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Pregnancy After Bariatric Surgery - How Long Should You Wait?

>> Tuesday, October 25, 2016

After bariatric surgery, it is recommended to wait at least 12-18 months (with some guidelines recommending to wait two full years) before considering pregnancy.  This is because rapid weight loss and a higher risk for nutritional deficiencies occurs during this phase, which may be a poor environment for fetal development. However, a recent study suggests that waiting two years may not be enough.

The study, published in JAMA Surgery, looked at data from women and their infants in Washington state who had had bariatric surgery (n=1859), and compared them to women and their infants who had not had bariatric surgery (n=8437).  They found that babies who were born to mothers who had had bariatric surgery had a 57% higher risk of prematurity, 25% higher risk of needing to be admitted to the NICU, 93% higher risk of being small for gestational age.

However, when 4 years or more had elapsed since bariatric surgery, the risk of these outcomes was lower when compared to women where 2 years or less had elapsed.  Specifically, the risk for babies born less than 2 years after bariatric surgery was 48% higher for prematurity and 54% higher for NICU admission, compared to babies born to mothers where 4 years or more had elapsed (the difference for being small for gestational age was not significant). For babies born in the 2-4 year window after bariatric surgery, the authors note that the prevalence of prematurity and NICU admission was not meaningfully different from babies born to women who had not had bariatric surgery.

So how do we interpret these data? Well, we already knew that the risks identified in this study exist for babies born to mothers after bariatric surgery, but we need to remember that there are benefits to pregnancy outcomes after bariatric surgery as well - for example, less babies born large for gestational age, less labor and delivery complications, lower risk of C section birth, lower risk of gestational diabetes and high blood pressure in pregnancy.  However, based on these data, it may be better to wait even longer than two years after bariatric surgery before conceiving.

Follow me on twitter! @drsuepedersen © 2016


Poke Free Blood Sugar Monitor Helps Prevent Lows

>> Monday, October 17, 2016

On behalf of my patients who struggle with the discomfort of having to poke their fingers to check their blood sugars every day, I am super excited about a new poke-free technology that will hopefully be approved in Canada soon – the Freestyle Libre.  With this glucose monitoring system, a small patch is applied to the upper arm with a tiny filament underneath which inserts under the skin.  Wave your glucose monitor over the patch and voilĂ ! – the last 8 hours of blood sugars, including current blood sugar, are transmitted to your monitor for evaluation.  Not only that, but it tells you the current trend in sugar (ie if your blood sugar is on its way up, down, or stable).

In the first randomized controlled trial of this device, it has now been show that monitoring with the Libre helps patients with type 1 diabetes prevent hypoglycemia (low blood sugars).  The study, published in The Lancet, randomized 241 patients with good blood sugar control to the Libre vs usual monitoring with finger pokes.  They found that over 6 months, people using the Libre spent 38% less time with low blood sugars than people using standard finger pokes.  (Despite this benefit, people using the Libre still spent a shocking 2 hours per day with low blood sugar, compared to 3.3 hours per day for people taking finger pokes - so clearly a better monitoring approach is only part of the solution.)

Ten patients reported concerns related to the sensor, primarily itching, allergic reaction, or redness at the site (not out of keeping of the usual risk of reactions to medical devices that stick to the skin).  Some aspects of quality of life were reported to be improved as well – not surprising,  since studies have shown that people with diabetes who have had severe low blood sugar in the past fear this occurring again as much as they fear blindness as a complication of their diabetes.

It would be interesting for this study to be repeated in people with type 2 diabetes, and also to compare the Libre to the continuous glucose monitoring system.

Bottom Line: The Libre would be a strong addition to our blood glucose monitoring options for diabetes in Canada.

Disclaimer: I have received honoraria as a continuing medical education speaker and consultant from the makers of the Freestyle Libre (Abbott). 

Follow me on twitter! @drsuepedersen © 2016


Toasty Roasty Kale and Bean Tomato Soup!

>> Monday, October 10, 2016

Brrr....!!! In our part of Canada at least, winter has come early, with the first snowfall already upon us!  I found this wonderful soup recipe that will help keep us warm through the cold months - but I amped up the spices, switched up the beans, and added kale for something a little different (and also to use the last of this season's kale from my mom's garden!).


  • 1 20-oz (540 mL) can of mixed beans, drained and rinsed (pure lentils would be awesome too)
  • 1 28-oz (796 mL) can of low sodium tomatoes, chopped, undrained
  • 2 cups vegetable or chicken broth, low sodium
  • 1 medium onion
  • 2 cups chopped kale
  • 1 tsp ground cinnamon
  • 1 tsp ground cumin
  • pepper to taste


1.  Put all ingredients except the kale into a large soup pot. 

2. Heat soup to boiling; reduce heat and simmer 5 minutes. 

3.  Stir kale into soup and simmer another 5 minutes. 

4.  Season to taste with pepper!

Makes 6 servings.  Per serving: 

Calories: 148
Protein: 9.5g
Carbs: 25g
Fat: 1.6g

Happy Canadian Thanksgiving!

Follow me on twitter! @drsuepedersen © 2016


Want a Lower Calorie Meal To Go?

>> Tuesday, October 4, 2016

For those days when you know you're going to need to eat on the run, it can be especially hard to resist the temptations of the take-out restaurant or deli that you hit up for your lunch.  A great way to cut calories on those days was proven in a recent study - order well ahead!

The study, published in the Journal of Marketing Research, found that longer delays between placing a lunch order and eating lunch was associated with a reduction in calorie content of the order, with 38 calories less ordered per hour of delay between the order and lunchtime.  They also found that people who ordered lunch immediately before eating had the highest calorie content of their order - about 100 calories more than someone ordering earlier in the day.

Ordering lunch soon after breakfast may be the best time to order, perhaps because of fullness from breakfast, or perhaps because it's easier to think about exerting self control over our future selves than our present selves.  Perhaps the stress of the day hasn't yet taken hold in the earlier morning, allowing us to make healthier lunch choices (stress can cause us to eat more and crave unhealthy foods).  Whatever the reason, try ordering lunch when you get to the office in the morning, and let me know how it goes via comments to this post!

Thanks to my friend Bob for the heads' up on this study!

Follow me on twitter! @drsuepedersen © 2016


Type 2 Diabetes Medications Exenatide Weekly and Dapagliflozin Studied In Combination

>> Monday, September 26, 2016

In the wake of the recent annual European diabetes (EASD) meeting, another important study (and heavy science blog post!) coming your way today.

In the care of people with type 2 diabetes, we have fully 9 classes of glucose lowering medications to choose from in Canada.  While some of these medications can cause weight gain, others are weight neutral, and some can cause weight loss, in addition to improving blood sugar control.  Two classes of medications can cause weight loss, namely the GLP1 receptor agonists, and the SGLT2 inhibitors.  As 90% of people with type 2 diabetes also have overweight or obesity, it is of interest to know whether these two classes of medications can be used together, for even better blood sugar control and greater weight loss.

Two of these medications, the GLP1 receptor agonist exenatide qweekly (Bydureon) and the SGLT2 inhibitor dapagliflozin (Forxiga) have now been studied in combination.  Recently published in The Lancet Diabetes & Endocrinology, the study randomized 695 patients with a baseline hemoglobin A1C of 8-12% to receive either exenatide qweekly, dapagliflozin, or the two medications in combination. 

After 28 weeks, hemoglobin A1C decreased by 1.6% in the exenatide group, by 1.4% in the dapagliflozin group, and by 2.0% in the combination group.   While the medications together were better than either drug alone, the benefit was not additive.  This does not surprise us, as we know that the higher starting A1C, the greater reduction we will see – so to be on two medications together would not expect to give an additive result compared to either medication alone.

The weight loss seen was additive, with a loss of -1.54kg in the exenatide group, -2.19kg in the dapagliflozin group, and -3.41kg in the combination group. Blood pressure reduction also exhibited an additive response, with a systolic BP reduction of -1.3mmHg on exenatide, -1.8mmHg reduction on dapagliflozin, and a full -4.2mmHg reduction on the combination.  These additive benefits make sense, given that each of these medications has a different mechanism of action on weight and blood pressure.

From a safety point of view, side effects that were seen were as expected from what we already know about each of these classes of medications, with no suggestion for any negative side effects of using the two medications in combination.

Finally, we have much awaited data that shows us that these two medications can be used safely in combination, with the result of better diabetes control, and an additive effect on both weight loss and blood pressure.

Disclaimer: I am involved in research trials of GLP-1 receptor agonists and SGLT2 inhibitors.  I receive honoraria as a continuing medical education speaker and consultant from the makers of exenatide and dapagliflozin (Astra Zeneca). 

Follow me on twitter! @drsuepedersen © 2016



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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