Archive for August, 2008

Sleep and High Blood Pressure… Check Your Kids!

August 27, 2008

Go to fullsize imageI just came across a new study that showed poor sleep is affecting a lot of our teens these days.  Its either they have problems falling asleep or problems waking up early or just plain LACK of Sleep for whatever reason.  This study involved around 200 adolescents between ages 13-16 was recently published in the Journal Circulation August issue and is really an eye opener for parents with kids… by making sure that their kids follow a sleep habit that is healthy.

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Odds of prehypertension associated with sleep disturbances

Sleep problem Unadjusted OR (95% CI) p Adjusted OR p
Low sleep efficiency (<85%) 4.52 (2.11-9.70) 0.0001 3.50 0.0028
Short sleep (<6 h) 2.79 (1.07-7.34) 0.0366 2.54 0.0679

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The kids with sleep inefficiency meaning they have trouble falling asleep or wake early and those with poor sleep (6.5 hours or less) had systolic blood-pressure levels that were higher than their peers on average 4 mm Hg.  This problem of hypertension may result in long lasting complications and development of end organ damage involving the heart, kidneys and eyes among our kids at an early age.  Fortunately this is one risk of hypertension that is MODIFIABLE.

What then can be modified to afford better sleep habit among our teens? 

I have three Simple recommendations:

  • Limit Home Internet Use.  Only for school work and no to games during school days!  Overexcitement results in being hyperactive due to adrenaline rush and this limits sleep quality.
  • A Good Study Habit to avoid cramming.  This should have been trained as early as preschool!
  • Limit soda or other drinks rich in caffeine especially during dinner time

A Better Adjusted Kid Is A Healthy Kid!

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Vitamin D and The Risk of Death….

August 22, 2008

While reviewing my journals…I again came across another study on Vitamin D but this time relating this vitamin to mortality or the risk of death in the general population.  This study was published in the Archives of Internal Medicine, August 15, 2008 issue.

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Background  In patients undergoing dialysis, therapy with calcitriol or paricalcitol or other vitamin D agents is associated with reduced mortality. Observational data suggests that low 25-hydroxyvitamin D levels (25[OH]D) are associated with diabetes mellitus, hypertension, and cancers. However, whether low serum 25(OH)D levels are associated with mortality in the general population is unknown.

Methods  We tested the association of low 25(OH)D levels with all-cause, cancer, and cardiovascular disease (CVD) mortality in 13 331 nationally representative adults 20 years or older from the Third National Health and Nutrition Examination Survey (NHANES III) linked mortality files. Participant vitamin D levels were collected from 1988 through 1994, and individuals were passively followed for mortality through 2000.

Results 

  •  In cross-sectional multivariate analyses, increasing age, female sex, nonwhite race/ethnicity, diabetes, current smoking, and higher body mass index were all independently associated with higher odds of 25(OH)D deficiency (lowest quartile of 25(OH)D level, <17.8 ng/mL
  • while greater physical activity, vitamin D supplementation, and nonwinter season were inversely associated.
  • During a median 8.7 years of follow-up, there were 1806 deaths, including 777 from CVD.  compared with the highest quartile, being in the lowest quartile (25[OH]D levels <17.8 ng/mL) was associated with a 26% increased rate of all-cause mortality (mortality rate ratio, 1.26; 95% CI, 1.08-1.46) and a population attributable risk of 3.1%.
  • The adjusted models of CVD and cancer mortality revealed a higher risk, which was not statistically significant.

Conclusion  The lowest quartile of 25(OH)D level (<17.8 ng/mL) is independently associated with all-cause mortality in the general population.

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Another reason for us to check our Vitamin D level.  All along I am right.  I have been a proponent of the wonders of Vitamin D and the perils of what Vitamin D Deficiency can do.

The best way again for us to avoid getting the lowest Vitamin D level is to eat foods rich in Vitamin D and to enjoy the sun as much as we can! The flesh of fish such as salmon, tuna, and mackerel aa well as fish liver oils are among the best sources of Vitamin D that we can get naturally.  I would not recommend supplements if we can avoid them.

Live Long… Enjoy the SUN!

Vitamin D and Your Risk To Fracture….

August 20, 2008

Go to fullsize imageVitamin D is a neglected vitamin.  I always consider it as one of those vitamins that have powerful effects on the body but has never got the attention fo the media. 

Through this website, I have been harping on the benefits of Vitamin D and the problems associated with subtle vitamin D Deficiency.

I recently had one patient who suffered from severe muskuloskeletal weakness that the neurologist was already doing a battery of tests but no diagnosis was given. When her vitamin D was checked..it was extremely low and with supplementation of Vitamin D, she eventually recovered in 1-2 months. The neurologist discounted the effect saying she is living in a hot tropical country with plenty of sun and therefore he doubts that she is vitamin D deficient.  Unknowingly to everyone… people in our country hide from the sun… they bring umbrellas during sunny days… they avoid the sun because it can cause wrinkles and freckles.  My patient was no exception!!!

Now comes a new study linking Vitamin D Deficiency to fractures….publsihed in the Annals of Internal Medicine August issue…

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Participants: 400 case-patients with incident hip fracture and 400 control participants matched on the basis of age, race or ethnicity, and date of blood draw. Both groups were selected from 39 795 postmenopausal women who were not using estrogens or other bone-active therapies and who had not had a previous hip fracture.

Measurements: Serum 25(OH) vitamin D was measured and patients were followed for a median of 7.1 years (range, 0.7 to 9.3 years) to assess fractures.

Results: Mean serum 25(OH) vitamin D concentrations were lower in case-patients than in control participants (55.95 nmol/L [SD, 20.28] vs. 59.60 nmol/L [SD, 18.05]; P = 0.007), and

  • lower serum 25(OH) vitamin D concentrations increased hip fracture risk (adjusted odds ratio for each 25-nmol/L decrease, 1.33 [95% CI, 1.06 to 1.68]).
  • Women with the lowest 25(OH) vitamin D concentrations (47.5 nmol/L) had a higher fracture risk than did those with the highest concentrations (70.7 nmol/L) (adjusted odds ratio, 1.71 [CI, 1.05 to 2.79]), and
  • the risk increased statistically significantly across quartiles of serum 25(OH) vitamin D concentration (P for trend = 0.016).
  • This association was independent of number of falls, physical function, frailty, renal function, and sex-steroid hormone levels and seemed to be partially mediated by bone resorption.

Limitations: Few case-patients were nonwhite women. Bone mineral density and parathyroid hormone levels were not accounted for in the analysis.

Conclusion: Low serum 25(OH) vitamin D concentrations are associated with a higher risk for hip fracture.

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This study for me is very important.  For one, we know that Vitamin D supplementation has always been part of the cocktail of meds a patient with osteoporosis have to take.  But this is one study that looked at Vitamin D deficiency and the risk to fracture.  The results clearly show a relationship!

My take home message for this is that…dont assume a patient to be Vitamin D replete just because she is living in the tropics. Again one reason why this vitamin is a neglected vitamin not only in terms of preventing a disease but also in its relationship to causing a disease. 

Getting Vitamin D level is an easy blood test and if found deficient, Vitamin D replacement can have a tremendous impact in terms of how the patient feels in terms of improving his/her quality of life and how it can prevent diseases like a fracture!

The best way to prevent Vitamin D Deficiency is to enjoy the SUN …the morning sun at least 10-15 min daily while goign to work or doing your daily exercise.  Or just leisurely sun bathing with a book to read!

It’s About Time We Take Respect and Enjoy The SUN!

A Very Successful AACE Convention in Cebu!!!!

August 19, 2008

Go to fullsize imageAs host to the recent Annual Convention of Clinical Endocrinologist- Philippine Chapter, it was really a very rewarding and a learning experience for me as all the efforts were visibly rewarded by the number of delegates we had: a total of 575 doctors and the great feedback we received from excellent to fulfilling!!!

The doctors really enjoyed the sessions as topics were carefully selected including our speakers with a total of 9 foreign speakers.  This included my mentor from the Mayo Clinic DR Hossein Gharib who is presently the President of the American College of Endocrinology, as our keynote lecturer. 

The society headed by our energetic president Dr George Tan made sure that the venue to the session hall to the details of the exhibit were all planned out!

So guys… this is the reason why Ive been out of new posts for the past few days… Bear with me as I will be updating this site again on a regular basis. 

Only two reasons for not coming out with regular posts: am out of the country attending a convention OR am busy preparing for a talk or a covention like this one held last August 14 to 18 in Mactan Shangrila.

Will be posting photos for everyone to see soon…

Again thanks to all our friends on the pharmaceutical who were so busy transporting doctors in and out of the venue.  And to the MRC and PCOC guys who made the event very succesfull and kudos to my good friend Ike Amor whose expertise in video clips and presentations made the event at par with foreign conventions…

Cheers to AACE: It was a Team Effort At Its BEST!

Watermelon Can Boost Your Sexual Function… How True?

August 11, 2008

Go to fullsize imageI saw the news: Watermelon as the Natural Viagra..how true? 

The study where this headline was taken from was published recently in the Journal NUTRITION and really is an eye opener for those who have problems with sexual function.  The question is…will the results translate to actual outcome?

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Methods

Subjects (n = 12–23/treatment) consumed a controlled diet and 0 (control), 780, or 1560 g of watermelon juice per day for 3 wk in a crossover design. The treatments provided 1 and 2 g of citrulline per day. Treatment periods were preceded by washout periods of 2 to 4 wk.

Results

Compared with the baseline, fasting plasma arginine concentrations increased 12% after 3 wk of the lower-dose watermelon treatment; arginine and ornithine concentrations increased 22% and 18%, respectively, after 3 wk of the higher-dose watermelon treatment. Fasting citrulline concentrations did not increase relative to the control but remained stable throughout the study.

Conclusion

The increased fasting plasma concentrations of arginine and ornithine and stable concentrations of plasma citrulline in response to watermelon juice consumption indicated that the citrulline from this plant origin was effectively converted into arginine. These results demonstrate that plasma concentration of arginine can be increased through intake of citrulline from watermelon.

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The only association with viagra is the fact that watermelon is rich in a substance called citrulline know to have dilating effects on the vessel as the study implies.  This amino acid citrulline is actually converted into arginine which is a precursor for nitric oxide that helps blood vessel dilate!  In theory…it looks good but how about in actual practice?

SO…before we grab all the watermelons in the market, it is very important for us to understand that no study as of now has been done to confirm if indeed intake of watermelon can improve erection!!!!  And likewise nobody knows how much watermelon we need to take to achieve the effect!!!! Probabaly tons of watermelon before enough arginine can be made to cause an effect!

So to say that watermelon is a natural viagra is a doubtful claim. And definitely needs more studies if ever any study will be done.  Remember, arginine deficiency is not the sole cause of erectile dysfunction but rather it is more complicated than that! 

I love watermelon…if indeed it can help me in my other needs…the better!!!! It’s a PLUS!

 

Happy Anniversary!!!!

August 7, 2008

Go to fullsize imageIts our 2nd year in providing you with medical information and updates not only in diabetes but updates on anything  affecting our general health.

To the readers and patients… thanks for all your comments.  Your visits to the site are the ones that drive me to continue doing what I love to do best…  And I cant do my work as a physician better than keeping my patients well informed through this website! 

Thanks also to this site, I met new friends along the way….

To more years of medical knowledge….

Cheers to more fun and learning!!!!

LICKING…A Way To Speed Up Wound Healing

August 6, 2008

Out of reflex…the moment we feel pain in any part of the body especially our fingers…our immediate reflex is to bring that finger into our mouth and start licking it.   I do the same all the time…believing that it eases the pain, and stops the bleeding!  And in reality, we were actually all right!

Now comes a study showing that indeed licking the wound with our saliva can accelerate wound healing.  This study will be published in the November issue of Federation of American Societies for Experimental Biology.

A specific compound found in human saliva that has the potential to heal wounds is the product called HISTATIN which in experimental studies have been shown to have antibacterial properties. Meaning this substance can indeed KILL the bacteria!  We were actually doing right in curing our small wound through licking through these years! 

This indeed is also great news especially the potential of this  product to be the answer to our diabetics with recurring and chronic ulcers since these non healing wounds can result in major morbidity and disabilty due to amputation.

Let’s wait therefore for commercial quantities of this product soon to be in the market.  In the same line as alcohol gels or handwashing lotions….

And for the meantine…stick with our tongues and continue licking … it’s easy and FREE!

Can Coffee Increase Your Lifespan?

August 4, 2008

I am a coffee drinker.  I usually have a cup of coffee everyday and nothing more.  Except on occasions where I take another cup in the afternoon but usually I average only 5-7 cups per week.  I’ve written about the many benefits of coffee in this website and in the newpapers…and seems like more benefits are being known the more we know about coffee.

Now comes a recently published article on coffee and mortality published in the Annals of Internal Medicine, June of 2008: the official journal of the American College of Physicians.

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Design: to investigate the association between coffee consumption and incidence of all-cause and disease-specific mortality in a prospective cohort study.

Setting: Health Professionals Follow-up Study and Nurses’ Health Study: 41 736 men and 86 214 women with no history of CVD or cancer at baseline.

Results: After adjustment for age, smoking, and other CVD and cancer risk factors, the relative risks for all-cause mortality in men across categories of coffee consumption (<1 cup per month, 1 cup per month to 4 cups per week, 5 to 7 cups per week, 2 to 3 cups per day, 4 to 5 cups per day, and 6 cups per day) were 1.0, 1.07 (95% CI, 0.99 to 1.16), 1.02 (CI, 0.95 to 1.11), 0.97 (CI, 0.89 to 1.05), 0.93 (CI, 0.81 to 1.07), and 0.80 (CI, 0.62 to 1.04), respectively (P for trend = 0.008). For women, the relative risks were 1.0, 0.98 (CI, 0.91 to 1.05), 0.93 (CI, 0.87 to 0.98), 0.82 (CI, 0.77 to 0.87), 0.74 (CI, 0.68 to 0.81), and 0.83 (CI, 0.73 to 0.95), respectively (P for trend < 0.001). This inverse association was mainly due to a moderately reduced risk for CVD mortality and was independent of caffeine intake.

By contrast, coffee consumption was not statistically significantly associated with risk for cancer death after adjustment for potential confounders.

Decaffeinated coffee consumption was associated with a small reduction in all-cause and CVD mortality.

Conclusion: Regular coffee consumption was not associated with an increased mortality rate in either men or women. The possibility of a modest benefit of coffee consumption on all-cause and CVD mortality needs to be further investigated.

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To further summarize the data in layman’s terms:

  • This study shows that increasing consumption of coffee was associated with decreasing mortality or death.  
  • People who drank at least 5 -7 cups of coffee per week had a significantly LOWER overall risk of dying from any cause. 
  • People who drank 4-5 cups per day or more had the strongest protection.

What was interesting also in the study was that among women who were coffee drinkers, most reduction in death was due to a reduction in cardiovascular disease. What I like most in coffee are the studies showing its frequent consumption to result in a reduction albeit small, in the risk of diabetes.

Is Regular better than Decaf?  Well, In the study, whether people drank regular or decaffeinated coffee, benefits were noted, suggesting that the one product present in coffee that results in health benefits maybe its high levels of polyphenols  known to reduce inflammation and also known to provide other positive effects on the heart, blood vessels, and blood sugar.

What more can you ask?

I will continue to enjoy my coffee everyday whatever benefits they give me is already a PLUS!!!!

Why Japanese Men Have Low Heart Disease….

August 1, 2008

Japanese are known to be workaholic.  They ahve been known to work long hours. Many are also smokers BUT why do they have a lower risk of heart disease?

A recent study published in the Journal of American College of Cardiology, August 2008 may have the reasons why….

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Methods: A population-based cross-sectional study in 281 Japanese (defined as born and living in Japan), 306 white (defined as white men born and living in the U.S.), and 281 Japanese-American men (defined as Japanese men born and living in the U.S.) ages 40 to 49 years was conducted to assess intima-media thickness (IMT) of the carotid artery, coronary artery calcification (CAC), and serum fatty acids.

Results:

  • Japanese men had the lowest levels of atherosclerosis, whereas whites and Japanese Americans had similar levels.
  • Japanese had 2-fold higher levels of marine-derived n-3 fatty acids than whites and
  • Japanese Americans in the U.S. Japanese had significant and nonsignificant inverse associations of marine-derived n-3 fatty acids with IMT and CAC prevalence, respectively.

Conclusions: Very high levels of marine-derived n-3 fatty acids have antiatherogenic properties that are independent of traditional cardiovascular risk factors and may contribute to lower the burden of atherosclerosis in Japanese, a lower burden that is unlikely the result of genetic factors.

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This study further proves why Fish is the healthiest meat to eat. This trully explains why Japanese have a low risk of heart disease because of their lifetime increased intake of fish esepcially salmona dn mackerel which are both rich in omega 3 fatty acids.

I caution those who are buying Omega 3 supplements though because the effects are not proven in terms of the omega 3’s protective effect on the heart with regard to supplements. 

Instead to reap the benefits of Omega 3:

Eat FISH 2-3 x a week!