Archive for the 'Medical News Bits' Category

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The Pedometer: “Small But Terrific” Gadget for Losing Weight

March 12, 2008

Go to fullsize imageObesity continues to be a problem worldwide.  Measures to make people lose weight have made a lot of entrepreneurs out of doctors from selling miracle drugs to lose weight to marketing centers promising dramatic weight loss.  The bottom line however continues to be the need to incorporate lifestyle change to every measure that we implement in increasing chances to a successful weight loss.

The pedometer is one such gadget that is small and handy but a powerful tool to help patients lose weight.  A new meta-analysis published recently in the Annals of Family Medicine showed the effectiveness of this gadget in curbong obesity.

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RESULTS Nine studies met the study inclusion criteria. Cohort sample size ranged from 15 to 106, for a total of 307 participants, 73% of whom were women and 27% of whom were men. The duration of the intervention ranged from 4 weeks to 1 year, with a median duration of 16 weeks. The pooled estimate of mean weight change from baseline using a fixed-effects model and combining data from all 9 cohorts was –1.27 kg (95% confidence interval, –1.85 to –0.70 kg). Longer intervention duration was associated with greater weight change. On average, participants lost 0.05 kg per week during the interventions.

CONCLUSION Pedometer-based walking programs result in a modest amount of weight loss. Longer programs lead to more weight loss than shorter programs.

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What This Study Found as stated by the Editors of the AFM “In Brief”:

 Walking programs that use a pedometer as a motivational tool result in a moderate amount of weight loss in overweight or obese sedentary adults. The average participant in a pedometer-based walking program without dietary change can expect to lose about 1 pound every 10 weeks, or about 5 pounds per year. Longer programs are associated with greater weight loss.

Implications

  • The amount of weight loss from pedometer-based walking programs is small but significant from a clinical perspective.
  • Walking programs that use pedometers can have health benefits that are associated with both a modest weight loss and increased physical activity.

Small Steps Can Lead to Big Changes in Health!!!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Truths on Obesity, Weight Loss Tips | 8 Comments »

How To Increase Compliance To Lifestyle Change…

March 10, 2008

Nowadays, physicians just dont have the time to talk with their patients. Patients feel shortchanged when they have been waiting outside our clinics only to be seen for 5 minutes. 

The lesson I’ve learned from my training at the Mayo Clinic was the importance of patient – doctor relationship that should go beyond treating a disease.  But more so to provide comfort to an anxious patient not knowing what she or he has and the need to listen and care!  The words of advise from a doctor’s mouth is more than worth their time in seeing you and these patients see us because they trust us to help them lead a better healthy life.

Now comes a new study that confirms my practice in my clinic published in the Archives of Internal Medicine this 2/2008.

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Background  Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits.

Methods  We conducted a randomized controlled trial of a 12-month intervention at 2 large community health centers, enrolling 310 patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater. In the intervention group, self-management goals for nutrition and physical activity were set using a tailored computer program. Goals were then reviewed at each clinic visit by physicians. The control group received only printed health education materials. The main outcome measures included change in physical activity and body weight.

Results  In the intervention group, recommended levels of physical activity increased from 26% at baseline to 53% at 12 months (P < .001) compared with controls (30% to 37%; P = .27), and 32% of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9% of controls (odds ratio, 2.2; P = .006).

Conclusion  A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss.

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This study confirms my belief and practice of spending more time with the patient in trying to help them understand how one can implement the standard of care in dealing with chronic diseases like obesity, high blood pressure, high cholesterol and diabetes.  If one understands the concept of why exercise and nutrition are important then the pressure is with the patient to comply otherwise he will suffer the consequences.

Compliance to medications and behavioral therapy is a must if one aims to reach the goal of preventing complications like stroke and heart attack!  I am always asked if I am successful with behavioral modification and in letting patient follow my dietary guidelines.  I guess I am because I spend time with them.

This has been my standing principle and guide in my practice and thus this website to help educate my patients and the public because I believe that….

“Understanding One’s Disease Is Key To Better Health”. 

Posted in General Health Tips, Medical News Bits, Nutrition Health Tips, Personal Thoughts | 6 Comments »

Is Acupuncture Safe?

March 6, 2008

Before I left the Mayo Clinic after my fellowship, the center was already into research regarding the efficacy of this ancient chinese remedy called the Acupuncture.  It is one of the widely practiced alternative medicine in the US and therefore the National Institute of Health is also funding research into this area.  It is one alternative therapy that does not entail any intake of drugs and therefore I bend a little and allow the use of this form of therapy among my patients.

Here is an excerpt of what acupuncture is from the National Institutes of Health:

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Practiced in China and other Asian countries for thousands of years, acupuncture is one of the key components of traditional Chinese medicine. In TCM, the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang

Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. According to TCM, health is achieved by maintaining the body in a “balanced state”; disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi (vital energy) along pathways known as meridians. Qi can be unblocked, according to TCM, by using acupuncture at certain points on the body that connect with these meridians. Sources vary on the number of meridians, with numbers ranging from 14 to 20. One commonly cited source describes meridians as 14 main channels “connecting the body in a weblike interconnecting matrix” of at least 2,000 acupuncture points.

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The US FDA admits that this form of therpay is pretty safe with very few complications.  However it is advised that needles be sterile, nontoxic, and labeled for single use by qualified practitioners only.  Furthermore, the NIH site cautions that: “Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.”

Whether the therapy really works for osteoarthritis to low back pain to diabetic foot ulcers remain to be seen.  The NIH is already funding research into these areas and their conclusions are worth waiting for!

For now… just like any alternative medicine…it is done at the patient’s will. It is not prescribed or advised but if asked then the doctor may tend to bend a little and allow this therapy to be done if other known modalities fail.

If Anything Else Fails..Try Acupuncture!

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

Want Your Kids To Lose Weight?

March 5, 2008

Go to fullsize imageA new study published in the Archives of Pediatric and Adolescent Medicine showed that cutting TV and Computer time can increase a child’s chances of controlling and losing weight. 

In a prepared statement from the authors…they theorized that:

  • “Television viewing is related to consumption of fast food and foods and beverages that are advertised on television,”
  • “Viewing cartoons with embedded food commercials can increase choice of the advertised item in preschoolers, and television commercials may prompt eating.”

The bottom line is: by restricitng TV time then the children can do other physical activites aside from benefiting from less exposure to food ads and therefore less chances for them to eat unhealthy junk.

My kids love cartoons and of course computer games.  But they’re off limits during school days.  Only when they finish their study period earlier that I allow them to play their PSP but restiricted to 30 minutes only.  The kid’s room has no cable so they cant watch cartoon network or other cable channels where junk food ads are in abundance.  They can however watch cartoon movies where I know nothing out of the box commercials promoting something I dont agree with will pop out in surprise!

I am a true follower of the above regulation in our house with regard to restricting TV and computer times and glad to say am pretty successful with my kids school and study habits PLUS improving their …

Health Through Better Nutrition and Discipline!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Weight Loss Tips | 1 Comment »

Can Multivitamins Prevent Cancer?

March 3, 2008

Do you take multivitamins daily?  Why? Out of habit? or because you believe they can prevent illneses especially cancer?

Well a new study refutes the claims that multivitamins can prevent cancer.  Recently published in the American Journal of Respiratory and Critical Care Medicine suggest that in fact the contrary maybe true and that is… it can be harmful!!!!__________________________________________________________

Rationale: Lung cancer is the leading cause of cancer-related mortality in the United States. Although supplements are used by half the population, limited information is available about their specific effect on lung cancer risk.

Objectives: To explore the association of supplemental multivitamins, vitamin C, vitamin E, and folate with incident lung cancer.

Methods: Prospective cohort of 77,721 men and women aged 50–76 years from Washington State in the VITAL (VITamins And Lifestyle) study. Cases were identified through the Seattle–Puget Sound SEER (Surveillance, Epidemiology, and End Results) cancer registry.

Measurements and Main Results:

  • Supplemental vitamin E was associated with a small increased risk of lung cancer (HR, 1.05 for every 100-mg/d increase in dose).
  • This risk of supplemental vitamin E was largely confined to current smokers (HR, 1.11 for every 100-mg/d increase) and was greatest for non–small cell lung cancer (HR, 1.07 for every 100-mg/d increase).

Conclusions: Supplemental multivitamins, vitamin C, vitamin E, and folate were not associated with a decreased risk of lung cancer. Supplemental vitamin E was associated with a small increased risk.

Patients should be counseled against using these supplements to prevent lung cancer.

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We have been disappointed with studies looking at whether multivitamins are beneficial or not.  Almost always they turn out to be negative and sometimes even do harm.  And yet we continue to take MVI as supplements to our diet for hope that they may replenish what have been lacking in our diets.  I even have patients who continue to show me their MVI preparations bought by their loved ones in the US whether they can take them or not.

What we know is that foods rich in vitmains have been proven to reduce the risk of cancer…BUT once these vitamins are packaged as pills…then the benefit is nowhere to be found!  And what is worst…in the above published study…Vitamin E was noted to increase the risk of lung Cancer especially among smokers!

The best option for us is not to rely on shortcuts to health packaged as pills…its in our lifestyle..the food we eat , the physical activities we do and the way we live our lives that matter most!

Health Shortcuts Packaged As Pills Are Of No Benefit!

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

Low Carb Diet and Diabetes: A Better Partner?

February 29, 2008

Go to fullsize imageDieatry intervention remains the cornerstone of therapy for Diabetes.  It requires education and self discipline for it to work!  It may be frustrating for doctors but if only we find time to explain the benefits and allow this intervention to work…it is really worth the effort.  My center now not only caters to diabetes education but has already 2 dieticians on board to see the dietary needs of my patients with diabetes, high blood pressure and high cholesterol.

I have been a proponent of the 40% carb and 40% fat diet for my diabetic patients. The fat however should be mainly monounstaurated which will give us the source of the good fat with less than 7% to 10% of the Saturated fat or the Bad fat!  I always emphasize the low fat sources or the vegetable sources of protein! 

This February 2008 comes a new study from the Harvard Medical Group of the longstanding Nurses Health Study that came up with the finding that indeed a Low Carb Diet may be the way to go for Diabetic patients.

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Design:  prospectively examined the association between low-carbohydrate-diet score (based on percentage of energy as carbohydrate, fat, and protein) and risk of diabetes among 85 059 women in the Nurses’ Health Study.

Results: During 20 y of follow-up, we documented 4670 cases of type 2 diabetes. 

  •  A higher dietary glycemic load was strongly associated with an increased risk of diabetes in a comparison of extreme deciles (RR: 2.47; 95% CI: 1.75, 3.47; P for trend < 0.0001)).
  • A higher carbohydrate consumption was also associated with an increased risk of diabetes in a comparison of extreme deciles (RR: 1.26; 95% CI: 1.07, 1.49; P for trend = 0.003).

Conclusion: These data suggest that diets lower in carbohydrate and higher in fat and protein do not increase the risk of type 2 diabetes in women. In fact, diets rich in vegetable sources of fat and protein may modestly reduce the risk of diabetes.

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The term glycemic load refers to the capacity of a food to increase ones blood sugar upon ingestion.  As a result, I always emphasize to my patients to avoid some of the fruits with the highest glycemic index like pineapple, mangos, watermelon and banana and instead enjoy apple and pear.  The study proves that indeed the higher the glycemic load, the higher the risk to develop diabetes or for those with diabetes…the more difficult blood sugar control will be!

One more reason to go low Carb!  This recommendation looks similar to the Atkins Diet but with a better and healthier protein source with less saturated fat!

Finding a partner in life requires committment… similar to finding a partner in our quest for controlling blood sugar through proper lifestyle and the right diet AND should be made…. a way of life!

Indeed Low Carb Is The BETTER Partner for Health!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Nutrition Health Tips, The Diabetes Facts, What's New in Diabetes | 7 Comments »

Obesity Surgery for Diabetes: A Cure?

February 28, 2008

It is known that obesity links patients to chronic diseases like diabetes, high blood pressure and high cholesterol.  These conditions then increase one’s risk to suffer from stroke and heart attack.  Ideally therefore, if only we can make all patients lose weight, then the burden of these chronic conditions from developing can be dramatically reduced.  Unfortunately telling patients to be careful with what they eat and to be physically active can be a daunting task.

What about obesity surgery?  Is it an effective way to lose weight? 

Gastric Banding is indeed one shortcut way of losing weight.  Our center has been active in handling patients wanting to lose weight using this less invasive procedure BUT will it’s weight loss translate to better health?  IT DOES… concludes a recent study published in JAMA which is an Unblinded randomized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia

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Of the 60 patients enrolled, 55 (92%) completed the 2-year follow-up.

  • Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group.
  • Relative risk of remission for the surgical group was 5.5.
  • Surgical and conventional-therapy groups lost a mean (SD) of 20.7% (8.6%) and 1.7% (5.2%) of weight, respectively, at 2 years 
  • Remission of type 2 diabetes was related to weight loss and lower baseline HbA1c levels
  • There were no serious complications in either group.

Conclusions:

Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed.

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The procedure used in the study was the less invasive laparoscopic gastric band where a band is surgically placed on top of the stomach. An access port is then secured closer to the skin where a saline solution can be injected into to fill up the circular inflation membrane, making the band tighter.  As a result it constricts the stomach opening, and reduces the amount of space inside, giving the patient an earlier feeling of fullness, limiting food consumption.

Finally, this study confirms that indeed weight loss is the key to better control… either achieved by proper diet and physical activity or through surgery. 

Weight Loss For Cure and Health!

Posted in General Health Tips, Medical News Bits, The Truths on Obesity, Weight Loss Tips | 6 Comments »

The Obesity and Fatness Tax

February 27, 2008

Go to fullsize imageJust came from a convention in Agra India where I read in the papers that UK is starting to charge more in terms of insurance premium depending on the degree of obesity. 

Meaning the higher the BMI ( a measure of fatness) , the higher the premium!  It is the insurance way of probably getting back at the skyrocketing cost of Obesity in terms of medical costs.

Fatness therefore is now becoming a Liability! 

Whether this measure will translate into more people taking care of themeselves remain to be seen!  But it is one way to getting people to exercise and live a healthier lifestyle.  And in the long run benefit both the patient and of course the insurance compnay!

Insure Yourself To Better Health!

Posted in Medical News Bits, Personal Thoughts, The Truths on Obesity | 2 Comments »

Can Noise Increase Blood Pressure?

February 21, 2008

Go to fullsize imageA sudden noise or commotion can make your heart rate go up and can be felt as sudden chest beating or palpitation.  We all know that one reason for an increased BP is an increase in heart rate.

A new study published in the European Journal of Hypertension Februaury 12, 2008 looked at this relationship and examined the population living near the airport. The BP and heart rates were checked and evaluated during the noise caused by the airplanes and the results were interesting.

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Non-invasive ambulatory BP measurements at 15 min intervals were performed. Noise was measured during the night sleeping period and recorded digitally for the identification of the source of a noise event.

  • An increase in BP 6.2 mmHg for systolic and 7.4 mmHg for diastolic was observed over 15 min intervals in which an aircraft event occurred.
  • A non-significant increase in HR was also observed (by 5.4 b.p.m.).
  • When the actual maximum noise level of an event was assessed there were no systematic differences in the effects according to the noise source.

Conclusion: Effects of noise exposure on elevated subsequent BP measurements were clearly shown. The effect size of the noise level appears to be independent of the noise source.

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This study has clinical implications on the future risk of heart disease and stroke with elevated BP. It would be nice to know the future risk of these population compared to the general population in terms of heart disease in relation to their exposure to noice.

Environment plays an important role in how stress manifests in our body. Noise generated from any source will definitely have the same effect as the study population and in itself increases a patient’s risk for heart disease due to rises in BP.  What is important is that the study also found that any level of noise including traffic sounds and other bedtime noise like snoring can cause a BP to spike!

For me… relaxing in between stresses in life can make a difference.  Any noise generated while at work can be stressful in itself and taking time to relax and listen to music or the waves of the sea and enjoy can spell a huge Difference!

Take a Break From Noise…Why Not Enjoy a Spa?

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, Tips on Hypertension, Tips To Protect Your Heart | 3 Comments »

Can I Eat Dark Chocolate Everyday?

February 20, 2008

Go to fullsize imageIt’s in the headlines and magazines…that dark chocolate is healthy and in fact protective to the heart.  But does this mean, any dark chocolate can have that effect? And if so, can we then eat dark chocolate everyday?

The Harvard Heart Letter commented on this specific topic recently to dispell myths that all dark chocolates are the same.

The main ingredient that has a positive effect on the heart is the flavanol compound.  This is present in abundance in certain foods not only cacao but also fruits like apples, vegetables like beans and also present in onions.  These flavanoids in cacao give the chocolate a bitter taste and unfortunately this is almost always removed during the processing of chocolate to give it a yummy taste!  Chocolates that also contain alkali during the processing removes most of the flavanoids. 

Unfortunately one can’t tell the content of the flavanoids based on the color of the chocolate.  So here are some tips to get the best dark chocolate from Dr Thomas Lee, the Editor of the Harvard Heart Letter:

  • Look for the least-processed chocolate you can find.
  • Skip those that have been treated with alkali.
  • Keep in mind that you don’t need much.
  • Studies showing the benefits of cocoa have used an ounce — sometimes less — of flavanol-rich chocolate. The tough part of this dietary “therapy” is stopping with a small piece. But stop you should. An ounce of dark chocolate delivers about 150 calories. Eat that much every day without cutting back elsewhere and the girth you gain would far outweigh any benefit from chocolate.

In short… you may eat chocolate everyday but make sure it’s only a bite size.  If you cant handle the satisfaction of that… then hold it for more on special occasions.  Remember… dont fool yourself into believing that you are eating dark chocolate to help your heart… there are other ways to do that. It is the calories that count and chocolates give you more than what you need in a day if you over indulge in it!

Gaining weight is not worth the benefit that you’ll get from eating chocolates if you can get the same amount of flavanoid from eating apples!  They may not taste the same but the health benefits maybe more with fruits!

Enjoy Chocolates Wisely!

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

Stress and Heart Disease: A Close Circuit!

February 18, 2008

Stress from work?  Who isnt? But the way we handle stress can make a difference in how it affects our lives.  We always associate it as part of our day to day activity otherwise, it is not living if we dont have stress.  It gives us the challenge to move on and to pursue what we have in mind to achieve. But along the way comes the roadblocks called “Stress”

Recently an nice article examined how stress can affect out health.  I am a believer of stress as a big factor in increasing a patient’s risk to develop chronic illnesses like diabetes and high blood pressure.  Now published in the European Heart Journal is a detailed examination of how stress can affect the heart!

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A total of 10 308 London-based male and female civil servants aged 35–55 of the Whitehall II study were studied. Exposures included work stress and outcomes included behavioural risk factors, the metabolic syndrome, heart rate variability, morning rise in cortisol, and incident CHD on the basis of CHD death, non-fatal myocardial infarction, or definite angina.

  • Chronic work stress was associated with CHD and this association was stronger among participants aged under 50 by 68%.
  • There were similar associations between work stress and low physical activity, poor diet, the metabolic syndrome, its components, and lower heart rate variability.
  • Cross-sectionally, work stress was associated with a higher morning rise in cortisol.
  • Around 32% of the effect of work stress on CHD was attributable to its effect on health behaviours and the metabolic syndrome.

Conclusion: Work Stress may be an important determinant of CHD among workiing-age populations, which is mediated through indirect effects on health behaviours and direct effects on neuroendocrine stress pathways.

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The above results are clear: once you’re stressed out… you produce stress hormones through the nueroendocrine system resulting in an increase of serum cortisol which can be harmful to the body including the way it signals how the heart beats! End result: Heart disease….

Further examination revealed that work stress is associated with a poorer diet in terms of eating less fruit and vegetables, and less exercise which also then contribute to increasing one’s risk for heart disease further.  I am sure a lot of the readers are guilty of this!  Too little time…too much to do! In fact in this study around 32% of the effect of work stress on CHD could be explained by its effect on health behaviors and the metabolic syndrome.

In short….Enjoy your work…problems come but solutions are abundant.  It is a matter of finding them!

Mind Your Heart… Eat Healthy, Exercie Freely and Be Stress Free!

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

The Plenary Debate… Good Luck To Me!!!!

February 13, 2008

plearny-board.jpgplenary-debate-inside.jpg

This will be a fun learning debate and will be the highlight of the joint annual convention of the  Philippine Society of Hypertension and Philippine Lipid Society in Manila.

 As doctors… we continue to study and learn non stop!

And as a lecturer and speaker… that’s where I study more and as a result I learn more!

Again.. In Health…Learning is NonStop!

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

Exercise As An Investment In Life…. Offers Great Returns!

February 12, 2008

Go to fullsize imageExercise can reduce risk of death!!!

Exercise can make you live longer and make you enjoy your life better. We know this for centuries but lifestyle continues to be one big struggle for doctors to ask their patients to comply. 

That’s the conclusion reached in a study recently published in Circulation Feb 2008.

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Methods and Results— We assessed the association between exercise capacity and mortality in  male veterans with and without cardiovascular disease who successfully completed a treadmill exercise test at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, Calif. Fitness categories were based on peak metabolic equivalents (METs) achieved. Subjects were followed up for all-cause mortality for 7.5±5.3 years.

Among clinical and exercise test variables, exercise capacity was the strongest predictor of risk for mortality. The adjusted risk was reduced by 13% for every 1-MET increase in exercise capacity

  • Compared with those who achieved <5 METs, the mortality risk was 50% lower for those with an exercise capacity of 7.1 to 10 METs
  • 70% lower for those achieving >10 METs 
  •  The findings were similar for those with and without cardiovascular disease.

Conclusions— Exercise capacity is a strong predictor of all-cause mortality !

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So the study suggests…the more we exercise and the more calories we burn resulting in a better shape and better exercise capacity, the longer we live!  A 70% reduction in the risk of death is GREAT news for exercise lovers! There you go guys…. it’s about time that we sit down and think…how much do we love ourselves.  Are we doing things to satisfy our ambitions in life with great disregard to our well being?

We may be great thinkers, scholars or successful businessmen… we may be great in everything we do BUT our body also deserves to be treated right.  Success in life comes in different forms and all come from doing what you think is best!

If you therefore want to to enjoy that success and live longer…enjoy the fruits of your labor longer…enjoy life and have more fun times with your kids and family… then take the extra steps to health.  Just like what you do in taking the extra effort to be successful in your careers and goals in life.  So take time to Exercise…It is indeed an investment worthy of its great returns…..

Take The Extra Time To EXERCISE!!!

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts | Leave a Comment »

The Truth About The Medical Myths….

February 9, 2008

Go to fullsize imageCame across a light article published in the reputable British Medical Journal December 2007 issue on the common myths in Medicine that have been passed from generations to generations and carried on in our practice as facts!

Below is my edited and shortened version of the original article which I hope you’ll all find useful inofrmation.

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People should drink at least eight glasses of water a day

The advice to drink at least eight glasses of water a day can be found throughout the popular press. One origin may be a 1945 recommendation that stated: A suitable allowance of water for adults is 2.5 litres daily in most instances…the statement could be interpreted as instruction to drink eight glasses of water a day. The complete lack of evidence supporting the recommendation to drink six to eight glasses of water a day is exhaustively catalogued in an invited review by Heinz Valtin in the American Journal of Physiology.

Hair and fingernails continue to grow after death

Johnny Carson even perpetuated this myth with his joke, “For three days after death hair and fingernails continue to grow, but phone calls taper off.

Dehydration of the body after death and drying or desiccation may lead to retraction of the skin around the hair or nails. The skin’s retraction can create an appearance of increased length or of greater prominence because of the optical illusion created by contrasting the shrunken soft tissues with the nails or hair. 

Shaving hair causes it to grow back faster, darker, or coarser

Strong scientific evidence disproves these claims. As early as 1928, a clinical trial showed that shaving had no effect on hair growth.  More recent studies confirm that shaving does not affect the thickness or rate of hair regrowth.  

Reading in dim light ruins your eyesight

Suboptimal lighting can create a sensation of having difficulty in focusing. It also decreases the rate of blinking and leads to discomfort from drying, particularly in conditions of voluntary squinting.  The important counterpoint is that these effects do not persist.

Mobile phones create considerable electromagnetic interference in hospitals

After publication of a journal article citing more than 100 reports of suspected electromagnetic interference with medical devices before 1993, the Wall Street Journal published a front page article highlighting this danger. Since that time, many hospitals banned the use of mobile phones, perpetuating the belief.

At the Mayo Clinic in 2005, in 510 tests performed with 16 medical devices and six mobile telephones, the incidence of clinically important interference was 1.2%.  

We Use only 10% of our Brain

The belief that we use only 10% of our brains has persisted for over a century, despite dramatic advances in neuroscience.  Some sources attribute this claim to Albert Einstein, but no such reference or statement by Einstein has ever been recorded. Evidence from studies of brain damage, brain imaging, localisation of function, microstructural analysis, and metabolic studies show that people use much more than 10% of their brains.  Detailed probing of the brain has failed to identify the “non-functioning” 90%.

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There you go guys…common myths that have been practiced by medical professionals as facts. We continue, for example to recommend patients to drink at least 8 glasses of water but so far based on the evidence…it is limited or nil.

As the author of the article concluded: “Medical practitioners should at least recognise when their practice is based on tradition, anecdote, or art.  Speaking from a position of authority, as physicians do, requires constant evaluation of the validity of our knowledge.“

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

Fish Oil and Weight Loss

February 7, 2008

Go to fullsize imageA new look at Fish Oil as a supplement with significant impact in terms of improving health. This new study looked at fish oil in patients without high triglycerides and found some interesting results.

The study was published by French Investigators in the December 2007 issue of the Americal Journal of Nutrition:

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Conclusions:

A moderate dose of n–3 PUFAs for 2 mo reduced adiposity and atherogenic markers without deterioration of insulin sensitivity in subjects with type 2 diabetes. Some adipose tissue inflammation-related genes were also reduced. These beneficial effects could be linked to morphologic and inflammatory changes in adipose tissue.

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I usually discourage my patients from taking fish oil because of its propensity to increase blood sugar.  The above findings though showed that a dose of 1.8 gms has negligible effects on sugar but actually have beneficial improvement in adiposity (or deposition of fat tissue) as well as biochemical parameters of inflammation ( parameters that increase the risk of heart disease) is a welcome news to all especially those who hate eating fish!

Caution however should be made to patients who are concomitantly taking anti-clotting medications since majority of patients taking fish oil have concomitant heart disease.

There you go… studies on supplements that are acceptable to the medical community is really a welcome endeavor. Although more similar researches should be done to confirm the findings.

Fish Oil May Indeed Have Health Benefits!

Posted in General Health Tips, Medical News Bits, Nutrition Health Tips, The Diabetes Facts | 1 Comment »

MODY : Another Form of Diabetes That You May Have!

February 6, 2008

Go to fullsize imageI was just scanning through some articles and this interesting review on MODY caught my attention because definitely some of our patients that are labelled Type 2 as insulin resistant diabetes may actually have MODY where the tissues are actually insulin sensitive.  As a result the way we treat these patients will actually change. 

Below is a summary of the salient features of MODY from Janet Ruhl published in Diabetes In Control online website:

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1. People with MODY are extremely sensitive to insulin.  A dose of as little as two units may have a strong effect on their blood sugar.

2. People with MODY, no matter how high their blood sugars might be after meals, may have near normal fasting C-peptide levels. This is because the defects characteristic of MODY does not affect basal insulin secretion but only the ability to secrete insulin as blood sugars rise after eating.

3. People with MODY do not have GAD or islet antibodies. Though people with severe expressions of MODY genes may be misdiagnosed in their teens with Type 1 diabetes, they can be distinguished from true Type 1s by the very low doses of insulin they need and the lack of the autoimmune antibodies.

4. People with MODY may respond extremely strongly to sulfonylurea drugs. These drugs are often prescribed as the appropriate treatment for MODY. However, these drugs  are most effective for people whose severe expression of these genes causes blood sugars high enough to be mistaken for Type 1 diabetes. For those whose MODY is milder, even 1/4 of a 1 mg tablet of Amaryl ( Glimipride) may cause a dramatic hypo. For these people the use of very small doses of insulin–no more than 2 to 4 units per meal–is more effective and more easily tailored to varying food intake.

5. MODY should always be suspected in a woman of normal weight who develops gestational diabetes early in a pregnancy and who tests negative for autoimmune antibodies. This is often how MODY first reveals itself.

6. The different forms of genetic diabetes that are lumped together under the heading of MODY have different complication profiles. The two most common forms are MODY-3 caused by a defect in HNF1-a and MODY-2 caused by a defect in the glucokinase gene GCK.

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The point of this post is for us doctors to be aware that this form of diabetes exists and that the way these patients respond to our medications differ from the typical insulin resistant Type 2 Diabetic.

Likewise patients should be aware that this kind of Diabetes exist and may need to inform their doctors if the features of the above fit their kind of diabetes.

I see a lot of diabetic patients and the need to be informed and updated all the time regarding new research on the pathophysiology, diagnosis and treatment of this epidemic is the main reason why I continue to study and learn in whatever mode or material either through books, journals, websites or conventions. 

I guess the same is true to everyone everyday…

We Should Never Stop LEARNING!

Posted in Medical News Bits, The Diabetes Facts, What's New in Diabetes | 10 Comments »

Can Soft Drinks Cause GOUT?

February 5, 2008

Another blow to the soft drinks industry published recently in the British Medical Journal January 31, 2008:

The study showed the risk of developing gout from drinking too much sweetened soda is increased but not with drinking diet soda.  It is the fructose in the drinks that is linked to increase uric acid level which is absent with diet drinks.

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Results During the 12 years of follow-up 755 confirmed incident cases of gout were reported. Increasing intake of sugar sweetened soft drinks was associated with an increasing risk of gout. Compared with consumption of less than one serving of sugar sweetened soft drinks a month the multivariate relative risk of gout for

  • 5-6 servings a week was 1.29 , meaning a 29% increased risk! 
  • for one serving a day was 1.45, meaning a 45% increased risk!
  • for two or more servings a day was 1.85, meaning  an 85% increased risk!
  • Diet soft drinks were not associated with risk of gout.
  • total fruit juice or fructose rich fruits (apples and oranges) were also associated with a higher risk of gout (P values for trend <0.05).

Conclusions Prospective data suggest that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men. Furthermore, fructose rich fruits and fruit juices may also increase the risk. Diet soft drinks were not associated with the risk of gout.

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We seldom consider fructose as a culprit since we are used to looking at foods high in protein or purine like red meat or organ meats to be responsible for gout. The pathway at which fructose increases uric acid has not been given much importance until now!

For Gout: Soda is No Better than Beer!

Posted in General Health Tips, Medical News Bits, Nutrition Health Tips | 6 Comments »

AACE Philippines 2nd CME Update: A Success!

February 2, 2008

Go to fullsize imageThe American Association of Clinical Endocrinologists or AACE Philippines recently held our 2nd CME update in Hongkong where members were invited sponsored by the organization for a 2 day meeting of lectures, comaraderie and family fun!

Dr Augusto Litonjua gave us an update on the Pathophysiology of Daibetes while I gave an update on Pathophysiology of Hypertension.  There was a lively interaction among the members and it was a fun intellectually stimulating CME overall!

The fellowship night was full of fun and excitement as members around 50 attended. Part of the itinerary of course was a full day fun at Disneyland and we all gathered to watch the fire works display. 

AACE Philippines strives to be family oriented. So we try to include the family members in all activities that we do.

We hope to invite more members to our team as our membership has been growing yearly.  Likewise the officers strive to make this organization an asset and a support arm to the members in clinical practice. 

Next in line is the Endocrine Day in March and we are now extra busy finalizing a more exciting program for our Annual Convention to be held again in Mactan Shangrila on August 15 to 17 where more debates, workshops and exciting plenary lectures from distinguished foreign and local faculty members will be on hand.

Check out some photos of the members in action under the catagory: AACE Philippine Chapter News (soon…..)

Posted in Medical News Bits, Personal Thoughts | Leave a Comment »

Red Meat and Fried Foods Linked To Disease….

January 28, 2008

Go to fullsize imageWe have known this association of westernized diet ( read meat, fried foods and refined sugar) and the development of chronic disease all along but this new study published in Circulation this year 2008.  confirmed this even more! This study included the dietary intake using prospective data from 9514 participants (age, 45 to 64 years) enrolled in the Atherosclerosis Risk in Communities (ARIC) study.

Metabolic Syndrome is the combination of 4 major diseases in one: Diabetes, High Blood Pressure, High Cholesterol and Obesity. The clinical implication of having the four diseases is the associated increased risk of heart disease and stroke.

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Findings:

  • Analysis of individual food groups revealed that meat, fried foods , and diet soda also were adversely associated with incident MetSyn.
  • Dairy consumption was beneficial.
  • No associations were observed between incident MetSyn and a prudent dietary pattern or intakes of whole grains, refined grains, fruits and vegetables, nuts, coffee, or sweetened beverages.

Conclusions—These prospective findings suggest that consumption of a Western dietary pattern, meat, and fried foods promotes the incidence of MetSyn, whereas dairy consumption provides some protection. The diet soda association was not hypothesized and deserves further study.

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The above findings suggest only 1 thing:  Be careful with what you eat because what you take in predicts the product and outcome in terms of health or disease!

Red Meat should be taken the least and White meat the most! Diet Soda may make one less guilty to eat steak and I believe that is where the association lies between drinking this no calorie drink and the development of the disease.  In contrast, drinking diary product does not entice one to eat more fried foods and therefore it’s a healthier choice!

It’s a choice of what is good versus bad…what is healthy versus not and what you want versus what you need!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, The Diabetes Facts, The Truths on Obesity | 1 Comment »

Can Ginkgo Biloba Improve Memory?

January 18, 2008

I am always asked this question whether there is a vitamin or supplement to improve memory.  There are alreay several claims of ginkgo biloba being a “great” memory enhancer but so far I havent come across a study that says it does.

Ginkgo herbs and supplements are actually derived from the tree leaves and is being marketed in supermarkets everywhere.  Again just like any herbal preparations, it should be taken at your own risk because I dont see any clinical indication in medicine to provide herbal supplements or medications that do not have studies to support any claims.

Medscape Endocrinology Online recently published an article on Gingko which I want to share:

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Studies in the United States have found that ginkgo stabilized — and in some cases improved — cognitive function and socialization in patients with Alzheimer’s disease, although the clinical significance of the improvement was not known. LeBars and colleagues reviewed 2020 patients in an intention-to-treat analysis that resulted in a 1.4-point advantage over placebo in the Alzheimer’s Disease Assessment Scale-Cognitive subscale.

In addition, studies have also demonstrated that the standardized extract of ginkgo biloba (EgB) 761, is effective in reducing symptoms of claudication, giving patients a 50% increase in pain-free walking distance.

In contrast, a recent clinical trial failed to demonstrate any improvement in cognitive function or in the quality of life in cognitively intact, older individuals.

Ginkgo leaves have been associated with mild gastrointestinal side effects and headache. Ingestion of ginkgo seeds may result in serious neurologic and allergic reactions; therefore, they are not used for medical purposes. Ingestion of leaf-based extracts has been associated with a spontaneous hyphema (blood in the anterior chamber of the eye) in an elderly man, and with spontaneous subdural hematomas.

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Whether this supplement will have a place in the therapeutic armamentarium of Alzheimer’s disease or conditions that lead to poor memory remains to be seen.  For now… it is best to ask for advice from your doctors before you take any herbal preparations because they may interact with some drugs that you are taking for your medical condition.

So my recommendtion to those who wish to take ginkgo to enhance their memory for purposes of taking a supplement…I would say NO!  To those who wish to take ginkgo to improve their memory for test taking skills… my advise is: better study more than depend on pills!

In short… no study yet has been done to support an indication of ginkgo as a treatment option. More studies need to be done to prove it works and that its benefits outweigh the risks.

Posted in Exercise and Activity Tips, Medical News Bits, Personal Thoughts | 2 Comments »

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