These different foods have different properties and compounds that can enhance brain health in different ways.
New research suggests that a structured programme that combines regular exercise with a brain-friendly diet may help improve memory and thinking skills in older adults who are at a higher risk of dementia.
The two-year study followed more than 1,000 adults aged between 60-77 across 11 Latin American countries who had risk factors such as high blood pressure, high cholesterol or smoking.
Half the participants completed supervised exercise four times a week, received personalised brain-healthy nutrition advice and took part in cognitive training, social activities and regular health monitoring.
The comparison group, meanwhile, received general health advice and attended four one-hour meetings over the two years.
“Healthy fats give brain cells structure and function, so I would recommend adding nuts to your shopping list,” suggests British dietitian Lesley Reid.
She recommends Brazil nuts in particular, because as well as containing all the healthy fats, they are also rich in selenium, which is a powerful antioxidant that is great for the brain.
“Have no more than three Brazil nuts per day because they’re pretty powerful,” she advises.
“Have them raw as a snack, or chop them up and mix them through a yoghurt.”
2. Chickpeas
Getting enough protein is also vital for brain health.
“We want to make sure we eat enough good protein sources because proteins are broken down into amino acids, and amino acids are the building blocks of all our cells,” explains Reid.
She adds that amino acids play a particularly important role in neurotransmitters, which make connections in the brain.
Many people think of protein shakes, meat and eggs when it comes to protein, but chickpeas are a great underrated source.
“Tins of chickpeas are a really good source of protein which are pretty cheap,” she says.
“You could roast them, add them to a salad, or blend them up and make them into a hummus to have with bread or as a dip with vegetables.”
3. Blueberries
“One colour of the rainbow that we are often missing from our diet is dark purple, and purple foods like blueberries are another great thing to add to your shopping list,” says Reid.
Blueberries are bursting full with brain-boosting properties, including flavonoids such as anthocyanins and quercetin.
“Research suggests that anthocyanins reduce brain inflammation, stimulate the growth of new brain cells and improve blood flow to the areas responsible for memory and focus,” says British nutritionist Priya Kannath.
“In addition, quercetin is a natural anti-inflammatory compound that helps protect brain cells from damage caused by everyday oxidative stress.”
Frozen blueberries are great because they last much longer than fresh ones.
“You can add them into smoothies, have them with porridge or blitz them with some yoghurt,” she recommends.
4. Green leafy vegetables
“Green leafy vegetables, such as kale and spinach, are rich in magnesium, high in B vitamins and are really good at supporting your energy production and nervous system function,” says Reid.
“They are also very high in vitamin C and offer that antioxidant protection, so are really good for brain function.”
Leafy greens are incredibly versatile and can be incorporated into your diet in many different ways.
“You could steam them, add them into curries, soups and casserole dishes.
“You could also add them into a quiche or into a green smoothie,” suggests Kannath.
5. Oily fish
“Research suggests that higher omega-3 intake has been linked to lower levels of beta amyloid proteins that are associated with Alzheimer’s disease,” says Kannath.
She notes that oily fish, such as sardines and salmon, are a great source of omega-3 fatty acids.
“I would recommend aiming for at least two portions of oily fish a week to get that omega-3 support,” she suggests.
“Canned fish is particularly great because it contains the softened bones of the fish, which will give an extra boost of vitamin D and calcium.
“However, if you prefer buying fresh or frozen fish, you could bake it, make a curry or grill it.”
6. Dark chocolate
“The more cocoa dark chocolate contains, the better it is,” says Kannath.
“Dark chocolate contains flavonoids – such as epicatechin, catechins and procyanidins – that can support cognitive function and also improve the blood flow to the brain.”
She recommends choosing a dark chocolate that is at least 70% cocoa.
“l would recommend eating a square of dark chocolate a day after your evening meal,” she says.
7. Extra virgin olive oil
“Extra virgin olive oil contains anti-inflammatory properties that can help support vascular health which is central to brain health,” says Kannath.
“I would recommend drizzling a little bit of extra virgin olive oil over a salad.” – PA Media/dpa
But from a health and long-term perspective of functional medicine and ageing, these problems that can apparently be separated from one another often seem to have a common denominator: declining blood vessel health.
Central to this process is the naturally-occurring molecule nitric oxide, which is responsible for circulation, metabolism, immune balance and healthy ageing.
Nitric oxide is a gas formed in the body that relaxes and widens the channels of blood vessels within the body – a process called vasodilation.
This basic action helps to ensure that oxygen and nutrients are delivered to all tissues in the body.
Even in very small amounts, nitric oxide has a huge impact on health.
It is typically considered in functional medicine to be a marker of vascular age as healthy blood vessels are crucial for determining how well the body functions over time.
Here is why nitric oxide matters to our health:
> Heart disease and high blood pressure
Heart disease remains a major cause of death in Malaysia.
Many people assume that high blood pressure or heart disease are just a consequence of advancing age or genetic fate.
In fact, one major contributor to these conditions is endothelial dysfunction, in which the lining of a blood vessel loses its ability to produce adequate nitric oxide.
When nitric oxide levels are low, our blood vessels become stiff and inflamed, causing the heart to work harder and blood pressure to eventually rise.
The longer this goes on, the more likely you are to experience complications like heart attack and stroke.
> Diabetes and metabolic syndrome
Nitric oxide also contributes to metabolic health, which has become an increasingly serious issue in Malaysia.
A sufficient level of nitric oxide assists in increasing cellular insulin sensitivity and aiding glucose to enter the muscles more effectively.
With decreased production of nitric oxide, insulin resistance and the occurrence of type 2 diabetes increases.
This vascular-metabolic connection explains why people with diabetes are at much higher risk for heart disease, and why the health of blood vessels is critical in long-term diabetes management.
> Ageing brains
Nitric oxide is crucial for brain health and cognitive longevity.
Reduced availability of nitric oxide is associated with impaired cerebral blood flow and a greater risk of neurodegenerative diseases, like Alzheimer’s disease.
The brain is exceptionally sensitive to changes in blood flow, and even small decreases in circulation can threaten memory, concentration and mental clarity.
From a lifelong perspective, sustaining healthy blood flow to the brain is the most critical means of preserving cognitive function and independence in old age.
> Energy and stamina
Nitric oxide is closely related to a person’s energy level and physical stamina.
A lot of middle-aged and elder Malaysians say that they are easily fatigued, have low exercise resistance or take longer to recover after playing sports.
Although such symptoms are frequently ascribed to ageing, they often indicate diminished nitric oxide generation instead.
When blood vessels do not dilate properly, muscles get less oxygen for activity, leading to mild tiredness and slower recovery.
Supporting pathways through nitric oxide helps to preserve mobility, strength and vitality – key elements of healthy ageing.
> Sexual health
Another important insight into nitric oxide status comes from sexual health.
Early indicators of the ageing of the vascular system often occur in men via erectile dysfunction and women via impaired sexual responsiveness.
Nitric oxide is critical for genital blood flow and normal sexual function, so trouble in that area often shows up years before more significant cardiovascular symptoms come about.
Thus, sexual health in functional medicine is conceptualised not just as an individual problem, but also as a window into overall cardiovascular and metabolic health.
> Living longer
Nitric oxide production naturally decreases with age due to several key factors.
Sadly, Malaysia’s modern lifestyle aspects – i.e. physical inactivity, consumption of refined carbohydrates and ultra-process-ed foods, chronic stress, poor sleep, smoking, and chronic metabolic disease – only exacerbate this decline.
When the amount of nitric oxide drops, blood vessels become stiffer, inflammation rises and the body’s capacity for coping with stress decreases.
This accelerates biological ageing and raises the risk of various chronic diseases.
From a functional medicine and longevity standpoint, the idea is to not just treat disease once it starts, but also preserve nitric oxide levels over the course of a lifetime by promoting early and consistent production.
It requires that the body’s natural nitric oxide pathways be supported by lifestyle and nutritional approaches, rather than relying only on drugs for the treatment of late stage disease.
Some examples of nitrate-containing vegetables in Malaysia include:
Spinach (bayam)
Water spinach (kangkung)
Mustard greens (sawi)
Lettuce
Beetroot
Ulam-ulam (pegaga, selom, daun ketumbar).
These vegetables help to fuel the nitrate to nitrite to nitric oxide pathway, which depends on healthful oral bacteria.
This pathway may be blocked by excessive use of antiseptic mouthwash.
Regular physical activity, adequate sleep, stress management and so on are also important to reduce chronic inflammation and oxidative stress, which quickly destroy nitric oxide and decrease blood vessel function.
> Ageing healthily
Nitric oxide, in the context of healthy ageing, is much more than a cardiovascular molecule.
It says everything about health as a healthy circulatory system serves all organs in the body.
Sufficient nitric oxide is related to higher energy metabolism, higher cognitive function, better metabolic control, healthier sexual function and resilience with ageing.
By boosting nitric oxide production, people aren’t just adding years to life, but are maximising the quality of those years.
Clinically, nitric oxide provides a valuable model of why many co-existing chronic diseases are often clustered in the same individual.
High blood pressure, diabetes, fatigue, erectile dysfunction and cognitive complaints are often treated independent of one another, but tend to stem from the same underlying problem: vascular dysfunction with a reduced availability of nitric oxide.
In a clinical setting, signs such as low exercise tolerance, chronic fatigue or sexual dysfunction should not be dismissed as standard ageing.
These findings are frequently early indicators of compromised endothelial function and increased risk of cardiometabolic disease.
Early intervention in nitric oxide pathways can help clinicians to prevent irreversible damage before it happens.
Do note however, that functional medicine does not replace medical treatment; it is an answer to root causes, not a substitute for clinical care.
Medications are often needed when necessary and life-saving, but improved long-term health happens when lifestyle problems, nutrition, metabolic state, sleep and stress are treated in parallel with pharmacological treatment.
Providing interventions to support nitric oxide production and utilisation by vascular systems provide an opportunity to enhance vascular resilience and potentially reduce the burden of future disease.
For patients, the real message is empowerment.
The many factors that affect nitric oxide – physical activity, diet, gut and oral health, sleep quality and stress – can be changed.
Even modest and consistent changes can lead to significant improvements in circulation, vitality and overall health.
Preserving nitric oxide is ultimately about protecting the body’s internal highways that connect oxygen, nutrients and signals to every cell.
When these are kept open and flexible, the body ages more slowly, recovers more efficiently and stays in use for longer.
This is what longevity-led, preventive care is about.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Informa-tion published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
The class of drugs known as GLP-1 receptor agonists have become renowned for their effects in helping weight loss.
MALAYSIA is the most obese and overweight nation in Asean.
Overweight
adults form 32.6% of the population, while obese adults form another
21.8%, adding up to 54.4% of the population.
Not only that, about 29.8% of children are obese or overweight.
In addition, about 21% of Malaysians are diabetic, of which 80% are obese or overweight.
The Health Ministry (MOH) is introducing glucagon-like peptide 1 (GLP-1) medicines for “vulnerable groups” this year.
Who the vulnerable groups are is unclear.
However, it behoves everyone to ensure that patient safety is not compromised by the use of GLP-1 medicines.
How they work
GLP-1
medicines are receptor agonists that mimic the GLP-1 hormone that is
naturally released in the gastrointestinal tract in response to
eating.
When a person eats, the digestive system breaks down carbohydrates into simple sugars that enter the bloodstream.
GLP-1 stimulates the release of insulin from the pancreas.
Insulin,
a pancreatic hormone, helps get glucose out of the bloodstream
into the body’s cells, where it is used for nourishment and energy.
In
diabetes, the body’s cells are resistant to insulin, do not produce
sufficient insulin, or both. GLP-I medicines stimulate the
pancreas to release insulin and reduce the release of glucagon.
Both insulin and glucagon control the blood glucose levels in humans, including type II diabetics.
GLP-1 medicines also act on the brain to reduce hunger and delay emptying of the stomach.
These drugs are used in the management of type II diabetes, and in some instances, obesity in non-diabetics.
They reduce food cravings, increase fullness (satiety), slow digestion and can help control blood glucose.
GLP-1
medicines were licensed for diabetes management in Malaysia in
2007, and was approved for obesity management in 2019.
As of 2025, there are more than 30 GLP-1 medicines registered.
There are different types of GLP-1 medicines.
Some are injections and others
are
tablets. Some are licensed for diabetes, and others are licensed for
weight-loss management, or to treat the overweight with
weight-related health problems.
Side effects
Like all medicines, GLP-1 agonists have side effects.
The
common ones are gastrointestinal, i.e. nausea, vomiting and
diarrhoea, which are usually mild to moderate, and of short
duration.
Sometimes, these side effects can be serious, leading to severe dehydration that requires hospitalisation.
A serious, but uncommon, side effect is pancreatitis.
Anyone on GLP-1 medicine with severe abdominal pain that radiates to the back should seek immediate medical attention.
Other
serious, but uncommon, side effects include: > Gastroparesis –
where movement of food out of the stomach is slowed or stopped >
Bowel obstruction – a blockage that keeps food from passing through
the intestines > Gallstone attacks, and
> Bile duct blockage.
Rapid
weight loss can cause facial changes that include a hollowed look,
wrinkles, sunken eyes, sagging jowls around the jaws and neck, and
changes in the size of the lips, cheek and chin.
This is commonly called the “Ozempic” face, after the brand name of one of the more wellknown GLP-1 medications.
If the weight loss is less rapid, the facial changes would not be so obvious.
Significant facial changes can be treated by plastic surgery.
The
sexual side effects of GLP-1 medicines involve both potential
improvements (through weight loss and hormonal optimisation), and
declines in libido or arousal, which is variable across sex and
individual profiles.
A full list of the known side effects is found in the product information of the individual GLP-1 medicine.
A recent review reported that
GLP-1 medicines may have little or no effect on obesity-related cancers, i.e. thyroid, breast, pancreatic or kidney.
They
may also have little or no effect on colorectal, oesophageal, liver,
gallbladder, ovarian or endometrial cancer; multiple myeloma; or
meningioma (low certainty).
The effect on gastric cancer was very uncertain.
Current
data does not support a causal association between GLP-1 medicines
and depression, suicidal ideation and suicide.
Precautions
GLP-1
medicines should not be taken in pregnancy, by those who are trying
to get pregnant or by those who are breastfeeding, because there is
insufficient data on the drugs’ safety in such situations.
In
the case of those trying to get pregnant, the number of months the
GLP-1 medicine should be stopped prior to attempting conception
varies, depending on the individual medicine.
Oral
contraceptive users should use barrier contraception, e.g.
condoms, for four weeks after starting GLP-1 medicines, and for four
weeks after any increase in dose.
The reason is that the GLP-1 medicines may reduce the effectiveness of oral contraceptives in the overweight or obese.
Alternatively,
a non-oral form of contraception, e.g. an intrauterine
contraceptive device (IUCD) or implant, which are not as affected by
GLP-1 medicines, can be used.
Prior to a
surgical procedure, the patient should inform their attending
doctors and nurses if they are taking GLP-1 medicines.
This
is because these drugs slow the emptying of the stomach, thereby
increasing the likelihood of stomach contents entering the
airways and lungs during the surgical procedure while under
general anaesthesia or sedation.
This means that modification of the pre-procedure instruction and anaesthetic technique may be required.
The attending doctor(s) will also advise on the taking of prescribed medicine(s).
Be aware
It is vital to remember that GLP-1 medicines are Group B poisons, i.e. they require a doctor’s prescription.
It is illegal to purchase them over the counter or through unlicensed online sellers.
Self-medication
is potentially dangerous – a message that applies not only to GLP-1
medicines, but also many prescription medicines.
Reports of misuse of GLP-1 medicines for cosmetic weightloss purposes are of concern.
The
global demand for GLP-1 medicines has led to the spread of false and
substandard products, with severe risks to patient safety, economic
impacts and erosion of public trust.
These
counterfeit medicines often contain incorrect dosages, harmful
ingredients or lack the active GLP-1 entirely, leading to
ineffective treatment and potentially life-threatening
complications such as hyper/hypoglycaemia and cardiovascular
(heart) issues.
The economic impacts are
considerable, with substantial costs incurred in managing
complications that include hospitalisation and increased
monitoring efforts.
Guidelines for doctors The framework for GLP-1 use in Malaysia is found in the
Clinical Practice Guidelines for the Management of Obesity.
GLP-1
medicines are recommended for adults with a body mass index (BMI)
more than 30kg/m2 or a BMI more than 27kg/m2 with one weight-related
concurrent illness, e.g. hypertension (high blood pressure), type
II diabetes or dyslipidaemia (abnormal fat levels).
The
World Health Organization (WHO) launched its guideline on the use of
GLP-1 therapies for the treatment of obesity in adults on Dec 1,
2025.
The good practice statements in the guideline are:
>
“Obesity is a chronic complex disease that requires lifelong care
beginning with clinical assessment and early diagnosis.
“Once
diagnosed, individuals should have access to comprehensive
chronic care programmes offering sustained behavioural and
lifestyle interventions.
“When
appropriate, pharmacological, surgical or other therapeutic
options may be used to support effective disease management.
“In parallel, care should address the prevention and treatment of obesity-related complications and comorbidities.”
>
“In adults living with obesity, GLP-1 receptor agonists or GIP/ GLP-1
dual agonists may be used as long-term treatment for obesity.”
>
“People living with obesity should receive context-appropriate
counselling on behavioural and lifestyle changes – including, but
not limited to, physical activity and healthy dietary practices –
as an initial step toward more structured behavioural
interventions.
“For individuals who are
prescribed GLP-1 receptor agonists or GIP/GLP-1 dual agonists,
counselling on behavioural and lifestyle changes should be provided
as a first step to intensive behavioural therapy to amplify and
support optimal health outcomes.
> “In
adults living with obesity who are prescribed GLP-1 receptor agonists
or GIP/GLP-1 dual agonists, intensive behavioural therapy may be
provided as a co-intervention within a comprehensive multimodal
clinical algorithm.”
The jury is out on whether the WHO good practice statements will be implemented in toto or partially in MOH facilities.
Part of a strategy
Recognising
that medicines by themselves would not by themselves address the
global obesity challenge, the WHO recommended a comprehensive
strategy based on:
> “Creating
healthier environments through robust population-level policies to
promote health and prevent obesity. > “Protecting individuals
at high risk of developing obesity and related comorbidities
through targeted screening and structured early interventions. >
“Ensuring access to lifelong person-centred care.”
The
safe use of GLP-1 medicines requires regulated distribution and
prescription by doctors, strong oversight, patient education and
stakeholders’ cooperation to ensure that public health is
protected.
Dr Milton Lum is a past
president of the Federation of Private Medical Practitioners
Associations and the Malaysian Medical Association. For more
information, email starhealth@thestar.com.my. The views expressed do
not represent that of organisations that the writer is associated
with. The information provided is for educational and
communication purposes only, and it should not be construed as
personal medical advice. Information published in this article is
not intended to replace, supplant or augment a consultation with a
health professional regarding the reader’s own medical care. The
Star disclaims all responsibility for any losses, damage to
property or personal injury suffered directly or indirectly from
reliance on such information.
