DiabetEASE June-July 2014 by Dan Cisneros

JUNE-JULY 2014

CONTENTS

behindthescenes

COVER STORY AND FEATURES

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Eating Sexy The new redefined way to getting sexy is through eating healthy. Not only does it promote a good figure, but it also caters to people with medical conditions. Mylene C. Orillo finds out why The Sexy Chef is just perfect for people with diabetes.

The Obsina Sisters: From Losers to Dreamers

While they ended their journey early in the Biggest Loser Pinoy Edition Doubles, Obsina sisters Dianne and Tin continued their quest to become fit. Candice Monique O. Brillon writes about how the sisters gained new perspective on being fit and beautiful.

At the Office of Senator Sonny Angara He dons different hats in a day—as son, father, senator, and advocate. Sen. Sonny Angara defies the odds of being young in an arena of veterans as he envisions a healthier Philippines. Gelyka Ruth R. Dumaraos interviews him on a usual day at his office and finds out more about his vision of combating diabetes in the country.

Senator Angara breaks from Senate routines for a short photo-op

regulars 6 | EDITOR’S EDICT 8 | WE’VE GOT MAIL 9 | SWEET NEWS ON THE COVER: The DiabetEASE team hurdles through the hustles & bustles of the Senate office to talk to Senator Angara himself on the laws that protect diabetes patients in the country and the legacy he wants to leave behind.

in depth 21

Male menopause: Myth or Reality? Men and women have their differences when it comes to the regulation of hormones. While female hormones drop suddenly, those of males’ decline gradually. Dr. Gerry H. Tan discusses the “midlife crisis” among men, the telltale signs, and the treatment of male menopause or andropause.

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Diabetes and Sex Dr. Jimmy B. Aragon addresses pressing issues and solutions when sex becomes problematic because of diabetes.

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Photographs by Arrian Alcantara Styling by Alvin Melgar Make-up by Bianca Mate Location: Senate of the Philippines, Roxas Blvd., Pasay City Special thanks to: Sugar Sallador of the Office of Senator Angara

Gut bacteria may override protection against diabetes (What does the GUT say?)

Erectile dysfunction and the diabetic male

Unhealthy food is one sure-fire way to getting diseases over time. Dr. Myla D.R. Capellan tells us why it’s all in the gut.

Men with diabetes are more prone to encountering prostate problems such as erectile dysfunction. Dr. Jose-Vicente T. Prodigalidad tackles the conflict that may arise in the fusion of both conditions.

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Educator’s Corner

Fightin’ For Fitness

Good Food Guide

Righteous Recipes

Insulin Pump Basics With the importance of the insulin pump for multiple insulin injections, one must know its basic steps for proper execution. Dr. Jocelyn Isidro files the proper procedure on its usage to guide diabetes patients.

Exercises without the Gym Equipment When you are so busy you cannot even go to the gym to work out, basic and regular things at home could be the way to getting fit sans the gym equipments. Coach Jim Saret gives exercising tips using common household items.

Decode Food Labels If food labels have become so mindboggling to read that you don’t look at them at all anymore, this guide is for you. Nutritionist Edreilyn Manalo gives you six questions to ask yourself so you can read food labels like a pro.

Exciting baons—quick and easy Regular go-to baons can be boring for kids and you as well in the workplace. Add oomph to your daily lunchbox with Chef Jun-jun de Guzman’s simple yet exciting baon tips.

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You Ask, We Answer

Product Spotlight

Stress Busters

Does Diabetes Cause Prostate Problems? Can diabetes mellitus trigger common prostate problems? Dr. Jose Carlos Miranda tackles the common prostate blues and how diabetes could get in the way.

The Word on Sugar-free Spreads What more could spice up plain old bread than a tasty spread? Michaela Sarah de Leon jots down healthy sugar-free and low-sugar spreads for your daily snack breaks.

10 School Stress Busters

Stress in school may dramatically affect a child’s health and way of life. Excel Dyquiangco enumerates ten school stress busters for parents to help their coping kids.

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Living Well

Dos and Don’ts

Affairs to Remember

Doodles & Dreams

My Father, My Fearless Knight Candice Monique Brillon writes her story of how her family struggled through major challenges and how her father stood fearless despite surviving through lung cancer only to end up with a hereditary case of Type 2 Diabetes.

Of Diabetes and Disasters The weather has been erratic these days that possible disasters are expected to strike any moment. Gelyka Ruth R. Dumaraos lists the dos and don’ts during disasters and how to deal with diabetes when the going gets tough.

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EDITOR’S EDICT

Honor Thy Father I believe that what we become depends on what our fathers teach us at odd moments, when they aren’t trying to teach us. We are formed by little scraps of wisdom. ~ Umberto Eco Mom always said, “Marry someone like your father”. That was a tall order. I was very fortunate to have had a father who finished first in his class all through kindergarten and law school, and even topped the bar. My dad also founded what may be one of the best law firms in the country. He and mom valued excellence, education, ethics and hard work. They also strongly believed in giving back to the community. Before dad passed on over 20 years ago, he and mom had already put dozens of scholars through college and priesthood besides their involvement in various charitable organizations. I couldn’t help but be reminiscent as Father’s Day nears. And to help pay tribute to all the wonderful fathers and men in our lives, we have covered issues that particularly affect men’s health. Men with diabetes can often be pestered by problems such as prostate infection, erectile dysfunction and “male menopause”. Prevalence of erectile dysfunction increases with age, from six percent in men aged 20 to 24 years, to 52 percent in men aged 55 to 59 years. About a third of men with diabetes have low testosterone levels, which may not only manifest symptoms akin to menopause but also be linked to higher risk of heart disease. Prostate problems such as prostatitis are also more common in men with uncontrolled diabetes. Gracing our cover is a scion of a famous father who has likewise managed to carve a name for himself – Ten Outstanding Young Men awardee, prolific legislator, dutiful father, loving husband, staunch advocate for diabetes, health and education – Senator Juan Edgardo “Sonny” Angara. May we learn to honor our fathers through living by the little scraps of wisdom they have imparted or continue to impart to us! Peace and thank you,

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

Editor-in-Chief

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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 Publisher: FAME Publishing, Inc. Editor-in-Chief: Joy Arabelle C. Fontanilla, MD Assistant Editors: Mylene C. Orillo Michaela Sarah de Leon

Gerry H. Tan, MD, FPCP, FACP, FPSEM, FACE

Dr. Tan is Past President of the American Association of Clinical Endocrinologists-Philippine Chapter. He is also a Professor and Chief of the Section of Endocrinology at Cebu Doctors’ University- College of Medicine.

Art Director: Donna I. Pahignalo Editorial Coordinator: Alexa Villano Writers: Ma. Cristina C. Arayata Jose Martin Punzalan Gelyka Ruth R. Dumaraos Graphics and Layout: Dan Cisneros

Jimmy B. Aragon, M.D.

Dr. Aragon is a Fellow of the Philippine Society of Endocrinology and Metabolism, and a Fellow of the American College of Endocrinology. He is also an internal medicine and endocrinology consultant at the Makati Medical Center and a past member of the board of directors of the American Association of Clinical Endocrinologists-Philippine Chapter.

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

Myla D.R. Capellan, M.D.

Dr. Capellan is an endocrinologist at the Makati Medical Center and St. Luke’s Medical Center Global City.

Representatives: Arjay Yano Advertising Assistant: Irina Mae Carampatana Officer-in-Charge, Circulation Department: Armando Sandajan Executive Assistant: Angeli M. Mamaril Legal Counsel: Castillo, Laman, Tan, Pantaleon and San Jose Law Firm

Jose-Vicente T. Prodigalidad, MD, FPUA

Dr. Prodigalidad is the head of the Laparoscopic Urology section, Department of Urology at the National Kidney Institute and head of the Urology Section, Department of Surgery at the Asian Medical Center.

Jocelyn Capuli-Isidro, MD, FPCP, FPSEM

Dr. Isidro is a Consultant Endocrinologist at 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.

Jim Saret, MSAT, PES, CAPT, SAQ

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 2014 by FAME, Inc.

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.

Edreilyn Manalo

Edreilyn C. Manalo is a nutrition-dietetics practitioner for clinical and hospital nutrition and weight management. She finished Bachelor of Science in Nutrition and Dietetics at Centro Escolar University; studied Bachelor of Science in Chemistry at Adamson University, and obtained a certificate of internship at the St. Luke’s Medical CenterQuezon City (SLMC). Edreilyn is a board passer in Nutrition and Dietetics, year 2013. She is currently a member of the Nutritionist-Dietitian Association of the Philippines (NDAP) and Philippine Association of Nutrition-Delta Chapter of CEU.

JUNE-JULY 2014

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Greetings, This is Lizbeth of Sampaloc, Manila and I am deeply inspired about the story of child star Mona Louise Rey. I have a 13-year old daughter who is also dealing with the condition and her story is such an inspiration not only to kids her age but also to mothers like me. I commend your team for a job well done! Thank you and God bless! Lizbeth Rivera Manila

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.

Hi DiabetEASE magazine, I read an article on your magazine about diets for kidney condition. It was such an enlightening piece for our family because my father has kidney problems along with hypertension. We hope you could publish more informative articles in the future. Gilbert via Facebook message

Good day to your team, I’d like to ask if you could give us details for subscription here in Lemery, Batangas? I am a nursing student here and also a diabetic and I would like to know more about diabetes and its other complications. Hope you could help me. Glenn via Facebook Hi, Glenn! We’re glad that someone as young as you is interested in health issues surrounding diabetes and its complications. To subscribe to DiabetEASE, please fill out our subscription form published every issue and snail mail it to our Circulations Department. You can either pay cash through bank deposit at BDO with saving account no. 1450-0241-47 or send a check via snail mail. This is our mailing address: Arman Sandajan Circulations Department 5/f Narra Building, 2276 Pasong Tamo Extension, Makati City 1232 If you have more questions about your DiabetEASE subscription, please call us at 892-0723. Happy reading! The DiabetEASE Team

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sweetnews

AAT seen to treat early type 1 diabetes

n anti-inflammatory protein could take part in the treatment of type 1 diabetes at its onset, researchers have identified in a study. Researchers in Israel and in U.S., spearheaded by immunologist Eli Lewis of Ben-Gurion University of the Negev, found in a clinical study that Alpha 1-Antitrypsin (AAT) could effectively treat early stages of type 1 diabetes. This protein produced by the body protects tissue from inflammatory damage in times of sickness. “While looking for drugs to cure diabetes, we sought a different path from available and experimental treatments – one that tackled the problem, not merely the symptom of dangerously high glucose levels,” Lewis said. The treatment is geared toward battling the inflammation of the tissue in its early stages as well as protecting islets from autoimmune response. While at the onset of type 1 diabetes, not all islet cells of the body—clusters of pancreatic cells that include the

insulin-producing beta cells—are destroyed by the immune system. The participants followed an 8-12 week of AAT routine and were able to come off insulin injections for more than two years. It had no adverse effects – an advantage for those who had to remain on insulin injections after AAT therapy. But Lewis stressed that this anti-inflammatory protein is not yet formally declared as a treatment for the condition. He noted that the FDA regulatory approval, for instance, is not expected until 2016 in the US and is currently only available with a prescription from a physician. Furthermore, investigators are conducting extension trials and plan to study possible treatment of other autoimmune conditions like multiple sclerosis and Crohn’s disease. Gelyka Ruth R. Dumaraos with Diabetes.uk report D

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Longer life spa n A in T1DM u nder investigation

study in Canada is set to investigate the reasons behind the longer life span in patients with type 1 diabetes mellitus (T1DM), who have lived with the disease for over 50 years. In the 20th century, persons with T1DM were told they had shortened life expectancies. But a growing number of T1DM patients are still living well even after 50 years of diagnosis. The Canadian study is set to find out the secrets to their longevity. The research in Mount Sinai Hospital in Toronto led by Dr. Bruce Perkins encompasses usage of data from questionnaires including health examination results

and the use of insulin pump or injections as factors in the longer life spans. They are also considering if health care is provided by a family doctor or endocrinologist (specialist in diabetes care). Dr. Perkins said that many patients died of kidney disease when they reached 40, but with the advent of better insulins and more meticulous blood sugar management over the years, life expectancy has continually risen. The researchers at the Mount Sinai Hospital are also collaborating with the Joslin Diabetes Center in Boston, which has been running a similar study. Gelyka Ruth R. Dumaraos with Diabetes.uk report D JUNE-JULY

sweetnews

Diabetes UK warns against ch a nging diet based on new claims Claims on eating two larger meals a day are still conflicting

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iabetes UK has warned people with type 2 diabetes mellitus (T2DM) against drastically changing their diets based on recent news stories published in two large UK News agencies. The claims that two larger meals a day may be better for managing T2DM than six smaller meals a day, although based on a new research, were still based on conflicting evidence, according to the lead researcher. “The evidence is definitely conflicting. We don’t really have a definitive answer on this topic,” said Dr. Hana Kahleova of the Institute for Clinical and Experimental Medicine in Prague. Dr. Richard Elliott, research and communications officer for Diabetes UK, explained that the study still contributes to “our overall understanding of diet and T2DM,” but agrees with Kahleova that the study is still not based on conclusive evidence. “Larger studies over longer periods of time will be needed to back up these findings before we would consider making changes to the dietary advice given to people with T2DM,” said Elliott. He adds that eating regular meals as part of a healthy balanced diet, regularly exercising, maintaining a healthy weight, and taking meds prescribed by the doctor are vital for effective management of T2DM. With Diabetes UK report D

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More physical activity reduces diabetes risk in GDM Increased TV watching ups T2DM risk in women

he researchers found that increasing physical activity in women with gestational diabetes mellitus (GDM) could lower their risk of progressing to type 2 diabetes mellitus. GDM is a common complication of pregnancy with glucose intolerance first recognized during pregnancy. The researchers found glycemic control could be achieved by physical activity, which also benefits weight loss and maintenance. The researchers calculated that for every increase of 100 minutes per week of moderate-intensity physical activity or 50 minutes per week of vigorous-intensity activity was linked to a nine percent lower risk of T2DM. The women who increased their physical activity by 150 minutes per week of moderate-intensity physical activity (or 75 minutes per week of vigorous-intensity activity) were found to have 47 percent lower risk of T2DM. The study used data from the Nurses’ Health Study II, which looked at 4,554 women with a history of GDM and followed between 1991-2006. It captured data on the women’s physical and sedentary activity, including TV watching. Of the over 4,000 participants, 635 women went on to get T2DM. Meanwhile, researchers have found that the more time women spent watching television, the greater the risk of T2DM, according to a study that investigates how sedentary lifestyle affects women with and without gestational diabetes. “For example, TV watching typically acts as a sedentary replacement for physical activity leading to a reduction in energy expenditure, and TV watching is associated with ‘mindless eating,’ increasing food and total energy intake,” the researchers said. “Finally, while watching TV, women may be influenced by commercial food advertisements for nutrient-poor, high-calorie foods.” The researchers were however wary that because the participants were all nurses, the results could be affected by their being more health-conscious than most. With a Medical News Today report D

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Most cereals “too sweet to be healthy” Children are consuming 10 lbs of sugar from cereals yearly - EWG

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bowl of cereal a day could mean consuming 10 pounds of sugar in an entire year for children, according to a comprehensive analysis by the Environmental Working Group (EWG), an international independent consumer research group based in the US. “Most (cereals) pack in so much sugar that someone eating an average serving of a typical children’s cereal would consume more than ten pounds of sugar a year from that source alone,” said the researchers in the study. The group studied 1,556 cereals, including 181 specifically marketed for children. Earlier research has found that although children are happy to eat lowsugar cereals, there are just too few choices of cereals. It was found children’s cereals with cartoon characters on the box are among the most highly sweetened of all. “Of all the cereals, those that have cartoon characters on the box indicating they are marketed directly to children are the most heavily loaded with added sugar, making them a significant source of empty calories,” said the group in the report. The group also found that on average 34 percent of the calories in children’s cereal come from sugar. They found that of the cereals studied, two-thirds of them contains more than a third of what experts recommend children should consume in an entire day. For 40 of the cereals studied, a single serving exceeds 60 percent of the daily amount of sugar and some even contain as many as six different types of sweeteners. EWG warned that serving sizes on the cereal packaging are notoriously small and recommends that people should only consume no more than a teaspoon or four grams of sugar per serving. Of the cereals that made it to EWG’s “winners’ list” – or the cereals that are low in sugar are Rice Krispies, Cheerios, Chex, and Crispix. Meanwhile, those that are on EWG’s “Hall of Shame” – or cereals that contain at least 50 percent sugar by weight are Honey Smacks, Golden Puffs, and Golden Crisp. Granola also made it high on the sugary list. However, of the cereals specifically meant for

children, not one was free of added sugar. The promotional labels on cereal boxes were also meant to distract consumers from focusing on the unhealthy sugar content by highlighting their health claims such as “Excellent Source of Vitamin D” or “Good Source of Fiber”. Seven of the 10 most heavily sugared children’s cereals feature a marketing claim that promotes nutrient content. The US Food and Drug Administration has not yet set a limit on the amount of added sugars allowed in products with nutritional claims. The agency does not include a percent Daily Value for sugar products to help inform consumers how much sugar is enough. FDA does both for saturated fat. “Sugars are added everywhere – from beverages to bread, tomato sauce, and salad dressings – contributing to growing waistlines, decayed teeth, and a multitude of obesity-related diseases,” said EWG. The researchers used EWG food database to determine the sugar content in each cereal. “Rankings were calculated by comparing the total sugar content by weight with guidelines issued by federal health agencies and other organizations.” Mica G. De Leon with a New England Journal of Medicine report D JUNE-JULY

youaskweanswer

Does diabetes cause

prostate problems?

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JUNE-JULY 2014

efore answering this query, let me tackle first what the common prostate problems are. There are three and these are prostatitis, benign prostatic hypertrophy, and prostate cancer. Prostatitis is inflammation of the prostate. It can be infectious and non-infectious in nature. There are two types of the infectious type: acute bacterial prostatitis which is caused by a sudden bacterial infection and chronic bacterial prostatitis which is due to chronic bacterial infection. Chronic non-bacterial prostatitis is defined as inflammation of the prostate in the absence of bacterial infection. It may be manifested as urinary and genital pain for at least three of the past six months. Benign prostatic hypertrophy or BPH is defined as a non-cancerous enlargement of the prostate. Itâ&#x20AC;&#x2122;s growth is mediated by dihydrotestosterone, a metabolite of testosterone. BPH, if left untreated may lead to difficulty in voiding, urinary retention, which may pose a risk for urinary tract infection. Prostate cancer, as the name implies, is the malignant (cancerous) enlargement of the prostate. Although the exact pathologic mechanism is still unclear, the major risk factors are family history, advancing age, and obesity. Does diabetes cause prostate problems? Poorly controlled diabetes mellitus predisposes an individual to urinary tract infection due to impaired immune host factors and high urine glucose. Although there is no direct evidence linking diabetes to prostatitis, it may contribute to its development. We have to keep in mind that prostatitis can be due to acute or chronic bacterial infection of the prostate which is part of the urinary tract system in men. As regards to benign prostatic hypertrophy, even if the exact relationship seems to be unclear, men with diabetes mellitus seem to have a higher predisposition to develop it. In one study, it was noted that men with diabetes have symptoms as severe as non-diabetic men eleven years older and

cer has been usually diagnosed in older men, and older men with diabetes would have low insulin levels. Insulin is a potent mitogen (substance that causes cell proliferation/growth), so less insulin, less cell growth. In one meta-analysis, they concluded that type 2 diabetes mellitus has been shown to have a 14 percent less risk of developing prostate cancer. Even if we see that diabetes mellitus may have a positive or negative impact on prostate health, it is of paramount importance that we control blood glucose early and maintain it to be normal as long as we can. Anything that is out of balance will definitely tip it to one side and that one side may be something that we donâ&#x20AC;&#x2122;t want to be in.

Sources: Diabetes and Prostate Cancer Risk in the REDUCE Trial C Wu, D M Moreira, L Gerber, R S Rittmaster, G L Andriole, S J Freedland Prostate Cancer Prostatic Dis. 2011;14(4):326-331. Type 2 Diabetes and Risk of Prostate Cancer A Meta-analysis of Observational Studies D Bansal, A Bhansali, G Kapil, K Undela, P Tiwari Prostate Cancer Prostatic Dis. 2013;16(2):151-158. The Impact of Diabetes Type 2 in the Pathogenesis of Benign Prostatic Hyperplasia: A Review K. Stamatiou, M. Lardas, E. Kostakos, V. Koutsonasios, and E. Michail Advances in Urology Volume 2009 (2009) Diabetes and benign prostatic hyperplasia/lower urinary tract symptoms--what do we know? Sarma AV1, Parsons JK, McVary K, Wei JT. Is There a Link Between Diabetes and Prostate Cancer? July 24, 2013 by Pat F. Bass III, M.D., M.S., M.P.H. D

Jose Carlos S. Miranda, MD, FACE, FPCDE Dr. Miranda has been a doctor of endocrinology for 17 years. He graduated from De La Salle University and had his residency and fellowship training in Makati Medical Center. He is now practicing in Our Lady of the Pillar Medical Center and Crisostomo General Hospital. He is also a member of the medical bureau of Diabetes Center Philippines (or Philippine Center for Diabetes Education Foundation) and one of the camp directors of its sumer camp for children with type 1 diabetes - Camp COPE.

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a urine flow rate similar to non-diabetic men seven years older. It has been postulated that the reasons may be due to male hormone activity alteration via insulin growth factor and/or frequent lower urinary tract infections that is observed in persons with diabetes mellitus. Does diabetes cause prostate cancer? If there seems to be a positive correlation between diabetes and prostatitis as well as diabetes and BPH, for prostate cancer, studies show a negative correlation. In several studies, men with diabetes mellitus were less likely to have prostate cancer. This may be due to the fact that men with diabetes have lower prostatic specific antigen (PSA) â&#x2C6;&#x2019; a screening marker for prostate cancer. Another reason for these findings is that prostate can-

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educatorsâ&#x20AC;&#x2122;corner

Insulin pu mp By Jocelyn Capuli-Isidro, MD

basics

he insulin pump seems to be the answer to the problem of multiple insulin injections to achieve target glycemic control. People with type 1 diabetes commonly use it, however, more type 2 diabetes patients are starting to use them when oral antidiabetic medications are not enough to control their blood sugars and they are shifted

to multiple insulin injections. Pump users who have mastered the proper technique say that this gadget adapts to their lifestyle instead of them adapting to the demands of injecting insulin. To them, the pump is user-friendly and responds appropriately to the needs of the body by releasing the desired units of insulin at any specific point in time.

An insulin pump is a computerized device, about the size of a cellphone, attached to the body through a small, flexible tube (called a catheter), which is inserted under the skin of the abdomen and taped in place. It has buttons and a screen where the units of insulin could be programmed. The rapid-acting insulin is encased in a cartridge. It is delivered continuously in a steady rate during waking and sleeping hours. In this manner, the pump is like a working pancreas delivering insulin in a steady state or like basal insulin that is injected once a day. Like a normal pancreas, the pump can also increase its insulin release during main meals or even snacks simulating the role of the rapid-and short-acting insulin that is injected to control the blood sugar excursions after each meal. The release of insulin can be adapted to the needs of the body. During sick days or when the patient has poor appetite, the insulin release can be adjusted down. It can also be programmed to release higher insulin doses in anticipation of a buffet dinner. Yes, it can allow the patient to eat more since the increase in blood sugar could be covered by raising the bolus rate. This, however, can lead to weight gain! Weight gain per se and fat accumulation in the body, particularly in the abdomen will worsen the glycemic control of patients. JUNE-JULY 2014

educatorsâ&#x20AC;&#x2122;corner Simple Steps on How to Use Insulin Pumps: Every 2-3 days, a thin plastic tube called a cannula is inserted just underneath the skin using an infusion set. The infusion set has a thin introducer needle to insert the soft, thin cannula, which is then removed once the cannula is under the skin. A tube connects the infusion set to the pump with a standard locking mechanism that securely keeps the tube attached to the pump. This type of pump requires a separate glucose meter for dose adjustment of insulin or rescue boluses immediately before each meal. Newer sophisticated insulin pumps now work together with a gadget for continuous glucose monitoring called CGM (continuous glucose monitoring). CGM measures blood sugar levels in realtime 24 hours a day. It provides alerts for highs and lows even when the patient is sleeping. It provides information on how food, sickness, medications, physical activities and even stress impact on blood glucose levels. This record of blood sugar can be uploaded to a computer and presented to the endocrinologist/ diabetologist for review.

Once the diabetes team and patient both agree to start the insulin pump device, the American Diabetes Association has the following guidelines for dose initiation:

1. Determine how much insulin to

use in the insulin pump by averaging the total units of insulin used per day for several days. (You may start with about 20 percent less if you are switching to rapid-acting insulin.)

2. Divide the total dosage into 4050 percent for basal and 50-60 percent for bolus insulin

3. Divide the basal portion by 24 to determine a beginning hourly basal rate.

4. Then, adjust the hourly basal

rate up or down for patterns of highs and lows, such as more insulin for dawn phenomenon, the early morning (4 a.m. to 8 a.m.) when we expect sudden rise in blood glucose level, â&#x20AC;¨and less for daily activity.

5. Determine a beginning carbohydrate dose (insulin:carb ratio) using the 450 (or 500) rule. Divide by the total units of insulin/day to get the number of grams of carbohydrate covered by one unit of insulin. This dose may be raised or lowered based on your history and how much fast-acting insulin you took in the past.

6. Determine the dose of insulin to

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correct high blood glucose with the 1800 (or 1500) rule. Divide 1800 by the total units of insulin/day to see how much one unit of insulin lowers your blood glucose. Your physician or diabetes care team must evaluate this dose.

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educatorsâ&#x20AC;&#x2122;corner

where, bring extra supplies or at least an insulin pen, in case you are unable to use your pump for some reason.

3. With an insulin pump,

when you eat, what you eat, and how much you eat is up to you. You can eat more carbohydrate and still manage your blood glucose, but weight gain can happen. Talk to a dietitian about this when you start on the pump. Itâ&#x20AC;&#x2122;s a lot easier to gain weight, than it is to lose it.

ing blood glucose checks, carbohydrate amounts, carbohydrate doses, correction doses, and exercise when you do them. It really helps to sit down and look over your blood glucose record at the end of every week (or even every day) to see if you have any problem areas. Reviewing your records is the key to improving blood glucose control.

6. Your diabetes provider

and insulin pump company have record forms, or you can make your own. Just be sure to have enough room to record everything you need. Keeping daily records is best, but some people find keeping records for two weekdays and one weekend day gives enough information to see the patterns.

tes.org.uk

2. When traveling any-

5. Make a habit of record-

inputdiabe

specific time, such as five minutes before you eat (for rapid insulin analogues such as lispro, aspart and glulisine), so you donâ&#x20AC;&#x2122;t forget boluses.

sulin pump off or turn it off, figure out a system to remember to turn it back on. Listen to the alarms on the pump or set a timer.

1. Take your insulin at a

4. When you take the in-

desang.n

Once you have started using it, it takes a while to really master the proper techniques of using the insulin pumps. Below are some tips from the American Diabetes Association on how to properly use the insulin pump:

In general, insulin pumps have advantages and disadvantages. For the advantages, insulin pump use allows more flexibility. It gives precise insulin delivery, reducing episodes of severe hypoglycemia, reducing wide fluctuations in blood glucose. On the other hand, some disadvantages are risk of skin infections at the catheter site, cost of the pump and the continuing cost of supplies, risk of diabetic emergencies such as diabetic ketoacidosis in case of pump failure.

After considering the above pros and cons, each patient who could be a candidate for insulin pump use must be prepared to accept the intricacies of maintaining the pump, and a supportive family and diabetes team should surround him in order to overcome the fears of starting to use this innovative gadget.

References: 1. Joslin Diabetes Center 2014. 2. Insulin Pumps. Diabetes.org 3. Diabetes Medtronic. com D

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fightin’forfitness

Exercises without the Gym Equipment Save up on expensive gym enrollments and high-tech exercise equipment by getting creative at home. Use these commonly ignored household things for a good round of workout. By Coach Jim Saret Illustrations by Rackel Selena R. Lumbang

lot of people tend to rely on gym equipment or machines when doing exercises. However, for those who don’t have access to machines or cannot afford the expensive equipment, there are many ways you can have a workout by simply using materials found at your house or a nearby hardware store. In the Biggest Loser Pinoy Edition Doubles, many of the equipment we got were from junkshops, hardware stores and those found at the contestants’ houses. Here is a list of the materials you can use and the exercises that can be done with them.

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fightin’forfitness

Water bottles

Depending on the size, you can use them for weight-lifting. Small water bottles can be used as dumbbells. A sack of rice or pots can also be used as weights too, but a reminder: when carrying a heavy sack, make sure you carry only what your body can. • Place a filled water bottle on each hand. Lift them side to side as if they were dumbbells. Do this for 10 repetitions.

Chains

The heavy chains when you swing them up and down can tone your arms. If you add jumps to it, then you are increasing metabolism. You can also use ropes, but make sure they are heavy ropes. These can be bought at a hardware store. • Lift the chains (or heavy ropes) with both hands. Swing them up and down. Add jumps while swinging. Do this for 10 repetitions.

Five-gallon jug of water

A five-gallon jug of water can also be used as weight for squats. When using the five- gallon, it would be handy if you have handles. Old tires can also be used. • Hold the jug of water with both hands. Bend your knees in a squat position hold the jug of water. Do this for 10 repetitions. • For tires, use both hands and lift the tire above your head while squatting. Do this also for 10 repetitions.

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fightin’forfitness

Old towels/shirts

You can use them for bicep curls, stretching, and other types of exercises.

Heavy Rope

Heavy rope can be used for TRX and can be tied anywhere like a tree or a handle bar for as long as it’s sturdy. You can also use the heavy rope for sit-ups. • Tie the heavy rope on a sturdy area. Holding the rope, do a sit-up position and lift yourself up and down. Do this for 10 repetitions.

• With both hands, place the towel/old shirt in front of you. Pull it, making sure that you can feel the stretch and tense on each arm. Do this for 10 repetitions.

Old basketball

This can be used as a medicine ball. Just open the ball and put enough sand and seal it. • Carry the medicine ball with both hands and lift it above your head. Slam it on the ground. Bend and pick up and slam it again on the ground. Do this for 10 repetitions.

You can also use the rope and tire together by simply tying them and putting rocks or sand in them to be heavy. Tow it and you have a full workout ahead of you. Other equipment you can use are chairs, tables, and even beer cases. The science behind it is at the end of the day, its just additional weight or what we call external resistance. It can come in any shape or form. The body doesn’t know what its lifting whether it’s a high-tech expensive gadget or really cheap makeshift workout equipment you made at home. All it knows is it’s getting resistance. The challenge is to make exercise interesting and meaningful. If there is no purpose then its nothing. Modify it to suit you and make sure that you only carry the weight that you can since everybody is different. Don’t forget to consult your doctor. The key is imagination so you definitely have to be creative. Even without expensive gym equipment, you can still work out, get fit, and live healthily. D

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indepth

Male menopause:

Myth or Reality?

By Gerry H. Tan, MD, FACE, FACP, FPCP, FPSEM

ezyhealth.com

ale menopause or andropause continues to baffle us whether it is really a true entity or a myth. Most of us may wonder why a member of the family starts becoming grumpier or having mood swings or depression that we always blame on “midlife crisis” either relating to female menopause or a “male menopause.” Both men and women have their own sets of hormones that regulate the body functions over time. Any decline in the female hormones at a certain age (around 45) results in a constellation of symptoms that we call menopause. In women, once ovulation stops, the level of female hormones drop in a relatively shorter time frame. However in men, changes in hormones are somewhat different. Instead of a sudden drop in hormone level, the changes occur gradually and therefore the symptoms are more subtle. In fact there are some men that are not affected by the hormonal changes over their lifetime. The level of testosterone (the male hormone) starts to decline after the age of 40 at a rate of around one percent per year. By the age of 80, about 50 percent of the men will have low testosterone although some men will be able to maintain their levels into old age.

The telltale signs

Most men will remain asymptomatic except JUNE-JULY 2014

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ezyhealth.com

for some symptoms that may be related to aging. To be sure if the patientâ&#x20AC;&#x2122;s symptoms are related to testosterone deficiency, the best test would be to get a serum testosterone level. So what would be the typical symptoms of male menopause? The most common complaint that men will have is the loss of sexual desire and the loss of spontaneous erections. Hot flushes, the typical symptoms that women complain of may not be evident at all. Other nonspecific symptoms like decreased energy or concentration, feeling moody and sad including problems of sleep can be attributed to testosterone deficiency. But almost always the symptoms are rather non-specific since these symptoms may be related to the daily stresses in life. In terms of physical appearance, male menopause can result in an increase in body fat with reduced muscle bulk. As a result men will complain of diminished physical or work

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performance overtime.

The treatment

Once a diagnosis of testosterone deficiency is made by history, physical examination, and the blood tests, then treatment is rather simple. Testosterone replacement therapy is available by injection and by mouth. However, testosterone replacement therapy continues to be controversial, as effects of treatment have not been shown to be uniformly effective. Plus the treatment has its own side effects to include prostate enlargement and heart disease. It is therefore important that prostate and heart evaluation be done before any treatment intervention is started. Herbal supplements are not worth trying. Their effects have not been validated nor their side effects studied. It is therefore advised at the present time to shy away from taking any herbal supplements to alleviate the symptoms of male menopause. So what do I advise my patients? The same advice I give to anyone else: eat right, stay active, and enjoy life! By eating right and staying active one is able to maintain a good outlook in life, and through daily activity one is able to maintain physical strength and endurance. And by doing so, one reduces the risk of the stressors in life that exacerbate the symptoms of andropause. Take care of your health by living right! D www. docgerrytan.com

indepth

Diabetes d Sex n a

diaadia.com.ar

By Jimmy B. Aragon, M.D.

ven in the 21st century, sex is still regarded as taboo in some sectors. People become shy to talk about it, refuse to say the word “sex” and refer it as “ano” (“it”), or any other colloquial term just to avoid the word. Undoubtedly, sex is important for both men and women, the act is not only for biblical procreation, but more as recreation

for many people. That is why doctors now keep an open communication with their patients regarding sex to lessen the impact of the stigma that may still be present. The act of sex, like breathing and the pumping of the heart, is governed by various systems predominantly the circulatory and nervous system. Men, for example, need the

parasympathetic nervous system, in order to have an erection. It is a complex series of nerve stimulation, including the participation from the brain cortex that eventually leads to the rushing of blood to the penis before finally climaxing to ejaculation, where the sympathetic nervous system takes over. The sexual act is theorized to release certain “reward” JUNE-JULY 2014

indepth neurochemicals in the brain like dopamine, which makes it pleasurable. Because sex is a form of exercise, it may be good for the heart. Sex may be a stress reliever, an immunity booster, a calorie burner and of course, it develops better intimacy between partners.

When sex becomes problem atic

What are the solutions?

1. Control the blood glucose: By controlling the blood glucose, the chance of getting nerve complications will decrease. Circulatory complications that can affect erection for men and lubrication for women, will also decrease. Uncontrolled blood glucose also predisposes to different infections, whether in the genital area or elsewhere. All of these cause low energy that lead to low libido. Controlling the blood glucose can help alleviate low libido. 2. Lubrication for women: Water-based lubrications are readily available in the local drugstores. Donâ&#x20AC;&#x2122;t be embarrassed to ask your pharmacist or ask your partner to buy them for you. This will lessen the friction and lessen the pain during intercourse. 3. Drugs like sildenafil: These drugs increases nitric oxide (NO) that dilates the blood vessels in the penis enabling erections. These drugs can also be used by women, ask your doctors about it. If you are taking antidiabetic drugs like nitrates, sildenafil may not be used.

Photo by Patty Lucero

People who have diabetes should not be exempted from the various benefits of sex, but this becomes a challenge when complications of diabetes take over. Neuropathy, which is a complication that damages the nerves, can affect the nervous system that controls erection for men. On the other hand, women who experience vaginal dryness can have neuropathy (nerves that release lubrication are damaged) or uncontrolled blood glucose. Another problem for women will be vaginal infection, particularly yeast infections triggered by elevated blood glucose. The irritation and dryness may contribute to pain during sex. This can traumatize the woman, making sex less pleasurable. Loss of libido whether due to loss of sensation from nerve problems or elevated blood glucose causing low energy, contribute

to lost of interest in sex.

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diabetes.sanofi.us

indepth

Be sure to clear with your doctor. Other drugs in the same category are vardenafil and tadalafil. 4. Open communication: Share your problems and worries with your physician and your partner. Your doctor can prescribe medications if you have infections and can prescribe drugs like sildenafil if you need it. The doctor can also adjust your diabetes medications if your sugars are uncontrolled. As with your partner, discuss with him/her about your fears so he/she can adjust with the situation. With your partnerâ&#x20AC;&#x2122;s understanding, you will feel less stress about your sex problems. 5. Review your medicines: Medicines like beta-blockers and diuretics may affect sex, ask your doctor about alternatives. Do not stop them by yourselves, as they can be important for your heart condition. 6. Control the blood pressure: For diabetics who have elevated BP, it can cause narrowing of the arteries over time, which will eventually cause lower blood flow to the penis for men and vagina for women. 7. Laboratory tests: Liver and

kidney diseases may contribute to low libido. See to it that they are tested. Other things like low testosterone for men and in some instances, also for women, can contribute to low libido. Menopause which rapidly decreases estrogen is also an important factor. 8. Check if you have depression: Diabetes and depression can go together. This should not be overlooked as this can cause loss of interest not only in sex but also for enjoyment in other things that were once pleasurable. Anti-depressant drugs can also affect sex. 9. Relax: Many times, even one incident of erectile dysfunction or painful sex can cause anxiety in subsequent performances. That is why communication is important. Relaxing can also mean getting a regular exercise, not only to make your muscles stronger but also to make you less stressed. Longer foreplay can make you more relaxed and confident before the intercourse. 10. Other techniques: You can play around with aroma and scents. For example, it is said that ylang ylang is relaxing while jasmine is erotic and soothing. Erotic videos may help for

some couples. Be sure to discuss it with your partner.

Some Precautions Before Sex

You might have watched a movie or a TV show where sex triggered a heart attack. In a study published in JAMA, a reputable medical journal, it doesnâ&#x20AC;&#x2122;t happen very often. To give you an idea, sex is like walking up the stairs, spending about three to four metabolic equivalents (METs). If you are engaged in a regular exercise, the chance of heart attack is literally one in a million per hour. If you are at risk of a heart attack, you may clear with your doctor, who may order a Treadmill Stress Test to evaluate your METs. If you are taking anti diabetic agents, your chance of hypoglycaemia may be increased, especially with unplanned sexual activity. Hypoglycemia can also be a cause of low libido. Checking your blood glucose before sex can ensure you are not getting hypoglycaemia. Diabetes does not mean your sex life is over. There are many things you can do to make it healthy even if you have diabetes. Keeping a healthy lifestyle and open communication are keys to enjoying sex even if you have diabetes. D

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indepth

Gut bacteria m ay override (What does the GUT say?) By Myla D.R. Capellan, M.D.

dailyrecord.co.uk

protection against diabetes

s numbers of people with Obesity and Diabetes have grown astoundingly, every possible cause is being dealt with utmost scrutiny. Both diseases are due to genetics and environmental exposure. The immune system plays a key role, too. Some scientists postulate that these begin the day that we are conceived by our mothers. Throughout our lifetime, our intestinal microbiota (little organisms that typically inhabit our gut) perform vital functions. They act as barriers to harmful bacteria and metabolic reactions. These microbiota play a major role in health and disease, and sometimes referred to as our “forgotten organ.” The gut microbiota interact with our immune system, providing signals to promote the maturation of immune cells and the normal development of immune function. The growth of intestinal microbiota in infants can be influenced by medical, cultural and environmental factors such as mode of delivery, diet, familial environment, diseases and therapies used. As the saying goes “Healthy mommy will deliver a healthy baby.” (Figure 1)

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Figure 1 The gut microbiota programmes host health - from mother to infant. The fetus comes into contact with microbes originating in the maternal gut through the placenta and amniotic fluid. A massive inoculum of maternal bacteria is encountered during vaginal delivery, which is also associated with increased maternal intestinal permeability and translocation of gut bacteria into breast milk. Breastfeeding not only modulates neonatal bacterial colonization and immune maturation, but is a direct source of maternal bacteria. After birth, skin-to-skin contact and nursing ensures direct transfer of maternal bacteria to the infant to enhance healthy immune and metabolic maturation.

indepth Large amounts of microbial community live in our digestive tract–specifically our large intestines. At the time we were still in our mothers’ wombs, the environment was supposedly clean (sterile) until we were delivered. Microbial colonization was thought to begin during birth and established a mutual cohabitation with the host (our body). Bacteria in the intrauterine environment suggests that these bacteria may result in prenatal colonization of the meconium (earliest feces of an infant, is composed of food materials ingested while inside the mother’s womb). Vaginal delivery seems not only provides substantial bacterial exposure but also gives healthy host-microbe interaction and immune development. Likewise, Figure 2 Impact of external factors on the intestinal microbiota to the infant. Green arrows breastfeeding can be viewed as show beneficial modification; red arrows show modification considered negative for healthy maternal guidance and protection development. Adapted from Trends in Microbiology April 2013, vol. 21, no.4. that facilitates survival and healthy programming in the microbial world during early life (Figure 2). The two main groups of bacteria present in our gut are the Firmicutes (Clostridium, Lactobacillus) and Bacteroidecetes (Bacteroides and Prevotella). The Fumicetes/Bacteroides ratio and its variation between individuals having a rich Western-type diet or a more rural vegetable-based diet is tightly linked to obesity and metabolic disorders. Type 1 diabetes is a proinflammatory disorder that results in specific destruction of pancreatic islet cells and loss of insulin production. Changes in the composition of the gut microbiome are also associated with mechanisms of intestinal autoimmunity and obesity. Different types of viruses (mumps,

rotavirus, rubella, Epstein–Barr virus, CMV and Varicella Zoster virus) were implicated as culprits in type 1 diabetes. Is there a role for gut bacteria in virus–induced type 1 diabetes? In various experimental rat subjects, a certain type of virus named parvovirus KRV (Killman rat virus) can alter the gut flora by increasing the number of Acinetobacter and Clostridia bacteria which can alter the immune system and cause insulitis and consequently depletion of insulin production. A broadspectrum drug like Sulfatrim can prevent this occurrence. Numerous evidence shows that intestinal microbiota may play a role in the development of obesity. Ridaura, et al demonstrated that

microbiota from lean or obese humans induce same phenotypes (body form). The microbiota from lean donors can invade and reduce fat gain (adiposity) in the obeserecipient mice if the mice were fed an appropriate diet (Figure 3). One of the main activities of the intestinal microbiota is to break down and ferment dietary fibers into short-chain fatty acids (SCFA) which promotes leanness by inhibiting fat accumulation in adipose tissue, raising energy expenditure and enhancing production of hormones associated with feelings of satiety (abdominal fullness). Understanding the importance of microbial contact during the early periods of fetal life, delivery

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indepth

Figure 3 Please pass the microbiota. (A) Germ-free mice inoculated with microbiota from obese or lean human twins take on the microbiota characteristics of the donor. Those receiving the obese microbiota (red outline) had increase in adiposity, whereas those receiving the lean microbiota (blue outline) remained lean. (B) If fed an appropriate diet, mice harboring the obese microbiota, when cohoused with mice harboring the lean microbiota, are invaded by the lean microbiota and do not develop increased adiposity (blue and red outline). By contrast, the obese microbiota does not effectively colonize mice harboring the lean microbiota, and these mice remain lean. Adapted from Science vol. 341 Sept. 2013.

and infancy to healthy immune and metabolic programming creates new opportunities to improve infant health and reduce diseases in later life. Since bacteria are transmitted from the mother to infant, the consumption of probiotics by the mother could influence the development of healthy microbiota in their children. Probiotics increase Bifidobacteria and Lactobacillus species which are essential and beneficial to infant’s normal intestinal flora. Infant’s milk containing probiotics showed reduction of harmful intestinal bacteria like Clostridia and E. coli. Both pre- and probiotics have shown beneficial effects in infants for protection against

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infection, diarrhea, necrotizing enterocolitis, eczema and atopic dermatitis. Initial microbial colonization of our intestines and the resulting immune and metabolic programming have a long-lasting influence on the risk of diseases like celiac disease, type 1 diabetes, asthma, obesity, metabolic disorders, glucose intolerance. As mothers, we are not only responsible for the condition of our children in our wombs up to the day of delivery but also their future health. Choosing healthier types of food (low fat, high fiber) can make our children healthier and hopefully disease-free in later life…it’s all in the GUT. D

indepth

Erectile dysfu nction and the diabetic m ale

kamagra-oraljellys.com

By Jose-Vicente T. Prodigalidad, MD, FPUA

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indepth Definition

Erectile dysfunction (ED) — the inability to get or maintain an erection firm enough for sex — is common in men who have diabetes. It can stem from problems caused by poor long-term blood sugar control, which result in damage to the nerves and blood vessels. Erection is a process that requires intact nerve function and the inflow of blood into the penile shaft. Therefore, damage to these vital structures may cause failure of erection.

Causes

It has been determined that erectile dysfunction is rarely caused by one particular problem but rather a multitude of factors. Psychological or psychogenic causes play a very important role in the development of ED and constitute majority of the cases of ED in men in general. In fact, majority of men who develop some form of ED early in their lives are more likely due to psychogenic rather than organic causes.3 Examples of these are stress, anxiety, marital conflicts and depression. Finally, anxiety, guilt, low self-esteem and paranoia about sexual failure are estimated to cause between 10 percent and 20 percent of ED cases. Thus, an episode of ED or “failure to perform” may perpetuate ED in their future attempts. Organic causes of ED involve neurologic (nerves), arterial (blood supply), cavernosal (structural) or hormonal pathways. Systemic diseases such as diabetes, hypertension, cerebrovascular diseases or stroke and low testosterone levels may cause ED through one of these pathways. Certain drugs that are used to treat these systemic diseases may also cause ED as a side effect.

Other medical conditions that may put a patient at risk for ED include the following: 1. Prostate problems (Benign Prostate Hyperplasia or Prostatitis) 2. Peripheral vascular disease 3. Dyslipidemia (increased cholesterol levels) It has been shown that ED may also be the first sign of underlying heart disease and therefore is potentially an early warning signal for physicians.7 The figure on the right shows the various causes of ED. Note that it is unlikely for impotence to be from one cause. Most cases have a psychogenic component of varying degree, and systemic diseases and pharmacologic effects can be concomitant and causative.3 There are also certain risk factors which may increase the risk of ED such as advancing age, smoking, increased

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Fig. 1 A Functional Classification of Erectile Dysfunction3

indepth

alcohol intake, obesity and lack of exercise.3 These have been proven to increase the chances of developing ED in men in general. Thus, it is important for patients to realize that a lot of their habits and lifestyle may play an important role in the development of ED.

Erectile dysfunction a nd diabetes

The incidence of ED in diabetic men can range anywhere from 3575 percent based on various studies. Men who have diabetes are thought to develop erectile dysfunction 10-15 years earlier than men who do not have diabetes.2 It is a very important issue to address because ED can affect the individuals ego and self esteem. It may also leave the patient and his partner feeling frustrated and discouraged. It is of utmost importance to gain good control of oneâ&#x20AC;&#x2122;s blood sugar levels. Poor blood sugar control leads to development and progression of ED. One may see delay of the occurrence of ED in patients with good blood sugar control as compared to patients with poor control.2 It has also been observed that the incidence of ED increased with age. It was notably less in patients from 20-24 years of age compared to those 50-59 years of age.4 This observation may indicate that other medical issues associated with age also contribute to the development of ED.Other factors like the presence of peripheral and autonomic neuropathy, retinopathy and a long duration of diabetes may also increase the incidence of ED.4 The presence and persistence of ED may also be a predictor of the

development of certain sequelae. It has been shown that diabetic men in whom ED persisted were more likely to develop retinopathy and neuropathy than men with normal erectile function. Furthermore, ED may also be a predictor of cardiovascular events in men with diabetes.5

Treatment Initial Evaluation Despite the prevalence of ED, studies show that only 10 percent of patients who suffer from ED actually seek and receive treatment. Majority of the patients never seek care for their problem. It is very important to realize that ED is a problem that can be addressed and solutions may be offered if one should only seek treatment. The first step to solving the problem of ED is to talk to your doctor. Donâ&#x20AC;&#x2122;t get embarrassed to discuss this issue. Your doctor will determine the probable causes of ED. He will also discuss the facts regarding ED as well as provide treatment options such as medications, etc. Once youâ&#x20AC;&#x2122;ve started opening up to your doctor, it will be easier to start looking for solutions. Since blood sugar control is of utmost importance, ask your doctor what you can do to keep your blood sugar levels in check. Poor blood

sugar control may lead to nerve and blood vessel damage that may then lead to ED. Ask your doctor about the best ways to manage your diabetes. The presence of other medical conditions may also lead to ED such as hypertension, cardiovascular and peripheral vascular disease. It is important for your doctor to diagnose such concomitant medical issues and discuss these conditions with you. Certain medications have been also known to cause or predispose one to ED such as antihypertensives, sedatives and antidepressants. It is important for one to know the medications he is taking because those may contribute to the development and progression of ED. Some medications may be shifted to those that cause fewer effects on ED. Anxiety and stress may also be risk factors for ED even in patients who do not have concomitant diabetes. It is important for one to seek medical advice or counseling in order to identify and help alleviate potential sources of anxiety or stress. It may be helpful to discuss this with your doctor or a counselor. JUNE-JULY 2014

vecernji.hr.com

indepth

There are individuals who experience occasional episodes of “failure to perform” at one point or the other. The mere fear of being unable to sexually satisfy his partner is a very strong source of stress and may precipitate ED. This becomes a vicious cycle. It is important to break this cycle. Your doctor can help you identify this and provide remedy. Treatment Strategy The treatment of ED starts off with identifying and altering modifiable causes and risk factors. Paramount for patients with diabetes is good blood sugar control. Altering modifiable risk factors include cessation of cigarette smoking, engaging in a good exercise program, getting enough sleep and rest, proper stress management, minimize or eliminate alcohol intake and weight loss in obese patients. It may also be necessary to change certain medications that may contribute or cause ED. This may be discussed with your doctor. If the ED is resolved, there is no need to take medications. However, if the ED remains unresolved, medications may be instituted unless contraindicated. The most popular and readily available medication is the phosphodiesterase type 5 (PDE5) inhibitor. The beauty of such drugs

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is that erection is achieved only after sexual stimulation or arousal. If there is no sexual stimulation or arousal, no erection will occur. This makes the process more natural and spontaneous. There are several types of PDE5 inhibitors available in the market. The various types have different durations of action starting with an effect of 3-4 hours up to 36 hours. This doesn’t mean, though, that there will be maintenance of an erection the entire duration of action but rather that the drug still remains effective should the need arise. The main contraindication to these drugs is the presence of ischemic heart disease. These patients may be on or may need to take nitrates. Nitrates together with PDE5 inhibitors may have fatal side effects. Alongside oral medications, it has been shown that sexual counseling and education with a physician or counselor is also helpful in treating ED. Most of the time, there is an improvement in the ED and patients remain on oral therapy on an “as needed” basis. Unfortunately, there are some patients who fail to respond to oral therapy and other local therapies may be required. For such patients, there are medications that are injected in the shaft of the penis and gels that are instilled in the urethra that may cause immediate erection

within 20-30 minutes regardless of whether this is sexual stimulation or not. A less invasive form of therapy is the vacuum device that is applied to the penis to create and temporarily sustain an erection. These forms of therapy are less spontaneous than the PDE5 inhibitors. For patients who still fail the above modes of treatment, surgical treatments may be of help. A prosthetic device is inserted into the penile shaft. An erection is produced by a miniature pump controlled by the patient himself. These devices usually constitute the last resort of therapy and are subject to certain potential complications like infection and pump failure. Newer devices have been improved, however, resulting in fewer complications. Take home message Erectile dysfunction is one potential complication of diabetes because of damage to the nerves and blood vessels. It is a topic not often discussed with the doctor but may cause serious self-esteem and marital issues. There are two important things to remember. First is to control blood sugar levels because good control may delay the onset of complications. Second is to openly discuss these issues with your doctor because he will be able to help you provide a solution to the problem. D

indepth

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feature

Eating

Sexy

The idea was to become sexy by eating healthy. Now, Rachel Alejandro and Chef Barni AlejandroRennebeck are redefining your eating habits by redefining theirs through The Sexy Chef. By Mylene C. Orillo Rachel (left) and Chef Barni (right)

here’s an ongoing trend for healthy meals delivered right at your doorstep and it began with an idea. The idea was to become sexy by being healthy and it came because of the need to maintain a figure. Singer-Actress Rachel Alejandro’s figure, in fact. “Being in show business, I have to maintain my figure. I asked my sister Barni to learn how to cook healthy meals for me. She became my personal chef,”

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said Rachel who is the co-owner and vice president for Marketing of The Sexy Chef. “Eventually we thought it would be a good idea for her to prepare healthy meals for other people. We created a business out of that.” The Sexy Chef caters to those who have a medical condition like diabetes and hypertension and those who need to lose a certain amount of weight – or maintain it. It is also for those who have very hectic schedules,

feature other clients. For instance, many clients have reported as much as 6 pounds in seven days in our Eat Clean Detox Plan - a vegan program,” said Rachel. The Sexy Chef also offers party and corporate event catering services, as well as affordable healthy lunch and dinner meals for delivery. Aside from its bestselling South Beach Diet, it also offers other weight-loss programs, including original diet plans. Individual meals cost PhP 70190, while the diet programs cost between PhP 975-1,200 a day. The five-day healthy meal lunch and dinner packages are between PhP 1,500-2,150. The Pounds Away and Fat

Good food has never been this sexy

live alone, or need to cook for a big family. Preparing a separate set of meals can be hassling, taxing, and downright time-consuming. Originally established by singeractress, Rachel Alejandro and her sister, Chef Barni AlejandroRennebeck, in 2004, The Sexy Chef started as diet-food catering services that specialize in delivering South Beach Diet meals to health- and figure-conscious Filipinos within Metro Manila.

The Sexy Progra ms

The Sexy Chef is the only company that currently offers seven different diet programs, said Rachel. It has the biggest selection of healthy, vegetarian, and low-calorie meals in the market and it is the only company that has released a bestselling cookbook and a TV cooking show as well. “We have a diet plan geared for those who have type 2 diabetes as well as those at risk for it called Fat Fighting 4 Diet, which is inspired by the diet plan described in the

book, Diabetes DTour Diet. This was co-created with The Biggest Loser Philippines’ resident food coach, UScertified nutritionist, Nadine Tengco,” said Rachel. The Sexy Chef’s bestseller is the Dine Lite 350 Calorie Meals with the menu changing every month. Those who come to The Sexy Chef, bearing their medical conditions are referred to their inhouse nutritionist. “We refer them to our inhouse nutritionist who makes an assessment of their needs and recommends a plan for them,” said Rachel. Although The Sexy Chef couldn’t guarantee any amount of weight loss, Rachel assured customers of better overall health improvement as a result of eating more wholesome food. “Getting to and maintaining an ideal weight can go a long way in treating many diseases. Our bodies are all different and react to food in various ways. We do mention the typical weight loss results of

Lentil Pasta Bolognese - Vegetarian

Mc Steamy Beef Burger - Pounds Away Diet Program

Pad Thai - Eat Clean Detox Plan

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feature Fighting 4 Diet Programs come in two levels: 1,200 calories per day and 1,400 calories per day. They include breakfast, lunch, dinner, and two snacks.

The history Albondigas - South Beach Diet Program

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Arroz Ala Cubana - Dine Lite 350 Calorie Meals

After the idea became a huge success, The Sexy Chef found herself in many other places before it landed a television show with Rachel and Barni at the helm. Barni is a co-owner and the vice president for Product Development. She graduated from the International School of Culinary Arts and Hotel Management. Two years after its creation, Gold’s Gym Philippines tapped The Sexy Chef to become their food partner. The company then opened and operated health food and beverage kiosks in three Gold’s Gym branches until 2010. In 2009, The Sexy Chef became a company owned by OBC 5 Star, Inc. with Rachel and Barni’s mother, Chef Myrna DeMauro as the president and managing director. Chef Myrna graduated at the Baltimore International Culinary School in Maryland, USA and attained her final culinary course in Dublin, Ireland with honors. She created the recipes featured in The Sexy Chef’s sister outfit, Chef Mom’s D-Lite’s Party Catering Menus. Today celebrities like singer Martin Nievera, news anchor Korina Sanchez, actor Dennis Trillo, and model Amanda Griffin swear by The Sexy Chef’s diet programs. The Sexy Chef is also in partnership with Sexy Solutions of Belo Medical Group, Juju Cleanse, and Nadine Tengco of I-Health. For more information, visit their website at www.thesexychef.ph or e-mail them at info@thesexychef.ph. D

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The Obsin a sisters: From losers to dreamers From Biggest Loser to Metafit coaches, Dianne and Tin Obsina are the “Losers” who gained a new perspective on beauty, health, family, and self. Now, their newfound belief in themselves has pushed them to dream bigger dreams By Candice Monique Brillon

Photo by Aaron Ebio, courtesy of The Biggest Loser Pinoy Edition Doubles Facebook page

t would have been easy for Biggest Loser sisters Katherine Dianne, 24, and Christine Anne, 25, Obsina to go back to their old ways, because they hadn’t really lost a lot of weight in their relatively short stay at The Biggest Loser Pinoy Edition Doubles camp. But they didn’t. “It was an easy road to go back to our old life since at that time when we exited, we didn’t lose so much weight,” said Dianne. “But my sister and I were fortunate to have our loving and supportive mom, Coach Jim, and Coach Toni Saret who were very encouraging and supportive.” In the end, their motivation was their goal to look just as good as those who reached the finals round. “My motivation was the goal to look as good as those contestants who will reach the finals. I wanted to achieve the goal of the contestants inside the camp. If they can do it, I can, too – and I made it!” Dianne said. JUNE-JULY 2014

feature Leaving too soon

Photos by Aaron Ebio, courtesy of The Biggest Loser Pinoy Edition Doubles Facebook page

“We believed at that time that we were still not strong and knowledgeable to handle the outside world and lose weight after we exited the camp. We were really sad and disappointed with our performance,” Dianne said of their two-week stay in the competition. The real challenge for her was being the first to be booted off since she would again be exposed to the challenges and real temptation in the outside world. For her, it was an everyday battle of choosing what is right over what she wanted. For Christine, the challenge of getting by after being booted out of the camp was in the things they learned about maintaining their health. “I was used to eating anything I wanted, including unhealthy food. It was a difficult transition because I was not fond of working out and eating healthy,” she said. “But our coaches told us that it is only going to be hard in the beginning. But once it becomes your lifestyle, things will be easy.” This is the thought that pushed Christine to wake up every single day with the willingness to exercise. “They (Coach Jim and Toni Saret) reminded us that losing weight is not just for the camp’s sake. It is a lifetime commitment,” Dianne said.

Working as a pair

Having a sister as a teammate in the camp is the best thing that happened to the Obsina sisters. Dianne was

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delighted because Christine knows her very well. Both of them connects and relates easily to each other even thru glances. “We knew exactly what worked for us and how to adjust to make things easier for both of us. We knew each other’s strengths and weaknesses so planning ahead was a piece of cake,” Christine said. For Dianne, embarking on a weight loss journey was not easy. Having someone who understands and knows her like her sister is a big thing. “She gets me and knows the best way to cheer me up and encourage me. I was sure I had someone to back me up and to lean on,” she said. Dianne also finds comfort in her sister. “Since I am older, there is added pressure on me to be a great example to her. I have to show her that despite being tired and sore, we have to keep on working hard,” Dianne said. There were days when she wants to give up but she forgets it because she wanted to be a motivation to her sister.

Coaches Dia n ne a nd Tin

“Being a coach in Metafit has inspired me and our participants to work hard and to never give up or lose hope no matter how hard,” Christine said. Today, they serve as inspirations to the Metafit participants they coach. “Whenever our participants tell me that I inspire them or that I am their idol or their goal is to look like me, I feel pressured, but it’s a good kind of pressure because hearing

feature When you feel beautiful inside, it will n aturally show. You h ave to gain confidence, feel great about yourself, a nd love yourself for people to see your beauty. If you do not believe in yourself, how will others believe in you?

Photo courtesy of ABS-CBN Public Relations website

that from them, it gives me more reason to keep pushing myself and continue my own journey in fitness to become better and inspire them even more,” she said. Metafit is about short-pocket high intensity workouts. It puts emphasis on quality workouts more than the quantity (longer time working out). With only 24 hours in a day, it doesn’t give anyone an excuse of not being able to have four minutes to workout. Everyone has four minutes to spare. “Metafit is about challenging yourself and pushing yourself more than what you think you can do,” said Dianne, who explains that Metafit exercises are designed according to different fitness levels. In camp, Dianne explains

Mrs. Anita (mother), Tin, Dianne, and Lorraine (sister) Obsina Photo courtesy of Lorraine Obsina’s Facebook page

that they teach and influence the participants on how to become fit and healthy – and stay that way – all their lives. “It’s a never-ending process to become better, stronger, fitter, and healthier.” “That is why in our camps, we tell our students to do the workouts they learned in camp at home on days that we don’t have sessions. We also always encourage our participants to challenge their bodies and surpass their limits because we know they can do it because we have done it and are still doing it,” Dianne said.

The Beauty Inside

The Obsina sisters changed their perspective on beauty when they realized that being beautiful is living

healthy with good values. Dianne pointed out that beauty comes from within. “When you feel beautiful inside, it will naturally show. You have to gain confidence, feel great about yourself, and love yourself for people to see your beauty. If you do not believe in yourself, how will others believe in you?” she said. Christine adds that, in order to be more successful and beautiful, the drive to become fit and to stay fit should be there. She says that it will all be worth it when the results are out. “Focus on your goal. Nothing great comes easy, but it will all be worth it. When you set your mind and heart into something, nothing is impossible,” Dianne said. “Never be afraid to dream big.”D

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Protecting the Rights of Diabetes Patients Is legislation atuned to the needs of the Filipino diabetes patient? Senator Sonny Angara sheds light on the National Diabetes Act of 1996 and what the law really means for everyone By Alexa Villano

o people with diabetes know there is a law specifically for their condition? While various medical laws in the Philippines have been pushed in the last few years (e.g., Universal Health Care, Reproductive Health Bill), one of the many landmark laws passed in Congress in the 90’s was Republic Act 8191, known as the National Diabetes Act of 1996, which established The National Commission on Diabetes to strengthen awareness and

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prevention of diabetes in the country. But not much has been heard about the commission since its establishment. Although various medical organizations and pharmaceutical companies have been working together in spreading awareness in the fight against diabetes, it seems much work is still ahead to alleviate the condition.

Nation al Diabetes Act of 1996

Approved during the time of

former President Fidel V. Ramos, the National Diabetes Act of 1996, aims to strengthen the awareness and fight against diabetes - one of the alarming diseases that have increased in the last century. The former president’s wife, Amelita Ramos, even spearheaded projects related to diabetes, currently sitting as chairperson of the Philippine Center for Diabetes Education Foundation. In the Diabetes Act of 1996, a special commission was created and tasked to help in the research, prevention, and awareness of diabetes mellitus. Nine members including the undersecretary for public health services serves as the ex-officio chairperson of the commission. Under section 2 of the law, it was written that “the state shall protect and promote the right to health of the people and instil health consciousness among them. There shall be priority for the needs of the underprivileged sick, elderly, disabled, women, and children.” While it is notable that a law is in place for diabetes patients, many wonder if diabetes patients do know about this and if the law is still applicable. Sen. Juan Edgardo “Sonny” Angara, who represented the country in the first-ever Parliamentary Champions For Diabetes Forum held last year at the World Diabetes Congress organized by the International Diabetes Federation in Melbourne, Australia, said that he would like to check if the law is still feasible. “I think it’s time to see if it (the law) needs updating. Dumadami pa rin ‘yung number, eh (The numbers are still increasing). There’s still an obesity epidemic…

feature we’re not alone in this aspect,” the senator told DiabetEASE magazine. “I’m also the chairman of the committee on games and sports so I think there is an interface with health. It is good if we can promote a sporty lifestyle.”

No new laws needed

In Sen. Angara’s point of view, it seems that the laws are sufficient and what is needed is implementation. “One of the big observations I saw in my exposure to Diabetes International is the importance of adopting best practices. There’s no need to reinvent the wheel. You can learn from countries that have already succeeded in lowering rates of diabetes and have already succeeded in providing accessible and affordable diabetes treatment to individuals,” he explained. He also said that there’s a big participation in all sectors to fight diabetes in other countries, something the Philippines needs. “I noticed in other countries there’s really participation between

the private sector, the government sector, and the academe. There’s not much participation from the government so I think that’s one aspect that needs to be strengthened – the participation of the government and the policymaking side especially on the end of lawmakers,” said Sen. Angara. With the Philippines emerging as a hotspot for diabetes, it seems that much campaign awareness has yet to be done. Under section 7 of the National Diabetes Act, it is stated that there should be a national diabetes and prevention control plan. Programs have been launched through the years. In fact, since Ramos’ time, National Diabetes Awareness Week has been celebrated every last week of July. This is different from the World Diabetes Day celebrated worldwide in November. With a promising law, diabetes patients and their families can surely look with hope. All that matters is the implementation, which will not only help them but also others with the same condition.

DIABETES PATIENTS AND THE LAW What does the law do for you and for diabetes patients in the country? We summarize important provisions in the law. Under the law, the, National Diabetes Commission: 1. Assesses the social and economic impact of diabetes. 2. Evaluates how much resources the country needs to address the prevention, diagnosis, and treatment of disease. 3. Prioritizes the needs of diabetes patients who are underprivileged, elderly, disabled, women, and children. 4. Implements the National Diabetes Prevention and Control Plan, which: a. Develops strategies to address diabetes in the country; b. Adopts screening methods for the detection of diabetes; c. Investigates epidemiology, etiology, diagnosis, treatment, prevention, and control of diabetes; d. Evaluates currently employed measures; e. Establishes mechanisms to reduce the impact of the disease on families and individuals; f. Grants incentives and support for organization, individuals, and families affected; g. Coordinate health systems and local government units; h. Reviews research on control and treatment of diabetes; i. Recommends for legislation laws for diabetes patients. JUNE-JULY 2014

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At the Office of Senator Sonny Angara The man, the son, the father, the rookie, and the legacy â&#x20AC;&#x201C; he is all that and more, Gelyka Ruth R. Dumaraos found as she spent a day at the office of the young and dynamic senator and the cusps of his work for stomping out diabetes in the country.

Words by: Gelyka Ruth R. Dumaraos | Photography by: Arrian Alcantara Styling by: Alvin Melgar | Make-Up by Bianca Mate Location: Senate of the Philippines, Roxas Blvd., Pasay City Special thanks to: Sugar Sallador of the Office of Senator Angara

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Cardigan from g2000 | Gingham Shirt and Chambray Shirt from Timothy | Scotch Belt from Uniqlo

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t was just another day at the office. Make that the Senate. Cameramen set up their equipment, reporters take down notes, and Senate staff members run about the hallways as if chasing Time itself. We were sort of the oddity in the whole hustle and bustle of the Senate. After battling temperatures over 35 degrees and an unforgiving sun outside, we didn’t look the part of journalists up for an interview with health advocate Senator Sonny Angara. And yet we found ourselves shaking hands with the man who greeted us by our first names as if we met for lunch just the other day. He was an oddity too in the frenetic energy of the Senate. His was an image of calmness amidst a chaotic political arena and even more chaotic veterans, donning the hat of an advocate for education, youth, and health. It was, after all, just another day at the Senate.

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The father

Time management is the key, he said. A typical day will start with a round of exercises and time with the kids before appointments begin and Senate committee hearings and sessions rock his day. In some days after sessions, he plays basketball with the Senate team. Weekends are meant the ‘normal stuff’ like going to the mall and watching movies with the family, if there are no commitments in the province. “We have to make sacrifices. You cannot attend all the functions; you have to learn to say ‘no’ to something on both sides,” he said, mentioning that what they have is a two-income household, so he and his wife would really talk on matters regarding their children and their outside commitments. Just a year ago, Sen. Sonny was just one of the many who eyed a Senate seat in the election, gaining the nod of the youth and campaigning with top young

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celebrities as his endorsers. It was his being articulate and intelligent coupled with such an enticing charisma that has captured the hearts of people who cast their votes with his name. Always beside him is his wife, Tootsy, who even had to take a leave of absence from her work as ABS-CBN’s Marketing executive, to help him in the campaign. Sen. Sonny acknowledges this great effort apart from all other ‘patongpatong na utang’ he owes his wife. “Wala, parang hindi ko na nabayaran ‘yung utang ko sa kanya. Parang sa sari-sari store, nilista na lang niya (It’s as if my debt to her has just piled up, and I could not pay her back. Like at a sarisari-store, she just took note of my debt),” he said, but added seriously that he took his family on a vacation abroad. He sets aside time for his family despite a very tight schedule. Time away from work is devoted to his growing kids, Manolo, Ines, and Javier, who, at their early ages, are now cultivating their respective interests in sports, music, and the arts.

The athlete

Many know that aside from being a lawyer and legislator, this man is a lover of sports. In college, he was a captain of the UP Law Basketball Team, and we aren’t surprised that he now heads the committee on games and sports. In a way, Sen. Sonny interfaces health in the promotion of a sporty lifestyle. He believes that because the Philippines is blessed with all the elements, there are no reasons not to be active in sports for Filipinos. He even believes that there is a potential to promote what the Philippines has to other countries and that a sedentary life will just lead to nowhere but possible health risks. “There is always something there to take you from door to door so the fitness benefit of walking is taken out and that is something we should return to society,” he said. Having lived abroad for quite some time, he saw the importance of a healthy mind and body that must be valued in the Philippines.

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The son

One would think that the genes of the family man and legislator were passed down to Senator Sonny from his father, former Senate President, Edgardo J. Angara. Theirs is a close-knit relationship, built with similarities and differences but equally paired with strong leadership skills making them distinctly Angara. Next to an inherent love for food, they both love books. The love for reading is also where they draw the line as the son is much sportier than the father who’d rather dedicate his time to reading. His father, a strong leader, was a bit authoritarian, whereas, Sen. Sonny says he’s got a more relaxed style of leadership. But what makes them both effective is this: they get things done.

Education, I think, it’s a great equalizer in a highly unequal society 46

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The rookie

His knowledge in leadership and government was honed through time, after years of studying here and abroad. In 1994, he earned his degree in Economics at the London School of Economics and Political Science in England. He took up law at the UP College of Law and graduated and passed the bar exams in 2000. He later pursued his post-graduate studies at Harvard Law School and earned his Master of Laws degree in 2003. He was also awarded as one of the Ten Outstanding Young Men (TOYM) of the Philippines for 2010, by President Benigno Aquino III. Before setting foot in the Senate, Sen. Sonny was a three-term representative of the lone district of Aurora, authoring numerous measures such as the Expanded Senior Citizens Act of 2010, Tourism Act of 2009, Tax Exemption for Minimum Wage Earners Law, and the Magna Carta of Women, and other bills campaigning

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for the good of family members and workers. His reputation in Congress followed him to the Senate. He was dubbed as the “wonder boy” of Philippine politics after securing a seat in the 13th Congress at the early age of 31, making him among the youngest. Major changes have since come when he clinched a seat in the Senate, becoming one of the ‘new blood’ of lawmakers in this batch of senators. “Kung magaling na bata ka, kahit ano ‘yong background mo, puwede kang sumikat, puwede kang umunlad (If you’re young and good at what you do, no matter what your background is, you can become famous and successful),” he said. Given that he and the other newbies in the Senate were once colleagues in Congress, this allowed them to relate well with each other. “We’re very informal with each other. We ask for JUNE-JULY 2014

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There’s no need to reinvent the wheel. You can learn from countries that have already succeeded in lowering rates of diabetes and have already succeeded in providing accessible and affordable diabetes treatment to individuals support of a bill parang two people asking for help,” he said, stressing that not because they are lawmakers means that they have to be very formal with each other. As senator, his advocacy for youth, education, health, and equality are among the things on his agenda. Noting that the Philippines needs social mobility to find ways to improve society, more so the economy, this is where he stands: “Education, I think, it’s a great equalizer in a highly unequal society.” Proving his commitment in his advocacy, majority of the bills he filed and supported in his first year as senator encompass matters concerning education. This includes the increase of wages for public school teachers, open learning and distance education, anti-bullying bill, and the ladderized education. Sen. Sonny believes that having a great number of young people in the country—something that not all countries have—is an opportunity itself. Abundant potential is just around the

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corner and waiting to be seized if only people would look at it from a different perspective where change could start. Aside from sustaining a thriving economy, he said that the country must focus on the health sector. He was one of the advocates that pushed for universal healthcare, which he firmly believes is the greatest achievement of the Aquino administration. This allows the government to widen the PhilHealth coverage and fund the health sector and its beneficiaries—the Filipino poor. The “No Balance Billing” is also a drive that he supports wholeheartedly. This must be widely implemented for the benefit of the poor who cannot afford to shell out money for hospitalization. “We’re talking about equalization of the poor and the rich. That is a very potent weapon for the poor who cannot afford good health and we know that more than half the population cannot even consult a doctor for their health,” he said.

[c And the Legacy

It is known to many that his father has been an active advocate in the fight against diabetes, a battle which he carries on now that he is in Senate. It made us think that his advocacy to stomp out diabetes may have taken roots from his own life. He talks to us about his grandmother who had diabetes and needed to inject insulin every few hours to manage the condition. This, he said, is one thing that taught them a lesson. That the condition is serious and that it can be a burden to someone’s life if not prevented soon. Just last year, Sen. Sonny was the country’s representative to the International Diabetes

Federation (IDF) Global Forum of Parliamentarians, where he was exposed to the adoption of best practices showed by international diabetes groups which give much import to the prevention and management of the condition. “There’s no need to reinvent the wheel. You can learn from countries that have already succeeded in lowering rates of diabetes and have already succeeded in providing accessible and affordable diabetes treatment to individuals,” he said. In addition, the level of participation of the private sector, the government, and the academe in other countries is one thing that should be emulated. As observed, Diabetes Philippines is mainly composed of

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healthcare practitioners with little participation from government. “I think that’s one aspect that we need to strengthen. The participation of the government and the policy-makers are needed. I noticed that a lot of legislators are very active with the setting of policy for diabetes and other noncommunicable diseases,” he said. Sen. Sonny is now looking to the exercise of good oversight and review of the National Diabetes Act passed in 1996, which is up for further updating. Another issue he is eyeing is the rising obesity epidemic, a factor in diabetes development, saying that lifestyle change is needed to prevent the condition. It’s just another day at the office for Senator Sonny Angara. D

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goodfoodguide 1. Wh at are you putting in your mouth â&#x20AC;&#x201C; mostly?

Decode food labels 6 questions to ask to really understand the numbers on the food label and how these can affect health By Edreilyn Manalo

alls have been made to national governments worldwide to update food labels in order to keep up with the changing times and to help the general public understand better the food and drinks they are consuming. In fact, the US Food and Drug Administration (FDA) is now ushering in a new breed of food labels to include ingredients and facts that were normally not included in the original food label. In the Philippines, the FDA ensures proper packaging and labelling of food distributed in the country. Transformation of packaging is noticeable in most food items due to high impact of health and nutrient claims provided by food companies. For years, food labels have been there to properly inform the public, but not many really understand what theyâ&#x20AC;&#x2122;re reading. DiabetEASE gives you six questions you have to ask yourself so you can decode food labels like a pro.

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Ingredients on all packed food are listed on the label in descending order of dominance of weight. If it makes up most of the packed food, it will be the first on the list and the majority of what you will be putting in your mouth. Labels present nutrition information per serving, which makes it necessary to first identify the size of the serving. The US FDA established specific serving sizes for various food products, which allow consumers to easily compare packed goods based on their higher or lower claims. This can help us determine how much of the packed food we can actually eat based on the serving size. Food for thought: Small bags such as chips and candies contain two or more servings, which, therefore, double or triple our food intake.

2. How much nutrient will you be absorbi ng?

Nutrition Facts, which the FDA requires to be on the food label, are presented in two ways: 1) quantities such as grams and 2) daily values or percentages of standards. The % Daily Values (%DVs) are based on the Daily Value recommendations for key nutrients but only for a 2,000 calorie daily diet â&#x20AC;&#x201C; not 2,500 calories. You, like most people, may not know how many calories you consume in a day. But you can still use the %DV as a frame of reference whether or not you consume more or less than 2,000 calories. The %DV helps you determine if a serving of food is high or

goodfoodguide low in a nutrient. Note: a few nutrients, like trans fat, do not have a %DV. Each nutrient is based on 100 percent of the daily requirements for that nutrient (for a 2,000 calorie diet). This way you can tell high from low and know which nutrients contribute a lot, or a little, to your daily recommended allowance (upper or lower). Food for thought: In the example

food label below, look at the Total Fat in serving. Is 18% DV contributing a lot or a little to your fat limit of 100% DV? It is not yet high, but if you ate the whole package, you would double that amount. You’d be eating 36 percent of your daily allowance for Total Fat. Coming from just one food, that leaves you with 64 percent of your fat allowance for all of the other foods that you eat that day – snacks and drinks included!

Source: http://www.fda.gov/food/ingredientspackaginglabeling/labelingnutrition/ucm274593.htm

3. Wh at do they mea n by free, high, a nd low?

Nutrient claims describe the level of a nutrient in the product, using terms such as free, high, and low; they also compare the level of a nutrient in a food to that of another food, using terms such as more, reduced, and lite. The Nutrition Labeling and Education Act of 1990 (NLEA) permits the use of label claims

that characterize the level of a nutrient in a food if they have been authorized by the FDA and are made in accordance with FDA’s authorizing regulations. Food for thought: A product having a label “cholesterol-free ” has less than two milligrams of cholesterol and may not contain more than two grams of saturated or trans fat combined per serving.

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goodfoodguide 4. How do I m ake sure it prevents sickness?

“Health claims” is described by the FDA as the relationship between a food substance (a food, food component, or dietary supplement ingredient), and reduced risk of a disease or health-related condition. Consumers reading health claims like “Diets low in sodium minimize risk of high blood pressure” was examined by FDA to prove that this establishes a clear list between diets and health. But it doesn’t mean that by solely consuming a certain food item which contain health claims, we can avoid or reduce the risk of contracting health conditions. Food for thought: FDA’s A “ ” list of health claims.

5. Ca n it really help improve my health?

Food labels also tell you how its specific nutrients affect your body like when a milk brand says that it makes bones stronger because of its high calcium content or when a ketchup brand says it can protect cells from damage because of lycopene present in it. The “Structure-function claims” is basically a part of the food label that may describe the role of a nutrient or dietary ingredient intended to affect the structure or function of the human body. Food for thought: Check for claims like these on the front of the label or in television commercials. Remember the margarine that claims to make children taller because of calcium or give children better eye sight because of the Vitamin A? Look out for claims like these.

6. Wh at if the food product doesn’t h ave a food label?

Food labels appear virtually on the packaging of all processed foods, posters, and brochures to provide similar nutrition for fresh meat, fruits, and vegetables. Some food products need not carry information labels, specifically those contributing few nutrients like plain coffee, tea, and spices. Products produced by small businesses and those prepared and sold in the same establishment also do not need to carry food labels, but some voluntarily do. Food for thought: As long as food products served in the restaurants don’t have food claims such as “high protein” and “low fat”, they don’t need to provide nutrition information. D

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righteousrecipes

Exciting baons â&#x20AC;&#x201C; quick a nd easy Recipes by Chef Jun-jun de Guzman Photos by Jose Martin Punzalan

ake recess and lunch exciting for the family with quick and easy recipes to add pizzazz to your weekly baon menu. Forget go-to baon regulars like hotdog, ham, and fried meat nuggets, which can be unhealthy when consumed daily. These dishes can be stored at room temperature for at least 6-8 hours as long as theyâ&#x20AC;&#x2122;re not exposed to direct heat. Cool them first before packing into containers.

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righteousrecipes

Ingredients:

Sardines Pesto Pen ne Serves 8 persons Prep Time: 30 minutes Cook Time: 15-20 minutes

Nutrition facts per serving: 371.4 calories 27.1 g fat 18.5 g carbohydrates 13.5 g protein

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500 g

Penne pasta, al dente

Pesto Sauce: –½ cup 2 pcs cup 1 tbsps ¼ cup

Fresh basil leaves Garlic cloves Extra virgin olive oil Toasted pine nuts Salt and pepper Parmesan cheese, grated

Sardine Mixture: 1 jar Sardines, drained and picked 1 tbsp Garlic, minced cup Onions, sliced ¼ cup Extra virgin olive oil

Procedure:

1. Pesto Sauce: Put all ingredients in a blender and process until pureed. Set aside. 2. Sardines Mixture: Sauté garlic and onions in olive oil. Add sardines and cook for one minute. Blend in ½ of the pesto mixture. Season with salt and pepper. 3. Toss in penne pasta and mix well. Serve.

righteousrecipes

Ingredients:

Chicken Tarragon Sliders Serves 5 persons Prep Time: 20 minutes Cooking Time: 20 minutes

Nutrition facts per serving: 383.9 calories 15.7 g fat 37.1 g carbohydrates 21.5 g protein

Meat: 300 g Chicken breast, ground Âź cup Onions, finely chopped 2 tbsps Carrots, finely chopped 2 tbsps Celery, finely chopped 1 pc Egg 2 tsp Worcestershire sauce Pinch Salt 1/16 tsps Ground pepper Âź cup Canola oil Burger: 2 pcs 10 pcs 10 pcs

Tomatoes, sliced into rounds Lettuce, cleaned and spun dried Dinner rolls or mini burger breads

Procedure:

1. Mix all ingredients. Start mixing vigorously to make the mixture bind together. 2. Let stand for 15 minutes. 3. Heat some oil in a non-stick pan. Spoon the mixture and fry on one side until brown then cook the other side. 4. Drain in paper towel lined pan. Let rest while preparing other ingredients needed for the assembly. 5. Cut dinner rolls into 2 pieces. Lay chicken burger on bread, add tomatoes and lettuce, and serve.

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righteousrecipes

Ingredients:

Pork Tenders Ch arSiu Sauce Serves 5 persons Prep Time: 20 minutes Cooking Time: 15 minutes

Nutrition facts per serving: 433.8 calories 10.8 g fat 52.1 g carbohydrates 31.6 g protein

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1 pc Pork tenderloin, around 500 g Salt and pepper 2 ½ tbsps Canola oil 1 tbsp Garlic, minced ½ cup Onions, sliced cup Leeks, finely chopped 100 g Oyster mushrooms, sliced 50 g (1 pack) CharSiu Sauce 1 tbsp Light Kikkomann 5 cups Rice, cooked

Procedure:

1. Slice pork tenderloin into ½ inch thickness. Season with salt and pepper. Set aside. 2. Sauté garlic and onions in canola oil until translucent. Add leeks in mushrooms and cook for around 10 minutes. 3. Add in pork tenderloin and cook until slightly browned. Add sauce and kikkoman and continue cooking. Adjust seasoning and serve over rice.

productspotlight

The word on healthy spreads By Michaela Sarah De Leon

hatâ&#x20AC;&#x2122;s the use of consuming sugar-free or any other healthier version of bread if you use spreads that only reload the calories and sugars that you supposedly wouldnâ&#x20AC;&#x2122;t consume? We scoured the grocery aisles again for the sugar-free and low-sugar spread concoctions to make your sandwiches a little less sinful and a little bit more healthful.

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productspotlight Fruity Spreads We start with the most obvious of the sugar-free/low sugar spreads: Fruit Spreads. They come in the most imaginable flavors you could think of. Most fruit spreads are already healthier than the average store-bought spreads. We looked for healthier versions of fruit spreads and found sugar-free alternatives to our favorite fruit spreads – strawberry jams and orange marmalade.

Sugar-Free Strawberry Ja ms Clara Olé Sugar-Free Strawberry Jam

We’ll just come out and say it. This version of Strawberry Jam tastes horrible. With no sugar substitute or sweetener, Clara Olé Sugar-Free Strawberry Jam is just a pile of mushy strawberry jelly that just poorly masks its unpleasantly sour and bitter flavor with strawberry undertones. But, of all the sugar free spreads featured here, Clara Olé’s sugar free strawberry jam is the most ubiquitous. On a good note, you’ll only get 10 calories from every serving. We’re curious as to why this strawberry jam needed strawberry flavoring.

Smucker’s Sugar-Free Strawberry Preserves

Taste-wise, Smucker’s Sugar-Free Strawberry Preserves is a lot better. In fact, it tastes almost the same as the original. Like Clara Olé’s sugar-free strawberry jam, you only get 10 calories from each serving. Unlike Clara Olé, you get the flavor from only strawberries and the sweetener. It’s only obvious disadvantage is its price.

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productspotlight

Sugar-Free Ora nge Marm alades

Clara Olé Sugar-Free Orange Marmalade

While not the go-to bread spread of the average Filipino, orange marmalade is a fun twist to the fruity and citrus spreads that we’re all familiar with. Clara Olé Sugar-Free Orange Marmalade also shares the same bitter and sour taste as its strawberry counterpart. Its tiny amount of sugar gives it a little more of an edge in terms of taste. Like the strawberry jam, it also has a jelly consistency, which is very unlike real orange marmalades. It still has the same textures reminiscent of actual orange marmalades, which is great. After all, what’s a good orange marmalade without candied orange peels?

Smucker’s Sugar-Free Orange Marmalade

Of course, Smucker’s version of the sugar-free orange marmalade is by far better than its competitor in terms of taste. It also has the candied orange peels and the sweetness close to its original counterpart. Its consistency is also runny, which is the classic consistency of sugary orange marmalades. The color is a mild turn-off. It is a bit too orange for an orange marmalade, which is usually clear with bits of orange peels. This is as close as you can get to an orange marmalade that won’t shoot up your blood sugar levels. Another great thing about Smucker’s sugar-free jams and jellies, they come in so many flavors so you’re not only limited to orange marmalade and strawberry jam varieties.

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productspotlight Crea my Spreads Our search for healthier versions of our favorite spreads won’t stop with just the fruit spreads. After all, how can you make a proper PB&J sandwich without peanut butter? This time, we looked really hard for healthier creamy spreads not only in grocery stores, but also in specialty stores and even food bazaars.

Peter Pan Whipped Creamy Peanut Butter 1/3 Less Sugar

Of all the creamy low-sugar creamy spreads, Peter Pan is the easiest to look for as it is available in almost all grocery stores. While their sugarfree variety of peanut butter has long been phased-out, its new Peter Pan Whipped and Creamy 1/3 Less Sugar is as it close as it can get. It’s a little bit lighter and there’s no oil pooling over the spread. Most peanut butter spreads have about 3 g of sugar per serving. One gram of sugar makes a whole lot of difference.

Simply Jiff Peanut Butter

Another low-sugar alternative, Simply Jiff Peanut Butter is pretty much like Peter Pan in terms of amount of sugar. The difference is it’s a total calorie bomb with 190 calories per serving and a total of 130 calories from fat! Its apparent advantage is in the amount of vitamins and minerals it offers like iron, vitamin E, ribofavin, and niacin. An obvious downside, it’s made with more sugars! Mono- and diglycerides, molasses, and sugar are all sugars that most brands don’t have.

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productspotlight

Skippy Natural Peanut Butter 1/3 Less Sodium and Sugar

What we like about Skippy other than its reduced amount of sugar is its lower sodium content and simplicity of ingredients. With only roasted peanuts, sugar, palm oil, and salt, you can be absolutely sure about what you’re putting in your mouth. However, the amount of calories in the mix is just horrible to look at with 210 calories and 150 calories from fat. This is also a little bit more difficult to look for as it is available in high-end stores, specialty stores, and, if you’re lucky, food fairs and bazaars.

Nutilight

We thought, if we’re looking for healthy spreads, there must be a chocolate variety out there! This is what we found. Nutilight is the healthier answer to our all-time favorite chocolate spread, Nutella. Made from non-genetically modified food, this hazelnut spread is not only sugar free, it’s also gluten free. It’s also made with natural sweeteners from plants with zero glycemic index. Chicory also makes for a good source of dietary fiber. It’s definitely the spread for diabetes patients. What the downside? This spread is so rare in the Philippines that you’ll be lucky to find it in food fairs and bazaars. Or you can buy a couple of jars of Nutilight from Amazon.com. D

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productspotlight

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stressbuster

10 School

Stress busters Easy solutions for parents to help children cope with school stress

By Excel V. Dyquiangco

t’s not just about school work. From bullying, after-school activities, standardized tests, and campus friendships to fear of failure, students face a lot of pressure these days. In addition, author Michelle L. Bailey says in her book, Parenting Your Stressed Child, children who experience such stresses often suffer in silence and greatly affect them in a negative way. “Chronic stress has a significant negative impact on health and may increase risk of cardiovascular disease,” she says. “Stress can also lead to a lot of negative and harmful behaviors for both children and teenagers.” Here are solutions that parents can apply when kids are stressed:

Don’t rush. Lori Lite, author of

cradlestocrayons.org

Stress Free Kids: A Parent’s Guide to Helping Build Self-Esteem, Manage Stress, and Reduce Anxiety in Children, says, “A rushed child is never a calm child.” Don’t rush the child’s school life and make sure that everything the child needs is ready before the school bus arrives.

Establish Good Sleeping Habits. Many studies have attested to the major health benefits of getting enough sleep. Set a routine for the child. Set bedtime at around 9 p.m. and wake him up at around 6 a.m. JUNE-JULY 2014

stressbuster

Control “screen” time. “Screen

The signs a nd symptoms of school stress

activities such as TV, video games, computer games, social media, cell phone usage (texting and calling) and movies have increased over the past few decades,” says Bailey. She suggests limiting screen time to at least two hours a day. During the school days, lock gadgets in a private room so that children can’t get to them.

Talk to the child. If a child is sus-

pected of having school stress, talk to him about the challenges he is facing in school. Ask questions on things that bother him. Says Bailey, you can even let your child know that stress is a normal part of life and that everyone deals with it on a daily basis.

5 6

Practice relaxation techniques.

Practice relaxation techniques such as exercising and deep breathing. Jog with the child around the block, do laps in the pool, or ride a bike.

Let the child rest. Making chil-

you talk to school officials to know what is going on with your child and his school environment. You may discover tidbits that the child has been keeping from you.

Be an example to your child.

Instead of pontificating to the child on how to cope with stress, embody a person who can cope with stress. When a work day is turning out badly, show the child that stress can be handled. Don’t yell at the child, instead, show examples of how to cope with stress.

Never criticize. Never talk nega-

tively about the child’s teachers or his school work. This can build up fear. “They’re already feeling stressed so you need to be the calming force,” Lite says. Always strive to be the positive force, the encouraging nurturer, and the helpful parent.

Seek help. If the child’s school

stress still persists, consider seeking the help of the school guidance counselors and school psychologists. D

m gnrhealth.co

dren do too many things after school can seriously stress out a child. After homework, don’t make the child do advance studying. Do something fun with the family instead. What’s important is allowing the child to rest.

Connect with school administrators. Make sure that

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livingwell

My father, my fearless knight By Candice Monique Brillon

Every daughter considers her father as her greatest protector â&#x20AC;&#x201C; her fearless knight. Being a father entitles a man to stand up and be a stable foundation for his family. I consider my father as my ultimate knight despite his having type 2 diabetes for nine years now. And as I pay tribute to him, I will take you to his quest to a fearless yet priceless journey of letting go and starting anew.

His First Battle

Even as Candice Monique Brillonâ&#x20AC;&#x2122;s family faced seemingly insurmountable challenges, her father stayed the knight in shining armor to his children despite living through a failed marriage and contracting type 2 diabetes just after overcoming lung cancer. Candice writes their story.

My Father, Mhar Faller Brillon, 52, was an Overseas Filipino Worker (OFW) for a decade in Saudi Arabia back in the 1990s. He was an undergraduate of Bachelor of Science in Civil Engineering at the Technological Institute of the Philippines, Manila. He was born and raised in Lucban, Quezon. During his younger days, he would help his father in their farm to suffice their daily needs. He motivated himself to work hard and to pay for his tuition during college. He started working as a mason in his godfatherâ&#x20AC;&#x2122;s construction site while studying in college. When he decided to start a family in 1989, he dreamed of giving us the best things in life. He decided to apply as an OFW. Working too much abroad weakened his immune system and gave him lung tumor. I have seen his struggles after he went back to the Philippines. His body weakened and became feverish almost every day. Despite his condition, he still forces himself to supervise construction jobs to feed our family. He would even crack jokes while in pain. I do not know how he manages that.

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livingwell I have seen his struggles so we told him to focus on his medications and rest instead. I cannot bear seeing my dad hurt too much so I stopped schooling after I graduated high school to take care of him and assist my sister in school activities. Another problem came when my mother, who was also working abroad, gradually changed her attitude toward the family in both emotional and financial ways. This resulted in a major struggle in their marriage and even bigger struggle for our family. I was about to give up, but dad was very determined to keep going. He wanted us to stay strong and continue to pray for strength. He motivated us to do our best and always think of the positive side of life. Our prayers have been answered. Relatives and friends came to help us financially. Dad was cleared by the doctors after six months of treatment and everything went back to normal.

Parti ng Ways

surprised or scared at all. He did not take diabetes as a problem but an opportunity to be more conscious of his health. He became more active. He practiced a balanced diet with adequate sleep. His ways to start anew was also reflected in how he dealt with our everyday needs. He made sure that we lived healthy and stress-free. At the end of the day, he would always tell us to smile and be thankful for life. Diabetes helped dad discover and improve himself more. It extended dad’s creativeness in staying fit and healthy every day. It showed dad a lesson of being good to yourself and not abusing your body. I may never have the most glamorous treasures in life or fame that any celebrity can hope for but I have my fearless knight – my dad. I owe him my strength and determination to live. His marriage did not have a happy ending and he struggled a lot about his health, but nobody can ever question him as a father. He is my ultimate protector, provider, and inspiration to survive. He will always be my knight and I will always be his little princess. D

The Ga me Ch a nger

While healing emotional wounds, dad started feeling the symptoms of diabetes. Findings proved that dad inherited diabetes from his parents. His siblings have type 2 diabetes, too. He was not

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wearejuxt.com

My dad had to deal with his rough marriage after recovering from lung cyst. He and mom decided to part ways because of irreconcilable differences. It was tough for all of us. The process of separation was difficult because I was only 19 years old at that time. I had a sister who just graduated from high school. But dad has always been our knight. He helped us move on as he moves on, too. His courage to face life again after a storm was very remarkable for us, his daughters. Their separation got worse when mom became so angry at everything. She started acting differently by locking us up in her house and refusing to allow us to see dad again. She said bad words against our love for dad and her failed marriage. We were so scared at that time, but I never let that fear consume me. I copied dad’s mantra of staying strong and positive. We decided to move out of mom’s house to live with dad instead.

dosanddon’ts

Of Diabetes a nd Disasters Live another day when disaster strikes. Practical tips for people with diabetes to survive any kind of calamity By Gelyka Ruth R. Dumaraos Reviewed By Joy C. Fontanilla, MD

tudies from the Department of Science and Technology and World Wide Fund for Nature have found that the weather is bound to become more erratic in the years to come. Thus, summers can become hotter and rainy seasons can become wetter. Add to those the unpredictability of earthquakes, super typhoons, volcanic eruptions, tsunamis, and even armed conflict. Without a doubt, the weather is one of the many great equalizers of the world. If people from different walks of life are affected the same way when calamity strikes, how much damage can a person with diabetes suffer when they are trapped in the most vulnerable conditions? Here are dos and don’ts to ponder on when disaster strikes:

DO’S

IIlustration by Rackel Selena Lumbang

Store emergency supplies. The American Diabetes Association’s foremost advice is to have a plan. Being prepared for emergencies could save your life when everything around you seems to shut down—electricity, water, communication, and transportation. Lacking these basic necessities can cripple diabetes patients especially since they also need to look for medical supplies for diabetes maintenance. Store up to a 30-day supply of your medications, the American Association of Clinical Endocrinologists suggests. This should also include a copy of your emergency information, medical list, insulin or pills, syringes, insulin pump supplies, lancing device and lancets, glucose meter, and other supplies. Keep in mind that you should also gather and sort general supplies like food, batteries, flashlights, mobile phones, candles, first-aid kits, important documents, and personal hygiene supplies. Check at least every two to three months for expiration dates. Safety and protection first. While helping rehabilitate a house damaged by flood or earthquake, see to it that you are in

good condition. Check your blood sugar regularly especially when you need to lift heavy weights or work under extreme heat or hard rain. Immediately seek for medical attention as soon as you can once emergency health centers are up and running – most especially in the event of a physical injury. The injury may cause more harm if you selfmedicate. Drink plenty of liquids. Hydration is always important for survival. Stock at least one gallon of water per person good for a week alongside your food supply. Be wary of contaminated water and food supplies.

Starve yourself. During disasters, meals are likely to become erratic. This can affect diabetes patients especially those taking oral medications or insulin. After taking insulin (depending on the type) or any drug for diabetes treatment, eat within 15 minutes after and not later than half an hour. The US Center for Disease Control and Prevention says that one must not let hunger go on for a long period of time nor overindulge when food arrives. Store hard candies, raisins, or glucose tablets

for fast source of sugar aside from crackers, canned goods like tuna and salmon, unsweetened cereals, and water-packed fruit. Food and water must be boiled for ten minutes to decontaminate them. Walk barefoot. Do not walk around on bare feet especially if the floods have not subsided. In case footwear is not available, use a clean cloth or a plastic bag to protect your feet from foreign debris that might lead to injury. Check if you have blisters, cuts, or animal bites that might trigger more infection if not given immediate medical attention. Stress out. Stress increases blood sugar. It is inevitable to feel stressed and tired during and after a disaster. Apart from having to worry about your loved ones’ survival, you must also take into consideration your own health that may be affected during a calamity. A tormented mind will not make the current state get any better. Panic can get into one’s mind at the onset of a disaster but let it not rule your mind that you forget to live and survive. Look after yourself while looking after the safety of your loved ones. Believe and trust that everything will be okay and let prayers ease your worries. D JUNE-JULY 2014

dosanddon’ts

Diyabetes at Kala midad

Maging ligtas sa panahon ng sakuna. Mga praktikal na paraan upang malagpasan ang pagsubok ng mga kalamidad para sa mga may diyabetes. Isinulat ni Gelyka Ruth R. Dumaraos Pinamatnugutan ni Joy C. Fontanilla, MD

apag-alaman sa pag-aaral ng Department of Science & Technology at World Wide Fund for Nature na ang panahon ay maaaring maging pabugsu-bugso sa mga susunod na taon. Kaya naman, ang tag-init ay lalong nagiging mainit, at ang panahon naman ng tag-ulan ay lalong lumalala. Idagdag pa ang mga lindol, bagyo, pagputok ng bulkan, tsunami, at iba pa. Kaya naman hindi na maikakaila pa na ang panahon ang siyang tinaguriang ‘great equalizer of the world.’ Kung ang mga tao sa iba’t ibang antas ng buhay ay maaaring mapahamak sa panahon ng kalamidad, paano pa kaya ang mga taong may diyabetes na talaga namang mas delikado ang kalagayan? Narito ang mga dapat at hindi dapat gawin kapag humampas ang kalamidad:

Unahin ang kaligtasan. Habang tumutulong sa pagsasaayos ng bahay na nasira ng baha o lindol, siguraduhing nasa magandang kondisyon ang katawan.

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posibleng pagbagsak ng asukal sa dugo, bukod pa sa mga biskwit, de lata tulad ng tuna, salmon, unsweetened cereals at water-packed fruits. Ang pagkain at tubig ay dapat napakuluan ng hanggang sampung minuto.

Uminom ng maraming tubig. Ang pagpapanatili ng tubig sa katawan ay makapagpapaiwas sa mga sakuna. Mag-imbak ng hindi bababa sa isang galon bawat isang tao sa loob ng isang linggo. Siguraduhing malinis ang tubig at pagkain na inaabot sa inyo.

Maglakad nang nakayapak. Huwag maglakad nang nakayapak lalo na kung hindi pa nawawala ang baha. Kung wala namang sapatos na maaaring gamitin, gumamit ng malinis na tela o plastic bag upang maprotektahan ang paa sa sugat. Tignan kung nagtamo ng galos, hiwa, o kagat ng hayop o insekto na maaaring maging sanhi ng impeksyon kung hindi mapatingnan kaagad sa doktor.

Gutumin ang sarili. Sa panahon ng kalamidad, ang oras ng pagkain ay maaaring maging di regular. Ito ay makaaapekto sa mga may diyabetes lalo na kung nakagamot o insulin. Pagkatapos magturok ng insulin, o mag-inom ng kung ano mang gamot para sa diyabetes, kumain sa loob ng 15 minuto at huwag palalagpasin ng kalahating oras. Sabi ng US Center for Disease Control and Prevention, hindi dapat magutom nang matagal o kaya kumain nang labis kung parating na ang pagkain. Mag-imbak ng kendi, pasas, or glucose tablets para malunasan ang

Mabalisa. Ang stress ay nakapagpapataas ng blood sugar. Hindi maiiwasan ang mataranta at mabahala kapag may kalamidad. Bukod sa kailangang isipin ang kapakanan ng mga mahal sa buhay, kailangan ding isaalang-alang ang sariling kondisyon na maaaring maapektuhan ng matinding pagod at tensyon. Ang pighati ay hindi makatutulong sa iyong kalagayan. Maaaring mauna ang takot sa simula ng kalamidad subalit huwag itong hayaang maghari hanggang sa puntong kalimutan mo na ang mabuhay. Alalahanin ang iyong kalagayan habang inaalalayan din ang mga mahal sa buhay. Mananalig na ang lahat ay maaayos din at magdasal upang mapanatag ang loob. D

IIlustration by Donna I. Pahignalo

Mag-imbak ng kagamitan. Ang pangunahing payo ng American Diabetes Association ay ang pagkakaroon ng plano. Ang pagiging handa sa panahon ng kalamidad ang maaaring magsalba sa iyong buhay kung halos lahat na ng nasa paligid mo ay hindi na abot-kamay—kuryente, tubig, komunikasyon, at transportasyon. Ang kawalan ng pangunahing pangangailangan tulad ng mga ito ay maaaring magpahirap sa may diyabetes dahil kailangan din nilang maghanap ng gamot para sa kanilang kondisyon. Magtago ng hanggang pang30 araw na gamutan, payo naman ng American Association of Clinical Endocrinologists. Kalakip nito dapat ang kopya ng emergency information, listahan ng gamot, mga kagamitan sa pagturok ng insulin, pagsuri ng asukal sa dugo, at iba pa. Mag-imbak din ng panustos tulad ng pagkain, baterya, flashlight, mobile phones, kandila, first-aid kits, mahahalagang dokumento, at personal hygiene supplies. Suriin ang mga ito kada dalawa o tatlong buwan pati na ang expiration dates.

Regular na i-tsek ang asukal sa dugo kung kinailangang magbuhat ng mabibigat na bagay o magtrabaho sa ilalim ng matinding sikat ng araw o malakas na ulan. Agad na kumonsulta kung mayroon nang mga naitayong emergency health center—lalong-lalo na kung may sugat sa katawan. Ito ay maaaring lumala kung gagamutin lang ang sarili.

dosanddon’ts

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affairstoremember

One Fitness Day held by AACE-Philippines

he American Association of Clinical Endocrinologists-Philippine Chapter (AACEPhilippines) tried something new this year with One Fitness Day in place of their regular G.O.O.D. (Goiter, Obesity, Osteoporosis, Diabetes) Run held yearly. Held at the Elements Tent of Eton Centris in Quezon City on March 29, 2014, One Fitness Day aimed to raise awareness on living a healthy lifestyle with particular focus on physical fitness. AACE-Philippines president Dr. Florence Santos said that she decided to partner with Karl Edward International to organize the first One Fitness Day. It featured a series of classes on the latest fitness trends like PlusFit (a form of bodyweight suspension training) by Coach Jaco Benin and TRX Philippines, Sexy Heels Fitness (dancing exercises in heels) by Sheena Vera Cruz, Forma Asana (a calm yoga-like stretching session) by Van Manalo of Plana Forma, and a Zumba session by Gold’s Gym. After a full morning of physical workout, the participants got to take a breather with a series of informative lectures on various health matters before they got on with the final Zumba dance party. The first one was a discussion on the uses and health benefits of fiber

2014 PSEM convention held

Basics and potentials in diabetes and endocrinology care emphasized

he Philippine Society of Endocrinology and Metabolism (PSEM) focused on past and future landmark studies in their Annual Convention held March 20-21, 2014 at the EDSA Shangri-La Hotel in Mandaluyong with the theme Diabetes and Endocrinology: The Basics from the Past and Potentials of the Future. Among the subjects covered were, Past and Future Landmark Trials in Diabetes Mellitus and CV Disease: Monumental Change or More of the Same? by Dr. Augusto D. Litonjua, Community-Based Interventions for Diabetes Mellitus and Non-communicable Diseases:

JUNE-JULY 2014

ZES Prince Paltu-Ob leads the crowd in an energetic zumba routine

presented by Ms. Nadine Tengco. The next was a lecture on how to fight and prevent gout by Dr. Joey Miranda of AACE-PC and the last was about the prevention of osteoporosis by Dr. Theresa Marie Faller. The Zumba dance party was led by the best Zumba instructors in the Philippines and abroad like Madelle Paltu-Ob and her husband Zumba Education Specialist (ZES) Prince Paltu-Ob, ZES George Lu of HongKong, and celebrity host and dancer Regine Tolentino. This event served as a fundraiser for the AACEPhilippines’ Power of Prevention Through Fitness and Nutrition (POPTFN) advocacy to raise awareness about obesity and its complications to students in the 5th and 6th grade. Jose Martin Punzalan D

Promises and Potentials by Dr. Elizabeth Pacheco, Philippine Research Initiatives in Diabetes and Endocrinology, and Interactive Endocrine Flipside, etc. In Dr. Pacheco’s lecture, she presented study results showing that patients in Diabetes Self-Management Education (DSME) groups had better blood sugar control than standard care groups. “Diabetics in the DSME group consistently had a better blood sugar control compared to the standard care group for up to the sixth month,” Dr. Pacheco explained. The group’s objective was to assess the effectiveness of a diabetes self-management education in improving anthropometric, biochemical, and health behavior outcomes among diabetes patients in the rural community. A discussion on Hypoglycemia in Diabetes: A Mix of Highs and Lows was also given by Dr. David Strain. Alexa Villano D

affairstoremember

AACE Philippines’ 2014 meeting slated for August

he Philippine chapter of the American Association of Clinical Endocrinologists (AACE-Philippines) is slating its 8th annual meeting and clinical congress and its 6th joint meeting with the U.S.-based AACE for August 14 to 16 at the Marriott Hotel Newport Boulevard, Pasay City. This year’s theme is Pursuing Hindrances, Issues, Learnings & Skills in Endocrinology. Among the topics to be discussed include Pitfalls in Endocrine Hypertension Diagnosis, Diabetic Foot: Ailing and Healing, Exercise Physiology in Diabetes, and the 2013 AACE New Comprehensive Diabetes Algorithm. In her acceptance speech in last year’s congress in Cebu, then incoming president, Dr. Florence Santos, said that the organization will be more patient-centered in 2014 and will initiate a rule of 10s advocacy. “I will be initiating the rule of 10s advocacy, basically covering diabetes, thyroid health, and nutrition,” she said. The rule of 10s refers to the association’s thrust to add 10 more beneficiaries to AACE-Philippines’ various programs. For more information on the congress, visit www.aacephil. com, call 553-0188 or email AACE-Philippines at aacephil@ yahoo.com. D

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affairstoremember

Diabetes Among 21st Century’s Biggest Problems Nutrition therapy recommended to prevent diabetes

iabetes has become one of the biggest problems of the 21st century, according to a former president of the Philippine Society of Endocrinology and Metabolism (PSEM) in a forum entitled Ask the Diabetes Expert April 30 in Makati. “It’s a growing problem. It’s one of the rapidly rising and prevalent non-communicable diseases in the whole world,” said Dr. Sjoberg Kho in the forum. He added that by 2030, 480 million are expected to have diabetes worldwide. Diabetes can lead to other conditions such as blindness, nephropathy, neuropathy and amputation. It is also one of the conditions that could lead to cardiovascular disease. He recommended undergoing nutrition therapy to prevent diabetes considering that proper diet and exercise alone cannot stop diabetes. He added that doctors are using the Philipine Diabetes Nutrition Algorithm, which

could help their patients manage the condition. In the same event, Dr. Rodolfo Jose Dimaano, medical director of Abbott, recommended taking the Glucerna Triple Care Challenge. “Glucerna Tripple Care offers an unparalleled combination with three key benefits – it’s clinically proven to manage blood sugar levels while supporting heart health and weight management – for those with prediabetes and diabetes,” he said. Abbott will conduct an awareness campaign on preventing diabetes nationwide. Alexa Villano D

Dr. Sjoberg Kho

Dr. Rodolfo Jose Dimaano

IIlustration by Rackel Selena Lumbang

doodles&dreams

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