MALE CIRCUMCISION
How Necessary Is It Today?

From Dr. Reynaldo Joson's Website

In the Philippine provinces, the summer months of March and April every year bring anxiety and apprehension to the hearts of young boys as this is the time when they get circumcised. Locally termed "tuli," Filipino boys (age 9 and above) are encouraged by their parents to get circumcised under the supervision of the town's foremost "albularyo" or "magtutule" who is usually an old man who uses a sharp bladed object to cut the penile foreskin. The boys are advised to chew on "bayabas" (guava) leaves which they will eventually spit on their male organs once the foreskin has been cut. This is the old-fashioned way of doing it. Those boys living in urban and suburban locations are circumcised by a doctor either in a clinic or a hospital setup.

These days, however, there is a voice of dissent heard against this practice. And it comes not from young Filipino boys but from a noted Filipino surgeon by the name of Dr. Reynaldo Joson, former head of the Department of Surgery of the Ospital ng Maynila Medical Center.

Check out his website against male circumcision and tell me what you think about it.

ALDOSTERONE LEVELS AND HYPERTENSION
Potential Harbinger of Hypertension

Aldosterone is a hormone produced by the adrenal glands. It helps regulate levels of sodium and potassium in the body, which in turn helps control blood pressure by regulating fluid distribution and electrolyte balance in the body. Today, doctors request a serum aldosterone test to detect excess secretion of aldosterone by the adrenal glands, which is a manifestation of a condition called aldosteronism or hyperaldosteronism.

There are 2 kinds of hypertension. There's what we call essential or primary hypertension, which accounts for more than 90% of all cases of high blood pressure. The real cause(s) of essential hypertension hasn't been determined as of this time, and despite years and years of research, scientists can not come up with a unifying theory to account for its development. The other type of hypertension is called secondary hypertension," because it is usually "secondary to--" some primary cause. It accounts for the remaining 5-10% cases of hypertension and is usually due to identifiable primary causes like chronic kidney disease, renal artery stenosis, pheochromocytoma, pre-eclampsia of pregnancy, stress, aortic coarctation, sleep apnea, hyper- or hypothyroidism, and primary hyperaldosteronism.

In another significant article (click here) in today's issue of the NEJM, a group of researchers focused on the role of aldosterone in essential hypertension, beginning with a hypothesis that "a gradient of increasing risk of hypertension may exist within the "normal" range of serum aldosterone and that this risk may vary according to dietary sodium intake." They also "evaluated the relation of the serum aldosterone level measured at a routine examination to the risk of an increase in blood pressure and the risk of the development of hypertension in a large, community-based sample."

You know what they found? The table below says it all.

This is a very interesting finding as far as I'm concerned. The researchers were able to demonstrate that increased aldosterone levels within the physiologic range of the community-based sample population predisposed persons to the development of hypertension.

And referring to my previous posts wherein I discussed that early humans were used to diets that were rich in potassium and low in sodium (fruit and vegetable diets), the researchers who wrote this study also doubt "whether human beings have biologic feedback mechanisms to lower aldosterone levels in the face of high-salt intakes" brought about by the diets we consume today, be it a Western or a Filipino type of diet. The authors (and I agree with them on this) theorize that "it is conceivable that an adaptive response essential to survival in a low-sodium environment could turn maladaptive in contemporary society."

Our ancestors (early humans) moved around a lot in rugged terrain (there were no cars then) and thus, I would assume, had plenty of physical activity and exercise. Their diet consisted mainly of fruits and vegetables that were low in sodium and high in potassium. Progress and industrialization, however, has reversed most of that way of life. The question is, has our bodies evolved and adapted to such progress? If so, why are there so many cases of hypertension, stroke, heart conditions and diabetes? These questions make me wonder if we can pick up some lessons from early humans on how we can modify our lives and become healthier individuals. I am not saying industrialization is bad. I'm saying if our bodies cannot adapt, then we should at least modify our lifestyle --- mainly diet and exercise.

GOING TO WAR HARMFUL TO YOUR HEALTH
US Soldiers in Iraq and Afghanistan

Since military operations began in Iraq, nearly 900 American casualties have been documented. In Afghanistan, US casualties are nearing the 150-mark. This is depressing and I do not see the numbers going down because of the non-stop ambush bombings taking place there. This week's issue of the NEJM carries an investigative article on the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan.

The report concluded "there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services particularly the perception of stigma among those most in need of such care."

From the NEJM
In wars like these and taken from the perspective of the soldier fighting, you do not know what is the kinder fate that you deserve. Surviving and going back home only to have sleepless nights relieving the scenes of the war you fought in. Other studies have shown that recent and frequent exposure to combat had resulted in considerable risks of mental health problems, including post-traumatic stress disorder (PTSD), major depression, substance abuse, impairment in social functioning and in the ability to work after the war deployment.

A bullet or shrapnel wound heals in weeks, but the mental wounds inflicted always remain among the victims. This post is just about the soldiers. You can imagine what happens to the civilians.