DiabetEASE December-January 2014 by Dan Cisneros

DECEMBER-JANUARY 2014

CONTENTS

behindthescenes

COVER STORY AND FEATURES

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Exercise is Medicine With the increasingly sedentary lifestyle in the country, the Philippine Association for the Study of Overweight and Obesity partners with key societies and companies in the fight against obesity via a new exercise program. Alexa Villano dissects this global program that has been launched locally.

SLMC’s Weight Management

It’s not just about exercising as nutrition plays a vital role in proper weight management. Cristina Arayata travels to the St. Luke’s Medical Center in Quezon City to know more about its program.

Winning in Life after Losing Emil Karlo dela Cruz catches up with former Biggest Loser contestant Hazel Chua on life after the show and how she’s inspiring people to fight the battle against the bulge.

The Winner Takes It All

Former karting champion Matteo Guidicelli sat down with Aencille Santos on making the big switch to acting, triathlon, and taking on the challenge as Game Master of the Biggest Loser Pinoy Edition Doubles.

The whole team poses with the cover boy

regulars 6 | EDITOR’S EDICT 8 | WE’VE GOT MAIL 9 | SWEET NEWS ON THE COVER: Sought-after actor and former karting champion Matteo Guidicelli switches gears towards triathlon and one of his biggest roles to date- as Game Master of the Biggest Loser Pinoy Edition Doubles.

in depth 44

Diabetes, Bones, Joints, and the Obese! Is there a relation between diabetes, obesity and the bones in the body? Drs. Yvette and Eric Jason Amante jointly write the observations they’ve made as practitioners of two different specialty fields.

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Holiday Weight Watching Tips It’s the time of year when food abounds in the various parties, making weight watching a difficult task. Dr. Jocelyn Isidro gives simple tips to avoid overeating and overdrinking this season.

DECEMBER-JANUARY 2014

Photography by Arrian Alcantara Styling by Rex Atienza Assisted by Denise Cajulis Jacket by Banana Republic Pullover by Nautica Grooming by by Ryan Panaligan of Peps Silvestre Salon Shot at The Heritage Hotel Manila Special thanks to Cris Navarro and Karmina de Ungria

Diabetes Drugs and Weight Loss - Lose weight while treating your diabetes

Diet Supplements: Are We The Biggest Loser?

With many medicines in the market, how do you choose what’s right for you? Dr. Monica Cabral looks into the different types of diabetes and weight loss drugs currently available.

Some people resort to diet supplements to lose weight fast but as Dr. Karla Fernando explains, not all shortcuts will show good results.

columns 15

Educator’s Corner

Fightin’ For Fitness

Blood Sugar Monitoring: The how to’s, profits and pitfalls Got a testing kit but don’t know how to use it? Dr. Joy Fontanilla shares the right way to use and choose your glucose meter. The 4-Minute Workout The Biggest Loser’s trainer Jim Saret gives four simple exercises that can burn 600 calories in a span of 4 minutes.

Righteous Recipes

Good Food Guide

3 Festive Dishes for the Holidays Tired of ham and turkey this season? Chef Junjun de Guzman whips up alternative dishes without those added pounds.

Eating Healthy This Holiday Season Nutritionist Edreilyn Manalo gives a lowdown on healthful eating this season.

DECEMBER-JANUARY 2014

sections 13

You Ask, We Answer

Product Spotlight

Stress Busters

Dos and Don’ts

What is the Paleo diet and is it suitable for diabetes patients? Another diet known as the Paleo or Caveman diet is making its rounds in the fitness community. Nutritionist Joy Rabbie Catungal explains its pros and cons. Drink Grass Looking for alternative drinks beyond those protein shakes and energy drinks? Michaela Sarah de Leon shares three wheat grass drinks currently out in the market.

Living Well

My Sugar Buddy Excel Dyquiangco interviews the facilitator of the Sugar Buddies, the Diabetes Club of Alabang

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‘Tis the Season to Be Jolly

Is shopping for gifts, preparing Noche Buena and work taking a toll on your body? Mylene C. Orillo lists down reminders to beat the infamous holiday stress.

Healthy Eating for the Holidays It’s non-stop eating and partying this holiday season but learn how to control it. Jose Martin Punzalan writes down the steps to avoid the holiday bulge.

Affairs to Remember Doodles & Dreams

DECEMBER-JANUARY 2014

EDITOR’S EDICT

Santa Makeover? Christmas is a necessity. There has to be at least one day of the year to remind us that we’re here for something else besides ourselves. ~Eric Sevareid Who wants a skinny Santa Claus? What if we took jolly old St. Nick, made him stop taking all those milk and cookies, got him to work out and reshape that portly belly to rock-hard abs?Uggh, suddenly, the thought of a sexy Santa got revolting! I like my Santa portly and fatherly. Fortunately, since he’s a magical being, he doesn’t get diabetes, arthritis, or high blood pressure from being obese. His rotundity reflects the excesses of the season – food, fun and festivity. And the excesses extend to the generosity that pervades many a soul this time of year. Unlike Kris Kringle though, we aren’t magical beings. People can get sick when they get too fat. And the overindulgence of the season can break even the most resolute health buff. Many people with diabetes sure don’t fit the resolute health buff mold, and when they let go of the rulebook, they can get sick very fast. Therefore, in this issue, we offer tips so diabetic folk can enjoy the holidays, and still keep their waistlines and blood sugars in check. And a big plus to help us all get “thinspired” this season, we have triathlete, TV heartthrob, and Biggest Loser’s New Game Master, Matteo Guidicelli gracing our cover. On a different note, the country has been brutally scourged these past several months by both man-made and natural calamities – the Napoles scam, the Zamboanga siege, the Bohol quake and supertyphoon Yolanda, to name a few. It’s quite moving to see how these catastrophes have brought our nation and the world community together to aid the afflicted. Even the Ebenezer Scrooges among us simply mustn’t stay apathetic. May we all emulate Santa’s big heart (not his huge belly) this Christmas and throughout the coming year! Happy healthy holidays and God bless us, everyone! Peace and thank you,

Joy C. Fontanilla, MD, FACE, FPCP, FPCDE, FPSEM, CCD

Editor-in-Chief

DECEMBER-JANUARY 2014

MEDICAL ADVISORY BOARD Ramon F. Abarquez Jr., MD Professor Emeritus, University of the Philippines College of Medicine; Academician, National Academy of Science and Technology Mary Ann Lim-Abrahan, MD Past President, Philippine Lipid and Atherosclerosis Society; Professor, University of the Philippines College of Medicine–Endocrine Section Abdias V. Aquino, MD President, Philippine Society of Hypertension; Past President, Stroke Society of the Philippines; Past President, Philippine College of Physicians Corazon VC. Barba, PhD, RND Past President, Nutritionist-Dietitian’s Association of the Philippines Ricardo E. Fernando, MD Founder and President, Institute for Studies on Diabetes Foundation, Incorporated Ruby T. Go, MD Past President, Philippine Lipid and Atherosclerosis Society; Head, Endocrine Section, Chinese General Hospital Augusto D. Litonjua, MD President, Philippine Center for Diabetes Education Foundation; Founding President, Philippine Society of Endocrinology and Metabolism; Philippine Association for the Study of Overweight and Obesity Roberto C. Mirasol, MD Past President, ASEAN Federation of Endocrine Societies; Past President, Philippine Society of Endocrinology and Metabolism Antonio R. Paraiso, MD Medical Specialist III, National Kidney and Transplant Institute; Assistant Professor, College of Medicine, University of the East Ramon Magsaysay Memorial Medical Center Ma. Teresa Plata-Que, MD Past President, Philippine Diabetes Association; Consultant, East Avenue Medical Center; National Kidney and Transplant Institute Tommy S. Ty-Willing, MD Past President, Diabetes Philippines; Trustee, Philippine Center for Diabetes Education Foundation; Founding President, Philippine Lipid Society; Consultant, Metropolitan Hospital

CONTRIBUTORS Marie Yvette Rosales-Amante, MD, FACE, FPCP, FPSEM

Publisher: FAME Publishing, Inc. Editor-in-Chief: Joy Arabelle C. Fontanilla, MD Assistant Editors: Mylene C. Orillo Emil Karlo dela Cruz Michaela Sarah de Leon Art Directors: Donna I. Pahignalo Michael Patricio Editorial Coordinator: Alexa Villano Senior Writers: Ma. Cristina Arayata Jose Martin Punzalan Aencille Santos Graphics and Layout: Dan Cisneros

A graduate of the University of the Philippines College of Medicine, Dr. Amante took up her residency in internal medicine at the University of Connecticut, and had her Fellowship in Endocrinology, Diabetes and Metabolism at the University of Massachusetts. She is Asst. Secretary of the American Association of Clinical Endocrinologists-Philippine Chapter and Endocrinology Section Chief at the Asian Hospital and Medical Center.

Eric Jason B. Amante, MD FPCP FPRA

Dr. Amante is the section chief of Rheumatology at the Asian Hospital and Medical Center, and Manila Doctors Hospital. A graduate of the UP College of Medicine INTARMED Program, he took his residency in Internal Medicine at the University of Connecticut and Fellowship in Rheumatology at the, Massachusetts General Hospital. He is currently the Vice-President of the Philippine Rheumatology Association, and is a Clinical Associated Professor at the UP College of Medicine.

Overall Marketing Manager: Hudson P. Pelayo Marketing Assistant: Godfrey Santos Group Sales Manager: Ma. Elna P. Jagape Senior Account Managers: Noel A. Ongkingco Charlotte Aireen Punzalan Representatives: Antonio Fajardo Jr. Florence Palapar Girlie Joy D. Jovero Leonard Anthony D. Baluyot

Karla Kristine Silverio-Fernando, FPCP, FPSEM

Dr. Fernando is a consultant in Endocrinology, Diabetes and Metabolism at the St. Luke’s Medical Center-Global City, Manila Doctors Hospital, and Parañaque Doctors Hospital.

Advertising Assistant: Irina Mae Carampatana Officer-in-Charge, Circulation Department: Armando Sandajan Executive Assistants: Angeli M. Mamaril Zenaida R. Fortes

Jocelyn Capuli-Isidro, MD, FPCP, FPSEM

Dr. Isidro is a Consultant Endocrinologist at the Makati Medical Center and the St. Luke’s Medical Center, Global City. She is also a member of the medical bureau of Diabetes Center Philippines or the Philippine Center for Diabetes Education Foundation, Inc.

Legal Counsel: Castillo, Laman, Tan, Pantaleon and San Jose Law Firm

Monica Therese Cating-Cabral, MD

Diabetes is not a one-size-fits-all disease. The information in DiabetEASE, therefore, is not meant to substitute for a health professional’s advice and readers are cautioned to consult with their healthcare provider before putting any of its contents into practice.

DiabetEASE is published by Friendly Alliances and Media Expressions, Inc. (FAME, Inc.). No part of the magazine may be reproduced in any manner without the permission of the publisher. Unsolicited manuscripts, photographs, and artwork will not be returned unless accompanied by self-addressed stamped envelopes. Address all correspondence and subscription inquiries to FAME Inc., Suite 503 Narra Building, 2276 Pasong Tamo Extension, Makati City, Philippines. Tel. Nos. 892-0723 to 24; 894-0483; 813-5433 or 36; Fax No. 892-8514; E-mail: diabetEASE.famepublishing@gmail.com. All rights reserved. Copyright 2013 by FAME, Inc.

Dr. Cabral graduated from the University of the Philippines College of Medicine and took her residency training in internal medicine at the Akron General Medical Center in Ohio, and fellowship training in endocrinology, diabetes and metabolism at the University of the Philippines – Philippine General Hospital. She is a diplomate of the American Board of Internal Medicine, Fellow of the Philippine College of Physicians as well as the Philippine Society of Endocrinology and Metabolism. She is an endocrinology consultant at the St. Luke’s Medical Center Global City, Makati Medical Center, and Asian Hospital and Medical Center.

Jim Saret, MSAT, PES, CAPT, SAQ

Coach Jim is a US-educated sports medicine expert and athletic-training specialist. He currently runs the FitFil movement, a fitness camp under Nestle Philippines together with wife Tonette and trainer for the Biggest Loser Pinoy Edition. He is also the founder and training director of APEX (Athletic Performance Enhancement) Sports Training Inc.

DECEMBER-JANUARY 2014

we’vegotmail

find us on www.facebook.com/diabetEASE @DiabetEASEmag @PhilYHusband @JYH7 wow so cute

Dear DiabetEASE, Got a copy of your anniversary issue featuring the Younghusbands and I must say that what they are wearing on the front cover is cute! – May via e-mail.

– Razel Joy Antonio via Twitter

@DiabetEASEmag Got a copy of your Oct.-Nov. issue. Good read on the Younghusband brothers. Hope to see them again on your cover. – Leslie Banzia via Twitter

You’re feature on the YH brothers was nice because we got to read about them more beyond their football and love lives.

DiabetEASE welcomes feedback from readers. Please send your comments, questions and suggestions through any of the following:

– Erika via e-mail

Snail mail: 503 Narra Building, 2276 Pasong Tamo Extension, Makati City 1232 Philippines Email address: diabetEASE.famepublishing@ gmail.com Fax number: (+632) 8928514 Telephone numbers: (+632) 8920723 to 24; 8940843; 8135433 or 36 DiabetEASE reserves the right to edit materials for publication.

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DECEMBER-JANUARY 2013

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sweetnews

Diabetes patients a mong victims of typhoon Yola nda

Binge eating tied to cardiometabolic risk in kids, teens

blog.xoom.com

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eople with diabetes struck by typhoon Yolanda (international name Haiyan) in the Eastern Visayas are finding it difficult to survive, as many of them rely on injecting insulin. Helen Cordial, one of the survivors, has diabetes. She told reporters on the scene that she was begging the soldiers to take her. “I was pleading with the soldiers. I was kneeling and begging because I have diabetes,” she said. “Do they want me to die in this airport? They are stonehearted,” she said, shuddering on the stretcher she was in. Helen said she is worried about the health risk from the dead bodies yet to be buried. More than 2,500 are believed to be dead. “[The dead] should be removed right away because all of us will get sick.” Yolanda, one of the most powerful typhoons on record slammed the country last November 8. Analysts said that Yolanda was three times more powerful than Hurricane Katrina and Sandy, which crippled New Orleans and New York in 2005 and 2012. Countries led by the United States, United Kingdom, Japan, and China have pledged help in the search, rescue and relief operations, with many of them providing medical support and medicines for the survivors. Alexa Villano with diabetes.co.uk and Associated Press D

vereating among kids and teens was linked to cardiometabolic risk, poor diet and physical activity. In a study presented during Obesity Week, researchers looked into the binge eating behavior of 492 children and adolescents with a mean age of 12 years old. The binge eating was measured via Binge Eating Scale and was determined through a 24-hour recall, macro nutrient analysis and assessment of daily energy intake. Screen period took into consideration the time spent watching TV, playing video games, contrasted with the duration of physical activity. The researchers found a positive correlation between the elevated Binge Scale and screen time (P=.038), as well as television viewing time specifically (P=.011), leptin levels (P=.03), waist-to-height ratio (P=.04) and fat-mass percentage (P=.019). Binge eating also was significantly correlated with daily energy intake (P=.017) and carbohydrate consumption (P=.03). A correlation between binge eating and computer or video game time was of borderline significance (P=.05). Binge eating was negatively correlated with physical activity duration (P=.026) and intake of polyunsatured fats (P=.021). “We found that binge eating behavior is associated with some cardiometabolic risk variables,” said Maria Edna de Melo of the Universidade de Sao Paulo, Brazil, in an interview with Cardiology Today. Epidemiological surveys estimate that binge eating prevalence ranges from 7.5 up to 30 percent in clinical studies with obese individuals seeking treatment,” researchers wrote. “Binge eating is a common condition associated with failure in obesity treatment due to a higher frequency of dropout and faster regain of weight among obese reporting binge eating.” with healio.com D

DECEMBER-JANUARY 2014

sweetnews

Naturally-occurring molecules target type 1 diabetes Harvard school study shows beta cell preservation possible in the face of immune attack

topnews.in

ype 1 diabetes mellitus (T1DM) can be targeted through a disease mechanism using naturally occurring molecules to help prevent the disease, according to a study by the Harvard School of Public Health (HSPH). “This study breaks new ground because it focuses on improving beta cell performance and shows that beta cell preservation is possible even in the face of such immune attack,” said senior author Gökhan S. Hotamisligil, chair of the Department of Genetics and Complex Diseases and J.S. Simmons Professor of Genetics and Metabolism at HSPH, in their study published in Science Translational Medicine. The work emphasizes an unrecognized molecular pathway that contributes to the malfunction of insulinproducing pancreatic beta cells in T1DM in humans and mice. It also shows a chemical intervention that can help beta cells function properly and survive. Today, the only treatment for T1DM is insulin therapy by injection or pump. Earlier research on T1DM

DECEMBER-JANUARY 2014

was mostly focused on preventing the autoimmune response of beta cells that mistakenly attacks the body’s own immune system. The researchers used pancreatic samples and mouse models to tease apart the mechanisms of beta cell failure in T1DM, homing in on the function of endoplasmic reticulum (ER). ER is found inside cells where proteins and lipids are processed and packaged and go through quality control before being distributed to different parts of the body. It is also important in supporting the work of beta cells. The researchers found that with T1DM, ER function in animal and human models are compromised by the immune attack, leading to the ER stress, which eventually contributes to the death of beta cells and the insulin insufficiency characteristic of T1DM. “This study is exciting because it suggests that improving ER function before the onset of disease could reduce T1DM incidence,” said lead author Feyz Engin, research associate in the HSPH Department of Genetics and Complex Diseases. Earlier studies have found that ER stress in other tissues plays a key role in obesity and in Type 2 diabetes mellitus and can be corrected by “chemicalchaperones” like tauroursodeoxycholic acid (TUDCA), a bile acid. The scientists used TUDCA in mouse models of T1DM and found that ER function improved in both mice with diabetes and pre-diabetes. It also led to beta cells that functioned better and that were less likely to die. It, however, surprised researchers that the treatment also dramatically reduced incidence of T1DM in the mice models, identifying with it the specific molecular pathway through which TUDCA influences ER function. “There is really a need for some safe and mild interventions that can prevent emergence of T1DM in these populations. TUDCA is safe and inexpensive. It’s possible that TUDCA or another molecule that acts via the described mechanisms could be use as a novel therapeutic approach to keep those at risk for T1DM disease-free for long periods of time, or could even prevent the disease all together,” said Hotamisligl. Michaela Sarah De Leon D

sweetnews

he International Diabetes Federation (IDF) predicted that cases of diabetes all over the world will rise 55 percent by 2035. People with diabetes are estimated to be at 382 million and could rise in the next decades. Type 2 diabetes is the most common form, accounting for 90 percent of cases all over the world. Causes of type 2 diabetes have been linked to inactive lifestyle and diet. While rare for many races, type 1 diabetes an autoimmune condition is also increasing in countries such as the United States and United Kingdom with the latter having one of the highest rates of type 1 diabetes. Many countries can now treat diabetes, but many struggle especially in developing countries. Based on the IDF’s Diabetes Atlas, the condition has been responsible for five millions deaths every year which translates to one every six seconds. The IDF also notes that populated countries such as China, India, and the United States have the biggest numbers of people with diabetes but has recently seen a rise in islands in the Pacific and Middle East. With diabetes.co.uk D

Acidic diet may lead to diabetes impactfitnessinc.com

Diabetes cases to rise by 55 percent in 2035

ood rich in acid like meat, cheese and soda may raise diabetes risk in women, according to a study in France. The report, published in Diabetologia, quoted Guy Fagherazzi, PhD, of Gustave Roussy Institute in Villejuif and colleagues who analyzed the E3N-EPIC cohort (European Prospective Investigation into Cancer and Nutrition) data. To access the connection of dietary acid load, Fagherazzi and his colleagues examined data on 66,485 women from the ESN-EPIC cohort who answered questionnaires. The dietary acid load was determined via two tests- the potential renal acid load (PRAL) score and the net endogenous acid production (NEAP) score. Acidic diets included more meat, fish, cheese, bread, and soft drinks, while more alkaline diets had more dairy products, fruits, vegetables, and coffee. During the 14-year follow-up, 1,372 new cases of type 2 diabetes occurred. In the overall population, those in the top 25 percent (quartile) for PRAL had a 56 percent increased risk of developing type 2 diabetes compared with the bottom quartile. Normal-weight women (BMI of 25 and under) had the highest increased risk (96 percent for top quartile versus bottom) while overweight women (BMI 25 and over) just had a 28 percent increased risk (top quartile versus bottom). The authors claimed: “A diet rich in animal protein may favor net acid intake, while most fruits and vegetables form alkaline precursors that neutralize the acidity. Contrary to what is generally believed, most fruits such as peaches, apples, pears, bananas and even lemons and oranges actually reduce dietary acid load once the body has processed them.” They then concluded: “We have demonstrated for the first time in a large prospective study that dietary acid load was positively associated with type 2 diabetes risk, independently of other known risk factors for diabetes. Our results need to be validated in other populations, and may lead to promotion of diets with a low acid load for the prevention of diabetes. Further research is required on the underlying mechanisms.”D DECEMBER-JANUARY 2014

Survival weight loss may reverse aging Post-bariatric surgery patients show longer telomeres after surgical weight loss

osing weight through surgery may reverse aging at a genetic level, according to a Stanford University study that is the first of its kind in obesity research. “Obesity has an adverse effect on health, causes pre-mature aging, and reduces life expectancy. This is the first study to show that surgical weight loss may be able to reverse the effects. If your telomeres get longer, you’re likely to reverse the effects of aging and have a lower risk of developing a wide range of age-related diseases such as type 2 diabetes, heart and respiratory diseases, and certain types of cancer,” said John M. Morton, MD, chief of Bariatric Surgery at the Stanford University Medical Center and president-elect of the American Society for Metabolic and Bariatric Surgery (ASMBS). The researchers reviewed the genetic data before and after gastric bypass surgery of 51 patients, mostly females around 49 years old. They had average body mass index (BMI) of 44.3. Patients lost an average of 71 percent of their excess weight and saw their C-reactive protein level drop by more than 60 percent. They also experienced a four-fold decline in their fasting insulin within 12 months of surgery. The results of the study were consistent with earlier studies on bariatric surgery barring an extra factor that the Stanford

DECEMBER-JANUARY 2014

thegethealthyhub.com

sweetnews

researchers measured – telomeres. The researchers measured the patients’ telomeres before and after surgical weight loss. Telomeres are genetic biomarkers important in cellular aging and the development of disease. As people grow old or contract chronic diseases, telomeres become shorter. After a gastric bypass, certain patients’ telomeres became longer. Patients with high levels of LDL (Bad cholesterol) cholesterol and (high levels of inflammation) CRP preoperatively not only saw a greater decrease of these levels but also had significant lengthening of their telomeres compared to those with lower LDL and CRP levels. There was also a significant positive correlation between weight loss and telomere length in the high preoperative CRP group. In the high preoperative LDL group, increases in HDL or good cholesterol were associated with telomere length. The research was presented at Obesity Week 2013 hosted by the ASMBS and The Obesity Society. They measured telomere length by using laboratory blood testing that measures specific DNA sequences. Further studies are needed to confirm the direct effects of telomere length on health outcomes. Michaela Sarah De Leon D

youaskweanswer

What is the Paleo diet and is it suitable for diabetes patients?

he Paleo Diet or Caveman diet has been a craze for the bodyweight-conscious nowadays. Most people who follow this kind of food regimen are athletes who do triathlon, crossfit, and other sport groups who need maximum athletic performance and strength. The biggest question is: what exactly is PALEO or CAVEMAN DIET and can diabetes patients follow this kind of diet? Paleo or Caveman Diet, refers to an attempt to simulate the diet of the Palileothic Era or the Caveman era wherein all of the food was gathered or hunted, and eaten by cavemen immediately. Their attitude with food is that for them to eat, they must hunt and before they hunt, they must be hungry. The idea originates from the urgency of the caveman to eat and have intake for him to feel full. To round things up, let’s walk you through this diet: PROS: Mostly all-natural food; no preservatives (including salt) – this is a good way to avoid hypertension and keep water retention. Salt will always seek water as its best friend; Good fat consumption from monounsaturated fats like olive oil, nuts and avocado – Fat choices must come from these sources in moderate amounts; Water and coconut water as beverage; No other fruit juices/sodas – Water is the best beverage a diabetic patient can have. Coconut water is still considered as fruit, though it may be consumed in moderate amount as fruit exchange; Eliminate sugar – avoiding simple sugars like table sugar (refined, brown or muscovado) is a must to maintain normal blood sugar and lose weight. CONS: Generous amounts of animal protein (red meat, internal organs, eggs, shellfish, and even fatty cuts are allowed) – Protein consumption of a diabetic patient should be monitored. High fat, choles-

terol and protein meat may lead to hypertension, kidney disease and other related ailments which are big no-nos for diabetic patients. Carbohydrates are not allowed (This includes complex carbohydrates like white/brown rice, oats, cereals, wheat, beans, peanuts, etc.) – a diabetic person should eat the right amount of a variety of carbohydrates. The recommended amount of carbohydrates, which is around 40-55 percent of total calories per day, is needed to maintain normal blood sugar for the rest of the day. Emphasis must be made on high fiber-containing carbohydrates so that it may help control post prandial blood sugar. Always remember that a diabetic person has medications to lower blood sugar. For this reason he/ she must consume complex carbohydrates to compensate with the medicines to avoid hypoglycemia which could be a life-threatening situation. Eat only when hungry – This is not applicable to diabetic patients because this may result in hypoglycemia. Meals should be regular and well-planned. A dietitian would recommend patients to have three meals and 2-3 snacks planned depending on a patient’s activity, medicine and present weight. DECEMBER-JANUARY 2014

youaskweanswer Eliminate dairy – Dairy products like milk or yogurt (low fat) may be a good source of calcium and other micronutrients which we cannot get from other food choices.

The rule of thumb is, as long as you are not 100-percent sure with what you will go through, seek the best advice from a professional to attain optimal lifestyle. D

As far as some diets establish their own regimen, it is still wise to say that regular check-ups and frequent consultation regarding your weight and food intake should be done with a Registered Nutritionist-Dietitian, to properly control diabetes.

Joy Rabbie M. Catungal, RND, CDE

Ms. Catungal is a nutritionist-dietitian who graduated with a degree in Nutrition and Dietetics at the University of Santo Tomas in 2007. She was a former nutritionist at the Makati Medical Center‘s Diabetes Center and Viva Healthcare in Quezon City. She is also a member of the Nutritionist-Dietitian’s Association of the Philippines and Philippine Society for Parenteral and Enteral Nutrition.

DECEMBER-JANUARY 2014

crossfitstoic.com

Saturated fat consumption – Having diabetes is a oneway fast-lane ticket to possible cardiovascular diseases. An example of this is the consumption of saturated fats like butter, beef tallow, chicken skin, coconut oil, etc. Avoiding these may lessen your risk of having cardiovascular complications.

educators’corner

Blood Sugar Monitoring:

The how to’s, profits and pitfalls By Joy C. Fontanilla, MD, FACE, FPCP, FPCDE, FPSEM, CCD

B bloomberg.com

lood glucose or blood sugar monitoring is a vital component of diabetes care. Self-monitoring of blood glucose (SMBG) may improve blood sugar control, as well as health outcomes in people with diabetes. SMBG aids patients in day-to-day choices regarding their meals, physical activity, insulin and other medication doses. It also helps them better recognize hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar), as well as educate them on the effects of lifestyle, illness and drugs on blood sugar levels. People with diabetes need to know the proper techniques in SMBG and learn the potential sources of error. Doing the Test To use your glucose meter correctly, read the instruction manual, package insert or consult your healthcare provider. Never share fingerstick lancing devices or blood sugar monitoring equipment. Sharing these could result in transmission of infections, such as hepatitis B, C or HIV. If blood sugar meters must be shared, make sure to clean and disinfect after each use as per manufacturer’s instructions. If no such instructions are provided, then the device should not be shared. Nurses or caregivers must change gloves and perform hand hygiene between fingerstick procedures to avoid infection spread. • Wash hands with soap and warm water. Alcohol may also be used but can result in excessive dryness and cracks in the skin. Dry hands thoroughly. • Insert a fresh lancet in the lancing

device. Lancets used more than once get blunted, and can cause more pain and injury to the skin. • Prepare the blood glucose meter and test strip (as per manufacturer’s instructions). • Using the lancing device, get a small drop of blood from the side of the fingertip or alternate site (like the skin of the forearm) (picture 1). Fingertip sides and alternate sites are often less painful than the middle of the fingertip which contains a lot more nerve endings. However, results from alternate sites are not as accurate as fingertip samples when the blood sugar is changing rapidly (picture 2). When suspecting hypoglycemia, fingertip samples are therefore preferred. If you have a hard time getting a good blood sample from the fingertip, try rinsing your fingers with warm water, shaking the hand below the waist, or squeezing (“milking”) the fingertip before pricking.

• Apply the blood drop to the test strip in the glucose meter. Results will be displayed after several seconds. • Dispose of the used lancet in a puncture-resistant container. Frequency of Testing SMBG is very important for all types of diabetes patients. How often you should test is based on factors such as mode of treatment (diet versus oral medication versus insulin), level of hemoglobin A1c (HbA1C), and treatment goals. People with type 1 diabetes, diabetes in pregnancy, multiple daily insulin injections or poor blood sugar control generally need to check several times daily. Healthcare providers can help determine how frequently to test. Interpreting Results Blood sugar measurements show if treatment goals are being met. Results can be affected by activity level, food DECEMBER-JANUARY 2014

educatorsâ&#x20AC;&#x2122;corner intake, and medications. Record blood sugar results along with the time and date, medication dose, as well as foods eaten, exercise, and presence of illness or stress. Review your blood sugar records regularly with your healthcare provider so appropriate treatment adjustments can be made. Check for ketones in the blood or urine if the blood sugar level is above 240 mg/dL (13.3 mmol/L), during episodes of illness or stress, or if symptoms of ketoacidosis are present, such as nausea, vomiting, and abdominal pain. Ketones are the acids formed when the body lacks insulin to get glucose into cells, causing the breakdown of fat instead for energy. High ketone levels can lead to ketoacidosis and diabetic coma. Call your healthcare provider immediately or go to the emergency room if you have ketones or symptoms of ketoacidosis. Accuracy of Results The accuracy of SMBG results can be affected by several factors such as those related to the glucose meter and strip, the patient, the environment, and drug interference. Glucose monitor and strip factors. Some SMBG devices require patients to input a special code for calibration. A common source of error is miscoding which can cause insulin and other medication dose errors, so patients need to make sure their strips are properly coded before testing. Fortunately, some newer meters can do automatic coding, Differences in strip design, blood sample and well size, as well as meter cleanliness can affect results. Some meters allow for these variances, while others donâ&#x20AC;&#x2122;t. Glucose test strips have a limited lifespan of about two years if stored properly. High temperature, humidity and leaving the strip container open shorten strip life. Moreover, the strips usually expire three months after the vial has been opened. Thus, it is important to note the date the vial was opened not just the expiration date stamped on it, which usually refers to the strip lifetime when the bottle remains unopened. Patient factors. Patients need to be adequately trained to use the meter correctly. Improper technique such as insufficient quality and size of the blood sample can affect the results. When the fingertip is squeezed only after the fingerprick, more of the interstitial fluid (or liquid found between cells) rather than blood will be measured. Cleanliness of the finger or body part where the blood sample is taken from can also influence readings. Forgetting to wash hands after eating candy, cookies, fruits, etc. can falsely raise test values. Some lotions may also lower results

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slightly. Alternate site testing normally has a lag of 15 to 30 minutes, reaching up to 1 hour when the arm is cooled. Fingertip samples are thus preferred when suspecting hypoglycemia or when rapid blood sugar fluctuations are expected (e.g., in response to eating, insulin or exercise). Medical conditions such as anemia and kidney failure can also alter test values. Environmental factors. Room temperature, altitude and humidity can all influence test readings. Pharmacologic factors. Certain drugs and other substances given to a patient can also alter test values. Some meters are affected by these interferences, while others are not. For example, test strips that use the enzymes glucose dehydrogenase (GDH), pyrroloquinolinequinone (PQQ), or glucose dye oxidoreductase (GO) can mistake icodextrin, maltose, galactose and xylose sugars for glucose and lead to falsely high blood sugar levels. These interfering sugars may be found in certain immunoglobulin products, foods, herbs, nutritional supplements and peritoneal dialysis solutions. The table below summarizes the effects of various factors on SMBG readings. Some Variables that Alter Blood Glucose Measurement

educators’corner Fig 1

Fig 2

scottmindeaux.com

Check glucose meter accuracy by occasionally bringing it to the lab when blood work is done. Use your home device to check your blood sugar at the same time that blood is drawn. There should be no more than a 15 percent difference between the lab and home meter values. A discrepancy may mean a problem with your device, strips, or your monitoring technique. Practice caution and common sense when interpreting your results. If the test value does not fit with your symptoms, recheck or use a different machine. SMBG devices are least accurate during hypoglycemia and severe hyperglycemia. Choosing A Blood Glucose Meter When selecting an SMBG device, the following factors may need to be considered: • Cost — Some companies offer discounts, rebates, and trade-ins on monitoring equipment. Check the cost and availability of supplies that go along with a meter, including test strips and lancets. • Convenience — Some devices are easier to use than others. Some require only tiny blood samples,

which therefore entail less effort and pain to obtain. Meters also vary in size and how quickly they put out the result (some in as little as five seconds). Smaller monitors are more discreet and portable. • Accuracy — Newer meters typically give more reliable results. • Sophistication — Some meters are fancier. Some have a large memory capacity, or capable of giving 7- to 14-day averages. Some allow you to enter variables (like food, medication or exercise), and come with software programs that allow you to upload data to a computer and plot blood glucose graphs. Meters that can “talk” or have large screens are also available for the vision-impaired. Take good care of your glucose meter, and use it wisely. SMBG isD a very valuable tool in managing diabetes. It may even help save your life some day.

*Consult product package inserts for information regarding meter accuracy and interfering substances. GO = glucose oxidase; GDH= glucose dehydrogenase; PQQ= pyrroloquinolinequinone. Table adapted from The Diabetes Education Group ©2010 (www.medscape.com). ©2010 (www.medscape.com).

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fightin’forfitness

The 4-Minute Workout By Jim Saret

We often hear people complain, wishing they had time to squeeze in a workout but are too tired to do so because of the fast-paced world we all live in. Unfortunately, “fast” means fast food and with the advent of technology, people may prefer to stay indoors, thus resulting in poor health. But what if you can work out in the comfort of your home or office, burn 600 calories and you don’t have to go to the gym or buy special equipment? Sounds too good to be true but, yes there is a way, thanks to the 4-Minute Workout. The 4-Minute Workout is a metabolic and highly intense workout that exercises all parts of your body in four short minutes. By maximizing the time given, you will burn calories equivalent to an hour’s workout, consisting of, say, a run in the village. The workout is simple. In four minutes, all you have to do are four types of exercises: A. Jumping Jacks B. Squats C. Push-ups D. Lunges

The key to this workout is not to go beyond the time allotted. While you can do this anytime, it is highly recommended that you exercise in the morning as it has been proven many times that working out after waking speeds up the metabolism.

A. Jumping Jacks 1. Stand straight with your feet together. Make sure your arms are on the side. 2. Starts jumping making sure that your legs are spread, your hands touching over your head like clapping. 3. Return to the first position and the exercise in 10 repetitions.

Now for those who have difficulty doing jumping jacks, you may modify them by spreading your legs left and right, with your hands clapping over your head.

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B. Squats 1. Stand straight with your feet and shoulders apart. Make sure your knees, hips and toes are forward. 2. With hands on the side, bend your body, your knees pointing forward. Make sure that you are not going beyond the toes. 3. Go back to neutral position and bend again until you reach 10 moves.

For the hand position, you may either bend with your arms front, hands back or depending on the level that you can do. Tip: You may not know it but sitting on the chair and standing and sitting again is already a squat.

C. Push-ups 1. Lay face down with your palms on the floor, your shoulders wide apart and your legs straight. 2. Push yourself up and down, your chest touching the floor but making sure that your body is straight. 3. Return to starting position and do it 10 times.

There are many variations of the push-ups. You may modify it by placing your knees on the floor, legs up or crisscrossed. You may also do the push-ups by using your desk table or pushing against the wall.

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D. Lunges 1. Put your hands on your hips. 2. Place one leg forward about two feet or more depending on your height. 3. Bend your knee with the front knee aligned with the ankle. The back knee meanwhile should be vertically aligned to the shoulder and hip. Make sure that the heel of your feet is lifted from the floor. 4. Do it on each leg, repeating it for 10 times.

For balancing purposes, you may use a chair for support. Notice anything with the workout? The key number is 10. Once you are finished with the lunges, start all over again with the jumping jacks, making sure that you have done four sets of each exercise. Some, however, may not be able to do it well at the start but the goal is to do all the exercises non-stop in the allotted time and challenge your body as you go

So there is no excuse not to workout. With these four simple exercises, youâ&#x20AC;&#x2122;ll surely get results and lose a pound or more. Remember, it is advisable to consult with a doctor before doing any rigorous training. D

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fightin’forfitness

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Exercise is Medicine Coca-Cola joins call for a fit and healthy community By Alexa Villano

ealth experts have time and again repeated that exercise is crucial in being healthy and fit. It is 40 percent perspiration, 60 percent balanced diet. But these days, more people have been leading a sedentary lifestyle, which accounts for the growing number of obese people. In a report by the World Health Organization in 2010, more than half (61 percent) of deaths in the Philippines were caused by non-communicable diseases (NCDs). About one-third of deaths were attributed to heart and vascular system conditions with cancer, respiratory diseases, and diabetes as primary factors. It was also reported in 2009 that five out of ten deaths in the country were caused by diseases of the heart. Realizing the need to promote fitness, Exercise is Medicine (EIM) was launched last September in the country with the Philippine Association for the Study of Overweight and Obesity as the organization in charge of the program.

Dr. Benedict Tan, Dr. Rodolfo Florentino, Caloy of Happiness, Mr. Guillermo Aponte & PASOO’s Dr. Gabriel Jasul raises the barbell as their commitment to the EIM

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Guillermo Aponte, president of Coca-Cola delivers his speech on the company’s participation in the EIM

What is Exercise is Medicine? Originating from the United States, EIM seeks to encourage health care providers to prescribe exercise and physical activity as a defense against chronic diseases and other health problems. “We’re very happy that we will join the worldwide network of EIM,” said Dr. Rodolfo Florentino, PASOO vice-president. “We consider EIM Philippines as a coalition of likeminded members with the vision of considering physical activity and exercise as a vital tool for the prevention and management of disease. The mission of EIM

Philippines will be to spread the word to physicians and allied practitioners all over the Philippines so that we can start prescribing, advising or counselling their patients and inform them of the proper physical activity and exercise (they need to do) in order to avoid worsening the condition or to help in the management of the disease they are treating.” The EIM philosophy is grounded on research showing that 150 minutes per week of moderate physical activity can have a huge impact on one’s quality of life. Through correct intensity and

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Participants doing the dance moves DOH Usec Dr. Eric Tayag teaches them

duration, exercise not only improves the quality of life but decreases the incidence of disease, chronic health conditions, and obesity. Coca-Cola’s Participation One of the companies promoting the event is Coca-Cola, the makers of many of today’s popular drinks. In his speech before the doctors and health experts at the PASOO convention last September, Guillermo Aponte, president of Coca-Cola Philippines said that they are very excited about EIM coming to the Philippines. “The commitment of the company (Coca-Cola) is to support the EIM task force to gain momentum and to institutionalize their initiatives in their medical community. We will provide the support, the knowledge, the best practices, the resources to make the EIM work properly,” he said. “The first thing is to elevate awareness among the medical community. They can actually provide and suggest to their patients to start being more active.” Dr. Maxime Buyckx, director of the health and wellness programs under Coca-Cola explained the rationale behind the program. “The importance of physical activity is increasingly recognized with its direct and indirect benefits. Individuals and communities are looking for effective solutions that can improve their lives and well being. Governments need to contain health care costs and promote healthy behaviors at the same time,” Dr. Buyckx said.

“Exercise is Medicine is not some idea that’s coming out from somebody’s head or for some reason. It’s really based on studies,” he added. The participation of Coca-Cola may raise the eyebrows of many. After all, they manufacture softdrinks, one of the causes of obesity and diabetes. However, Aponte points out that they are acknowledging the situation. “We are sure about the benefits of our products. We don’t have anything to hide. We have nothing to be ashamed of. But we know that obesity is a major problem in communities all over the world. So we want to be part of the solution and we know healthy living, balanced diets, and exercise are the solutions to that problem and this is where we have a huge commitment to society,” he said. Sports such as basketball, football, and dance competitions are just some of the health programs Coca-Cola has done in the Philippines to promote physical activity. EIM Philippines Although EIM has yet to go full blast, PASOO has already started the program. In its website obesity.org. ph, exercises for various conditions have been listed. These conditions include: arthritis, lower back pain, weight loss, hypertension, type 2 diabetes, and asthma. EIM Philippines is also gearing up for an information drive in the

Dr. Tayag doing a dance demo before the audience

next few months. Training sessions with doctors will start in 2014. It hopes to contribute to the Department of Health’s goal of decreasing the rate of physical inactivity from 60.5 (2008) to 50.8 in 2016 (DOH, National Objectives for Health 2011-2016) through training doctors nationwide to prescribe exercise as a part of medicine. PASOO is also happy with the support given to them by the other organizations actively promoting EIM in the country. “Aside from PASOO we have PCP, Diabetes Philippines, and then of course, groups of nutritionistsdietitians, sports specialists, and others. So we’re organized and soon we will be spreading the word and campaigning the implementation of EIM Philippines, inviting more members and more partners and then we start the training of doctors, training of paramedical people in order for them to start their mission of spreading the word that physical activity and exercise is vital for the prevention and management of disease,” Dr. Florentino said.D

Participants having fun during the dance demonstration

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SLMC’s Weight Management Center By Ma. Cristina C. Arayata

f you’ve got a problem with weight management, whether it’s weight loss or weight gain, the Weight Management Center in St. Luke’s Medical Center (SLMC) in Quezon City can help you. SLMC offers different levels of trainings, from the simplest (one month) to the most comprehensive (three months). According to Iree Velasco, a dietitian at the SLMC, the one-month program is a fitness program usually availed of by those who are here for vacation, and those who have relatives confined in SLMC. What’s the advantage of enrolling in a weight management center rather than a gym? A team of doctors will be there to look at your case. The said team is composed of endocrinologists, cardiologists, pulmonologists, psychiatrists and physiatrists both for adults and kids, as well as clinical dietitians and nutrition support physicians. SLMC made sure they could provide adult and pediatric weight management. Screening will be the first step in the process. Also, through the use of food models, clients will be educated on the proper portions, quality selection with regard to their food/diet. The center can also provide individualized diets. The center considers the different needs of their clients, of both genders, from as young as 6 years old to as old as 70+. Facilities Gym – Equipments found in the gym are merely focused on weight loss. Patients/clients are also allowed to take a shower in their spacious bathroom. Velasco said that they make sure the gym is spacious. She even noted that their (weighing) scale can cater to obese people. “All they need is to go there even while in a wheelchair,” she said. Dietitian’s Room – This is where you can find the food models. Also, patients are allowed to wear a 20-lbs. belt, just to make them feel its weight, and let them imagine how much weight they could probably lose for instance. One can also find a Body Fat Analyzer in this room. Velasco noted that only SLMC QC and SLMC Global City have this kind of analyzer.

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Consultation Room â&#x20AC;&#x201C; While the center also offers home-patient counseling, definitely they want to modify the behavior and attitude of their clients. A team of MDs is always available to help clients with their needs. About the center and its services First opened in 2003, the Weight Management Center in SLMC-QC has a lot of enrollees. It is open Tuesdays to Fridays from 8:00 am to 8:00 pm, and every Saturday from 8:00 am to 7:00 pm. It offers the following services and packages: Fitness A (Php 3,969) A guided nutritional program which includes two sessions of consultation with a Weight Management Specialist; body fat analysis and four sessions of nutrition counseling. Fitness A is an aid to weight loss and management. Fitness B (Php 5,027.40) An exercise program medically guided to ensure physical activities. Clients are entitled to two sessions

of consultation with a Weight Management Physiatrist and 12 sessions of therapeutic exercises guided by a Physical Therapist. Fitness C (Php 11,995.20) A fundamental program in weight management which will give clients four sessions of consultation with a Weight Management Specialist; Cardiac Clearance; two sessions with a physiatrist; four sessions of nutrition counseling; two sessions of body fat analysis and 12 sessions of therapeutic exercises guided by a physical therapist. Pediatric Screening / Preenrollment phase (Php 1,587.60) Includes initial screening by a consultant and body fat analysis Phase 1 Therapeutic Phase (Php 17,904.60) This phase, which lasts for three months, includes various diagnostic procedures such as Dime 12, CBC, Urinalysis, body fat analysis (2X) and other diagnostics DECEMBER-JANUARY 2014

feature that may be requested by physicians. It also includes the following services: endocrine evaluation; family counseling; cardiac clearance; nutrition counseling; exercise prescription; periodic prescription and therapeutic exercises.

Phase 2- Maintenance Package (Php 17,110.80) This phase, meanwhile, discusses long term weight loss and maintenance goals, continued family counseling and nutrition program. The package also includes body fat analysis, family counseling and behavioral modification, nutrition counseling, exercise prescription, periodic reassessment and therapeutic exercises. For adults: Screening / Pre-enrollment phase (Php 1587.60) – Includes initial screening by a WMC consultant and body fat analysis Phase 1 – Therapeutic Phase – lasts for three months. This phase includes various diagnostic procedures such as Dime12, CBC, Urinalysis, ECG, Treadmill Exercise Testing, TSH and Modified OGTT. Services (Php 22,050) includes endocrine evaluation; cardio-pulmonary clearance; psychiatric clearance; nutrition counseling; exercise prescription; therapeutic exercises. Phase 2 – Peri-Bariatric Package – follows te screening and serves as a clearance prior to surgery. Additional test includes Pulmonary Function Test. Services (Php 26,901) includes body fat analysis, surgical consultation, endocrine clearance, cardiac clearance, nutrition counseling, pulmonary clearance and psychiatric evaluation. Phase 3 – Maintenance Package – ensures proper followup after the Therapeutic Phase or the Pre-Bariatric Phase. The program runs for three months. Services (PhP19,492.20) includes Body Fat Analysis; consultation with weight management specialist, nutrition counseling, exercise prescription, therapeutic exercises.

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For more information, the Weight Management Center can be contacted at numbers 723-0101/723-0301 local 5209, fax at 723-0199 local 5209. You can also visit their website at www.stluke.com.ph. D

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Hazel Chua: Win ning in life after losing How this Biggest Loser contestant found happiness in an unlikely career By Emil Karlo Dela Cruz

n a busy strip at Bonifacio Global City, Hazel Chua stands in front of her army. They are a curious bunch: office workers, 20-something yuppies, mothers, couples, foreigners, even kids. All have gathered under a common goal. All patiently await the order of their commander. Hands on her hips, Hazel scanned their battleready faces. With a whistle, the army disperses and forms into six separate groups. Another signal, and each group starts doing a set of movements, pausing for a bit then starting again. They do this over and over again until brows line with sweat. Hazel moves around, inspecting her troops while shouting instructions. Occasionally, she would

throw a soft punch to an individual’s gut, checking the firmness of their core, motivating their resolve in the process. After some time, Hazel blows on her whistle once more, signalling her troops to switch with each other and do a different set of exercises. She does this six more times until everyone is exhausted but happy at the premise of being healthier. Having been in a

position where her own life was in danger from being physically unfit, Hazel knows very well that one can’t be complacent in the Battle of the Bulge. Life after Biggest Loser If you had known Hazel four years back and saw her now, you would be convinced that the person standing in front of you is a different individual altogether. Her physical transformation pales in comparison to the change in her personality; the once shy, timid girl has blossomed into a confident, outgoing woman who helps people achieve their ideal weight for a living. “I am a motivational coach,” says Hazel, in an interview with DiabetEASE

magazine. “I think it is the perfect fit for me. From being obese, I became fit, so most people can identify with me.” She is talking about what transpired back in 2011, considered as a turning point in her life. Hounded by weight and confidence issues, the lass decided to join the local version of the hit reality show The Biggest Loser. Every week, contestants had to lose enough pounds to keep from being eliminated. The last man standing will be proclaimed as “the biggest loser”, and will receive the grand prize. The beauty of the show is that each contestant had access to a top-notch fitness trainer and a solid weight-loss program, such that even though they

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Hazel together with Coach Jim Saret, Tonette Dimaguila and the other coaches in Bangkok during a fitness seminar

were eliminated, they can still apply what they learned post - Biggest Loser. Hazel bowed out of the competition early on but returned as a fan favourite. It was also here where she found romance in the company of fellow contestant Raffy Tan. After the show, Hazel thought she would resume life from where she left off: a nurse in her hometown of Bicol. But fate had other plans for her. She and boyfriend Raffy were given job offers by Biggest Loser trainer Jim Saret, as “motivational coaches” for Nestle Wellness’ FITFIL boot camp. Composed of 15 session programs that run three times a week, FITFIL takes exercising outdoors, with various activities including Muay Thai, Dragonboat, Yoga, and Crossfit, among others. It follows a three-pronged approach to fitness, putting emphasis on physical exercise, nutrition, and motivation. “We became full-time motivational FITFIL coaches in 2012,” says Hazel. “We were entrusted with the camp, making us administrators/coaches. Minsan pahinante din! (sometimes laborers, too!),” jokes Hazel. “I realized that, had I returned to my previous life, I don’t think I would be as happy with my chosen career

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as a nurse,” Hazel confesses. “I found my life’s passion in coaching. It may be tiring, but you won’t feel a thing (because you are enjoying it so much). At first, Hazel had doubts about her effectiveness as a coach. During The Biggest Loser, people saw her as somewhat meek with almost zero confidence -- how then will she be able to inspire others? “I was very nervous when I started. I kept asking myself: ‘Will I inspire anyone? Will they learn anything from me?’” Eventually, Hazel started to gain confidence once the camp went into full swing. Turns out that people saw her not as the bashful girl from the show, but as someone who rose above adversity and proved that, with enough willpower and perseverance, even someone obese can become physically fit. Her weight-loss story also turned out to be her greatest motivational tool. People look at her and see a “normal” person they can relate to. In turn, Hazel prides herself as a “coach with a heart.” She understands the plight of individuals who can’t keep up with the rest of the group, having been in a similar situation in the past. “If you place me side by side with the other coaches who have certificates,

Hazel as one of the motivational coaches of the FITFIL camp

With members of the Fitfil Camp

On one of her adventures

feature walang wala naman talaga ako (I can’t compete). But I can say I have a very strong relationship with my group.” “I tell them to ‘just smile, keep smiling!’ especially when they are very tired,” says Hazel. “Or, sometimes, I would give icebreakers and deliver jokes to motivate them.” She does this several times during the exercise session, spreading cheerfulness to a group who seem to be at their limit doing sit-ups. Her attitude is madly infectious, and soon, one by one, the exercisers break out into a smile and tap into their reserves, just to please their bubbly coach. “I think I am able to inspire and help them to the point that they stick around. This is the 7th leg of FITFIL and some of the participants are from the very first season,” she beams proudly. On staying fit Of course, Hazel wouldn’t be able to do her job properly if she let figure go. To prevent this, she makes it a habit to exercise outside the FITFIL camp.

She hits the gym at least three times a week, going for exercises that are high in intensity but short in duration. “In the gym, I would go ‘boom boom boom! Super high intensity but after 4 minutes, bagsak na (“I’m exhausted”),” says Hazel, referring to the 4-minute workout they teach at FITFIL. She adds: “I try to find ways to shorten the time, since it is hard to fill one hour of workout. It’s particularly hard if you are alone.” As a fitness enthusiast, she makes it a point to engage in many physical activities during her free time. Thanks to the camp, she was introduced to Dragonboat Racing, which piqued her interest. “I like the fact that you are in a team and you have to work together,” says Hazel. “During our Dragonboat activity, we competed with each other at kinareer ko na talaga! (I took it seriously).” She admits that she dislikes running since she gets bored easily. But if she were given the opportunity to go on a triathlon, she wouldn’t back down. “Challenge accepted!” she

says, quoting a popular TV catchphrase. “I want to be a marathoner. I already conquered a 21k run, so next is 42K.” She knows how important it is to keep fit, and how easy it is to fall down the slippery slope into obesity. The Biggest Loser finale happened three years ago but the lessons she took from it still rings true today: the food plan, the workouts, the philosophy, coach Saret’s tips on how to stay motivated – all these things have become her fitness Bible. “The best explanation (to gaining weight) is that you are like a sponge. It might be dehydrated now. But the smallest drop and boom! (you get fat),” explains Hazel. She adds: “It’s not that you can’t eat; You just have to do things in

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Hazel with her FITFIL group in BGC

Together with the other coaches

With boyfriend and Biggest Loser participant Raffy Tan

moderation. So if you crave for sweets or lechon, you can have some (from time to time) as long as you control yourself!” Hazel also keeps in mind that, as a motivational coach, she has an image to uphold. Slip and regress into being overweight, and soon, people might not trust her coaching skills. “The participants keep me motivated to stay healthy, to exercise. Ayoko silang biguin (I don’t want to let them down).” On keeping diabetes at bay Now, Hazel is in the pink of health. She radiates a beautiful glow made even more luminous by her budding relationship with Raffy. “Going strong,” she says, of her lovelife. “So far, we haven’t encountered any major major problems, and I’m happy that we are in this career together.” “It’s better if you have someone to relate with, someone who has gone through the same things you have. I think that is what made our relationship stronger.” Despite her current fitness level, things were very different in the past for the once-obese Hazel. The threat of diabetes hung over her head like Damocles’ sword, and she knew it was only a matter of time before she got that fateful diagnosis. “Both my mother’s and father’s side has it,” reveals Hazel. “Even though there weren’t any signs for me, I didn’t want to wait until I was already diabetic.” She admits being diagnosed with diabetes was one of her principle fears. Much like her fellow contestants at the Biggest Loser household, Hazel knew that if she continued down her unhealthy path and didn’t alter her lifestyle, she won’t live long. “Not thinking of the prizes or anything, the number one reason I joined was to improve my health,” says Hazel. “Second, I wanted to improve

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my confidence. Ang baba baba kasi ng tingin ko sa sarili ko dati (I had such a low self-esteem). But after the show, it gave me the confidence to face people, to face the crowd.” “I considered myself as having an ‘ugly duckling syndrome’,” she reveals. “It was like I was in a shell, not being able to do any activity because of my weight.” Now, after finally being at peace with her self-image, she finds herself in a position to help others deal with their issues, teaching them to break out of their own shell piece by piece. For Hazel, the most challenging aspect of the job is being able to produce results in a span of just two sessions. This is usually the make-or-break point of the program, where a select few might choose not to continue further. What I’m after is to show them that something changed within themselves, be it their stamina, muscle tone, weight, etc,” she says. “It delights me to hear people come up to me and say ‘Coach, I lost this many pounds!’ or ‘Coach, someone noticed my new body!’” And every so often, this is exactly what happens after a session: the trainees will flock Hazel, talking about how tough but energizing the workout was. They exchange jokes, ask for advice, thank their teacherfor being patient with them, for not giving up on them.It is a conversation among friends, not just trainee-trainer. In the middle of it all, the now confident girl looks genuinely happy. She nods and bids everyone ‘farewell!’ and ‘see you next time!’ From the twinkle in her eyes and the way she smiles while talking to others, you can tell that she lives for moments like these. D If you are interested in joining the FITFIL program, visit www.coachjimsaret. ph for more information

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herever Matteo Guidicelli goes, he comes out a winner. At 9, he began riding a motocross bike, a gift from his grandfather. At 14 years old, the racing prodigy won the title â&#x20AC;&#x2DC;Karter of the Yearâ&#x20AC;&#x2122; three times in a row. At 23, he bagged Rookie of the Year 2013 for SwimBikeRun. ph. And this is just the beginning.

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Sweat Shirt by Ralph Lauren | Shorts by Zobha of Aura Athletica

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Red windbreaker by Giordano | Sports shirt by Planet Sports | Shorts by Zobha of Aura Athletica

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[c His thirst for adventure started at age 9 when he was given a motocross bike by his grandfather. By 10, he went on to horse racing. By 11, it was kart racing, which sparked his boyhood dream of becoming the first Filipino F1 racer. “My parents were never overprotective of me. They wanted me to explore new things all the time,” he said. He paints the image of a boy who, immediately after school, would be the first to arrive on the racetrack and the last one to leave. Driven to succeed by a passionate father, he would come

in at 6 AM whereas others would arrive at 8. If others finish by 3, he would finish at 5. “If I want to excel in something, I have to do more than others so I can be better,” the tan athlete said. The entire Guidicelli family then moved to Manila from Cebu to help support Matteo’s dream of racing an F1. Each day was spent on the race track after school, with Matteo working meticulously towards that dream. Unfortunately, an accident put his fasttrack to fame to a halt, and he was asked to stop riding by his mother. Years after, Matteo was not the first Filipino to race under an F1 team. Racing history was made by his close

friend, Marlon Stockinger, on May 2013. “When [Marlon] brought the first F1 race car in the Mall of Asia, it was such an emotional experience to see an F1 car in [our streets]. And my friend driving it! Oh God, I cried literally,” he shared. “I said, ‘dude, this is our dream when we were 10 years old.” “Now, what’s my goal now?” he asked.“ [It’s] to leave a mark in showbiz and create change – that’s the idea.”

His path to stardom started when Matteo auditioned for Brent International School’s adaptation of Pippin: The Musical. “Bro, hindi ka bagay d’yan. You’re an athlete!,” Matteo’s friends would tell him. Caught in a real-life Troy Bolton (High School Musical) scenario, Matteo managed to win the hearts of his friends and audiences after the show. “Everything changed for me that time,” he said. While everybody else went to big business schools, Matteo chose the path to making musical theater a career, and left for Columbia College in Chicago. Three years of culture shock, independent living, borderless

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socialization, and theater roles, the time came for Matteo to go back to Manila and be gainfully employed under ABSCBN’s Star Magic program. “If you’re hungry for something, never stop and go for it.” Matteo practices what he preaches – even if it means learning lessons the

hard way. During the shooting of his first ever TV series, Gokada Go!, Matteo discovered the most crucial skill every halfie actor should know: speaking Tagalog. “Hindi pa ko marunong magTagalog noon, but all my lines were in Tagalog. It was so hard!” he revealed. “My nape would become so hot kasi kinakabahan na ‘ko. Like we had to have different takes for just one line I had to say. It was really bad.” From then on, the meaning of “show business” transformed before the eyes of the young actor. From superficial glitz and glamour, it became something more serious. “I take stuff for granted,” Matteo admitted. “I’m not taking things 110 percent seriously. But I realized I have to do something about this. So I surrounded myself with all of these Tagalog-speaking people. I started DECEMBER-JANUARY 2014

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Sports shirt by Planet Sports | Shorts by Zobha of Aura Athletica

reading Tagalog comics. No classes, just practice.” But learning a new language was only half the battle. During Matteo’s first lead movie role, My Cactus Heart, in 2012 (along side A-listers Maja Salvador and Xian Lim) the actor realized that he needed to step up his game, acting-wise. “I have so much to learn. Every project, I try to improve myself and look at things differently,” he said. “I’m going to take everything step by step and not be in a rush.You should give your 100 percent and put your life and passion into that project.” Does a winner get lost, or off-track at all? “Always,” he admitted.

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The burning passion for victory flows through Matteo’s veins. But the same can’t be said for the grace of handling failure and frustrations. “There were times in racing that my mechanic would lap the time. And sometimes, if I don’t [reach my goal], I get so mad,” he said. “I was like ‘I quit, I can’t do it. I give up! I’m always here on the racetrack, and I don’t have a life anymore.’” Showbiz is a cruel world that creates and ruthlessly destroys. Matteo’s career, fitness, and social life are pestered with speed bumps which sometimes leads him off-course. “In racing, your instruments are your car, your tires, steering wheel, and the engine. In showbiz, your instrument is yourself, your emotions, and skills,” he said. “You really have to have a

good team of people to motivate you and keep you straight-minded.” Sports and fitness have always kept Matteo focused on his goals. “I was lucky enough that sports has always kept me on the straight path, kept my mind straight… always have a goal to look forward to.” Matteo does not spend his free days idly by. “If you fall into that circle of not being active, it’s so hard to come back. Maintain [your time].”

“I used to think ‘I don’t want to do triathlon. That’s so boring! You swim, you bike, and you run? Those are the three most boring things in the world’.” But Matteo had to eat his words, two years after.

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Blazer and long sleeved shirt by GAP | Pants by Giordano

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Blazer and long sleeved shirt by GAP | Pants by Giordano

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“Our Christmas used to be intact. Noon, our family used to gather from Cebu and Manila to our house in Cebu. Ang dami namin. We were like 30 people in one house. As the years passed, I don’t know why, but everything starts to fade away. Everybody started to spend their own Christmas in their own houses. I want everything to be back together the way they used to be at least once. That’s the Christmas I miss and I want again. Baka one day when were all married and have kids, we’ll get back together [for] one big Christmas reunion.”

Shirt by Giordano | Pants by Malboro Classics Pullover by GAP

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[c He revealed that his father used to be as big as a polar bear, weighing around 240 lbs. After doing triathlons, it resulted in his father’s weight loss and drastic transformation due to healthy living. “[My dad] then bought me a bike, so I used it just for fun. At first, it was just normal biking, but [there is more to it] than what it seemed,” he said. Matteo had to learn the art of “swim-bike-run” which had its own set of technicalities. This factor piqued his interest and fuelled his competitive spirit. “I joined in a couple of races and started to appreciate the sport more. It was so challenging, it gave me a hard time and I wanted to learn more about it,” he said. The intense training was all in the name of victory, leading to outstanding race statistics in and out of the country in 2012. However, when his showbiz career shifted full speed, championship-level training had to take a backseat. “In triathlon, you have groups: elite and age groups. I’m just an age grouper and I have to be realistic to myself,” he said. “I love the sport, I want to be healthy. I’m not here to win, I’m just here for the passion.” During the calorie-burning tri season, Matteo eats anything he wants. He emphasized, however, that he prefers to eat fresh vegetables and unprocessed meats, staying away from junk food.

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people.It’s my life now.” The racer-turned-actor knows that the limelight will not last forever. Until he’s here, Matteo will do everything to win. “As much as I can, I’m gonna do everything when its still here. I don’t want to take this opportunity for granted. Until it's here, I’m going to do whatever it takes.” It was then when we realized that Matteo was never out of the running when it came to winning. He only shifted his gear. D

The triathlete does not intend to keep his fitness ideas to himself. As the upcoming Biggest Loser Pinoy Edition's Game Master, it is his role to unleash hell on earth for the participants. Matteo wears it like a badge of honor. His sole purpose is to push the contestants to their limits. “No, it’s more than that. You build relationships with these contestants. You learn that they’re not just here because they want to lose weight. It’s more about proving themselves to their family – really heavy stuff.” The body, for Matteo, is capable of more things than one expects. That there is an underlying power that can be harnessed from within. “It’s very easy for us to say no because hindi na kaya. But you can do it. You just have to take initiative and just do what you need to do. Finish your workout,” he said firmly. They say child stars go bad when they grow up. But if 23-year-old Matteo met his 13-year-old self now, he would make his younger self proud. “I can say that from 13 to 23, a lot has changed,” he said. “Before, I wouldn’t show people my emotions but now, I’m very open. It made me learn about so many different DECEMBER-JANUARY 2014

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Total Diabetes Care Requires Complete Oral Care

he facts aren’t sweet. Diabetes is one of the most prevalent conditions in the Philippines. In fact, the Philippines is among the countries in the world where this disease has increasing occurrence. 1 According to a study published by the National Statistics Office in 2012, diabetes is the 7th leading cause of death among Filipinos. 2 This may continue growing since the Filipino lifestyle involves a lot of food, especially sweets. There’s a war in your mouth. And people with diabetes must be armed. For they are two times more likely to have unhealthy gums.3 This is due to the decreased ability to fight bacteria that invade the gums, occurring along the gum line.4 Because of their condition, bacteria build-up may result. Bacteria accumulation in the mouth, if not taken care of, may result in serious gum concerns. So apart from daily health management, people with diabetes also need to take care of their over-all oral health.

Have you found the one? To ensure that people with diabetes are able to maintain healthy gums, it is recommended that they use oral care products that are especially made with anti-bacterial ingredients. One can use a toothpaste that can fight bacteria build-up particularly along the gum line as well as the rest of the mouth. The risk of having gum concerns, cavities, tooth sensitivity, tartar and bad breath can be addressed with the right toothpaste and toothbrush.

live healthier and happier. Always remember that it is also true that oral health is wealth.

Aside from over-all physical well-being, give proper attention to your oral health so you can

4 Montadon A, Zuza E, Toledo BE. “Prevalence and reasons for tooth loss in a sample from a dental clinic in Brazil.” Int J Dent. 2012; 2012; 2012:719750. 2012:719750. Epub Epub 2012 2012 Aug Aug 29. 29.

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References & Citations: 1 Baltazar JC, Ancheta CA, Aban IB, Fernando RE, BaquilodMM. “Prevalence and correlates of diabetes mellitus and impaired glucose tolerance among adults in Luzon, Philippines.”Diabetes Res ClinPract 2004;64(May): 107–15. 2 National Statistics Office (NSO), Republic of the Philippines. “Philippines in Figures 2012.” Health and Welfare 2012; 48; http://www.census.gov.ph/data/publications/pif2012_in_CD.pdf 3 Taylor GW, Borgnakke WS. “Periodontal disease: associations with diabetes, glycemic control and complications.” Oral Diseases 2008; 14: 191-203

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Diabetes, Bones, Joints, a nd the Obese!

Relationships between Diabetes Mellitus, Arthritis, Osteoporosis and Obesity By Marie Yvette R. Amante MD, FPCP, FACE and Eric Jason B. Amante FPCP, FPRA

s a practicing endocrinologist and rheumatologist who occupy the same clinic, we often frequently see ourselves needing to refer patients to each other for seemingly interrelated conditions. This makes us all wonder, are diabetes mellitus, forms of arthritis, osteoporosis and obesity somehow related?

Links with the Metabolic Syndrome It is widely known that a condition called metabolic syndrome exists in up to 20-25 percent of the world’s adult population. The consensus worldwide definition by the International Diabetes Foundation published in 2006 for adults states a person must have: Central obesity (defined as BMI of >30kg/m2 or waist circumference of ≥90 cm for South Asian males, and ≥80 cm for South Asian females) Plus any two of the following four factors: a. Raised fasting plasma glucose (FPG) ≥100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes

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b. Raised triglyceride levels c. Reduced HDL cholesterol d. Raised blood pressure Of note, a separate definition for metabolic syndrome has been published for children as young as 10 years old, underlining how early it may occur. It is now clear that insulin resistance and obesity are the major contributory factors to this Syndrome. Gout If one has gouty arthritis, an episodic arthritis with severe painful inflammatory attacks that is related to hyperuricemia (or high uric acid levels in the blood), an individual is 3x more

likely to have underlying metabolic syndrome than patients without Gout. Links between Insulin resistance and hyperuricemia have long been well-established, contributing to this relationship. Osteoarthritis Obesity is of further burden when one has osteoarthritis, a degenerative arthritis that causes joint pains in the knees, hips, finger joints and spine, increasing mechanical loads on weight-bearing joints and increasing risk for worsening. What is most interesting recently is the increased presence as well in the knees of proteins such as adiponectin and

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Osteoporosis Osteoporosis is a condition characterized by decreased bone strength and decreased bone mineral density, which increases a patientâ&#x20AC;&#x2122;s risk for fracture with or without trauma. The link between osteoporosis and obesity is unclear at this time. Patients thought to be obese based on higher Body Mass Index (BMI) seem to develop less osteoporosis. However, patients with obesity based on increased percent body fat especially

Multidisciplinary therapy Clearly based on the above discussion, these diseases are interrelated, often causally. Thus treatment for one may indirectly benefit the other. Obesity treatment requires a good multidisciplinary approach and agreement between the patient, physician and even a nutrition specialist. Combining diet with a type of aerobic exercise one enjoys is still the best approach to treatment initially. Calorie counting and reinforcement of diet is key to sustaining gains. Diabetes therapy has been frequently discussed in this magazine, and must be catered to the individual

around the waist seem to have a higher risk for osteoporosis. Those with more fat in their bone marrows are prone to osteoporosis as well. Patients with obesity also may have lower vitamin D levels, which may also lead to osteoporosis. It is well-known that Type 1 diabetes mellitus patients develop osteoporosis sooner, though the evidence for association is less clear for type 2 diabetes mellitus. Importantly, intake of inflammatory arthritis treatments such as corticosteroids often elevate blood sugars and unmask diabetes mellitus, and are also linked to profound bone loss and osteoporosis.

patient, whether using oral antihyperglycemic agents or insulin. Prevention of wounds in the lower extremities and feet, as well as frequent eye checkups and evaluations of kidney function and the heart as necessary are important adjuncts to treatment. Treatment of acute gout attacks may entail use of ice, elevation and immobilization as necessary, NSAIDs, short courses of corticosteroids, colchicine, and even injections of steroid into the joint affected. Chronic gout is given maintenance antihyperuricemic treatment such as allopurinol or febuxostat if the patient has very frequent attacks, tophi, or

involvement of the kidney. Avoiding prolonged use of oral and IV steroids especially at 7-mg/ day and beyond of prednisone is key to preventing hyperglycemia and osteoporosis. A bone mineral density DXA scan is diagnostic of osteoporosis. If one has osteoporosis, avoidance of falls, intake of 1200 mg of calcium and 800 IU of vitamin D are crucial. Pharmacological treatments include oral and IV bisphosphonates, raloxifene daily, strontium ranelate daily and injections of denusomab every six months. As populations increase in age, diabetes mellitus, obesity, arthritis and osteoporosis become more

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Leptin (hormones released by fat cells), similar to those seen in obesity and in the metabolic syndrome, suggesting clear associations.

and more common problems. Thorough understanding of their interrelationships and early correct treatments are vital to preventing longterm damage, and ensuring better quality of life for our patients! D

References 1. IDF Consensus worldwide definition of Metabolic Syndrome, 2006 2. HK Choi et al, Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2007 3. HK Choi et al, Prevalence of the metabolic syndrome in individuals with hyperuricemia. Am J Med 2007 May 4. Katz JD et al. Getting to the heart of the matter: osteoarthritis takes its place as part of the metabolic syndrome. Curr Opinion Rheumatol 2010 Sept 5. Sowers, MR. The evolving role of obesity in knee osteoarthritis. Curr Opinion Rheumatol 2010 Sept 6. Lagunova Z et al. The dependency of vitamin D status on body mass index, gender, age and season. Anticancer Res.2009 Sept Anticancer Res.2009 Sept

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Holiday weight watching tips By Jocelyn Capuli-Isidro, MD

hristmas is the season of gift giving, merry making and partying. This is also the time of year when we gain the most weight. Because we lack the usual routines of work, and yet the parties that we need to attend are many, this often becomes a season of piling up unwanted calories. People with diabetes are not exclusions to this rule. After a year of strict adherence to diet, at this time of year, they try to loosen up a bit, find an excuse to eat more and slowly deviate from their specified diet. I find more patients skipping their scheduled clinic visit after Christmas because they know that their blood results will show the number of glasses of wine they consumed, the big portions of â&#x20AC;&#x153;lechonâ&#x20AC;? they had in each party and the bowls of fruit salads that they enjoyed. All these significantly result in a five-pound weight gain and around a two-inch increase in their waistlines. Remember, diabetic patients can go on holidays but diabetes cannot! Here are some tips to guide us through this Christmas season.

Tip # 1

Eat your meals as scheduled and avoid going to parties hungry. This way, you can afford to be picky with the food that you want to try.

Tip # 2

When eating at a buffet, survey the scene. Choose the food that you want to eat and always remember the healthy ones. Before going to the main course, try to satisfy your craving with green salad and vinaigrette dressing instead of creambased dressings.

Tip # 5

Continue checking your blood sugars especially during parties. Blood sugar values will be your reminder that you are already exceeding your caloric limits.

Tip # 3

When trying to drink a little alcohol, remember that wine has fewer calories than beer. A shot of white or red wine is fine once a day. As the old trick in the book would say, dilute the wine with low calorie drink such as diet soda or low calorie lemonade. This will allow you to enjoy your drink more with fewer calories.

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Tip # 4

Prepare healthy meals and snacks. Take off the skin of your chicken and remove the fat off your pork dishes. Nibble on roasted nuts instead of creamy pudding or chocolate cookies. Tomatobased pasta has lesser calories than creambased. Add more colors on your table by adding green salads and vegetables in your menu. High fiber diet can make you feel full easily preventing you from indulging in highfat, high calorie foods.

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Burn the unwanted calories by regularly exercising. Despite the laziness during this season, always find time to exercise. Continue brisk walking. Shopping will allow you to burn calories but beware of the tempting snacks around you.

Tip # 7

Always try to space your meals. If you are injecting insulin, try to continue having your small snacks in between the main meals to prevent hypoglycemia. Remember that these snacks should be healthy snacks and not the common snacks for Christmas like fruit cakes, pastries and chocolates.

Tip # 8

Take your medicines on time. If you will eat your dinner at a party, bring your medicine with you and take it as prescribed.

Tip # 9

Allow yourself to have a complete rest after a very busy schedule. This will energize you and prevent you from indulging in sweets thinking that these are better sources of energy.

Tip # 10

Remember that Christmas season is a time of togetherness. Focus your attention on your loved ones and not on food. Spend some quality time with family and friends doing outdoor activities such as ball games, swimming and many more.

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Christmas is a time when we pause for a while and reflect on the blessings that we have received. Let us not forget that the true meaning of the season is sharing and loving one another…sharing through good deeds, togetherness and camaraderie. Let us all enjoy the true meaning of Christmas, diabetic and non-diabetic persons alike, while relishing the festivity of the season. The above tips can guide people with diabetes how to enjoy the holidays without much guilt. Merry Christmas! D

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Diabetes Drugs a nd Weight Loss Lose weight while treating your diabetes By Monica Therese Cating-Cabral MD

or most patients with diabetes, one of the most dreaded pieces of advice heard at every doctor’s visit is – “You need to lose weight.” Diabetes is worsened by being overweight or obese, and for most patients it is a struggle to maintain a healthy weight. Along with diet, exercise, and behavior modification, drug therapy may be helpful in the treatment for overweight or obese patients. The role of drug therapy has been questioned, however, because of

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concerns about drug safety and effectiveness. It has been observed that after initial rapid weight loss, body weight slows and then levels off with continued treatment, and most patients regain weight when their weight-loss drugs are stopped. Remember that the use of these medications should be done under the supervision of a physician. Diabetes Medications Metformin Most patients with

diabetes

have insulin resistance. When food is eaten, our blood sugar rises and the pancreas releases a hormone called insulin. Insulin is the key that unlocks our cells for sugar to get in, which in turn enables your body to use the food you consume. Sometimes the key either gets stuck or has difficulty getting into the lock. Or, if it does get in, it can’t turn the lock, hence the term “resistant.” If the body develops a resistance to insulin, you are not able to utilize the food you take in, which can increase

indepth your fatigue and your cravings for ever-increasing amounts of carbohydrates. Other consequences include the ability to store fat more easily, as well as increases in blood pressure and cholesterol, which can lead to increased fat in the liver. The good news is that there are some medications for diabetes that treat insulin resistance that also help with weight loss. One such medication is metformin. MetforminÂ is commonly the first medication prescribed when the diagnosis of diabetes is made. Being on metformin can lead to a weight loss of about 1 to 2 kg. If it is taken consistently at the recommended dose, the weight loss can even be higher at 4.5 kg, and can be maintained as long as 10 years. Metformin should be taken with meals. It is usually started at a low dose that is slowly increased over a few weeks to the maximum dose. The most common side effects of metformin include a metallic taste in the mouth, mild loss of appetite, nausea, abdominal discomfort, and soft bowel movements or diarrhea. These symptoms are usually mild, short-lived and reversible after lowering the dose or stopping the drug. Some patients may have less symptoms when taking extended release form of metformin.

as subcutaneous injections either Weight-loss drugs once (liraglutide) or twice a day (exenatide). Orlistat Orlistat is a medication that Exenatide alters the way fat is digested. DiWeight loss is commonly seen with etary fats need to be broken down exenatide, about 1.44 kg, with more into smaller pieces before the body weight lost as the dose is increased. can absorb them. Orlistat works Nausea is a common adverse effect by blocking the enzyme that breaks but this is generally mild and wanes down fats in the diet. This undigested over time. This can also be lessened fat then passes out of the body with by lowering the dose of the drug. bowel movements. Orlistat does Weight loss is not solely due to the not block the absorption of calories nausea, although treated patients with from sugar and other non-fat foods, nausea lose substantially more weight so patients still need to restrict total than patients without nausea. intake of calories to maintain weight loss. Liraglutide Together with a healthy diet and The weight loss seen with pa- exercise, taking orlistat can bring tients on liraglutide is about 2.0 to about weight loss of 5 to 10 kg that 2.5 kg. Patients on higher doses can be maintained for up to 3 years. report more nausea and vomiting. Weight regain is also slowed down. Thus, weight loss may be due, in Being on orlistat can also improve part, to these side effects. blood sugar and glycohemoglobin (HbA1c) levels. In patients with pre-diabetes, taking orlistat can decrease the chances of having fullblown diabetes. Orlistat can also improve hypertension and cholesterol levels.

GLP-1 Analogs Glucagon-like peptide-1 (GLP1) is a hormone produced by the gut that sends signals to the pancreas to make more insulin when food is eaten. GLP-1 analogs are medications that act like GLP-1 and these are used to treat patients with diabetes who are otherwise uncontrolled on other oral medications. These medications also slow down the digestion of food in the stomach, which can lead to reduced food intake and weight loss. These are administered DECEMBER-JANUARY 2014

indepth Orlistat is taken before a meal that contains fat, up to 1 hour after a meal, three times a day. Those taking orlistat should also take a multivitamin at bedtime because certain vitamins such as vitamins A, D, E and K need fat to be absorbed and their levels are lowered when taking orlistat. The side effects of orlistat therapy are due to changes in bowel function that occur because of the unabsorbed fat. Patients may have fatty or oily stool, oily spotting, intestinal gas with discharge, a feeling of needing to have a bowel movement right away, increased number of bowel movements, or poor bowel control. These side effects may get worse if patients eat more fat than they should. In very rare instances orlistat can cause liver damage. This can occur suddenly, but again is uncommon. Nevertheless, patients should contact their doctor if itching, yellowing of the skin and whites of the eyes (jaundice), pale color stools, or loss of appetite develop. When fat is not digested this can also cause changes in the way other minerals are absorbed, such as calcium and oxalate, causing kidney stones. Orlistat should also not be used by patients who have a history of calcium oxalate kidney stones.

Although phentermine is a widely prescribed weight loss drug, it is only approved for short-term use (up to 3 months) due to possible side effects. Phentermine can increase heart rate and blood pressure, and as such is not advisable for patients with heart disease, hypertension and hyperthyroidism. Other side effects include insomnia, dry mouth, constipation and nervousness. Being a stimulant drug, it can potentially be misused, and is not recommended for patients with a history of drug abuse.

Lorcaserin Another medication used for helping with weight loss is lorcaserin. It is used in patients who are obese or overweight who have other medical problems such as diabetes, high blood pressure and high cholesterol. Weight loss with lorcaserin is about 3-4 kg, when combined with a reduced-calorie diet and exercise. Obese patients have been shown to lose about 5% of their weight, but once the medication is stopped it is possible to gain the weight back within the next two years. Lorcaserin works via serotonin, a substance that helps send signals throughout the brain, controlling mood, sleep and appetite. Locaserin reduces Phentermine hunger, bringing about less food Phentermine is a type of stimu- intake and thus weight loss. Adlant medication that is used for the verse effects are generally mild treatment of obesity. On this medi- and these include headache, upcation patients feel full sooner, and per respiratory infections, dizzithis decreases the amount of food ness, and nausea. If 5% of body that is eaten, leading to weight weight has not been lost after loss. Patients can lose 0.23 kg (0.5 taking it for 3 months, the medipounds) a week, but this slows when cation should be stopped. Lorthe medication is stopped, then re- caserin should be not be used sumes when it is taken again. by patients with more advanced

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kidney and liver disease. Lorcaserin may also interact with other medications, so patients should inform their physician of all their other medications, including herbal ones, before starting. Hope in a pill? Unfortunately there is no one â&#x20AC;&#x153;magic pillâ&#x20AC;&#x2122; that can bring about weight loss. The good news is that together with a healthy diet and increased physical activity, these medications can give obese and overweight patients with diabetes a head start. D

References: 1. www.uptodate.com 2. http://www.huffingtonpost.com/susan-b-dopartms-rd/weight-loss-tips-are-your_b_598250.html 3. Garber AJ. Metformin: mechanisms of antihyperglycemic action, other pharmacodynamic properties, and safety perspectives. Endocr Pract. 1997 NovDec;3(6):359-70. 4. http://www.webmd.com/drugs/drug-17220orlistat+oral.aspx

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“Diet Supplements: Are We The Biggest Loser?” By Karla Silverio-Fernando, MD

ith the advent of fast foods and modern technology, wherein almost everything can be done with the “push” of a touchscreen, it is not surprising that obesity has now become an epidemic. Eating calorie-rich food and upsized servings have become the norm, coupled with sedentary lifestyle encouraged by modern gadgets. When it comes to losing weight, most people want shortcuts and instant results as well. This is why a lot of diet pills and weight loss supplements have become popular – they promise weight loss with minimum effort. They also claim to have no side effects since most of them are “natural”. But is there any truth to their claims? Are supplements and herbs really as effective and safe as they say? Let us take a look at some of the common weight loss supplements available in the market today.

1. L-carnitine We see this incorporated even in some drinks that are being promoted for weight loss. Lcarnitine is a molecule that allows the cells to break down fat and get energy from the stored fat reserves. Because of this action, it has been proposed as a treatment for weight loss. Available studies however show that L-carnitine does not seem to have a significant effect. In a small study done by RG Villani and colleagues in 2000 on the effect of L-carnitine supplementation in obese women, there were no differences in the total body mass as well as fat mass between subjects who took 2 grams of L-carnitine per day and those who did not. Furthermore, some subjects who took L-carnitine experienced nausea or diarrhea.

2.Chromium This is an essential trace element that seems to enhance the effects of insulin and lower glucose levels in some patients, especially those with chromium deficiency. It is often seen as part of supplements being promoted to help diabetes. Some say that taking chromium picolinate for 2 to 3 months may also produce a small weight loss of about 1.1 kg, but most clinical studies show no significant effect. The proposed mechanism of weight loss is decrease in appetite and increase in calories burned. However, there is a lack of good scientific evidence to support this. Uncommon adverse effects of chromium include headache, insomnia, irritability, mood changes and cognitive dysfunction. 3. Bitter orange (citrus aurantium) Bitter orange peel is used to imDECEMBER-JANUARY 2014

indepth prove appetite, and ironically, it is also used for weight loss. The proposed mechanism for this is an increase in metabolism, thus increasing calories burned. It was thought to be a safer alternative to Ephedra, a weight loss supplement that was banned due to its cardiovascular adverse effects. While some evidence for weight loss is promising, it doesnâ&#x20AC;&#x2122;t seem any better than Ephedra with regards to safety. This supplement can increase your heart rate and blood pressure and is therefore not recommended especially for those with hypertension and/or heart problems. The combination of bitter orange and caffeine is frequently seen in weight loss and bodybuilding products, and this can cause high blood pressure and increased heart rate even in healthy adults with otherwise normal blood pressure.

b. Whey protein This supplement is commonly found in health stores, used mainly for building muscles. However, it is also found to suppress appetite and is thus promoted for weight loss. c. Beta glucan This is a soluble fiber derived from yeasts, mushrooms, and algae. It is said to lower cholesterol and promote weight loss probably by reducing fat absorption. d. Glucomannan This fiber is derived from an Asian plant called Konjac, and is said to be effective for sugar control and weight loss. It helps absorb water in the digestive tract, reducing cholesterol and carbohydrate absorption.

5.Conjugated linoleic acid (CLA) CLA occurs naturally in small amounts in dairy products and red meat. It was proposed to be beneficial for obesity, diabetes, and cholesterol problems. A small study by MA Belury et al showed that CLA is inversely correlated with weight. However, subsequent larger studies on the role of CLA on obesity and metabolism showed conflicting results. In several studies, administration of CLA for 12 weeks has been reported to decrease body fat mass, but with no changes in body weight, cholesterol, or glucose metabolism. Furthermore, there were several human studies that showed detrimental effects of CLA on lipids and glucose metabolism. Based on the available data, the use of CLA a. Chitosan for the management of obesity or This is a fiber that comes from chi- diabetes is not recommended. tin, the main component in the shells of insects and crustaceans. It has 6.Green tea extract been promoted as a type of dietary This is said to decrease appetite fiber that may help reduce absorption while increasing calorie and fat meof fats. tabolism, thus increasing the use of

4. Fiber Fiber helps you lose weight by making you feel full, thus making it easier to control the amount of food that you eat. It does this by delaying gastric emptying and staying in the stomach longer. Although taking an appropriate amount of fiber can be good for you, taking too much can cause constipation and even gastrointestinal obstruction. When taking fiber supplements, be sure to add fiber to your diet slowly and to drink plenty of water. In general, evidence for the effectivity of fiber in weight loss is still lacking. Some of the weight loss supplements that act as fiber are discussed below:

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energy. However, current evidence to support this is still lacking. The components in green tea extract that have shown some effect on lowering body weight are catechins, caffeine and theanine. Adverse effects include dizziness, insomnia, agitation, nausea, vomiting, bloatedness and diarrhea. 7. Meal Replacements This is probably the weight loss supplement with the best scientific evidence. Choosing a low-calorie, nutritious diet in our current environment that offers a surplus of palatable, energy-dense, nutrient-poor food choices can easily push anyone to obesity. Meal replacements are a good option since they contain a known energy and macronutrient content. They are therefore a good strategy to eliminate problematic food choices or complex meal planning. Several studies have shown equivalent or greater weight loss with structured meal replacement plans compared to low-calorie diet treatments. The American Dietetic Association recommends substituting one or two daily meals or snacks as a successful weight loss and weight maintenance strategy. Meal replacements are sold in most pharmacies and health stores in the form of bars and shakes. 8. HCG Human chorionic gonadotropin is a hormone produced by the human. Approved indications for the use of HCG include treatment of select cases of female infertility and hormone treatment in men. FDA-approved HCG products are only available in injection-form and require a prescription. Currently, there are no FDA-approved HCG drug products for weight loss since there is no substantial evidence that HCG

indepth increases weight loss. Additionally, increasing the blood levels of serothe labeling for the “homeopath- tonin and catecholamine). Adverse ic” HCG products states that each effects of Bangkok Pills include inproduct should be taken in con- creased heart rate, palpitation, irjunction with a very low calorie diet regular heart rhythm, chest pain, (VLCD) thus putting consumers at tremors, anxiety, insomnia, fatigue, increased risk for side effects includ- drowsiness, dehydration, nausea, ing gallstone formation, electrolyte vomiting, seizures, stroke, or even imbalance, and heart arrhythmias. death. The US FDA banned this A VLCD should only be used under anti-obesity drug in September 15, proper medical supervision. 1997. There are two supplements from 9. Bangkok Pills, Emagrece Sim, Brazil that also gained popularity esand Herbathin pecially in the United States, namely We should also be careful about Emagrece Sim (or Brazilian diet pill) weight loss supplements that are ac- and Herbathin dietary supplement. tually a concoction of several sub- These, however, have been shown stances, some of which might be un- to contain prescription drugs such safe. Some of these substances are as Chlordiazepoxide (anti-anxiety), actually prescription or restricted Fluoxetine (anti-depressant), and drugs. An example is the Bangkok Fenproporex (a stimulant that is Pills that became very popular sev- c o n v e r t ed in the body eral years ago. These pills contain bisacodyl (a laxative), furosemide (a diuretic), phentermine (raises levels of the hormone leptin, causing appetite suppression), and fenfluramine (an appetite suppressant that acts by

to amphetamine, the family of shabu). In 2006, the US FDA issued a warning to consumers not to take these diet pills. This review of weight loss supplements shows us that over-the-counter doesn’t mean risk-free. Most aren’t supported by good scientific evidence, and some may even be dangerous. Dietary supplements aren’t subject to the same rigorous standards as are prescription drugs. They can therefore be sold with limited proof of effectiveness or safety. So the next time you walk into a health store or search online for the perfect diet supplement, you might want to check out the label and do a little research. And while you’re at it, you might want to do a little dieting and exercising as well… you might just find Dyour perfect solution to weight loss.

References: Villani RG et al. L-Carnitine supplementation combined with aerobic training does not promote weight loss in moderately obese women. Int J Sport Nutr Exerc Metab. 2000 Jun;10(2):199-207. Belury MA, Mahon A, Banni S. The conjugated linoleic acid (CLA) isomer, t10c12-CLA, is inversely associated with changes in body weight and serum leptin in subjects with type 2 diabetes mellitus. J Nutr 2003; 133(1):257S-260S. Over-the-counter weight-loss pills: Do they work? www.mayoclinic.com New Weight Loss Supplements With Top Scientific Ratings. www.forbes.com,Proven Weight Loss Supplements: Which weight loss supplements really work? www.webmd. com,Chua, Philip S. Health@Heart. www.thenewstoday.info, Position of the American Dietetic Association: Weight Management. J Am Diet Assoc. Feb 2009; 109(2), pp. 330-346.FDA website. www.fda.gov, Endotext website. www.endotext.org, UpToDate website. www.uptodate.com

DECEMBER-JANUARY 2014

righteousrecipes

Festive Dishes for the Holidays

By Chef Junjun de Guzman

Photos By Jose Martin Punzalan

t's the holiday season once again and it means reunions, Christmas parties and non-stop eating. But for the health conscious, fear not as you can try these three recipes without the guilt.

DECEMBER-JANUARY 2014

righteousrecipes

Seafood In Olive Oil Pasta Nutrition facts per serving: 570.55 calories 24.04g fat 49.5g carbohydrates 39.88g protein

Serves 6 persons Preparation Time: 30 minutes Cooking time: 10 minutes

Ingredients:

Procedure:

½ cup extra virgin olive oil 3 tbsps minced garlic ½ cup canned pimientos, chopped ½ cup canned mushrooms, sliced thinly 1 cup shrimps, blanched and peeled 1 cup fish cubes, blanched ¾ cup clams, blanched and remove from shell ¾ cup mussels, blanched and remove from shell ¼ tsp salt 1 tsp ground black pepper 500 gms spaghetti or linguine pasta, cooked al dente

1. Heat extra virgin olive oil in a large pan, sauté garlic and cook until aromatic. 2. Add in pimientos and mushrooms. 3. Add in blanched seafood and toss well. 4. Add more olive oil and simmer. Season with salt and pepper. Add in cooked pasta and serve immediately.

DECEMBER-JANUARY 2014

righteousrecipes

Chicken Relleno Loaf Nutrition facts per serving: 151.14 calories 5.05g fat 10.9g carbohydrates 13g protein

Serves 6 persons Preparation Time: 30 minutes Cooking time: 45 minutes

Ingredients:

Procedure:

300 gms ground chicken 2 pcs sliced bread, cubed cup fresh milk (lowfat) ¼ cup finely chopped onions cup finely chopped carrots 3 tbsps finely chopped celery 2 pcs smoked turkey ham, finely chopped ¼ cup pickle relish, drained 1 pc egg 1 tbsp all purpose flour ¼ tsp ground pepper

1. Heat extra virgin olive oil in a large pan, sauté garlic and cook until aromatic. 2. Add in pimientos and mushrooms. 3. Add in blanched seafood and toss well. 4. Add more olive oil and simmer. 5. Season with salt and pepper. 6. Add in cooked pasta and serve immediately.

DECEMBER-JANUARY 2014

righteousrecipes

Brown Rice And Vegetable Paella Nutrition facts per serving: 122.37 calories 8.47g fat 12.8g carbohydrates 2.91g protein

Serves 8 persons Preparation Time: 40 minutes Cooking time: 45 minutes

Ingredients:

Procedure:

¼ cup 1 tbsp ½ cup 1 tbsp ¼ cup 2 tbsps 2 tbsps ½ cup 1½ -2 cups 1 ½ cup ½ cup ½ cup ½ cup ½ cup 1 cup

1. Soak brown rice in water for 2 hours 2. In a wide pan that will fit almost 4 cups of rice, sauté garlic and onions in extra virgin olive oil. 3. Cook until onions are translucent. 4. Add in paprika and cook for a minutes. 5. Add in bell pepper, celery, carrot and kalabasa. 6. Cook until lightly browned. 7. Add in water and boil. 8. Simmer then add in brown rice. Cook for 20 minutes. 9. Add water if needed. When rice is cooked, add all the other vegetables on the top of the rice. 10. Cover with foil and continue cooking for 10 minutes. 11. Serve while warm.

extra virgin olive oil minced garlic chopped onions Spanish paprika chopped red bell pepper chopped celery chopped carrots cubed kalabasa water brown rice broccoli, top only cauliflower, top only eggplant, sliced zucchini, sliced asparagus tips

DECEMBER-JANUARY 2014

goodfoodguide

DECEMBER-JANUARY 2014

goodfoodguide

Recipe from food.com

DECEMBER-JANUARY 2014

goodfoodguide specialadvertisingfeature

Have a Guiltless Christm as with Herbalife

o know how to manage your diet and to live this Christmas season guilt-free, a round table discussion conducted by Herbalife, a global nutrition company, transpired last November 12 at Chateau 1771 in Greenbelt 5, Makati City. Fitness Coach Chappy Callanta was the main speaker for the event. He shared tips on how to manage your diet this holiday. “During the holidays we feel that we have the right to binge since it’s that season once more,” he says. “But in reality, our body really doesn’t care if it’s Christmas or not. With that in mind, just be mindful of what you need to do to be able to maintain a healthy lifestyle. Be conscious and be aware as well.” He added that if it’s an intimate gathering, you can tell the host about your condition and take

DECEMBER-JANUARY 2014

the initiative to tell them what you should eat and not. “As a rule, anything in excess is bad so live everything in moderation,” says Callanta. He also dished out five ways to manage your diet during the holiday. First, follow your daily caloric limit. “There are daily websites nowadays that can help you calculate your daily caloric intake,” he says. “So this is based on your height and your weight and your activity level. If you go through these websites, you can also input a goal and what you want to achieve with your weight.” Second, know the calorie cost of your food. “What I do, I always equate it with exercise,” he says. “For example, 200 grams leche flan equals 30 minutes circuit training; 300 grams crispy pata is one hour run at 8 kmph; and 1 serving of lechon is 20 minutes skip rope.” Third, exchange sweets with fruits. Fourth, follow this quick routine before a heavy meal: 30-second planks, 20 air squats, 20 push-ups, and 10 lunges per side. Lastly, exchange meals with a low calorie nutritional shake. Herbalife’s Formula 1 Nutritional Shake Mix serves as a nutritionally balanced meal with up to 20 vitamins, minerals and essential nutrients. It also has a low glycemic index, contains 8 grams of soy protein, and only 80 calories. “Whenever you go to a party, just go back to the basic rule of moderation,” says Callanta. “Working out can also help you as well as taking supplements.”

goodfoodguide

DECEMBER-JANUARY 2014

productspotlight

Drinking Grass By Michaela Sarah De Leon

rass as part of a diet is not a curious idea anymore. In fact, grasses – like wheatgrass and barley grass – might just be what you need for a healthier lifestyle.

Grasses with fancy names like wheatgrass and barley grass are finding their way into your diet. While most cringe at the idea of eating grass like a cow, the promise of nutrient explosion is worth a second look. Wheatgrass is a concentrated source of vitamin A, C, and E, iron, calcium, magnesium, and amino acids. It promises improvement in sugar disorders like diabetes, prevention of tooth decay and bacterial infections, and helping in wound healing. Meanwhile, it’s less popular cousin, barley grass, is packed with chlorophyll, vitamins, minerals and antioxidants. Among disorders it can help prevent are diabetes, heart diseases, hypertension, inflammation, and (surprise!) insomnia. We look at three grass-based food supplements available at many drugstores.

Grass #1 : Easy Pha-Max Wheatgrass Powder Easy Pha-Max is the easiest to find among the three products featured here. It comes in three forms: powder, capsule, and can, and contains basically powdered wheatgrass. Mixed with water, Easy Pha-Max’s consistency and texture is just right. Its regular variety’s grassy taste borders on herbal. For a sweeter version, try Pha-Max’s Wheatgrass Honey. While most sweeteners mixed with grassy

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undertones usually ruins taste, *Wheatgrass Honey does not. Of the three products featured here, Pha-Max variety of wheatgrass drinks are not as in-your-face. It’s the most simple of the three. It won’t overwhelm a first-time wheatgrass flavor although it does not leave the same level cleansing feel that the others leave. In fact, it tastes a little like regular powdered iced tea.

productspotlight

Grass #2: Green Fit Dietary Supplement Powder Green Fit looks, tastes, and feels overwhelming. It’s dark green before and after mixing in water. The smell is a strange mix of sweet and grassy; however, the same scent does not reflect in the taste. The consistency is almost jelly-like thanks to the Psyllium fiber mixed in the powder. The very powerful taste is a mix of berry, herb, and grass that could overwhelm the taste buds. Unlike Pha-Max which is comfortable in its simplicity, Green Fit is mixed with apple

powder, oat powder, oil palm fiber (contains lignin), oligosaccharides (simple sugars), psyllium seed husk, wheatgrass powder, spirulina, alfalfa chlorophyll, and aloe vera. Too many flavors are fighting for attention in every gulp. For its setbacks in taste, Green Fit makes up with additional nutrients and fiber. Green Fit is not for the faint of heart, but it’s for grassdrinkers who are looking for more in their supplements.

Grass #3: Herb All Organic Barley Powdered Drink Compared to Pha-Max and Green fit, Herb All Organic Barley Powdered Drink is almost tasteless. It tastes like Pha-Max Wheatgrass Honey only not as flavorful. Its consistency is watery and smooth. It’s the only grass

drink supplement featured here that’s mixed with nondairy creamer, which explains why the color of the drink is whitish-green. Its sweet taste comes from the maltodextrin, an oligosaccharide that’s used as a food additive. D

DECEMBER-JANUARY 2014

livingwell

My Sugar Buddy By Excel Dyquiangco

iabetes can’t be fought alone. It’s an illness that needs and breathes “community”. It’s a condition that should be surrounded by friends and family who work together to combat and wage war against the dreaded malady.

Fortunately as more and more people are now becoming aware of the complications and what to do to maintain that healthy lifestyle, there is a group that is devoted to keeping the patients fit, strong, and aware: Sugar Buddies. “Sugar Buddies is composed of people with diabetes,” says Ferdinand Lentejas RN, facilitator and Diabetes Nurse Educator at the Asian Hospital

and Medical Center (AHMC). He is in charge of coordinating speakers and the program for the events of Sugar Buddies. “The organization was conceptualized by Dr. Ivy Amante and other doctors from AHMC and its purpose is to help patients manage their diabetes and inform them of what the disease is all about – complications, preventions and others.

DECEMBER-JANUARY 2014

Patients need to manage and control their sugar levels, of course.” Started in August 2009, Sugar Buddies whose name comes from the terms sugar and buddies (because patients and doctors need to nurture each other and work together) has now grown to around forty people and has included lectures and fora in their programs. During these

times, the patients also have their blood sugar levels checked. The group is composed of patients from the AHMC but those from other hospitals are also welcome. But since this is a doctor-patient relationship, it is highly advised that patients should come from the AHMC since their doctors are there working with them them.

livingwell The Programs of Sugar Buddies Since the celebration of Diabetes Awareness Week in 2011, Sugar Buddies has started joining dance competitions to show that one should be physically fit to maintain a healthy lifestyle. These events were participated in by other support groups, and diabetes clubs, as well as the organizations caring for diabetes patients. The next year, they joined another competition. And just last July, they bagged the championship award. Sugar Buddies also conducts for a every quarter to inform diabetes patients how to manage the disease. The purpose of this is to also let them – and their caregivers - be aware of the complications if sugar level rises way beyond expectations. Other activities and programs include the checking of blood sugar levels for free (at least every month) and joining healthy and fit competitions outside the Asian Hospital such as the recent Diabetes Awareness Week campaign led by the Diabetes Center Philippines in Pasig entitled I-Zumba Mo ang Diabetes Mo where participants were made to showcase their dance exercise prowess via zumba.

Sugar Buddies has also embarked on fund raising projects to finance its programs and activities. How is Sugar Buddies different from other support groups for people with diabetes? “They actually complement each other,” says Lentejas. “Just like other support groups, the doctors of the Asian Hospital encourage the patients to join Sugar Buddies so that they would become more aware of what to do when they have diabetes. Our purpose is just to inform – and to educate.” As for the future programs of Sugar Buddies, eventually next year after the reorganization of Sugar Buddies, there would be many more activities in which the patients could participate. For people who have diabetes, Lentejas has this advice: “Learn about the disease first. Educate yourself because awareness is the key. You’d know what to do, what to eat, what not to eat, and even what to avoid. It is really helpful if you are aware of the disease.” Those who would like to become a part of Sugar Buddies can visit and drop by the Asian Hospital Diabetes Education Center. There is a minimal fee for the identification card and everything else comes free. D

Learn about the disease first. Educate yourself because awareness is the key. You’d know what to do, what to eat, what not to eat, and even what to avoid. It is really helpful if you are aware of the disease DECEMBER-JANUARY 2014

stressbuster

‘Tis the season to be jolly How to beat the holiday stress By Mylene C. Orillo

oliday season is supposed to be fun and relaxing. But let’s admit, more often than not, holiday season becomes one of the sources of stress and/or misunderstanding between families, relatives, and friends. So here are some ways to beat the holiday stress: Remember the reason for the season. Most people stress themselves for the wrong reasons. Let’s re-think why you are celebrating Christmas – that is to celebrate the birth of Jesus Christ. So why fuss over expensive gifts or elaborate decorations when you should be honoring Jesus Christ? And the best way to honor Him is to attend church service, give thanks, or share your blessings by doing charity work.

Consider ‘potluck’ in family celebrations. If your family has been used to yearly reunions or gatherings, don’t stress yourself by cooking

all the meals. Make them participate. List all the food items and assign each one to a family member. Don’t stress yourself by taking all the responsibility. After all, it is a family occasion, so make them responsible, too. Delegate. Assign a committee on food, programs, physical arrangement, or entertainment so you won’t have to do the job all by yourself. Knowing that they are part of the preparation will encourage them to be more creative and participative. Who knows, they may even do the preparation for next year’s event?.

DECEMBER-JANUARY 2014

Avoid last-minute shopping. In case you really need to buy gifts for Christmas parties, for your nieces, nephews, sisters, brothers, or godchildren, shop as early as you can. Stop putting off for tomorrow what you can do today. Make a list of people you intend to buy gifts for so you won’t stress yourself by being stuck in long queues and traffic jams.

4 5

Exercise. Eating is not an exercise. If your clothes won’t fit anymore, then that’s one source of stress. So don’t postpone that “I’m going to go tothe gym or run everyday” resolution you

always make every year. Do it today. Start today. Remember, it’s harder to lose weight than gain weight. Holidays are not an excuse to skip thetreadmill or hit the road. Keep it sweet and simple. Don’t focus on just the physical aspects of the celebration, but take into consideration the emotional side or the experience. It’s the moments that count, not how detail-oriented or elaborate you are when it comes to your preparations, decorations, or menus. Keep your cool and stay positive that everything will turn out well.

Lastly, thank God and share your blessings. Now is the best time to do these things. After all, you are more blessed than the people in typhoon-affected areas so instead of stressing yourself with your relatives or friends who can afford gifts, why not give back to the needy or the poor? These people may not be able to give you something back but at least, your efforts will be much appreciated. Remember, it’s better to give than to receive. D

dosanddon’ts

Healthy holiday eating By Jose Martin Punzalan Reviewed By Joy Arabelle Castillo Fontanilla, MD

ne of the best things about Christmas holiday celebrations is the food. This is when everything delicious and special gets served. For people with diabetes who always need to be watchful of what they eat, they can still enjoy the feast with their loved ones by following these simple precautions for eating during the holidays:

DO’S Focus on friends and family instead of food. If you want to get away from the temptation of eating, go and catch up with your relatives and loved ones, play with the kids, help out with the chores, etc. Just do something else to get your mind off the food for a while.

after all have high calorie content. One drink for women and two for men is enough (One drink equals a 5 oz glass of wine, a 12 oz bottle of beer or 1 ½ oz of vodka, whiskey or gin).

IIlustration by Donna I. Pahignalo

Bring your own food. The food served in the banquet is likely to not be diabetes-friendly so instead of having to stop yourself from enjoying the food, bring something to the table that you know is good for you. This way, you also get to contribute something healthy to the feast.

Get back on track. The holiday season is nonetheless a time to relax and enjoy. You don’t need to be too strict with yourself regarding diet and exercise. Allow yourself some time to indulge particularly with food but do remember to make up for it. Just get back to your usual eating habits the following day and spend some extra time and effort on physical exercise. Ask your doctor, too if you need to adjust your medication for when you do indulge.

Eat before drinking alcohol. This will ensure that your body has the energy it requires and prevents blood glucose levels from suddenly dropping. And of course, drink in moderation. Alcoholic beverages

Don’t overeat. Do enjoy the available food especially the ones you rarely get to try but never

lose track of your carbohydrate consumption. If you want to eat more of a certain dish, just cut back on eating other meals. Eat in reasonable proportions, making sure to eat slow and savor the dish. This will stop you from eating too much too fast. Don’t skip meals. Skipping earlier meals to give your body more room for calories and carbohydrates for the dinner feast is not a good idea. Coming in hungry will just increase your tendency to overeat. This will also make it more difficult to control your blood glucose. Don’t stop exercising. It’s easy to just want to bum around during the holidays, but a better way to spend your free time is to do more physical activity, or at least maintain your regular routine. Even just doing regular chores is enough. This way, you get to keep your weight and sugar levels in check. D DECEMBER-JANUARY 2014

dosanddonâ&#x20AC;&#x2122;ts

Wastong pagkain sa kapaskuh an Isinulat ni Jose Martin Punzalan Pinamatnugutan ni Joy Arabelle Castillo Fontanilla, MD

sa sa mga bagay na ikinagagalak tuwing pasko ay ang pagkain. Ito ang panahon kung kailan lahat ng masasarap at espesyal ay inihahain. Bagamat kailangang magingat sa pagkain ang mga may diyabetes, maaari pa rin nilang matamasa ang sarap ng pagkain basta sundin ang mga gabay na ito:

Magbaon. Malaki ang posibilidad na ang pagkain sa handaan ay hindi angkop para sa mga may diyabetes. Maaari kang magdala ng pagkain na hindi lamang angkop at katakam-takam para sa iyo, makapag-aambag ka pa ng masustansiyang pagkain sa handaan. Kumain bago uminom ng alak. Ito ay isang paraan para masiguro na ang iyong katawan ay may sapat na lakas at sustansya para hindi bumagsak nang bigla ang iyong asukal sa dugo. Uminom lang ng katamtamang dami lalo paâ&#x20AC;&#x2122;t mataas

DECEMBER-JANUARY 2014

Bumalik sa tamang landas Ang kapaskuhan ay panahon ng pagpapahinga at pagsasaya. Hindi kailangan maghigpit nang labis sa iyong diyeta. Ok lang na mapasarap sa pagkain ngunit siguraduhing bumalik sa wastong diyeta pagkatapos ng handa at kasiyahan. Magtanong din sa iyong doktor kung kailangang baguhin ang dosis ng gamot tuwing mapaparami ang kain. Magdagdag din ng oras at sikap sa inyong ehersisyo para makabawi sa iyong mga kinain.

Huwag lumamon. Lasapin ang pagkain na bihira mong matikman ngunit huwag kaligtaang sukatin ang dami ng iyong carbohydrates.

Kung gusto mong damihan ang isang putahe, magbawas ka nalang sa iba. Kumain nang mabagal at katamtamang dami para malasap ang pagkain. Huwag magliban sa pagkain. Hindi maganda ang pag-iwas ng pagkain sa umaga para makarami sa handaan sa gabi. Mapapalamon ka lalo at mahihirapan kang kontrolin ang iyong asukal sa dugo. Huwag huminto sa pag-ehersisyo. Madaling magpakatamad tuwing bakasyon ngunit mas mainam na gamitin ang oras upang magehersisyo. Marahil kahit karaniwang gawaing bahay ay sapat na. Sa ganitong paraan, mapapanatili mo ang malusog na timbang at antas ng asukal sa dugo. Masarap sanang kumain lang nang kumain na walang pakundangan. Ngunit kung mag-iingat sa kakainin, mananatili tayong malakas at malusog para mas magsaya pa sa panahon ng kapaskuhan. D

IIlustration by Donna I. Pahignalo

Makihalubilo muna bago kumain. Para maiwasan ang tukso ng pagkain, makihalubilo muna sa inyong mga kamag-anak o kaibigan, makipaglaro sa mga bata, tumulong sa paghahanda o mga gawaing bahay, at iba pa. Maging abala sa ibang bagay upang mapalayo ang isip sa pagkain.

ang calories ng alak. Tama na ang isang inuming may alkohol para sa mga babae at dalawa naman sa mga lalaki (Ang isang inumin ay katumbas ng isang baso (5 oz) ng alak, isang bote (12 oz) ng beer, o 1 Â˝ oz ng vodka, whiskey, o gin).

affairstoremember

DECEMBER-JANUARY 2014

affairstoremember

“Diabetes League” launched in Manila

anila -- Last October 7, pharmaceutical company Eli Lilly and Company, in partnership with the Department of Health (DOH), the NBA Indiana Pacers, and different medical organizations, launched “Diabetes League”, a campaign on diabetes prevention and control. The said movement is also aligned with the DOH’s “Pilipinas Go4Health” campaign, which aims to prevent and control non-communicable diseases through healthy lifestyle. Eli Lilly Philippines President and General Manager Reynaldo Dela Cruz, Jr. explained that they chose the Indiana Pacers since Eli Lilly and Company is an Indianapolis-based company. Moreover, the said basketball team advocates healthy lifestyle to fight diabetes. Lilly Philippines noted that the launch of “Diabetes League” symbolizes the need for everyone – Lilly employees, MDs, patients, caregivers and the government, to stand united against diabetes. According to World Health Organization, 80 percent of diabetes deaths occur in low- and middle-income

countries. It was estimated that in 2011, about 5 million Filipinos suffered from diabetes. The National Epidemiology Center, meanwhile, stated that the number of deaths due to diabetes grew fastest among all diseases between1999 to 2005. The IDF Diabetes Atlas (2011) revealed that globally, the incidence of diabetes is expected to grow by 51 percent in 2030. Also present during the launch were representatives from the American Association of Clinical Endocrinologists Philippine Chapter, Diabetes Philippines, Institute for the Studies on Diabetes Foundation, Philippine Society of Endocrinology and Metabolism, Philippine Society of Pediatric Metabolism and Endocrinology and the Diabetes Center Philippines (aka Philippine Center for Diabetes Education Foundation). Ma. Cristina C. Arayata D

DOH officials, Lilly Phils, general manager, medical society partners and the NBA Indiana Pacers (Photo from NBA Indiana Pacers’ website)

Diabetes Philippines holds Gimik Diabetes Year 7

Participants in the annual Gimik Diabetes together with the speakers

DECEMBER-JANUARY 2014

n celebration of the World Diabetes Day, Diabetes Philippines gathered doctors and diabetes clubs last November 16 for the annual Gimik Diabetes convention held at the Star Mall in Mandaluyong City. With opening remarks by Diabetes President and Chairman Dr. Richard Elwyn Fernando, topics for this year’s lay convention included stem cell therapy, foot care, nephropathy and the role of vitamins in diabetes care. This year’s speakers included Dr. Melanie Duran, Dr. Rosa Mia Balolong, also a registered nurse, Ms. Imelda Cardino, and Dr. Khristine Llave. Following the question-and-answer segment, three winners were given new glucose meters from Abbott Philippines. Sponsors Novo Nordisk, LRI-Therapharma, and Bayer were also present. Alexa Villano D

affairstoremember

PSEM says stem cell not standard cure for diabetes

he Philippine Society of Endocrinology and Metabolism (PSEM) warned patients that stem cell therapy is not yet scientifically proven for treating diabetes. In a forum held last October 22 at the Annabel’s Restaurant in Quezon City, members of the organization declared that stem cell therapy is still at an experimental stage for Type 1 and Type 2 diabetes. “There is as yet, no conclusive evidence that stem cell therapy is effective and safe for diabetes and as such, it cannot be made available to individuals with diabetes as a standard treatment like the usual drug prescriptions. Stem cell can only be given to individuals with diabetes under controlled conditions such as, under experimental protocols of clinical trials,” said Dr. Cecilia Jimeno, PSEM President. According to the Food and Drug Administration (FDA) Circular No. 2013-020, dated August 13, only hematopoietic stem cell transplantation, corneal resurfacing with limbal stem cells, and skin regeneration

Left to right: Dr. Aurora Macaballug, Dr. Gabriel Jasul, Dr. Cecilia Jimeno, Dr. Leillani Asis

with epidermal stem cells for burns are the three standards of health care that are generally recognized by the FDA. Dr.Jimeno also disseminated Memorandum Circular No. 2013-017 which enumerated the requirements and the standards on safety and efficacy of Human Stem Cellbased Products. “Stem cell provides medical practitioners an innovative approach to restore health and offers the patients alternative choices. However, the promise of stem cell therapy must be backed by science- and evidence-based medicine, before it can be part of the standard health care. Any clinical use of stem cell products outside of the FDA-approved indications is illegal,” Dr. Jimeno added. Also present at the forum on stem cell therapy and diabetes were Dr. Leilani Mercado-Asis, Dr. Aurora Macaballug, and Dr. Gabriel Jasul. Alexa Villano D

Diabetes awareness event held at Trinoma

DiabetEASE mascot AntamEASE hams it up

iabetEASE magazine recently held the third edition of the Sweet Escape series (a minifair that promotes diabetes awareness) last November 12, at the Trinoma Activity Center. Dubbed as “Sugar Crush”, the event aimed to inform individuals about ways to combat and prevent diabetes and pre-diabetes, through various activities and lectures. Dr. Rodolfo Florentino of the Philippine Association for the Study of Overweight and Obesity kicked off the event by discussing the importance of exercise as a tool to keep fit and as a form of medicine followed by a raffle draw. The afternoon session resumed with Dr. Lermah Bunoy of the Philippine Society of Endocrinology and Medicine with a lecture entitled Diabetes and Your Health. Jennina Duatin, a nutritionist from the Philippine Association of Diabetes Educators discussed the importance of eating right, giving the audience a food chart and the calories each food contains. A diabetes DECEMBER-JANUARY 2014

affairstoremember management talk was also delivered by Dr. Therese Marie Faller courtesy of Sanofi which introduced its state-of-theart glucose meter, BG Star. Capping off the afternoon was the launch of DiabetEASEâ&#x20AC;&#x2122;s 8th anniversary issue, featuring Azkals mainstays Phil and James Younghusband. The two actively pursue a healthy lifestyle for their football career, and health, having lost their mother from diabetes complications in 2011. D

Emcee Godfrey Santos and DiabetEASE editor-in-chief Dr. Joy Fontanilla with one of the raffle winner

doodles&dreams

DECEMBER-JANUARY 2014

The DiabetEASE 8th anniversary issue cover