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Is the Birth Control Pill Less Effective In Obesity?

>> Monday, March 27, 2017





The birth control pill is used by many women for prevention of pregnancy.  While generally very effective to prevent pregnancy if taken correctly, failure to prevent pregnancy can occur.

It has been noted in observational studies that women with obesity may have a higher risk of birth control pill failure, compared to women without obesity.  How could this be?

It turns out that the oral contraceptive has altered pharmacokinetics in obesity - meaning that the way the body handles the medication is a little bit different. Specifically, some research has suggested that the half life of the birth control pill is longer, meaning that it takes longer for the pill to reach therapeutic levels in women with obesity (ie at the beginning of the pack each month).

Strategies to minimize birth control pill failure in women with obesity have been suggested, such as taking the pill continuously, or using a higher dose than the low dose regimens that are commonly prescribed.   However, these strategies would have to be weighed against the potential for increased risks such as potential increased risk of blood clots with higher estrogen exposure.  One thing I feel we can conclude from this information is that taking the pill correctly (not starting a new pack late, not missing doses, and taking it within the required time frame each day) is especially important.


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2017

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New Cholesterol Medication Evolocumab Reduces Cardiovascular Events

>> Sunday, March 19, 2017





In follow up to my recent blog post, we now have the detailed results from the FOURIER trial, demonstrating that the PCSK9 inhibitor evolocumab reduces cardiovascular events in patients with cardiovascular disease.

Just published (and free to read online) in the New England Journal of Medicine, this large study randomized 27,564 patients to either evolocumab or placebo, to examine the impact on the primary endpoint of cardiovascular death, heart attack, stroke, hospitalization for unstable angina, or coronary revascularization.  Patients in the study already had existing cardiovascular disease, had a bad cholesterol (LDL) of 1.8 mmol/L or greater, and were all on statin therapy (the current gold standard group of lipid lowering medications).

After a median of 2.2 years, evolocumab reduced cardiovascular events by 15%, with 9.8% of patients on treatment having an event, vs 11.3% of patients on placebo. This difference was driven by a reduction in heart attack, stroke, and coronary revascularization, with no significant difference in cardiovascular death or hospitalization for unstable angina.

Evolocumab reduced LDL by 59%, from a median baseline value of 2.4 mmol/L to 0.78 mmol/L. The reduction in cardiovascular events was consistent, regardless of baseline LDL.  The only side effect that was significantly different between the evolocumab vs placebo groups was injection site reaction, seen in 2.1% vs 1.6% of patients respectively.

While these results give us important information regarding the benefit of evolocumab in patients with established cardiovascular disease, we still need data to know if these benefits would also be enjoyed by people with high cardiovascular risk but without established cardiovascular disease. We also need to know more about long term effects of PCSK9 inhibitors.  As noted in the accompanying editorial, it is not known whether prolonged exposure to extremely low LDL levels could affect neurocognitive function (though no difference was seen in the FOURIER study); longer term studies are underway.

The benefits of additional LDL lowering with evolocumab in addition to statins to reduce cardiovascular events in patients with established cardiovascular disease are clear from this study.  Cost of currently available PCSK9 inhibitors (evolocumab and alirocumab) are currently a major limitation to their use, but hopefully this will change with time as evidence regarding benefits hopefully accumulate.

Disclaimer: I have been involved as an investigator in a clinical trial of PCSK9 inhibition.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2017








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Excess Weight Is Risk Factor for Developing Multiple Myeloma

>> Monday, March 13, 2017




We know that carrying excess weight is a risk factor for many types of cancer, including colon, breast, liver, kidney, and several others.  A new study suggests that in people who carry a risk factor for multiple myeloma called MGUS, having excess body weight increases the risk of developing multiple myeloma.

MGUS stands for Monoclonal Gammopathy of Undetermined Significance.  When people have MGUS, their bone marrow makes too much of one type of white blood cell, which makes this MGUS protein.  In most cases, MGUS does not lead to any problems, but in some cases, MGUS can progress to a cancer called multiple myeloma.

The study, published in the Journal of the National Cancer Institute, analyzed data on 7,878 patients from the US Veterans Affairs database (predominantly men), diagnosed with MGUS. Over a median of 5-6 years, they found that 4.6% of patients with overweight and 4.3% of patients with obesity went on to develop multiple myeloma, compared with only 3.5% of patients with normal weight.

In the multivariable analysis that controls for other factors, they found that patients with overweight and obesity with MGUS had a 55% and 98% higher risk of progression to multiple myeloma, respectively, than normal-weight patients with MGUS.

I have seen many online agencies reporting on this study leading with titles like 'Weight Loss May Help Prevent Multiple Myeloma'.  While this study does suggest that carrying excess weight increases the risk of multiple myeloma, this does not prove that weight loss decreases the risk.  Additional studies need to be done to understand whether healthy weight loss in people with MGUS helps to prevent progression to multiple myeloma.



Follow me on twitter! @drsuepedersen

www.drsue.ca © 2017

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Slow Cooked Pulled Pork Tenderloin With Apples!

>> Monday, March 6, 2017






One word: YUM.  Ok two words: HEALTHY!  Pulled pork is a favourite for adults and kids alike... the only problem is, it is usually made with high fat cuts of pork and doused in high sugar, high calorie barbeque sauce or something similar.   Pork shoulder has a whopping 24g of fat and 317 calories per 100g serving - contrast this with pork tenderloin, which has just 3.5g of fat and 143 calories per 100g serving!

I went on a mission to come up with a delicious concoction using pork tenderloin, which is a lean cut of pork, and voilĂ ! Success. I used this recipe as the base, and sauced it up Dr Sue style.  It was a huge hit at our house!


INGREDIENTS:

  • 1 kg pork tenderloin (2 tenderloins)
  • 3 Gala apples, sliced into wedges
  • 1 sweet onion, sliced into strips
  • 5 cloves of garlic, chopped finely
  • 2 cups 100% apple juice
  • 1 cup chicken broth
  • 1/4 cup pure maple syrup
  • 2 tbsp oregano
  • 3 tbsp Mediterranean spice (or Italian)
  • salt and pepper to taste


DIRECTIONS:  It really IS this easy!

1. Put everything into your slow cooker. Put the pork tenderloin in first so that it is submerged in liquid while cooking.  Set on low and cook for 8 hours.

2. Around 5-6 hours into cooking, use two forks to start pulling the pork apart parallel to the fiber of the meat.

3.  Around 7 hours, finish pulling the pork apart - at this point it should really be looking like pulled pork (tendrils of meat).


Serve over one half of a whole wheat bun, or eat on its own!

Makes 10 servings.  Per serving: (not including the bun)

Calories: 223
Fat: 3.5g
Carbs: 19.5g
Protein: 26g


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2017

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How Does Breastfeeding Protect Against Obesity?

>> Monday, February 27, 2017



Breast is best, when women are able to breast feed – we know this without a doubt.  Infants who are breastfed enjoy a long list of health benefits, including a reduced risk of infections, autoimmune diseases, SIDS, leukemia, and more.

Breastfeeding reduces the risk of obesity as well – the available data on this suggests that there is a 15-30% reduction in adolescent and adult obesity rates if any breastfeeding occurred in infancy, compared with no breastfeeding.  With the reduction in obesity risk comes a 40% decreased risk of the child developing type 2 diabetes later in life as well.  

So, how does breastfeeding protect against developing obesity later in life?  Well, there are a number of hypotheses.  For one, when a baby is breastfeeding, the amount of milk s/he takes in is self regulated. Simply put: when they are full, they stop drinking.  When a baby is bottle fed, there may be a push for baby to finish the bottle  - possibly resulting in the baby taking in more food than s/he otherwise would have.  Thus, with breastfeeding, the baby’s brain is programmed to self regulate how much s/he wants to eat – programming that is likely carried on with them later in life.

Secondly, the gut bacteria that the baby develops may be influenced by whether the baby is breast or bottle fed.  We now know that the type of gut bacteria we carry can have a significant impact on the risk of obesity and metabolic disease such as diabetes.   Also, if a baby needs to take antibiotics, this can change the bacteria in his/her gut and may affect the risk of obesity.  Breastfed infants have a markedly lower risk of respiratory and gastrointestinal tract infection, portending a lower risk of needing antibiotics as well.

Thirdly, what the baby is being fed is of course different.  While every effort has been made to make infant formula as close to human milk as possible, there are many differences, with many factors unique to human milk that may affect nutritional status, energy balance and/or satiety.   

Still so much we need to research, learn, and understand about this fascinating area!


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2017




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A HEARTFELT WELCOME!

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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