Posts tagged ‘Diabetes’
HEART diseases are a major cause of death today. This week, we look at some of the symptomatic signs of heart diseases.
Chronic low-grade inflammation damages the arterial wall leading to lesions, which then attract oxidised and/or glycated cholesterol and dietary fats to help form plaques.
The presence of arterial plaques is a sign of heart disease.
Damaged cholesterol molecules and dietary fats are treated by our immune system as antibodies, hence, promoting inflammation. Any inflammatory condition can promote hypertension and slow wound healing as well.
The blood marker hs-CRP and IL-6 are widely used to measure cardiovascular inflammation and even mortality.
Inflammatory foods abound such as farmed animal, livestock, fish, and excessive use of omega-6 vegetable cooking oils.
A high-inflammatory diet carries higher risk of arterial plaque rupture. And recently-formed plaques are much more likely to rupture than stable calcified ones, which will increase the risk of fatal heart attack.
Chronic inflammation easily destabilises soft arterial plaques, especially in the presence of uncontrolled hypertension.
Vascular inflammation may be lowered by nutrients such as DHA/EPA (both being omega-3 fatty acids), trans-resveratrol, quercetin, soy genistein, tea polyphenols, curcumin, gingerol, grape seed extract (OPC), vitamins A, C and, D, magnesium citrate, as well as Malaysian cocoa, dark chocolate, and rosemary.
Genistein strengthens arterial wall which helps explain why soy (rather than animal) protein lowers risk of heart attack.
Regular exercises also lower overall inflammation.
High blood pressure is one of the top risk factors for developing cardiovascular disease.
Dr Mark C. Houston, in What Your Doctor May Not Tell You About Heart Disease, stresses that hypertension isn’t a disease but rather a marker for vascular (blood vessels) and endothelial (artery wall) dysfunction promoted by our environment interacting with our genes.
This means that if you’ve a genetic predisposition to high blood pressure but don’t have the bad environment, lifestyle and/or dietary habits stimuli to trigger hypertension, you don’t generally develop this silent killer.
Vascular ageing may be evidenced by progressive arterial stiffness or hardening, loss of arterial elasticity, and pulse pressure.
Salt, monosodium glutamate (MSG), and caffeinated drinks have been implicated in causing arterial stiffness, whereas soy protein isolate, omega-3 fish oil, dark green leafy vegetables, and garlic can reduce artery hardening.
Widely-used nutrient L-arginine for complementary treatment of hypertension is generally effective since it raises nitric oxide, which dilates arteries.
DHA, NAC (N-acetyl cysteine), gamma tocopherol (vitamin E) and resveratrol also can lower blood pressure besides reducing oxidation of ‘bad’ LDL cholesterol.
Endothelial dysfunction, which precedes hypertension, can cause insulin resistance which then promotes diabetes.
Refined sugars including sorbitol, mannitol, erythritol, tagatose, and steviol-glycosides can cause insulin spikes, stimulate the ageing gene, TOR, and suppress the longevity gene, SIRT.
Additionally, a diet high in refined starches can raise levels of homocysteine and toxic free radicals.
Diabetic people, on the whole, produce lower levels of endothelial progenitor cells for arterial repair and renewal.
Nutritional therapist reduces the negative effects of diabetes by designing a protocol containing nutraceutical such as alpha lipoic acid, trans-resveratrol, charantin, cinnamon, hydroxycitric acid, EPA/DHA, calorie restriction, adequate sleep, as well as by raising the patient’s metabolism through regular exercise and lifestyle modifications.
Poor dietary and/or lifestyle habits can adversely affect immune vascular function, which will lead to vascular heart disease.
Any form of autoimmune disorders (immune system gone haywire) – such as rheumatoid arthritis, lupus, eczema, psoriasis, and asthma – promotes inflammatory diseases including atherosclerosis.
This is also true with chronic infections such as those inflicted by common H. Pylori and viruses.
► Oxidative stress
High blood sugar or triglyceride levels induce oxidative stress. Only oxidised cholesterol and/or fats are known to form part of the vulnerable arterial plaques.
Tea polyphenols, resveratrol, and monounsaturated fatty acids can reduce oxidation of ‘bad’ LDL cholesterol. Resveratrol can be found in cocoa and peanut.
Systemic (whole body) oxidative stress can even affect our brain cells triggering inflammatory response and hypertension.
For men and menopausal women, elevated blood ferritin (iron store) from the consumption of excess red meat, organ meat and eel also enhances oxidation.
► Mental conditions
Unresolved anger or anxiety disorder can severely damage heart health. For heart patients, it significantly raises their risk of a second heart attack.
Sleeping very late and for less than six hours a night elevates physical and mental stress while doubling the risk of developing diabetes type 2.
Unhealthy cellular mitochondria strongly promote oxidative stress.
L-carnitine is needed to transport long-chain fatty acids to the mitochondria, which are energy-generating components of our heart cell inherited only from our mother.
Co-enzyme Q10 can energise the heart muscles while lowering systolic blood pressure.
Calorie restriction can improve mitochondrial function and activate their biogenesis (regeneration).
Shorter telomeres in our cell chromosomes have been linked to increased coronary artery calcification, chronic inflammation, oxidative stress, arterial stiffness, and even higher mortality rate.
Its length is determined partly by nutritional status and levels of physical activity.
A high vegetable diet, regular exercises, stress reduction, and intake of omega-3 fatty acids, selenium, vitamins C and E are known to increase enzyme telomerase activity in preventing early telomere shortening.
NEW YORK — Without cutting back on calories, adopting a Mediterranean diet rich in extra-virgin olive oil may protect people at high risk for heart disease against diabetes, a new study found.
Researchers who analyzed data on more than 3,500 people at an increased risk for heart disease found those who were put on a Mediterranean diet were about 30 percent less likely to develop diabetes over the next four years, compared to those assigned to a general low-fat diet.
“Randomized trials have shown that lifestyle interventions promoting weight loss can reduce the incidence of type 2 diabetes, however, whether dietary changes without calorie restriction or increased physical activity also protect from diabetes development has not been evaluated in the past,” Dr. Jordi Salas-Salvado wrote to Reuters Health in an email.
Salas-Salvado is the study’s lead author and a professor of nutrition at Rovira i Virgili University and the head of the Department of Nutrition at the Hospital de Sant Joan de Reus in Spain.
Previous research, including another study from Salas-Salvado and colleagues, suggested Mediterranean diets may be protective against diabetes.
Mediterranean diets are generally high in vegetables, fiber-rich grains, legumes, fish and plant-based sources of unsaturated fat – particularly olive oil and nuts. They are low in red meat and high-fat dairy, prime sources of saturated fat.
In addition to being touted as beneficial to people with heart disease, Mediterranean diets are believed to have components that reduce inflammation throughout the body and may have some impact on diabetes.
Type 2 diabetes, sometimes referred to as adult-onset diabetes, is when the body’s cells are resistant to insulin or the body doesn’t make enough of the hormone, so glucose remains in the bloodstream and can climb to dangerously high levels. Insulin gives glucose – or blood sugar – access to the body’s cells to be used as fuel.
For the new study, published in the Annals of Internal Medicine, the researchers used data from an existing trial that compared the effectiveness of Mediterranean-style diets to a low-fat diet. http://bit.ly/SQRXAa
Between 2003 and 2009, 3,541 Spaniards ages 55 to 80 were enrolled in the trial. None of the participants had diabetes at the start of the trial, but all had three or more risk factors for heart disease. Those include smoking, being overweight and having high cholesterol.
The participants were randomly assigned to adopt one of three diets.
One diet consisted of a Mediterranean diet that derived most of its unsaturated fat from extra-virgin olive oil. Another group was assigned a Mediterranean diet that used mixed nuts as its main source of unsaturated fat. The third diet emphasized reducing all fat consumption.
None of the diets, however, asked the participants to cut down on how many calories they ate or to increase how much they exercised.
After about four years, 273 of the participants had developed diabetes. That included 6.9 percent of participants from the extra-virgin olive oil group, 7.4 percent from the mixed nuts group and 8.8 percent from the reduced-fat group.
The researchers caution that the difference in diabetes cases among people on the mixed nuts and reduced-fat diets may have been due to chance. They can’t explain why the mixed nuts diet didn’t show quite the same benefit as the extra-virgin olive oil diet.
But Salas-Salvado said the difference between the two Mediterranean diets could also be a coincidence, because both have additional unsaturated fatty acids that are linked to a reduced diabetes risk.
He said cutting calories along with adopting a Mediterranean-style diet would likely reduce risks even further.
“These benefits have been observed in participants between 55 to 80 years old at high cardiovascular risk,” he said. “Therefore, the message is that it is never too late to switch to a healthy diet like the Mediterranean.”
Malaysians need to make the right decision to change in order to keep diabetes at bay.
AWARENESS and education are key aspects to help us break down barriers, change, move forward, and ultimately help us live better lives. This could not be more needful for people living with diabetes.
Since knowing what to do may not always result in doing, we need to persevere and continually share insights so we can prompt change among people with diabetes, as well as those at risk.
Today, diabetes is one of the most common non-communicable diseases around the globe. Data from various research show that this prevalence is rising with each passing year, affecting more and more people worldwide.
Based on the data we have, the prevalence of diabetes in Malaysia shows this same worrying trend. In 2006, 11.6% of the Malaysian adult population (those above 18 years old) have diabetes. Over the course of five years, this figure rose to 15.2% in 2011, affecting about 2.6 million people, or one in seven Malaysian adults. Additionally, 43% of Malaysians have abdominal obesity, which indicates high risk of developing type 2 diabetes.
With these staggering statistics, I find myself asking: Why is this scenario prevalent in Malaysia? How aware and knowledgeable are Malaysians when it comes to diabetes? Are we safeguarding our health? Why aren’t we doing something before it is too late?
The recent Novo Nordisk Diabetes Awareness Survey in Malaysia conducted by pharmaceutical company Novo Nordisk sheds light on these questions.
Through the recruitment of 1,012 men and women above 18 from all over Malaysia, this representative survey gives us the much-needed localised data to highlight the gap between knowledge and behaviour to combat the rising incidence of diabetes in Malaysia.
It certainly supports the trend that many of my colleagues and I observe in our clinical practice.
According to the survey, the average BMI of the population is 24 (considered as overweight), higher than that of our neighbours such as Indonesia and Vietnam, which have an average of 23 and 22 respectively. Yet, 72% believe their weight is just about right, or even too low, indicating that a majority of those at high risk of diabetes also may deny that their weight is too high!
These findings seem to show the lack of understanding or just denial among Malaysians of the actual state of their health; a cause for worry indeed.
I often ask my patients if they know what diabetes is. In general, many correctly identify its main symptoms and risk factors. They know that being overweight and living sedentary lifestyles increases the risk of developing diabetes.
Also, a majority are aware that the onset of diabetes can be delayed or prevented by practising healthier lifestyle habits, which include eating well and exercising regularly.
Surprisingly, despite this level of knowledge, it doesn’t translate into action to commit to healthy habits.
In the survey, diet and exercise are found to be low in priority, especially among those at high risk. Fifty-seven percent of respondents at high risk do not observe 30 minutes of physical activity on a daily basis, while 17% of the general population (out of which 31% are at high risk) do not exercise at all, further increasing their risk of developing the condition.
A common question I am often asked is what are the possible complications of diabetes, even by people who have it.
In a similar vein, 87% of survey respondents with diabetes have not been informed on the possible complications. Fifty-eight percent of respondents agree that diabetes is a manageable condition, and therefore, do not believe it to be as serious as other conditions. This is potentially dangerous as less attention may be given to manage blood sugar levels, which would help avoid debilitating health consequences, including kidney failure, blindness, disability by amputation, and especially, cardiovascular diseases such as heart attacks and stroke. At times, such complications can even lead to death.
Additionally, managing and treating diabetes is also incredibly expensive in the long term. A report published in the American Journal of Preventative Medicinecalculates it to be as costly as buying a house. This not only places the burden on the individual, but also on the national healthcare system, as increasingly more people with diabetes will require treatment for the condition, as well as related complications.
In Malaysia, 16% of the national healthcare budget in 2010 was allocated towards diabetes-related expenditure, listing it among the top 10 countries in the world in terms of percentage spent.
Tablets are the most popular way of treating diabetes. Many people are afraid to start injectable treatment, which may indicate why tablets are popular.
People need to know that timely use of insulin can be more effective in preventing or delaying painful complications. Furthermore, with technological advancements, insulin delivery devices such as insulin pens are now more convenient and discreet, and can be easily carried around.
The fine-point needles available have also made the procedure quite painless. So why not accept the little “ant bite”, as opposed to the “pain” of footing a staggering healthcare bill or the suffering from disease complications?
Combining these findings and my own clinical experience, I have come to this conclusion: Although the general population in Malaysia knows that diabetes is a prevalent problem, there is a gap between awareness and knowledge in translating into action and healthy behaviours. There is a critical need for healthcare professionals and individuals to aggressively address this phenomenon.
Fellow Malaysians, I encourage you to stand up and take charge of your health. Seek professional advice and healthcare information from proper channels. Be proactive in learning more about diabetes and how it can affect you. Get tested for diabetes especially if you have close family members with the condition, high blood pressure, and/or high cholesterol.
At the end of the day, your health is priceless.
With that, I pose this question to you: Will you learn from this and do something about it today? If I have caused you to sit up and take note, I would have played my part in helping you keep diabetes at bay.
Do the same for your loved one or friend. Don’t let them become a statistic!
Consultant endocrinologist Professor Emeritus Datuk Dr Khalid Abd Kadir highlights the general symptoms of the disease
DIABETES can be so sneaky that most people don’t even know they have it until the signs are too obvious to ignore. Actor Tom Hanks, famous for his roles in blockbusters such as The Da Vinci Code, Saving Private Ryan and Forrest Gump, revealed recently that he has the condition.
In many cases, people tend to attribute certain symptoms, especially a feeling of constant tiredness to lack of rest, stress, overwork or old age.
Ignoring the symptoms over the long-term could cause permanent damage and lead to a more serious diabetic condition, with more health complications affecting other organs such as the heart, eyes and kidneys.
There are two types of diabetes — Type 1 and Type 2. It is estimated that around 90 per cent of people who suffer from diabetes, are of Type 2. It’s a popular misconception that Type 2 is less serious possibly because people suffering from Type 1 have to inject themselves with insulin.
In Type 1, the body is not producing insulin while in Type 2 the cells are not responding properly to the insulin and/or there is not enough insulin being produced. Both types are serious if not managed well.
Here are 10 general symptoms of diabetes that you can look out for. Not everyone will experience the symptoms and they are usually not severe in those who do get them. Many people have Type 2 for years without realising it as the early symptoms can be mild.
Doctors can do a simple test to assess your risk of diabetes. The results can give you an indication of how at risk are you. Then, you can make adjustments to your lifestyle before it’s too late.
1. High blood sugar level
The best way to check your blood sugar level is to have it tested by your doctor. After you consume food, the level of blood sugar will naturally rise.
However, a persistently high level is abnormal especially if there is no constant eating throughout the day.
2. Excessive thirst and increased urination at night
Very frequent visits to the bathroom followed by excessive thirst at night could be a symptom of diabetes. The excessive thirst exists despite having drank enough water before sleeping.
When there is too much glucose in your blood, your kidneys go into overdrive mode — working harder to get rid of that extra sugar.
This forces you to want to urinate, sometimes several times during the night. After that your body loses water and makes you even thirstier.
It is your body’s way of managing high blood sugar. The excessive thirst means that your body is trying to replenish the lost fluids.
3. Sudden rapid weight loss
Very high blood sugar levels can cause rapid weight loss of about 2-3 kg over two or three months. Some people may rejoice over this but it is not a healthy weight loss. Since the insulin hormone isn’t getting glucose into the cells where it can be used as energy, the body thinks it’s starving and starts breaking down fats from the muscles as an alternate source of fuel.
This causes the production of exhaust ketones and leads to the diabetic feeling generally unwell. The kidneys start to work overtime to eliminate the excess sugar, causing stress to the kidneys and harm to the organ in the long-term.
4. Bad hunger pangs
When a diabetic lacks insulin or does not respond normally to insulin in the body, glucose cannot be processed by the body as usual, causing the blood sugar levels to sometimes drop.
When the blood sugar levels drop suddenly, the body thinks that you are starving and craves for more glucose that the cells need to function. This signal is interpreted by the body as hunger pangs.
5. Slow-healing wounds
This is a classic sign of diabetes. It happens because the blood vessels are being damaged by the excessive amounts of glucose travelling in the veins and the arteries. This makes it hard for blood, which is needed to facilitate healing, to reach the different areas of the body.
6. Fatigue and irritability
The extra effort your body is expending to compensate for its glucose deficiency will make you tired. Getting up to go to the bathroom several times during the night will also make you tired because it interrupts your sleep. Naturally, being tired all the time would make anyone irritable.
When people have been suffering this for a prolonged period, they can get used to chronically not feeling well and assume that it is nothing unusual.
7. Prone to yeast infections (men and women)
Women, in particular, need to watch out for vaginal candida infections. Diabetes is considered an immunosuppressed state. It means heightened susceptibility to a variety of infections, the most common being yeast (candida) and other fungal infections. Fungi and bacteria thrive in sugar-rich environments.
As for men, the yeast infection tends to affect those who are uncircumcised at the tip of the penis or at the foreskin. Consequently, the tissue on the penis becomes scarred and erection becomes painful.
8. Blurry vision
When the glucose in the blood is high, it changes the shape of the lens and the eye, causing blurry vision.
The good news is that this symptom is reversible once the blood sugar levels return to normal or near normal. High blood sugar, unchecked for long periods, will cause permanent damage, possibly even blindness.
9. Sensations on hands and feet
Tingling, numbness, burning pain or swelling in hands and feet: These are signs that the nerves are being damaged by diabetes. Similarly with vision, if the blood sugar levels are allowed to run rampant for too long, nerve damage (neuropathy) will be permanent.
10. Irritable skin
This could be a warning sign of diabetes as are other skin conditions such as acanthosis nigricans. It is a darkening of the skin around the neck or the armpit area. People who have this will already experience an insulin-resistance process even though their blood sugar may not be high.
A medical conference on gastroenterology will look at, amongst other topics, bariatric surgery as an option for both weight loss and controlling metabolic diseases.
IF you’re obese and want another option to lose weight, consider bariatric surgery. It has been proven to be an effective and sustainable method of shedding excess kilos.
Based on the United Nations Statistics Division 2012, among Asean countries, Malaysia has the highest percentage of obese people in the population (ie with a body mass index, or BMI of above 30 kg/m²).
There are 19.5% obese Malaysians, followed by Thailand (9.1%), Brunei (7.9%), Singapore (6.4%), the Philippines (6.1%), Indonesia (4.8%), Myanmar (4.1%), Laos (3.5%), Cambodia (2.2%) and Vietnam (1.5%).
Our consumption of high-caloric foods, combined with a lack of exercise, are the main culprits for this. But, thanks to medical advances, help is available.
“Bariatric surgery is basically a procedure to change the gastrointestinal tract to initiate early fullness.
“Most of the procedures create a restriction in the stomach. Some techniques have rearranged the gastrointestinal tract to reduce absorption of nutrients.
“In South-East Asia, we have achieved excellent results in terms of weight loss. The percentage of weight loss and remission rate of co-morbidities (the simultaneous presence of two chronic diseases or conditions in a patient) are comparable to the West, while our complication rates are as low as that in the West,” said bariatric surgeon Dr Suthep Udomsawaengsup from Chulalongkorn University’s (Thailand) Faculty of Medicine.
The most popular bariatric procedure in this region is sleeve gastrectomy (the removal of a portion of the stomach), and gastric bypass (making the stomach smaller, causing food to bypass a large part of the stomach, as well as parts of the small intestine, so that less nutrients and calories are absorbed).
The other bariatric procedure, gastric banding, is not common any more.
More women are prone to obesity compared to their male counterparts, and Dr Udomsawaengsup said hormones could be a contributing aspect. However, diet and exercise are still pertinent factors in weight control.
“For those who are morbidly obese (BMI of more than 37.5 or more than 32.5 with diabetes and/or high blood pressure and/or dyslipidaemia) and/or have obstructive sleep apnoea, bariatric surgery may be necessary,” he said.
Dr Ramesh observes that although the field of bariatric surgery is still in its infancy in Malaysia, it’s a rapidly expanding one.
Critical to the success of the surgery is the patient.
Dr Udomsawaengsup said: “They have to understand the process well. After the operation, their life will be totally changed, but this will lead to better health. They will lose one to two kilogrammes a week. There are some patients who can trim themselves to their ideal body weight, but the majority will be able to lose 60-80% of their excess weight within a year or two.”
Initially, the procedure specifically targeted patients who had to lose weight, thus the name bariatric surgery. But lately, results have shown that the procedure is also effective for those who are not obese, but suffering from metabolic diseases such as diabetes.
“The positive effects on the obese with co-morbidities such as diabetes, gave us the idea of treating those with difficulty in controlling diseases through this procedure, so the terminology has been changed to metabolic surgery.
“The International Diabetes Federation has given approval for the surgery to be considered an option for treating diabetes,” explained Dr Udomsawaengsup
So essentially, metabolic surgery and bariatric surgery involve similar procedures, differing only in their stated goals.
However, he pointed out, “Bariatric surgery is a complex surgery. There are many challenges and complications that can occur at any point, but in a centre that regularly performs the procedure, the complication rate is acceptably low.”
Dr Udomsawaengsup will be presenting a talk on “Metabolic Surgery: The Asian Perspective” at a conference organised by the Malaysian Upper Gastrointestinal Surgery Society (MUGIS) and Seremban’s Tuanku Ja’afar Hospital from Sept 27-29. His presentation will address the rationale of performing the surgery on those with a BMI of less than 35.
Besides local speakers, there will be 15 international experts from Japan, Singapore, Hong Kong and Thailand, who will give their views on gastrointestinal disease.
Among other highlights at the three-day conference being held at The Avillion, Port Dickson, Negeri Sembilan, are “New Technologies in Diagnosis of Gastric Cancer” (Dr Akiko Shiotani, Japan), “Prevention of Gastric Cancer by H. pylori Eradication: The Japanese Experience” (Dr Tomoari Kamada, Japan) and “Detecting and Managing Complications of Metabolic Surgery” (Dr Assim Shabbir, Singapore).
According to consultant upper gastrointestinal surgeon and president of the newly-established MUGIS, Dr Ramesh Gurunathan, the field of bariatric surgery, although in its infancy locally, is a rapidly expanding one.
“We intend to create interest in this field, which is fairly new in Malaysia.
“We also like to keep abreast with current treatment of diseases related to the upper gastrointestinal tract by having regular meetings with local and international experts,” he said.
MUGIS was formed in March to bring together a community of homegrown upper gastrointestinal surgeons and to create awareness of upper gastrointestinal diseases among doctors.