Archive for the 'Medical News Bits' Category

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Advocacy to Educate Through the Media

September 10, 2007

imagesabcds.jpgMy article on this website on coffee and diabetes has caught the attention of media people and requested me to write about it in detail for publication in major newspapers.  The first publication in People’s Tonight   came out last Saturday, subsequently it will also be published this week in major national dailies like the Philippine Daily Inqurier, Philippine Star and The Manila Bulletin.

My hope to reach more people thorugh this website has taken its hold. Now I get comments from other parts of the country through my website and I find it Great! A reader through the article in People’s Tonight inquired if I have clinic in Manila which unfortunately I dont have.  But readers can always ask me or get in contact with me anytime through this website.

It is just amazing how powerful the media can be.  And I am glad I have found a great outlet of propagating what I love to do and what I plan to do ever since I decided to take up Medicine…. to educate the inquiring minds and to share what is healthy and right to those who seek for them.

Posted in Medical News Bits, Personal Thoughts | 2 Comments »

What Does SPF mean?

September 8, 2007

While in Vienna, my wife always remind me to put on a sunscreen for my face.  It is always a struggle because I hate putting stuff on my face.  But being exposed to the sun with the travels and the dry weather, I obliged.  But what SPF is important to protect our skin?

We all know that sunscreens have long been promoted extensively against skin cancer.  However, it is reported that skin cancer rates continue to creep up, at about 3 percent a year according to the U.S. Centers for Disease Control and Prevention. Most likely because people ignore warnings and still bask themselves in the sun!  But most likely too, these people are protecting themselves with sunscreen…so what is wrong?

The U.S. Food and Drug Administration at the present time only allows manufacturers to only market products with a Sun Pretection Factor or SPF 30-plus on their labels, since they believe that any higher value is misleading to consumers. The belief that sunscreen is all you need to ward off the bad effects of the sun is apparently wrong.  Likewise the belief that the higher the SPF the better protection because it can last longer is also questioned.

It is advised that if you know you will burn under UV exposure in 10 minutes and you use the product with an SPF of 15 then the protection using this sunscreen will last for 150 minutes or 2 1/2 hours.  The problem is… in reality this is not so because, the sunscreen wears off with sweat or can be rub off easily after a dip in the water.  Be aware therefore that the protection you get is less than what you think. 

So, per guidelines… the recommendation is :

  • aim for a product with an SPF of 15 or higher.  But remember that the higher the SPF, the higher the protection agianst UV BUT not necessarily LONGER in protection!
  • Re apply the lotion after 30 min to 1 hour under the sun unless you dont sweat at all!  And more frequently if you swim.

There you go…. now after this post… I will follow my wife’s advise and try to use sunsscreen everyday.  But more so I guess to protect my face from early wrinkles.  So guys… protect your face will a daily sunscreen before it’s too late!

Daily Sunscreen For Baby Face!

Posted in Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts | 1 Comment »

Can Coffee Prevent Skin Cancer?

August 30, 2007

coffee_drinker_print_web.jpgI was asked whether drinking coffee would be better than drinking caffeineated soda.  Trying to cut down on coffee but increasing intake of the diet soda may in fact not be a good idea because of the many studies linking coffee and health benefits.

A new study showed that a cup of coffee before going to work especially after a morning exercise can be healthy especially for the skin. This study published in the Proceedings of the National Academy of Sciences, July 30, 2007,  shows the combination of caffeine and regular exercise “appears to help kill some of the precancerous cells damaged by the sun’s ultraviolet-B (UVB) radiation.”

The study was done using mice where one group of mice drank the human equivalent of two cups of coffee a day while the other group voluntarily ran , and a third did both.  All the subjects were then exposed to UV radiation from lamps that damaged their skin cells.

Results: The rate of cell death among the precancerous cells was highest in the group that drank caffeine and exercised.

Implications: If precancerous cells destined to be cancer can be aborted by whatever mechanism then it has a tremendous impact in the prevention of disease.  This new data therefore is promising because this shows that drinking coffee can probably be of benefit to the prevention of skin cancer.

This is just one of the many health benefits now attributed to drinking coffee.  Is it the caffeine itself or also the coffee in itself that has benefits need to be answered.

So Grab A Cup and Enjoy The Taste for Health!

Read My Other Related Articles:

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts | 4 Comments »

The Importance of An Annual Check Up

August 25, 2007

2713261149.jpgDo we need annual physical exam? Why and How soon?

Actually there is still an ongoing debate as to whether annual exam is necessary or helpful.  Several institutions have abandoned the requirement of subjecting healthy subjects to this annual routine.  But in a recent survey published in the Archives of Internal Medicine … majority of the doctors and patients alike i.e. 9 out 10 surveyed out of the 800 still believe that annual physical exam do more benefits than harm.

In a recent publication from the Annals of Internal Medicine, Feb 2007 issue, a study was done to determine if indeed it is beneficial to have one:

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Data Synthesis: The best available evidence assessing benefits or harms of the Physical Health Exam or PHE consisted of 21 studies published from 1973 to 2004. The PHE had a consistently beneficial association with patient receipt of gynecologic examinations and Papanicolaou smears, cholesterol screening, and fecal occult blood testing. The PHE also had a beneficial effect on patient “worry” in 1 randomized, controlled trial but had mixed effects on other clinical outcomes and costs.

Conclusions: Evidence suggests that the PHE improves delivery of some recommended preventive services and may lessen patient worry. Although additional research is needed to clarify the long-term benefits, harms, and costs of receiving the PHE, evidence of benefits in this study justifies implementation of the PHE in clinical practice.

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This study has showned that one or more well visits per year may actually be beneficial to patients and doctors alike by improving patient- doctor relationship as well as alleviate patient’ worries.

By having an annual exam, one is able to check the onset of certain conditions where the abnormality will not show symptoms but may manifest initially with a biochemical or laboratory abnormality.  Healthy subjects specifically with a family history of known inherited conditions like diabetes, hypertension or high cholesterol will definitely benefit by having one.  More so with patients whose parents have a history of tumors or cancers of whatever organ should have routine annual exam.

Routine tests that have been shown to be beneficial in screening includes a fasting blood sugar, liver function tests, lipid profile to check cholesterol, occult blood and urinalysis.  Certain procedures like pap smear and breast exam for women are also beneficial since early detection and diagnosis of cancer have a big impact in terms of disability and survival.  What’s more, there did not appear to be any harm associated with period health exams, including undergoing inappropriate tests or excessive costs.

So when should one have an annual health exam? 

  • If you have a family history of chronic diseases like diabetes or heart disease … I would recommend to do the exam ealrier after the age of 30.  Majority of heart attacks is due to diabetes and the early a diagnosis of diabetes is done the better is the outcome in terms of control and prevention of complications. 
  • Between the age of 40 to 50 if you have a family history of certain tumors where occult blood testing or flexible sigmoidoscopy would be helpful
  • Otherwise after the age of 50 should be a reasonable age to do the annual exam for an otherwise healthy individual.

As the saying goes: 

It Is Better To Be Early Than Sorry…

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts | 5 Comments »

Foods To Avoid If You Have Migraine

August 23, 2007

249069055.jpgMigraine is not an uncommon complaint among friends and patients.  It is pretty bothersome, and can make your day irritating and stressful.  It can occur anytime if a a trigger food is ingested.  These headaches usually start  within 20-25 minutes after consuming these products.  You may notice it coming if you start complaining of  pressure in the chest and in the face, sometimes burning sensation in the chest, neck or shoulders accompanied by facial flushing and dizziness.  The headache can occur across the front or sides of the head.  Some patients may complain of feeling nauseated due to the associated dizziness.  Treating this headache can also be challenging as simple paracetamol may not do the trick.  Preventing the occurence of this headache is therefore of paramount importance to avoid having a bad day ahead!

So which specific food triggers have been shown to be the culprits and therefore should be avoided:

  • Tyramine containing foods found natu.rally in aged cheeses, and also found in red wine, alcoholic drinks, and some processed meats.
  • Food additives/preservatives like nitrates and nitrites found in hot dogs, ham, sausage, and other processed or cured meats.
  • Monosodium glutamate (MSG) in Chinese food.
  • Alcohol — specifically the impurities in alcohol or by-products your body produces as it metabolizes alcohol.  Culprits include red wine, beer, whiskey and champagne
  • Caffeine: coffee, chocolate, tea, colas, sodas
  • Pepperoni, hot dogs, luncheon meats
  • Bread and other baked goods and crackers
  • Dried fruits
  • Smoked or dried fish
  • Potato chips
  • Pizza, peanuts, peanut butter
  • chicken livers, and other specific foods and

Likewise for my diabetics…artificial sweeteners like aspartame can be bad triggers of headaches.  Also to be avoided are any COLD beverages especially after an exercise. Sensitivity to ice cream has been reported among migraine sufferers so avoid the temptation!

Trigger Free To Be Migraine Free!

Posted in General Health Tips, Medical News Bits | 31 Comments »

Why You Should Not Take Supplements….

August 22, 2007

imagesghy.jpgSupplements are always promoted as healthy alternatives to the usual medications doctors prescribe.  The marketeers are always advertising the products as devoid of any side effects because they come from “natural sources” of which the labeling may not actually tell us what they are and where they come from.  But almost always our patients are “tricked” into buying them because of the ads on TV or radio based on testimonials that they can cure a variety of ailments or based on the “convincing” strategy of the expert sellers. 

The US FDA and local BFAD have been very lenient with this multi-billion dollar industry in terms of limiting their exposure to the public lest their products can harm.  Instead you see them proliferating with seals of aproval from these agencies as” approved by BFAD”.  Although there is always a label ” No Therapeutic Claim” but who reads them when all the patients hear are the blubbering testimonials and ads on TV and radios….

One recent example of what can happen if these products go undetected is the recent warning of a supplement which actually contained an Anticholesterol agent.  Although the product is approved for use as a drug…but if it is present in a supplement, the patients taking them may not mind checking for possible side effects trusting the sellers of the product as side effect free!

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FDA Warns Consumers to Avoid Red Yeast Rice Products Promoted on Internet as Treatments for High Cholesterol


The U.S. Food and Drug Administration is warning consumers not to buy or eat three red yeast rice products promoted and sold on Web sites. The products may contain an unauthorized drug that could be harmful to health. The products are promoted as dietary supplements for treating high cholesterol.

The potentially harmful products are: Red Yeast Rice and Red Yeast Rice/Policosonal Complex, sold by Swanson Healthcare Products, Inc. and manufactured by Nature’s Value Inc. and Kabco Inc., respectively; and Cholestrix, sold by Sunburst Biorganics. FDA testing revealed the products contain lovastatin, the active pharmaceutical ingredient in Mevacor, a prescription drug approved for marketing in the United States as a treatment for high cholesterol.

“This risk is even more serious because consumers may not know the side effects associated with lovastatin and the fact that it can adversely interact with other medications,” said Steven Galson, M.D., M.P.H., director of FDA’s Center for Drug Evaluation and Research.

These red yeast rice products are a threat to health because the possibility exists that lovastatin can cause severe muscle problems leading to kidney impairment. This risk is greater in patients who take higher doses of lovastatin or who take lovastatin and other medicines that increase the risk of muscle adverse reactions. These medicines include the antidepressant nefazodone, certain antibiotics, drugs used to treat fungal infections and HIV infections, and other cholesterol-lowering medications.

FDA has issued warning letters advising Swanson and Sunburst Biorganics to stop promoting and selling the products. Companies that do not resolve violations in FDA warning letters risk enforcement actions, such as an injunction against continuing violations and a seizure of illegal products.

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There you go… this is only one of the many that we see patients getting complications either of the liver or the kidney arising from taking supplements. As physicians we can not go after anybody since the supplemetns are bought by patients at their own free will. 

The local BFAD however should be more careful in approving supplements and should have more teeth to penalize companies that promote these products as drugs which are now being done extensively.  Just watch your cable TV and you’ll be bombarded by ads on the numerous illnesses that these supplements can heal!

Be Smart…Know The Real From The Fake!

Read My Other Related Articles:

  1. The FDA Rules On Dietary Supplements
  2. Beware of the Weight Loss Myth
  3. What You Need To Know About Dietary Supplements
  4. The Harmless Herbs?

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

The Opportunity to Learn More….

August 21, 2007

imagesq1.jpgA tidbit news: It is but interesting to note that my alma mater where I trained my endocrinology fellowship continues to lord over the rest of the IVY League institutions since the 1997.  Below is the list of the Best Hospitals in Endocrinology….

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U.S. News has ranked 173 hospitals in 16 specialties.                                                                           

  1.  Mayo Clinic, Rochester, Minn.      
  2.  Massachusetts General Hospital, Boston  
  3. Johns Hopkins Hospital, Baltimore                             
  4. University of California, SF Medical Center       
  5. New York-Presbyterian
  6. Cleveland Clinic                                                           
  7.  Washington University, St. Louis                                
  8. University of Virginia Medical Center                         
  9. Brigham and Women’s Hospital, Boston                      
  10. Hospital University of Pennsylvania                          

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Ones professional training whether it may be music, culture or medicine will always be part of ones life… It will be engrained in ones DNA.  And wherever you are and whatever you do, you will always carry with you the name of the institution that made you who you are.

Once a rare opportunity knocks …  grab it! And not because of luck but because one strives to get it… through hard work and dedication- then you deserve it!

My belief is that one should not settle for less but to aim for what is the best in field!  I will be going for my third preceptorship this November at UCSF and Stanford in Endocrinology.  I was at Harvard in 2004 and Johns Hopkins in 2005 for the same preceptorship program. For me nothing beats Mayo Clinic!  But the opportunity to have been trained by the #1 Endocrinology Hospital and the chance to be sent for preceptorship training in the top 2 and 3 hospital and again this november to UCSF- Stanford Program is a rare opportunity that I will not fail to grab and look forward to learning what they can offer.

In life we should not stop to learn and learn.  That’s what I teach my kids.  It is through learning and exploring that we get smarter and wiser! Never give yourself a break from learning new things!  It may come from reading books, your travels or your meetings with other people.  For me to continue learning is the other meaning of happiness from within!

Grab Whatever Opportunity You Have To Learn…

Posted in Medical News Bits, Personal Thoughts | 2 Comments »

Obesity Can Spread Among Friends….

August 20, 2007

v8chmcaa05ticcak5yizmca823xazcafcorr9cau78ovncabxtl0pcazrko7ecaf2w095ca5k5nuxca5ged70ca3tp5t0ca8cc9bocaouwo3hcazf6mzccauuysvrcahe8nawca7phliscaild0s8.jpgA family with obese children is a pretty common sight.  The family may have the same set of genes but it’s the relationship among family members that count…the way they spend time together or the way they choose the lifestyle from the kind of food to the kind of leisurely activities.  So I always counsel my patients to be extra careful with what they choose to eat or keep in the fridge because those are the choices that their kids will have for the rest of their lives…and they may have devastating outcome!

Now comes a study that proves the social networking not only affect close relatives but also friends….. A recent online publication of the Premier Journal of Medicine: The New England Journal of Medicine July 26, 2007 issue reported the effect of having friends who are obese….

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 Methods:  The authors evaluated a densely interconnected social network of 12,067 people assessed repeatedly from 1971 to 2003 as part of the Framingham Heart Study. The body-mass index was available for all subjects. We used longitudinal statistical models to examine whether weight gain in one person was associated with weight gain in his or her friends, siblings, spouse, and neighbors.

Results:

  1. A person’s chances of becoming obese increased by 57% (95% confidence interval [CI], 6 to 123) if he or she had a friend who became obese in a given interval.
  2. Among pairs of adult siblings, if one sibling became obese, the chance that the other would become obese increased by 40% (95% CI, 21 to 60).
  3. If one spouse became obese, the likelihood that the other spouse would become obese increased by 37% (95% CI, 7 to 73).
  4. These effects were not seen among neighbors in the immediate geographic location.
  5. Persons of the same sex had relatively greater influence on each other than those of the opposite sex.
  6. The spread of smoking cessation did not account for the spread of obesity in the network.

Conclusions:  Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. __________________________________________________________________________________________________

These findings have implications for clinical and public health interventions.  It’s the social networking that really makes a difference…whether the influence is positive or negative.  Teaching kids the right way from the way they choose : the kind of food… to the kind of friends… to the kind of activities… should start from the young!

The authors’ summary of their report says it all: 

“The spread of obesity in social networks appears to be a factor in the obesity epidemic. Yet the relevance of social influence also suggests that it may be possible to harness this same force to slow the spread of obesity. Network phenomena might be exploited to spread positive health behaviors, in part because people’s perceptions of their own risk of illness may depend on the people around them.”

As the saying goes….. 

Tell Me Who Your Friends Are…And I’ll Tell You Who You Are!

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

BYETTA and Weight Loss

August 18, 2007

imageslo.jpgExtensive research is being done in the field of Diabetes. The prevalence of this disease is just increasing worldwide and expected to reach 333 million by year 2025.  The scary thought coupled with difficulty in getting drugs invented and approved can make this a big epidemic in the future.

As new drugs come…some are worth it some are not.  The avandia scare made everyone realized that any drug no matter how great will always have side effects.  Any avandia taker should have realized that any patient with heart failure should not take the drug because it can worsen the condition.  

So what’s with this new agent called Byetta?  Is it all worth the hype?

Discovered from the Saliva of a Gila monster…Exenatide (Byetta) was just recently approved by the Food and Drug Administration in April 2005 for the treatment of type 2 diabetes. It was just recently launcehd in the Philippines. It is to be taken as an injection but although it is an injection, Byetta is not insulin!!!

Byetta improves blood sugar control by mimicking the action of the hormone incretin called GLP1 which allows insulin to work more effectively in the body.  The good thing with Byetta is that it also helps in preventing the further destruction of the Beta cells which are the cells that produce insulin.  It is this defect that remains unabated by current medications that will make a patient require insulin in the long run.  Now we have drugs that are proven to help prevent these cells from deteriorating including Rosiglitazone, Pioglitazone and now Byetta.

What is the Major Side effect of Byetta that as endocrinologist and patients alike like? It’s the WEIGHT LOSS! Finally we have a good drug that does not make a patient gain weight but instead lose weight. Its the downside that’s actually a PLUS! A weight loss of around 10 to 12 lbs can be achieved and sustained long term. A report from the New York Times mentioned about a patient who lost 60 lbs after Byetta use…  BUT… dont use this drug as a weight loss agent because this has not yet been studied for that purpose and the safety of this agent for non diabetics is not yet known.

Cost however is pretty prohibitive so better discuss this option with your doctors to assess benefit cost ratio.

Do I recommend this drug?  Yes I do and have started using this agent already. It was just recently launched at the AACE Philippine Chapter meeting in Shangrila and few doctors have been given the privilege to start using this drug for their patients by Eilly Lilly.  Its something new and revolutionary thus am writing about this in my website.  The New York Times Calls It: The Ray of Hope…

For more information on Byetta: check out this site: www.byetta.com

The Gila Monster and the Man in Byetta!

Posted in Medical News Bits, The Diabetes Facts, The Truths on Obesity, What's New in Diabetes | 20 Comments »

The Many Benefits of Walking…

August 17, 2007

imagesedg.jpgIs walking good? Is it enough as an exercise? Or Do we need to do more intense exercise to achieve benefit?  I love to walk…it’s my form of physical activity every afternoon after work.  I have fun doing it walking around the house or around our subdivision.  You can enjoy the view while walking… you can do it anytime and anywhere and the most important of all is that…It is FREE!

Dr James Levine who is a colleague of mine at the Mayo Clinic wrote a nice editorial at the

Mayo Clinic Proceedings based on this news report from the Mayo Clinic newsroom:

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“Getting out there and taking a walk is what it’s all about,” says James Levine, M.D., Ph.D., and a Mayo Clinic expert on obesity. “You don’t have to join a gym, you don’t have to check your pulse. You just have to switch off the TV, get off the sofa and go for a walk.”

The health benefit associated with walking is the subject of Dr. Levine’s editorial in the July issue of Mayo Clinic Proceedings. Dr. Levine’s piece is entitled, “Exercise: A Walk in the Park?” and accompanies a Proceedings article that showcases the merits of walking as beneficial exercise.

The study, undertaken by physicians from the Shinshu University Graduate School of Medicine in Matsumoto, Japan, determined that high-intensity interval walking may protect against high blood pressure and decreased muscle strength among older people.

Over five months, the Japanese researchers studied 246 adults who engaged in either no walking or moderate to high-intensity walking. The group who engaged in high-intensity walking experienced the most significant improvement in their health, the researchers found. In his editorial, Dr. Levine says the study lends credence to the notion that walking is a legitimate, worthy mode of exercise for all people. Dr. Levine says it’s a welcome message for his patients, who fight obesity and appreciate that a walk is one way to improve their health.

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It is therefore a package deal…you walk…you exercise as well as keep your health in control. There is no way I will accept any patient of mine telling me he has no time to exercise because walking can be done anywhere and anytime!

Do it now and this very minute… after reading this article…turn off your computer or TV for a while and take a stroll.  In simple terms…Just move.  It is much better than staying put and be sedentary.

Life is too short…enjoy your surroundings and walk because once you get the dreaded complication of obesity and diabetes which is a stroke or heart failure…you will end up in bed for the rest of life anyway…by then…you will miss walking!

Take A Step Forward Now For Health!

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, Tips To Protect Your Heart, Weight Loss Tips | 6 Comments »

Can Avandia Cause Heart Attack? A Fact or A Fiction….

August 16, 2007

2749016741.jpgJust came back from Manila just this morning where I was one of the 5 invited speakers to share our views on the Avandia meta-analysis that sparked the controversy of this drug.  It was a well organized meeting and a very fruitful one as delegates ( enodcrinologists and diabetologists from all over the Philippines)  went home more enlightend by the fact tat avandia is actually safe or even safer than the other drugs sold in the market.

The highlight of the meeting was a detailed analysis of the article by Niesen published in NEJM in May 2007 by Dr Cecilia Gimeno who is herself an endocrinologist and a clinical epidemiologist from UP-PGH.

She highlighted why meta anaysis cant be trusted and what the flaws were in the article’s calculation of the statistics and data gathering.

TAKE HOME messages form the meeting which I want to share to my readers and patients as well:

  1. The Meta analysis was not a good study since it compiled several small studies lump together to generate a bigger population BUT with each study had a different patient population with different outcomes ( not cardiovascular ) and had small number of subjects of short duration ( < 6 m).
  2. The statistical analysis was flawed including omission of certain studies with no MI or CV deaths.  The exact nature of heart attack or death was not determined since the authors did not have the luxury of examining the data…they solely relied on results given to them. Did the patients take their other meds like for cholesterol or high blood pressure which in themselves can increase ones risk for heart attack and stroke?
  3. Recalculation of the flawed statistics and numbers resulted in an almost the same risk of heart attack of patients on avandia and other drugs!!!!
  4. The studies included in the analysis were short term ( < 6 m) … and short term studies do not predict long term results.  Similar problems were encountered by Metformin, Sulfonylureas and Pioglitazone where initial < 1 year studies showed increased heart attack risk but long term studies after 5-6 years showed benefit!
  5. The 3 big prospective studies on avandia (ADOPT, DREAM and RECORD) which are randomized involving >4000 patients are true OUTcome studies which help clinicians formulate our treatment approach and which can be trusted showed that Avandia use is not associated with increased risk of heart attack compared to metformin or sulfonylurea!  In fact the use of a sulfonylurea was assessed to have higher cardiovascular death than avandia.  These studies are however masked by the controversy of one study of which the medical community deems contain numerous flaws!

My Conclusion of this matter: 

That Avandia is safe and is not associated with any increase in Heart Attack risk. 

Remember a patient with Diabetes in itself is already a Cardiovascular equivalent :  a Diabetic is equivalent to a ” non diabetic with a heart attack” in terms of his risk for cardiovascular mortality.  And if we consider the data of the Meta analysis as acceptable: the absolute risk is very small: a 0.1% absolute risk only…meaning 1 heart attack for every 1000 patients on avandia… BUT since the analysis was flawed… the absolute risk therefore of a patient on Avandia is really much lower than 0.1%  and the patient’s risk for heart attack is most likely just the inherent risk for being a Diabetic and nothing else!

For me it would be unfortunate if the benefits of this drug which includes: reducing ones risk to develop diabetes by 60 % ( DREAM) and reducing one risk to progression of diabetes by 60% compared to a sulfonylurea and 30% compared to a metformin (ADOPT) … are masked by this turn of events based on a flawed study!!!!

A Fact Can Harm If It Is Actually A Fiction!

Posted in Medical News Bits, Personal Thoughts, The Diabetes Facts | 4 Comments »

Alcohol Lowers Blood Pressure and Heart Attack Risk…

August 14, 2007

3161158791.jpgAfter a hectic schedule or meeting or after a stressful event …one gets invited for a drink!  And one of the common questions I get from friends or patients alike is the question of how BAD is alcohol to one’s body Or how much alcohol can they take.

Alcohol for a diabetic patients is a no-no if one is poorly controlled BUT once the blood glucose is well controlled… alcohol can be made part of the total caloric load as long as it doesnt exceed 2 drinks a day! And this is true to patients with hypertension or cholesterol problems as well.

I came across a very good article from the Harvard Health Letter which I want to share.  Aparently, drinking alcohol can have beneficial effects on one’s blood pressure and the risk of heart attack!

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Lay off alcohol is one of the first things people with newly diagnosed high blood pressure are told. Alcohol can cause high blood pressure as well as contribute to it. Abstinence, though, might not be necessary, and may even deny some folks a pleasurable way to ward off heart attacks.

A long-term study of male health professionals suggests that responsible, moderate drinking may benefit people with high blood pressure. In a study published in the January 2, 2007, Annals of Internal Medicine, only 4.9% of the men with high blood pressure who classified themselves as moderate drinkers (one or two drinks a day) had a heart attack during 16 years of follow-up, compared with 6.7% of nondrinkers. That’s about a 25% reduction in heart attack risk. The results are similar to a study of male doctors, which showed fewer deaths due to cardiovascular disease among moderate drinkers than nondrinkers over a five-year period.

Keep in mind that this work shows the average response to alcohol. How it affects you depends on your genes, metabolism, diet, and medications, as well as you and your family’s relationship with alcohol.A drink a day won’t help your blood pressure. (If you are concerned about it, use a home blood pressure monitor that’s been checked at your doctor’s office to make sure it is accurate.) But along with a healthful lifestyle, moderate drinking could protect you from one of its feared effects — a heart attack.

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Again…. the old cliche…

 

Be Safe…Drink in Moderation!

 

 

 

 

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Nutrition Health Tips, Personal Thoughts | 1 Comment »

Adding TAX on Mc Donald’s Burger and Fries…

August 6, 2007

imagessdfert.jpg

I came across a very unique study that has probably never been done before.  How about adding extra tax everytime we take unhealthy fast foods ? Everytime we hear about being FAT and unhealthy…it has always been associated with Mc Donalds because of the way the place used to cook meals using high saturated fat or trans fat products.  Likewise the marketing strategy of UPSIZING french fries and burgers with unlimited soft drinks have been blamed as culprits for the majority of the Obesity epidemic in America and probably in the world as Mc Donalds has crossed barriers and invaded every nation in the world!

 The study was published recently in the Journal of Epidemiology and Community Health and looked at the assumption of extending vlaue added tax to unhealthy foods and what could be its impact in terms of health and economic costs : Could targeted food taxes improve health?  J. Epidemiol. Community Health, Aug 2007; 61: 689 – 694.
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Data: Consumption patterns and elasticity data were taken from the National Food Survey of Great Britain. The health effects of changing salt and fat intake were from previous meta-analyses.

Results: (1) Taxing only the principal sources of dietary saturated fat is unlikely to reduce the incidence of cardiovascular disease because the reduction in saturated fat is offset by a rise in salt consumption. (2) Taxing unhealthy foods, defined by SSCg3d score, might avert around 2300 deaths per annum, primarily by reducing salt intake. (3) Taxing a wider range of foods could avert up to 3200 cardiovascular deaths in the UK per annum (a 1.7% reduction).

Conclusions: Taxing foodstuffs can have unpredictable health effects if cross-elasticities of demand are ignored. A carefully targeted fat tax could produce modest but meaningful changes in food consumption and a reduction in cardiovascular disease.

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Probably based on this study…it can work! and most likely as a last resort to our continuing battle against the BULGE!   But again it may not plainly because people will still look for things they’ve been used to liking.  Just look at cigarettes and alcohol.  Even with the so called SIN taxes on these products, people continue to splurge and enjoy them no matter the consequences.In short… everything boils down to DISCIPLINE and CHARACTER if we have to change the habit of EATING of every individual and the country as a whole.  And to be successful… this should be shaped during childhood! 

Remember if you’re child is obese by 6 years old…his likelihood of becoming obese for life is 40% and if he is obese by 12 years old… his chances of becoming obese for life is 80%!

Tax or No Tax… The Discipline Starts at HOME!

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

Are You FAT But FiT?

August 4, 2007

3283079462.jpgYou maybe Fat but Fit and as a result your risk to develop heart disease is actually lower than your counterpart who Fat and Unfit!  This according to a new study published in the Archives of Internal Mediciane, July issue. 

Below is the summary of the study as published in heart.org:

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“Arsenault et al studied 169 asymptomatic men with diabetes mellitus who were participating in the Quebec Family Study, a population-based study of French Canadian families living in and around Quebec. They measured abdominal adipose tissue accumulation, cardiorespiratory fitness (CRF), and indexes of plasma glucose-insulin homeostasis and lipoprotein-lipid profiles.  

After matching individuals with similar BMIs, men with low CRF were characterized by more visceral adipose tissue accumulation than men with high CRF (mean 114.4 cm2 vs 87.8 cm2; p<0.007) and by a poorer metabolic profile. When matched for visceral ( Abdominal) adipose tissue accumulation, however, such differences were no longer significant.

“This study underlines the importance of visceral (abdominal) adipose tissue or fat accumulation in the previously reported association between CRF and metabolic complications predictive of coronary heart disease and type 2 diabetes mellitus” .

“Our results suggest that visceral abdominal tissue accumulation could be a key confounding factor when the relationship of CRF, coronary heart disease risk, and metabolic syndrome is examined.”

Physical activity should be promoted, irrespective of age, sex, or degree of obesity as a measure to reduce adiposity, to increase energy expenditure, and to potentially decrease atherogenic visceral adipose tissue mass, they conclude. “

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There you go… being fat may not actually mean poor health risk RATHER it’s the cardiovascular fitness level or the Physical Activity that counts.

The more active we become…the less evil is our fat and the less likely we develop the outcomes of the disease of obesity!

Being FIT Matters….

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

The Protective Effect of Mediterranian Diet

August 3, 2007

imagesafg.jpgA diet that’s high-fat… because of the large amounts of monounsaturated fatty-acid-rich olive oil used in Mediterranean cultures—may be a useful tool against blocking of the arteries, particularly in individuals at high risk of developing heart disease.

A new study looking at High Mononunsaturated Fat( MUFA) diet has finally proven the proponents of this diet to be protective was recently published in the June 11, 2007 issue of the Annals of Internal Medicine.

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Interventions: Participants were assigned to a low-fat diet (n = 257) or to 1 of 2 Mediterranean diets. Those allocated to Mediterranean diets received nutritional education and either free virgin olive oil, 1 liter per week (n = 257), or free nuts, 30 g/d (n = 258). The authors evaluated outcome changes at 3 months.

Results:  Compared with the low-fat diet, the 2 Mediterranean diets produced beneficial changes in most outcomes. Compared with the low-fat diet, the mean changes in the Mediterranean diet with olive oil group and the Mediterranean diet with nuts group were –0.39 mmol/L (95% CI, –0.70 to – 0.07 mmol/L) and – 0.30 mmol/L (CI, –0.58 to – 0.01 mmol/L), respectively, for plasma glucose levels; –5.9 mm Hg (CI, –8.7 to –3.1 mm Hg) and – 7.1 mm Hg (CI, –10.0 to –4.1 mm Hg), respectively, for systolic blood pressure; and –0.38 (CI, –0.55 to – 0.22) and – 0.26 (CI, –0.42 to –0.10), respectively, for the cholesterol–high-density lipoprotein cholesterol ratio. The Mediterranean diet with olive oil reduced C-reactive protein levels by 0.54 mg/L (CI, 1.04 to 0.03 mg/L) compared with the low-fat diet.

 Conclusion: Compared with a low-fat diet, Mediterranean diets supplemented with olive oil or nuts have beneficial effects on cardiovascular risk factors.

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In short… participants in the two Mediterranean-diet groups had significantly lower mean plasma glucose levels, lower systolic blood pressure, and lower total-cholesterol/HDL-cholesterol ratios than those in the low-fat-diet group… which may explain the protective effects of this diet to develop heart disease.  

So what diet Do I recommend to my Patients? 

Ive been proponent of a 40% of total calorie diet to be from fat with 20% of total calories from MUFA.  Ive been pretty successful with this diet in terms of regulating my patients Blood sugar and lipids while maintaining their weight!  This study really proves me right. 

You will not go wrong having a diet rich in fruits and vegetables and supplemented with virgin olive oil and nuts…it’s a diet proven to  improve cholesterol ratios and the effects on blood pressure and inflammation.   One option to Olive oil that we can use daily in our cooking is Canola Oil which is also rich in MUFA and PUFA.  Likewise taking walnuts or cashew nuts for snacks as healthy alternatives to burgers and fries!

As The Saying Goes…GO NUTS!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, Personal Thoughts, Tips To Protect Your Heart | 1 Comment »

How To Exercise The Right Way

August 2, 2007

4143585627.jpgWe know we need to exercise.  We are often told to be active most days in a week if we want to lose weight or just 20 to 30 mintues 3 x a week for cardiovascular workout.

BUT what’s the BEST way to do it?… do we exercise 1 hour straight? or is it better to have a rest period in between activities to burn fat effectively?

Excerpts from the Study of Dr Goto published in the Journal Of Applied Physiology…. 

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This study compared the fat metabolism between “a single bout of prolonged exercise” and “repeated bouts of exercise” of equivalent exercise intensity and total exercise duration. Seven men performed three trials: 1) a single bout of 60-min exercise (Single); 2) two bouts of 30-min exercise, separated by a 20-min rest between exercise bouts (Repeated); and 3) rest.  In the Repeated trial, serum free fatty acids (FFA), acetoacetate, and 3-hydroxybutyrate concentrations showed rapid increases (P < 0.05) during a subsequent 20-min rest period. During the second 30-min exercise bout, FFA and epinephrine responses were significantly greater in the Repeated trial than in the Single trial. 

The relative contribution of fat oxidation to the energy expenditure showed significantly higher values (P < 0.05) in the Repeated trial than in the Single trial during the recovery period.

These results indicate that repeated bouts of exercise cause enhanced fat metabolism compared with a single bout of prolonged exercise of equivalent total exercise duration.

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In simple terms… it’s better to rest in between exercise activity than a single prolonged activity.  The rest period most likely made the tissues and body more efficient in burning more fat especially during the repeat exercise after the rest!

Meaning Rest in between activities is a good way to burn more calories and have time to take a breathier in between workouts!

My advise?  Exercise for 30 minutes then take a rest for 10 to 15 minutes then take a plunge to more activites again before heading back home….

What A way To Rest and Burn More Calories!

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

The FDA Ruling on Avandia…

August 1, 2007

imagessdff.jpgJuly 31 was a big day for Avandia after the US FDA ruled out removing the drug from the market.  The FDA hearing looked at several arguments whether indeed Avandia can result in increased risk of heart disease.

A report on the US FDA recommendation and Hearings:

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The US Food and Drug Administration’s (FDA’s) Advisory Committee came to an almost unanimous decision yesterday, voting 22-1 for Avandia, GlaxoSmithKline’s much-maligned diabetes treatment, to remain on the US market.

Concern about side effects associated with Avandia (rosiglitazone) was raised by a meta-analysis published in the New England Journal of Medicine in May. The analysis, led by Steven Nissen of the Cleveland Clinic, Ohio, US, concluded that the drug increased the risk of heart attack and death .

The committee convened to evaluate all of the post-approval clinical data and assess the ‘overall risk-benefit profile’ of the drug.

During a press conference following the meeting, the acting committee chair, Clifford Rosen from the Maine Center for Osteoporosis, Bangor, US, highlighted a ‘significant number of caveats’ for the prescription of Avandia.

‘I think there are clear-cut reasons not to use this drug in certain types of diabetes patients,’ he said. ‘These include those with or prone to congestive heart failure and people with significant risk of cardiovascular disease.’

The FDA will now consider the panel’s recommendations and make its final decision about what action to take. This could include the addition of appropriate warning labels on the drug’s packaging and the provision of advice to prescribing doctors. 

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In short… just like any other drug out there…prudent use of this drug among our patients is necessary.  Never to use among older patients at risk for heart disease and those with significant risk factors for heart disease especially among those already on insulin.  The problem is that majority of patients are put on insulin by doctors late after several years of poorly controlled diabetes… such that complications especially heart disease have already set in.  I dont believe this to be the case among young patients whom we start Early Insulinization where the risk for heart disease is not the same as somebody put on insulin late in the disease process.

All along I was right.  I believe in the efficacy of this drug so I was confident based on the available data that more studies need to be done.  Metformin and Pioglitazone on their initial short term studies proved harmful but long term studies proved otherwise!  I am sure that the longer duration studies will prove also Avandia to be worth taking to reduce ones risk for heart disease. 

Again…

It‘s Choosing The Right Patient for The Right Drug!

Read My Other Related Posts:

Posted in Medical News Bits, Personal Thoughts, The Diabetes Facts | 1 Comment »

Orange Juice Can Prevent Kidney Stones

July 31, 2007

imageserty.jpgGood news for orange juice drinkers.  More benefits come your way than just taking the extra Vitamin C with this new study looking at extra help of orange juices in prevnting kidney stones.

It is known in the medical community that potassium citrate found in most citrus juice can slow down formation of kidney stones BUT are all citrus fruits the same?.

In a recent study by a team from the University of Texas Southwestern Medical Center at Dallas, published in Oct. 26 issue of the Clinical Journal of the American Society of Nephrology found that components found in orange juice can affect a juice’s ability to prevent stones.  In the study the volunteers drank 13 ounces of orange juice, lemonade or distilled water three times a day with meals. They were also put on a low-calcium, low-oxalate diet, which also helps cut stone formation.

The Results:

One possible explanation as to why OJ is better than Lemonade is that the citrate in orange is accompanied by a potassium ion ( the same goes with Grapefruit) while the citrate in lemonade and cranberry juice is accompanied by a hydrogen ion.  The problem with hydrogen ions is that they counteract the beneficial effects of high citrate content while potassium ions do not!!!

So…. for those with risks to develop Kidney stones, here’s one that we can incorporate in our diets!  One that we can enjoy every morning with our breakfast!

An OJ Each Day May Prevent Stones Today!

Posted in General Health Tips, Medical News Bits, Nutrition Health Tips | 2 Comments »

Dark Chocolate for Hypertension? Anyone?

July 30, 2007

22173473171.jpgWe have long heard about the good news of enjoying dark chocolates.  The mere thought of eating one makes your tummy growl for food! Just recently while browsing my JAMA journal noted another study on dark chocolate which is really good news to chocolate lovers.

The July 4, 2007 issue of the Journal of the American Medical Association reported a new study to show the benefits of cocoa in dark chocolate long-term — the study lasted 18 weeks.  

This study is a well conducted study being a randomized, controlled, investigator-blinded, parallel-group trial with 44 adults, aged 56 to 73, with untreated mildhypertension without concomitant risk factors.  This study is well matched and the two groups compared were given either a one square (6.3 g) of a commercial brand of dark chocolate per day, constituting just 30 kcal, or white chocolate which is  polyphenol-free to enjoy for 18 weeks.

Results Are Amazingly GOOD NEWS:

From baseline to 18 weeks, dark-chocolate intake reduced mean systolic BP by 2.9 mm Hg (p<0.001) and diastolic BP by 1.9 mm Hg (p<0.001) without changes in body weight, lipids, glucose, or 8-isoprostane. Hypertension prevalence decreased from 86% to 68%.  There was  a sustained increase of S-nitrosoglutathione by 0.23 nmol/L (p<0.001) and the appearance of cocoa phenols in the plasma among the dark chocolate eaters.

Te reseacrchers explain the phenomonon: “The apparent mechanisms by which dark chocolate lowered BP suggests a chronic increase in the production of nitric oxide in the vascular endothelium… and it is likely that cocoa flavanols in dark chocolate were responsible for the observed effects on S-nitrosoglutathione and BP.”

BUT before everyone indulges on dark chocolates… it is important to remember that it should be DARK and not Milk or White chocolates…likewise keep in mind the AMOUNT because remember the CALORIES! The one square of dark choco can give you around 30 kcal per day.

A Chocolate A Day Keeps Your Doctor Away!

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Nutrition Health Tips, Tips on Hypertension | 5 Comments »

How Much Salt Can We Take?

July 28, 2007

imagessd.jpgThe new recommendations from the American Medical Association should be a wake up call to all of us.   We know that salt is important for the taste of our foods but taking too much can be harmful.  As physicians weve been harping on lowering salt intake to our patients when they prepare their foods not recognizing that the culprit may actually be food in the restaurant and the processed foods we buy in the groceries!

We know from studies that populations with an average sodium ingestion of less than 1400 mg/day have virtually no hypertension BUT the average intake of salt in the world is around 4000 mg per day while Filipinos usually take in more.  This is way above the recommended daily allowance of 2000 to 2300 mg per day.   

The recently published advisory in the Archives of Internal Medicine, July issue urged the Food and Drug Administration to take a look at the standards set for salt and to limit sodium in processed and restaurant foods. It is recommneded that a minimum 50% reduction in sodium in processed foods, fast-food products, and restaurant meals should be sought in the next decade it we have to decrease the risks associated with high blood pressure. More so to address the labelling of products known to contain High Salt levels.

The AMA paper has this to say: 

“Across populations, the level of blood pressure, the incremental rise in blood pressure with age, and the prevalence of hypertension are directly related to sodium intake. Observational studies and randomized controlled trials document a consistent effect of sodium consumption on blood pressure. The majority of sodium consumption in the United States is derived from amounts added during food processing and preparation. Leading scientific organizations and governmental agencies advise limiting sodium intake to 2400 mg or less daily (approximately 6000 mg of salt). Substantial public health benefits accrue from small reductions in the population blood pressure distribution. A 1.3-g/d lower lifetime sodium intake translates into an approximately 5-mm Hg smaller rise in systolic blood pressure as individuals advance from 25 to 55 years of age, a reduction estimated to save 150 000 lives annually.

With an appropriate food industry response, combined with consumer education and knowledgeable use of food labels, the average consumer should be able to choose a lower-sodium diet without inconvenience or loss of food enjoyment. In the continued absence of voluntary measures adopted by the food industry, new regulations will be required to achieve lower sodium concentrations in processed and prepared foods.”

A Pinch Of Salt For A Healthy You!

 

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

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