Chewing Nuts and Weight Loss

March 3, 2009

I recommend munching on nuts like almonds or cashew for snacks among my patients becuase of their monounsaturated fat content.  The problem however with nuts is the tendency to overeat and the difficulty of stopping.

We are told that chewing ones food more often than swallowing right away after chewing 2x can have a dramatic effect on satiety and weight. More often than not, we chew our food only few times then swallow then grab some more food until we feel so bloated.  Thus it is often my principle to chew food properly and do it more times to allow my brain to inform my body that I am full!

Here’s one study that I found interesting published recently in the Journal of Clinical Nutrition.  This study looked at the number of times one chew the nuts and measure their level of satiety.

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Background: Epidemiologic and clinical data indicate that nuts can be incorporated into the diet without compromising body weight. This has been attributed to strong satiety properties, increased resting energy expenditure, and limited lipid bioaccessibility.

Objective: The role of mastication was explored because of evidence that the availability of nut lipids is largely dependent on the mechanical fracture of their cell walls.

Design: In a randomized, 3-arm, crossover study, 13 healthy adults (body mass index, in kg/m2: 23.1 ± 0.4) chewed 55 g almonds 10, 25, or 40 times. Blood was collected and appetite was monitored during the following 3 h. Over the next 4 d, all foods were provided, including 55 g almonds, which were consumed under the same chewing conditions. Complete fecal samples were collected.

Results: Hunger was acutely suppressed below baseline (P < 0.05), and fullness was elevated above baseline longer (P < 0.05) after 40 chews than after 25 chews. Two hours after consumption, fullness levels were significantly lower and hunger levels were significantly higher after 25 chews than after 10 and 40 chews (P < 0.05). Initial postingestive glucagon-like peptide-1 concentrations were significantly lower after 25 chews than after 40 chews (P < 0.05), and insulin concentrations declined more rapidly after 25 and 40 chews than after 10 chews (both P < 0.05). Fecal fat excretion was significantly higher after 10 chews than after 25 and 40 chews (both P < 0.05). All participants had higher fecal energy losses after 10 and 25 chews than after 40 chews (P < 0.005).

Conclusion: The results indicate important differences in appetitive and physiologic responses to masticating nuts and likely other foods and nutrients. 

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For me the significance of this study boils down to one: Chewing ones food more often is healthier for the body in terms of early satiety and therefore better for weight control.  This study really justifies the concept of chewing food slowly around 20 times or more before swallowing to allow your body to register that food has entered and that you’re full.  By practicing this behavior, one also is able to control the appetite and therfore results in better regulation of weight! 

So if you love nuts…chew them properly…chew them more than 40 x if you want… they’re not only healthy snack alternatives but better for weight loss too.

Posted in General Health Tips | 8 Comments »

Take Action on Your Weight!!! The Risks Associated with Being Overweight…

February 28, 2009

Go to fullsize imageBeing overweight needs immediate action!  Thats why when I registered a BMI of 25.6 with a fasting blood sugar of 96, I decided to take action and become healthier with my diet and physical activity.  Being overweight carries with it chronic diseases like diabetes, high blood pressure and cholesterol problem.  Not mentioning stroke and heart attack as endpoints!

For year 2009: Its NOW a Global Call to action as more and more children and adolescence are gaining weight.  There’s no time to sit back and relax on this matter as inaction means DISASTER in the long run for these children!

A recent study published in www.bmj.com showed that obese adolescents have the same risk of premature death in adulthood as people who smoke more than 10 cigarettes a day!!!!   This is indeed a scary thought.

Those who are overweight have the same risk as less heavy smokers.

BMI is a measure of your weight according to your height.  For Caucasians, a BMI of >25 if already overweight but for Asians, a lower BMI of 23 is considered abnormal already.

What if one is underweight?

Being underweight carries with it a better prognosis  as it carries with it no increased risk, irrespective of smoking status.  However, if you are also too thin with a a body mass index of less than 17; then it carried with it the same risk of premature death as being overweight.

The study suggests therefore that being OBESE and Overweight at the age of  18 carries the same risk of premature death as being too thin!  Both conditions stem from poor nutrition either too much or too little.

Its not late to start and do something for yourself or for our kids…. NOW!

Life is short..Take time to Take Care of your HEALTH!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Truths on Obesity | 1 Comment »

High Blood Sugar Predicts Death in Heart Attack Patients

February 26, 2009

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

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

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

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

Results 

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

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

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

No ifs or buts…its the RULE!

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

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

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

Posted in Medical News Bits, The Diabetes Facts, Tips To Protect Your Heart, What's New in Diabetes | 9 Comments »

Can Daily Intake of Eggs Be Healthy?

February 23, 2009

Go to fullsize imageControversies continue to surround whether eggs can cause harm if taken daily or not. Debate among the experts continue with assumptions that cholesterol in the diet actually has little effect on blood cholesterol.  No doubt that intake of saturated fat can increase the level of blood cholesterol and risk a patient to develop heart attack and stroke.  The relationship of Egg intake to disease continues to be debatable.

Now comes a new study publsished in the Diabetes Care , this February 2009  that for sure will add fuel to the ongoing controversy:

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OBJECTIVE—Whereas limited and inconsistent findings have been reported on the relation between dietary cholesterol or egg consumption and fasting glucose, no previous study has examined the association between egg consumption and type 2 diabetes. This project sought to examine the relation between egg intake and the risk of type 2 diabetes in two large prospective cohorts.

RESEARCH DESIGN AND METHODS—In this prospective study, we used data from two completed randomized trials: 20,703 men from the Physicians’ Health Study I (1982–2007) and 36,295 women from the Women’s Health Study (1992–2007). Egg consumption was ascertained using questionnaires, and we used the Cox proportional hazard model to estimate relative risks of type 2 diabetes.

RESULTS—During mean follow-up of 20.0 years in men and 11.7 years in women, 1,921 men and 2,112 women developed type 2 diabetes. Compared with no egg consumption, multivariable adjusted hazard ratios for type 2 diabetes were 1.09 (95% CI 0.87–1.37), 1.09 (0.88–1.34), 1.18 (0.95–1.45), 1.46 (1.14–1.86), and 1.58 (1.25–2.01) for consumption of <1, 1, 2–4, 5–6, and 7 eggs/week, respectively, in men (P for trend <0.0001). Corresponding multivariable hazard ratios for women were 1.06 (0.92–1.22), 0.97 (0.83–1.12), 1.19 (1.03–1.38), 1.18 (0.88–1.58), and 1.77 (1.28–2.43), respectively (P for trend <0.0001).

CONCLUSIONS—These data suggest that high levels of egg consumption (daily) are associated with an increased risk of type 2 diabetes in men and women. Confirmation of these findings in other populations is warranted.

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The question arises: whether it is the intake of egg that increased the risk to develop diabetes.  Or is it the relationship of the high fat diet associated with the egg intake that increased the risk.  It is known that high cholesterol and saturated fat intake can increase a patients risk to develop diabetes.

So when the study participants’ daily cholesterol intake was assessed, it showed a relationship related to diabetes risk!!!  When the researchers factored this relationship in, the association between egg intake and diabetes weakened suggesting that a cholesterol-rich diet might promote diabetes.  This also suggest that a person who may like eggs may also eat other fatty foods that will result in increasing the risk to deveolp the disease.

So a not so good news for egg lovers who have family history of diabetes.  This is one food that one may have to limit for now until more studies will show the relationship to be otherwise.

But for the others who have no risk of developing diabetes…I suggest that eggs should remain to be enjoyed as long as one should not exceed 3-5 eggs per week.  This recommnedation will stay for now. 

But do … Watch out in this site if new developments come in about eggs because for sure I will be the first to know and you will be the first to be informed !!!!

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, What's New in Diabetes | 3 Comments »

Is There Any Benefit in Taking A Multivitamin?

February 12, 2009

Go to fullsize imageI used to take one multivitamin pill per day.  I know of others who take tons of vitamins because they make them feel “better”. Or just a habit difficult to change. Or better still, relatives in the US send us with big bottles of these Vitamins as presents.  But are they USEFUL? 

Ever since, I already doubted the usefullness of these vitamins UNLESS one is not eating properly or is very choosy with food that predisposes one to deficiency of certain vitamins that we usually get from food.  But for people that have problems of the Opposite, that is… controlling the intake, I suggest you might as well spend your money on something else that’s healthy and has important benefit on ones health.

The latest issue of the Archives onf Internal Medicine published this recent study looking at the effectiveness of taking multivitamins.

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Background  Millions of postmenopausal women use multivitamins, often believing that supplements prevent chronic diseases such as cancer and cardiovascular disease (CVD). Therefore, we decided to examine associations between multivitamin use and risk of cancer, CVD, and mortality in postmenopausal women.

Methods  The study included 161 808 participants from the Women’s Health Initiative clinical trials (N = 68 132 in 3 overlapping trials of hormone therapy, dietary modification, and calcium and vitamin D supplements) or an observational study (N = 93 676). Detailed data were collected on multivitamin use at baseline and follow-up time points. Study enrollment occurred between 1993 and 1998; the women were followed up for a median of 8.0 years in the clinical trials and 7.9 years in the observational study. Disease end points were collected through 2005.

We documented cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocardial infarction, stroke, and venous thromboembolism); and total mortality.

Results  A total of 41.5% of the participants used multivitamins. After a median of 8.0 years of follow-up in the clinical trial cohort and 7.9 years in the observational study cohort, 9619 cases of breast, colorectal, endometrial, renal, bladder, stomach, lung, or ovarian cancer; 8751 CVD events; and 9865 deaths were reported. Multivariate-adjusted analyses revealed no association of multivitamin use with risk of cancer (hazard ratio [HR], 0.98, and 95% confidence interval [CI], 0.91-1.05 for breast cancer; HR, 0.99, and 95% CI, 0.88-1.11 for colorectal cancer; HR, 1.05, and 95% CI, 0.90-1.21 for endometrial cancer; HR, 1.0, and 95% CI, 0.88-1.13 for lung cancer; and HR, 1.07, and 95% CI, 0.88-1.29 for ovarian cancer); CVD (HR, 0.96, and 95% CI, 0.89-1.03 for myocardial infarction; HR, 0.99, and 95% CI, 0.91-1.07 for stroke; and HR, 1.05, and 95% CI, 0.85-1.29 for venous thromboembolism); or mortality (HR, 1.02, and 95% CI, 0.97-1.07).

Conclusion  After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women’s Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women.

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In short … wanna live long?  Live a healthy lifestyle.  There are other ways to better living not simple taking of pills as a shortcut or better still … lets take a walk and think again.

Pills or exercise?  I know your answers…keep it to yourselves.  You choose … it’s your life!

Posted in General Health Tips, Medical News Bits, Nutrition Health Tips | 2 Comments »

The New Way To Exercise and Get Results….

February 9, 2009

Go to fullsize imageGood news to those who just dont have the time to exercise.

A new study published online by the BMC, 2009 showed a new way to exercise that will have the same or better impact on our body’s metabolism than previously thought.

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Background

Classic, long duration aerobic exercise reduces cardiovascular and metabolic disease risk but this involves a substantial time commitment. Extremely low volume high-intensity interval training (HIT) has recently been shown to cause similar improvements to aerobic performance, but it has not been established whether HIT has the capacity to improve glycemic control.

Methods

Sixteen young men  performed 2 weeks of supervised HIT comprising of a total of 15 min of exercise (6 sessions; 4-6 x 30-s cycle sprints per session). Aerobic performance (250-kJ self-paced cycling time trial), and glucose, insulin and NEFA responses to a 75-g oral glucose load (oral glucose tolerance test; OGTT) were determined before and after training.

Results

Following 2 weeks of HIT, the area under the plasma glucose, insulin and NEFA concentration-time curves were all reduced (12%, 37%, 26% respectively, all P<0.001). Fasting plasma insulin and glucose concentrations remained unchanged, but there was a trend towards reduced fasting plasma NEFA concentrations post-training (pre: 350 +/- 36 v post: 290 +/- 39 mumol * l-1, P=0.058). Insulin sensitivity as measured by the Cederholm index was improved by 22.5% (P<0.01). Aerobic cycling performance was improved by ~6% (P<0.01).

Conclusions

The efficacy of a high intensity exercise protocol, involving only ~250 kcal work each week, to substantially improve insulin action in young sedentary subjects is remarkable. We feel this novel time-efficient training paradigm can be used as a strategy to reduce metabolic risk factors in young and middle aged sedentary populations who otherwise would not adhere to a classic high volume, time consuming exercise regimens

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In this study short burst of intense exercise activity lasting for like 30 seconds resulted in improvement of parameters that can have an impact in preventing chronic illnesses. 

The subjects used exercise bikes which we can easily buy in sports stores… performed a quick sprint insturcted to do it at their highest possible intensity for around 30 seconds.  The results showing significant improvements in exercise parameters biochemically suggest that any highly vigorous activity carried out in few minutes in a few days per week should achieve the same protective metabolic improvements. 

This is definitely good news to those who just cant find the right time and place to do their exercise workout.  This is one of the first studies to document that short bouts of exercise can be as effective in improving metabolic parameters as the usual recommendations of moderate exercise for 30 minutes most days of the week. 

Now my friends… no more excuses!!!

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

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 »

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