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The Ultimate Caesar Salad Recipe

>> Monday, August 13, 2018

Caesar salad gets a bad rap as a non healthy food choice - deservedly so in most cases, as they often contain a generous content of mayo, parmesan, croutons, and oil.  These versions can easily come in at a higher calorie count than a Big Mac!

Here is a fabulous, calorie savvy recipe that is sure to be a crowd pleaser.  Instead of adding croutons and cheese, throw a grilled chicken breast or salmon on top to make a fantastic, protein-rich dinner.
Note that this dressing is not low salt, due to the salt in the anchovies.

INGREDIENTS: (super easy to remember, as everything but the anchovies are in 2's):
  • 2 tbsp lemon juice
  • 2 tbsp olive oil
  • 2 tbsp red wine vinegar
  • 2 cloves of garlic, crushed
  • 2 tsp ground pepper
  • 1 can of anchovies (in olive oil) - 'Millionaires' brand tastes best
  • 2 large heads of romaine lettuce, chopped

DIRECTIONS:  (it couldn't be easier!)

Put the first six ingredients into a small blender (e.g. Magic Bullet).  Blend until smooth. 

Put the lettuce in a large bowl, pour the dressing on top, and toss.    Serve into bowls. 

Makes four dinner sized servings. Per serving:
  • calories: 133
  • fat: 11g
  • carbs: 4.5g
  • protein: 3g

Follow me on twitter! @drsuepedersen © 2018


Could Intermittent Fasting Benefit Our Metabolism?

>> Sunday, August 5, 2018

(this figure is from the study discussed below)

Intermittent fasting (IF) is a popular dietary strategy these days amongst people who are looking to shed pounds.  While IF has not been shown to be any better than daily calorie restriction for weight loss, many have speculated that IF may improve cardiometabolic health, with conflicting data as to whether this is actually the case.

A new study suggests that IF at the right time of day may actually improve metabolic health.

The study was small but elegant - 8 men with pre diabetes, who were assigned to intermittently fast using a new technique called 'time restricted feeding' by eating during only 6 hours per day (with dinner before 3pm), or to eat over a more typical 12 hour period each day.  They followed this eating pattern for 5 weeks, and later crossed over to the opposite eating assignment for another 5 weeks.
All meals were supervised, and were geared towards keeping body weight the same (i.e. this was not a weight loss study).

They found that eating only 6 hours per day resulted in improved insulin sensitivity, blood pressure, appetite, and markers of oxidative stress.

How does this work?  Well, there is a hypothesis that after 12 hours or more without food, our bodies flip a 'metabolic switch' of sorts, turning to fat as a fuel source once liver glycogen (sugar) stores have run out (there is an interesting review from the journal Obesity on this).

Interestingly, the time of day when food is eaten seems to be important - while this study showed a metabolic benefit to restricting food intake to 6 hours earlier in the day, other studies restricting food intake to the late afternoon or evening have shown either no benefit or worsening of metabolic parameters (these studies are referenced in the article).  This may be because eating earlier in the day fits better with our circadian rhythm of hormones, as our insulin sensitivity, and also the calories we burn while digesting food are higher in the morning.

We often recommend: "Eat breakfast like a king, lunch like a prince, and dinner like a pauper."  While this principle was founded on the idea of avoiding overeating in the evening due to not eating enough during the day, it seems that there may be a physiologic basis for eating earlier in the day to promote metabolic health.

Perhaps our new slogan should be: Eat breakfast like a king, lunch like a prince... and have your dinner early.

Stay tuned to for discussion of a brand new study on intermittent fasting in people with type 2 diabetes, coming soon!

Follow me on twitter! @drsuepedersen © 2018


Patients' Journeys Affect Everyone In Health Care

>> Monday, July 30, 2018

In my reading this week, I was particularly touched by a perspective article in the New England Journal of Medicine.  

In medicine, we see many happy stories, but also some very sad and difficult journeys that our patients endure.  It is well known and increasingly discussed how much impact these sad stories can have on the psyche and well being of doctors, nurses, and allied health care professionals, but as this article points out - what about those who have administrative and support roles in medicine?   I think it is wonderful that this article brings this important point to attention, and so I wanted to share it.

The article is written by a physician, recalling a day when her secretary became upset after transcribing a letter written by the doctor about a patient's impending death due to cancer.

“Rough morning?” (the doctor asks)

She takes off her headset. “This letter. I have been typ
ing letters about Kathy for a couple of years now. I’ve never met her, but she’s always so nice on the phone. I just wish I could just write a different ending to her story.”

Administrative, secretarial and support members of the clinical care paradigm are right up there with us on the front lines of patient care - even on the front lines for us in many cases, handling phone calls of patients dealing with serious health issues, being the first smiling face patients see as they arrive at our offices, and often getting to know our patients quite well if they are frequently visiting us, calling us, or seeing us over an extended period of time (in the practice of endocrinology, this can be years or even decades).   Our patients' journeys have an impact on everyone whose lives they touch.

I feel that it is so important to keep the lines of communication and friendship open amongst everyone participating in clinical care, so that everyone knows they have the support they need if they are struggling to handle the emotional burden of a patient case or situation.  I feel so grateful to have such a wonderful work family at our clinic, and I think I can speak for all of us to say that it enhances the quality of our work days and our satisfaction with our work lives, to know that we truly are a family, not only celebrating the successes but also sharing the burden of any sadness that we encounter in our patients' journeys.

Follow me on twitter! @drsuepedersen © 2018


Obesity Stigma and People First Language

>> Monday, July 23, 2018

In our efforts to help society and the medical profession understand that obesity is a medical condition and not simply a lifestyle issue,  a very important principle to remember is how we speak about obesity.  Obesity is a diagnosis, not a description of a person, and the way in which we should speak about obesity is called People First language.

This may seem minor to some, but actually, it is an extremely important point.  Consider the difference:

Jamie is an obese person.


Jamie is a person with obesity. (person first language)

Or even more simply, compare:

Jamie is obese. 


Jamie has obesity. 

Obesity is a medical condition that is unfortunately terribly stigmatized, and when a person is described by this medical condition (ie as being obese rather than having obesity), it comes with negative connotations and can sound outright shaming.   Let's consider someone with sleep apnea. Which would you choose?

Lou is a sleep apnea person.


Lou is a person with sleep apnea. (person first language)

Saying that Lou is a sleep apnea person doesn't even make sense. He has a diagnosis of sleep apnea.

Or consider this - which would you choose?

Mark has cancer.


Mark is cancer.

Well of course, we would all choose 'Mark has cancer'. We would never want cancer to define Mark  - so why would we want obesity to define Jamie?

So remember: obesity/overweight is a medical condition, not an adjective to describe a person or a population.  Try avoiding the word 'obese' in favour of 'obesity' and you'll automatically switch to Person First language in most cases. I would like to see the word 'obese' removed from our vocabulary entirely.

We would like to see all medical and general public literature to change to person first language.  We have a long way to go on this - most medical journals, for example, sadly still have not made this switch.

In the 2018 Diabetes Canada Clinical Practice Guidelines, we speak about obesity in patient first language, and we hope that this leads the way in Canada and globally towards uniformly adopting Patient First Language!

It's time to transfer the baton from the old way of thinking to the new - always put People First and Patients First.

Follow me on twitter! @drsuepedersen © 2018


Should Fertility Clinics Deny Treatment To Women With Obesity?

>> Monday, July 16, 2018

As blogged previously, due to concerns about poor clinical outcomes and maternal/fetal risks, many fertility clinics in Canada impose an upper body mass index (BMI) cutoff of about 35-40 kg/m2, above which they will not offer fertility treatments.  Is this the right thing to do?

The new Canadian Clinical Practice Guideline for the delivery of fertility care to women with obesity reviews the evidence on this very controversial topic.

Based on survey studies of fertility clinics, whether a BMI cutoff is used, and what BMI cutoff is used if so, is highly variable and not based on any specific or clear evidence.  Most clinics that have an upper BMI cutoff beyond which they will not offer fertility treatments cite anesthesia risk as the main reason for the cutoff.

Not only are BMI cutoffs arbitrary and without consensus, getting below the BMI cutoff goals may be very difficult for many women with obesity to achieve.  Furthermore, one study suggested that over half of the fertility clinics with a BMI cutoff did not offer any weight loss instructions or guidance to their patients - sounds to me like telling a person to row a boat but not showing them how to use the oars.

Denying fertility care to women with obesity is highly stigmatizing and discriminatory, and can worsen feelings of low self esteem, social isolation, anxiety, and depression. Denying older women fertility care until they have lost weight may cost them valuable time and any chance of pregnancy.

There is no doubt that there are risks of obesity to both the mother and the unborn child, and weight loss should be encouraged and supported.  However, as the guidelines point out, the risk of obstetrical obesity-related complications does not clearly exceed the risk of complications with other pre-existing medical conditions like hypertension, diabetes, or epilepsy. In addition, obesity related health status is a better predictor of pregnancy with fertility treatment than BMI, and also a better predictor of overall health outcomes in general, so why is there so much focus on the numbers on the scale in the first place?

As the Guideline states:

In the absence of simple, safe, and effective strategies that reliably help patients with obesity lose weight in a timely fashion, it is difficult to advocate for a universal BMI cut-off in place of careful counselling, screening for metabolic abnormalities and informed consent. 

Programs that impose BMI cut-offs should offer resources for patients to help them lose weight, and should inform patients about both the risks and benefits of delaying fertility treatment.

Follow me on twitter! @drsuepedersen © 2018



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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