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What's In Store on DrSue.ca?

>> Thursday, December 27, 2012




A very happy holiday season to everyone!  Here is what you can look forward to in the drsue.ca lineup for upcoming 2013 posts:

Dangers of Energy Drinks:  Why are energy drinks dangerous?  Why is it bad to mix them with alcohol?  Is there a lethal dose of caffeine? (the answer is yes)

Does Obesity Surgery Change What Tastes Good?  Is a change in how we perceive and enjoy flavors one of the drivers of weight loss after bariatric surgery?

Born To Run!  Learn how humans were designed, and how this helps explain our society's battle against the bulge.

Sex Drive, Fertility, and Bariatric Surgery:  Could a more powerful female libido be one of the drivers that improves fertility after obesity surgery?



Dr Sue Pedersen www.drsue.ca © 2012 

Follow me on Twitter for daily tips! @drsuepedersen




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Yuletide Munchies Power Snack!

>> Tuesday, December 18, 2012






There's something about the holiday season that gets many of us (myself included) craving that cinnamon-y, nutmeg-y taste.  Maybe it's the cozy feeling that is associated with these flavors, reminiscent of childhoods of gingerbread cookies and cold winter nights snuggled up by a fireplace.  Unfortunately, most places we find these delicious flavors are hard on our waistlines: Christmas cookies, candies, caffe lattes and the like.  Here's an idea for a delicious snack, laden with spice and flavor that packs a whopping 21 grams of protein, for just 175 calories!

OK.  First, I need you to open your mind to this.  It sounds like an unusual combo, but trust me, it tastes amazing!  I got the idea to combine these flavors from a cooking website where the spices are combined with peanut butter to make a spread.  I thought I'd take it a step further and convert the flavors into a super healthy, protein powered recipe!


INGREDIENTS:

  • 1/3 of a 500g container of no salt added cottage cheese (pictured).  'No salt added' is key - as far as I know, in Canada, only Safeway carries it
  • 1 tsp light peanut butter
  • 2 packets of Splenda
  • cinnamon to taste
  • nutmeg or allspice to taste
  • a few drops of vanilla extract 



DIRECTIONS:
1.  Mix.
2.  Eat!


This tasty combination makes a great part of breakfast - remember, it's so important to have lots of protein in the morning, as this helps to keep you filling fuller through the day.

The other option is to use a small blender or Magic Bullet to whip these ingredients together, and then freeze until semi-solid - tastes like a Christmas Cheesecake!

NUTRITIONAL INFORMATION:

  • calories: 175
  • protein: 21 grams
  • fat: 5 grams
  • carbs: 9 grams

I bet this could be tasty with a little bit of pumpkin thrown in there too... if you try it, let me know how it goes!

Happy Holidays!!

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen


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Caffeine in Diabetes - Friend or Foe?

>> Tuesday, December 11, 2012





While the temperature of caffeinated beverages may vary, there is no doubt that this debate is hot!   The question is: does caffeine contribute to elevated blood sugars in diabetes, or could caffeine consumption help to prevent diabetes?

The caffeine - diabetes debate has proven to be quite a complicated issue.  Studies looking at general populations have shown that higher regular consumption of coffee or tea is associated with a lower risk of type 2 diabetes.  However, short term laboratory studies have shown that caffeine decreases our sensitivity to insulin, causing blood sugars to climb, thereby suggesting that caffeine may increase the risk or severity of type 2 diabetes.   Throw into the mix the fact that many caffeinated beverages are sweetened with sugar, and throw also into the mix that we still don't have a clear picture of the effect of sweeteners on metabolism.  Now there's a muddied...muddled... venti triple shot.... decaf (or caf?).... something.

A recent study is the latest of many that has tried to clarify the relationship between caffeine and diabetes.    The study, by Bhupathiraju and colleagues, is impressive in its size - they examined data from over 100,000 people over the span of 25 years.  They reported the following:


1.  BOTH caffeinated coffee, AND decaffeinated coffee, was associated with a lower risk of developing type 2 diabetes in men and women:

  • for men, there was a 4% decreased risk for caffeinated coffee, and a 7% decreased risk for decaf coffee drinkers
  • for women, there was an 8% decreased risk for both caffeinated coffee and also 8% decreased risk for decaf coffee

2.  For females who drink caffeinated tea, there was a 5% decreased risk of diabetes.  There was no effect for decaf tea, and no effect for any kind of tea for men.


3.  Sugar sweetened beverage consumption was associated with an increased risk of type 2 diabetes, but the risk depending on whether or not they were caffeinated was different between men and women.


  • For women, the risk of diabetes was 13% higher for caffeinated sugary beverages, but only 11% higher for decaffeinated sugary beverages. 


  • For men, it was opposite:  the risk of diabetes was 16% higher for caffeinated sugary beverages, and 23% higher for decaf sugary drinks. 


4.  Replacing caffeinated, carbonated beverages with coffee or tea was associated with a lower risk of diabetes.

5.  Replacing decaf carbonated beverages with decaf coffee was associated with a lower risk of diabetes.

6.  In women, artificially sweetened, non caffeinated beverages were associated with a 6% higher risk of diabetes.



Confused?!  Yeah, me too.  One thing that is clear from this study is that consumption of sugar containing drinks increases the risk of diabetes.  It may be that drinking coffee or tea instead of sugary beverages is what decreases the risk of diabetes.  The data from this study also brings into question whether sweeteners are best avoided - though the authors note that they had no way of knowing what type or amount of sweeteners were used.  Or could there be something else in carbonated/sweetened beverages that is problematic? We don't know.

So the Bottom Line is: Avoid sugary drinks.  As for the relationship between caffeine itself and blood sugars - we still don't know.

It just struck me - is it ironic that I am sitting in Starbucks writing this blog?
I'm sure you're eager to know...... in my hand is a grande.... decaf... Americano.  :)

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen




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Healthy Holiday Dessert (or Salad!): Baked Pears with Walnuts and Cranberries!

>> Tuesday, December 4, 2012





Happy December!  'Tis the season for fun and festivities, hosting and being hosted at gatherings with wonderful family and friends.  Enjoying meals together is a natural part of these events, and you may be wondering how you can choose a dessert you've been asked to bring to next weekend's potluck without hampering you or your friends' dedication to the permanent lifestyle changes that have been made over the last year.

I see two options here:

1) Practice portion control (ie make whatever you want, but portion it into small servings - this should be the back up plan any time you are served food that may not be the healthiest; or

2) Choose to make a healthier dessert.

I polled my facebook friends for a new dessert idea, and the prize goes to my friend Carol, for finding this recipe on About.com on their Low Fat Cooking page (there's lots of great ideas here!).  I like that this recipe contains walnuts, which are rich in essential amino acids and omega 3 fatty acids (one of the healthier fats).  Cranberries have some putative health benefits including possible antioxidant capacity, and, well.... they just plain taste good!  Remember that walnuts and dried cranberries are both high in calories, so the key is moderation.

INGREDIENTS:

  • 3 ripe but firm pears, peeled, cored and quartered
  • 1/3 cup pomegranate juice OR cranberry juice OR apple cider
  • 1/2 cup dried cranberries
  • 1/4 cup chopped walnuts



DIRECTIONS:

1.  Preheat oven to 350 F.
2.  Place quartered pears in a baking dish.  Drizzle juice or cider over the pears, and sprinkle the walnuts on top.
3.  Bake for 20 minutes, or until pears or tender.
4.  Serve in a smal bowl with the juices


Makes 4 servings.  PER SERVING:

  • Calories: 170
  • Fat: 5g
  • Carbs: 34g
  • Protein: 2g


To top this off, you could add 2 tbsp of Cool Whip lite to each serving, for an extra 20 calories (and 3g of carbs).


Here's the really cool thing about this recipe - it can double as a salad!  Throw the pears on top of a bed of arugula, and voila!

Enjoy!

Dr Sue Pedersen www.drsue.ca © 2012 

Follow me on Twitter for daily tips! @drsuepedersen

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Are Low Blood Sugars a Normal Part of Having Diabetes?

>> Tuesday, November 27, 2012







Diabetes is a condition that is diagnosed on the basis of elevated blood sugars.  We know that high blood sugars over time can cause damage to the heart, kidneys, eyes, nerves, and other organs, so an important part of diabetes treatment is to keep blood sugars as normal as possible.  Some medications used to treat diabetes can cause low blood sugars if more is taken than what is needed.  So, is having low blood sugars a normal part of being treated for diabetes?


(for THE BOTTOM LINE, skip to below)

As I discussed at this weekend's Rocky Mountain Internal Medicine conference in Banff, Canada, my first point on this important topic is that having low blood sugars in diabetes is more common than we think.  Several studies have demonstrated that if blood sugars in diabetics are continuously monitored for 24 hours, a significant proportion of people are having low blood sugars - and don't know it.  There are a couple of reasons why you may not know you are having lows:  symptoms of lows (shakes, sweats, heart pounding, etc) decrease after 10-15 years of having diabetes, and older people may not get these symptoms even early in their diabetes.   Low sugars can have some atypical symptoms as well, such as nightmares.  A fall in the middle of the night in an older individual could be due to a low blood sugar, so if this is happening, it's important to check.

My second point is that low blood sugars have many negative effects.  A low sugar can be dangerous if it happens behind the wheel of a car or while operating machinery - this is why it's mandatory to check sugars before doing these things, if you are on medications that can cause low blood sugars.  A severely low sugar can cause a seizure or heart rhythm problems, though fortunately, severely low sugars are not common, especially if diabetes is managed well.  

An important aspect of having low blood sugars that is sometimes overlooked is the effect that low sugars has on quality of life.  Having a low sugar is a scary feeling, and people who have had lows often fear - a lot - the possibility that it could happen again, and their family does too.  Seven to 10% of people who have a low blood sugar while at school or work will go home and miss the rest of the day, and some will miss the next day too.  Having a low sugar requires taking in carbohydrate calories to correct it, which can make it harder for overweight people to lose weight.   Having low sugars is expensive too, as it ends up costing in lost time at work, extra meter strips to check sugars, and so on.

The good news is that not all medications to treat diabetes cause lows.  Insulin and two classes of oral medications for Type 2 diabetes called sulfonylureas (includes glyburide, gliclazide, and others) and meglitinides (includes repaglinide) are the ones that can cause low blood sugars.  There are many other classes of medications to treat Type 2 diabetes that do not cause low blood sugars.

As far as insulin goes, insulin is required to treat Type 1 diabetes, and it is also required for many Type 2 diabetics, depending on how advanced their diabetes is.  However, there are different kinds of insulins available, some with lower risk of low sugars than others.

Some diabetes medications can also be adjusted depending on what you feel like eating.  For these medications, lower doses can be taken if less food is eaten to avoid a low blood sugar, rather than having to eat a regimented meal pattern every day to avoid your diabetes medication causing a low blood sugar.     Some diabetes medications can also be decreased for days that you are more active, rather than having to eat more on active days to avoid having a low sugar.

THE BOTTOM LINE:  Low blood sugars do NOT have to be a normal part of having diabetes.  I'm a big believer in adjusting diabetes medications to fit a person's lifestyle, rather than a patient having to alter their lifestyle to fit their medications (and avoid lows).   If you are struggling with low blood sugars as part of your diabetes treatment, speak to your doctor to find out what can be done to decrease the risk of lows, or possibly eliminate the risk entirely.


Dr Sue Pedersen www.drsue.ca © 2012 

Follow me on Twitter for daily tips! @drsuepedersen


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Bariatric Surgery and Bone Health

>> Tuesday, November 20, 2012




The decision to undergo obesity (bariatric) surgery is a complex one, as the potential benefits and potential risks are many.  A longterm potential complication that is often overlooked is the effect that bariatric surgery can have on bones.


As outlined in an excellent review by Brzozowska and colleagues, the effect of bariatric surgery on bone health is not well understood.  As the potential effects, as well as what we know (and don't) is quite variable depending on what type of bariatric surgery is performed, here are a few notes organized by procedure:  (you can also read more about the procedures in general here)

Gastric Bypass Surgery:  We know that gastric bypass alters bone metabolism in favor of bone breakdown.  In many cases, this is at least partially due to vitamin D and/or calcium deficiency - both require supplementation lifelong after gastric bypass, and inadequate replacement will cause bone depletion over time.  There are many other factors involved as well - several hormones made in the fat tissue and the gut that change after gastric bypass surgery have been implicated in changes in bone metabolism as well.

Sleeve Gastrectomy:  As a newer procedure, very little is known about the effect of sleeve gastrectomy on bone.  The available data suggests that sleeves do affect bone metabolism and can cause bone loss over time.

Gastric Banding:  It is not known whether gastric banding has an adverse effect on bones or not - studies done so far have shown conflicting results.  Gastric banding is a less invasive procedure that doesn't cause calcium or vitamin D deficiency, and doesn't cause as many hormonal changes as the other two surgeries.  (That being said, gastric banding is falling out of favor due to its poor longterm efficacy and high reoperation rates over the long term.)

A few important caveats to the above discussion:

1.  It is not known whether changes in bone metabolism seen with bariatric surgery result in an increase in fracture risk - more study is needed.

2.  The long term effect on bone metabolism is not known, as most studies done to date are only a year or two in duration.  Longer term studies will help us to understand the effect on long term fracture risk as well, which is the most important outcome measure.

3.  The effect on bones may be different not only by the type of surgical procedure, but also by age and gender - again, more study is needed.

The Bottom Line: Anyone having bariatric surgery should have a baseline bone density done before surgery, and bone density should be monitored after surgery as well (guidelines are available here).   While adequate calcium and vitamin D is an important component of bone health, there is much more about the effects of bariatric surgery on bone that we still don't understand.


Dr Sue Pedersen www.drsue.ca © 2012 

Follow me on Twitter for daily tips! @drsuepedersen


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Struggles with Weight or Cholesterol? Turn Off Your Light At Night!

>> Wednesday, November 14, 2012





It is a well known fact that not getting enough sleep is a risk factor for obesity.  However, if you think you ARE one of the lucky ones who actually does get enough sleep, ask yourself if you are getting enough sleep in darkness?  A new study suggests that people who are exposed to light at night (even if they are sleeping) may be at an increased risk of carrying extra body weight, and even of having higher cholesterol!

The study, published in the current issue of the Journal of Clinical Endocrinology and Metabolism, examined body weight and cholesterol levels amongst older people (average age 73) in Japan.  Researchers went into participants' homes and recorded exposure to light overnight, and found that those who are exposed to light overnight were 89% more likely to be obese, and 72% more likely to have cholesterol problems, compared to those who sleep in the dark.  

While this study needs to be repeated in a younger population to know if these findings hold true outside of older age, there is already lots of evidence that sleep deprivation increases the risk of obesity, and that blue light exposure in particular (including from computer and mobile device screens) makes it harder to fall asleep - a habit that is particularly relevant for younger generations.


The Bottom Line:  Lights Out!

Dr Sue Pedersen www.drsue.ca © 2012 

Follow me on Twitter for daily tips! @drsuepedersen 





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Raspberry Ketone Myth Busting (not fat busting)

>> Tuesday, November 6, 2012




In the last few months, I've been hearing an awful lot about raspberry ketones, and I've been asked frequently as to whether there is any substance to the weight loss claims.  Time to bust the myths! (hmmm this may already answer the question...)

Raspberry ketone is a chemical that gives raspberries their smell.  It's used as a perfume in cosmetics, and has been studied as a potential skin whitener.

Studies in test tubes have shown that raspberry ketone can increase fat breakdown in fat cells and increase release of a hormone called adiponectin (I'll get back to this later).  Rat experiments have suggested some anti obesity potential of raspberry ketone.

The use of raspberry ketone as a weight loss aid really took off when a certain physician/celebrity promoted it on his TV show, based on the above studies, and testimonial evidence from people who have used it with success.

HOWEVER.  Raspberry ketones have NOT been studied in humans in proper clinical trials, and there is therefore no scientific study or evidence to support the safety or benefit of using raspberry ketones in humans.  From a safety perspective, it has been suggested that raspberry ketone has a stimulant effect, and there have been reports of people taking them experiencing palpitations.  Raspberry ketones may interfere with a long list of medications, including blood thinners, antidepressants, and others.

From a benefit perspective, there is no study in humans to show the effect on body weight, and no study in humans to show the effect on adiponectin levels in the living body. Adiponectin is a 'good' hormone, in that higher levels are associated with a better metabolic profile and lower body fat.  However, while raspberry ketone may increase adiponectin in a test tube, we have no idea if this actually happens in real life.

When the pharmaceutical industry tries to develop a drug to treat obesity, it goes through very rigorous clinical trials that start with test tube data, followed by huge amounts of animal study, then small human studies, then big human clinical trials.  This all happens before a medication can hit the shelves.  These steps are important for our health and safety, so that we have a good understanding of the benefits and risks of medications before we start prescribing them.

In contrast, like other drugs in the herbal industry (and yes they should be considered to be drugs), little to no study is required before they end up on shelves.  In the case of raspberry ketone, we have no idea if it results in weight loss in humans, and even worse, we do not understand the potential side effects or dangers of taking it.

A special thank you to Steven Niles, Certified Diabetes Educator, for the first heads' up!

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen 





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Sweet Potato Lentil Stew!

>> Tuesday, October 30, 2012





In our neck of the woods, winter has come early!  Here's a recipe that will warm you up on a chilly night.  It needs no oil or added fats at all - the taste from this creative blend of spices is mouth watering all on its own!



Ingredients:
  • 1 medium onion, diced
  • 2 small tomatoes, diced
  • 1 teaspoon minced fresh ginger
  • 1 1/2 teaspoons turmeric
  • 1 teaspoon cumin
  • 1 teaspoon ground coriander
  • 1/2 teaspoon ground cinnamon
  • 1/8 teaspoon cayenne
  • Pinch of fine sea salt (optional)
  • 3 medium sweet potatoes, peeled and cut into 3/4” cubes
  • 7 cups low-sodium vegetable broth
  • 1 cup brown or red lentils


Directions:

1.  Heat two tablespoons of the broth over medium heat in a large, deep pot. 

2.  Add the onion and cook, stirring frequently, for two minutes or until the onion starts to soften. 

3.  Stir in the tomatoes and ginger and cook for three minutes. 

4.  Stir in the turmeric, cumin, coriander, cinnamon, cayenne, and a small pinch of salt, if using. Cook and stir for two minutes, then taste for seasonings; try to use only enough salt to heighten the flavors.

5.  Add the sweet potatoes, broth, and lentils. Stir well, and bring to a boil over high heat. When the mixture comes to a boil, reduce the heat, cover, and simmer for 40 minutes or until the lentils and sweet potatoes are soft.

Makes 6 servings. 

Per serving: (approximate)

  • calories: 190
  • fat: 0.3g 
  • protein: 10g
  • carbohydrates: 36g

Recipe adapted from Alicia Silverstone's The Kind Diet  .  Thanks to my friend Susan for the inspiration!

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen

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Type 2 Diabetes in Children

>> Tuesday, October 23, 2012






Along with the rise in obesity, so too are we witnessing a growing epidemic of type 2 diabetes in children.  I was recently interviewed along with my colleague Dr Bernie Zinman for an article in Today's Parent about type 2 diabetes in children - I thought I'd share it with you here.


Enjoy!

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen


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The Stigma of Obesity

>> Tuesday, October 16, 2012



With over 1.5 billion overweight adults worldwide (approximately one quarter of the entire world's population), it is somewhat surprising that overweight and obesity still carries a serious stigma along with it.  This stigma has its basis in a poor understanding of the complex nature of the causes and contributing factors that are responsible for obesity - it is so much more complex that just what we eat and how much we do or don't exercise.


In a position statement regarding the support of bariatric surgery as a treatment option for Type 2 Diabetes, the International Diabetes Federation Task Force writes:

There are widely held community attitudes that the majority of obese individuals are responsible for their current weight.  Severe obesity is too often misconstrued as a 'cosmetic' problem and as a result of personal failure or lack of motivation. 


However, this perspective ignores the very strong genetic and developmental bases to severe obesity compounded by physical, emotional and societal issues.  It also fails to consider the pervasive obesity promoting effects of modern societies (the 'obesigenic environment') where an abundant food supply, changes in food preparation, increasing sedentary behavior and other lifestyle factors mitigate against weight control for individuals.  Additionally, it ignores the emerging evidence that body weight is defended by powerful physiological mechanisms, making long term maintenance of weight loss difficult. 


In the context of treatment, negative societal attitudes have been a barrier to the provision of clinically effective, and cost-effective, health care for people with severe obesity and type 2 diabetes.  As noted earlier, obesity is a complex, multifactorial and chronic disorder with serious adverse consequences for health which requires a comprehensive approach to both prevention and treatment.  People affected by severe obesity often struggle not only with the health and physical consequences of their chronic condition, but discrimination at work, socially and within the health care system. 


In order to be able to successfully work together as a society to tackle the issue of obesity, these societal attitudes must be cast aside, such that this very serious health issue can be handled with open arms, minds, and hearts, by each and every one of us.

Dr. Sue © 2012   www.drsue.ca     drsuetalks@gmail.com

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Lower Vitamin D Increases Risk of Gestational Diabetes

>> Tuesday, October 9, 2012







Included the long list of possible actions of vitamin D in humans is the possibility that it has a role in the regulation of blood sugar.   A new study supports that this may be true in pregnant women, as it has shown that women who have lower levels of vitamin D in the first trimester of pregnancy have a higher risk of developing gestational diabetes during that pregnancy.

At the European Association for the Study of Diabetes (EASD) meeting in Berlin last week, lead author Dr Lacroix from Sherbrooke University in Quebec, Canada, presented the study.  They looked at vitamin D levels in 558 pregnant women in the first trimester of pregnancy who did NOT have diabetes in the first trimester, and then tested them for gestational diabetes (ie, diabetes that develops during pregnancy) in the second trimester (which is the standard time to test for gestational diabetes).

They found that lower vitamin D levels in the first trimester were associated with a higher risk of developing gestational diabetes, with 37% of gestational diabetic women having had a lower vitamin D in the first trimester, and only 26% of non-gestational diabetic women having had a lower vitamin D in the first trimester.   (Scientists: lower vitamin D was defined as less than 50 nmol/L; also note that this difference remained statistically significant after adjusting for potential confounding factors including age, BMI, and body fat percent).


The bottom line:  Vitamin D levels may be one of many factors to consider in minimizing the risk of developing gestational diabetes.  If you are pregnant or considering becoming pregnant, speak to your doctor about vitamin D.

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen

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New Data on Type 2 Diabetes and Obesity Surgery

>> Tuesday, October 2, 2012




At the European Association for the Study of Diabetes (EASD) meeting in Berlin today, I had the pleasure of sitting in on a session discussing the effects of obesity surgery on type 2 diabetes.  Whereas previous years of diabetes meetings have seen very sparse attendance at bariatric surgery talks, this session was absolutely packed. 

At this session, a number of fascinating studies were
presented.  Highlights included: (be warned - it's a very science-heavy blog this week!)

A study by S. Steven and colleagues (UK) looked at a group of 92
patients who had type 2 diabetes prior to having gastric bypass
surgery, with the aim of determining which factors were associated
with a greater chance of diabetes remission after surgery. One of
their findings was that the degree of weight loss achieved post op was
the main determinant of diabetes remission - controversial, as the
bulk of currently available evidence suggests that remission of
diabetes is independent of weight lost.

A study by Pournaras and colleagues found that a nifty removable liner placed
inside of the first 60cm of small intestine (called a duodenal-jejunal
bypass liner) improved type 2 diabetes control over a 1 year trial period.
This introduces the question as to whether, in the future, we can
consider less invasive alternatives to bariatric surgery (such as
these) to help control type 2 diabetes.


A couple of elegant studies out of Denmark (including colleagues Jens Juul Holst and Sten Madsbad who I collaborate with on research studies personally) and Sweden were presented, designed to give us a better understanding of just how obesity surgery improves type 2 diabetes (with a lot of arrows pointing to the increase in the hormone GLP-1 that is seen after surgery).

Finally, there was a neat study from Finland showing that the insulin resistance of fat in femoral bone marrow improves with bariatric surgery (I personally had not previously thought about bone marrow being insulin resistant!).  

Overall, a very exciting day, and a very exciting meeting!

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen



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Curry Roasted Cauliflower!

>> Thursday, September 27, 2012







OK.  I don't know how I'm going to get this message across without being able to make letters jump off a page...  this is an AMAZING CREATION!!  Since I discovered this recipe, I have been going through cauliflower like nobody's business.  It makes a great veggie dish for company, or just to enjoy on your own!  No muss, no fuss.   I've tweaked the recipe from the original at summertomato.com - thanks for the inspiration!

Two words:  TRY IT!



INGREDIENTS (yes it can be this simple!)


  • 1 head of cauliflower, cut into bite sized pieces
  • curry powder to taste
  • 2 packets of Splenda
  • 1 tbsp canola oil
  • salt to taste

DIRECTIONS: 

1.  Preheat oven to 500F (260C). 

2.  Mix all of the above together in a bowl to coat evenly.  

3.  Cover a baking tray with tin foil and spray with a bit of cooking spray.  Spread the cauliflower evenly over the tray. 

4.  Cover with another layer of tin foil and bake for 15 minutes.  Remove the foil and continue baking another 10-15 minutes, stirring every few minutes to cook evenly.   The goal is to cook until the tips of the cauliflower are a bit browned and crispy. 


Makes 4 servings.  PER SERVING: (assuming medium size cauliflower, 1kg = just over 2lb): 

CALORIES: 90
CARBS: 10g
FAT: 4g
PROTEIN: 5g

Mmmmmm.....ENJOY!!   Thanks to my friend Susan for pointing this magical creation out to me. :)


Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen




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Women, Sex, and Diabetes

>> Thursday, September 20, 2012








It is well known that men with diabetes are at risk of erectile dysfunction (ED).  We are now learning that it is not only diabetic men that are at risk of sexual challenges - a new research study reveals that women with diabetes can struggle with several aspects of sexual function too.

The study, which was done in California, administered questionnaires to well over 2,000 women aged 40-80, asking questions about sexual function.  They found that:


  • women with diabetes were more likely to report low sexual satisfaction;
  • insulin treated diabetic women were more likely to have problems with lubrication and orgasm than women without diabetes.
  • women with serious complications of their diabetes (eg heart disease, kidney complications, stroke) reported less sexual satisfaction and activity than diabetic women without these complications.


So what is the link between diabetes and lower sexual health?  Just like for men, several possibilities exist, including:


  • blood flow to the genital organs may be impaired (in the same way that blood supply to other organs can be damaged over time, especially if blood sugar control is poor);
  • the nerve supply can be damaged over time (just like nerves to the feet can be affected, again, especially if blood sugar control is poor over the long term);
  • some medications can affect sexual function;
  • sex drive can be decreased if a person is not well because of their diabetes, or diabetes-related complications.  

A note on the finding that insulin treated women had more problems with lubrication and orgasm -  this probably reflects the fact that the women using insulin had more advanced complications of their diabetes (eg nerve damage), and should NOT be interpreted to mean that insulin itself decreases sexual satisfaction.  That being said, if a woman on insulin is having frequent problems with low blood sugars, this could certain dampen the sex drive - the solution here would be to adjust the insulin dosing with the help of health care providers so that the lows are no longer occurring.   The psychological issues that are sometimes associated with starting insulin could have an effect on the libido as well, which can certainly take time to work through - I want to emphasize that the solution is not to stop the insulin, as not taking insulin when it's required can have truly devastating effects on health.   I always encourage my patients to think of starting insulin in a positive light, as it provides the opportunity to get good control of diabetes!


BOTTOM LINES:

1.  Diabetic women are at risk of having sexual health issues - both patients and health care providers need to ask about it, and talk about it.

2.  Preserving sexual health is one more important reason to have good control of blood sugars, as poor control increases the risk of damage to nerves and blood vessels that are important for good sexual function.

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen


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Making Healthy Meals as a Working Parent

>> Friday, September 14, 2012





My patients often tell me that having to find time to cook for their family makes it harder to eat well themselves.  I polled some of my friends who are working moms to get some real life tips, and I got an especially awesome response with lots of great ideas from my good friend Dr Ronagh Hatcher, a family physician in Calgary who has two little ones at home.  Here's what she had to say!  


#1 - Be organized.   It takes time to get there but the more you can plan ahead the healthier you will eat.  As we have food alergies/intolerances in our family, we don't have a lot of options so we have to be organized.  Every Sunday, we plan out our meals for the week; from there, we develop a grocery list.  That way, every day I know what we are having for dinner, and most days we already have everything we need.  You will also find it saves you money!!


#2 - Make freezer meals.   Once a week I try to make triple or more of a meal that freezes well.  We have it for dinner that night, then store the unused portions for those days when you won't have time to cook.  After a few weeks I end up with a great selection in the freezer.  This is a huge timesaver as it means I don't have to cook a few nights a week.  Things I find that freeze well are spaghetti sauce, pulled pork, lasagna, curries, chicken taco meat, shepards pie, turkey meatballs, chili...  Just to name a few!  Homemade muffins and soups also freeze well for healthy lunch/snack options.  I invested in some quality Pyrex glass storage wear with plastic lids...  They can go straight from the freezer to the microwave or oven.  


Dr Sue's comment:  I'm secretly a bit envious of Ronagh's family and all the great food they get to eat.  Ronagh was my roommate years ago in med school, and I LOVED it when she cooked for me!



#3 - Get aquainted with a slow cooker - this is key for working parents!!!! It means you can take 5-10 minutes in the morning to throw stuff in your slow cooker, turn it on, and presto...  dinner is done when you get home.  I recommend buying a large volume one because these meals are usually good for leftovers, or for 'freezer meals'.  I have a recipe book that does not require you brown the meat first, which is also a big time saver.  




#4 - Make ahead healthy lunch options.  There are certain lunches that I can eat for days in a row and never get sick of them.  It is worth making the effort one day to have the convenience for the next three!  Things I like to do this with are homemade soups, like roasted butternut squash, or salads like couscous or quinoa ones that keep well.  Some pre made options I really like are 'Imagine Organic Creamy Tomato' and Costco quinoa salad.  

Dr Sue:  Nutritional info for these foods is in the links - just click on them! Remember to portion control. :)




#5 - Shop around for healthier pre made food options for when you just dont have the time or energy...  here's a few ideas to get you started:

  • Superstore blue menu has some great flax chicken strips
  • Buy Costco falafels, heat in a pan and serve with rice and salad
  • Cooked whole chicken -  chop and sauté with onions and tomato sauce for a quick pasta sauce, or serve over salad for a fresh lighter meal.  The possibilities are endless here.  
  • If you need a pizza fix...  Delicio harvest wheat thin crust pizza is a MUCH healthier opinion than takeout
  • local premade food companies...  I use one called 'Green Figs and Yams' - for $16 dollars a dish you can buy healthy freezer ready entrees for 3-4 people.  

#6 - If you don't know how to cook, learn!   Some great healthy cookbooks are the Looney spoons/Crazy Plates ones.   They have tons of healthy yet tasty recipes, complete with nutritional information. 


Dr Sue's comment - I use these recipe books too - I love them so much that I asked for (and received) permission from the authors to post the odd recipe from their collection



Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen

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Sensational Baked Portobello Mushroom Wedges!

>> Friday, September 7, 2012








French fry fan?  Here is a great substitute that is much fuller in taste and easier on the waistline.   Note that as always, portion size is important - share this delicious treat with three friends or family and enjoy at only 140 calories per serving!

Thanks to closetcooking.com for the fabulous recipe idea which we've tweaked a bit, and to my best friend Deb for finding it!  We think that Prego tomato sauce makes a great dip, or indulge with two tablespoons of Bolthouse Farms Caesar Parmigiano Yogurt Dressing, at 25 calories per tablespoon (good for a creamy dressing, but not as low calorie as the Prego sauce which comes in around 8 calories per tablespoon) - remember to portion control the sauces as well.  

INGREDIENTS:

  • 2 medium portobello mushrooms (about 150g each), gills removed, sliced about 1/4" thick 
  • 1/2 cup flour
  • 2 egg whites, beaten
  • 3/4 cup panko bread crumbs
  • 1/4 cup grated parmesan cheese
  • spices as you like: try salt & pepper; cajun spice; rosemary & spice - or make up your own!
DIRECTIONS:

1.  Preheat the oven to 425F. 

2.  Mix the bread crumbs, cheese, and spices together. 

3.  Roll the mushroom slices in flour, then the egg white, then the bread crumb mixture. 

4.  Place the mushroom slices on a baking sheet (lined with tin foil and sprayed with a bit of non stick spray) until golden, about 7-10 minutes per side. 

Makes 4 servings. PER SERVING: (Approximate, and not including sauces!)

CALORIES: 140
PROTEIN 10g
CARBS: 21g 
FAT 2.5g

***NOTE that this nutritional info assumes that ALL of the flour and breadcrumb mixture is used, but in reality, there is still some left after you've coated all the mushrooms.  

Therefore, FOR DIABETICS who are counting carbs, please note that the amount of carbs will actually be lower than what is written here.  It's a bit tough to say exactly how much carb you will be getting, as it totally depends on how much of the flour and bread crumb mixture you use, as this is where most of the carbs in the recipe come from.   If you only use half of the flour and bread crumbs, cut the carb count above in half per serving (ie 10g of carbs instead of 21g). 

I'd be thrilled to hear what kind of herbs and flavors you try in this recipe - please feel free to comment and share your ideas!

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen



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Obesity Surgery to Treat Type 2 Diabetes?

>> Thursday, August 30, 2012




At the recent inaugural meeting of the Canadian Association of Bariatric Physicians and Surgeons, I was asked to review the recent consensus statement released by the International Diabetes Federation on the use of bariatric (obesity) surgery to treat patients with obesity and type 2 diabetes.

(Skip to MY BOTTOM LINES below for a summary, or read through for the nitty gritty!)

The International Diabetes Federation consensus states:

1.  Bariatric surgery is an appropriate treatment for people with type 2 diabetes 
and obesity not achieving recommended treatment targets with medical 
therapies, especially when there are other major co-morbidities.

2.  Surgery should be an accepted option in people who have type 2 diabetes 
and a body mass index (BMI) of 35 or more.  (note - you can calculate your BMI in the right column here)

3.  Surgery should be considered as an alternative treatment option in patients 
with a BMI between 30 and 35 when diabetes cannot be adequately controlled 
by optimal medical regimen, especially in the presence of other major 
cardiovascular disease risk factors.


As I reviewed at the meeting, the literature shows that most patients with obesity and poorly controlled type 2 diabetes experience an improvement in their diabetes with obesity surgery (especially gastric bypass and sleeve gastrectomy).  We have more data for patients with a BMI ≥35 than we do for patients with a BMI of 30-35 at this point in time, but the literature for the latter group is growing.

A large proportion of patients with type 2 diabetes will go into remission from their diabetes (meaning their diabetes goes away) after bariatric surgery, which of course sounds like a very attractive possibility to the person who has to deal with diabetes on a daily basis.


HOWEVER: 

  • Based on the data we have currently available, about half of these cases of diabetes that went into remission after gastric bypass surgery come back by 5 years after surgery (called 'recurrence').
  • Almost all of the long term data for diabetes remission rates is in patients with a BMI ≥ 35; there is almost no data to help us understand what the long term recurrence rate of type 2 diabetes is in the BMI 30-35 group.  People who have diabetes with this lower BMI may have a stronger genetic predisposition towards having diabetes, so it is plausible that these people would be less likely to have their diabetes stay away over the long term.
  • There is little data to help us understand long term recurrence rates of diabetes after sleeve gastrectomy (which is becoming increasingly popular - read more about the types of surgeries here).
  • The definition of diabetes 'remission' was previously quite loose and has now become much stricter; therefore, the remission rates reported in the literature are overinflated.


MY BOTTOM LINES on this controversial topic are:

1.  For people with a BMI of ≥ 35, with POORLY CONTROLLED diabetes:   Bariatric surgery is an option that provides a good opportunity to improve diabetes control.

2.  For people with BMI 30-35, with POORLY CONTROLLED diabetes:  There is very little information to guide us in this group of patients, but so far, it appears that bariatric surgery could provide a good opportunity to improve diabetes control.

3.  For people with BMI of ≥ 35 with GOOD CONTROL of their diabetes: Bariatric surgery can offer an opportunity to make diabetes go away - but for at least half of these patients (and possibly more over the longer term), the diabetes will come back.

4.  For people with BMI of 30-35 with GOOD CONTROL of their diabetes: Bariatric surgery can make diabetes go away, but we don't yet know what percentage return to diabetes.  Due to genetics, their risk of return to diabetes may be higher than those with BMI ≥35.

5.  Any patient whose diabetes goes into remission after bariatric surgery MUST be followed for the rest of their life for screening for the possible return of diabetes.

And of course, for ALL people who are thinking about having bariatric surgery, the risks and benefits of the procedure as a whole must be carefully weighed by both patient and their health care providers, to decide if this intervention is the right thing for them.



Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen

PS - Bariatric surgery has been shown to PREVENT development of Type 2 diabetes as well (scientists - recent follow up to the SOS study published in the New England Journal of Medicine) - a story for another day's blog!



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Top 10 Advantages Of Being Diabetic

>> Friday, August 24, 2012




This week, I want to share with you a truly inspirational blog - an amazing example of how a very positive light can be shed on having diabetes, or any chronic medical condition for that matter.

My friend Tim (not my patient) happens to be a Type 1 Diabetic, and he's written a truly inspiring post on his blog, about his perspective on how he sees his diabetes being an advantage in his life.  This blog brought tears to my eyes, from laughter (he's funny!), yes, but mostly from being so moved and heart warmed that he can find so many positive things in the challenges that he faces ever day.  

Not to mention that he's using his blog to raise funds for the Juvenile Diabetes Research Foundation.

Check it out - and please share your thoughts!

Tim's amazing attitude is summed up in his catch line at the top of his blog about Type 1 Diabetes:
No longer a type, but more a skillset.

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen



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Sweeteners - Friend or Foe?

>> Friday, August 17, 2012







Artificial sweeteners have long been available, as a way to sweeten drinks and food while avoiding the calorie impact of sugar.  Recently, sweeteners have been on the hot seat, as it has been questioned whether these chemicals are friend or foe in the battle of the bulge.


There are several sweeteners currently available (as blogged previously), and the first thing that bears saying is that each of these chemicals is a very different compound, so the effects of each one could be different.   (to jump over the scientific part of this discussion, skip to The Bottom Line below)

Interestingly, in recent years, we have learned that sweeteners can activate not only the sweet receptors in our mouths, but also in our intestines and our pancreas (though it's only the receptors in our mouths that give us the feeling of eating something sweet).  It has therefore been suggested that artificial sweeteners may have an effect on the production of appetite regulating hormones, leading to weight gain.

As recently reviewed, some 'test tube' (in vitro) studies have shown that artificial sweeteners can affect the production of appetite hormones from gut cells, while other test tube studies have shown no effect.  In human and animal studies, most have NOT shown an effect of sweeteners on appetite hormones.  Thus, overall, the research suggests that sweeteners do not have an effect on appetite - though the research is far from complete, and there is still a lot of ongoing study in this area. 

In addition, several studies have shown that a higher consumption of sweeteners is linked with a higher risk of obesity.  However, what these studies are not able to separate is whether higher sweetener consumption is seen in people who are overweight because they are drinking the sweeteners in an attempt to lose the weight, or whether the sweeteners are actually causing the weight struggle.   There is much research being actively done in the area to give us an answer to this question.

The Bottom Line: As it stands now, there is not enough evidence to convince us that sweeteners lead to weight gain, while the evidence that excess sugar leads to weight gain is very clear.  There are many excellent clinical trials underway in this area, which will hopefully give us more clarity on the subject.



Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen




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Bisphenol A Exposure from Canned Soup

>> Friday, August 10, 2012





There is mounting evidence that exposure to a widely used chemical called bisphenol A is associated with an increased risk of obesity, diabetes, and metabolic syndrome.  A recent study reveals that eating canned soup for just 5 days can dramatically increase exposure to this potentially dangerous chemical.

Bisphenol A is a widely used chemical, found in a variety of products ranging from plastics to cash register receipts.  Most of our exposure is thought to be through food; in addition to being present in many water bottles and plastic food storage containers, it is also present in the interior epoxy coatings of many canned goods used to prevent corrosion.

The study was eloquently simple.  Seventy-five students and staff at the Harvard School of Public Health were each asked to eat soup for lunch for 5 consecutive days, and were randomly assigned to eating either canned soup, versus homemade soup from scratch. The following week, they ate soup each day for lunch once again, but they ate the opposite kind of soup from what they had eaten the week previously (researchers: thereby providing a randomized, single blinded, crossover design). 

The results were, in my opinion, quite astonishing: the researchers found that the bisphenol A levels in the urine were nearly twenty times higher after a week of canned soup consumption, compared to after homemade soup consumption.  Further, the urine bisphenol A levels after the canned food week were 60% higher than the higher end of urine bisphenol A levels noted in the general population. 

The study did not test the bisphenol A levels in the blood, so we don’t know if these people quickly cleared the bisphenol A from their systems, or whether the bisphenol A levels in their blood or other tissues was also elevated, or for how long.  That being said, the study does clearly show that just 5 days of eating canned soup dramatically increases exposure to this potentially harmful compound. 

Let’s hope that this study gives an extra push towards using bisphenol A – free linings to canned goods, as well as yet another reason to cook and enjoy healthy food made at home!  

Thanks to my friend and colleague Jon for pointing out this study!



Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

Follow me on Twitter for daily tips! @drsuepedersen 

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Abuse in Childhood Increases Risk of Obesity in Adulthood

>> Saturday, August 4, 2012




The struggle with weight is very complex, and goes so much deeper than simply a balance between calories in and calories out. For many people, there is an emotional contributor to the weight struggle, and for some, a history of abuse in their childhood.

An ongoing study called the ACE (Adverse Childhood Experiences) study has done much to educate us on the important relationship between childhood abuse and obesity later in life.  This study, which includes data from over 17,000 people, is one of the largest studies ever conducted to help us understand the associations between childhood maltreatment, and health and wellbeing later in life.

The obesity substudy surveyed adults by mail about their first 18 years of life, and looked for associations between their answers and their body weight as adults.

An alarming two thirds of the study population reported some sort of abuse during their childhood years.  Physical and verbal abuse were most strongly associated with obesity.  People who reported being 'often hit and injured' had a 40% increased risk of obesity.  Furthermore, the risk of obesity was higher with the number of different types, and severity, of abuse.

This study shows us that some people's struggles with obesity may be deeply rooted in a history of abuse in their childhood.  It is of the utmost importance for health care providers to do everything they can to help people identify, understand, and manage these complex and serious issues.

Taken as a whole, the ACE study suggest that certain childhood experiences such as abuse, neglect, and family dysfunction are risk factors for several illnesses as well as poor quality of life.  The ACE study is still ongoing, and is now looking at the relationship between these childhood experiences, the use of health care resources, and causes of death.

As the ACE study website notes: Progress in preventing and recovering from the nation's worst health and social problems is likely to benefit from understanding that many of these problems arise as a consequence of adverse childhood experiences.

Thank you to my friend and colleague, Margaret, for bringing this important study to my attention.

Dr Sue Pedersen www.drsue.ca © 2012 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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