Archive for March, 2008

Your Weight and Your Risk To Develop Breast Cancer….

March 26, 2008

Go to fullsize imageObesity is one big epidemic that is becoming a huge economic burden due to the medical complications arising form the disease. 

In the recent issue of the the journal Clinical Cancer Research, the relationship between increased weight and the risk of developing breast cancer has been shown to be closely linked:

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Purpose: The purpose of this retrospective study was to determine the association and prognostic value of body mass index (BMI) at the time of initial diagnosis in patients with locally advanced breast cancer (LABC). 

Results: 

  • Obese patients tended to have a higher incidence of IBC compared with overweight and normal/underweight groups (P = 0.01). Median follow up was 6 years for all patients.
  • Patients with Locally Advanced Breast Cancer who were obese or overweight had a significantly worse Survival and Recurrence Free Survival (P = 0.001) and a higher incidence of visceral recurrence compared with normal/underweight patients.
  • In a multivariable model, BMI remained significantly associated with both Overall Survival and Recurrence Free Survival for the entire cohort. 

Conclusion: Patients with Locally Advanced Breast Cancer and high BMI have a worse prognosis.

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This study shows us that being obese is more than what we think it is… as mere cosmetics…rather it is a risk factor in itself that can result in a more aggressive type of a disease like breast cancer and can even lead to long term disability like stroke and early death as shown in several studies.

The excess adipose tissue or fat cell results in more circulating estrogen and more inflammatory substances that may be responsible for a more aggressive breast cancer and lesser cancer survival.  We now know that any excess fat cell results in a bigger machinery that produces a lot of substances we never knew about before… that can be harmful to our body!  In short… these fat cells are pretty active and definitely not the passive bystanders that we used to think they are… and therefore need to be dealt with more aggressively!

Another good reason for us to take care and get rid of the FAT….

Be Health and Weight Conscious!

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Lower Your Risk To Develop Diabetes By Eating Veggies….

March 24, 2008

www.calpoly.edu/~lcimarel/vegetables.jpgWe all know veggies are good.  But this recent finding that veggies can prevent diabetes is a welcome news to us trying to curb the epidemic of this disease due to unhealthly lifestyle and poor dietary habits.

I have trained my kids to eat veggies.  I found it amusing that one day my son said to me:  “Dad my classmates are teasing me that I am a Vegetarian!”  Suggesting that of all his classmates, he was the only one who had veggies on his lunch box.  Lucky me… my kids love veggies….and for a good reason!

This good news about veggies and diabetes was published in the March 2008 issue of the Journal of Nutrition:

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A population-based prospective study of 64,191 women with no history of T2D or other chronic diseases at study recruitment and with valid dietary information.

The relative risk for T2D for the upper quintile relative to the lower quintile of vegetable intake was 0.72 (95%CI: 0.61–0.85; P < 0.01) in multivariate analysis. Individual vegetable groups were all inversely and significantly associated with the risk of T2D.

Fruit intake was not associated with the incidence of diabetes in this population.

Our data suggest that vegetable consumption may protect against the development of T2D.

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This data is great suggesting that those who consumed the highest amount of vegiies in 4-5 years reduced the likelihood of developing diabetes by 28%.  That is… taking 428 grams of veggies per day reduced ones chances to develop this chronic disabling disease compared to if you only take 121 grams of veggies per day!

The advantages of veggies is that it contains high fiber as well as other substances like phytates and isoflavones that may help in reducing the risk for developing diabetes.

Although fruits did not show benefit…it likewise did not show harm.  Just the same fruits have been shown to reduce the risk of developing other diseases like cancer or heart disease.  Such that… its intake remains to be a cornerstone in promoting health!

Train Yourself and Your Kids To Eat Veggies for Health!

The Use of Aspirin and The Risk of Death and Cancer…

March 19, 2008

Diabetics are at risk for cardiovascular disease.  As such, an anticlotting agent like aspirin is always part of the drug regimen that we prescribe to our patients.  Studies have proven the use of aspirin to be beneficial in preventing heart disease and prolongoing survival to those at risk of cardiovascular disease in both men and women.

Now comes a new study that looked at the effect of taking aspirin on women without cardiovascular disease and to see if benefits are still present in terms of preventing heart disease or cancer.  This study involved 79,439 women who were enrolled in the Nurses’ Health Study since 1980 published in the Archives of Internal Medicine.

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  • In women who reported current aspirin use, there was a 25% reduction in death from all causes compared with women who never used aspirin regularly.
  • The risk reduction was more apparent for death from cardiovascular disease at 38%.
  • The risk reduction for death from cancer was only 12%.
  •  Use of aspirin for 1 to 5 years was associated with significant reductions in cardiovascular mortality 
  • In contrast, a significant reduction in risk of cancer deaths was not observed until after 10 years of aspirin use.
  • The benefit associated with aspirin was confined to low and moderate doses and was significantly greater in older participants and those with more cardiac risk factors.

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The above study points out that women who take low to moderate doses of aspirin meaning less than 6 tablets per week have lower risk for death from all causes as well as a lower risk for death from cardiovascular disease within 5 years of taking the drug.  However the lower risk for death from cancer was only noted after a longer exposure of 10 years. 

This study continues to propagate the magic of aspirin as a “health” drug.  It helps by preventing a complication that can result in long lasting disability like heart disease and softens the long term economic burden to an already “burdened” risk patient due to polypharmacy arising from diabetes or hypertension.

More studies of similar or better study design should give us more bullets to use to support the long term use of aspirin especially to women or men without risk of cardiovascular disease.

An Aspirin A Day Keeps Your Heart Beat Everyday!

Nutrition in Health and Disease….

March 17, 2008

This is called the Paradox of Food:  you need food to live and survive but the very reason for disease and illnesses stem from the abundance of food and poor nutrition!

I practice a field dealing with the metabolic diseases where poor nutrition plays a key role in its onset and progression to develop complications.  Control of blood glucose requires the right balance of nutrition, exercise and medications. The same formula apllies when treating obesity, hypertension and high cholesterol.

The problem with handling these diseases stem from the medical field lack of understanding of nutrition and the lack of importance given to medical nutrition therapy!   If you make rounds in the hospital … you see the diet prepared for a diabetic hypertensive is almost similar if not similar to the other patient in the other room who is not a  diabetic…  It may not be the dietician’s fault but the doctor prescribing the diet!  This is where I am very particular with my patients because I believe the long term success of successfully controlling their blood sugar or blood pressure or cholesterol stem from not what I give them as medications but what they take in as food!

The recent 2008 ADA recommendation for Nutrition  reasons out why Nutrition is important:

Clinical trials/outcome studies of Medical Nutrition Therapy have reported decreases in HbA1c (A1C) of 1% in type 1 diabetes and 1–2% in type 2 diabetes, depending on the duration of diabetes . Meta-analysis of studies in nondiabetic, free-living subjects and expert committees report that MNT reduces LDL cholesterol by 15–25 mg/dl . After initiation of MNT, improvements were apparent in 3–6 months. Meta-analysis and expert committees also support a role for lifestyle modification in treating hypertension .

The proportion of calories in the specific nutrition Rx will now be individualized and should be prescribed by your doctor.  I have my own personal dietician in my clinic now that I offer free couseling to my patients where personal preferences of food is taken into consideration.  I believe in individualized counseling so as to offer a  more successful diet regimen.  No prepared diets printed on a piece of paper!

I have been a proponent of using a 40% of total calories from carbohydrates for my diabetic patients as more and more data are coming out regarding the benefits of limited carbohydrate not only for losing weight but for better glycemic control.  It is but proper that for the first time the American Diabetes Association came up with their position paper recommending the same.

For me…it is plain and simple challenging one’s self discipline in not giving in to the “want” but following to the details of what is nutritious and healthy!!!

Live Life To The Fullest…By Eating Right!

Wanna Lift Weights? Why Not?

March 15, 2008

When people talk about exercise… it is almost always synonymous to aerobic exercises like jogging, walking and dancing. Never does weight training come into the picture. Combining both should be better!

But why lift weights? Is it advantageous than just sweating it out by running?

A recent article from the Harvard HealthBeat beautifully illustrates the reasons  why:

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Muscle tissue, bone density, and strength all dwindle over the years. So, too, does muscle power. These changes open the door to accidents and injuries that can compromise your ability to lead an independent, active life. Strength training is the most effective way to slow and possibly reverse much of this decline.

Having smaller, weaker muscles doesn’t just change the way people look or move. Muscle loss affects the body in many ways. Strong muscles pluck oxygen and nutrients from the blood much more efficiently than weak ones. That means any activity requires less cardiac work and puts less strain on your heart.

Strong muscles are better at sopping up sugar in the blood and helping the body stay sensitive to insulin (which helps cells remove sugar from the blood). In these ways, strong muscles can help keep blood sugar levels in check, which in turn helps prevent or control type 2 diabetes and is good for the heart. Strong muscles also enhance weight control.

On the other hand, weak muscles hasten the loss of independence as everyday activities — such as walking, cleaning, shopping, and even dressing — become more difficult. They also make it harder to balance your body properly when moving or even standing still, or to catch yourself if you trip. The loss of power compounds this.

Perhaps it’s not so surprising that, by age 65, one in three people reports falls. Because bones also weaken over time, one out of every 20 of these falls ends in fracture, usually of the hip, wrist, or leg. The good news is that the risk of these problems can be reduced by an exercise and fitness routine that includes strength training.

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As we prevent complications from illnesses to happen…we also should have this obligation to live longer but healthier! And one sure thing to accomplish this goal is to exercise regularly and exercise the right way!

Incorporating weight training to your regimen not only strengthens muscles but likewise prevents obesity since the more muscle you have, the less fat you get and the more metabolically active the muscle mass is compared to fat! As a result you likewise help prevent the onset of chronic illnesses like diabetes and hypertension!

I do incorporate weights into my exercise regimen. I don’t go to the gym but after my sit-ups in the morning, I then do my routine abdominal twisting disc then do the weights using the arm band that you can buy in sports shops, or my barbell weights. You can likewise do the tiptoe setup by putting you two hands on the wall then tiptoe to raise yourself as high as you can then hold it for few seconds then repeat it 8 to 10 x daily!

Simple Rules and Simple Measures For a Healthier You!

The Pedometer: “Small But Terrific” Gadget for Losing Weight

March 12, 2008

Go to fullsize imageObesity continues to be a problem worldwide.  Measures to make people lose weight have made a lot of entrepreneurs out of doctors from selling miracle drugs to lose weight to marketing centers promising dramatic weight loss.  The bottom line however continues to be the need to incorporate lifestyle change to every measure that we implement in increasing chances to a successful weight loss.

The pedometer is one such gadget that is small and handy but a powerful tool to help patients lose weight.  A new meta-analysis published recently in the Annals of Family Medicine showed the effectiveness of this gadget in curbong obesity.

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RESULTS Nine studies met the study inclusion criteria. Cohort sample size ranged from 15 to 106, for a total of 307 participants, 73% of whom were women and 27% of whom were men. The duration of the intervention ranged from 4 weeks to 1 year, with a median duration of 16 weeks. The pooled estimate of mean weight change from baseline using a fixed-effects model and combining data from all 9 cohorts was –1.27 kg (95% confidence interval, –1.85 to –0.70 kg). Longer intervention duration was associated with greater weight change. On average, participants lost 0.05 kg per week during the interventions.

CONCLUSION Pedometer-based walking programs result in a modest amount of weight loss. Longer programs lead to more weight loss than shorter programs.

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What This Study Found as stated by the Editors of the AFM “In Brief”:

 Walking programs that use a pedometer as a motivational tool result in a moderate amount of weight loss in overweight or obese sedentary adults. The average participant in a pedometer-based walking program without dietary change can expect to lose about 1 pound every 10 weeks, or about 5 pounds per year. Longer programs are associated with greater weight loss.

Implications

  • The amount of weight loss from pedometer-based walking programs is small but significant from a clinical perspective.
  • Walking programs that use pedometers can have health benefits that are associated with both a modest weight loss and increased physical activity.

Small Steps Can Lead to Big Changes in Health!!!

How To Increase Compliance To Lifestyle Change…

March 10, 2008

Nowadays, physicians just dont have the time to talk with their patients. Patients feel shortchanged when they have been waiting outside our clinics only to be seen for 5 minutes. 

The lesson I’ve learned from my training at the Mayo Clinic was the importance of patient – doctor relationship that should go beyond treating a disease.  But more so to provide comfort to an anxious patient not knowing what she or he has and the need to listen and care!  The words of advise from a doctor’s mouth is more than worth their time in seeing you and these patients see us because they trust us to help them lead a better healthy life.

Now comes a new study that confirms my practice in my clinic published in the Archives of Internal Medicine this 2/2008.

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Background  Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits.

Methods  We conducted a randomized controlled trial of a 12-month intervention at 2 large community health centers, enrolling 310 patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater. In the intervention group, self-management goals for nutrition and physical activity were set using a tailored computer program. Goals were then reviewed at each clinic visit by physicians. The control group received only printed health education materials. The main outcome measures included change in physical activity and body weight.

Results  In the intervention group, recommended levels of physical activity increased from 26% at baseline to 53% at 12 months (P < .001) compared with controls (30% to 37%; P = .27), and 32% of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9% of controls (odds ratio, 2.2; P = .006).

Conclusion  A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss.

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This study confirms my belief and practice of spending more time with the patient in trying to help them understand how one can implement the standard of care in dealing with chronic diseases like obesity, high blood pressure, high cholesterol and diabetes.  If one understands the concept of why exercise and nutrition are important then the pressure is with the patient to comply otherwise he will suffer the consequences.

Compliance to medications and behavioral therapy is a must if one aims to reach the goal of preventing complications like stroke and heart attack!  I am always asked if I am successful with behavioral modification and in letting patient follow my dietary guidelines.  I guess I am because I spend time with them.

This has been my standing principle and guide in my practice and thus this website to help educate my patients and the public because I believe that….

“Understanding One’s Disease Is Key To Better Health”. 

Is Acupuncture Safe?

March 6, 2008

Before I left the Mayo Clinic after my fellowship, the center was already into research regarding the efficacy of this ancient chinese remedy called the Acupuncture.  It is one of the widely practiced alternative medicine in the US and therefore the National Institute of Health is also funding research into this area.  It is one alternative therapy that does not entail any intake of drugs and therefore I bend a little and allow the use of this form of therapy among my patients.

Here is an excerpt of what acupuncture is from the National Institutes of Health:

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Practiced in China and other Asian countries for thousands of years, acupuncture is one of the key components of traditional Chinese medicine. In TCM, the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang

Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. According to TCM, health is achieved by maintaining the body in a “balanced state”; disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi (vital energy) along pathways known as meridians. Qi can be unblocked, according to TCM, by using acupuncture at certain points on the body that connect with these meridians. Sources vary on the number of meridians, with numbers ranging from 14 to 20. One commonly cited source describes meridians as 14 main channels “connecting the body in a weblike interconnecting matrix” of at least 2,000 acupuncture points.

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The US FDA admits that this form of therpay is pretty safe with very few complications.  However it is advised that needles be sterile, nontoxic, and labeled for single use by qualified practitioners only.  Furthermore, the NIH site cautions that: “Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.”

Whether the therapy really works for osteoarthritis to low back pain to diabetic foot ulcers remain to be seen.  The NIH is already funding research into these areas and their conclusions are worth waiting for!

For now… just like any alternative medicine…it is done at the patient’s will. It is not prescribed or advised but if asked then the doctor may tend to bend a little and allow this therapy to be done if other known modalities fail.

If Anything Else Fails..Try Acupuncture!

Want Your Kids To Lose Weight?

March 5, 2008

Go to fullsize imageA new study published in the Archives of Pediatric and Adolescent Medicine showed that cutting TV and Computer time can increase a child’s chances of controlling and losing weight. 

In a prepared statement from the authors…they theorized that:

  • “Television viewing is related to consumption of fast food and foods and beverages that are advertised on television,”
  • “Viewing cartoons with embedded food commercials can increase choice of the advertised item in preschoolers, and television commercials may prompt eating.”

The bottom line is: by restricitng TV time then the children can do other physical activites aside from benefiting from less exposure to food ads and therefore less chances for them to eat unhealthy junk.

My kids love cartoons and of course computer games.  But they’re off limits during school days.  Only when they finish their study period earlier that I allow them to play their PSP but restiricted to 30 minutes only.  The kid’s room has no cable so they cant watch cartoon network or other cable channels where junk food ads are in abundance.  They can however watch cartoon movies where I know nothing out of the box commercials promoting something I dont agree with will pop out in surprise!

I am a true follower of the above regulation in our house with regard to restricting TV and computer times and glad to say am pretty successful with my kids school and study habits PLUS improving their …

Health Through Better Nutrition and Discipline!

Can Multivitamins Prevent Cancer?

March 3, 2008

Do you take multivitamins daily?  Why? Out of habit? or because you believe they can prevent illneses especially cancer?

Well a new study refutes the claims that multivitamins can prevent cancer.  Recently published in the American Journal of Respiratory and Critical Care Medicine suggest that in fact the contrary maybe true and that is… it can be harmful!!!!__________________________________________________________

Rationale: Lung cancer is the leading cause of cancer-related mortality in the United States. Although supplements are used by half the population, limited information is available about their specific effect on lung cancer risk.

Objectives: To explore the association of supplemental multivitamins, vitamin C, vitamin E, and folate with incident lung cancer.

Methods: Prospective cohort of 77,721 men and women aged 50–76 years from Washington State in the VITAL (VITamins And Lifestyle) study. Cases were identified through the Seattle–Puget Sound SEER (Surveillance, Epidemiology, and End Results) cancer registry.

Measurements and Main Results:

  • Supplemental vitamin E was associated with a small increased risk of lung cancer (HR, 1.05 for every 100-mg/d increase in dose).
  • This risk of supplemental vitamin E was largely confined to current smokers (HR, 1.11 for every 100-mg/d increase) and was greatest for non–small cell lung cancer (HR, 1.07 for every 100-mg/d increase).

Conclusions: Supplemental multivitamins, vitamin C, vitamin E, and folate were not associated with a decreased risk of lung cancer. Supplemental vitamin E was associated with a small increased risk.

Patients should be counseled against using these supplements to prevent lung cancer.

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We have been disappointed with studies looking at whether multivitamins are beneficial or not.  Almost always they turn out to be negative and sometimes even do harm.  And yet we continue to take MVI as supplements to our diet for hope that they may replenish what have been lacking in our diets.  I even have patients who continue to show me their MVI preparations bought by their loved ones in the US whether they can take them or not.

What we know is that foods rich in vitmains have been proven to reduce the risk of cancer…BUT once these vitamins are packaged as pills…then the benefit is nowhere to be found!  And what is worst…in the above published study…Vitamin E was noted to increase the risk of lung Cancer especially among smokers!

The best option for us is not to rely on shortcuts to health packaged as pills…its in our lifestyle..the food we eat , the physical activities we do and the way we live our lives that matter most!

Health Shortcuts Packaged As Pills Are Of No Benefit!