A Simple Blood Test To Determine Your Risk for Diabetes…

September 17, 2007

imagesx.jpgIf you think you are at risk of developing diabetes, our recommendation for now is to check your fasting blood sugar.  This is a test always included in executive panels.  However a more important measure of diabetes control is called A1c.  It is being done every three months among our diabetic patients to check their control or compliance to their medications.  Now a new study has supported the possible role of this blood test in predicting a patient’s risk of developing diabetes.

This study published in the American Journal of Medicine looked at a cohort of subjects in the Nurses Health Study and established the possible linked of A1c and the future risk of developing diabetes:

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(HbA1c) is a marker of cumulative glycemic exposure over the preceding 2- to 3-month period.   The authors examined baseline HbA1c levels as a predictor of incident clinical diabetes in a prospective cohort study beginning in 1992 of 26,563 US female health professionals aged 45 years or more without diagnosed diabetes or vascular disease (median follow-up 10.1 years).

Results: During follow-up, 1238 cases of diabetes events occurred.  After multivariable adjustment, HbA1c remained a strong predictor of diabetes.

 In analyses of threshold effects, adjusted relative risks for incident diabetes in HbA1c categories of less than 5.0%, 5.0% to 5.4%, 5.5% to 5.9%, 6.0% to 6.4%, 6.5% to 6.9%, and 7.0% or more were 1.0, 2.9, 12.1, 29.3, 28.2, and 81.2, respectively.

Conclusions:  HbA1c levels are elevated well in advance of the clinical development of type 2 diabetes, supporting recent recommendations for lowering of diagnostic thresholds for glucose metabolic disorders.

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It has been a continuing debate whether to use A1c as a diagnostic tool for diabetes.  We are using it to assess control rather than diagnosis.  We know that the higher the A1c… the higher the risk of complications of diabetes espcially death and heart attacks.  Therefore, we should impart the information to our diabetics that lowering A1c is lowering your risk to suffer from disability!

Now, our focus is for those at risks and those with apparently no risks to embark on a healthy lifestyle to avoid getting this chronic disease strongly associated with obesity and poor lifestyle!  If in doubt, we may be able to use this simple blood test to determine our risk… and if indeed that risk is high… it can be a better motivational tool to change lifestyle and be better in terms of choices of food and more physical activity!

The study has shown that in those with no risk… checking A1c can predict the outcome. That if ones A1c is >5% ; the risk to develop diabetes in the future starts to double!

Be Proactive… Better to Check Early Than Have The Disease!

Posted in General Health Tips, Medical News Bits, The Diabetes Facts, What's New in Diabetes | 4 Comments »

The Danger of Eating French Fries…or Why Trans Fat Is Bad!

September 15, 2007

I have been an advocate of avoiding fried foods.  However firm we are in avoiding frying foods, you sometimes cant help and avoid enjoying eating foods that are fried…not only are they crunchy but they also taste so good.  So resisting the temptation to enjoy great food is difficult. But at the expense of health and heart attacks!

I came across a recent article in the Harvard Medical School Health Publication: HealthBeat which I want to share especially to parents who allow their kids to enjoy french fries almost at every meal.

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 If you needed another reason to avoid trans fats, here it is. Researchers with the ongoing Nurses’ Health Study measured the amount of trans fat stored in red blood cells. Among the 32,000 middle-aged women participating in the study, 166 had heart attacks or died of heart disease during a six-year period. Their red blood cells had slightly higher loads of trans fat than did red blood cells of 327 women of the same ages and characteristics who remained free of heart disease.

Artificial trans fats are found in hard margarines, many commercially baked goods, and the fried foods in many restaurants, and research has consistently shown they aren’t good for the heart and blood vessels. Across the board, the more trans fat in red blood cells, the greater the chances of having a heart attack. Women with the highest trans fat load had triple the risk of women with the lowest. This study, published in the April 10, 2007, Circulation, strongly supports recommendations by the Institute of Medicine and the USDA’s Dietary Guidelines for Americans to cut back — or better yet, cut out — trans fats in the diet. Eliminating them from the food supply could avert as many as 264,000 heart attacks and heart-related deaths each year in the United States alone.

Trans Fats at Home and Abroad

A prime source of trans fat is partially hydrogenated oil, which many fast-food restaurants continue to use for deep frying. To see if this differed by country, three Danish doctors determined the trans fat content of French fries and chicken nuggets bought in 24 McDonald’s and KFC restaurants on four continents. As shown above, a large fries-and-nuggets combination delivered 10 grams of trans fat in New York City but less than a gram in Denmark, which limits the use of trans fats. A similar serving of fries and chicken nuggets in a KFC in Hungary delivered a whopping 25 grams of trans fat.

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Anothr reason to be alarmed over what we preceived a s a way of showing affection and reward to our kids… Crunchy fried chicken and french fries.  If we indulge in these kinds of foods once in a while or only during children’s parties .. its acceptable BUT if our kids eat only fried foods because that’s the only food they will eat then it will do no good to their future!

Start training them young.  My friend Maxim is one nice guy to dine with because he’s health conscious and therefore you tend to follow what he eats or be conscious of what you order.  And I guess there is so much truth to the study that showed…if your friends are obese, the more likely you will too….

A Feast with French Fries is A Feast with Trans Fat!

Posted in General Health Tips, Healthy Practice Tips, Medical News Bits, Nutrition Health Tips, The Truths on Obesity, Tips To Protect Your Heart | 6 Comments »

Jogging and The Risk of Heart Disease…

September 14, 2007

imagesqwa.jpgPrevious studies have linked city pollution to ishcemic heart disease.  The mechanism of which was not really studied well until recently.  It has been shown that ambient air pollution is associated with increased cardiovascular morbidity and mortality.

Jogging as an exercise is perfect.  It promotes well being and health.  But the place where one jogs should be considered especially with the findings below published in New England Journal of Medicine in 2007, regarding the risk of cardiovascular disease and air pollution:

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“Brief exposure to dilute diesel exhaust promotes myocardial ischemia and inhibits endogenous fibrinolytic capacity in men with stable coronary heart disease. Our findings point to ischemic and thrombotic mechanisms that may explain in part the observation that exposure to combustion-derived air pollution is associated with adverse cardiovascular events.”  

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The most likely mechanism of the above maybe genetics as explained in one study published also almost at the same time in Genome Biology, 2007.

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Diesel exhaust particles and oxidized phospholipids synergistically affect the expression profile of several gene modules that correspond to pathways relevant to vascular inflammatory processes such as atherosclerosis.

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I promote wellness through proper choices of food and physical activity.  These studies point out that patients with pre existing risk factors for heart disease should avoid being in areas where exposure to air pollution is present.  Exercising therefore in an area within the city where combustion particles are part of what you’ll inhale should be avoided.

I guess running a marathon in Boston area or any city for that matter can therefore have an impact on one’s risk and therefore should be reconsidered.

So running is good for the heart but for now avoid the city!

 

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts, Tips To Protect Your Heart | 3 Comments »

Smoking and The Heart…

September 13, 2007

2752053521.jpgWe know that smoking is bad.  But we still see lots of people in the streets enjoying their time smoking as if they’re oblivious to the ongoing damage that smoking has on their bodies.  It is said that the acute effects of smoking can occur within 30 seconds of inhaling that smoke… THAT FAST!  The part of the blood that is responsible for clotting… the platelets will then get stickier, and the lining of the blood vessels will no longer function well.

 One study that was presented during the European Society of Cardiology Scientific Sessions in Austria, was looking at the impact of banning smoking in workplaces in Ireland.  You see in Europe, you can still see places where smokers mingle with non smokers.  And Ireland was the first to do this in 2004.  At one time in Vienna, we have to move places or even change to another venue because my brother and I just can tolerate the smell of smoke.  It is just unfair that we be exposed to the danger of smoking when we dont smoke… the same is true to wives of husbands who smoke.. more so the children!

In the study, the investigators noted that since the introduction of a smoking ban in Ireland in 2004 , they were able to note a decline in the rate of admission of heart disease by 11% within 1 year of implementing the ban… a reduction that occurred mainly in males.

This observational study is significant because it impacts on reducing a patients risk to suffer from heart disease by avoiding the risk of second hand smoke.  Likewise, it is expected that with the smoking ban, individuals in the restaurant or public places who want to enjoy a cup of coffee who are non smokers are removed from that threat and the impact of this should be noticed right away.

The impact howevre will be higher on the smokers who will give up smoking because they are at the highest risk of developing heart disease and by giving up smoking, that risk declines very rapidly, as early as within a year!

Avoid The Smoke- It Can KILL!

Posted in General Health Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts | 2 Comments »

Is There A Link Between Junk Food and A Hyperactive Child?

September 11, 2007

imagesaqw.jpgHave you noticed your child to be hyperactive after eating chocolates? or candies or after drinking artificially colored drinks?  I see them often when parents bring their kids to my office while having their regular check ups.  These kids almost always are munching on junk foods!  And I guess we may be right that certain foods can indeed trigger the hyperactivity of a child which in itself maybe linked to Attention Deficit Hyperactivity Disorder or ADHD as a disease.

A new study published in Lancet has provided us a new proof regarding this link between food additives like food coloring and hyperactive state. 

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The study involved 300 children between 3-year-olds and 8- and 9-year-olds. Over three one-week periods, the children were then assigned to consume fruit drinks daily:

  • one contained additivies typically found in childrens diet
  • a second drink had a lower concentration of the additives
  • a third was additive-free.
  • All the drinks looked and tasted alike.
  • Qualities such as restlessness, lack of concentration, fidgeting, and talking or interrupting too much were then evaluated on each child.

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The study showed that kids were more hyperactive in the first group with the highest additives in the drinks that usually occur within 1 hour after consumption.  These are additives we usually get from eating candies and other junk foods.

The above findings have the clinical implications to those whose children get the most attention from teachers in school because of restlessness and hyperactivity.  This study is also the first to note a link between food additives typically seen in drinks,  candies or chocolates and junk foods that our children love to eat!

What more with the yummy candy and junk food ads our children see on TV? No wonder we are diagnosing more and more children with hyperactive behavioral problems.  Just look around any pediatrician specializing in hyperactive child, and you’ll have problems getting an appointment.

Go For The Healthier Alternative!

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

Advocacy to Educate Through the Media

September 10, 2007

imagesabcds.jpgMy article on this website on coffee and diabetes has caught the attention of media people and requested me to write about it in detail for publication in major newspapers.  The first publication in People’s Tonight   came out last Saturday, subsequently it will also be published this week in major national dailies like the Philippine Daily Inqurier, Philippine Star and The Manila Bulletin.

My hope to reach more people thorugh this website has taken its hold. Now I get comments from other parts of the country through my website and I find it Great! A reader through the article in People’s Tonight inquired if I have clinic in Manila which unfortunately I dont have.  But readers can always ask me or get in contact with me anytime through this website.

It is just amazing how powerful the media can be.  And I am glad I have found a great outlet of propagating what I love to do and what I plan to do ever since I decided to take up Medicine…. to educate the inquiring minds and to share what is healthy and right to those who seek for them.

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

What Does SPF mean?

September 8, 2007

While in Vienna, my wife always remind me to put on a sunscreen for my face.  It is always a struggle because I hate putting stuff on my face.  But being exposed to the sun with the travels and the dry weather, I obliged.  But what SPF is important to protect our skin?

We all know that sunscreens have long been promoted extensively against skin cancer.  However, it is reported that skin cancer rates continue to creep up, at about 3 percent a year according to the U.S. Centers for Disease Control and Prevention. Most likely because people ignore warnings and still bask themselves in the sun!  But most likely too, these people are protecting themselves with sunscreen…so what is wrong?

The U.S. Food and Drug Administration at the present time only allows manufacturers to only market products with a Sun Pretection Factor or SPF 30-plus on their labels, since they believe that any higher value is misleading to consumers. The belief that sunscreen is all you need to ward off the bad effects of the sun is apparently wrong.  Likewise the belief that the higher the SPF the better protection because it can last longer is also questioned.

It is advised that if you know you will burn under UV exposure in 10 minutes and you use the product with an SPF of 15 then the protection using this sunscreen will last for 150 minutes or 2 1/2 hours.  The problem is… in reality this is not so because, the sunscreen wears off with sweat or can be rub off easily after a dip in the water.  Be aware therefore that the protection you get is less than what you think. 

So, per guidelines… the recommendation is :

  • aim for a product with an SPF of 15 or higher.  But remember that the higher the SPF, the higher the protection agianst UV BUT not necessarily LONGER in protection!
  • Re apply the lotion after 30 min to 1 hour under the sun unless you dont sweat at all!  And more frequently if you swim.

There you go…. now after this post… I will follow my wife’s advise and try to use sunsscreen everyday.  But more so I guess to protect my face from early wrinkles.  So guys… protect your face will a daily sunscreen before it’s too late!

Daily Sunscreen For Baby Face!

Posted in Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts | 1 Comment »

The Benefits of Classical Music: Lessons Learned In Vienna

September 7, 2007

Just came from a week off in Vienna , Austria.  Definitely…one of the best places to visit and one of my Top 5 places that I enjoyed very much.

Aside from the beautiful landscapes and beautiful architecture… the history and the culture are so rich that you just cant digest too much information in one setting.  But one thing that made this trip enjoyable was the people…from the receptionists in our hotel, to the taxi drivers… everyone seemd so mild mannered and helpful.  And one cant help but wonder whether the people’s exposure to classical music so well known in this part of Europe because of the influence of Mozart may have made a difference.

Does Classical Music make a place safe to live?  Does exposure to this kind of music make people well mannered?

I found this one report entitled: How Classical Music Help Fight Crime… made me realized that my conclusion may be right!

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In 2004 in London, England, the British Transport Police piped classical music into London Underground stations in some of the area’s most dangerous neighborhoods. After playing the music for six months:

  • Robberies were cut by 33 percent
  • Staff assaults decreased by 25 percent
  • Vandalism went down 37 percent

This is not the first time that classical music has been used to deter crime. In 2001, police in West Palm Beach, Florida installed a CD player and speakers on an abandoned building in a crime-ridden neighborhood. After playing classical music — mostly Mozart, Bach and Beethoven — 24 hours a day for about three months, shootings, thefts, loiterers and drug deals decreased.

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During the convention, one of the doctors suffered a minor ailment and we have to rush him to a County Hospital.  It was really a surprise because it was clean and huge but very well equipped and you dont see a lot of crime related cases loitering in the emergency rooms.  We later found out that Vienna has one of the lowest crime rates in the region…. Because of Classical Music?

While roaming District One area which is the commercial center of Vienna, one can see a lot of Mozart like costumed guides marketing different concerts featuring different orchestras playing in different parts of Vienna.  If we have lots of singers and dancers in our country, Vienna has lots of violinist or cellist in the ranks…. 

Exposing our babies to Classical Music has long been advised by our pediatricians and I guess Vienna as a place to visit confirms that teaching…. that this kind of music can soothe ones nerves, calms us down and uplifts our moods.

So….  

If You’re Not in The Mood? Listen to Mozart!

Posted in Lifestyle Measures, Memories and Trips, Personal Thoughts | 5 Comments »

Can Coffee Prevent Skin Cancer?

August 30, 2007

coffee_drinker_print_web.jpgI was asked whether drinking coffee would be better than drinking caffeineated soda.  Trying to cut down on coffee but increasing intake of the diet soda may in fact not be a good idea because of the many studies linking coffee and health benefits.

A new study showed that a cup of coffee before going to work especially after a morning exercise can be healthy especially for the skin. This study published in the Proceedings of the National Academy of Sciences, July 30, 2007,  shows the combination of caffeine and regular exercise “appears to help kill some of the precancerous cells damaged by the sun’s ultraviolet-B (UVB) radiation.”

The study was done using mice where one group of mice drank the human equivalent of two cups of coffee a day while the other group voluntarily ran , and a third did both.  All the subjects were then exposed to UV radiation from lamps that damaged their skin cells.

Results: The rate of cell death among the precancerous cells was highest in the group that drank caffeine and exercised.

Implications: If precancerous cells destined to be cancer can be aborted by whatever mechanism then it has a tremendous impact in the prevention of disease.  This new data therefore is promising because this shows that drinking coffee can probably be of benefit to the prevention of skin cancer.

This is just one of the many health benefits now attributed to drinking coffee.  Is it the caffeine itself or also the coffee in itself that has benefits need to be answered.

So Grab A Cup and Enjoy The Taste for Health!

Read My Other Related Articles:

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

Why Men Can Be Happier ( or Healthier) Than Women…

August 28, 2007

3316430238.jpgI got this funny and I guess truthful statements of why men can be happier than women. 

But does this translate as to why men get to hospital or see a doctor lesser than women? Are they healthier?  Probably not… it’s the mens’ attitudes (probably in our genes) that we are invincible to the harm of nature that accepting the truth of vulnerability is not an accepted norm !

But nonetheless…I have to agree that men can actually be happier than women.  Read this and you’ll know why…..

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Why Men are just happier people.

What do you expect from such simple creatures? Your last name stays put. The garage is all yours. Wedding plans take care of themselves. Chocolate is just another snack. You can be President. You can never be pregnant. You can wear a white T-shirt to a water park. You can wear NO shirt to a water park. Car mechanics tell you the truth.

The world is your urinal. You never have to drive to another gas station restroom because this one is just too icky. You don’t have to stop and think of which way to turn a nut on a bolt. Same work, more pay. Wrinkles add character. Greying hair adds attraction. Wedding dress~$5000. Tux rental~$100. People never stare at your chest when you’re talking to them. The occasional well-rendered belch is practically expected. New shoes don’t cut, blister, or mangle! your feet. One mood all the time. Phone conversations are over in 30 seconds flat. You know stuff about tanks.

A five-day vacation requires only one suitcase. You can open all your own jars. You get extra credit for the slightest act of thoughtfulness. If someone forgets to invite you, he or she can still be your friend. Your underwear is $8.95 for a three-pack. Three pairs of shoes are more than enough. You almost never have strap problems in public. You are unable to see wrinkles in your clothes.

Everything on your face stays its original color. The same hairstyle lasts for years, maybe decades. You only have to shave your face and neck. You can play with toys all your life. Your belly usually hides your big hips. One wallet and one pair of shoes one color for all seasons. You can wear shorts no matter how your legs look. You can “do” your nails with a pocket knife. You have freedom of choice concerning growing a mustache. You can do Christmas shopping for 25 relatives on December 24 in 25 minutes.

No wonder men are happier. Send this to the women who can handle it and to the men who will enjoy reading it.

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To Jimmy, thanks for sending this to me.  It made me smile this early of the day.  Humor is FUN and Healthy . And probably to my friends, a little humor to start your day can make this day a better one than the rest!

Let your voices be heard…to those who agree or disagree….

Posted in Personal Thoughts | 3 Comments »

Just A Plate A Meal…To Make You Lose Weight

August 27, 2007

I’ve been counseling my patients with regard to a meal that they should only eat the foods that can fit in a plate and that’s it! I have written about it here in my website: The Will Power To Stop the Urge To Eat suggesting that the food should consist of rice, 2 slices of meat, 2 cups of vegetables and a fruit.  I was actually happy to know that a August 2007  article in the Harvard Health Letter recommends the same concept:

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Balance your plate

Balance Your Plate

A balanced plate helps you reduce your total calories, reduce the saturated fat and carbohydrates in your diet, and increase heart-healthy nutrients like antioxidants, B vitamins, and fiber.

It’s also important to make sure you’re getting all the important nutrients your body needs. Here’s an easy way to see if you’re eating a well-balanced meal. As you prepare or serve your food, think of a three-section plate.

In the big section (half of the plate), serve yourself two different vegetables or a vegetable and a fruit. In one of the two smaller sections (a quarter of the plate), put a serving of fish, poultry, beans (like black, pinto, or kidney beans), or another healthy protein. Fill the remaining section with a whole grain, such as brown rice or a whole-wheat roll, or another healthy carbohydrate.

As you divide your plate, keep in mind that vegetables are not all the same. Starchy vegetables-sweet potatoes, peas, corn, and winter squash-have about triple the amount of calories and carbohydrates as nonstarchy vegetables. So reserve the vegetable section for the likes of broccoli, leafy greens, tomatoes, carrots, and green beans. And put starchy (but nutrient-filled) vegetables in the carbohydrate quarter.

A balanced plate helps you reduce your total calories, reduce the saturated fat and carbohydrates in your diet, and increase heart-healthy nutrients like antioxidants, B vitamins, and fiber.

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Simple and Balanced… Easy to remember.  It is the concept and remembering it that counts.  I have been sticking to this simple formula for a long time and I myself is doing this to limit and balance my meals.  Likewise this is one way to limit intake and therefore lose weight.

BUT on very important maneuver to do to make this diet a success is to avoid further visual stimulation by leaving the table after consuming the food in the plate!  Otherwise the temptation to eat more will overcome the discipline to eat the balanced meal prepared on the plate!  Guilty? 

A Balanced Diet In A Plate For Health!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Nutrition Health Tips, Weight Loss Tips | 1 Comment »

The Importance of An Annual Check Up

August 25, 2007

2713261149.jpgDo we need annual physical exam? Why and How soon?

Actually there is still an ongoing debate as to whether annual exam is necessary or helpful.  Several institutions have abandoned the requirement of subjecting healthy subjects to this annual routine.  But in a recent survey published in the Archives of Internal Medicine … majority of the doctors and patients alike i.e. 9 out 10 surveyed out of the 800 still believe that annual physical exam do more benefits than harm.

In a recent publication from the Annals of Internal Medicine, Feb 2007 issue, a study was done to determine if indeed it is beneficial to have one:

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Data Synthesis: The best available evidence assessing benefits or harms of the Physical Health Exam or PHE consisted of 21 studies published from 1973 to 2004. The PHE had a consistently beneficial association with patient receipt of gynecologic examinations and Papanicolaou smears, cholesterol screening, and fecal occult blood testing. The PHE also had a beneficial effect on patient “worry” in 1 randomized, controlled trial but had mixed effects on other clinical outcomes and costs.

Conclusions: Evidence suggests that the PHE improves delivery of some recommended preventive services and may lessen patient worry. Although additional research is needed to clarify the long-term benefits, harms, and costs of receiving the PHE, evidence of benefits in this study justifies implementation of the PHE in clinical practice.

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This study has showned that one or more well visits per year may actually be beneficial to patients and doctors alike by improving patient- doctor relationship as well as alleviate patient’ worries.

By having an annual exam, one is able to check the onset of certain conditions where the abnormality will not show symptoms but may manifest initially with a biochemical or laboratory abnormality.  Healthy subjects specifically with a family history of known inherited conditions like diabetes, hypertension or high cholesterol will definitely benefit by having one.  More so with patients whose parents have a history of tumors or cancers of whatever organ should have routine annual exam.

Routine tests that have been shown to be beneficial in screening includes a fasting blood sugar, liver function tests, lipid profile to check cholesterol, occult blood and urinalysis.  Certain procedures like pap smear and breast exam for women are also beneficial since early detection and diagnosis of cancer have a big impact in terms of disability and survival.  What’s more, there did not appear to be any harm associated with period health exams, including undergoing inappropriate tests or excessive costs.

So when should one have an annual health exam? 

  • If you have a family history of chronic diseases like diabetes or heart disease … I would recommend to do the exam ealrier after the age of 30.  Majority of heart attacks is due to diabetes and the early a diagnosis of diabetes is done the better is the outcome in terms of control and prevention of complications. 
  • Between the age of 40 to 50 if you have a family history of certain tumors where occult blood testing or flexible sigmoidoscopy would be helpful
  • Otherwise after the age of 50 should be a reasonable age to do the annual exam for an otherwise healthy individual.

As the saying goes: 

It Is Better To Be Early Than Sorry…

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Medical News Bits, Personal Thoughts | 5 Comments »

Grapefruit and Your Medications…

August 24, 2007

2592766622.jpgIt is very important that one should be careful with food to drug or drug to drug interactions.  It is for this reason that as physicians, we are so careful in allowing our patients to take any medications without our knowledge.  Chinese medications for example can be a headache because patients can just buy them anywhere.  They work BUT what do they contain and what are the side effects?

Similar problems can be encountered with foods like fruits.  Take grapefuit as an example. I was asked this question several times so I thought of sharing this information to all.

There’s no question that grapefruit juice provides many nutrients, such as vitamin C and lycopene or fiber that can help lower cholesterol and triglyserides.  But  the pulp and the peel can also contain chemicals that can affect the actions of certain medications by interfering with the enzymes that break down the drugs in your digestive system. This interaction can be deleterious as the patient can have an excessively high levels of the active drug compound resulting in an increased risk of serious side effects.

This caution includes dietary supplements that contain grapefruit bioflavonoids – because in itself…it can also interact with certain medications. So be sure to read labels of your viatmins that may contain this compound.

Below is the list of drugs that one should avoid if you are a fan of grapefruit or better still take caution with these drugs if you eat grapefruit.  The list came from the Mayo Clinic Health Site.

Grapefruit and drug interactions
The following drugs are known to have potentially serious interactions with grapefruit products, tangelos and Seville oranges.
Drug name Type of drug
Carbamazepine (Carbatrol, Tegretol) An anti-seizure medication
Buspirone (BuSpar), clomipramine (Anafranil) and sertraline (Zoloft) Antidepressants
Diazepam (Valium), triazolam (Halcion) Tranquilizers
Felodipine (Plendil), nifedipine (Adalat, Procardia), nimodipine (Nimotop), nisoldipine (Sular) and possibly verapamil (Isoptin, Verelan) Calcium channel blockers used to treat high blood pressure
Saquinavir (Invirase) and indinavir (Crixivan) HIV medications
Simvastatin (Zocor), lovastatin (Mevacor, Altoprev) and atorvastatin (Lipitor), simvastatin-ezetimibe (Vytorin) HMG-CoA reductase inhibitors used to treat high cholesterol
Cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf) and sirolimus (Rapamune) Immunosuppressant drugs
Amiodarone (Cordarone) A drug used to treat and prevent abnormal heart rhythms (arrhythmias)
Methadone Pain relief medication
Sildenafil (Viagra) Erectile dysfunction medication

Other sources of Vitamin C like oranges, and lemons are okay to eat and have not been shown to affect drug levels.

Remember, the effect of this food to drug interaction can last from 1 to 3 days so please advise your doctors especially if you are taking certain drugs whose level if they go up can have serious effects like the blood thinning medication warfarin or coumadin.

The bottom like is: … dont take anything without checking!  Please be very cautious in taking supplements or chinese medications. Check with your doctors first.  Dont believe your friends or the advertisers that they’re safe!

I guess it’s the same thing in business and personal relationships … dont get into something that you are not sure of because trouble will hit you and hit you HARD!!!!

Better To Be Sure Than SORRY!

Posted in General Health Tips, Healthy Practice Tips, Lifestyle Measures, Nutrition Health Tips, Personal Thoughts | 2 Comments »

Foods To Avoid If You Have Migraine

August 23, 2007

249069055.jpgMigraine is not an uncommon complaint among friends and patients.  It is pretty bothersome, and can make your day irritating and stressful.  It can occur anytime if a a trigger food is ingested.  These headaches usually start  within 20-25 minutes after consuming these products.  You may notice it coming if you start complaining of  pressure in the chest and in the face, sometimes burning sensation in the chest, neck or shoulders accompanied by facial flushing and dizziness.  The headache can occur across the front or sides of the head.  Some patients may complain of feeling nauseated due to the associated dizziness.  Treating this headache can also be challenging as simple paracetamol may not do the trick.  Preventing the occurence of this headache is therefore of paramount importance to avoid having a bad day ahead!

So which specific food triggers have been shown to be the culprits and therefore should be avoided:

  • Tyramine containing foods found natu.rally in aged cheeses, and also found in red wine, alcoholic drinks, and some processed meats.
  • Food additives/preservatives like nitrates and nitrites found in hot dogs, ham, sausage, and other processed or cured meats.
  • Monosodium glutamate (MSG) in Chinese food.
  • Alcohol — specifically the impurities in alcohol or by-products your body produces as it metabolizes alcohol.  Culprits include red wine, beer, whiskey and champagne
  • Caffeine: coffee, chocolate, tea, colas, sodas
  • Pepperoni, hot dogs, luncheon meats
  • Bread and other baked goods and crackers
  • Dried fruits
  • Smoked or dried fish
  • Potato chips
  • Pizza, peanuts, peanut butter
  • chicken livers, and other specific foods and

Likewise for my diabetics…artificial sweeteners like aspartame can be bad triggers of headaches.  Also to be avoided are any COLD beverages especially after an exercise. Sensitivity to ice cream has been reported among migraine sufferers so avoid the temptation!

Trigger Free To Be Migraine Free!

Posted in General Health Tips, Medical News Bits | 31 Comments »

Why You Should Not Take Supplements….

August 22, 2007

imagesghy.jpgSupplements are always promoted as healthy alternatives to the usual medications doctors prescribe.  The marketeers are always advertising the products as devoid of any side effects because they come from “natural sources” of which the labeling may not actually tell us what they are and where they come from.  But almost always our patients are “tricked” into buying them because of the ads on TV or radio based on testimonials that they can cure a variety of ailments or based on the “convincing” strategy of the expert sellers. 

The US FDA and local BFAD have been very lenient with this multi-billion dollar industry in terms of limiting their exposure to the public lest their products can harm.  Instead you see them proliferating with seals of aproval from these agencies as” approved by BFAD”.  Although there is always a label ” No Therapeutic Claim” but who reads them when all the patients hear are the blubbering testimonials and ads on TV and radios….

One recent example of what can happen if these products go undetected is the recent warning of a supplement which actually contained an Anticholesterol agent.  Although the product is approved for use as a drug…but if it is present in a supplement, the patients taking them may not mind checking for possible side effects trusting the sellers of the product as side effect free!

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FDA Warns Consumers to Avoid Red Yeast Rice Products Promoted on Internet as Treatments for High Cholesterol


The U.S. Food and Drug Administration is warning consumers not to buy or eat three red yeast rice products promoted and sold on Web sites. The products may contain an unauthorized drug that could be harmful to health. The products are promoted as dietary supplements for treating high cholesterol.

The potentially harmful products are: Red Yeast Rice and Red Yeast Rice/Policosonal Complex, sold by Swanson Healthcare Products, Inc. and manufactured by Nature’s Value Inc. and Kabco Inc., respectively; and Cholestrix, sold by Sunburst Biorganics. FDA testing revealed the products contain lovastatin, the active pharmaceutical ingredient in Mevacor, a prescription drug approved for marketing in the United States as a treatment for high cholesterol.

“This risk is even more serious because consumers may not know the side effects associated with lovastatin and the fact that it can adversely interact with other medications,” said Steven Galson, M.D., M.P.H., director of FDA’s Center for Drug Evaluation and Research.

These red yeast rice products are a threat to health because the possibility exists that lovastatin can cause severe muscle problems leading to kidney impairment. This risk is greater in patients who take higher doses of lovastatin or who take lovastatin and other medicines that increase the risk of muscle adverse reactions. These medicines include the antidepressant nefazodone, certain antibiotics, drugs used to treat fungal infections and HIV infections, and other cholesterol-lowering medications.

FDA has issued warning letters advising Swanson and Sunburst Biorganics to stop promoting and selling the products. Companies that do not resolve violations in FDA warning letters risk enforcement actions, such as an injunction against continuing violations and a seizure of illegal products.

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There you go… this is only one of the many that we see patients getting complications either of the liver or the kidney arising from taking supplements. As physicians we can not go after anybody since the supplemetns are bought by patients at their own free will. 

The local BFAD however should be more careful in approving supplements and should have more teeth to penalize companies that promote these products as drugs which are now being done extensively.  Just watch your cable TV and you’ll be bombarded by ads on the numerous illnesses that these supplements can heal!

Be Smart…Know The Real From The Fake!

Read My Other Related Articles:

  1. The FDA Rules On Dietary Supplements
  2. Beware of the Weight Loss Myth
  3. What You Need To Know About Dietary Supplements
  4. The Harmless Herbs?

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

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 »

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