.

Dalai Lama's 18 Rules for Living

For happy and healthy living, let's go through the 18 rules proposed by H.H. Dalai Lama:

1.Take into account that great love and great achievements involve great risk.

2.When you lose, don't lose the lesson.

3.Follow the three R's:

• Respect for self
• Respect for others
• Responsibility for all your actions.

4.Remember that not getting what you want is sometimes a wonderful stroke of luck.

5.Learn the rules so you know how to break them properly.

6.Don't let a little dispute injure a great friendship.

7.When you realize you've made a mistake, take immediate steps to correct it.

8.Spend some time alone every day.

9.Open your arms to change, but don't let go of your values.

10.Remember that silence is sometimes the best answer.

11.Live a good, honorable life. Then when you get older and think back, you'll be able to enjoy it a second time.

12.A loving atmosphere in your home is the foundation for your life.

13.In disagreements with loved ones, deal only with the current situation. Don't bring up the past.

14.Share your knowledge. It's a way to achieve immortality.

15.Be gentle with the earth.

16.Once a year, go someplace you've never been before.

17.Remember that the best relationship is one in which your love for each exceeds your need for each other.

18.Judge your success by what you had to give up in order to get it.

Laptops in classrooms: Learning aid or distraction?

Almost a decade ago, there was a news report which stated that Australia had introduced a programme to ensure every secondary school student in the country had a computer as part of a so-called "digital education revolution". The A$2.4 billion programme was introduced in 2007 and laptop was declared "the toolbox of the 21st century". But the push to roll out technology in classrooms is facing a backlash now, with some schools and teachers saying computers are a "distraction" and can hinder learning.

One of Australia's leading schools, Sydney Grammar School, which was attended by Prime Minister Malcolm Turnbull, has now banned students from bringing laptops to school. The elite private boys' school is also requiring students up to grade 10 - the third-last year of secondary school - to handwrite assignments. The school's headmaster, Dr John Vallance, says the use of laptops and iPads in the classroom is a distraction and prevents students from being able to express themselves by writing. Dr Vallance expresses his views,"We see teaching as fundamentally a social activity... It's about interaction between people, about discussion, about conversation. We find that having laptops or iPads in the classroom inhibits conversation - it's distracting".

Another school, St Paul's Catholic College in Sydney has banned the use of laptops for one day a week to encourage students to play sport and to reduce reliance on the machines. "Computers have been oversold and there is no evidence that they improve outcomes," said the principal, Mr Mark Baker of the above-mentioned college. "The problem is maturity. They (students) are very good at using technology for social interaction but not for learning." The Australian Education Union's President, Ms Correna Haythorpe, said schools should consider ways to effectively incorporate technology, including protocols to ensure computers were being used for education purposes.

The use of computers in classrooms has become a vexed topic among schools and educators around the globe. The Organisation for Economic Cooperation and Development has expressed concern about the potential overuse of technology in schools. Its research has found that as students use technology more intensively, their reading skills begin to drop substantially. "The reality is that technology is doing more harm than good in our schools today," the organisation's director for education and skills, Mr Andreas Schleicher, reportedly told the Global Education and Skills Forum in Dubai in February,2016.

According to OECD figures from 2012, Australia had the world's second-highest proportion of students using computers in school - 93.7 per cent, slightly behind the Netherlands. Singapore's figure was 69.9 per cent. But Singapore was at the top of the OECD global education rankings for maths and science released last May, with Australia in 14th place. Australia's place in the rankings has slipped in recent years, despite the promotion of technology in classrooms.

Experts in Australia have expressed mixed views about the technology roll-out. An expert on learning and technology, Professor Glenn Finger from Griffith University, said he did not agree with banning computers or requiring handwritten assignments but supported a "balanced" approach. "To go the other way and not use any technology at all may not be productive either. You can have a blended learning approach which takes advantage of the technology and of excellent teaching," he said. He likened banning computers to banning books. "For a student, it is dangerous to have a ban," he said. "Handwritten assignments are from a pre-1993 analogue world. It is not how most people in business or government or young people operate."

So, we the educators and policy makers, have to sit and rethink on our overemphasis on the use of laptop as the main mode of imparting education, which is reducing the role of the teacher to that of facilitator. That is already showing its negative effects on the students, in the form of their shorter attention spans, distractions, hooked to social media, poor performance in class as well as in exams! We need to adopt the blended approach to learning and teaching in such a way that technology complements the process of actual teaching in the classroom.

Managing our cholesterol levels

We often hear of some people avoiding certain types of food like eggs because they think their cholesterol level will go up by eating it. For sure, high cholesterol levels will put us at risk of coronary heart disease, heart attack and stroke, but dietary cholesterol does not raise our blood cholesterol as much as large amounts of saturated fats do.

Cholesterol is a waxy, fat-like substance that is made and used by our bodies to make some hormones (e.g., sex hormones), vitamin D, bile and other substances. It is mainly found in foods from animal sources, such as meat, poultry and full-fat dairy products. When we eat a diet high in saturated and trans fats, our livers will produce more cholesterol.

Many people do not know their cholesterol level is too high as high cholesterol levels do not cause symptoms. A blood test will tell us if our cholesterol level is too high. We can control our cholesterol level with a healthy diet and regular aerobic exercise, though some people will also need to take medications. Let's take a closer look.

How does high cholesterol affect us?

Excess cholesterol in our blood will build up in the walls of our arteries and this plaque will make it harder for our heart to circulate blood. A heart attack or stroke can occur from sudden blood clots in these narrowed arteries. Cholesterol is transported through our blood stream by carriers called lipoproteins, of which the two main types are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

LDL is the bad cholesterol as it carries cholesterol to the tissues, including the arteries, and elevated levels of LDL are strongly linked to increased cardiosvascular risk. HDL is considered "good" cholesterol because it transports cholesterol back to the liver, where it is passed from the body.

What types of food should we avoid?

Cholesterol levels can certainly be lowered by dietary changes, especially by avoiding red meat, butter, fried foods, cheese and other foods that have a lot of saturated fat. Also, we need to restrict our intake of sugar, sweets and refined grains, which are found in food such as white bread, white rice and most forms of pasta. Eggs are fine; however, moderate consumption of up to one a day, is acceptable and is safe for the heart.

What is a good diet to follow?

A Mediterranean diet appears to reduce the risk of cardiovascular events. This diet typically consists mainly of fruits and vegetables, whole grains, beans, nuts, seeds and olive oil as an important source of fat. It also usually includes low to moderate amounts of fish, poultry, dairy products and little red meat.

When do I need medication (e.g., statins)?

Statins are drugs that can block a substance our body needs to make cholesterol. Several trials have unequivocally demonstrated the benefit of statins in patients with coronary artery plaque disease and especially in those who have suffered a heart attack. The decision to start statins is made after a personalised assessment of the patient's overall cardiovascular risk. So, if one's long-term risk of experiencing a heart attack or stroke is high for instance, statins may help.

Although medications can rapidly lower our cholesterol levels, it often takes 6 to 12 months before the effects of lifestyle modifications are noticeable. The treatment of high cholesterol - and triglycerides, a type of fat that contributes partly towards our total cholesterol count - is a lifelong process. It is thus important to stick with the treatment plan once we begin to see results.

Many people request to discontinue their statin treatment because of its side effects. Statins are generally very safe, though some people do not tolerate it well. Some of the common side effects include muscle and joint pain, nosebleeds, sore throat, headache and problems with the digestive system like diarrhoea, according to Britain's National Health Service (NHS). Also, liver problems can happen but are rare. Cognitive impairment like memory loss and confusion is another side effect that has been reported. The US Food and Drug Administration said these experiences are rare. Furthermore, the symptoms were not serious and were reversible within a few weeks after the patient stopped using the drug.

Statins may also confer "a small increased risk of developing diabetes" and this risk becomes slightly greater with high doses than moderate doses. However, there is overwhelming evidence from clinical trials that shows that statins reduce heart attacks in patients with and without diabetes. The beneficial effects of statins on cardiovascular protection thus far outweigh the increased risk.

How much would you pay to extend your life by a year?

If you have recently watched TV (in Singapore or New Delhi), you will have likely seen the commercial where somebody's future older self scolds his current younger self for not properly planning for the future. The commercial raises an interesting question about our ability to predict what our future self is likely to want.

A study published in the prestigious journal Science suggests that our predictions about future are likely to be wrong. It presents something the authors call the "end-of-history illusion". The authors surveyed more than 19,000 adults and asked them to report how much they had changed in the past and to predict how much they would likely change in the future.

Results showed that regardless of how old they were, people generally responded that they felt they had changed a lot in the past but were unlikely to change much in the future. In other words, in the moment, we all believe we know our true selves, but we are almost surely wrong. As the illusion becomes clear, when asked again at any point in the future, we are likely to make the same erroneous claim.

The end-of-history illusion suggests that our current and future selves are likely to disagree on many issues, but it is the concept of 'present bias' that provides insight into which side the two parties will take. Present bias implies an irrational preference for current over future consumption, and therefore too little investment in the future. From the future self's perspective, the current self will exercise too little, eat too much, and not save for a rainy day. By the time the current self becomes the future self, it is too late and all that is left to do is to regret the decisions made by their former selves.

There are many practical implications of these biases.Many studies were conducted at the Lien Centre for Palliative Care at Duke-NUS Medical School, Singapore, to explore the extent to which these and other biases influence treatment choices for life-limiting illnesses like cancer. These showed that caregivers were far more aggressive in their willingness to pursue treatments with only moderate survival benefits. As a result, patients who do not have a say in their treatment are likely to be over-treated compared to what they would receive if actively involved in the treatment decisions. In short, the results are alarming and suggest that patients with life-limiting illnesses are unlikely to receive care consistent with their preferences.

As an example, over 500 healthy older Singaporeans and 320 cancer patients were surveyed to explore how much each group would be willing to pay for moderately life-extending treatments and other end-of-life services. Healthy older adults stated, on average, that they would pay less than $3,000 to extend their life by one year if diagnosed with a life-limiting illness such as advanced cancer. Cancer patients, on the other hand, were willing to pay roughly $18,000, six times what healthy adults thought they would pay if in the same situation. Clearly, the current and future selves are seeing things differently.

In Singapore, as with many other Asian countries, patients often defer to family members to make decisions as to which end-of-life treatments to receive. Anecdotally, up to one-third of cancer patients either do not know or pretend not to know that they have cancer. For them, all treatment decisions are made by the family, with input from the doctor.

This would not be problematic if patients and their family caregivers had similar views on end-of-life treatments. However, a second study conducted by at the Centre reveals that is unlikely to be the case, presumably because caregivers want to retain hope and avoid any regret for not doing everything within their power to extend the life of their loved one. In this study, cancer patients' willingness to pay for end-of-life treatments was compared with that of their family caregivers. We found that caregivers were far more aggressive in their willingness to pursue treatments with only moderate survival benefits.

For a treatment that would extend the patient's life by one year, in contrast to the $3,000 stated by healthy adults for extending their own life and the $18,000 stated by patients, caregivers would pay over $61,000 - more than three times what patients would pay for themselves. As a result, patients who do not have a say in their treatment are likely to be overtreated compared with what they would receive if actively involved in the treatment decisions.

One might hope that doctors would intervene to ensure overtreatment does not occur. However, a third study suggests this is unlikely to be the case. In this study, 285 local doctors were surveyed and given hypothetical scenarios describing patients with life-limiting illnesses but with characteristics that varied by age, expected survival, cognitive status and treatment costs. For each scenario, the physicians were asked whether or not they would recommend life-extending treatments.

Results showed a lack of consistency in physician recommendations. For example, for a 75-year-old patient who is not cognitively impaired and whose life could be extended by one year at a cost of $55,000, roughly 45 per cent of physicians stated they would recommend the life-extending treatment and the remainder said they would not. This is close to a coin toss and suggests that if a patient were to get a second or third opinion on the recommended course of treatment, it would almost surely differ from the first. This would clearly cause great anxiety on the part of the patient and family.

However, it suggests that physicians should educate patients and their families on the clinical benefits of various treatment options but because clinical benefit is only one of many factors that influence treatment choices for patients with life-limiting illnesses, physicians are not in a good position to make treatment decisions on behalf of the patient. This is best left to the patient, with input from the family.

So what are the implications of the above?

In short, the results of the Singapore studies suggest that we cannot count on our current selves to properly forecast what our future selves would want if diagnosed with a life-limiting illness. Most likely, we will underestimate our future demand and therefore not plan appropriately. Contrarily, our loved ones, not wanting to give up hope and wanting to avoid future regret, are likely to push us towards treatments that we will feel are not worth the expense, thus exposing the family to significant financial risk. Physicians, often spurred by a healthcare system that pursues aggressive treatments even with limited survival benefits, are unlikely to go against the wishes of the family if the care has any potential to extend life.

There are no easy fixes to these problems. Advance care planning and open discussions about treatment choices if diagnosed with an advanced illness are other recommended solutions. These discussions should take place early and often, and should include considerations about costs but also discussions about trade-offs between quality of life and care that modestly extends life but potentially at a low quality.

One finding this research makes clear is that patients value dying at their place of choice, avoiding severe pain and receiving well-coordinated healthcare where they are treated with dignity and respect far more than they value moderate increases in life expectancy. Caregivers, providers and policymakers need to understand what matters most to patients as they approach the end of life and work to ensure those priorities are met.