Archive for the 'Personal Thoughts' Category

The Benefit of Smoking…. or Is There?

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

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

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

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

High Protein Diets and Health…..

October 6, 2008

I am always asked regarding the best diet to have to lose weight. People tend to adhere to diet fads for easy way out.  But studies after studies have shown that a fad will always fade and therefore will not have long term success.

High protein diets initially were received with overwhelming rejection by the medical community.  However, although it is hard to accept, the usual recommendation of healthy diets recommended by authorities never were popular because these diets never resulted in significant weight loss. Until the high protein diet came into full force.

A new study published in Current Opinions in Endocrinology, 2008 that looked at evidence regarding the benefits of high protein diet show that this diet really works albeit so far only on short term basis.  But coupled with other lifestyle changes and discipline, I bet this is the diet that will work well with diabetic and obese people trying to shed some pounds with a long term aim of beng able to maintain their weights.

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Abstract:
Purpose of review: High-protein diets, often with carbohydrate restriction, are quite popular among overweight Americans pursuing strategies for weight control. Recently, well designed clinical trials have evaluated the anthropometric and metabolic effects of these diets. This review focuses on the impact of high-protein diets on energy expenditure and satiety; the diets’ effects on weight loss, body composition, cardiovascular risk, and glycemic control; and potential detrimental consequences of high-protein intake.

Recent findings:

  • Current evidence indicates that protein-induced energy expenditure and satiety contribute to weight control.
  • Randomized, controlled trials continue to show comparable, if not superior, effects of high-protein diets compared with lower protein diets on weight loss, preservation of lean body mass, and improvement in several cardiovascular risk factors for up to 12 months.
  • Evidence that chronic high-protein intake affects glucose metabolism is inconclusive at present.
  • Further study of the long-term safety of diets with varying amounts of protein is warranted.

Summary:

On the basis of patients’ metabolic profiles and preferences, practitioners can recommend individualized, nutrient-rich diets within current nutritional guidelines for weight control.

Diets moderately increased in protein and modestly restricted in carbohydrate and fat, particularly saturated fat, may have beneficial effects on body weight, body composition, and associated metabolic parameters.

Key issues must be resolved regarding the long-term compliance and safety of chronic high-protein intake.

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This diet resulted in sigificant wieght loss which in turn resulted in significant improvements in cholesterol, blood sugar and reductions in markers of cardiovascular risk like CRP.  Cosmetic PLUS health: a bonus!

So, do I recommend this diet to my patients.  Acutally YES.  I have my own dietician and I specifically formulate the plan for my patients with specifics in terms of percent calories per food group. The choice of protein source however is important because one may have a high protein source but also high in saturated fat and therefore harmful to the body example is s Steak!!!!  I dont advocate a No carbohydrate meal with the high proetein diet because long term this will never work.

Then of course, any meal plan as long as there is discipline, determination to do lifestyle change and maintain the good habit of healthy choices and good clean living should result in more success than you think!

We’ll await more long term studies on high protein diets.  So far however as long as one is careful not to harm the kidneys further with a high protein load, one should be cautious in recommneding this diet to patients with renal or kidney disease.

A Better Weight BY Eating Right!

Socioeconomic Class And the Risk for Cancer….

September 29, 2008

We all know that disease affecting an elderly can differ from the young.  A new study highlights the impact of one socioeconomic status and the risk of common ailments that we dread of having: CANCER.

Here’s an interesting study opublished recently in the BMC-Cancer looking at how ones socioeconomic status can have an impact on ones risk to develop cancer:

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Background

Cancer incidence varies by socioeconomic group and these variations have been linked with environmental and lifestyle factors, differences in access to health care and health seeking behaviour. Socioeconomic variations in cancer incidence by region and age are less clearly understood but they are crucial for targeting prevention measures and health care commissioning.

Results

  • Incidence was highest for the most deprived patients for lung cancer and cervical cancer
  • the opposite was observed for malignant melanoma and breast cancer.
  • The difference in incidence between the most and the least deprived groups was higher for lung cancer patients aged under 65 at diagnosis than those over 65 at diagnosis, which may indicate a cohort effect. 
  •  If the incidence of lung and cervical cancer were decreased to that of the least deprived group it would prevent 36% of lung cancer cases in men, 38% of lung cancer cases in women and 28% of cervical cancer cases.
  • Incidence of breast cancer and melanoma was highest in the least deprived group

Conclusions

National comparison of socioeconomic variations in cancer incidence by region and age can provide an unbiased basis for public health prevention and health commissioning. Decreasing inequalities in incidence requires the integration of information on risk factors, incidence and projected incidence but targeted public health interventions could help to reduce regional inequalities in incidence and reduce the future cancer burden.

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The way we live and the way we practice how we live definitely can have an impact on what diseases will affect our bodies. Breast cancer is noted to be predominant among the wealthy obviously because for me, these people tend to more vigilant in doing yearly exams but more so because they tend to behave not very well in terms of lifetstyle.  I have heard news from relatives to friends who developed breast cancer.

 Look around you and you will see obese women with their obese siblings.  Culture tells us that being a little fat is better and “culturally” better than thin because the “fatness conotes a happy marriage! WHEW! I absolutely DIASGREE! 🙂  and am sure a lot of you are!  I am happily married with three kids BUT I keep it a point to be careful with what I eat including my wife and kids MAKING sure we will not be one of th tagged “obese family” that will increase our chances of getting obesity related diseases like cancer.

Being obese will increase your chances of having a higher circulating estrogen which can increase ones chances to develop breast cancer.  So by keeping oneself fit and avoiding red meat can one improve to lower that risk.

What You Can Afford Does Not Mean It is Healthy!

Massage and Mood…

September 22, 2008

Go to fullsize imageIve long believe in massage and touch therapy to help alleviate pts of anxiety, hyperactivity and mood.  I go to massage 2 x every week to relax and be pampered after a long day’s hard work.  It de- stresses me as well as improve my mood for work the next day.

Now comes a study published in the Annals of Internal Medicine that fully supports my belief in massage.  Although the study is not conclusive that massage is superior to light touch… the feeling of relaxation and pampering oneself is more than worth the time to do it.

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Objective: To evaluate the efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer.

Patients: 380 adults with advanced cancer who were experiencing moderate-to-severe pain; 90% were enrolled in hospice.

Intervention: Six 30-minute massage or simple-touch sessions over 2 weeks.

Measurements: Primary outcomes were immediate (Memorial Pain Assessment Card, 0- to 10-point scale) and sustained (Brief Pain Inventory [BPI], 0- to 10-point scale) change in pain. Secondary outcomes were immediate change in mood (Memorial Pain Assessment Card) and sustained change in quality of life (McGill Quality of Life Questionnaire, 0- to 10-point scale), symptom distress (Memorial Symptom Assessment Scale, 0- to 4-point scale),

Results: 298 persons were included in the immediate outcome analysis and 348 in the sustained outcome analysis. A total of 82 persons did not receive any allocated study treatments (37 massage patients, 45 control participants).

  • Both groups demonstrated immediate improvement in pain (massage, –1.87 points [95% CI, –2.07 to –1.67 points]; control, –0.97 point [CI, –1.18 to –0.76 points]) and mood (massage, 1.58 points [CI, 1.40 to 1.76 points]; control, 0.97 point [CI, 0.78 to 1.16 points]).
  • Massage was superior for both immediate pain and mood (mean difference, 0.90 and 0.61 points, respectively; P < 0.001).

Conclusion: Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study groups, the potential benefits of attention and simple touch should also be considered in this patient population.

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This simple study is worth looking into.  Although the study only involved cancer patients but the implication of the study results can be applied to every patient that we see or be advised to those with chronic illness beyond their usual therapies.

Simple touch to patients can definitely offer hope, relief and comfort.  This is what I learned at the Mayo Clinic.  Bedside skills involving interaction with patients through touch were as important as the skill of a surgeon or the bright minds of the internists.  How much more with a soothing massage… whew!  I cant wait to get one while composing this post 🙂

In Bad Mood? or Feeling sick and getting Depressed? or Maybe from too much pressure from work?

Massage To The Rescue!

We All Deserve A BREAK!!!!

September 18, 2008

I just came back from a very relaxing Mediterranean Cruise with my wife. It was a well deserved break for both of us and boy do I recommend everyone who has a chance to get a cruise for vacation.

Taking a break gives you a better outlook in life… a better understanding of the need to enjoy while we are still alive! We all deserve to relax and enjoy and have a break in between the hard work.  I hate those trips where you need to take a break after your vacation because you were so exhausted with the vacation you had!!!  Cant see the logic there.

The cruise took us to Barcelona then to Malta then to Naples where we had a chance to visit Pompei, Capri and Sorrento.  Then we proceeded to Rome then to Florence then finally to Nice where we had a visit to Monacco.  What made the trip so fun is the fact that one does not need to pack and unpack everytime you visit a place.  You can relax and enjoy the facilities especially the gym of the ship at your own convenient time.

The downside however for me is the FOOD!  It was just everywhere and anytime plus it was always a Buffet from breakfast to lunch to dinner!  It was not a happpy site for me to see people gorging for food even if they dont need to.  A sad fact of life!

We need a Break BUT be sure you do it to maintain your health both “emotional” and physical Health!  If you neglect the right way to proper nutrition then you are doing harm even for the duration of the trip and for me it is no excuse!

This is our third cruise together and I will continue to endorse a Cruise as the right way to enjoy a vacation where you can have both fun and relsxation at their peak! But enjoy it the right way!

Take a Break for Health But Dont Break It By Indulging the Unhealthy Way!

How To Reduce Your Risk To Develop DIABETES….

September 1, 2008

If you have a family history of diabetes, if you are overweight and sedentary  and wants to reduce your risk to develop diabetes, then this article is for you!

This new study was recently published in the Archives of Internal Medicine and as far as I know is the first one that conclusively looked at how fruits and vegtables can alter the risk of a patient to develop this chronic disease called diabetes.

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Methods  We administered a semiquantitative food frequency questionnaire to men and women from a population-based prospective cohort (European Prospective Investigation of Cancer–Norfolk) study who were aged 40 to 75 years at baseline (1993-1997) when plasma vitamin C level was determined and habitual intake of fruit and vegetables was assessed. During 12 years of follow-up between February 1993 and the end of December 2005, 735 clinically incident cases of diabetes were identified among 21 831 healthy individuals. We report the odds ratios of diabetes associated with sex-specific quintiles of fruit and vegetable intake and of plasma vitamin C levels.

Results 

  • A strong inverse association was found between plasma vitamin C level and diabetes risk.
  • The odds ratio of diabetes in the top quintile of plasma vitamin C was 0.38 (95% confidence interval, 0.28-0.52) in a model adjusted for demographic, lifestyle, and anthropometric variables.
  • In a similarly adjusted model, the odds ratio of diabetes in the top quintile of fruit and vegetable consumption was 0.78 (95% confidence interval, 0.60-1.00).

Conclusions  Higher plasma vitamin C level and, to a lesser degree, fruit and vegetable intake were associated with a substantially decreased risk of diabetes. Our findings highlight a potentially important public health message on the benefits of a diet rich in fruit and vegetables for the prevention of diabetes.

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A word of caution from this study is that the plasma Vitamin C level correlated with the intake of fruits and vegetables and NOT Vitamin C Supplements.  Therefore do not grab all the Vitamin C supplements in the shelves to boost up your levels.  It is believed that beyond Vitamin C, there are properties in fruits and vegetables that help patients reduce their risk to develop diabetes.

As fas a I know, this is the first conclusive evidence that looked objectively at the effect of fruit and vegetable intake and the risk of diabetes.  And a reduction of diabetes risk by 62% is a great bonus to those who love fruits and vegetables on top of the other benefits associated with their intake.

So Eat Vegetables everyday and every meal… take fruits after each meal and you can even enjoy an apple or pear for snacks. Chances are… the more you eat the better the risk reduction.  Again…go for the low glycemic index fruits like apple and pear instead of a mango, banana or pineapple!

Love Yourself By Eating Right!

Vitamin D and The Risk of Death….

August 22, 2008

While reviewing my journals…I again came across another study on Vitamin D but this time relating this vitamin to mortality or the risk of death in the general population.  This study was published in the Archives of Internal Medicine, August 15, 2008 issue.

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Background  In patients undergoing dialysis, therapy with calcitriol or paricalcitol or other vitamin D agents is associated with reduced mortality. Observational data suggests that low 25-hydroxyvitamin D levels (25[OH]D) are associated with diabetes mellitus, hypertension, and cancers. However, whether low serum 25(OH)D levels are associated with mortality in the general population is unknown.

Methods  We tested the association of low 25(OH)D levels with all-cause, cancer, and cardiovascular disease (CVD) mortality in 13 331 nationally representative adults 20 years or older from the Third National Health and Nutrition Examination Survey (NHANES III) linked mortality files. Participant vitamin D levels were collected from 1988 through 1994, and individuals were passively followed for mortality through 2000.

Results 

  •  In cross-sectional multivariate analyses, increasing age, female sex, nonwhite race/ethnicity, diabetes, current smoking, and higher body mass index were all independently associated with higher odds of 25(OH)D deficiency (lowest quartile of 25(OH)D level, <17.8 ng/mL
  • while greater physical activity, vitamin D supplementation, and nonwinter season were inversely associated.
  • During a median 8.7 years of follow-up, there were 1806 deaths, including 777 from CVD.  compared with the highest quartile, being in the lowest quartile (25[OH]D levels <17.8 ng/mL) was associated with a 26% increased rate of all-cause mortality (mortality rate ratio, 1.26; 95% CI, 1.08-1.46) and a population attributable risk of 3.1%.
  • The adjusted models of CVD and cancer mortality revealed a higher risk, which was not statistically significant.

Conclusion  The lowest quartile of 25(OH)D level (<17.8 ng/mL) is independently associated with all-cause mortality in the general population.

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Another reason for us to check our Vitamin D level.  All along I am right.  I have been a proponent of the wonders of Vitamin D and the perils of what Vitamin D Deficiency can do.

The best way again for us to avoid getting the lowest Vitamin D level is to eat foods rich in Vitamin D and to enjoy the sun as much as we can! The flesh of fish such as salmon, tuna, and mackerel aa well as fish liver oils are among the best sources of Vitamin D that we can get naturally.  I would not recommend supplements if we can avoid them.

Live Long… Enjoy the SUN!

Vitamin D and Your Risk To Fracture….

August 20, 2008

Go to fullsize imageVitamin D is a neglected vitamin.  I always consider it as one of those vitamins that have powerful effects on the body but has never got the attention fo the media. 

Through this website, I have been harping on the benefits of Vitamin D and the problems associated with subtle vitamin D Deficiency.

I recently had one patient who suffered from severe muskuloskeletal weakness that the neurologist was already doing a battery of tests but no diagnosis was given. When her vitamin D was checked..it was extremely low and with supplementation of Vitamin D, she eventually recovered in 1-2 months. The neurologist discounted the effect saying she is living in a hot tropical country with plenty of sun and therefore he doubts that she is vitamin D deficient.  Unknowingly to everyone… people in our country hide from the sun… they bring umbrellas during sunny days… they avoid the sun because it can cause wrinkles and freckles.  My patient was no exception!!!

Now comes a new study linking Vitamin D Deficiency to fractures….publsihed in the Annals of Internal Medicine August issue…

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Participants: 400 case-patients with incident hip fracture and 400 control participants matched on the basis of age, race or ethnicity, and date of blood draw. Both groups were selected from 39 795 postmenopausal women who were not using estrogens or other bone-active therapies and who had not had a previous hip fracture.

Measurements: Serum 25(OH) vitamin D was measured and patients were followed for a median of 7.1 years (range, 0.7 to 9.3 years) to assess fractures.

Results: Mean serum 25(OH) vitamin D concentrations were lower in case-patients than in control participants (55.95 nmol/L [SD, 20.28] vs. 59.60 nmol/L [SD, 18.05]; P = 0.007), and

  • lower serum 25(OH) vitamin D concentrations increased hip fracture risk (adjusted odds ratio for each 25-nmol/L decrease, 1.33 [95% CI, 1.06 to 1.68]).
  • Women with the lowest 25(OH) vitamin D concentrations (47.5 nmol/L) had a higher fracture risk than did those with the highest concentrations (70.7 nmol/L) (adjusted odds ratio, 1.71 [CI, 1.05 to 2.79]), and
  • the risk increased statistically significantly across quartiles of serum 25(OH) vitamin D concentration (P for trend = 0.016).
  • This association was independent of number of falls, physical function, frailty, renal function, and sex-steroid hormone levels and seemed to be partially mediated by bone resorption.

Limitations: Few case-patients were nonwhite women. Bone mineral density and parathyroid hormone levels were not accounted for in the analysis.

Conclusion: Low serum 25(OH) vitamin D concentrations are associated with a higher risk for hip fracture.

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This study for me is very important.  For one, we know that Vitamin D supplementation has always been part of the cocktail of meds a patient with osteoporosis have to take.  But this is one study that looked at Vitamin D deficiency and the risk to fracture.  The results clearly show a relationship!

My take home message for this is that…dont assume a patient to be Vitamin D replete just because she is living in the tropics. Again one reason why this vitamin is a neglected vitamin not only in terms of preventing a disease but also in its relationship to causing a disease. 

Getting Vitamin D level is an easy blood test and if found deficient, Vitamin D replacement can have a tremendous impact in terms of how the patient feels in terms of improving his/her quality of life and how it can prevent diseases like a fracture!

The best way to prevent Vitamin D Deficiency is to enjoy the SUN …the morning sun at least 10-15 min daily while goign to work or doing your daily exercise.  Or just leisurely sun bathing with a book to read!

It’s About Time We Take Respect and Enjoy The SUN!

A Very Successful AACE Convention in Cebu!!!!

August 19, 2008

Go to fullsize imageAs host to the recent Annual Convention of Clinical Endocrinologist- Philippine Chapter, it was really a very rewarding and a learning experience for me as all the efforts were visibly rewarded by the number of delegates we had: a total of 575 doctors and the great feedback we received from excellent to fulfilling!!!

The doctors really enjoyed the sessions as topics were carefully selected including our speakers with a total of 9 foreign speakers.  This included my mentor from the Mayo Clinic DR Hossein Gharib who is presently the President of the American College of Endocrinology, as our keynote lecturer. 

The society headed by our energetic president Dr George Tan made sure that the venue to the session hall to the details of the exhibit were all planned out!

So guys… this is the reason why Ive been out of new posts for the past few days… Bear with me as I will be updating this site again on a regular basis. 

Only two reasons for not coming out with regular posts: am out of the country attending a convention OR am busy preparing for a talk or a covention like this one held last August 14 to 18 in Mactan Shangrila.

Will be posting photos for everyone to see soon…

Again thanks to all our friends on the pharmaceutical who were so busy transporting doctors in and out of the venue.  And to the MRC and PCOC guys who made the event very succesfull and kudos to my good friend Ike Amor whose expertise in video clips and presentations made the event at par with foreign conventions…

Cheers to AACE: It was a Team Effort At Its BEST!

Watermelon Can Boost Your Sexual Function… How True?

August 11, 2008

Go to fullsize imageI saw the news: Watermelon as the Natural Viagra..how true? 

The study where this headline was taken from was published recently in the Journal NUTRITION and really is an eye opener for those who have problems with sexual function.  The question is…will the results translate to actual outcome?

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Methods

Subjects (n = 12–23/treatment) consumed a controlled diet and 0 (control), 780, or 1560 g of watermelon juice per day for 3 wk in a crossover design. The treatments provided 1 and 2 g of citrulline per day. Treatment periods were preceded by washout periods of 2 to 4 wk.

Results

Compared with the baseline, fasting plasma arginine concentrations increased 12% after 3 wk of the lower-dose watermelon treatment; arginine and ornithine concentrations increased 22% and 18%, respectively, after 3 wk of the higher-dose watermelon treatment. Fasting citrulline concentrations did not increase relative to the control but remained stable throughout the study.

Conclusion

The increased fasting plasma concentrations of arginine and ornithine and stable concentrations of plasma citrulline in response to watermelon juice consumption indicated that the citrulline from this plant origin was effectively converted into arginine. These results demonstrate that plasma concentration of arginine can be increased through intake of citrulline from watermelon.

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The only association with viagra is the fact that watermelon is rich in a substance called citrulline know to have dilating effects on the vessel as the study implies.  This amino acid citrulline is actually converted into arginine which is a precursor for nitric oxide that helps blood vessel dilate!  In theory…it looks good but how about in actual practice?

SO…before we grab all the watermelons in the market, it is very important for us to understand that no study as of now has been done to confirm if indeed intake of watermelon can improve erection!!!!  And likewise nobody knows how much watermelon we need to take to achieve the effect!!!! Probabaly tons of watermelon before enough arginine can be made to cause an effect!

So to say that watermelon is a natural viagra is a doubtful claim. And definitely needs more studies if ever any study will be done.  Remember, arginine deficiency is not the sole cause of erectile dysfunction but rather it is more complicated than that! 

I love watermelon…if indeed it can help me in my other needs…the better!!!! It’s a PLUS!

 

Can Coffee Increase Your Lifespan?

August 4, 2008

I am a coffee drinker.  I usually have a cup of coffee everyday and nothing more.  Except on occasions where I take another cup in the afternoon but usually I average only 5-7 cups per week.  I’ve written about the many benefits of coffee in this website and in the newpapers…and seems like more benefits are being known the more we know about coffee.

Now comes a recently published article on coffee and mortality published in the Annals of Internal Medicine, June of 2008: the official journal of the American College of Physicians.

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Design: to investigate the association between coffee consumption and incidence of all-cause and disease-specific mortality in a prospective cohort study.

Setting: Health Professionals Follow-up Study and Nurses’ Health Study: 41 736 men and 86 214 women with no history of CVD or cancer at baseline.

Results: After adjustment for age, smoking, and other CVD and cancer risk factors, the relative risks for all-cause mortality in men across categories of coffee consumption (<1 cup per month, 1 cup per month to 4 cups per week, 5 to 7 cups per week, 2 to 3 cups per day, 4 to 5 cups per day, and 6 cups per day) were 1.0, 1.07 (95% CI, 0.99 to 1.16), 1.02 (CI, 0.95 to 1.11), 0.97 (CI, 0.89 to 1.05), 0.93 (CI, 0.81 to 1.07), and 0.80 (CI, 0.62 to 1.04), respectively (P for trend = 0.008). For women, the relative risks were 1.0, 0.98 (CI, 0.91 to 1.05), 0.93 (CI, 0.87 to 0.98), 0.82 (CI, 0.77 to 0.87), 0.74 (CI, 0.68 to 0.81), and 0.83 (CI, 0.73 to 0.95), respectively (P for trend < 0.001). This inverse association was mainly due to a moderately reduced risk for CVD mortality and was independent of caffeine intake.

By contrast, coffee consumption was not statistically significantly associated with risk for cancer death after adjustment for potential confounders.

Decaffeinated coffee consumption was associated with a small reduction in all-cause and CVD mortality.

Conclusion: Regular coffee consumption was not associated with an increased mortality rate in either men or women. The possibility of a modest benefit of coffee consumption on all-cause and CVD mortality needs to be further investigated.

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To further summarize the data in layman’s terms:

  • This study shows that increasing consumption of coffee was associated with decreasing mortality or death.  
  • People who drank at least 5 -7 cups of coffee per week had a significantly LOWER overall risk of dying from any cause. 
  • People who drank 4-5 cups per day or more had the strongest protection.

What was interesting also in the study was that among women who were coffee drinkers, most reduction in death was due to a reduction in cardiovascular disease. What I like most in coffee are the studies showing its frequent consumption to result in a reduction albeit small, in the risk of diabetes.

Is Regular better than Decaf?  Well, In the study, whether people drank regular or decaffeinated coffee, benefits were noted, suggesting that the one product present in coffee that results in health benefits maybe its high levels of polyphenols  known to reduce inflammation and also known to provide other positive effects on the heart, blood vessels, and blood sugar.

What more can you ask?

I will continue to enjoy my coffee everyday whatever benefits they give me is already a PLUS!!!!

A Hearty Breakfast Equals Weight Loss?

July 10, 2008

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

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

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

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

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

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

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

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

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

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

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

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

For now…

Eat Your Breakfast To Help You Lose Weight!

How to Prevent Erectile Dysfunction….

July 7, 2008

One of the many aspects in life that we desire is to be happy in all areas of our daily activities…and that includes nighttime responsibilities of a husband to the partner! And what comes worst is the problem of impotence or erectile dysfunction due to medical diseases like diabetes or non medical like psychological in nature…being the most common cause.

Now comes a very interesting piece of information for all of us! This study on how we can prevent the problem of poor sex life due to erection problems was recently published in the American Journal of Medicine, July 2008.

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Background

Erectile dysfunction is common among men aged more than 60 years. Its cause involves both physiologic and psychosocial factors.

Methods

Data were analyzed from a population-based 5-year follow-up study that was conducted in Pirkanmaa, Finland, using postal questionnaires. The study sample consisted of 989 men aged 55 to 75 years (mean 59.2 years).

The most common comorbidities were hypertension (32%), heart disease (12%), depression (7%), diabetes (4%,) and cerebrovascular disorder (4%).

Results

The overall incidence of moderate or complete erectile dysfunction was 32 cases per 1000 person-years (95% confidence interval [CI], 27-38). After adjustment for comorbidity and other major risk factors:

  1. men reporting intercourse less than once per week at baseline had twice the incidence of erectile dysfunction compared with those reporting intercourse once per week (79 vs 33/1000, incidence rate ratio 2.2, 95% CI, 1.3-3.8).
  2. The risk of erectile dysfunction was inversely related to the frequency of intercourse.
  3. No relationship between morning erections and incidence of moderate or severe erectile dysfunction was found.

Conclusion

Regular intercourse protects against the development of erectile dysfunction among men aged 55 to 75 years.

This may have an impact on general health and quality of life; therefore, doctors should support patients’ sexual activity.

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Yes…I fully support my patients sexual activity because I know it is a very important cause of depression among my diabetic patients. In fact this is one of the reasons why I am very aggressive in treating my diabetic patients especially if they are also hypertensives because I want them to preserve the fun of sex and avoid the problem of impotence later in life.

So doing it more frequently is the way to go!!!!  What a fun way to prevent a disease… the more the better…

Enjoy Life…Have More …The Better!

An Aspirin A Day Can Keep BP At Bay…

June 24, 2008

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

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

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

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

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

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

Another Wonderful News on Aspirin and Health!

Tips For The Insomniacs….

June 11, 2008

One of the common complaints I get from my patients is the inability to sleep.  It may seem so simple but if you are an insomniac, trying to sleep can be a torture.  We all know sleep debt makes us feel weak and sluggish.  But what is not known is that sleep debt can lead to chronic illnesses like an increased risk to develop diabetes and heart disease.

So what should an insomniac do?

Here are some simple tips from the Harvard Health Letter…

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 Changing your behavior, rather than medication, may be the first step to a better night’s sleep. And surprisingly, for chronic insomnia, the best treatment may be to cut back on the time you spend trying to sleep.

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People with insomnia often find that spending less time in bed promotes more restful sleep and helps make the bedroom a welcome sight instead of a torture chamber. As you learn to fall asleep quickly and sleep soundly, the time in bed is slowly extended until you obtain a full night’s sleep.

Some sleep experts suggest starting with five or six hours at first, or whatever amount of time you typically sleep at night. Setting a rigid early morning waking time often works best. If the alarm is set for 7 a.m., a five-hour restriction means that no matter how sleepy you are, you must stay awake until 2 a.m. Once you are sleeping well during the allotted five hours, you can add another 15 or 30 minutes, then repeat the process until you’re getting a healthy amount of sleep.

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Hope this simple formula can work well for you.  If we can do this without any dependence to medications, the better. 

Lastly…Dont go to bed if you’re not sleepy! Dont watch TV! Read a book instead on a dim lighted area favorably with a yellow light! Asscociate your bed with sleep.  Enjoy every minute of your time with your bed.  Dont think of it as a torture chamber!  Just hug your pillow and think about how nice it is to sleep.  Dont think otherwise or you will really find yourself wondering… why you’re still awake and the more you think about it…. the more you will feel frustrated about not going to sleep.

Good Sleep Keeps You Fit!

Quick Steps To Achieve Healthy Weight…

June 6, 2008

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

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

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

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

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

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

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

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Simple common sense tips for healthy living as well…

Live Life To The Fullest…By Living Healhty!

The Many Benefits of Mediterranean Diet

June 4, 2008

What is Mediterranean Diet?

The common Mediterranean dietary pattern has these characteristics according to the American Heart Association :

  • high consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
  • olive oil is an important monounsaturated fat source
  • dairy products, fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
  • eggs are consumed zero to four times a week
  • wine is consumed in low to moderate amounts

The diet simply put focuses more on our consumption of olive oil, vegetables, fruits, nuts ( my post on Going nuts on Nuts) , cereals, legumes and fish ( my post on the Benefits of Eating fish)  and avoiding the well liked and “unhealthy meat and “saturated fat loaded” dairy products.

The many touted benefits of this diet has long been known in the medical field.  In fact major organizations have patterned their recommended healthy diets on the contents of the mediterranean diet.  Why?  Because… Many epidimeological studies have shown that the incidence of heart disease in Mediterranean countries is lower than in the United States where meat and saturated fat is a plenty!!!!.  In fact in those studies, where people practice the Mediterranean diet, mortality rates or the risk of death were also significantly lower!!!!

In a recent article published in the May 30 online of BMJ, Mediterranean diet has been shown to lower the risk of developing diabetes.  Another PLUS to this otherwise healthy alternative way of eating….

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Participants who adhered closely to a Mediterranean diet had a lower risk of diabetes. The incidence rate ratios adjusted for sex and age were 0.41 (95% confidence interval 0.19 to 0.87) for those with moderate adherence (score 3-6) and 0.17 (0.04 to 0.75) for those with the highest adherence (score 7-9) compared with those with low adherence (score <3). In the fully adjusted analyses the results were similar.

A two point increase in the score was associated with a 35% relative reduction in the risk of diabetes (incidence rate ratio 0.65, 0.44 to 0.95), with a significant inverse linear trend (P=0.04) in the multivariate analysis.

Conclusion Adherence to a Mediterranean diet is associated with a reduced risk of diabetes.

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In this study, during an average of 4 years of follow-up, the researches found that found that people who adhered to a Mediterranean diet very closely had a lower risk of developing type 2 diabetes. and their risk were reduced by 83 percent.

It is however very important to emphasize that major health benefits may not be entirely due to the diet alone.  A healthy diet should always partner with healthy lifestyle including more physical activity.  All these require no shortcut but plain discipline!

A Healthy Diet For More Wealth!

The Wonders of Vitamin D…

May 28, 2008

Vitamin D has been a negelcted Vitamin for several centuries.  People are so mystified by Vitamin E and Vitamin C that almost always every patient that I encounter is either on E or C as vitamin supplements.  But recent data have shown that one Vitamin that stand out among the rest in terms of preventing illnesses is Vitamin D.

A new study that looked at how important Viatmin D in terms of it causing muscle pain was recently published. It looked at how deficiency of Vitamin D may play a big role in causing this chronic complaints among the elderly population. This study published in the American Journal of Geriatrics in May 2008 involved Nine hundred fifty-eight persons (aged ≥65) selected from city registries of Greve and Bagno a Ripoli.

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Lower concentrations of 25(OH)D are associated with significant back pain in older women but not men. Because vitamin D deficiency and chronic pain are fairly prevalent in older adults, these findings suggest it may be worthwhile to query older adults about their pain and screen older women with significant back pain for vitamin D deficiency.

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The main function of Vitamin D is in helping maintain a normal calcium level in the blood which is important for bone strength.  It aids in the absorption of calcium from the gut and can provide protection from osteoporosis as well as other chronic illnesses like hypertension (high blood pressure), cancer, and others.

Some health benefits of Vitamin D although will need more studies to fully prove its worth include for:

  •  Diabetes where Vitamin D has been shown to improve insulin sensitivity; 
  •  Colon cancer where a Metaanalysis showed VitaminD supplementation decreased the risk
  •  Multiple Sclerosis
  •  Prostate cancer where a reduction in risk was noted with higher Vitamin D Intake among others….

So how can we get enough Vitamin D?

Exposure to the morning sun for 10 to 15 minutes should provide you enough Vtamin D.  Other food sources include fish like salmon and tuna , egg yolk, cheese, fortified milk including yogurt, and cod liver oil.  It is best to check your Vitamin D level to determine if you are deficient or not.  There are many supplements of Vitamin D available in the market and it is best to discuss which is best for you with your doctor.

Soy Protein and The Heart….

May 26, 2008

Go to fullsize imageThere are many conflicting data on soy protein and the heart especially the claim that they lower cholesterol.  In fact in 1999 based on studies during that time, the US FDA allowed a health claim on food labels stating that a daily diet containing 25 grams of soy protein, also low in saturated fat and cholesterol, may reduce the risk of heart disease. 

However, the American Heart association in January of 2006 made a review of available data and made a conclusion that soy protein in itself did not significantly lower the bad cholestrol nor did it have any significant effect in increasing the good cholesterol.

But as an endocrinologist looking for alternative source of meat protein, the use of soy protein in place of meat which has high staurated fat will continue to play a major role in our attempt to reduce the risk of our patients from cardiovascular disease.

Recently a new article on the benefit of soy protein came out in Annals of Internal Medicine.  This study is so relevant to my practice especially among diabetic patients with kidney disease.  These are the patients we try to avoid taking meat protein because of the possibility of causing kidney function deterioration.  The study did not only show a good effect in sugar control but also markers of inflammation suggesting a potential effect in reducing cardiovascular disease plus improving markers of kidney function.

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Soy protein consumption significantly affected cardiovascular risks such as fasting plasma glucose , total cholesterol , LDL cholesterol, and serum triglyceride concentrations.

Serum CRP levels were significantly decreased by soy protein intake compared with those in the control group .

Significant improvements were also seen in proteinuria  and urinary creatinine ( both measures od kidney function) by consumption of soy protein.

CONCLUSIONS—Longitudinal soy protein consumption significantly affected cardiovascular risk factors and kidney-related biomarkers among type 2 diabetic patients with nephropathy.

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Here is a list of the common sources of soy protein that we can enjoy includes: Tofu, soymilk, soyflour. Tempeh and Miso.  The soymilk and textured soy protein can be used as subsitute for meat or cows milk while the soyflour can be used in baking needs.

I believe in the benefits of soy protein.  I hope for more studies to come that will provide us with more data on its beneifts and potential to reduce disease risk especially the Heart!

Soy Protein: A Better Partner for the Heart!

Having High Sugar and High Blood Pressure Can be Deadly…

May 23, 2008

Go to fullsize imageAlmost always a patient that suffers from diabetes is obese, have high triglycerides and low HDL and develops high blood pressure and high cholesterol… the combination of which is called the Metabolic syndrome.  If any of these conditions are not addressed then ones risk to suffer from chronic complication like heart disease is increased.  Whether the sum of the components or the combination of two parts or only one component is present makes a patient more at risk to die is not well documented.

The new study published in Annals of Internal Medicine May 2008 now shows that having two parts increases the risk to die more than having the combination for the components of the syndrome itself….

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  1. After multivariable adjustment, compared with persons without MetS, those with MetS had a 22% higher mortality .
  2. Higher risk with MetS was confined to persons having elevated fasting glucose level  or treated diabetes mellitus or hypertension as one of the criteria;
  3. Persons having MetS without High Fasting Glucose or MetS without hypertension did not have higher risk.
  4. Evaluating MetS criteria individually, we found that only hypertension and EFG predicted higher mortality;
  5. Persons having both hypertension and Elevated Fasting Glucose had 82% higher mortality .
  6. Substantially higher proportions of deaths were attributable to EFG and hypertension (population attributable risk fraction [PAR%], 22.2%) than to MetS (PAR%, 6.3%).

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There you go my friends…just having diabetes or hypertension makes one at higher risk to die from heart disease.  More so if high blood sugar is joined by high blood pressure then the risk to die is 82%!!!!

The above study therefore tells us that making a diagnosis of metabolic syndrome does not entail more risk to die than having just diabetes of hypertension alone.  Such that… it’s utility as a diagnosis and as a risk factor for cardiovascular mortality is put in question. 

So friends…please dont take these two conditions lightly!!! As an endocrinologist, I take these conditions seriously and that all patients with Diabetes are screened for blood pressure and cholesterol abnormalities and vice versa! 

To summarize the study:

Having High Sugar especially if with High Blood Pressure Can Be DEADLY!