Archive for May, 2008

The Wonders of Vitamin D…

May 28, 2008

Vitamin D has been a negelcted Vitamin for several centuries.  People are so mystified by Vitamin E and Vitamin C that almost always every patient that I encounter is either on E or C as vitamin supplements.  But recent data have shown that one Vitamin that stand out among the rest in terms of preventing illnesses is Vitamin D.

A new study that looked at how important Viatmin D in terms of it causing muscle pain was recently published. It looked at how deficiency of Vitamin D may play a big role in causing this chronic complaints among the elderly population. This study published in the American Journal of Geriatrics in May 2008 involved Nine hundred fifty-eight persons (aged ≥65) selected from city registries of Greve and Bagno a Ripoli.

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Lower concentrations of 25(OH)D are associated with significant back pain in older women but not men. Because vitamin D deficiency and chronic pain are fairly prevalent in older adults, these findings suggest it may be worthwhile to query older adults about their pain and screen older women with significant back pain for vitamin D deficiency.

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The main function of Vitamin D is in helping maintain a normal calcium level in the blood which is important for bone strength.  It aids in the absorption of calcium from the gut and can provide protection from osteoporosis as well as other chronic illnesses like hypertension (high blood pressure), cancer, and others.

Some health benefits of Vitamin D although will need more studies to fully prove its worth include for:

  •  Diabetes where Vitamin D has been shown to improve insulin sensitivity; 
  •  Colon cancer where a Metaanalysis showed VitaminD supplementation decreased the risk
  •  Multiple Sclerosis
  •  Prostate cancer where a reduction in risk was noted with higher Vitamin D Intake among others….

So how can we get enough Vitamin D?

Exposure to the morning sun for 10 to 15 minutes should provide you enough Vtamin D.  Other food sources include fish like salmon and tuna , egg yolk, cheese, fortified milk including yogurt, and cod liver oil.  It is best to check your Vitamin D level to determine if you are deficient or not.  There are many supplements of Vitamin D available in the market and it is best to discuss which is best for you with your doctor.

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Soy Protein and The Heart….

May 26, 2008

Go to fullsize imageThere are many conflicting data on soy protein and the heart especially the claim that they lower cholesterol.  In fact in 1999 based on studies during that time, the US FDA allowed a health claim on food labels stating that a daily diet containing 25 grams of soy protein, also low in saturated fat and cholesterol, may reduce the risk of heart disease. 

However, the American Heart association in January of 2006 made a review of available data and made a conclusion that soy protein in itself did not significantly lower the bad cholestrol nor did it have any significant effect in increasing the good cholesterol.

But as an endocrinologist looking for alternative source of meat protein, the use of soy protein in place of meat which has high staurated fat will continue to play a major role in our attempt to reduce the risk of our patients from cardiovascular disease.

Recently a new article on the benefit of soy protein came out in Annals of Internal Medicine.  This study is so relevant to my practice especially among diabetic patients with kidney disease.  These are the patients we try to avoid taking meat protein because of the possibility of causing kidney function deterioration.  The study did not only show a good effect in sugar control but also markers of inflammation suggesting a potential effect in reducing cardiovascular disease plus improving markers of kidney function.

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Soy protein consumption significantly affected cardiovascular risks such as fasting plasma glucose , total cholesterol , LDL cholesterol, and serum triglyceride concentrations.

Serum CRP levels were significantly decreased by soy protein intake compared with those in the control group .

Significant improvements were also seen in proteinuria  and urinary creatinine ( both measures od kidney function) by consumption of soy protein.

CONCLUSIONS—Longitudinal soy protein consumption significantly affected cardiovascular risk factors and kidney-related biomarkers among type 2 diabetic patients with nephropathy.

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Here is a list of the common sources of soy protein that we can enjoy includes: Tofu, soymilk, soyflour. Tempeh and Miso.  The soymilk and textured soy protein can be used as subsitute for meat or cows milk while the soyflour can be used in baking needs.

I believe in the benefits of soy protein.  I hope for more studies to come that will provide us with more data on its beneifts and potential to reduce disease risk especially the Heart!

Soy Protein: A Better Partner for the Heart!

Having High Sugar and High Blood Pressure Can be Deadly…

May 23, 2008

Go to fullsize imageAlmost always a patient that suffers from diabetes is obese, have high triglycerides and low HDL and develops high blood pressure and high cholesterol… the combination of which is called the Metabolic syndrome.  If any of these conditions are not addressed then ones risk to suffer from chronic complication like heart disease is increased.  Whether the sum of the components or the combination of two parts or only one component is present makes a patient more at risk to die is not well documented.

The new study published in Annals of Internal Medicine May 2008 now shows that having two parts increases the risk to die more than having the combination for the components of the syndrome itself….

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  1. After multivariable adjustment, compared with persons without MetS, those with MetS had a 22% higher mortality .
  2. Higher risk with MetS was confined to persons having elevated fasting glucose level  or treated diabetes mellitus or hypertension as one of the criteria;
  3. Persons having MetS without High Fasting Glucose or MetS without hypertension did not have higher risk.
  4. Evaluating MetS criteria individually, we found that only hypertension and EFG predicted higher mortality;
  5. Persons having both hypertension and Elevated Fasting Glucose had 82% higher mortality .
  6. Substantially higher proportions of deaths were attributable to EFG and hypertension (population attributable risk fraction [PAR%], 22.2%) than to MetS (PAR%, 6.3%).

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There you go my friends…just having diabetes or hypertension makes one at higher risk to die from heart disease.  More so if high blood sugar is joined by high blood pressure then the risk to die is 82%!!!!

The above study therefore tells us that making a diagnosis of metabolic syndrome does not entail more risk to die than having just diabetes of hypertension alone.  Such that… it’s utility as a diagnosis and as a risk factor for cardiovascular mortality is put in question. 

So friends…please dont take these two conditions lightly!!! As an endocrinologist, I take these conditions seriously and that all patients with Diabetes are screened for blood pressure and cholesterol abnormalities and vice versa! 

To summarize the study:

Having High Sugar especially if with High Blood Pressure Can Be DEADLY! 

Foods That Can Make Us Feel FULL….

May 12, 2008

Go to fullsize imageDifferent kinds of food give us different levels of satiety and the feeling of fullness.  You may not have realized it but in one meal, you get easily hungry in less than 2 hours and are wondering why this is so.

It is important for us to remember that the main role of food is solely to satisfy our craving, our hunger and definitely to provide us the needed calories for energy.  But the kind of food we eat will determine if we feel the feeling of satisfaction or not.  This satiety factor therefore will be a factor in making us eat more and therefore provide us with unecessary calories that make us gain weight!

What determines the feeling of fullness include the quantity of food we eat, the actual contents of the food and the texture including the smell.  Signals to the brain from the stomach make us feel satisfied or make us eat more.   

What foods can give us the highest satiety level? 

If your food contains a high level of protein, enough amounts of fiber and water, this food will give you the highest satisfaction rating.  In contrast foods high in fat will make you less satisfied and makes you want to eat more…this be the reason why a high fat diet makes you gain weight!  Intake of protein like a meal that includes fish meat or egg  gives a higher satiety level than carbohydrates.  But carbohydrate rich foods like pasta, rice or bread also provides a high satiety level. 

So to provide one with the highest satiety level of food for a meal… a whole grain bread with leans cuts of meat can provide a better satiety level and longer period of preventing hunger than if one eats a croissant!

The satiety factor of a food like glycemic index is just one of the many factors that affect the way we eat, the way we manage our lifestyle and the way we prevent weight gain. Complex factors come into play including social norms, culture and even mood in deciding whether we feel satisifed and enough food is enough for the meal!

The bottom line is: the higher the satiety factor the lesser we eat!  Likewise…my advise to all: once you feel full…then stop eating especially if you are indulging in a high carbohydrate meal!!!! Sometimes, its the great taste of food even if we are already full that makes us want to eat more. 

Dont be Fooled by Food…Be “Fulled” The Right Way!

Signs of Aging? Better Check Your Thyroid Gland…

May 8, 2008

Go to fullsize imageIf you complain of too much fatigability, or weakness and memory loss.. these may not be signs of aging but rather an abnormality in your thryoid gland. 

So where is the thyroid gland?  It is found in the neck just below the Adam’s apple.  Any malfunction of the thyroid gland results in a reduction body temperature ( you cant tolerate cold) , decrease in heart rate and muscle strength as well as increase in cholesterol.  Worst of all the symptoms are a decrease in memory and mood due to a sluggish feeling and weight gain.  When  these symptoms occur, you feel tired all the time and may blame aging as the culprit!

It si very easy to check thru blood tests called TSH ot Thyroid Stimulating Hormone and Free T4 or the thyroid hormone.  These tests are readily available but must be interpreted properly because any mistake in analysis can results in a wrong therapy.  Make sure you have the test confirmed for evaluation by a certified endocrinologist in your area.

A High TSH and Low FT4 is diagnostic.  Treatment is simple and requires thyroid hormone replacement. And boom…you will feel better, become more active and better sense of well being!  And feel young again!

So The next time….

You Feel unexpectedly Sluggish?…Check your Thyroid!

Mixing Fun and Work Equals FUN…

May 6, 2008

Just came back from Manila this afternoon after I was invited to give a lecture in the annual convention of the Philippine College of Physoicians- the biggest organozation of all internists in the Philippines.  But before this date, I brought my family to take a vacation in Manila and visited some sights both for entertainment and cultural learnings.  I would have wanted to bring my family somewhere in Asia again during this summer but my being away to attend conventions for these past few months have made me decide to have fun with them in time for my work. And boy it was full of fun!

To those with kids and plan to explore Manila… these are the fun things you can do with your kids.  First we visited The Manila Ocean Park where the Oceanarium is located. It was full of fun for the kids and was the first time for my youngest to see such a huge collection of sea life. It can compete with the aqauriums in Hongkong and Singapore. 

 Then we proceeded to go to Star City which is a covered amusement park where the Snow World is located. Its bigger than the Snow City of Singapore and is more fun BUT… you need to bring your own jacket and boots if you like more time inside because they only provide you with a light jacket without boots which are not enough considering the freezing temperature.  Overall, Star City has lots of other fun rides for the kids and also clean and safe.  This early the kids are expressing their desire to go back!.

The next day we went to the Kiddie Fun ranch near Tiendesitas just around Ortigas also. The place has a huge adventure zone like playground and a huge inflatable slides with mini boat rides and games. Avilon mini zoo was a lso nearby and a walking distance which was also both fun and educational for the kids. But the most fun for them was when they rode on a donkey, held an eagle and fed the rabbits with a carrot stick on their hands.

The next day was more cultural as my son wanted to see the places he has learned in his Social Studies especailly Intramuros, Fort Santiago and Jose Rizal.  We toured Intramuros using a Kalesa ride and gave us a glimpse of the past.  We visited the place where Jose Rizal was imprisoned and traced his footsteps on the way to his death!  We visited the museum and glanced at his book the Noli mi Tangere and El Filibusterismo which my son knows about.  Then we visited the Discovery Science Center where the most amazing for my kids was the talking fish who interacted with them with questions and dances.  They now want to go back becuase of the FISH!  It has a Planetarium with an IMAX theater and Robotics.  Worth to visit.

The last day was a visit to Tom’s World and Toys R Us and a swim in our hotel…my favorite the Discovery Suite.

This Sunday I will be attending the American Association if Clinical Endocrinologist meeting in Orlando.  This one educational meeting that I always attend to update me of what’s new in my field. I will be away again for a week for work. But all these for the benefit to learning more so as a specialist I can update my knowledge of this ever changing field of Medicine.

But as all of us are busy, taking time to be with our kids and just be away from work is all much fun.  My way of mixing fun with work worked!  Grab all the time to be happy with them and bond with them.  They will be young only once! I feel better, healthier just laughing with them and younger as I rode the rides with them and as we all shouted together as if I was young again! 

Are Eggs Healthy To Eat?

May 1, 2008

One of the top posts in my website is my article on how much eggs can one eat.  The emphasis on eggs as being healthy but laden with cholesterol has made the public very confused.  Now comes a new study published in the American Journal of Nutrition done in Harvard University linking consumption of egg to increased mortality. 

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Background: A reduction in dietary cholesterol is recommended to prevent cardiovascular disease (CVD). Although eggs are important sources of cholesterol and other nutrients, limited and inconsistent data are available on the effects of egg consumption on the risk of CVD and mortality.

Objective: We aimed to examine the association between egg consumption and the risk of CVD and mortality.

Design: In a prospective cohort study of 21 327 participants from Physicians’ Health Study I, egg consumption was assessed with an abbreviated food questionnaire. Cox regression was used to estimate relative risks.

Results: In an average follow-up of 20 y, 1550 new myocardial infarctions (MIs), 1342 incident strokes, and 5169 deaths occurred.

  • Egg consumption was not associated with incident MI or stroke in a multivariate Cox regression.
  • Adjusted hazard ratios (95% CI) for mortality were 1.0 (reference), 0.94 (0.87, 1.02), 1.03 (0.95, 1.11), 1.05 (0.93, 1.19), and 1.23 (1.11, 1.36) for the consumption of <1, 1, 2–4, 5–6, and 7 eggs/wk, respectively (P for trend < 0.0001).
  • This association was stronger among diabetic subjects, in whom the risk of death in a comparison of the highest with the lowest category of egg consumption was twofold (hazard ratio: 2.01; 95% CI: 1.26, 3.20; P for interaction = 0.09).

Conclusions: Infrequent egg consumption does not seem to influence the risk of CVD in male physicians. In addition, egg consumption was positively related to mortality, more strongly so in diabetic subjects, in the study population.

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The data suggests that the higher the number of eggs consumed, the higher the mortality risk especially among diabetic patients.  This seems interesting because the risk to develop heart disease was not seen among those who are frequent egg eaters suggesting that the risk to die was not associated with heart disease but something else! Nevertheless, looking at prevoius relationships of cholesterol and death, the most likely explanation as assessed in the editorial by Dr Eckel of University of Colorado is still atherosclerotic disease.

The relationship between egg consumption and heart disease continues to be confusing.  This is understandable because now we know that the effect of cholesterol intake in the diet has less effect on the LDL or bad cholesterol in the blood than an intake of saturated fat or trans fat in the diet.  And as we all know, the egg yolk mainly contains cholesterol.

The editorial sums it all up:

So, if you are a male physician and are going to eat 1 egg/d, why not eat the whites only? Just think—with all of the trimmings, that 3-white egg omelet is almost indistinguishable by taste from an omelet enriched with 600 mg cholesterol, and the whites-only omelet also remains a very good source of protein, riboflavin, and selenium. If you cannot do without the yolks, go ahead and enjoy them, but why eat them >3–4 d/wk? If you are a man with diabetes, a more limited egg intake pattern seems prudent. But, remember: eggs are like all other foods—they are neither “good” nor “bad,” and they can be part of an overall heart-healthy diet.