Archive for the 'Personal Thoughts' Category
Are All Sugars The Same?
January 11, 2013Calcium Supplements May Not Be That Safe After All….
April 25, 2011It has always been my practice to make sure women take their daily calcium supplements to prevent osteoporosis. It is my contention that by building bone the right way and preventing a fracture is very important health issue. It is recommended by diffirent medical societies that calcium supplements be given between 1000- 1200 mg per day.
Now comes a new study showing proofs that calcium supplements may not be that safe after all. A study published in BMJ in JUly 2010 with a reanalysis done in 2011 showed that calcium supplementation should be reviewed due to inherent harm.
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Abstract
OBJECTIVE:
To investigate whether calcium supplements increase the risk of cardiovascular events.
DESIGN:
Patient level and trial level meta-analyses.
DATA SOURCES:
Medline, Embase, and Cochrane Central Register of Controlled Trials (1966-March 2010), reference lists of meta-analyses of calcium supplements, and two clinical trial registries. Initial searches were carried out in November 2007, with electronic database searches repeated in March 2010.
STUDY SELECTION:
Eligible studies were randomised, placebo controlled trials of calcium supplements (>or=500 mg/day), with 100 or more participants of mean age more than 40 years and study duration more than one year. The lead authors of eligible trials supplied data. Cardiovascular outcomes were obtained from self reports, hospital admissions, and death certificates.
RESULTS:
15 trials were eligible for inclusion, five with patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035). Non-significant increases occurred in the incidence of stroke (1.20, 0.96 to 1.50, P=0.11), the composite end point of myocardial infarction, stroke, or sudden death (1.18, 1.00 to 1.39, P=0.057), and death (1.09, 0.96 to 1.23, P=0.18). The meta-analysis of trial level data showed similar results: 296 people had a myocardial infarction (166 allocated to calcium, 130 to placebo), with an increased incidence of myocardial infarction in those allocated to calcium (pooled relative risk 1.27, 95% confidence interval 1.01 to 1.59, P=0.038).
CONCLUSIONS:
Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.
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The reanalysis of this study done recently and published in the same journal showed that the risk of MI is actualy MODEST at best around 20% for MI and 30% for stroke BUT… considering the huge number of women doctors have been recommending to take calcium supplements… justify a further close look at this practice as this will have enormous impact on health care risk.
For the past year…I have not been recommending calcium supplements to my patients especially my diabetic hypertensive patients. I make sure that my dietitian supplements their diet with enough calcium sources from food and milk. If need be, those patients who cant take enough from food are the ones given the supplements but this number is becoming less each day.
If you are taking calcium supplements on your own , my recommendation is to stop. If you are taking the supplements as part of your osteoporosis program then talk to your doctor first before stopping.
Heres A Simple Way To Lose Weight…
September 11, 2010
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!
Coffee or Tea To Prevent Diabetes…
July 27, 2010I 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.
Cut Down on Sweetened Juice To Help Improve BP
June 14, 2010
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!
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 
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!!!
To My Medical Students..Past and Present
January 7, 2010
I just had the chance to teach the third year medical students again at Cebu Doctor’s University College of Medicine, my alma mater, this afternoon. I find it interesting how these students interact and how they intently listened to every word I said. I always find it fun to teach and lecture on people who are eager to learn be it the medical students, the residents or fellow doctors. I give lectures here and abroad but the best audience are those that you know are there because they want to learn. And the ones that are there are present because they believe they will go out of the lecture hall with hopes of getting something important from you!!! Is there pressure in giving lectures to medical students? I guess… they are the most critical.
At Cebu Doctor’s, I just learned each student critics the professor at every lecture. I really dont know my score yet hehehe but I guess this practice is great for the teachers to know if they need to change their teaching skills. But am pretty confident with my skills having been voted “Teacher of the Year” by New York Medical College Medical students when I was there during my residency years. For those who will be visiting my website…any feedback? bad or good is welcome!!!
I thank all my students old and new… because seeing you become doctors and successful in your own practice is worth our effort in spending time preparing for our lecture making sure they’re easy to comprehend, easy to digest and worthy of your time. And seeing you blossom to be great doctors in the future is all worth it! Just dont forget to say thank you to those who made marks in your life and who inspired you to be better!
Teaching for me is a great way to share knowledge. I am blessed to have been taught in an institution where sharing of knowledge is the priority. I guess that’s what made my alma mater the Mayo Clinic world famous and that I will forever be indebted in the way medicine is taught and practiced in that institution which I hope I will continue to share to my students, residents and fellow doctors in my everyday life.
Diet Sodas and Your Kidneys… BEWARE!
December 17, 2009Drinking 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!
How Much Exercise is Needed to Lose the FAT?
November 26, 2009
It has been known that losing weight is a game of discipline and balance… Balance between food intake and physical activity.
But what is not known is how much activity is needed to lose the fat inside the viscera or abdomen known to be the Bad Fat! Remember if you want to lose weight: the equation is more toward lesser intake of FOOD… while If you want physical conditining and maintenance of weight, the balance points more to physical activity.
Now comes this interesting data that looked at this particular question. How much exercise does one need to lose fat? The study was published in journal Obesity, Oct 8, 2009
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The purpose of this study was to determine what effect aerobic and resistance exercise training has on gain of visceral fat during the year following weight loss.
After being randomly assigned to aerobic training, resistance training, or no exercise training, 45 European-American (EA) and 52 African-American (AA) women lost 12.3 
2.5 kg on a 800 kcal/day diet. Computed tomography was used to measure abdominal subcutaneous and visceral adipose tissue, whereas total fat and regional fat (leg, arm, and trunk) were measured by dual energy X-ray absorptiometry after weight loss and 1 year following the weight loss. Because not all the subjects adhered to the 2 time/week 40 min/day exercise training during the 1-year follow-up, subjects were divided into five groups for analysis: aerobic adherers, aerobic nonadherers, resistance adherers, resistance nonadherers, and no exercise.
No significant differences were observed between the aerobic training and resistance training adherers for any variable. However, the aerobic (3.1 kg) and resistance (3.9 kg) exercise adherers gained less weight than any of the other three groups (all >6.2 kg).
In addition, the two exercise adherence groups did not significantly increase visceral fat (<0.8%) as compared with the 38% increase for the two nonadhering exercise groups and the 25% for the nonexercise group.
In Conclusion:
As little as 80 min/week aerobic or resistance training had modest positive effects on preventing weight regain following a diet-induced weight loss. More importantly, both aerobic and resistance training prevented regain of potentially harmful visceral fat.
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I have been a believer of this fact… that relying heavily on physical activity alone to help one lose weight is doomed to fail. One needs to brisk walk for example around 70 minutes to burn 250 calories while eating french fries in a 5 minute snack time will already give you 320 calories!!!!
The above study points out the balance between cutting calories and physical activity. The mere 80min per week exercise resulted in the prevention of weight regain after a diet induced weight loss … especially the prevention of the regain of the visceral fat which is considered the Bad fat!
Now that is definitely not difficult to do!!!! How much more if we do physical activity on a daily basis? Once you get used to it…you’re hooked.
An example of being hooked: Just last night for example, I have to be in a symposium to give a lecture to cardiologists…but I really squeezed in at least a 20 min run prior to preparing for my talk…boy was it exhilirating to have sweat it out and boy was it refreshing afterwards!
No more excuses….
A little of something is better than Nothing….
Running and The Risk of Joint Disease…. Will My Jogging Cause Arthritis?
November 9, 2009
Not necessarily….
A 14 year prospective longitudinal study published in Arthritis Research and Therapy involving 961 men and women, aged 50 and over, found results that will be good news to us runners all over the world. I am not really a “runner” like my good friend Yong Larrazabal of the Cebu Doc Group of Hospitals but I do jog daily around 4k as my form of physical activity.
The study below clearly showed that “exercise was associated with a substantial and significant reduction in pain even after adjusting for gender, baseline BMI, and attrition”. Read on………
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We studied the long term impact of running and other aerobic exercise on musculoskeletal pain in a cohort of healthy aging male and female seniors who had been followed for 14 years.
We conducted a prospective, longitudinal study in 866 Runners’ Association members (n = 492) and community controls (n = 374). Subjects were also categorized as Ever-Runners (n = 565) and Never-Runners (n = 301) to include runners who had stopped running.
Pain was the primary outcome measure and was assessed in annual surveys on a double-anchored visual analogue scale (0 to 100; 0 = no pain). Baseline differences between Runners’ Association members and community controls and between Ever-Runners versus Never-Runners were compared using chi-square and t-tests. Statistical adjustments for age, body mass index (BMI), gender, health behaviors, history of arthritis and comorbid conditions were performed using generalized estimating equations.
Runner’s Association members were younger (62 versus 65 years, p < 0.05), had a lower BMI (22.9 versus 24.2, p < 0.05), and less arthritis (35% versus 41%, p > 0.05) than community controls. Runners’ Association members averaged far more exercise minutes per week (314 versus 123, p < 0.05) and miles run per week (26 versus 2, p < 0.05) and tended to report more fractures (53% versus 47%, p > 0.05) than controls. Ever-Runners were younger (62 versus 66 years, p < 0.05), had lower BMI (23.0 versus 24.3, p < 0.05), and less arthritis (35% versus 43%, p < 0.05) than Never-Runners. Ever-Runners averaged more exercise minutes per week (291 versus 120, p < 0.05) and miles run per week (23 versus 1, p < 0.05) and reported a few more fractures (52% versus 48%, p > 0.05) than Never-Runners.
- Exercise was associated with significantly lower pain scores over time in the Runners’ Association group after adjusting for gender, baseline BMI, and study attrition (p < 0.01). Similar differences were observed for Ever-Runners versus Never-Runners.
- Consistent exercise patterns over the long term in physically active seniors are associated with about 25% less musculoskeletal pain than reported by more sedentary controls, either by calendar year or by cumulative area-under-the-curve pain over average ages of 62 to 76 years.
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The above study only further confirms what other studies have shown in regards to the relationship between greater physical activity and the associated less pain and disability associated with a higher health related quality of life. These studies refute the earlier claims and excuses of non exercisers that long term… runners will have debilitating arthritis or joint diseases! For me…they are mere excuses for those who lead a sedentary lifestyle.
An analogy to this finding would be our recommendations for people with heart attack. A stressful activity may trigger the event BUT the long term risk is decreased by more activity. As more physical activties with lifestyle change have been shown to be helpful long term in reducing risk for chronic debilitating diseases.
Take Home message of this all:
- It is the “ too little activity over time” that may in fact be the primary cause of a large percentage of musculoskeletal injuries and NOT the other way around!
- With the worldwide epidemic of obesity, diabetes and Hypertension, it is but prudent to suggest that too much exercise is not the major public health problem… rather it is the Inactivty that is a Problem and the associated diseases that come with it!
Remember….All the studies have proven so far that on the contrary… the more once moves the joints, the stronger they become to withstand injuries long term suggesting that indeed….
Lifetime physical activity Is Protective… to your joints, muscles and the whole physical being!
So guys…let’s all enjoy running!!!
Weight Loss and Health….
November 6, 2009
Now the good news….
The main reason for my weight loss through lifestyle change is my aim to reduce my risk to develop diabetes in the future. After a scary 96 mg/dl fasting blood sugar during my annual executive checkup, I pushed myself to achieve my ideal BMI becuase apparently I was overweight.
Now as published in Lancet this October 29, 2009, the long term Diabetes Prevention Program extended study showed long term benefits of modest weight loss through lifestyle as better in preventing the progression of the disease compared to intake of medication called Metformin.
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Background
In the 2·8 years of the Diabetes Prevention Program (DPP) randomised clinical trial, diabetes incidence in high-risk adults was reduced by 58% with intensive lifestyle intervention and by 31% with metformin, compared with placebo. We investigated the persistence of these effects in the long term.
Methods
All active DPP participants were eligible for continued follow-up. 2766 of 3150 (88%) enrolled for a median additional follow-up of 5·7 years (IQR 5·5—5·8). 910 participants were from the lifestyle, 924 from the metformin, and 932 were from the original placebo groups. On the basis of the benefits from the intensive lifestyle intervention in the DPP, all three groups were offered group-implemented lifestyle intervention. Metformin treatment was continued in the original metformin group (850 mg twice daily as tolerated), with participants unmasked to assignment, and the original lifestyle intervention group was offered additional lifestyle support. The primary outcome was development of diabetes according to American Diabetes Association criteria. Analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00038727.
Findings
During the 10·0-year (IQR 9·0—10·5) follow-up since randomisation to DPP, the original lifestyle group lost, then partly regained weight. The modest weight loss with metformin was maintained. Diabetes incidence rates during the DPP were 4·8 cases per 100 person-years (95% CI 4·1—5·7) in the intensive lifestyle intervention group, 7·8 (6·8—8·8) in the metformin group, and 11·0 (9·8—12·3) in the placebo group. Diabetes incidence rates in this follow-up study were similar between treatment groups: 5·9 per 100 person-years (5·1—6·8) for lifestyle, 4·9 (4·2—5·7) for metformin, and 5·6 (4·8—6·5) for placebo. Diabetes incidence in the 10 years since DPP randomisation was reduced by 34% (24—42) in the lifestyle group and 18% (7—28) in the metformin group compared with placebo.
Interpretation
During follow-up after DPP, incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group, but the cumulative incidence of diabetes remained lowest in the lifestyle group. Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years.
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The study clearly shows that weight loss through lifestyle changes can significantly reduce ones risk to develop diabetes by as much as 34%.
The Intensive lifestyle changes in the study consisted of lowering fat and calories in the diet and increasing regular physical activity to 150 minutes per week. Most exercise was in a form of walking. Modest weight loss was around 15 lbs in the first year but overtime regained them all but 5 lbs over the next 10 years. I guess this shows that lifestyle really is difficult for some to maintain.
What matters most for this study is that lifestyle change through fitness and nutrition really works. The only problem is how one can maintain to be active throughout ones life and how one can withstand the sight of FOOOOD!!!!
For me….Its a matter of discipline and focus… The two main ingredients to achieving success through behavioral modification. Clinically, the measure of success is when one is able to maintain the weight loss beyond 1 year of intervention. Losing weight in 6 months is good…but gaining them back in the next 6 months is bad…..
The Facts are here… the Benefits are known… The rest now depends on YOU!
Walking versus Jogging
October 12, 2009
Walking as an exercise is the simplest form of activity. I used to walk at least 4x a week. That has been my form of exercise eversince I decided to emabark on a healthy lifestyle. BUT I was not really consistent in doing so. There was always a reason for me not to do it this day or the next day.
But when I started a new regimen of activity after I had a blood sugar of 96 ( with my strong family hist0ry and being the youngest of 9 with a diabetic mother: my risk is pretty high)…and a BMI of 26…I was definitely overweight… I found the differerence between simply brisk walking and running or actually jogging.
I only jog. Meaning leisurely running 5 km per hour. I posted my regimen before as the WOG: where I Walk and Jog but for the past several months Ive elevated the activity to all- jogging for 45 min per day.
The difference in terms of stamina, ” the feeling good” after the exercise and the “urge” to do it again the next day was something I did not feel whan I was brisk walking. The sweating was 100 x more and the ” good sense of well being” feeling after the exercise was experienced even more! I guess the endorphins are really kicking in when you sweat more and do more strenuous activities than just by simply walking without sweating it out!
The added factor to this exercise activity is of coure the maintenance of ones weight. So far with my diet regimen and my jogging, Ive successfully maintained my weight and BMI of 22.
So guys… which is better?
Try it yourself and you make a choice. Whatever your choice is …both are great activities to keep you healthy!
The Thigh and The Heart…Where’s The Connection?
September 21, 2009
Check your thighs… are they thin or thick? big or small?
Now get a tape measure and read on…..
An intriguing study published in the British Medical Journal made me think….
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Objective To examine associations between thigh circumference and incident cardiovascular disease and coronary heart disease and total mortality.
Design Prospective observational cohort study with Cox proportional hazards model and restricted cubic splines.
Setting Random subset of adults in Denmark.
Participants 1436 men and 1380 women participating in the Danish MONICA project, examined in 1987-8 for height, weight, and thigh, hip, and waist circumference, and body composition by impedance.
Main outcome measures 10 year incidence of cardiovascular and coronary heart disease and 12.5 years of follow-up for total death.
Results:
- A small thigh circumference was associated with an increased risk of cardiovascular and coronary heart diseases and total mortality in both men and women.
- A threshold effect for thigh circumference was evident, with greatly increased risk of premature death below around 60 cm.
- Above the threshold there seemed to be no additional benefit of having larger thighs in either sex.
- These findings were independent of abdominal and general obesity, lifestyle, and cardiovascular risk factors such as blood pressure and lipid concentration.
Conclusions:
- A low thigh circumference seems to be associated with an increased risk of developing heart disease or premature death.
- The adverse effects of small thighs might be related to too little muscle mass in the region.
- The measure of thigh circumference might be a relevant anthropometric measure to help general practitioners in early identification of individuals at an increased risk of premature morbidity and mortality.
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What is interesting of this study is the finding that the risk to cardiovascular disease was in fact more highly related to thigh circumference than to waist circumference.
Now therefore…we have a very simple way of determining based on a method we can easily do anywhere pt measure and assess ones risk!
The CUT OFF size is 60 cm…that’s the magic number …anything smaller is harmful so the study says….
Will the risk reverse once we increase the circumference of the thighs? Again …the whole picture of a healthy lifestyle still is the best way to combat chronic diseases and heart disease.
But for now, thinner thighs mean lesser muscle mass which may mean insulin may not work properly and therefore can predispose this individual to diseases like diabetes and high blood pressure. In this study, the people with a thigh measurement of less than 46.5 centimetres (18 inches)had roughly double the chances of getting heart and circulation problems or dying during the study.
So what needs to be done? If you have a small thighs you can do something about it!!!!
Exercise!!!
Another reason for us to move and work out!
Obesity and Bullying…
September 10, 2009
In one study that looked at overweight children, 60% of boys reported being bullied in school. Whether children report the incident to their parents or not is another matter.
So when I give a talk on obesity and the risks associated with having overweight kids, I also emphasize not only the medical aspect of the problem but aso the psychosocial problems associated with childhood obesity.
Recently a report on the effect of bullying in children was publ;ished in Archives of General Psychiatry, September 7, 2009 issue. It showed that a history of being a victim of bullying at age 8 years among females independently predicted psychiatric hospital treatment and use of antipsychotic, antidepressant and anxiolytic drugs… this association was regardless of psychiatric problems at baseline.
Among males on the other hand , victims of frequent bullying predicted the future use of antidepressant and anxiolytic drugs as well as increase psychiatric hospital treatment and use of antipsychotics.
This new study clearly emphasizes the need for parents to further look at how we feed our children becuase giving in to their desires and wants rather than need can mean a future that is filled with medical risks.
The association of being overweight and being targets of bullying cant be over emphasized. There should be a stop somewhere and it should start within the confines of our home…
Teaching them the right amount and the right kind of food means a better future for them both physically and emotionally.
How To Eat and Live Longer….
September 3, 2009People have been looking for the miracle pill to live longer. Cosmetic surgeries are on the rise because of vanity and the desire to feel and look young. Healthy lifestyle through proper food choices have always been advocated by different medical societies as the way to go BUT finding the right choices of food and the most practical activities to do remain elusive to most.
The so called Mediterranean diet has long been touted as having shown to have the most healthy components in terms of food choices. Recently in a population based study done in Greece published in British Medical Journal, June, 2009, Mediterranean diet appeared to contribute to increased longetivity.
After a mean follow-up of 8.5 years, there were more deaths among individuals who were on low Mediterranean diet components than among individuals whose diet components were high of the Mediterranean-diet. Furthermore, the study was able to teased out the contribution of each component to low mortality:
- moderate consumption of alcohol (23.5% of the effect),
- low consumption of meat (16.6%),
- high consumption of vegetables (16.2%),
- high consumption of fruits and nuts (11.2%),
- high monounsaturated-to-saturated lipid ratio (10.6%), and
- high consumption of legumes (9.7%).
The study suggested therefore that the largest effects on reduced mortality came from drinking moderate amounts of alcohol equivalent to five small glasses of wine (10 g/day to less than 50 g/day) for men and half that for women as well as eating little meat while eating lots of vegetables, eating fruits and nuts, and using olive oil. It is however very important to note that the individual components of the Mediterranean diet gave an additive protective effect to the overall mortality. The study suggests that it is still the overall dietary habit that will determine whether your diet is healthy and can lead to longer life than just relying on the health benefits of an individual diet component.
So change to a healthier lifestyle with five servings of vegetables, three to four servings of fruits, nuts a day, lots of vegetables, less meat and moderate amount of the so called French Paradox: Wine
Toast To A Long Life!!!
US Best Hospitals: Where To Go for the Best Care and Where To Train…
July 30, 2009
It is noteworthy to share with you the recent ranking of the US Best Hospitals.
This post will help us make wise decisions where in the US can we get the best care… and the best specialty training for those planning to go the US for further studies.
New Rankings of the 2009 Best US Hospitals
from WebMD — a health information Web site for patients
Hospitals are listed below by total points. Here are the 21 hospitals that made the magazine’s honor roll (two are tied for 10th place):
- Johns Hopkins Hospital, Baltimore
- Mayo Clinic, Rochester, Minn.
- Ronald Reagan UCLA Medical Center, Los Angeles
- Cleveland Clinic
- Massachusetts General, Boston
- New York-Presbyterian University Hospital of Columbia and Cornell
- University of California-San Francisco Medical Center
- Hospital of the University of Pennsylvania, Philadelphia
- Barnes-Jewish Hospital/Washington University, St. Louis
- Brigham and Women’s Hospital, Boston
- Duke University Medical Center, Durham, N.C.
- University of Washington Medical Center, Seattle
- UPMC-University of Pittsburgh Medical Center
- University of Michigan Hospitals and Health Centers, Ann Arbor
- Stanford Hospital and Clinics, Stanford, Calif.
- Vanderbilt University Medical Center, Nashville, Tenn.
- New York University Medical Center
- Yale-New Haven Hospital, New Haven, Conn.
- Mount Sinai Medical Center, New York
- Methodist Hospital, Houston
- Ohio State University Hospital, Columbus
Top Hospitals by Specialty
Here are the No. 1 hospitals in each specialty, according to U.S. News and World Report:
- Cancer: M.D. Anderson Center, University of Texas, Houston
- Diabetes and endocrine disorders: Mayo Clinic, Rochester, Minn.
- Digestive disorders: Mayo Clinic
- Ear, nose, throat: Johns Hopkins Hospital, Baltimore
- Geriatric care: Ronald Reagan UCLA Medical Center, Los Angeles
- Gynecology: Brigham and Women’s Hospital, Boston
- Heart and heart surgery: Cleveland Clinic
- Kidney disorders: Brigham and Women’s Hospital
- Neurology and neurosurgery: Mayo Clinic
- Ophthalmology: Bascon Palmer Eye Institute, University of Miami
- Orthopaedics: Mayo Clinic
- Psychiatry: Massachusetts General, Boston
- Rehabilitation: Rehabilitation Institute of Chicago
- Respiratory disorders: National Jewish Hospital, Denver
- Rheumatology: Johns Hopkins Hospital
- Urology: Johns Hopkins Hospital
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Johns and Hopkins and the Mayo Clinic have been consistent topnotcher with only few points separating the two. And their ranking have been the same since the time I had the privilege to train at the Mayo Clinic for my Endocrinology Fellowship from 1993 to 1996.
Consistency with the best of care and the best team for specialty training therefore is the name of the game!
And having grabbed the opportunity to be part of a great system and to be trained by great teachers will forever be one of the best achievements of my career!
The Benefits of Exercise Go Beyond Prevention….
July 23, 2009
We all know the benefits of exercise. It has been shown to afford a better lifestyle due to prevention of chronic diseases associated with sedentary behavior.
What we dont know is how following a rigorous physical activity and being FIT can have an impact on a patients recovery from certain illnesses that unfortunately can happen due to the NON modifiable risk factors like family history and age!
A study from the Mayo Clinic published in BMJ this month shows us that indeed the benefits of exercise can go beyond Prevention:
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Background: The importance of physical activity as a modifiable risk factor for stroke in particular and cardiovascular disease in general is well documented. The effect of exercise on stroke severity and stroke outcomes is less clear. This study aimed to assess that effect.
Methods: Data collected for patients enrolled in the Ischemic Stroke Genetics Study were reviewed for prestroke self-reported levels of activity and 4 measures of stroke outcome assessed at enrollment and approximately 3 months after enrollment. Logistic regression was used to assess the association between physical activity and stroke outcomes, unadjusted and adjusted for patient characteristics.
Results: A total of 673 patients were enrolled; 50.5% reported aerobic physical activity less than once a week, 28.5% reported aerobic physical activity 1 to 3 times weekly, and 21% reported aerobic physical activity 4 times a week or more. Patients with moderate and high levels of physical activity were more likely to have higher Barthel Index (BI) scores at enrollment. A similar association was detected for the Oxford Handicap Scale (OHS). After 3 months of follow-up, moderate activity was still associated with a high BI score. No significant association was detected for activity and the OHS or Glasgow Outcome Scale at follow-up after adjustment for patient characteristics.
Conclusions: Higher levels of self-reported prestroke physical activity may be associated with functional advantages after stroke. Our findings should be seen as exploratory, requiring confirmation, ideally in a longitudinal study of exercise in an older population.
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Theoritically, the study results are obvious in that according to the author….”A brain that generally has good blood and oxygen flow from aerobic exercise will be in a better position to compensate for neurological deficits caused by a stroke.”
The results also say it all: that Exercise indded can be beneficial in all phases of the disease from prevention to recovery.
Among patients who reported less exercise in the year before their stroke those individuals were significantly more likely to have one or more bad outcomes while those who were into moderate to high levels of activity, the odds of a better outcome were higher.
Likewise, in terms of recovery and functional capacity post stroke after three months , individuals who had both moderate and high exercise levels were associated with significantly better functional outcomes. Great News specially to our diabetic patients who love to exercise!
There you go… the many wonders of exercise !!!
You Get Everything GOOD with EXERCISE!
The 20-40 RULE in Fitness and Disease
July 13, 2009
My 20-40 rule:
A low fitness level in your teens translate to a high level of risk for developing diabetes by age 40!
That’s the message I got from this study published in Diabetes Care called the CARDIA Fitness Study.
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Objective: Test the association of fitness changes over 7- and 20-years on the development of diabetes in middle-age.
Research Design and Methods: Fitness was determined based on the duration of a maximal graded exercise treadmill test (Balke protocol) at up to three examinations over 20-years from 3989 black and white men and women from the Coronary Artery Risk Development in Young Adults study. Relative fitness change (%) was calculated as the difference between baseline and follow-up treadmill duration/baseline treadmill duration. Diabetes was identified as fasting glucose ≥126 mg/dL, post-load glucose ≥200 mg/dL, or use of diabetes medications.
Results:
- Diabetes developed at a rate of 4 per 1000 person-years in women (n=149) and men (n=122) and lower baseline fitness was associated with a higher incidence of diabetes in all race-sex groups (hazard ratios from 1.8 to 2.3).
- On average, fitness declined 7.6% in women and 9.2% in men over 7 years.
- The likelihood of developing diabetes increased per standard deviation decrease (19%) from the 7-year population mean change (−8.3%) was in women (hazard ratio [HR]=1.22, 95% CI: 1.09, 1.39) and men (HR=1.45, 95% CI: 1.20, 1.75) following adjustment for age, race, smoking, family history of diabetes, baseline fitness, body mass index (BMI), and fasting glucose.
- Participants who developed diabetes over 20 years experienced significantly larger declines in relative fitness over 20 years vs those who did not..
Conclusions: Low fitness is significantly associated with diabetes incidence and explained in large part by the relationship between fitness and BMI.
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This study shows that inidviduals risk to develop lifestyle related diseases especially diabetes are at increasing overtime depending on the level of fitness:
- Women were at 22% increased risk of developing diabetes
- men were at a 45% increased risk…
for every standard deviation decrease from the mean fitness change. This relationship continued to exists even after adjusting for age, smoking, family history of diabetes, and baseline fasting glucose. In fact the researchers noted that the baseline BMI was a better predictor for developing diabetes than the baseline fasting glucose as well as baseline fitness.
What Do These Data MEAN?
- If two individuals have similar fitness level; the bigger person with a higher BMI is more likely to develop diabetes than the smaller frame guy overtime in the next 10-20 years.
- The possible mechanism by which fitness decreases risk for diabetes is most likely related to the regulation of body mass. A lower BMI means better insulin sensitivity and less production of toxic substances by increased adiposity that can lead to further cardiovascular complications associated with obesity and diabetes.
The authors conlcuded:
That regular physical activity to “improve and maintain cardiorespiratory fitness is an important component of a healthy lifestyle.”
AMEN!
Walk and Jog or The WOG… A Perfect Exercise!!!
July 7, 2009
Can we call it the WOG? Short for Walk and Jog!!!
Ive been a brisk walker for sometime. I find it a good exercise that’s not too tiring nor too destructive for my joints. But overtime, after several articles touting the benefits of short bouts of exercise in between breaks that I thought of trying to alternate my walking exercise with jogging.
The intensity of exercise is more…the surge of adrenaline is more and boy…you feel better and better everytime you do the routine. Lots and lots of sweat too! Besides, you allow you body to rest in between the jogging by brisk walking.
Jogging being a high-intensity exercise kicks your metabolism up and by doing so, your metabolic rate stays up longer (five times longer after a vigorous workout than after an easy one). By doing the same routine, one therefore tends to add up the number of calories burned because the jogging can easily add up another 200 calories compared to walking alone.
Here’s what I do:
Before I walk, warming up by stretching the muscles is very important. Then I start my brisk walking slowly increasing the pace until I start jogging.
I then do the alternate walk and jog routine every 3 minutes until 40 to 40 minutes!!!!
Initially it may seem “laborious” compared to walking alone but soon…you will be running a marathon as the running becomes easier. But at this time, I have no plans to pursue a running career! I just want to burn more calories and make myself healthier and hopefully avoid myself getting the risk of developing diabetes!
To stay Fit and Slim…Discipline is the KEY!
You are What You Eat and Do the WOG!
Know The HEALTH FACTS ... Because WEALTH THRU PERSONAL HEALTH is a COMMITMENT... NOT A CHOICE!
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