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Does the 'time of the month' affect your dieting success?

>> Saturday, February 26, 2011

Ladies, picture it: It's 10 pm, and you are just about to go to bed. You've had a reasonable day, but your mood has been a bit under the weather, for which a concrete reason does not seem quite at hand. You've been craving chocolate all day despite eating a healthy and filling breakfast and lunch, and you've given in to the craving once already in the afternoon.... but the other half of that unforgettable chocolate bar is still in your cupboard and calling your name..... You run to the kitchen, you eat... you smile.

The cycle repeats for a few days, following which comes the explanation for the seemingly unexplainable: Aunt Flo makes her monthly appearance (on a Saturday morning when you were on your way to the pool, the lake, or the beach - naturally!).

I'm sure there are many ladies out there who can relate to this story.

Here are some interesting facts about the relationship between menstrual cycle and dieting:

1. Clinical trials have frequently shown that females are less successful than males at losing weight and keeping it off.

2. In the second half of the month (the luteal phase of the menstrual cycle), women's energy intake AND energy expenditure are both increased.

3. In the luteal phase, women also experience more frequent cravings for food, particularly those that are high in carbohydrate and fat, compared to the first half of the menstrual cycle (called the follicular phase).

4.  The rate of emptying of food from the stomach may be slower in the first (follicular) phase of the menstrual cycle than the second (luteal) phase, based on findings from a recent study.  This slower stomach emptying may be part of the reason for less hunger and food intake during the first phase of the cycle. 

5.  Some studies have suggested a tendency towards greater use of fat as a fuel source (with less use of carbohydrates) in the second half of the month. Women are also able to exercise at a high intensity for a longer period of time during this phase.

6.  Chocolate is the food item most craved by premenstrual women!

These facts make a lot of sense, when you consider the purpose of the menstrual cycle. In the follicular (first) phase, which starts on the first day of menstrual bleeding, your body has essentially realized that it is not going to conceive that month, so the lining of the uterus is shed. About two weeks later, another egg is released, which marks the beginning of the luteal (second) phase. So, your body turns it up a notch (under the influence of changes in your reproductive hormones), to be in the best stead to begin growing a new life: you intake more energy (food), your body kicks your metabolism up a notch (increased energy expenditure), and your ability to exert yourself at a high niveau is augmented as well.

The hormonal stimulus to intake extra energy is probably what fuels the food cravings during this time. Why chocolate? Well, it is the prototype of a food high in carb and fat... not to mention that it may simply be the most delectable food product on Earth!... in some people's opinion, anyway :)

Empowered by this knowledge, what can you do to put your monthly rhythm to your best advantage?

1. Try aiming for heavier workouts in the latter half of the month.

2. Understand the reasons for the seemingly 'unreasonable' cravings - and perhaps give into them, a little (in a portion controlled fashion!). You may find more success in adhering to your diet plan if you allow yourself a little freedom to enjoy the finer things.

3. With the increased intensity of workouts in the second half of the month, you may allow yourself a few more Calories In per day (perhaps 100-200), but not more than that. Again, working with your body's rhythm may increase your ability to adhere to your weight loss plan, and give you greater success in the long run!

Dr. Sue © 2011

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Unraveling the Mystery Behind Weight Gain in Menopause

>> Saturday, February 19, 2011

It is a well known fact that menopause is often accompanied by unwanted weight gain.  In my clinical practice as an endocrinologist, I meet many women struggling with this exact issue.  While we are far from understanding all of the exact mechanisms involved in this weight gain, there is much that we do know about it, and a recent study brings us one step closer to understanding the intricate steps involved.

At the time of menopause, the reproductive function of the ovaries cease, and with that, levels of estrogen, progesterone, and testosterone naturally decline to low levels.  As these hormones (particularly testosterone) are involved in maintaining lean body mass, one change that we seen in menopause is an increased tendency towards increasing fat mass and decreasing muscle mass, even if the total body weight remains stable.  We also see an increased predisposition towards accumulation of 'visceral' fat, which is fat surrounding the abdominal organs.  Visceral fat is metabolically active fat, and therefore associated with a higher risk of developing conditions such as diabetes, high blood pressure, high cholesterol, and heart disease.

Further to that, it is also thought that the natural estrogen deficiency that occurs with menopause may cause weight gain by promoting increased food intake.  Studies in rodents and humans suggest that estrogen supplementation may decrease food intake, as well as increase metabolic rate (the latter may be due to the effect on muscle mass described above, as muscle burns more calories per kg than fat).

An interesting study published by SS Dhillon and colleagues in the International Journal of Obesity brings us one step closer to understanding how estrogen may inhibit food intake.  In a study of rodent neuronal cell cultures from the hypothalamus (one of the key areas of the brain involved in regulation of food intake), it was demonstrated that estrogen decreased the secretion of a hormone called neuropeptide Y, which is the most potent known hormonal stimulator of food intake.  Therefore, the natural loss of estrogen production at and after menopause may result in loss of suppression of neuropeptide Y, thereby leading to increased hunger, increased food intake, and weight gain.  This hypothesis, based on the above study, now needs to be explored further to see if it holds true in humans. 

So, what might this mean for the woman who is combating weight gain during and after the menopausal transition?  Well,  it is my firm belief that understanding these natural changes are the first step towards being better equipped to deal with them.  We do not recommend hormone replacement therapy as the answer, as this has been shown to be associated with an increased risk of potentially fatal diseases, such as heart disease, breast cancer, and blood clots in the legs or lung.  However, maintaining an appropriate level of physical activity is crucially important to maintaining the more metabolically active muscle mass (see my previous blog to find out how much activity is recommended by the new 2011 Canadian Guidelines for Physical Activity).  The increased tendency towards hunger can be countered by actions such as increased attention towards eating small, frequent meals; drinking water before meals; and eating lots of FreeVeg to decrease your overall calorie intake!

Dr Sue Pedersen © 2011

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Tips for Eating Savvy at Restaurants

>> Saturday, February 12, 2011

Although it is usually best to prepare as much of one's own food as possible, this is simply not practical in many situations. A vacation or a busy work week can result in the frequent need to eat out. Here are a few tips to help maintain a calorie controlled diet while you are on the go! (with pictures from my personal photo journal)

1. Choose a restaurant that serves healthy choices. It doesn't have to be expensive - Subway will do just fine. Ask for nutritional information at the counter, as they will often have this available for your reading pleasure, but only if you ask for it. A restaurant like the one pictured above should generally be avoided!

2.  Actively consider ways to reduce the calorie count on the meal you've ordered. Dressings, for example, are often a substantial source of calories. Just one tablespoon of oil contains a whopping 135 calories, and many dressings have oil as their first ingredient! Order your dressing on the side and dip the tip of your fork in it - that is often all you need for the taste sensation!

3.  When coffee time rolls around after the meal, think twice about what you are adding to that otherwise calorie free drink. Many restaurant chains will only have sugar packets presented on your table, as sweetener often cannot be repackaged to match the branding of the restaurant chain and therefore doesn't look as nice on the table as the branded sugar, salt, and pepper packages. Don't hesitate to ask if there is sweetener available - they will most often be able to produce some for you.

Dr. Sue Pedersen © 2011

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2011 Canadian Physical Activity Guidelines - Are You Getting Enough?

>> Saturday, February 5, 2011

In today's society, most of us do not exert ourselves physically unless we make a conscious effort to set aside special time dedicated towards physical activity.  As such, it is important that we are all making sure that we do get enough exercise, and Canada now has brand new guidelines.  Are you getting enough?

On January 24th, the Canadian Society for Exercise Physiology published the 2011 Canadian Physical Activity Guidelines, which are easily downloadable for free online.  There are four sets of guidelines for different age groups, each on an easy-to-read one page summary sheet.  Here is a summary of what is currently recommended:

Children aged 5-17 years:
  • at least 60 minutes of moderate to vigorous intensity physical activity per day:
  • this should include vigorous activity at least 3 days per week;
  • this should include activity that strengthens muscle and bone at least 3 days per week
  • at least 150 minutes of moderate to vigorous intensity aerobic physical activity per week, in bouts of 10 minutes or more
  • add muscle strengthening activities using major muscle groups, at least twice a week
  • for adults aged 65 and older, those with poor mobility should perform physical activities to enhance balance and prevent falls

It is noted for all age groups that more daily physical activity (above what is recommended) provides greater health benefits.  Specific helpful suggestions are also provided for the different age groups for possible activities to engage in. 

Take a moment and review these guidelines with your family - are you and your loved ones getting enough exercise?  If not, think about how you can work some extra activity into your daily life.  Remember that before you engage in any new exercise program, it is important to speak with your doctor to review the safety of any planned changes in physical activity in the context of your personal health; in some cases, a heart checkup (possibly with additional testing) is important before engaging in any new exercise.  No different that getting your bike checked after some time in storage, before you take it for a ride!

Have fun!!

Dr Sue Pedersen © 2011

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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