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New Canadian Diabetes Association Clinical Practice Guidelines Update

>> Monday, December 5, 2016




While the full Canadian Diabetes Association (CDA) Clinical Practice Guidelines are formally updated every 5 years (with the next edition due in 2018), interim updates are published if new evidence emerges that is considered to be practice changing.  As such, the CDA has just released an interim update with revised recommendations, in light of the new cardiovascular outcome trial of a diabetes medication called liraglutide.

As blogged previously, in people with type 2 diabetes who were at high risk of cardiovascular disease, the liraglutide cardiovascular trial (called the LEADER trial) demonstrated that liraglutide reduced the risk of cardiovascular events by 13%.  Put another way: if 66 people are treated for 3 years with liraglutide, one cardiovascular event would be prevented.

In the LEADER trial, 81% of patients had a past history of established cardiovascular disease, while 19% of patients did not (but they were still considered to be at high risk of CV events due to their risk factors).  Subgroup analyses suggested that it was patients who had a history of established cardiovascular disease who had the reduction in risk with liraglutide. As patients had to be age 50 or older to be included in the study, we do not know if these findings apply to a younger population.

In the revised CDA Guidelines, liraglutide now joins another medication called empagliflozin, as medications to consider after metformin, in patients with type 2 diabetes and established cardiovascular disease, who are not at target blood sugar control.  As ongoing cardiovascular outcome trials of diabetes medications are completed and published, the CDA Guidelines will be updated accordingly.

I have pasted the new algorithm below, but the resolution isn't great - it's a little friendlier on the eyes here.





Disclaimer: I am a member of the Expert Committee for the writing of the Canadian Diabetes Association 2018 Clinical Practice Guidelines. 



Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016


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Reality Check On Coconut Oil

>> Monday, November 28, 2016


In today's marketplace, it seems that we are constantly being presented with the next great thing - a way of eating, a food product, or a supplement, promising health benefits ranging from better skin to weight loss to a longer, healthier life.   Because marketers are so slick, it is often really tough to figure out which claims are true, and which are an inflated or completely false version of reality.

Coconut oil is an example of a very successful marketing engine that has tirelessly promoted the its benefits, to the point where it seems almost commonly accepted that coconut oil is a healthy choice.

Coconut oil is an oil that is extracted from the nut of the coconut palm tree.  Coconut oil is actually one of the least healthy oils you can eat, because it is almost purely saturated fat - it contains even more saturated fat than lard.   Overall, studies show that saturated fat consumption is associated with an increased risk of heart disease.


(Sidebar: While studies overall have suggested that saturated fat is associated with an increased risk of heart disease, this has recently come into question with recovery of data from Minnesota Coronary Experiment in the 1960s.   What is quite clear (from much more recent studies) is that replacing saturated fat with carbohydrates (ie a low fat, high carb diet) does not reduce heart risk.  In fact, eating excess carbs as a replacement for saturated fat actually increases the risk of diabetes, weight gain and metabolic syndrome. Conversely, replacing saturated fat with polyunsaturated fat in your diet can confer substantial health benefits, possibly including a reduction in cardiovascular events and mortality - read recent studies about this here and here.)



So why has coconut oil been touted as a 'healthy' fat?  Here are some of the health claims that have been made:


1. Health Claim: Medium chain fatty acids (contained in coconut oil) may not raise bad cholesterol (LDL) as much as long chain fatty acids (found in other oils) do.

Reality check:  This is highly controversial, with conflicting results in the small studies that have been done.  There is also very little study of the effect of coconut oil on heart health, which is why we we care about LDL in the first place.  Contrast this with extra virgin olive oil, which has been shown as part of a randomized clinical trial to reduce the risk of cardiovascular disease.


2.  Health Claim: Fatty acids in coconut oil (medium chain) may not be as readily stored in fat tissue as long chain fatty acids.

Reality check: Whether or not this is true, adding additional fat to your diet should be avoided - coconut oil still contains 117 calories per tablespoon (this is about 10% of the total calories for a whole day for a typical woman trying to lose weight).


3.  Health Claim: Coconut oil can improve Alzheimer's disease and/or dementia.

Reality check:  This claim started with a YouTube clip that went viral in 2012, showing a patient with Alzheimer's who dramatically improved with eating coconut oil.  This case was never confirmed or reported in any medical or scientific literature, and there is no clinical trial data to substantiate or refute this claim.


THE BOTTOM LINE:   Avoid adding extra fat to your diet.  When you do use fats or oils for cooking, monounsaturated or polyunsaturated fats are a better choice than saturated fat (eg extra virgin olive oil and canola oil).  Coconut oil is not the way to go.



Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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Risks of Overweight and Underweight Before Pregnancy

>> Monday, November 21, 2016





Doing one's best to achieve an appropriate amount of weight gain in pregnancy is important for best health outcomes for baby and mother.  As it turns out, mom's weight before pregnancy is an important predictor of birth outcomes as well.

A recent review summarizes available data on this issue, looking at 60 studies involving over 1.3 million women.

They found that for women with overweight or obesity before pregnancy, compared to women with normal weight, the risks were as follows:

  • 45% higher risk of having a large for gestational age baby
  • 24% higher risk of having a small for gestational age baby
  • 29% higher risk of the newborn baby needing admission to intensive care after birth
  • 27% higher risk of stillbirth

For women with underweight before pregnancy: (again, compared to women with normal weight)
  • 30% higher risk of preterm birth
  • 67% higher risk of having a small for gestational age baby

These data remind us of the importance of managing weight as well as possible not only during pregnancy, but also before consideration of pregnancy.

Recommended weight gain during pregnancy is based on pre-pregnancy Body Mass Index, and can be calculated using Health Canada's handy Pregnancy Weight Gain Calculator.


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016





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Could Diet Drinks Be Sabotaging Your Weight Loss Efforts?

>> Monday, November 14, 2016






We know that consumption of beverages containing sugar increases the risk of obesity, metabolic syndrome, and type 2 diabetes, so it is often advised to consume diet drinks instead.  However, it has been suggested that even diet beverages may be associated with an increased risk of type 2 diabetes.  As such, a recent study studied the effect of diet beverages vs water as part of a weight management program in women with overweight or obesity and type 2 diabetes.

The study, published in Diabetes, Obesity & Metabolism, randomized 81 women who were habitual consumers of diet beverages, to consume either water after lunch five times per week instead of her usual diet drink, or to continue to drink diet beverages after lunch, during a 6 month weight loss program which consisted of dietary modifications and exercise.

They found that women who switched up diet drinks to water had a 1.2kg greater decrease in body weight compared to women who continued to drink diet beverages, as well as greater improvements in fasting blood sugar, fasting insulin levels, and post meal blood sugars.

While the differences in the study were small, it is interesting to consider how diet drinks could be detrimental to weight loss efforts.  It has been proposed that artificial sweeteners may raise the hedonic desire for sweet, energy dense foods. The women drinking diet beverages did consume a few more calories per day than those drinking water, so this may be a plausible mechanism of the differences seen in this study.  There may also be an effect of sweeteners on gut bacteria, which we are learning have an important impact on energy balance and metabolic homeostasis.

It should also be noted that there is conflict in the research in this area, with other studies showing no effect on weight between water vs diet beverages or even a benefit of diet beverages over water.


However, based on the current study, it seems that water may be best.


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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Do Calcium Supplements Increase The Risk Of Heart Disease?

>> Monday, November 7, 2016





Calcium is a nutrient that is essential for bone health.  While adequate calcium intake is recommended for maintaining bone health, some studies have suggested that calcium supplements may increase the risk of heart attack.  It seems that these fears may not have been warranted after all: the most recent review of existing literature suggests that recommended levels of calcium intake are NOT associated with cardiovascular risk in generally healthy adults.

The data on calcium supplements and heart disease risk was recently assessed in systematic review and meta-analysis done by the American National Osteoporosis Foundation, and published as a joint position statement with the American Society for Preventive Cardiology.  Published in the Annals of Internal Medicine, they found that calcium intake from either food or supplement sources at levels within the recommended tolerable upper intake range in USA of 2000-2500 mg/day are not associated with cardiovascular disease risk in generally healthy adults.

They do recommend that wherever possible, recommended intake of calcium should be obtained through natural food sources rather than supplements, but that supplements can be used safely when food sources do not meet goals.  One of the theories behind the benefits of getting calcium through real food is that absorption of calcium occurs more gradually from the intestinal tract, whereas absorption of calcium from supplements may be faster, resulting in more of a ‘spike’ of calcium in the blood.


The authors note that the available data to answer this question about calcium supplements and cardiovascular health is not the best, as none of the studies looked at cardiovascular endpoints are the primary outcome.  This type of study is unlikely ever to be done, as it would be very costly and likely need to be very large to detect small differences.  In the absence of such data, the currently available data suggests that calcium supplements are a safe approach to reach recommended calcium intake, in situations where calcium intake from real food is insufficient.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016


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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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