Post Transplant, Osteoporosis & Right Diet (后移植、 骨质疏松症 & 正确的饮食)

Post Transplant, Osteoporosis & Right Diet (后移植、 骨质疏松症 & 正确的饮食)

Why this topic – Post Transplant & Osteoporosis?

I hope by sharing my experience on this topic will benefit many other post-transplant friends as many doesn’t even aware of the importance of Bone Mineral Density (BMD) test (骨密度测试).  One of the post-transplant complications is osteoporosis. Post-transplant osteoporosis and fracture occur in a substantial proportion of patients.

Many patients who had undergoing kidney dialysis prior to undergoing transplantation are already having low bone mineral density and vitamin D deficiency.

So what is BMD test? 

BMD Test

It is a test using X-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone.

Purposes of BMD Test

·      Identify decreases in bone density before you break a bone

·      Determine the risk of broken bones (fractures)

·      Confirm a diagnosis of osteoporosis

·      Monitor osteoporosis treatment

The higher your bone mineral content, the denser your bones are (骨矿物含量越高，骨头的密度越大). And the denser your bones, the stronger they generally are and the less likely they are to break (密度越大的骨头，更不容易破裂).

My doctor orders test on my spine and hip twice a year.

Relationship of Osteoporosis and Post-Transplant

Transplant patients are highly recommended to have periodic BMD test because of:

·      Taking steroid medications such as prednisolone interferes with the bone-rebuilding process and will lead to osteoporosis.

·      Anti-rejection drugs taken by transplant patients interfere with the bone-rebuilding process and thus we are at higher risk of osteoporosis

In addition, I strongly recommend you taking a BMD Test prior to transplant if you are undergoing dialysis now.  Such test will give you a base line to measure against post-transplant.  Those had dialysis for many years tend to have higher risk of osteoporosis as against those with shorter period of dialysis.

How is BMD being measured? 

Results are reported in two numbers:

·      T-score

·      Z-score

T-score – The bone density as compare to what is normally expected in a healthy young adult of same sex. T-score is the number of units — called standard deviations — that is above or below the average population.

T-score	What your score means
-1 and above	Your bone density is considered normal.
Between -1 and  -2.5	Your score is a sign of osteopenia, a condition in which bone density is below normal and may lead to osteoporosis.
-2.5 and below	Your bone density indicates you likely have osteoporosis.

 

Z-score – It is the number of standard deviations above or below what's normally expected for someone of your age, sex, weight, and ethnic or racial origin. If your Z-score is -2 or lower, it may suggest that something other than aging is causing abnormal bone loss. If your doctor can identify the underlying problem, that condition can often be treated and the bone loss slowed or stopped.

Symptoms

Osteoporosis is being nicknamed as the ‘silent disease’ because bone loss occurs without symptoms and is painless. The condition often is not detected until it is quite advanced. Some signs in the advanced stages may include:

·      Fracture of the hip, spine and wrists

·      Back pain

·      Loss of height over time

What is the right diet?

Taking calcium-rich foods like milk and soya products can grow strong bones to protect against osteoporosis developing later (吸收象牛奶和大豆产品的钙丰富的食物可能生长强的骨头以防止受到后期骨质疏松症).

Vegetables:

1.   Kai Lan (Kale)

2.   Chinese and English Spinach (菠菜)

3.   Chye Sim (菜心)

4.   Long and French bean (长和扁豆)

5.   Broccoli (绿花椰菜)

Fish:

1.   Salmon (鲑鱼)

2.   Cooked Sardine once a week (1 sardine = 190mg of sardine) {煮熟的沙丁鱼每星期一次 (1个沙丁鱼沙丁鱼=190mg)}

3.   Anchovies (aka Ikan Bilis) soup and eat the bones which has the calcium that is essential for the growth and maintenance of strong bones

Others:

1.   High calcium but low fat milk such as HL Milk (高钙，但是低脂牛奶例如HL Milk)

2.   Four tea-spoons of milk powder (四个茶匙奶粉)

3.   Wholemeal bread (全麦面包)

4.   Packed soy milk (包装的豆奶)

5.   Exposed your hands to sunlight for 10 minutes between 10am to 3pm

6.   Palm full of almond or peanuts daily (每日吃小部分杏仁或花生)

For the past one year, I have been following the above diet though I don’t take milk power that much nowadays.  So how’s my HydroxyVitamin D serum test result?  Here you go:

·      February 2015 – 30.5 MCG/L

·      May 2014 – 21.2 MCG/L

The acceptable reference range is 10.1 – 41.3 MCG/L

Calcium Supplements

Some doctors suspect that calcium supplement may increase risk of heart attack.  A recent study from the National Institutes of Health suggests there is an increased risk of heart attack, stroke or other cardiovascular diseases from taking calcium supplements for men only. Other studies suggest there is an increased risk for both men and women.  As such, further researches are necessary.  I am glad that I have stopped taking the supplements one year ago.

Underlying message of my post to you:

·      One can change the diet to achieve the desirable results – It’s Your Life

·      Have regular check up to ensure one is healthy

·      Exercise regularly to build up strong bones – Engage in regular weight-bearing exercise

Other Relevant Posts for your Reading (您能读其他相关的博克):

·   Eating Healthy to Lower Your Blood Pressure {Update#1} (吃健康降低您的血压)

·   Type 2 Diabetes - Myths & Facts (神话&事实关于第二类型糖尿病)

·  How Will a 15 Minutes of Walking Improve Quality of Life (15分钟走步行怎么将改进生活水平?)

·  Blood Test Report & Creatinine (验血报告&肌氨酸酐)

·  Difference between Glycosylated Hemoglobin (HbA1c) and Blood Glucose (葡基化的血红蛋白 (HbA1c) 和血糖之间的别)

Disclaimer: I am not a Medical Doctor. All my blog postings are based on my personal experience that I've went thru and what I've read up from the internet. If you've any symptoms of diabetes OR want to better manage your health, I strongly urge you to have regular medical-ups to avoid future complications. In addition, control your diet portions and have regular exercise. 

(我不是一位医生。所有我的博克投稿是我的个人经验，并且我从互联网读了。如果您有糖尿病的任何症状或要更好处理您的健康，我强烈敦促您有规则健康检查以避免未来复杂化。另外，控制您的饮食部分并且有定期运动.)

FDA Approves Toujeo_® for Type 2 Diabetes (粮食与药物管理局批准Toujeo_® 治疗第二类型糖尿病)

In February 2015, The U.S. Food and Drug Administration (FDA) approved Sanofi’s new once daily long acting insulin, Toujeo (insulin glargine [rDNA origin] injection, 300 U/mL) for treatment of adults living with type 1 and type 2 diabetes.  Sanofi is the same manufacturer who brought the blockbuster, Lantus, to the market.  Toujeo has since launched in April 2015.

The French drug maker believes the new product, Toujeo, is better than its aging diabetes blockbuster Lantus for stabilizing blood-sugar levels but it can’t say so as a result of a recent U.S. regulatory ruling.

The approval of Toujeo was based on FDA review of results from the EDITION clinical trial program, which was comprised of a series of international Phase III studies evaluating the efficacy and safety of Toujeo in more than 3,500 adults from broad and diverse diabetes populations (type 1 and type 2).  It is found to be just as safe and effective as Lantus and it produced similar blood glucose control as compare to Lantus, but with lower rates of hypoglycemia (low blood glucose).

Toujeo is a long-acting human insulin analogy indicated to improve glycaemic control in adults with diabetes mellitus. It should be taken once a day at the same time each day to lower blood glucose.

Do not use Toujeo to treat diabetic ketoacidosis.

Both Toujeo and Lantus are insulins, a hormone that prevents sugar from pooling in the blood and becoming toxic.

The most common side effect of any insulin, including Toujeo, is low blood sugar (hypoglycemia), which may be serious and can be life-threatening. Symptoms of serious low blood sugar may include shaking, sweating, fast heartbeat and blurred vision. Severe hypoglycemia may cause harm to your heart or brain. Other possible side effects may include swelling, weight gain and allergic reactions. In rare cases, some allergic reactions may be life-threatening. Injection site reactions are also possible, and may include changes in fat tissue at the injection site, skin thickening, redness, swelling and itching. 

I am using Levemir manufactures by Novo of Denmark, one of its biggest competitors in the insulin market.  Your Doctor will prescribe the appropriate product for you. 

Click here for Full Prescribing Information for Toujeo^®

My other Relevant Posts for your Reading (您能读其他相关的博克):

·     Eating Healthy to Lower Your Blood Pressure {Update#1} (吃健康降低您的血压)

·      Type 2 Diabetes - Myths& Facts [神话&事实关于第二类型糖尿病]

·      How Will a 15 Minutes of Walking Improve Quality of Life (15分钟走步行怎么将改进生活水平?)

·     Blood Test Report & Creatinine (验血报告&肌氨酸酐)

·     Difference between Glycosylated Hemoglobin (HbA1c) and Blood Glucose (葡基化的血红蛋白 (HbA1c) 和血糖之间的别)

Disclaimer: I am not a Medical Doctor. All my blog postings are based on my personal experience that I've went thru and what I've read up from the internet. If you've any symptoms of diabetes OR want to better manage your health, I strongly urge you to have regular medical-ups to avoid future complications. In addition, control your diet portions and have regular exercise. 

(我不是一位医生。所有我的博克投稿是我的个人经验，并且我从互联网读了。如果您有糖尿病的任何症状或要更好处理您的健康，我强烈敦促您有规则健康检查以避免未来复杂化。另外，控制您的饮食部分并且有定期运动.)

Eating Healthy to Lower Your Blood Pressure {Update#1} (吃健康降低您的血压)

Eating Healthy to Lower Your Blood Pressure {Update#1}

(吃健康降低您的血压)

UPDATE – This Update is based on a recent study conducted by Duke-NUS Graduate Medical School in Singapore – A very first study that associates meals eaten away from home and high blood pressure and a first on Southeast Asian population.  In my earlier postings, I have mentioned where a friend’s high salt diet had linked to his kidney failure.

The study was team lead by Duke-NUS Professor Tazeen Jafar and based on a population of 501 university-going young adults aged 18 to 40 years in Singapore.  Research data was based on blood pressure, body mass index and lifestyle which include meals eaten away from home and physical activity levels.

A summary of results from the survey:

·             27.4% of the total population has pre-hypertension

·             38% ate more than 12 meals away from home per week

·             49% of the male has pre-hypertension as compare to only 9% in female

·             Those with pre-hypertension tends to have lesser physical activities and current smokers

Dr. Jafar's team shows that the significance of even eating one extra meal away from home will raise the odds of pre-hypertension by 6%.

With this study, Clinicians can advise young adults to modify their lifestyle behaviours while food policy changes can be made to regulate salt and fat in eateries. Clinicians can also advise younger male patients that they are at higher risk for pre-hypertension in order to make them more aware of their predisposition to the condition.

"The important thing is taking preventive steps," said Prof Jafar, stressing the value of being physically active and eating healthy food. "Behaviours that people adopt early in life tend to continue as they become adults."

Underlying message of my post to you:

·             Avoid and minimize salty or fried stuff.  When eating away from home, re-used oil will increase your cholesterol

·             Have a balanced diet and take more vegetables

·             Exercise three to four times a week

·             Stop smoking

My Original Blog was Posted in October 2014

High blood pressure is a serious condition that can lead to coronary heart disease, heart and kidney failure, stroke and other health problems. There are usually no signs or symptoms associated with high blood pressure, which is why it is so important to “know your numbers” and have your blood pressure checked regularly (see box below).

Fortunately, high blood pressure can be treated with lifestyle changes and medication. One of the easiest ways to maintain normal blood pressure is to eat a healthy diet. Dietician Cynthia Finley, RD, recommends a diet that is rich in fruits and vegetables, whole grains, low-fat dairy and lean proteins. “You also should decrease or eliminate foods that are high in sodium, fat and sugar, which are known to increase blood pressure,” she says.  [My personal experience – During my dialysis day, I met a guy with end stage kidney failure where his systolic number is about 200.  He admitted he has high sodium diet most of the times.]

The DASH diet (Dietary Approaches to Stop Hypertension) is a flexible and balanced eating plan that studies have shown helps lower blood pressure. It is low in saturated fat, cholesterol and total fat, focusing instead on fruits, vegetables, fat-free or low-fat dairy products, whole grains, fish, poultry, beans, seeds and nuts. The DASH diet contains fewer sweets, sugars and sugary beverages, sodium and red meats than the typical American diet.

“Different diets work for different people and should be customized to ensure compliance,” says Finley. “If you want to lower your blood pressure by changing your diet, you should schedule an appointment with a dietician. He or she will be able to customize a plan that best suits your needs and will meet your individual goals.”

Know Your Numbers

Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps. It is measured as systolic (blood pressure when the heart beats) and diastolic (blood pressure when the heart is at rest between beats).You most often will see blood pressure numbers written with the systolic number before the diastolic number, such as 120/80.

Below is a table that illustrates normal blood pressure numbers and ranges that put you at greater risk for health problems. What are your numbers?

Category	Systolic	Diastolic
	(top number)	(bottom number)
Normal	Less than 120	Less than 80
Pre-hypertension	120-139	80-89
High blood pressure, Stage 1	140-159	90-99
High blood pressure, Stage 2	160 or higher	100 or higher

Controlling Your Blood Pressure

·             Maintain a healthy weight.

·             Be moderately physically active on most days.

·             Follow a healthy eating plan, which includes foods lower in sodium.

·             If you drink alcoholic beverages, do so in moderation.

·             If you are prescribed “medication for high blood pressure”, always take it as directed.

Some of the above information is courtesy of Johns Hopkins Medicine.

Other Relevant Posts for your Reading (您能读其他相关的博克):

·      Type 2 Diabetes - Myths & Facts (神话&事实关于第二类型糖尿病)

·      How Will a 15 Minutes of Walking Improve Quality of Life (15分钟走步行怎么将改进生活水平?)

·     Blood Test Report & Creatinine (验血报告&肌氨酸酐)

·     Difference between Glycosylated Hemoglobin (HbA1c) and Blood Glucose (葡基化的血红蛋白 (HbA1c) 和血糖之间的别)

Disclaimer: I am not a Medical Doctor. All my blog postings are based on my personal experience that I've went thru and what I've read up from the internet. If you've any symptoms of diabetes OR want to better manage your health, I strongly urge you to have regular medical-ups to avoid future complications. In addition, control your diet portions and have regular exercise. 

(我不是一位医生。所有我的博克投稿是我的个人经验，并且我从互联网读了。如果您有糖尿病的任何症状或要更好处理您的健康，我强烈敦促您有规则健康检查以避免未来复杂化。另外，控制您的饮食部分并且有定期运动.)