If death was not bad enough, now blindness is  a possible complication of obesity and it’s treatment.  A series of patients have recently been identified who presented with  Vitamin A deficiency  from several months to 18 years after gastric bypass surgery.  With the increasing frequency of the  procedure, both patients and  healthcare providers need to be aware of the potential for Vitamin A deficiency in patients who have had any number of surgeries for obesity as well as other surgeries such as liver transplants.  I myself identified a young man with severe Vitamin A deficiency after a liver transplant.  It would appear that the complaint of night blindness is the most common presentation as it was in this patient as well as the four patients recently reported by researchers from Texas.

So, another good reason to look carefully at one’s diet and lifestyle, avoid the Metabolic Syndrome X, gastric bypass surgery,and purpose to maintain an ideal body weight.

Michael Mong, M.D.
Grapevine, Texas

Yet another report that shows a 70% decrease in the progression of macular degeneration in patients who report even modest levels of routine exercise.  Imagine that, the mere fact of regular exercise was shown to reduce the chance of serious vision loss in a group of several thousand patients. Exercise may help protect against age-related macular degeneration (AMD), according to the results of a large cohort study published online in the October 31 issue of the British Journal of Ophthalmology.

"These data show a protective effect of physical activity for incident exudative AMD, independent of body mass index and other confounders," the authors write. "These data suggest a possible modifiable behavior that might be protective against developing AMD."

Longer life, less diabetes, fewer Metabolic Syndrome X symptoms, and now less vision loss, are all associated with increased physical activity and increased muscle mass.  Now, purpose to exercise 4 to 5 times a week regularly as your health allows.  For those of you that are diabetics, I would strongly suggest checking out resources on this blog from Dr. Richard K. Bernstein.  He has excellent materials you can view here.  Listen to informative audio programs from him here.

Michael Mong, M.D.
Ophthalmologist
Grapevine, Texas

A recent research report from Finland highlights why I have started this Blog and why I am providing information about Metabolic Syndrome X, diabetes, obesity, and related issues that negatively impact ocular health and general well being.   This study reported in a November 2006 issue of Lancet. 2006;368:1673-1679 confirms previous work that indicates that changing peoples lifestyle can reduce the risk of developing Type 2 diabetes by close to 60%.  In the Finnish study, the effect of lifestyle interventions reduced the risk of becoming a diabetic by 38% and the effect lasted for a three year period.  In a similar report found in the New England Journal of Medicine, February 2002 called the Diabetes Prevention Program Study, showed a reduction in type 2 diabetes by an impressive 58%.  This was compared with a lesser reduction with a common medication called metformin.  A third medication, Rezulin was also used in the study but had to be stopped due to liver damage in the study participants.

"From a public health point of view there is an important message: an intensive lifestyle intervention lasting for a limited time can yield long-term benefits in reducing the risk of type 2 diabetes in high-risk individuals," say Lindstrom and colleagues.

The studies show that helping patients address the fundamental issue (and I must say the principle issue) of diet and exercise is the most effective way to prevent type 2 diabetes.  It is more effective than the search for the proverbial "silver bullet".  If one’s diet and exercise routines are not what they need to be, medications merely offer a short term "fix" to make one’s lab work look better but lead to increases in weight, hypertension, fatigue, frustration, and a general decline in health.  As an ophthalmologist, I also know that diabetes and other Metabolic Syndrome X symptoms such as hypertension and elevated cholesterol and triglycerides lead to destruction of the circulation in the eye and eventual retinopathy and thus damage to the eye.

It make sense doesn’t it.  If the problem stems from inappropriate diet and insufficient exercise, the fix is a better diet and increased  exercise.  Medications at best are a bridge or crutch for most patients to get them started.  If you break a leg, you need a cast and a set of crutches.  The will heal if given half a chance, the cast comes off and you get rid of the crutches.  What would happen to the leg if the cast and crutches are added and never removed?  The answer is obvious, nothing good.  Likewise, to rely on medications to make up for poor diet and exercise is a prescription for long term failure.  Besides, working with patients to address these "lifestyle" issues work the best as these studies show.
I have had increasing success over the last several years at helping my patients loss weight, reduce their blood sugar and HgA1c levels, and even reduce or eliminate medication by taking a few extra minutes to address these key issues.  Many patients, if given the right information, are very able and willing to make significant changes in their diets and exercise.  It takes a bit more time, but it is the only long term solution for most patients who want to optimize their health and wellbeing.

So, the reason for the blog and effort is to educate interested individuals about the critical issues with respect to Metabolic Syndrome X, diabetes, and the eyes and attempt to effect longterm and lasting changes for the best.  I sincerely hope many individual will find this effort of benefit.

Michael Mong, M.D.
Grapevine, Texas

A recent review article highlights the many essential functions that our muscles play in preventing many of the common chronic health problems of our day including Metabolic Syndrome X. To quote from the article The under appreciated role of muscle in health and disease^{1,2,3 by} Robert R Wolfe

"The importance of maintaining muscle mass and physical and metabolic functions in the elderly is well-recognized. Less appreciated are the diverse roles of muscle throughout life and the importance of muscle in preventing some of the most common and increasingly prevalent clinical conditions, such as obesity and diabetes. It is therefore imperative that factors directly related to muscle be included in future studies designed to demonstrate optimal lifestyle behaviors throughout the life span, including physical activity and diet."

Exercise is really one of the best "medicines", and I recommend a vigorous exercise program for all my patients who do not have any medical contraindications.