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Por-Puffed Wheat Squares

>> Monday, August 21, 2017

So I'm sure you're already wondering... what on earth is a PorPuffed Wheat Square?

A couple of weeks ago, I wandered into a local cafe in Calgary, and found these enormous puffed wheat squares staring me in the face:

I bought one of these mammoth creations.... and before digging into it, I decided to cut it up just to see how many appropriately (in my opinion) portion-sized squares it would make.  I thought maybe 4, 5, 6.....



I cut it up into 16 pieces and brought them to work to share with my work family.

(And yes ok maybe I caved and bought a Rice Krispie square too.)

ONE Rice Krispie square is cut up in the bag on the left.
ONE Puffed Wheat square is in the bag cut up on the right.

So the teaching today is about portions: sadly, portion sizes have grown by 3-4x (and in this case, 16x!) compared to what portion sizes were in the marketplace 30-40 years ago.  This is a problem especially out of control in North America (travellers may notice that portions are usually smaller on other continents).

So here's my recipe for PorPuffed Wheat Squares (short for Portioned-Puffed).  There are many permutations on this out there - this one is chocolaty, delightful, and will make a square that stays fairly soft for several days, if you follow my guidance below.

Disclaimer: the ingredients are high glycemic index and not healthy (though puffed wheat squares will have a lower calorie bill than something more dense like a brownie or granola-based bar), but portioned appropriately, they are a delectable and very reasonable little treat once in a while.


  • 1/2 cup corn syrup
  • 1 cup brown sugar
  • 1/2 cup margarine
  • 5 tbsp cocoa powder
  • 8 cups puffed wheat


1.  Melt the first 4 ingredients under low-medium heat until the mixture just starts to boil.  (don't wait any longer or the squares will be too hard)

2.  Remove from heat and fold in the puffed wheat.

3.  Press into a 9x13" pan, lightly greased with margarine. 

That's it!  Super easy. 

Makes 20 squares. Per square: 
  • Calories: 135
  • Carbs: 21g
  • Fat: 4.8g
  • Protein: 1g

Follow me on twitter! @drsuepedersen © 2017


Eating for Two? Risks of Too Much - or Too Little - Weight Gain In Pregnancy

>> Monday, August 14, 2017

Many studies have suggested that too much, or too little, weight gain in pregnancy can be harmful to both baby and mother.  A recent review brings together data from over 1.3 million women, to help us understands what the health risk are of inappropriate weight gain in pregnancy.

First, let's review the recommendations for weight gain in pregnancy.  The recommended amount is based on Body Mass Index pre pregnancy, which is calculated by your weight in kg, divided by your height in metres squared (kg/m2). Note that these numbers apply to single pregnancies only (recommendations are higher for twin, triplets etc).

  • BMI less than18.5:  28-40 lbs (about 13-18 kg)
  • BMI 18.5-24.9:       25-35 lbs (about 11-16 kg)
  • BMI 25-29.9:          15-25 lbs (about 7-11 kg)
  • BMI 30 or more:     11-20 lbs (about 5-9 kg)

The review, published in the Journal of the American Medical Association, found that gestational weight gain fell below these guidelines in 23% of pregnancies, and above these guidelines in 47% of the pregnancies studied.

For women not gaining enough weight in pregnancy, there was a 53% higher risk of having a small for gestational age baby, and a 70% increase in the risk of preterm birth.

For women gaining excessive weight in pregnancy, there was an 85% higher risk of having a large for gestational age baby, and a 30% increased risk of needing a C section.

Not only do we know that it is important to manage weight during pregnancy, but optimizing weight prior to pregnancy is important too, as underweight or overweight pre-pregnancy is also associated with adverse outcomes.

If you are pregnant or thinking about becoming pregnant, be sure to speak with your doctor about optimizing weight both before and during pregnancy.

Follow me on twitter! @drsuepedersen © 2017


Could Antacid Medications Affect Blood Sugar Control in Diabetes?

>> Tuesday, August 8, 2017

Proton pump inhibitors (PPIs) are medications commonly prescribed to treat heartburn and peptic ulcer disease [eg omeprazole (Losec), pantoprazole (Pantoloc), esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Pariet)].    Since PPIs work by blocking acid secretion in the stomach, and since a higher acid content of food lowers its glycemic index, I was asked whether PPIs could increase the effective glycemic index of a meal and thus have a negative impact on diabetes control.

It turns out that PPIs have a very interesting relationship with pancreatic function and blood sugars.

Firstly, as PPIs work by blocking acid secretion in the stomach,  PPIs do increase the pH in the stomach and very high up in the small intestine (proximal duodenum).  However, there is little to no effect on pH in the majority of the small intestine, where carbohydrates are absorbed.

PPIs raise serum levels of a hormone called gastrin, which is responsible for stimulating acid secretion in the stomach.  This is because the gastrin secreting cells in the stomach sense that acid production is low, so more gastrin gets cranked out in an attempt to increase acid secretion.

Interestingly, gastrin stimulates glucose-induced insulin secretion from the beta cells of the pancreas.  There is also some experimental evidence that gastrin may stimulate the production of new beta cells.   Further, PPIs slow emptying of the stomach, because less acid in the stomach means that it takes longer for solid food to be broken down and be ready to pass into the small intestine.

So, based on these mechanisms, it seems that PPIs could possibly have a benefit to blood sugar levels.  While the studies on this are still quite limited, the available evidence suggests that PPIs could lower A1C (a marker of diabetes control) by 0.5% to as much as 1% - possibly as much as a diabetes medication!

PPIs are medications that have benefits but also potential risks, including increased risk of gastrointestinal infections, malabsorption of important micronutrients like calcium, magnesium, vitamin B12, and iron, increased risk of fracture, changes in gut bacteria, and others (note this list is not exhaustive), and they should not be prescribed for the purpose of blood sugar control.

That being said, I will be watching blood sugar control with extra interest the next time one of my patients with diabetes is started on a PPI for their gastrointestinal issues.

Follow me on twitter! @drsuepedersen © 2017


Is Resveratrol Good For Me?

>> Monday, July 31, 2017

You may just be kicking back with a good glass of Merlot to read my blog this evening, with the thought that you are doing your body a favour by choosing red wine over, say, a bottle of beer.  The reported benefits of red wine have often been attributed to resveratrol.  'Naturally' (haha), the supplement industry has jumped all over this, and now markets resveratrol supplement.  Resveratrol is touted as having a whole list of benefits... but is it really good for us?

Resveratrol is a natural phenol which is actually found not only in grapes, but also blueberries, raspberries, and peanuts.  The highest readily available quantities per serving are found in grape juice or red wine.   Resveratrol got some attention with the discovery that moderate consumption of red wine (1-2 glasses (5oz each) per day) may be associated with a decreased risk of heart disease, and since then, high doses of resveratrol (in supplement form) has been touted to carry a number of health benefits, including a decreased risk of cancer, improved diabetes control, neurological benefits, and even benefits to the skin.

While the evidence overall seems to suggest that red wine is associated with a decreased risk of cardiovascular disease, the reasons for this are not clear. Red wine increases levels of good cholesterol (HDL), but it's not clear if it's the resveratrol, or flavonoids in red wine, or something else that brings these benefits.

As for the remainder of the long list of supposed health benefits of resveratrol - these are far from being proven.  A systematic review was undertaken a few years ago (which is the best way to look for evidence when there are only a smattering of studies otherwise), stating that the published evidence was not strong enough to recommend resveratrol beyond the dose that is found in dietary sources.

In terms of side effects, they found that there was no valid data on the the toxicity of chronic intake, and that the main known side effect of high doses of resveratrol is a laxative effect.  Since then, a small randomized controlled clinical trial was recently published suggesting that resveratrol supplements had no benefit on any aspect of metabolic syndrome, and that high dose resveratrol actually had detrimental effects on cholesterol.

As for any supplement, in an industry which is very loosely regulated (and I use the term 'regulated' loosely at that), there is a huge amount of variation in the amount of resveratrol that one might actually get in a particular supplement.  Purity varies as well, with the supplements containing other chemicals with unknown effects on human health.

Bottom Line: We find resveratrol in the same camp as most other natural remedies - there is insufficient data to suggest a benefit of taking high doses (supplements) to human health, and we don't know about the safety of doing so.

As for getting resveratrol from red wine: It is not recommended to begin alcohol consumption for health reasons, as alcohol has many dangers and toxicities associated with it as well.  For those who do enjoy a small amount of alcohol, it seems that red wine may be a good choice.  See Canada's Low Risk Alcohol Drinking Guidelines for more information on what is considered to be safe in terms of alcohol consumption.

Follow me on twitter! @drsuepedersen © 2017


Could Artificial Sweeteners Cause Weight GAIN?

>> Monday, July 24, 2017

While artificial sweeteners have previously been touted as an excellent way to replace sugar in your diet and help with weight loss, they have in recent years been found to impact our biology in ways that may have adverse effects on our metabolism.  Rather than helping in a quest for weight loss, is it possible that sweeteners could actually cause weight gain and metabolic disease?

A recent systematic review and meta-analysis was recently published in the Canadian Medical Association Journal, which collected the currently available evidence to try to answer this question and received worldwide attention in doing so.  They included 37 trials (including 7 randomized controlled trials and 30 cohort studies), looking at a total of over 400,000 individuals (about 1,000 of whom were in the randomized studies).

In their analysis of the randomized controlled trials, over a median follow up of 6 months, they found no significant effect on body mass index (BMI) or measures of body composition.  So, use of sweeteners did not result in weight loss, but there was no weight gain seen either.

In the cohort studies, over a median follow up of 10 years, they found an increase in weight, BMI, and waist circumference, and a higher incidence of obesity, metabolic syndrome, type 2 diabetes, high blood pressure, stroke, and cardiovascular events.

So overall, none of the evidence assessed showed a benefit to weight, and the observational data suggested adverse effects of sweeteners on weight and health - none of which is good news.  And why is there a difference in conclusions between the randomized trials versus the observational (cohort) data?

Well, it's possible that the randomized trials were not long enough or big enough to show a negative impact on health, and that if they had been longer trials, perhaps results would have been different.

On the other hand, observational (cohort) data does not give us as trustworthy of an answer to any research question, because the results can be muddied by other factors. One concern is that these data may be confounded by 'reverse causation' - meaning that people with obesity, or those more prone to develop obesity (eg family history of obesity) are more likely to use sweeteners to help manage their weight (rather than the sweeteners being the cause of weight gain).

Either way, there is research to suggest biological mechanisms by which sweeteners could have an adverse impact on our metabolic health, particularly in relation to changes they induce in our gut bacteria, as well as our neurobiological response to these chemicals.  Further research is clearly needed to better understand their effect on our health.

Remember also that there is no doubt that excess sugar consumption is associated with weight gain and all of the above metabolic complications - so swapping sugar back in is not the answer either.

Follow me on twitter! @drsuepedersen © 2017



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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