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Holiday Pumpkin Pancakes

>> Saturday, December 24, 2011





Here's a neat twist on pancakes to try over the holidays.  As regular readers will know, I'm a big fan of pumpkin recipes - they are an excellent low calorie way to add moistness and flavour to many baked products and desserts.



Ingredients

  • 1 1/4 cups whole grain flour
  • 3 tbsp brown sugar Splenda
  • 2 tsp baking powder
  • 1 1/4 tsp pumpkin pie spice
  • 1 tsp cinnamon
  • 3/4 tsp salt
  • 1 cup skim milk
  • 3/4 cup canned pure pumpkin
  • 3 large eggs
  • 2 tbsp melted butter or margarine
  • 1 tsp vanilla extract

Simply make these pancakes as you would any other pancake.  Whisk the dry ingredients in a large bowl.  Whisk the wet ingredients in a separate bowl.  Add the wet to the dry, and whisk just until smooth (batter will be thick). 

Heat a non stick pan over medium-high heat.  Pour 1/4 cup of batter onto the pan.  Cook until bubbles form on the top of the pancake and bottoms are a bit brown, about 1 minute.  Flip and cook for about another 30 seconds or until they are cooked. 

Delicious with some cinnamon and Splenda sprinkled on top!

Makes about 15 pancakes.  

Per pancake:  About 80 calories, 3g fat (if made with butter), 9g carbohydrate, 3g protein. 


Thanks again goes to Deb's Kitchen for this creation. 

Happy Holidays!  

Dr Sue Pedersen www.drsue.ca © 2011 


drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen  


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The Global Impact of Diabetes

>> Saturday, December 17, 2011






Though the prevalence of diabetes is alarming in every country, the Middle East has come on the radar more recently, and is in fact home to six of the top 10 countries for diabetes rates worldwide.  It is thus very fitting that this year's World Diabetes Congress, hosted by the International Diabetes Federation, was held last week in Dubai, United Arab Emirates.  I had the pleasure of hearing diverse speakers from around the globe at the conference, and what I would like to share with you this week are some hard numbers and facts about the impact of diabetes around the planet (with reference to the excellent speakers, as well as the International Diabetes Federation's Diabetes Atlas, 5th edition).

Did you know that:

1.  There are currently 366 million people in the world with diabetes (including about 8.3% of the world's adult population).   By 2030, this number will be 552 million.

2. There is little gender difference in diabetes rates, with 185 million men and 181 million women affected worldwide.

3. All nations are suffering the impact of the diabetes endemic; there is no country in the world where diabetes rates are not increasing.

4. Fifty percent of people who have diabetes - don't know it.  In Africa, 78% of people with diabetes are undiagnosed.

5. There are more people with diabetes living in urban areas compared to rural areas.  (The reasons why are probably several: urbanites tend to have more access to fast/Western unhealthy food choices, and tend to be less active, to name two.)

6. The greatest number of people with diabetes are in the 40-59 age group.

7. In addition to the people who already have diabetes, an additional 6.4% of the world's adults are estimated to have impaired glucose tolerance (a form of prediabetes).  That's a total of nearly 15% of the world's adults who currently have prediabetes or diabetes.

8. Rates of gestational diabetes (diabetes in pregnancy) are on the rise worldwide as well; further, women who have had gestational diabetes are at very high risk of developing type 2 diabetes.

9.  80% of people with diabetes live in low and middle income countries, who often have little or no access to medications needed for control of blood sugars.

10. The country with the highest diabetes prevalence is the Pacific island nation Kiribati, at a staggering 25.7%.

Food for thought.  (pun intended)



Dr Sue Pedersen www.drsue.ca © 2011 

drsuetalks@gmail.comFollow me on Twitter for daily tips! @drsuepedersen  



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The Vote is In, but the Jury is Out - Is Bariatric Surgery Appropriate For Treatment of Type 2 Diabetes?

>> Thursday, December 8, 2011




At this week's World Diabetes Congress in Dubai, hosted by the International Diabetes Federation, I had the opportunity to listen to a fantastic debate as to whether bariatric (weight loss) surgery is an appropriate treatment option for Type 2 Diabetes.

The argument in favor of bariatric surgery was presented by Dr Francesco Rubino, a bariatric surgeon and leading authority on the issue from Cornell University, in New York.   He highlighted key points of evidence regarding the benefits of bariatric surgery in terms of improving diabetes, noting that bariatric surgery provides a powerful potential opportunity to reverse the course of an otherwise progressive disease.  While the current criteria for bariatric surgery in diabetics include a Body Mass Index (BMI) ≥35, he presented for us the International Diabetes Federation position statement on the role of bariatric surgery, which suggests that surgery should also be considered in people with BMI 30 to 35 when diabetes cannot be adequately controlled by medical therapy, especially in the presence of other cardiovascular risk factors.  (BMI can be calculated here)

Dr Rubino noted that bariatric surgery stands apart from some other medical treatments of diabetes, in that many medications cause weight gain, whereas bariatric surgery can result in substantial weight loss.  He noted that patients who are most likely to have the greatest improvement (or complete remission) of diabetes include those with a shorter duration of diabetes, and lower preoperative medication requirements; in other words, earlier intervention appears to produce the best results.  He noted that not only does bariatric surgery improve diabetes, but can also be very effective to prevent new cases of diabetes.  Other benefits include some improvement in cholesterol profile and blood pressure, which are also risk factors for cardiovascular disease.  Gastric bypass is superior to gastric banding in achieving these effects.  (Sleeve gastrectomy was not discussed in particular - I enter my own editorial comment here, that sleeves are proving to be quite effective to treat type 2 diabetes as well, somewhere between gastric bypass and banding in terms of efficacy, but so far appearing to be closer in efficacy to gastric bypass).

In discussion of the very limited accessibility to bariatric surgery, Dr Rubino provocatively noted:

"If there were a pill or a shot that can control blood sugars, improve body weight, cholesterol and blood pressure, and improve survival, would it be acceptable that >99% of people do not have access to the treatment? "

He concluded with the comment that we should not be using BMI as the most important criteria or cutoff in choosing the right patient for bariatric surgery; rather, we should be considering the metabolic disease (in particular, diabetes) that each patient carries, and stratify our decision re surgical candidates based on cardiovascular risk profile, as the BMI does not tell the whole story.  

The negatives for bariatric surgery in the treatment of type 2 diabetes was presented by Dr John Pinkney, professor of diabetic medicine from Plymouth, UK.

Dr Pinkney opened with a discussion of the treatment goals for type 2 diabetes, including increasing life expectancy, reducing cardiovascular disease, reducing small vessel complications of diabetes (eye, kidney, and peripheral nerve complications), and improving quality of life, using treatment modalities where the benefits exceed the risks.   Many of these health goals are achieved by optimizing control of vascular risk factors (diabetes control, blood pressure, and cholesterol).

In terms of treatment targets for diabetes, Dr Pinkney notes that several recent diabetes trials have suggested that tight glucose control may not actually prevent cardiovascular events, compared to slightly less tight glycemic control.  He wondered, then, whether getting diabetes into excellent control with bariatric surgery would really be of that much benefit (and worth the risk?) in patients who had reasonable control of their diabetes in the first place.

He noted that while the improvements in blood pressure and cholesterol with bariatric surgery are statistically significant, that the absolute improvements are not that big.  From the prevention of small vessel diabetes complications perspective, he noted that there is not yet much study in this area, and the question as to whether bariatric surgery prevents these diabetes complications in the long term remains unanswered.

While improvements or remission of diabetes is certainly impressive, the long term durability of diabetes remission was discussed, in that the most recent literature is now suggesting that a substantial proportion of diabetes that initially goes into remission, recurs years down the road.

The downsides of bariatric surgery require very serious consideration, and the risks vs benefits must be weighed carefully.  The risk of death due to the surgery itself was discussed, though Dr Rubino noted that this risk is approximately that of a gall bladder removal surgery (ie, fairly low as far as surgeries are concerned).  Although the need for diabetes medications may decrease with surgery, these treatments are 'traded in' for the need for a new array of lifelong nutritional supplements (the exact array of supplements needed depends on the type of surgery).  Not taking these supplements or not having them monitored carefully can result in life threatening complications.  The removal of the freedom to 'eat as I wish' and the potential impact on quality of life was also noted.

Dr Pinkney noted that type 2 diabetes is a complex disease that is very common, and suggested that it may not be feasible or productive in general to consider a treatment (surgery) that is very expensive, requires lifelong follow up, and is therefore not accessible for any but a small sliver of the people with diabetes worldwide.

Both presenters were grateful for the opportunity to present this important topic, noting that the topic of bariatric surgery has only been taken seriously as a potential therapy for diabetes in the last few years.

At the conclusion of the presentations, a show of hands of the audience was requested as to how many people were in favor vs against the use of bariatric surgery to treat type 2 diabetes (this was an auditorium containing several hundred diabetes health care professionals from around the world) - to my eye, the vote was roughly evenly split.

My feeling on this issue is reflected in an underlying theme to both of these presentations: the decision for bariatric surgery is a highly patient specific decision.  Each patient must be considered on a case by case basis, with the benefits and risks carefully weighed and discussed in exquisite detail.  For the right diabetic patient, bariatric surgery can provide an appropriate treatment option.


Dr Sue Pedersen www.drsue.ca © 2011 

drsuetalks@gmail.comFollow me on Twitter for daily tips! @drsuepedersen  

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Tips for Surviving the Holidays!

>> Saturday, December 3, 2011



If there is one time of year that is a test of our willpower and our waistlines, this is it - the holiday season!  Delights abound on every table and countertop, and in almost every home and office we walk in to.  Although this environment can be difficult to control, there are many things we can control to make healthier choices and a healthier home environment during the holidays.  Here are just a few suggestions: 



1.  Think simple. Don't have a whole bunch of different dishes, as calorie intake increases with the variety of a meal.  Also, keep the ingredients simple:  steamed broccoli has less calories than a cheesy broccoli casserole.   If you are doing holiday baking, bake perhaps 1 or 2 different things rather than a half dozen selections.  This will free up time for you to get outside and be more active as well. 

2.  Look for ways to cook healthier choice alternatives.  For example, try these fantastic chocolate espresso brownies instead of a heavy chocolate cake or Christmas cookies.   Use skim condensed milk in baking.  Substitute splenda instead of sugar. 

3.  Go for a walk after a meal.   This helps to work off some of the calories, prevents second helpings, and in the case of diabetics, helps to control blood sugar after the meal. 

4.  Watch out for sauces and gravies.  These are a major contributor to calorie intake at holiday meals.  If you want them, make low fat gravy, and consider dipping your fork in it rather than drowning your plate. 

5.  Don't allow weight gain over the holidays, with a plan to lose it later.  When we allow our weight to fluctuate up and down, we are doing our metabolism harm.  Our bodies remember the maximum weight we have ever weighed, and from then on, the body exerts mechanisms to try to get back up to that previous weight.  Metabolism is downregulated with weight loss, and hormonal triggers stimulate the drive to eat our way back up to our previous weight.   It is harder for a 200lb person who previously weighed 240lb to keep their weight stable, compared to an otherwise identical 200lb person who has never weighed more than that.  Therefore, not only is it difficult to shed excess pounds after they have come on, but it is also harder to maintain your weight if you have previously weighed in higher. 


Dr Sue Pedersen www.drsue.ca © 2011 

drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen  

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A HEARTFELT WELCOME!

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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