HYPERTENSION

May 19 is World Hypertension Day.  How do you combat this disease?

H – Have a balanced diet.  Not just fruits and vegetables, but a delicate variety and balance of carbohydrates, fats, and proteins as well.  And yes, just a little taste of sweets and fatty foods once in a while to relieve stress, but don’t overdo it.

Y – Yearly cholesterol monitoring.  Even if you don’t feel any symptoms, it is good to have your blood cholesterol and triglyceride levels monitored annualy starting at age 35.  Remember: high cholesterol is directly correlated to increased risk for heart diesease and stroke, and it could escape detection if not monitored.

P – Pressure check.  It doesn’t take much effort to run to the nearest health center once in a while for blood pressure monitoring.  It also does not hurt to have an electronic blood pressure monitoring device at home.  Just make sure it is always calibrated and the batteries are not worn out.

E – Exercise.  Be active and sweat a little.  This will strenghten your heart muscles and make your blood vessels more compliant, leading to better circulation.

R – Relax.  Avoid getting stressed out.  Remove all your hang-ups, hurts, and hatefulness.

T – Talk to your doctor.  Take medications when needed.  Treatment must not be delayed to avoid complications.

E – Ease up on the alcohol.  Binge drinking stresses the heart and leads to heart failure in the long run.

N – Na.  This is the symbol for sodium, which is present in salt.  Avoid too much salt, because it retains fluid and overloads the heart muscle.

S – Sleep.  A rested mind with adequate sleep keeps epinephrine levels down, which reduces vasoconstriction and improves blood flow to the tissues.

I – Identify your health history.  If you have family members with hypertension, be more vigilant.

O – Omega 3 supplementation.  Population studies and clinical trials provide compelling evidence that omega-3 fatty acids have cardioprotective effects.  One gram a day may be all that you need.

N – No to smoking.  It does not just prevent hypertension, but most other degenerative diseases as well.

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CAN WE BEAT CANCER?

The Human Body -- Cancer

Image by n0cturbulous via Flickr

Cancer can strike people in the prime of their life during their most productive years.  This creates a big impact on the economy and the workforce of a nation.

Cancer is the second leading cause of  mortality in the Philippines, next to cardiovascular diseases.   The sad part is most cancer patients seek consultation only at advanced stages. Another problem is that cancer survival rates are relatively low, and the costs are prohibitive for many of those afflicted.

At present there are various strategies being studied in order to prevent cancer and its spread.  The idea of inhibiting the blood supply to cancer cells is of particular interest to cancer researchers.  Targeting the  blood supply will inhibit blood flow to the tumor and inhibit its growth.

The growth of new blood vessels, called angiogenesis,  is now widely believed to be a necessary event for the development of cancer.  Therefore, drugs that can block tumor angiogenesis will be effective against a wide range of cancers.  Angiogenesis is a highly regulated process, and inhibitors of angiogenesis are predicted to be better tolerated than conventional cancer therapies that affect all rapidly growing cells.  This would result in a decrease in treatment-associated side effects.

Angiogenesis is the hallmark of many proliferative disorders other than cancer, including psoriasis, rheumatoid arthritis, diabetic retinopathy, and age-related macular degeneration. Thus, this mode of treatment could be effective for non-cancer diseases as well.

A group of drugs called Vascular Endothelial Growth Factor (VEGF)  inhibitors are now available.  VEGF is the most prominent inducer of angiogenesis.    VEGFs such as bevacizumab, are now available, but the therapy is not applicable to all types of cancers and patients.  More research is now underway to determine ways to identify those who would benefit from VEGF inhibitors.

So don’t lose hope!  Today’s researchers are working hard to find a cure for cancer.  As of now, the best way to beat cancer is through prevention by doing the following:

1.  Take phytochemical-rich foods.  Fruits, vegetables, dark chocolates, and even red wine (in moderation) are beneficial for cancer prevention. Research on animals published in the “Journal of Biological Chemistry” suggests that phytochemicals can have beneficial effects on prevention and treatment of leukemia, skin and breast cancers. This is because these phytochemicals have antioxidant and anti-inflammatory properties.  Inflammation is said to be one of the triggers for tumor growth.
2.  Supplement with selenium. Whereas antioxidants work to minimize and repair the damage of free radicals on individual cells, the mineral selenium has been shown to reduce the production of free radicals. The recommended dose of selenium is 200 micrograms a day.

3.  Get enough exercise. Physical activity helps prevent cancer. Research shows that exercise helps the body regulate blood sugar, insulin levels, and the production of sex hormones. Regular exercise also promotes a healthy immune system, and is recommended even for those already diagnosed with cancer.

HOW TO LOSE WEIGHT – IS THERE A PROPER DIET?

A diet rich in soy and whey protein, found in ...

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“What we tell people to do to lose weight – eat less and exercise – is exactly what you’d do if you wanted to make yourself hungry.”

Gary Taubes

We have all been bombarded by information on weight control.  But what diet and exercise regimen really works?  We all know that obesity leads to complications.   As of 2011, it has been estimated that there are around 350 million diabetics worldwide, and obesity is blamed for this number.  Are our modern methods of diet and exercise insufficient to stop this ballooning epidemic?

Recent diet regimens that have been in vogue include the Atkins Diet, the South Beach Diet, and the Zone Diet.  Atkins fans claim that processed carbohydrates and insulin, not excess kilocalories, are responsible for weight gain and obesity.  South Beach suggests low glycemic index meals.  The Zone Diet is 40% carbohydrate, 30% protein, and 30 percent fat, which deviates from the usual 60% carbohydrate : 20% Fat : 20% Protein ration often suggested.  If you notice, all these diets push for a reduction in carbohydrate intake.

An article by Gary Taubes published in Reader’s Digest’s October 2011 has got me thinking.  Here are some of the things that intrigued me:

1.  You don’t get fat because of overeating.  You get fat because of what you are eating.

2.  Diets don’t work.  Food restriction also leads to less energy expenditure.

3.  There is no compelling evidence that exercise leads to weight loss.  Exercising will not keep you thin.

4.  It’s impossible to count calories, so don’t do it.

5.  A high fat diet is better for your heart.

Mr. Taubes suggests a low carbohydrate diet, not a low fat diet.

According to the Mayo Clinic, the reason for promoting a low-carb diet is to stimulate fat breakdown by inhibiting  insulin secretion.  In other words, with the low-carb diet, the body burns stored fat for energy.  However, the American Heart Association (AHA) recommends unrefined whole grain foods, fruits, and vegetables, which contain more carbohydrates and less fat.  The members of the AHA include noted heart disease experts, who have always suggested a lower intake of saturated fats and cholesterol-rich foods.

What do you think?  Should we lower our carbohydrate intake by removing rice from our diet?  Must we stay away from wheat bread and pasta dishes?   Or is it better to count calories and limit the intake of  fats as suggested by the American Heart Association?

Let the debate begin.  Send me your thoughts on this.

ARTIFICIAL NUTRITION AND HYDRATION AT THE END OF LIFE

Pediatric polysomnography patient, Children's ...

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It is not necessary to feed a person when it no longer results in a better quality of life.  Surprised?  Yes, most people are.  The notion of withholding food runs contrary to our beliefs regarding care.  Just look at today’s babies.  When they cry, what do parents do to stop them?  If the diaper is dry, the next step is most likely to insert a feeding bottle into the mouth.  For adults, a get-together is not complete without food.  When we travel to faraway places, we often give food as “pasalubong” to our loved ones when we arrive back home.  No wonder why an advice of withholding feeding is often met with much contradiction from the family.  We equate food with good health, satisfactory care, and loving gestures.  So when we stop feeding, it is as if we no longer care.

Legally, all medical interventions can be refused by patients who still have the capacity to decide.  Artificial feeding is no exception, even if it results in death.  If relief of suffering and improvement of the quality of life can no longer be accomplished by nutritional supplementation and feeding, there is no reason to feed.  In an article published by the Palliative and Supportive Care Journal in 2006, it was also stated that there is no ethical or legal difference between withholding a  feeding tube versus placing the feeding tube and then later removing it.

—Despite increased nutrient delivery, trials show disappointing results in improving clinical outcome for chronically ill patients.  —Improvements in biochemical markers also inconsistently correlate with objective clinical benefits for artificial nutrition and hydration.  Minimal  benefit was also derived from enteral or parenteral nutrition in terminally ill cancer patients, other than for those with obstruction of the stomach or intestine.  Hunger is often not noted and relieved by giving the patient ice chips or small amounts of food and drink.  Dehydration is a normal component of the dying process that does not result in thirst or suffering.  In fact, treating dehydration may actually lead to more pain and difficulty.

There are some cases, however, when artificial feeding and hydration at the end of life may be warranted.  But we must always weigh the advantages and disadvantages of the intervention.  Also important to consider are the wishes of the family and the individualized goal for providing care.  Key principles to consider are autonomy (honoring the patient’s wishes), nonmaleficence (doing no harm), beneficence (doing what is in the patient’s best interest), and capacity (ensuring that the patient and the family understand the information needed to make a decision and provide consent).

It is important to understand that artificial feeding should always be considered relative to patient goals. Physicians and patients, with the patient’s family, must be prepared to discuss the options, bearing in mind the evidence that feeding will do to attain therapeutic goals.  If the viable option is to withhold feeding, don’t despair – it is totally acceptable.    Caring does not stop even if feeding and hydration are withheld.  After all, our ultimate goal is to provide a better quality of life and preserve the human dignity of our loved ones.