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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



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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