Archive for August, 2007

Can Coffee Prevent Skin Cancer?

August 30, 2007

coffee_drinker_print_web.jpgI was asked whether drinking coffee would be better than drinking caffeineated soda.  Trying to cut down on coffee but increasing intake of the diet soda may in fact not be a good idea because of the many studies linking coffee and health benefits.

A new study showed that a cup of coffee before going to work especially after a morning exercise can be healthy especially for the skin. This study published in the Proceedings of the National Academy of Sciences, July 30, 2007,  shows the combination of caffeine and regular exercise “appears to help kill some of the precancerous cells damaged by the sun’s ultraviolet-B (UVB) radiation.”

The study was done using mice where one group of mice drank the human equivalent of two cups of coffee a day while the other group voluntarily ran , and a third did both.  All the subjects were then exposed to UV radiation from lamps that damaged their skin cells.

Results: The rate of cell death among the precancerous cells was highest in the group that drank caffeine and exercised.

Implications: If precancerous cells destined to be cancer can be aborted by whatever mechanism then it has a tremendous impact in the prevention of disease.  This new data therefore is promising because this shows that drinking coffee can probably be of benefit to the prevention of skin cancer.

This is just one of the many health benefits now attributed to drinking coffee.  Is it the caffeine itself or also the coffee in itself that has benefits need to be answered.

So Grab A Cup and Enjoy The Taste for Health!

Read My Other Related Articles:

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Why Men Can Be Happier ( or Healthier) Than Women…

August 28, 2007

3316430238.jpgI got this funny and I guess truthful statements of why men can be happier than women. 

But does this translate as to why men get to hospital or see a doctor lesser than women? Are they healthier?  Probably not… it’s the mens’ attitudes (probably in our genes) that we are invincible to the harm of nature that accepting the truth of vulnerability is not an accepted norm !

But nonetheless…I have to agree that men can actually be happier than women.  Read this and you’ll know why…..

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Why Men are just happier people.

What do you expect from such simple creatures? Your last name stays put. The garage is all yours. Wedding plans take care of themselves. Chocolate is just another snack. You can be President. You can never be pregnant. You can wear a white T-shirt to a water park. You can wear NO shirt to a water park. Car mechanics tell you the truth.

The world is your urinal. You never have to drive to another gas station restroom because this one is just too icky. You don’t have to stop and think of which way to turn a nut on a bolt. Same work, more pay. Wrinkles add character. Greying hair adds attraction. Wedding dress~$5000. Tux rental~$100. People never stare at your chest when you’re talking to them. The occasional well-rendered belch is practically expected. New shoes don’t cut, blister, or mangle! your feet. One mood all the time. Phone conversations are over in 30 seconds flat. You know stuff about tanks.

A five-day vacation requires only one suitcase. You can open all your own jars. You get extra credit for the slightest act of thoughtfulness. If someone forgets to invite you, he or she can still be your friend. Your underwear is $8.95 for a three-pack. Three pairs of shoes are more than enough. You almost never have strap problems in public. You are unable to see wrinkles in your clothes.

Everything on your face stays its original color. The same hairstyle lasts for years, maybe decades. You only have to shave your face and neck. You can play with toys all your life. Your belly usually hides your big hips. One wallet and one pair of shoes one color for all seasons. You can wear shorts no matter how your legs look. You can “do” your nails with a pocket knife. You have freedom of choice concerning growing a mustache. You can do Christmas shopping for 25 relatives on December 24 in 25 minutes.

No wonder men are happier. Send this to the women who can handle it and to the men who will enjoy reading it.

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To Jimmy, thanks for sending this to me.  It made me smile this early of the day.  Humor is FUN and Healthy . And probably to my friends, a little humor to start your day can make this day a better one than the rest!

Let your voices be heard…to those who agree or disagree….

Just A Plate A Meal…To Make You Lose Weight

August 27, 2007

I’ve been counseling my patients with regard to a meal that they should only eat the foods that can fit in a plate and that’s it! I have written about it here in my website: The Will Power To Stop the Urge To Eat suggesting that the food should consist of rice, 2 slices of meat, 2 cups of vegetables and a fruit.  I was actually happy to know that a August 2007  article in the Harvard Health Letter recommends the same concept:

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Balance your plate

Balance Your Plate

A balanced plate helps you reduce your total calories, reduce the saturated fat and carbohydrates in your diet, and increase heart-healthy nutrients like antioxidants, B vitamins, and fiber.

It’s also important to make sure you’re getting all the important nutrients your body needs. Here’s an easy way to see if you’re eating a well-balanced meal. As you prepare or serve your food, think of a three-section plate.

In the big section (half of the plate), serve yourself two different vegetables or a vegetable and a fruit. In one of the two smaller sections (a quarter of the plate), put a serving of fish, poultry, beans (like black, pinto, or kidney beans), or another healthy protein. Fill the remaining section with a whole grain, such as brown rice or a whole-wheat roll, or another healthy carbohydrate.

As you divide your plate, keep in mind that vegetables are not all the same. Starchy vegetables-sweet potatoes, peas, corn, and winter squash-have about triple the amount of calories and carbohydrates as nonstarchy vegetables. So reserve the vegetable section for the likes of broccoli, leafy greens, tomatoes, carrots, and green beans. And put starchy (but nutrient-filled) vegetables in the carbohydrate quarter.

A balanced plate helps you reduce your total calories, reduce the saturated fat and carbohydrates in your diet, and increase heart-healthy nutrients like antioxidants, B vitamins, and fiber.

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Simple and Balanced… Easy to remember.  It is the concept and remembering it that counts.  I have been sticking to this simple formula for a long time and I myself is doing this to limit and balance my meals.  Likewise this is one way to limit intake and therefore lose weight.

BUT on very important maneuver to do to make this diet a success is to avoid further visual stimulation by leaving the table after consuming the food in the plate!  Otherwise the temptation to eat more will overcome the discipline to eat the balanced meal prepared on the plate!  Guilty? 

A Balanced Diet In A Plate For Health!

The Importance of An Annual Check Up

August 25, 2007

2713261149.jpgDo we need annual physical exam? Why and How soon?

Actually there is still an ongoing debate as to whether annual exam is necessary or helpful.  Several institutions have abandoned the requirement of subjecting healthy subjects to this annual routine.  But in a recent survey published in the Archives of Internal Medicine … majority of the doctors and patients alike i.e. 9 out 10 surveyed out of the 800 still believe that annual physical exam do more benefits than harm.

In a recent publication from the Annals of Internal Medicine, Feb 2007 issue, a study was done to determine if indeed it is beneficial to have one:

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Data Synthesis: The best available evidence assessing benefits or harms of the Physical Health Exam or PHE consisted of 21 studies published from 1973 to 2004. The PHE had a consistently beneficial association with patient receipt of gynecologic examinations and Papanicolaou smears, cholesterol screening, and fecal occult blood testing. The PHE also had a beneficial effect on patient “worry” in 1 randomized, controlled trial but had mixed effects on other clinical outcomes and costs.

Conclusions: Evidence suggests that the PHE improves delivery of some recommended preventive services and may lessen patient worry. Although additional research is needed to clarify the long-term benefits, harms, and costs of receiving the PHE, evidence of benefits in this study justifies implementation of the PHE in clinical practice.

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This study has showned that one or more well visits per year may actually be beneficial to patients and doctors alike by improving patient- doctor relationship as well as alleviate patient’ worries.

By having an annual exam, one is able to check the onset of certain conditions where the abnormality will not show symptoms but may manifest initially with a biochemical or laboratory abnormality.  Healthy subjects specifically with a family history of known inherited conditions like diabetes, hypertension or high cholesterol will definitely benefit by having one.  More so with patients whose parents have a history of tumors or cancers of whatever organ should have routine annual exam.

Routine tests that have been shown to be beneficial in screening includes a fasting blood sugar, liver function tests, lipid profile to check cholesterol, occult blood and urinalysis.  Certain procedures like pap smear and breast exam for women are also beneficial since early detection and diagnosis of cancer have a big impact in terms of disability and survival.  What’s more, there did not appear to be any harm associated with period health exams, including undergoing inappropriate tests or excessive costs.

So when should one have an annual health exam? 

  • If you have a family history of chronic diseases like diabetes or heart disease … I would recommend to do the exam ealrier after the age of 30.  Majority of heart attacks is due to diabetes and the early a diagnosis of diabetes is done the better is the outcome in terms of control and prevention of complications. 
  • Between the age of 40 to 50 if you have a family history of certain tumors where occult blood testing or flexible sigmoidoscopy would be helpful
  • Otherwise after the age of 50 should be a reasonable age to do the annual exam for an otherwise healthy individual.

As the saying goes: 

It Is Better To Be Early Than Sorry…

Grapefruit and Your Medications…

August 24, 2007

2592766622.jpgIt is very important that one should be careful with food to drug or drug to drug interactions.  It is for this reason that as physicians, we are so careful in allowing our patients to take any medications without our knowledge.  Chinese medications for example can be a headache because patients can just buy them anywhere.  They work BUT what do they contain and what are the side effects?

Similar problems can be encountered with foods like fruits.  Take grapefuit as an example. I was asked this question several times so I thought of sharing this information to all.

There’s no question that grapefruit juice provides many nutrients, such as vitamin C and lycopene or fiber that can help lower cholesterol and triglyserides.  But  the pulp and the peel can also contain chemicals that can affect the actions of certain medications by interfering with the enzymes that break down the drugs in your digestive system. This interaction can be deleterious as the patient can have an excessively high levels of the active drug compound resulting in an increased risk of serious side effects.

This caution includes dietary supplements that contain grapefruit bioflavonoids – because in itself…it can also interact with certain medications. So be sure to read labels of your viatmins that may contain this compound.

Below is the list of drugs that one should avoid if you are a fan of grapefruit or better still take caution with these drugs if you eat grapefruit.  The list came from the Mayo Clinic Health Site.

Grapefruit and drug interactions
The following drugs are known to have potentially serious interactions with grapefruit products, tangelos and Seville oranges.
Drug name Type of drug
Carbamazepine (Carbatrol, Tegretol) An anti-seizure medication
Buspirone (BuSpar), clomipramine (Anafranil) and sertraline (Zoloft) Antidepressants
Diazepam (Valium), triazolam (Halcion) Tranquilizers
Felodipine (Plendil), nifedipine (Adalat, Procardia), nimodipine (Nimotop), nisoldipine (Sular) and possibly verapamil (Isoptin, Verelan) Calcium channel blockers used to treat high blood pressure
Saquinavir (Invirase) and indinavir (Crixivan) HIV medications
Simvastatin (Zocor), lovastatin (Mevacor, Altoprev) and atorvastatin (Lipitor), simvastatin-ezetimibe (Vytorin) HMG-CoA reductase inhibitors used to treat high cholesterol
Cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf) and sirolimus (Rapamune) Immunosuppressant drugs
Amiodarone (Cordarone) A drug used to treat and prevent abnormal heart rhythms (arrhythmias)
Methadone Pain relief medication
Sildenafil (Viagra) Erectile dysfunction medication

Other sources of Vitamin C like oranges, and lemons are okay to eat and have not been shown to affect drug levels.

Remember, the effect of this food to drug interaction can last from 1 to 3 days so please advise your doctors especially if you are taking certain drugs whose level if they go up can have serious effects like the blood thinning medication warfarin or coumadin.

The bottom like is: … dont take anything without checking!  Please be very cautious in taking supplements or chinese medications. Check with your doctors first.  Dont believe your friends or the advertisers that they’re safe!

I guess it’s the same thing in business and personal relationships … dont get into something that you are not sure of because trouble will hit you and hit you HARD!!!!

Better To Be Sure Than SORRY!

Foods To Avoid If You Have Migraine

August 23, 2007

249069055.jpgMigraine is not an uncommon complaint among friends and patients.  It is pretty bothersome, and can make your day irritating and stressful.  It can occur anytime if a a trigger food is ingested.  These headaches usually start  within 20-25 minutes after consuming these products.  You may notice it coming if you start complaining of  pressure in the chest and in the face, sometimes burning sensation in the chest, neck or shoulders accompanied by facial flushing and dizziness.  The headache can occur across the front or sides of the head.  Some patients may complain of feeling nauseated due to the associated dizziness.  Treating this headache can also be challenging as simple paracetamol may not do the trick.  Preventing the occurence of this headache is therefore of paramount importance to avoid having a bad day ahead!

So which specific food triggers have been shown to be the culprits and therefore should be avoided:

  • Tyramine containing foods found natu.rally in aged cheeses, and also found in red wine, alcoholic drinks, and some processed meats.
  • Food additives/preservatives like nitrates and nitrites found in hot dogs, ham, sausage, and other processed or cured meats.
  • Monosodium glutamate (MSG) in Chinese food.
  • Alcohol — specifically the impurities in alcohol or by-products your body produces as it metabolizes alcohol.  Culprits include red wine, beer, whiskey and champagne
  • Caffeine: coffee, chocolate, tea, colas, sodas
  • Pepperoni, hot dogs, luncheon meats
  • Bread and other baked goods and crackers
  • Dried fruits
  • Smoked or dried fish
  • Potato chips
  • Pizza, peanuts, peanut butter
  • chicken livers, and other specific foods and

Likewise for my diabetics…artificial sweeteners like aspartame can be bad triggers of headaches.  Also to be avoided are any COLD beverages especially after an exercise. Sensitivity to ice cream has been reported among migraine sufferers so avoid the temptation!

Trigger Free To Be Migraine Free!

Why You Should Not Take Supplements….

August 22, 2007

imagesghy.jpgSupplements are always promoted as healthy alternatives to the usual medications doctors prescribe.  The marketeers are always advertising the products as devoid of any side effects because they come from “natural sources” of which the labeling may not actually tell us what they are and where they come from.  But almost always our patients are “tricked” into buying them because of the ads on TV or radio based on testimonials that they can cure a variety of ailments or based on the “convincing” strategy of the expert sellers. 

The US FDA and local BFAD have been very lenient with this multi-billion dollar industry in terms of limiting their exposure to the public lest their products can harm.  Instead you see them proliferating with seals of aproval from these agencies as” approved by BFAD”.  Although there is always a label ” No Therapeutic Claim” but who reads them when all the patients hear are the blubbering testimonials and ads on TV and radios….

One recent example of what can happen if these products go undetected is the recent warning of a supplement which actually contained an Anticholesterol agent.  Although the product is approved for use as a drug…but if it is present in a supplement, the patients taking them may not mind checking for possible side effects trusting the sellers of the product as side effect free!

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FDA Warns Consumers to Avoid Red Yeast Rice Products Promoted on Internet as Treatments for High Cholesterol


The U.S. Food and Drug Administration is warning consumers not to buy or eat three red yeast rice products promoted and sold on Web sites. The products may contain an unauthorized drug that could be harmful to health. The products are promoted as dietary supplements for treating high cholesterol.

The potentially harmful products are: Red Yeast Rice and Red Yeast Rice/Policosonal Complex, sold by Swanson Healthcare Products, Inc. and manufactured by Nature’s Value Inc. and Kabco Inc., respectively; and Cholestrix, sold by Sunburst Biorganics. FDA testing revealed the products contain lovastatin, the active pharmaceutical ingredient in Mevacor, a prescription drug approved for marketing in the United States as a treatment for high cholesterol.

“This risk is even more serious because consumers may not know the side effects associated with lovastatin and the fact that it can adversely interact with other medications,” said Steven Galson, M.D., M.P.H., director of FDA’s Center for Drug Evaluation and Research.

These red yeast rice products are a threat to health because the possibility exists that lovastatin can cause severe muscle problems leading to kidney impairment. This risk is greater in patients who take higher doses of lovastatin or who take lovastatin and other medicines that increase the risk of muscle adverse reactions. These medicines include the antidepressant nefazodone, certain antibiotics, drugs used to treat fungal infections and HIV infections, and other cholesterol-lowering medications.

FDA has issued warning letters advising Swanson and Sunburst Biorganics to stop promoting and selling the products. Companies that do not resolve violations in FDA warning letters risk enforcement actions, such as an injunction against continuing violations and a seizure of illegal products.

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There you go… this is only one of the many that we see patients getting complications either of the liver or the kidney arising from taking supplements. As physicians we can not go after anybody since the supplemetns are bought by patients at their own free will. 

The local BFAD however should be more careful in approving supplements and should have more teeth to penalize companies that promote these products as drugs which are now being done extensively.  Just watch your cable TV and you’ll be bombarded by ads on the numerous illnesses that these supplements can heal!

Be Smart…Know The Real From The Fake!

Read My Other Related Articles:

  1. The FDA Rules On Dietary Supplements
  2. Beware of the Weight Loss Myth
  3. What You Need To Know About Dietary Supplements
  4. The Harmless Herbs?

The Opportunity to Learn More….

August 21, 2007

imagesq1.jpgA tidbit news: It is but interesting to note that my alma mater where I trained my endocrinology fellowship continues to lord over the rest of the IVY League institutions since the 1997.  Below is the list of the Best Hospitals in Endocrinology….

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U.S. News has ranked 173 hospitals in 16 specialties.                                                                           

  1.  Mayo Clinic, Rochester, Minn.      
  2.  Massachusetts General Hospital, Boston  
  3. Johns Hopkins Hospital, Baltimore                             
  4. University of California, SF Medical Center       
  5. New York-Presbyterian
  6. Cleveland Clinic                                                           
  7.  Washington University, St. Louis                                
  8. University of Virginia Medical Center                         
  9. Brigham and Women’s Hospital, Boston                      
  10. Hospital University of Pennsylvania                          

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Ones professional training whether it may be music, culture or medicine will always be part of ones life… It will be engrained in ones DNA.  And wherever you are and whatever you do, you will always carry with you the name of the institution that made you who you are.

Once a rare opportunity knocks …  grab it! And not because of luck but because one strives to get it… through hard work and dedication- then you deserve it!

My belief is that one should not settle for less but to aim for what is the best in field!  I will be going for my third preceptorship this November at UCSF and Stanford in Endocrinology.  I was at Harvard in 2004 and Johns Hopkins in 2005 for the same preceptorship program. For me nothing beats Mayo Clinic!  But the opportunity to have been trained by the #1 Endocrinology Hospital and the chance to be sent for preceptorship training in the top 2 and 3 hospital and again this november to UCSF- Stanford Program is a rare opportunity that I will not fail to grab and look forward to learning what they can offer.

In life we should not stop to learn and learn.  That’s what I teach my kids.  It is through learning and exploring that we get smarter and wiser! Never give yourself a break from learning new things!  It may come from reading books, your travels or your meetings with other people.  For me to continue learning is the other meaning of happiness from within!

Grab Whatever Opportunity You Have To Learn…

Obesity Can Spread Among Friends….

August 20, 2007

v8chmcaa05ticcak5yizmca823xazcafcorr9cau78ovncabxtl0pcazrko7ecaf2w095ca5k5nuxca5ged70ca3tp5t0ca8cc9bocaouwo3hcazf6mzccauuysvrcahe8nawca7phliscaild0s8.jpgA family with obese children is a pretty common sight.  The family may have the same set of genes but it’s the relationship among family members that count…the way they spend time together or the way they choose the lifestyle from the kind of food to the kind of leisurely activities.  So I always counsel my patients to be extra careful with what they choose to eat or keep in the fridge because those are the choices that their kids will have for the rest of their lives…and they may have devastating outcome!

Now comes a study that proves the social networking not only affect close relatives but also friends….. A recent online publication of the Premier Journal of Medicine: The New England Journal of Medicine July 26, 2007 issue reported the effect of having friends who are obese….

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 Methods:  The authors evaluated a densely interconnected social network of 12,067 people assessed repeatedly from 1971 to 2003 as part of the Framingham Heart Study. The body-mass index was available for all subjects. We used longitudinal statistical models to examine whether weight gain in one person was associated with weight gain in his or her friends, siblings, spouse, and neighbors.

Results:

  1. A person’s chances of becoming obese increased by 57% (95% confidence interval [CI], 6 to 123) if he or she had a friend who became obese in a given interval.
  2. Among pairs of adult siblings, if one sibling became obese, the chance that the other would become obese increased by 40% (95% CI, 21 to 60).
  3. If one spouse became obese, the likelihood that the other spouse would become obese increased by 37% (95% CI, 7 to 73).
  4. These effects were not seen among neighbors in the immediate geographic location.
  5. Persons of the same sex had relatively greater influence on each other than those of the opposite sex.
  6. The spread of smoking cessation did not account for the spread of obesity in the network.

Conclusions:  Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. __________________________________________________________________________________________________

These findings have implications for clinical and public health interventions.  It’s the social networking that really makes a difference…whether the influence is positive or negative.  Teaching kids the right way from the way they choose : the kind of food… to the kind of friends… to the kind of activities… should start from the young!

The authors’ summary of their report says it all: 

The spread of obesity in social networks appears to be a factor in the obesity epidemic. Yet the relevance of social influence also suggests that it may be possible to harness this same force to slow the spread of obesity. Network phenomena might be exploited to spread positive health behaviors, in part because people’s perceptions of their own risk of illness may depend on the people around them.”

As the saying goes….. 

Tell Me Who Your Friends Are…And I’ll Tell You Who You Are!

BYETTA and Weight Loss

August 18, 2007

imageslo.jpgExtensive research is being done in the field of Diabetes. The prevalence of this disease is just increasing worldwide and expected to reach 333 million by year 2025.  The scary thought coupled with difficulty in getting drugs invented and approved can make this a big epidemic in the future.

As new drugs come…some are worth it some are not.  The avandia scare made everyone realized that any drug no matter how great will always have side effects.  Any avandia taker should have realized that any patient with heart failure should not take the drug because it can worsen the condition.  

So what’s with this new agent called Byetta?  Is it all worth the hype?

Discovered from the Saliva of a Gila monster…Exenatide (Byetta) was just recently approved by the Food and Drug Administration in April 2005 for the treatment of type 2 diabetes. It was just recently launcehd in the Philippines. It is to be taken as an injection but although it is an injection, Byetta is not insulin!!!

Byetta improves blood sugar control by mimicking the action of the hormone incretin called GLP1 which allows insulin to work more effectively in the body.  The good thing with Byetta is that it also helps in preventing the further destruction of the Beta cells which are the cells that produce insulin.  It is this defect that remains unabated by current medications that will make a patient require insulin in the long run.  Now we have drugs that are proven to help prevent these cells from deteriorating including Rosiglitazone, Pioglitazone and now Byetta.

What is the Major Side effect of Byetta that as endocrinologist and patients alike like? It’s the WEIGHT LOSS! Finally we have a good drug that does not make a patient gain weight but instead lose weight. Its the downside that’s actually a PLUS! A weight loss of around 10 to 12 lbs can be achieved and sustained long term. A report from the New York Times mentioned about a patient who lost 60 lbs after Byetta use…  BUT… dont use this drug as a weight loss agent because this has not yet been studied for that purpose and the safety of this agent for non diabetics is not yet known.

Cost however is pretty prohibitive so better discuss this option with your doctors to assess benefit cost ratio.

Do I recommend this drug?  Yes I do and have started using this agent already. It was just recently launched at the AACE Philippine Chapter meeting in Shangrila and few doctors have been given the privilege to start using this drug for their patients by Eilly Lilly.  Its something new and revolutionary thus am writing about this in my website.  The New York Times Calls It: The Ray of Hope

For more information on Byetta: check out this site: www.byetta.com

The Gila Monster and the Man in Byetta!

The Many Benefits of Walking…

August 17, 2007

imagesedg.jpgIs walking good? Is it enough as an exercise? Or Do we need to do more intense exercise to achieve benefit?  I love to walk…it’s my form of physical activity every afternoon after work.  I have fun doing it walking around the house or around our subdivision.  You can enjoy the view while walking… you can do it anytime and anywhere and the most important of all is that…It is FREE!

Dr James Levine who is a colleague of mine at the Mayo Clinic wrote a nice editorial at the

Mayo Clinic Proceedings based on this news report from the Mayo Clinic newsroom:

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“Getting out there and taking a walk is what it’s all about,” says James Levine, M.D., Ph.D., and a Mayo Clinic expert on obesity. “You don’t have to join a gym, you don’t have to check your pulse. You just have to switch off the TV, get off the sofa and go for a walk.”

The health benefit associated with walking is the subject of Dr. Levine’s editorial in the July issue of Mayo Clinic Proceedings. Dr. Levine’s piece is entitled, “Exercise: A Walk in the Park?” and accompanies a Proceedings article that showcases the merits of walking as beneficial exercise.

The study, undertaken by physicians from the Shinshu University Graduate School of Medicine in Matsumoto, Japan, determined that high-intensity interval walking may protect against high blood pressure and decreased muscle strength among older people.

Over five months, the Japanese researchers studied 246 adults who engaged in either no walking or moderate to high-intensity walking. The group who engaged in high-intensity walking experienced the most significant improvement in their health, the researchers found. In his editorial, Dr. Levine says the study lends credence to the notion that walking is a legitimate, worthy mode of exercise for all people. Dr. Levine says it’s a welcome message for his patients, who fight obesity and appreciate that a walk is one way to improve their health.

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It is therefore a package deal…you walk…you exercise as well as keep your health in control. There is no way I will accept any patient of mine telling me he has no time to exercise because walking can be done anywhere and anytime!

Do it now and this very minute… after reading this article…turn off your computer or TV for a while and take a stroll.  In simple terms…Just move.  It is much better than staying put and be sedentary.

Life is too short…enjoy your surroundings and walk because once you get the dreaded complication of obesity and diabetes which is a stroke or heart failure…you will end up in bed for the rest of life anyway…by then…you will miss walking!

Take A Step Forward Now For Health!

Can Avandia Cause Heart Attack? A Fact or A Fiction….

August 16, 2007

2749016741.jpgJust came back from Manila just this morning where I was one of the 5 invited speakers to share our views on the Avandia meta-analysis that sparked the controversy of this drug.  It was a well organized meeting and a very fruitful one as delegates ( enodcrinologists and diabetologists from all over the Philippines)  went home more enlightend by the fact tat avandia is actually safe or even safer than the other drugs sold in the market.

The highlight of the meeting was a detailed analysis of the article by Niesen published in NEJM in May 2007 by Dr Cecilia Gimeno who is herself an endocrinologist and a clinical epidemiologist from UP-PGH.

She highlighted why meta anaysis cant be trusted and what the flaws were in the article’s calculation of the statistics and data gathering.

TAKE HOME messages form the meeting which I want to share to my readers and patients as well:

  1. The Meta analysis was not a good study since it compiled several small studies lump together to generate a bigger population BUT with each study had a different patient population with different outcomes ( not cardiovascular ) and had small number of subjects of short duration ( < 6 m).
  2. The statistical analysis was flawed including omission of certain studies with no MI or CV deaths.  The exact nature of heart attack or death was not determined since the authors did not have the luxury of examining the data…they solely relied on results given to them. Did the patients take their other meds like for cholesterol or high blood pressure which in themselves can increase ones risk for heart attack and stroke?
  3. Recalculation of the flawed statistics and numbers resulted in an almost the same risk of heart attack of patients on avandia and other drugs!!!!
  4. The studies included in the analysis were short term ( < 6 m) … and short term studies do not predict long term results.  Similar problems were encountered by Metformin, Sulfonylureas and Pioglitazone where initial < 1 year studies showed increased heart attack risk but long term studies after 5-6 years showed benefit!
  5. The 3 big prospective studies on avandia (ADOPT, DREAM and RECORD) which are randomized involving >4000 patients are true OUTcome studies which help clinicians formulate our treatment approach and which can be trusted showed that Avandia use is not associated with increased risk of heart attack compared to metformin or sulfonylurea!  In fact the use of a sulfonylurea was assessed to have higher cardiovascular death than avandia.  These studies are however masked by the controversy of one study of which the medical community deems contain numerous flaws!

My Conclusion of this matter

That Avandia is safe and is not associated with any increase in Heart Attack risk. 

Remember a patient with Diabetes in itself is already a Cardiovascular equivalent :  a Diabetic is equivalent to a ” non diabetic with a heart attack” in terms of his risk for cardiovascular mortality.  And if we consider the data of the Meta analysis as acceptable: the absolute risk is very small: a 0.1% absolute risk only…meaning 1 heart attack for every 1000 patients on avandia… BUT since the analysis was flawed… the absolute risk therefore of a patient on Avandia is really much lower than 0.1%  and the patient’s risk for heart attack is most likely just the inherent risk for being a Diabetic and nothing else!

For me it would be unfortunate if the benefits of this drug which includes: reducing ones risk to develop diabetes by 60 % ( DREAM) and reducing one risk to progression of diabetes by 60% compared to a sulfonylurea and 30% compared to a metformin (ADOPT) … are masked by this turn of events based on a flawed study!!!!

A Fact Can Harm If It Is Actually A Fiction!

Alcohol Lowers Blood Pressure and Heart Attack Risk…

August 14, 2007

3161158791.jpgAfter a hectic schedule or meeting or after a stressful event …one gets invited for a drink!  And one of the common questions I get from friends or patients alike is the question of how BAD is alcohol to one’s body Or how much alcohol can they take.

Alcohol for a diabetic patients is a no-no if one is poorly controlled BUT once the blood glucose is well controlled… alcohol can be made part of the total caloric load as long as it doesnt exceed 2 drinks a day! And this is true to patients with hypertension or cholesterol problems as well.

I came across a very good article from the Harvard Health Letter which I want to share.  Aparently, drinking alcohol can have beneficial effects on one’s blood pressure and the risk of heart attack!

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Lay off alcohol is one of the first things people with newly diagnosed high blood pressure are told. Alcohol can cause high blood pressure as well as contribute to it. Abstinence, though, might not be necessary, and may even deny some folks a pleasurable way to ward off heart attacks.

A long-term study of male health professionals suggests that responsible, moderate drinking may benefit people with high blood pressure. In a study published in the January 2, 2007, Annals of Internal Medicine, only 4.9% of the men with high blood pressure who classified themselves as moderate drinkers (one or two drinks a day) had a heart attack during 16 years of follow-up, compared with 6.7% of nondrinkers. That’s about a 25% reduction in heart attack risk. The results are similar to a study of male doctors, which showed fewer deaths due to cardiovascular disease among moderate drinkers than nondrinkers over a five-year period.

Keep in mind that this work shows the average response to alcohol. How it affects you depends on your genes, metabolism, diet, and medications, as well as you and your family’s relationship with alcohol.A drink a day won’t help your blood pressure. (If you are concerned about it, use a home blood pressure monitor that’s been checked at your doctor’s office to make sure it is accurate.) But along with a healthful lifestyle, moderate drinking could protect you from one of its feared effects — a heart attack.

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Again…. the old cliche…

 

Be Safe…Drink in Moderation!

 

 

 

 

The Success Story of Hard Work…

August 13, 2007

p8101997.jpgThe AACE – Philippine Chapter annual convention came to a close yesterday.  It was and will be a great learning experience for me as a member of the organizing committee and in charge of inviting the foreign speakers.  The members really did a good job and simply put…it was hard work that was actually full of fun. 

I guess the looks and the comments of the attendees and from our friends in pharmaceutical industry were more than enough for us to now start thinking how we can do much better next year!

c305scd1.jpgMy other assignment was to make sure my “sons” ( invited foreign speakers in photo) were all well fed and literally well!  Lucky me, they were so impressed with our program, the venue and the orgnization as a whole.  Dr Gharib who is currently the President Elect of the American College of Endocrinology and my mentor will write about us in The Messenger which is a publication of the AACE – US for all members all over the world to know what transpired and how the meeting met all the mother society’s vision of advocacy and education.

We spent sleepless nights but were all worth it.  Our togetherness the-friends.jpgand comarderie even strenghened…more so, as our expected attendance ballooned from an expected 120 doctors to more than 400!!!!  We were just literally overwhelmed!  Dr Steven Petak ( in photo) who is the Past President of the AACE even announced that our meeting should be made a model for the rest of the world to pattern and in fact said in his talk… that he is learning from us and will suggest some changes to be made by the US AACE meetings to pattern after AACE Philippines! What a complement!

All in all…it was FUN, Factual and Fulfilling!  Will I do it Again?  YES! Not only did I learn a lot about friendship with my colleagues and our pharmaceuticual friends, but also the great learning from all the great talks we heard during the convention are good reasons for me to do it again! Dr Litonjua who is the founding mentor and adviser and President Emeritus of the organization wants us to do it again in Cebu!

Overall…our petite President DR George Tan did a fantastic job! He endured the most of the pains and challenges along the way but they made him stronger in the end and the fruits of his labor bore fruit…and it was a great success!

So to all those who made the affair a success… Thank You!

See You All Again in Cebu Next Year!

To Help Teach and Spread Knowledge…

August 8, 2007

2145155937.jpgIt will be a busy week for me starting tomorrow.  I will pick a friend and a mentor at the Mayo Clinic who has accepted my invitation to speak during our Annual Convention of the American Association of Clinical Endocrinologists- Philippine Chapter: our first ever here in Cebu.  He will do it gratis…meaning without honorarium.  What a man and what a legacy.

And being the host, I hope my friends from Manila and our foreign speakers will not be disappointed with the preparations the organizing committee has done so far.  It has been tough but at the same time too much FUN and comaraderie.

We have so far more than 200 pre-registered guests… when our initial forcast was only 120 doctors.  The CME activites were really formulated by me and Dr Estrelle Lopez of UST to make sure that we have a balanced program that will cater to all physicians handling endocrine cases in our country.

The members of this organization are doing this for free.  Our task is solely to promote the organization with the sole purpose of letting the public know that Endocrinology is one specialty that caters to diseases known to every family in this country especially…Diabetes, Hypertension, Goiter, Osteoporosis among the many….

Our goal is to spread what we know in this specialty that hopefully physicians in far reach areas of the country can still manage their patients without necessarily coming to Cebu or Manila.  This annual convention is only our first in terms of its grand scale but this wont be our last. We will continue to have projects and workshops because our advocacy is to teach… and spread the news of what is right and best for each patient with endocrine disorders.

To Help and Spread Knwoledge is what I do… that’s why I accept invitations to speak to doctors, to laymen, do research and grant interviews for newpapers, radios or TV and write in this website. 

I believe I can do better and be happier if I know I have not only touched the lives of my patients and their families but more than that… by helping other physicians do their job the right way and in turn touched the lives of their patients I havent met or didnt even know. 

For me… my role as a Physician is to continue my “Trio” of advocacy:  

  • To Educate,

  • To Help and

  • To Heal…….

How To Keep Family Safe From HARM…

August 7, 2007

Safety is of paramount importance to us especially our kids.  With the news surrounding us regarding safety concerns of products made in China from too much formalin in certain package foods to lead content in kids toys…it is but prudent to also be vigilant with regard to food safety in our own homes.

Here are some tips that I got from the Harvard Health Letter that I want to share and hopefully help us make our home safer. Here is a summary of some of the problematic bacteria you want to protect your family from include:

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E. coli. This bacterium, found mainly in ground beef, causes an estimated 25,000 cases of food poisoning in the United States each year and kills about 100 people. Some people infected with E. coli suffer permanent kidney damage. Contamination occurs during meat processing, when E. coli from the animals’ intestines becomes mixed in with the meat.

Salmonella. This bacterium is found mostly in meat and eggs. But it spreads to other foods, such as ice cream and fruit, when they are shipped with contaminated meat or eggs.

Campylobacter. This bacterium is especially common in poultry. Antibiotic-resistant strains are becoming more prevalent because of the widespread use of antibiotics in chicken feed. In a 2001 report in the New England Journal of Medicine, 17% of chickens sampled in supermarkets in four states had campylobacter strains that were resistant to antibiotics.

You can prevent most cases of food poisoning in your household by preparing and storing your foods safely.

  • Rinse foods. Rinsing can wash off some germs from meat, poultry, and fish and pesticide residues from produce. Rinse all meat, poultry, and fish under running water before cooking. Rinse all fruits and vegetables under running water before cooking or serving them.
  • Wash your hands. Frequent handwashing helps prevent you from passing germs from one food to another. Use soap and water to wash your hands each time you handle a raw food. Don’t wipe your hands on a dishtowel without washing them first.
  • Use separate utensils. Don’t prepare meat and fish on the same surface that you use for other foods — otherwise, you risk contaminating those foods with bacteria from the meat and fish. Use one cutting board for meats and fish and a second one for produce. Be sure to wash the cutting boards with soap and water after each use. Use different knives to cut different foods to prevent cross-contamination.
  • Cooking. Cook all meat, poultry, eggs, and freshwater fish. Don’t rely on color alone to indicate whether meat is fully cooked. The USDA recommends that everyone use a meat thermometer. Different temperatures are required to kill off germs in different kinds of meat. It’s also important to cook hot dogs and other precooked meats and fish, to destroy bacteria that may have contaminated them in the processing plants.
  • Storing. Don’t leave any foods, before or after cooking, at room temperature for more than two hours (one hour if the air temperature is above 90° F). Put them in the refrigerator or freezer. The temperature inside your refrigerator should be 40° F or below; your freezer should be at 0° F or below.
  • Divide The Leftovers. If you have large amounts of leftovers, divide them into small batches when you put them away in the refrigerator or freezer. That way, the temperature of each batch will reach a safe level faster. Keep in mind that freezing does not necessarily kill bacteria; wash meats and poultry thoroughly after thawing, and handle them the same as you would fresh meats. 

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Watch the things we buy…Plan ahead the meals we’ll serve and be sure to follow simple rules of home safety. 

Remember as mentioned in my previous post to avoid storing your leftover foods in take- away plastic containers because they have been shown to be harmful if reused! 

Just a simple reminder to keep us all from harm….

Plan and Ban The Harm! 

Adding TAX on Mc Donald’s Burger and Fries…

August 6, 2007

imagessdfert.jpg

I came across a very unique study that has probably never been done before.  How about adding extra tax everytime we take unhealthy fast foods ? Everytime we hear about being FAT and unhealthy…it has always been associated with Mc Donalds because of the way the place used to cook meals using high saturated fat or trans fat products.  Likewise the marketing strategy of UPSIZING french fries and burgers with unlimited soft drinks have been blamed as culprits for the majority of the Obesity epidemic in America and probably in the world as Mc Donalds has crossed barriers and invaded every nation in the world!

 The study was published recently in the Journal of Epidemiology and Community Health and looked at the assumption of extending vlaue added tax to unhealthy foods and what could be its impact in terms of health and economic costs : Could targeted food taxes improve health?  J. Epidemiol. Community Health, Aug 2007; 61: 689 – 694.
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Data: Consumption patterns and elasticity data were taken from the National Food Survey of Great Britain. The health effects of changing salt and fat intake were from previous meta-analyses.

Results: (1) Taxing only the principal sources of dietary saturated fat is unlikely to reduce the incidence of cardiovascular disease because the reduction in saturated fat is offset by a rise in salt consumption. (2) Taxing unhealthy foods, defined by SSCg3d score, might avert around 2300 deaths per annum, primarily by reducing salt intake. (3) Taxing a wider range of foods could avert up to 3200 cardiovascular deaths in the UK per annum (a 1.7% reduction).

Conclusions: Taxing foodstuffs can have unpredictable health effects if cross-elasticities of demand are ignored. A carefully targeted fat tax could produce modest but meaningful changes in food consumption and a reduction in cardiovascular disease.

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Probably based on this study…it can work! and most likely as a last resort to our continuing battle against the BULGE!   But again it may not plainly because people will still look for things they’ve been used to liking.  Just look at cigarettes and alcohol.  Even with the so called SIN taxes on these products, people continue to splurge and enjoy them no matter the consequences.In short… everything boils down to DISCIPLINE and CHARACTER if we have to change the habit of EATING of every individual and the country as a whole.  And to be successful… this should be shaped during childhood! 

Remember if you’re child is obese by 6 years old…his likelihood of becoming obese for life is 40% and if he is obese by 12 years old… his chances of becoming obese for life is 80%!

Tax or No Tax… The Discipline Starts at HOME!

Are You FAT But FiT?

August 4, 2007

3283079462.jpgYou maybe Fat but Fit and as a result your risk to develop heart disease is actually lower than your counterpart who Fat and Unfit!  This according to a new study published in the Archives of Internal Mediciane, July issue. 

Below is the summary of the study as published in heart.org:

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Arsenault et al studied 169 asymptomatic men with diabetes mellitus who were participating in the Quebec Family Study, a population-based study of French Canadian families living in and around Quebec. They measured abdominal adipose tissue accumulation, cardiorespiratory fitness (CRF), and indexes of plasma glucose-insulin homeostasis and lipoprotein-lipid profiles.  

After matching individuals with similar BMIs, men with low CRF were characterized by more visceral adipose tissue accumulation than men with high CRF (mean 114.4 cm2 vs 87.8 cm2; p<0.007) and by a poorer metabolic profile. When matched for visceral ( Abdominal) adipose tissue accumulation, however, such differences were no longer significant.

“This study underlines the importance of visceral (abdominal) adipose tissue or fat accumulation in the previously reported association between CRF and metabolic complications predictive of coronary heart disease and type 2 diabetes mellitus” .

“Our results suggest that visceral abdominal tissue accumulation could be a key confounding factor when the relationship of CRF, coronary heart disease risk, and metabolic syndrome is examined.”

Physical activity should be promoted, irrespective of age, sex, or degree of obesity as a measure to reduce adiposity, to increase energy expenditure, and to potentially decrease atherogenic visceral adipose tissue mass, they conclude. “

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There you go… being fat may not actually mean poor health risk RATHER it’s the cardiovascular fitness level or the Physical Activity that counts.

The more active we become…the less evil is our fat and the less likely we develop the outcomes of the disease of obesity!

Being FIT Matters….

The Protective Effect of Mediterranian Diet

August 3, 2007

imagesafg.jpgA diet that’s high-fat… because of the large amounts of monounsaturated fatty-acid-rich olive oil used in Mediterranean cultures—may be a useful tool against blocking of the arteries, particularly in individuals at high risk of developing heart disease.

A new study looking at High Mononunsaturated Fat( MUFA) diet has finally proven the proponents of this diet to be protective was recently published in the June 11, 2007 issue of the Annals of Internal Medicine.

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Interventions: Participants were assigned to a low-fat diet (n = 257) or to 1 of 2 Mediterranean diets. Those allocated to Mediterranean diets received nutritional education and either free virgin olive oil, 1 liter per week (n = 257), or free nuts, 30 g/d (n = 258). The authors evaluated outcome changes at 3 months.

Results:  Compared with the low-fat diet, the 2 Mediterranean diets produced beneficial changes in most outcomes. Compared with the low-fat diet, the mean changes in the Mediterranean diet with olive oil group and the Mediterranean diet with nuts group were –0.39 mmol/L (95% CI, –0.70 to – 0.07 mmol/L) and – 0.30 mmol/L (CI, –0.58 to – 0.01 mmol/L), respectively, for plasma glucose levels; –5.9 mm Hg (CI, –8.7 to –3.1 mm Hg) and – 7.1 mm Hg (CI, –10.0 to –4.1 mm Hg), respectively, for systolic blood pressure; and –0.38 (CI, –0.55 to – 0.22) and – 0.26 (CI, –0.42 to –0.10), respectively, for the cholesterol–high-density lipoprotein cholesterol ratio. The Mediterranean diet with olive oil reduced C-reactive protein levels by 0.54 mg/L (CI, 1.04 to 0.03 mg/L) compared with the low-fat diet.

 Conclusion: Compared with a low-fat diet, Mediterranean diets supplemented with olive oil or nuts have beneficial effects on cardiovascular risk factors.

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In short… participants in the two Mediterranean-diet groups had significantly lower mean plasma glucose levels, lower systolic blood pressure, and lower total-cholesterol/HDL-cholesterol ratios than those in the low-fat-diet group… which may explain the protective effects of this diet to develop heart disease.  

So what diet Do I recommend to my Patients? 

Ive been proponent of a 40% of total calorie diet to be from fat with 20% of total calories from MUFA.  Ive been pretty successful with this diet in terms of regulating my patients Blood sugar and lipids while maintaining their weight!  This study really proves me right. 

You will not go wrong having a diet rich in fruits and vegetables and supplemented with virgin olive oil and nuts…it’s a diet proven to  improve cholesterol ratios and the effects on blood pressure and inflammation.   One option to Olive oil that we can use daily in our cooking is Canola Oil which is also rich in MUFA and PUFA.  Likewise taking walnuts or cashew nuts for snacks as healthy alternatives to burgers and fries!

As The Saying Goes…GO NUTS!

How To Exercise The Right Way

August 2, 2007

4143585627.jpgWe know we need to exercise.  We are often told to be active most days in a week if we want to lose weight or just 20 to 30 mintues 3 x a week for cardiovascular workout.

BUT what’s the BEST way to do it?… do we exercise 1 hour straight? or is it better to have a rest period in between activities to burn fat effectively?

Excerpts from the Study of Dr Goto published in the Journal Of Applied Physiology…. 

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This study compared the fat metabolism between “a single bout of prolonged exercise” and “repeated bouts of exercise” of equivalent exercise intensity and total exercise duration. Seven men performed three trials: 1) a single bout of 60-min exercise (Single); 2) two bouts of 30-min exercise, separated by a 20-min rest between exercise bouts (Repeated); and 3) rest.  In the Repeated trial, serum free fatty acids (FFA), acetoacetate, and 3-hydroxybutyrate concentrations showed rapid increases (P < 0.05) during a subsequent 20-min rest period. During the second 30-min exercise bout, FFA and epinephrine responses were significantly greater in the Repeated trial than in the Single trial. 

The relative contribution of fat oxidation to the energy expenditure showed significantly higher values (P < 0.05) in the Repeated trial than in the Single trial during the recovery period.

These results indicate that repeated bouts of exercise cause enhanced fat metabolism compared with a single bout of prolonged exercise of equivalent total exercise duration.

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In simple terms… it’s better to rest in between exercise activity than a single prolonged activity.  The rest period most likely made the tissues and body more efficient in burning more fat especially during the repeat exercise after the rest!

Meaning Rest in between activities is a good way to burn more calories and have time to take a breathier in between workouts!

My advise?  Exercise for 30 minutes then take a rest for 10 to 15 minutes then take a plunge to more activites again before heading back home….

What A way To Rest and Burn More Calories!