PDF - Philippine Society of Endocrinology and Metabolism

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Hormon
Hotspots"
HOTFLASHES
Thyroid: Neck, Neck Mo
Hormone Hirit
Obesity: Wow, Bigat
Eba at Adan
DIABETES, Kay Tamis n9 Buhay
Secondary Hypertension: Kakaibang Altapresyon
Lipids Metabolism: Sebo...di Macho
Gizmos and Gadgets
OSTEOPOROSIS: BUTO-BUTO SA LANGIT
ale t
~O?iglitazone '
A~
ia-
GlaxoSmithKline
A publication
of the Philippine
& Metabolism
Society of Endocrinology
H Staff
ADVOCACY COMMITTEE:
Editor: Gabriel V. Jasul, MD, FPCP, FPSEM
Managing Editor: Patricia B. Gatbonton, MD, FPCP, FPSEM
Art Director: Dondi B. Gerardino, TTB
Printer: Color Production Group
Cover: The birth of Venus, original art by Boticel/i;
additional graphics by Dondi Gerardino
Opinions expressed in the articles are those of the authors and do not necessarily reflect
the views of Philippine Society of Endocrinology & Metabolism (PSEM). Acceptance
of the advertising does not imply that these products and services are recommended
by PSEM. Please exercise your own discretion with respect to the products and services
advertised.
Hormone
Hotspots"
H Contents
4
5
6
7
11
11
14
17
From the Editor
President's Corner
Hormone Hotspots, 2007 All rights reserved. No part of the publication may be reproduced
or transmitted in any form or by any means without the written prior permission of the
PSEM.
September
18
10
11
Secondary Hypertension:
Kakaibang Altapresion
Gizmos and Gadgets
Lipid Metabolism:
Sebo ...di Macho
Diabetes: Kay Tamis Ng
Buhay
Hormone Hirit
Obesity: Wow, Bigat
Eba at Adan
Osteoporosis:
Buto-Buto sa Langit
What's up En Doc
14
16
18
Thyroid: Neck, Neck Mo
Hot Flushes: Dietary
Supplements for Weight Loss splendid for the waist or simply
a waste?
Advocacy Programs
2008 Issue
11
From the Ed itor
Dear readers, patients, and partners,
As Hormone Hotspots turns a year old, the PSEM Officers and Board of Directors and
the PSEM Patient Advocacy Committee celebrate our partnership with all of you in our
quest for HEALTH and HAPPINESS. Our activities geared towards patient education and
empowerment have really been successful in reaching out to a wider base in the communities
that our PSEM members serve. Our past two issues of the "H" magazine were well-received
and appreciated for the crisp and clear articles tackling the basics of important endocrine
conditions. This third issue follows the same path and will focus on the treatment aspect
of these diseases.
Your "H" staff made sure you will again find the articles useful as guide and quick reference
in your daily routine. We hope you will be able to share again this magazine and all the valuable information with your
families and friends. The spirit of sharing remains our major goal and that's the reason why we are doing our best to make
sure you receive the "H" magazine for free. That spirit of sharing, once passed on to you, dear readers, would be the best
compliment for all the efforts the PSEM and the "H" staff in all our patient advocacy programs. That spirit of sharing also
marks an effective, working partnership between the PSEM and you.
As you enjoy reading this issue, allow us to pay tribute to the PSEM members, endocrinologists serving the different
regions of the country. Our members represent the best that the PSEM can offer through quality patient care. We applaud
the efforts of our colleagues who have chosen to stay here in the Philippines and remain dedicated to serve the Filipino
patients. Our members, especially those practicing in the countryside, have responded to the calling of service and have
accepted the challenge to give the best in patient care despite the difficulties and limitations, not to mention the lure of
the proverbial greener pasture. The "H" magazine is our way of honouring our members and helping them in their efforts
towards excellent patient education.
As the "H" magazine strengthens the bond between you and your hormone doctors, Filipino endocrinologists serving Filipino
patients, let us wish all of us a life blessed with HEALTH and HAPPINESS.
Again, your input and feedback are most welcome. Let us keep the lines of communication
you the best. Enjoy reading and learning!
if.
vfr.",w-V
open so we can continue to give
~~
G riel V. Jasul, MD, F
E tior, Hormone Hotspots
P, PSEM
Philippine Society of Endocrinology & Metabolism
Our Mission
To lead in the pursuit of excellence in Endocrinology
Our Vision
Quality Endocrine care, education ad research in every region of the Philippines by 2010
IJ
President's Corner
With great pride and pleasure, we bring to you the third issue of Hormone Hotspots, the
PSEM lay magazine dedicated to bring to patients, their families and health professionals
information on the different endocrine disorders like diabetes, thyroid diseases, dyslipidemia,
obesity, osteoporosis, etc, thereby increasing awareness and understanding of these important
disease entities. Hopefully, this would translate in the long term to better care and outcomes
for our patients.
The past two issues have received positive and heartwarming responses from our patients,
colleagues, friends from the pharmaceutical companies and even professional writers. I
would therefore like to congratulate our hard-working staff and contributors of the Hormone
Hotspots and the dynamic PSEM Officers and Board and the members of the Advocacy
Committee for their passion and dedication to bring to you twice a year a magazine that you will not only enjoy reading but
could actually change your lives for the better.
I would also like to thank the PSEM members for their invaluable help in disseminating the H magazine in their areas of
practice helping fulfil our vision of bringing quality endocrine care and education
in every region of the Philippines.
In our third issue, competent and compassionate endocrinologists will bring to you new knowledge on the different endocrine
disorders in a very user friendly manner. We hope you enjoy the magazine as much as our staff has enjoyed preparing it
for you.
We look forward
to bringing
you more exciting
issues of the H magazine
in the near future.
Happy reading! H marks the spot to good Health and Happiness!
PS EM OFFICERS
& BOARD OF DIRECTORS 2008-2009
LAURA TRANO-ACAMPADO,
President
PSEM ADVOCACY AND PUBLIC RELATION
COMMITTEE 2008
MD, FPCP, FPSEM
PATRICIA B. GATBONTON, MD, FPCP, FPSEM
Vice-President
LEILANI B.MERCADO-ASIS, MD, PhD, FPCP, FPSEM
Secretary
GABRIEL V. JASUL, Jr., MD, FPCP, FPSEM
Treasurer
Directors
Ma. LUZ VICENTA V. GUANZON, MD, FPCP, FPSEM
HERBERT HO, MD, FPCP, FPSEM
SJOBERG A. KHO, MD, FPCP, FPSEM
CECILlA A. JIMENO, MD, FPCP, FPSEM
JOSEPHINE CARLOS-RABOCA, MD, FPCP, FPSEM
Immediate Past President
Chair:
Co-Chair:
Members:
Dr. Gabriel V. Jasul, Jr.
Dr. Patricia B. Gatbonton
Dr. Rosa Allyn G. Sy
Dr. Roberto C. Mirasol
Dr. Laura Trajano-Acampado
Dr. Josephine Carlos-Raboca
Dr. Leilani Mercado-Asis
Or. Ma. Luz Vicenta Guanzon
Or. Sjoberg A. Kho
Or. Aimee Andag-Silva
Or. Bien J. Matawaran
Or. Nemencio A. Nicodemus Jr.
Dr. Mary Jane Gutierrez
Dr. Mia Fojas
Dr. Pepito Dela Pena
Dr. Elaine Cunanan
Dr. Cecille Annonuevo-Cruz
Unit 1701, 17/F Medical Plaza Ortigas, San Miguel Avenue,
Ortigas Center 1600 Pasig City
Tel No. 633-6420· Fax No. 637-3162
E-mail: [email protected] • Website: www.endo-society.org.ph
The
Top TEN ....
THINGS YOU
SHOULD DO TO
CONTROL YOUR
BLOOD SUGARS
Roberto
c. Mirasoi,
MD, FPCp, FPSEM
Blood glucose control is an important component in the prevention of
complications due to diabetes. This has been shown in numerous landmark
studies. The recommendetion is to keep your sugars to as near normal as
you could get them to be. A lot of times, you fail. The following is a list you
should consider to hit your elusive targets.
1. Avoid too much sweet foods.
Avoid honey, jams, jellies, preserves,
chocolates, candies, pastries, cakes,
ice cream, halo halo, kakanin. They are
high in simple sugars and can increase
your blood sugar precipitously. Recent
recommendations allow for some simple
sugars in the diet but the amount should
be limited. Bread, rice, pasta, noodles
are allowed depending on your meal
plan.
fruit per meal is allowed.
increase blood sugars.
4. Takeyour medications regularly
and on time.
Beta blockers and steroids are known
to increase blood sugar. If you could
avoid these drugs do so.
This cannot be overemphasized. There
is no cure for diabetes and you need
to take your medications to help you
keep the sugars down. Poorly compliant
patients have poor blood glucose
results.
5. Monitor
2. Exercise regularly.
The recommendation is to exercise 30
minutes of moderate intensity most days
of the week (5 days a week minimum).
Walk to church. Climb up and down
stairs. Have a carless day. Clean the
house. Wash your car. Do gardening.
Aside from the great feeling after
exercising, you get bonuses of decrease
in blood pressure and cholesterol levels.
Exercise will help burn the extra calories
to bring down the sugar.
3. Refrain from eating too much
fruits.
Fruits are good sources of vitamins,
minerals and fiber. They could be eaten
in limited quantities. Some fruits have
high GI (glycemic index) which will make
your sugars go up. You could eat half
a mango, 10 pieces of grapes, medium
sized banana, and slice of papaya. One
your blood sugars.
Monitoring creates immediate feedback
and helps you make right decisions. It
has been shown that monitoring brings
down the blood sugars to a considerable
extent.
Fats contribute 9 calories per gram. If
taken in excess may lead to weight gain
and insulin resistance which increases
your blood sugars. Avoid butter,
margarine, oils. Trim off excess fat.
Avoid junk food eating- high in saturated
fats! Animal sourced fats should be
minimized.
Fried foods should be
removed from your diet.
10. Lose weight
if you could.
Even just 10% off your current weight
will do wonders to your blood sugars.
6.Avoid stress.
Stress contributes to increasing your
sugars by producing counter regulatory
hormones which are contra to insulin
and therefore increase your blood
sugars.
Learn to relax and avoid
pressures.
Meditate
and pray.
If all else fails and you still have high
sugars, reassess your diet and activity
prescription. Adjust your medications,
you may need more. You can plan this
out with your endocrinologist
and
dietician.
Remember
good blood
glucose
less complications!
=
7. Treat infections.
Infections usually elevate your sugars.
Seek the help of your endocrinologist
to help you treat these infections.
Diabetes
medication
may need
adjustment.
8. A void medications
9.Avoid fatty foods.
known to
I
ns -HIRIT
-HORm
Patricia B. Gatbonton,
MD, FPCp, FPSEM
Diabetes
is an ancient disease. The
Papyrus Ebers, an Egyptian document
from 1550 B.C., describes its classic
symptoms: frequent urination (polyuria),
excessive thirst (polydipsia) and intense
hunger (polyphagia),
long before
physicians put a name to the syndrome.
Intriguing
Insulin
though, since Frederick Banting and
Charles Best discovered insulin in 1921.
We may be no closer to a cure, but new
drugs and designer insulins help lower
blood sugar levels of persons with
diabetes (PWD).
Sugar, sugar everywhere
Diabetes comes from the Greek word
meaning "siphon," or "to go through,"
mellitus is Latin for honey-sweet. Early
physicians would taste their patient's
urine to confirm
the diagnosis.
Remedies ranged from various herbs
and potions, astringents, leeching to
carbohydrate
restrictive
diets.
How .does
diabetes
come
about?
Rice, bread, potatoes--any carbohydrate
we eat--is broken down in our stomachs
by digestive enzymes into glucose. This
is sugar's simplest form, the raw material
that generates the body's energy.
Protein and fat are alternative glucose
sources which are stored in muscle and
Arateus of Cappadocia
in the 2nd
century describes the patient's plight
thus, "Patients never stop making water
fat tissue and mobilized when we are
and the flow is incessant.. .Iife is short,
fasting.
unpleasant
and painful,
thirst
.u n que n c h a b le,
d r ink i n g
excessive ... if for a while they
1. TIle stomach
changes food
abstain from drinking, their mouths
Into glucose.
become parched and their bodies
2. Glucose en ers
dry; the viscera seems scorched
the bloodstream.
up; the patients are affected by
nausea, restlessness and a burning
thirst, and within a short time, they
expire."
An ancient disease;
but 21 st
century man, with computer brains
and the latest technology, has yet
to find a cure.
Medicine
has come a long way
3. The pancreas
makes little or
no InSulin.
4. I le or no Ins In
enters the bloodstream
Normally, after a meal, the sugar in our
stomach triggers sensors that alert the
pancreas, a small factory that lies
behind the curve of the stomach. Special
cells, the 11 -cells of the islets of
Langerhans
(which comprise
70
percent) synthesize,
package and
discharge stored insulin in two bursts,
an immediate tall spike, followed by a
second, smoother curve that releases
insulin in a steady stream (but smaller
amplitude) that brings down glucose
levels to normal.
Ins and outs of Insulin
Insulin is a hormone,
a chemical
messenger made up of 51 amino acids
or proteins in two chains (A and B) held
together by chemical bonds that are
first produced as pre-proinsulin and
proinsulin. Splitting of proinsulin yields
insulin and C-peptide,
which
clinicians can use to indirectly
measure
insulin
secretion.
Insulin docks on insulin receptors
on every cell in the body-affecting
their function especially in insulin
sensitive tissues: the liver, muscle
and fat cells, which are responsible
for energy storage-and sets off a
complicated chain reaction that
allows specific glucose transporters
to pick up glucose waiting outside
the cell doors. Imagine that insulin
is the key that unlocks the door.
Once inside the cell, glucose enters
a process (remember the Kreb's
Normally, our body sources glucose in different ways. One way is from the food
we eat. When we are not eating, in between meals or for longer stretches, when
we are asleep through the night, the liver, the hub of glucose production, makes
even more sugar from glycogen (glycogenolysis), its storage form.
Because of insulin
resistance,
the
--"""
o:=-..::
pancreas
works
bat•.-.--.
overtime to produce
extra insulin. Initially,
"""-•...•. •....
by
increasing
production
by 150
o~-:=
percent
or more,
o =:::.•....=-.*
blood sugars remain
normal. Unfortunately,
the pancreas cannot
keep this up for long,
and
the
compensatory
mechanism
fails.
Eventually, the ~-cells
are exhausted, insulin
cycle?) that goes on in the mitochondria,
production drops and fasting blood
glucose levels rise above 126 mg
the cell's powerhouse that generates
energy so our hearts can pump, so we
percent-the
diagnostic
cut off for
can breathe, think, see, speak, live.
diabetes.
•••
_-
--~.I-
..•
b_
•••
.n- ..- .
....
t~1D1.Iffts
•
Th8t ••••
.-:.
tlMl:lctlDa.d
-
Insulin
also
does
the
following:
• Inhibits new glucose production from
liver glycogen and muscle protein
• Increases transport of glucose into fat
and muscle
• Increase glycogen breakdown in fat
and muscle
(increasing
glucose
breakdown)
• Stimulation
of glycogen
synthesis
A state of insulin resistance results when
insulin receptors are less responsive to
the effect of insulin. Higher-than-normal
amounts of insulin are necessary to
maintain blood sugars at normal levels.
In spite of the high levels of insulin, the
insulin signal inside the cell is weak and
fewer transporters travel to the cell wall
to pick up the waiting glucose. Much
less glucose enters the cell.
This deficiency
in ~-cells
insulin
production together with a resistance
to the effect of insulin in the body's
tissues, results in Type 2 diabetes
mellitus.
(glycogenolysis),
its storage form. It
does this to support our brain which
needs a certain amount of glucose each
hour for its processes to work properly.
Once its own stores have run out, the
liver pulls out protein and fat stores and
manufactures
more
s u q ar
(gluconeogenesis). The problem is, all
that extra sugar is useless and inflates
the glucose levels further. It is a
destructive cycle. Excess glucose is
toxic to cells; it damages small and
large arteries, oxidizes blood and lipids,
leaks out in the urine, drawing water
along with it causing frequent urination.
Because the body wastes all its energy
and cannot store any, the patient loses
weight and has to eat voraciously to
replenish himself.
By the time the full clinical spectrum of
diabetes (frequent urination, extreme
thirst and hunger) is manifest - some
10 to 15 years after the problem begins
- the diabetic
has numerous
accompanying
complications
(hypertension,
abnormal cholesterol
The diabetic has sugar
everywhere but the body
cannot use it properly. In
the midst of plenty the
body starves for glucose.
Normally,
our body
sources
glucose
in
different ways. One way
is from the food we eat.
When we are not eating,
in between meals or for
longer stretches, when
we are asleep through the
night, the liver, the hub of
glucose
production,
makes even more sugar
from
glycogen
Normal insulin
production
Insufficient insulin
production
(diabetes metlitus)
levels, heart disease, kidney disease,
etc).
production
back
up
The bottom line: Only
replace insulin!
No escape
The most important thing to understand
is that almost all Type 2 diabetic patients
will require insulin at some point
because at diagnosis,
l1-cells cell
reserve is approximately 50 percent.
With each year of diabetes, especially
if blood sugars remain persistently high,
you lose an additional 4 percent per
year. Do the math. If you are lucky to
be alive by the 10th year of your
diabetes, you will only be able to
produce less than 10 percent of your
insulin requirement. How quickly this
process happens depends on how good
your glucose control is. No matter what
or how many oral medications you take,
you cannot
kick your pancreas'
to
normal.
insulin
Stayed tuned,
control!
I
and in good glucose
can
Next issue, we will tackle the types of
insulin, insulin regimens and tips and
techniques to inject insulin.
I Metabolic
I Glucose
actions of insulin on lipid and protein metabolism
(from UptoDate 2008)
metabolism
Lipid metabolism
Inhibition of lipolysis in fat; decreased
Stimulation
plasma fatty acid concentrations
of fatty acid and triacylglycerol
Increased lipoprotein
synthesis in fat and liver
lipase activity in fat; increased triglyceride
uptake into fat
Decreased fatty acid oxidation in muscle and liver
Increased rate of formation
of very-low-density
lipoproteins
in liver
Protein metabolism
Increased transport of some amino acids into muscle, adipose tissue, liver and other cells
Increased rate of protein synthesis in muscle, adipose tissue, liver and other tissues
Decreased
proteolysis
Decreased
urea formation
Different people
Different meters
in muscle
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ARE YOU ONE OF
THOSE WITH A
WEIGHT PROBLEM?
Rosa Allyn G. Sy, MD, FPCp, FPSEM
The public is well aware of the need to maintain a healthy weight
but how to do it safely and the healthy way is an issue.
Unfortunately the public has always become a prey to
misinformation from deceitful advertisements.
OBESITY
is a chronic
disease caused by a number of
modifiable and non-modifiable factors.
At one extreme it results from singlegene mutations, which produce massive
obesity, fortunately this is quite rare. At
the other extreme it may result from
various environmental influences like
unhealthy eating habits and sedentary
lifestyle. As a lifestyle disease I have
mentioned
in our last issue that
behavioral modification is essential to
succeed. In fact, it has become standard
in most treatment programs in the last
25 years. However, obesity being a
chronic disease may require medication
to achieve the target goals.
Who will require and benefit from antiobesity drugs? The National Institute
for Health, Clinical Practice Guidelines
state that individuals with a BMI (body
mass index) of 30 or individuals with
BMI of 25 and with other medical
problems like diabetes, heart disease,
hypertension, arthritis may benefit from
anti-obesity
drugs.
However,
administration
of anti-obesity drugs
should be taken under doctor's
supervision and monitoring.
To date, there are only two drugs
approved by BFAD for the treatment of
obesity. These are sibutramine and
orlistat. Sibutramine (REDUCTIL and
ZYTRIM) affects the eating behavior
and attitude of the person through a
central mechanism by making a person
feel fuller earlier than usual. Hence, the
drug is intended to make the person
eat less. Sibutramine does not affect
or change the appetite of the person.
Therefore,
sibutramine
does not
interfere or change the natural response
of the brain to food making the individual
less deprived of satisfaction of eating.
Sibutramine does not only increase a
person's satiety (feeling of fullness) but
it also increases the ability of the person
to burn more calories. This effect is
more pronounced
if the patient
combines the drug with regular exercise.
The other drug in the market is Orlistat
( LESOFAT and XENICAL) which acts
locally in the intestines by inhibiting the
absorption of 30% of fat taken during
the meal. The drug does not affect the
fat stored in the body; it only prevents
the absorption of additional fat. It is
therefore very important to remember
to combine orlistat with dietary restriction
and regular physical activity to achieve
target goals.
Both drugs SIBUTRAMINE
and
ORLlSTAT have strong evidence to
show that both drugs do not only help
in weight loss but it also helps improve
health. The 2-year STORM trial of
sibutramine showed that its use also
reduced
blood
glucose
levels,
cholesterol and triglyceride level. It also
helps increase the adiponectin levels
of overweight and obese individuals, a
hormone that is known to protect
individuals from medical problems. The
XENDOS trial of orlistat also showed
that the drug when given to pre-diabetic
individuals can revert back their sugar
metabolism
to normal
by 58%.
Drugs are helpful and are used as
adjuvant therapy but not a quick fix to
weight problem. Should you expect a
rapid drop in weight when you take
these drugs? The answer is NO. You
should only expect a 2-3 Ibs weight loss
per week or a total of 5 - 10% weight
loss from your baseline weight within a
6 months period to avoid medical
problems.
In our next issue, we will talk about
other treatment strategies in obesity.
H
Mary Jane Gutierrez, MD, FPCp, DPSEM
Ika W
ba ay isang lalaking mahigit
sa edad na 50 taon? Napansin mo ba
kamakailan ang pagbabago sa iyong
pangangatawan tulad ng paglaki ng
tiyan 0 di kaya ang pagliit ng kalamnan?
Nagbago din ba ang iyong lakas 0
enerhiya? Kawalan ng interes sa "sex"
o pakikipagtalik? Ikaw ba ay bugnutin
o iritable sa mga maliliit na bagay? Ito
kaya ay parte ng pagtanda 0 isang
medikal na kondisyon na tinatawag na
"male andropause"?
Tulad ng kababaihan,
ang mga
kalalakihan ay nakakaranas ng pagbaba
ng "sex hormone" habang tumatanda
(sa babae -"estrogen";
sa lalaki "testosterone").
Ang dahan-dahang
panghihina ng kakayahan ng "gonads"
ng isang tao ang nagiging sanhi ng
pagbaba ng "sex hormones"
at ito
ang nagdudulot ng "hypogonadism" .
. Ang mga pagbabagong
ito ang
naghuhudyat ng "menopause" para
kay lola Eba at "andropause" para kay
1010 Adan.
Sa mga babae, ang
"menopause"
ay karaniwang
nararanasan pagdating sa edad na 45
-55 taon, subalit sa lalaki, walang
eksaktong edad ang panimula ng
"andropause"
pero ang mga pagaaral ay nagpapakita
na ang mga
pagbabagong ita ay nagsisimula sa
edad na 30 taon. Ang impormasyon
ukol sa paggamit ng sigarilyo, pag-inom
ng alak, gamot (opiates, steroid, ferrous
sulfate, androgen therapy, estrogen,
bromocriptine, para sa kombulsyon 0
anti-epileptics),
iba't ibang sakit
(diabetes, kabigatan 0 obesity, sakit sa
thyroid, pangmatagalang sakit sa bato,
baga at puso, sakit sa at ay tulad ng
hepatitis at cirrhosis) ay kabilang din
sa mahalagang kaalaman na maaaring
makaapekto
sa pagkakaroon
ng
"hypogonadism".
Liban
sa
pagbabagong pisikal at sintomas, may
iba't ibang dahilan ang maaari pang
magdulot ng "hypogonadism",
kung
kaya't mahalaga ang pagpapagawa ng
laboratory na magpapakita
ng mga
kondisyong ito.
buhay
0 p aqiqrnq
m alunqkutin
3. Pagkabawas ng tangkad
4. Nabawasang pagnanasa sa
pakikipagtalik 0 "sex"
5. Pagkabawas ng pagkatindi ng
paninigas ng ari
6. Hirap matulog
7. Bugnutin
0 mainitin
ang ulo
8. Malilimutin
9. Pagliit ng kalamnan, paglaki ng
tiyan 0 pagtaas ng "fat mass" at
panghihina ng buto
Ang mga sintomas ng "Andropause" ay
mga sumusunod:
Ang lupon ng katanungan buhat sa
"Morley Screening Questionnaire for
Andropause"
ay inilathala para sa
pagsusuri
sa mga taong
may
"andropause"
at ita ay isinalin sa
1. Mababang
enerhiya
0 lakas
2. Pagkabawas ng kaligayahan sa
20
25
30
40
45
Tagalog (subalit kailangan ng dagdag
"validation") (Palugod et ai, 2006 PJIM).
1. Nabawasan ba ang inyong
pagnanasa sa pikikipagtalik 0 "sex"?
2. Nabawasan ba ang iyong enerhiya?
3. Nabawasan ba ang iyong lakas 0
tibay/tagal?
4. Nabawasan ba ang iyong tangkad?
5. Napansin mo ba ang pagkabawas
ng iyong kaligayahan sa buhay?
6. Ikaw ba ay malungkot 0 bugnutin?
7. Ang paninigas ng iyong ari ay hindi
ganoon katindi?
8. Napansin mo ba ang kamakailang
pagbabawas ng iyong kakayahang
sumali sa gawaing pangsports?
9. Nakakatulog ka ba pagkatapos
kumain ng hapunan?
10. Nakakaranas ka ba kamakailan
lamang ng pagbabawas ng iyong
kakayahang
magtrabaho?
Garnot
Sa mga
pagbabagong
napansin
kaakibat
ng pagtanda,
ugaliing
kumunsulta sa isang Endocrinologist
upang magabayan sa mga institusyong
gumagawa ng "screening tests" na
kailangan. Maraming uri ng formulation
ng "Testosterone Replacement Therapy
(TRT)"
"patches,
gel, pills,
intramuscular injections" at ang ilan sa
benepisyong nalathala sa paggamit ng
mga ito ay ang sumusunod:
1. Paglaki ng pangangatawan at
pagbaba ng "fat mass"
2. Pagtaas ng "bone mineral density"
3. Pagtaas ng enerhiya at abilidad ng
pagawa ng pisikal na Gawain
4. Pagtaas ng libido
Ang paggamit ng TRT ay may kaakibat
din na "side effect",
tulad sa mga
kontrobersiya
sa paggamit ng mga
taong may problema sa prostata 0
"prostate"at
puso kung kaya't mas
matagal na pag-aaral ang kailangan
dito. Napagalaman
din na ita ay
nakataas ng paggawa ng pula ng dugo
na maaaring maging sanhi ng paglapot
nito na maaaring pagmulan ng "blood
clots" at maaaring magbunsod ng "heart
attack" at "stroke". Ang TRT ay maaari
din makadagdag sa problema ng "sleep
apnea" kung kaya't ito ay kontra sa
kondisyong nasaad.
Ang pangkalahatang
kalagayan ng
katawan ay dapat ipagsaalang-alang .
Kung ang TRT ay sinimulan ng duktor,
ugaliing makipag-ugnayan
sa iyong
duktor upang ang mga sintomas at mga
laboratory ay patuloy na natutunghayan
para ang mga "side effects"
ay
maiwasan·H
Ma. Luz Vicenta V. Guanzon, MD, FPCp,
FPSEM
Exercise and Osteoporosis
Osteoporosis
means
the bone becomes brittle such that it
can break even at the slightest amount
of pressure. It means that even just
falling from a standing position can
result in fracture in an osteoporotic
individual.What is vital in osteoporosis
is prevention of fractures. Calcium-rich
diet, sunlight exposure, and proper
exercise can all prevent osteoporosis
from occurring.
It is a common misnomer that if you
have osteopenia
or osteoporosis
exercise is discouraged because of the
fear of fracture.
On the contrary,
exercise
is encouraged
so as to
promote muscle strength, improve
·coordination and balance, and therefore
prevent the chances of falling. There
are exercises which can promote bone
health which are suitable to people with
or without osteoporosis, and which can
be performed anywhere, without the
need to enroll one's self in the gym,
and with or without using exercise aids,
such as dumbbells,
leg weights,
vestibular balls. The following simple
exercises developed by Prof. Maria
Fiatarone
Singh are taken from
Australian
Organization
for
Osteoporosis hand outs for consumer
use.
Part i
TYPES
OF EXERCISE
PROMOTE BONE HEALTH
Weight-bearing
aerobic
THAT
exercise
Weight-bearing exercises are those that
use the large muscle groups in a
rhythmic pattern and are performed in
a standing position. These exercises
should be done at a rate that increases
your heart rate, blood pressure and
breathing to at least a 'moderately hard'
level. Examples are brisk walking,
hiking, stair climbing, jogging and
aerobic dance. Swimming, cycling,
seated exercises and arm exercises
are non-weight-bearing
aerobic
exercises and have little effect on bone
health. Aerobic exercise is also known
as endurance
or cardiovascular
exercise.
weights, i.e. dumbbells or ankle weights
(e.g. knee extension and flexion, hip
extension, flexion and abduction, leg
raises, shoulder strengthening, biceps
curl and triceps lift).
Figure 1. Weight lifting improves bone
health. Exercises can be done on weight
machines (such as the leg press) or
using free weights (dumbbells and ankle
weight).
Resistance training
Resistance training is also known as
strength training or weight lifting. It is
the use of targeted muscle groups to
lift and lower moderate
to heavy
weights. In traditional weight lifting, the
weight is lifted and lowered slowly; in
power training, it is lifted as fast as
possible and then lowered slowly.
Exercises can be machined-based (e.g.
leg press, seated rowing, pull down and
knee extension) or done using free
EXERCISE
FRACTURE
& OSTEOPOROSIS
PREVENTION
Enhancing balance
If necessary, hold on to the back of the
chair for support weight lifting exercises
performed in the standing position, such
as hip extension, flexion and abduction.
As your balance improves, progress on
using two hands on the chair to one
hand, one fingertip, no hands, and then
no hands and eyes closed.
Figure 3. Hip extension is one of the
several exercises done to strengthen
the muscles on the lower back-hip-thigh
region, so as to protect the bones of
the hip from osteoporosis
fracture
holding on to a railing.
• Lift items with one hand instead of
both.
• Avoid having poor posture, particularly
forward flexion of the spine. To improve
your sitting posture, sit on a Swiss ball
or a backless chair.
STRENGTH TRAINING EXERCISES
You should do two or three sets of eight
repetitions of each exercise per session,
and two or three sessions per week.
In the rest period of at least a minute
between each set, you should do one
jump or heel drop (see photo 14).
Calf raise
ANY
4a
4b
Incorrect
X
Strengthens the muscles that pull the
legs out to the side.
The rest period between sets of weight
lifting exercises can be used for high
impact exercise. For example, perform
one jump between each set, aiming for
a total of about 20 to 60 jumps per
week. If wearing ankle weights, keep
them on for the jump.
WITHOUT
Hip Abduction
Each session should take 30 to 45
minutes.
Each of the exercise
descriptions
below counts as one
repetition.
Enhancing bone growth and strength
EXERCISING
EQUIPMENT
1. Wearing ankle weights, stand
holding the back of a chair, close to it.
2. Bend one knee and slowly lift this
food backwards to as close to the
back of your thigh as possible.
Keep the upper part of your leg still,
and your body upright.
3. Hold, then slowly lower your leg.
4. Repeat for the other leg.
Strengthens
muscles.
the ankle and the calf
1. Wearing ankle weights, stand
holding the back of a chair, close to it.
2. Without bending your knee or waist,
move one leg straight out to the
side, keeping your toes pointing
forwards.
3. Hold, then slowly lower your leg.
4. Repeat for the other leg.
Knee extension
You can incorporate balance and high
impact exercises into your daily activities
if you don't have access to weight lifting
and other equipment.
Some simple
exercises are listed here.
• Stand on one leg whenever you are
standing at a sink or counter or in a
queue.
• Walk heel-ta-toe
between rooms
(place the heel of one foot directly in
front of the toes of the other foot, so
that they touch or almost touch).
• Stand up and sit down slowly without
using your arms.
• Squat to pick up items or reach into
low shelves or drawers, rather than
bending over.
• Jump up and down steps and stairs
using both feet to land; advance to one
leg hops. If your balance is poor, start
1. Wearing ankle weights, stand
holding
the back of a chair.
2. Lifting your heels, rise up on the
toes of both feet, as high as
possible.
3. Hold, then slowly lower your heels.
4. When this is too easy, use one leg
at a time, alternately (photo 2c).
7a
7b
Incorrect
Strengthens the quadriceps
which straightens the knee.
Knee flexion
3b
Strengthens the hamstring
which bend the knee.
Incollect
X
muscles,
X
muscle,
1. Wearing ankle weights, sit in a chair
with a good upright posture and the
back of your knees resting against
the chair seat.
2. Raise one foot in front of you until
your knee is as straight as possible,
keeping your thigh on the chair and
your toes pointing up.
Pull your toes towards your head
as far as possible.
3. Hold, then slowly lower your leg.
4. Repeat for the other leg.
The fol/owing are exercises which can
help improve balance.
crossing one leg in front of the other,
placing your feet parallel to each
other with the toes level.
2. Have a chair, rail or another person
close by in case of overbalancing.
This guide is based on 'Patient
Handouts'
by Professor
Maria A.
Fiatarone Singh that were first published
in Medicine Today in February 2007
(Medicine Today 2007; 8(2): 61-64) and
in March 2007 (Medicine Today 2007;
BALANCE EXERCISES
8(3): 69-74).
Balance exercises are best done before
strength training exercises to minimize
fatigue and the risk of falling. You should
do one set of five repetitions of each
exercise per session.
Osteoporosis
A ustralia
acknowledges
Medicine
providing
this material
Tandem walking
Also known as heel-to-toe
MARIA A. FIATORONE
FRACP
gratefully
Today for
for print.
SINGH
MD,
walking.
15
Sideways
stepping
over object
1. Walk sideways over three or four
objects of differing heights, placing
your feet parallel to each other with
the toes level.
2. Have a chair, rail or another person
close by in case of overbalancing
1. Walk for 3 to 4 metres placing the
heel of one foot directly in front of
the other, placing your feet parallel
to each other with the toes level.
2. Have a chair, rail or another person
close by in case of overbalancing.
16
Crossover walking
1. Walk sideways for 3 to 4 metres
Standing on one leg, eyes closed
1. With your eyes close and one hand
resting on the back of a chair for
support, stand on one leg for 30
seconds.
2. Repeat for the other leg.
3. To increase difficulty, add a mental
task such as naming animals or
subtracting 7's from 200.
4. To further increase the difficulty,
reduce the hand support from one
hand to one finger to one fingertip
to no hands.
H
Professor Fiatarone Singh is the John
Sutton Chair of Exercise and Sport
Science,
Exercise,
Health
and
Performance Research Group, Faculty
of Health Sciences,
University
of
Sydney, and Professor of Medicine,
University of Sydney, NSW She is also
Senior Research Associate, Hebrew
SeniorLife,
Boston,
and Visiting
Scientist, Jean Mayer USOA Human
Nutrition Research Center on Aging at
Tufts University,
Boston,
USA.
Bien J. Matawaran, MD, DPSEM
This column is the obligatory
question and answer portion of Hormone Hotspots. We will entertain any questions about Endocrinology
& Metabolism from
all of you---patients, friends, colleagues and even enemies (just don't hold your breath waiting for the answer :-). I will try to be simple minded as possible
(as if I can try to be otherwise) so that comprehension of endocrine topics will hopefully be easier. I will be your resident Joe D' Mango/Kuya Cesar cum
Helen Vela--- well known "showbiz advisers",
until the editors can find a qualified and saner writer for this column.
But for now you don't heve a choice
but read on or tear this page ASAP.
Just
want to let you in on a little
secret... my Editor is fuming mad since
I've been procrastinating. Such a bad
habit for a doctor whose main object is
to get to targets FAST. I was not able
to turn over my article on time mainly
because
YOU
have
been
procrastinating.
I've been waiting for
your queries,
so turn over those
questions fast!
1. An abbreviated (sarcasm) question from
a distraught patient ....I've been very conscious
about my health since I just discovered
all my brothers
diabetic.
and sisters
It was probably
that
turned out to be
not much
of a
surprise since my father was likewise diabetic
and was obese. Since then, I 've been checking
my fasting blood sugar (FBS) every 3 months
and all have been normal except for the most
recent which showed
a value of 119 mg/dL
(6:61 mmol/L) which my doctor said was 'prediabetes'. What does this mean and should I
take any medications
for this condition?
Answering this patient with regards to
the diagnosis of 'Pre-diabetes' is quite
easy but the question on treatment is
one winding path to tread. Pre-diabetes
is a term applied to blood glucose
determination showing values above
normal but are below the threshold for
the diagnosis of diabetes mellitus. This
term includes the condition we call
"Impaired
fasting
glycemia"
and
"Impaired
glucose
tolerance."
Determination of fasting blood glucose,
done after an overnight fast of at least
8 hours, is the simpliest
way of
diagnosing diabetes mellitus. Normal
blood sugar for non-pregnant individuals
is defined as less than 100 mg/dl (5.5
mmol/L) and diabetes mellitus as a
value of more than or equal to 126mg/dL
(7 mmol/L). So if you have a FBS value
of between normal blood sugar and
diabetes mellitus, then this is impaired
fasting blood sugar that is 'pre-diabetes.'
This only means that you are at a
greater risk to develop diabetes in the
future. These values are based on
epidemiologic studies that are utilized
by the American Diabetes Association
(ADA) as well as the International
Diabetes
Federation
(IDF) in its
guidelines.
The meat of the question is harder to
answer, and that is if she needs
treatment. There are several studies
done specifically to patients with prediabetes to evaluate the effect of
different interventions-diet and exercise,
metformin, rosiglitazone, pioglitazone,
acarbose and orlistat, to 'prevent'
diabetes
mellitus
type 2. These
interventions have been proven effective
however; it is still lifestyle modification
that has provided a more favorable
result. So in this group of patients what
I usually say is that if they can sustain
lifestyle modification and lose weight,
then they would not need any tablets
to reverse pre-diabetes.
2. Still on risk for diabetes, my sister has been
bugging
me regarding
her blood sugar. She
is a 32 year old mother of one who developed
gestational
diabetes
mellitus
(GDM) or
diabetes
insulin
during
pregnancy,
necessitating
therapy. I had this stressful
situation
of taking care of her blood sugar during the
duration of her pregnancy, making sure that
she
sticks
monitoring
with
her
and
insulin
diet,
blood
sugar
injections.
After
delivery, her blood sugar returned to normal
so now she would like to know if she can now
binge and enjoy food as our family is known
for being "voracious
eaters"?
To be truthful about it, she can actually
take in anything she likes since she not
a diabetic. However I also tell her that
we have a family history of diabetes
mellitus and she is far from model slim.
Her history of gestational diabetes
actually increases her risk to develop
diabetes mellitus in the future, that is
in addition to all her other previous risks.
As mentioned above, you can also
consider gestational diabetes mellitus
as a pre-diabetic state.
WHAT'S UP AND WHAT'S NOT!
If you want to know a
government
initiatives regarding diabetes mellitus,
log on www.doh.gov.ph and click on
public health programs. You would be
surprised that diabetes is clumped up
with Diabetes, Osteo, Arthritis, Musculoskeletal. Is that not unfortunate? ®®®
KAKAIBANG
ALTAPRESYON
Secondary Hypertension: Unveiling the
silence of the' Silent Killer'
Pete de la Pefla, MD, FPCp, DPSEM
Secondary Hypertension::
Pay attenti~n - this is "essential"
the pathophysiology of it all.
Hypertension
is an
intermittent or sustained elevation of
diastolic or systolic blood pressure. At
least one of the following two criteria
is present.
a. Systolic blood pressure>=
140
mmHg on two separate occasions
b. Diastolic blood pressure >= 90mmHg
on two separate occasions
The two major types of hypertension
are essential, also called primary or
diopathic and secondary, majority of
which are endocrine
in nature.
To discuss the pathophysiology
of
secondary hypertension,
one must
know how hypertension
happens.
ESSENTIAL
HYPERTENSION
:
Hypertension may be caused by an
increase
in cardiac
output,
total
peripheral
resistance
or both.
Cardiac output may be increased by
conditions that increase the heart rate
or stroke volume.
Peripheral resistance may be increased
by conditions
that increase blood
viscosity or a reduction of the lumen of
the blood vessels.
Strong family history, race, gender,
stress, obesity, a diet high in sodium or
fat, use of tobacco, a sedentary lifestyle
and aging may all play a role.
Why does it all happen?
Some speculations help explain the
development
of hypertension.
• Abnormally
increased tone in the
sensory
nervous system causing
Always remember that hypertension usually doesn't produce signs and symptoms
until vascular changes in the heart, brain, or kidneys occur. Complications occur
late in the disease and can lead to organ damage.
angiotensin-aldosterone system and
renal perfusion causing rise in blood
pressure.
2. Cushing's Syndrome - An excess
of cortisol levels also lead to
increase in blood pressure by
increasing renal sodium retention,
angiotensin I levels and increased
vascular response to
norepinephrine.
3. Primary aldosteronism
- An
excess of aldosterone levels may
also lead to an increased
intravascular volume, altered
sodium concentration in vessel
walls. This may also lead to
increased peripheral resistance.
4. Pheochromocytoma
Urine test
increased
peripheral
Blood test
resistance
• Changes in the arteriolar wall causing
resistance
• Increased blood volume resulting from
• Increase in arteriolar thickening which
may be caused by genetic factors
• Abnormal renin release resulting to
the formation of angiotensin 11 , which
constricts the vessel wall and increases
blood volume
SECONDARY
HYPERTENSION:
Hypertension that is related to the
underlying disease. As discussed in the
ECGreading
previous issue, secondary hypertension
may be caused by the following:
*renal parenchymal disease
*renovascular disease
*pheochromocytoma
*primary aldosteronism
"cushinqs syndrome
*dysfunction of the thyroid,
parathyroid
pituitary,
WHY? WHY? WHY? - for secondary
hypertension.
1. Chronic renal disease - Damage
to the kidney either from chronic
glomerulonephritis/ renal artery
stenosis interferes with sodium
excretion. It also disrupts the renin-
- This is due
to increased secretion of
epinephrine and norepinephrine.
Epinephrine increases cardiac
contractility and rate while
norepinephrine increases peripheral
resistance.
It is important to know why hypertension
happens. Knowing the pathophysiology
of hypertension whether' essential' or
'secondary' leads to proper treatment.
Always remember that hypertension
usually doesn't produce signs and
symptoms until vascular changes in the
heart,
brain,
or kidneys
occur.
Complications occur late in the disease
and can lead to organ damage.
If only your heart can speak, Pay
attention - "Stop pushing so hard!
I don't need all this pressure. "
H
PSEM in the Web
h
t t
p .
J
. 0
r
Mia C. Fojas, MD, FPCp, DPSEM
Aft er
46 years, the PSEM has
created its own website that's up and
running.
Conceptualized
in 2006 under the
guidance of the society's president, Dr.
Rosa Allyn Sy, the PSEM at last has
it's own independent website that would
cater to the needs of the society's
members, health professionals and the
lay interested in knowing more about
hormones, diabetes, the thyroid, and
other endocrine disorders.
The website's
mainpage
following in focus:
has the
,
VIJ'''''I'"J
... shows important announcements to
all PSEM Members and Endocrine
trainees.
...fAIdA.1!L
... are for both health and non-health
professionals who would like to know
what the society has in store for
everyone. More updated articles will
also be added to address issues with
regard to emerging therapies
and
supplements.
... contains
the "scoop"
of what
happened during each of PSEM's
activities during the past quarter.
,,.,,,
( &) Crt~14"
u,lA/'J
... is for all health professionals
interested in bringing themselves up to
date with regard to recent results of
randomized controlled trials, and both
international
and local endocrine
research outputs. These are divided
according
to the following
topics:
Diabetes, Thyroid, Adipose Tissue and
Metabolic
Syndrome,
General
Endocrine Conditions.
• Our Leaders portion shows the year's
Officers
and Board of Directors,
Philippine
Society
Board
of
Endocrinology
and Metabolism,
Standing and Ad-Hoc Committees, Past
Presidents and Life Fellows.
PRESIDENT'S CORNER
·.. is an exclusive portion of the website
for the incumbent President of the
PSEM.
"How to Join" specifies the different
membership
categories
within the
organization.
Membership
requirements, as mentioned in the by-
On the right column, after the
main page, selecting on "About
Us" would direct you to the
following:
• History of PSEM, wherein one
could also down load or view
"PSEM
at
45
years,"
summarizing
the society's
achievements
in a 5-minute
video,
• Mission and Vision of PSEM,
with its summary in the "PSEM
Hymn," composed by Drs. Bien
Matawaran
and Nemencio
Nicodemus, Jr., and arranged
by one of PSEM's friends, Mr.
Noel Espenida. The hymn can
also be down loaded as video
both in this site and in Youtube .
(See Dra. Rosa Allyn Sy sing
the hymn!),
• By-Laws, which has been
updated in 2007 as approved
by the Board of Directors can
be down loaded in portable disk
format (.pdf) style, and
""-'"--- ------..._
--- ....•.....•
- :---- :~-=-='~-:!.
•..•... ------.....
societies locally and internationally, and
Research Papers done by the society's
members. Research papers have been
classified according to subject and are
also searchable.
For now, however,
the publications are only available for
diplomates and fellows of the society.
"From the Gallery" contains fun
pictures of each of PSEM's activities
through the years-
laws are enumerated.
The four
institutions for Endocrinology fellowship
training are also mentioned in this area,
with their corresponding
email
addresses.
"Our Members" is probably one of the
most helpful portions for those looking
for an endocrinologist
in their area.
The members
can be searched
according
to their
membership
classification, clinic address, contact
numbers,
and email addresses.
Hopefully soon, we will be including
pictures in this field.
materials. PSEM's exclusive Hormone
Hotspots
Magazine
can also be
down loaded here.
"Position Statements"
shows the
society's stand regarding important
issues in the management of different
metabolic problems, such as Diabetes.
"Research
Grants and Awards"
shows the different study grants and
studies that are on-going as funded by
the society, different pharmaceutical
companies and partner organizations.
"Contact Us" has a comment area
where one could post to the webmaster
important questions for as long as there
is a validated return email address.
This also contains the address, contact
numbers and e-mail address of the
PSEM.
I
::,,' -,
I ~
•. ' It\,
,
,·T, D"· "0 ... contains links to
I
I! ••
the
most
recent
Practice
Guidelines issued by partner endocrine
Ccrre' Clinical
On the right column, upcoming Events
are announced.
Events, include the
PSEM Annual Convention, Lay fora,
Interhospital
Grand Rounds, etc.
The
Calendar
helps
both
members and nonmembers
schedule
their
activities for the
year, so as not to
ten",...,..
miss important
pursuits
for
continuing medical
education and training.
)1
~...-.•.,.:::r:-, ."~.
.~
The website, www.endosociety.org.ph
is quite
young
and
more • ..:;;~~.
information will be available
soon.
Currently,
the
PSEM's website committee
is working on releasing a '
Forum where everyone can
post questions and get the
answer from an expert, or
just simply talk about
"anything
endocrine".
Hope you can visit the site soon!
"Advocacy Links for the Lay" is the
website's portion wherein materials for
teaching diabetes, thyroid diseases,
osteoporosis
and obesity can be
downloaded in .pdf format (not in .ppt).
Acrobat
Reader
(also
freely
downloadable from the PSEM website)
is needed to use all these teaching
The PSEM Website Committee (PSEM
Spideys) would like to thank everyone
in the society who helped in its creation,
including members of the secretariat,
Pia and Victor.
The website was developed with the
help of Mr. Jim Sanchez of Rave
Studios .•
LIPID
Aimee Andag-Si/va,
MD, FPCp, FPSEM
Makakatulong nga ba ang Virgin Coconut
Oil sa Pagpapababa ng Ating Kolesterol?
Ang kasikatan
ng
"Virgin Coconut Oil" (VCO) ay laganap
na sa buong mundo- bukod sa iba't
ibang brand na nasa loob ng maraming
tindahan ay napakaraming website sa
intemet ang tumatanggap ng mga mailorders para dito. Hanggang sa ngayon
ay hindi malinaw kung ana talaga ang
benepisyo nito sa mga tao na may
mataas na blood sugar 0 kolesterol
ngunit maraming
pangako tayong
maaririning sa mga nagtitinda nito.
Ano nga ba ang Virgin Coconut Oil?
Ito ay langis na hinahango mula sa mga
niyog sa pamamagitan ng natural na
pamamaraan 0 sa pamamagitan ng
makinarya 0 pag-init na hindi naglalagay
ng mga
kemikal
na
pampaputi 0 pampabango
o kung anumang kemikal na
maaariing
makasira
ng
pagka puro nito. Ano naman
ang pagkakaiba
nito sa
tradisyonal na langis na dati
na nating ginagawa?
Ang
langis
na
mu la
sa
pinatuyong laman ng niyog
o "copra" ay dumadaan pa
sa proseso ng pagpapaputi
(bleaching)
at
p a 9 pap
a ban
9 0
(deodorizing)
at iba pang
paraan ng refining. Ito ang
malaon nang ina-angkat sa
atin ng ibang bansa upang gamiting
sangkap ng mga sabon, pampadulas
ng balat at buhok, at sangkap sa gamot
para sa balat. Ang langis ng niyog ay
hindi madaling masira sa pagbabago
ng panahon 0 kahit sa pagsasa-ilalim
nito sa matinding init.
Ngunit bakit ang langis na mula sa niyog
ay ginagamit lamang sa industriya
bilang sangkap ng mga pan-Iagay sa
balat at buhok, at hindi bilang bahagi
ng mga pagkain? Nakasasama ba ito
sa kalusugan? Ang langis ng niyog ay
isang uri ng saturated fats - ang uri ng
taba na malakas ang kaugnayan sa
pag kakaroon ng sakit sa puso. Tulad
nang na-ilathala na sa nakaraang isyu,
kailangang di hihigit sa 7% ng ating
calories
sa araw-araw
ang dapat
makuha sa pag-kain ng SATURATED
FATSkasama
ita
sa
mga
rekomendasyon upang maka-iwas sa
pagtaas ng kolesterol
sa dugo at
pagkakaroon ng baradong ugat sa puso
ayon sa balangkas ng World Health
Organization.
Gayun
pa man,
ay maraming
panibagong
pagsasaliksik
ang
nakatuklas na hindi lamang ang uri ng
taba na saturated ang may masamang
epekto sa kalusugan. Lumalabas na
ang haba at dami ng fatty acids sa
kabuuan ng isang uri ng langis ay may
epekto rin sa katawan. Ang tinatawag
na MEDIUM-CHAIN TRIGL YCERIDES
ay mas madaling matunaw sa ating
bituka
kumpara
sa long chain
triglycerides
at mahusay
din ito
magbigay ng enerhiya. Dito nagiging
lamang ang langis ng niyog sapagka't
sa lahat ng langis na mu la sa halaman,
ito ang may pinaka maraming medium
Ang mga /angis na hindi
madaling masira tu/ad ng
galing sa niyog at sa
pa/mera ay hindi na
kailangan ng
hydrogenation kaya ito ay
tinaguriang trans fatsfree.
Dahil sa mga bagong pagsusuri sa mga
uri ng langis na may kaugnayan sa sakit
sa puso ay naqkakaroon
na rin ng
panibagong puwang sa industriya ng
pag-kain ang langis ng niyog. Ngunit
ang iba pang benepisyo nito sa larangan
ng kalusugan- sa pagtunaw ng sebo
sa ugat, sa asukal sa dugo, sa panlaban
sa sakit 0 sa pagpapababa ng kolesterol
ay hindi pa gaanong malinaw. Kaya't
hindi pa rin natin dapat isama ito sa
mga rekomendasyon.
chain triglycerides.
Ang isa pang lumabas
sa mga
pananaliksik ay ang kaugnayan sa sakit
sa puso ng pag-kain ng TRANS FATS.
Ito ay nagmumula sa langis na galing
sa halaman tulad ng soy bean kapag
ito ay pinasa ilalim sa proseso ng
hydrogenation. Ang mga langis na hindi
madaling masira tulad ng galing sa
niyog at sa palmera ay hindi na
kailangan ng hydrogenation
kaya ito
ay tinaguriang
trans fats- free.
Wala na sigurong mas matutuwa pa
kaysa sa mga Pinoy endocrinologists
kung tunay na mapapatunayan
na
maganda sa metabolismo ng sebo at
asukal sa dugo ng tao ang langis ng
niyog- birhen man 0 hindi- sapagka't
laganap ita sa ating kapaligiran at
bahagi ng ating kasarinlan.1
Thyroid: Neck,
Neck Mo
Nemencio A. Nicodemus
Jr., MD, FPCp, DPSEM
Gaya ng anumang karamdaman
na may kinalaman sa mga hormones,
ang ating thyroid gland ay maaaring
maapektuhan sa dalawang paraan:
maaaring sobra ang dami ng ginagawa
nitong sangkap 0 thyroid hormones
(hyperthyroidism)
0 kakaunti lamang
(hypothyroidism). Sa isyung ito, ating
bibigyang
pansin
ang
hypothyroidism.kung tawagin ay "thyroid
hormones."
Ang tamad na thyroid:
HYPOTHYROIDISM
hypothyroidism.
ito sa thyroid
Maaaring ihalintulad
gland
na tamad.
Too little Hormone
Produced
Kapag ang thyroid gland ay nasira dahil
sa epekto ng karamdaman,
ito ay
nagdudulot ng unti-unting pagkaubos
ng mga thyroid hormones, na mas kilala
sa tawag na T4 at T3. Ang kondisyon
kung saan ang katawan ay nagkukulang
sa T4 at T3 ay tinatawag
na
Mayroon ding mga gamot na maaaring
pumigil sa paggawa ng thyroid gland
ng sapat na dami ng T4 0 T3. Kabilang
dito
ang
Amiodarone,
PTU,
Methimazole at Lithium.
f ~ ...
'":\..
May mga karamdaman din na maaaring
humantong sa hypothyroidism gaya ng
tumor ng mga kulani ng thyroid (thyroid
lymphoma) at tumor sa bahagi ng utak
na kung tawagin
ay pituitary
at
hypothalamus.
Bakit nagkakaroon
ng Hypothyroidism
ang isang tao?
Ano
ba
ang
Hypothyroidism?
dulot ng mga panlaban na ginagawa
ng katawan sa sarili nito (antibodies).
Ito ay tinatawag
na thyroiditis.
Maraming dahilan kung bakit nagiging
hypothyroid ang isang tao. Sa mga
bansa sa Asya, isa sa pangunahing
dahilan ay ang kakulangan ng iodine
sa katawan
na dulot naman ng
kakulangan ng iodine sa pagkain. Dahil
dito ay nagkakaroon ng goiter 0 bosyo
ang isang tao. Ito ay tinatawag na iodine
deficiency goiter.
Maraming
tao din ang nagiging
hypothyroid
pagkatapos na si la ay
maoperahan sa thyroid (thyroidectomy)
o matapos na sila ay mapainom ng
radioactive iodine (RAI). Maaari din
unti-unting masira ang thyroid gland
Ano-ano ang mga
sintomas at senyales
ng Hypothyroidism?
Ang pagkakaroon ng mga sintomas ng
hypothyroidism ay may kaugnayan sa
katagalan ng sakit at kung gaano ita
kalala.
Kabilang
dito ang mga
sumusunod:
• Pagtaba 0 pagbigat ng timbang nang
hindi sinasadya
• Mabilis na pagkapagod
• Paghirap
• Madaling
0
sa pagdumi
nilalamig
pagkahingal
0
0
pagtitibi
giniginaw
Ang mga pagkain na makatutuiong upang mabilis na mapa-normai ang
antas ng inyong thyroid hormones ay ang mga sagana sa iodine gaya
ng mga isdang dagat at haiamang dagat.
Ang isang tao na nagtataglay ng mga
sintomas at senyales na binanggit sa
itaas ay dapat magpasuri sa isang
endocrinologist upang malaman kung
ang mga ito nga ay posibleng dahil sa
hypothyroidism. Ang pinakamahalagang
paraan
upang makasiguro
kung
hypothyroid
ang isang tao ay ang
pagsukat ng antas ng TSH (thyroid
stimulating hormone) at T4 sa dugo.
Dito ay makikita na mababa ang lebel
ng T4 na galling sa thyroid gland
samantalang mataas naman ang TSH
• Pagbagal ng pag-iisip
makakalimutin
0
inumin. Ginagamit
na batayan sa
pagbabago
ng dosis
ang mga
nararamdaman
ng pasyente at ang
resulta ng TSH. Importante ang regular
na pagbalik sa inyong doktor sapagkat
mayroon ding hindi magandang epekto
ang kulang 0 sobranq
dosis ng
levothyroxine.
Ang gamutan ng hypothyroidism
ay
habang buhay kung kaya hindi dapat
pagiging
• Pananakit ng laman-Iaman 0 muscles
magpawala ng levothyroxine araw-araw.
Sa pagsusuri naman ng doktor ay
maaaring makita ang mga sumusunod:
• Pagbagal ng tibok ng puso
na galing sa utak.
• Panunuyo ng balat
• Magaspang
• Pagkakaroon
Pamamanas
0
manipis
ng goiter
ng mukha
na buhok
0 bosyo
Paano ginagamot
ang
hypothyroidism?
at paa
Paano malalaman
kung ang isang tao
ay may
Hypothyroidism?
Ang gamutan ng hypothyroidism
ay
simple lamang sapagkat iisang gamot
lang ang kailangang
ibigay -ang
levothyroxine. Subalit dahil sa iba-iba
ang dosis na kailangan
ng bawat
pasyente, dapat ay regular na bumalik
sa endocrinologist
upang malaman
kung anong dosis ng gamot ang dapat
Ang mga pagkain na makatutulong
upang mabilis na mapa-normal ang
antas ng inyong thyroid hormones ay
ang mga sagana sa iodine gaya ng
mga isdang dagat at halamang dagat.
Ang iodized salt ay mura at simpleng
pinagmumulan din ng iodine sa pagkain.
Para sa karagdagang kaalaman tungkol
sa sakit
na hypothyroidsism,
magpakonsulta
lamang sa inyong
endocrinologist.1I
fLASHES
Elaine Cunanan, MD, FPCp, DPSEM
Wh 0 does not envy those whistle- I
bait figures gracing magazine covers
or TV screens? Yes, we know that
lifestyle change with diet and exercise
remains the best way to lose and
maintain our ideal weight, but then
again, who has the time to exercise?
Who can resist that tempting chocolate
cake and frappuccino after a meal
complete with soda? Popping overthe-counter diet pills seems like a saner
solution to losing weight in contrast to
engaging in time-consuming exercise
or self-tormenting "fast from sweets." It
seems hard to pass up the alluring offer
by dietary supplements of immediate
success without the need to reduce
calories or increase physical activity
especially
if endorsed
by popular
celebrities showing off their sculptured
bodies.
Dietary Supplement
Ingredients
What they claim
Chitosan
Blocks absorption of dietary fat
Chromium
Reduces body fat and builds
muscle
• Relatively safe at usual dosages
• Not enough evidence for weight loss
• Muscle (rhabdomyolysis) and renal problem reported
with doses> 1000mcg/day1
• Long-term effects unknown
Conjugated linoleic
acid (CLA)
Reduces body fat, decreases
appetite and builds muscle
• Might decrease body fat and increase muscle, but not
enough proof that it reduces body weight
• Can cause diarrhea, indigestion and other
gastrointestinal problems
Ephedra
("Ma Huang")
Decreases appetite
• Can cause high blood pressure, heart rate irregularities,
sleeplessness, seizures, heart attacks, strokes and even
death
• Banned because of safety concerns, but may still be
legally sold as a tea
• Despite the ban, many ephedra products are still sold
on the Internet
Green tea extract
Increases calorie and fat
metabolism and decreases
appetite
• Limited evidence to support weight loss claim
• Can cause vomiting, bloating, indigestion and diarrhea
• May contain a large amount of caffeine
Guar gum
Blocks absorption of dietary fat
and increases feeling of fullness
• Relatively safe, but unlikely to cause weight loss
• Can cause diarrhea, flatulence and other gastrointestinal
problems
• May cause intestinal obstruction if not taken with enough
water
Hoodia
Decreases appetite
Hydroxycitric
L-carnitine
acid
Increase fat breakdown and
reduce fat production
Fat burner
What is actually known
•
•
•
•
Derived from crustacean shells
Relatively safe
Has no weight loss benefits'
Can cause constipation, bloating and other
gastrointestinal complaints
• Long-term effects unknown
• No conclusive evidence to support weight-loss claim
• Relatively safe but lacks evidence for weight loss'
• Produced by liver from amino acids lysine and methionine
• Found in red meat and dairy products
• Plays a role in energy metabolism, but added carnitine
from supplement does not appear to have benefit beyond
the necessary physiological dose2
• No scientific evidence to date to show that it leads to
weight loss'
I
Many weight-loss dietary supplements contain a cocktail of ingredients usually a mixture of herbs, vitamins, minerals or other add-ons, such as
caffeine or laxatives.
interact individually and collectively with
your body is largely unknown. Using
them can also be risky, especially if you
are taking
other
medications.
Read labels closely and talk with your
doctor about any dietary supplements
you're taking or planning to take.
Here are some worthy take-home
advice from the FDA regarding diet pills
and fads:
It is no wonder that dietary supplements
have increasingly invaded our local
drugstores,
health
shops
and
supermarkets.
More options
are
available online. Here is a list of
available dietary supplement ingredients
and their alleged weight loss benefits.
The problem with dietary supplements,
though, is that they do not undergo the
same rigorous scrutiny required of
prescription drugs. Thus, they can be
marketed
with limited
proof
of
effectiveness or safety. Manufacturers
can make health claims about products
based on their own review and
interpretation of studies without the
authorization of the US Food and Drug
Administration (US-FDA) or our local
Bureau of Food and Drug (BFAD).
The regulatory authorities can only pull
a product off the market if it's proven to
be dangerous.
Many weight-loss dietary supplements
contain a cocktail of ingredients - usually
a mixture of herbs, vitamins, minerals
or other add-ons, such as caffeine or
laxatives.
How these ingredients
• Any claims that you can lose weight
effortlessly are false. The only proven
way to lose weight is either to reduce
the number of calories you eat or to
increase the number of calories you
burn off through exercise. Most experts
recommend a combination
of both.
reducing
when
attempted.
the
next
diet
is
• To lose weight safely and keep it off
requires long-term changes in daily
eating and exercise habits. Many
experts recommend a goal of losing
about a pound a week. A modest
reduction of 500 calories per day will
achieve this goal, since a total reduction
of 3,500 calories is required to lose a
pound of fat. An important way to lower
your calorie intake is to learn and
practice healthy eating habits.H
• Very low-calorie diets are not without
risk and should be pursued only under
medical supervision. Unsupervised very
low-calorie diets can deprive you of
important nutrients and are potentially
dangerous.
• Fad diets rarely have any permanent
effect. Sudden and radical changes in
your eating patterns are difficult to
sustain over time. In addition, so-called
"crash" diets often send dieters into a
cycle of quick weight loss, followed by
a "rebound" weight gain once normal
eating resumes, and even more difficulty
References:
i Saper
RB, Eisenberg
OM, Phillips
RS. Common
dietary supplements
for weight loss. Am Fam
Physician 2004;70:1731-38
ii http://www.chasefreedom.comllcarnitine.html
ill MayoClinic.com.
"Tools for a healthier life: Over-the-counter
weight loss pills do they work?" accessed
2008-07-01.
iv U. S. Food and Drug Administration.
FoA/FTCINAAG
Brochure':
1992
LEARl\lIN:G
ABOUT PSEM
PATIEN.T
A.DVOCACY
PROGRAMS:
Galing sa PSEM,
Para sa inyo
REACHING OUT
TO PATIENTS,AND
MANY MORE
Gabriel V. Jasul, Jr., MD, FPCp, FPSEM
PS E M
has taken patient
advocacy another notch higher· when it
recently organized the first Philippine
Thyroid Cancer Summit,
dubbed
PULONG PULONG UKOL SA BUKOL.
The Summit, held at the Crowne Plaza
Hotel last June 28, 2008, was attended
by 120 thyroid cancer survivors with
their families and marked the initial
stages in the formation of the Philippine
Thyroid Cancer Support Group. While
this was initiated by the PS EM through
its Patient Advocacy Committee and
the Thyroid
Working
Group, the
organization of the Thyroid Cancer
Support Group is envisioned to be
patient-driven
with guidance
and
assistance from the PSEM.
This initial gathering brought to fore the
pressing needs and concerns of the
thyroid cancer patients in the country
and was indeed a heartwarming
. experience
for those present that
afternoon. The attendees
actively
participated
in the discussion and in
planning the next course of action.
Leaders were identified
from the
discussion groups and were tapped to
form the organizing committee of the
Thyroid
Cancer
Support
Group.
A meeting of these leaders has been
set on August 16, 2008 at the PSEM
office to finalize the plans for the support
group. The Mission and Vision for the
Thyroid
Cancer Summit 2008 is
presented here, together with the
photographs taken during the June 28
event.
PSEM has made available a Thyroid
Cancer Advocacy pin ta drum up the
campaign to increase public awareness
about thyroid cancer and to improve
the treatment of thyroid cancer in the
country. Indeed, the Thyroid Cancer
Advocacy pin symbolizes what the
PSEM has envisioned as well-stated in
the Mission and Vision and Objectives
of the Thyroid
Cancer
Summit.
We will keep everyone posted about
this undertaking as we continue to look
forward to a better future for thyroid
cancer patients in the Philippines.1
VISION:
"BEST
CARE
AND
BEST
OUTCOMES FOR PATIENTS WITH
THYROID CANCER"
OBJECTIVES:
The FIVE "I"s of the PHILIPPINE
THYROID
CANCER
SUPPORT
GROUP
1. To increase public awareness of
thyroid cancer
2. To improve understanding of the
thyroid cancer among patients and
their families
3. To intensify early diagnosis and
optimum treatment of thyroid cancer
4. To involve patients and their families
in the many phases of thyroid cancer
treatment
5. To interact with other patients with
thyroid cancer, their families and
health professionals in a supportive
environment
Philippine
Thyroid
Cancer
Summit 2008
Crow ne Plaza Hotel,
June 28, 2008
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PULONGUKOL
SA BUKOL
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