Coffee or Tea Keeps Diabetes Away….

May 11, 2010

Anothe rgood news for coffee lovers like me… Now comes a new study agina showing the reduction in ones risk to develop diabetes.  The study was recently published in the Archives of Internal Medicine December issue…

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Background  Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus. Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes. Methods  Relevant studies were identified through search engines using a combined text word and MeSH (Medical Subject Headings) search strategy. Prospective studies that reported an estimate of the association between coffee, decaffeinated coffee, or tea with incident diabetes between 1966 and July 2009.

Results  Data from 18 studies with information on 457 922 participants reported on the association between coffee consumption and diabetes. Six (N = 225 516) and 7 studies (N = 286 701) also reported estimates of the association between decaffeinated coffee and tea with diabetes, respectively. We found an inverse log-linear relationship between coffee consumption and subsequent risk of diabetes such that every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes relative risk, 0.93 [95% confidence interval, 0.91-0.95]) after adjustment for potential confounders.

Conclusions  Owing to the presence of small-study bias, our results may represent an overestimate of the true magnitude of the association. Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes. The putative protective effects of these beverages warrant further investigation in randomized trials.

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This study again shows same conclusion as in the past that a mere 4 cups of coffee per day whether regular or decaf has been shown to reduce ones risk to develop diabetes by 27%.  And what is interesting is that for every extra cup of coffee, an additional 7 % further reduction is risk to develop diabetes was noted.

The study therefore points out to one thing…that caffeine may not be the factor as decaf can result in similar reduction in risk.  Other chemicals present in coffee therefore need to be explored…. 

However…one should not resort to just relying on coffee to reduce our risk to develop diabetes.  We have to remember that lifestyle and proper food intake has been shown to reduce the risk of developing diabetes by a whoooping 50%….

There you go guys…enjoy our coffee!!!!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, The Diabetes Facts, What's New in Diabetes | 9 Comments »

Carbohydrate Fanatics and the Heart…

April 14, 2010

Filipinos love bread.  We are carbohydrate eaters. You see bread shoppes in every corner of the Philippines. Cheap and easy to get and filling.  But in every food that we eat comes the recommendation of moderation.  One reason why diabetes is rising  in epidemic proportion in our country is because of the loads of carbos that we eat and the lack of exercise that we usually hate. 

Now comes this article published in Archives of Internal Medicine, April 2010 that looked at carbohydrate intake and the risk of heart disease.

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Background  Dietary glycemic load (GL) and glycemic index (GI) in relation to cardiovascular disease have been investigated in a few prospective studies with inconsistent results, particularly in men. The present EPICOR study investigated the association of GI and GL with coronary heart disease (CHD) in a large and heterogeneous cohort of Italian men and women originally recruited to the European Prospective Investigation into Cancer and Nutrition study.
 
Methods  We studied 47 749 volunteers (15 171 men and 32 578 women) who completed a dietary questionnaire. Multivariate Cox proportional hazards modeling estimated adjusted relative risks (RRs) of CHD and 95% confidence intervals (CIs).

Results  During a median of 7.9 years of follow-up, 463 CHD cases (158 women and 305 men) were identified. Women in the highest carbohydrate intake quartile had a significantly greater risk of CHD than did those in the lowest quartile (RR, 2.00; 95% CI, 1.16-3.43), with no association found in men (P = .04 for interaction). Increasing carbohydrate intake from high-GI foods was also significantly associated with greater risk of CHD in women (RR, 1.68; 95% CI, 1.02-2.75), whereas increasing the intake of low-GI carbohydrates was not. Women in the highest GL quartile had a significantly greater risk of CHD than did those in the lowest quartile (RR, 2.24; 95% CI, 1.26-3.98), with no significant association in men (P = .03 for interaction).

Conclusion  In this Italian cohort, high dietary GL and carbohydrate intake from high-GI foods increase the overall risk of CHD in women but not men.

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So what are the foods that have high Glycemic Index?

Foods we usually eat daily like white bread, honey, the ube or mango jam that we usually spread in our bread,the yummy cheese and bacon pizza, and our daily rice.  On the other hand the foods that are low in glycemic index include noodles or pasta and fruit.  Low GI foods are what we recommend to our diabetic pateints becuase they dont increase the blood sugar as much.

The study showed that increasing carbohydrate intake from foods with a high glycemic index was associated with increasing risk of developing heart disease. The increase in risk is as high as 68% which is really significant compared to those who took foods that are low in sugar content.  The risk maybe related to the changes in triglycerides and HDL ( the good cholesterol) seen among women known to have a significant impact in heart disease risk.  The higher the carbo intake, the higher the triglycerides will be and the lower the good cholesterol can become.

So,,,Easy on Pizza loading the next time you are in the mall!!!!

To our carbo fanatics… take it easy on your next craving. 

Posted in General Health Tips | 11 Comments »

Is Running A Marathon Healthy?

March 26, 2010

I run leisurely… the most I have run is 5K and am happy to get the target below 30 minutes. I love the feeling of rush when you reach your goal target and I guess that’s what keeps marathoners going for more.  A lot of my friends are convincing me to run a marathon…I doubt if Ill ever do that.  A 42 K marathon…running for that long will probably take me 6 hours…hehe.  Anyway, the question that has always come to my mind is this: is running too long healthy or can it do harm long term? 

In the recent American College of Cardiology meeting, the question of distance running and its effect on health was discussed.  Ill quote the article published recently in Heartwire online:

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Presenting the results of the study at the American College of Cardiology (ACC) 2010 Scientific Sessions, Schwartz, along with senior investigator Dr Robert Schwartz (Minneapolis Heart Institute, MN), his father, said that at least three runners have died this year during marathons, and three runners died during the 2009 Detroit Marathon, a race that included nearly 4000 finishers. Runners are typically considered a healthy subgroup of the general population, so these deaths are usually high profile and attract a great deal of media attention. One recent estimate suggests the rate of sudden cardiac death among marathoners is rare, roughly 0.8 per 100 000 participants.

In this study, the father-and-son team, both runners, wanted to assess coronary artery plaque in an elite group of marathon runners and compare their arteries with a control group. They identified 25 runners who completed the Minneapolis-St Paul Twin Cities Marathon every year for 25 consecutive years, thus completing a minimum of 25 marathons.

All subjects underwent coronary computed tomography angiography (CTA) using a 64-slice machine. Compared with controls, marathoners had significantly more calcified plaque volume—274 mm3 for the marathoners and 169 mm3 for the controls—and higher calcium scores and noncalcified plaque volumes, although the latter two measures did not reach statistical significance.

patient age, systolic blood pressure, total cholesterol, LDL cholesterol, and triglyceride levels were similar between the marathoners and controls, but heart rate, weight, and body-mass index were lower in the runners. Also, HDL-cholesterol levels were significantly higher in the runners than in the controls. The average total- and LDL-cholesterol levels were 190 mg/dL and 115 mg/dL, respectively, in the marathon runners, suggesting that diet is not the reason for the increased calcification.

Jonathan Schwartz said they don’t know why the runners had more plaque in the arteries than the controls and that the findings are “counterintuitive.” However, he pointed out that metabolic and mechanical stresses might be a contributing factor. For example, long-distance runners train at increased heart rates and blood pressures, as well as spend increased time in an anaerobic state, possibly leading to antioxidant damage. Also, damage to the bones might lead to calcium leaking into the bloodstream. They stressed, however, such possible explanations need to be explored further.

Another study, also presented during the ACC meeting, suggested that marathon runners had increased aortic stiffness compared with individuals who exercised recreationally. The researchers, led by Dr Despina Kardara (Athens Medical School, Greece), evaluated blood pressure and aortic elasticity in 42 males and seven females who trained for and ran marathons and 46 men who did not participate in endurance exercise training. On average, the runners trained between two to nine hours per week and had been doing so for periods of 30 months to 21 years.

The marathon runners had significantly higher systolic blood pressure compared with the control group (126 mm Hg vs 115 mm Hg) and higher diastolic blood pressures. Pulse-wave velocity, used to assess aortic stiffness, was significantly higher in the marathon group.

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The findings however need further studies.  But suffice it to say that too much mechanical stress to any part of the body can do harm than good.   

I guess the take home message on this particular study is this:

Try not to push too hard in achieving your goal especially if it entails putting too much pressure on ones body especially the heart… Running is healthy as a form of exercise but anything we do and if we push ourselves to the limit may cause more harm than good.

If you run a marathon…dont stop.  Continue to enjoy it but again dont push yourself too hard….

Take Life In A Stride…!

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits | 5 Comments »

Soft Drinks and Health….

March 1, 2010

More and more studies are linking the consumption of soft drinks to health hazards… a recent article published in Cancer, Epidimeology, Biomarkers and Prevention showed that consumption of thses sugary drinks can increase ones risk to develop pancreatic cnacer.

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Background: Sugar-sweetened carbonated beverages (called soft drinks) and juices, which have a high glycemic load relative to other foods and beverages, have been hypothesized as pancreatic cancer risk factors. However, data thus far are scarce, especially from non-European descent populations. We investigated whether higher consumption of soft drinks and juice increases the risk of pancreatic cancer in Chinese men and women.

Methods: A prospective cohort analysis was done to examine the association between soft drink and juice consumption and the risk of pancreatic cancer in 60,524 participants of the Singapore Chinese Health Study with up to 14 years of follow-up. Information on consumption of soft drinks, juice, and other dietary items, as well as lifestyle and environmental exposures, was collected through in-person interviews at recruitment. Pancreatic cancer cases and deaths were ascertained by record linkage of the cohort database with records of population-based Singapore Cancer Registry and the Singapore Registry of Births and Deaths.

Results: The first 14 years for the cohort resulted in cumulative 648,387 person-years and 140 incident pancreatic cancer cases. Individuals consuming ≥2 soft drinks/wk experienced a statistically significant increased risk of pancreatic cancer (hazard ratio, 1.87; 95% confidence interval, 1.10-3.15) compared with individuals who did not consume soft drinks after adjustment for potential confounders. There was no statistically significant association between juice consumption and risk of pancreatic cancer.

Conclusion: Regular consumption of soft drinks may play an independent role in the development of pancreatic cancer. Cancer Epidemiol Biomarkers Prev; 19(2); 447–55

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The study highlights the consumption of sugar laden soft drinks as a culprit but not other sugary fruit juices.  Other findings that I need to highlight include:

  • Smokers in the study  had a 49% increased risk for pancreatic cancer.  Another reason for one to consider stopping smoking.
  • A history of diabetes was not associated with an increased risk for pancreatic cancer.  But I would say…any diabetic should be screend for pancreatic cancer and this disease manifests a high blood suagr.
  • Drinking 2 or more soft drinks per week was associated with more than 80% increase in risk for pancreatic cancer after adjustment for other risks.  Now …. I know of some who drink soft drinks daily 2-3 x. Scary thought indeed!!!!  In short LIMIT!

Heres a confusing thought from the study though: after adjustment, juice intake of 2 or more drinks per week overall was not associated with increased risk, but when smokers were excluded, there was an association between juice intake and pancreatic cancer risk increasing a persons risk by 60%.  More studies need to be done to examine this relationship. 

So friends…just like my reminder all the time… Limit and limit and not totally eliminate!

We still dont know what is really in the soft drinks that make us unwell.  For now… enjoy it but limit the consumption to sugar free Diet soft drinks. 

Better still enjoy the water!  its FREE!

Posted in Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Diabetes Facts | 5 Comments »

Avandia or Rosiglitazone is In The News Again!

February 24, 2010

I have to write this special post on avandia as many of my patients at present are on it.   Unfortunatelty people responsible for this controversy will not lay to rest the issue that has long been addressed.  In short this is plain OLD issue that has been repackaged and made again into a media hype!  The problem is the laymen – our patients who read the news and interpret the news as they are written. 

Here is the response of the American Association of Clinical Endocrinologists: the Voice of Endocrinology on this particular issue.  The same sentiments as I have.  It is just unfortunate that this drug is involved in  the midst of a controversy inside the FDA.

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AACE Patient Safety – Editorials
 
Commentary on February 19 New York Times article on Avandia
2010-02-22 15:41:32
By: Alan Garber, MD, PhD
Editor, AACE Patient Safety Exchange

 

A rash of headlines appeared this weekend as a Senate report on Avandia was leaked to the New York Times. It contained the usual accusations and concerns of certain FDA staffers such as Dr Graham who spoke 1-2 years ago at prior Avandia Advisory Boards and whose comments were largely based upon the meta-analysis of Nissen and Wolski using post hoc data derived from short term studies with Avandia. Those studies were largely conducted to obtain glycemic control data. Since that time considerable republication of similar meta-analyses, using the same or similar data have appeared. These have spread the concerns regarding Avandia further. Of course since that original meta-analysis was published in 2007, a number of subsequent studies have appeared to alleviate or to directly address the concerns raised by Drs Nissen and Wolski. In 2007, two prior large scale randomized prospective clinical trials had also contained data regarding CHD events with Avandia, namely DREAM and ADOPT. Both studies failed to show increased risk with Avandia, contrary to the conclusions attributed to them in the current New York Times article by Gardiner Harris. But these were post hoc analyses and therefore not definitive. Of course the meta-analysis was as well. Subsequent studies were also analyzed for potential adverse consequences of Avandia, including ACCORD and VADT. Neither trial showed adverse effects and VADT may have suggested benefit instead. A direct test of cardiovascular safety – the RECORD was completed and published in Lancet in June 2009 (373:2125-35) by Philip Home and colleagues. This five year study of nearly 4500 patients with diabetes randomized to treatments containing or not containing Avandia showed no increased risk of death or hospitalization for cardiovascular disease in patients taking Avandia as compared to those not taking Avandia. Since this was the prespecified primary endpoint, it seems proven that the suggestions provided by the meta-analysis have no validity. This conclusion is support by the recently published Perspective by Charles Hennekens and David DeMets in JAMA (302:2361-2, 2009). Here the authors decry overreliance upon meta-analyses of small scale short term studies in favor of data provided by large scale randomized long term trials. Dr Hennekens, a former Professor of Preventive Medicine at Harvard, and a colleague on the NCEP, concludes that the findings of RECORD lay to rest the concerns raised by the meta-analysis.
 
None of these newer studies are addressed or even considered in the article now appearing in the New York Times and the concerns it raises appear to have been adequately addressed and laid to rest by these newer studies. In short, this is old news, quite old indeed.

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So to my patients: no need to worry.  Again this is an old issue repackaged by the New York Times made big in the headlines due to Senate inquiry.

Unless the US FDA will succumb to the pressures by the media and the senate…. there is no reason for this drug not to be available to our patients who need it!

Subsequent proscpective- meaning better made studies like the RECORD, ACCORD and the BARI2D that looked at patient safety on avandia have consistently shown that those taking avandia had in fact lesser risk for cardiovascular  mortality than the comparator drugs including a recent publication in UK  that compared avandia to the commonly used sulfonylurea and metformin.

A Diabetes Care metaanalysis in 2008 likewise showed that Sulfonylurea -metfomin combination in fact also increases risk of heart attack but this study was never caught by the media.  Again since this is only a metaanalysis- exactly the same kind of study that started the Avandia contorversy…it is a hypothesis driven article and therefore cant be trusted but worth proving by making prospective randomized trials.

I hope this article will clear some issues hounding the patients on avandia.  Remember…one reason why we need to control a patient’s blood sugar together with cholesterol and blood pressure is to reduce a patient’s risk for heart attack and stroke!

In medical field…. Analysis of data is of paramount importance.  Dont believe what you read in the news!

Posted in Medical News Bits | 1 Comment »

Parents: WE Still RULE

February 13, 2010

 Go to fullsize imageWhile coming back from San Francisco after attending the postgrad course of the American Diabetes Association, I happened to read a very nice article in USA today on: Teenagers do Listen.  I will be having a teenager son soon, so I was intrigued about the article.

 The article discussed a recent media survey by Kaiser Family Foundation that showed typical kids spend as much as 7 hours and 38 minutes a day consuming entertainment media like TV, computer and game consoles.  Not surprisingly why obesity is now a main global concern with our kids high tech lifestyle.

 But what was astounding about the survey was that the kids whose parents set the rule plugged in to the media for only 3 hours suggesting parents have a big influence on our kids in terms of what they do and think.

 Other studies likewise have shown that activities and behavior of kids are mainly influence by their parents:

 1. Teens who had a bedtime at 10PM or earlier set by parents got more sleep and were less likely to be depressed published in Sleep in January.

2. Teen drivers whose parents set and enforced rules were more likely to wear seat belts and less likely to suffer road accidents including the use of cellphones while driving published in Pediatrics in September.

3.Teens whose parent also set the rules also smoke less, delay sex and do better in school.

 The reality is… Teenagers care deeply about what their parents say… the challenge is getting across the rules and boundaries that don’t seem controlling!

 There you go guys.  It’s not too late. 

Let’s GIVE MORE  time to communicate with our kids…be it while eating dinner together or while driving our kids to school or while bringing them back home. The notion that fewer rules mean lesser fights may not be right after all.  The welfare of our kids continue to be a priority because for me…

What they will become is a reflection of how good we are AS  parents!!!

Posted in Lifestyle Measures, Medical News Bits, Memories and Trips, Personal Thoughts | 1 Comment »

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 »

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