Archive for the 'General Health Tips' Category

2011 in Review for That Health Rules

January 1, 2012

The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog.

Here’s an excerpt:

London Olympic Stadium holds 80,000 people. This blog was viewed about 300,000 times in 2011. If it were competing at London Olympic Stadium, it would take about 4 sold-out events for that many people to see it.

Click here to see the complete report.

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What a way to END the YEAR

January 1, 2012

2011 has been very busy for me as i was inducted as the President of the American Association of Clinical Endocrinologists Philippines (AACE Philippines). My term will end by August 2012. This is the only year where I did not have a post every month.

One of the legacies I want to give and share during my presidency is the giving back our precious time to help and treat those in far flung barangays who cant afford the fee of a specialist. Thus was born the Goiter Obesity Osteoporosis and Diabetes (GOOD) doctors outreach and medical mission held end of November 2012. The group was able to treat and helped 2800 residents of Argao, Cebu. a total of 40 specialists from all over the country helped in the effort.

Overall…the feeling of having helped and served your fellowmen is what makes the true essence of what a doctor is all about.

Thanks 2011…. And more challenges ahead for 2012…

How To Lose Weight: A Novel Way To Teach Kids About Proper Nutrition

December 24, 2011

Recent article published in AMERICAN JOURNAL OF PUBLIC HEALTH brings us back to how fast our world is becoming obese and how slow we have been in addressing this issue.  The temptation to eat and the lack of discipline to follow what is right and adequate make each one of us vulnerable to this dreaded condition we call Obesity.

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Objectives. We examined the effect of an intervention to provide caloric information about sugar-sweetened beverages (SSBs) on the number of SSB purchases.

Methods. We used a case-crossover design with 4 corner stores located in low-income, predominately Black neighborhoods in Baltimore, Maryland. The intervention randomly posted 1 of 3 signs with the following caloric information: (1) absolute caloric count, (2) percentage of total recommended daily intake, and (3) physical activity equivalent. We collected data for 1600 beverage sales by Black adolescents, aged 12–18 years, including 400 during a baseline period and 400 for each of the 3 caloric condition interventions.

Results. Providing Black adolescents with any caloric information significantly reduced the odds of SSB purchases relative to the baseline (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.36, 0.89). When examining the 3 caloric conditions separately, the significant effect was observed when caloric information was provided as a physical activity equivalent (OR = 0.51; 95% CI = 0.31, 0.85).

Conclusions. Providing easily understandable caloric information—particularly a physical activity equivalent—may reduce calorie intake from SSBs among low-income, Black adolescents.

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The study tells us one thing:

Letting out kids understand the nutrition information of the food they eat versus telling them how long they have to workout or exercise to burn the calories can make a difference.

The impact was noticeable more if kids understand how long they have to run to burn the amount of calories they ingested from the sugary drinks.  The easier it is for everyone to understand the equivalent amount of physical activity of what we take in makes sense.  You get a clearer picture of what you need to do to burn those calories.

A great article and a great wake up call for everyone.

AACE Philippines as part of our advocacy is providing modules to Grade school students on the Power of Prevention Through Fitness and Nutrition or POPFTN. For this year, we already have started the program and involved the Grade 5 students of St Bennedicts and for January, we will go to PAREF Springadale both in Cebu.  AACE Philippines as an organization composed of Endocrine Specialists dealing with Diabetes, Obesity and endocrine diseases hope to make a difference in the early lives of these kids.

Do We Need MULTIVITAMINs?

November 2, 2011

The concept of taking mutivitamins as a way to improve health has never been proven.  It has not been shown to cause harm BUT has not been shown to help reduce disease… so when a study on multivitamin around 2009 came out saying that taking these supplements has not been shown to have any effect on health or disease prevention…I literally stopped taking one.

Now comes a new study that gtives us more doubt on this practice. A study published in Archives of Internal Medicine, Oct issue showed that these supplements are not helpful healthwise, they can actually be HARMFUL

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Methods We assessed the use of vitamin and mineral supplements in relation to total mortality in 38 772 older women in the Iowa Women’s Health Study; mean age was 61.6 years at baseline in 1986. Supplement use was self-reported in 1986, 1997, and 2004. Through December 31, 2008, a total of 15 594 deaths (40.2%) were identified through the State Health Registry of Iowa and the National Death Index.

Results  In multivariable adjusted proportional hazards regression models, the use of multivitamins (hazard ratio, 1.06; 95% CI, 1.02-1.10; absolute risk increase, 2.4%), vitamin B6(1.10; 1.01-1.21; 4.1%), folic acid (1.15; 1.00-1.32; 5.9%), iron (1.10; 1.03-1.17; 3.9%), magnesium (1.08; 1.01-1.15; 3.6%), zinc (1.08; 1.01-1.15; 3.0%), and copper (1.45; 1.20-1.75; 18.0%) were associated with increased risk of total mortality when compared with corresponding nonuse. Use of calcium was inversely related (hazard ratio, 0.91; 95% confidence interval, 0.88-0.94; absolute risk reduction, 3.8%). Findings for iron and calcium were replicated in separate, shorter-term analyses (10-year, 6-year, and 4-year follow-up), each with approximately 15% of the original participants having died, starting in 1986, 1997, and 2004.

Conclusions  In older women, several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk; this association is strongest with supplemental iron. In contrast to the findings of many studies, calcium is associated with decreased risk.

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This study confimrs what I have been suspecting in a long time.  As a supplement, these drugs are not being screened for what they contain.  The drugs dont need to prove they work… for them to be sold in the market nor are these drugs required to show their long term safety. Now I hope the public knows better!!!!

In this paper, the patients who were studied took supplements in the form of calcium, multivitamins, vitamin C, and vitamin E.  The data showed that the use of multivitamins especially those containing vitamin B6, folic acid, iron, magnesium, zinc, and copper supplements were associated with greater all-cause mortality through 19 years of follow-up.  This is BIG news!!!!

What then is our recommendation?

Better invest in healthy lifestyle.  As always, it has been our advocate to promote what is proven right and safe.  Eat right and Move!!!

Avoid taking a palm full of supplements thinking this can make one live longer and healthier because on the contrary…the fewer supplements or ZERO supplements – the better!!!!  We cannot and will NEVER recommend the use of vitamin and mineral supplements as a preventive measure!!!!, As they dont add anything beneficial from what we can get by eating the healthy fruits and vegetables!

Regular Exercise Keeps Your Arteries Healthy….

June 19, 2011

Go to fullsize imageIt is known that high sugar and high cholesterol in the blood spell trouble.  Any diabetics almost always has high blood pressure or high cholesterol problem.  Therefore, we aggressively treat their sugars, blood pressure and cholesterol hoping to lower their risk to suffer from a stroke and heart attack.

Most often, doctors tend to forget to remind patients to be more physically active.  Some patients also feel so comfortable that they are already on medications that they dont need to watch out what they eat or do. 

Now comes a new study presented at the Annual Meeting of the American College of Sports Medicine that looked at the value of regular physical activity among patients already on aggressive lowering of sugar and cholesterol and see if regular exercise contributes further to preventing heart disease.

This is so far the first study to document that if one exercise reglarly at least 30 minutes like walking, further reduction in ones risk to heart disease progression can be seen.  When pulse wave activity was measured after 2-5 years, those that exercise less or not at all, had a 14% increase in pulse wave activity suggesting more arterial stiffness.  The study confirms that progression of atherosclerosis or blockage of blood vessels can be sloweddown or halted by adding physical activity to the usual medications we give to lower sugar and cholesterol.

This study further emphasizes to all of us that whatever we do and have in life…

 if we are healthy.. go out and exercise;

if we have heart disease…go out and exercise

if you’re pregnant…go out and exercise….

Exercise will continue to add benefit to whatever medications youre taking for whatever disease you have! PLUS

Exercise difinitely PREVENTS you from falling ill…

Take care of your body…its the only one you have!

Sleep and Diabetes: Quality Matters NOT Quantity!!!!

May 30, 2011

Go to fullsize imageLack of sleep causes stress. Stress increases stress hormones that can increase glucose. Understandably,lack of sleep equals risk for diabetes.  I used to believe from previous studies that a duration of sleep less than 7 hours increases ones risk to develop diabetes. 

 Now comes a new study published in Diabetes Care March 2011, that tell us Quality is important than Quantity…

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OBJECTIVE To examine whether sleep duration and quality are associated with fasting glucose, fasting insulin, or estimated insulin resistance in a community-based sample of early middle-aged adults.

RESEARCH DESIGN AND METHODS This was an ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Habitual sleep duration and fragmentation were estimated from 6 days of wrist actigraphy collected in 2003–2005. Insomnia was defined as self-reported difficulty falling asleep or waking up in the night three or more times per week plus average sleep efficiency of <80% based on actigraphy. Fasting blood samples to measure glucose and insulin were collected after the sleep measures during the CARDIA clinical examination in 2005–2006. Insulin resistance was estimated using the homeostatic model assessment (HOMA) method. Analyses were cross-sectional and stratified by the presence of diabetes.

RESULTS There was no association between sleep measures and fasting glucose, insulin, or HOMA in the 115 subjects without diabetes. Among the 40 subjects with diabetes, after adjustment for covariates, 10% higher sleep fragmentation was associated with a 9% higher fasting glucose level, a 30% higher fasting insulin level, and a 43% higher HOMA level. Insomnia was associated with a 23% higher fasting glucose level, a 48% higher fasting insulin level, and an 82% higher HOMA level.

CONCLUSIONS The observed association between poor sleep quality and higher glucose, insulin, and estimated insulin resistance among subjects with diabetes warrants further examination of the effect of sleep disturbances on glucose control in type 2 diabetes.

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In the study, sleep duration was assessed as the amount of sleep obtained per night while sleep fragmentation was based on the periods of restlessness and movements that the pateints had during the night.

What is interesting in the study was that there was no association between sleep duration and glucose metabolism in groups with or without diabetes.  This is in contrast to earlier studies which showed otherwise. 

However sleep fragmentation was signicantly associated with increasing blood sugar so that for every 10% higher sleep fragmentation,  there was an associated 9% higher fasting glucose and higher insulin level suggesting insulin resistance.  What is important is that sleep fragmentation WAS not associated with higher glucose if one is NOT a diabetic.  Meaning, sleep disturbance is a risk factor  for poor blood sugar control among diabetics!

In conclusion, the authors assessed that POOR sleep and NOT Short Duration is associated with poor glucose control!!!  That intervention to warrant investigations of causes for poor sleep can help make diabetics have better control.

So do you snore? and probably stop breathing often?

Ask your partner… and better have your sleeping pattern assessed as this may lead to better control of your blood sugar if corrected!

Calcium Supplements May Not Be That Safe After All….

April 25, 2011

It has always been my practice to make sure women take their daily calcium supplements to prevent osteoporosis.  It is my contention that by building bone the right way and preventing a fracture is very important health issue.  It is recommended by diffirent medical societies that calcium supplements be given between 1000- 1200 mg per day. 

Now comes a new study showing proofs that calcium supplements may not be that safe after all.  A study published in BMJ in JUly 2010 with a reanalysis done in 2011 showed that calcium supplementation should be reviewed due to inherent harm.

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Abstract

OBJECTIVE:

To investigate whether calcium supplements increase the risk of cardiovascular events.

DESIGN:

Patient level and trial level meta-analyses.

DATA SOURCES:

Medline, Embase, and Cochrane Central Register of Controlled Trials (1966-March 2010), reference lists of meta-analyses of calcium supplements, and two clinical trial registries. Initial searches were carried out in November 2007, with electronic database searches repeated in March 2010.

STUDY SELECTION:

Eligible studies were randomised, placebo controlled trials of calcium supplements (>or=500 mg/day), with 100 or more participants of mean age more than 40 years and study duration more than one year. The lead authors of eligible trials supplied data. Cardiovascular outcomes were obtained from self reports, hospital admissions, and death certificates.

RESULTS:

15 trials were eligible for inclusion, five with patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035). Non-significant increases occurred in the incidence of stroke (1.20, 0.96 to 1.50, P=0.11), the composite end point of myocardial infarction, stroke, or sudden death (1.18, 1.00 to 1.39, P=0.057), and death (1.09, 0.96 to 1.23, P=0.18). The meta-analysis of trial level data showed similar results: 296 people had a myocardial infarction (166 allocated to calcium, 130 to placebo), with an increased incidence of myocardial infarction in those allocated to calcium (pooled relative risk 1.27, 95% confidence interval 1.01 to 1.59, P=0.038).

CONCLUSIONS:

Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.

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The reanalysis of this study done recently and published in the same journal showed that the risk of MI is actualy MODEST at best around 20% for MI and 30% for stroke BUT… considering the huge number of women doctors have been recommending to take calcium supplements… justify a further close look at this practice as this will have enormous impact on health care risk.

For the past year…I have not been recommending calcium supplements to my patients especially my diabetic hypertensive patients.  I make sure that my dietitian supplements their diet with enough calcium sources from food and milk.  If need be, those patients who cant take enough from food are the ones given the supplements but this number is becoming less each day.

If you are taking calcium supplements on your own , my recommendation is to stop.  If you are taking the supplements as part of your osteoporosis program then talk to your doctor first before stopping.

The Health Issue of Cell Phone Use

April 13, 2011

Ive long been cautious of letting my kids use cell phones even for a short period of time.  Their brains are still developing and need the best nurturing they can get and if we can limit inflicting harm to avoid long term defects would be ideal.

A novel study recently published in JAMA tells us that cell phone use was shown to affect brain activity:

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Context The dramatic increase in use of cellular telephones has generated concern about possible negative effects of radiofrequency signals delivered to the brain. However, whether acute cell phone exposure affects the human brain is unclear.

Objective To evaluate if acute cell phone exposure affects brain glucose metabolism, a marker of brain activity.

Design, Setting, and Participants Randomized crossover study conducted between January 1 and December 31, 2009, at a single US laboratory among 47 healthy participants recruited from the community. Cell phones were placed on the left and right ears and positron emission tomography with (18F)fluorodeoxyglucose injection was used to measure brain glucose metabolism twice, once with the right cell phone activated (sound muted) for 50 minutes (“on” condition) and once with both cell phones deactivated (“off” condition). Statistical parametric mapping was used to compare metabolism between on and off conditions using paired t tests, and Pearson linear correlations were used to verify the association of metabolism and estimated amplitude of radiofrequency-modulated electromagnetic waves emitted by the cell phone. Clusters with at least 1000 voxels (volume >8 cm3) and P < .05 (corrected for multiple comparisons) were considered significant.

Main Outcome Measure Brain glucose metabolism computed as absolute metabolism (μmol/100 g per minute) and as normalized metabolism (region/whole brain).

Results Whole-brain metabolism did not differ between on and off conditions. In contrast, metabolism in the region closest to the antenna (orbitofrontal cortex and temporal pole) was significantly higher for on than off conditions (35.7 vs 33.3 μmol/100 g per minute; mean difference, 2.4 [95% confidence interval, 0.67-4.2]; P = .004). The increases were significantly correlated with the estimated electromagnetic field amplitudes both for absolute metabolism (R = 0.95, P < .001) and normalized metabolism (R = 0.89; P < .001).

Conclusions In healthy participants and compared with no exposure, 50-minute cell phone exposure was associated with increased brain glucose metabolism in the region closest to the antenna. This finding is of unknown clinical significance.

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Analysis of the data showed that the human brain is indeed sensitive to the effects of radiofrequency from acute cell phone use.  And that the area closest to the antennae revealed the highest brain activity.  Whether this disruption in brain activity has long term consequences is still unknown.

Take Home message?

Use the phone for texting…and use it sparingly for calling.

Restricting use of cell phones in kids will continue to be my recommendation until better studies will show that indeed its use is safe for kids until age 18.  Too late? well better be safe than sorry….

But hopefully soon before my son reaches tha age where cell phones are a must..we have better studies showing its safety…Cross my fingers!!!

Tylenol and Hypertension: Is There A Link?

April 13, 2011

It has always been my notion that tylenol is the safest of all pain relievers.  Most patinets of mine are advised to take acetaminophen instead of NSAIDS especially if they have arthritis  and have concomitant heart disease or kidney problem.  We all know about the Viox controversy when it was pulled out due to cardiovascular safety.

Now comes a recent report from the Harvard Health Beat regarding a Swiss study that showed taking acetaminophen better known for the brand Tylenol, can actually cause an elevation of Blood pressure.

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The researchers asked 33 men and women with one or more of these problems to take either 1,000 milligrams (mg) of acetaminophen or an identical placebo three times a day for two weeks. Then, after a two-week break, each volunteer took the other treatment. The amount of acetaminophen used in the study is a standard daily dose for pain.

When the participants took acetaminophen, average systolic blood pressure (the top number of a blood pressure reading) increased from 122.4 to 125.3, while the average diastolic pressure (the bottom number) increased from 73.2 to 75.4. Blood pressure stayed steady when participants took the placebo. These increases aren’t large. But they indicate that acetaminophen, like NSAIDs, somehow affects the cardiovascular system.

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Acetaminophen indeed is a safe alternative to the pain killers known as NSAIDs becuase it is safe to the stomach and avoid gastric irritation. 

It is also a better alternative especially to patients taking anticoagulants or drugs to prevent blood clots because it does not interfere with their actions nor further increase bleeding tendencies.

However… people should be extra careful with this new information and therefore should not take acetaminophen lightly.  Meaning, one should also be cautious in taking acetaminophen with a slight onset of headache especially among patients with concomitant cardiovascular disease. 

No matter how safe a drug is perceived to be… along the way comes an alternative that will always be safer… or the other way around.  It is best that we be kept informed because we may be taking drugs that may instead cause harm than good. It is therefore always worth having a periodic visits to your family doctor.

Why Daily Video and Internet Gaming Can Be Harmful….

January 20, 2011

I am planning to publish this article for my son to read in FB ( which he is allowed to do in my room only during weekends) and for the other parents to reconsider the practice of allowing kids to play video and internet games at their leisure. It is easy to use these gadgets as surrogate nannies because they make our kids stay put and have their own world.  Part of the compromise for busy parents is to buy their kids the best gadgets because kids wont complain their absence as long as they have the gadgets to enjoy.

Now comes a study published in Pediatrics regarding the long term dangers of allowing our kids to enjoy these gadgets on a daily basis:

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 Objectives : We aimed to measure the prevalence and length of the problem of pathological video gaming or Internet use, to identify risk and protective factors, to determine whether pathological gaming is a primary or secondary problem, and to identify outcomes for individuals who become or stop being pathological gamers.

Methods : A 2-year, longitudinal, panel study was performed with a general elementary and secondary school population in Singapore, including 3034 children in grades 3 (N = 743), 4 (N = 711), 7 (N = 916), and 8 (N = 664). Several hypothesized risk and protective factors for developing or overcoming pathological gaming were measured, including weekly amount of game play, impulsivity, social competence, depression, social phobia, anxiety, and school performance.

Results:  The prevalence of pathological gaming was similar to that in other countries (9%). Greater amounts of gaming, lower social competence, and greater impulsivity seemed to act as risk factors for becoming pathological gamers, whereas depression, anxiety, social phobias, and lower school performance seemed to act as outcomes of pathological gaming.

Conclusion:  This study adds important information to the discussion about whether video game “addiction” is similar to other addictive behaviors, demonstrating that it can last for years and is not solely a symptom of comorbid disorders.

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According to the opinion of Medpage Today… two important things that we learned from the study: 

  • That spending hours with a PlayStation or an Xbox including Internet Games every day can lead to serious psychiatric problems in children.
  • That increases in pathological gaming symptoms were predictive of depression, anxiety, social phobia, and school performance at follow-up.

That’s a WAKE-UP call…

Healthy Cereals for Breakfast

December 14, 2010

Its always difficult to wake kids up during school days…more difficult to let them eat.  I usually alternate oatmeal, cereals and rice on my kids breakfast meal.  Oats with fruits and milk, low sugar Cherrios cereals and in between days they get rice and eggs with ham.  It is always good to start the kids young and learn the importance of a healthy breakfast.

The mistake that parents always have with regard to kids food choices is that we always allow our kids to dictate what they like to eat.  Or rely our kids meals on their yayas.  It is easier for us to fry chicken with french fries because for sure the kids will eat them BUT are they healthy?  Likewise yayas find it easier to feed fried chicken than veggies.  As the saying goes..at least they eat rather than no breakfast!  This is the reason why in the long run, parents will find it difficult to introduce healthy food choices for the kids.

Now comes a new study published in Pediatrics that these Cherrios low sugar cereals are really acceptable options for a healthy breakfast.  Likewise surprisingly kids love them!

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Objectives To test (1) whether children will consume low-sugar ready-to-eat (RTE) cereals and (2) the effects of serving high- versus low-sugar cereals on the consumption of cereal, refined sugar, fresh fruit, and milk.

Participants and Methods Using an experimental design, we randomly assigned children (n = 91) who were attending summer day camp to receive a breakfast that included either the choice of 1 of 3 high-sugar cereals (high-sugar condition) or low-sugar cereals (low-sugar condition), as well as low-fat milk, orange juice, bananas, strawberries, and sugar packets. Participants served themselves and completed a background questionnaire after eating. Researchers measured the amount and calories consumed of each food.

Results In both conditions, children reported “liking” or “loving” the cereal they chose. Children in the low-sugar cereal condition consumed, on average, slightly more than 1 serving of cereal (35 g), whereas children in the high-sugar condition consumed significantly more (61 g) and almost twice the amount of refined sugar in total (24.4 vs 12.5 g). Milk and total calories consumed did not differ significantly between conditions, but children in the low-sugar condition were more likely to put fruit on their cereal (54% vs 8%) and consumed a greater portion of total calories from fresh fruit (20% vs 13%).

Conclusions Compared with serving low-sugar cereals, high-sugar cereals increase children’s total sugar consumption and reduce the overall nutritional quality of their breakfast. Children will consume low-sugar cereals when offered, and they provide a superior breakfast option.

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This clinical study is true based on my experience.  My kids love these Cherrios low sugar low fat whole grain cereals more than the sugary chocolate laden corn flakes.   The good news with these data is that those children in the study who were offered low-sugar cereals enjoyed their breakfast with good satisfaction but only consumed half the amount of refined sugar at breakfast compared with those who ate high-sugar cereals (12.5 g versus 24.4 g, P<0.001).  Not only are the parents happy but the kids are satisfied too!

It is really best to start our kids day with a healthy meal that can provide them with calories that matter…

Choose wisely and Be Involved!

The Dangers of Sugary Drinks

November 16, 2010

Consumption of sugary drinks not only make you gain weight BUT now has been proven to strongly increase your risk to develop Diabetes and other obesity related diseases. 

A new study has shown us there is a  link regarding the risk of developing diabetes to intake of sugary drinks and this link is high enough to approximate the risk that one gets from smoking!!!!

This new study is published in the recent publication of Diabetes Care in 2010:

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OBJECTIVE: Consumption of sugar-sweetened beverages (SSBs), which include soft drinks, fruit drinks, iced tea, and energy and vitamin water drinks has risen across the globe. Regular consumption of SSBs has been associated with weight gain and risk of overweight and obesity, but the role of SSBs in the development of related chronic metabolic diseases, such as metabolic syndrome and type 2 diabetes, has not been quantitatively reviewed.

RESEARCH DESIGN AND METHODS: We searched the MEDLINE database up to May 2010 for prospective cohort studies of SSB intake and risk of metabolic syndrome and type 2 diabetes. We identified 11 studies (three for metabolic syndrome and eight for type 2 diabetes) for inclusion in a random-effects meta-analysis comparing SSB intake in the highest to lowest quantiles in relation to risk of metabolic syndrome and type 2 diabetes.

RESULTS: Based on data from these studies, including 310,819 participants and 15,043 cases of type 2 diabetes, individuals in the highest quantile of SSB intake (most often 1-2 servings/day) had a 26% greater risk of developing type 2 diabetes than those in the lowest quantile (none or <1 serving/month) (relative risk [RR] 1.26 [95% CI 1.12-1.41]). Among studies evaluating metabolic syndrome, including 19,431 participants and 5,803 cases, the pooled RR was 1.20 [1.02-1.42].

CONCLUSIONS: In addition to weight gain, higher consumption of SSBs is associated with development of metabolic syndrome and type 2 diabetes. These data provide empirical evidence that intake of SSBs should be limited to reduce obesity-related risk of chronic metabolic diseases.

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In practical terms, the association between intake of sugary drinks and Diabetes can be translated to something like this:

For every  12 oz sugar laden drink that you order in a restaurant today like the ever famous and popular sugary and tasty Ice Tea or canned OJ… a roughly 25% increase in risk  for you to develop Diabetes on top of your risk to gain more weight!

So if one actually drinks 2-3 bottles of Soda per day then the risk is further increased to 30% roughly similar to the risk one gets due to smoking!

Would it be better to take Diet Drinks then? It maybe safer BUT the associated increase in food intake is the culprit.  Likewise there are some concerns now that link Diet Sodas also to increased risk of Metabolic syndrome suggesting that artificial sweeteners may have a role in itself. 

So my recommendation to my patients is to limit one’s consumption to only 1 diet soda per day and if possible enjoy Water instead!

Diet Alone without Exercise Can Reduce risk of Diabetes

October 26, 2010

The title indeed is intriguing but it’s TRUE. 

For the first time, a study has looked at controlling food and specifying the kind of food without restricting it and without any exercise resulted in health benefit.  We always recommend the combination of proper healthy diet and exercise to achieve benefit but this new study published in Diabetes Care showed us otherwise.

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Objective – To test the effects of two Mediterranean-diet interventions versus a low-fat diet on incidence of diabetes.

Research Design and Methods – Three-arm randomized trial in 418 nondiabetic subjects aged 55-80 years recruited in one center (PREDIMED-Reus, North-Eastern Spain) of the PREDIMED study, a large nutrition-intervention trial for primary cardiovascular prevention in persons at high cardiovascular risk. Participants were randomized to education on a low-fat diet (control group) or one of two Mediterranean diets, supplemented with either free virgin olive oil (1 liter/week) or nuts (30 g/day). Diets were ad libitum and no advice on physical activity was given.

The main outcome was diabetes incidence diagnosed by the 2009 American Diabetes Association criteria. Results – After a median follow-up of 4.0 years, diabetes incidence was 10.1% (95% confidence interval [CI], 5.1-15.1), 11.0% (5.9-16.1), and 17.9% (11.4-24.4) in the Mediterranean-diet with olive oil group, the Mediterranean-diet with nuts group, and the control group, respectively. Multivariable-adjusted hazard ratios of diabetes were 0.49 (0.25-0.97) and 0.48 (0.24-0.96) in the Mediterranean-diet groups supplemented with olive oil and nuts, respectively, compared to the control group. When pooling the two Mediterranean-diet groups compared to the control group, diabetes incidence was reduced by 52% (27-86). In all study arms, increased adherence to the Mediterranean-diet was inversely associated with diabetes incidence. Diabetes risk reduction occurred in the absence of significant changes in body weight or physical activity.

Conclusion – Mediterranean diets without calorie restriction appear to be effective in the prevention of diabetes in subjects at high cardiovascular risk.

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The traditional Mediterranean diet, which was recommended in the present study,included the following components:

  • Use of olive oil for cooking and dressing.
  • Increased consumption of fruit, vegetables, legumes, and fish.
  • Reduction in total meat consumption, white meat instead of red meat.
  • Use of homemade sauce with tomato, garlic, onion, and spices with olive oil to dress vegetables, pasta, rice, and other dishes.
  • No No to butter, cream, fast-food, sweets, pastries, and sugar-sweetened beverages.
  • In alcohol drinkers, moderate consumption of red wine.

This diet is not difficult to follow.  In fact, the study showed no restriction resulting in no weight loss.  Remember, this is to see if this diet can indeed help lower the diabetes risk and not specifically to reduce weight.  Calorie intake continues to be a factor in affecting ones weight. 

In short, if one aims for both risk reduction and weight loss, then simply restricting calories using this diet plus exercise should achieve optimal benefit!

This diet resulted in a 52% reduction in the risk of developing diabetes. This reduction is understandable considering that the diet is rich in monounsaturated fats as well as anitoxidants known to combat the risk factors of chronic ailments including heart disease…suggesting that long term, this diet should also help reduce risk for heart disease.

But…dont aim for less…aim for more…

Please do continue to aim to be more physically active and achieve OPTIMAL benefit for Your HEALTH!

TV Time and the Kids

October 12, 2010

I have practiced limiting my kids TV times to only during the weekends.  This rule includes palying PSP or nintendo.  They only open the computer for assignments but never for games. So they resort to board games like scrabble, chess, Game of the generals and Mastermind Game.  My eldest also writes his own  ” book” about Clyde and Clod and he is now on his third series on these two characters.  This aside from finishing 3 ” do it your own” Diary of the Wimpy Kid book.  The two girls obviously followed.  Kids therefore can have other fun stuff to do and use their brains to think instead of a one sided affair with TV’s.  On occasions I allow them to play the Wii provided they sweat.  I dont bring them to my daily run this past few days because of the dengue scare especially I run aroung 5:30PM.   My wife also bought them Hullahoop where the kids except the youngest can now do the Hullahoop thing up to 400 counts…imagine the sweat!

My rule had basis after all….now comes a study published in Pediatrics  linking TV time to Psych problems and peer relationship problems.

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Objective: We hypothesized that greater screen use would be associated with greater psychological difficulties and that children with high levels of screen entertainment use and low levels of physical activity would have the most-negative psychological profiles.

Methods: Participants were 1013 children (age, mean ± SD: 10.95 ± 0.41 years), who self-reported average daily television hours and computer use and completed the Strengths and Difficulties Questionnaire. Sedentary time (minutes per day with <100 cpm) and moderate/vigorous physical activity (MVPA) (minutes with 2000 cpm) were measured by using accelerometers. Multivariate regression models examined the association between television viewing, computer use, sedentary time, and Strengths and Difficulties Questionnaire scores, with adjustment for MVPA, age, gender, level of deprivation, and pubertal status.

Results: Greater television and computer use were related to higher psychological difficulty scores after adjustment for MVPA, sedentary time, and confounders. However, sedentary time was inversely related to psychological difficulties after adjustment. Children who spent >2 hours per day watching television or using a computer were at increased risk of high levels of psychological difficulties (television, odds ratio [OR]: 1.61 [95% confidence interval [CI]: 1.20–2.15]; computer, OR: 1.59 [95% CI: 1.32–1.91]), and this risk increased if the children also failed to meet physical activity guidelines (television, OR: 1.70 [95% CI: 1.09–2.61]; computer, OR: 1.81 [95% CI: 1.02–3.20]).

Conclusion:

 Both television viewing and computer use are important independent targets for intervention for optimal well-being for children, irrespective of levels of MVPA or overall sedentary time.

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In short, allowing your kids to watch TV for more than two hours a day will result in them a 61%  risk  of having an increased  hyperactivity and emotional problems… PLUS difficulty in concentration and conduct problems which can be an issue with poor grades in school and peer problems with friends and classmates.

Now I see my kids grades getting better without the TV and more attention span.  I dont have to pressure them to read or study!   Plus the bonding time with them is better and great interaction with board games and fun!

Guys.. Discpline really works.  Just adhere to what you think is best for the kids…and once the rule becomes a habit…everything flows  smoothly!

Heres A Simple Way To Lose Weight…

September 11, 2010

Go to fullsize imageJust being too busy or just plain lazy, we have many excuses why we cant exercise.  Too stressed out at work gives us the reason to indulge in  food that we feel comfortable and happy.  But outcomes do matter and weight gain spells disaster.

We have heard of fad diets that do work but temporarily.  It still boils down to strict discipline and watching carefully what we eat and following the right regimen to the right activity.  We all know that… we heard that advice in the news, in the magazine so what esle is new?  Something that is simple and so close within your grabs but never thought about it?

Well heres something interesting and novel study  that was presented at the 2010 National Meeting of the American Chemical Society in Boston:

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The study included 48 adults between age 55 and 75 who were divided into two groups.  The study participants drank about 1.5 cups of water per day prior to joining in the study.

One group drank two cups of water before meals and the other didn’t. All participants ate a low-calorie diet throughout the study.

After 12 weeks, water drinkers lost about 15.5 pounds, compared to non-water-drinking dieters, who lost only 11 pounds.

Not only were those who drank water before meals more successful after 12 weeks, but they also kept “the weight off for a full year after the weight loss study.”  Even better, most water drinkers, followed for an additional 12 months, not only kept weight off but “even lost another 1 to 2 pounds”.

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The study is really not novel in idea but for the first time, a scientific study has been done to substantiate what I have been recommending to my patients who are diabetics and overweight.  It is a smple formula of dirinking water before each meal to allow one to feel full and therefore less hungry.  By doing so, one tends to be more careful with what one eats and therefore has the best  chance of losing weight or maintaining it.

Water is still the best to fill you up…. its available 24 hours and free.  How much water do I recommend one to take daily?

I recommend at least 8- 10 glasses of water for women and up to 14 glasses for men!

But remember.. to be successful means the triad of discipline, low calorie healthy food and the right amount of exercise! Now ADD Plenty of WATER!!!!

Simple regimen to lose weight…TRY IT!

Coffee is GOOD for the HEART

August 27, 2010

Go to fullsize imageAnother good news for us coffee lovers. 

Coffee has been shown to have good effects on the vessels and has been shown to improve the vessels capacity to dilate.  This finding is another plus factor for us drinkers of coffee because it helps reduce the stress of the heart in pushing blood out of the vessels. 

And this plus effect is on top of previous studies showing coffee to be protective against developing diabetes.

The study will be presented during the European Society of Cardiology meeting as an abstract.  The abstract was discussed online in MedPage today.

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One to two cups a day correlated with greater aortic distensibility compared with rarely consuming coffee (P=0.45) in a cohort of men and women 65 and older on the Greek island of Ikaria

Likewise, Chrysohoou and colleagues found that, compared with rarely drinking coffee, moderate consumption of one or two cups a day was associated with:

  • Lower prevalence of diabetes (22% versus 34%, P=0.02)
  • Lower prevalence of high cholesterol (41% versus 55%, P=0.001)
  • Lower body mass index (28 versus 29 kg/m2, P=0.04)
  • Higher creatinine clearance levels (70.2 versus 65 mL/min, P=0.01)
  • Lower prevalence of cardiovascular disease (19% versus 26%, P=0.04)
  • Higher values of aortic distensibility (P<0.05)

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The coffee blend that was used according to the authors were of the traditional Greek blends, which apprently have higher levels of phenol compounds thought to be protective for the heart than coffee typically consumed in the U.S.

This study tells us to drink coffee in moderation and advises us to drink only 1-2 cups per day.

There you go guys…another toast to more days of fun with coffee……

Napping May Not Be Healthy After All….

August 23, 2010

Go to fullsize imageSiesta is still practiced by some of us up to now.  We take a break after lunch to take a nap to recharge and be back to work in the afternoon feeling fresh. But is this practice really healthy or can it cause harm instead?

A new study published in Sleep has this to say:

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Study Objective: Intentional napping is very common, particularly in China. However, there are limited data regarding its potential health effects. We therefore examined the possible relationship between napping and type 2 diabetes.
 

Design: Cross-sectional analysis of baseline data from the Guangzhou Biobank Cohort Study.

Setting: Community-based elderly association in Guangzhou, China.

Participants: 19,567 Chinese men and women aged 50 years or older.

Measurements and Results: Self-reported frequency of napping was obtained by questionnaire and type 2 diabetes was assessed by fasting blood glucose and/or self-reports of physician diagnosis or treatment. Participants reporting frequent naps (4-6 days/week and daily) were 42% to 52% more likely to have diabetes. The relationships remained essentially unchanged after adjustments were made for demographics, lifestyle and sleep habits, health status, adiposity, and metabolic markers (odds ratio for diabetes 1.36 [95% CI 1.17–1.57] in 4-6 days/week, 1.28 [1.15–1.44] in daily nappers). Similar associations were found between napping and impaired fasting glucose. Removal of those with potential ill health and daytime sleepiness did not alter the observed associations.

Conclusions: Napping is associated with elevated prevalence of diabetes and impaired fasting glucose in this older Chinese sample. Our finding suggests that it is less likely that diabetes leads to daytime sleepiness. This raises the possibility that napping may increase the risk of diabetes. Confirmation by longitudinal studies is needed.

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In the study approxiametly 2/3 of the napper took a nap just like everyopne else i.e. around 1 hour after lunch and usually lasts around 60 minutes. 

So I guess the population is really well represented as this is the usual behaviour of a typical napper. 

 What is important is that the longer and more frequent one naps, the higher the risk of developing diabetes.

The study confirms previous studies from the US and Germany regarding the association of napping and diabetes as well as all cause mortality or death.  Imagine trying to take a break to feel better and instead cuts down on your life span.  Something to think about! 

In Short: Napping may not be safe or healthy after all!!!

Coffee or Tea To Prevent Diabetes…

July 27, 2010

I have posted studies on coffee and tea as a way to prevent diabetes based on single study results.  Now comes a metaanalysis which compiles all data from  different studies to see if there are trends toaward prevention.  This new metaanalysis was published in  Archives of Internal Medicine this year:

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Background  Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus. Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes.

Methods  Relevant studies were identified through search engines using a combined text word and MeSH (Medical Subject Headings) search strategy. Prospective studies that reported an estimate of the association between coffee, decaffeinated coffee, or tea with incident diabetes between 1966 and July 2009.

Results  Data from 18 studies with information on 457 922 participants reported on the association between coffee consumption and diabetes. Six (N = 225 516) and 7 studies (N = 286 701) also reported estimates of the association between decaffeinated coffee and tea with diabetes, respectively. We found an inverse log-linear relationship between coffee consumption and subsequent risk of diabetes such that every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes relative risk, 0.93 [95% confidence interval, 0.91-0.95]) after adjustment for potential confounders.

 Conclusions  Owing to the presence of small-study bias, our results may represent an overestimate of the true magnitude of the association. Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes. The putative protective effects of these beverages warrant further investigation in randomized trials.

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 This study hypothesizes what we believe is a true association to the protective effect of coffee and tea in developing diabetes.

What is significant is the fact that so far no untoward problems have been encountered with drinking coffee except a benefit to preventing diabetes which may have a great implication to those at risk of the disease.

But dont forget…lifestyle change should continue to be the priority in the heirarchy of prevention.  Coffee is just an add on….

I will definitely continue to enjoy my cup of coffee every morning and another cup in the afternoon daily.  Decaf at night is tempting.

Another Reason To Exercise…

July 1, 2010

weight-loss.womendiary.net/pic/kids-exercise.jpgI really dont look at exercise as a way to lose weight. Definitiely it can help but the bottom line for weight loss is really restricting the amount of calories one takes in.  But the reality of exercise are the benefits one gets with it especially if done regularly.

I do exercise daily by jogging solely to maintain my weight to a normal level for my height because of my risk to develop diabetes due to a strong family history.

Recently in a report from the American Diabetes Association as reported in Medscape Endocrinology June 26, 2010 is a good study that looked at the effect of exercise in preventing diabetes:

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Obese boys who engaged in regular aerobic or resistance exercise — without dietary changes — had significant improvements over 3 months in their total body fat, visceral adipose tissue concentrations, and insulin sensitivity than their more sluggish counterparts.

The results were independent of the type of exercise assigned, and suggest that a moderate increase in activity (180 minutes per week) can help prevent type 2 diabetes mellitus in this high-risk population.

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In the study, whether aerobic or resistance training did not matter.  The insulin sensitivity analysis was the same in both groups although better with the resistance training group. 

Plus… this study only looked at the effect of exercise and risk for diabetes without restricting calorie intake.  Suggesting that exercise indeed can have tremendous benefical effects in preventing one from developing chronic medical metabolic conditions that can have long term complications.

There you go guys… another good reason to get going…grab your shoes and start running!

Cut Down on Sweetened Juice To Help Improve BP

June 14, 2010

Go to fullsize imageOne major aspect in controlling ones BP is to lower salt intake. Salt basically increases the reaction of the blood vessels to contrict or “close” – raise your BP then increase the pressure of the heart in pumping blood out of the circulation which in the long term cause heart failure or heart enlargement. As a precaution, we always warn patients from enjoying too much salt.

Now comes an interesting study published in Circulation in June 2010 looking at another aspect of food that we know should be avoided if one has high sugar…but now is known to affect and lower ones BP also.

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BACKGROUND: Increased consumption of sugar-sweetened beverages (SSBs) has been associated with an elevated risk of obesity, metabolic syndrome, and type II diabetes mellitus. However, the effects of SSB consumption on blood pressure (BP) are uncertain. The objective of this study was to determine the relationship between changes in SSB consumption and changes in BP among adults.

METHODS AND RESULTS: This was a prospective analysis of 810 adults who participated in the PREMIER Study (an 18-month behavioral intervention trial). BP and dietary intake (by two 24-hour recalls) were measured at baseline and at 6 and 18 months. Mixed-effects models were applied to estimate the changes in BP in responding to changes in SSB consumption. At baseline, mean SSB intake was 0.9+/-1.0 servings per day (10.5+/-11.9 fl oz/d), and mean systolic BP/diastolic BP was 134.9+/-9.6/84.8+/-4.2 mm Hg. After potential confounders were controlled for, a reduction in SSB of 1 serving per day was associated with a 1.8-mm Hg (95% confidence interval, 1.2 to 2.4) reduction in systolic BP and 1.1-mm Hg (95% confidence interval, 0.7 to 1.4) reduction in diastolic BP over 18 months. After additional adjustment for weight change over the same period, a reduction in SSB intake was still significantly associated with reductions in systolic and diastolic BPs (P<0.05). Reduced intake of sugars was also significantly associated with reduced BP. No association was found for diet beverage consumption or caffeine intake and BP. These findings suggest that sugars may be the nutrients that contribute to the observed association between SSB and BP.

CONCLUSIONS: Reduced consumption of SSB and sugars was significantly associated with reduced BP. Reducing SSB and sugar consumption may be an important dietary strategy to lower BP.

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What does this study tell us:

 That of the >800 adults in the study: that drinking one less sugar-sweetened beverage a day resulted in the lowering of both systolic and diastolic BP by about 1.2 mm Hg and 1.1 mm Hg  over 18 months period of observation.

I am actually not surprised by this relationship.  We all know, anytime a patient has high BP, I always make sure he is not at risk to become diabetic with high cholesterol since the three always come in groups and are always partners in crime. So controlling for one may result in the improvement of the other.  So any dietary intevention that I do for my patients incorporate for the control of the three conditions.

Remember: For every 3-mm-Hg reduction in systolic BP : the risk of dying from stroke is reduced by 8% and the risk of dying for heart disease is redcued by 5%.  So any small amount of decrement is worth it!

There you go guys: another reason to cut down on SUGAR!