Archive for the 'Personal Thoughts' Category

The Benefits of Exercise Go Beyond Prevention….

July 23, 2009

We all know the benefits of exercise.  It has been shown to afford a better lifestyle due to prevention of chronic diseases associated with sedentary behavior. 

What we dont know is how following a rigorous physical activity and being FIT can have an impact on a patients recovery from certain illnesses that unfortunately can happen due to the NON modifiable risk factors like family history and age!

A study from the Mayo Clinic published in BMJ this month shows us that indeed the benefits of exercise can go beyond Prevention:

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Background: The importance of physical activity as a modifiable risk factor for stroke in particular and cardiovascular disease in general is well documented. The effect of exercise on stroke severity and stroke outcomes is less clear. This study aimed to assess that effect.

Methods: Data collected for patients enrolled in the Ischemic Stroke Genetics Study were reviewed for prestroke self-reported levels of activity and 4 measures of stroke outcome assessed at enrollment and approximately 3 months after enrollment. Logistic regression was used to assess the association between physical activity and stroke outcomes, unadjusted and adjusted for patient characteristics.

Results: A total of 673 patients were enrolled; 50.5% reported aerobic physical activity less than once a week, 28.5% reported aerobic physical activity 1 to 3 times weekly, and 21% reported aerobic physical activity 4 times a week or more. Patients with moderate and high levels of physical activity were more likely to have higher Barthel Index (BI) scores at enrollment. A similar association was detected for the Oxford Handicap Scale (OHS). After 3 months of follow-up, moderate activity was still associated with a high BI score. No significant association was detected for activity and the OHS or Glasgow Outcome Scale at follow-up after adjustment for patient characteristics.

Conclusions: Higher levels of self-reported prestroke physical activity may be associated with functional advantages after stroke. Our findings should be seen as exploratory, requiring confirmation, ideally in a longitudinal study of exercise in an older population.

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Theoritically, the study results are obvious in that according to the author….”A brain that generally has good blood and oxygen flow from aerobic exercise will be in a better position to compensate for neurological deficits caused by a stroke.”

The results also say it all: that Exercise indded can be beneficial in all phases of the disease from prevention to recovery.  

 Among patients who reported less exercise in the year before their stroke those individuals were significantly more likely to have one or more bad outcomes while those who were into moderate to high levels of activity, the odds of a better outcome were higher. 

Likewise, in terms of recovery and functional capacity post stroke after three months , individuals who had both moderate and high exercise levels were associated with significantly better functional outcomes.  Great News specially to our diabetic patients who love to exercise! 

There you go… the many wonders of exercise !!!

You Get Everything GOOD with EXERCISE!  

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The 20-40 RULE in Fitness and Disease

July 13, 2009

My 20-40 rule:

A low fitness level in your teens translate to a high level of risk for developing diabetes by age 40! 

That’s the message I got from this study published in Diabetes Care called the CARDIA Fitness Study.

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Objective: Test the association of fitness changes over 7- and 20-years on the development of diabetes in middle-age.

Research Design and Methods: Fitness was determined based on the duration of a maximal graded exercise treadmill test (Balke protocol) at up to three examinations over 20-years from 3989 black and white men and women from the Coronary Artery Risk Development in Young Adults study. Relative fitness change (%) was calculated as the difference between baseline and follow-up treadmill duration/baseline treadmill duration. Diabetes was identified as fasting glucose ≥126 mg/dL, post-load glucose ≥200 mg/dL, or use of diabetes medications.

Results:

  • Diabetes developed at a rate of 4 per 1000 person-years in women (n=149) and men (n=122) and lower baseline fitness was associated with a higher incidence of diabetes in all race-sex groups (hazard ratios from 1.8 to 2.3).
  •  On average, fitness declined 7.6% in women and 9.2% in men over 7 years.
  • The likelihood of developing diabetes increased per standard deviation decrease (19%) from the 7-year population mean change (−8.3%) was in women (hazard ratio [HR]=1.22, 95% CI: 1.09, 1.39) and men (HR=1.45, 95% CI: 1.20, 1.75) following adjustment for age, race, smoking, family history of diabetes, baseline fitness, body mass index (BMI), and fasting glucose.
  • Participants who developed diabetes over 20 years experienced significantly larger declines in relative fitness over 20 years vs those who did not..

Conclusions: Low fitness is significantly associated with diabetes incidence and explained in large part by the relationship between fitness and BMI.

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This study shows that inidviduals risk to develop lifestyle related diseases especially diabetes are at increasing overtime depending on the level of fitness:

  • Women were at 22% increased risk of developing diabetes
  • men were at a 45% increased risk…

 for every standard deviation decrease from the mean fitness change.  This relationship continued to exists even after adjusting for age, smoking, family history of diabetes, and baseline fasting glucose.  In fact the researchers noted that the baseline BMI was a better predictor for developing diabetes than the baseline fasting glucose as well as baseline fitness.

What Do These Data MEAN?

  • If two individuals have similar fitness level; the bigger person with a higher BMI is more likely to develop diabetes than the smaller frame guy overtime in the next 10-20 years.
  •  The possible mechanism by which fitness decreases risk for diabetes is most likely related to the regulation of body mass.  A lower BMI means better insulin sensitivity and less production of toxic substances by increased adiposity that can lead to further cardiovascular complications associated with obesity and diabetes. 

The authors conlcuded:

That regular physical activity to “improve and maintain cardiorespiratory fitness is an important component of a healthy lifestyle.” 

 AMEN!

Walk and Jog or The WOG… A Perfect Exercise!!!

July 7, 2009

Since the time Ive lost weight, Ive been apporached several times by my friends how I did it.  Ive posted in thia website my diet regimen…now I am posting my exercise routine.  To lose weight…the right food and the right discipline are both essential.  To maintain your weight, then the right kind of exercise that you feel good and you can do for years should be the best way to increase your metabolic rate!

Can we call it the WOG?  Short for Walk and Jog!!!

Ive been a brisk walker for sometime.  I find it a good exercise that’s not too tiring nor too destructive for my joints.  But overtime, after several articles touting the benefits of short bouts of exercise in between breaks that I thought of trying to alternate my walking exercise with jogging.

The intensity of exercise is more…the surge of adrenaline is more and boy…you feel better and better everytime you do the routine.  Lots and lots of sweat too!  Besides, you allow you body to rest in between the jogging by brisk walking.

Jogging being a high-intensity exercise kicks your metabolism up and by doing so,  your metabolic rate stays up longer (five times longer after a vigorous workout than after an easy one).   By doing the same routine, one therefore tends to add up the number of calories burned because the jogging can easily add up another 200 calories compared to walking alone.

Here’s what I do:

Before I walk, warming up by stretching the muscles is very important.  Then I start my brisk walking slowly increasing the pace  until I start jogging. 

 I then do the alternate walk and jog routine every 3 minutes until 40 to 40 minutes!!!!  

Initially it may seem “laborious” compared to walking alone but soon…you will be running a marathon as the running becomes easier.  But at this time, I have no plans to pursue a running career!  I just want to burn more calories and make myself healthier and hopefully avoid myself getting the risk of developing diabetes!

To stay Fit and Slim…Discipline is the KEY!

You are What You Eat and Do the WOG!

How To Exercise To Reduce Heart Disease…

June 30, 2009

We heard the news of Michael Jackson’s death.  It is known that Heart disease continues to be a leading killer worldwide.  Blame it to lifestyle and the world’s reliance to fast food and technology.  In parallel to the rise of heart disease is the rising prevalence of Diabetes and Obesity which I believe will no longer spare anyone because of the environment we are in and the kind of acitvities and lifestyle the next generation is in and will have!

It is therefore imperative that we deal with this rising prevalence of heart disease upfront and not relying heavily on medications to get us through!  Simple steps can be done but steps that need diligence, perseverance and discipline!  It is therefore best to start these steps NOW than later!

I myself am doing these steps NOW and not later when I will get the disease of Diabetes due to age and strong family history. 

The recent guideline of the American Heart Association is timing to the events around the world. 

There’s no better time than now to emphasize lifestyle change and exercise but now!  So what do we recommend?

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To improve cardiovascular risk, it is recommended that patients with T2DM accumulate a minimum of 150 minutes per week of at least moderate-intensity and/or 90 minutes per week of at least vigorous-intensity cardiorespiratory exercise.

In addition, resistance training should be encouraged. These guidelines can be achieved with varying contributions of moderate- to vigorous-intensity cardiorespiratory exercise.

Patients should train on at least 3 nonconsecutive days each week to maximize benefits. Individual sessions should last for no less than 10 minutes.

 Sedentary behaviors should be minimized. Exercise training should be implemented long-term.

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Additional recommendations highlighted in the guidelines include:

  • Resistance training should use all muscle groups and progress to  2–4 sets of 8–10 repetitions at a weight that cannot be lifted >8–10 times, with 1–2 minute rest periods between sets.
  • The duration of each individual session can vary, although the aim should be a minimum of 10 minutes per session, at least 3 sessions per day.
  • Patients who elect to walk should perform the task at a brisk pace to be effective.
  • Go guys… jump on to the bandwagon.  Just look around you.  Lance Gokongwei has joined the fitness world!  So can we!

    It’s in the decision When to start that somehow manages to make us Weak and defenseless. Be determined and do it now. 

    Be Fit…Be Slim…

    Be Smart and Be Healthy!

    How To Lower Cholesterol Levels Naturally

    June 3, 2009

    Here’s one interesting article from the Harvard Health Publications HealthBeat on ways we can do to lower cholesterol naturally without meds:

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    15 tips for lowering your cholesterol naturally

    Many factors contribute to the development of heart disease or stroke. Genes and gender play a role, but for most of us, what we eat is an important factor as well. The good news is that a few small changes to your diet can help lower your cholesterol, which in turn will lower your risk for heart disease and stroke. Here are 15 heart-healthy eating tips to help you in the fight against high cholesterol.

    1. Eat meat sparingly. Relegate meat to a minor part of your diet instead of making it the centerpiece of most meals. Trim off fat and skin from meats and poultry. Avoid fatty cuts of beef, pork, and lamb; instead choose lean meats, or substitute fish or skinless white-meat poultry. When dining out, choose a smaller portion of meat, or meatless pasta or fish dishes.

    2. Opt for low-fat dairy products. Avoid dairy foods that contain whole milk or cream; instead, use low-fat or nonfat versions.

    3. Watch the snacks. Choose low-fat snacks (homemade popcorn, carrots, dried fruits, or fresh fruits) instead of high-fat ones (potato chips and candy bars). Avoid store-bought bakery products unless they are explicitly low in saturated fats and free of trans fats.

    4. Cut down on saturated fat in cooking. Use liquid cooking oils rather than butter or margarine. Use nonstick pans. Instead of frying your food, bake, broil, roast, steam, or stew. Discard drippings, and baste with wine or broth.

    5. Avoid palm and coconut oils. Most vegetable oils are unsaturated, but these two contain mostly saturated fat. Choose canola, sunflower, safflower, corn, soybean, olive, and peanut oils.

    6. Reduce dietary cholesterol. Strive to eat less than 200 mg of dietary cholesterol a day. Limit eggs to no more than four egg yolks per week; two egg whites can replace a whole egg in most recipes. Limit lean meat, fish, and poultry to no more than 6 ounces per day (a 3-ounce portion is about the size of a deck of playing cards). Stay away from cholesterol-rich organ meats, such as liver, brains, and kidneys.

    7.  Increase complex carbohydrates and fiber. Emphasize foods with complex carbohydrates—such as fruits and vegetables, whole-grain products, and legumes (dried beans and peas)—that are low in calories and high in fiber. Eat more water-soluble fiber, such as that found in oat bran and fruits. This type of fiber can significantly lower your blood cholesterol level when eaten in conjunction with a low-fat diet.

    8. Eat fruits and vegetables. To protect your heart, eat plenty of fruits and vegetables.

    9. Go for nuts. Nuts are associated with a lower risk of heart disease. They’re a healthful and filling source of protein, but go easy on them; they have lots of calories, so too much could cause weight gain.

    10. Add fish to your diet. Countries with high fish consumption have a lower risk of death from all causes as well as from cardiovascular disease. Like nuts, oily fish contain the essential fatty acids known as omega-3s and omega-6s. Since our bodies can’t make these, we have to eat foods that contain them to gain their benefits, which include improved cholesterol levels.

    11. Reduce salt intake. High blood pressure is a major risk factor for cardiovascular disease. Diets high in salt increase risk of hypertension.

    12. Avoid trans fats. According to the Institute of Medicine’s Food and Nutrition Board, there are no redeeming qualities to trans fats, and no safe levels. They raise LDL cholesterol and lower HDL cholesterol. The National Cholesterol Education Program urges people to eat as little as possible. Avoid or eat only very small quantities of foods that list hydrogenated oil or partially hydrogenated oil among their first ingredients. These products contain a lot of trans fat.

    13. Drink alcohol only in moderation. Regular, moderate drinking can reduce the risk of cardiovascular disease, but heavy drinking negates the benefits. Moreover, the advantages aren’t strong enough to recommend alcohol for anyone who doesn’t already drink. For those who do, the Dietary Guidelines for Americans recommend no more than one drink a day for women, and one or two drinks a day for men.

    14. Read labels carefully. Avoid prepared foods that list any of the following among the first few ingredients: meat fat, coconut or palm oil, cream, butter, egg or yolk solids, whole milk solids, lard, cocoa butter, chocolate or imitation chocolate, or hydrogenated or partially hydrogenated fat or oil. Watch out for fast foods and other unlabeled products; when you don’t know what you’re getting, eat sparingly.

    15. Change strategies. If three months of healthy eating doesn’t bring your total and LDL cholesterol levels into the desired range, consult your physician and a dietitian. If the numbers still don’t budge after six months, it may be time to consider medication.

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    Simple measures we can at home to avoid getting th compications associated with a high cholestrol level in the blood.  High cholesterol levels have been shown to increase ones risk to suffer from stroke and heart attack. 

    The good news is , we now have ways to control and lower the cholestrol levels by taking care of what we eat and through medications.

    Be Health Smart and Check the Labels!

    Intelligence Equates Fitness!

    May 29, 2009

    I found this very interesting article and I find it rather amusing… linking inteligence to physical fitness.   This is the first time I have read such a study published in the journal Intelligence and I want to share the information to all….

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    We suggest that an over-arching ‘fitness factor’ (an index of general genetic quality that predicts survival and reproductive success) partially explains the observed associations between health outcomes and intelligence. As a proof of concept, we tested this idea in a sample of 3654 US Vietnam veterans aged 31–49 who completed five cognitive tests (from which we extracted a g factor), a detailed medical examination, and self-reports concerning lifestyle health risks (such as smoking and drinking).

    As indices of physical health, we aggregated ‘abnormality counts’ of physician-assessed neurological, morphological, and physiological abnormalities in eight categories: cranial nerves, motor nerves, peripheral sensory nerves, reflexes, head, body, skin condition, and urine tests. Since each abnormality was rare, the abnormality counts showed highly skewed, Poisson-like distributions. The correlation matrix amongst these eight abnormality counts formed only a weak positive manifold and thus yielded only a weak common factor.

    However, Poisson regressions showed that intelligence was a significant positive predictor of six of the eight abnormality counts, even controlling for diverse lifestyle covariates (age, obesity, combat and toxin exposure owing to service in Vietnam, and use of tobacco, alcohol, marijuana, and hard drugs).

    These results give preliminary support for the notion of a superordinate fitness factor above intelligence and physical health, which could be further investigated with direct genetic assessments of mutation load across individuals.

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    This study showed that being healthy is linked to being more intelligent.  And this relationship is linked to a certain genetic “fitness factor” that regulates both the health fitness  to that of brain intelligence.  

    In other studies, the relationship was believed to be more of a “cause and effect” relationship where by being more intelligent means more likely to live a healthy lifestyle by eating the right kind of food and knowing the benefits of exercise.  Unfortunately, this cause and effect relationship may not be that simple after all because I know of intelligent people who may not be at their best of fitness level.

    On the other hand, the researchers further noted that the lower intelligence predicted health problems more than deviant lifestyle factors like smoking or alcohol intake.

    All these date suggest that there indeed is the existence of a genetic ‘fitness factor’ that influences both health fitness and the way our brains work!

    Look Smart By Being Fit!!!!

    Licking Speeds Up Wound Healing….

    April 15, 2009

    Call it reflex but the moment something feels painful or see blood in our fingers or hands, we immediately bring that finger into our mouth to lick it!  We feel better and we think it stops the bleeding.

    Now science tells us indeed we were right all along.  A recent study published online by FASEB showed that licking a wound can indeed speed up wound healing:

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    Wounds in the oral cavity heal much faster than skin lesions. Among other factors, saliva is generally assumed to be of relevance to this feature. Rodent saliva contains large amounts of growth factors such as epidermal growth factor (EGF) and nerve growth factor (NGF).

    In humans, however, the identity of the involved compounds has remained elusive, especially since EGF and NGF concentrations are 100,000 times lower than those in rodent saliva.

    Using an in vitro model for wound closure, we examined the properties of human saliva and the fractions that were obtained from saliva by high-performance liquid chromotography (HPLC) separation.

    • We identified histatin 1 (Hst1) and histatin 2 (Hst2) as major wound-closing factors in human saliva.
    • In contrast, the D-enantiomer of Hst2 did not induce wound closure, indicating stereospecific activation. Furthermore, histatins were actively internalized by epithelial cells and specifically used the extracellular signal-regulated kinases 1/2 (ERK1/2) pathway, thereby enhancing epithelial migration.

    This study demonstrates that members of the histatin family, which up to now were implicated in the antifungal weaponry of saliva, exert a novel function that likely is relevant for oral wound healing.

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    Now we know why nature tells us to lick our wounds…why dogs and cats do it too!!!!  This study also explains why mouth sores heal easily even if we dont do anything to them.

    Hopefully in the future, this will help scientists develop new and better ways to help heal the wounds especially among those with diabetes or poor circulation that require the most aggressive way of treating the wounds to avoid complications like amputation.

    For now…if you can lick it… go for it!!!!

    Meat Is Not NEAT!

    April 7, 2009

    Go to fullsize imageIt is easier to convince a child to eat meat than to eat veggies.  This scenario is given.  We are exposed to too many ads on meat whether chicken meat or beef meat on TV and newspapers.  It is therefore a challenge to parents to introduce other varieties of food that we deem healthier to the next generation.  It may take us some time to be successful but a little step can indeed go a long way overtime!

    Now comes another study to support the concept that meat is really not neat!  Published in the latest edition of  Archives of Internal Medicine:

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    Background  High intakes of red or processed meat may increase the risk of mortality. Our objective was to determine the relations of red, white, and processed meat intakes to risk for total and cause-specific mortality.

    Methods  The study population included the National Institutes of Health–AARP (formerly known as the American Association of Retired Persons) Diet and Health Study cohort of half a million people aged 50 to 71 years at baseline. Main outcome measures included total mortality and deaths due to cancer, cardiovascular disease, injuries and sudden deaths, and all other causes.

    Results  There were 47 976 male deaths and 23 276 female deaths during 10 years of follow-up.

    • Men and women in the highest vs lowest quintile of red (HR, 1.31 [95% CI, 1.27-1.35], and HR, 1.36 [95% CI, 1.30-1.43], respectively) and processed meat (HR, 1.16 [95% CI, 1.12-1.20], and HR, 1.25 [95% CI, 1.20-1.31], respectively) intakes had elevated risks for overall mortality.
    • Regarding cause-specific mortality, men and women had elevated risks for cancer mortality for red (HR, 1.22 [95% CI, 1.16-1.29], and HR, 1.20 [95% CI, 1.12-1.30], respectively) and processed meat (HR, 1.12 [95% CI, 1.06-1.19], and HR, 1.11 [95% CI 1.04-1.19], respectively) intakes.
    • Furthermore, cardiovascular disease risk was elevated for men and women in the highest quintile of red (HR, 1.27 [95% CI, 1.20-1.35], and HR, 1.50 [95% CI, 1.37-1.65], respectively) and processed meat (HR, 1.09 [95% CI, 1.03-1.15], and HR, 1.38 [95% CI, 1.26-1.51], respectively) intakes.
    • When comparing the highest with the lowest quintile of white meat intake, there was an inverse association for total mortality and cancer mortality, as well as all other deaths for both men and women.

    Conclusion  Red and processed meat intakes were associated with modest increases in total mortality, cancer mortality, and cardiovascular disease mortality.

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    This study further confirms the relationship between red meat and cancer, heart and overall risk of death.  Likewise, the study also showed that fish or intake of white meat was associated with a reduction in the risk of death.

    Translating the data to common language…it means…

    Over 10 years, those that eat meat equivalent to a quarter-pound hamburger can increase ones risk to die from cancer by 22 percent and the risk to die from heart disease by 27 percent. 

    Bottom Line is:

    Cut The Red Meat… Enjoy Fish in time for the Lenten Season….

    Can I Eat Eggs Everyday? Yes You Can!!!!

    March 28, 2009

    New studies have been made to refute the previous claims that eggs can increase ones cholesterol. 

    A recent article published in the International Journal of Obesity showed that the previous notion of limiting eggs because they can increase cholesterol is no longer an acceptable fear.  In fact eggs can help one lose weight!

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    Objective:

     To test the hypotheses that an egg breakfast, in contrast to a bagel breakfast matched for energy density and total energy, would enhance weight loss in overweight and obese participants while on a reduced-calorie weight loss diet.

    Design:

    Otherwise healthy overweight or obese participants were assigned to Egg (E), Egg Diet (ED), Bagel (B) or Bagel Diet (BD) groups, based on the prescription of either an egg breakfast containing two eggs (340 kcal) or a breakfast containing bagels matched for energy density and total energy, for at least 5 days per week, respectively. The ED and BD groups were suggested a 1000 kcal energy-deficit low-fat diet, whereas the B and E groups were asked not to change their energy intake.

    Results:

    After 8 weeks, in comparison to the BD group,

    • the ED group showed a 61% greater reduction in BMI,
    • a 65% greater weight loss ,
    • a 34% greater reduction in waist circumference (P<0.06) and
    • a 16% greater reduction in percent body fat (P=not significant).
    • No significant differences between the E and B groups on the aforementioned variables were obtained.
    • Further, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides, did not differ between the groups.

    Conclusions:

      The egg breakfast enhances weight loss, when combined with an energy-deficit diet, but does not induce weight loss in a free-living condition. The inclusion of eggs in a weight management program may offer a nutritious supplement to enhance weight loss.
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    It is however to be emphasized that in this study, the egg diet was part of a calorie restircted diet suggesting that eating eggs as part of a low calorie diet can help one lose weight.  
    • But the added bonus of the study is the fact that eggs did not have any effect on the blood cholesterol level suggesting that it is really the intake of Saturated fat in the diet found in pastries, cakes and cookies that is harmful to the body!
    • The results of the study  were further confirmed in a similar finding from the University of Surrey research group which showed a similar no effect on cholesterol level with intake of 2 eggs per day for 6 to 8 weeks.
    Hopefully…these two studies can now end the debate as to whether eggs are safe to eat or not.  Enjoy!!!!!

    How Safe Are Artificial Sweeteners….

    March 25, 2009

    One topic that has never died down during these years is the safety of artifical sweteeners.  The problem stems from internet messages and information being propagated by unknown sources regarding the dangers of these products.  As an endocrinologist, I have been recommending these sweeteners to my patients as they actually help stave off the craving for sugar without necessarily increasing the sugar load.

    But how much is enough for these sweeteners?

    Recently the Mayo Clinic organization published views on this controversy and recommendations.

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    The Food and Drug Administration (FDA) has approved the following low-calorie sweeteners for use in a variety of foods. The FDA has established an “acceptable daily intake” (ADI) for each sweetener. This is the maximum amount considered safe to eat each day during your lifetime. ADIs are intended to be about 100 times less than the smallest amount that might cause health concerns.

    Artificial sweetener ADI* Estimated ADI equivalent** OK for cooking?
    Aspartame (NutraSweet, Equal) 50 milligrams (mg) per kilogram (kg) 18 to 19 cans of diet cola No
    Saccharin (Sweet’N Low, SugarTwin) 5 mg per kg 9 to 12 packets of sweetener Yes
    Acesulfame K (Sunett, Sweet One) 15 mg per kg 30 to 32 cans of diet lemon-lime soda*** Yes
    Sucralose (Splenda) 5 mg per kg 6 cans of diet cola*** Yes

    *FDA-established acceptable daily intake (ADI) limit per kilogram (2.2 pounds) of body weight.
    **Product-consumption equivalent for a person weighing 150 pounds (68 kilograms).
    ***These products usually contain more than one type of sweetener.

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    How about the safety of these products?

    Although this is one product has been bombarded with bad publicity probably because of its popularity being present in almost any low calorie foods to diet sodas… the National Cancer Institute and other major health oragnizations including the American Diabetes Association and the US FDA continue to refute these claims… as so far,  there’s no scientific evidence that any of the artificial sweeteners approved for use in the United States cause cancer and that there are now numerous studies to confirm that artificial sweeteners are safe for the general population.

    I for one contnue to use aspartame or splenda for my coffee eevry morning or in the afternoon. I am a user and a believer in these low calorie sweeteners that as long as used properly and not in excess of what is recommended…then it is safe!

    Enjoy The Sweetness of Health!

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

    February 28, 2009

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

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

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

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

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

    What if one is underweight?

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

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

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

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

    Quit Smoking and Get Back Your Health…

    December 11, 2008

    Smoking is indeed addicting.  A lot of smokers know the risks but cant help themselves to quit smoking.  It is actually easier said than done… similar to asking patients to eat less to lose weight!

    The good news is…quitting smoking can do a lot of things to reverse the bad efffects of smoking done to ones body and therefore, it is never too late to QUIT.

    The Harvard News Letter nicely summarized how the body responds immediately to weeks and months after quitting smoking:

    Why bother? Even if you’ve smoked for years, you’ll greatly improve your health.

    • Within days, your blood vessels will regain much of the normal function that is damaged by smoking.
    • Within weeks, you’ll be able to taste food better, and your sense of smell will recover from tobacco’s assault.
    • Within months, symptoms of chronic bronchitis ease up, and lung function improves within a year.
    • Quitting reduces the risk of heart attack and stroke within two to five years.
    • And the risk of lung cancer begins to drop substantially within five to nine years of quitting.

    More benefits await one that will decide to come clean this Christmas and the New Year. 

    What better Christmas gift to give to oneself than a Clean bill of health… and what better resolution to have for oneself is to Aim for Discipline for Good Health for the New Year!

    Alarming Rise in Adult Diseases Amongst Children….

    December 4, 2008

    As the world is becoming more obese… as our food industry is creating better marketing strategies to entice people to eat… as we see more children spending more time watching television… not surprisingly, we see more kids suffering from the chronic illnesses not known to kids in last century!

    Now new data support our fear that indeed obesity is becoming more prevalent in our region as more international food chains are creeping up and luring our kids with better and bigger processed foods.  In the ned, our own personal health, our kids health and the health of our nation will suffer because we will be spending our fortune in treating the complications of what we have eaten during our lifetime.

    A study published in Pediatrics this year is not only alarming but an eye opener…for all of us with kids!!!!

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    First-quarter 2002 baseline prevalence of chronic medication use per 1000 child beneficiaries ranged from a high of 29.5 for antiasthmatics to a low of 0.27 for antihyperlipidemics. Except for asthma medication use, prevalence rates were higher for older teens aged 15 to 19 years.

    During the study period, the prevalence rate for type 2 antidiabetic agents doubled, driven by 166% and 135% increases in prevalence among females aged 10 to 14 and 15 to 19 years, respectively.

    Prevalence of use growth was more moderate for antihypertensives and antidepressants (1.8%). R

    Rates of growth were dramatically higher among girls than boys for type 2 antidiabetics (147% vs 39%), 

    CONCLUSIONS. Prevalence of chronic medication use in children increased across all therapy classes evaluated. Additional study is needed into the factors influencing these trends, including growth in chronic disease risk factors, greater awareness and screening, and greater affinity toward early use of drug therapy in children.

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    Well for me this data say it all.  Where else can one get diabetes at an early age except from the rising prevalence of obesity.  Excess fat results in a state called insulin resistance where the body has to produce more insulin to counteract the resistance by fat to the effect of insulin.  We need insulin to drive sugar inside our muscles to be used for energy!!! 

    Simple equation of FAT= Insulin resitance + Diabetes and others.

    Others mean: high blood pressure, high cholesterol, hgh uric acid, infertility, increased risk for blood clot, cancer and more…  Meaning, our kids if we let them be with their choices of food nowadays will be taking the medications that our fathers used to take when they were in their 70’s.  A scary though indeed BUT it’s now a reality!

    In short… start good nutrition among the young. And have a happy healthy kid.

    The Conflict of Taking Care of A Loved One….

    December 2, 2008

    Obejectivity is important as a physician taking care of patients. But the personal side of it is as important as patients seek our help to feel comfort that their illness is not all that bad after all…  The conflict comes when as physicians, we have to deal with an illness in the family.  Almost always by chance, we commit a blunder in our decision which creates the conflict… a situation we all want to avoid.

    The recent article published in the Annals of Internal Medicine succinctly targetted the issue of the conflict that a physician in the family and the sick loved one have to expect with medical care:

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    Conventional wisdom and professional ethics generally dictate that physicians should avoid doctoring family members because of potential conflicts of interest.
    Nevertheless, cross-sectional surveys find that the practice is commonplace. Physicians have unique opportunities to influence their family member’s care because they possess knowledge and status within the health care system; however, when physicians participate in the care of family members, they must not lose objectivity and confuse their personal and professional roles.

    Because health care systems are complicated, medical information is difficult to understand, and medical errors are common, it can be a great relief for families to have someone “on the inside” who is accessible and trustworthy. Yet, the benefits of becoming involved in a loved one’s care are accompanied by risks, especially when a physician takes action that a nonphysician would be incapable of performing. Except for convenience, most if not all of the benefits of getting involved can be realized by physician–family members acting as a family member or an advocate rather than as a physician.

    Rules about what is or what is not appropriate for physician–family members are important but insufficient to guide physicians in every circumstance. Physician–family members can ask themselves, “What could I do in this situation if I did not have a medical degree?” and consider avoiding acts that require a medical license.

    __________________________________________________________________________________________________

    The best role that a physician family member can do is support.  And be there in times of need.  And the thought that other family members know that there is a doctor in the family that knows better than they do….is comforting enough…. 

    The conflict though begins whan the question of … where do personal reasoining ends when objectivity is required….

    Life is But a Full of Challenges…and for us physicians, the situation can be one..

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

    November 29, 2008

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

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

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

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

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

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

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

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

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

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

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

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

    The Healing Powers of a Doctor…

    November 25, 2008

    Patients see some of us as healers. 

    Patients see us because they’re sick. It is therefore our role to give them comfort.  Never to make them feel useless or hopeless.

    The trials of being a physician are enormous.  It is a skill to master the art of healing. Diagnosing a disease can be easy with enormous references to read but to learn the art of healing needs mastery…and this differentiates a healer from an ordinary doctor.

    In a recent article published in the Annals of Internal  Medicine, some interesting facts came out as eight skills necessary to be considered a healer:

    • do the little things;
    • take time;
    • be open and listen;
    • find something to like, to love;
    • remove barriers;
    • let the patient explain;
    • share authority; and
    • be committed.

    It is however sad that a lot of the above are forgotten in clinical practice. Oblivious of the fact that following the art of healing to every patient that we see allows us to be better persons and better doctors. 

    It is just fulfilling to see patients welcome your passion to treat them with dignity, not to be in a hurry but willing to take time for them to share what they feel… in return will be their admiration and deep gratitude because they can feel your healing powers. And more than enough… for them- seeing you is worth the wait!

    The article concluded that :

    “Mastery of these skills would provide enduring improvements in patient care and reaffirm medicine’s calling as a healing profession.” 

    What Your Waistline Means To Your Health…

    November 14, 2008

    Go to fullsize imageI just came from a trip to Rio, Brazil to attend the International Congress of Endocrinology which is held every 2-4 years.  Our hotel was stationed right across the Copacobana Beach.  This is a place that epitomizes physical activity where unlike the Waikiki Beach front, I dont see a lot of people swimming but rather engaged in activities like walking, jogging or playing volleyball using their hands or feet.  On the sides are people eateries serving fresh coconut juice but also burgers and fries!  But an interesting observation was that… not a lot of Brazilians can be considered obese and not a lot have their bellies haging out of their waist….

    We know about the risk of death and weight and BMI.  For Asians, anything above 23 is considered overweight already and increases ones risk to develop chornic diseases like Diabetes and cancer.  A waistline of more than 36 is considered high risk for men and 34 inches for women for chronic diseases.  It is for this reason that I have been committed to a healthier lifestyle and now from a waistline of 34 , I was able to maintain a waistline of  31inches and my BMI dropped from a high of 25.6 to 23.  It is all about a balance of what you eat and what you do and the DISCIPLINE you put into your goal! 

    Now comes a timely study published in the New England Journal of Medicine, November issue regarding the risk of dying based on ones waistline and weight:

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    Background Previous studies have relied predominantly on the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) to assess the association of adiposity with the risk of death, but few have examined whether the distribution of body fat contributes to the prediction of death. Methods We examined the association of BMI, waist circumference, and waist-to-hip ratio with the risk of death among 359,387 participants from nine countries in the European Prospective Investigation into Cancer and Nutrition (EPIC). We used a Cox regression analysis, with age as the time variable, and stratified the models according to study center and age at recruitment, with further adjustment for educational level, smoking status, alcohol consumption, physical activity, and height.

    Results During a mean follow-up of 9.7 years, 14,723 participants died. The lowest risks of death related to BMI were observed at a BMI of 25.3 for men and 24.3 for women.

    • After adjustment for BMI, waist circumference and waist-to-hip ratio were strongly associated with the risk of death.
    • Relative risks among men and women in the highest quintile of waist circumference were 2.05 (95% confidence interval [CI], 1.80 to 2.33) and 1.78 (95% CI, 1.56 to 2.04), respectively, and
    • in the highest quintile of waist-to-hip ratio, the relative risks were 1.68 (95% CI, 1.53 to 1.84) and 1.51 (95% CI, 1.37 to 1.66), respectively.
    • BMI remained significantly associated with the risk of death in models that included waist circumference or waist-to-hip ratio (P<0.001).

    Conclusions These data suggest that both general adiposity and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-to-hip ratio in addition to BMI in assessing the risk of death.

     

    ____________________________________________________________________________________________

    IN SHORT…The risk of dying was higher among participants with a larger waistline of more than 47.2 inches for men and more than 39.4 inches for women compared to subjects with a smaller waistline of less than 31.5 inches for men and less than 25.6 inches for women. This study showed us that for each 2-inch increase in waist circumference, there was an associated 17% higher risk for death in men and a 13% higher risk for death in women .

    There you go guys… thess bulging bellies are no longer as silent as we thought these”fats” can be but rather we know them now as machines producing substances that can harm the heart and vessels.  Aside from trying to aim for a BMI of 23 and below, one therefore has to be more aware of the risk of premasture death with higher waistline! 

    Every little loss of the waist circumference can go a along way in helping us maintain HEALTH!  Do somtehting now and reap the rewards along the way!  It requires a lot of discipline but health benefits are enormous…and this equates to what I call Wealth!

    Are Your Supplements “FDA Approved?”

    November 5, 2008

    You see supplements marketed as FDA Approved! Am not sure how the policy of the local FDA works but almost always, the same agencies operating elsewhere look at policies of the US FDA as their basis for regulating drugs.

    Let us be clear what”FDA Approved” means.  The US FDA website has this to say:

    FDA approves new drugs and biologics.

    New drugs and biologics must be proven safe and effective to FDA’s satisfaction before companies can market them. FDA does not develop or test products; FDA experts review the results of laboratory, animal, and human clinical testing done by manufacturers.

    If FDA grants an approval, it means the agency has determined that the benefits of the product outweigh the risks for the intended use.

    Meaning research should be done and presented to the body and then these studies should prove the products benefit outweigh the risks.  If however the risks outweigh the benefits then the marketing of the drug is not approved!

    Now…How about the Dietary Supplements?  What about their claims for FDA Approval?

    FDA does not approve dietary supplements.

    Unlike new drugs, dietary supplements are not reviewed and approved by FDA based on their safety and effectiveness. The notification must include the information that was the manufacturer or distributor’s basis for concluding that the dietary supplement will reasonably be expected to be safe.

    After dietary supplements are on the market, FDA evaluates their safety through research and adverse event monitoring.

    If you will note…the supplement will be in the market first and then if  adverse events occur then action will be taken by the FDA.  Meaning..no review of side effects or untoward effects are made before releasing a supplement to the market. BUT how many patients will complain of side effects especially that supplements are marketed as having Zero side effects?  and where do they go to report when only the salesmen or networking friends advised or convinced  them of the safety of the supplements?

    FDA does not approve structure-function claims on dietary supplements and other foods.

    Structure-function claims describe the role of a food or food component (such as a nutrient) that is intended to affect the structure or function of the human body. 

    Structure-function claims on dietary supplements carry a disclaimer stating that the claim has not been reviewed by FDA, and that the product is not intended to diagnose, treat, cure, or prevent any disease. Conventional foods are not required to carry such a disclaimer.

    So Beware of the claims that these supplements are good for Diabetes, to boost ones Immunity or other medical benefits because NONE are based on studies and no proofs exist that they work!

    In short DONT be FOOLED by claims that the product is FDA or BFAD APPROVED!!!

    __________________________________________________________________________________________________

    How to EAT and Lose Weight….

    October 27, 2008

    Go to fullsize imageMy previous posts have always been toward trying to help people lose weight.  I am one person following my own theories and they worked and are working up to now.  Here are the no-nonsense tips that I follow DAILY: 

    If you want to lose weight…

    • EAT,  But stop when you feel you’re already FULL and Leave the table at once. 
    • CHEW your food properly so it will take time for you to finish a meal and by the time you’re halfway through…you’re FULL! 
    • Avoid the visual stimulation of food… the longer you stay in the table, the more likely you’ll eat more!

    Then of course… you MOVE!

    A recent article publsihed in the British Medical Journal confirms these basic prinicples:

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    Participants 3287 adults (1122 men, 2165 women) aged 30-69 who participated in surveys on cardiovascular risk from 2003 to 2006.

    Main outcome measures Body mass index (overweight 25.0) and the dietary habits of eating until full (lifestyle questionnaire) and speed of eating (validated brief self administered questionnaire).

    Results 571 (50.9%) men and 1265 (58.4%) women self reported eating until full, and 523 (45.6%) men and 785 (36.3%) women self reported eating quickly. For both sexes the highest age adjusted mean values for height, weight, body mass index, and total energy intake were in the eating until full and eating quickly group compared with the not eating until full and not eating quickly group. The multivariable adjusted odds ratio of being overweight for eating until full was 2.00 (95% confidence interval 1.53 to 2.62) for men and 1.92 (1.53 to 2.40) for women and for eating quickly was 1.84 (1.42 to 2.38) for men and 2.09 (1.69 to 2.59) for women. The multivariable odds ratio of being overweight with both eating behaviours compared with neither was 3.13 (2.20 to 4.45) for men and 3.21 (2.41 to 4.29) for women.

    Conclusion Eating until full and eating quickly are associated with being overweight in Japanese men and women, and these eating behaviours combined may have a substantial impact on being overweight.

    ___________________________________________________________________________________________________________________ There you go…Simple tips and simple measures that will surely WORK for ALL!

    How To Be Active Without Trying….

    October 22, 2008

    Physical activity is part of the equation of fitness and weight maitenance. 

    “Easier said than done”, everyone knows it best that exercise is key to a healthy lifestyle.  Excuses to avoid feeling guilty continue to be part of what makes us believe that we just dont have enough time to exercise!  But new studies have been published that physical activity need not be a structured time frame that we should follow … rather any activity should be the norm to our day to day life.  In short…as long as one does not follow a sedentary lifestyle… one should be better off following an active lifestyle.

    Heres a new study Published in the journal Current Opinions in Endocrinology that proves nothing is better than just being active:

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    Purpose of review: To discuss the potential importance of spontaneous physical activity in regulating body weight and outline possible reasons for the large interindividual variance in spontaneous physical activity.

    Recent findings: Spontaneous physical activity is highly variable among people, with some having high levels and some low, and can contribute significantly to interindividual differences in total daily energy expenditure. Cross-sectionally, spontaneous physical activity is inversely related to body weight; however, more importantly, spontaneous physical activity is inversely associated with weight gain in prospective studies, and experimental weight perturbations do not appear to change spontaneous physical activity behavior. Spontaneous physical activity is a familial trait and is biologically influenced, although the environment exerts a significant impact.

    Summary: Although spontaneous physical activity is a biologically driven behavior, interventions to increase nonexercise activity within the workplace and school hold promise in increasing daily energy expenditure for the average sedentary American. However, many large-scale efforts will need to take place within our sedentary-promoting environment to encourage more daily spontaneous physical activity-related activity.

    _________________________________________________________________________________________________

    This new study tells us one thing: No more EXCUSES!!!!

    Any spontaneous movement or activity is better.  Even fidgety movements while sitting down working on your computer and other daily tasks that require activity is more than enough for the body to be healthy.  Any household chores and any walking to the workplace or the act of getting something are activities of daily living that can help with energy expenditure. These nonexercise activities should not be a problem for anyone to follow.  Meaning NO MORE EXCUSES!

    There you go… The best way to be active without really trying ( going to a gym) is to be more active in our day to day activities. Do it everyday and make it part of a habit and you’re on your way to healthier you!