Soy Protein and The Heart….

May 26, 2008

Go to fullsize imageThere are many conflicting data on soy protein and the heart especially the claim that they lower cholesterol.  In fact in 1999 based on studies during that time, the US FDA allowed a health claim on food labels stating that a daily diet containing 25 grams of soy protein, also low in saturated fat and cholesterol, may reduce the risk of heart disease. 

However, the American Heart association in January of 2006 made a review of available data and made a conclusion that soy protein in itself did not significantly lower the bad cholestrol nor did it have any significant effect in increasing the good cholesterol.

But as an endocrinologist looking for alternative source of meat protein, the use of soy protein in place of meat which has high staurated fat will continue to play a major role in our attempt to reduce the risk of our patients from cardiovascular disease.

Recently a new article on the benefit of soy protein came out in Annals of Internal Medicine.  This study is so relevant to my practice especially among diabetic patients with kidney disease.  These are the patients we try to avoid taking meat protein because of the possibility of causing kidney function deterioration.  The study did not only show a good effect in sugar control but also markers of inflammation suggesting a potential effect in reducing cardiovascular disease plus improving markers of kidney function.

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Soy protein consumption significantly affected cardiovascular risks such as fasting plasma glucose , total cholesterol , LDL cholesterol, and serum triglyceride concentrations.

Serum CRP levels were significantly decreased by soy protein intake compared with those in the control group .

Significant improvements were also seen in proteinuria  and urinary creatinine ( both measures od kidney function) by consumption of soy protein.

CONCLUSIONS—Longitudinal soy protein consumption significantly affected cardiovascular risk factors and kidney-related biomarkers among type 2 diabetic patients with nephropathy.

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Here is a list of the common sources of soy protein that we can enjoy includes: Tofu, soymilk, soyflour. Tempeh and Miso.  The soymilk and textured soy protein can be used as subsitute for meat or cows milk while the soyflour can be used in baking needs.

I believe in the benefits of soy protein.  I hope for more studies to come that will provide us with more data on its beneifts and potential to reduce disease risk especially the Heart!

Soy Protein: A Better Partner for the Heart!

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

Having High Sugar and High Blood Pressure Can be Deadly…

May 23, 2008

Go to fullsize imageAlmost always a patient that suffers from diabetes is obese, have high triglycerides and low HDL and develops high blood pressure and high cholesterol… the combination of which is called the Metabolic syndrome.  If any of these conditions are not addressed then ones risk to suffer from chronic complication like heart disease is increased.  Whether the sum of the components or the combination of two parts or only one component is present makes a patient more at risk to die is not well documented.

The new study published in Annals of Internal Medicine May 2008 now shows that having two parts increases the risk to die more than having the combination for the components of the syndrome itself….

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  1. After multivariable adjustment, compared with persons without MetS, those with MetS had a 22% higher mortality .
  2. Higher risk with MetS was confined to persons having elevated fasting glucose level  or treated diabetes mellitus or hypertension as one of the criteria;
  3. Persons having MetS without High Fasting Glucose or MetS without hypertension did not have higher risk.
  4. Evaluating MetS criteria individually, we found that only hypertension and EFG predicted higher mortality;
  5. Persons having both hypertension and Elevated Fasting Glucose had 82% higher mortality .
  6. Substantially higher proportions of deaths were attributable to EFG and hypertension (population attributable risk fraction [PAR%], 22.2%) than to MetS (PAR%, 6.3%).

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There you go my friends…just having diabetes or hypertension makes one at higher risk to die from heart disease.  More so if high blood sugar is joined by high blood pressure then the risk to die is 82%!!!!

The above study therefore tells us that making a diagnosis of metabolic syndrome does not entail more risk to die than having just diabetes of hypertension alone.  Such that… it’s utility as a diagnosis and as a risk factor for cardiovascular mortality is put in question. 

So friends…please dont take these two conditions lightly!!! As an endocrinologist, I take these conditions seriously and that all patients with Diabetes are screened for blood pressure and cholesterol abnormalities and vice versa! 

To summarize the study:

Having High Sugar especially if with High Blood Pressure Can Be DEADLY! 

Posted in General Health Tips, Medical News Bits, Personal Thoughts, The Diabetes Facts, Tips To Protect Your Heart | 1 Comment »

Foods That Can Make Us Feel FULL….

May 12, 2008

Go to fullsize imageDifferent kinds of food give us different levels of satiety and the feeling of fullness.  You may not have realized it but in one meal, you get easily hungry in less than 2 hours and are wondering why this is so.

It is important for us to remember that the main role of food is solely to satisfy our craving, our hunger and definitely to provide us the needed calories for energy.  But the kind of food we eat will determine if we feel the feeling of satisfaction or not.  This satiety factor therefore will be a factor in making us eat more and therefore provide us with unecessary calories that make us gain weight!

What determines the feeling of fullness include the quantity of food we eat, the actual contents of the food and the texture including the smell.  Signals to the brain from the stomach make us feel satisfied or make us eat more.   

What foods can give us the highest satiety level? 

If your food contains a high level of protein, enough amounts of fiber and water, this food will give you the highest satisfaction rating.  In contrast foods high in fat will make you less satisfied and makes you want to eat more…this be the reason why a high fat diet makes you gain weight!  Intake of protein like a meal that includes fish meat or egg  gives a higher satiety level than carbohydrates.  But carbohydrate rich foods like pasta, rice or bread also provides a high satiety level. 

So to provide one with the highest satiety level of food for a meal… a whole grain bread with leans cuts of meat can provide a better satiety level and longer period of preventing hunger than if one eats a croissant!

The satiety factor of a food like glycemic index is just one of the many factors that affect the way we eat, the way we manage our lifestyle and the way we prevent weight gain. Complex factors come into play including social norms, culture and even mood in deciding whether we feel satisifed and enough food is enough for the meal!

The bottom line is: the higher the satiety factor the lesser we eat!  Likewise…my advise to all: once you feel full…then stop eating especially if you are indulging in a high carbohydrate meal!!!! Sometimes, its the great taste of food even if we are already full that makes us want to eat more. 

Dont be Fooled by Food…Be “Fulled” The Right Way!

Posted in General Health Tips, Lifestyle Measures, Nutrition Health Tips, Personal Thoughts, Weight Loss Tips | 1 Comment »

Signs of Aging? Better Check Your Thyroid Gland…

May 8, 2008

Go to fullsize imageIf you complain of too much fatigability, or weakness and memory loss.. these may not be signs of aging but rather an abnormality in your thryoid gland. 

So where is the thyroid gland?  It is found in the neck just below the Adam’s apple.  Any malfunction of the thyroid gland results in a reduction body temperature ( you cant tolerate cold) , decrease in heart rate and muscle strength as well as increase in cholesterol.  Worst of all the symptoms are a decrease in memory and mood due to a sluggish feeling and weight gain.  When  these symptoms occur, you feel tired all the time and may blame aging as the culprit!

It si very easy to check thru blood tests called TSH ot Thyroid Stimulating Hormone and Free T4 or the thyroid hormone.  These tests are readily available but must be interpreted properly because any mistake in analysis can results in a wrong therapy.  Make sure you have the test confirmed for evaluation by a certified endocrinologist in your area.

A High TSH and Low FT4 is diagnostic.  Treatment is simple and requires thyroid hormone replacement. And boom…you will feel better, become more active and better sense of well being!  And feel young again!

So The next time….

You Feel unexpectedly Sluggish?…Check your Thyroid!

Posted in General Health Tips | 2 Comments »

Mixing Fun and Work Equals FUN…

May 6, 2008

Just came back from Manila this afternoon after I was invited to give a lecture in the annual convention of the Philippine College of Physoicians- the biggest organozation of all internists in the Philippines.  But before this date, I brought my family to take a vacation in Manila and visited some sights both for entertainment and cultural learnings.  I would have wanted to bring my family somewhere in Asia again during this summer but my being away to attend conventions for these past few months have made me decide to have fun with them in time for my work. And boy it was full of fun!

To those with kids and plan to explore Manila… these are the fun things you can do with your kids.  First we visited The Manila Ocean Park where the Oceanarium is located. It was full of fun for the kids and was the first time for my youngest to see such a huge collection of sea life. It can compete with the aqauriums in Hongkong and Singapore. 

 Then we proceeded to go to Star City which is a covered amusement park where the Snow World is located. Its bigger than the Snow City of Singapore and is more fun BUT… you need to bring your own jacket and boots if you like more time inside because they only provide you with a light jacket without boots which are not enough considering the freezing temperature.  Overall, Star City has lots of other fun rides for the kids and also clean and safe.  This early the kids are expressing their desire to go back!.

The next day we went to the Kiddie Fun ranch near Tiendesitas just around Ortigas also. The place has a huge adventure zone like playground and a huge inflatable slides with mini boat rides and games. Avilon mini zoo was a lso nearby and a walking distance which was also both fun and educational for the kids. But the most fun for them was when they rode on a donkey, held an eagle and fed the rabbits with a carrot stick on their hands.

The next day was more cultural as my son wanted to see the places he has learned in his Social Studies especailly Intramuros, Fort Santiago and Jose Rizal.  We toured Intramuros using a Kalesa ride and gave us a glimpse of the past.  We visited the place where Jose Rizal was imprisoned and traced his footsteps on the way to his death!  We visited the museum and glanced at his book the Noli mi Tangere and El Filibusterismo which my son knows about.  Then we visited the Discovery Science Center where the most amazing for my kids was the talking fish who interacted with them with questions and dances.  They now want to go back becuase of the FISH!  It has a Planetarium with an IMAX theater and Robotics.  Worth to visit.

The last day was a visit to Tom’s World and Toys R Us and a swim in our hotel…my favorite the Discovery Suite.

This Sunday I will be attending the American Association if Clinical Endocrinologist meeting in Orlando.  This one educational meeting that I always attend to update me of what’s new in my field. I will be away again for a week for work. But all these for the benefit to learning more so as a specialist I can update my knowledge of this ever changing field of Medicine.

But as all of us are busy, taking time to be with our kids and just be away from work is all much fun.  My way of mixing fun with work worked!  Grab all the time to be happy with them and bond with them.  They will be young only once! I feel better, healthier just laughing with them and younger as I rode the rides with them and as we all shouted together as if I was young again! 

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Are Eggs Healthy To Eat?

May 1, 2008

One of the top posts in my website is my article on how much eggs can one eat.  The emphasis on eggs as being healthy but laden with cholesterol has made the public very confused.  Now comes a new study published in the American Journal of Nutrition done in Harvard University linking consumption of egg to increased mortality. 

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Background: A reduction in dietary cholesterol is recommended to prevent cardiovascular disease (CVD). Although eggs are important sources of cholesterol and other nutrients, limited and inconsistent data are available on the effects of egg consumption on the risk of CVD and mortality.

Objective: We aimed to examine the association between egg consumption and the risk of CVD and mortality.

Design: In a prospective cohort study of 21 327 participants from Physicians’ Health Study I, egg consumption was assessed with an abbreviated food questionnaire. Cox regression was used to estimate relative risks.

Results: In an average follow-up of 20 y, 1550 new myocardial infarctions (MIs), 1342 incident strokes, and 5169 deaths occurred.

  • Egg consumption was not associated with incident MI or stroke in a multivariate Cox regression.
  • Adjusted hazard ratios (95% CI) for mortality were 1.0 (reference), 0.94 (0.87, 1.02), 1.03 (0.95, 1.11), 1.05 (0.93, 1.19), and 1.23 (1.11, 1.36) for the consumption of <1, 1, 2–4, 5–6, and 7 eggs/wk, respectively (P for trend < 0.0001).
  • This association was stronger among diabetic subjects, in whom the risk of death in a comparison of the highest with the lowest category of egg consumption was twofold (hazard ratio: 2.01; 95% CI: 1.26, 3.20; P for interaction = 0.09).

Conclusions: Infrequent egg consumption does not seem to influence the risk of CVD in male physicians. In addition, egg consumption was positively related to mortality, more strongly so in diabetic subjects, in the study population.

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The data suggests that the higher the number of eggs consumed, the higher the mortality risk especially among diabetic patients.  This seems interesting because the risk to develop heart disease was not seen among those who are frequent egg eaters suggesting that the risk to die was not associated with heart disease but something else! Nevertheless, looking at prevoius relationships of cholesterol and death, the most likely explanation as assessed in the editorial by Dr Eckel of University of Colorado is still atherosclerotic disease.

The relationship between egg consumption and heart disease continues to be confusing.  This is understandable because now we know that the effect of cholesterol intake in the diet has less effect on the LDL or bad cholesterol in the blood than an intake of saturated fat or trans fat in the diet.  And as we all know, the egg yolk mainly contains cholesterol.

The editorial sums it all up:

So, if you are a male physician and are going to eat 1 egg/d, why not eat the whites only? Just think—with all of the trimmings, that 3-white egg omelet is almost indistinguishable by taste from an omelet enriched with 600 mg cholesterol, and the whites-only omelet also remains a very good source of protein, riboflavin, and selenium. If you cannot do without the yolks, go ahead and enjoy them, but why eat them >3–4 d/wk? If you are a man with diabetes, a more limited egg intake pattern seems prudent. But, remember: eggs are like all other foods—they are neither “good” nor “bad,” and they can be part of an overall heart-healthy diet.

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, Personal Thoughts, The Diabetes Facts | 7 Comments »

Level of Activity In the Young Predicts What You Become…

April 26, 2008

Go to fullsize imageChronic diseases will abound in the next century.  The ones who will be most affected are the children of today.  And this prediction wil come true based on this new study published in Dynamic Medicine. which looked at the level of activity of the young and the risk of developing Metabolic Sydrome in adulthood: Diabetes, Hypertension and High cholesterol.

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Purpose: Metabolic syndrome (MS) is a clustering of cardiovascular disease risk factors that identifies individuals with the highest risk for heart disease. Two factors that may influence the MS are physical activity and aerobic fitness. This study determined if adolescent with the MS had low levels of aerobic fitness and physical activity as children.

Methods

This longitudinal, exploratory study had 389 participants: 51% girls, 84% Caucasian, 12% African American, 1% Hispanic, and 3% other races, from the State of North Carolina. Habitual physical activity (PA survey), aerobic fitness (VO2max), body mass index (BMI), blood pressure, and lipids obtained at 7-10 y of age were compared to their results obtained 7 y later at ages 14 -17 y.

Results

Eighteen adolescents (4.6%) developed 3 or more characteristics of the MS. Logistic regression, adjusting for BMI percentile, blood pressure, and cholesterol levels, found that adolescents with the MS were 6.08 (95%CI = 1.18-60.08) times more likely to have low aerobic fitness as children and 5.16 (95%CI = 1.06-49.66) times more likely to have low PA levels.

Conclusions

Low levels of childhood physical activity and aerobic fitness are associated with the presence of the metabolic syndrome in adolescents. Thus, efforts need to begin early in childhood to increase exercise.

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The study tells us that the level of activity is as important as keeping fit!  One does not need to be overweight to be at risk. One may not be obese but if the level of activity is low then he is still not fit and therefore at risk of future diseases. This study tells us to allow our kids to be more active rather than live a sedentary lifestyle of gameboys, PSPs and computers.

This study clearly shows the relationship of what we train our kids to do and become to what happens to them in the future.  Lets train them early to be fit and healthy so as they can carry their lives in a healthier way! 

For me… Teaching our Kids How to keep FIT is the best future we can give them!

Posted in Lifestyle Measures, Medical News Bits, Personal Thoughts, The Diabetes Facts | Leave a Comment »

The Dangers of Too Much TEA….

April 24, 2008

One of the highlights of the Mayo Endocrine Course in Mallorca Spain was the Clinical Pearls that we get after a case presentation.  And one of those cases that I found very interesting was a case of  lady who had a bone xray suggestive of a “strong” bone and a bone mass that was suggestive of a “thick ” bone.  She was therefore confident that she won’t fracture because she did not have any osteoporosis based on Xray and Bone mass measurement.

However upon review at the Mayo Clinic her bones were actually not normal.  So further evaluation was done and showed her to be drinking at least 10 tea bags of a commercial brand per day as a way of quenching her thirst.  Without her knowledge, she was taking in too much flouride into her sytsem coming from drinking too much tea!!!  She was developing a state of Flourosis which can cause a bone disease called Osteosclerosis.  From being told that she has strong bones to now being counseled to be careful not to fracture… was too extreme for her to understand!

Osteosclerosis can be due to taking in too much flouride in the body.  The problem with this disease is you have Brittle bones and therefore on Xray, you may have thick bones but the quality of the bone is poor!!!

Just how much flouride in is one tea bag?  In one study published in Amercan Journal of Medicine in 2005:

“Two independent testing laboratories determined that mean fluoride concentrations in 10 brand-name tea solutions ranged from 1.0 to 6.5 ppm. One tea exceeded the EPA safety limit of 4.0 ppm for drinking water, and several surpassed the U.S. Food and Drug Administration limit of 1.4 to 2.4 ppm for bottled beverages. “

So my frineds…please be careful with too much tea in a day.  I know of some chinese patients who use tea as their drinking water.  Just as the saying goes…

 Too much of a Good Thing can also be BAD!

Posted in General Health Tips, Medical News Bits, Nutrition Health Tips, Personal Thoughts | 16 Comments »

In Quest For More Learning…

April 15, 2008

I will not be able to update my blog for this week because I will be attending the Mayo Endocrine Course in Mallorca, Spain which will officially start tomorrow April 16.

This will be an opportunity to review the latest in Endocrinology with my former mentors who fortunately after having graduated there for my fellowship 10 years ago… 14 of the professors who will be giving lectures were my former mentors. Two of the speakers were my former co-fellows…so it will be worth the learning and the fun of meeting them again in Spain.

As doctors , we continue to study and learn the new trends in diagnosing and treating diseases from the world experts. Will continue to do so in the near future so as i can provide the best care to my patients assuring them of what is right and what is best!

In quest for more learning…I may be out of my clinic but rest assured…it is for the best of everyone so I can provide the best care possible.

Learning should be Continuous…it should have no END!

Posted in General Health Tips | 1 Comment »

A High Fiber Diet: Does It Really Matter?

April 11, 2008

Go to fullsize imageWe have been exposed to ads regarding the benefits of a high fiber diet.  We know it is good for our health but what does it do and where do we get these fiber rich products?

It has been shown in several studies that a high fiber diet can indeed lower ones risk to develop heart diseaese by as much as 30% as well as lower ones risk to develop diabetes and improve cholesterol.   We know it works well for roughage and therefore can prevent constipation and improve bowel habits.  In fact it was recommended as a way of preventing colon polyps and cancer BUT so far no long term studies have proven that fiber can indeed lower the risk for colon cancer.  Nonetheless, the multiple benefits we can get from eating a high fiber meals are more than enough to recommend intake of these products to our patients and the public in general.

But what are the best sources of fiber? Here is a list of the different kinds of fiber compiled by the Harvard School of Nutrition:

Sources of Fiber

Soluble Fiber

Insoluble Fiber
oatmeal
oatbran
nuts and seedslegumes

  • dried peas
  • beans
  • lentils

apples
pears
strawberries
blueberries

 whole grains

  • whole wheat breads
  • barley
  • couscous
  • brown rice
  • bulgur

whole-grain breakfast cereals
wheat bran
seeds
carrots
cucumbers
zucchini
celery
tomatoes

The best fiber source in several studies that proved a high fiber diet to be beneficial is the cereal based fiber or fiber from grains and those coming from fruits.  It is recommended that a diet with at least 21 to 38 gms of fiber should be taken per day.  On an average Filipino diet, we are only consuming at most less than 15 gms of fiber per day so we better bulk it up more with the sources mentioned in the table for health reasons.  Increase the fiber intake gradually rather that abruptly and to make sure we also increase the intake of water ans fiber absorbs water.

What Do I recommend: here’s a sample advise that I give to my patients:

  • Avoid fruit juices as they are devoid of fiber, instead eat whole fruits.
  • Eat brown rice instead of white rice
  • Buy whole grain products instead of white bread and pasta.
  • Try snacking with raw veggies..they may not be as yummy as a pastry BUT they are triple times  as healthy.
  • Choose whole-grain cereals for breakfast instead of rice and sausage! 

    • Eat Right By Eating Healthy..Try FIBER!

     

    Posted in General Health Tips, Healthy Practice Tips, Nutrition Health Tips, Personal Thoughts, The Diabetes Facts | 1 Comment »

    The Magic of Fish Oil… Is It Hype or a Fact?

    April 8, 2008

    Go to fullsize imageWe have heard about the benefits of fish oil. Touted as a magic pill to protect the heart.  They are found on the shelves of supermarkets and health stores.  The problem with fish oil supplements is that as supplements the content of the drug is not regulated by the FDA and therefore the quality cant be tested.

    Recently the Mayo Clinic Proceedings, March 2008 published a timely article that tackles the issue of fish oil…are the benefits really real? and are they worth becoming part of the drug therapy against heart disease?

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    The most compelling evidence for the cardiovascular benefit provided by omega-3 fatty acids comes from 3 large controlled trials of 32,000 participants randomized to receive omega-3 fatty acid supplements containing docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) or to act as controls.

    These trials showed reductions in cardiovascular events of 19% to 45%.

    These findings suggest that intake of omega-3 fatty acids, whether from dietary sources or fish oil supplements, should be increased, especially in those with or at risk for coronary artery disease.

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    So furthermore, the data based on the review article suggest and recommend:

    • Patients should consume both DHA and EPA.
    • The target DHA and EPA consumption levels are about 1 g/d for those with known coronary artery disease and at least 500 mg/d for those without disease.
    • Patients with hypertriglyceridemia benefit from treatment with 3 to 4 g/d of DHA and EPA, a dosage that lowers triglyceride levels by 20% to 50%.
    • Although 2 meals of oily fish per week can provide 400 to 500 mg/d of DHA and EPA,
    • Secondary prevention patients and those with hypertriglyceridemia must use fish oil supplements if they are to reach 1 g/d and 3 to 4 g/d of DHA and EPA, respectively.
    • Combination therapy with omega-3 fatty acids and a statin is a safe and effective way to improve lipid levels and cardiovascular prognosis beyond the benefits provided by statin therapy alone.
    • Blood DHA and EPA levels could one day be used to identify patients with deficient levels and to individualize therapeutic recommendations.

    But dont just grab any fish oil in the market because what is sold in the health food stores have not been validated to contain the amount stated on the label. Ask your physician if you will start taking fish oil and if it will not interfere with the other drugs you are currently taking.

    What is important is that evidence for now has shown it to be beneficial….

    Fish Oil To The Rescue!!!! 

    Posted in General Health Tips | 3 Comments »

    Check The Music Your Kids Listen…and Be Warned!

    April 7, 2008

    Parents are sometime caught unaware that our kids Ipod is loaded with music that may not be healthy to their social and emotional well being.  We know classical music soothes our body and improves health and mood but other kinds of music like rap or rock have been shown to have disturbing impact.

    An article recently published in Addiction Research and Theory, April 2008 issue showed how the rise in drug wars could be contributed by the kinds of music these kids are exposed to.

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    This article explores the role of changing images of drug use in rap music from the 1970s to the 1990s. A sample of 341 rap music lyrics were coded for drug mentions, behaviours and contexts; drug attitudes and consequences; and music genres.
    • The results show that from 1979-1997, songs with references to drugs increased over 6-fold;
    • those exhibiting positive attitudes and consequences rose substantially
    • references to particular drug types changed significantly.
    • increased references to using drugs to signify glamour, wealth and sociability.

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    There you go guys… be careful with what music our kids listen to.  If rap music before warns about the dangers of drug use, apparently recent rap music tend to glorify drug use… and this message may not be the kinds of inspiration our kids need.  The increase in drug reference was pretty alarming increasing form a mere 10% in the early 70’s to >60% in early 90’s!!!!

    Check the music videos your kids watch and the contents of their iPods… It is better to intervene early than be sorry for the effects of these music on our kids in their social skills and adult behavior!

    To Intervene Or Not To Intervene….

     

     

    Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts | 4 Comments »

    Acupuncture and Diabetes

    April 5, 2008

    Go to fullsize imageAlternative therapies continue to be in the mainstream of Diabetes Armamentarium.  You see patients bringing bottles of herb supplements apparently marketed as a treatment for Diabetes and related illnesses like high blood pressure and high cholesterol.  But one form of treatment that has gained wide acceptance both in the East where it originated and in the West where it is now widely practiced is Acupuncture.  And almost always in my practice do I come across a patient asking me about acupuncture and diabetes.

     

    It is said that the effect of acupuncture is its ability to improve blood flow.  By balancing the energy levels, one’s circulation can be improved and therefore has the potential to prevent debilitating complications of diabetes related to poor circulation like foot amputation and the crippling nerve damage or diabetic neuropathy.  Anecdotal reports and few small scale studies have proven acupuncture to help ease pain and prevent diabetic foot ulcers but only if applied early in the disease process.   The problem is the absence of acceptable and properly done wide scale studies where proven results are duplicated. A research funding by the National Institutes of Health in the United States is being done in quest for an answer…

     

    As medical practitioners, it is best to advise to patients that no studies at present can prove acupuncture to work beyond placebo effect. It is being tolerated by the US FDA considering its relative safety.  But it is always prudent for patients not to discontinue their medications or the proven therapies we provide them and to use acupuncture only conjunction with their medications.  Likewise it is best that patients should inform their physicians about their desire to have an acupuncture done and likewise should not accept any diagnosis of a disease from those performing the acupuncture..

     

    Acupuncture…It’s a wait and see for now but so far results seem promising….

    Posted in Medical News Bits, The Diabetes Facts | 3 Comments »

    Your Weight and Your Risk To Develop Breast Cancer….

    March 26, 2008

    Go to fullsize imageObesity is one big epidemic that is becoming a huge economic burden due to the medical complications arising form the disease. 

    In the recent issue of the the journal Clinical Cancer Research, the relationship between increased weight and the risk of developing breast cancer has been shown to be closely linked:

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    Purpose: The purpose of this retrospective study was to determine the association and prognostic value of body mass index (BMI) at the time of initial diagnosis in patients with locally advanced breast cancer (LABC). 

    Results: 

    • Obese patients tended to have a higher incidence of IBC compared with overweight and normal/underweight groups (P = 0.01). Median follow up was 6 years for all patients.
    • Patients with Locally Advanced Breast Cancer who were obese or overweight had a significantly worse Survival and Recurrence Free Survival (P = 0.001) and a higher incidence of visceral recurrence compared with normal/underweight patients.
    • In a multivariable model, BMI remained significantly associated with both Overall Survival and Recurrence Free Survival for the entire cohort. 

    Conclusion: Patients with Locally Advanced Breast Cancer and high BMI have a worse prognosis.

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    This study shows us that being obese is more than what we think it is… as mere cosmetics…rather it is a risk factor in itself that can result in a more aggressive type of a disease like breast cancer and can even lead to long term disability like stroke and early death as shown in several studies.

    The excess adipose tissue or fat cell results in more circulating estrogen and more inflammatory substances that may be responsible for a more aggressive breast cancer and lesser cancer survival.  We now know that any excess fat cell results in a bigger machinery that produces a lot of substances we never knew about before… that can be harmful to our body!  In short… these fat cells are pretty active and definitely not the passive bystanders that we used to think they are… and therefore need to be dealt with more aggressively!

    Another good reason for us to take care and get rid of the FAT….

    Be Health and Weight Conscious!

    Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, The Truths on Obesity | 4 Comments »

    Lower Your Risk To Develop Diabetes By Eating Veggies….

    March 24, 2008

    www.calpoly.edu/~lcimarel/vegetables.jpgWe all know veggies are good.  But this recent finding that veggies can prevent diabetes is a welcome news to us trying to curb the epidemic of this disease due to unhealthly lifestyle and poor dietary habits.

    I have trained my kids to eat veggies.  I found it amusing that one day my son said to me:  “Dad my classmates are teasing me that I am a Vegetarian!”  Suggesting that of all his classmates, he was the only one who had veggies on his lunch box.  Lucky me… my kids love veggies….and for a good reason!

    This good news about veggies and diabetes was published in the March 2008 issue of the Journal of Nutrition:

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    A population-based prospective study of 64,191 women with no history of T2D or other chronic diseases at study recruitment and with valid dietary information.

    The relative risk for T2D for the upper quintile relative to the lower quintile of vegetable intake was 0.72 (95%CI: 0.61–0.85; P < 0.01) in multivariate analysis. Individual vegetable groups were all inversely and significantly associated with the risk of T2D.

    Fruit intake was not associated with the incidence of diabetes in this population.

    Our data suggest that vegetable consumption may protect against the development of T2D.

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    This data is great suggesting that those who consumed the highest amount of vegiies in 4-5 years reduced the likelihood of developing diabetes by 28%.  That is… taking 428 grams of veggies per day reduced ones chances to develop this chronic disabling disease compared to if you only take 121 grams of veggies per day!

    The advantages of veggies is that it contains high fiber as well as other substances like phytates and isoflavones that may help in reducing the risk for developing diabetes.

    Although fruits did not show benefit…it likewise did not show harm.  Just the same fruits have been shown to reduce the risk of developing other diseases like cancer or heart disease.  Such that… its intake remains to be a cornerstone in promoting health!

    Train Yourself and Your Kids To Eat Veggies for Health!

    Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Nutrition Health Tips, Personal Thoughts, The Diabetes Facts, What's New in Diabetes | 1 Comment »

    The Use of Aspirin and The Risk of Death and Cancer…

    March 19, 2008

    Diabetics are at risk for cardiovascular disease.  As such, an anticlotting agent like aspirin is always part of the drug regimen that we prescribe to our patients.  Studies have proven the use of aspirin to be beneficial in preventing heart disease and prolongoing survival to those at risk of cardiovascular disease in both men and women.

    Now comes a new study that looked at the effect of taking aspirin on women without cardiovascular disease and to see if benefits are still present in terms of preventing heart disease or cancer.  This study involved 79,439 women who were enrolled in the Nurses’ Health Study since 1980 published in the Archives of Internal Medicine.

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    • In women who reported current aspirin use, there was a 25% reduction in death from all causes compared with women who never used aspirin regularly.
    • The risk reduction was more apparent for death from cardiovascular disease at 38%.
    • The risk reduction for death from cancer was only 12%.
    •  Use of aspirin for 1 to 5 years was associated with significant reductions in cardiovascular mortality 
    • In contrast, a significant reduction in risk of cancer deaths was not observed until after 10 years of aspirin use.
    • The benefit associated with aspirin was confined to low and moderate doses and was significantly greater in older participants and those with more cardiac risk factors.

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    The above study points out that women who take low to moderate doses of aspirin meaning less than 6 tablets per week have lower risk for death from all causes as well as a lower risk for death from cardiovascular disease within 5 years of taking the drug.  However the lower risk for death from cancer was only noted after a longer exposure of 10 years. 

    This study continues to propagate the magic of aspirin as a “health” drug.  It helps by preventing a complication that can result in long lasting disability like heart disease and softens the long term economic burden to an already “burdened” risk patient due to polypharmacy arising from diabetes or hypertension.

    More studies of similar or better study design should give us more bullets to use to support the long term use of aspirin especially to women or men without risk of cardiovascular disease.

    An Aspirin A Day Keeps Your Heart Beat Everyday!

    Posted in Medical News Bits, Personal Thoughts | 2 Comments »

    Nutrition in Health and Disease….

    March 17, 2008

    This is called the Paradox of Food:  you need food to live and survive but the very reason for disease and illnesses stem from the abundance of food and poor nutrition!

    I practice a field dealing with the metabolic diseases where poor nutrition plays a key role in its onset and progression to develop complications.  Control of blood glucose requires the right balance of nutrition, exercise and medications. The same formula apllies when treating obesity, hypertension and high cholesterol.

    The problem with handling these diseases stem from the medical field lack of understanding of nutrition and the lack of importance given to medical nutrition therapy!   If you make rounds in the hospital … you see the diet prepared for a diabetic hypertensive is almost similar if not similar to the other patient in the other room who is not a  diabetic…  It may not be the dietician’s fault but the doctor prescribing the diet!  This is where I am very particular with my patients because I believe the long term success of successfully controlling their blood sugar or blood pressure or cholesterol stem from not what I give them as medications but what they take in as food!

    The recent 2008 ADA recommendation for Nutrition  reasons out why Nutrition is important:

    Clinical trials/outcome studies of Medical Nutrition Therapy have reported decreases in HbA1c (A1C) of 1% in type 1 diabetes and 1–2% in type 2 diabetes, depending on the duration of diabetes . Meta-analysis of studies in nondiabetic, free-living subjects and expert committees report that MNT reduces LDL cholesterol by 15–25 mg/dl . After initiation of MNT, improvements were apparent in 3–6 months. Meta-analysis and expert committees also support a role for lifestyle modification in treating hypertension .

    The proportion of calories in the specific nutrition Rx will now be individualized and should be prescribed by your doctor.  I have my own personal dietician in my clinic now that I offer free couseling to my patients where personal preferences of food is taken into consideration.  I believe in individualized counseling so as to offer a  more successful diet regimen.  No prepared diets printed on a piece of paper!

    I have been a proponent of using a 40% of total calories from carbohydrates for my diabetic patients as more and more data are coming out regarding the benefits of limited carbohydrate not only for losing weight but for better glycemic control.  It is but proper that for the first time the American Diabetes Association came up with their position paper recommending the same.

    For me…it is plain and simple challenging one’s self discipline in not giving in to the “want” but following to the details of what is nutritious and healthy!!!

    Live Life To The Fullest…By Eating Right!

    Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, Personal Thoughts, The Diabetes Facts, The Truths on Obesity, Tips on Hypertension, What's New in Diabetes | 4 Comments »

    Wanna Lift Weights? Why Not?

    March 15, 2008

    When people talk about exercise… it is almost always synonymous to aerobic exercises like jogging, walking and dancing. Never does weight training come into the picture. Combining both should be better!

    But why lift weights? Is it advantageous than just sweating it out by running?

    A recent article from the Harvard HealthBeat beautifully illustrates the reasons  why:

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    Muscle tissue, bone density, and strength all dwindle over the years. So, too, does muscle power. These changes open the door to accidents and injuries that can compromise your ability to lead an independent, active life. Strength training is the most effective way to slow and possibly reverse much of this decline.

    Having smaller, weaker muscles doesn’t just change the way people look or move. Muscle loss affects the body in many ways. Strong muscles pluck oxygen and nutrients from the blood much more efficiently than weak ones. That means any activity requires less cardiac work and puts less strain on your heart.

    Strong muscles are better at sopping up sugar in the blood and helping the body stay sensitive to insulin (which helps cells remove sugar from the blood). In these ways, strong muscles can help keep blood sugar levels in check, which in turn helps prevent or control type 2 diabetes and is good for the heart. Strong muscles also enhance weight control.

    On the other hand, weak muscles hasten the loss of independence as everyday activities — such as walking, cleaning, shopping, and even dressing — become more difficult. They also make it harder to balance your body properly when moving or even standing still, or to catch yourself if you trip. The loss of power compounds this.

    Perhaps it’s not so surprising that, by age 65, one in three people reports falls. Because bones also weaken over time, one out of every 20 of these falls ends in fracture, usually of the hip, wrist, or leg. The good news is that the risk of these problems can be reduced by an exercise and fitness routine that includes strength training.

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    As we prevent complications from illnesses to happen…we also should have this obligation to live longer but healthier! And one sure thing to accomplish this goal is to exercise regularly and exercise the right way!

    Incorporating weight training to your regimen not only strengthens muscles but likewise prevents obesity since the more muscle you have, the less fat you get and the more metabolically active the muscle mass is compared to fat! As a result you likewise help prevent the onset of chronic illnesses like diabetes and hypertension!

    I do incorporate weights into my exercise regimen. I don’t go to the gym but after my sit-ups in the morning, I then do my routine abdominal twisting disc then do the weights using the arm band that you can buy in sports shops, or my barbell weights. You can likewise do the tiptoe setup by putting you two hands on the wall then tiptoe to raise yourself as high as you can then hold it for few seconds then repeat it 8 to 10 x daily!

    Simple Rules and Simple Measures For a Healthier You!

    Posted in Exercise and Activity Tips, General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Weight Loss Tips | 3 Comments »

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

    March 12, 2008

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

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

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

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

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

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

    Implications

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

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

    Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, The Truths on Obesity, Weight Loss Tips | 8 Comments »

    How To Increase Compliance To Lifestyle Change…

    March 10, 2008

    Nowadays, physicians just dont have the time to talk with their patients. Patients feel shortchanged when they have been waiting outside our clinics only to be seen for 5 minutes. 

    The lesson I’ve learned from my training at the Mayo Clinic was the importance of patient – doctor relationship that should go beyond treating a disease.  But more so to provide comfort to an anxious patient not knowing what she or he has and the need to listen and care!  The words of advise from a doctor’s mouth is more than worth their time in seeing you and these patients see us because they trust us to help them lead a better healthy life.

    Now comes a new study that confirms my practice in my clinic published in the Archives of Internal Medicine this 2/2008.

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    Background  Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits.

    Methods  We conducted a randomized controlled trial of a 12-month intervention at 2 large community health centers, enrolling 310 patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater. In the intervention group, self-management goals for nutrition and physical activity were set using a tailored computer program. Goals were then reviewed at each clinic visit by physicians. The control group received only printed health education materials. The main outcome measures included change in physical activity and body weight.

    Results  In the intervention group, recommended levels of physical activity increased from 26% at baseline to 53% at 12 months (P < .001) compared with controls (30% to 37%; P = .27), and 32% of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9% of controls (odds ratio, 2.2; P = .006).

    Conclusion  A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss.

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    This study confirms my belief and practice of spending more time with the patient in trying to help them understand how one can implement the standard of care in dealing with chronic diseases like obesity, high blood pressure, high cholesterol and diabetes.  If one understands the concept of why exercise and nutrition are important then the pressure is with the patient to comply otherwise he will suffer the consequences.

    Compliance to medications and behavioral therapy is a must if one aims to reach the goal of preventing complications like stroke and heart attack!  I am always asked if I am successful with behavioral modification and in letting patient follow my dietary guidelines.  I guess I am because I spend time with them.

    This has been my standing principle and guide in my practice and thus this website to help educate my patients and the public because I believe that….

    “Understanding One’s Disease Is Key To Better Health”. 

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

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