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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

Follow me on Twitter for daily tips! @drsuepedersen


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

Follow me on Twitter for daily tips! @drsuepedersen


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

Follow me on Twitter for daily tips! @drsuepedersen



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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