Archive for November, 2007

The Motivation To Lose Weight….

November 30, 2007

Go to fullsize imageI just found this new finding very intriguing and really true.  We doctors need to know what motivates people to lose weight so we can focus our attention to achieve the goal with more success.

In one study done in University of Bath in UK revealed some interesting facts:

“Fear of looking unattractive can be a stronger motivation for keeping people going to the gym than the hope of looking good”

This is really something… I guess this is where marketing strategies of beauty products are engaged in. You see beautfiul actresses marketing beauty products luring women to use the same products so as to look like them!  And I guess they’re pretty successful.

But what happens is when fear can motivate people to lose weight and look good…  once that fear subsides, either because they feel they have lost weight and now look good.. the motivation from fear goes away.  And I believe this is one reason why the yo-yo phenomenon in losing weight comes in.  You lose now then you gain….

Motivating people using the positive outlook should be the way to go.  How losing weight results now in better health  for a more lasting effect!

Motivating Poeple The Right Way Is Key To Better Health and Better Life!


 adtxtimg5.gif 2/18/08

Notes From Our Marketing Friends: 

People are becoming fitness freaks and are very conscious to lose weight. Many health centers and weight loss centers provide people with healthy weight loss program. This includes many supplementary diets like the south beach diet and many others. However such diets must not be taken without consulting the physicians.

Vitamin E and Heart Disease Among Diabetics…

November 27, 2007

Vitamin E has received a lot of good news and bad news. Now you read it being the antioxidant of choice in one study…then the next…it shows the opposite result.  Majority of these studies however are epidimeological and observational in nature and not well controlled prospective studies.  The HOPE and NIH studies were prospective studies that did not show positive effect of Vitamin E on heart disease.

Recently a new data on the possible important role of Vitamin E came about in a new prospective study which is worth looking published in the Journal Atherocsclerosis, Thrombosis and Vascular Biology….


Methods- 1434 DM individuals  55 years of age with the Hp 2-2 genotype were randomized to vitamin E (400 U/d) or placebo. The primary composite outcome was myocardial infarction, stroke, and cardiovascular death. At the first evaluation of events, 18 months after initiating the study, the primary outcome was significantly reduced in individuals receiving vitamin E (2.2%) compared with placebo (4.7%; P=0.01) and led to early termination of the study.

Conclusions—Vitamin E supplementation appears to reduce cardiovascular events in individuals with DM and the Hp 2-2 genotype.


Since 40% of our diabetic population has the Hp 2-2 gene…It’s probably about time for us to rethink whether all diabetics should take Vitamin E or not…

However the bottom line is:  more studies need to be done and outcome studies to support this new finding!

Vitamin E Is Worth a Second Look!

Resting To Burn Fat Faster….

November 24, 2007

exerc.jpgHere’s one good news to those who hate long hours of exercise to get a benefit! 

A study published in the Journal of Applied Physiology this June of 2007  showed that:

repeated bouts of exercise cause enhanced fat metabolism compared with a single bout of prolonged exercise of equivalent total exercise duration.”

The exercise regimen that they tested?

… Exercise for 30 minutes…take a break for 20 minutes… then exercise again for 30 min…. 

The rest period resulted in more fats being burned than no rest period at all…

So just like any activity… the body needs to rest and rejuvenate!


Overdoing Even A Good Thing May Do More Harm!!!



adtxtimg3.gif 2/18/08 

Notes From Our Marketing Friends: 

One should apply healthy cleaning strategies at ones home. Use dust cleaners to avoid dust allergy. Many sort of allergies lead to serious diseases like eczema etc. Go for proper eczema treatment is you are suffering form eczema. Dirty carpets are the source of much kind of allergies. Use handy vacuum cleaner to ensure the complete cleanliness of the carpets.

What is An A1c?…. A New Guideline For The Diabetics….

November 23, 2007 have to write about this new guideline in interpreting A1c for my Diabetic Patients who have been loyal followers of this website.  Or to those who are not used to doing home glucose monitoring and rely solely on A1c results in their blood test to check if their control is good or not.  Although I am not advocating to do away with monitoring…in fact I strongly advise all diabetics to do so!

Recently a new calculation was made to correlate A1c to average blood glucose levels.  Now there is a computation one can do and based on data from continuous home glucose monitoring, the correlation is now better than what it used to be.

This is a new information I gathered from the American Association of Diabetes Glucose Control Trials from the ADA News as reported in Diabetes in Control:


Prior to this new information, the A1c was tied to the results of the DCCT, where a 6% was equal to 135mg/dL.  This came about when they checked the A1c and then looked at a couple of thousand finger sticks and averaged them out.  Now with the use of hundreds of thousands of readings, not just with the finger sticks but also with the use of continuous blood glucose monitors, we have more accurate results.  The equation yields a linear correlation over a wide range of A1c. This means that a 6% is no longer an average of 135mg/dL:  The new numbers:

o 6% = 126 mg/dl
o 7% = 155 mg/dl
o 8% = 182 mg/dl
o 9% = 211 mg/dl
o 10% = 239 mg/dl


So for all patients who wonder what this A1c means…now this new information will help you decide what to do to your lifestyle especially if you go beyond the A1c of 6.5% that we recommend to help prevent the onset of complications. 

Remember a single blood sugar alone does not give you the whole picture…so if your physician keeps on checking just a Fasting blood sugar and tells you you’re doing fine…demand for an A1c level!

More Sleep Time To Prevent Childhood Obesity

November 22, 2007

Go to fullsize imageChildhood Obesity is getting to be a huge problem not only in developed countries but worldwide!  The AACE Philippine Chapter in fact recently launched our Power of Prevention Program aimed at preventing Obesity among children where different school prinicpals and administrators were invited to the launching initially to involve Metro Manila school children. 

Now comes a remedy to wegiht gain among children that we can do at home!  A new interesting study was recenlty published in Pediatrics November 2007 issue , linking the lack of sleep or inadequate sleep among children and the risk of being overweight.


Of 785 children, 50% were male, 81% were white, and 18% were overweight in 6th grade.

  • Shorter sleep duration in 6th grade was independently associated with a greater likelihood of overweight in 6th grade.
  • Shorter sleep duration in 3rd grade was also independently associated with overweight in 6th grade, independent of the child’s weight status in 3rd grade.
  • Sleep problems were not associated with overweight.


So how many hours of sleep should our children have?  This study provided us some insights:

  • Sixth-graders with less than 8.5 hours of sleep a night had a 23 percent rate of obesity,
  • Well-rested peers with more than 9.25 hours of sleep had at 12 percent rate of obesity.

For me this study tells us one thing:

  • By putting your kids to sleep earlier… means less TV time…means less chances to munch on junk food…resulting in a lesser risk to gain weight!
  • Sleep is as important as healthy food and physical activity when it comes to Weight control.

Put Premium on Sleep Than Being Awake Especially For Our Children!


 adtxtimg8.gif 2/18/08

Notes From Our Marketing Friends: 

There are many sensitive issues that a lactating mother must be keeping in mind. During lactation mother should follow healthy food recipes to avoid any kind of deficiency in her. As a lactating mother feeds her baby on her milk, so she should take complete care her breasts. There are many lactation equipments now available in the market that helps a mother to nourish her baby with her milk. These include medela breast pump, maternity bras and large cup nursing bras etc.

Tips On How To Be Healthy MINUS The Vitamins!

November 20, 2007

Supplements insluding Multivitamins continue to make market leaders in terms of income.  Many people inlcuding myself take multivitamins as part of the daily requirement to hopefully supply the vitamins not taken by our daily meals.  But do we have proofs that we really need them? Or are we better off without them?

I came across a new article from the Harvard News Letter which answered this specific questions published in November of 2007:


Most experts agree that supplements add little, if anything, to a well-balanced diet. Exercise, however, is proven to achieve the benefits claimed for vitamins, even for people who eat properly, reports the November 2007 issue of Harvard Men’s Health Watch.

One leading reason people take vitamin supplements is to protect against cancer. But sadly, this strategy has been a flop. While studies continue on whether vitamin E and selenium can help reduce prostate cancer risk, data already show that beta carotene actually boosts the risk of lung cancer in smokers. And zinc, as well as high doses of folic acid, may also do more harm than good for men seeking to ward off prostate cancer.

The bottom line: Supplements do not reduce cancer risk.

In addition, vitamins are not recommended for heart disease prevention.

  • Trials of B vitamins have failed to demonstrate protection against heart disease. 
  • But people who eat fish twice a week enjoy a reduced risk of heart attack and sudden cardiac death.
  • Leafy, green vegetables and whole grains also help protect against heart disease.

If supplements can’t protect you against cancer or heart disease, what can? Current evidence suggests that exercise may be a crucial weapon in reducing the risk of some cancers.

  • Studies show that active people are less likely to develop colon cancer than sedentary individuals, and that
  • women who exercise can reduce their breast cancer risk. 
  •  Exercise’s effect on prostate cancer, however, is less clear; studies have produced varying results.
  • Evidence is also incomplete for lung and pancreatic cancers.

But when it comes to reducing the risk of heart disease, regular exercise is associated with a sharp reduction in heart attacks and cardiac deaths.


We always look for shortcuts! I guess this is true to everybody in every walk of life.  Why make it more difficult if there’s a shorter way to achieve the same goal.  BUT…life is not that simple especially when it comes to better health!

There has been no single study to date to prove otherwise…that exercise can do harm than good… from prevention studies to community data. But we all know it’s good to do it…we just refuse to indulge ourselves to it and instead look for a pill that can do the same job…which up to now remains a fantasy than a reality! 

Dont be fooled in believing that Supplements can do the Health Job for you!  Remember….

In Health…There Are No ShortCuts!

 adtxtimg1.gif 2/18/08:

Notes From Our Marketing Friends: 

With the advancement in the technology everything is now in the access of the people while sitting at home. Many drug store are operating online. You can buy drugs and medicines from them. For example you can buy fioricet online as well as other medicines like aspirin etc. There are many online pharmacies which offer private medicines like generic cialis online as well.

Does Avandia Cause Heart Attack? : The Ongoing Controversy

November 16, 2007

Recently, The US FDA made a new ruling regarding the controversy on whether the popular antidiabetic agent Avandia can really cause heart attack.  Below are important excerpts of the FDA ruling released as of November 14, 2007:


People with type 2 diabetes who have underlying heart disease or who are at high risk of heart attack should talk with their health care provider about the revised warning as they evaluate treatment options. FDA advises health care providers to closely monitor patients who take Avandia for cardiovascular risks.

Avandia is approved to be used as a single therapy or used in combination with metformin and sulfonylureas, other oral anti-diabetes treatments.

During the past year, FDA has carefully weighed several complex sources of data, some which show conflicting results, related to the risk of chest pain, heart attacks and heart-related deaths, and deaths from any cause in patients treated with Avandia.

At this time, FDA has concluded that there isn’t enough evidence to indicate that the risks of heart attacks or death are different between Avandia and some other oral type 2 diabetes treatments. Therefore, FDA has requested that GSK conduct a new long-term study to evaluate the potential cardiovascular risk of Avandia, compared to an active control agent. GSK has agreed to conduct the study and FDA will ensure it is initiated promptly.

The revision of Avandia’s existing boxed warning – FDA’s strongest form of warning – includes the following statement:

A meta-analysis of 42 clinical studies (mean duration 6 months; 14,237 total patients), most of which compared Avandia to placebo, showed Avandia to be associated with an increased risk of myocardial ischemic events such as angina or myocardial infarction. Three other studies (mean duration 41 months; 14,067 patients), comparing Avandia to some other approved oral antidiabetic agents or placebo, have not confirmed or excluded this risk. In their entirety, the available data on the risk of myocardial ischemia are INCONCLUSIVE!

The previous upgraded warning, added to certain diabetes drugs (in class of drugs related to Avandia) on Aug. 14, 2007, emphasized that these types of drugs may worsen heart failure, a condition in which the heart does not adequately pump blood, in some patients. GSK is also developing a Medication Guide for patients to provide additional information about the benefits and risks and safe use of Avandia.

To date, no oral anti-diabetes drug has been conclusively shown to reduce cardiovascular risk. Consequently, the agency also will be requesting that labeling of all approved oral anti-diabetes drugs contain language describing the lack of data showing this benefit.

Today’s action follows recommendations made at the July 2007 joint meeting of FDA’s Endocrine and Metabolic Drugs and Drug Safety and Risk Management Advisory Committees. At the meeting, members voted 22-1 to recommend that Avandia stay on the market, pending a review of additional data. The committee also advised that information warning of the potential for increased risk of heart attacks should be added to the drug labeling. _______________________________________________

Ever since the data on avandia came into light after the Niessen article, further analysis of that article showed flaws in the statistical analysis.  It is therefore not surprising to me why this drug will not be pulled out in the market solely because of that article.  The medical community looks at actual facts rather than what is reported in newspapers or the media.

Based on my experience, the benefits of this drug continue to outweigh the potential risks…and just like any other drugs… all one needs to do is use the right drug for the right patient profile!

Meaning..never use this drug if the patient has heart failure or heart disease.  And this is true to all antidiabetic agents as reported by the US FDA as the risk of heart attack has not been shown to be different among the different oral agents. 

Plus…all patient with Diabetes…by the time of diagnosis… more than 5o% or probably ALL already have ongoing heart disease because by the time ones fasting blood sugar is abnormal…the disease process has been ongoing for 7 to 10 years already!

Therefore and Again… I always emphasize to all patients at risk: Lifestyle Change.  If one has the risk to develop Diabetes … do something NOW!  

Remember… All medications have risks!  But the benefits should always outweigh the risks before any drug is started on any patient!

Tips on How To Get A Flat Tummy Without Tummy Tuck!

November 15, 2007

Go to fullsize imageI am ” no no” when it comes to cosmetic surgery.  It is definitely temporary measure of something that can be done with healthy lifestyle and discipline. Beauty as we said is deep within… and for me… only if you are using your face or body for business like being a movie star and marketing for extra mileage that one may elect to have them done.

Recently I came accross a short article on how we can flatten our tummy without necessarily resorting to surgery.  This comes from a reliable Health Source of the Mayo Clinic….


Just can’t seem to maintain a flat tummy, even though you are not overweight? According to the August issue of the Mayo Clinic Women’s HealhSource, you could just have a genetic tendency to accumulate fat in that area. Or if you have lost some height over the years, bulges can become more prominent. Whatever the cause, you can help flatten your stomach.

  • Get regular, general exercise. Burning calories reduces overall body fat. (Just doing sit-ups won’t flatten the bulge.)
  • Target lower and deeper abdominal muscles. Exercises that target these muscle groups can help. An example is a pelvic tilt. Lie on your back on the floor with knees bent. Flatten your back against the floor by tightening your abdomen and bending your pelvis up. Hold for five to 10 seconds. Work up to 10 to 20 repetitions.
  • Stand tall. A slouched position makes your tummy more prominent.
  • Beware of bloating. Some foods — beans, cabbage and bran, for example — can cause bloating and accentuate your bulge.


There you go my friends.  Simple and concise.  Do them daily…change your lifestyle that incorporates exercise or physical activity to your daily life.

Everyday before I take a bath…I lie on my bathroom floor and do the situps and tummy exercise.  Then I hop on to my waist twisting disc then I do the strength exercise using a rubberized belt ( I am not sure what you call it actually).  Once an activity is incorporated into your system…then its difficult to start the day without it!

Give Your Body The Look You Want It To Have….

Thru Exercise!



Notes From Our Marketing Friends:

As people are becoming aware with the health and fitness issues they are spending most of their time in health and fitness centers. There are many 24 hour fitness centers which provide services round the clock. However you can make your own gym at your home as well. All the gym equipments are available online you can purchase weight scale, tread mills, racing cycles or anything you want. Accessories like yoga mats, water bottles are also available over the internet.


How Often Can Surgery Go Wrong?

November 14, 2007

Go to fullsize imageMore often than not… we will have one surgery in our lifetime.  And among my diabetics… almost always, eye surgeries are common because of chronic complications arising from uncontrolled blood sugar or high blood pressure.  Cataract formation is so common that surgery is often advised to improve vision.

You may have heard of horror stories of wrong surgeries done on the wrong patient or the wrong leg or the wrong eye!  How common can this be?

Recently in the November issue of the Archives of Ophthalmology comes a rather alarming data on the issue of wrong surgery on the wrong eye!


Objective  To investigate the hypothesis that surgical confusions rarely occur but are unacceptable to the public; occur in predictable circumstances; involve a wrong lens implant more often than a wrong eye, procedure, or patient.

Methods  A retrospective series of 106 cases, including 42 from the Ophthalmic Mutual Insurance Company and 64 from the New York State Health Department.

Results  The most common confusion was wrong lens implants, accounting for 67 cases (63%). Wrong-eye operations occurred in 15 cases, wrong-eye block in 14, wrong patient or procedure in 8, and wrong corneal transplant in 2.

Conclusions  Surgical confusions occur infrequently. Although they usually cause little or no permanent injury, consequences for the patient, the physician, and the profession may be serious. Measures to prevent such confusions deserve the acceptance, support, and active participation of ophthalmologists.


Doctors are humans and we make mistakes.  However wrong surgery on a wrong patient is almost always avoidable if universal precautions are adopted.  The team approach to confirming the patient’s identity on several occasions from different personnel can avoid this problem.

I always advise this to my patients who will undergo a procedure:

  1. Ask for a schedule early in the morning.
  2. Schedule the procedure on a Monday after a Sunday… when the surgeon has had plenty of rest!
  3. Look for the right surgeon and not just any surgeon.
  4. Be sure to ask around for the surgeons reputation and expertise.

Can Surgery go wrong? It can but can definitely be avoided if one is vigilant enough to avoid a disaster! It’s a matter of choosing the right guy to do the right procedure!!!

Precaution Is The Key!

Snoring and The Risk of Diabetes

November 13, 2007

Just came back from a successful preceptorship at the UCSF- Stanford University- Whittier Institute for Diabetes in San Francisco and San Diego.  There were only 10 MDs from the Asia Pacific region being taught by more that 12 professors.  It’s actually more than a 1:1 learning from the 4th Best institution in Endocrinology from the survey in The US News and World Report 2007.

One very interesting topic we discussed was snoring and the risk of developing diabetes.  Needless to say…snroing can be very common and yet often negelcted symptom.  We alwaus associatet snoring as… the person is either being too tried from work or just in a deep good night sleep.  But now studies have shown that snoring is indeed an unhealthy sign of future disease risk.

In a study published in the Journal of Epidimeology… it was noted that snoring actually increases a persons risk to develop Diabetes….


Purpose: To examine the association between snoring and risk of developing type II diabetes mellitus, the authors analyzed data from the Nurses’ Health Study cohort.

Methods: This analysis included 69,852 US female nurses aged 40–65 years without diagnosed diabetes, cardiovascular disease, or cancer at baseline in 1986. Snoring patterns were ascertained by questionnaire.

Results: During 10 years of follow-up, 1,957 women were diagnosed with type II diabetes. In analyses adjusted for age and body mass index, snoring was associated with risk of diabetes

  1. for occasional snoring vs. nonsnoring, relative risk (RR) = 1.48 (95% confidence interval (CI): 1.29, 1.70);
  2. for regular snoring vs. nonsnoring, RR = 2.25 (95% CI: 1.91, 2.66); p for trend < 0.0001).
  3. Analyses stratified by body mass index, smoking history, or parental history of diabetes showed a consistent association between snoring and diabetes within the categories of these variables.

Conclusion: These results suggest that snoring is independently associated with elevated risk of type II diabetes.


Snoring can be benign but can also be due to a more difficult disease called Obstructive Sleep Apnea where patients intermittently stop breathing with episodes of snoring suggesting obstruction.  Inability to breath causes them to cough and then resume sleeping.  Unfortunately these patients dont get into deep sleep and therefore feels tired when they wake up and tend to sleep or nap while awake in the chair or anywhere they feel sleepy.

We now know lack of sleep can be a stress factor that can contribute to increasing ones risk to develop diabetes.  It is therefore not surprising that snoring as a sign of sleep apnea is one way of being sleep debt!

Treating sleep apnea therefore in a person who is diabetic or at risk to develop diabetes can definitely have an impact on ones health…by improving his risk profile and improving blood sugar control.

My recommendation therefore for all  my diabetics who snore is to get a sleep study.  The sleep lab can determine what kind of sleep disorder one has and then implement measures to help one sleep including the administration of a CPAP machine.

Ask your partner if you snore… discuss it with your specialist and demand for a sleep study.  Treating sleep apnea can have a tremendous impact in controlling your blood sugar including ones risk to be overweight!  Plus.. you feel better when you wake up and a better sense of well being.

Snoring Can Be Bad For Your Health!

I Am Taking A Break….

November 4, 2007

I will be one of the 12 to 15 doctors worldwide invited to attend a 7 day preceptorial study at the University of San Francisco- Stanford University Program in Endocrinology courtesy of INNOVARA, USA starting today till November 10.

This is one opportunity that I will never miss as this is already my third invitation from them after the same study program done at Massachussetts General Hospital- Harvard Univiersity Program in 2004 and the Johns Hopkins University Program in 2005.

Having been trained at the Mayo Clinic for my endocrinology fellowship has been a big advantage in having the confidence to meet and discuss interesting cases with professors in these prestigious institutions.

Not only is the experience rewarding but likewise a memory to behold. Interacting with professors in your field of work and sharing knowledge with fellow endocrinologists from different parts of the world is all worth the time off form my practice and my family!

The camaraderie and the social bonding that develop with fellow doctors and professors is what counts most as we share our calling cards and ideas in the small classroom! You get to know each one of them as we share the same hotel, the same lunch and dinner area and the same classroom throughout the week.

I will still try to update my website if I can but my apologies for the coming week if I will be too tired learning and enjoying at the same time….

The Benefit of Taking Siestas Or A Nap…

November 2, 2007

We’re know how to take naps and siestas in the past… BUT this habit is becoming a rarity rather than a need with the changing times.  However, new studies have come up that in regions where naps continue to be practiced, the incidence of cardiac problems seem to be on a decline… and now a new study may give us the reason why. 

Siesta apparently is associated with lowering of BP and as a result it reduces the strain to the heart in an article published in Journal of Applied Physiology  October of 2007 issue. 


The siesta habit is associated with a 37% reduction in coronary mortality, possibly because of reduced cardiovascular stress associated with daytime sleep.  Whether the most important behavior is the daytime nap itself, a supine posture, or the expectancy of a nap is unknown.

We present the first detailed description on healthy individuals of the acute changes in cardiovascular function during defined phases of the daytime sleep-onset period. These responses were compared with lying awake and standing.

Following a night of restricted (4 h) sleep, nine healthy participants (aged 34 ± 5 yr) were allowed to sleep at 1400 for up to 1 h. Polysomnography was used to calculate three phases of daytime sleep onset: phase 1, a baseline period of relaxed wakefulness before lights out; phase 2, the period between lights out and onset of stage 1 sleep; and phase 3, the period between onsets of stages 1 and 2 sleep.

Differences (means ± SD) in blood pressure, heart rate, and forearm cutaneous vascular conductance (CVC) between phases were analyzed. During the 9.7 ± 13.8 min of phase 2, systolic and diastolic blood pressure was 4.7 ± 4.5 and 3.6 ± 2.8 mmHg lower than baseline, whereas CVC was 9.5 ± 4.3% higher than baseline (P < 0.05). Subsequent changes in cardiovascular function during the sleep itself were trivial (P > 0.05). The above changes were not observed when subjects stood or laid supine in relaxed wakefulness for 1 h (P > 0.05).

Our findings suggest that the period between lights out and sleep onset is associated with the largest acute reduction in blood pressure during one afternoon siesta.


Now we know why siestas make us feel good and “healthier”.  In fact studies have shown that this blood pressure reduction may actually be the reason why there is lower coronary mortality rates in Mediterranean and Latin American populations where siestas are common… the effect of naps on the heart!

Simple take home message from this study: 

  1. Take time to rest and a nap…if you can have it in between breaks…go for it. 
  2. Sleep is likewise important… now it shows that sleep debt is unhealthy and dangerous!

Life is too short not to enjoy it BUT make sure you get enough rest and sleep to enjoy the beauty of life to live longer!

Siestas Equate To Better Health!