Are You Fit?

February 6, 2009

DID YOU KNOW:

Heart Rate of More Than 70 Beats Per Minute Increases Risk of Heart Failure: The finding that heart rate, specifically a heart rate more than 70 beats per minute, increased the risk of cardiac events in heart failure patients was the top take-home message for the Dutch cardi who chaired the European Society of Cardiology program committee.

Check your heart rate… feel your pulse and count how many beats in one minute. 

What better way to help keep your heart fit is increasing physical activity.  Athletes for example can have a heart rate of less than 50/min.  Suggesting that their hearts dont need to work and pump more to give enough blood to the body… that’s what we call as FITNESS!

To be fit does not necessarily mean your slim and vice versa.  Fitness is a totally different ballgame in the field of health.  Fitness is a way of life… it requires the discipline to achieve it and the determination to make it part of daily living.  In the end… losing the FATNESS will follow.

Fitness Minus Fatness Equals Cardiovascular Health!

Posted in General Health Tips | Leave a Comment »

The Many Lessons I Learned in London

January 29, 2009

The experience I had travelling to London is a memorable one. I attended a postgraduate course in Endocrinology sponsored by the Royal College of Physicians and the trip was both culturally and educationally enriching.

After this trip, London is now among my top 5 must visits places in the world.  Not only is the place rich in culture ( watched Les Miserables in Queens Theatre in West End: marvelous experience), history (from Darwin to the Queen) and beautiful landmarks ( The Big Ben, The Palaces and the Eye) but also the warm hospitality that one can feel dealing with the British citizens.  One is warmly welcomed by the time one reaches the airport to the hotel staff to the cab drivers, waiters and store keepers.  You dont see homeless loitering around your path and was it safe to walk  around the Central London without fear of being mugged or robbed.

I was able to reunite with old  friends now staying in London and unfortunately some may have made it well but a lot of our OFWs are actually languishing in debt.  It makes one feel so vulnerable in a foreign land especially in times of economic crisis where London is the hardest hit among Europe’s developed countries.

The good news also is that our Filipino nurses occupy around 60% of the workforce in London’s major government hospital.  Interesting to note is that nurses are now handling endoscopy procedures as well as laparoscopic cholecystectomy procedures which is probably not going to happen in our country.  This is one thing unique in the British Health Care system.

Overall… this trip has been one welcome respite from the busy days in Cebu and what a great experience it has been.  I will definitely go back to London and this is one place that I will probably learn more things the more times I go back!

Posted in Lifestyle Measures, Memories and Trips | 4 Comments »

Saw Palmetto and Bleeding….

January 23, 2009

Go to fullsize imageI just came across a patient who is taking this herb without my knowledge.  He apparently was taking this supplement to treat his urinary urgency secondary to an enlarged prostate.  Thinking it as an approved herbal supplement and therefore safe, he thought of not telling anyone regarding this pill.  Not until he underwent dental extraction when he was referred because of bleeding.

I have always been against taking herbal supplements as a drug.  These meds may have “no apporved therapeutic claims”  BUT the advertisements that we see on TV and hear on radio claim otherwise and in fact a “cure for all” sort of ads.  Therefore we cant blame our laymen to be enticed to take them in hopes of feeling better, looking younger and curing their illness.

Mayo Clinic website  has this to say in the side effects of saw palmetto:

Few severe side effects of saw palmetto are noted in the published scientific literature. The most common complaints involve the stomach and intestines, and include stomach pain, nausea, vomiting, bad breath, constipation, and diarrhea. Stomach upset caused by saw palmetto may be reduced by taking it with food. Some reports suggest that there may be less abdominal discomfort with the preparation lipidosterolic extract of Serenoa repens (LSESR). A small number of reports describe ulcers or liver damage and yellowing of the skin (jaundice), but the role of saw palmetto is not clear in these cases. Similarly, reports of headache, dizziness, insomnia, depression, breathing difficulties, muscle pain, high blood pressure, chest pain, abnormal heart rhythm, and heart disease have been reported, but are not clearly caused by saw palmetto. People with health conditions involving the stomach, liver, heart, or lungs should use caution.

Caution is advised in people scheduled to undergo some surgeries or dental work, who have bleeding disorders, or who are taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

So BEWARE…again..Be Aware… that not all what you hear are TRUE.  Consult your doctors if you are taking any herbal supplements as they may interfere with the actions of the drugs we are giving to make you feel better!

A lesson to my patient? DEFINITELY!

Posted in General Health Tips, Medical News Bits | Leave a Comment »

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

January 19, 2009

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

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Objective

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

Results

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

Conclusions

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

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

Is this nutritional therapy easy to do? 

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

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

A Quick Note on Exercise and Diabetes…

January 15, 2009

This past week has been extra busy for me and my staff in the clinical research unit because our site has been audited by the European Medicine Agency- the US counterpart of US FDA . My research site has been enrolling a significant number of patients and for that, this is to assure that the site is doing things according to international standards and making sure of patient safety.  This is I understand is the first of my sponsor, the first for my site and the first for Asia Pacific region.  But once we passed this inspection, I can then proudly say, we are EMEA “accreditied” 🙂

Just the same, no matter how busy one is, there should be no excuse why one cant exercise.  As Ive said in my previous post, I have lost weight and been trying to maintain my weight to prevent the onset of diabetes.  And the best way to prevent the onset of diabetes continues to be the PLAIN “E”. And I want to share this quick information regarding exercise and diabetes:

 DID YOU KNOW:
One hour of brisk walking a day cuts your Type II diabetes risk by 50% according to the Nurse’s Health Study. Many physicians recommend walking and exercise to help diabetics with weight and maintaining their blood sugar levels.

Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips | 3 Comments »

The Protective Effect of Eating Fish On Your Kidneys…

January 6, 2009

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

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

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Background

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

Study Design

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

Setting & Participants

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

Predictors

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

Results

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

Conclusions

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

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

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

You Cant Go Wrong With FISH!

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Read my previous post on The Benefits of Eating FISH

Posted in General Health Tips, Medical News Bits, The Diabetes Facts | 2 Comments »

Tips For The Holidays…..

December 23, 2008

The Christmas holiday spirit is just around the corner and everyone is now busy preparing for reunions with family and friends.  And what better way to prepare the celebration is to have a feast!  What is Christmas anyway without the parties?  The bulge and the extra fat that we get after these merry making activities is what makes us feel guilty enough to make us vow to do better on our Annual New Year’s resolutions.

So how can one avoid gaining weight during the holidays? Common sense advise is to keep in mind to always keep track of the calories we take in. But most of all, in situations where food is in abundance in the buffet table…my advise is to enjoy the foods that are nutrient rich but modestly high in protein (20 to 25% of the total calories) and low in carbohydrates (40% to 45% of total calories).

The fad of low carbohydrate and high protein diet has put protein at the center stage.  Since the Atkins Diet and the South Beach diet came into our attention, a lot of controversies has been made because of the absence of long term studies to document their efficacy and safety.  Recent data however have shown that a moderate intake of protein is not only efficacious in making one lose weight but also in improving blood sugar and cholesterol.

Protein intake is important to our body. If we don’t get enough protein- it can lead to growth failure, loss of muscle mass, a reduction in heart and lung function as well as impairment in ones immunity.  However, too much protein can also cause harm.  It can take a lot of calcium from the bone and can lead to fractures. Likewise, people with kidney disease should be warned about a high protein diet since it can further exacerbate the kidney problem.

Let me give you some tips on how to enjoy the benefits of a modestly high protein diet SAFELY….

Remember…different protein sources give different effects on our health.  Proteins coming from vegetables definitely are healthier because they are devoid of fat than those coming from meat. A steak and a salmon may have the same amount of protein but the saturated fat in beef is more than half that of the fish. It is the FAT that can cause harm and can lead to chronic disabling conditions like heart attack and stroke! 

Here are some Tips in Choosing Your Protein Sources wisely:

1. If you are a meat lover then get the lean cuts of beef or pork.  However a healthier alternative would be the white meat of fish and chicken breast.

2. A better option for a healthier protein source would be from vegetable sources like nuts, lentils, beans and whole grain.

3. For your daily protein needs, get them from different sources…mix and match for variety!

4. Soy based foods are also good alternatives to red meat but limit to 2 to 3 servings a week.

Lastly… simple lifestyle measures that you can observe during parties or in preparation for the holiday parties that can matter most in avoiding weight gain:

1.     Always eat breakfast everyday of your life.  If you haven’t done so regularly…do it now!  Avoid skipping meals as this habit can cause more weight gain!

2.     Begin your meals with soup or salad to lessen your cravings for the sinful fat filled dishes on the buffet table.

3.     Try to eat slowly by chewing your food thoroughly so your body will have time to analyze that you are already full.

4.     Once full then stop and walk away from the sight of food.  This habit will make you avoid getting more food even if you are no longer hungry!

5.     Use a smaller plate so it will look full with only a small amount of food.  

A nutrient rich meal that has a modest increase in protein content and a modest restriction of carbohydrates coupled with simple practical lifestyle measures can go along way in helping us avoid the holiday bulge!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Nutrition Health Tips | 5 Comments »

Cancer Is On The RISE… Blame the Lifestyle…

December 12, 2008

Cancer is on the rise year after year… why?

It is set to overtake Cardiovascular disease as the number one killer…why?

Blame it on the poor eating habits and bad lifestyle … the “western” habits of enjoying life!…so BEWARE!

Here’s the excerpt of the recent media release of the International Research on Cancer in cooperation with the American Heart Association:

the burden of cancer doubled globally between 1975 and 2000 and is set to double again by 2020 and nearly triple by 2030.

The report—which was discussed at an event in Atlanta this week called Conquering Cancer: A Global Effort—says that low- and middle-income countries will experience the impact of higher cancer incidence and death rates more sharply than industrialized countries.

WHY? Apparently the cause of this rise is similar to why cardiovascualr disease used to be number 1:

  • Poor eating habits: high fat low fiber, high calorie foods…they are just so yummy that we cant afford not to eat and enjoy them at the expense of diseases!  They say..life is too short…lets enjoy whatever we food we like.  I love that saying life is too short therefore we should enjoy…I do BUT I dont like to suffer and endure a hard suffering and ending.  That’s the main reason I am careful!  Poor eating habits have been blamed to be the culprit of OBESITY…obesity on the other hand is responsible for increasing the prevalence of breast cancer and other cancers.  The link between food intake and obesity to diseases are getting closer and closer and becoming dangerously closely linked!
  • Smoking and tobacco use: a known culprit of chronic illness but up to now continues to be a major health issue. 

Just a BAD habit to break so everyone says.  Again for me…just like losing weight..it all boils down to the plain D as in DISCIPLINE!

Life is too short…I agree.  But live it well… take care of the short life.  Be healthy and enjoy a wonderful healthy sense of well being!

Posted in General Health Tips | 1 Comment »

Quit Smoking and Get Back Your Health…

December 11, 2008

Smoking is indeed addicting.  A lot of smokers know the risks but cant help themselves to quit smoking.  It is actually easier said than done… similar to asking patients to eat less to lose weight!

The good news is…quitting smoking can do a lot of things to reverse the bad efffects of smoking done to ones body and therefore, it is never too late to QUIT.

The Harvard News Letter nicely summarized how the body responds immediately to weeks and months after quitting smoking:

Why bother? Even if you’ve smoked for years, you’ll greatly improve your health.

  • Within days, your blood vessels will regain much of the normal function that is damaged by smoking.
  • Within weeks, you’ll be able to taste food better, and your sense of smell will recover from tobacco’s assault.
  • Within months, symptoms of chronic bronchitis ease up, and lung function improves within a year.
  • Quitting reduces the risk of heart attack and stroke within two to five years.
  • And the risk of lung cancer begins to drop substantially within five to nine years of quitting.

More benefits await one that will decide to come clean this Christmas and the New Year. 

What better Christmas gift to give to oneself than a Clean bill of health… and what better resolution to have for oneself is to Aim for Discipline for Good Health for the New Year!

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

Alarming Rise in Adult Diseases Amongst Children….

December 4, 2008

As the world is becoming more obese… as our food industry is creating better marketing strategies to entice people to eat… as we see more children spending more time watching television… not surprisingly, we see more kids suffering from the chronic illnesses not known to kids in last century!

Now new data support our fear that indeed obesity is becoming more prevalent in our region as more international food chains are creeping up and luring our kids with better and bigger processed foods.  In the ned, our own personal health, our kids health and the health of our nation will suffer because we will be spending our fortune in treating the complications of what we have eaten during our lifetime.

A study published in Pediatrics this year is not only alarming but an eye opener…for all of us with kids!!!!

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First-quarter 2002 baseline prevalence of chronic medication use per 1000 child beneficiaries ranged from a high of 29.5 for antiasthmatics to a low of 0.27 for antihyperlipidemics. Except for asthma medication use, prevalence rates were higher for older teens aged 15 to 19 years.

During the study period, the prevalence rate for type 2 antidiabetic agents doubled, driven by 166% and 135% increases in prevalence among females aged 10 to 14 and 15 to 19 years, respectively.

Prevalence of use growth was more moderate for antihypertensives and antidepressants (1.8%). R

Rates of growth were dramatically higher among girls than boys for type 2 antidiabetics (147% vs 39%), 

CONCLUSIONS. Prevalence of chronic medication use in children increased across all therapy classes evaluated. Additional study is needed into the factors influencing these trends, including growth in chronic disease risk factors, greater awareness and screening, and greater affinity toward early use of drug therapy in children.

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Well for me this data say it all.  Where else can one get diabetes at an early age except from the rising prevalence of obesity.  Excess fat results in a state called insulin resistance where the body has to produce more insulin to counteract the resistance by fat to the effect of insulin.  We need insulin to drive sugar inside our muscles to be used for energy!!! 

Simple equation of FAT= Insulin resitance + Diabetes and others.

Others mean: high blood pressure, high cholesterol, hgh uric acid, infertility, increased risk for blood clot, cancer and more…  Meaning, our kids if we let them be with their choices of food nowadays will be taking the medications that our fathers used to take when they were in their 70’s.  A scary though indeed BUT it’s now a reality!

In short… start good nutrition among the young. And have a happy healthy kid.

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Diabetes Facts, The Truths on Obesity | 3 Comments »

The Conflict of Taking Care of A Loved One….

December 2, 2008

Obejectivity is important as a physician taking care of patients. But the personal side of it is as important as patients seek our help to feel comfort that their illness is not all that bad after all…  The conflict comes when as physicians, we have to deal with an illness in the family.  Almost always by chance, we commit a blunder in our decision which creates the conflict… a situation we all want to avoid.

The recent article published in the Annals of Internal Medicine succinctly targetted the issue of the conflict that a physician in the family and the sick loved one have to expect with medical care:

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Conventional wisdom and professional ethics generally dictate that physicians should avoid doctoring family members because of potential conflicts of interest.
Nevertheless, cross-sectional surveys find that the practice is commonplace. Physicians have unique opportunities to influence their family member’s care because they possess knowledge and status within the health care system; however, when physicians participate in the care of family members, they must not lose objectivity and confuse their personal and professional roles.

Because health care systems are complicated, medical information is difficult to understand, and medical errors are common, it can be a great relief for families to have someone “on the inside” who is accessible and trustworthy. Yet, the benefits of becoming involved in a loved one’s care are accompanied by risks, especially when a physician takes action that a nonphysician would be incapable of performing. Except for convenience, most if not all of the benefits of getting involved can be realized by physician–family members acting as a family member or an advocate rather than as a physician.

Rules about what is or what is not appropriate for physician–family members are important but insufficient to guide physicians in every circumstance. Physician–family members can ask themselves, “What could I do in this situation if I did not have a medical degree?” and consider avoiding acts that require a medical license.

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The best role that a physician family member can do is support.  And be there in times of need.  And the thought that other family members know that there is a doctor in the family that knows better than they do….is comforting enough…. 

The conflict though begins whan the question of … where do personal reasoining ends when objectivity is required….

Life is But a Full of Challenges…and for us physicians, the situation can be one..

Posted in General Health Tips, Lifestyle Measures, Personal Thoughts | 3 Comments »

My Advise for a Practical and Doable Way to Lose Weight!

November 29, 2008

I happened to be in Manila yesterday to attend the blessing of our society’s AACE office then had a meeting till 12N then another meeting at 1PM then another event at 6:30 PM.  And throughout the day from the time I got to the airport to the time I was in the Blessing…I was asked only ONE question…How did I lose weight?!

Can you imagine me retelling the reason and the way I did to more than 15 people up to the time I got back to airport early morning today ….so I thought of this topic should be retold and discussed in my website….

The best way to help yourself avoid the probelms of the new century is to mainitain a healthy weight.  And if you are overweight then the best gift you can give to yourself for the holidays is to lose weight.  I did it for health reasons since I am at risk to become a diabetic being the youngest of a family of 9 with a mother who is a diabetic.

I am not a fan of any fad diet and will never be. I believe a high protein diet can help one lose weight but I dont believe it as the magic formula for wieght loss and I know the effect will not last long term.

My prescription for a successful weight loss is plain and simple cutting down on calorie intake PERIOD!  Sounds Boring but it works and heres how I did it:

Three key points: 1) set a goal 2) work on it 3) maintain on the strategy.

Simple way of cutting calories? Heres my Practical DOABLE advise:

Get a little rice, a serving of meat and veggies then eat… after the portions are consumed…assess if you still need more BUT NOT because you like the food BUT based on whether you’re still hungry or full already.  If you FEEL full…then stop…leave the table and o something else.  SIMPLE? yes… but in reality the temptation to eat more is so strong that if you dont have the DISCIPLINE to achieve the goal you have set for you to do… then the strategy will FAIL!  THAT’s IT!

That is my strategy..meaning…I eat what I like but I stop once I feel full. Simple and yet perfect in cutting down a lot of calories.

The problem with our society nowadays is that we use food for COMFORT…to Destress our minds…and to ENJOY but at the expense of HEALTH!

Then I do my afternoon exercise of enjoying my iPod while brisk walking. Enjoy the sceneries my friends…enjoy the fresh air and get out of your web!!!!

For the Holidays…Watch OUT for the FOOD!  Yummmy!!!!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Personal Thoughts, Weight Loss Tips | 7 Comments »

The Healing Powers of a Doctor…

November 25, 2008

Patients see some of us as healers. 

Patients see us because they’re sick. It is therefore our role to give them comfort.  Never to make them feel useless or hopeless.

The trials of being a physician are enormous.  It is a skill to master the art of healing. Diagnosing a disease can be easy with enormous references to read but to learn the art of healing needs mastery…and this differentiates a healer from an ordinary doctor.

In a recent article published in the Annals of Internal  Medicine, some interesting facts came out as eight skills necessary to be considered a healer:

  • do the little things;
  • take time;
  • be open and listen;
  • find something to like, to love;
  • remove barriers;
  • let the patient explain;
  • share authority; and
  • be committed.

It is however sad that a lot of the above are forgotten in clinical practice. Oblivious of the fact that following the art of healing to every patient that we see allows us to be better persons and better doctors. 

It is just fulfilling to see patients welcome your passion to treat them with dignity, not to be in a hurry but willing to take time for them to share what they feel… in return will be their admiration and deep gratitude because they can feel your healing powers. And more than enough… for them- seeing you is worth the wait!

The article concluded that :

“Mastery of these skills would provide enduring improvements in patient care and reaffirm medicine’s calling as a healing profession.” 

Posted in General Health Tips, Lifestyle Measures, Personal Thoughts | 6 Comments »

The Dangers of Having a Poor Sleep….

November 18, 2008

How many hours of sleep do you have daily?  Does the duration matter?

Yes it does based on a new study published in Archives of Internal Medicine:

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Background  It is not known whether short duration of sleep is a predictor of future cardiovascular events in patients with hypertension.

Methods  To test the hypothesis that short duration of sleep is independently associated with incident cardiovascular diseases (CVD), we performed ambulatory blood pressure (BP) monitoring in 1255 subjects with hypertension (mean [SD] age, 70.4 [9.9] years) and followed them for a mean period of 50 (23) months. Short sleep duration was defined as less than 7.5 hours (20th percentile). Multivariable Cox hazard models predicting CVD events were used to estimate the adjusted hazard ratio and 95% confidence interval (CI) for short sleep duration. A riser pattern was defined when mean nighttime systolic BP exceeded daytime systolic BP. The end point was a cardiovascular event: stroke, fatal or nonfatal myocardial infarction (MI), and sudden cardiac death.

Results 

  • In multivariable analyses, short duration of sleep (<7.5 hours) was associated with incident CVD (hazard ratio [HR], 1.68; 95% CI, 1.06-2.66; P = .03).
  • A synergistic interaction was observed between short sleep duration and the riser pattern (P = .09).
  • When subjects were classified according to their sleep time and a riser vs nonriser pattern, the group with shorter sleep duration plus the riser pattern had a substantially and significantly higher incidence of CVD than the group with predominant normal sleep duration plus the nonriser pattern (HR, 4.43; 95% CI, 2.09-9.39; P < .001), independent of covariates.

Conclusions  Short duration of sleep is associated with incident CVD risk and the combination of the riser pattern and short duration of sleep that is most strongly predictive of future CVD, independent of ambulatory BP levels. Physicians should inquire about sleep duration in the risk assessment of patients with hypertension.

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It has long been known that sleep debt is one factor that affects a patient’s risk to develop diseases like diabetes.  This new study relates sleep deprivation to a more devastating illness of the cardiovascular system.

The study showed that if one sleeps less than 7.5 hours per night, he or she has a 68-percent higher risk to develop heart attack, stroke or cardiac arrest than the counterparts that sleep better.  Furthermore, if one does not show a drop in overnight blood pressure, the risk is even higher — a more than four-fold greater chance of heart attack, stroke or cardiac death.

Again,.. this boils down to STRESS! Stress factors deprive one of a good sleep… if one goes to bed with deep mental anguish and thoughts, this can result in a hyperactive nervous system that can manifest as anxiety.  Overwokred individuals with too many worries to think for the next day can suffer the fate of sleep debt.  You should seek help if suddenly in the middle of the night you are awake and unable to go back to sleep.  This can lead to non dipping of blood pressure overnight that can increase your risk of heart disease even more.

Dont go to sleep Angry or worried.  Associate your bed with good rest and leave worries for the next day!

Indeed…Sleep is GOOD!

Posted in General Health Tips | 4 Comments »

What Your Waistline Means To Your Health…

November 14, 2008

Go to fullsize imageI just came from a trip to Rio, Brazil to attend the International Congress of Endocrinology which is held every 2-4 years.  Our hotel was stationed right across the Copacobana Beach.  This is a place that epitomizes physical activity where unlike the Waikiki Beach front, I dont see a lot of people swimming but rather engaged in activities like walking, jogging or playing volleyball using their hands or feet.  On the sides are people eateries serving fresh coconut juice but also burgers and fries!  But an interesting observation was that… not a lot of Brazilians can be considered obese and not a lot have their bellies haging out of their waist….

We know about the risk of death and weight and BMI.  For Asians, anything above 23 is considered overweight already and increases ones risk to develop chornic diseases like Diabetes and cancer.  A waistline of more than 36 is considered high risk for men and 34 inches for women for chronic diseases.  It is for this reason that I have been committed to a healthier lifestyle and now from a waistline of 34 , I was able to maintain a waistline of  31inches and my BMI dropped from a high of 25.6 to 23.  It is all about a balance of what you eat and what you do and the DISCIPLINE you put into your goal! 

Now comes a timely study published in the New England Journal of Medicine, November issue regarding the risk of dying based on ones waistline and weight:

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Background Previous studies have relied predominantly on the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) to assess the association of adiposity with the risk of death, but few have examined whether the distribution of body fat contributes to the prediction of death. Methods We examined the association of BMI, waist circumference, and waist-to-hip ratio with the risk of death among 359,387 participants from nine countries in the European Prospective Investigation into Cancer and Nutrition (EPIC). We used a Cox regression analysis, with age as the time variable, and stratified the models according to study center and age at recruitment, with further adjustment for educational level, smoking status, alcohol consumption, physical activity, and height.

Results During a mean follow-up of 9.7 years, 14,723 participants died. The lowest risks of death related to BMI were observed at a BMI of 25.3 for men and 24.3 for women.

  • After adjustment for BMI, waist circumference and waist-to-hip ratio were strongly associated with the risk of death.
  • Relative risks among men and women in the highest quintile of waist circumference were 2.05 (95% confidence interval [CI], 1.80 to 2.33) and 1.78 (95% CI, 1.56 to 2.04), respectively, and
  • in the highest quintile of waist-to-hip ratio, the relative risks were 1.68 (95% CI, 1.53 to 1.84) and 1.51 (95% CI, 1.37 to 1.66), respectively.
  • BMI remained significantly associated with the risk of death in models that included waist circumference or waist-to-hip ratio (P<0.001).

Conclusions These data suggest that both general adiposity and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-to-hip ratio in addition to BMI in assessing the risk of death.

 

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IN SHORT…The risk of dying was higher among participants with a larger waistline of more than 47.2 inches for men and more than 39.4 inches for women compared to subjects with a smaller waistline of less than 31.5 inches for men and less than 25.6 inches for women. This study showed us that for each 2-inch increase in waist circumference, there was an associated 17% higher risk for death in men and a 13% higher risk for death in women .

There you go guys… thess bulging bellies are no longer as silent as we thought these”fats” can be but rather we know them now as machines producing substances that can harm the heart and vessels.  Aside from trying to aim for a BMI of 23 and below, one therefore has to be more aware of the risk of premasture death with higher waistline! 

Every little loss of the waist circumference can go a along way in helping us maintain HEALTH!  Do somtehting now and reap the rewards along the way!  It requires a lot of discipline but health benefits are enormous…and this equates to what I call Wealth!

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Truths on Obesity | 3 Comments »

Are Your Supplements “FDA Approved?”

November 5, 2008

You see supplements marketed as FDA Approved! Am not sure how the policy of the local FDA works but almost always, the same agencies operating elsewhere look at policies of the US FDA as their basis for regulating drugs.

Let us be clear what”FDA Approved” means.  The US FDA website has this to say:

FDA approves new drugs and biologics.

New drugs and biologics must be proven safe and effective to FDA’s satisfaction before companies can market them. FDA does not develop or test products; FDA experts review the results of laboratory, animal, and human clinical testing done by manufacturers.

If FDA grants an approval, it means the agency has determined that the benefits of the product outweigh the risks for the intended use.

Meaning research should be done and presented to the body and then these studies should prove the products benefit outweigh the risks.  If however the risks outweigh the benefits then the marketing of the drug is not approved!

Now…How about the Dietary Supplements?  What about their claims for FDA Approval?

FDA does not approve dietary supplements.

Unlike new drugs, dietary supplements are not reviewed and approved by FDA based on their safety and effectiveness. The notification must include the information that was the manufacturer or distributor’s basis for concluding that the dietary supplement will reasonably be expected to be safe.

After dietary supplements are on the market, FDA evaluates their safety through research and adverse event monitoring.

If you will note…the supplement will be in the market first and then if  adverse events occur then action will be taken by the FDA.  Meaning..no review of side effects or untoward effects are made before releasing a supplement to the market. BUT how many patients will complain of side effects especially that supplements are marketed as having Zero side effects?  and where do they go to report when only the salesmen or networking friends advised or convinced  them of the safety of the supplements?

FDA does not approve structure-function claims on dietary supplements and other foods.

Structure-function claims describe the role of a food or food component (such as a nutrient) that is intended to affect the structure or function of the human body. 

Structure-function claims on dietary supplements carry a disclaimer stating that the claim has not been reviewed by FDA, and that the product is not intended to diagnose, treat, cure, or prevent any disease. Conventional foods are not required to carry such a disclaimer.

So Beware of the claims that these supplements are good for Diabetes, to boost ones Immunity or other medical benefits because NONE are based on studies and no proofs exist that they work!

In short DONT be FOOLED by claims that the product is FDA or BFAD APPROVED!!!

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Posted in General Health Tips, Medical News Bits, Personal Thoughts | 14 Comments »

How to EAT and Lose Weight….

October 27, 2008

Go to fullsize imageMy previous posts have always been toward trying to help people lose weight.  I am one person following my own theories and they worked and are working up to now.  Here are the no-nonsense tips that I follow DAILY: 

If you want to lose weight…

  • EAT,  But stop when you feel you’re already FULL and Leave the table at once. 
  • CHEW your food properly so it will take time for you to finish a meal and by the time you’re halfway through…you’re FULL! 
  • Avoid the visual stimulation of food… the longer you stay in the table, the more likely you’ll eat more!

Then of course… you MOVE!

A recent article publsihed in the British Medical Journal confirms these basic prinicples:

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Participants 3287 adults (1122 men, 2165 women) aged 30-69 who participated in surveys on cardiovascular risk from 2003 to 2006.

Main outcome measures Body mass index (overweight 25.0) and the dietary habits of eating until full (lifestyle questionnaire) and speed of eating (validated brief self administered questionnaire).

Results 571 (50.9%) men and 1265 (58.4%) women self reported eating until full, and 523 (45.6%) men and 785 (36.3%) women self reported eating quickly. For both sexes the highest age adjusted mean values for height, weight, body mass index, and total energy intake were in the eating until full and eating quickly group compared with the not eating until full and not eating quickly group. The multivariable adjusted odds ratio of being overweight for eating until full was 2.00 (95% confidence interval 1.53 to 2.62) for men and 1.92 (1.53 to 2.40) for women and for eating quickly was 1.84 (1.42 to 2.38) for men and 2.09 (1.69 to 2.59) for women. The multivariable odds ratio of being overweight with both eating behaviours compared with neither was 3.13 (2.20 to 4.45) for men and 3.21 (2.41 to 4.29) for women.

Conclusion Eating until full and eating quickly are associated with being overweight in Japanese men and women, and these eating behaviours combined may have a substantial impact on being overweight.

___________________________________________________________________________________________________________________ There you go…Simple tips and simple measures that will surely WORK for ALL!

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Nutrition Health Tips, Personal Thoughts, The Truths on Obesity, Weight Loss Tips | 4 Comments »

How To Be Active Without Trying….

October 22, 2008

Physical activity is part of the equation of fitness and weight maitenance. 

“Easier said than done”, everyone knows it best that exercise is key to a healthy lifestyle.  Excuses to avoid feeling guilty continue to be part of what makes us believe that we just dont have enough time to exercise!  But new studies have been published that physical activity need not be a structured time frame that we should follow … rather any activity should be the norm to our day to day life.  In short…as long as one does not follow a sedentary lifestyle… one should be better off following an active lifestyle.

Heres a new study Published in the journal Current Opinions in Endocrinology that proves nothing is better than just being active:

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Purpose of review: To discuss the potential importance of spontaneous physical activity in regulating body weight and outline possible reasons for the large interindividual variance in spontaneous physical activity.

Recent findings: Spontaneous physical activity is highly variable among people, with some having high levels and some low, and can contribute significantly to interindividual differences in total daily energy expenditure. Cross-sectionally, spontaneous physical activity is inversely related to body weight; however, more importantly, spontaneous physical activity is inversely associated with weight gain in prospective studies, and experimental weight perturbations do not appear to change spontaneous physical activity behavior. Spontaneous physical activity is a familial trait and is biologically influenced, although the environment exerts a significant impact.

Summary: Although spontaneous physical activity is a biologically driven behavior, interventions to increase nonexercise activity within the workplace and school hold promise in increasing daily energy expenditure for the average sedentary American. However, many large-scale efforts will need to take place within our sedentary-promoting environment to encourage more daily spontaneous physical activity-related activity.

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This new study tells us one thing: No more EXCUSES!!!!

Any spontaneous movement or activity is better.  Even fidgety movements while sitting down working on your computer and other daily tasks that require activity is more than enough for the body to be healthy.  Any household chores and any walking to the workplace or the act of getting something are activities of daily living that can help with energy expenditure. These nonexercise activities should not be a problem for anyone to follow.  Meaning NO MORE EXCUSES!

There you go… The best way to be active without really trying ( going to a gym) is to be more active in our day to day activities. Do it everyday and make it part of a habit and you’re on your way to healthier you!

Posted in Exercise and Activity Tips, General Health Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, Weight Loss Tips | 1 Comment »

The Many Benefits of Broccoli…

October 16, 2008

Go to fullsize imageI am a fan of Brocolli.  I thought of making broccoli the star of today’s post and thought of what ways can this veggie benefit us all.

A recent study done in University of Warwick published in the Journal Diabetes showed some interesting findings that made me realize how lucky am I to enjoy Broccoli.  The study looked at a compound present in broccoli that has the potential to help prevent complications of diabetes.

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RESEARCH DESIGN AND METHODS–: Human microvascular HMEC-1 endothelial cells were incubated in low and high glucose concentrations (5 and 30 mM) and activation of nrf2 assessed by nuclear translocation. The effect of SFN on multiple pathways of biochemical dysfunction, increased reactive oxygen species (ROS) formation, hexosamine pathway, protein kinase C pathway and increased formation of methylglyoxal, was assessed.

RESULTS–: Activation of nrf2 by SFN induced nuclear translocation of nrf2 and increased ARE-linked gene expression. For example, 3 – 5 fold increased expression of transketolase and glutathione reductase. Hyperglycemia increased the formation of ROS – an effect linked to mitochondrial dysfunction and prevented by SFN. ROS formation was increased further by knockdown of nrf2 and transketolase expression. This also abolished the counteracting effect of SFN, suggesting mediation by nrf2 and related increase of transketolase expression. SFN also prevented hyperglycemia-induced activation of the hexosamine and protein kinase C pathways, and prevented increased cellular accumulation and excretion of the glycating agent, methylglyoxal.

CONCLUSION–: We conclude that activation of nrf2 may prevent biochemical dysfunction and related functional responses of endothelial cells induced by hyperglycemia in which increased expression of transketolase has a pivotal role.

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This study is particularly interesting because it is known that patients with diabetes are at higher risk to develop complications especially heart disease.  And from previous studies, it has also been shown that eating vegetables like broccoli was significantly linked to reduced heart disease.  The relationship stems from the finding that damage to blood vessels is due to an increased levels of reactive oxygen species (ROS) in the presence of high sugar.  The recent study has confirmed that the substance Sulforaphane present in Broccoli can indeed prevent damage brought about by these ROS with high sugar level. 

Sulforaphane substance present in abundance in broccoli was able to reduce ROS level by 73% and likewise results in activation of an gene regulator in the cells that resulted in the increase of antioxidant compounds. Great news!!! Great findings!!!

But does this mean lets all eat broccoli? We have to wait for studies that will look at end result.  But whatever it is…we know veggies are healthy food, broccoli for one has the potential to be a “star” vegetable due to its touted many benefits including prevention of cancer, cataracts Plus this new finding which am sure will make my diabetic patients crave for more broccoli.

Eat Veggies…Eat Broccoli… for Health!

Posted in General Health Tips, Medical News Bits, Nutrition Health Tips | 6 Comments »

The Benefit of Smoking…. or Is There?

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

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

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

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

Posted in General Health Tips, Healthy Practice Tips, Personal Thoughts | 3 Comments »

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