Archive for the 'Healthy Practice Tips' Category

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Can Vitamin C Help Prevent GOUT?

March 19, 2009

Go to fullsize imageGood news for patients at risk of developing gout because a very common remedy and very affordable at that has been shown to help prevent gout.

A new study published in the latest edition of Archives of Internal Medicine showed a relationship linking higher intake of Vitamin C to lower risk of developing gout:

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Background  Several metabolic studies and a recent double-blind, placebo-controlled, randomized trial have shown that higher vitamin C intake significantly reduces serum uric acid levels. Yet the relation with risk of gout is unknown.

Methods  We prospectively examined, from1986 through 2006, the relation between vitamin C intake and risk of incident gout in 46 994 male participants with no history of gout at baseline. We used a supplementary questionnaire to ascertain the American College of Rheumatology criteria for gout. Vitamin C intake was assessed every 4 years through validated questionnaires.

Results  During the 20 years of follow-up, we documented 1317 confirmed incident cases of gout. Compared with men with vitamin C intake less than 250 mg/d, the multivariate relative risk (RR) of gout was 0.83  for total vitamin C intake of 500 to 999 mg/d, 0.66  for 1000 to 1499 mg/d, and 0.55 (0.38-0.80) for 1500 mg/d or greater. The multivariate RR per 500-mg increase in total daily vitamin C intake was 0.83 . Compared with men who did not use supplemental vitamin C, the multivariate RR of gout was 0.66  for supplemental vitamin C intake of 1000 to 1499 mg/d and 0.55 (0.36-0.86) for 1500 mg/d or greater.

Conclusions  Higher vitamin C intake is independently associated with a lower risk of gout. Supplemental vitamin C intake may be beneficial in the prevention of gout.

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 What the study patients took were supplements of 1,500 mg daily.  What is interesting to note is that for every increase in Vitamin C intake of 500 mg per day, the risk of developing gout was decreased by 17%.

Likewise, those who took the 1500 mg supplemental form of Vitamin C had a 45% lower risk of developing gout than those who took lower doses of Vitamin C.  On the other hand those that took 1000 mg ov Vitamin had a 34% lower risk of developing gout!

It is known that Vitamin C can decrease the levels of uric acid oin the blood by increasing its excretion in the urine.

Does this mean,. we now go ahead and grab more Vitamin Cs in the market? I guess we need to wait for more studies to confirm this finding. 

But to those who continue to believe in Vitamin C and its role in preventing colds, this is one good news!

For me… getting the Vitmain Cs from fruits would be a better option.  Remember one orange can give you 70 mg of Vitamin C already.  Plus the ther benefits of fruit intake!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits | 4 Comments »

Take Action on Your Weight!!! The Risks Associated with Being Overweight…

February 28, 2009

Go to fullsize imageBeing overweight needs immediate action!  Thats why when I registered a BMI of 25.6 with a fasting blood sugar of 96, I decided to take action and become healthier with my diet and physical activity.  Being overweight carries with it chronic diseases like diabetes, high blood pressure and cholesterol problem.  Not mentioning stroke and heart attack as endpoints!

For year 2009: Its NOW a Global Call to action as more and more children and adolescence are gaining weight.  There’s no time to sit back and relax on this matter as inaction means DISASTER in the long run for these children!

A recent study published in www.bmj.com showed that obese adolescents have the same risk of premature death in adulthood as people who smoke more than 10 cigarettes a day!!!!   This is indeed a scary thought.

Those who are overweight have the same risk as less heavy smokers.

BMI is a measure of your weight according to your height.  For Caucasians, a BMI of >25 if already overweight but for Asians, a lower BMI of 23 is considered abnormal already.

What if one is underweight?

Being underweight carries with it a better prognosis  as it carries with it no increased risk, irrespective of smoking status.  However, if you are also too thin with a a body mass index of less than 17; then it carried with it the same risk of premature death as being overweight.

The study suggests therefore that being OBESE and Overweight at the age of  18 carries the same risk of premature death as being too thin!  Both conditions stem from poor nutrition either too much or too little.

Its not late to start and do something for yourself or for our kids…. NOW!

Life is short..Take time to Take Care of your HEALTH!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Truths on Obesity | 1 Comment »

The New Way To Exercise and Get Results….

February 9, 2009

Go to fullsize imageGood news to those who just dont have the time to exercise.

A new study published online by the BMC, 2009 showed a new way to exercise that will have the same or better impact on our body’s metabolism than previously thought.

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Background

Classic, long duration aerobic exercise reduces cardiovascular and metabolic disease risk but this involves a substantial time commitment. Extremely low volume high-intensity interval training (HIT) has recently been shown to cause similar improvements to aerobic performance, but it has not been established whether HIT has the capacity to improve glycemic control.

Methods

Sixteen young men  performed 2 weeks of supervised HIT comprising of a total of 15 min of exercise (6 sessions; 4-6 x 30-s cycle sprints per session). Aerobic performance (250-kJ self-paced cycling time trial), and glucose, insulin and NEFA responses to a 75-g oral glucose load (oral glucose tolerance test; OGTT) were determined before and after training.

Results

Following 2 weeks of HIT, the area under the plasma glucose, insulin and NEFA concentration-time curves were all reduced (12%, 37%, 26% respectively, all P<0.001). Fasting plasma insulin and glucose concentrations remained unchanged, but there was a trend towards reduced fasting plasma NEFA concentrations post-training (pre: 350 +/- 36 v post: 290 +/- 39 mumol * l-1, P=0.058). Insulin sensitivity as measured by the Cederholm index was improved by 22.5% (P<0.01). Aerobic cycling performance was improved by ~6% (P<0.01).

Conclusions

The efficacy of a high intensity exercise protocol, involving only ~250 kcal work each week, to substantially improve insulin action in young sedentary subjects is remarkable. We feel this novel time-efficient training paradigm can be used as a strategy to reduce metabolic risk factors in young and middle aged sedentary populations who otherwise would not adhere to a classic high volume, time consuming exercise regimens

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In this study short burst of intense exercise activity lasting for like 30 seconds resulted in improvement of parameters that can have an impact in preventing chronic illnesses. 

The subjects used exercise bikes which we can easily buy in sports stores… performed a quick sprint insturcted to do it at their highest possible intensity for around 30 seconds.  The results showing significant improvements in exercise parameters biochemically suggest that any highly vigorous activity carried out in few minutes in a few days per week should achieve the same protective metabolic improvements. 

This is definitely good news to those who just cant find the right time and place to do their exercise workout.  This is one of the first studies to document that short bouts of exercise can be as effective in improving metabolic parameters as the usual recommendations of moderate exercise for 30 minutes most days of the week. 

Now my friends… no more excuses!!!

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits | 5 Comments »

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.

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips | 3 Comments »

Tips For The Holidays…..

December 23, 2008

The Christmas holiday spirit is just around the corner and everyone is now busy preparing for reunions with family and friends.  And what better way to prepare the celebration is to have a feast!  What is Christmas anyway without the parties?  The bulge and the extra fat that we get after these merry making activities is what makes us feel guilty enough to make us vow to do better on our Annual New Year’s resolutions.

So how can one avoid gaining weight during the holidays? Common sense advise is to keep in mind to always keep track of the calories we take in. But most of all, in situations where food is in abundance in the buffet table…my advise is to enjoy the foods that are nutrient rich but modestly high in protein (20 to 25% of the total calories) and low in carbohydrates (40% to 45% of total calories).

The fad of low carbohydrate and high protein diet has put protein at the center stage.  Since the Atkins Diet and the South Beach diet came into our attention, a lot of controversies has been made because of the absence of long term studies to document their efficacy and safety.  Recent data however have shown that a moderate intake of protein is not only efficacious in making one lose weight but also in improving blood sugar and cholesterol.

Protein intake is important to our body. If we don’t get enough protein- it can lead to growth failure, loss of muscle mass, a reduction in heart and lung function as well as impairment in ones immunity.  However, too much protein can also cause harm.  It can take a lot of calcium from the bone and can lead to fractures. Likewise, people with kidney disease should be warned about a high protein diet since it can further exacerbate the kidney problem.

Let me give you some tips on how to enjoy the benefits of a modestly high protein diet SAFELY….

Remember…different protein sources give different effects on our health.  Proteins coming from vegetables definitely are healthier because they are devoid of fat than those coming from meat. A steak and a salmon may have the same amount of protein but the saturated fat in beef is more than half that of the fish. It is the FAT that can cause harm and can lead to chronic disabling conditions like heart attack and stroke! 

Here are some Tips in Choosing Your Protein Sources wisely:

1. If you are a meat lover then get the lean cuts of beef or pork.  However a healthier alternative would be the white meat of fish and chicken breast.

2. A better option for a healthier protein source would be from vegetable sources like nuts, lentils, beans and whole grain.

3. For your daily protein needs, get them from different sources…mix and match for variety!

4. Soy based foods are also good alternatives to red meat but limit to 2 to 3 servings a week.

Lastly… simple lifestyle measures that you can observe during parties or in preparation for the holiday parties that can matter most in avoiding weight gain:

1.     Always eat breakfast everyday of your life.  If you haven’t done so regularly…do it now!  Avoid skipping meals as this habit can cause more weight gain!

2.     Begin your meals with soup or salad to lessen your cravings for the sinful fat filled dishes on the buffet table.

3.     Try to eat slowly by chewing your food thoroughly so your body will have time to analyze that you are already full.

4.     Once full then stop and walk away from the sight of food.  This habit will make you avoid getting more food even if you are no longer hungry!

5.     Use a smaller plate so it will look full with only a small amount of food.  

A nutrient rich meal that has a modest increase in protein content and a modest restriction of carbohydrates coupled with simple practical lifestyle measures can go along way in helping us avoid the holiday bulge!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Nutrition Health Tips | 5 Comments »

My Advise for a Practical and Doable Way to Lose Weight!

November 29, 2008

I happened to be in Manila yesterday to attend the blessing of our society’s AACE office then had a meeting till 12N then another meeting at 1PM then another event at 6:30 PM.  And throughout the day from the time I got to the airport to the time I was in the Blessing…I was asked only ONE question…How did I lose weight?!

Can you imagine me retelling the reason and the way I did to more than 15 people up to the time I got back to airport early morning today ….so I thought of this topic should be retold and discussed in my website….

The best way to help yourself avoid the probelms of the new century is to mainitain a healthy weight.  And if you are overweight then the best gift you can give to yourself for the holidays is to lose weight.  I did it for health reasons since I am at risk to become a diabetic being the youngest of a family of 9 with a mother who is a diabetic.

I am not a fan of any fad diet and will never be. I believe a high protein diet can help one lose weight but I dont believe it as the magic formula for wieght loss and I know the effect will not last long term.

My prescription for a successful weight loss is plain and simple cutting down on calorie intake PERIOD!  Sounds Boring but it works and heres how I did it:

Three key points: 1) set a goal 2) work on it 3) maintain on the strategy.

Simple way of cutting calories? Heres my Practical DOABLE advise:

Get a little rice, a serving of meat and veggies then eat… after the portions are consumed…assess if you still need more BUT NOT because you like the food BUT based on whether you’re still hungry or full already.  If you FEEL full…then stop…leave the table and o something else.  SIMPLE? yes… but in reality the temptation to eat more is so strong that if you dont have the DISCIPLINE to achieve the goal you have set for you to do… then the strategy will FAIL!  THAT’s IT!

That is my strategy..meaning…I eat what I like but I stop once I feel full. Simple and yet perfect in cutting down a lot of calories.

The problem with our society nowadays is that we use food for COMFORT…to Destress our minds…and to ENJOY but at the expense of HEALTH!

Then I do my afternoon exercise of enjoying my iPod while brisk walking. Enjoy the sceneries my friends…enjoy the fresh air and get out of your web!!!!

For the Holidays…Watch OUT for the FOOD!  Yummmy!!!!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Personal Thoughts, Weight Loss Tips | 7 Comments »

The Benefit of Smoking…. or Is There?

October 14, 2008
Actually none except ill health. But no, I found the intriguing editorial from the Archives of Internal Medicine that made me believe that probably there is a hidden reason why smokers just refuse to quit…
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 Cigarette smoking remains a persistent and difficult public health problem. Approximately 1 in 5 adults continues to smoke, and annual long-term successful abstinence rates run around 2% to 3%. Most smokers are aware that smoking poses risks to their health, and approximately 60% to 70% of smokers report having been counseled by their physicians to quit smoking.

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Clearly… education regarding smoking cessation has failed to fully take effect as abstinence form addiction to smoking remains nil.  Every smoker knows it is not healthy to smoke nor is it healthy for members of the family to inhale their smoke but still the practice of smoking continues to be very prevalent.

And I agree fully with the editor when he titled his editorial to fully state what we as medical practitioners believe is the true essence why smokers refuse to quit…. is that they want to:

Live Fast, Die Young, Leave a Good-looking Corpse!

Posted in General Health Tips, Healthy Practice Tips, Personal Thoughts | 3 Comments »

How To Check Your Blood Pressure At Home….

October 1, 2008

High blood pressure is now a common ailment that we hear among our friends.  The way we live our lives, the genes and our lifestyle contribute sugnoificantly to increasing this risk.  Almost always, doctors require patienhts to monitor their blood pressure at home however, majority do it wrongly or make use of wrong machines to record their BP.

The Harvard News Letter has come up with some tips that I want to share with you:

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Your blood pressure changes from hour to hour, sometimes even minute to minute. Standing up, watching an exciting sports event, eating a meal, even the time of day influence your blood pressure. It jumps around so much that you are more likely to get a “normal” reading if you check it at home rather than in the doctor’s office.

When it comes to measuring blood pressure, technique matters. Doing it wrong can give you a reading that’s too high or too low. (To see a brief video on using a home blood pressure monitor, visit health.harvard.edu/128.)
There are two things to do before you start. First, check your machine against the one in your doctor’s office. Second, make sure you have the right size cuff — the inflatable part should encircle at least 80% of your upper arm.

When you first start to check your blood pressure at home, measure it early in the morning, before you have taken your blood pressure pills, and again in the evening, every day for a week. After that, follow the plan your doctor recommends, or check it one or two days a month. Each time you take a reading:

  • Avoid caffeinated or alcoholic beverages, and don’t smoke, during the 30 minutes before the test.
  • Sit quietly for five minutes with your back supported and feet on the floor.
  • When making the measurement, support your arm so your elbow is at the level of your heart.
  • Push your sleeves out of the way and wrap the cuff over bare skin. Measure your blood pressure according to the machine’s instructions. Leave the deflated cuff in place, wait a minute, then take a second reading. If the readings are close, average them. If not, repeat again and average the three readings.
  • Don’t panic if a reading is high. Relax for a few minutes and try again.
  • Keep a record of your blood pressure readings and the time of day they are made.

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Simple tips that can go a long way in ensuring good control of BP.  Remember, the doctor can only help in advising what type of drug is best for you.  Then the remaining half of the job is done by you… making sure you eat the right food, the right amount of salt and getting the right amount of “stress”.

By making it a habit to check your blood pressure may not help “cure the disease” as 99% of hypertension has no identifiable cause,  BUT it will help ensure a smooth control of BP during the day to day activity that you do.  As a result, you can be assure that the simple measures that you do are being done to help prevent complications including heart attack and stroke.

Keep Your BP in Control!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Tips To Protect Your Heart | 4 Comments »

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!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Tips To Protect Your Heart | 2 Comments »

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!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Personal Thoughts | 1 Comment »

A Hearty Breakfast Equals Weight Loss?

July 10, 2008

This new study again refutes what has been said about the low carb hype.

We all know the breakfast is an important meal. In this website, I have emphasized that skipping breakfast equals weight gain equals metabolic syndrome. Therefore it is a must that we all have to break the fast to maintain our weight and be healthy.

In the recent convention of the Endocrine Society, one abstract that caught the attention of many was the study comparing the low carb high fat high protein diet versus high carb, high protein low fat diet.

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The low-carb diet allowed 1,085 calories a day with 17 grams of carbohydrates, 51 grams of protein, and 78 grams of fat. Breakfast for members of this group was to be 290 calories with 7 grams of carbohydrates and 12 grams of protein.
The modified form of this diet allowed 1,240 calories a day with less total fat (46 grams) but more carbs (97 grams) and protein (93 grams). The main feature was a 610-calorie “big breakfast” accounting for about half of the daily carbohydrates (58 grams), protein (47 grams), and fat (22 grams).

During the first 16-week weight-loss phase, the big-breakfast group lost about the same amount of weight as the low-carb group (10.6 kg versus 12.6) with no significant difference between groups.

During the following 16-week maintenance phase, though, the groups’ experience diverged. The big-breakfast group continued losing weight and reached an average 21.3% weight loss by the end of the trial (18.1 kg below baseline).

The low-carb group, on the other hand, regained much of the weight lost to end at just 4.5% below baseline (4.3 kg). The protein- and carbohydrate-heavy breakfast appeared to regulate hunger cues, the researchers said.

Visual analog scale scores after breakfast for the two groups were improved with the big-breakfast diet compared with the low carb diet for the following:

  • Hunger (P=0.018)
  • Feeling of still being able to eat a lot more food (P=0.001)
  • Fullness (P=0.001)
  • Satiety (P=0.07)

The difference in fullness extended beyond lunch and through 11 p.m. (P=0.001).

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This study suggests that having a heart high carb and high protein breakfast translates to lesser craving for sweets and lesser hunger.  Again as we emphasized in any weight loss counseling, it is not recommended that patients trying to lose weight are on a dietary regimen that makes them feel hungry.

This is one study that I will wait for the final posting in a peer reviewed journal.  It would be nice to see how the study was conducted and see where the flaws could be and whether this can be translated into clinical practice.

For now…

Eat Your Breakfast To Help You Lose Weight!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Nutrition Health Tips, Personal Thoughts, The Truths on Obesity | 3 Comments »

An Aspirin A Day Can Keep BP At Bay…

June 24, 2008

Aspirin has been touted a miracle drug because of its health benefits in protecting high risk patients like our diabetics from heart attack and stroke. The combination of illnesses including diabetes , hypertension and cholesterol increases a patients risk for stroke and heart attack.

In the recent American Society of Hypertension Annual Convention, a particular study was presented regarding the effect of aspirin on hypertension. The study is discussed in detail at the Diabetes in Control website...

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The subjects were randomized into three groups: lifestyle modification only, lifestyle modification plus aspirin 100 mg every morning, or lifestyle modification and aspirin 100 mg taken at bedtime. They underwent continuous blood pressure monitoring for 48 hours at baseline and after 3 months of intervention.

Ambulatory blood pressure was unchanged in the nonpharmacologic group and in the morning aspirin group, but the nighttime aspirin administration resulted in a mean decrease of 5.4 mm Hg in systolic blood pressure and 3.4 mm Hg in diastolic blood pressure compared to baseline values, without any change in heart rate or physical activity. Reductions in blood pressure were similar for both day and night.

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This study will somehow affect the way we give aspirin. In clinical practice, it really doesnt matter when aspirin is taken as long as patients are taking it eveyday. But with this recent outcome…might as well give them at night until this study will be proven otherwise….

And as always…we continue to emphasize a low salt diet and more physical activity on top of medications to help curb the rising prevalence of complications arising from hypertension.

Another Wonderful News on Aspirin and Health!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Personal Thoughts, Tips To Protect Your Heart | 4 Comments »

Is Working Overtime Harmful?

June 21, 2008

Here’s a study for all workaholics and overtime workers. It may be the time to reflect… and ask… if we can only manage our time better and try to avoid long night hours at work…so much the better. One has to realize and believe that having the time to take care of ones health is an obligation and a GIVEN!

This study looked at whether working overtime can have harmful effects on the body especially the psychological well being. This study was recently published in the Journal of Occupational and Environmental Medicine.

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Objective: To examine whether long work hours are associated with increased levels and prevalences of anxiety and depression.

Results: Overtime workers of both genders had significantly higher anxiety and depression levels and higher prevalences of anxiety and depressive disorders compared with those working normal hours. Findings suggest a dose-response relationship between work hours and anxiety or depression.

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So to the boses and managers out there…your employees well being is tantamount to more productivity and better work outcome. Take time to analyze each workload and better still instill the discipline of not working long hours because in the long run, health takes its toll and work output suffers in the end…physically and psychologically,

Again… I practice this principle at work. I make sure I dont work long hours as I instill on my patients the discipline of setting an appointment. Have time to relax and exercise. Burning out is the layman’s term to being depressed and losing steam at work. Avoid this from happening otherwise Work becomes a Burden!

Overtime Can Hinder Productivity! Learn To Manage Your Time!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits | 1 Comment »

Quick Steps To Achieve Healthy Weight…

June 6, 2008

Go to fullsize imageI came across a well written short article on how to achieve a healthy weight.  The advises sound so simple yet precise and direct to the point of concern.  We tend to disregard simple measures in life and then look for rigorous steps to achieve our goal.  That’s where failure can set in.  Make things simple and Let them work for you….

Here’s the quick 5 steps to a healthy weight from the Harvard Medical Group: The Harvard School of Public Health

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1. Ban the strange diets. They may work in the short term, but almost any strange, extreme diet is doomed to fail. Your best friends when it comes to losing weight—and keeping it off? Choosing healthy foods and eating smaller portions, slowly.

2. Be more active. If there’s one best weight loss mantra it’s “exercise, exercise, exercise.” Choose activities you enjoy and do them every day. Exercising with a friend can help keep you on track. 

3. Turn off the television. Watching less TV can give you more time to be active—and less time to be enticed by junk food ads. Two easy ways to cut back on TV-watching: take the TV out of your bedroom, and make sure it’s off during meals.

4. Skip the sugary drinks. Drinking sugared soda, fruit drinks, or juice can give you several hundred calories a day without realizing it. Research suggests children and adults who drink soda or other sugary drinks are more likely to gain weight than those who don’t, and that switching from these to water or unsweetened drinks can reduce weight.

5. Think before you eat. Before you mindlessly reach for a snack, pause and ask yourself, Am I really hungry? Is there a healthier choice? It’s easy to lose sight of good food choices in today’s ad-crazy world. Simple questions like these can help keep us on track.

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Simple common sense tips for healthy living as well…

Live Life To The Fullest…By Living Healhty!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Nutrition Health Tips, Personal Thoughts, Weight Loss Tips | Leave a Comment »

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!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, Personal Thoughts, Tips To Protect Your Heart | Leave a Comment »

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.

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, Personal Thoughts, The Diabetes Facts | 7 Comments »

A High Fiber Diet: Does It Really Matter?

April 11, 2008

Go to fullsize imageWe have been exposed to ads regarding the benefits of a high fiber diet.  We know it is good for our health but what does it do and where do we get these fiber rich products?

It has been shown in several studies that a high fiber diet can indeed lower ones risk to develop heart diseaese by as much as 30% as well as lower ones risk to develop diabetes and improve cholesterol.   We know it works well for roughage and therefore can prevent constipation and improve bowel habits.  In fact it was recommended as a way of preventing colon polyps and cancer BUT so far no long term studies have proven that fiber can indeed lower the risk for colon cancer.  Nonetheless, the multiple benefits we can get from eating a high fiber meals are more than enough to recommend intake of these products to our patients and the public in general.

But what are the best sources of fiber? Here is a list of the different kinds of fiber compiled by the Harvard School of Nutrition:

Sources of Fiber

Soluble Fiber

Insoluble Fiber
oatmeal
oatbran
nuts and seedslegumes

  • dried peas
  • beans
  • lentils

apples
pears
strawberries
blueberries

 whole grains

  • whole wheat breads
  • barley
  • couscous
  • brown rice
  • bulgur

whole-grain breakfast cereals
wheat bran
seeds
carrots
cucumbers
zucchini
celery
tomatoes

The best fiber source in several studies that proved a high fiber diet to be beneficial is the cereal based fiber or fiber from grains and those coming from fruits.  It is recommended that a diet with at least 21 to 38 gms of fiber should be taken per day.  On an average Filipino diet, we are only consuming at most less than 15 gms of fiber per day so we better bulk it up more with the sources mentioned in the table for health reasons.  Increase the fiber intake gradually rather that abruptly and to make sure we also increase the intake of water ans fiber absorbs water.

What Do I recommend: here’s a sample advise that I give to my patients:

  • Avoid fruit juices as they are devoid of fiber, instead eat whole fruits.
  • Eat brown rice instead of white rice
  • Buy whole grain products instead of white bread and pasta.
  • Try snacking with raw veggies..they may not be as yummy as a pastry BUT they are triple times  as healthy.
  • Choose whole-grain cereals for breakfast instead of rice and sausage! 

    • Eat Right By Eating Healthy..Try FIBER!

     

    Posted in General Health Tips, Healthy Practice Tips, Nutrition Health Tips, Personal Thoughts, The Diabetes Facts | 1 Comment »

    Your Weight and Your Risk To Develop Breast Cancer….

    March 26, 2008

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

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

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

    Results: 

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

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

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

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

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

    Be Health and Weight Conscious!

    Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, The Truths on Obesity | 4 Comments »

    Lower Your Risk To Develop Diabetes By Eating Veggies….

    March 24, 2008

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

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

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

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

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

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

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

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

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

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

    Train Yourself and Your Kids To Eat Veggies for Health!

    Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Nutrition Health Tips, Personal Thoughts, The Diabetes Facts, What's New in Diabetes | 1 Comment »

    Nutrition in Health and Disease….

    March 17, 2008

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

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

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

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

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

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

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

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

    Live Life To The Fullest…By Eating Right!

    Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, Personal Thoughts, The Diabetes Facts, The Truths on Obesity, Tips on Hypertension, What's New in Diabetes | 4 Comments »

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