Archive for January, 2009

The Many Lessons I Learned in London

January 29, 2009

The experience I had travelling to London is a memorable one. I attended a postgraduate course in Endocrinology sponsored by the Royal College of Physicians and the trip was both culturally and educationally enriching.

After this trip, London is now among my top 5 must visits places in the world.  Not only is the place rich in culture ( watched Les Miserables in Queens Theatre in West End: marvelous experience), history (from Darwin to the Queen) and beautiful landmarks ( The Big Ben, The Palaces and the Eye) but also the warm hospitality that one can feel dealing with the British citizens.  One is warmly welcomed by the time one reaches the airport to the hotel staff to the cab drivers, waiters and store keepers.  You dont see homeless loitering around your path and was it safe to walk  around the Central London without fear of being mugged or robbed.

I was able to reunite with old  friends now staying in London and unfortunately some may have made it well but a lot of our OFWs are actually languishing in debt.  It makes one feel so vulnerable in a foreign land especially in times of economic crisis where London is the hardest hit among Europe’s developed countries.

The good news also is that our Filipino nurses occupy around 60% of the workforce in London’s major government hospital.  Interesting to note is that nurses are now handling endoscopy procedures as well as laparoscopic cholecystectomy procedures which is probably not going to happen in our country.  This is one thing unique in the British Health Care system.

Overall… this trip has been one welcome respite from the busy days in Cebu and what a great experience it has been.  I will definitely go back to London and this is one place that I will probably learn more things the more times I go back!

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Saw Palmetto and Bleeding….

January 23, 2009

Go to fullsize imageI just came across a patient who is taking this herb without my knowledge.  He apparently was taking this supplement to treat his urinary urgency secondary to an enlarged prostate.  Thinking it as an approved herbal supplement and therefore safe, he thought of not telling anyone regarding this pill.  Not until he underwent dental extraction when he was referred because of bleeding.

I have always been against taking herbal supplements as a drug.  These meds may have “no apporved therapeutic claims”  BUT the advertisements that we see on TV and hear on radio claim otherwise and in fact a “cure for all” sort of ads.  Therefore we cant blame our laymen to be enticed to take them in hopes of feeling better, looking younger and curing their illness.

Mayo Clinic website  has this to say in the side effects of saw palmetto:

Few severe side effects of saw palmetto are noted in the published scientific literature. The most common complaints involve the stomach and intestines, and include stomach pain, nausea, vomiting, bad breath, constipation, and diarrhea. Stomach upset caused by saw palmetto may be reduced by taking it with food. Some reports suggest that there may be less abdominal discomfort with the preparation lipidosterolic extract of Serenoa repens (LSESR). A small number of reports describe ulcers or liver damage and yellowing of the skin (jaundice), but the role of saw palmetto is not clear in these cases. Similarly, reports of headache, dizziness, insomnia, depression, breathing difficulties, muscle pain, high blood pressure, chest pain, abnormal heart rhythm, and heart disease have been reported, but are not clearly caused by saw palmetto. People with health conditions involving the stomach, liver, heart, or lungs should use caution.

Caution is advised in people scheduled to undergo some surgeries or dental work, who have bleeding disorders, or who are taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

So BEWARE…again..Be Aware… that not all what you hear are TRUE.  Consult your doctors if you are taking any herbal supplements as they may interfere with the actions of the drugs we are giving to make you feel better!

A lesson to my patient? DEFINITELY!

Another Reason to Follow the Low Carb Diet… Your Blood Sugar!

January 19, 2009

Go to fullsize imageFinally a study that looked at the practice of using low carbohydarte diet for our diabetics in helping control their blood glucoses was recently published in Nutrition and Metabolism journal.  Everytime I give a lecture on Nutritional therapy the question of my practice in lowering the total carbohydrate content of the calorie intake is the central issue.  This study is one proof that the concept of limiting the carbs can do wonders to ones blood sugar!

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Objective

Dietary carbohydrate is the major determinant of postprandial glucose levels, and several clinical studies have shown that low-carbohydrate diets improve glycemic control. In this study, we tested the hypothesis that a diet lower in carbohydrate would lead to greater improvement in glycemic control over a 24-week period in patients with obesity and type 2 diabetes mellitus. Research design and methods: Eighty-four community volunteers with obesity and type 2 diabetes were randomized to either a low-carbohydrate, ketogenic diet (<20 g of carbohydrate daily; LCKD) or a low-glycemic, reduced-calorie diet (500 kcal/day deficit from weight maintenance diet; LGID). Both groups received group meetings, nutritional supplementation, and an exercise recommendation. The main outcome was glycemic control, measured by hemoglobin A1c.

Results

Forty-nine (58.3%) participants completed the study. Both interventions led to improvements in hemoglobin A1c, fasting glucose, fasting insulin, and weight loss. The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p=0.03), body weight (-11.1 kg vs. -6.9 kg, p=0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p<0.001) compared to the LGID group. Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p<0.01).

Conclusions

Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes. The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.

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What is amazing of the results is that by following a low carb diet, diabetes medications were reduced or eliminated in 95 percent and likewise resulted in a greater weight loss.  We also know that by losing weight, patient becomes more insulin sensitive and therefore contributes further to improvements in metabolic profile. These are the two effects that we like whether we employ diet or medication to any patient we assessed to have a disease of the lifestyle. 

Is this nutritional therapy easy to do? 

Definitely not BUT its the determination to succeed and be treated without medication that can drive our patients to follow the regimen.  Just like any regimen involving FOOD… our vigilance to do what is healthy is more important than following our DESIRE to love food and EAT more!

A Quick Note on Exercise and Diabetes…

January 15, 2009

This past week has been extra busy for me and my staff in the clinical research unit because our site has been audited by the European Medicine Agency- the US counterpart of US FDA . My research site has been enrolling a significant number of patients and for that, this is to assure that the site is doing things according to international standards and making sure of patient safety.  This is I understand is the first of my sponsor, the first for my site and the first for Asia Pacific region.  But once we passed this inspection, I can then proudly say, we are EMEA “accreditied” 🙂

Just the same, no matter how busy one is, there should be no excuse why one cant exercise.  As Ive said in my previous post, I have lost weight and been trying to maintain my weight to prevent the onset of diabetes.  And the best way to prevent the onset of diabetes continues to be the PLAIN “E”. And I want to share this quick information regarding exercise and diabetes:

 DID YOU KNOW:
One hour of brisk walking a day cuts your Type II diabetes risk by 50% according to the Nurse’s Health Study. Many physicians recommend walking and exercise to help diabetics with weight and maintaining their blood sugar levels.

The Protective Effect of Eating Fish On Your Kidneys…

January 6, 2009

Go to fullsize imageWe know the many benefits of eating fish.  I love fish and I cultivate the fun of eating fish rather than meat to my kids.  It may take several trials to be successful but for them to eat fish and enjoy it is worth the many trials.

A recent study published in the American Journal of Kidney Diseases gave us a new look at how fish can be beneficial to our kidneys.  The study measure ther urine excretion of albumin which is a measure of kidney damage.

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Background

Studies have shown a potential beneficial role for fish and fish oil consumption in the management of diabetes and its complications. The aim of this study is to examine the association between fish consumption and albuminuria in individuals with and without diabetes.

Study Design

A cross-sectional analysis conducted in the European Prospective Investigation of Cancer–Norfolk population-based cohort study.

Setting & Participants

22,384 men and women from general practices in the city of Norwich and vicinity, of whom 517 had diabetes by self-report and 21,867 did not report diabetes.

Predictors

Fish consumption was measured in a validated semiquantitative food frequency questionnaire and categorized as less than 1, 1 to 2, and more than 2 portions/wk. Interaction between fish intake and diabetes status was hypothesized a priori.

Results

Prevalences of microalbuminuria were 22.6% in participants with diabetes and 11.4% in participants without diabetes. Prevalences of macroalbuminuria were 8.3% and 0.6%, respectively. Fish consumption was associated with a lower risk of macroalbuminuria in participants with diabetes (odds ratio, 0.22, >2 versus <1 portion/wk; 95% confidence interval, 0.07 to 0.70; P for trend = 0.009) after adjustment for confounding. This association was not observed in participants with diabetes with microalbuminuria or in the nondiabetic population. There was a significant interaction between diabetes status and fish consumption of 1 to 2 portions/wk (P = 0.03) and more than 2 portions/wk (P = 0.007) for risk of macroalbuminuria.

Conclusions

Greater fish intake was associated with a lower risk of macroalbuminuria in a self-defined diabetic population. These findings merit confirmation in prospective studies and intervention trials and suggest that fish intake may be beneficial for albuminuria in people with diabetes.

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This study confirms my practice of asking patients to minimize red meat and eat more white meat to help protect their kidneys.  Diabetes continues to be a leading cuase of kidney failure worldwide and haviong dialysis two to three times a week is not only physically disabling but emotionally and financially as well.

So for the new year… even if one is not a diabetic… eating fish should be the way to go.

You Cant Go Wrong With FISH!

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Read my previous post on The Benefits of Eating FISH