Archive for the 'Lifestyle Measures' Category

What Makes Us OVEREAT….

January 4, 2012

Let me share with you one nice article from theHarvard Medical School publication: HealthBeat on what makes people overeat…

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How stress can make us overeat

It’s been another hectic day. On impulse, you grab an extra-large candy bar during your afternoon break. You plan to take just a few bites. But before you know it, you’ve polished off the whole thing — and, at least temporarily, you may feel better.

Rest assured you’re not alone. Stress, the hormones it unleashes, and the effects of high-fat, sugary “comfort foods” push people toward overeating.

Effects on appetite

In the short term, stress can shut down appetite. A structure in the brain called the hypothalamus releases corticotropin-releasing hormone, which suppresses appetite. The brain also sends messages to the adrenal glands atop the kidneys to pump out the hormone epinephrine (also known as adrenaline). Epinephrine helps trigger the body’s fight-or-flight response, a revved-up physiological state that temporarily puts eating on hold.

But if stress persists — or is perceived as persisting — it’s a different story. The adrenal glands release another hormone called cortisol, and cortisol increases appetite and may also ramp up motivation in general, including the motivation to eat. Once a stressful episode is over, cortisol levels should fall, but if the stress doesn’t go away — or if a person’s stress response gets stuck in the “on” position — cortisol may stay elevated.

Fat and sugar cravings

Stress also seems to affect food preferences. Numerous studies — granted, many of them in animals — have shown that physical or emotional distress increases the intake of food high in fat, sugar, or both. High cortisol levels, in combination with high insulin levels, may be responsible. Other research suggests that ghrelin, a “hunger hormone,” may have a role.

Once ingested, fat- and sugar-filled foods seem to have a feedback effect that inhibits activity in the parts of the brain that produce and process stress and related emotions. So part of our stress-induced craving for those foods may be that they counteract stress.

Of course, overeating isn’t the only stress-related behavior that can add pounds. Stressed people lose sleep, exercise less, and drink more alcohol, all of which can contribute to becoming overweight.

Different responses

Some research suggests a gender difference in stress-coping behavior, with women being more likely to turn to food and men to alcohol or smoking. A Finnish study that included over 5,000 men and women showed that obesity was associated with stress-related eating in women but not in men. Other research has shown that high stress levels lead to weight gain in both women and men, but the effect is typically greater in men.

Harvard researchers have reported that stress from work and other sorts of problems correlates with weight gain, but only in those who were overweight at the beginning of the study period. One explanation: overweight people have elevated insulin levels, and stress-related weight gain is more likely to occur in the presence of high insulin.

How much cortisol people produce in response to stress may also factor into the stress–weight gain equation. Several years ago, British researchers designed an ingenious study that showed that people who responded to stress with high cortisol levels in an experimental setting were more likely to snack in response to daily hassles in their regular lives than low-cortisol responders.

Steps you can take

Stress reduction is a growth industry these days.

There are dozens of things to try. Here are three suggestions:

    1. Meditate. Countless studies show that meditation reduces stress, although much of the research has focused on high blood pressure and heart disease. Meditation may also help you be more mindful of food choices. With practice, a person may be able to pay better attention to the impulse to grab a fat- and sugar-loaded comfort food and inhibit the impulse.
   2.  Exercise more. Intense exercise increases cortisol levels temporarily, but low-intensity exercise seems to reduce them. University of California researchers reported results in 2010 that exercise — and this was vigorous exercise — may blunt some of the negative effects of stress. Some activities, such as yoga and tai chi, have elements of both exercise and meditation.
    3. Visit with friends. Social support seems to have a buffering effect on the stress people experience. For example, researchers have found that the mental health of people working in stressful situations, like hospital emergency departments, is better if they receive it. But even those of us who live and work in situations where the stakes aren’t as high will, as Lennon and McCartney suggested, be better off if we get a little help from our friends.

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Steps you can do to reduce stress anytime of the the day…

Bad Habits to avoid when stressed!

Sound Simple and Pure…

 

How To Lose Weight: A Novel Way To Teach Kids About Proper Nutrition

December 24, 2011

Recent article published in AMERICAN JOURNAL OF PUBLIC HEALTH brings us back to how fast our world is becoming obese and how slow we have been in addressing this issue.  The temptation to eat and the lack of discipline to follow what is right and adequate make each one of us vulnerable to this dreaded condition we call Obesity.

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Objectives. We examined the effect of an intervention to provide caloric information about sugar-sweetened beverages (SSBs) on the number of SSB purchases.

Methods. We used a case-crossover design with 4 corner stores located in low-income, predominately Black neighborhoods in Baltimore, Maryland. The intervention randomly posted 1 of 3 signs with the following caloric information: (1) absolute caloric count, (2) percentage of total recommended daily intake, and (3) physical activity equivalent. We collected data for 1600 beverage sales by Black adolescents, aged 12–18 years, including 400 during a baseline period and 400 for each of the 3 caloric condition interventions.

Results. Providing Black adolescents with any caloric information significantly reduced the odds of SSB purchases relative to the baseline (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.36, 0.89). When examining the 3 caloric conditions separately, the significant effect was observed when caloric information was provided as a physical activity equivalent (OR = 0.51; 95% CI = 0.31, 0.85).

Conclusions. Providing easily understandable caloric information—particularly a physical activity equivalent—may reduce calorie intake from SSBs among low-income, Black adolescents.

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The study tells us one thing:

Letting out kids understand the nutrition information of the food they eat versus telling them how long they have to workout or exercise to burn the calories can make a difference.

The impact was noticeable more if kids understand how long they have to run to burn the amount of calories they ingested from the sugary drinks.  The easier it is for everyone to understand the equivalent amount of physical activity of what we take in makes sense.  You get a clearer picture of what you need to do to burn those calories.

A great article and a great wake up call for everyone.

AACE Philippines as part of our advocacy is providing modules to Grade school students on the Power of Prevention Through Fitness and Nutrition or POPFTN. For this year, we already have started the program and involved the Grade 5 students of St Bennedicts and for January, we will go to PAREF Springadale both in Cebu.  AACE Philippines as an organization composed of Endocrine Specialists dealing with Diabetes, Obesity and endocrine diseases hope to make a difference in the early lives of these kids.

Do We Need MULTIVITAMINs?

November 2, 2011

The concept of taking mutivitamins as a way to improve health has never been proven.  It has not been shown to cause harm BUT has not been shown to help reduce disease… so when a study on multivitamin around 2009 came out saying that taking these supplements has not been shown to have any effect on health or disease prevention…I literally stopped taking one.

Now comes a new study that gtives us more doubt on this practice. A study published in Archives of Internal Medicine, Oct issue showed that these supplements are not helpful healthwise, they can actually be HARMFUL

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Methods We assessed the use of vitamin and mineral supplements in relation to total mortality in 38 772 older women in the Iowa Women’s Health Study; mean age was 61.6 years at baseline in 1986. Supplement use was self-reported in 1986, 1997, and 2004. Through December 31, 2008, a total of 15 594 deaths (40.2%) were identified through the State Health Registry of Iowa and the National Death Index.

Results  In multivariable adjusted proportional hazards regression models, the use of multivitamins (hazard ratio, 1.06; 95% CI, 1.02-1.10; absolute risk increase, 2.4%), vitamin B6(1.10; 1.01-1.21; 4.1%), folic acid (1.15; 1.00-1.32; 5.9%), iron (1.10; 1.03-1.17; 3.9%), magnesium (1.08; 1.01-1.15; 3.6%), zinc (1.08; 1.01-1.15; 3.0%), and copper (1.45; 1.20-1.75; 18.0%) were associated with increased risk of total mortality when compared with corresponding nonuse. Use of calcium was inversely related (hazard ratio, 0.91; 95% confidence interval, 0.88-0.94; absolute risk reduction, 3.8%). Findings for iron and calcium were replicated in separate, shorter-term analyses (10-year, 6-year, and 4-year follow-up), each with approximately 15% of the original participants having died, starting in 1986, 1997, and 2004.

Conclusions  In older women, several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk; this association is strongest with supplemental iron. In contrast to the findings of many studies, calcium is associated with decreased risk.

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This study confimrs what I have been suspecting in a long time.  As a supplement, these drugs are not being screened for what they contain.  The drugs dont need to prove they work… for them to be sold in the market nor are these drugs required to show their long term safety. Now I hope the public knows better!!!!

In this paper, the patients who were studied took supplements in the form of calcium, multivitamins, vitamin C, and vitamin E.  The data showed that the use of multivitamins especially those containing vitamin B6, folic acid, iron, magnesium, zinc, and copper supplements were associated with greater all-cause mortality through 19 years of follow-up.  This is BIG news!!!!

What then is our recommendation?

Better invest in healthy lifestyle.  As always, it has been our advocate to promote what is proven right and safe.  Eat right and Move!!!

Avoid taking a palm full of supplements thinking this can make one live longer and healthier because on the contrary…the fewer supplements or ZERO supplements - the better!!!!  We cannot and will NEVER recommend the use of vitamin and mineral supplements as a preventive measure!!!!, As they dont add anything beneficial from what we can get by eating the healthy fruits and vegetables!

Regular Exercise Keeps Your Arteries Healthy….

June 19, 2011

Go to fullsize imageIt is known that high sugar and high cholesterol in the blood spell trouble.  Any diabetics almost always has high blood pressure or high cholesterol problem.  Therefore, we aggressively treat their sugars, blood pressure and cholesterol hoping to lower their risk to suffer from a stroke and heart attack.

Most often, doctors tend to forget to remind patients to be more physically active.  Some patients also feel so comfortable that they are already on medications that they dont need to watch out what they eat or do. 

Now comes a new study presented at the Annual Meeting of the American College of Sports Medicine that looked at the value of regular physical activity among patients already on aggressive lowering of sugar and cholesterol and see if regular exercise contributes further to preventing heart disease.

This is so far the first study to document that if one exercise reglarly at least 30 minutes like walking, further reduction in ones risk to heart disease progression can be seen.  When pulse wave activity was measured after 2-5 years, those that exercise less or not at all, had a 14% increase in pulse wave activity suggesting more arterial stiffness.  The study confirms that progression of atherosclerosis or blockage of blood vessels can be sloweddown or halted by adding physical activity to the usual medications we give to lower sugar and cholesterol.

This study further emphasizes to all of us that whatever we do and have in life…

 if we are healthy.. go out and exercise;

if we have heart disease…go out and exercise

if you’re pregnant…go out and exercise….

Exercise will continue to add benefit to whatever medications youre taking for whatever disease you have! PLUS

Exercise difinitely PREVENTS you from falling ill…

Take care of your body…its the only one you have!

Sleep and Diabetes: Quality Matters NOT Quantity!!!!

May 30, 2011

Go to fullsize imageLack of sleep causes stress. Stress increases stress hormones that can increase glucose. Understandably,lack of sleep equals risk for diabetes.  I used to believe from previous studies that a duration of sleep less than 7 hours increases ones risk to develop diabetes. 

 Now comes a new study published in Diabetes Care March 2011, that tell us Quality is important than Quantity…

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OBJECTIVE To examine whether sleep duration and quality are associated with fasting glucose, fasting insulin, or estimated insulin resistance in a community-based sample of early middle-aged adults.

RESEARCH DESIGN AND METHODS This was an ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Habitual sleep duration and fragmentation were estimated from 6 days of wrist actigraphy collected in 2003–2005. Insomnia was defined as self-reported difficulty falling asleep or waking up in the night three or more times per week plus average sleep efficiency of <80% based on actigraphy. Fasting blood samples to measure glucose and insulin were collected after the sleep measures during the CARDIA clinical examination in 2005–2006. Insulin resistance was estimated using the homeostatic model assessment (HOMA) method. Analyses were cross-sectional and stratified by the presence of diabetes.

RESULTS There was no association between sleep measures and fasting glucose, insulin, or HOMA in the 115 subjects without diabetes. Among the 40 subjects with diabetes, after adjustment for covariates, 10% higher sleep fragmentation was associated with a 9% higher fasting glucose level, a 30% higher fasting insulin level, and a 43% higher HOMA level. Insomnia was associated with a 23% higher fasting glucose level, a 48% higher fasting insulin level, and an 82% higher HOMA level.

CONCLUSIONS The observed association between poor sleep quality and higher glucose, insulin, and estimated insulin resistance among subjects with diabetes warrants further examination of the effect of sleep disturbances on glucose control in type 2 diabetes.

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In the study, sleep duration was assessed as the amount of sleep obtained per night while sleep fragmentation was based on the periods of restlessness and movements that the pateints had during the night.

What is interesting in the study was that there was no association between sleep duration and glucose metabolism in groups with or without diabetes.  This is in contrast to earlier studies which showed otherwise. 

However sleep fragmentation was signicantly associated with increasing blood sugar so that for every 10% higher sleep fragmentation,  there was an associated 9% higher fasting glucose and higher insulin level suggesting insulin resistance.  What is important is that sleep fragmentation WAS not associated with higher glucose if one is NOT a diabetic.  Meaning, sleep disturbance is a risk factor  for poor blood sugar control among diabetics!

In conclusion, the authors assessed that POOR sleep and NOT Short Duration is associated with poor glucose control!!!  That intervention to warrant investigations of causes for poor sleep can help make diabetics have better control.

So do you snore? and probably stop breathing often?

Ask your partner… and better have your sleeping pattern assessed as this may lead to better control of your blood sugar if corrected!

Why Daily Video and Internet Gaming Can Be Harmful….

January 20, 2011

I am planning to publish this article for my son to read in FB ( which he is allowed to do in my room only during weekends) and for the other parents to reconsider the practice of allowing kids to play video and internet games at their leisure. It is easy to use these gadgets as surrogate nannies because they make our kids stay put and have their own world.  Part of the compromise for busy parents is to buy their kids the best gadgets because kids wont complain their absence as long as they have the gadgets to enjoy.

Now comes a study published in Pediatrics regarding the long term dangers of allowing our kids to enjoy these gadgets on a daily basis:

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 Objectives : We aimed to measure the prevalence and length of the problem of pathological video gaming or Internet use, to identify risk and protective factors, to determine whether pathological gaming is a primary or secondary problem, and to identify outcomes for individuals who become or stop being pathological gamers.

Methods : A 2-year, longitudinal, panel study was performed with a general elementary and secondary school population in Singapore, including 3034 children in grades 3 (N = 743), 4 (N = 711), 7 (N = 916), and 8 (N = 664). Several hypothesized risk and protective factors for developing or overcoming pathological gaming were measured, including weekly amount of game play, impulsivity, social competence, depression, social phobia, anxiety, and school performance.

Results:  The prevalence of pathological gaming was similar to that in other countries (9%). Greater amounts of gaming, lower social competence, and greater impulsivity seemed to act as risk factors for becoming pathological gamers, whereas depression, anxiety, social phobias, and lower school performance seemed to act as outcomes of pathological gaming.

Conclusion:  This study adds important information to the discussion about whether video game “addiction” is similar to other addictive behaviors, demonstrating that it can last for years and is not solely a symptom of comorbid disorders.

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According to the opinion of Medpage Today… two important things that we learned from the study: 

  • That spending hours with a PlayStation or an Xbox including Internet Games every day can lead to serious psychiatric problems in children.
  • That increases in pathological gaming symptoms were predictive of depression, anxiety, social phobia, and school performance at follow-up.

That’s a WAKE-UP call…

Healthy Cereals for Breakfast

December 14, 2010

Its always difficult to wake kids up during school days…more difficult to let them eat.  I usually alternate oatmeal, cereals and rice on my kids breakfast meal.  Oats with fruits and milk, low sugar Cherrios cereals and in between days they get rice and eggs with ham.  It is always good to start the kids young and learn the importance of a healthy breakfast.

The mistake that parents always have with regard to kids food choices is that we always allow our kids to dictate what they like to eat.  Or rely our kids meals on their yayas.  It is easier for us to fry chicken with french fries because for sure the kids will eat them BUT are they healthy?  Likewise yayas find it easier to feed fried chicken than veggies.  As the saying goes..at least they eat rather than no breakfast!  This is the reason why in the long run, parents will find it difficult to introduce healthy food choices for the kids.

Now comes a new study published in Pediatrics that these Cherrios low sugar cereals are really acceptable options for a healthy breakfast.  Likewise surprisingly kids love them!

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Objectives To test (1) whether children will consume low-sugar ready-to-eat (RTE) cereals and (2) the effects of serving high- versus low-sugar cereals on the consumption of cereal, refined sugar, fresh fruit, and milk.

Participants and Methods Using an experimental design, we randomly assigned children (n = 91) who were attending summer day camp to receive a breakfast that included either the choice of 1 of 3 high-sugar cereals (high-sugar condition) or low-sugar cereals (low-sugar condition), as well as low-fat milk, orange juice, bananas, strawberries, and sugar packets. Participants served themselves and completed a background questionnaire after eating. Researchers measured the amount and calories consumed of each food.

Results In both conditions, children reported “liking” or “loving” the cereal they chose. Children in the low-sugar cereal condition consumed, on average, slightly more than 1 serving of cereal (35 g), whereas children in the high-sugar condition consumed significantly more (61 g) and almost twice the amount of refined sugar in total (24.4 vs 12.5 g). Milk and total calories consumed did not differ significantly between conditions, but children in the low-sugar condition were more likely to put fruit on their cereal (54% vs 8%) and consumed a greater portion of total calories from fresh fruit (20% vs 13%).

Conclusions Compared with serving low-sugar cereals, high-sugar cereals increase children’s total sugar consumption and reduce the overall nutritional quality of their breakfast. Children will consume low-sugar cereals when offered, and they provide a superior breakfast option.

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This clinical study is true based on my experience.  My kids love these Cherrios low sugar low fat whole grain cereals more than the sugary chocolate laden corn flakes.   The good news with these data is that those children in the study who were offered low-sugar cereals enjoyed their breakfast with good satisfaction but only consumed half the amount of refined sugar at breakfast compared with those who ate high-sugar cereals (12.5 g versus 24.4 g, P<0.001).  Not only are the parents happy but the kids are satisfied too!

It is really best to start our kids day with a healthy meal that can provide them with calories that matter…

Choose wisely and Be Involved!

The Dangers of Sugary Drinks

November 16, 2010

Consumption of sugary drinks not only make you gain weight BUT now has been proven to strongly increase your risk to develop Diabetes and other obesity related diseases. 

A new study has shown us there is a  link regarding the risk of developing diabetes to intake of sugary drinks and this link is high enough to approximate the risk that one gets from smoking!!!!

This new study is published in the recent publication of Diabetes Care in 2010:

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OBJECTIVE: Consumption of sugar-sweetened beverages (SSBs), which include soft drinks, fruit drinks, iced tea, and energy and vitamin water drinks has risen across the globe. Regular consumption of SSBs has been associated with weight gain and risk of overweight and obesity, but the role of SSBs in the development of related chronic metabolic diseases, such as metabolic syndrome and type 2 diabetes, has not been quantitatively reviewed.

RESEARCH DESIGN AND METHODS: We searched the MEDLINE database up to May 2010 for prospective cohort studies of SSB intake and risk of metabolic syndrome and type 2 diabetes. We identified 11 studies (three for metabolic syndrome and eight for type 2 diabetes) for inclusion in a random-effects meta-analysis comparing SSB intake in the highest to lowest quantiles in relation to risk of metabolic syndrome and type 2 diabetes.

RESULTS: Based on data from these studies, including 310,819 participants and 15,043 cases of type 2 diabetes, individuals in the highest quantile of SSB intake (most often 1-2 servings/day) had a 26% greater risk of developing type 2 diabetes than those in the lowest quantile (none or <1 serving/month) (relative risk [RR] 1.26 [95% CI 1.12-1.41]). Among studies evaluating metabolic syndrome, including 19,431 participants and 5,803 cases, the pooled RR was 1.20 [1.02-1.42].

CONCLUSIONS: In addition to weight gain, higher consumption of SSBs is associated with development of metabolic syndrome and type 2 diabetes. These data provide empirical evidence that intake of SSBs should be limited to reduce obesity-related risk of chronic metabolic diseases.

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In practical terms, the association between intake of sugary drinks and Diabetes can be translated to something like this:

For every  12 oz sugar laden drink that you order in a restaurant today like the ever famous and popular sugary and tasty Ice Tea or canned OJ… a roughly 25% increase in risk  for you to develop Diabetes on top of your risk to gain more weight!

So if one actually drinks 2-3 bottles of Soda per day then the risk is further increased to 30% roughly similar to the risk one gets due to smoking!

Would it be better to take Diet Drinks then? It maybe safer BUT the associated increase in food intake is the culprit.  Likewise there are some concerns now that link Diet Sodas also to increased risk of Metabolic syndrome suggesting that artificial sweeteners may have a role in itself. 

So my recommendation to my patients is to limit one’s consumption to only 1 diet soda per day and if possible enjoy Water instead!

TV Time and the Kids

October 12, 2010

I have practiced limiting my kids TV times to only during the weekends.  This rule includes palying PSP or nintendo.  They only open the computer for assignments but never for games. So they resort to board games like scrabble, chess, Game of the generals and Mastermind Game.  My eldest also writes his own  ” book” about Clyde and Clod and he is now on his third series on these two characters.  This aside from finishing 3 ” do it your own” Diary of the Wimpy Kid book.  The two girls obviously followed.  Kids therefore can have other fun stuff to do and use their brains to think instead of a one sided affair with TV’s.  On occasions I allow them to play the Wii provided they sweat.  I dont bring them to my daily run this past few days because of the dengue scare especially I run aroung 5:30PM.   My wife also bought them Hullahoop where the kids except the youngest can now do the Hullahoop thing up to 400 counts…imagine the sweat!

My rule had basis after all….now comes a study published in Pediatrics  linking TV time to Psych problems and peer relationship problems.

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Objective: We hypothesized that greater screen use would be associated with greater psychological difficulties and that children with high levels of screen entertainment use and low levels of physical activity would have the most-negative psychological profiles.

Methods: Participants were 1013 children (age, mean ± SD: 10.95 ± 0.41 years), who self-reported average daily television hours and computer use and completed the Strengths and Difficulties Questionnaire. Sedentary time (minutes per day with <100 cpm) and moderate/vigorous physical activity (MVPA) (minutes with 2000 cpm) were measured by using accelerometers. Multivariate regression models examined the association between television viewing, computer use, sedentary time, and Strengths and Difficulties Questionnaire scores, with adjustment for MVPA, age, gender, level of deprivation, and pubertal status.

Results: Greater television and computer use were related to higher psychological difficulty scores after adjustment for MVPA, sedentary time, and confounders. However, sedentary time was inversely related to psychological difficulties after adjustment. Children who spent >2 hours per day watching television or using a computer were at increased risk of high levels of psychological difficulties (television, odds ratio [OR]: 1.61 [95% confidence interval [CI]: 1.20–2.15]; computer, OR: 1.59 [95% CI: 1.32–1.91]), and this risk increased if the children also failed to meet physical activity guidelines (television, OR: 1.70 [95% CI: 1.09–2.61]; computer, OR: 1.81 [95% CI: 1.02–3.20]).

Conclusion:

 Both television viewing and computer use are important independent targets for intervention for optimal well-being for children, irrespective of levels of MVPA or overall sedentary time.

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In short, allowing your kids to watch TV for more than two hours a day will result in them a 61%  risk  of having an increased  hyperactivity and emotional problems… PLUS difficulty in concentration and conduct problems which can be an issue with poor grades in school and peer problems with friends and classmates.

Now I see my kids grades getting better without the TV and more attention span.  I dont have to pressure them to read or study!   Plus the bonding time with them is better and great interaction with board games and fun!

Guys.. Discpline really works.  Just adhere to what you think is best for the kids…and once the rule becomes a habit…everything flows  smoothly!

Heres A Simple Way To Lose Weight…

September 11, 2010

Go to fullsize imageJust being too busy or just plain lazy, we have many excuses why we cant exercise.  Too stressed out at work gives us the reason to indulge in  food that we feel comfortable and happy.  But outcomes do matter and weight gain spells disaster.

We have heard of fad diets that do work but temporarily.  It still boils down to strict discipline and watching carefully what we eat and following the right regimen to the right activity.  We all know that… we heard that advice in the news, in the magazine so what esle is new?  Something that is simple and so close within your grabs but never thought about it?

Well heres something interesting and novel study  that was presented at the 2010 National Meeting of the American Chemical Society in Boston:

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The study included 48 adults between age 55 and 75 who were divided into two groups.  The study participants drank about 1.5 cups of water per day prior to joining in the study.

One group drank two cups of water before meals and the other didn’t. All participants ate a low-calorie diet throughout the study.

After 12 weeks, water drinkers lost about 15.5 pounds, compared to non-water-drinking dieters, who lost only 11 pounds.

Not only were those who drank water before meals more successful after 12 weeks, but they also kept “the weight off for a full year after the weight loss study.”  Even better, most water drinkers, followed for an additional 12 months, not only kept weight off but “even lost another 1 to 2 pounds”.

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The study is really not novel in idea but for the first time, a scientific study has been done to substantiate what I have been recommending to my patients who are diabetics and overweight.  It is a smple formula of dirinking water before each meal to allow one to feel full and therefore less hungry.  By doing so, one tends to be more careful with what one eats and therefore has the best  chance of losing weight or maintaining it.

Water is still the best to fill you up…. its available 24 hours and free.  How much water do I recommend one to take daily?

I recommend at least 8- 10 glasses of water for women and up to 14 glasses for men!

But remember.. to be successful means the triad of discipline, low calorie healthy food and the right amount of exercise! Now ADD Plenty of WATER!!!!

Simple regimen to lose weight…TRY IT!

Napping May Not Be Healthy After All….

August 23, 2010

Go to fullsize imageSiesta is still practiced by some of us up to now.  We take a break after lunch to take a nap to recharge and be back to work in the afternoon feeling fresh. But is this practice really healthy or can it cause harm instead?

A new study published in Sleep has this to say:

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Study Objective: Intentional napping is very common, particularly in China. However, there are limited data regarding its potential health effects. We therefore examined the possible relationship between napping and type 2 diabetes.
 

Design: Cross-sectional analysis of baseline data from the Guangzhou Biobank Cohort Study.

Setting: Community-based elderly association in Guangzhou, China.

Participants: 19,567 Chinese men and women aged 50 years or older.

Measurements and Results: Self-reported frequency of napping was obtained by questionnaire and type 2 diabetes was assessed by fasting blood glucose and/or self-reports of physician diagnosis or treatment. Participants reporting frequent naps (4-6 days/week and daily) were 42% to 52% more likely to have diabetes. The relationships remained essentially unchanged after adjustments were made for demographics, lifestyle and sleep habits, health status, adiposity, and metabolic markers (odds ratio for diabetes 1.36 [95% CI 1.17–1.57] in 4-6 days/week, 1.28 [1.15–1.44] in daily nappers). Similar associations were found between napping and impaired fasting glucose. Removal of those with potential ill health and daytime sleepiness did not alter the observed associations.

Conclusions: Napping is associated with elevated prevalence of diabetes and impaired fasting glucose in this older Chinese sample. Our finding suggests that it is less likely that diabetes leads to daytime sleepiness. This raises the possibility that napping may increase the risk of diabetes. Confirmation by longitudinal studies is needed.

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In the study approxiametly 2/3 of the napper took a nap just like everyopne else i.e. around 1 hour after lunch and usually lasts around 60 minutes. 

So I guess the population is really well represented as this is the usual behaviour of a typical napper. 

 What is important is that the longer and more frequent one naps, the higher the risk of developing diabetes.

The study confirms previous studies from the US and Germany regarding the association of napping and diabetes as well as all cause mortality or death.  Imagine trying to take a break to feel better and instead cuts down on your life span.  Something to think about! 

In Short: Napping may not be safe or healthy after all!!!

Coffee or Tea To Prevent Diabetes…

July 27, 2010

I have posted studies on coffee and tea as a way to prevent diabetes based on single study results.  Now comes a metaanalysis which compiles all data from  different studies to see if there are trends toaward prevention.  This new metaanalysis was published in  Archives of Internal Medicine this year:

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Background  Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus. Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes.

Methods  Relevant studies were identified through search engines using a combined text word and MeSH (Medical Subject Headings) search strategy. Prospective studies that reported an estimate of the association between coffee, decaffeinated coffee, or tea with incident diabetes between 1966 and July 2009.

Results  Data from 18 studies with information on 457 922 participants reported on the association between coffee consumption and diabetes. Six (N = 225 516) and 7 studies (N = 286 701) also reported estimates of the association between decaffeinated coffee and tea with diabetes, respectively. We found an inverse log-linear relationship between coffee consumption and subsequent risk of diabetes such that every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes relative risk, 0.93 [95% confidence interval, 0.91-0.95]) after adjustment for potential confounders.

 Conclusions  Owing to the presence of small-study bias, our results may represent an overestimate of the true magnitude of the association. Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes. The putative protective effects of these beverages warrant further investigation in randomized trials.

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 This study hypothesizes what we believe is a true association to the protective effect of coffee and tea in developing diabetes.

What is significant is the fact that so far no untoward problems have been encountered with drinking coffee except a benefit to preventing diabetes which may have a great implication to those at risk of the disease.

But dont forget…lifestyle change should continue to be the priority in the heirarchy of prevention.  Coffee is just an add on….

I will definitely continue to enjoy my cup of coffee every morning and another cup in the afternoon daily.  Decaf at night is tempting.

Another Reason To Exercise…

July 1, 2010

weight-loss.womendiary.net/pic/kids-exercise.jpgI really dont look at exercise as a way to lose weight. Definitiely it can help but the bottom line for weight loss is really restricting the amount of calories one takes in.  But the reality of exercise are the benefits one gets with it especially if done regularly.

I do exercise daily by jogging solely to maintain my weight to a normal level for my height because of my risk to develop diabetes due to a strong family history.

Recently in a report from the American Diabetes Association as reported in Medscape Endocrinology June 26, 2010 is a good study that looked at the effect of exercise in preventing diabetes:

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Obese boys who engaged in regular aerobic or resistance exercise — without dietary changes — had significant improvements over 3 months in their total body fat, visceral adipose tissue concentrations, and insulin sensitivity than their more sluggish counterparts.

The results were independent of the type of exercise assigned, and suggest that a moderate increase in activity (180 minutes per week) can help prevent type 2 diabetes mellitus in this high-risk population.

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In the study, whether aerobic or resistance training did not matter.  The insulin sensitivity analysis was the same in both groups although better with the resistance training group. 

Plus… this study only looked at the effect of exercise and risk for diabetes without restricting calorie intake.  Suggesting that exercise indeed can have tremendous benefical effects in preventing one from developing chronic medical metabolic conditions that can have long term complications.

There you go guys… another good reason to get going…grab your shoes and start running!

Cut Down on Sweetened Juice To Help Improve BP

June 14, 2010

Go to fullsize imageOne major aspect in controlling ones BP is to lower salt intake. Salt basically increases the reaction of the blood vessels to contrict or “close” - raise your BP then increase the pressure of the heart in pumping blood out of the circulation which in the long term cause heart failure or heart enlargement. As a precaution, we always warn patients from enjoying too much salt.

Now comes an interesting study published in Circulation in June 2010 looking at another aspect of food that we know should be avoided if one has high sugar…but now is known to affect and lower ones BP also.

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BACKGROUND: Increased consumption of sugar-sweetened beverages (SSBs) has been associated with an elevated risk of obesity, metabolic syndrome, and type II diabetes mellitus. However, the effects of SSB consumption on blood pressure (BP) are uncertain. The objective of this study was to determine the relationship between changes in SSB consumption and changes in BP among adults.

METHODS AND RESULTS: This was a prospective analysis of 810 adults who participated in the PREMIER Study (an 18-month behavioral intervention trial). BP and dietary intake (by two 24-hour recalls) were measured at baseline and at 6 and 18 months. Mixed-effects models were applied to estimate the changes in BP in responding to changes in SSB consumption. At baseline, mean SSB intake was 0.9+/-1.0 servings per day (10.5+/-11.9 fl oz/d), and mean systolic BP/diastolic BP was 134.9+/-9.6/84.8+/-4.2 mm Hg. After potential confounders were controlled for, a reduction in SSB of 1 serving per day was associated with a 1.8-mm Hg (95% confidence interval, 1.2 to 2.4) reduction in systolic BP and 1.1-mm Hg (95% confidence interval, 0.7 to 1.4) reduction in diastolic BP over 18 months. After additional adjustment for weight change over the same period, a reduction in SSB intake was still significantly associated with reductions in systolic and diastolic BPs (P<0.05). Reduced intake of sugars was also significantly associated with reduced BP. No association was found for diet beverage consumption or caffeine intake and BP. These findings suggest that sugars may be the nutrients that contribute to the observed association between SSB and BP.

CONCLUSIONS: Reduced consumption of SSB and sugars was significantly associated with reduced BP. Reducing SSB and sugar consumption may be an important dietary strategy to lower BP.

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What does this study tell us:

 That of the >800 adults in the study: that drinking one less sugar-sweetened beverage a day resulted in the lowering of both systolic and diastolic BP by about 1.2 mm Hg and 1.1 mm Hg  over 18 months period of observation.

I am actually not surprised by this relationship.  We all know, anytime a patient has high BP, I always make sure he is not at risk to become diabetic with high cholesterol since the three always come in groups and are always partners in crime. So controlling for one may result in the improvement of the other.  So any dietary intevention that I do for my patients incorporate for the control of the three conditions.

Remember: For every 3-mm-Hg reduction in systolic BP : the risk of dying from stroke is reduced by 8% and the risk of dying for heart disease is redcued by 5%.  So any small amount of decrement is worth it!

There you go guys: another reason to cut down on SUGAR!

Coffee or Tea Keeps Diabetes Away….

May 11, 2010

Anothe rgood news for coffee lovers like me… Now comes a new study agina showing the reduction in ones risk to develop diabetes.  The study was recently published in the Archives of Internal Medicine December issue

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Background  Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus. Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes. Methods  Relevant studies were identified through search engines using a combined text word and MeSH (Medical Subject Headings) search strategy. Prospective studies that reported an estimate of the association between coffee, decaffeinated coffee, or tea with incident diabetes between 1966 and July 2009.

Results  Data from 18 studies with information on 457 922 participants reported on the association between coffee consumption and diabetes. Six (N = 225 516) and 7 studies (N = 286 701) also reported estimates of the association between decaffeinated coffee and tea with diabetes, respectively. We found an inverse log-linear relationship between coffee consumption and subsequent risk of diabetes such that every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes relative risk, 0.93 [95% confidence interval, 0.91-0.95]) after adjustment for potential confounders.

Conclusions  Owing to the presence of small-study bias, our results may represent an overestimate of the true magnitude of the association. Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes. The putative protective effects of these beverages warrant further investigation in randomized trials.

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This study again shows same conclusion as in the past that a mere 4 cups of coffee per day whether regular or decaf has been shown to reduce ones risk to develop diabetes by 27%.  And what is interesting is that for every extra cup of coffee, an additional 7 % further reduction is risk to develop diabetes was noted.

The study therefore points out to one thing…that caffeine may not be the factor as decaf can result in similar reduction in risk.  Other chemicals present in coffee therefore need to be explored…. 

However…one should not resort to just relying on coffee to reduce our risk to develop diabetes.  We have to remember that lifestyle and proper food intake has been shown to reduce the risk of developing diabetes by a whoooping 50%….

There you go guys…enjoy our coffee!!!!

Is Running A Marathon Healthy?

March 26, 2010

I run leisurely… the most I have run is 5K and am happy to get the target below 30 minutes. I love the feeling of rush when you reach your goal target and I guess that’s what keeps marathoners going for more.  A lot of my friends are convincing me to run a marathon…I doubt if Ill ever do that.  A 42 K marathon…running for that long will probably take me 6 hours…hehe.  Anyway, the question that has always come to my mind is this: is running too long healthy or can it do harm long term? 

In the recent American College of Cardiology meeting, the question of distance running and its effect on health was discussed.  Ill quote the article published recently in Heartwire online:

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Presenting the results of the study at the American College of Cardiology (ACC) 2010 Scientific Sessions, Schwartz, along with senior investigator Dr Robert Schwartz (Minneapolis Heart Institute, MN), his father, said that at least three runners have died this year during marathons, and three runners died during the 2009 Detroit Marathon, a race that included nearly 4000 finishers. Runners are typically considered a healthy subgroup of the general population, so these deaths are usually high profile and attract a great deal of media attention. One recent estimate suggests the rate of sudden cardiac death among marathoners is rare, roughly 0.8 per 100 000 participants.

In this study, the father-and-son team, both runners, wanted to assess coronary artery plaque in an elite group of marathon runners and compare their arteries with a control group. They identified 25 runners who completed the Minneapolis-St Paul Twin Cities Marathon every year for 25 consecutive years, thus completing a minimum of 25 marathons.

All subjects underwent coronary computed tomography angiography (CTA) using a 64-slice machine. Compared with controls, marathoners had significantly more calcified plaque volume—274 mm3 for the marathoners and 169 mm3 for the controls—and higher calcium scores and noncalcified plaque volumes, although the latter two measures did not reach statistical significance.

patient age, systolic blood pressure, total cholesterol, LDL cholesterol, and triglyceride levels were similar between the marathoners and controls, but heart rate, weight, and body-mass index were lower in the runners. Also, HDL-cholesterol levels were significantly higher in the runners than in the controls. The average total- and LDL-cholesterol levels were 190 mg/dL and 115 mg/dL, respectively, in the marathon runners, suggesting that diet is not the reason for the increased calcification.

Jonathan Schwartz said they don’t know why the runners had more plaque in the arteries than the controls and that the findings are “counterintuitive.” However, he pointed out that metabolic and mechanical stresses might be a contributing factor. For example, long-distance runners train at increased heart rates and blood pressures, as well as spend increased time in an anaerobic state, possibly leading to antioxidant damage. Also, damage to the bones might lead to calcium leaking into the bloodstream. They stressed, however, such possible explanations need to be explored further.

Another study, also presented during the ACC meeting, suggested that marathon runners had increased aortic stiffness compared with individuals who exercised recreationally. The researchers, led by Dr Despina Kardara (Athens Medical School, Greece), evaluated blood pressure and aortic elasticity in 42 males and seven females who trained for and ran marathons and 46 men who did not participate in endurance exercise training. On average, the runners trained between two to nine hours per week and had been doing so for periods of 30 months to 21 years.

The marathon runners had significantly higher systolic blood pressure compared with the control group (126 mm Hg vs 115 mm Hg) and higher diastolic blood pressures. Pulse-wave velocity, used to assess aortic stiffness, was significantly higher in the marathon group.

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The findings however need further studies.  But suffice it to say that too much mechanical stress to any part of the body can do harm than good.   

I guess the take home message on this particular study is this:

Try not to push too hard in achieving your goal especially if it entails putting too much pressure on ones body especially the heart… Running is healthy as a form of exercise but anything we do and if we push ourselves to the limit may cause more harm than good.

If you run a marathon…dont stop.  Continue to enjoy it but again dont push yourself too hard….

Take Life In A Stride…!

Soft Drinks and Health….

March 1, 2010

More and more studies are linking the consumption of soft drinks to health hazards… a recent article published in Cancer, Epidimeology, Biomarkers and Prevention showed that consumption of thses sugary drinks can increase ones risk to develop pancreatic cnacer.

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Background: Sugar-sweetened carbonated beverages (called soft drinks) and juices, which have a high glycemic load relative to other foods and beverages, have been hypothesized as pancreatic cancer risk factors. However, data thus far are scarce, especially from non-European descent populations. We investigated whether higher consumption of soft drinks and juice increases the risk of pancreatic cancer in Chinese men and women.

Methods: A prospective cohort analysis was done to examine the association between soft drink and juice consumption and the risk of pancreatic cancer in 60,524 participants of the Singapore Chinese Health Study with up to 14 years of follow-up. Information on consumption of soft drinks, juice, and other dietary items, as well as lifestyle and environmental exposures, was collected through in-person interviews at recruitment. Pancreatic cancer cases and deaths were ascertained by record linkage of the cohort database with records of population-based Singapore Cancer Registry and the Singapore Registry of Births and Deaths.

Results: The first 14 years for the cohort resulted in cumulative 648,387 person-years and 140 incident pancreatic cancer cases. Individuals consuming ≥2 soft drinks/wk experienced a statistically significant increased risk of pancreatic cancer (hazard ratio, 1.87; 95% confidence interval, 1.10-3.15) compared with individuals who did not consume soft drinks after adjustment for potential confounders. There was no statistically significant association between juice consumption and risk of pancreatic cancer.

Conclusion: Regular consumption of soft drinks may play an independent role in the development of pancreatic cancer. Cancer Epidemiol Biomarkers Prev; 19(2); 447–55

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The study highlights the consumption of sugar laden soft drinks as a culprit but not other sugary fruit juices.  Other findings that I need to highlight include:

  • Smokers in the study  had a 49% increased risk for pancreatic cancer.  Another reason for one to consider stopping smoking.
  • A history of diabetes was not associated with an increased risk for pancreatic cancer.  But I would say…any diabetic should be screend for pancreatic cancer and this disease manifests a high blood suagr.
  • Drinking 2 or more soft drinks per week was associated with more than 80% increase in risk for pancreatic cancer after adjustment for other risks.  Now …. I know of some who drink soft drinks daily 2-3 x. Scary thought indeed!!!!  In short LIMIT!

Heres a confusing thought from the study though: after adjustment, juice intake of 2 or more drinks per week overall was not associated with increased risk, but when smokers were excluded, there was an association between juice intake and pancreatic cancer risk increasing a persons risk by 60%.  More studies need to be done to examine this relationship. 

So friends…just like my reminder all the time… Limit and limit and not totally eliminate!

We still dont know what is really in the soft drinks that make us unwell.  For now… enjoy it but limit the consumption to sugar free Diet soft drinks. 

Better still enjoy the water!  its FREE!

Parents: WE Still RULE

February 13, 2010

 Go to fullsize imageWhile coming back from San Francisco after attending the postgrad course of the American Diabetes Association, I happened to read a very nice article in USA today on: Teenagers do Listen.  I will be having a teenager son soon, so I was intrigued about the article.

 The article discussed a recent media survey by Kaiser Family Foundation that showed typical kids spend as much as 7 hours and 38 minutes a day consuming entertainment media like TV, computer and game consoles.  Not surprisingly why obesity is now a main global concern with our kids high tech lifestyle.

 But what was astounding about the survey was that the kids whose parents set the rule plugged in to the media for only 3 hours suggesting parents have a big influence on our kids in terms of what they do and think.

 Other studies likewise have shown that activities and behavior of kids are mainly influence by their parents:

 1. Teens who had a bedtime at 10PM or earlier set by parents got more sleep and were less likely to be depressed published in Sleep in January.

2. Teen drivers whose parents set and enforced rules were more likely to wear seat belts and less likely to suffer road accidents including the use of cellphones while driving published in Pediatrics in September.

3.Teens whose parent also set the rules also smoke less, delay sex and do better in school.

 The reality is… Teenagers care deeply about what their parents say… the challenge is getting across the rules and boundaries that don’t seem controlling!

 There you go guys.  It’s not too late. 

Let’s GIVE MORE  time to communicate with our kids…be it while eating dinner together or while driving our kids to school or while bringing them back home. The notion that fewer rules mean lesser fights may not be right after all.  The welfare of our kids continue to be a priority because for me…

What they will become is a reflection of how good we are AS  parents!!!

Exercise and High Blood Pressure

January 29, 2010

We all know that both diet and exercise are important.  We know they work together to help keep our body healy. Pure determination to succeed and discipline are the two keys to help keep and manage our body’s health.

Recently a new article published in the Archives of Internal Medicine ,January 2010, showed that diet alone may not be as effective as diet PLUS exercise in helping control ones blood pressure.

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BACKGROUND: Although the DASH (Dietary Approaches to Stop Hypertension) diet has been shown to lower blood pressure (BP) in short-term feeding studies, it has not been shown to lower BP among free-living individuals, nor has it been shown to alter cardiovascular biomarkers of risk.

OBJECTIVE: To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension (systolic BP, 130-159 mm Hg; or diastolic BP, 85-99 mm Hg).

DESIGN AND SETTING: Randomized, controlled trial in a tertiary care medical center with assessments at baseline and 4 months. Enrollment began October 29, 2003, and ended July 28, 2008. PARTICIPANTS: Overweight or obese, unmedicated outpatients with high BP (N = 144).

INTERVENTIONS: Usual diet controls, DASH diet alone, and DASH diet plus weight management.

OUTCOME MEASURES: The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring. Secondary outcomes included pulse wave velocity, flow-mediated dilation of the brachial artery, baroreflex sensitivity, and left ventricular mass.

 RESULTS: Clinic-measured BP was reduced by 16.1/9.9 mm Hg (DASH plus weight management); 11.2/7.5 mm (DASH alone); and 3.4/3.8 mm (usual diet controls) (P < .001). A similar pattern was observed for ambulatory BP (P < .05). Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity, baroreflex sensitivity, and left ventricular mass (all P < .05).

CONCLUSION: For overweight or obese persons with above-normal BP, the addition of exercise and weight loss to the DASH diet resulted in even larger BP reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass.

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The above study showed that the famed DASH diet should be combined with exercise and weight loss to result in greater BP reductions than just the DASH diet by itself or usual diet.   Likewise the study showed based on some biochemical markers that weight management augmented the cardiovascular benefits of the DASH diet.

Overall this study tells us the importance of including behavioral modification and lifestyle programs for patients with high blood pressure.  This is an important study result because the combination of diet and exercise should remain the cornerstone of therapy of any chronic diseases associated with high blood pressure including diabetes and high cholesterol.

Another reason to EXERCISE!!!!

Diet Sodas and Your Kidneys… BEWARE!

December 17, 2009

Drinking soad is not really helping people achieve a healthier lifestyle.  They contain no vitamins or macronutrients except artificial flavoring, sodium ,artifical color and sweetener.  People drink soda instead of water or milk or the healthier tea.

Now comes some no to good  health news relating to intake of diet soda and kidney function. 

During the recent convention of the American Society of Nephrology comes a novel finding of diet soda and kidney function.  The study from Brigham and Women’s Hospital in Bosto involving 3,256 women, median age of 67 participating in the Nurses’ Health Study were involved.  Apparently, there is an association between increase intake of diet soda and the decline in kidney function apprently related to the sodium content.

Results of the study showed that women who drank diet soda > 2 cns a day resulted in a 30% decline of kidney function which was considered significant.  The results persisted even after considering other factors, such as age, physical activity, high blood pressure, and diabetes.

No link howevere was ssen among women who took less than 2 diet sodas per day.

Implications of the study:  Some women I know use diet sodas to help them lose weight.  To help them reduce their cravings for food and to make feel full easily.  It may be true that they contain zero caloris but now concerns regarding the food additives, the artificial coloring and the high sodium content of these drinks may cause harm.

Long term prospective studies however need to be done to determine the exact culprit of the decline…. but for now…suffice it to say taht diet sodas will always be at the bottom of the health food pyramid…and should never be used as a substitute for milk or water.

So this Christmas season…maybe a can every not so often will suffice.  Even during this merry holiday season, lets not forget that health is still a priority and  for me…. the best gift I can offer to myself!

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