The Opportunity to Learn More….

August 21, 2007

imagesq1.jpgA tidbit news: It is but interesting to note that my alma mater where I trained my endocrinology fellowship continues to lord over the rest of the IVY League institutions since the 1997.  Below is the list of the Best Hospitals in Endocrinology….

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U.S. News has ranked 173 hospitals in 16 specialties.                                                                           

  1.  Mayo Clinic, Rochester, Minn.      
  2.  Massachusetts General Hospital, Boston  
  3. Johns Hopkins Hospital, Baltimore                             
  4. University of California, SF Medical Center       
  5. New York-Presbyterian
  6. Cleveland Clinic                                                           
  7.  Washington University, St. Louis                                
  8. University of Virginia Medical Center                         
  9. Brigham and Women’s Hospital, Boston                      
  10. Hospital University of Pennsylvania                          

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Ones professional training whether it may be music, culture or medicine will always be part of ones life… It will be engrained in ones DNA.  And wherever you are and whatever you do, you will always carry with you the name of the institution that made you who you are.

Once a rare opportunity knocks …  grab it! And not because of luck but because one strives to get it… through hard work and dedication- then you deserve it!

My belief is that one should not settle for less but to aim for what is the best in field!  I will be going for my third preceptorship this November at UCSF and Stanford in Endocrinology.  I was at Harvard in 2004 and Johns Hopkins in 2005 for the same preceptorship program. For me nothing beats Mayo Clinic!  But the opportunity to have been trained by the #1 Endocrinology Hospital and the chance to be sent for preceptorship training in the top 2 and 3 hospital and again this november to UCSF- Stanford Program is a rare opportunity that I will not fail to grab and look forward to learning what they can offer.

In life we should not stop to learn and learn.  That’s what I teach my kids.  It is through learning and exploring that we get smarter and wiser! Never give yourself a break from learning new things!  It may come from reading books, your travels or your meetings with other people.  For me to continue learning is the other meaning of happiness from within!

Grab Whatever Opportunity You Have To Learn…

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

Obesity Can Spread Among Friends….

August 20, 2007

v8chmcaa05ticcak5yizmca823xazcafcorr9cau78ovncabxtl0pcazrko7ecaf2w095ca5k5nuxca5ged70ca3tp5t0ca8cc9bocaouwo3hcazf6mzccauuysvrcahe8nawca7phliscaild0s8.jpgA family with obese children is a pretty common sight.  The family may have the same set of genes but it’s the relationship among family members that count…the way they spend time together or the way they choose the lifestyle from the kind of food to the kind of leisurely activities.  So I always counsel my patients to be extra careful with what they choose to eat or keep in the fridge because those are the choices that their kids will have for the rest of their lives…and they may have devastating outcome!

Now comes a study that proves the social networking not only affect close relatives but also friends….. A recent online publication of the Premier Journal of Medicine: The New England Journal of Medicine July 26, 2007 issue reported the effect of having friends who are obese….

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 Methods:  The authors evaluated a densely interconnected social network of 12,067 people assessed repeatedly from 1971 to 2003 as part of the Framingham Heart Study. The body-mass index was available for all subjects. We used longitudinal statistical models to examine whether weight gain in one person was associated with weight gain in his or her friends, siblings, spouse, and neighbors.

Results:

  1. A person’s chances of becoming obese increased by 57% (95% confidence interval [CI], 6 to 123) if he or she had a friend who became obese in a given interval.
  2. Among pairs of adult siblings, if one sibling became obese, the chance that the other would become obese increased by 40% (95% CI, 21 to 60).
  3. If one spouse became obese, the likelihood that the other spouse would become obese increased by 37% (95% CI, 7 to 73).
  4. These effects were not seen among neighbors in the immediate geographic location.
  5. Persons of the same sex had relatively greater influence on each other than those of the opposite sex.
  6. The spread of smoking cessation did not account for the spread of obesity in the network.

Conclusions:  Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. __________________________________________________________________________________________________

These findings have implications for clinical and public health interventions.  It’s the social networking that really makes a difference…whether the influence is positive or negative.  Teaching kids the right way from the way they choose : the kind of food… to the kind of friends… to the kind of activities… should start from the young!

The authors’ summary of their report says it all: 

“The spread of obesity in social networks appears to be a factor in the obesity epidemic. Yet the relevance of social influence also suggests that it may be possible to harness this same force to slow the spread of obesity. Network phenomena might be exploited to spread positive health behaviors, in part because people’s perceptions of their own risk of illness may depend on the people around them.”

As the saying goes….. 

Tell Me Who Your Friends Are…And I’ll Tell You Who You Are!

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

BYETTA and Weight Loss

August 18, 2007

imageslo.jpgExtensive research is being done in the field of Diabetes. The prevalence of this disease is just increasing worldwide and expected to reach 333 million by year 2025.  The scary thought coupled with difficulty in getting drugs invented and approved can make this a big epidemic in the future.

As new drugs come…some are worth it some are not.  The avandia scare made everyone realized that any drug no matter how great will always have side effects.  Any avandia taker should have realized that any patient with heart failure should not take the drug because it can worsen the condition.  

So what’s with this new agent called Byetta?  Is it all worth the hype?

Discovered from the Saliva of a Gila monster…Exenatide (Byetta) was just recently approved by the Food and Drug Administration in April 2005 for the treatment of type 2 diabetes. It was just recently launcehd in the Philippines. It is to be taken as an injection but although it is an injection, Byetta is not insulin!!!

Byetta improves blood sugar control by mimicking the action of the hormone incretin called GLP1 which allows insulin to work more effectively in the body.  The good thing with Byetta is that it also helps in preventing the further destruction of the Beta cells which are the cells that produce insulin.  It is this defect that remains unabated by current medications that will make a patient require insulin in the long run.  Now we have drugs that are proven to help prevent these cells from deteriorating including Rosiglitazone, Pioglitazone and now Byetta.

What is the Major Side effect of Byetta that as endocrinologist and patients alike like? It’s the WEIGHT LOSS! Finally we have a good drug that does not make a patient gain weight but instead lose weight. Its the downside that’s actually a PLUS! A weight loss of around 10 to 12 lbs can be achieved and sustained long term. A report from the New York Times mentioned about a patient who lost 60 lbs after Byetta use…  BUT… dont use this drug as a weight loss agent because this has not yet been studied for that purpose and the safety of this agent for non diabetics is not yet known.

Cost however is pretty prohibitive so better discuss this option with your doctors to assess benefit cost ratio.

Do I recommend this drug?  Yes I do and have started using this agent already. It was just recently launched at the AACE Philippine Chapter meeting in Shangrila and few doctors have been given the privilege to start using this drug for their patients by Eilly Lilly.  Its something new and revolutionary thus am writing about this in my website.  The New York Times Calls It: The Ray of Hope…

For more information on Byetta: check out this site: www.byetta.com

The Gila Monster and the Man in Byetta!

Posted in Medical News Bits, The Diabetes Facts, The Truths on Obesity, What's New in Diabetes | 20 Comments »

The Many Benefits of Walking…

August 17, 2007

imagesedg.jpgIs walking good? Is it enough as an exercise? Or Do we need to do more intense exercise to achieve benefit?  I love to walk…it’s my form of physical activity every afternoon after work.  I have fun doing it walking around the house or around our subdivision.  You can enjoy the view while walking… you can do it anytime and anywhere and the most important of all is that…It is FREE!

Dr James Levine who is a colleague of mine at the Mayo Clinic wrote a nice editorial at the

Mayo Clinic Proceedings based on this news report from the Mayo Clinic newsroom:

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“Getting out there and taking a walk is what it’s all about,” says James Levine, M.D., Ph.D., and a Mayo Clinic expert on obesity. “You don’t have to join a gym, you don’t have to check your pulse. You just have to switch off the TV, get off the sofa and go for a walk.”

The health benefit associated with walking is the subject of Dr. Levine’s editorial in the July issue of Mayo Clinic Proceedings. Dr. Levine’s piece is entitled, “Exercise: A Walk in the Park?” and accompanies a Proceedings article that showcases the merits of walking as beneficial exercise.

The study, undertaken by physicians from the Shinshu University Graduate School of Medicine in Matsumoto, Japan, determined that high-intensity interval walking may protect against high blood pressure and decreased muscle strength among older people.

Over five months, the Japanese researchers studied 246 adults who engaged in either no walking or moderate to high-intensity walking. The group who engaged in high-intensity walking experienced the most significant improvement in their health, the researchers found. In his editorial, Dr. Levine says the study lends credence to the notion that walking is a legitimate, worthy mode of exercise for all people. Dr. Levine says it’s a welcome message for his patients, who fight obesity and appreciate that a walk is one way to improve their health.

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It is therefore a package deal…you walk…you exercise as well as keep your health in control. There is no way I will accept any patient of mine telling me he has no time to exercise because walking can be done anywhere and anytime!

Do it now and this very minute… after reading this article…turn off your computer or TV for a while and take a stroll.  In simple terms…Just move.  It is much better than staying put and be sedentary.

Life is too short…enjoy your surroundings and walk because once you get the dreaded complication of obesity and diabetes which is a stroke or heart failure…you will end up in bed for the rest of life anyway…by then…you will miss walking!

Take A Step Forward Now For Health!

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

Can Avandia Cause Heart Attack? A Fact or A Fiction….

August 16, 2007

2749016741.jpgJust came back from Manila just this morning where I was one of the 5 invited speakers to share our views on the Avandia meta-analysis that sparked the controversy of this drug.  It was a well organized meeting and a very fruitful one as delegates ( enodcrinologists and diabetologists from all over the Philippines)  went home more enlightend by the fact tat avandia is actually safe or even safer than the other drugs sold in the market.

The highlight of the meeting was a detailed analysis of the article by Niesen published in NEJM in May 2007 by Dr Cecilia Gimeno who is herself an endocrinologist and a clinical epidemiologist from UP-PGH.

She highlighted why meta anaysis cant be trusted and what the flaws were in the article’s calculation of the statistics and data gathering.

TAKE HOME messages form the meeting which I want to share to my readers and patients as well:

  1. The Meta analysis was not a good study since it compiled several small studies lump together to generate a bigger population BUT with each study had a different patient population with different outcomes ( not cardiovascular ) and had small number of subjects of short duration ( < 6 m).
  2. The statistical analysis was flawed including omission of certain studies with no MI or CV deaths.  The exact nature of heart attack or death was not determined since the authors did not have the luxury of examining the data…they solely relied on results given to them. Did the patients take their other meds like for cholesterol or high blood pressure which in themselves can increase ones risk for heart attack and stroke?
  3. Recalculation of the flawed statistics and numbers resulted in an almost the same risk of heart attack of patients on avandia and other drugs!!!!
  4. The studies included in the analysis were short term ( < 6 m) … and short term studies do not predict long term results.  Similar problems were encountered by Metformin, Sulfonylureas and Pioglitazone where initial < 1 year studies showed increased heart attack risk but long term studies after 5-6 years showed benefit!
  5. The 3 big prospective studies on avandia (ADOPT, DREAM and RECORD) which are randomized involving >4000 patients are true OUTcome studies which help clinicians formulate our treatment approach and which can be trusted showed that Avandia use is not associated with increased risk of heart attack compared to metformin or sulfonylurea!  In fact the use of a sulfonylurea was assessed to have higher cardiovascular death than avandia.  These studies are however masked by the controversy of one study of which the medical community deems contain numerous flaws!

My Conclusion of this matter: 

That Avandia is safe and is not associated with any increase in Heart Attack risk. 

Remember a patient with Diabetes in itself is already a Cardiovascular equivalent :  a Diabetic is equivalent to a ” non diabetic with a heart attack” in terms of his risk for cardiovascular mortality.  And if we consider the data of the Meta analysis as acceptable: the absolute risk is very small: a 0.1% absolute risk only…meaning 1 heart attack for every 1000 patients on avandia… BUT since the analysis was flawed… the absolute risk therefore of a patient on Avandia is really much lower than 0.1%  and the patient’s risk for heart attack is most likely just the inherent risk for being a Diabetic and nothing else!

For me it would be unfortunate if the benefits of this drug which includes: reducing ones risk to develop diabetes by 60 % ( DREAM) and reducing one risk to progression of diabetes by 60% compared to a sulfonylurea and 30% compared to a metformin (ADOPT) … are masked by this turn of events based on a flawed study!!!!

A Fact Can Harm If It Is Actually A Fiction!

Posted in Medical News Bits, Personal Thoughts, The Diabetes Facts | 4 Comments »

Alcohol Lowers Blood Pressure and Heart Attack Risk…

August 14, 2007

3161158791.jpgAfter a hectic schedule or meeting or after a stressful event …one gets invited for a drink!  And one of the common questions I get from friends or patients alike is the question of how BAD is alcohol to one’s body Or how much alcohol can they take.

Alcohol for a diabetic patients is a no-no if one is poorly controlled BUT once the blood glucose is well controlled… alcohol can be made part of the total caloric load as long as it doesnt exceed 2 drinks a day! And this is true to patients with hypertension or cholesterol problems as well.

I came across a very good article from the Harvard Health Letter which I want to share.  Aparently, drinking alcohol can have beneficial effects on one’s blood pressure and the risk of heart attack!

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Lay off alcohol is one of the first things people with newly diagnosed high blood pressure are told. Alcohol can cause high blood pressure as well as contribute to it. Abstinence, though, might not be necessary, and may even deny some folks a pleasurable way to ward off heart attacks.

A long-term study of male health professionals suggests that responsible, moderate drinking may benefit people with high blood pressure. In a study published in the January 2, 2007, Annals of Internal Medicine, only 4.9% of the men with high blood pressure who classified themselves as moderate drinkers (one or two drinks a day) had a heart attack during 16 years of follow-up, compared with 6.7% of nondrinkers. That’s about a 25% reduction in heart attack risk. The results are similar to a study of male doctors, which showed fewer deaths due to cardiovascular disease among moderate drinkers than nondrinkers over a five-year period.

Keep in mind that this work shows the average response to alcohol. How it affects you depends on your genes, metabolism, diet, and medications, as well as you and your family’s relationship with alcohol.A drink a day won’t help your blood pressure. (If you are concerned about it, use a home blood pressure monitor that’s been checked at your doctor’s office to make sure it is accurate.) But along with a healthful lifestyle, moderate drinking could protect you from one of its feared effects — a heart attack.

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Again…. the old cliche…

 

Be Safe…Drink in Moderation!

 

 

 

 

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

The Success Story of Hard Work…

August 13, 2007

p8101997.jpgThe AACE – Philippine Chapter annual convention came to a close yesterday.  It was and will be a great learning experience for me as a member of the organizing committee and in charge of inviting the foreign speakers.  The members really did a good job and simply put…it was hard work that was actually full of fun. 

I guess the looks and the comments of the attendees and from our friends in pharmaceutical industry were more than enough for us to now start thinking how we can do much better next year!

c305scd1.jpgMy other assignment was to make sure my “sons” ( invited foreign speakers in photo) were all well fed and literally well!  Lucky me, they were so impressed with our program, the venue and the orgnization as a whole.  Dr Gharib who is currently the President Elect of the American College of Endocrinology and my mentor will write about us in The Messenger which is a publication of the AACE – US for all members all over the world to know what transpired and how the meeting met all the mother society’s vision of advocacy and education.

We spent sleepless nights but were all worth it.  Our togetherness the-friends.jpgand comarderie even strenghened…more so, as our expected attendance ballooned from an expected 120 doctors to more than 400!!!!  We were just literally overwhelmed!  Dr Steven Petak ( in photo) who is the Past President of the AACE even announced that our meeting should be made a model for the rest of the world to pattern and in fact said in his talk… that he is learning from us and will suggest some changes to be made by the US AACE meetings to pattern after AACE Philippines! What a complement!

All in all…it was FUN, Factual and Fulfilling!  Will I do it Again?  YES! Not only did I learn a lot about friendship with my colleagues and our pharmaceuticual friends, but also the great learning from all the great talks we heard during the convention are good reasons for me to do it again! Dr Litonjua who is the founding mentor and adviser and President Emeritus of the organization wants us to do it again in Cebu!

Overall…our petite President DR George Tan did a fantastic job! He endured the most of the pains and challenges along the way but they made him stronger in the end and the fruits of his labor bore fruit…and it was a great success!

So to all those who made the affair a success… Thank You!

See You All Again in Cebu Next Year!

Posted in Personal Thoughts | 14 Comments »

To Help Teach and Spread Knowledge…

August 8, 2007

2145155937.jpgIt will be a busy week for me starting tomorrow.  I will pick a friend and a mentor at the Mayo Clinic who has accepted my invitation to speak during our Annual Convention of the American Association of Clinical Endocrinologists- Philippine Chapter: our first ever here in Cebu.  He will do it gratis…meaning without honorarium.  What a man and what a legacy.

And being the host, I hope my friends from Manila and our foreign speakers will not be disappointed with the preparations the organizing committee has done so far.  It has been tough but at the same time too much FUN and comaraderie.

We have so far more than 200 pre-registered guests… when our initial forcast was only 120 doctors.  The CME activites were really formulated by me and Dr Estrelle Lopez of UST to make sure that we have a balanced program that will cater to all physicians handling endocrine cases in our country.

The members of this organization are doing this for free.  Our task is solely to promote the organization with the sole purpose of letting the public know that Endocrinology is one specialty that caters to diseases known to every family in this country especially…Diabetes, Hypertension, Goiter, Osteoporosis among the many….

Our goal is to spread what we know in this specialty that hopefully physicians in far reach areas of the country can still manage their patients without necessarily coming to Cebu or Manila.  This annual convention is only our first in terms of its grand scale but this wont be our last. We will continue to have projects and workshops because our advocacy is to teach… and spread the news of what is right and best for each patient with endocrine disorders.

To Help and Spread Knwoledge is what I do… that’s why I accept invitations to speak to doctors, to laymen, do research and grant interviews for newpapers, radios or TV and write in this website. 

I believe I can do better and be happier if I know I have not only touched the lives of my patients and their families but more than that… by helping other physicians do their job the right way and in turn touched the lives of their patients I havent met or didnt even know. 

For me… my role as a Physician is to continue my “Trio” of advocacy:  

  • To Educate,

  • To Help and

  • To Heal…….

Posted in Personal Thoughts | 2 Comments »

How To Keep Family Safe From HARM…

August 7, 2007

Safety is of paramount importance to us especially our kids.  With the news surrounding us regarding safety concerns of products made in China from too much formalin in certain package foods to lead content in kids toys…it is but prudent to also be vigilant with regard to food safety in our own homes.

Here are some tips that I got from the Harvard Health Letter that I want to share and hopefully help us make our home safer. Here is a summary of some of the problematic bacteria you want to protect your family from include:

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E. coli. This bacterium, found mainly in ground beef, causes an estimated 25,000 cases of food poisoning in the United States each year and kills about 100 people. Some people infected with E. coli suffer permanent kidney damage. Contamination occurs during meat processing, when E. coli from the animals’ intestines becomes mixed in with the meat.

Salmonella. This bacterium is found mostly in meat and eggs. But it spreads to other foods, such as ice cream and fruit, when they are shipped with contaminated meat or eggs.

Campylobacter. This bacterium is especially common in poultry. Antibiotic-resistant strains are becoming more prevalent because of the widespread use of antibiotics in chicken feed. In a 2001 report in the New England Journal of Medicine, 17% of chickens sampled in supermarkets in four states had campylobacter strains that were resistant to antibiotics.

You can prevent most cases of food poisoning in your household by preparing and storing your foods safely.

  • Rinse foods. Rinsing can wash off some germs from meat, poultry, and fish and pesticide residues from produce. Rinse all meat, poultry, and fish under running water before cooking. Rinse all fruits and vegetables under running water before cooking or serving them.
  • Wash your hands. Frequent handwashing helps prevent you from passing germs from one food to another. Use soap and water to wash your hands each time you handle a raw food. Don’t wipe your hands on a dishtowel without washing them first.
  • Use separate utensils. Don’t prepare meat and fish on the same surface that you use for other foods — otherwise, you risk contaminating those foods with bacteria from the meat and fish. Use one cutting board for meats and fish and a second one for produce. Be sure to wash the cutting boards with soap and water after each use. Use different knives to cut different foods to prevent cross-contamination.
  • Cooking. Cook all meat, poultry, eggs, and freshwater fish. Don’t rely on color alone to indicate whether meat is fully cooked. The USDA recommends that everyone use a meat thermometer. Different temperatures are required to kill off germs in different kinds of meat. It’s also important to cook hot dogs and other precooked meats and fish, to destroy bacteria that may have contaminated them in the processing plants.
  • Storing. Don’t leave any foods, before or after cooking, at room temperature for more than two hours (one hour if the air temperature is above 90° F). Put them in the refrigerator or freezer. The temperature inside your refrigerator should be 40° F or below; your freezer should be at 0° F or below.
  • Divide The Leftovers. If you have large amounts of leftovers, divide them into small batches when you put them away in the refrigerator or freezer. That way, the temperature of each batch will reach a safe level faster. Keep in mind that freezing does not necessarily kill bacteria; wash meats and poultry thoroughly after thawing, and handle them the same as you would fresh meats. 

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Watch the things we buy…Plan ahead the meals we’ll serve and be sure to follow simple rules of home safety. 

Remember as mentioned in my previous post to avoid storing your leftover foods in take- away plastic containers because they have been shown to be harmful if reused! 

Just a simple reminder to keep us all from harm….

Plan and Ban The Harm! 

Posted in General Health Tips, Healthy Practice Tips, Personal Thoughts | Leave a Comment »

Adding TAX on Mc Donald’s Burger and Fries…

August 6, 2007

imagessdfert.jpg

I came across a very unique study that has probably never been done before.  How about adding extra tax everytime we take unhealthy fast foods ? Everytime we hear about being FAT and unhealthy…it has always been associated with Mc Donalds because of the way the place used to cook meals using high saturated fat or trans fat products.  Likewise the marketing strategy of UPSIZING french fries and burgers with unlimited soft drinks have been blamed as culprits for the majority of the Obesity epidemic in America and probably in the world as Mc Donalds has crossed barriers and invaded every nation in the world!

 The study was published recently in the Journal of Epidemiology and Community Health and looked at the assumption of extending vlaue added tax to unhealthy foods and what could be its impact in terms of health and economic costs : Could targeted food taxes improve health?  J. Epidemiol. Community Health, Aug 2007; 61: 689 – 694.
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Data: Consumption patterns and elasticity data were taken from the National Food Survey of Great Britain. The health effects of changing salt and fat intake were from previous meta-analyses.

Results: (1) Taxing only the principal sources of dietary saturated fat is unlikely to reduce the incidence of cardiovascular disease because the reduction in saturated fat is offset by a rise in salt consumption. (2) Taxing unhealthy foods, defined by SSCg3d score, might avert around 2300 deaths per annum, primarily by reducing salt intake. (3) Taxing a wider range of foods could avert up to 3200 cardiovascular deaths in the UK per annum (a 1.7% reduction).

Conclusions: Taxing foodstuffs can have unpredictable health effects if cross-elasticities of demand are ignored. A carefully targeted fat tax could produce modest but meaningful changes in food consumption and a reduction in cardiovascular disease.

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Probably based on this study…it can work! and most likely as a last resort to our continuing battle against the BULGE!   But again it may not plainly because people will still look for things they’ve been used to liking.  Just look at cigarettes and alcohol.  Even with the so called SIN taxes on these products, people continue to splurge and enjoy them no matter the consequences.In short… everything boils down to DISCIPLINE and CHARACTER if we have to change the habit of EATING of every individual and the country as a whole.  And to be successful… this should be shaped during childhood! 

Remember if you’re child is obese by 6 years old…his likelihood of becoming obese for life is 40% and if he is obese by 12 years old… his chances of becoming obese for life is 80%!

Tax or No Tax… The Discipline Starts at HOME!

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

Are You FAT But FiT?

August 4, 2007

3283079462.jpgYou maybe Fat but Fit and as a result your risk to develop heart disease is actually lower than your counterpart who Fat and Unfit!  This according to a new study published in the Archives of Internal Mediciane, July issue. 

Below is the summary of the study as published in heart.org:

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“Arsenault et al studied 169 asymptomatic men with diabetes mellitus who were participating in the Quebec Family Study, a population-based study of French Canadian families living in and around Quebec. They measured abdominal adipose tissue accumulation, cardiorespiratory fitness (CRF), and indexes of plasma glucose-insulin homeostasis and lipoprotein-lipid profiles.  

After matching individuals with similar BMIs, men with low CRF were characterized by more visceral adipose tissue accumulation than men with high CRF (mean 114.4 cm2 vs 87.8 cm2; p<0.007) and by a poorer metabolic profile. When matched for visceral ( Abdominal) adipose tissue accumulation, however, such differences were no longer significant.

“This study underlines the importance of visceral (abdominal) adipose tissue or fat accumulation in the previously reported association between CRF and metabolic complications predictive of coronary heart disease and type 2 diabetes mellitus” .

“Our results suggest that visceral abdominal tissue accumulation could be a key confounding factor when the relationship of CRF, coronary heart disease risk, and metabolic syndrome is examined.”

Physical activity should be promoted, irrespective of age, sex, or degree of obesity as a measure to reduce adiposity, to increase energy expenditure, and to potentially decrease atherogenic visceral adipose tissue mass, they conclude. “

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There you go… being fat may not actually mean poor health risk RATHER it’s the cardiovascular fitness level or the Physical Activity that counts.

The more active we become…the less evil is our fat and the less likely we develop the outcomes of the disease of obesity!

Being FIT Matters….

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

The Protective Effect of Mediterranian Diet

August 3, 2007

imagesafg.jpgA diet that’s high-fat… because of the large amounts of monounsaturated fatty-acid-rich olive oil used in Mediterranean cultures—may be a useful tool against blocking of the arteries, particularly in individuals at high risk of developing heart disease.

A new study looking at High Mononunsaturated Fat( MUFA) diet has finally proven the proponents of this diet to be protective was recently published in the June 11, 2007 issue of the Annals of Internal Medicine.

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Interventions: Participants were assigned to a low-fat diet (n = 257) or to 1 of 2 Mediterranean diets. Those allocated to Mediterranean diets received nutritional education and either free virgin olive oil, 1 liter per week (n = 257), or free nuts, 30 g/d (n = 258). The authors evaluated outcome changes at 3 months.

Results:  Compared with the low-fat diet, the 2 Mediterranean diets produced beneficial changes in most outcomes. Compared with the low-fat diet, the mean changes in the Mediterranean diet with olive oil group and the Mediterranean diet with nuts group were –0.39 mmol/L (95% CI, –0.70 to – 0.07 mmol/L) and – 0.30 mmol/L (CI, –0.58 to – 0.01 mmol/L), respectively, for plasma glucose levels; –5.9 mm Hg (CI, –8.7 to –3.1 mm Hg) and – 7.1 mm Hg (CI, –10.0 to –4.1 mm Hg), respectively, for systolic blood pressure; and –0.38 (CI, –0.55 to – 0.22) and – 0.26 (CI, –0.42 to –0.10), respectively, for the cholesterol–high-density lipoprotein cholesterol ratio. The Mediterranean diet with olive oil reduced C-reactive protein levels by 0.54 mg/L (CI, 1.04 to 0.03 mg/L) compared with the low-fat diet.

 Conclusion: Compared with a low-fat diet, Mediterranean diets supplemented with olive oil or nuts have beneficial effects on cardiovascular risk factors.

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In short… participants in the two Mediterranean-diet groups had significantly lower mean plasma glucose levels, lower systolic blood pressure, and lower total-cholesterol/HDL-cholesterol ratios than those in the low-fat-diet group… which may explain the protective effects of this diet to develop heart disease.  

So what diet Do I recommend to my Patients? 

Ive been proponent of a 40% of total calorie diet to be from fat with 20% of total calories from MUFA.  Ive been pretty successful with this diet in terms of regulating my patients Blood sugar and lipids while maintaining their weight!  This study really proves me right. 

You will not go wrong having a diet rich in fruits and vegetables and supplemented with virgin olive oil and nuts…it’s a diet proven to  improve cholesterol ratios and the effects on blood pressure and inflammation.   One option to Olive oil that we can use daily in our cooking is Canola Oil which is also rich in MUFA and PUFA.  Likewise taking walnuts or cashew nuts for snacks as healthy alternatives to burgers and fries!

As The Saying Goes…GO NUTS!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, Personal Thoughts, Tips To Protect Your Heart | 1 Comment »

How To Exercise The Right Way

August 2, 2007

4143585627.jpgWe know we need to exercise.  We are often told to be active most days in a week if we want to lose weight or just 20 to 30 mintues 3 x a week for cardiovascular workout.

BUT what’s the BEST way to do it?… do we exercise 1 hour straight? or is it better to have a rest period in between activities to burn fat effectively?

Excerpts from the Study of Dr Goto published in the Journal Of Applied Physiology…. 

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This study compared the fat metabolism between “a single bout of prolonged exercise” and “repeated bouts of exercise” of equivalent exercise intensity and total exercise duration. Seven men performed three trials: 1) a single bout of 60-min exercise (Single); 2) two bouts of 30-min exercise, separated by a 20-min rest between exercise bouts (Repeated); and 3) rest.  In the Repeated trial, serum free fatty acids (FFA), acetoacetate, and 3-hydroxybutyrate concentrations showed rapid increases (P < 0.05) during a subsequent 20-min rest period. During the second 30-min exercise bout, FFA and epinephrine responses were significantly greater in the Repeated trial than in the Single trial. 

The relative contribution of fat oxidation to the energy expenditure showed significantly higher values (P < 0.05) in the Repeated trial than in the Single trial during the recovery period.

These results indicate that repeated bouts of exercise cause enhanced fat metabolism compared with a single bout of prolonged exercise of equivalent total exercise duration.

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In simple terms… it’s better to rest in between exercise activity than a single prolonged activity.  The rest period most likely made the tissues and body more efficient in burning more fat especially during the repeat exercise after the rest!

Meaning Rest in between activities is a good way to burn more calories and have time to take a breathier in between workouts!

My advise?  Exercise for 30 minutes then take a rest for 10 to 15 minutes then take a plunge to more activites again before heading back home….

What A way To Rest and Burn More Calories!

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

The FDA Ruling on Avandia…

August 1, 2007

imagessdff.jpgJuly 31 was a big day for Avandia after the US FDA ruled out removing the drug from the market.  The FDA hearing looked at several arguments whether indeed Avandia can result in increased risk of heart disease.

A report on the US FDA recommendation and Hearings:

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The US Food and Drug Administration’s (FDA’s) Advisory Committee came to an almost unanimous decision yesterday, voting 22-1 for Avandia, GlaxoSmithKline’s much-maligned diabetes treatment, to remain on the US market.

Concern about side effects associated with Avandia (rosiglitazone) was raised by a meta-analysis published in the New England Journal of Medicine in May. The analysis, led by Steven Nissen of the Cleveland Clinic, Ohio, US, concluded that the drug increased the risk of heart attack and death .

The committee convened to evaluate all of the post-approval clinical data and assess the ‘overall risk-benefit profile’ of the drug.

During a press conference following the meeting, the acting committee chair, Clifford Rosen from the Maine Center for Osteoporosis, Bangor, US, highlighted a ‘significant number of caveats’ for the prescription of Avandia.

‘I think there are clear-cut reasons not to use this drug in certain types of diabetes patients,’ he said. ‘These include those with or prone to congestive heart failure and people with significant risk of cardiovascular disease.’

The FDA will now consider the panel’s recommendations and make its final decision about what action to take. This could include the addition of appropriate warning labels on the drug’s packaging and the provision of advice to prescribing doctors. 

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In short… just like any other drug out there…prudent use of this drug among our patients is necessary.  Never to use among older patients at risk for heart disease and those with significant risk factors for heart disease especially among those already on insulin.  The problem is that majority of patients are put on insulin by doctors late after several years of poorly controlled diabetes… such that complications especially heart disease have already set in.  I dont believe this to be the case among young patients whom we start Early Insulinization where the risk for heart disease is not the same as somebody put on insulin late in the disease process.

All along I was right.  I believe in the efficacy of this drug so I was confident based on the available data that more studies need to be done.  Metformin and Pioglitazone on their initial short term studies proved harmful but long term studies proved otherwise!  I am sure that the longer duration studies will prove also Avandia to be worth taking to reduce ones risk for heart disease. 

Again…

It‘s Choosing The Right Patient for The Right Drug!

Read My Other Related Posts:

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

Orange Juice Can Prevent Kidney Stones

July 31, 2007

imageserty.jpgGood news for orange juice drinkers.  More benefits come your way than just taking the extra Vitamin C with this new study looking at extra help of orange juices in prevnting kidney stones.

It is known in the medical community that potassium citrate found in most citrus juice can slow down formation of kidney stones BUT are all citrus fruits the same?.

In a recent study by a team from the University of Texas Southwestern Medical Center at Dallas, published in Oct. 26 issue of the Clinical Journal of the American Society of Nephrology found that components found in orange juice can affect a juice’s ability to prevent stones.  In the study the volunteers drank 13 ounces of orange juice, lemonade or distilled water three times a day with meals. They were also put on a low-calcium, low-oxalate diet, which also helps cut stone formation.

The Results:

One possible explanation as to why OJ is better than Lemonade is that the citrate in orange is accompanied by a potassium ion ( the same goes with Grapefruit) while the citrate in lemonade and cranberry juice is accompanied by a hydrogen ion.  The problem with hydrogen ions is that they counteract the beneficial effects of high citrate content while potassium ions do not!!!

So…. for those with risks to develop Kidney stones, here’s one that we can incorporate in our diets!  One that we can enjoy every morning with our breakfast!

An OJ Each Day May Prevent Stones Today!

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

Dark Chocolate for Hypertension? Anyone?

July 30, 2007

22173473171.jpgWe have long heard about the good news of enjoying dark chocolates.  The mere thought of eating one makes your tummy growl for food! Just recently while browsing my JAMA journal noted another study on dark chocolate which is really good news to chocolate lovers.

The July 4, 2007 issue of the Journal of the American Medical Association reported a new study to show the benefits of cocoa in dark chocolate long-term — the study lasted 18 weeks.  

This study is a well conducted study being a randomized, controlled, investigator-blinded, parallel-group trial with 44 adults, aged 56 to 73, with untreated mildhypertension without concomitant risk factors.  This study is well matched and the two groups compared were given either a one square (6.3 g) of a commercial brand of dark chocolate per day, constituting just 30 kcal, or white chocolate which is  polyphenol-free to enjoy for 18 weeks.

Results Are Amazingly GOOD NEWS:

From baseline to 18 weeks, dark-chocolate intake reduced mean systolic BP by 2.9 mm Hg (p<0.001) and diastolic BP by 1.9 mm Hg (p<0.001) without changes in body weight, lipids, glucose, or 8-isoprostane. Hypertension prevalence decreased from 86% to 68%.  There was  a sustained increase of S-nitrosoglutathione by 0.23 nmol/L (p<0.001) and the appearance of cocoa phenols in the plasma among the dark chocolate eaters.

Te reseacrchers explain the phenomonon: “The apparent mechanisms by which dark chocolate lowered BP suggests a chronic increase in the production of nitric oxide in the vascular endothelium… and it is likely that cocoa flavanols in dark chocolate were responsible for the observed effects on S-nitrosoglutathione and BP.”

BUT before everyone indulges on dark chocolates… it is important to remember that it should be DARK and not Milk or White chocolates…likewise keep in mind the AMOUNT because remember the CALORIES! The one square of dark choco can give you around 30 kcal per day.

A Chocolate A Day Keeps Your Doctor Away!

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Nutrition Health Tips, Tips on Hypertension | 5 Comments »

How Much Salt Can We Take?

July 28, 2007

imagessd.jpgThe new recommendations from the American Medical Association should be a wake up call to all of us.   We know that salt is important for the taste of our foods but taking too much can be harmful.  As physicians weve been harping on lowering salt intake to our patients when they prepare their foods not recognizing that the culprit may actually be food in the restaurant and the processed foods we buy in the groceries!

We know from studies that populations with an average sodium ingestion of less than 1400 mg/day have virtually no hypertension BUT the average intake of salt in the world is around 4000 mg per day while Filipinos usually take in more.  This is way above the recommended daily allowance of 2000 to 2300 mg per day.   

The recently published advisory in the Archives of Internal Medicine, July issue urged the Food and Drug Administration to take a look at the standards set for salt and to limit sodium in processed and restaurant foods. It is recommneded that a minimum 50% reduction in sodium in processed foods, fast-food products, and restaurant meals should be sought in the next decade it we have to decrease the risks associated with high blood pressure. More so to address the labelling of products known to contain High Salt levels.

The AMA paper has this to say: 

“Across populations, the level of blood pressure, the incremental rise in blood pressure with age, and the prevalence of hypertension are directly related to sodium intake. Observational studies and randomized controlled trials document a consistent effect of sodium consumption on blood pressure. The majority of sodium consumption in the United States is derived from amounts added during food processing and preparation. Leading scientific organizations and governmental agencies advise limiting sodium intake to 2400 mg or less daily (approximately 6000 mg of salt). Substantial public health benefits accrue from small reductions in the population blood pressure distribution. A 1.3-g/d lower lifetime sodium intake translates into an approximately 5-mm Hg smaller rise in systolic blood pressure as individuals advance from 25 to 55 years of age, a reduction estimated to save 150 000 lives annually.

With an appropriate food industry response, combined with consumer education and knowledgeable use of food labels, the average consumer should be able to choose a lower-sodium diet without inconvenience or loss of food enjoyment. In the continued absence of voluntary measures adopted by the food industry, new regulations will be required to achieve lower sodium concentrations in processed and prepared foods.”

A Pinch Of Salt For A Healthy You!

 

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Nutrition Health Tips, Tips on Hypertension, Tips To Protect Your Heart | 2 Comments »

The Low Cholesterol and Cancer Link…

July 27, 2007

Lowering the cholesterol level of any patient with risk for heart disease is very important.  It is a MUST for any patient with Diabetes or Hypertension. It is sometimes difficult to convince patients to take anticholesterol meds because many are so afraid of the link to liver disease rather than be afraid of the heart disease if cholesterol is not regulated.  Likewise, patient remains asymptomatic even with elevated cholestrol so the urgency to seek treatment is not there.

Now comes another story linking low cholesterol to cancer!!!!

The increase in cancer incidence among statin users was small — about one extra case per 1,000 people, according to the study in the July 31 issue of the Journal of the American College of Cardiology. Apparently the slight increase in cancer incidence was found in 13 trials among statin users who achieved the lowest LDL cholesterol levels.

Is This A Cause For Alarm?

Most likely NOT! Again this is only an observation among the 23 trials studied and NOT a Cause and Effect Situation.  This calls for more attention and further study but again just like any drug or intervention we do…If there’s an effect…there almost always a Side Effect!  If you take a drug based on a premise that it is so safe without side effects then you are in for the worst!  Most likely you were sold by the marketing strategy of the sales agent!

Remember… the economic burden of suffering from heart disease is more than the risk of getting cancer in this case.  Likewise the effect of lowering cholesterol and lowering ones risk for heart disease is PROVEN .  It is also possible that by postponing disability and death due to heart disease, we make people live longer and in population studies, the longer we live the more likely we will get other diseases and cancer is one of them!.

My Recommendation is for my patients NOT TO WORRY!

The benefits of lowering cholesterol continue to outweigh the risks! Continue taking the drugs and I will continue to implement the same strategy of aggressiive lowering of cholesterol to prevent the target organ of high cholesterol levels…The HEART!

Low Cholesterol Unlinks The Burden Of Heart Attack!

Posted in General Health Tips, Medical News Bits, Tips To Protect Your Heart | 4 Comments »

AACE Philippine Chapter Annual Convention

July 26, 2007

scan0001.jpgThe American Association of Clinical Endocrinologist – Philippine Chapter will hold its Annual Convention on August 10 to 12, 2007 at Shangrila Mactan.

All doctors of all specialties are invited to join the affair as the organization has prepared a well balanced sessions for great learning!  As the one in charge of inviting foreign speakers it was pretty tough but finally there will be 6 foreign speakers– all world renowned in their own field of interest who will join us in the event.

  • Dr Hossein Gharib of the Mayo Clinic , my friend and my great boss… a respected expert in the field of Thyroid Diseases ,who is also presently the President Elect of the American College of Endocrinology will talk of  FAQ on Thyroid Diseases and another symposium on Controversies of Thyroid Cancer.
  • DR Steven Petak who is the Past President of the American Association of Clinical Endocrinologist will talk on Updates on Osteoporosis as well as Vitamin D: Bone and Beyond.
  • Dr James Gavin of Emory University will talk about The new Drug for Diabetes called Byetta and a plenary on Diabetes in Pregnancy
  • Dr Cecil Lansang of California who will talk and teach participants on the Thyroid Ultrasonography;
  • Dr Melvin Tan from the National University of Singapore will talk on Diabetes and Hypertension
  • Dr JJ Mukherjee also from the National University of Singapore will talk on Updates in Endocrine Hypertension and Male Hypogonadism

Prominent Local Speakers will also be present:

  • Dr Augusto Litonjua of Makati Medical Center who will talk on the New Incretins and GLP1 drugs for Diabetes,
  • Dr Ricardo Fernando of ISDF on Advances in Diabetes Care,
  • DR Estrelle Lopez of UST on Nutrition and Diabetes and
  • Dr Gerry H Tan of Cebu Doctors’ University will talk on The Proper Use of Insulin in Diabetes.

Registration will be FREE for the Residents in Training from all hospitals.  For Consultants, it will be a nominal fee of only P500 for the 3 day affair.  Registration will start at 8:00 to 11:00AM on Friday Aug 10 with the First Luncheon Symposium on Insulin Therapy at 11:30AM to 1:30 PM. There will also be exhibits from our pharmaceutical partners.

This is an opportunity for fellow Cebuano Doctors and neighboring cities and provinces to take part in this grand affair where you will have the chance to ask your personal questions regarding your patients with the experts in the field of Endocrinology.

For questions…please call Dr Gerry H Tan at 032-412-4803 and Dr Marsha Tolentino at 032-412-2767.

Or you can write to me in this website for any inquiries….

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

Can Diet Coke Cause Heart Disease?

July 25, 2007

212693807.jpgI usually allow my patients to drink soda as long as it is a “diet” or “light” soda…meaning, no sugar added but the sweetness is plainly due to an approved sweetener.  I usually caution them to drink only 1 can a day and not more.  The only concern I have is the amount of sodium in the soda rather than it causing harm to my diabetic patients.  It is therefore rather surprising to me that a study published in Circulation July 24 issue came up with a warning that “drinking more than one soda a day — even if it’s the sugar-free diet kind — is associated with an increased incidence of metabolic syndrome, a cluster of risk factors linked to the development of diabetes and cardiovascular disease.”

The study is not the ideal study population or method that can come up with a firm conclusion or assoiciation since this is a population based study where more than 6,000 participants in the Framingham Heart Study were followed up since 1948.  The study found that after four years of the study, “people who consumed more than one soft drink of any kind a day were 44 percent more likely to develop metabolic syndrome than those who didn’t drink a soda a day.”

Theories as to why this happen are intriguing steming from the fondness of sugary foods among people drinking soda to the caramel content of the soda promoting metabolic changes in the body.  Unfortunately, this study only proves a possible association and cannot in itself infer causality.  In other words…There is no proof that soda in itself is the culprit until further studies on causality can be done.

So if you love soft drinks then I would recommend allowing yourself to enjoy a”diet” or a “light” soda and only 1 can per day.  Overconsumption of a certain food does not allow one to prevent a disease by consuming more of a certain beverage even if it deemed safe by the medical community.

So…Can Diet Coke Cause Heart Disease? 

I doubt it.  This is only an observational study.  The same kind of method that initially suggested that Estrogen hormone therapy can lower ones risk for heart disease but eventually when a randomized prospective study was done… hormone replacement therapy actually increased ones risk for heart disease. BUT the study for me tells us only one thing: that even if it is “diet and has zero calories does not mean it is safe to over indulge!

The American Heart Association continues to recommend low calorie beverage as a good option for a healthy meal and likewise issued a statement :

“Since this is an observational study, it is important to note that the study does not show that soft drinks cause risk factors for heart disease. It does show that the people studied who drank soft drinks were more likely to develop risk factors for heart disease.

“However, it is possible that other factors could explain this relationship. Often people who drink soft drinks also eat and drink more calories, saturated fat and trans fat and less fiber and dairy products. Also, these people tend to be less physically active. This was true among the subjects in this study.”

So for me … the verdict is in:

It’s the LIFESTYLE Not The Drink! 

Read My Other Related Posts:

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, The Diabetes Facts | 6 Comments »

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