DO THEY PRACTICE WHAT THEY PREACH?
MEDICAL OBSERVER talks to a cardiologist, a diabetologist, and an oncologist to find out their dietary habits
By Sunly Coo, Contributing Writer
Antonio Sibulo, cardiologist
"A cardiologist should be the epitome of health. If I see a cardiologist indulging too much and smoking-I really frown on cardiologists who smoke-he is doing a disservice to his patients by being a bad example," says the 56-year-old director of St. Luke's Heart Institute.
So what kind of diet does one of the country's eminent cardiologists live by? "Basically, my household doesn't go for meat. Hardly, because I believe in the saying, 'You are what you eat,'" he replies. "And about 80 percent of what I eat is fish and vegetables." Being a Bicolano, one of his favorites is
laing, taro stalks and leaves slowly cooked in coconut milk. "Before, they said that coconut has bad cholesterol, but studies show now that it's not. It has medium-chain fatty acids, which is healthy for you."
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Breakfast is usually scrambled eggs minus the yolks. "Since we're five in the family, we just add one yolk (to the batch of egg whites) for color. I'm also watching my carbs so I have a little rice on the side," he says. The carbohydrate-control continues in lunch, where he hardly takes rice-"maybe just two spoonfuls"-along with his vegetables. If he ends up with
pinakbet, he would remove the fats and the meat. Such a meager and virtually riceless meal might not be enough for most Filipinos, but for Sibulo it is sufficient. "Nasa office
lang naman ako the whole day," he says. Besides, he can always snack when he needs an energy boost in the afternoon. During
merienda, he gives himself the license to break away from his low-carbohydrate diet by treating himself in moderation to some
puto seko or rice cake. "I try to avoid cookies and processed foods, because they're rich in transfatty acids. Transfatty acid is worse than your low-density lipoprotein. It's more atherogenic and causes more coronary diseases than LDL (low-density lipoproteins)," he explains. In the weekends, he sometimes goes for
kesong puti, which is "lower in cholesterol than other types of cheese."
Dinner often includes fish that's either fried in canola or olive oil or cooked in
sinigang broth. He almost always requests for sinigang na isda, tuna belly preferably, after playing golf in Canlubang. Keen on physical fitness, the doctor practices his swing and, with a little more effort from him, hits the gym twice a week.
Since he has a family history of diabetes-but thankfully, he does not have the disease-he tries to avoid cakes and too much sweets, preferring fruits for dessert instead. "I'm not a banana or apple person. My favorite is chico and atis, but my number one is watermelon," he says. In fact, his favorite drink is fresh melon that has been blitzed in the juicer and taken straight up without sugar or milk. It refreshes him after a game of golf and in the evenings.
Sibulo also enjoys red wine, as his large collection of vino proves. He allows himself two to three glasses a week, a moderate-enough consumption that studies claim can offer cardiac protection. And if he has to choose between coffee or tea, he's rather have the latter from teabags or ready-to-drink bottles for its rich antioxidant properties.
Because he is lactose intolerant, he takes calcium supplements. You won't find multivitamins next to them, though. "If you eat balanced meals, you don't really need them," he advises. An essential part of his balanced diet is limiting sodium intake, which he credits for his being hypertension-free.
"We have a running joke here. I ask my patients if they eat oatmeal. When they say yes, then it's a sure sign of ageing," he says with a chuckle. "As you grow older, you tend to be more conscious about the food you eat. But you have to remember that cardiovascular disease doesn't happen overnight. It's a long process, a gradual buildup of factors. You have to invest (in good nutrition habits) early in life.
Hindi pwedeng pagdating ng 60 bago ka mag-uumpisa," he warns.
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Ricardo Fernando, diabetologist
At a time when most of us are still in bed, the sprightly 78-year-old "father of Philippine diabetology" starts the day at four A.M. with a simple breakfast of bread that's thinly spread with peanut butter-no sugar added-or Cheese Whiz, perhaps an egg, and a glass of juice, usually unsweetened pineapple. Then, he's off to making hospital rounds. "That is my morning exercise. We (my fellows and trainees) practically run, and we don't use the elevator or escalator," he says. By seven, he sees his first appointment in the clinic.
He was diagnosed with diabetes 13 years ago, but he's happy that his blood-sugar level is perfectly normal, as is his cholesterol level. These, he owes to a healthy diet plan which the good-humored doctor sums up succinctly: "Stay away from
baboy, baka-all four-footed animals-mantika, taba, asukal, saka honey. Only when your back is against the wall, then you have to take it. That means avoiding butter, margarine, mayonnaise, cheese, and foods that are
ginisa (sautéed) or pinirito (fried), as much as possible. Cooking oil should be used sparingly."
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Does he recommend any specific type? Surprisingly, he answers, "No, because I believe that once fats enter the body, they are broken into free fatty acids (FFA). The pancreas cannot tell where the FFA came from, whether it's from the good, the bad, or the intermediate, as they call it. Fatty acids in big amounts are not good for the beta cells of the Islets of Langerhans, the ones concerned with diabetes.
Nagkakaroon ng apoptosis, death of beta cells." Thus, his dishes are either
nilaga, sinigang, inihaw, pinakbet, or pesa.
He is also particularly aversive to cooking by microwave. "It produces oxidants. Even water is converted to H2O2, which is an oxidant. The number one culprit in the generation of cancer is microwave. Microwave causes cancer, diabetes, hypertension, heart disease, kidney disease.
Maraming kasalanan yan," he says. "Sudden intense heat converts food, especially fats, into oxidants. Yung fast food,
ganun din yung principle nun, sudden intense heat. The latest na isinama sa list
ay yung corn flakes and popcorn. The temperature should rise gradually."
When he advised one of his patients against using microwave oven, the latter asked him what he should do with the one he recently bought. "Ibalot mo na lang at iregalo sa kaaway mo," he says, chortling. There is never a dull moment with Fernando.
His diet, though, may just be a tad too dull for meat-loving Filipinos. What's on the doctor's menu most of the time is fish, vegetables, and chicken, ideally the breast with its skin removed prior to cooking. He accompanies them with rice, restricted to one cup, during lunch.
Snacks can be as varied as a bowl of
nilugawang manok, a reasonable amount of fruits, a serving of veggies such as
singkamas and cucumber dipped in vinegar, a cup of sugar-free gulaman-a favorite of his and his patients-or a can of chocolate-flavored Glucerna. "Sometimes I do not take supper and Glucerna is my meal already," he says. If he needs a pick-me-up, he'll take Chinese green tea over coffee most of the time, in order to benefit from the ancient drink's antioxidative power.
"Dinner should be the lightest meal of a diabetic," he says, adding that he consumes less than one cup of rice in the evenings. It also makes sense to cut down on calories on the last meal of the day-no snacks after that either-since the succeeding waking hours is when the body expends the least amount of energy.
To those physicians who take a casual attitude to their dietary habits, Fernando has only this statement to make: "It's up to them whether they want to live longer or shorter lives."
"The average Filipino when he dies is 68, according to the National Statistics Office. So I treat my patients up to 68, so he still has good eyes,
hindi siya nai-stroke, naba-bypass, nada-dialysis, and he still has two good feet," he says. "After 68, 70, they can choose to die early with complications or die later. It's a matter of their personal philosophy in life."
"Sabi nga sa akin ng pasyente na 90 years old
na, si Senator Salonga, 'Iho, sa edad kong ito, wala nang bawal-bawal. How else do you want me to die?'" he recounts, his eyes twinkling.
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Romulo de Villa, molecular and nutritional oncologist
The first thing that 56-year-old de Villa religiously takes when he wakes up is two glasses of water. "It hydrates the body and washes the digestive system. It's a healthy habit to do so one hour before breakfast, and preferably before every meal," he says. Another drink he never misses in the morning is one of New Zealand's full-cream powdered milk, which he takes twice a day. Wait a minute, did he say full cream? Well, he certainly did and he explains why: "Studies show that those who consume short-chain fatty acids-butyric acid-found in the cream of the milk have a reduced risk of colon cancer. They nourish the lining of the colon and strengthen it. Twenty percent of the fat from the milk is butyric. Another fat in the milk is conjugated linoleic acid, which is anticarcinogenic."
His daily consumption of milk sometimes exceeds two glasses when he's having champorado or, more often, muesli, sweetened with muscovado sugar. Otherwise, he fuels up for the day with a more substantial fare of mixed red-and-brown rice, plus two eggs, always boiled and never fried. "Avoid frying especially with unsaturated oils," he cautions. "Studies show that when you heat unsaturated oils, they turn into bad oil, lipid peroxide."
Describing his diet as predominantly fruits and vegetables, de Villa passionately details the two key reasons for his diet choice. One, it promotes the growth of healthy gastrointestinal flora. The good bacteria in the intestines feed on the fiber of fruits and vegetables, fermenting them in the process. "When they do that, they generate butyric acid. The bifidus bacteria-lactobacilli-produce butyric acid. Most of them reside in the colon and keep it healthy," he elaborates.
Two, fruits and vegetables carry fewer toxins. He came to this conclusion after reviewing a list of all the pollutant chemicals in the environment and the workplace. A trained biochemist, he noticed that about 80 percent are fat-soluble; the rest, water-soluble. "If you want to avoid these chemicals, avoid the fatty foods," he says, referring to animals with high fat content. "You apply the principle of biology-bioaccumulation-where the higher you go up the food chain, the more pollutants are consumed. There are many pesticides that do not break down biologically; they only accumulate in the environment and in the human body. We are the highest in the food chain." The solution, then, is "to eat lower in the food chain." He cites as an example the Japanese centenarians, whose diet is 80-percent plant-based.
While he may not be a vegetarian, he certainly restricts his red- and white-meat intake to no more than two to three times a week. He reveals that he would eat beef, but not pork, after discovering that while pork has unsaturated fats, its proportion of omega 3 to omega 6-the two types of unsaturated fats-is of an unhealthy proportion. "According to FNRI (Food and Nutrition Research Institute), USFDA (United States Food and Drug Administration), it should be 1:1 to 1:4. Borderline is 1:6. Pork is 1:9," he states.
To test his suspicion, he set up an experiment. "I had gouty arthritis at the time, so I avoided high-uric-acid foods, but not beef or pork. When I found out about the unhealthy proportion of fats in pork, I stopped eating pork for two weeks. Then, I ate a plateful of peanuts, which usually nakakaningas ng joints ko the next day and, after a few days, becomes very painful. I did this for one whole week. No pain, nothing. Once, outside, I ate pork. I told myself
minsan-minsan lang naman, but then I suffered. The key is to stop eating pork to stop arthritis. That's one: [Pork] is more inflammatory because of the excess omega 6, which from what I know in biochemistry, is more inflammatory than omega 3."
His second point against pork shatters another common myth-that pork has less fats than beef. In a home experiment, he boiled a quarter kilo each of lean beef and lean pork separately and bottled their broth. "From the surface,
mas malaki yung sebo ng beef. But when you look at the side-fat is not just the
sebo, it's the oil-mas makapal yung oil sa pork. I did it twice to confirm," he says.
Other animals that you won't see on de Villa's plate are shrimps and shellfish. According to him, these types of seafood, which live at the bottom of the river mouth where factories are positioned, are exposed to industrial waste products. Fish, such as salmon, is a healthier alternative. He prefers it cooked in water or sushi-style.
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DOCTORS' FOOD
MEDICAL OBSERVER conducted an informal poll on the nutrition practices of some of our local health experts in cardiology, gastroenterology, internal medicine, nephrology, and clinical nutrition. Their ages range from 29 to 49. Here are the results:
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43 percent say they skip breakfast sometimes, while only 24 percent make it
a daily habit.
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19 percent eat fast-food items everyday, while nearly 40 percent patronize
them one to three times a week.
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42 percent do not take vitamin/mineral supplements. Among those who do, vitamin C is preferred, followed by multivitamins.
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Good news. A whopping 70 percent say they eat fish three times a week or more.
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About 25 percent drink milk regularly; low fat is preferred.
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43 percent eat one to three servings of red meat every day. When it comes to nonlean meat, only five percent avoid it entirely.
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52 percent have one to three servings of fruits a day; 44 percent eat one to three servings of vegetables daily.
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48 percent will sometimes eat chicken skin, and only five percent won't touch it.
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57 percent are regular coffee drinkers, who average two cups a day. 24 percent drink fruit juice everyday, with orange ranking the highest. Only 19 percent take tea daily.
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14 percent drink a can of soda a day, and about 53 percent limit it to two to three cans a week.
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47 percent avoid alcohol entirely.
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None of the respondents follow a strict dietary plan.
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