Photo shows (from L to R) Dr. Jaime Montoya, Executive Director of Philippine Council for Health Research and Development of the Department of Science and Technology; Dr. Dolores A. Ramirez, National Scientist; Dr. Teresita Borromeo, Professor and Head of the Plant Genetic Resource Division, UP Los Baños; Dr. Cecilia Maramba, Director of the National Institutes of Health; Dr. Fabian Dayrit, Professor, Department of Chemistry, Ateneo de Manila University; and Dr. Eliseo Banaynal, Executive Director of Sekaya.
The Philippine Council for Health Research and Development (PCHRD) and Filipino scientists were in full force during the recent inauguration of the Sentrong Katutubong Yaman (Sekaya) Research and Development plant, a facility that is envisioned to become a collaborative research and development center for local medicinal plant products.
Sekaya, an affiliate of United Laboratories, Inc. (Unilab), the leading pharmaceutical and healthcare company in the Philippines, was built as a platform to develop natural products grounded on science to help the indigenous communities and small farmers to protect and benefit from the country’s rich plant resources.
The Department of Science and Technology (DOST), through PCHRD, has been at the forefront of the government’s efforts to develop the herbal medicine landscape to maximize the potentials of plant-based medicines.
People who cycle to work have a substantially lower risk of developing cancer or heart disease or dying prematurely, and governments should do all they can to encourage more active commuting, scientists said on Thursday.
In a study published in the BMJ British medical journal, the researchers found that cycling to work was linked to the most significant health benefits - including a 45 percent lower risk of developing cancer and a 46 percent lower risk of heart disease compared to non-active commuters.
Walking to work was linked to a 27 percent lower risk of developing heart disease and a 36 percent lower risk of dying from it, though it also appeared to have no effect on cancer risk or overall premature death risk, the study showed.
The research involved 264,377 people with an average age of 53 whose data forms part of the UK Biobank - a database of biological information from half a million British adults.
Since the study was observational, no firm conclusions can be drawn about cause and effect, the researchers said. Its findings could also be affected by some confounding factors, they added, including that the mode and distance of commuting was self-reported, rather than objectively measured.
However, "the findings, if causal, suggest population health may be improved by policies that increase active commuting, particularly cycling", they said.
These would include creating more cycle lanes, introducing more bike buying or hiring schemes, and providing better access for cyclists on public transport.
Lars Bo Andersen, a professor at the Western Norwegian University of Applied Sciences, who was not directly involved in the research but wrote a commentary on it in the BMJ, said its findings "are a clear call for political action on active commuting", saying this had the potential to significantly improve public health by reducing rates of chronic disease.
"A shift from cars to more active modes of travel will also decrease traffic in congested city centers and help reduce air pollution, with further benefits for health," he said.
Coughing, difficulty breathing, shortness of breath—you may have this lung disease.
There is a silent killer in our midst.
Slowly, but surely, a growing percentage of the population suffers from abnormal wound healing in the lungs. This eventually leads to respiratory lung failure, in some cases even lung cancer and, in most cases, it takes years before it is even discovered.
Many end up dying from it without knowing what really killed them in the first place.
What is its name? Idiopathic Pulmonary Fibrosis or IPF is a category of diseases under Interstitial Lung Diseases or ILD.
Dr. Dina Diaz, a pulmonologist with a sub-specialty in Pulmonary Medicine (Adult Pulmonology), Occupational Lung Diseases (including Interstitial Lung Disease), and Respiratory Physiology, is on a mission to spread awareness about this silent but deadly killer.
She wants to raise awareness because there is really no known way to prevent it, hence the name idiopathic.
Filipinos especially need to be more aware because in general, we have bad health-seeking behavior.
Know When to Worry
“Health is at the lowest level of priority. When you have money, extra or not, you won’t think immediately about getting an x-ray or a check-up. Only when you’re really sick, that’s when health becomes a priority,” she says.
She even notes in jest that there is a certain month, every year like clockwork, that her patients increase: the time when weather changes and allergens abound. That is the time she sees her once-a-year patients called asthmatics. She adds that more often than not, they stop taking medicine and maintenance the moment the asthma symptoms stopped. Dr. Diaz recommends for asthmatics in remission, meaning those who have not had attacks in three years or more, to continue taking the maintenance because asthma can come back any time.
Interestingly, Dr. Diaz became a pulmonologist because she comes from a family of asthmatics. She knows what she is talking about.
This is the most surprising insight: Many patients who have been treated for pneumonia or tuberculosis are possible misdiagnoses of IPF.
Dr. Diaz explains, “The presenting clinical manifestations are the same like any other pulmonary problem such as difficulty of breathing, shortness of breath, and chronic cough.”
She says IPF is more difficult to diagnose as it is not common, meaning there is not enough supporting data on it because people don’t know they have or had it.
“It is unrecognized unfortunately even by the specialists, it is always misdiagnosed as pneumonia. For example, if treatment is done for pneumonia and their symptoms keep coming back, they end up having several admissions for pneumonia or being treated for TB and feel bad because they are not getting better,” she says.
The problem with the difficulty in diagnosing it also lies in the kinds of tests done, as tests to rule out pneumonia, TB, and other ILDs are the same.
IPF, a debilitating and fatal lung disease, causes permanent scarring of the lungs, which results in difficulty of breathing.
“IPF is progressive-causing tissue damage in the lungs,” explains Dr. Diaz. “Interstitial is a tissue between your airways and blood vessels in the lungs and gas exchange should happen between these two but once this area is damaged, gas exchange is affected. It’s basic oxygenation.”
This build-up or fibrosis causes decrease in lung function, which results in decrease of amount of oxygen that goes around from the lungs to all the major organs of the body.
Given the number of years that she has now studied cases with IPF, Dr. Diaz can help diagnose when a patient has IPF using the same processes and procedures that her fellow pulmonologists use. She just knows what she is looking for.
Left untreated, she says a patient misses out on “proper treatment and supportive treatment, including preventive methods like avoiding infections to not add injury in the lungs. New treatments can slow it but it cannot be cured because it is progressive.”
Dr. Diaz is also adamant that more information on this health condition be spread because while it does target older patients more, chronic coughing can be caught early. “The danger of not being diagnosed is it becomes fatal if the case really is IPF and a patient is getting bad or wrong treatment that may hasten and can do harm. Patients can get treatment for pneumonia and be diagnosed late, but they don’t get the appropriate supportive treatment.”
Another reason that it is vitally important that IPF be diagnosed properly is because when patients don’t know what they have, they panic and turn to Dr. Google. In these cases, the Internet does not help at all.
Dr. Diaz, who was the first council head of the Council of Interstitial and Occupational Lung Diseases back in the ‘90s, is also a member of the Philippine College of Chest Physicians.
They have been studying and continue to study and focus on these diseases and, to date, they are still trying to increase awareness.
For her, red flags that signal something other than the usual ILD is when “you don’t get usual results from usual treatments, it must lead you to thinking if you really have that or something else so if you are not responding and it keeps coming back it is something else.”
Currently, Dr. Diaz heads the Department of Pulmonary Medicine at the Lung Center of the Philippines and says that many patients do come in because of referral basis. She wants to remind the public that if your x-ray doesn’t show improvement, watch out. “Under ILD some are treatable, some are uniformly fatal whatever you do, and IPFs, which account for 51 percent of the known ILD is considered uniformly fatal,” says the doctor. “You end up with fibrosis and you lack oxygen and at same point, lung scarring, so you can’t breathe anymore and you go into lung failure.”
Are you at Risk?
While there is no singular reason to be predisposed to IPF, again, it is idiophatic, there are high risk factors to consider and be mindful of, just like any lung disease: smoking, old age, and other causative factors which include occupational exposures, radiation, and drugs.
Since IPF is abnormal wound healing in the lungs, the fibrosis also predisposes one to cancer or heart issues.
She adds that for those who have IPF, they could still be functioning with a lung function that is more than 50 to 60 percent but these are hard to find or spot. “They may get more breathless than usual, or experience non-stop coughing, like a dry cough.
There are those who rapidly progress within three years of diagnosis and end up dying. And then there are those who stabilize but are still breathless every day. And some go into slow decline every year with a decreased lung function,” she says.
Dr. Diaz adds that while you can’t be cured from IPF, quality of life improves once you know what you have and you know what to avoid. Regular monitoring helps, along with a measure of pulmonary rehabilitation, to teach you how to manage breathlessness.
“We are hoping that now that treatments are available, more awareness and health-seeking behavior will happen. Treatments may trigger increasing awareness,” she says.
One of the new available treatments in the Philippines is called Nintedanib.
Dr. Diaz explains that Nintedanib can be measured objectively as it was made to specifically reduce progression in decrease of lung function as an objective measure by managing lung function at 60 to 70 percent and stabilizing it.
It has just been introduced and this targeted drug receptor directly involves itself in the abnormal fibrosis and helps it from progressing quickly.
Nintedanib with the specific name OFEV was developed by Boehringer Ingelheim and has been approved in the US, European Union, and Japan. It is given as an oral treatment in capsule form, twice daily.
She recalls that before Nintedanib became available, her most notable cases of patients with IPF didn’t have it easy.
She had one who came in, a patient who went through three years of suffering with multiple admissions.
Another one, her now longest-living IPF patient, was diagnosed in 2007 or 2009, and is now oxygen dependent. She shares how he has weathered all the problems because he is very positive and he has a loving wife by his side. In IPF, family support is critical.
Another case, this one a referral from the province, came to her after spending a lot of money and seeing a lot of doctors. He wasn’t left with much by the time he came to her. “When he came to see me, he said, “All I need is for you to tell me what I have,’” she recounts. “So when I broke the news to him, that his lungs were that bad, he was happy because he finally got a diagnosis. He knew what was happening to him.”
Living on Borrowed Air
Dr. Diaz remarks that disclosing IPF is like disclosing cancer when you have to tell a patient that you are not going to get better. Barring a lung transplant, which is the only guarantee that you will get better, IPF patients live on borrowed air, so to speak.
Of course, any time a patient finds out they have IPF and once it is explained to them, Dr. Diaz says they respond the same way anyone who gets news of a terminal illness.
Lung transplants are not yet available in the Philippines, but IPF patients can hope to retain lung function at 70 percent with the new treatments available.
While it can be genetic or familial, it is but a small percentage of the diagnosed population.
Dr. Diaz gives the following important pointers: “The first thing is if you have a family member who you think may have had this, get checked. If you have progressive shortness of breath that doesn’t seem to be improving and coughing that doesn’t get better for months, meaning it is chronic, get an x-ray. Any other lung condition should be gone in two weeks. Some people think it is part of aging when they start to cough.”
In most of the cases, IPF has been diagnosed in middle-aged men but it doesn’t mean women are off the hook. That is why Dr. Diaz does an eight-page questionnaire as it takes her a long time to process any referral, followed by a lot of work-up and two more consults.
The Royal Brompton Chest Hospital in the United Kingdom, the equivalent in the Philippines being the Lung Center of the Philippines, employs a multi-disciplinary team approach. Dr. Diaz says that in the Philippines we are just starting to copy the same approach when it comes to treating IPF.
In Royal Brompton, they have 1,000 cases every month which they can confer on, look at the cases, read the x-rays and CT scans, and decide if a case is IPF. In this approach, the pulmonologist is joined by the radiologist and in some cases the histopathologist if there is a need for biopsy.
She explains that in the United Kingdom all the centers refer because everyone is aware of it: “We want to put up something like that and train other hospitals to put up their own so that someone is always looking into the possible IPF cases.”
She has started by organizing case-based sessions so that more and more doctors are used to seeing cases and reading scans of IPF cases. In this way, they can all learn together and teach each other. Diaz says all CT-scans end up looking the same, so if it’s all interstitial, the attending clinician or pulmonologist can tell the radiologist his or her suspicion and they can discuss, sit down, and look at the cases, working together to figure out a course of action.
The last say will of course have to be the pulmonologist as he or she is the one who interfaces with the patient but at least, in this way, more eyeballs are looking at cases.
Aside from the Nintedanib treatments, they also recommend exercise tests and the Bi-Lung function test, which is a Pulmonary Function Test to check breathing by looking at actual numbers.
She can’t repeat enough the reminder to consider IPF or any ILD whenever a patient is not responding to treatments for a pulmonary problem and to consult a specialist or a center because this may be what you have. To Dr. Diaz, awareness and recognition is key.
“Get an x-ray some time in your life, especially if you are breathless and coughing. Or take a Lung Function Test. Yes, the elderly are more prone, especially the middle-aged males. The usual preventive measures would apply like not smoking but since IPF is idiopathic, it can happen to anyone as it is a reaction of your lung to injury. There is no evidence it is airborne! IPF is a rare disease in the lungs, not easy to recognize, so be more aware of the status of your health.”
Is it really true that experts now say that we do not really need to limit our dietary intake of cholesterol to prevent heart disease? Does this mean cholesterol does not really have anything to do with the development of heart disease?
You’re right—medical, dietary, and public health experts who wrote the latest Dietary Guidelines for Americans have concluded that “cholesterol is not considered a nutrient of concern for overconsumption. This means we need not limit the amount of cholesterol-rich food in our diet but it does not mean cholesterol is not involved in the development of heart disease. In fact, high blood cholesterol is still considered an important risk factor in the development of atherosclerosis.
High blood cholesterol level is bad for us because excess cholesterol in the blood has a tendency to be deposited in the form of plaques in the walls of blood vessels, much like rust deposits in lead pipes, which over time, weaken and/or completely clog many of these vessels. This condition, known as atherosclerosis, is particularly disastrous if it involves the blood vessels of the heart and brain—which, unfortunately, is often the case—because it can result in a heart attack or a stroke.
The real reason behind a high blood cholesterol level
For decades, the generally accepted belief among doctors is that a high blood cholesterol level is brought about by the consumption of a lot of cholesterol-rich food. Accordingly, they urged patients to avoid eggs, shellfish, and other food items that have high cholesterol content. This advice, as latest review of evidence has proved, is not based on science.
After re-examining available scientific data, experts responsible for the dietary guidelines found out that consumption of cholesterol-rich food has little bearing on overall levels of cholesterol in the bloodstream. Cholesterol from the diet represents only about 20 percent of the cholesterol circulating in the human bloodstream, so lowering cholesterol intake affects blood cholesterol levels only marginally. Evidently, cholesterol blood levels are impacted not by dietary intake, but by genetics and high saturated fat intake.
The bottom line on dietary fat and cholesterol
All told, cholesterol is no longer a dietary concern but saturated fat still is. In fact, the same experts recommend that people eat less saturated fat than before. The new guidelines state that saturated fat should make up only eight percent of a person’s daily calorie intake, down from the 10 percent that the 2010 guidelines advised. And here lies a catch! Food that is rich in cholesterol are is also rich in saturated fat, except for a couple of major food item—eggs, and shellfish. Eggs and shellfish are high on cholesterol but low on saturated fats, aside from being rich in other beneficial nutrients. Shellfish, in particular, have high content of omega-3-fatty acids, which are good for heart health.
The new guidelines imply that we may add back cholesterol into our diet, but only if the cholesterol comes from egg or shellfish. We still need to watch our intake of animal meat.
The new dietary guidelines are not radically different from the previous ones—they still promote consumption of plant products over animal products. To quote, “A diet higher in plant-based food items such as vegetables, fruits, whole grains, legumes, nuts and seeds, and lower in calories and animal-based foods is more health promoting.”
Balance. Yin and yang. These are the basic principles of traditional Chinese medicine (TCM) that has been around and still in practice for thousands of years. It is believed that this balance is directly correlated to a person’s state of health and wellbeing. Thus achieving it depends on the individual’s own needs. Unlike Western medicine that approaches treatments for various ailments singularly, the Chinese believe that ailments are brought by different causes and each person responds to treatments differently, and therefore these must be addressed by individualized treatments and therapies according to their needs. Acupuncture has the same concept of harmony that our body is connected by meridians or paths where energy, or qi, flows, and an imbalance in energy can lead to disease (Lee and Lio, p. 111). So you may ask, can acupuncture treat acne? Is there science in acupuncture or is it only brought by tradition?
Acupuncture is one of the therapies in TCM. It aims to alleviate pain while healing an individual’s physical, mental, and emotional being by using thin needles to stimulate various touch points on the body to achieve a balanced, healthy state. Acupuncture has been used among individuals with various illnesses or discomforts, such as lower back pain, allergies, headaches, and nausea. But did you know that acupuncture is also used in TCM as part of the treatment for other skin conditions?
Acne. TCM has long reported the connection between diet and acne, and various tests have been done with the effectivity of acupuncture in acne through the years. Although most had promising results, other factors came into consideration such as the difference in treatment per individual or the level of experience of the acupuncturist, among other things, to conclude that acupuncture as indeed an effective treatment for acne.
Atopic Dermatitis. The same goes with Atopic Dermatitis, where trials have been tested showing positive results such as a decrease in itch, some that reduced inflammation, and another study (this time with TCM) where subjects had even lessened their medication. More studies, however, have to be conducted to conclude that acupuncture may be done to patients to treat or manage atopic dermatitis as well.
Neurodermatitis. A more promising outlook is seen with acupuncture and neurodermatitis. Also called Lichen simplex, it is caused by constant friction on the skin such as the neck, wrist, ankle or thigh, resulting in thicker skin. It has been reported that acupuncture is effective when the needles are placed near the said areas.
Urticaria. Similarly, acupuncture has been tested due to the positive results it yields for those with Uritcaria or hives. In fact, acupuncture has been used to treat it for centuries. While it successfully relieved acute urticaria in one study, results for those with chronic urticaria were mixed, but still had favorable results. Still, more studies are needed to confirm the effectiveness of this type of therapy.
As acupuncture is gaining popularity in the west, and more studies are being done to validate its efficacy, advantage, and value, we can only hope for good things to come from it. While trying acupuncture on your own may yield results different from others, it won’t hurt to do it (yes, literally!). As discussed above, however, it cannot serve as a sole treatment for an ailment or disease. Acupuncture may be effective when taken in combination with evidence-based medicine or with medication as prescribed by your physician. And when trying this out, make sure that the acupuncturist is certified and your doctor knows about it.
Every skin is different, and we know that. Start your skin journey today with holistic complimentary medicine.