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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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