Archive for February, 2008

Low Carb Diet and Diabetes: A Better Partner?

February 29, 2008

Go to fullsize imageDieatry intervention remains the cornerstone of therapy for Diabetes.  It requires education and self discipline for it to work!  It may be frustrating for doctors but if only we find time to explain the benefits and allow this intervention to work…it is really worth the effort.  My center now not only caters to diabetes education but has already 2 dieticians on board to see the dietary needs of my patients with diabetes, high blood pressure and high cholesterol.

I have been a proponent of the 40% carb and 40% fat diet for my diabetic patients. The fat however should be mainly monounstaurated which will give us the source of the good fat with less than 7% to 10% of the Saturated fat or the Bad fat!  I always emphasize the low fat sources or the vegetable sources of protein! 

This February 2008 comes a new study from the Harvard Medical Group of the longstanding Nurses Health Study that came up with the finding that indeed a Low Carb Diet may be the way to go for Diabetic patients.

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Design:  prospectively examined the association between low-carbohydrate-diet score (based on percentage of energy as carbohydrate, fat, and protein) and risk of diabetes among 85 059 women in the Nurses’ Health Study.

Results: During 20 y of follow-up, we documented 4670 cases of type 2 diabetes. 

  •  A higher dietary glycemic load was strongly associated with an increased risk of diabetes in a comparison of extreme deciles (RR: 2.47; 95% CI: 1.75, 3.47; P for trend < 0.0001)).
  • A higher carbohydrate consumption was also associated with an increased risk of diabetes in a comparison of extreme deciles (RR: 1.26; 95% CI: 1.07, 1.49; P for trend = 0.003).

Conclusion: These data suggest that diets lower in carbohydrate and higher in fat and protein do not increase the risk of type 2 diabetes in women. In fact, diets rich in vegetable sources of fat and protein may modestly reduce the risk of diabetes.

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The term glycemic load refers to the capacity of a food to increase ones blood sugar upon ingestion.  As a result, I always emphasize to my patients to avoid some of the fruits with the highest glycemic index like pineapple, mangos, watermelon and banana and instead enjoy apple and pear.  The study proves that indeed the higher the glycemic load, the higher the risk to develop diabetes or for those with diabetes…the more difficult blood sugar control will be!

One more reason to go low Carb!  This recommendation looks similar to the Atkins Diet but with a better and healthier protein source with less saturated fat!

Finding a partner in life requires committment… similar to finding a partner in our quest for controlling blood sugar through proper lifestyle and the right diet AND should be made…. a way of life!

Indeed Low Carb Is The BETTER Partner for Health!

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Obesity Surgery for Diabetes: A Cure?

February 28, 2008

It is known that obesity links patients to chronic diseases like diabetes, high blood pressure and high cholesterol.  These conditions then increase one’s risk to suffer from stroke and heart attack.  Ideally therefore, if only we can make all patients lose weight, then the burden of these chronic conditions from developing can be dramatically reduced.  Unfortunately telling patients to be careful with what they eat and to be physically active can be a daunting task.

What about obesity surgery?  Is it an effective way to lose weight? 

Gastric Banding is indeed one shortcut way of losing weight.  Our center has been active in handling patients wanting to lose weight using this less invasive procedure BUT will it’s weight loss translate to better health?  IT DOES… concludes a recent study published in JAMA which is an Unblinded randomized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia

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Of the 60 patients enrolled, 55 (92%) completed the 2-year follow-up.

  • Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group.
  • Relative risk of remission for the surgical group was 5.5.
  • Surgical and conventional-therapy groups lost a mean (SD) of 20.7% (8.6%) and 1.7% (5.2%) of weight, respectively, at 2 years 
  • Remission of type 2 diabetes was related to weight loss and lower baseline HbA1c levels
  • There were no serious complications in either group.

Conclusions:

Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed.

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The procedure used in the study was the less invasive laparoscopic gastric band where a band is surgically placed on top of the stomach. An access port is then secured closer to the skin where a saline solution can be injected into to fill up the circular inflation membrane, making the band tighter.  As a result it constricts the stomach opening, and reduces the amount of space inside, giving the patient an earlier feeling of fullness, limiting food consumption.

Finally, this study confirms that indeed weight loss is the key to better control… either achieved by proper diet and physical activity or through surgery. 

Weight Loss For Cure and Health!

The Obesity and Fatness Tax

February 27, 2008

Go to fullsize imageJust came from a convention in Agra India where I read in the papers that UK is starting to charge more in terms of insurance premium depending on the degree of obesity. 

Meaning the higher the BMI ( a measure of fatness) , the higher the premium!  It is the insurance way of probably getting back at the skyrocketing cost of Obesity in terms of medical costs.

Fatness therefore is now becoming a Liability! 

Whether this measure will translate into more people taking care of themeselves remain to be seen!  But it is one way to getting people to exercise and live a healthier lifestyle.  And in the long run benefit both the patient and of course the insurance compnay!

Insure Yourself To Better Health!

Can Noise Increase Blood Pressure?

February 21, 2008

Go to fullsize imageA sudden noise or commotion can make your heart rate go up and can be felt as sudden chest beating or palpitation.  We all know that one reason for an increased BP is an increase in heart rate.

A new study published in the European Journal of Hypertension Februaury 12, 2008 looked at this relationship and examined the population living near the airport. The BP and heart rates were checked and evaluated during the noise caused by the airplanes and the results were interesting.

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Non-invasive ambulatory BP measurements at 15 min intervals were performed. Noise was measured during the night sleeping period and recorded digitally for the identification of the source of a noise event.

  • An increase in BP 6.2 mmHg for systolic and 7.4 mmHg for diastolic was observed over 15 min intervals in which an aircraft event occurred.
  • A non-significant increase in HR was also observed (by 5.4 b.p.m.).
  • When the actual maximum noise level of an event was assessed there were no systematic differences in the effects according to the noise source.

Conclusion: Effects of noise exposure on elevated subsequent BP measurements were clearly shown. The effect size of the noise level appears to be independent of the noise source.

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This study has clinical implications on the future risk of heart disease and stroke with elevated BP. It would be nice to know the future risk of these population compared to the general population in terms of heart disease in relation to their exposure to noice.

Environment plays an important role in how stress manifests in our body. Noise generated from any source will definitely have the same effect as the study population and in itself increases a patient’s risk for heart disease due to rises in BP.  What is important is that the study also found that any level of noise including traffic sounds and other bedtime noise like snoring can cause a BP to spike!

For me… relaxing in between stresses in life can make a difference.  Any noise generated while at work can be stressful in itself and taking time to relax and listen to music or the waves of the sea and enjoy can spell a huge Difference!

Take a Break From Noise…Why Not Enjoy a Spa?

Can I Eat Dark Chocolate Everyday?

February 20, 2008

Go to fullsize imageIt’s in the headlines and magazines…that dark chocolate is healthy and in fact protective to the heart.  But does this mean, any dark chocolate can have that effect? And if so, can we then eat dark chocolate everyday?

The Harvard Heart Letter commented on this specific topic recently to dispell myths that all dark chocolates are the same.

The main ingredient that has a positive effect on the heart is the flavanol compound.  This is present in abundance in certain foods not only cacao but also fruits like apples, vegetables like beans and also present in onions.  These flavanoids in cacao give the chocolate a bitter taste and unfortunately this is almost always removed during the processing of chocolate to give it a yummy taste!  Chocolates that also contain alkali during the processing removes most of the flavanoids. 

Unfortunately one can’t tell the content of the flavanoids based on the color of the chocolate.  So here are some tips to get the best dark chocolate from Dr Thomas Lee, the Editor of the Harvard Heart Letter:

  • Look for the least-processed chocolate you can find.
  • Skip those that have been treated with alkali.
  • Keep in mind that you don’t need much.
  • Studies showing the benefits of cocoa have used an ounce — sometimes less — of flavanol-rich chocolate. The tough part of this dietary “therapy” is stopping with a small piece. But stop you should. An ounce of dark chocolate delivers about 150 calories. Eat that much every day without cutting back elsewhere and the girth you gain would far outweigh any benefit from chocolate.

In short… you may eat chocolate everyday but make sure it’s only a bite size.  If you cant handle the satisfaction of that… then hold it for more on special occasions.  Remember… dont fool yourself into believing that you are eating dark chocolate to help your heart… there are other ways to do that. It is the calories that count and chocolates give you more than what you need in a day if you over indulge in it!

Gaining weight is not worth the benefit that you’ll get from eating chocolates if you can get the same amount of flavanoid from eating apples!  They may not taste the same but the health benefits maybe more with fruits!

Enjoy Chocolates Wisely!

Stress and Heart Disease: A Close Circuit!

February 18, 2008

Stress from work?  Who isnt? But the way we handle stress can make a difference in how it affects our lives.  We always associate it as part of our day to day activity otherwise, it is not living if we dont have stress.  It gives us the challenge to move on and to pursue what we have in mind to achieve. But along the way comes the roadblocks called “Stress”

Recently an nice article examined how stress can affect out health.  I am a believer of stress as a big factor in increasing a patient’s risk to develop chronic illnesses like diabetes and high blood pressure.  Now published in the European Heart Journal is a detailed examination of how stress can affect the heart!

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A total of 10 308 London-based male and female civil servants aged 35–55 of the Whitehall II study were studied. Exposures included work stress and outcomes included behavioural risk factors, the metabolic syndrome, heart rate variability, morning rise in cortisol, and incident CHD on the basis of CHD death, non-fatal myocardial infarction, or definite angina.

  • Chronic work stress was associated with CHD and this association was stronger among participants aged under 50 by 68%.
  • There were similar associations between work stress and low physical activity, poor diet, the metabolic syndrome, its components, and lower heart rate variability.
  • Cross-sectionally, work stress was associated with a higher morning rise in cortisol.
  • Around 32% of the effect of work stress on CHD was attributable to its effect on health behaviours and the metabolic syndrome.

Conclusion: Work Stress may be an important determinant of CHD among workiing-age populations, which is mediated through indirect effects on health behaviours and direct effects on neuroendocrine stress pathways.

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The above results are clear: once you’re stressed out… you produce stress hormones through the nueroendocrine system resulting in an increase of serum cortisol which can be harmful to the body including the way it signals how the heart beats! End result: Heart disease….

Further examination revealed that work stress is associated with a poorer diet in terms of eating less fruit and vegetables, and less exercise which also then contribute to increasing one’s risk for heart disease further.  I am sure a lot of the readers are guilty of this!  Too little time…too much to do! In fact in this study around 32% of the effect of work stress on CHD could be explained by its effect on health behaviors and the metabolic syndrome.

In short….Enjoy your work…problems come but solutions are abundant.  It is a matter of finding them!

Mind Your Heart… Eat Healthy, Exercie Freely and Be Stress Free!

The Plenary Debate… Good Luck To Me!!!!

February 13, 2008

plearny-board.jpgplenary-debate-inside.jpg

This will be a fun learning debate and will be the highlight of the joint annual convention of the  Philippine Society of Hypertension and Philippine Lipid Society in Manila.

 As doctors… we continue to study and learn non stop!

And as a lecturer and speaker… that’s where I study more and as a result I learn more!

Again.. In Health…Learning is NonStop!

Exercise As An Investment In Life…. Offers Great Returns!

February 12, 2008

Go to fullsize imageExercise can reduce risk of death!!!

Exercise can make you live longer and make you enjoy your life better. We know this for centuries but lifestyle continues to be one big struggle for doctors to ask their patients to comply. 

That’s the conclusion reached in a study recently published in Circulation Feb 2008.

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Methods and Results— We assessed the association between exercise capacity and mortality in  male veterans with and without cardiovascular disease who successfully completed a treadmill exercise test at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, Calif. Fitness categories were based on peak metabolic equivalents (METs) achieved. Subjects were followed up for all-cause mortality for 7.5±5.3 years.

Among clinical and exercise test variables, exercise capacity was the strongest predictor of risk for mortality. The adjusted risk was reduced by 13% for every 1-MET increase in exercise capacity

  • Compared with those who achieved <5 METs, the mortality risk was 50% lower for those with an exercise capacity of 7.1 to 10 METs
  • 70% lower for those achieving >10 METs 
  •  The findings were similar for those with and without cardiovascular disease.

ConclusionsExercise capacity is a strong predictor of all-cause mortality !

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So the study suggests…the more we exercise and the more calories we burn resulting in a better shape and better exercise capacity, the longer we live!  A 70% reduction in the risk of death is GREAT news for exercise lovers! There you go guys…. it’s about time that we sit down and think…how much do we love ourselves.  Are we doing things to satisfy our ambitions in life with great disregard to our well being?

We may be great thinkers, scholars or successful businessmen… we may be great in everything we do BUT our body also deserves to be treated right.  Success in life comes in different forms and all come from doing what you think is best!

If you therefore want to to enjoy that success and live longer…enjoy the fruits of your labor longer…enjoy life and have more fun times with your kids and family… then take the extra steps to health.  Just like what you do in taking the extra effort to be successful in your careers and goals in life.  So take time to Exercise…It is indeed an investment worthy of its great returns…..

Take The Extra Time To EXERCISE!!!

The Truth About The Medical Myths….

February 9, 2008

Go to fullsize imageCame across a light article published in the reputable British Medical Journal December 2007 issue on the common myths in Medicine that have been passed from generations to generations and carried on in our practice as facts!

Below is my edited and shortened version of the original article which I hope you’ll all find useful inofrmation.

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People should drink at least eight glasses of water a day

The advice to drink at least eight glasses of water a day can be found throughout the popular press. One origin may be a 1945 recommendation that stated: A suitable allowance of water for adults is 2.5 litres daily in most instances…the statement could be interpreted as instruction to drink eight glasses of water a day. The complete lack of evidence supporting the recommendation to drink six to eight glasses of water a day is exhaustively catalogued in an invited review by Heinz Valtin in the American Journal of Physiology.

Hair and fingernails continue to grow after death

Johnny Carson even perpetuated this myth with his joke, “For three days after death hair and fingernails continue to grow, but phone calls taper off.

Dehydration of the body after death and drying or desiccation may lead to retraction of the skin around the hair or nails. The skin’s retraction can create an appearance of increased length or of greater prominence because of the optical illusion created by contrasting the shrunken soft tissues with the nails or hair. 

Shaving hair causes it to grow back faster, darker, or coarser

Strong scientific evidence disproves these claims. As early as 1928, a clinical trial showed that shaving had no effect on hair growth.  More recent studies confirm that shaving does not affect the thickness or rate of hair regrowth.  

Reading in dim light ruins your eyesight

Suboptimal lighting can create a sensation of having difficulty in focusing. It also decreases the rate of blinking and leads to discomfort from drying, particularly in conditions of voluntary squinting.  The important counterpoint is that these effects do not persist.

Mobile phones create considerable electromagnetic interference in hospitals

After publication of a journal article citing more than 100 reports of suspected electromagnetic interference with medical devices before 1993, the Wall Street Journal published a front page article highlighting this danger. Since that time, many hospitals banned the use of mobile phones, perpetuating the belief.

At the Mayo Clinic in 2005, in 510 tests performed with 16 medical devices and six mobile telephones, the incidence of clinically important interference was 1.2%.  

We Use only 10% of our Brain

The belief that we use only 10% of our brains has persisted for over a century, despite dramatic advances in neuroscience.  Some sources attribute this claim to Albert Einstein, but no such reference or statement by Einstein has ever been recorded. Evidence from studies of brain damage, brain imaging, localisation of function, microstructural analysis, and metabolic studies show that people use much more than 10% of their brains.  Detailed probing of the brain has failed to identify the “non-functioning” 90%.

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There you go guys…common myths that have been practiced by medical professionals as facts. We continue, for example to recommend patients to drink at least 8 glasses of water but so far based on the evidence…it is limited or nil.

As the author of the article concluded: “Medical practitioners should at least recognise when their practice is based on tradition, anecdote, or art.  Speaking from a position of authority, as physicians do, requires constant evaluation of the validity of our knowledge.

Fish Oil and Weight Loss

February 7, 2008

Go to fullsize imageA new look at Fish Oil as a supplement with significant impact in terms of improving health. This new study looked at fish oil in patients without high triglycerides and found some interesting results.

The study was published by French Investigators in the December 2007 issue of the Americal Journal of Nutrition:

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Conclusions:

A moderate dose of n–3 PUFAs for 2 mo reduced adiposity and atherogenic markers without deterioration of insulin sensitivity in subjects with type 2 diabetes. Some adipose tissue inflammation-related genes were also reduced. These beneficial effects could be linked to morphologic and inflammatory changes in adipose tissue.

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I usually discourage my patients from taking fish oil because of its propensity to increase blood sugar.  The above findings though showed that a dose of 1.8 gms has negligible effects on sugar but actually have beneficial improvement in adiposity (or deposition of fat tissue) as well as biochemical parameters of inflammation ( parameters that increase the risk of heart disease) is a welcome news to all especially those who hate eating fish!

Caution however should be made to patients who are concomitantly taking anti-clotting medications since majority of patients taking fish oil have concomitant heart disease.

There you go… studies on supplements that are acceptable to the medical community is really a welcome endeavor. Although more similar researches should be done to confirm the findings.

Fish Oil May Indeed Have Health Benefits!

MODY : Another Form of Diabetes That You May Have!

February 6, 2008

Go to fullsize imageI was just scanning through some articles and this interesting review on MODY caught my attention because definitely some of our patients that are labelled Type 2 as insulin resistant diabetes may actually have MODY where the tissues are actually insulin sensitive.  As a result the way we treat these patients will actually change. 

Below is a summary of the salient features of MODY from Janet Ruhl published in Diabetes In Control online website:

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1. People with MODY are extremely sensitive to insulin.  A dose of as little as two units may have a strong effect on their blood sugar.

2. People with MODY, no matter how high their blood sugars might be after meals, may have near normal fasting C-peptide levels. This is because the defects characteristic of MODY does not affect basal insulin secretion but only the ability to secrete insulin as blood sugars rise after eating.

3. People with MODY do not have GAD or islet antibodies. Though people with severe expressions of MODY genes may be misdiagnosed in their teens with Type 1 diabetes, they can be distinguished from true Type 1s by the very low doses of insulin they need and the lack of the autoimmune antibodies.

4. People with MODY may respond extremely strongly to sulfonylurea drugs. These drugs are often prescribed as the appropriate treatment for MODY. However, these drugs  are most effective for people whose severe expression of these genes causes blood sugars high enough to be mistaken for Type 1 diabetes. For those whose MODY is milder, even 1/4 of a 1 mg tablet of Amaryl ( Glimipride) may cause a dramatic hypo. For these people the use of very small doses of insulin–no more than 2 to 4 units per meal–is more effective and more easily tailored to varying food intake.

5. MODY should always be suspected in a woman of normal weight who develops gestational diabetes early in a pregnancy and who tests negative for autoimmune antibodies. This is often how MODY first reveals itself.

6. The different forms of genetic diabetes that are lumped together under the heading of MODY have different complication profiles. The two most common forms are MODY-3 caused by a defect in HNF1-a and MODY-2 caused by a defect in the glucokinase gene GCK.

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The point of this post is for us doctors to be aware that this form of diabetes exists and that the way these patients respond to our medications differ from the typical insulin resistant Type 2 Diabetic.

Likewise patients should be aware that this kind of Diabetes exist and may need to inform their doctors if the features of the above fit their kind of diabetes.

I see a lot of diabetic patients and the need to be informed and updated all the time regarding new research on the pathophysiology, diagnosis and treatment of this epidemic is the main reason why I continue to study and learn in whatever mode or material either through books, journals, websites or conventions. 

I guess the same is true to everyone everyday…

We Should Never Stop LEARNING!

Can Soft Drinks Cause GOUT?

February 5, 2008

Another blow to the soft drinks industry published recently in the British Medical Journal January 31, 2008:

The study showed the risk of developing gout from drinking too much sweetened soda is increased but not with drinking diet soda.  It is the fructose in the drinks that is linked to increase uric acid level which is absent with diet drinks.

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Results During the 12 years of follow-up 755 confirmed incident cases of gout were reported. Increasing intake of sugar sweetened soft drinks was associated with an increasing risk of gout. Compared with consumption of less than one serving of sugar sweetened soft drinks a month the multivariate relative risk of gout for

  • 5-6 servings a week was 1.29 , meaning a 29% increased risk! 
  • for one serving a day was 1.45, meaning a 45% increased risk!
  • for two or more servings a day was 1.85, meaning  an 85% increased risk!
  • Diet soft drinks were not associated with risk of gout.
  • total fruit juice or fructose rich fruits (apples and oranges) were also associated with a higher risk of gout (P values for trend <0.05).

Conclusions Prospective data suggest that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men. Furthermore, fructose rich fruits and fruit juices may also increase the risk. Diet soft drinks were not associated with the risk of gout.

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We seldom consider fructose as a culprit since we are used to looking at foods high in protein or purine like red meat or organ meats to be responsible for gout. The pathway at which fructose increases uric acid has not been given much importance until now!

For Gout: Soda is No Better than Beer!

Exercise for Life….

February 4, 2008

Go to fullsize imageHarvard News Letter: The HelathBeat just came out with an article solely devoted to the benefits of exercise.  This post is just a reminder to all that exercise is good for the health not only to prevent disease but to live long and enjoy a better life:

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Exercise at a glance

This is what exercise can do:

  • reduce your chances of getting heart disease. For those who already have heart disease, exercise reduces the chances of dying from it.
  • lower your risk of developing hypertension and diabetes.
  • reduce your risk for colon cancer and some other forms of cancer.
  • improve your mood and mental functioning.
  • keep your bones strong and joints healthy.
  • help you maintain a healthy weight.
  • help you maintain your independence well into your later years.

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It’s a matter of taking time to do it and the willingness to do it! 

Because in Health … There is NO Shortcut!

AACE Philippines 2nd CME Update: A Success!

February 2, 2008

Go to fullsize imageThe American Association of Clinical Endocrinologists or AACE Philippines recently held our 2nd CME update in Hongkong where members were invited sponsored by the organization for a 2 day meeting of lectures, comaraderie and family fun!

Dr Augusto Litonjua gave us an update on the Pathophysiology of Daibetes while I gave an update on Pathophysiology of Hypertension.  There was a lively interaction among the members and it was a fun intellectually stimulating CME overall!

The fellowship night was full of fun and excitement as members around 50 attended. Part of the itinerary of course was a full day fun at Disneyland and we all gathered to watch the fire works display. 

AACE Philippines strives to be family oriented. So we try to include the family members in all activities that we do.

We hope to invite more members to our team as our membership has been growing yearly.  Likewise the officers strive to make this organization an asset and a support arm to the members in clinical practice. 

Next in line is the Endocrine Day in March and we are now extra busy finalizing a more exciting program for our Annual Convention to be held again in Mactan Shangrila on August 15 to 17 where more debates, workshops and exciting plenary lectures from distinguished foreign and local faculty members will be on hand.

Check out some photos of the members in action under the catagory: AACE Philippine Chapter News (soon…..)