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Cheesecake Extravaganza!

>> Sunday, December 27, 2009

The holidays are in full swing, and if your house is anything like ours, it's full of all sorts of well meaning, edible gifts from family and friends - chocolate, squares, cake... the list goes on! I've put most of ours in the freezer, but it is admittedly tough to ignore their existence. So, when the holiday goodies are calling your name, try this delectable diversion as a very tasty, very satisfying, but very healthy alternative.

You won't believe this until you try it. Trust me on this! Cottage cheese and a blender... it's a miracle! These treats are high in protein, which leaves you feeling full much longer than a sugary Christmas cookie.

Note: even better than a blender is a Magic Bullet - it is the perfect size to make these recipes, and you can store the cups you blend in directly in the fridge or freezer. We got ours at Canadian Tire for about $40.

Thank you to Cara's Cravings for the inspiration!



  • 10 oz (280g) 1% cottage cheese (salt free if you can find it)
  • 1.5 tbsp Kraft light smooth peanut butter
  • 2 packets of Splenda (1g each)
Blend all above until smooth. Put it in the freezer for about 45mins until it is semi-solidified and takes on a cheesecake consistency.

Makes 2 servings. Per serving: 160 calories, 4g fat, 17g protein!


  • 1/3 c blueberries (frozen)
  • 1/2 c (125g) 1% cottage cheese (salt free, if you can find it)
  • 2 packets of Splenda (1g each)
  • a dash of vanilla
Blend all above until smooth. Put it in the freezer for about a hour, until it is semi-solidified and takes on a cheesecake consistency.

Makes 1 serving: 100 cal, 1g fat, 14g protein.


  • 6 oz (180 g) 1% cottage cheese (salt free, if you can find it)
  • 1/4 c pumpking puree
  • about 1/2 tsp pumpkin pie spice
  • 2-3 packets of Splenda (1g each)

Blend all above until smooth. Put it in the freezer for about a hour, until it is semi-solidified and takes on a cheesecake consistency.

Makes 2 servings. Per serving: 75 cal, 1g fat, 11g protein.

Dr. Sue © 2009


Breaking the Calorie Code on Alcohol

>> Monday, December 21, 2009

It's a well known fact that routine or excess alcohol consumption can lead to weight gain. But if you are going to choose the odd bevvy during the holiday season, is there one choice that is better than another? It's a bit challenging to find this information, as nutritional information is not laid out on the labels of most alcoholic products, and can even be hard to find on the internet.

There are two elements to consider regarding the drink itself, those being a) the type of alcohol, and b) the mix.

As far as the caloric content of the alcohol goes:

  • 1 can or bottle of beer (360 mL): 140 cal
  • 1 can/bottle of light beer (360 mL): 100 cal
  • 1 can/bottle of non alcoholic beer (360 mL) 50-75 cal
  • 1 glass of wine (5 oz): 105 cal
  • 1 glass of dessert wine (50z): 235 cal
  • 1 glass of non alcoholic wine (5oz) 10 cal
  • 1 cooler (360 mL): 310 cal
  • 1 light cooler (360 mL): 210 cal
  • 1.5 oz hard liquor: 100 cal
  • 1.5 oz liquer/cordial: 175 cal

As for the mixes, your best bet is a diet pop or club soda, which are calorie free. Others:

  • regular pop (8 oz): 85-120 cal
  • tonic water (8 oz): 85 cal
  • orange juice (8 oz): 110 cal
  • cranberry juice (8 oz): 110 cal
  • tomato juice (8 oz): 40 cal

One hundred extra calories per day results in a 10 lb weight gain in one year, so you can see that the above numbers can add up quickly. One rum and coke per day is 20 pounds on the bathroom scale over that year!

On top of that, alcohol decreases our inhibitions, which can often lead to overindulging on food simultaneously. Even worse, alcohol inhibits the ability of our livers to produce glucose, resulting in increased hunger and food consumption in an effort to maintain blood sugar levels.

The bottom line is that alcohol consumption should be in moderation for many reasons - only one of which is the additional calories. Note that if you choose to enjoy a small amount of alcohol, the daily intake should be limited to maximum 1 drink for women, and 2 drinks for men. For more information about the potential hazards of alcohol consumption, and to find out if a moderate intake is safe for you, speak to your doctor.

Dr. Sue © 2009


Winter Root Vegetable Fries!

>> Saturday, December 12, 2009

Carbohydrates are the part of a meal that it is too easy to eat too much of! A tasty, home baked bread disappears before you know it; a heaping pile of rice seems to dissolve on your plate; pasta glides down so easily you hardly have to chew!

Consider a healthy, heaping serving of root vegetables as your carbohydrate at dinner time. Laden with vitamins, minerals, and fibre, these veggies fill you up in a healthy way, without providing a lot in the way of calories (though it should be noted that they are NOT FreeVeg - they must be counted as carbs).

Here is a delicious recipe from my wonderful family in Denmark, where root vegetables are a staple of the winter diet. This dish tastes like french fries, with a sweet twist from the beets that make it simply outstanding!!


  • 300g parsnips, peeled and cut into french fry shapes
  • 500g red beets, peeled and cut into french fry shapes
  • 400g carrots, peeled and cut into french fry shapes
  • chili pepper flakes, garlic powder, thyme, pepper, and salt, to taste
  • 2 tsp canola oil
Mix oil together with veggies in a large bowl. Spread over a baking sheet covered in tin foil. Sprinkle spices over top. Place in 400F oven and bake for 45 minutes. Every 10-15 minutes, stir the veggies around to ensure they are baked evenly.

Serves 6, with 83 calories per serving!

Dr. Sue © 2009


Prevent Diabetes with Lifestyle: Study

>> Saturday, December 5, 2009

An important study was published in November 14th's edition of the Lancet medical journal, which proves that diabetes can be prevented with lifestyle changes, and that this benefit can persist over the long term.

This study is called the Diabetes Prevention Program Outcome Study (DPPOS), and is a follow up to the landmark Diabetes Prevention Program initial study (DPP) that was published in 2002 in the New England Journal of Medicine.

The DPP was a study of over 3,000 prediabetics who were randomized to received either intensive lifestyle counseling, a diabetes medication called metformin, or placebo treatment, to see how effective these strategies were in preventing progression to full blown diabetes. The DPP trial was stopped prematurely, because the evidence for the superiority of the lifestyle intervention was already clear. After an average of 2.8 years, the lifestyle group had a 58% lower rate of development of diabetes than the placebo group, which was even better than the metformin treated group, who had a 31% lower rate of development of diabetes than placebo. Weight loss was also superior in the lifestyle group at 5.6kg, compared to 2.1kg in the metformin group, and 0.1kg in the placebo group.

In the DPPOS follow up study, all patients were offered lifestyle therapy, similar to the initial lifestyle group of the DPP, but in a less intense format. Placebo was stopped, and the metformin group continued their metformin.

During the 10 year follow up in the DPPOS, the original lifestyle group regained most of their weight, which may be related to the less intense nature of the DPPOS lifestyle program. Both the metformin and the original placebo groups lost a bit of weight (with the onset of the lifestyle program), but gained it back. As such, there was no significant difference in weight between the 3 groups at the end of the DPPOS.

However, despite there being no difference in weight, there continued to be an overall lower rate of onset of diabetes in the original lifestyle and metformin groups: they still had a 34% and 18% lower incidence of diabetes than the original placebo group, respectively. In other words, the original intensive lifestyle undertaken in the first 2.8 years of this study delayed diabetes onset by 4 years, and metformin delayed diabetes onset by 2 years.

Furthermore, although the overall diabetes incidence was highest in the placebo group, the rate of onset of diabetes in both the placebo and metformin groups fell to equal the rate of onset in the original lifestyle group, due to the institution of lifestyle therapy at the start of DPPOS. This points again towards the benefits of lifestyle in prevention of diabetes.

The bottom lines:

  • Effectively changing your lifestyle in favor of healthy eating and increasing exercise is beneficial to prevent diabetes.
  • The more intensive the support and counseling in making these changes, the more effective that program is to prevent diabetes.
  • Even if an intensive support program is not feasible for the very long term, the benefits of diabetes prevention during the time of the intense program are still maintained over the long term!
Dr. Sue © 2009


The Seven Sins... of a Chinese Food Buffet?

>> Sunday, November 29, 2009

Okay. I'm not saying that the following are actually sins.

I'm also not suggesting that a buffet is a preferred venue for eating out, as it is very difficult to adhere to the principles of portion control in that setting. Nor am I recommending Chinese food as the fifth food group - most of the protein is swathed in a layer of fat, and Free Veg is a figment of another world far, far away....

However: A recent study by B Wansink and CR Payne, published in the journal Obesity, identified some important eating patterns amongst overweight people attending a Chinese food buffet. Here is a summary of their findings - and some suggestions for what can be done to improve upon these behaviors!

1. People with a higher BMI were more likely to choose a large plate than a small plate.

Studies have clearly demonstrated that the larger the plate provided, the greater the amount of food that is served up on that plate. This, in turn, results directly in a greater number of calories consumed, as compared to the same person eating from a smaller plate. Plate sizes have grown over the last few decades - in remarkable parallel to the growth of obesity.

This phenomenon stems from the simple fact that it is asthetically displeasing to have a half full plate! The solution is simple: be sure to use a smaller set of dishware. Also, make a conscious decision to choose a smaller plate whenever you are out and you have the option.

2. Thinner people browsed the buffet before loading up, whereas heavier people dished up before checking out what was available.

Taking an assessment of what is available before you make your food choices allows you to:

a. Budget your calories towards the food that you'd most like to eat (rather than choosing and eating something mediocre, and finding out after that that must-have favorite food is on the next buffet stand that you didn't make it to the first time around); and

b. Find the healthiest options on the buffet.

3. Heavier people sat facing the buffet head on; lighter people were more likely to sit in a spot without direct view of the food.

Out of sight, out of mind! Having food in your direct line of sight makes it hard to forget that there is unlimited food right at your fingertips. The truth of the matter is, that in our society, there is always unlimited food at our finger tips - the key is to do what you can to make it less accessible and less in the forefront of your mind.

It is okay to go to a buffet for the purpose of having a great selection from which to choose - but the usual principle of one serving only still applies. This is much easier to effect if you choose a seat that doesn't tempt with the view. The same is true for how you place food around the house - put a bowl of fruit on the kitchen counter, and put the cookies in the cupboard (far, far to the back....)!

4. Chopsticks were more often used by normal weight.

Now here is something that the Chinese food restaurant does right! Chopsticks are an excellent form of portion control, as you can generally take less food with sticks than you can pierce with a fork. It therefore takes a longer time to consume food with chopsticks - as such, by the time your satiety hormones kick in to tell you that you're full (about 15 mins into a meal), you have consumed less calories than if you had been eating with standard utensils.

If you are able to eat with chopsticks, it isn't a bad idea to use them routinely. And although many of us have not grown up using them, there is no time like the present to learn!

5. Thin people were more likely to place a napkin in their laps than heavier people.

This likely comes down to the amount of time that is spent preparing for and enjoying a meal, and to whether or not a person plans to stand up and head back to the buffet for seconds.

6. Thinner people chewed more times per mouthful.

Chewing more per mouthful enables us to take the time to enjoy the taste and sensation of food, thereby providing more satisfaction per mouthful and decreasing the number of mouthfuls needed to feel that a good meal has been consumed. In addition, slower eating results in less calories being consumed before those satiety hormones start to act (15 minutes).

7. Thinner people left more on their plate than heavier people.

Which is the chicken and which is the egg? It is possible that the thinner people left more food on their plate because their satiety signals are better able to tell them they are full? Or are they thinner because they make a conscious decision to stop eating sooner than the overweight person? Do overweight people have better ingrained manners to clean their plates? Is this a contributor to becoming overweight in the first place?

Though it represents a change in tradition, it needs to be okay not to finish what is on our plates. Instead of teaching our children to finish everything, the focus should be on teaching them to take smaller portions, to eat slowly and to enjoy their food. If sometimes our eyes are bigger than our stomachs, an unfinished plate sometimes just has to be.

Dr. Sue © 2009


Nouveau Quiche!

>> Sunday, November 22, 2009

Here is a fantastic recipe from the gurus of Crazy Plates! I know lots of people who are not quiche fans, so when I make this I tend not to say the 'q' word until after they've tasted it - and I always get a look of surprise! It is crustless, which cuts out lots of empty calories. This recipe is super tasty and packed with protein - trust me on this and give it a try!


  • 3 cups sliced mushrooms
  • 1 cup each diced onions and diced red bell pepper
  • 2 cloves garlic, minced
  • 1.5 cups egg whites
  • 3/4 c evaporated 2% milk
  • 1/4 c grated parmesan cheese
  • 1/2 tsp dry mustard powder
  • 1/4 tsp each salt and black pepper
  • 8 oz canned, fresh, or frozen lump crabmeat (drain well)
  • 3/4 c shredded, reduced fat sharp cheddar cheese (3 oz)
  • 1/4 c chopped green onions

1. Spray a large saucepan with non stick spray. Add mushrooms, onions, red pepper, and garlic. Cook and stir over medium heat until veggies are tender, about 6-7 mins. Remove from heat and let cool slightly.

2. In a large bowl, whisk together egg whites, milk, parmesan, mustard powder, salt, and pepper. Stir in crabmeat, mushroom mixture, cheddar cheese, and green onions. Pour into a 9 inch deep-dish quiche pan or pie plate that has been sprayed with non stick spray.

3. Bake quiche at 350 F for 40-45 mins, until firm to touch. Let stand 10 miuntes before slicing.

Makes 6 servings. Per serving:
  • 160 cal
  • 5g fat
  • 20.1g protein
  • 9.5g carbohydrate
  • 491 mg sodium
Dr. Sue © 2009


Who Said 'Never Trust a Skinny Chef'?

>> Monday, November 16, 2009

As much as everyone enjoys eating out, it can really be hazardous for someone trying to lose weight, as restaurant meals are a notorious source of hidden calories and huge portions. As such, research is being done to try to figure out how best to cut back on those calories, while preserving the experience and taste sensation of eating out.

Research presented by Dr. Barbara Rolls and colleagues at the recent Obesity Society meeting asked chefs how they thought the industry could best help out to shave calories in light of the obesity epidemic.

These chefs were more interested in creating new inventions for calorie-savvy customers, rather than changing their existing dishes: 67% thought that introducing a new reduced-calorie item would sell well, whereas only 44% felt reducing the calories in an existing item would be successful.

They were also divided on whether putting calorie information on the menu would hurt or help sales. Interestingly, a separate study from New York examined the effects of mandatory calorie labeling, which went into effect in fast food restaurants in their city in July 2008. It was found that although some people said they were purchasing fewer calories based on this information, there was actually no difference in the average number of calories people purchased before vs after the implementation.

In a previous survey study, chefs also admitted that they ladle up serving sizes that are two to four times the size of recommended servings!

Where does this leave us? Well, it is unlikely that restaurant food will ever be uniformly 'safe' to eat from a dieters' point of view, regardless of how many reduced calorie options show up at your favorite spot. The definition of 'reduced calorie' or 'reduced fat' remains somewhat nebulous, and remember that low fat dishes often replace the missing fat with sugar, which can bring the calorie count right back up to equal or exceed the high fat version! The best thing to do when eating out, is to bring the following principles with you:

  • Cut your portions in half. Ask your waiter to bring half your meal in a take away container before it even hits your plate.
  • Do look for options labelled as 'reduced calorie' or 'low fat' on the menu, as they are probably better options - but cut your portion in half as well. Ask your waitress what changes were made in the dish to make it healthier.
  • Opt for the dishes heavy in fresh greens, such as salads. Get your dressing on the side!
  • Give the menu back to the waiter as soon as you have ordered, to avoid the temptation to order dessert!
  • Choose restaurants that specialize in fresh food - this can be anything from sushi to Subway! It is harder to hide calories (eg cooking oils, sauces) in food that is fresh.

Gone are the days where we should say "Never trust a skinny chef!"


New weight loss drugs on the horizon!

>> Saturday, November 7, 2009

For people who have not had success with lifestyle interventions (diet & exercise) to lose weight, treatment with medication may be appropriate, to be used in conjunction with ongoing efforts to change from a lifestyle perspective. In addition to the two medications currently available (Sibutramine (Meridia) and Orlistat (Xenical)), there are at least three new medications that are in the final stages of research, and may become available soon:

Qnexa: This medication incorporates low doses of two previously approved prescription medications: the diet drug phentermine, and topiramate, which is used to treat epilepsy and chronic migraines. Phentermine reduces appetite, and is occassionally used alone to assist with weight loss in the short term (3 months). Topiramate increases the sense of fullness.

In two separate studies, the mean weight loss was 13.2% (30 pounds) and 14.7% (37 pounds) for patients who were treated with full-dose Qnexa for 56 weeks. When people who didn't complete the trials are included, the percentage of total weight lost drops to 10.4% to 11%.

Lorcaserin: It works by stimulating serotonin receptors in the brain, thereby decreasing appetite. Patients who stayed on lorcaserin combined with lifestyle changes for one year lost an average of 17 pounds. About two-thirds of lorcaserin patients lost at least 5% of their body weight; about a third of those who took the placebo and made lifestyle changes accomplished this. The most responsive 25% of patients lost an average of 35 pounds.

Contrave: This medication combines two drugs already on the market — bupropion, an antidepressant and smoking cessation medication (also known as Zyban or Wellbutrin SR), and naltrexone, currently used for alcohol and opioid addiction. It works to fight food cravings and improves the ability to control eating. The research shows patients lost about 6% to 9.3% of their starting weight in a year on the medication.

Medical therapy for weight loss can be considered for individuals who have a BMI of 30 or more, or a BMI of 27 or more with complications of obesity such as diabetes, sleep apnea, or high blood pressure. (You can calculate your BMI at using the 'BMI Calculator' in the right hand column!) Important considerations for drug treatment for obesity include:

  • Medications to treat obesity generally result in only a modest weight reduction. However, this weight reduction can be twice as much when combined with changes in lifestyle (healthier food choices, portion control, and exercise!).

  • Currently approved weight loss drugs have 2-4 years' of safety data. In other words, we do not know what the effects of taking such medications for 10 years might have, and therefore, they should not be used indefinitely. This has important implications, as studies consistently show that once a medication for obesity treatment is stopped, the vast majority gain the weight back.

  • All medications have risks and the potential for side effects, and these should be discussed thoroughly by your doctor if drug therapy is being considered. Drug treatment for obesity is available only by prescription from your physician, and should never be undertaken without medical (MD) supervision.
In my opinion, there is certainly a role for drug treatment of obesity, and it can be of great help to some people. The key to success is to view drug treatment as a kick start to weight loss, in combination with a permanent alteration of lifestyle habits, primarily geared towards reducing your caloric intake to 500 calories per day less than what you need. (You can calculate your daily caloric requirements at using the Basal Metabolic Rate (BMR) Calculator in the right hand column.)

Once 10-20 pounds are shed, and with an extra spring in your step, you can then ramp up the exercise (under the guidance of your physician) to increase your caloric expenditure. With these new diet and exercise changes solidly adopted into your life, the drug therapy can then be phased out. Obesity is a lifestyle problem for most people - and as such, the permanent solution lies in lifestyle too!

Dr. Sue © 2009


Salba: Seed of the 21st Century?

>> Saturday, October 31, 2009

In a time where we know so much about what is good for us, but have so many non-nutritious options in our food supply, the race is on to find new food sources that are rich in the nutrients we need.

It turns out that the ancient Aztecs may have known about one of these food sources all along - and you can find it on the shelves of your local health food store!

Salba, which is a white seed from the plant Salvia hispanica, is a seed which is relatively new to the western world. This plant is part of the Chia family, which is native to parts of Mexico and Guatemala. It produces black and white seeds, which the Aztecs used to sustain them on long, arduous hunting expeditions, and in preparation for battles. In honor of the effects they felt these seeds had, the Aztecs also used them in rituals symbolizing enhanced vigor and longevity.

Fast forward to the 21st century! The white seeds have been cultivated by selective breeding (ie selecting the parts of the plant producing white seeds to re-plant and grow more white seeds) to bring us whole bags full of this seed, which has been named Salba (S for the Salvia plant + 'alba', latin for white).

The Salba seed is the highest known natural food source of both dietary fiber AND alpha-linolenic acid or ALA, which is an omega-3 polyunsaturated fatty acid. Studies have suggested that increased ALA consuption may be related to a lower risk of cardiovascular disease.

So, is there any evidence supporting a benefit to eating Salba? A Canadian study by Dr. Vuksan randomized 27 overweight diabetic patients to receive either Salba or wheat baked into bread for a 12 week period, followed by each patient receiving the reverse for another 12 week period (what we call a 'crossover' study design). An analysis of the 20 people who completed the study showed that Salba use resulted in a lower blood pressure after 12 weeks of use. There was a small benefit with regards to select cardiovascular risk factor markers (in blood) compared to the wheat group; however, the comparison to the wheat group is difficult to interpret, as the dietary composition of carbs and fat was not controlled for, and ended up being significantly different on the two diets. Thus, aside from the blood pressure benefit (which was quite clear), the other benefits of Salba are not well defined.

My take on Salba? Though there is not nearly enough data to give a definite 'yes' or 'no' to its health benefits, its high content of fibre and omega 3's makes it an interesting prospect. Definitely worthy of further study! And it's tasty too....

If you do choose to incorporate Salba into your diet, do it in moderation: 2 tbsp provides 3.9g of fibre and 2.3g of omega 3's... but also 47 calories!

Dr. Sue © 2009


The Skinny on Sweeteners!

>> Friday, October 23, 2009

I picked up a pack of sugar free peppermint gum with my coffee at Starbucks the other day, and as I popped a 'cool burst of minty freshness' in my mouth, I noticed that the package says 'NOT a low calorie food'. I quickly scanned the nutritional information to see that each piece holds 5 calories, and is, as promised, sugar free. No fat, or protein, either. So, where in the world do those 5 calories come from?

Welcome to the mystical world of Sweeteners! Artificial sweeteners come in all shapes and sizes, and not all of them are calorie free.

Artificial sweeteners that contain calories are predominantly the sugar alcohols: examples include xylitol, maltitol, mannitol, sorbitol, and isomalt. These are chemically modified sugars, which contain about 1/2 to 3/4 the calories of sugar per gram. They are not as sweet as sugar, but are good at masking the unpleasant taste of some of the high intensity, truly calorie-free sweeteners (see below). In addition, some sugar alcohols produce a cooling sensation in your mouth, which is why they are included in many minty candies and chewing gum. (Turns out that the caloric offenders in my Starbucks gum were, indeed, Xylitol and Sorbitol.)

Sweeteners that are truly calorie free include aspartame (Equal, NutraSweet), acesulfame potassium (Acesulfame K), saccharin (Sweet 'n' Low), sucralose (Splenda), cyclamates (Sugar Twin), and steviosides (Stevia). They range between 40 to 600 times as sweet as sugar! Each of them have their own little quirks:

  • Some have an unpleasant aftertaste (particularly saccharin), which is why they are often blended with the sugar alcohols to mask their taste.

  • Sucralose and steviosides are heat stable, making them preferable for use in baked products, compared to aspartame and saccharin, which are not heat stable.

  • Aspartame and acesulfame K are almost always combined in products such as carbonated drinks, because they taste more like sugar in combination than separately.
The safety of the various sweeteners have been the subject of much controversy over the years, and continue to be under debate today. A thorough discussion of just one of the above products could fill an entire textbook! Here are some bottom lines from key Canadian agencies:

  • Health Canada has concluded that the addition of sugar alcohols to foods is safe.

  • Sugar alcohol consumption in excess of 10g per day can produce adverse gastrointestinal symptoms, such as bloating, flatulence, and diarrhea. (There is 1g of sugar alcohol per piece of Starbuck's gum.). 10g/day is the maximum recommended by the Canadian Diabetes Association.

  • As per the Canadian Diabetes Association (CDA) 2008 guidelines, the following daily maximums for sweetener consumption are considered safe:

    Aspartame: 40 mg/kg body weight (2,800 mg for a 70kg person)
    AcesulfameK : 15 mg/kg body weight (1,050 mg for a 70kg person)
    Cyclamates: 11 mg/kg body weight (770 mg for a 70 kg person)
    Saccharin: 5 mg/kg body weight (350mg for a 70 kg person)
    Sucralose: 9 mg/kg body weight (630 mg for a 70 kg person)

  • To put the last point into real terms:

    A 500 mL bottle of Coke Zero contains 121 mg of aspartame and 65 mg of acesulfame K. Thus, a 70 kg person (154 lb) would have to drink 8 L of Coke Zero to reach their maximum intake.

    A 1g packet of Splenda contains 12mg of sucralose. Fifty-two packets later, you're at your daily max!

    In other words, with normal food consumption patterns, it is pretty tough to exceed the above recommended limits.

  • Safety of sweeteners in pregnancy has not been rigorously tested. However, because of their wide history of use without reported adverse effects, acesulfame K, aspartame, and Splenda may be consumed within acceptable daily intakes, according to the CDA. Sweet 'n' Low and Sugar Twin are not recommended in pregnancy due to a lack of evidence for their safety.

  • Health Canada concluded in 2006 that an Acceptable Daily Intake of Stevia was a maximum of 1mg/kg body weight per day (or maximum 70 mg per day for an adult). Because evidence suggests that Stevia may pose risk to pregnant women, children, and people with low blood pressure, Stevia should not be used by these groups.

Dr. Sue © 2009


Lentil Dhal Nirvana!

>> Sunday, October 18, 2009

Lentils are amazing little creations which, in my opinion, are not used often enough in the Western world. They are used quite extensively in many developing nations, particularly India, as a key source of protein. One hundred grams of lentils contains 26g of protein and 31g of fibre, making them an inexpensive source of both!

Admittedly, lentils are something I don't use enough of in my own cooking. I've had a bag of red ones staring me in the eye from my kitchen cupboard for the last few months, so I decided to do some experimenting, and I'd like to share a great success story I call Red Lentil Dhal Nirvana!!

Dhal is an indian dish that is quite spicy, but you can lighten up on the flavor if you feel it's too much. It is often made with a lot of oil, as I found while trekking through India last year - instead, try this oil-free recipe!!

It is traditionally served with naan bread and rice, but given that these are both high in carbs, I'd suggest picking a portion controlled serving of one of these, and add a heap of greens on your plate instead!!


  • 1 c dry red lentils
  • 3 c water
  • 1 can chopped tomatoes
  • 1.5 onions, diced
  • 4 cloves garlic
  • 2-3 tbsp curry powder
  • 1-2 tsp cumin
  • dry red chili flakes, to taste
  • 4 packets of Splenda (1g each)
  • dash of salt
  • pepper to taste

1. Boil water, then add lentils. Boil for 1 minute, then reduce heat to a simmer, and cook until the lentils resemble a paste.

2. In a separate pan sprayed with non stick spray, add onions and garlic, and saute until soft.
Add can of tomatoes and all spices, and saute for another 3-5 minutes.

3. When lentils are paste-like, add the tomato mixture to the lentils, stir, and cook on low heat for another 10 minutes.

To alter the flavor, you can also try ginger (fresh or ground) and/or coriander.

Makes 4 servings.

Nutritional info per serving:
Calories: 250
Protein: 16g
Carbs: 37g
Fat: <1g>

Enjoy - and - send me an email if you think of any interesting modifications to the recipe!


ERGEM: Gastric Bypass Research Study!

>> Thursday, October 15, 2009

I was interviewed this week by the Danish Heart Institute, regarding a research study I have put together with colleagues at the Department of Nutrition, University of Copenhagen this year. It's called the ERGEM study: Effect of Roux en y Gastric bypass on Energy Metabolism.

You can also read about our study on

More to come about this study on this site - stay tuned!!

Dr. Sue © 2009 /


Dietary Supplement DANGERS

>> Friday, October 9, 2009

As discussed on the New England Journal of Medicine's website this week, the risks of using unregulated and potentially contaminated dietary supplements has reached alarming proportions. Many of these supplements are marketed as weight loss aids.

Taking these supplements could represent a serious risk to your health.

Since the American FDA's most recent evaluation of the market, there are now over 140 contaminated products identified, most of them labelled as dietary supplements - though it is thought that these represent only a fraction of the contaminated supplements that are actually available (both on shelves and on the internet). This is particularly alarming, given the sheer numbers of people who consume a supplement in one form or another - over half of the American adult population (and similarly in Canada)!

So what kind of 'contamination' are we talking about here? Examples of contaminants include:

1. Prescription drugs. For example, the weight loss drug, sibutramine, has been found in several dietary supplements, at levels as high as triple the recommended dose.

2. Hidden prescription drugs: Some supplement manufacturers have taken to altering drugs just slightly before putting them in their magic pill, so that these chemicals are difficult to detect, should that product ever undergo testing (which they most often do not - see below). Because these so-called drug 'analogs' have not been tested in humans, their side effects are unknown. More to the point - it is unknown to both you and your doctor that you are taking these drugs at all, as they are not listed on the supplement's label.

3. Drugs that have been rejected by the FDA because of safety concerns.

4. Bacteria.

5. Heavy metals.

The list goes on.....

How does this happen? Well, unfortunately, dietary supplements are simply not subject to the same rigorous controls and approval processes that prescription drugs must undergo. This leniency has resulted in a marketplace where manufacturers can introduce products containing just about anything with relative ease, and with claims that are often unsubstantiated.

Many of these products are heavy on the promotion of the fact that they are 'natural'. However, don't forget that tobacco - one of man's biggest killers - is a natural product, too. Digoxin, a powerful antiarrhythmic agent that is very useful to treat heart rhythm problems such as atrial fibrillation, is a purified extract from the foxglove plant - very useful in the right patient and the right dose - but in excess, it can be fatal.

So - is there a happy ending to this story? Well, even if Health Canada tightens up regulation of these supplements, they can still be acquired with ease online from the US and from overseas.

As such, the regulation of these products, for the time being, lies with you. Until dietary supplements are regulated and tested in the same rigorous fashion as prescription medications, they cannot be recommended.

Dr. Sue © 2009


The SLEEP AHEAD Study: Weight Loss Improves Obstructive Sleep Apnea

>> Saturday, October 3, 2009

Obstructive sleep apnea (OSA) is a huge problem. Did you know that 25% of adults are at risk of having OSA? Amongst obese type 2 diabetics, a whopping 86% suffer this disorder. Even worse - many don't know that they have it.

In obstructive sleep apnea, breathing is abnormal during sleep because of narrowing or closure of the throat; this results in air movement being periodically diminished or stopped. It is a serious condition that can affect a person's ability to safely perform normal daily activities and can affect long term health.

It is a well known fact that obesity increases the risk of developing obstructive sleep apnea, and as such, it would make sense that weight loss would improve OSA; however, this had not been definitively proven - until this week.

In the Archives of Internal Medicine, Gary Foster and colleagues published results from their SLEEP AHEAD study. They enrolled 264 overweight or obese patients with type 2 diabetes, and randomized them to receive either a portion controlled diet plus a moderate exercise program, versus three group diabetes education sessions without a specific weight loss plan, for a 1-year period. People in the diet group lost 24 lbs, compared with just over 1 lb in controls. Overall, there was a marked improvement in OSA in the diet group, while OSA worsened in the control group, despite not gaining weight. In addition, more than three times as many participants in the diet group had total remission of their OSA compared to the control group.

Take home messages here are:

1. If you have a risk factor for OSA, or symptoms of OSA, speak with your family doctor about it, as OSA is often underdiagnosed. Risk factors include overweight, male gender, increasing age, and use of sedative medications. Symptoms can include restless sleep, morning headaches, awakening with a choking sensation, awakening feeling unrested, and having difficulty concentrating.

2. We now have clear evidence that in overweight individuals, weight loss improves OSA. Though this study was conducted in diabetics, it is likely that this weight loss benefit would extend to non diabetics as well.

3. A big weight loss and significant improvement in OSA was seen using simple measures: portion control and moderate exercise! Portion control in this study was in the form of liquid meal replacements, snack bars, and portion controlled meals (such as Healthy Choice and Lean Cuisine), which are great options; a portion control plate is a good choice as well!

Dr. Sue © 2009


Do YOU know what's in your Mocha Frap?

>> Sunday, September 27, 2009

One strategy that has been employed in helping people tighten their belts, is to tighten up the policies on nutritional labelling. This is a surprisingly recent change in regulations - it is only since the end of 2007 that labelling has been required for most Canadian products.

Alongside this trend, we have also seen an increase in availability of nutritional information in some food chains and restaurants. New York City has been a real leader in this arena - they require that nutritional information is posted on menu boards at chain restaurants.

Having said that... how often do people actually look at this nutritional information, when it is made available?

A recent study in the American Journal of Public Health says - almost NEVER! Christina Roberto and associates observed 4,311 people walking into Starbucks, McDonalds, Burger King, and Au Bon Pain, all of which provide nutritional information in either poster, pamphlet, or on-site computer format.

Out of these 4,311 people, only SIX people (0.1%) consulted the nutritional information before making their purchase. (This includes five people who were counted as consulting the info simply by walking towards a wall poster and turning their heads towards it.)

In order to make healthy decisions when we are eating out, it is important to know how much energy our food choices contain. There are many hidden calories out there - for example, that Mocha Frappucino I asked you about ladles up 380 calories in a Grande - almost a third of the total day's caloric needs for a typical woman who is trying to lose weight. (The nutritional information for any Starbucks product is readily available online by navigating from the attached link.)

In Canada, while it is not required to post nutritional information in restaurants, many chains do have this information available behind the counter. This can be in the form of a pamphlet, or sometimes a binder.

So - here's a great opportunity to EMPOWER YOURSELF!!

The first step is to calculate what your day's caloric needs are - you can do this with the BMR calculator in the right hand column at

The second step: Be active in your search for healthier choices. Ask for the information behind the counter. Look online before you go out! You will be surprised at how much information that is out there - and you will probably be surprised at how many calories are out there, too.

Dr. Sue © 2009


Are we slave to our obesity genes?

>> Monday, September 21, 2009

Since the Human Genome Project was completed in 2003, bringing our entire chromosomal composition to our fingertips, there has been a surging of interest in exploring genetic associations with illness and disease - and obesity is no exception. Whole-genome mapping has identified several genes that may be associated with increased risk of obesity. One of the strongest candidates of these is the FTO, or 'fat mass associated' gene. About 16% of the population carries two copies of this gene, and thereby carry a 1.5 times higher risk of obesity.
So... are we slave to our genes? Does genetic predispostion prevail over dietary modifications, exercise and a healthy lifestyle?

A recent study says no. E. Sonestedt et al just published data in the American Journal of Clinical Nutrition, examining whether dietary factors and exercise modifies the association between the FTO gene and obesity. They found that amongst 4,839 subjects from Malmø, Sweden, that the observed increase in body mass index (BMI) across FTO genotypes was restricted to those who ate a high fat diet. Amongst people who ate a low fat diet, the FTO association with overweight was nonexistent. Further to that, the association between FTO and body weight was mainly restricted to sedentary people.

How do we interpret this? First of all, these results tell us that having a high fat diet or a low exercise level accentuates susceptibility to obesity in people who carry the offending gene. However, it also tells us some good news, and that is that a low fat diet and an active lifestyle appears to override the FTO genetics - meaning that lifestyle is the dominant power determining BMI.

So, in the case of the FTO gene at least, the power to control and affect our health and BMI seems to be firmly in our grip!

Dr. Sue © 2009


Sugar Free Spray Candy?

>> Monday, September 14, 2009

Here is an interesting new idea in the battle against obesity, which I came across in a magazine while on a cycling holiday in Scotland last month.

You read correctly - there is now a whole line of sugar free candy sprays available, that are designed to help quench those cravings for sweets. There are all sorts of flavors out there to appeal to your inner child, from Mike and Ike to Hot Tamales. You can even 'taste' your favorite cartoon character, from Hello Kitty (does she really taste like marshmallows?) to Sponge Bob Square Pants. Simulated dessert sprays appeal to a more adult palate, such as key lime pie flavor.

My take on these products: Not an unreasonable way to satisfy a candy craving if taken in moderation (ie a few sprays per day) - if the alternative is downing a bag of sweets, well, this is better. The Sour Apple variety has 24 calories per 1 oz bottle, so a couple of sprays a day can be considered to be Free.

Having said that, Free Veg will always be my #1 recommendation to have a party in your mouth without the expense of calories - veggies can be really satisfying and tasty, AND they give you the benefit of vitamins and nutrients! Sorry to be a stick in the mud but it's true...) :)

Dr. Sue © 2009


Bulgur Lovin'

>> Sunday, September 6, 2009

There are lots of interesting options for carbohydrate accompaniments to your meal besides rice, pasta, and potatoes out there, and one of my new found favorites is bulgur!

Bulgur is a cereal food made from several different wheat species, but most often from durum wheat. It is usually sold parboiled, dried and de-branned, but whole-grain, high-fiber bulgur can be found in natural food stores. Bulgur has a light, nutty flavor, and finds its home in many Turkish, Middle Eastern, Indian and Mediterranean dishes.

Here is my latest invention!

1 cup bulgur (dry)
2 peppers, each of a different color (green, yellow, red, or orange), chopped
1/2 small onion, chopped
3 cloves garlic, crushed
one big handful of parsley, chopped
1-2 tbsp lemon juice (to taste)
1 tsp each cinammon and cumin
ground pepper and a touch of salt, to taste
3 packs of Splenda (1g each)

Cook the bulgur as per package directions, but using water only (don't use any oil, even if cooking instructions recommend it - you don't need it!). Put veggies in a bowl and add the bulgur. Add remaining ingredients, stir, and enjoy!

Makes 6 servings.
Calories per serving: 150!

Dr. Sue © 2009


Weight Loss Surgery

>> Sunday, August 30, 2009

Weight loss surgery, or bariatric surgery as it's called, is one hot topic in the obesity world. And I have lots to say about it, as it is the main focus of my research during my year-long sabbatical here at the University of Copenhagen. Here's a little introduction....

Desperate times call for desperate measures. We exist in a global society that has seen an explosion of obesity in the last few decades. The majority of Canadian adults are overweight at a staggering 59%, with one in four being clinically obese.

The treatment of overweight and obesity must be approached on an individual basis. For most people, obesity has its roots in lifestyle problems, and as such, adopting a new paradigm of lifestyle is the best solution. However, for some people, this seems to be beyond reach. For some people, medications for treating obesity can result in successful weight loss, though they may not be effective for long term weight loss, particularly if not accompanied by lifestyle alterations. For those individuals who are severely overweight, and have not been successful with intensive attempts at lifestyle alteration and/or medical therapy, surgery may be the most appropriate option.

At present, bariatric sugery is a treatment that is reserved for people with very severe, or very complicated obesity.

Commonly accepted criteria for qualifications for surgery include:
  • A BMI (body mass index) of 40 or more; or

  • a BMI of 35 or more, PLUS either type 2 diabetes, high blood pressure, or obstructive sleep apnea (as complications of obesity)

(You can calculate your BMI using the BMI calculator on my website, in the right hand column

There are several types of bariatric surgery. The most commonly performed currently are Roux-en-Y gastric bypass surgery (RYGB), and laparoscopic adjustable gastric banding (LAGB).

  • LAGB involves putting an inflatable ring around the stomach near the top of the stomach, such that it restricts the size of the stomach.

  • RYGB is more complex surgery in which the stomach is made smaller, and part of the small intestine is also bypassed, thereby reducing both the amount of food a person can intake, as well as the capacity to absorb that food (diagram displayed above).

There are pros and cons to both procedures. LAGB is a less complicated procedure, and is reversible. RYGB results in greater weight loss and has a higher likelihood of curing diabetes and other cardiovascular risk factors, but has a higher risk of operative complications.

Stay tuned for much more in the coming months.....

Is this topic of interest to you? Email if you'd like to hear more.


Does Vitamin D prevent the common cold?

>> Saturday, August 22, 2009

We all dread it, and we do everything we can to avoid it - but the cough & cold season is just a month or two away. Are there any vitamins we can take to prevent it?

Vitamin C is usually the vitamin that jumps to mind in conjunction with this answer, but a recent study in the Archives of Internal Medicine considered whether vitamin D may actually be where it's at.

Dr. A. Ginde and colleagues conducted an analysis based on US population data, comparing the association between vitamin D levels and a recent history of upper respiratory tract infection. They found that the lower the vitamin D levels, the higher the likelihood of having had a recent cough or cold. This association was even stronger in people with asthma or lung disease from smoking (emphysema).

Why did they think to look at Vitamin D? Recent evidence suggests that vitamin D plays an important role in immunity, and previous smaller studies had also suggested a relationship between lower vitamin D levels and risk of cough & cold. Vitamin D is a hotbed of research these days, as studies have shown that higher vitamin D levels are not only beneficial in terms of bone health, but are also associated with a lower risk of multiple sclerosis, type 1 diabetes, and possibly cancer.

Dr. Ginde's results must be taken with a grain of salt, however, because association does not necessarily mean causality. In other words, just because lower vitamin D levels were seen in people with higher rates of coughs and colds, does not mean that the lower vitamin D was the reason for the susceptibility to infection. There may be other factors playing in here - for example, a person who takes better care of themselves may be in better general health (therefore less infections), and in keeping with good habits, are more likely to take vitamin D supplements regularly (though the study does take several of these potential 'confounders' into consideration). Randomized controlled clinical trials need to be done to explore this relationship further.

As for our old friend, vitamin C: Overall, the evidence does not actually support that it decreases the risk or the severity of colds, though it may decrease the duration of colds slightly.

While the jury is still out on whether vitamin D prevents the common cold, there are many other important health reasons to make sure you are getting enough vitamin D - and most Canadians do not. For most adults, total vitamin D intake of 800 to 1,000 IU per day will maintain optimal vitamin D levels, and this is very rarely attained through diet alone - an additional supplement is required. Talk to your doctor about your vitamin D status and how much supplementation is right for you.


Does aspirin prolong survival after diagnosis of colon cancer?

>> Friday, August 14, 2009

Colon cancer, unfortunately, is a common and potentially lethal disease. The risk of colon cancer is 50% higher in overweight individuals, relative to people who are not overweight. Obesity also increases the risk of dying from colon cancer.

The good news is that aspirin appears to increase lifespan in people who have had non-metastatic colon cancer, according to a study published in this week's JAMA (Journal of the American Medical Association).

Dr. Andrew Chan and colleagues conducted an observational study of 1279 men and women who were diagnosed with colon cancer, designed to examine the impact of aspirin use after the diagnosis on both colon cancer-specific, and overall, survival.

They found that after 12 years of follow up, aspirin users had a 29% lower colon cancer-specific mortality and a 21% lower overall mortality than nonusers. In people who did not use aspirin before diagnosis, but started using it after diagnosis, the effect was greatest, with a 47% decrease in the risk of colon cancer-specific death.

The link between aspirin and colon cancer is an enzyme called COX-2 (or cycloogenase 2), which promotes inflammation and multiplication of cells. COX-2 is overexpressed by 80-85% of colon cancers, and in these colon cancers, is likely promoting growth of the tumor.

Aspirin works by inhibiting the COX enzymes, of which there are actually 2 types:

  • COX-1 is a 'housekeeping' enzyme that is expressed in most tissues in the body, regulating normal cellular functions, including maintaining protection of the lining of the stomach, as well as blood clotting.

  • COX-2 is the enzyme that mediates the inflammatory response (as above). This mechanism is also what makes us feel better when we take aspirin for headaches or inflammatory pain.

In light of aspirin's ability to decrease COX-2 activity, it is therefore not surprising that Chan's study found benefit for aspirin use only in those patients whose colon cancers produce COX-2 (remembering that most colon cancers do express COX-2).

The benefits of aspirin, of course, have to be balanced against the potential risks. The side effects of aspirin stem from the unwanted effect that aspirin has on COX-1. The most significant of these effects is the risk of bleeding, especially from stomach ulcers.

It is important to point out that this study was an observational study. In other words, it was not the gold standard 'randomized controlled trial' that we like to hang our hat on - there is potential for error in the conclusions. While there is certainly a suggestion that aspirin is beneficial to patients who have had colon cancer (and this has been suggested in other studies as well), we are not at a point where it can be recommended routinely. Further studies are required, and in fact, one such randomized trial is already underway.

Dr. Sue © 2009


Who is the Lucky Winner?

>> Saturday, August 8, 2009

I had a really neat interview with a Danish newspaper recently, which started with 4 real-life weight loss success stories:

1. Ulla has lost 10 lbs. She eats whatever she wants, but exercises at high intensity for an hour, 6 times per week. She eats chocolate every day, and calls herself an exercise addict.

2. Claus lost 25 lbs with help from a dietician. He eats more protein and vegetables than he used to. He takes his dog on a 30 minute leisurely walk every day.

3. Katrina lost 20 lbs by counting calories. She eats 1400 calories per day, and goes to the gym 3 times a week.

4. Jakob lost 33 pounds. He has been working with a dietician, and has also hired a personal trainer.

Question to me: Are all of these good ways to lose weight?

Answer: The principle behind any successful weight loss is Calories In <>
It is a great idea to get a dietician involved, if this is accessible to you - they can help you figure out a detailed weight loss diet plan and help you find the healthiest food choices with which to do so. The important point from the stories above is that there are a variety of approaches out there, and it is a matter of finding which one works for you!

I am a bit concerned about Ulla's long term success, because she has not made any changes to her diet. If she develops an injury, or some other reason why she cannot exercise, she will probably start to put the pounds back on again. For a weight loss/maintenance program to be successful long term, the biggest focus should be on the dietary side of the equation (though I certainly do advocate for exercise!)

Question: Can you lose weight without exercising?

Answer: Yes! This bit of information is particularly important for people who are extremely overweight, or who have related problems such as osteoarthritis, which usually affects weight bearing joints. These issues can make it very difficult to exercise to much extent. A reasonable approach is to start just by decreasing food intake such that the pounds start to come off - with time and weight loss, people often find a weight lifted (literally!) off their shoulders, such that they have the energy and physical capacity to start exercising! From there, it is a positive reinforcement cycle of weight loss >> more energy >> more exercise >> more weight loss, etc.!

Alternatively, swimming is a great way to start exercising, as it does not cause pain or strain on weight bearing joints.

Question: Should exercise and diet be combined into one big plan?

Answer: Absolutely! The bigger the difference between Calories In and Calories Out, the better!

Remember to be alert to the increase in appetite that comes with working out. Also remember that exercise does not give you the carte blanche to eat your heart out, or drink your heart out for that matter - you can undo an hour long run in as long as it takes to down a venti Caramel Frappucino (R) from Starbucks (500 cal, in case you're wondering).

Question: Are there any methods which you would not recommend to lose weight?

Answer: I would not recommend using herbal or alternative products to lose weight. It is often unknown what these products contain, and further to that, their content, quality, and safety are not strictly regulated like prescription medications are. If you feel that you are not having any success with any lifestyle/diet/exercise intervention, you should speak with your doctor about futher options.

Dr. Sue © 2009


Ten Reasons to Exercise!

>> Friday, July 31, 2009

I am often asked if it is necessary to exercise to shed pounds. The short answer to this is no - you can certainly lose weight by decreasing your caloric intake alone, and in fact, dietary changes are probably more important than alterations in your activity level. However, it is clear that we live in a sedentary, internet-driven society, and the more time we spend sitting still, the lower our caloric expenditures will be! Our bodies were built to use - so - let's get out there and use them!

Remember that it is important to:

a) increase your exercise gradually, to avoid injury and to be sure you can tolerate it; and

b) discuss your exercise program with your doctor before you start, to get the A-OK to go ahead with your plan! (your doctor may want to do some tests of your heart and/or exercise tolerance before you start)

Here are ten great reasons to exercise! (and I have a hundred more...)

1. Being active will increase the difference between Calories In (what you eat) and Calories Out (activity) - the bigger the difference, the faster you will shed pounds! It is clear that exercise results in weight loss as well as a reduction in body fat.

2. Exercise increases your sensitivity to insulin, putting less stress on your pancreas to control your blood sugars.

3. How cool is this: Adhering to a physical activity program results in a decrease of 6,000 heart beats per day in men, and 3,000 heart beats per day in women! (and yes, this is after taking into account the increased number of heart beats during the workout itself). Think of all the work you are saving your heart in the long run!

4. Regular physical activity improves your sensitivity to other hormones as well, such as adrenaline and glucagon, both of which are involved with regulation of your blood sugar levels. Thus, exercise overall enhances the accuracy of your body to regulate use and storage of sugar and fat.

5. Several studies suggest that exercise provides some protection against cancer, specifically breast cancer, pancreatic cancer, and other intestinal malignancies.

6. Reduce your stress! There's nothing like a good workout to burn off some stress after a hard day at work.

7. Amongst older individuals, exercise decreases the risk of dementia and Alzheimer's disease (one study showed a 40% decreased risk of Alzheimer's!).

8. Cure those blues! Exercise decreases the risk of depression and anxiety as well.

9. Working out regularly decreases your risk of developing type 2 diabetes.

10. Because it's FUN!! Find an activity or sport that you enjoy, and make the most of it!!

Dr. Sue © 2009


Does Insulin Glargine cause Cancer?

>> Sunday, July 26, 2009

Both Health Canada and the FDA are undertaking a safety review of insulin glargine (trade name is Lantus ©), in response to four studies that were published in this month's Diabetologia journal. Three of these four European observational studies suggested that there may be higher rates of cancer amongst patients who use Lantus insulin.

Lantus is one of two long acting synthetic insulins (the other is insulin detemir, trade name Levemir ©). Levemir © was not studied in the above mentioned studies, because it is a newer insulin that was not available at that time. These insulins have been altered from long acting human insulin (known as N or NPH insulin), resulting in different actions of these insulins, with benefits including a longer duration of action and lower risk of low blood sugars (hypoglycemia) compared to human insulin.

Some studies have suggested an increased risk of cancer in all patients with diabetes (on any kind of treatment), though the common denominator here may be obesity (obesity is a well known risk factor for several types of cancers). People with type 2 diabetes (particularly in the earlier years) and people who are overweight or obese often have high insulin levels, also known as insulin resistance. Insulin is an important growth factor, for example for cells that line the colon; in fact, insulin has been shown to stimulate colonic tumor cells. So, insulin in general, whether produced internally, or given as a treatment of diabetes, may be associated with an increased risk of cancer.

So how does Lantus © play into all of this? Lantus © is known to interact with insulin growth factor receptors to a higher degree than other insulins, which could theoretically be associated with increased cancer risk. However, it has to be taken into consideration that these recent studies were observational only, and therefore not high quality data (in other words, not something we can hang our hat on).

The bottom line is, that we do not know at this time whether Lantus © increases cancer risk. Health Canada and the FDA are doing the right thing by looking into this issue. In the meantime, it is important not to take extreme reaction to information that is highly debatable. If you are taking Lantus ©, it is important that you do not simply stop taking it, as not treating your diabetes can lead to dangerously high blood sugars. If you are concerned, please speak to your doctor about the issue, and make a decision about your diabetes treatment that is best for you.

Dr. Sue © 2009


The Link Between Parent & Child Obesity

>> Sunday, July 19, 2009

I was asked to comment in a Danish newspaper on a recent BBC article last week, so I thought I'd share my thoughts with you as well!

A recent study from the UK suggests that childhood obesity is more closely linked to obesity in a same-sex parent than to obesity in a parent of the opposite sex.
Is this surprising, I was asked? Not surprising at all. Obesity is a consequence primarily of environmental and behavioral factors, in the context of an individual's genetic tendencies. It is clear that obesity tends to run in families, partly because of genetics, but with a strong influence of learned behaviors within that family unit (poor eating habits, etc).

Enter the gender role: we all know that little girls look up to their female adult role models, and little boys to the older men in their lives, and as such, they want to emulate the behaviors of those people they look up to. If mom wears high heels, then so does the little girl want to try them out; if mom wears blue eyeshadow, then little Jane wants to as well.

This emulative behavior is no different when it comes to healthy or unhealthy lifestyles.

If mom likes to roll out and eat a batch of Pilsbury cookies after dinner, then the girl wants to take part in the baking, and surely the eating, too. If mom, however, is out for a figure skate on a winter day, or snacking on some funny looking jicama (vegetable) or edamame beans, then little Jane is more likely to adopt those healthy behaviors instead.

This same study found that 41% of eight-year-old daughters of obese mothers were obese, whereas only 4% of daughters of normal-weight mothers were obese.

The question is asked:

Do obese children turn into obese adults?


Do obese parents lead to obese children?

The answer is, both.

The important take home message here is that obesity treatment needs to be a family based approach. The focus of obesity treatment is a shift in lifestyle paradigm - it makes no sense to try to teach an obese child this new behavioral paradigm if the parents are not involved too. As an example, I am currently involved in a research study at the University of Calgary and Alberta Children's Hospital, which is studying the effect of a child's portion control plate to treat childhood obesity. For each child in the study who is using this 'Magic Plate', we are also providing the parents with the adult version of the portion control plate. The goal is to alter the lifestyle of the family as a whole, such that they can adopt a new paradigm together and become healthier as a family unit!

Dr. Sue © 2009


Parent and Child Obesity In the News

>> Tuesday, July 14, 2009

Here is an article I interviewed for, for the Danish readers out there, in Denmark's Ekstra Bladet.

I will comment on this issue on this website on Monday, stay tuned!

Dr. Sue © 2009


The Fat Burning Zone: Truth or Hype?

>> Monday, July 13, 2009

Well, it's about time I do some talking about the Calories Out side of the body weight equation - and that is exercise.

I am often asked about what intensity of exercise is the most effective for weight loss. At the gym or on your home workout machine, you may have noted that the medium range of exertion is labelled as the 'fat burning zone', and the intense range of exercise is labelled as the 'carb burning zone'. Based on this, many people conclude that they will lose weight (fat) faster if they exercise at moderate intensity, than if they work out at a higher intensity.

True or False?

The short answer: False!

The long answer:

Your rate of weight loss, or weight gain, is based simply on the difference between your Calories In (what you eat) and your Calories Out (what you expend). So, if you exercise at a higher intensity for a fixed period of time (let's say, cycling hard for 30 minutes), you will burn more calories than if you do the same activity for the same period of time, but at a moderate intensity (cycling at a medium intensity for 30 minutes).

So what is this 'fat burning zone' all about? Well, it is true that when you exercise at moderate intensity, your metabolism is in a zone where it will choose primarily fat as its fuel source, whereas when you are in the high intensity zone, your body is choosing carbohydrate as its primary energy source. The key point, however, is that the body is exceptionally talented at moving energy stores around between fat, carbohydrate and protein. Thus, when all is said and done, the body will balance out these energy stores again, such that it is prepared for the next period where you demand of it again. So while you burn proportionally more fat (relative to carbohydrate) at medium intensity, the overall calories burnt is lower, and once your body finishes redistributing your energy stores, you end up with more energy (including fat) left in your body than if you had exercised at a high intensity. At the high intensity, on the other hand, your body would have burned proportionally more carbs (relative to fat), but after re-equilibrating, your body would have had to draw on some fat stores to replenish the carb stores, and with less calories overall in your body, you will also have less fat! (It is a bit more complicated than that, but this is the jist of it.)

Repeated over time, the difference between moderate and high intensity workouts adds up! If you burn an extra 100 calories per day (which can be very reasonably accomplished by turning up a moderate 30 minute workout into an intense one), you will lose 10 pounds in a year. This, of course, assumes that you have recognized and avoided the #1 PITFALL of high intensity workouts to the person trying to lose weight - and that is that high intensity workouts can make you HUNGRY!! An appetite just as intense as the workout you just had can result in overconsumption of calories, to the point where you have lost the benefit of the intense workout, and perhaps eaten yourself into bringing more Calories In than what you put out! One third of a Snickers bar can wipe out that 100 calorie extra burn that you got from your workout.

If you decide to step up your workouts, make sure you speak with your doctor first, particularly if you have any medical conditions. It is also advisable to ramp up your workouts gradually rather than just jumping into hard core workouts - this is safest from a cardiovascular perspective, and also helps to avoid injury.

Dr. Sue © 2009


Fortifying Junk Food??

>> Sunday, July 5, 2009

Will this be the new 'Vitamin M'?? but they could potentially become fortified with vitamins, falsely leading us to believe that eating them is good for us.

Fortified junk food may soon be appearing on grocery shelves, according to a recent proposal from Health Canada. The proposed policy change would allow food manufacturing companies to add vitamins and minerals like iron and calcium to their junk food, in order to make their product appear healthier to us, the consumer. Health Canada's thinking behind this is that if we are going to eat junk food, we might as well be getting some kind of 'nutritional benefit' out of it. The problem with this plan is that it runs the risk of leading us to believe that eating junk food is good for us.

In a society where we are battling an ever increasing prevalence of obesity, we are fighting hard to decrease consuption of high calorie junk food. If this Health Canada policy is put into action, the concern is that this will actually lead to an increase in junk food consumption.

For example: You might have been told by your doctor that you are not getting enough calcium in your diet, so if you saw a bag of chips on the shelves fortified with calcium, would that make you more likely to buy them? Whereas if those chips hadn't been on the shelves, you would have continued down and past the chips aisle, and on to purchase some skimmed milk or a bottle of Tums (both great sources of calcium).

Canada does fortify a limited number of foods already, such as adding vitamin D to milk, and folic acid to flour. However, the key differences here are:

1. These fortifications were designed to replace specific deficiencies in the population; and
2. These fortifications were added to foodstuffs that are generally healthy staples of our diets.

In contrast, adding iron to a chocolate bar is not replacing a specific deficiency in the population, nor is a chocolate bar a healthy daily staple in our diet! We are not a nation plagued with a multitude of vitamin and nutrient deficiencies in need of rapid correction - a multivitamin is a calorie free way to get most of what you need (be sure to speak to your doctor about your specific requirements).

Human nature, based on thousands of years of evolution, drives us to want to eat high calorie, good tasting foods, to store fat for times where food is not readily available. In a world where food is abundant at all times, we have to let our brains override our genetic drive, in order to make the conscious choice to walk by the unhealthy, high calorie junk food in favor of healthier choices.

There are enough excuses to eat junk food out there - who needs another one?

Dr. Sue © 2009


Keep your breakfast portions under control!

>> Wednesday, July 1, 2009

Did you know that if you are eating a whole bowl of muslix at breakfast, you are likely eating more than half of your total daily caloric needs in that sitting? On the other hand, you could eat 3 full bowls of Puffed Wheat and barely get up to half your daily caloric needs. Well, here is an easy way to keep your breakfast cereal portions under control, while maintaining the freedom to choose what kind of cereal you like to eat.

The Diet Bowl is a portion control tool that is part of The Diet Plate system, and it is remarkably easy to use. The bowl is intended for breakfast cereal, and using this bowl for cereal will give you a fixed 200 calorie breakfast every day. There are four color coded lines on the bowl, from the bottom up: red, yellow, green, and blue. Each of these lines corresponds to a color coded list of breakfast cereals that comes with the bowl. All you do is find your cereal on the list, fill to the appropriate line, add ½ cup of skim or 1% milk, and there you have it! 200 calories in your breakfast bowl.

Examples of what types of cereal reach which colored line on the bowl:
Red – hot cereals; muslix, granola
Yellow – the sugary types of cereal (Fruit Loops, Honey Nut Cheerios)
Green – All Bran, Corn Flakes
Blue – The only cereal to make it this high is... Puffed Wheat! (and alas no, not puffed wheat squares..)

In my research study on The Diet Plate ® ™ system, I did not insist that the participants use the bowl – this would take away the freedom aspect of these tools. I simply asked participants to use it any day that they chose to have breakfast cereal as their breakfast meal. As could be anticipated, we saw a wide variety of frequency of bowl usage, from people who used it every day, to those who did not use it at all. Our results did show that the bowl in itself was very useful: people who used the plate on 80% or more of mornings were almost 5 times more likely to lose a clinically significant amount of body weight (5% of body weight) compared to people who were not using the portion control system. And just by cutting back the morning nosh!

Cereal is not for everyone, it’s true.... So here are a few suggestions of other ways you can intake about 200 calories at breakfast:

2 pieces of whole wheat toast, plain
1 piece of whole wheat bread with 1 tbsp peanut butter
2 pieces of fruit
½ cup low fat yogurt and 1 piece of fruit
2 eggs and ½ piece of whole wheat toast, plain

Dr. Sue © 2009



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