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Holiday Trick: Water Before Meals Enhances Weight Loss

>> Sunday, December 26, 2010

Especially during the holiday season, any little tips to help maintain (or even lose) weight can be a great help. Here's an easy one to consider through the holidays, and onward into the New Year - it's as simple as H-2-0!

Drinking calorie-free, refreshing water before meals is often recommended to help fill the stomach before eating. A recent randomized controlled clinical trial strengthens this point, showing the benefits that drinking water can have towards helping you slim down.

This trial, conducted by Davy and colleagues at Virginia Tech University, was the first randomized, controlled clinical trial to address this issue. Forty-eight adults were included in the trial, all of whom were provided with calorie-restricted diets to follow. Half of participants were required to drink two 8oz glasses of water about 20 minutes before each meal.

After 12 weeks, the participants consuming water before meals lost an average of 5lb more than the control group, who did not consume water before meals.

The way in which the strategy of drinking water before meals works is two-fold:

1. The physical presence of water in your stomach sets off the 'stretch sensors' in your stomach, releasing hormones that tell your brain that your stomach is filling up.

2. Mixing water with your meal decreases the energy density of your meal (ie the number of calories per gram of material ingested). As blogged previously, a lower energy density diet is beneficial because you feel more full after ingesting a larger mass of food with fewer calories, than if you ingested a high energy density, smaller meal such as a high fat food or dessert. Eating lots of FreeVeg operates under the same principles, as these are very low energy density foods. In fact, one of the contributors to the low energy density of FreeVeg is the very fact that they have a high water content!

Happy New Year to All!!

Dr Sue Pedersen © 2010

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A Christmas Hit: Crustless Pumpkin Pie!

>> Saturday, December 18, 2010

Due to the popularity of last week's Blueberry Crisp recipe, I have decided to one-up myself with the help of my sleuthing friend Deb, who has located a fantastic, even lower calorie dessert recipe for us. Thanks go to the Hungry Girl for this invention!

One 15-oz. can pure pumpkin
One 12-oz. can evaporated fat-free milk
1/2 cup fat-free liquid egg substitute
3/4 cup Splenda (granulated)
2 tsp. pumpkin pie spice

Preheat oven to 350 degrees.

Combine all ingredients in a bowl, and mix thoroughly.

Place mixture in an 8" x 8" baking dish sprayed lightly with nonstick spray, and bake in the oven for 45 minutes. (It will remain a little soft, like pie filling.)

Once ready to serve (it's delicious eaten hot or cold), cut into 9 pieces.

Makes 9 servings. Per serving: only 65 calories!

Tip: I made this for my better half last night, and his feeling was that a 4 tbsp puff of light whipped cream on the top was worth the extra 30 calories to make this dessert a little richer tasting. The total for this delicious treat still comes in just under 100 calories. I'll let you decide!!

Happy Holidays!!

Dr Sue Pedersen © 2010

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Blueberry Crisp Yuletide Dessert!

>> Sunday, December 12, 2010

The wonderful holiday season is upon us!! It's a joyous time to spend time with friends and loved ones, with much hosting done from home. Large, filling, high calorie meals are the norm during the holidays, and dessert can often double the total calorie intake of the meal. Here is a suggestion for a fabulous dessert that is not calorie free by any means, but is at least reasonable at 256 calories per serving. My suggestion is to scale down to a half portion for only 128 calories! Eating a half portion also scales down the carbohydrate count (attenntion, diabetics!) to a very reasonable 24 grams.

This recipe comes from my favorite Canadian chefs Janet and Greta Podleski, from their fabulous cookbook, Eat, Shrink, and Be Merry!

Blueberry Crisp (aka Rhapsody in Blueberry)


  • 6 cups blueberries (best if fresh)
  • 1/3 cup granulated sugar
  • 2 tbsp cornstarch
  • 2 tbsp freshly squeezed lemon juice
  • 2 tsp grated lemon zest
  • 1 cup quick-cooking rolled oats (not instant)
  • 1/2 cup all purpose flour
  • 1/3 cup lightly packed brown sugar
  • 1/2 tsp ground cinnamon
  • 1/4 cup margarine, melted
  • 2 tbsp apple juice or orange juice

1 cup low fat vanilla yogurt


1. Preheat oven to 375F. Spray a 9 x 13 inch baking dish with cooking spray. Add blueberries. Sprinkle bueberries with granulated sugar, cornstarch, lemon juice, and lemon zest. Mix well and set aside.

2. To make topping, combine oats, flour, brown sugar, and cinnamon in a medium bowl. Add melted margarine and juice. Using a fork, stir until mixture resembles coarse crumbs. Sprinkle crumb mixture evenly over coated blueberries.

3. Bake for 30 minutes, until blueberries are bubbling around edge of pan and crumb topping is golden brown. Cool for 10 minutes before serving.

4. Serve with a dollop of low fat vanilla yogurt, if desired.

Makes 8 servings. Per serving:
  • 256 calories
  • 6.9g fat
  • 3g protein
  • 48g carbohydrate
Divide the above numbers by 2 for half servings (recommended!).

To further cut calories, I'd be interested to see how this recipe turns out with Splenda as a substitute for granulated sugar, and/or Brown Sugar Splenda as a substitution for brown sugar. Try it out, and leave a comment to let our readers know how it turns out!

Happy Holidays!

Dr Sue Pedersen © 2010

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Video Blog on Measuring Metabolism: Step Inside a Respiration Chamber!

>> Saturday, December 4, 2010

In this video blog, Dr Sue takes you right inside the respiration chambers at the Department of Human Nutrition, University of Copenhagen, which are used to measure metabolism in a research setting.

By simply measuring oxygen consumption, carbon dioxide output, and nitrogen production over a 24 hour period, we can measure exactly how many calories a person burns over 24 hours, and how much of that calorie burn comes from protein vs fat vs carbohydrates as the fuel source.

These chambers are currently being used in a study of gastric bypass surgery patients that Dr Sue is involved in, as well as study of the effects of sleep deprivation on metabolism in kids.

Dr Sue Pedersen © 2010

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Higher Protein, Lower Glycemic Index Diet is Better for Weight Maintenance

>> Friday, November 26, 2010

Attention 'yo-yo' dieters! While many people are able to shed pounds with a variety of dietary and lifestyle interventions, the obstacle that is the largest for many is keeping the pounds off. Many studies have tried to find the optimum diet for weight control and prevention of weight regain, but these studies have been small and conflicting in their results. A new study finally provides some larger scale guidance, showing that a higher protein, lower glycemic index diet is beneficial in prevention of weight regain. (Learn more about what 'glycemic index' means here.)

The DIOGENES study, led by my colleague Thomas Meinert Larsen at the Department of Human Nutrition, University of Copenhagen, where I worked on research sabbatical last year, was published in this week's issue of the New England Journal of Medicine. This is a large study of 773 participants in 8 European countries, testing the effect of five different diets on weight maintenance:

  • a high protein, high glycemic index (GI) diet
  • a high protein, low GI diet
  • a low protein, high GI diet
  • a low protein, low GI diet
  • a control diet (typical to the country's usual diet; moderate protein, with no GI recommendations)
Following a period of weight loss on a low calorie (800 cal/d) diet, participants were randomized to one of the five diets above. In two of the research centres, including the Copenhagen site, participants shopped for free in the research supermarket, so that the exact composition of food intake could be strictly monitored. (This is the same research supermarket that I have video blogged from previously.)

Participants were not limited as to the amount of food intake (food intake was 'ad lib'), but were instructed to try to keep their body weight stable (though further weight loss was also allowed).

Among the 548 patients who completed the six month study, weight regain was seen only in the low protein, high glycemic index diet. The high protein component of the diets spared about 1.4kg (3 lb) of weight regain, and the low glycemic index component spared 1.1 kg (2.4 lb) of weight regain. Participants in the high protein, low glycemic index diet were the only group that continued to lose weight through the study period.

Dropout rates were also highest in the low protein, high glycemic index diet, suggesting that this poorly satiating diet may be harder to adhere to.

Interestingly, these differences in results and adherence were seen with only a small difference achieved in dietary composition between groups. The differences that were achieved in the study were 5.4 percentage points of total energy in protein content between the high-protein and the low-protein groups, and 4.7 glycemic index units between the low glycemic index and the high glycemic index groups.

The study concludes that a diet moderately high in protein intake and slightly reduced in glycemic index improved maintenance of weight loss and compliance with the diet, and is therefore ideal to prevent weight regain.

Dr Sue Pedersen © 2010

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Dental Disease and Diabetes: What's the Connection?

>> Saturday, November 20, 2010

It is well known that diabetics are at an increased risk of vascular complications, and that control of blood sugar, cholesterol, and blood pressure are important to prevent these complications from developing. One often overlooked risk factor in diabetics is periodontal disease, a chronic bacterial infection affecting the gums and bone that support the teeth.

Periodontal disease is known as gingivitis in its mildest form, presenting as tenderness, redness, and swelling of the gumline. If untreated with proper oral hygiene (adequate brushing and flossing), this can evolve to a chronic condition with gum recession, plaque accumulation and bone loss, called periodontitis.

The relationship between periodontal disease and Type 2 Diabetes is something of a vicious cycle. First of all, it is known that diabetics are at higher risk of developing periodontal disease, and that it is more severe than in non diabetics. The elevated blood sugars increase the susceptibility to infection - bacteria thrive on the excess sugar that is available.

On the other side of the coin, having periodontal disease is associated with an increased risk of developing diabetes, and is also associated with poor blood sugar control in patients with diabetes.

A key factor responsible for the relationship between periodontal disease and diabetes appears to be inflammation. As discussed by Dr Tenenbaum and colleagues in a recent publication by the Canadian Diabetes Association, periodontal disease produces a low grade inflammatory state, with increased levels of inflammatory chemicals in the blood stream. These inflammatory mediators are known to be associated with increased risk of vascular disease, and true to that, an increased prevalence and incidence of cardiovascular disease has been observed in patients with periodontal disease. We also know that Type 2 Diabetes and the complications that develop are partially mediated by inflammatory changes in the blood vessel wall, so this may be part of the link between the two conditions.

To minimize your risk of periodontal disease, follow these important tips from the Canadian Dental Association:

  1. Brush your teeth and tongue twice a day with toothpaste and floss once a day to remove plaque between teeth. When choosing oral health care products, check for the Canadian Dental Association (CDA) Seal of Recognition.

    Products bearing this Seal have been reviewed by CDA and have demonstrated specific oral health benefits.

  2. Check your gums regularly. Look for the warning signs of gingivitis and report them to your dentist right away.
  3. See your dentist for regular check ups, and schedule a professional cleaning to remove stains and built-up tartar.
  4. Eat healthy foods for your oral health as well as your overall health. Eating excess sugar is one of the primary causes of dental problems. With the proper nutrients that come from healthy eating and proper oral hygiene, you can fight cavities and gingivitis.
  5. Don't smoke. Smoking is a major contributor to dental problems and may cause oral cancer.

Dr Sue Pedersen © 2010

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Overweight and Undernourished?

>> Saturday, November 13, 2010

It seems like a contradiction in terms, but the truth of the current state of affairs is that while most North Americans are overweight, many of us are simultaneously undernourished, being deficient in essential nutrients that are key to disease prevention and optimum cellular function.

As extensively discussed in the 2010 Dietary Guidelines for Americans, published by the Dietary Guidelines Advisory Committee (DGAC), the root of the problem lies in the fact that we tend to eat food that is high in calories, but low in nutritional value. Americans currently consume 35% of their total daily caloric intake as Solid Fats and Added Sugars (SoFAS), which results in excessive saturated fat and cholesterol intakes, with insufficient intake of dietary fiber and other nutrients. The big offenders in the SoFAS category are:

  • grain based desserts, including cakes, cookies, pies, doughnuts, and granola bars;
  • cheese, sausage, bacon, franks, ribs;
  • pizza
  • french fries and hash browns
  • dairy desserts such as ice cream
  • soda, fruit drinks, and candy
On the note of beverages, US adults drink an average of 394 calories per day! For a typical woman trying to lose weight, this amounts to about one third of her desired total daily caloric intake. Major sources of liquid calories include soda, coffee/tea (with added milk or sugar... a large Double Double contains 230 cal), milk, fruit juices, and alcohol. (Note that while obesity rates in Canada are not quite as staggering as they are in USA, the principles still apply.)

While the typical American eats almost three times the recommended maximum intake of SoFAS, they eat only 15% of recommended whole grain intake and 59% of recommended veggie intake.

The Dietary Guidelines for Americans recommend that intake of SoFAS be dramatically reduced, with an increased focus on consumption of nutrient dense foods that will provide adequate vitamin and mineral intake, including vegetables, fruits, high fiber whole grains, low fat milk products, seafood, lean meat and poultry, eggs, soy products, nuts, seeds, and oils. With the right balance of this food list, the end result should also be a less calorically dense diet (eg with increase in FreeVeg consumption), which should result in less weight gain, if not weight stability or even weight loss.

An issue I have with these DGAC guidelines is that it still leaves the average American lost in a sea of recommendations, without enough concrete instructions and guidance to truly be of help in making permanent lifestyle changes. They are also too open for (mis)interpretation, potentially resulting in continued nutritional deficiencies. There is also danger of these guidelines leading to continued weight gain with little room for error: adding two tablespoons of a 'healthy' oil to your diet will add 260 calories, which for many women amount to 20% of their total daily caloric goals - and you haven't eaten anything yet! (The Canada Food Guide is guilty of making this recommendation as well.)

Thus, I am not optimistic that there will be great adherence to these guidelines, nor am I optimistic that they will go far in our battle against obesity.

Further, these DGAC guidelines anticipate that in adherence to their recommendations, that there should be no need for a multivitamin in the general, healthy population. While it may be true that adherence to their dietary recommendations could preclude the need for a multivitamin, in the practical world, it is likely that adherence to their dietary recommendations will be suboptimal. Until the DGAC has confirmed good compliance with their dietary recommendations, it may be a bit premature to recommend against multivitamin consumption.

It is important for all of us to do our best to decrease consumption of SoFAS and to focus instead on nutrient rich foods. There are several issues that must be weighed in consideration of whether a particular individual should consume a multivitamin, and if so, which one; speak with your doctor about your own situation.

Dr Sue Pedersen © 2010

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Bariatric Surgery: Patient Guide to Endocrine and Nutritional Management

>> Saturday, November 6, 2010

As blogged previously, bariatric (weight loss) surgery is a treatment options for people with severe obesity that has proven to be resistant to treatment with more traditional and conservative measures. The treatment does not end with the surgery itself, however - the story is far more complex than that.

As beautifully summarized in the Patient Guide to Endocrine and Nutritional Management after Bariatric Surgery in the Journal of Clinical Endocrinology and Metabolism (a free download!), there are several aspects which require close attention and follow up in order to minimize the chance of weight regain after surgery, to minimize the risk of developing a complication of bariatric surgery, and to ensure that complications of obesity are well managed postoperatively.

To decrease the chance of weight regain after surgery, a lot of the preventive work actually has to happen before the surgery is even done. It must be recognized, as with any 'diet', that the lifestyle change being made has to be a permanent one. This is not about eating smaller portions or altering food choices for a short period of time - this is forever. It is also absolutely critical that the relationship with food is thoroughly explored and managed well before the surgery takes place. There are many contributing factors to overeating, many of them emotional: eating in sadness, in joy, to comfort, to alleviate stress, even to service a true addiction to food. People who have not had help in dealing with these aspects of their weight struggles, or who have not worked through these issues prior to surgery, are not appropriate candidates for bariatric surgery, as they stand a high risk of weight regain postoperatively if those habits and coping mechanisms are not managed beforehand.

The risk of nutritional deficiencies is very real after bariatric surgery, particularly after gastric bypass surgery (pictured above), which involves a re-routing of the small intestine such that about 1.5 meters of small intestine is no longer exposed to food and the enzymes required to digest it. Patients who undergo gastric bypass surgery are at risk of life threatening complications if they do not adhere to their supplement regimen, which for most patients includes a specific multivitamin, calcium, vitamin B12, vitamin D, and often iron. An individual who is committed to having gastric bypass surgery must be equally committed to taking supplementation for the rest of their lives. Protein malnutrition is a potentially severe complication of any type of bariatric surgery due to decreased intake; it is essential to follow the protein consumption recommendations provided by the bariatric program's dietician (usually at least 90 grams of protein intake per day).

Because bariatric surgery often has a profound beneficial impact on several obesity-related complications such as diabetes, high blood pressure, obstructive sleep apnea, cholesterol, and osteoarthritis (to name a few), it is important to have physicians involved both pre- and post-operatively who can help to manage changes in medications and treatment approach that are often necessary.

While bariatric surgery is a very appropriate treatment option for some people, it must always be remembered that bariatric surgery is not a quick fix or a cure; it is the exchange of one set of medical issues for another (though usually in a positive direction), and it is most certainly a permanent lifestyle alteration.

Dr Sue Pedersen © 2010

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Sleep Deprivation is Strongly Linked to Obesity

>> Saturday, October 30, 2010

I'm sure that everyone reading this blog will be familiar with the phenomenon of sleep deprivation - it is something that all of us have experienced, and for some of us, it plagues our daily lives. It turns out that the effect of sleep deprivation goes much farther than just feeling tired; it can actually have a profound effect on body weight and the risk of obesity.

Dr Jean-Phillipe Chaput, a Canadian colleague of mine who also spent time researching at the Department of Nutrition at the University of Copenhagen, Denmark, is an expert in the area of sleep research. For the scientists among you, he provides an excellent video presentation (the website is from Denmark, but Dr. Chaput's presentation is in English - just press play to watch the video. References to the data below can also be located in Dr Chaput's presentation.)

Along with the epidemic of obesity, we have seen a decrease in the overall amount of sleep we get. According to the National Sleep Foundation, the proportion of young adults getting less than 7 hours of sleep per night was 16% in the year 1960; in 2001, this number increased to 37%.

A study from Quebec showed that children with short sleep were more than 3 times more likely to be overweight, and this association was stronger than other risk factors examined such as parental obesity, television viewing time, and physical activity. Amongst adults age 18-65, the same association was found, with short sleepers (5-6 hours) being 3.8 times more likely to be obese than adults sleeping 7-8 hours per night. Again, this risk factor was stronger than the association of obesity with high fat intake in the diet or physical inactivity. It should also be noted that too much sleep is also associated with obesity; the sleep duration with the lowest body mass index in adults is at 7.7 hours per night.

One obvious factor responsible for this association is that we are simply awake for more hours where we may be inclined to eat. More hours awake equates with a longer period of time per day where we are exposed to our toxic environment that pushes food at us everywhere we look. We may also be more inclined to eat during these extra waking hours due to the activities we undertake during those late night hours - often sedentary activities such as computer time or TV, which often results in snacking on unhealthy foods.

However, the story is much more complex than simply being awake for more hours in a day.

There are several hormonal variations with decreased sleep: we see lower leptin levels (a hormone that normally tells us we feel full and also works to stimulate energy expenditure). We also see higher levels of the hunger hormone, ghrelin, in shorter sleepers, thereby increasing the sense of hunger and desire to eat. Some studies also suggest that the stress hormone, cortisol, increases with shorter sleep duration.

There is also evidence to suggest that decreased sleep may decrease basal metabolism; for example, it has been found that there is a decrease in core body temperature with acute sleep deprivation (lower body temperature being associated with a lower basal calorie burn). We also see a decrease in fidgeting and other behaviours such as our body posture when we are sleep deprived, resulting in a lower calorie burn. Think of how you sit when you are well rested - perhaps sitting in a straight backed chair while you work - versus when you are exhausted, you may be more inclined to assume a more relaxed pose on the couch. These differences may be small, but they matter! Also on the energy expenditure side of the equation, we are less likely to engage in active physical activity when we are tired.

For individuals who struggle with their weight, and also for prevention of weight gain, it is important to include a good night's sleep as part of the overall management approach. The optimum amount of sleep appears to be between 7-8 hours for an adult - be sure to set this as a lifestyle priority!

Dr Sue Pedersen © 2010

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Lemon Parmesan Broccoli!

>> Saturday, October 23, 2010

Here is a great way to shake up your broccoli! Broccoli on its own is a Free Veg, meaning that you can eat it in generous amounts without taking in many calories (it's only 30 cal per cup!). It is not quite free with the addition of a little bit of Lite Parmesan... but it's pretty darn close!


  • 6 cups of broccoli (about 4 heads)
  • 1 lemon
  • 3 tbsp light powdered Parmesan cheese
Cut your broccoli into florets. The broccoli needs to be dry - if you wash it, be sure to dry it thouroughly. Arrange in a 9x13" baking dish.

Zest your lemon and finely chop the pile of zest you get. Chop your lemon in half.

Spray broccoli briefly with an aerosol sprayer such as Pam (a great alternative to oil!). Add a bit of salt & pepper to taste, and squeeze the juice of one half of your lemon on the broccoli. Put your dish of broccoli in a preheated oven at 400C for 20-25 mins. The goal is for the tips of the broccoli to be a little crispy, but not burned.

Remove from oven, sprinkle with the lemon zest, squeeze the juice from your other half of lemon all over the broccoli and top with the parmesan cheese. Return to the oven for 1-2 mins until the parmesan melts, then serve!

Makes 6 servings. Per serving:
  • 50 cal
  • only 1g fat!

Dr Sue Pedersen © 2010

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Benefits to Barley and Buckwheat? The Low Glycemic Index Diet

>> Saturday, October 16, 2010

Amongst the plethora of weight loss strategies that abound out there, the Low Glycemic Index Diet is touted as yet another way to 'guarantee' substantial weight loss. Let's debulk the mystery - is this fact or fiction?

The Glycemic Index of a particular food refers to the rapiditiy with which the sugars (carbohydrates) in that food are absorbed into our bloodstream. Technically speaking, it is defined by the incremental rise in blood sugar after ingestion of 50 grams of a particular carbohydrate, compared to 50 g of a reference food, which is usually white bread. White bread has arbitrarily been set to have a glycemic index (GI) of 100. A low GI food has a GI of less than 55, while a high GI food has a GI of more than 70.

There has been much controversy as to whether a low GI diet actually results in weight loss. Overall, studies show that a low GI diet is NOT particularly effective, resulting in a 2 lb weight loss over the course of 6-12 months, with a 10-15 GI difference between diets. As low GI diets are usually also high fiber diets, it may actually be the higher fiber content of the low GI diet that is responsible for any weight loss that is seen, as fiber helps to keep us feeling fuller longer, therefore resulting in a lower caloric intake overall.

For diabetics, however, glycemic index is a very important consideration, as a lower GI diet helps to control the rise in blood sugar that is often seen after eating. Having said that, however, the glycemic index has its limitations, as it tells us nothing about the quantity of carbohydrate, only about the quality of carbohydrate.

Therefore, it is not only the glycemic index, but also the Glycemic Load that is important. The Glycemic Load is defined as the GI of a food, multiplied by the number of grams of carbohydrate in a serving of that food, thereby capturing both the quality AND quantity of carbohydrate intake. In other words, if you consume a low GI food (eg brown rice, GI=50) but a large quantity of it (resulting in a high Glycemic Load), the quantity of carbohydrates can contribute not only to a post meal glucose rise, but also to significant weight gain. Thus, it is important to exercise portion control in order to limit the Glycemic Load of a meal.

To improve diabetes control, and to assist in weight maintenance, a few important tips are as follows:

1. Switch up your high Glycemic Index foods for lower GI foods. Examples are to exchange white bread, pasta, or rice, for brown. Try incorporating some interesting carbohydrate alternatives such as pearl barley (pictured above, GI=25-33), lentils (GI 21-30), or buckwheat (GI=50-54).

2. Exercise portion control to limit your Glycemic Load!

3. Balance your meal: including protein, a small amount of fat, or a more acidic content to your meal decreases the Glycemic Index of your meal overall, and can decrease post meal blood sugars by as much as 20%!

Dr Sue Pedersen © 2010

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Thriving Through Thanksgiving!

>> Friday, October 8, 2010

The Canadian Thanksgiving long weekend is here! It's a fantastic opportunity to get together with family and friends to enjoy some quality time, rest and relaxation. Along with the gatherings, and in line with tradition, we can also expect to see tables heaped with delectable food and seasonal treats. Here are some tips to help your waistline and healthy lifestyle program survive the holiday!

1. Portion Control. Naturally, all of us will want to participate in enjoying the delicious treats on offer this weekend. Avoiding the pumpkin pie completely is an option, but it may also leave you with a 'bad taste' (so to speak) in your mouth, as depriving yourself completely on a special holiday can result in resentment for your diet plan, and make it less likely that you'll stick with it in the long term. On a special occassion, consider allowing yourself that special treat in a smaller portion (eg half the usual size), so that you can enjoy that special something in moderation.

For those of you who are calorie counting: 1/6 of an 8" comercially prepared pumpkin pie (109g per slice) contains about 229 calories, though this can certainly vary substantially depending on the recipe.

2. Use a Smaller Plate. Studies show that the larger the plate we serve our meals on to, the larger the number of calories that are consumed. This is simply due to the fact that more food can be accomodated on a larger plate - no one likes the look of a plate that does not appear full. Consider using a portion control plate such as The Diet Plate to help you portion your meal components appropriately, or alternatively, grab a lunch plate to serve up your meal and forgo the larger dinner plate.

3. Pass on the Sauces (or Dip the Tip). Salad dressings and gravies are two examples of high calorie additions to a meal. There are 130 calories in one tablespoon of oil, for example - that is over 10% of the total daily caloric intake recommended for the typical woman who is trying to lose weight - and nothing has actually been eaten yet! A salad dressing that contains a lot of oil can therefore add a lot of calories to your day. Gravies are another big offender, as it is very difficult to know how much fat or how many calories they contain, and they are often prepared with the fat drippings from the bird or roast being prepared.

An alternative to skipping the sauces completely is to have a small bowl of the sauce on the side, in which you can dip the tip of your fork before piercing the food. That way, you still get the taste sensation, without a heap of accompanying calories.

4. Festive Foul: Remove the Skin! Poultry, such as turkey, is often served at Thanksgiving dinners, and is actually a very healthy, protein rich, low fat food source. The skin of a bird, however, can be crispy and delicious but also contains a lot of calories from fat (particularly for duck or chicken). Removing the skin will cut your calories substantially. Also, go for the white meat rather than the dark meat to ensure you are getting the leanest meat possible (for example, there are 20% more calories in dark turkey meat than in light meat).

5. Take Only One Serving, and Eat Slowly! The festive family gatherings are much like a buffet-type meal: the food sits on the table for the duration of the meal, and it is accepted (and in many cases, expected!) to take several helpings. Eating slowly is a great way to combat the tendency to take twice. Fullness hormones first take effect after 10-15 minutes, so be sure to give yourself at least 15 minutes after you finish your first helping before you consider a second - most often, you'll find that you have changed your mind and no longer need the additional serving. Eating slowly also means that you are likely to still have food on your plate when second helpings are offered; this enables you to politely say that you are not ready for seconds yet, without affending your hosts. By the time others are finished their second helping, you will be finished your first, and the fact that you didn't go back for seconds will be unlikely to register!

Happy Thanksgiving!!

Dr Sue Pedersen © 2010

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Video Blog: The New Nordic Diet!

>> Sunday, October 3, 2010

On a research trip to Denmark this week, Dr Sue took the opportunity to bring you to the research supermarket where an innovative new diet called the New Nordic Diet is being studied. In an interview with Sanne Poulsen, PhD student at the Department of Human Nutrition, University of Copenhagen, we learn about the New Nordic Diet Study, which compares the effects of this diet with the traditional Danish diet on body weight, body composition, and cardiovascular risk factors.

The New Nordic Diet focuses on healthy foods that are cultivated in Scandinavia, such as whole grains (rye, barley, oats), berries, root vegetables, and fish. There is also an emphasis on choosing foodstuffs that are produced in an environmentally sustainable fashion.

Thanks to my friend Brian at for technological support!

Dr Sue Pedersen © 2010

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Video Blog: Test Tubes Illustrate High vs Normal Blood Sugars

>> Sunday, September 26, 2010

In this video blog, Dr Sue shows you two mock test tubes, illustrating what normal blood looks like and how it flows, compared to blood when blood sugar is high. It is important to control blood sugars (keeping levels as close to normal as possible) to prevent or delay the complications of diabetes over time, including damage to the eyes, heart, kidneys, nerves in the feet, and blood vessels throughout the body.

Dr Sue Pedersen © 2010

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Avandia Use Suspended in Europe, Continued in USA

>> Thursday, September 23, 2010

It has been an absolute whirlwind week at the European Association for the Study of Diabetes Meeting in Stockholm, Sweden, and I have many interesting thing to share with my readers over a series of upcoming blogs. The week's biggest news is pretty much uncontested, however, and it regards the future of a commonly used diabetes medication called rosiglitazone, or Avandia.

Both the European Medicines Agency (EMEA) and the American FDA released statements regarding the future of Avandia on September 23, 2010. While the EMEA has suspended the use of Avandia in Europe, the FDA has allowed Avandia use to continue, while restricting access and adding additional safety labeling.

Avandia has been under mounting scrutiny since a meta analysis of data suggested that Avandia use may be associated with an increase risk of cardiovascular events. By controlling blood sugars, one of the major complications of diabetes that we are aiming to PREVENT, of course, is heart disease. While more than one such analysis of data has suggested there may be an increased cardiac risk with Avandia, no 'gold standard' randomized, controlled, clinical trial has proven this to be the case. The RECORD trial, which was a randomized clinical trial, did not demonstrate a significantly increased cardiovascular risk (though this data is subject to several criticisms).

With these analyses in hand, then, regulatory agencies have had a very difficult and controversial decision to make, and it is due to this uncertainty that the EMEA and the FDA have leaned in slightly different directions this week.

The European Medicines Agency concluded that the benefits of rosiglitazone no longer outweigh its potential risks. They indicate that Avandia will no longer be available in Europe in a few months' time, and advise patients to book an appointment with their physician to plan cessation of Avandia and to discuss other suitable medication to treat their diabetes. The suspension will remain in place unless convincing data can be provided to identify a group of patients in whom the benefits of Avandia outweigh their risks.

The FDA, on the other hand, has allowed Avandia use to continue, but has restricted its use to those who cannot control their diabetes on other medications. The FDA will also require a Risk Evaluation and Mitigation Strategy program with additional measures to ensure the safe use of the medicine. This includes a reevaluation of data from the RECORD trial mentioned above.

In addition, the FDA has put the TIDE trial on hold, which was designed to compare Avandia to a drug in the same class called Actos, with regard to effect on cardiovascular outcomes in high risk patients with type 2 diabetes.

For any patients who are taking Avandia and are either affected by it suspension (ie, living in Europe) or unsure of how to proceed, be sure to book in with your doctor to discuss before making any changes.

Dr. Sue Pedersen © 2010

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FDA Advisory Committee Rulings on Obesity Drugs Not Favorable

>> Saturday, September 18, 2010

The FDA has been busy this week, with meetings to discuss the future of two obesity drugs, one of which is currently available, and one of which is in the pre-approval phase. Overall, the future for both looks bleak.

Sibutramine (Meridia) is an obesity drug that works as an appetite suppressant, and has been available in Canada for a decade. It has come under scrunity in the past year following the results of the SCOUT trial, which was a study examining the effects of sibutramine vs placebo in over 10,000 participants who had preexisting heart disease, diabetes, or both. This study, which was published in the New England Journal of Medicine a couple of weeks ago, showed that there was a 16% increase in risk of heart attack and stroke. The increased risk was seen only in patients with known cardiovascular disease; patients with diabetes but no known history of heart disease did not have an increased risk of these events.

In response to these data, which were made available earlier this year, sibutramine was pulled from the market in Europe, but it has remained available in North America. An FDA Advisory Meeting held this week (with Alberta's own Dr Arya Sharma being one of the presenters to the committee) resulted in a 50/50 vote as to whether to recommend that the drug be pulled from the American market. Eight members voted that the drug be removed from the market, while the other 8 voted that it remain on the market with new labelling restrictions.

The following day, the FDA held another advisory meeting, this time to discuss a new obesity medication called lorcaserin. The panel voted 9 to 5 against its approval for use in USA, stating that the modest weight loss seen did not make up for several unanswered questions about its safety.

Thus, the struggle to find effective and safe weight loss medications is still underway. A newer class of injectable medication used to treat type 2 diabetes, called GLP-1 analogs, assist with weight reduction, and are currently in trials for weight loss (though not yet approved for this purpose) in non-diabetics. In September 2010, these seem to be the brightest spot on the horizon.

Dr. Sue Pedersen © 2010

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Inspiration to Exercise!

>> Sunday, September 12, 2010

Although it seems that summer has all too rapidly come to a close in western Canada, race season is still in full swing. I competed in the bike leg of a team triathlon in Banff on Saturday (a personal first), and I spent Sunday as the physician on call for the Dinosaur Valley Half Marathon in Drumheller, AB ( During the weekend, I had the opportunity to observe and be inspired by the athletes, and to think about the variety of ways in which people motivate themselves to exercise and stay active.

One key theme was that people were often found to be competing in groups. At the marathon, I met mothers and daughters, friends, and neighbors who had banded together to train up for race day. Although triathlons are traditionally a solo sport, there were many groups who enrolled as a three person team, with one person assigned to each of the swimming, cycling, and running legs of the race. For myself, it was a great opportunity to enrol as a family and cheer each other on at our respective sports. For all of these groups, the important message that shone through each time was that having the common goal of the race in mind provided an excellent opportunity to support each other through the months of training before the race. It's true - exercise programs are often more successful in a group support setting than when a person tries to go it alone. Consider planning workouts with a group of at least 3 people, such that if one person cancels, the other two can still provide mutual motivation to burn some calories!

Another theme was the sense of accomplishment that arose from participation in these events. At the Dinosaur Valley marathon, I had the great joy of watching contestants of all ages and abilities walk or run anywhere from 5km to a full half marathon (26km). I was equally inspired by every individual who competed, because I knew that each person was challenging themselves personally to accomplish their goal. Aspiring towards a personal best provided sufficient motivation for many an athlete to train towards their goal in the preceding months. I came across a number of athletes this weekend who were going it solo, and felt that the drive to succeed was motivation enough!

One interesting theme I heard time and time again, was that people who were racing were doing it to set a good example for their children. Childhood overweight has become a serious problem, and although there are many contributory factors, a key contributor is the increase in sendentary behavior that has been noted (TV watching, internet, etc). At the Banff Triathlon, there was many a child cheering on their parents as they crossed the finish line. At the marathon, I was thrilled to see whole families running the 5km race together!

These are just a few ideas to consider to increase motivation and adherence to exercise. To all this weekend's competitors - hats off to you!

Dr. Sue Pedersen © 2010

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What We Can Learn from Elephants: The Low Energy Density Diet

>> Saturday, September 4, 2010

On a safari in Kruger National Park, South Africa, last week, I had an amazing experience learning all about the abundant wildlife we encoutered: giraffes, lions, leopards, zebras, wildebeest, hippos, crocs, and the like. One thing that stands out in my mind is the astounding eating capacity of the elephants: they eat a whopping 250 kilograms of food each day!

For an adult male elephant, weighing about 5500 kg, this equates to 1kg of food per 22kg body weight. The weight of food consumed by a human per day will vary substantially depending on what type of food is consumed, but is considerably less, proportional to body weight, compared to what an elephant consumes to maintain body weight.

So - how do the elephants do it?

The secret is in the low energy density of the food that the elephants are consuming; in other words, the caloric content of their food is very low. Elephants are herbivores, meaning that they eat only vegetation: leaves, grass, twigs, roots, bark, and small amounts of fruit, seeds, and flowers. In addition, only about 40% of their ingested food is actually digested; the remaining 60% is excreted in the stool without absorbing the caloric content. In human terms, this would be equivalent to eating a very, VERY high fiber diet - too high for human physiology - but the principle still applies.

The take home message here is that eating larger amounts of Free Veg (vegetables that have minimal calories - green leafy vegetables especially) and aiming for 25-30 grams of daily dietary fiber can decrease the overall energy density of your diet, allowing you to enjoy a more generous amount of food while maintaining a calorie-controlled diet!

Dr. Sue Pedersen © 2010

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Multivitamin Results in Weight Loss in Chinese Women

>> Sunday, August 29, 2010

As my readers and patients know, I often emphasize the importance of vitamin and mineral supplementation (see previous blogs about multivitamins, and vitamin D). A recent randomized clinical trial has now shown that supplementation with a multivitamin was effective in inducing weight loss in a group of Chinese women.

This clinical trial, published in the International Journal of Obesity, enrolled 96 overweight or obese Chinese women, and randomized them to receive either a multivitamin & mineral supplement, a calcium supplement, or placebo. After 6 months, they found that women taking the multivitamin lost 8lb, compared with 2.5lb on calcium, and 0.5lb on placebo. Note that the weight loss seen with the multivitamin is similar to that seen with the weight loss medication orlistat (Xenical). The multivitamin group was found to have a higher metabolic rate compared with placebo, and both the vitamin and the calcium groups enjoyed some improvement in their cholesterol levels.

As noted in the accompanying editorial by my colleagues Drs Astrup and BΓΌgel at the Department of Human Nutrition, University of Copenhagen, Denmark, the rather impressive degree of weight loss seen in this study with a multivitamin is intriguing, and the study needs to be repeated, in greater number and in other ethnic groups, before we can draw any broad conclusions. However, there are some physiological mechanisms that can support the weight loss seen. Several vitamins and minerals are known to have a key role in the function of the mitochondria, which function as the 'power plants' of our cells. Therefore, repleting important nutrients with a multivitamin may improve mitochondrial function and result in increased caloric burn by each of our cells.

The bottom line is that it is difficult to obtain all necessary vitamins and minerals in our nutritionally deplete food supply, and therefore, a multivitamin is recommended for most people. The potential for weight loss is one more item to add to the list of potential benefits. Speak to your doctor to find out which multivitamin is best for you!

Dr. Sue Pedersen © 2010

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Obstructive Sleep Apnea: Are You or Your Bed Partner at Risk?

>> Sunday, August 22, 2010

Does this image seem familiar to anyone? A snoring bed partner is a common problem! However, the problem may go far beyond nighttime frustration: it may be an indicator of an important medical problem called Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a disorder that is characterized by periods of diminished breathing or pauses in breathing during sleep, caused by repetitive collapse of the upper airway.

Symptoms of sleep apnea include:

  • restlessness and snoring during sleep
  • awakening with a choking or gasping sensation
  • waking feeling unrested
  • daytime sleepiness or fatigue
  • morning headaches, dry mouth, or sore throat
  • poor concentration
  • waking frequently to urinate

The number one risk factor for sleep apnea is overweight or obesity: the risk of OSA increases with increasing body weight. Other risk factors include increasing age, male gender, abnormalities of the upper airway, medications that induce somnolence, and alcohol.

Obstructive sleep apnea can be a serious medical problem, as it is associated with an increased risk of high blood pressure, diabetes, heart attack or heart arryhtmias, congestive heart failure, and increased risk of accidental injury and motor vehichle accidents. In patients with untreated severe sleep apnea, the risk of death is 3 to 6 times higher than people without sleep apnea.

Sleep apnea is best diagnosed in a sleep lab, where breathing patterns during sleep are assessed. In-home portable monitoring devices can also be used to make the diagnosis.

In terms of treatment of obstructive sleep apnea, weight loss is an essential component. Weight loss has been shown to decrease the severity of OSA, decrease daytime sleepiness, as well as improve quality of life. Sleeping in positions other than on your back is helpful, but may be difficult to maintain all night. Avoidance of alcohol and sedating medications is of benefit as well.

The most effective mechanical treatment of OSA is a machine that provides positive airway pressure, applied during sleep. By blowing air gently into the airway, the pressure generated helps to keep the airway open and avoid obstruction during sleep. Oral or dental devices are also available that can help alleviate obstruction in some people. For a minority of patients, surgery on the upper airway to help alleviate obstruction can be helpful, but the success rate is generally less than 50%.

Be sure to speak to your doctor if you think that you or your bed partner are at risk!

Doctor Sue © 2010

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Contrave: The Next Weight Loss Drug?

>> Sunday, August 15, 2010

As blogged previously, there are a number of weight loss drugs currently under study. The latest study on a combination weight loss medication called Contrave shows good effect to induce weight loss, but with the potential for significant side effects that must be taken into careful consideration.

Contrave is a combination of two medications already on the market: bupropion, a smoking cessation agent and antidepressant, and naltrexone, which is used to treat alcohol or narcotic addictions. The study, published in a recent edition of The Lancet by Greenway and colleagues, compares the effect of this combination medication in two different doses compared to placebo. In this 56 week trial, participants taking the combination drug in higher dose lost 6.1% of their body weight, compared to 1.3% in the placebo group. This amount of weight loss rivals, or is superior to, weight loss seen with our currently available weight loss drugs, sibutramine and orlistat respectively.

As noted in an accompanying editorial in The Lancet by my colleague Dr. Arne Astrup, from the Department of Human Nutrition, University of Copenhagen, an upside of this proposed new weight loss combination drug is that both medications have been around since the mid 1980s, and as such, we are quite knowledgeable of the potential side effects of each individual drug. For example, it is known that both drugs can cause anxiety and a small increase in blood pressure. What is not known, however, is whether these particular side effects could be additive in nature. Though the current study did not find any increase in anxiety, they did find less blood pressure reduction at 1 year than would have been expected with the weight loss that was seen. Thus, it is exceptionally important that cardiovascular risk factors and outcomes are closely monitored as we gain more experience with this combination medication.

Overall, Contrave may represent an effective and generally well tolerated addition to our current sparse armamentarium of weight loss medications, if it is ultimately approved by regulatory agencies. However, as always, we must remain vigilant for the potential of unwanted side effects, and continually monitor and evaluate outcomes.

Dr Sue Pedersen © 2010

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Video Blog: Increase the Activity in Your Life!

>> Thursday, August 12, 2010

Did you know that 63% of Canadians don't get enough activity in their daily lives to reap the health benefits of exercise?

In this video blog, Dr Sue explores ways that you can increase the activity and calorie burn in your daily life, to achieve the 60 minutes of daily activity that is recommended. Learn about a lifestyle change that could burn the equivalent of 18 pounds of fat in a year!

Dr. Sue Pedersen © 2010

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Bean Salad with a Hint of Lime!

>> Saturday, August 7, 2010

Thanks go out to my best friend Deb for staking out this recipe! Give it a try and let us know what you think. From 'Full of Beans' cookbook by Violet Currie and Kay Spicier - thanks for the inspiration! A great way to enjoy the 'hint of lime' flavor fad.

  • 1 cup rinsed canned black beans
  • 1 cup rinsed canned kidney beans
  • 1 cup corn ( canned, thawed frozen or ideally cut right off the cob if it is in season(this is best!))

  • 1/4 cup lime juice
  • 1/4 cup fat free plain yogurt
  • 2 tsp sugar
  • 1 small clove minced garlic
  • 1/2 tsp salt
  • 1/4tsp cumin
  • 1/4 tsp pepper

Toss over the bean mixture and refrigerate for a couple hours. Just before serving, add:
  • 1 tomato, seeded and diced
  • 1 small cucumber, diced
  • 1 red, yellow or orange bell pepper, diced

Toss well and serve!

Makes 8 servings. Per serving:
  • 106 cal
  • 0g fat
  • 5g protein
  • 22g carb
  • 243 mg sodium

Keeps really well in the fridge and makes great leftovers. It's also really easy to tweak to your own liking...different types of beans, different proportions of beans to corn, extra bell peppers.. however you like it. Add a little extra lime juice to up the ante on the flavor scale!

This salad is so tasty that you may have to share...consider protecting yourself!

Dr Sue Pedersen © 2010


Menopausal Hot Flashes Improve with Weight Loss Program

>> Sunday, August 1, 2010

Hot flashes are a common concern of postmenopausal women, and adequate symptom control can be difficult to achieve. A new study shows that a weight loss program can help to decrease these troublesome symptoms.

Hot flashes are a symptom which occur due to low estrogen levels that are seen in menopause. They may last for a brief duration for some women, but for at least one third of women, symptoms persist for 5 years or more. Since we learned of the harms of hormone replacement therapy and no longer recommend it (due to the increased risk of breast cancer, heart disease, and blood clots), hot flashes have become more challenging to treat.

Interestingly, a number of studies have suggested that hot flashes worsen in both frequency and severity with increasing body mass index, though the reason for the association is not clear. With this background in mind, Huang and colleagues embarked on a study to determine whether a behavioral weight loss program would help to decrease symptoms of hot flashes amongst post menopausal women.

In this substudy of a larger randomized study looking at postmenopausal urinary incontinence, 154 women who reported menopausal hot flashes received either an intensive lifestyle and behavior change program designed to assist with weight loss, versus a structured education program. The intensive program included weekly meetings led by experts in nutrition, exercise, and behavior change, as well as instruction in following a reduced calorie meal plan. The control group received monthly sessions teaching about nutrition, exercise, and general health promotion.

The results of this study show that women in the intensive program lost more weight after 6 months (average 16.5 lb) than the control group (average 4.4 lb). As for hot flashes, the intensive group reported significantly greater improvement in flushing symptoms than the control group. Improvements in weight, body mass index, and waist circumference were associated with improvements in hot flash symptoms. Interestingly, however, self reported physical activity and caloric intake were not associated with an improvement in symptoms.

It remains unclear why overweight may increase the severity of hot flashes, or why weight loss may improve these symptoms; inflammatory chemicals secreted by fat tissue, neural changes, and psychosocial factors may all play a part.

I see two important messages from this study:

1. On balance, it seems that yet another health benefit to weight loss may be an improvement in menopausal hot flashes.

2. A more intensive lifestyle program, with more support and follow-up, provides better weight loss results than a less intensive program.

Dr Sue Pedersen © 2010


Beyond Sun & Bones: The Importance of Vitamin D Supplementation!

>> Sunday, July 25, 2010

Vitamin D has proven to be extremely important to human health, and most Canadians are deficient in vitamin D if they are not taking supplementation. In recent years, as we learn more about vitamin D and what defines an optimum blood level, some confusion has been generated as to how much vitamin D a person should take.

Fortunately, in a recent edition of the Canadian Medical Association Journal, a very timely update for vitamin D supplementation in Canada provides guidelines as to how much vitamin D supplementation is appropriate.

First of all, let's talk about the health benefits of vitamin D. It has been known for decades that vitamin D deficiency has negative consequences on the bones. Severe vitamin D deficiency can cause a form of weak bones called rickets in children, or osteomalacia in adults. Low vitamin D also increases the risk of osteoporosis and fracture. Adequate vitamin D supplementation is an important part of osteoporosis prevention and treatment, as well as maintenance of overall bone health.

In addition, vitamin D deficiency has more recently been discovered to have many other health consequences:

  • Low vitamin D levels are associated with an increased risk of death, particularly deaths from cardiovascular disease. Low vitamin D levels are also associated with an increased risk of death from colon cancer.
  • The lower a person's vitamin D, the higher the risk of heart disease, heart failure, and peripheral vascular disease.
  • Low vitamin D is associated with an increased risk of autoimmune diseases, including Multiple Sclerosis and Type 1 diabetes.
  • Sufficient vitamin D is important for the function of white blood cells, which fight infection. Studies have shown that the risk of upper respiratory tract infection is higher in people with lower vitamin D levels.
  • Low vitamin D levels are associated with overweight and obesity. Excess fat tissue stores away vitamin D, such that less is available for use in the rest of the body. It is not clear whether vitamin D deficiency itself increases the risk of obesity (though this has been shown to be the case in animal studies).

In Canada, there is a small amount of vitamin D supplementation in food products such as milk (which generally contains 100 international units (IU) per cup). This is not nearly enough to reach the levels that we need to optimize our defenses against the medical conditions listed above. While our bodies do synthesize some vitamin D from the sun, production of vitamin D in the skin falls to near zero for four to five months of the year in Canada, due to our latitude, decrease in sunlight hours, and lack of exposed skin in the cold! Sun is a known carcinogen (cancer causing agent), so it makes sense to protect ourselves from excessive sun exposure, and take a vitamin D supplement instead.

The recent Canadian guidelines, published by Dr Hanley and colleagues on behalf of Osteoporosis Canada, has made the following recommendations for vitamin D supplementation:

1. In healthy adults under age 50, without osteoporosis or conditions affecting vitamin D absorption or action: 400–1000 International Units (IU) daily is recommended.

2. Adults over 50 years: supplementation with at least 800-1,000 IU per day is recommended.

3. Doses up to 2,000 IU per day are safe for most people. (Higher doses should not be taken without the supervision of your doctor, as vitamin D can be toxic in excess.)

If you have other medical problems, or do not fit into the above categories, the correct amount of vitamin D supplementation may vary. Speak to your doctor about how much vitamin D supplementation is right for you!

Dr. Sue Pedersen © 2010

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Video Blog: Does Exercise Help Us Lose Weight?

>> Wednesday, July 21, 2010

In this video blog, Dr Sue discusses the impact of exercise on body weight and overall health. Find out how many calories you burn when you exercise, and how this relates with energy intake. Exercise alone is very important for overall cardiovascular health, and decreases the risk of a long list of diseases. While exercise can help to maintain body weight, it is rarely effective as a sole weight loss strategy, unless it is accompanied by a reduced calorie meal plan.

Dr. Sue Pedersen © 2010


Lorcaserin: A Weight Loss Medication with less Side Effects?

>> Saturday, July 17, 2010

As published in this week's edition of the New England Journal of Medicine, and as previously blogged, study of a new weight loss medication called Lorcaserin is well underway. So far, it appears that the potential benefit of making this medication available to the general public would be that it appears to have a better side effect profile than currently available weight loss medications.

In the recent study, Smith et al conducted a study with over 3,000 participants, examining the efficacy of lorcaserin to induce and maintain weight loss over a two year period. They found that participants on lorcaserin lost about 4kg more than those taking placebo over the first year; however, about half of this weight was gained back by the two year mark. On balance, then, lorcaserin seems to induce about a 2kg weight loss (4.4 lbs) after two years, which is a similar weight loss seen with another currently available weight loss medication called orlistat (Xenical), and slightly less than our other weight loss medication, sibutramine (Meridia).

However, as noted in an accompanying editorial in the New England Journal of Medicine by my colleague Dr. Arne Astrup at the Department of Human Nutrition, University of Copenhagen, the side effect profile of lorcaserin appears to be more favorable than that of either of the two currently approved medications. Orlistat is often not well tolerated due to gastrointestinal upset and diarrhea. Sibutramine has recently come under scrutiny, and in fact was removed from the European market (it is still available in Canada and the US) due to preliminary results from a trial that found an increased risk of heart attack and stroke in patients with diabetes and cardiovascular disease. (Sibutramine is currently under full review by the American FDA.)

Additional study of the efficacy and safety of lorcaserin is still underway, and it is still some time before it would be considered for release on to the market. Perhaps it would be of benefit to have a medication available for weight loss that has a better side effect profile, but this has to be taken on balance with the less than stellar weight loss that is seen over the long term. The future is bright, though: other medications with other mechanisms are currently under study which, so far, appear to have greater potential for weight loss, with a reasonable side effect profile.

Dr. Sue Pedersen © 2010


Mindless Eating

>> Thursday, July 15, 2010

Dr Sue discusses the enigma of Mindless Eating - eating without giving specific thought or attention to the process of food consumption - and the consequences this can have on eating to excess.

Take Home Messages:
1. Savor your food, and
2. Be mindful of portion sizes!

Doctor Sue © 2010


What's in YOUR Multivitamin?

>> Saturday, July 10, 2010

It's a consumer marketplace out there, and multivitamins are no exception. One has only to walk down the supplement aisle of the local pharmacy or grocery store to become instantly innundated with shelves upon shelves of various options. If you take multivitamins yourself, reflect for a moment - how did you choose yours? It turns out that that all multivitamins are not created equal.

If you turn over your multivitamin bottle to examine the label, you're likely to see a long list of vitamins, and/or minerals listed. Vitamins include the standard vitamins that we think of: vitamin A, several variants of B, C, D, E, folate, and others. Minerals are chemical elements that we need for cellular function, and include iron, copper, zinc, and selenium.

Some vitamins that are available are marketed towards certain age groups. For example, a children's multivitamin would have a very different composition from an adult multivit. Some formulations are targeted towards adults over age 50, most often because they contain a little more vitamin D for bone protection. There are also particular multivitamins for pregnant women, due to an increased requirement for nutrients such as folate and iron. Within the 'regular adult' multivitamins, you will find a wide range of selections, with varying compositions in each one. Some multivitamins contain iron as the only mineral, while some contain a whole host of minerals, including the ones listed above.

So the big question is: How do you know which multivitamin is right for you? The bottom line is that it is important to speak to your doctor to find out what type is best for you. For people who have kidney problems, some multivitamins would not be appropriate. Patients who have had bariatric surgery have very special vitamin requirements, depending on the type of procedure being done. The vitamin D provided in a multivitamin is rarely enough - discuss with your physician how much is right for you. Additional calcium supplementation may be appropriate as well - again, be sure to talk to your doctor!

Dr. Sue © 2010


What's In YOUR Multivitamin?

>> Thursday, July 8, 2010

A text version of this video blog will appear on within the next few days. Enjoy!

Dr. Sue © 2010


The Psychology of Weight Loss Surgery

>> Friday, July 2, 2010

For an individual who is being considered for bariatric (weight loss) surgery for management of their obesity, it is becoming increasingly clear just how pivotal psychological issues are in the management before, during, and after the procedure. While there are many psychological benefits to bariatric surgery, there are also significant psychological risk that must be taken into careful consideration.

At the American Diabetes Association meeting in Orlando, FL, last week, I attended a lecture by Dr Lucy Faulkonbridge, Assistant Professor of Psychology at the University of Pennsylvania, who reviewed this topic for her audience.

There are many great things to be said about the psychological benefits of bariatric surgery. Bariatric surgery has been found to reduce depression and anxiety amongst individuals undergoing these procedures. The majority report improvement in body image, psychosocial functioning, and quality of life. Sexual function is also usually improved, as a consequence of many factors, including increased interest and improved mobility.

Having said the above, there are also potential negative consequences, some of which are absolutely devastating. While depression usually improves with weight loss, symptoms of depression can return, particularly in those who had significant depression prior to surgery. Importantly, while one study found that the risk of death was reduced by 40% at 7 years after gastric bypass surgery, they also found an increased risk of death from suicide and accidental deaths in this population.

Although bariatric surgery is typically very successful in achieving weight loss, the results can vary greatly from person to person. According to the landmark Swedish Obese Subjects' Study , as many as 10% of gastric bypass and 25% of gastric banding patients are unable to maintain even a five percent weight reduction with surgery. (We do appreciate a 5% body weight reduction, as 5% weight loss in an obese individual decreases the risk of developing serious obesity-related complications such as heart disease, diabetes, and cancer.) Interestingly, the success of weight loss surgery seems to depend in part on psychological issues. While a background of psychological issues in a general sense is not predictive of degree of weight loss, active symptoms of depression or a tendency towards binge eating prior to surgery tends to result in smaller weight losses after surgery.

Although the literature in this area is somewhat conflicting, Dr Faulkonbridge postulated that while distress related to psychological illness may be an impediment to the success of bariatric surgery, distress related to extreme obesity may be a predictor of greater success, as this distress should improve with weight loss. The key is to determine what the source (or sources) of distress is/are prior to surgery, such that these issues can be addressed and dealt with prior to surgery, in order to optimize the medical and psychological outcomes of the procedure.

The psychology behind post operative exercise routines may play a part, too. In patients who have had gastric banding, those who did not increase their activity level after surgery are much more likely to have weight regain than those who do become more active post operatively. There is also some data to suggest that some patients may actually engage in less physical activity after the surgery, despite having shed pounds and most often enjoying increased mobility. Having an exercise program established prior to surgery is an important component to maintaining long term success with these permanent lifestyle changes as well.

Follow up patterns with the surgeon was also identified as being associated with weight loss success. While only 40% of patients return for their annual visits with their surgeon after their operation, it is these patients who seem to have the best weight loss success. The relationship between weight loss success and compliance with follow up is likely multifactorial.

It is clear that psychological issues must be taken into very serious consideration prior to, during, and after bariatric surgery. Key points to highlight include:

1. Thorough psychological evaluation and counseling before bariatric surgery is paramount. This should ideally take place in the form of screening questionnaires, as well as counseling and support from mental health care professionals. It is important that active mental health issues are dealt with as well as possible prior to surgery, to provide the greatest chance of success. It is noted that some people may not be appropriate candidates for bariatric surgery if their psychological issues are not stable or well managed.

Ideally, this process should take place as part of a team approach to preparation for bariatric surgery, including help from dieticians, nurses, physicians, and occupational therapists. Psychological support is also crucially important towards preparation for the permanent lifestyle change that defines bariatric surgery (very small portion sizes, alteration in food preferences, and a permanent change in one's relationship with food).

2. Psychological support and access to mental health professionals through and following the bariatric procedure, both short term and long term. The needs of the individual patient will vary greatly - it is the availability, and experience of health care professionals in dealing with the issues that may arise, which are key.

3. Support from friends and family throughout the process. A solid support network provides outlets to deal with emotional issues that may arise. It is important that a patient's loved ones are accepting and understanding of the motivations behind bariatric surgery, and are equally prepared to both endure the trials, and celebrate the tribulations, that may lay along the path towards successful weight loss.

Dr. Sue © 2010



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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