Archive for the 'Lifestyle Measures' Category

Television Viewing and Diabetes: The LINK

November 17, 2014

We just celebrated the World Diabetes Day this November 14 and what a better way to celebrate this day than to help share awareness of this disease to the general public. I was invited to share about Diabetes on radio last sunday and was happy to share to the public general information and knowledge about what diabetes is, how it is diagnosed and what the treatment options are.

I recently read an article which I believe will be worth contemplating about.

in the clinics I now advised my patients that for every hour of sitting in office, make sure to take time to stand and walk for at least 10 minutes. This practice not only can curb obesity but also can increase your metabolic rate and help curb chronic diseases like diabetes and heart disease.

It is therefore not surprising that in a recent article published in JAMA , a study showed further a strong link between TV viewing and the risk for Diabetes and Heart disease risk:

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Abstract

CONTEXT:

Prolonged television (TV) viewing is the most prevalent and pervasive sedentary behavior in industrialized countries and has been associated with morbidity and mortality. However, a systematic and quantitative assessment of published studies is not available.

OBJECTIVE:

To perform a meta-analysis of all prospective cohort studies to determine the association between TV viewing and risk of type 2 diabetes, fatal or nonfatal cardiovascular disease, and all-cause mortality.

DATA SOURCES AND STUDY SELECTION:

Relevant studies were identified by searches of the MEDLINE database from 1970 to March 2011 and the EMBASE database from 1974 to March 2011 without restrictions and by reviewing reference lists from retrieved articles. Cohort studies that reported relative risk estimates with 95% confidence intervals (CIs) for the associations of interest were included.

DATA EXTRACTION:

Data were extracted independently by each author and summary estimates of association were obtained using a random-effects model.

DATA SYNTHESIS:

Of the 8 studies included, 4 reported results on type 2 diabetes (175,938 individuals; 6428 incident cases during 1.1 million person-years of follow-up), 4 reported on fatal or nonfatal cardiovascular disease (34,253 individuals; 1052 incident cases), and 3 reported on all-cause mortality (26,509 individuals; 1879 deaths during 202,353 person-years of follow-up). The pooled relative risks per 2 hours of TV viewing per day were 1.20 (95% CI, 1.14-1.27) for type 2 diabetes, 1.15 (95% CI, 1.06-1.23) for fatal or nonfatal cardiovascular disease, and 1.13 (95% CI, 1.07-1.18) for all-cause mortality. While the associations between time spent viewing TV and risk of type 2 diabetes and cardiovascular disease were linear, the risk of all-cause mortality appeared to increase with TV viewing duration of greater than 3 hours per day. The estimated absolute risk differences per every 2 hours of TV viewing per day were 176 cases of type 2 diabetes per 100,000 individuals per year, 38 cases of fatal cardiovascular disease per 100,000 individuals per year, and 104 deaths for all-cause mortality per 100,000 individuals per year.

CONCLUSION:

Prolonged TV viewing was associated with increased risk of type 2 diabetes, cardiovascular disease, and all-cause mortality.

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The study clearly shows that for every two hours of television watched daily,

Diabetes development is increased by 20%,
Cardiovascular disease is increased by 15%, and
All-cause mortality and death is increased by 13%.
Obviously the habit of watching TV correlates with the amount of popcorn, chips, sugary drinks that accompany the activity. Meaning this practice of prolonged TV viewing is worst that any passive sedentary activities like driving or tinkering on a computer.

So guys, it is therefore not yet late to adopt on a different lifestyle. Learn to change and remember to include your children on this health change. Let them see you as parents embarking on a healthy lifestyle so they also can adopt to it.

No TV on weekdays for my kids but this rule is solely to let them focus on studying BUT I let them join me everyday of our bonding of fun run , biking and swimming.

Take time to Care about your Health… be active and Proactive!

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Sitting All Day and Your Health

August 21, 2014

AACE_EmPower5K_LasVegas_2014_542A new study published at the Mayo Clinic Proceedings showed that being an office worker and sitting all day may not be good for your health at all.

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Objective
To determine the association between cardiorespiratory fitness and sedentary behavior, independent of exercise activity.

Patients and Methods
We included 2223 participants (aged 12-49 years; 1053 females [47%]) without known heart disease who had both cardiovascular fitness testing and at least 1 day of accelerometer data from the National Health and Nutrition Examination Survey 2003-2004. From accelerometer data, we quantified bouts of exercise as mean minutes per day for each participant. Sedentary time was defined as less than 100 counts per minute in mean minutes per day. Cardiorespiratory fitness was derived from a submaximal exercise treadmill test. Multivariable-adjusted linear regression analyses were performed with fitness as the dependent variable. Models were stratified by sex, adjusted for age, body mass index, and wear time, and included sedentary and exercise time.

Results
An additional hour of daily exercise activity time was associated with a 0.88 (0.37-1.39; P<.001) metabolic equivalent of task (MET) higher fitness for men and a 1.37 (0.43-2.31; P=.004) MET higher fitness for women. An additional hour of sedentary time was associated with a −0.12 (−0.02 to −0.22; P=.03) and a −0.24 (−0.10 to −0.38; P<.001) MET difference in fitness for men and women, respectively.

Conclusion
After adjustment for exercise activity, sedentary behavior appears to have an inverse association with fitness. These findings suggest that the risk related to sedentary behavior might be mediated, in part, through lower fitness levels.

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The study actually tells us interesting facts about prolonged sitting.  That for every hour we  spend sitting in our offices, it will reduce the gains of a daily workout by eight percent.  So it is suggested that we stand and walk in between our daily routine work sitting in our office tables.  One can use the break times to take short brisk walks around the building or to a vending machine and back as simple means to achieve the goal.

What is interesting in the study also is the fact that a daily dose of an hour of exercise can work wonders.  It can offset the bad effects of the six to seven hours of sitting. Perfect data for me!!!!

This is what I practice in my daily routine…..

As a physician, sitting all day listening to my patients is a routine.  I therefore interspersed my sitting times listening to their problems by simply standing up to do the physical examination. This is on top of my daily afternoon run and my daily morning weights and sit ups that totally make my day complete!

Perfect Combination of Sitting , Standing or just Simply MOVING!

More Vegetables and Fruits Make More Years of Your Life….

April 3, 2014

True enough, and more studies proving that eating veggies really make a more healthier life.  A recent study offered more information detailing that more fruits and veggies really help deter the onset of diseases especially cancer and heart disease.

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Background Governments worldwide recommend daily consumption of fruit and vegetables. We examine whether this benefits health in the general population of England.

Methods Cox regression was used to estimate HRs and 95% CI for an association between fruit and vegetable consumption and all-cause, cancer and cardiovascular mortality, adjusting for age, sex, social class, education, BMI, alcohol consumption and physical activity, in 65 226 participants aged 35+ years in the 2001–2008 Health Surveys for England, annual surveys of nationally representative random samples of the non-institutionalised population of England linked to mortality data (median follow-up: 7.7 years).

Results Fruit and vegetable consumption was associated with decreased all-cause mortality (adjusted HR for 7+ portions 0.67 (95% CI 0.58 to 0.78), reference category <1 portion). This association was more pronounced when excluding deaths within a year of baseline (0.58 (0.46 to 0.71)). Fruit and vegetable consumption was associated with reduced cancer (0.75 (0.59–0.96)) and cardiovascular mortality (0.69 (0.53 to 0.88)). Vegetables may have a stronger association with mortality than fruit (HR for 2 to 3 portions 0.81 (0.73 to 0.89) and 0.90 (0.82 to 0.98), respectively). Consumption of vegetables (0.85 (0.81 to 0.89) per portion) or salad (0.87 (0.82 to 0.92) per portion) were most protective, while frozen/canned fruit consumption was apparently associated with increased mortality (1.17 (1.07 to 1.28) per portion).

Conclusions A robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+ portions daily. Further investigations into the effects of different types of fruit and vegetables are warranted.

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The study clearly shows the inverse relationship between the amount of consumed fruits and veggies and risk of death and diseases.  The consumption of seven or more servings of fruits and vegetables was associated with reduced cancer mortality  and  mortality associated with heart disease more than what has been recommended by policy makers of 5 servings daily.

So here’s one food where consumption of more leads to better health.

 

Nuts and Health

December 5, 2013

I ama  regular nut eater… mostly pistachios. Nuts are my favorite snacks.

Health benefits derived from eating nuts are numerous and this new study published in NEJM, 2013 affirms that association.

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BACKGROUND

Increased nut consumption has been associated with a reduced risk of major chronic diseases, including cardiovascular disease and type 2 diabetes mellitus. However, the association between nut consumption and mortality remains unclear.

METHODS

We examined the association between nut consumption and subsequent total and cause-specific mortality among 76,464 women in the Nurses’ Health Study (1980–2010) and 42,498 men in the Health Professionals Follow-up Study (1986–2010). Participants with a history of cancer, heart disease, or stroke were excluded. Nut consumption was assessed at baseline and updated every 2 to 4 years.

RESULTS

During 3,038,853 person-years of follow-up, 16,200 women and 11,229 men died. Nut consumption was inversely associated with total mortality among both women and men, after adjustment for other known or suspected risk factors. The pooled multivariate hazard ratios for death among participants who ate nuts, as compared with those who did not, were 0.93 (95% confidence interval [CI], 0.90 to 0.96) for the consumption of nuts less than once per week, 0.89 (95% CI, 0.86 to 0.93) for once per week, 0.87 (95% CI, 0.83 to 0.90) for two to four times per week, 0.85 (95% CI, 0.79 to 0.91) for five or six times per week, and 0.80 (95% CI, 0.73 to 0.86) for seven or more times per week (P<0.001 for trend). Significant inverse associations were also observed between nut consumption and deaths due to cancer, heart disease, and respiratory disease.

CONCLUSIONS

In two large, independent cohorts of nurses and other health professionals, the frequency of nut consumption was inversely associated with total and cause-specific mortality, independently of other predictors of death. (Funded by the National Institutes of Health and the International Tree Nut Council Nutrition Research and Education Foundation.)

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Skipping Breakfast? Read This!

July 30, 2013

Breakfast is considered the most important meal of the day.  It breaks the fasting period and therefore allows ones metabolism to be back up and running for the day.  Likewise, skipping breakfast has been shown in studies to put a patient at risk for multiple conditions including increasing risk of diabetes since fat breakdown during the period of prolonged fast can cause insulin resistance.  Now comes a new study published in Circulation 2013, showing that skipping breakfast is not healthy and friendly to the heart.

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Abstract

Background—Among adults, skipping meals is associated with excess body weight, hypertension, insulin resistance, and elevated fasting lipid concentrations. However, it remains unknown whether specific eating habits regardless of dietary composition influence coronary heart disease (CHD) risk. The objective of this study was to prospectively examine eating habits and risk of CHD.

Methods and Results—Eating habits, including breakfast eating, were assessed in 1992 in 26 902 American men 45 to 82 years of age from the Health Professionals Follow-up Study who were free of cardiovascular disease and cancer. During 16 years of follow-up, 1527 incident CHD cases were diagnosed. Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals for CHD, adjusted for demographic, diet, lifestyle, and other CHD risk factors. Men who skipped breakfast had a 27% higher risk of CHD compared with men who did not (relative risk, 1.27; 95% confidence interval, 1.06–1.53). Compared with men who did not eat late at night, those who ate late at night had a 55% higher CHD risk (relative risk, 1.55; 95% confidence interval, 1.05–2.29). These associations were mediated by body mass index, hypertension, hypercholesterolemia, and diabetes mellitus. No association was observed between eating frequency (times per day) and risk of CHD.

Conclusions—Eating breakfast was associated with significantly lower CHD risk in this cohort of male health professionals.

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This study may not be conclusive due to study limitations BUT the results are not surprising to me at all.

Further studies need to be done especially on the relationship of late snacking and death.

A common theme arises however in all these studies that BREAKFAST is important for health and preservation of life.

The Amount of Exercise You need to Burn off Calories from eating a Burger…

April 26, 2013

Let me share you this link from Yahoo. Very interesting fact that one can use this strategy to lose weight.  Think how much exercise you need to do to burn off the calories from the food you re eating…

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Is a Burger Worth 7,500 Sit-Ups?

Most people have stared down a pint of ice cream or a bag of chips and tried to figure out how much more they’d need to work out in order to burn off the extra calories. Unfortunately, you can’t really eat whatever you want and just work out a little more later. “No, it is not an even exchange,” Franci Cohen, a personal trainer, certified nutritionist, and exercise physiologist in New York City, told Yahoo! Shine. “In fact, over-exercising will actually cause the muscles to break down instead of build up, and the metabolism slows down as a result of excess exercise as well.” Still, a Texas Christian University study of 300 adults presented at the Experimental Biology 2013 conference in Boston this week found that learning how much more you’d need to exercise to work off a burger was enough to make people pick a lower-calorie meal. Wondering if that candy bar is worth it? Here’s what it would take to work off some of our favorite indulgences. 

A single Whopper from Burger King is 630 calories, or the equivalent of spending an hour going full-tilt on the elliptical machine. Rather do sit-ups or crunches? You’ll have to bust out 7,500 of them. (All workout results calculated for a 140 pound woman, using exercise data from HealthStatus.com.)

Ben & Jerry’s Phish Food premium ice cream packs 280 calories into each 1/2-cup serving. That’s a little more than an hour’s worth of pumping iron. But who stops at a single serving? Eat the whole pint and do about five hours of weight lifting (or almost two hours of bare-handed rock climbing).

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I enjoyed reading the link that it makes us realize… fat is really from all the food we eat..and therefore…controlling ones desire to indulge is key to curbing  your appetite.

Indulge but only on occasions.

 

Walk the Talk… The Risk fo Sedentary Lifestyle….

February 3, 2013

It is now advised that for every hour of sitting in office, make sure to take time to stand and walk for at least 10 minutes.  This practice not only can curb obesity but also can increase your metabolic rate and help curb chronic diseases like diabetes and heart disease.

It is therefore not surprising that in an article published in JAMA , a study showed further a strong link between TV viewing and the risk for Diabetes and Heart disease risk:

__________________________________________________

Abstract

CONTEXT:

Prolonged television (TV) viewing is the most prevalent and pervasive sedentary behavior in industrialized countries and has been associated with morbidity and mortality. However, a systematic and quantitative assessment of published studies is not available.

OBJECTIVE:

To perform a meta-analysis of all prospective cohort studies to determine the association between TV viewing and risk of type 2 diabetes, fatal or nonfatal cardiovascular disease, and all-cause mortality.

DATA SOURCES AND STUDY SELECTION:

Relevant studies were identified by searches of the MEDLINE database from 1970 to March 2011 and the EMBASE database from 1974 to March 2011 without restrictions and by reviewing reference lists from retrieved articles. Cohort studies that reported relative risk estimates with 95% confidence intervals (CIs) for the associations of interest were included.

DATA EXTRACTION:

Data were extracted independently by each author and summary estimates of association were obtained using a random-effects model.

DATA SYNTHESIS:

Of the 8 studies included, 4 reported results on type 2 diabetes (175,938 individuals; 6428 incident cases during 1.1 million person-years of follow-up), 4 reported on fatal or nonfatal cardiovascular disease (34,253 individuals; 1052 incident cases), and 3 reported on all-cause mortality (26,509 individuals; 1879 deaths during 202,353 person-years of follow-up). The pooled relative risks per 2 hours of TV viewing per day were 1.20 (95% CI, 1.14-1.27) for type 2 diabetes, 1.15 (95% CI, 1.06-1.23) for fatal or nonfatal cardiovascular disease, and 1.13 (95% CI, 1.07-1.18) for all-cause mortality. While the associations between time spent viewing TV and risk of type 2 diabetes and cardiovascular disease were linear, the risk of all-cause mortality appeared to increase with TV viewing duration of greater than 3 hours per day. The estimated absolute risk differences per every 2 hours of TV viewing per day were 176 cases of type 2 diabetes per 100,000 individuals per year, 38 cases of fatal cardiovascular disease per 100,000 individuals per year, and 104 deaths for all-cause mortality per 100,000 individuals per year.

CONCLUSION:

Prolonged TV viewing was associated with increased risk of type 2 diabetes, cardiovascular disease, and all-cause mortality.

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The study clearly shows that for every two hours of television watched daily,

  • Diabetes development is increased by 20%,
  • Cardiovascular disease is increased by 15%, and
  • All-cause mortality and death is increased by 13%.

Obviously the habit of watching TV correlates with the amount of popcorn, chips, sugary drinks that accompany the activity.  Meaning this practice of prolonged TV viewing is worst that any passive sedentary activities like driving or tinkering on a computer. So guys, it is therefore not yet late to adopt on a different lifestyle. Learn to change and remember to include your children on this health change. Let them see you as parents embarking on a healthy lifestyle so they also can adopt to it. No TV on weekdays for my kids  but this rule is solely to let them focus on studying BUT I let them join me everyday of our bonding of fun run , biking and swimming. Its Sunday… so its TV time later after our round of running….

Are All Sugars The Same?

January 11, 2013

Read the rest of this entry »

Your Neighborhood Can Put You At Risk of Diabetes….

September 30, 2012

It is a known fact that diabetes develops because of the changing environment.  From processed food to urbanization resulting in the lack of time to do exercise. But one study done recently and published in Diabetes Care, Sept 2012, tells us that this maybe in reality just right in the corner of our backyard.

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Abstract

OBJECTIVE This study was designed to examine whether residents living in neighborhoods that are less conducive to walking or other physical activities are more likely to develop diabetes and, if so, whether recent immigrants are particularly susceptible to such effects.

METHODS We conducted a population-based, retrospective cohort study to assess the impact of neighborhood walkability on diabetes incidence among recent immigrants (n = 214,882) relative to long-term residents (n = 1,024,380). Adults aged 30–64 years who were free of diabetes and living in Toronto, Canada, on 31 March 2005 were identified from administrative health databases and followed until 31 March 2010 for the development of diabetes, using a validated algorithm. Neighborhood characteristics, including walkability and income, were derived from the Canadian Census and other sources.

RESULTS Neighborhood walkability was a strong predictor of diabetes incidence independent of age and area income, particularly among recent immigrants (lowest [quintile 1 {Q1}] vs. highest [quintile 5 {Q5}] walkability quintile: relative risk [RR] 1.58 [95% CI 1.42–1.75] for men; 1.67 [1.48–1.88] for women) compared with long-term residents (Q1 to Q5) 1.32 [1.26–1.38] for men; 1.24 [1.18–1.31] for women). Coexisting poverty accentuated these effects; diabetes incidence varied threefold between recent immigrants living in low-income/low walkability areas (16.2 per 1,000) and those living in high-income/high walkability areas (5.1 per 1,000).

CONCLUSIONS Neighborhood walkability was inversely associated with the development of diabetes in our setting, particularly among recent immigrants living in low-income areas.

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This study has general implications for primary prevention of diabetes. Choosing the right place to live is probably the most preventable risk to developing diabetes which is not well controlled can have significant long term health implication.

It is the belief that if your neighborhood is conducive to walking or running or biking… then most of the dwellers will have no reason not to exercise.  But if the environment where you live is not conducive to walking, then this becomes an excuse to be a couch potato.

 

 

Jogging Can Prolong Your Life

May 23, 2012

Let me share with you this interesting article from The Coopenhagen Heart Study soon to be published presented at EuroPRevent2012 in Dublin on the effect of jogging on one’s health and one’s life .

The study has one simple but strong conclusion:

Men who regularly jog can add at least 6.2 years to their life.

Women who regularly jog can add 5.6 years to their life.

How Much Jogging is necessary to reap the benefits?

Not that long but a mere 1 hour up to 2 hours and 30 min per week that can be broken down in 2 to 3 sessions, done at slow to average pace that can leave you a little breathless. Don’t OVERDO it though because the figures from the study indicate that people who do a lot of jogging actually had the tendency to die early similar to those who don’t engage in jogging at all.

There you go guys. My daily “me time” of running around the block in my own home backyard every afternoon at least 2 x is therefore not only ideal but a perfect pace for long life.

Remember in another study done few years ago, maintaining an aerobic fitness through middle age has been shown to delay biologic aging by 12 years.

What Makes Us OVEREAT….

January 4, 2012

Let me share with you one nice article from theHarvard Medical School publication: HealthBeat on what makes people overeat…

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How stress can make us overeat

It’s been another hectic day. On impulse, you grab an extra-large candy bar during your afternoon break. You plan to take just a few bites. But before you know it, you’ve polished off the whole thing — and, at least temporarily, you may feel better.

Rest assured you’re not alone. Stress, the hormones it unleashes, and the effects of high-fat, sugary “comfort foods” push people toward overeating.

Effects on appetite

In the short term, stress can shut down appetite. A structure in the brain called the hypothalamus releases corticotropin-releasing hormone, which suppresses appetite. The brain also sends messages to the adrenal glands atop the kidneys to pump out the hormone epinephrine (also known as adrenaline). Epinephrine helps trigger the body’s fight-or-flight response, a revved-up physiological state that temporarily puts eating on hold.

But if stress persists — or is perceived as persisting — it’s a different story. The adrenal glands release another hormone called cortisol, and cortisol increases appetite and may also ramp up motivation in general, including the motivation to eat. Once a stressful episode is over, cortisol levels should fall, but if the stress doesn’t go away — or if a person’s stress response gets stuck in the “on” position — cortisol may stay elevated.

Fat and sugar cravings

Stress also seems to affect food preferences. Numerous studies — granted, many of them in animals — have shown that physical or emotional distress increases the intake of food high in fat, sugar, or both. High cortisol levels, in combination with high insulin levels, may be responsible. Other research suggests that ghrelin, a “hunger hormone,” may have a role.

Once ingested, fat- and sugar-filled foods seem to have a feedback effect that inhibits activity in the parts of the brain that produce and process stress and related emotions. So part of our stress-induced craving for those foods may be that they counteract stress.

Of course, overeating isn’t the only stress-related behavior that can add pounds. Stressed people lose sleep, exercise less, and drink more alcohol, all of which can contribute to becoming overweight.

Different responses

Some research suggests a gender difference in stress-coping behavior, with women being more likely to turn to food and men to alcohol or smoking. A Finnish study that included over 5,000 men and women showed that obesity was associated with stress-related eating in women but not in men. Other research has shown that high stress levels lead to weight gain in both women and men, but the effect is typically greater in men.

Harvard researchers have reported that stress from work and other sorts of problems correlates with weight gain, but only in those who were overweight at the beginning of the study period. One explanation: overweight people have elevated insulin levels, and stress-related weight gain is more likely to occur in the presence of high insulin.

How much cortisol people produce in response to stress may also factor into the stress–weight gain equation. Several years ago, British researchers designed an ingenious study that showed that people who responded to stress with high cortisol levels in an experimental setting were more likely to snack in response to daily hassles in their regular lives than low-cortisol responders.

Steps you can take

Stress reduction is a growth industry these days.

There are dozens of things to try. Here are three suggestions:

    1. Meditate. Countless studies show that meditation reduces stress, although much of the research has focused on high blood pressure and heart disease. Meditation may also help you be more mindful of food choices. With practice, a person may be able to pay better attention to the impulse to grab a fat- and sugar-loaded comfort food and inhibit the impulse.
   2.  Exercise more. Intense exercise increases cortisol levels temporarily, but low-intensity exercise seems to reduce them. University of California researchers reported results in 2010 that exercise — and this was vigorous exercise — may blunt some of the negative effects of stress. Some activities, such as yoga and tai chi, have elements of both exercise and meditation.
    3. Visit with friends. Social support seems to have a buffering effect on the stress people experience. For example, researchers have found that the mental health of people working in stressful situations, like hospital emergency departments, is better if they receive it. But even those of us who live and work in situations where the stakes aren’t as high will, as Lennon and McCartney suggested, be better off if we get a little help from our friends.

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Steps you can do to reduce stress anytime of the the day…

Bad Habits to avoid when stressed!

Sound Simple and Pure…

 

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!

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!

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!