Archive for the 'The Truths on Obesity' Category

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!

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

March 12, 2008

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

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

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

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

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

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

Implications

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

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

Obesity Surgery for Diabetes: A Cure?

February 28, 2008

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

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

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

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

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

Conclusions:

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

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

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

Weight Loss For Cure and Health!

The Obesity and Fatness Tax

February 27, 2008

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

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

Fatness therefore is now becoming a Liability! 

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

Insure Yourself To Better Health!

Red Meat and Fried Foods Linked To Disease….

January 28, 2008

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

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

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Findings:

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

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

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

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

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

Diabetes and Obesity: The Cancer Link…

December 11, 2007

New studies recently surfaced regarding the increased risk of diabetics or obese individuals to different kinds of cancer.  The hyperinsulinemic state associated with these two metabolic conditions may be responsible to predisposing these individuals to a higher cancer risk.

The American Cancer Research Society website published recent researches linking the two conditions to cancer:

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1.Women with diabetes are 1.5 times more likely to develop colorectal cancer than those who do not have the metabolic disorder, according to researchers at the University of Minnesota.

2.Women with invasive breast cancer and high blood levels of C-peptide (a marker of insulin secretion) face a risk of death nearly three times higher than women with lower blood levels of C-peptide, according to findings from the Health, Eating, Activity and Lifestyle (HEAL) Study, a long-term observational study of breast cancer patients. The effect was most notable, researchers say, among women in their 40s.

3.Gaining weight following a diagnosis of invasive breast cancer could increase a woman’s risk of death from the disease by more than half, according to researchers leading the Collaborative Women’s Longevity Study. In fact, the researchers associated weight gain with a measurable increase in risk of death due to all causes, not just breast cancer.

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But this risk is not uniform to all types of cancer. Diabetics for example have been shown to have lower risk to develop prostate cancer.  As to why remains unclear but maybe related to diabetics having a lower testosterone level.

New reasons for us to really be aware of the dangers of gaining weight to the level of being overweight and to avoid being obese.

So….. 

This Holidays…Think Healthy and Be Wise!

The Motivation To Lose Weight….

November 30, 2007

Go to fullsize imageI just found this new finding very intriguing and really true.  We doctors need to know what motivates people to lose weight so we can focus our attention to achieve the goal with more success.

In one study done in University of Bath in UK revealed some interesting facts:

“Fear of looking unattractive can be a stronger motivation for keeping people going to the gym than the hope of looking good”

This is really something… I guess this is where marketing strategies of beauty products are engaged in. You see beautfiul actresses marketing beauty products luring women to use the same products so as to look like them!  And I guess they’re pretty successful.

But what happens is when fear can motivate people to lose weight and look good…  once that fear subsides, either because they feel they have lost weight and now look good.. the motivation from fear goes away.  And I believe this is one reason why the yo-yo phenomenon in losing weight comes in.  You lose now then you gain….

Motivating people using the positive outlook should be the way to go.  How losing weight results now in better health  for a more lasting effect!

Motivating Poeple The Right Way Is Key To Better Health and Better Life!


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 adtxtimg5.gif 2/18/08

Notes From Our Marketing Friends: 

People are becoming fitness freaks and are very conscious to lose weight. Many health centers and weight loss centers provide people with healthy weight loss program. This includes many supplementary diets like the south beach diet and many others. However such diets must not be taken without consulting the physicians.
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What Happens To The Heart Of An Obese Child?

October 25, 2007

2069806394.jpgChildhood obesity is now becoming a major health problem not only in the US but also in the developing world. We know the consequences of our child becoming obese and how it will impact on out kids future in terms of their chances to become obese FOR LIFE.

What we dont know are the cardiac or heart consequences associated with increasing obesity in childhood.  This recent 2007 study published in the Journal of Cardiometabolic Syndrome looked at changes seen as markers that can lead to early heart problems among our obese children.

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Childhood obesity is a major health care issue in the United States. This epidemic has important cardiovascular implications. Newer imaging modalities in obese adults have demonstrated abnormal systolic and diastolic cardiac function. The authors proposed to determine whether these abnormalities are present in obese children.

A total of 168 children were identified from our echocardiographic database. Body mass index for age was calculated.

Echocardiographic clips were analyzed using imaging technology to determine myocardial motion, strain, and strain rate. Patients at risk for obesity and those meeting criteria for obesity had increased late diastolic myocardial motion compared with normal-weight children. Obese patients had decreased systolic strain compared with normal-weight children.

As with adults, obese children have significant differences in diastolic function and strain. These abnormalities may be subtle markers for the emergence of future cardiac disease. (JCMS. 2007;2:30–34)

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Children therefore are not immune to the structural and heart abnormalities associated with excess adipose tissue.  It is therefore not acceptable for parents to accept the old concept that since they are kids…lets allow them to gain weight because they are still in their growing years.  Now we know better…we are doing MORE harm than good to these children. 

It is likewise very important to educate our grandparents who tend to spoil our kids with the ancient concept of overfeeding and that overweight kids are healthier babies!

Times Have Changed..Begin the Year with Healthier kids!

Eating Together As A Family… Is Healthy!

October 5, 2007

2746116766.jpgSpending quality time with your kids have a lasting impact not only in the way children will remember us as caring parents but have been shown to have lasting impact in the way these kids eat as adults.  The way kids eat help the way they shape their health because lifestyle habits have been shown to have the most impact if started early in life!

A new study that looked at the impact of eating together as a family involved more than 1,500 students surveyed once during high school and again when they were 20 years old specifically ” to determine the long-term effects of family meals on diet quality, social eating, meal structure and meal frequency.” This study published in  September Journal of the American Dietetic Association gives us a glimpse that the truth of all the problems we have now in terms of poor eating habits among our children may stem from the fact that we may not be spending enough time with our kids….

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The Objective: To describe meal patterns of young adults and determine if family meal frequency during adolescence is associated with diet quality, meal frequency, social eating, and meal structure during young adulthood.

Surveys and food frequency questionnaires were completed by 946 female students and 764 male students in high school classrooms at Time 1 (1998-1999; mean age 15.9 years) and by mail at Time 2 (2003-2004; mean age 20.4 years).

Results:

  • Family meal frequency during adolescence predicted higher intakes of fruit, vegetables , dark-green and orange vegetables, and key nutrients and

  • Family meal frequency was associated with lower intakes of soft drinks during young adulthood.

  • Frequency of family meals also predicted more breakfast meals in females and for both sexes predicted more frequent dinner meals.

  • Family Frequency also was associated with higher priority for meal structure , and higher priority for social eating.

Conclusions : Family meals during adolescence may have a lasting positive influence on dietary quality and meal patterns in young adulthood.

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There you go my friends.  Children need our help, our support and our guidance.  They should be taught well the younger they are the better! They need our company not only for fun but to know whats right and proper…including choices of the right healthy food!  Meaning as parents we should also set the right example of what to eat and what NOT to eat!

Make sure we take time to earn a living but not to forget that we have other obligations to our children and family!  Its should be a good balance in life that one should aim for… that can make one a better person both as a family man and as a good individual in the society.

Ensure the health of our children… one way is to….

Spend More Time With Your KIDS!

On Why America Is Becoming Overweight!

October 4, 2007

231112061.jpgAmerica as a nation is really becoming “overweight”.  Inspite of what we know about obesity and its dreaded complications, the urge to eat or the habit to enjoy food continues to be a challenge especially among Americans.

During this recent trip to San Antonio, Texas… everything seems to be status quo.  Nobody seems to care about the kind of food that is being ordered or served in the restaurants to the amount or serving sizes that everyone is given as choices.  Or are there choices?  It seems that if one orders the regular portions of food, you just cant seem to finish them all… but I guess to them… these portions are but the routine servings that they know of since they were kids! I guess this comes to what they been exposed to since childhood…they see what their parents eat and therefore its the norm!

Steaks abound in every resto we go to.  With the food comes mashed potastoes…and you are given the choices of butter, mayonnaise or garlic.  Not a simple boiled potato but a potato laced with other stuff! Next comes the salad…but its laced with fat because of its dressing! Whew…. you really can gain weight in America!  So am just happy to be back home and settle with the usual small servings that we get and the way we cook our food.

Likewise… am not sure but I think BUFFET was discovered in America.  This has made matters worst!  The problem is… we are also starting to be enjoying buffets and you can see it being offered by our local restaurants as well.  No wonder, our country is one place that is expected to have a dramatic rise in obesity in the Asia Pacific region.

Am not sure how the US will be able to combat her battle of Obesity. Its the attitude that should change… and should start from the young!

Otherwise…San Antonio as a city was pretty quiet, rich in history and remarkably safe as we only rented a car and drove the place on our own to explore!  Of course, my friends and I did this only after we have studied and learned the newest things in Endocrinology during this past year.

It’s What We Eat That Counts!

The Danger of Eating French Fries…or Why Trans Fat Is Bad!

September 15, 2007

I have been an advocate of avoiding fried foods.  However firm we are in avoiding frying foods, you sometimes cant help and avoid enjoying eating foods that are fried…not only are they crunchy but they also taste so good.  So resisting the temptation to enjoy great food is difficult. But at the expense of health and heart attacks!

I came across a recent article in the Harvard Medical School Health Publication: HealthBeat which I want to share especially to parents who allow their kids to enjoy french fries almost at every meal.

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 If you needed another reason to avoid trans fats, here it is. Researchers with the ongoing Nurses’ Health Study measured the amount of trans fat stored in red blood cells. Among the 32,000 middle-aged women participating in the study, 166 had heart attacks or died of heart disease during a six-year period. Their red blood cells had slightly higher loads of trans fat than did red blood cells of 327 women of the same ages and characteristics who remained free of heart disease.

Artificial trans fats are found in hard margarines, many commercially baked goods, and the fried foods in many restaurants, and research has consistently shown they aren’t good for the heart and blood vessels. Across the board, the more trans fat in red blood cells, the greater the chances of having a heart attack. Women with the highest trans fat load had triple the risk of women with the lowest. This study, published in the April 10, 2007, Circulation, strongly supports recommendations by the Institute of Medicine and the USDA’s Dietary Guidelines for Americans to cut back — or better yet, cut out — trans fats in the diet. Eliminating them from the food supply could avert as many as 264,000 heart attacks and heart-related deaths each year in the United States alone.

Trans Fats at Home and Abroad

A prime source of trans fat is partially hydrogenated oil, which many fast-food restaurants continue to use for deep frying. To see if this differed by country, three Danish doctors determined the trans fat content of French fries and chicken nuggets bought in 24 McDonald’s and KFC restaurants on four continents. As shown above, a large fries-and-nuggets combination delivered 10 grams of trans fat in New York City but less than a gram in Denmark, which limits the use of trans fats. A similar serving of fries and chicken nuggets in a KFC in Hungary delivered a whopping 25 grams of trans fat.

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Anothr reason to be alarmed over what we preceived a s a way of showing affection and reward to our kids… Crunchy fried chicken and french fries.  If we indulge in these kinds of foods once in a while or only during children’s parties .. its acceptable BUT if our kids eat only fried foods because that’s the only food they will eat then it will do no good to their future!

Start training them young.  My friend Maxim is one nice guy to dine with because he’s health conscious and therefore you tend to follow what he eats or be conscious of what you order.  And I guess there is so much truth to the study that showed…if your friends are obese, the more likely you will too….

A Feast with French Fries is A Feast with Trans Fat!

Obesity Can Spread Among Friends….

August 20, 2007

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

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

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

Results:

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

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

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

The authors’ summary of their report says it all: 

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

As the saying goes….. 

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

BYETTA and Weight Loss

August 18, 2007

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

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

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

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

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

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

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

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

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

The Gila Monster and the Man in Byetta!

Adding TAX on Mc Donald’s Burger and Fries…

August 6, 2007

imagessdfert.jpg

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

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

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

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

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

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

Tax or No Tax… The Discipline Starts at HOME!

Are You FAT But FiT?

August 4, 2007

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

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

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

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

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

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

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

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

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

Being FIT Matters….

How To Exercise The Right Way

August 2, 2007

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

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

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

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

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

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

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

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

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

What A way To Rest and Burn More Calories!

How To Live Longer Without Exercising!

July 20, 2007

3904728485.jpgBeing busy or too busy to exercise may not be bad after all….

A recent report from the Mayo Clinic may prove to be worth considering if we talk about the need to be more active to live long.  We all know the fact that increasing exercise not only prevents one from developing chronic illnesses associated with inactivity and obesity but also can make us feel better and live longer.

According to the March issue of Mayo Clinic Women’s HealthSource: marathon training or going to a gym is not required but by staying busy and active all day can do the trick.  Such activities that can help people live longer by expending more energy include household chores such as vacuuming, mopping the floor, washing windows, lawn work, caring for children or adults, walking or volunteering.

The study, published in the Journal of the American Medical Association, tracked 302 adults between the ages of 70 and 84 for six years.  The study showed that:

” Participants who had shown the highest energy expenditures due to more physical activities had about half the chances of dying of those with the lowest energy expenditures. Participants most likely to be in the high-energy group reported climbing stairs or working for pay as a daily part of their lives.”

There you go… being busy can mean healthier lives as long as people who are “too busy” for exercise,  can stay “too busy” around the house and at work, or in the community doing what they have to do and in return live healthier lives.

Great news to those busy bees…. just dont be geeks and be sedentary and “too busy” sitting in your chair facing your computers with only your fingers and mouths exercising.  Those activities dont count!

No More Excuses..Start Moving!

Too Little Sleep Because Of Work?

July 10, 2007

imagesslp.jpgIt’s not uncommon to party all night… study for our exams (especially when I was in Medical school) or staying awake late at night because of hospital duties OR as parents being awake all night with a sick child!  Whew… those were the times! 

 During these “Awake” periods our body tends to compensate by making us sleep more the next day…our bodies way of        ” catching up”.  These acute sleep debt or loses are not known to be harmful because our body is able to adapt to acute changes in life from sleep to emotions to hormonal changes.  What is not known until now is the chronic lack of sleep where we lose a little bit of sleep over a period of days, months or even years due to work and work and work!!!!!

Understanding the effects of chronic lack of sleep was recently published online by the Proceedings of the National Academy of Sciences (PNAS) from the group of Northwestern University.  In that study, the researchers discovered that “when animals are partially sleep deprived over consecutive days they no longer attempt to catch up on sleep, despite an accumulating sleep deficit.”  

The impact of these finding in humans is immense as experimental studies in humans showed that chronic partial sleep loss of even two to three hours per night was found to have detrimental effects on the body.  The effects include: impairments in cognitive performance, as well as cardiovascular, immune and endocrine functions.

The problem with these sleep-debt people is that they dont look sleepy nor report feeling sleepy BUT their performance on tasks was shown to decline.  Likewise, repeated partial sleep restriction in humans has been linked to metabolic dysfunction and cardiovascular disease.  In fact in our recent Endocrine Society Meeting, Sleep debt is now considered one major risk factor for Obesity and Diabetes!!!!

So how do we counter the effects of chronic sleep loss?

 Harvard Women’s Health Watch suggests: if you’ve missed 10 hours of sleep over one week, make up for it over the weekend and the following week. If you’ve missed sleep for decades, it could take a few weeks to repay the debt. Plan a vacation with a light schedule, and sleep every night until you wake naturally. Once you’ve determined how much sleep you need, factor it into your daily schedule.

So guys… it’s not bad to work and finish our tasks on time BUT if we overdo things to satify somebody even ourselves at the expense of our health…is something else!

Enjoy Your Work But Stay Within The LIMITS!

Obesity Surgery Can Help Diabetics Live Better Lives….

July 9, 2007

imagesobesir.jpgThe prevalence of Obesity and Diabetes is fast rising with an apparent increase of 60 to 70% within a 10 year period.  The relationship between the two is closely linked which brought a new disease state called: Diabesity or Diabetes plus Obesity!  Two major epidemics in one… result into TROUBLE!  They have the same major problem of lifestyle: improper food intake and plain inactivity and the same kinds of complications long term.

One magic bullet to hit two birds with one stone is the procedure called: Laparoscopic Gastric Banding.  This is a procedure that we now routinely perform in our institution with remarkable success.  It is a less invasive procedure than gastric bypass and has written about its procedure in one post in this website.  In a study done recently, not only did the procedure resulted in weight loss but likewise resulted in changes that reduced the culprit of developing diabetes , hypertension and high cholesterol: the Insulin Resistance State.

Below is the summary of the results of the study from the American Physiological Society Homepage

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   *      prior to surgery, there were expected gender differences in body composition measures. Men were heavier, had greater waist circumferences, and HbA1c( a measure of overall blood sugar control). Women had higher a percentage of body fat.

*      6months after surgery the overall group had a l5 percent reduction in body weight (275 vs. 233 pounds), a 14 percent reduction in BMI (43.4 vs. 37.3), a 13 percent reduction in body fat percentage (49 vs. 43 percent), a 13 percent reduction in waist circumference (53 vs. 46 inches) and a 10 percent reduction in hip circumference (57 vs. 51 inches).

*      six-months after surgery the insulin resistance was reduced 60 percent, according to a HOMA score. This was due primarily to a 50 percent reduction in fasting insulin concentrations with no change in fasting glucose concentrations.

*      there were a few gender differences in surgery-related changes. In women only, the waist-to-hip ratio tended to decrease (0.92 vs. 0.86), and the HbA1c tended to decrease (5.8 vs. 5.6 percent).  Diastolic blood pressured tended to decrease (81 vs. 75 mmHg) and CRP tended to decrease (8.3 vs. 4.7 mg/L).

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The findings are really promising.  If we reduce the state of Insulin Resistance by making a patient lose weight then we unburden our pancreas from over producing insulin in response to our meals. Likewise we therefore reduce a patients risk from developing chronic complications that can cause disability.

The authors concluded that:” These improvements occurred despite the fact that patients were still clinically obese. Rapid improvements in insulin resistance after surgery will have a positive impact on long-term patient health and may delay or prevent progression to diabetes.”

Behavioral Therapy remains the cornerstone of losing weight as well as managing diabetes.  If one can lose weight without invasive procedures through discipline with proper food intake and physical activity…the BETTER! 

But for weight loss remedy beyond the weight loss achieved by behavioral modification that may have lasting long term outcomes especially with regard to risks for chronic complications like heart disease and stroke…then

LAP Banding Is The Way To Go!

For further readings on Lap Banding: The Magic Way To Lose Weight

Sleep and The Risks of Obesity and Diabetes…

June 9, 2007

One of the highlights of the Endocrine Society meeting that I attended just this week in Toronto Canada was  a plenary session on Sleep Debt and the Risk of Diabetes and Obesity

While reading Canada’s daily newpaper, the headline was that… companies are now allowing their workers also to take a nap in between work schedules with nap stations in their offices to allow workers to relax and sleep and be more productive as a result.  Suggesting that sleep debt is actually affecting productivity in the work place!

BUT how much sleep is healthy? or how many hours of sleep are needed to reduce diabetes and obesity risks? 

The magic number is 7 hours!!!

A study published in Diabetes Care this March of 2006 showed that  men who got little sleep (< 7 hours ) or a lot of sleep (8-10 hours) were more likely to develop diabetes than men with 7 hours of nightly sleep.  The same token people with less than 7 hours of sleep have a 23% to 73% increased risk of obesity!

But quality of sleep is also as important. Deep sleep is a must.  Even 7 hours of light sleep may do no good but harm.

Again the stress hormones may be responsible as more activation of the sympathetic nervous system resulting in overproduction of cathecholamies may be result in the increased risk.  Likewise, obesity may follow if you sleep less because you easily feel hungry and you tend to eat more if you’re awake!

So…..

Sleep Well and Be Well!