Ways To A Healthier Heart

February 3, 2010

See full size imageJust came across this wonderful wonderful article in Harvard HealthBeat News Letter that I want to share.  They are practical steps yet very true to every word.  Worth meditating and taken seriously… and true to its mission…A Healthy Heart!

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10 small steps for better heart health

Change is an important part of living with heart disease or trying to prevent it. A jump in blood pressure or cholesterol earns you a lecture on healthy lifestyle changes. Heart attack and stroke survivors are often told to alter a lifetime of habits.

Some people manage to overhaul their exercise pattern, diet, and unhealthy habits with ease. The rest of us try to make changes, but don’t always succeed. Instead of undertaking a huge makeover, you might be able to improve your heart’s health with a series of small changes. Once you get going, you may find that change isn’t so hard. This approach may take longer, but it could also motivate you to make some big changes.

Here are 10 small steps to get you on the road to better health in 2010.

1. Take a 10-minute walk. If you don’t exercise at all, a brief walk is a great way to start. If you do, it’s a good way to add more exercise to your day.

2. Give yourself a lift. Lifting a hardcover book or a two-pound weight a few times a day can help tone your arm muscles. When that becomes a breeze, move on to heavier items or join a gym.

3. Eat one extra fruit or vegetable a day. Fruits and vegetables are inexpensive, taste good, and are good for everything from your brain to your bowels.

4. Make breakfast count. Start the day with some fruit and a serving of whole grains, like oatmeal, bran flakes, or whole-wheat toast.

5. Stop drinking your calories. Cutting out just one sugar-sweetened soda or calorie-laden latte can easily save you 100 or more calories a day. Over a year, that can translate into a 10-pound weight loss.

6. Have a handful of nuts. Walnuts, almonds, peanuts, and other nuts are good for your heart. Try grabbing some instead of chips or cookies when you need a snack, adding them to salads for a healthful and tasty crunch, or using them in place of meat in pasta and other dishes.

7. Sample the fruits of the sea. Eat fish or other types of seafood instead of red meat once a week. It’s good for the heart, the brain, and the waistline.

8. Breathe deeply. Try breathing slowly and deeply for a few minutes a day. It can help you relax. Slow, deep breathing may also help lower blood pressure.

9. Wash your hands often. Scrubbing up with soap and water often during the day is a great way to protect your heart and health. The flu, pneumonia, and other infections can be very hard on the heart.

10. Count your blessings. Taking a moment each day to acknowledge the blessings in your life is one way to start tapping into other positive emotions. These have been linked with better health, longer life, and greater well-being, just as their opposites — chronic anger, worry, and hostility — contribute to high blood pressure and heart disease.

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As the saying goes…

Dont Worry…Be Healthy and Be Happy!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Tips To Protect Your Heart | Leave a Comment »

Exercise and High Blood Pressure

January 29, 2010

We all know that both diet and exercise are important.  We know they work together to help keep our body healy. Pure determination to succeed and discipline are the two keys to help keep and manage our body’s health.

Recently a new article published in the Archives of Internal Medicine ,January 2010, showed that diet alone may not be as effective as diet PLUS exercise in helping control ones blood pressure.

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BACKGROUND: Although the DASH (Dietary Approaches to Stop Hypertension) diet has been shown to lower blood pressure (BP) in short-term feeding studies, it has not been shown to lower BP among free-living individuals, nor has it been shown to alter cardiovascular biomarkers of risk.

OBJECTIVE: To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension (systolic BP, 130-159 mm Hg; or diastolic BP, 85-99 mm Hg).

DESIGN AND SETTING: Randomized, controlled trial in a tertiary care medical center with assessments at baseline and 4 months. Enrollment began October 29, 2003, and ended July 28, 2008. PARTICIPANTS: Overweight or obese, unmedicated outpatients with high BP (N = 144).

INTERVENTIONS: Usual diet controls, DASH diet alone, and DASH diet plus weight management.

OUTCOME MEASURES: The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring. Secondary outcomes included pulse wave velocity, flow-mediated dilation of the brachial artery, baroreflex sensitivity, and left ventricular mass.

 RESULTS: Clinic-measured BP was reduced by 16.1/9.9 mm Hg (DASH plus weight management); 11.2/7.5 mm (DASH alone); and 3.4/3.8 mm (usual diet controls) (P < .001). A similar pattern was observed for ambulatory BP (P < .05). Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity, baroreflex sensitivity, and left ventricular mass (all P < .05).

CONCLUSION: For overweight or obese persons with above-normal BP, the addition of exercise and weight loss to the DASH diet resulted in even larger BP reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass.

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The above study showed that the famed DASH diet should be combined with exercise and weight loss to result in greater BP reductions than just the DASH diet by itself or usual diet.   Likewise the study showed based on some biochemical markers that weight management augmented the cardiovascular benefits of the DASH diet.

Overall this study tells us the importance of including behavioral modification and lifestyle programs for patients with high blood pressure.  This is an important study result because the combination of diet and exercise should remain the cornerstone of therapy of any chronic diseases associated with high blood pressure including diabetes and high cholesterol.

Another reason to EXERCISE!!!!

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Tips on Hypertension | 2 Comments »

To My Medical Students..Past and Present

January 7, 2010

I just had the chance to teach the third year medical students again at Cebu Doctor’s University College of Medicine, my alma mater, this afternoon.  I find it interesting how these students interact and how they intently listened to every word I said. I always find it fun to teach and lecture on people who are eager to learn be it the medical students, the residents or fellow doctors.  I give lectures here and abroad but the best audience are those that you know are there because they want to learn.  And the ones that are there are present because they believe they will go out of the lecture hall with hopes of getting something important from you!!!  Is there pressure in giving lectures to medical students?  I guess… they are the most critical.

At Cebu Doctor’s, I just learned each student critics the professor at every lecture.  I really dont know my score yet hehehe but I guess this practice is great for the teachers to know if they need to change their teaching skills.  But am pretty confident with my skills having been voted “Teacher of the Year” by New York Medical College Medical students when I was there during my residency years. For those who will be visiting my website…any feedback? bad or good is welcome!!!

I thank all my students old and new… because seeing you become doctors and successful in your own practice is worth our effort in spending time preparing for our lecture making sure they’re easy to comprehend, easy to digest and worthy of your time.  And seeing you blossom to be great doctors in the future is all worth it!  Just dont forget to say thank you to those who made marks in your life and who inspired you to be better!

Teaching for me is a great way to share knowledge.  I am blessed to have been taught in an institution where sharing of knowledge is the priority.  I guess that’s what made my alma mater the Mayo Clinic world famous and that I will forever be indebted in the way medicine is taught and practiced in that institution which I hope I will continue to share to my students, residents and fellow doctors in my everyday life.

Posted in Memories and Trips, Personal Thoughts | 4 Comments »

Diet Sodas and Your Kidneys… BEWARE!

December 17, 2009

Drinking soad is not really helping people achieve a healthier lifestyle.  They contain no vitamins or macronutrients except artificial flavoring, sodium ,artifical color and sweetener.  People drink soda instead of water or milk or the healthier tea.

Now comes some no to good  health news relating to intake of diet soda and kidney function. 

During the recent convention of the American Society of Nephrology comes a novel finding of diet soda and kidney function.  The study from Brigham and Women’s Hospital in Bosto involving 3,256 women, median age of 67 participating in the Nurses’ Health Study were involved.  Apparently, there is an association between increase intake of diet soda and the decline in kidney function apprently related to the sodium content.

Results of the study showed that women who drank diet soda > 2 cns a day resulted in a 30% decline of kidney function which was considered significant.  The results persisted even after considering other factors, such as age, physical activity, high blood pressure, and diabetes.

No link howevere was ssen among women who took less than 2 diet sodas per day.

Implications of the study:  Some women I know use diet sodas to help them lose weight.  To help them reduce their cravings for food and to make feel full easily.  It may be true that they contain zero caloris but now concerns regarding the food additives, the artificial coloring and the high sodium content of these drinks may cause harm.

Long term prospective studies however need to be done to determine the exact culprit of the decline…. but for now…suffice it to say taht diet sodas will always be at the bottom of the health food pyramid…and should never be used as a substitute for milk or water.

So this Christmas season…maybe a can every not so often will suffice.  Even during this merry holiday season, lets not forget that health is still a priority and  for me…. the best gift I can offer to myself!

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

How Much Exercise is Needed to Lose the FAT?

November 26, 2009

It has been known that losing weight is a game of discipline and balance… Balance between food intake and physical activity. 

But what is not known is how much activity is needed to lose the fat inside the viscera or  abdomen known to be the Bad Fat!  Remember if you want to lose weight: the equation is more toward lesser intake of FOOD…  while If you want physical conditining and maintenance of weight, the balance points more to physical activity.

Now comes this interesting data that looked at this particular question.  How much exercise does one need to lose fat?  The study was published in journal  Obesity, Oct 8, 2009

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The purpose of this study was to determine what effect aerobic and resistance exercise training has on gain of visceral fat during the year following weight loss.

After being randomly assigned to aerobic training, resistance training, or no exercise training, 45 European-American (EA) and 52 African-American (AA) women lost 12.3 plusminus 2.5 kg on a 800 kcal/day diet. Computed tomography was used to measure abdominal subcutaneous and visceral adipose tissue, whereas total fat and regional fat (leg, arm, and trunk) were measured by dual energy X-ray absorptiometry after weight loss and 1 year following the weight loss. Because not all the subjects adhered to the 2 time/week 40 min/day exercise training during the 1-year follow-up, subjects were divided into five groups for analysis: aerobic adherers, aerobic nonadherers, resistance adherers, resistance nonadherers, and no exercise.

No significant differences were observed between the aerobic training and resistance training adherers for any variable. However, the aerobic (3.1 kg) and resistance (3.9 kg) exercise adherers gained less weight than any of the other three groups (all >6.2 kg).

In addition, the two exercise adherence groups did not significantly increase visceral fat (<0.8%) as compared with the 38% increase for the two nonadhering exercise groups and the 25% for the nonexercise group.

In Conclusion:

 As little as 80 min/week aerobic or resistance training had modest positive effects on preventing weight regain following a diet-induced weight loss. More importantly, both aerobic and resistance training prevented regain of potentially harmful visceral fat.

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I have been a  believer of this fact… that relying heavily on physical activity alone to help one lose weight is doomed to fail.  One needs to brisk walk for example around 70 minutes to burn 250 calories while eating french fries in a 5 minute snack time will already give you 320 calories!!!!

The above study points out the balance between cutting calories and physical activity.  The mere 80min per week exercise resulted in the prevention of weight regain after a diet induced weight loss … especially the prevention of the regain of the visceral fat which is considered the Bad fat!

Now that is definitely not difficult to do!!!!  How much more if we do physical activity on a daily basis?  Once you get used to it…you’re hooked. 

An example of being hooked: Just last night for example, I have to be in a symposium to give a lecture to cardiologists…but I really squeezed in at least a 20 min run prior to preparing for my talk…boy was it exhilirating to have sweat it out and boy was it refreshing afterwards!

No more excuses….

A little of something is better than Nothing….

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Nutrition Health Tips, Personal Thoughts, The Truths on Obesity, Weight Loss Tips | 12 Comments »

Running and The Risk of Joint Disease…. Will My Jogging Cause Arthritis?

November 9, 2009

Not necessarily….

A 14 year prospective longitudinal study published in Arthritis Research and Therapy  involving  961 men and women, aged 50 and over, found results that will be good news to us runners all over the world.  I am not really a “runner” like my good friend Yong Larrazabal of the Cebu Doc Group of Hospitals but I do jog daily around 4k as my form of physical activity.

The study below clearly showed that “exercise was associated with a substantial and significant reduction in pain even after adjusting for gender, baseline BMI, and attrition”.  Read on………

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We studied the long term impact of running and other aerobic exercise on musculoskeletal pain in a cohort of healthy aging male and female seniors who had been followed for 14 years.

We conducted a prospective, longitudinal study in 866 Runners’ Association members (n = 492) and community controls (n = 374). Subjects were also categorized as Ever-Runners (n = 565) and Never-Runners (n = 301) to include runners who had stopped running.

Pain was the primary outcome measure and was assessed in annual surveys on a double-anchored visual analogue scale (0 to 100; 0 = no pain). Baseline differences between Runners’ Association members and community controls and between Ever-Runners versus Never-Runners were compared using chi-square and t-tests. Statistical adjustments for age, body mass index (BMI), gender, health behaviors, history of arthritis and comorbid conditions were performed using generalized estimating equations.

Runner’s Association members were younger (62 versus 65 years, p < 0.05), had a lower BMI (22.9 versus 24.2, p < 0.05), and less arthritis (35% versus 41%, p > 0.05) than community controls. Runners’ Association members averaged far more exercise minutes per week (314 versus 123, p < 0.05) and miles run per week (26 versus 2, p < 0.05) and tended to report more fractures (53% versus 47%, p > 0.05) than controls. Ever-Runners were younger (62 versus 66 years, p < 0.05), had lower BMI (23.0 versus 24.3, p < 0.05), and less arthritis (35% versus 43%, p < 0.05) than Never-Runners. Ever-Runners averaged more exercise minutes per week (291 versus 120, p < 0.05) and miles run per week (23 versus 1, p < 0.05) and reported a few more fractures (52% versus 48%, p > 0.05) than Never-Runners.

  • Exercise was associated with significantly lower pain scores over time in the Runners’ Association group after adjusting for gender, baseline BMI, and study attrition (p < 0.01). Similar differences were observed for Ever-Runners versus Never-Runners.
  • Consistent exercise patterns over the long term in physically active seniors are associated with about 25% less musculoskeletal pain than reported by more sedentary controls, either by calendar year or by cumulative area-under-the-curve pain over average ages of 62 to 76 years.

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 The above study only further confirms what other studies have shown in regards to the relationship between greater physical activity and the associated less pain and disability associated with a higher health related quality of life.  These studies refute the earlier claims and excuses of non exercisers that long term… runners will have debilitating arthritis or joint diseases!   For me…they are mere excuses for those who lead a sedentary lifestyle.

An analogy to this finding would be our recommendations for people with heart attack.  A stressful activity may trigger the event BUT the long term risk is decreased by more activity.  As more physical activties with lifestyle change have been shown to be helpful long term in reducing risk for chronic debilitating diseases.

Take Home message of this all:  

  1. It is the ” too little activity over time” that may in fact be the primary cause of a large percentage of musculoskeletal injuries and NOT the other way around!   
  2. With the worldwide epidemic of obesity, diabetes and Hypertension, it is but prudent to suggest that too much exercise is not the major public health problem… rather it is the Inactivty that is a Problem and the associated diseases that come with it!

Remember….All the studies have proven so far that on the contrary… the more once moves the joints, the stronger they become to withstand injuries long term suggesting that indeed….

Lifetime physical activity Is Protective… to your joints, muscles and the whole physical being!

So guys…let’s all enjoy running!!!

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, Weight Loss Tips | 6 Comments »

Weight Loss and Health….

November 6, 2009

Now the good news….

The main reason for my weight loss through lifestyle change is my aim to reduce my risk to develop diabetes in the future.  After a scary 96 mg/dl fasting blood sugar during my annual executive checkup, I pushed myself to achieve my ideal BMI becuase apparently I was overweight.

Now as published in Lancet this October 29, 2009, the long term Diabetes Prevention Program extended study showed long term benefits of modest weight loss through lifestyle as better in preventing the progression of the disease compared to intake of medication called Metformin. 

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Background

In the 2·8 years of the Diabetes Prevention Program (DPP) randomised clinical trial, diabetes incidence in high-risk adults was reduced by 58% with intensive lifestyle intervention and by 31% with metformin, compared with placebo. We investigated the persistence of these effects in the long term.

Methods

All active DPP participants were eligible for continued follow-up. 2766 of 3150 (88%) enrolled for a median additional follow-up of 5·7 years (IQR 5·5—5·8). 910 participants were from the lifestyle, 924 from the metformin, and 932 were from the original placebo groups. On the basis of the benefits from the intensive lifestyle intervention in the DPP, all three groups were offered group-implemented lifestyle intervention. Metformin treatment was continued in the original metformin group (850 mg twice daily as tolerated), with participants unmasked to assignment, and the original lifestyle intervention group was offered additional lifestyle support. The primary outcome was development of diabetes according to American Diabetes Association criteria. Analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00038727.

Findings

During the 10·0-year (IQR 9·0—10·5) follow-up since randomisation to DPP, the original lifestyle group lost, then partly regained weight. The modest weight loss with metformin was maintained. Diabetes incidence rates during the DPP were 4·8 cases per 100 person-years (95% CI 4·1—5·7) in the intensive lifestyle intervention group, 7·8 (6·8—8·8) in the metformin group, and 11·0 (9·8—12·3) in the placebo group. Diabetes incidence rates in this follow-up study were similar between treatment groups: 5·9 per 100 person-years (5·1—6·8) for lifestyle, 4·9 (4·2—5·7) for metformin, and 5·6 (4·8—6·5) for placebo. Diabetes incidence in the 10 years since DPP randomisation was reduced by 34% (24—42) in the lifestyle group and 18% (7—28) in the metformin group compared with placebo.

Interpretation

During follow-up after DPP, incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group, but the cumulative incidence of diabetes remained lowest in the lifestyle group. Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years.

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The study clearly shows that weight loss through lifestyle changes can significantly reduce ones risk to develop diabetes by as much as 34%. 

The Intensive lifestyle changes in the study consisted of lowering fat and calories in the diet and increasing regular physical activity to 150 minutes per week.  Most exercise was in a form of walking.  Modest weight loss was around 15 lbs in the first year but overtime regained them all but 5 lbs over the next 10 years.  I guess this shows that lifestyle really is difficult for some to maintain.

What matters most for this study is that lifestyle change through fitness and nutrition really works.  The only problem is how one can maintain to be active throughout ones life and how one can withstand the sight of FOOOOD!!!! 

For me….Its a matter of discipline and focus… The two main ingredients to achieving success through behavioral modification.  Clinically, the measure of success is when one is able to maintain the weight loss beyond 1 year of intervention.  Losing weight in 6 months is good…but gaining them back in the next 6 months is bad…..

The Facts are here… the Benefits are known… The rest now depends on YOU!

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Nutrition Health Tips, Personal Thoughts, The Diabetes Facts, What's New in Diabetes | 4 Comments »

High Protein Diet and Alzheimers’ Dsiease: Is There a Link?

October 27, 2009

Go to fullsize imageThe famous FAD diet fo the century is the Atkins or High Protein diets.  Short term weight loss made these diets so popular that even the medical community has to take a second look.

One new possible side effect of  this FAD-  high protein diet is believed to be neurotoxicity that can possibly lead to premature aging or alzheimers disease. 

In a recent study published in Molecular Neurodegeneration, 2009, 4:40 (21 October 2009), animal studies involving mice that were fed with this kind of diet resulted in having brains that apprently shrank.  This clinically may therefore be relevant to the onset of forgetfulness in the long run to humans.

This study is experimental but may be a signal to further develop a prospective study to elucidate the important effects of a high protein diet in the brain on humans.  Whether this is true to any age group or not remains to be seen.

In my practice, I maybe a maverick in terms of  prescribing a specific diet plan for my pateints BUT ive always been against any FAD diets which I know will only result in short term results rather than long term outcomes.

Better Still… Be Well by Eating Right!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, The Truths on Obesity, Weight Loss Tips | 3 Comments »

Walking versus Jogging

October 12, 2009

Walking as an exercise is the simplest form of activity.  I used to walk at least 4x a week.  That has been my form of exercise eversince I decided to emabark on a healthy lifestyle.   BUT I was not really consistent in doing so. There was always a reason for me not to do it this day or the next day. 

But when I started a new regimen of activity after I had a blood sugar of 96 ( with my strong family hist0ry and being the youngest of 9 with a diabetic mother: my risk is pretty high)…and a BMI of 26…I was definitely overweight… I found the differerence between simply brisk walking and running or actually jogging.

I only jog.  Meaning leisurely running 5 km per hour.  I posted my regimen before as the WOG: where I Walk and Jog but for the past several months Ive elevated the activity to all- jogging for 45 min per day. 

 The difference in terms of stamina, ” the feeling good” after the exercise and the “urge” to do it again the next day was something I did not feel whan I was brisk walking.  The sweating was 100 x more and the ” good sense of well being” feeling after the exercise was experienced even more!  I guess the endorphins are really kicking in when you sweat more and do more strenuous activities than just by simply walking without sweating it out!

The added factor to this exercise activity is of coure the maintenance of ones weight.  So far with my diet regimen and my jogging, Ive successfully maintained my weight and BMI of 22.

So guys… which is better?

Try it yourself and you make a choice.  Whatever your choice is …both are great activities to keep you healthy!

Posted in Exercise and Activity Tips, General Health Tips, Health Facts on Osteoporosis, Healthy Practice Tips, Lifestyle Measures, Personal Thoughts, The Diabetes Facts | 16 Comments »

The Thigh and The Heart…Where’s The Connection?

September 21, 2009

Check your thighs… are they thin or thick?  big or small?

Now get a tape measure and read on…..

An intriguing study published in the British Medical Journal made me think….

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Objective To examine associations between thigh circumference and incident cardiovascular disease and coronary heart disease and total mortality.

Design Prospective observational cohort study with Cox proportional hazards model and restricted cubic splines.

Setting Random subset of adults in Denmark.

Participants 1436 men and 1380 women participating in the Danish MONICA project, examined in 1987-8 for height, weight, and thigh, hip, and waist circumference, and body composition by impedance.

Main outcome measures 10 year incidence of cardiovascular and coronary heart disease and 12.5 years of follow-up for total death.

Results:

  •  A small thigh circumference was associated with an increased risk of cardiovascular and coronary heart diseases and total mortality in both men and women.
  •  A threshold effect for thigh circumference was evident, with greatly increased risk of premature death below around 60 cm.
  • Above the threshold there seemed to be no additional benefit of having larger thighs in either sex.
  • These findings were independent of abdominal and general obesity, lifestyle, and cardiovascular risk factors such as blood pressure and lipid concentration.

Conclusions:

  • A low thigh circumference seems to be associated with an increased risk of developing heart disease or premature death.
  • The adverse effects of small thighs might be related to too little muscle mass in the region.
  • The measure of thigh circumference might be a relevant anthropometric measure to help general practitioners in early identification of individuals at an increased risk of premature morbidity and mortality.

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What is interesting of this study is the finding that the risk to cardiovascular disease was in fact  more highly related to thigh circumference than to waist circumference. 

Now therefore…we have a very simple way of determining based on a method we can easily do anywhere pt measure and assess ones risk! 

The CUT OFF size is 60 cm…that’s the magic number …anything smaller is harmful so the study says….

Will the risk reverse once we increase the circumference of the thighs? Again …the whole picture of a healthy lifestyle still is the best way to combat chronic diseases and heart disease. 

But for now, thinner thighs mean lesser muscle mass which may mean insulin may not work properly and therefore can predispose this individual to diseases like diabetes and high blood pressure.   In this study, the people with a thigh measurement of less than 46.5 centimetres (18 inches)had roughly double the chances of getting heart and circulation problems or dying during the study.  

So what needs to be done? If you have a small thighs you can do something about it!!!!

Exercise!!!

Another reason for us to move and work out!

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Diabetes Facts, Tips To Protect Your Heart | 7 Comments »

Obesity and Bullying…

September 10, 2009

In one study that looked at overweight children, 60% of boys reported being bullied in school.  Whether children report the incident to their parents or not is another matter. 

So when I give a talk on obesity and the risks associated with having overweight kids, I also emphasize not only the medical aspect of the problem but aso the psychosocial problems associated with childhood obesity. 

Recently a report on the effect of bullying in children was publ;ished in Archives of General Psychiatry, September 7, 2009 issue. It showed that a history of being a victim of bullying at age 8 years among females independently predicted psychiatric hospital treatment and use of antipsychotic, antidepressant and anxiolytic drugs… this association was regardless of psychiatric problems at baseline.

Among males on the other hand , victims of frequent bullying predicted the future use of antidepressant and anxiolytic drugs as well as increase  psychiatric hospital treatment and use of antipsychotics.

This new study clearly emphasizes the need for parents to further look at how we feed our children becuase giving in to their desires and wants rather than need can mean a future that is filled with medical risks. 

The association of being overweight and being targets of bullying cant be over emphasized.  There should be a stop somewhere and it should start within the confines of our home…

Teaching them the right amount and the right kind of food means a better future for them both physically and emotionally.

Posted in General Health Tips, Medical News Bits, Personal Thoughts, The Truths on Obesity | 5 Comments »

How To Eat and Live Longer….

September 3, 2009

People have been looking for the miracle pill to live longer.  Cosmetic surgeries are on the rise because of vanity and the desire to feel and look young. Healthy lifestyle through proper food choices have always been advocated by different medical societies as the way to go BUT finding the right choices of food and the most practical activities to do remain elusive to most.

The so called Mediterranean diet has long been touted as having shown to have the most healthy components in terms of food choices.  Recently in a population based study done in Greece published in British Medical Journal, June, 2009, Mediterranean diet appeared to contribute to increased longetivity.

After a mean follow-up of 8.5 years, there were more deaths among individuals who were on low Mediterranean diet components than among individuals whose diet components were high of the Mediterranean-diet.  Furthermore, the study was able to teased out the contribution of each component to low mortality:

  • moderate consumption of alcohol (23.5% of the effect),
  •  low consumption of meat (16.6%),
  • high consumption of vegetables (16.2%),
  • high consumption of fruits and nuts (11.2%),
  • high monounsaturated-to-saturated lipid ratio (10.6%), and
  • high consumption of legumes (9.7%).

The study suggested therefore that the largest effects on reduced mortality came from drinking moderate amounts of alcohol equivalent to five small glasses of wine (10 g/day to less than 50 g/day) for men and half that for women as well as eating little meat while eating lots of vegetables, eating fruits and nuts, and using olive oil.  It is however very important to note that the individual components of the Mediterranean diet gave an additive protective effect to the overall mortality.  The study suggests that it is still the overall dietary habit that will determine whether your diet is healthy and can lead to longer life than just relying on the health benefits of an individual diet component.

So change to a healthier lifestyle with five servings of vegetables, three to four servings of fruits, nuts a day, lots of vegetables, less meat and moderate amount of the so called French Paradox: Wine

Toast To A Long Life!!!

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

Hibernation….

August 28, 2009

Just didnt realized it that I have not updated my site for almost a month now.

To give myself an excuse to this hibernation… as host to the recent First Joint meeting of the American Association of Clinical Endocrinologist- US and the Philippine Chapter…it was no small task.   The preparations leading to the convention making sure that evrything was in place were enormous.

The meeting was held in Mactan Shangrila last August 13 to 16 and we had 7 invited foreign speakers…not company sponsored but AACE US board members as our plenary speakers. 

 To sum it up: the event was well attended by almost 500 delegates with foreign guests from Singapore.  The Board memebrs inclduing DR Hossein Gharib my mentor at the Mayo Clinic, as the Past President of the society as well as Dr Allgeo, the Chair of the AACE International Committee were all impressed.  All we got were praises form the delegates form the great scientific program to the excellent teachers and professors.  All hard work paid off and due to the great teamwork of the AACE Philippine chapter board members headed by our President Dr H Gomez.

See you all again In Manila next year for the annual meeting to be held at Sofital Hotel.

Immediately after the event, I enjoyed few more days of rest and travel to Prague, Krakow Poland then to Budapest. It was indeed a great trip to enjoy and learn about the Nazi camps and its history.  Plus Prague and Budapest had their own rich cultural history.

So guys, am back… sorry for those who visited my site and havent been answered regarding their querries and comments.  Will do that soon!

Posted in General Health Tips | 1 Comment »

US Best Hospitals: Where To Go for the Best Care and Where To Train…

July 30, 2009

It is noteworthy to share with you the recent ranking of the US Best Hospitals. 

This post will help us make wise decisions where in the US can we get the best care… and the best specialty training for those planning to go the US for further studies.

New Rankings of the 2009 Best US Hospitals

from WebMD — a health information Web site for patients

Hospitals are listed below by total points. Here are the 21 hospitals that made the magazine’s honor roll (two are tied for 10th place):

  1. Johns Hopkins Hospital, Baltimore
  2. Mayo Clinic, Rochester, Minn.
  3. Ronald Reagan UCLA Medical Center, Los Angeles
  4. Cleveland Clinic
  5. Massachusetts General, Boston
  6. New York-Presbyterian University Hospital of Columbia and Cornell
  7. University of California-San Francisco Medical Center
  8. Hospital of the University of Pennsylvania, Philadelphia
  9. Barnes-Jewish Hospital/Washington University, St. Louis
  10. Brigham and Women’s Hospital, Boston
  11. Duke University Medical Center, Durham, N.C.
  12. University of Washington Medical Center, Seattle
  13. UPMC-University of Pittsburgh Medical Center
  14. University of Michigan Hospitals and Health Centers, Ann Arbor
  15. Stanford Hospital and Clinics, Stanford, Calif.
  16. Vanderbilt University Medical Center, Nashville, Tenn.
  17. New York University Medical Center
  18. Yale-New Haven Hospital, New Haven, Conn.
  19. Mount Sinai Medical Center, New York
  20. Methodist Hospital, Houston
  21. Ohio State University Hospital, Columbus

Top Hospitals by Specialty

Here are the No. 1 hospitals in each specialty, according to U.S. News and World Report:

  • Cancer: M.D. Anderson Center, University of Texas, Houston
  • Diabetes and endocrine disorders: Mayo Clinic, Rochester, Minn.
  • Digestive disorders: Mayo Clinic
  • Ear, nose, throat: Johns Hopkins Hospital, Baltimore
  • Geriatric care: Ronald Reagan UCLA Medical Center, Los Angeles
  • Gynecology: Brigham and Women’s Hospital, Boston
  • Heart and heart surgery: Cleveland Clinic
  • Kidney disorders: Brigham and Women’s Hospital
  • Neurology and neurosurgery: Mayo Clinic
  • Ophthalmology: Bascon Palmer Eye Institute, University of Miami
  • Orthopaedics: Mayo Clinic
  • Psychiatry: Massachusetts General, Boston
  • Rehabilitation: Rehabilitation Institute of Chicago
  • Respiratory disorders: National Jewish Hospital, Denver
  • Rheumatology: Johns Hopkins Hospital
  • Urology: Johns Hopkins Hospital

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Johns and Hopkins and the Mayo Clinic have been consistent topnotcher with only few points separating the two.  And their ranking have been the same since the time I had the privilege to train at the Mayo Clinic for my Endocrinology Fellowship from 1993 to 1996. 

Consistency with the best of care and the best team for specialty training therefore is the name of the game! 

And having grabbed the opportunity to be part of a great system and to be trained by great teachers will forever be one of the best achievements of my career!

Posted in Medical News Bits, Personal Thoughts | 1 Comment »

The Benefits of Exercise Go Beyond Prevention….

July 23, 2009

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

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

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

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

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

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

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

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

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

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

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

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

You Get Everything GOOD with EXERCISE!  

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Diabetes Facts | 2 Comments »

The 20-40 RULE in Fitness and Disease

July 13, 2009

My 20-40 rule:

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

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

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

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

Results:

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

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

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

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

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

What Do These Data MEAN?

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

The authors conlcuded:

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

 AMEN!

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Diabetes Facts, The Truths on Obesity, What's New in Diabetes | 4 Comments »

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

July 7, 2009

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

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

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

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

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

Here’s what I do:

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

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

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

To stay Fit and Slim…Discipline is the KEY!

You are What You Eat and Do the WOG!

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Nutrition Health Tips, Personal Thoughts, The Truths on Obesity, Weight Loss Tips | 4 Comments »

Sleep Well To Prevent High Blood Pressure!!!

July 4, 2009

A simple measure to reduce BP is to have a good night’s sleep!!!

Here’s a new study that shows us one tip to have a better controlled blood pressure  published in Archives of Internal Medicine:

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BACKGROUND: Epidemiological studies have reported an association between self-reported short sleep duration and high blood pressure (BP). Our objective was to examine both cross-sectional and longitudinal associations between objectively measured sleep and BP.

METHODS: This study is ancillary to the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. Blood pressure was measured in 2000 and 2001 and in 2005 and 2006. Sleep was measured twice using wrist actigraphy for 3 consecutive days between 2003 and 2005. Sleep duration and sleep maintenance (a component of sleep quality) were calculated. Analyses included 578 African Americans and whites aged 33 to 45 years at baseline. Outcome measures were systolic BP (SBP) and diastolic BP (DBP) levels, 5-year change in BP, and incident hypertension.

RESULTS: After we excluded the patients who were taking antihypertensive medications and adjusted for age, race, and sex,

  • shorter sleep duration and lower sleep maintenance predicted significantly higher SBP and DBP levels cross-sectionally as well as more adverse changes in SBP and DBP levels over 5 years (all P < .05).
  • Short sleep duration also predicted significantly increased odds of incident hypertension (odds ratio, 1.37; 95% confidence interval, 1.05-1.78).
  •  Adjustment for 16 additional covariates, including snoring and daytime sleepiness, slightly attenuated the associations between sleep and BP.

 CONCLUSION: Reduced sleep duration and consolidation predicted higher BP levels and adverse changes in BP, suggesting the need for studies to investigate whether interventions to optimize sleep may reduce BP.
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There you go guys… nake sure you sleep better..and rest well. 

Dont let worries or pressure bother you too much. 

Associate the bed with a good night’s sleep…  not only will you feel refreshed the next day BUT healthier too!

For a Healthier Heart… Sleep Well!!!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Tips on Hypertension, Tips To Protect Your Heart | 1 Comment »

What’s Really the IDEAL Weight To Live Longer?

July 2, 2009

My brother in law’s blog article had this title: A Little Extra Weight can Make you Live Longer! 

That obviously caught my attention.  So searching the source of the article was actually published in the  OBESITY journal  June 2009.  Below is the abstract:

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Although a clear risk of mortality is associated with obesity, the risk of mortality associated with overweight is equivocal. The objective of this study is to estimate the relationship between BMI and all-cause mortality in a nationally representative sample of Canadian adults.

A sample of 11,326 respondents aged 25 in the 1994/1995 National Population Health Survey (Canada) was studied using Cox proportional hazards models.

  • A significant increased risk of mortality over the 12 years of follow-up was observed for underweight (BMI <18.5; relative risk (RR) = 1.73, P < 0.001) and obesity class II+ (BMI >35; RR = 1.36, P <0.05).
  • Overweight (BMI 25 to <30) was associated with a significantly decreased risk of death (RR = 0.83, P < 0.05).
  • The RR was close to one for obesity class I (BMI 30–35; RR = 0.95, P >0.05).

Our results are similar to those from other recent studies, confirming that underweight and obesity class II+ are clear risk factors for mortality, and showing that when compared to the acceptable BMI category, overweight appears to be protective against mortality. Obesity class I was not associated with an increased risk of mortality.

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But a Word of Caution …..

As clearly stated by Mark Kaplan, DrPH, the coauthor: “Our study only looked at mortality, not at quality of life, and there are many negative health consequences associated with obesity, including high blood pressure, high cholesterol, and diabetes.”

What made the study interesting were the following outcomes:

  • Overweight individuals were 17 percent less likely to die than normal weight inidividuals. 
  • Not surprising are the outcomes for the underweight people as they were noted to be 70 percent more likely than people of normal weight to die. 
  • The same outcome was noted with the extremely obese people who were 36 percent more likely to die.

The problem of the study is it only looked at mortality data and nothing else. One may have lived longer but the quality of life due to disabling complications arising from chronic conditions associated with obesity is poor. 

And this has always been our battle cry for a healthy lifestyle and achieve a healthy normal weight:

  •  To reduce the risk for chronic diseases that can cause disability and that
  •  Excess weight can shorten your lifespan…

The bottom line is: 

  • A Little overweight is better than having excess weight BUT

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  • Normal weight should continue to be The Goal … and always

    •  

  • AIM to Achieve a healthy lifestyle to live longer because:

 Quality is More Important Than Quantity!

Posted in General Health Tips | 4 Comments »

How To Exercise To Reduce Heart Disease…

June 30, 2009

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

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

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

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

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

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

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

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

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

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Additional recommendations highlighted in the guidelines include:

  • Resistance training should use all muscle groups and progress to  2–4 sets of 8–10 repetitions at a weight that cannot be lifted >8–10 times, with 1–2 minute rest periods between sets.
  • The duration of each individual session can vary, although the aim should be a minimum of 10 minutes per session, at least 3 sessions per day.
  • Patients who elect to walk should perform the task at a brisk pace to be effective.

    • Go guys… jump on to the bandwagon.  Just look around you.  Lance Gokongwei has joined the fitness world!  So can we!

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

    Be Fit…Be Slim…

    Be Smart and Be Healthy!

    Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Diabetes Facts | 2 Comments »

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