Archive for the 'The Diabetes Facts' Category

High Blood Sugar Predicts Death in Heart Attack Patients

February 26, 2009

Just a note for all of the readers with family members who are diabetics.  This is just to make you aware that control of sugar is of paramount importance even at the time of hospitalization especially due to heart attack.

This new study published in Archives of Internal Medicine, Feb 2009 shows that the relationship between fasting blood sugar on admission and its ability to predict outcome of death within 6 months of the acute attack.

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Background  Elevated blood glucose level at admission is associated with worse outcome after a myocardial infarction. The impact of elevated glucose level, particularly fasting glucose, is less certain in non–ST-segment elevation acute coronary syndromes. We studied the relationship between elevated fasting blood glucose levels and outcome across the spectrum of ST-segment elevation and non–ST-segment elevation acute coronary syndromes in a large multicenter population broadly representative of clinical practice.

Methods  Fasting glucose levels were available for 13 526 patients in the Global Registry of Acute Coronary Events. A multivariate logistic regression analysis was used for assessing the association between admission or fasting glucose level and in-hospital or 6-month outcome, adjusted for the variables from the registry risk scores.

Results 

  • Higher fasting glucose levels were associated with a graded increase in the risk of in-hospital death (odds ratios [95% confidence intervals] vs <100 mg/dL: 1.51 [1.12-2.04] for 100-125 mg/dL, 2.20 [1.64-2.60] for 126-199 mg/dL, 5.11 [3.52-7.43] for 200-299 mg/dL, and 8.00 [4.76-13.5] for 300 mg/dL).
  • When taken as a continuous variable, higher fasting glucose level was related to a higher probability of in-hospital death, without detectable threshold and irrespective of whether patients had a history of diabetes mellitus.
  • Higher fasting glucose levels were found to be associated with a higher risk of postdischarge death up to 6 months.
  • The risk of postdischarge death at 6 months was significantly higher with fasting glucose levels between 126 and 199 mg/dL (1.71 [1.25-2.34]) and 300 mg/dL or greater (2.93 [1.33-6.43]), but not within the 200- to 299-mg/dL range (1.08 [0.60-1.95]).

Conclusions  Short-term and 6-month mortality was increased significantly with higher fasting glucose levels in patients across the spectrum of acute coronary syndromes, thus extending this relation to patients with non–ST-segment elevation myocardial infarction. The relation between fasting glucose level and risk of adverse short-term outcomes is graded across different glucose levels with no detectable threshold for diabetic or nondiabetic patients.

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Better still…. across the spectrum of diabetes management that good control should always be practiced.  

No ifs or buts…its the RULE!

Reduction in short term complications, the sense of well being…plus reduction of long term complications like stroke and heart attack…are more than enough for any diabetic in the family to make sure that good control should always be practiced.  

Ths study tells us that up to the time of the acute event, high sugar continues to present itself as a menace.  And that high sugar should not be relegated as a mere stress effect but for me should be aggressively treateed as metabolic effects can have lasting impact on ones health and are irreversible!

Be aggressive as high sugar may not manifest any symptoms until its late!

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Another Reason to Follow the Low Carb Diet… Your Blood Sugar!

January 19, 2009

Go to fullsize imageFinally a study that looked at the practice of using low carbohydarte diet for our diabetics in helping control their blood glucoses was recently published in Nutrition and Metabolism journal.  Everytime I give a lecture on Nutritional therapy the question of my practice in lowering the total carbohydrate content of the calorie intake is the central issue.  This study is one proof that the concept of limiting the carbs can do wonders to ones blood sugar!

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Objective

Dietary carbohydrate is the major determinant of postprandial glucose levels, and several clinical studies have shown that low-carbohydrate diets improve glycemic control. In this study, we tested the hypothesis that a diet lower in carbohydrate would lead to greater improvement in glycemic control over a 24-week period in patients with obesity and type 2 diabetes mellitus. Research design and methods: Eighty-four community volunteers with obesity and type 2 diabetes were randomized to either a low-carbohydrate, ketogenic diet (<20 g of carbohydrate daily; LCKD) or a low-glycemic, reduced-calorie diet (500 kcal/day deficit from weight maintenance diet; LGID). Both groups received group meetings, nutritional supplementation, and an exercise recommendation. The main outcome was glycemic control, measured by hemoglobin A1c.

Results

Forty-nine (58.3%) participants completed the study. Both interventions led to improvements in hemoglobin A1c, fasting glucose, fasting insulin, and weight loss. The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p=0.03), body weight (-11.1 kg vs. -6.9 kg, p=0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p<0.001) compared to the LGID group. Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p<0.01).

Conclusions

Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes. The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.

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What is amazing of the results is that by following a low carb diet, diabetes medications were reduced or eliminated in 95 percent and likewise resulted in a greater weight loss.  We also know that by losing weight, patient becomes more insulin sensitive and therefore contributes further to improvements in metabolic profile. These are the two effects that we like whether we employ diet or medication to any patient we assessed to have a disease of the lifestyle. 

Is this nutritional therapy easy to do? 

Definitely not BUT its the determination to succeed and be treated without medication that can drive our patients to follow the regimen.  Just like any regimen involving FOOD… our vigilance to do what is healthy is more important than following our DESIRE to love food and EAT more!

The Protective Effect of Eating Fish On Your Kidneys…

January 6, 2009

Go to fullsize imageWe know the many benefits of eating fish.  I love fish and I cultivate the fun of eating fish rather than meat to my kids.  It may take several trials to be successful but for them to eat fish and enjoy it is worth the many trials.

A recent study published in the American Journal of Kidney Diseases gave us a new look at how fish can be beneficial to our kidneys.  The study measure ther urine excretion of albumin which is a measure of kidney damage.

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Background

Studies have shown a potential beneficial role for fish and fish oil consumption in the management of diabetes and its complications. The aim of this study is to examine the association between fish consumption and albuminuria in individuals with and without diabetes.

Study Design

A cross-sectional analysis conducted in the European Prospective Investigation of Cancer–Norfolk population-based cohort study.

Setting & Participants

22,384 men and women from general practices in the city of Norwich and vicinity, of whom 517 had diabetes by self-report and 21,867 did not report diabetes.

Predictors

Fish consumption was measured in a validated semiquantitative food frequency questionnaire and categorized as less than 1, 1 to 2, and more than 2 portions/wk. Interaction between fish intake and diabetes status was hypothesized a priori.

Results

Prevalences of microalbuminuria were 22.6% in participants with diabetes and 11.4% in participants without diabetes. Prevalences of macroalbuminuria were 8.3% and 0.6%, respectively. Fish consumption was associated with a lower risk of macroalbuminuria in participants with diabetes (odds ratio, 0.22, >2 versus <1 portion/wk; 95% confidence interval, 0.07 to 0.70; P for trend = 0.009) after adjustment for confounding. This association was not observed in participants with diabetes with microalbuminuria or in the nondiabetic population. There was a significant interaction between diabetes status and fish consumption of 1 to 2 portions/wk (P = 0.03) and more than 2 portions/wk (P = 0.007) for risk of macroalbuminuria.

Conclusions

Greater fish intake was associated with a lower risk of macroalbuminuria in a self-defined diabetic population. These findings merit confirmation in prospective studies and intervention trials and suggest that fish intake may be beneficial for albuminuria in people with diabetes.

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This study confirms my practice of asking patients to minimize red meat and eat more white meat to help protect their kidneys.  Diabetes continues to be a leading cuase of kidney failure worldwide and haviong dialysis two to three times a week is not only physically disabling but emotionally and financially as well.

So for the new year… even if one is not a diabetic… eating fish should be the way to go.

You Cant Go Wrong With FISH!

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Read my previous post on The Benefits of Eating FISH

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.

Recommended Foods If You ARe AT Risk Of Diabetes?

September 24, 2008

Go to fullsize imageI am one of those at risk to develop Diabetes.  I am the youngest of 9 siblings and am sure my mom was already a diabetic by the time I was born.  In short I have the genetic makeup to have one and it now depends on the environment …how I can modify the risk factors… that will determine if indeed I will develop this disease or not.

So when my latest Fasting blood sugar reached 96 mg/dl… I was laready alarmed.  Remember from my previous posts that individuals with a normal fasting blood sugar between 89 to 99 mg/dl have the highest risk to become diabetic in the next few years.  So the first thing I did was to change the way I eat…modify my lifestyle in terms of preference of food and settled in to more fruits and vegetables PLUS brisk walking almost everyday. I have already lost at least 14 pounds and I have reached a normal BMI of 22 …YAHOOO:)

Now comes a new study publsihed this September 2008 in Diabetes Care:

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Subjetcs: White, black, Hispanic, and Chinese adults, aged 45–84 years and free of cardiovascular disease and diabetes, completed food frequency questionnaires at baseline (2000–2002). Incident type 2 diabetes was defined at three follow-up exams (2002–2003, 2004–2005, and 2005–2007) as fasting glucose >126 mg/dl, self-reported type 2 diabetes, or use of diabetes medication.
Two types of dietary patterns were studied: four empirically derived (principal components analysis) and one author-defined (low-risk food pattern) as the weighted sum of whole grains, vegetables, nuts/seeds, low-fat dairy, coffee (positively weighted), red meat, processed meat, high-fat dairy, and soda (negatively weighted).
RESULTS

  • High intake of tomatoes, beans, refined grains, high-fat dairy, and red meat was associated with an 18% greater risk :95% CI 1.06–1.32]
  •  High intake of whole grains, fruit, nuts/seeds, green leafy vegetables, and low-fat dairy was associated with a 15% lower diabetes risk (0.85 [0.76–0.95]; P = 0.005).
  • The low-risk food pattern was also inversely associated with diabetes risk (0.87 [0.81–0.99]
  • Individual component food groups were not independently associated with diabetes risk.
  • Associations were not modified by sex or race/ethnicity.

CONCLUSIONS—Multiple food groups collectively influence type 2 diabetes risk beyond that of the individual food groups themselves.

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Beans and tomatoes are nutrient-rich foods so I thought they should be part of a healthy meal?  But the most likely reason why intake of tomatoes and beans are linked to a higher risk of diabetes is the fact that in the study group, their intake was associated with intake of less healthy meals from pizza parlors or burger junctions as well as cheese and tacos

The study specifically also points out that in terms of health benefits and effects of foods, one should focus more on the importance of the whole diet rather than on certain foods or food groups that might be beneficial to us.

So…I guess am doing well with my lifestyle change because I am eating foods now proven to help me lower my risk and am enjoying eating them.

Again By Eating Right … We Should Live Well!

 

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!

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!!!!

Are You Sure Your Sugar Is Normal?

July 29, 2008

Go to fullsize imageHere’s an interesting article: published in the American Journal of Medicine this July.  I bet after reading this article…you will have to review your old blood tests and determine if you are at risk to develop diabetes in the near future.

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This study included:

46,578 members of Kaiser Permanente Northwest who had fasting plasma glucose levels less than 100 mg/dL between January 1, 1997, and December 31, 2000, and who did not previously have diabetes or impaired fasting glucose.

  • Subjects developed diabetes at a rate of less than 1% per year during a mean follow-up of 81.0 months.
  • Each milligram per deciliter of fasting plasma glucose increased diabetes risk by 6% (hazard ratio [HR] 1.06, 95% confidence interval [CI], 1.05-1.07, P < .0001) after controlling for other risk factors.
  • Compared with those with fasting plasma glucose levels less than 85 mg/dL, subjects with glucose levels of 95 to 99 mg/dL were 2.33 times more likely to develop diabetes (HR 2.33; 95% CI, 1.95-2.79; P < .0001).
  • Subjects in the 90 to 94 mg/dL group were 49% more likely to progress to diabetes (HR 1.49; 95% CI, 1.23-1.79; P <.0001).
  • All other risk factors except sex were significantly associated with a diabetes diagnosis.
Conclusions

The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors suggests that diabetes risk increases as fasting plasma glucose levels increase, even within the currently accepted normal range.

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This study although with limitations sends a strong signal that everytime one gets an executive panel test.. a thorough evaluation has to be made from the numbers that will give us SIGNALS of future disease risk.  There is no room for saying that the results are borderline or of no significance because waiting fo the sugar to be abnormal before one recommends action is tantamount to negligience!

Targeting out patients early means preventing onset of the the disease resulting in lesser chances of developing chronic complications which can be disabling and costly!

Lifestyle changes will continue to be the mainstay for these patients with sugars within the normal range but are at the highest risk to develop diabetes in the next few years!  A little sacrifice can do a long way in preventing illness and promoting health!

Get hold of your last years blood tests…look at the numbers…is your blood suagr 97 mg/dl?  Then be aware that you are at risk to develop diabetes in the near future… and therefore DO SOMETHING!!!! Lose weight, take care of what you eat and MOVE!

Hearing Loss and Diabetes…

July 2, 2008

Go to fullsize imageI have long suspected a relationship. 

It seems more prevalent the older the patient gets but seems to be more common among my diabetic nowadays.  And my suspicion is right based on a new article published in the Annals of Internal Medicine, July issue:

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Background: Diabetes might affect the vasculature and neural system of the inner ear, leading to hearing impairment.

Design: Cross-sectional analysis of nationally representative data. National Health and Nutrition Examination Survey, 1999 to 2004.

Results: 5140 noninstitutionalized adults age 20 to 69 years who had audiometric testing.

  • Hearing impairment was more prevalent among adults with diabetes. Age-adjusted prevalence of low- or mid-frequency hearing impairment of mild or greater severity in the worse ear was 21.3% (95% CI, 15.0% to 27.5%) among 399 adults with diabetes compared with 9.4% (CI, 8.2% to 10.5%) among 4741 adults without diabetes.
  • Similarly, age-adjusted prevalence of high-frequency hearing impairment of mild or greater severity in the worse ear was 54.1% (CI, 45.9% to 62.3%) among those with diabetes compared with 32.0% (CI, 30.5% to 33.5%) among those without diabetes.

Conclusion: Hearing impairment is common in adults with diabetes, and diabetes seems to be an independent risk factor for the condition.

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The more likely explanation to this complication is still diabetes related microcirculation abnormality which is seen in other organs affected by this condition. Whether tight control of blood glucose can help prevent the onset and progression of this condition remains to be seen. 

Still the same, good control has been shown to help prevent circulatory problems of the affected organs in the body such as the eyes and the kidneys….and therefore there should be no reason why the same wont hold true to the cochlea.

This study therefore helps us realize that patients with diabetes should probably start screening for hearing impariment so as to avoid exposure to unnecessary factors that can help aggravate the condition like noise pollution, loud music and some drugs that have been shown to cause hearing loss.

Hearing Loss: Another Reason To Aim For Good Control!

Metformin for Pregnant Diabetics?

June 9, 2008

Go to fullsize imageYes we can!!!!

A recent published study: The MiG trail or the Metformin for Gestational Diabetes in the New England Journal of Medicine, May 2008 provide us more proofs that the use of metformin is not only preferred by pregnant dabetics BUT likewise is not associated with perinatal complications.

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Results

Of the 363 women assigned to metformin, 92.6% continued to receive metformin until delivery and 46.3% received supplemental insulin.

The rate of the primary composite outcome was 32.0% in the group assigned to metformin and 32.2% in the insulin group (relative risk, 1.00; 95% confidence interval, 0.90 to 1.10).

More women in the metformin group than in the insulin group stated that they would choose to receive their assigned treatment again (76.6% vs. 27.2%, P<0.001). The rates of other secondary outcomes did not differ significantly between the groups.

There were no serious adverse events associated with the use of metformin.

Conclusions

In women with gestational diabetes mellitus, metformin (alone or with supplemental insulin) is not associated with increased perinatal complications as compared with insulin. The women preferred metformin to insulin treatment.

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This is one randomized trial that we have been waiting for.  Now as an endocrinologist, I have more arms to support the use of this medication for my pregnant women diagnosed with gestational diabetes.  The more options a patient have , the better!  Controlling their blood glucoses while pregnant is important!  It is our aim to hopefully prevent them from becoming diabetics after the delivery by lessening the burden of the pancreas brought about by the hormonal changes of pregnancy.

It is therefore very important that for all women to know that if they have risk factors for diabetes including obesity and a strong family history of diabetes…that they make sure to ask their obstetricians that they be screened for gestational diabetes.  This is one case where the early diagnosis is paramount to early treatment… the better for the health of the pancreas.

This is indeed good news to our women who have fear for needles because now we have a safe and effective alternative to insulin.

Another Welcome Option To The Medical World!

 

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!

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! 

Are Eggs Healthy To Eat?

May 1, 2008

One of the top posts in my website is my article on how much eggs can one eat.  The emphasis on eggs as being healthy but laden with cholesterol has made the public very confused.  Now comes a new study published in the American Journal of Nutrition done in Harvard University linking consumption of egg to increased mortality. 

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Background: A reduction in dietary cholesterol is recommended to prevent cardiovascular disease (CVD). Although eggs are important sources of cholesterol and other nutrients, limited and inconsistent data are available on the effects of egg consumption on the risk of CVD and mortality.

Objective: We aimed to examine the association between egg consumption and the risk of CVD and mortality.

Design: In a prospective cohort study of 21 327 participants from Physicians’ Health Study I, egg consumption was assessed with an abbreviated food questionnaire. Cox regression was used to estimate relative risks.

Results: In an average follow-up of 20 y, 1550 new myocardial infarctions (MIs), 1342 incident strokes, and 5169 deaths occurred.

  • Egg consumption was not associated with incident MI or stroke in a multivariate Cox regression.
  • Adjusted hazard ratios (95% CI) for mortality were 1.0 (reference), 0.94 (0.87, 1.02), 1.03 (0.95, 1.11), 1.05 (0.93, 1.19), and 1.23 (1.11, 1.36) for the consumption of <1, 1, 2–4, 5–6, and 7 eggs/wk, respectively (P for trend < 0.0001).
  • This association was stronger among diabetic subjects, in whom the risk of death in a comparison of the highest with the lowest category of egg consumption was twofold (hazard ratio: 2.01; 95% CI: 1.26, 3.20; P for interaction = 0.09).

Conclusions: Infrequent egg consumption does not seem to influence the risk of CVD in male physicians. In addition, egg consumption was positively related to mortality, more strongly so in diabetic subjects, in the study population.

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The data suggests that the higher the number of eggs consumed, the higher the mortality risk especially among diabetic patients.  This seems interesting because the risk to develop heart disease was not seen among those who are frequent egg eaters suggesting that the risk to die was not associated with heart disease but something else! Nevertheless, looking at prevoius relationships of cholesterol and death, the most likely explanation as assessed in the editorial by Dr Eckel of University of Colorado is still atherosclerotic disease.

The relationship between egg consumption and heart disease continues to be confusing.  This is understandable because now we know that the effect of cholesterol intake in the diet has less effect on the LDL or bad cholesterol in the blood than an intake of saturated fat or trans fat in the diet.  And as we all know, the egg yolk mainly contains cholesterol.

The editorial sums it all up:

So, if you are a male physician and are going to eat 1 egg/d, why not eat the whites only? Just think—with all of the trimmings, that 3-white egg omelet is almost indistinguishable by taste from an omelet enriched with 600 mg cholesterol, and the whites-only omelet also remains a very good source of protein, riboflavin, and selenium. If you cannot do without the yolks, go ahead and enjoy them, but why eat them >3–4 d/wk? If you are a man with diabetes, a more limited egg intake pattern seems prudent. But, remember: eggs are like all other foods—they are neither “good” nor “bad,” and they can be part of an overall heart-healthy diet.

Level of Activity In the Young Predicts What You Become…

April 26, 2008

Go to fullsize imageChronic diseases will abound in the next century.  The ones who will be most affected are the children of today.  And this prediction wil come true based on this new study published in Dynamic Medicine. which looked at the level of activity of the young and the risk of developing Metabolic Sydrome in adulthood: Diabetes, Hypertension and High cholesterol.

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Purpose: Metabolic syndrome (MS) is a clustering of cardiovascular disease risk factors that identifies individuals with the highest risk for heart disease. Two factors that may influence the MS are physical activity and aerobic fitness. This study determined if adolescent with the MS had low levels of aerobic fitness and physical activity as children.

Methods

This longitudinal, exploratory study had 389 participants: 51% girls, 84% Caucasian, 12% African American, 1% Hispanic, and 3% other races, from the State of North Carolina. Habitual physical activity (PA survey), aerobic fitness (VO2max), body mass index (BMI), blood pressure, and lipids obtained at 7-10 y of age were compared to their results obtained 7 y later at ages 14 -17 y.

Results

Eighteen adolescents (4.6%) developed 3 or more characteristics of the MS. Logistic regression, adjusting for BMI percentile, blood pressure, and cholesterol levels, found that adolescents with the MS were 6.08 (95%CI = 1.18-60.08) times more likely to have low aerobic fitness as children and 5.16 (95%CI = 1.06-49.66) times more likely to have low PA levels.

Conclusions

Low levels of childhood physical activity and aerobic fitness are associated with the presence of the metabolic syndrome in adolescents. Thus, efforts need to begin early in childhood to increase exercise.

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The study tells us that the level of activity is as important as keeping fit!  One does not need to be overweight to be at risk. One may not be obese but if the level of activity is low then he is still not fit and therefore at risk of future diseases. This study tells us to allow our kids to be more active rather than live a sedentary lifestyle of gameboys, PSPs and computers.

This study clearly shows the relationship of what we train our kids to do and become to what happens to them in the future.  Lets train them early to be fit and healthy so as they can carry their lives in a healthier way! 

For me… Teaching our Kids How to keep FIT is the best future we can give them!

A High Fiber Diet: Does It Really Matter?

April 11, 2008

Go to fullsize imageWe have been exposed to ads regarding the benefits of a high fiber diet.  We know it is good for our health but what does it do and where do we get these fiber rich products?

It has been shown in several studies that a high fiber diet can indeed lower ones risk to develop heart diseaese by as much as 30% as well as lower ones risk to develop diabetes and improve cholesterol.   We know it works well for roughage and therefore can prevent constipation and improve bowel habits.  In fact it was recommended as a way of preventing colon polyps and cancer BUT so far no long term studies have proven that fiber can indeed lower the risk for colon cancer.  Nonetheless, the multiple benefits we can get from eating a high fiber meals are more than enough to recommend intake of these products to our patients and the public in general.

But what are the best sources of fiber? Here is a list of the different kinds of fiber compiled by the Harvard School of Nutrition:

Sources of Fiber

Soluble Fiber

Insoluble Fiber

oatmeal
oatbran
nuts and seedslegumes

  • dried peas
  • beans
  • lentils

apples
pears
strawberries
blueberries

whole grains

  • whole wheat breads
  • barley
  • couscous
  • brown rice
  • bulgur

whole-grain breakfast cereals
wheat bran
seeds
carrots
cucumbers
zucchini
celery
tomatoes

The best fiber source in several studies that proved a high fiber diet to be beneficial is the cereal based fiber or fiber from grains and those coming from fruits.  It is recommended that a diet with at least 21 to 38 gms of fiber should be taken per day.  On an average Filipino diet, we are only consuming at most less than 15 gms of fiber per day so we better bulk it up more with the sources mentioned in the table for health reasons.  Increase the fiber intake gradually rather that abruptly and to make sure we also increase the intake of water ans fiber absorbs water.

What Do I recommend: here’s a sample advise that I give to my patients:

  • Avoid fruit juices as they are devoid of fiber, instead eat whole fruits.
  • Eat brown rice instead of white rice
  • Buy whole grain products instead of white bread and pasta.
  • Try snacking with raw veggies..they may not be as yummy as a pastry BUT they are triple times  as healthy.
  • Choose whole-grain cereals for breakfast instead of rice and sausage! 
  • Eat Right By Eating Healthy..Try FIBER!

     

    Acupuncture and Diabetes

    April 5, 2008

    Go to fullsize imageAlternative therapies continue to be in the mainstream of Diabetes Armamentarium.  You see patients bringing bottles of herb supplements apparently marketed as a treatment for Diabetes and related illnesses like high blood pressure and high cholesterol.  But one form of treatment that has gained wide acceptance both in the East where it originated and in the West where it is now widely practiced is Acupuncture.  And almost always in my practice do I come across a patient asking me about acupuncture and diabetes.

     

    It is said that the effect of acupuncture is its ability to improve blood flow.  By balancing the energy levels, one’s circulation can be improved and therefore has the potential to prevent debilitating complications of diabetes related to poor circulation like foot amputation and the crippling nerve damage or diabetic neuropathy.  Anecdotal reports and few small scale studies have proven acupuncture to help ease pain and prevent diabetic foot ulcers but only if applied early in the disease process.   The problem is the absence of acceptable and properly done wide scale studies where proven results are duplicated. A research funding by the National Institutes of Health in the United States is being done in quest for an answer…

     

    As medical practitioners, it is best to advise to patients that no studies at present can prove acupuncture to work beyond placebo effect. It is being tolerated by the US FDA considering its relative safety.  But it is always prudent for patients not to discontinue their medications or the proven therapies we provide them and to use acupuncture only conjunction with their medications.  Likewise it is best that patients should inform their physicians about their desire to have an acupuncture done and likewise should not accept any diagnosis of a disease from those performing the acupuncture..

     

    Acupuncture…It’s a wait and see for now but so far results seem promising….

    Lower Your Risk To Develop Diabetes By Eating Veggies….

    March 24, 2008

    www.calpoly.edu/~lcimarel/vegetables.jpgWe all know veggies are good.  But this recent finding that veggies can prevent diabetes is a welcome news to us trying to curb the epidemic of this disease due to unhealthly lifestyle and poor dietary habits.

    I have trained my kids to eat veggies.  I found it amusing that one day my son said to me:  “Dad my classmates are teasing me that I am a Vegetarian!”  Suggesting that of all his classmates, he was the only one who had veggies on his lunch box.  Lucky me… my kids love veggies….and for a good reason!

    This good news about veggies and diabetes was published in the March 2008 issue of the Journal of Nutrition:

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    A population-based prospective study of 64,191 women with no history of T2D or other chronic diseases at study recruitment and with valid dietary information.

    The relative risk for T2D for the upper quintile relative to the lower quintile of vegetable intake was 0.72 (95%CI: 0.61–0.85; P < 0.01) in multivariate analysis. Individual vegetable groups were all inversely and significantly associated with the risk of T2D.

    Fruit intake was not associated with the incidence of diabetes in this population.

    Our data suggest that vegetable consumption may protect against the development of T2D.

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    This data is great suggesting that those who consumed the highest amount of vegiies in 4-5 years reduced the likelihood of developing diabetes by 28%.  That is… taking 428 grams of veggies per day reduced ones chances to develop this chronic disabling disease compared to if you only take 121 grams of veggies per day!

    The advantages of veggies is that it contains high fiber as well as other substances like phytates and isoflavones that may help in reducing the risk for developing diabetes.

    Although fruits did not show benefit…it likewise did not show harm.  Just the same fruits have been shown to reduce the risk of developing other diseases like cancer or heart disease.  Such that… its intake remains to be a cornerstone in promoting health!

    Train Yourself and Your Kids To Eat Veggies for Health!

    Nutrition in Health and Disease….

    March 17, 2008

    This is called the Paradox of Food:  you need food to live and survive but the very reason for disease and illnesses stem from the abundance of food and poor nutrition!

    I practice a field dealing with the metabolic diseases where poor nutrition plays a key role in its onset and progression to develop complications.  Control of blood glucose requires the right balance of nutrition, exercise and medications. The same formula apllies when treating obesity, hypertension and high cholesterol.

    The problem with handling these diseases stem from the medical field lack of understanding of nutrition and the lack of importance given to medical nutrition therapy!   If you make rounds in the hospital … you see the diet prepared for a diabetic hypertensive is almost similar if not similar to the other patient in the other room who is not a  diabetic…  It may not be the dietician’s fault but the doctor prescribing the diet!  This is where I am very particular with my patients because I believe the long term success of successfully controlling their blood sugar or blood pressure or cholesterol stem from not what I give them as medications but what they take in as food!

    The recent 2008 ADA recommendation for Nutrition  reasons out why Nutrition is important:

    Clinical trials/outcome studies of Medical Nutrition Therapy have reported decreases in HbA1c (A1C) of 1% in type 1 diabetes and 1–2% in type 2 diabetes, depending on the duration of diabetes . Meta-analysis of studies in nondiabetic, free-living subjects and expert committees report that MNT reduces LDL cholesterol by 15–25 mg/dl . After initiation of MNT, improvements were apparent in 3–6 months. Meta-analysis and expert committees also support a role for lifestyle modification in treating hypertension .

    The proportion of calories in the specific nutrition Rx will now be individualized and should be prescribed by your doctor.  I have my own personal dietician in my clinic now that I offer free couseling to my patients where personal preferences of food is taken into consideration.  I believe in individualized counseling so as to offer a  more successful diet regimen.  No prepared diets printed on a piece of paper!

    I have been a proponent of using a 40% of total calories from carbohydrates for my diabetic patients as more and more data are coming out regarding the benefits of limited carbohydrate not only for losing weight but for better glycemic control.  It is but proper that for the first time the American Diabetes Association came up with their position paper recommending the same.

    For me…it is plain and simple challenging one’s self discipline in not giving in to the “want” but following to the details of what is nutritious and healthy!!!

    Live Life To The Fullest…By Eating Right!

    Low Carb Diet and Diabetes: A Better Partner?

    February 29, 2008

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

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

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

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

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

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

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

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

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

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

    Indeed Low Carb Is The BETTER Partner for Health!

    Fish Oil and Weight Loss

    February 7, 2008

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

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

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    Conclusions:

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

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

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

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

    Fish Oil May Indeed Have Health Benefits!