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Metabolic Syndrome in College Football Linemen

>> Saturday, February 25, 2012

While elite athletes are typically thought of as representing the pinnacle of fitness and health, this may not always be the case.  A recent Canadian study reports that amongst college (American) football linemen, there may be particular concerns regarding metabolic health.

The study, published in the Canadian Journal of Diabetes, looked at the prevalence of metabolic syndrome on the University of Saskatchewan's Huskie football team, which is one of the most prestigious University football programs in Canada.

Metabolic syndrome is defined by a constellation of several criteria, including waist circumference, blood pressure, blood sugar, and cholesterol measurements (both triglyceride levels, and the 'good cholesterol' called HDL).  Meeting three of the five criteria makes the diagnosis of metabolic syndrome.   It is associated with an increased risk of diabetes, heart disease, and a long list of other potential medical complications.

The study found that amongst the Huskies studied,  18 of 21 linemen had at least 1 feature of metabolic syndrome, compared to only 4 of the 18 non-linemen studied.  Three of 21 linemen had the full blown metabolic syndrome, whereas none of the non-lineman had the diagnosis.  Not surprisingly, linemen were also substantially taller, heavier, and had a much higher Body Mass Index (35.6) than the non-linemen (26.4).

Higher body mass is viewed as an advantage for athletes who play the position of linemen, but the health consequences as seen in this study are a serious concern.  The age at which children begin playing football has decreased over the last decade, suggesting that progressively younger children may be being encouraged to pack on the pounds to play the position of lineman more effectively.  As the authors point out, when these young athletes retire from the sport, their longstanding eating patterns may be difficult to break, putting them at even higher risk of significant health consequences of obesity.

As the authors conclude, "much work is necessary to inform policy and to educate on the long term consequences of increased body size" in these young athletes.

Article:  Mannsell K et al.  Prevalence of metabolic syndrome among college football linemen. Can J Diab 2011; 35(5):497.

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen 


Metformin Improves Survival in Type 2 Diabetics with Cancer

>> Saturday, February 18, 2012

There are many different treatment options available for Type 2 diabetes, ranging from several classes of oral medications, to injectable therapies including insulin.  Metformin is considered in most countries to be the first line treatment for Type 2 diabetes for a long list of reasons, and a recent study adds improved survival after a diagnosis of cancer to this list of metformin-related benefits.

The study, recently published in the journal Diabetes Care, looked at data from over 350 primary care practices in the United Kingdom.  They examined data regarding patients who had a diagnosis of both type 2 diabetes and cancer, and then looked at what diabetes medications these people were prescribed.

The authors found that cancer mortality in this population was 9% higher amongst diabetics, compared to non diabetics.  When they looked at diabetic patients on metformin, they found that the cancer mortality rates were lower compared to patients using sulfonylureas or insulin alone to treat their diabetes, and were also lower than the cancer mortality rates in nondiabetics.  In patients using a combination of metformin + sulfonylurea, or metformin + insulin, the cancer mortality rates were the same as for non diabetics.

So what does this mean?  Firstly, these data further strengthen the position of metformin as first line treatment for type 2 diabetes, and adds to the known benefits of metformin (including improvement in blood sugars, decreased risk of diabetes-related complications, a minor amount of weight loss, doesn't cause low blood sugars, etc).  It also increases interest in the potential use of metformin as anticancer therapy in patients who don't have diabetes; in fact, metformin is currently being studied in trials with breast cancer chemotherapy, to treat breast cancer in non diabetics.  

In regards to the comparison of metformin with other diabetes medications, we have to be careful of factors that can confound (confuse) these conclusions.  For example, the patient who requires insulin to treat their diabetes is metabolically different than the patient who does not require insulin - those needing insulin are often more insulin resistant, and this very likely has an impact on cancer related risk.   Furthermore, it is often necessary to use a combination of medications to treat diabetes, as metformin is often not enough to control blood sugars in many people.

Control of blood sugars is of paramount importance to the health of diabetics, and for many, multiple medications are needed to maintain blood sugar control.    The take home message from this study is that metformin remains the first line treatment for type 2 diabetes, and should be included as part of the diabetes treatment regimen, provided that the patient tolerates it and does not have any health conditions that would prohibit its use.

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen 


Does The Composition of Your Diet Affect POUNDS LOST?

>> Saturday, February 11, 2012

The research world has long been trying to figure out whether the protein, carbohydrate, and fat content of a diet matters, or whether it is 'simply' all about the number of calories being taken in, that determines the end effect on weight.  While a large clinical trial suggested that the composition of the diet doesn't matter, there may be certain elements of this trial that make it difficult to draw these conclusions.

In the POUNDS LOST trial, originally published in 2009 in the New England Journal of Medicine, over 800 overweight adults were randomly assigned to diets with different proportions of fat, carbs, and protein.  At the two year follow up, weight lost was similar in all groups, regardless of the diet composition, leading the authors to conclude that the composition of the diet doesn't matter, and that it's all about the calories.

In a follow up to the POUNDS LOST trial, the authors recently published further data suggesting that there was not only no difference in weight between the various diet groups, but no difference in changes in body composition, abdominal fat, or liver fat lost between the groups either.

In an accompanying editorial in the American Journal of Clinical Nutrition, my colleague Arne Astrup and I comment that further analysis of the POUNDS LOST data show that, based on urine excretion of nitrogen, which is a marker of dietary protein intake, there was actually no difference in protein intake between the low and high protein diet groups.  In other words, despite being assigned diets with different protein content, the participants ended up eating the same amount of protein after all.   As such, it is not actually possible to assess the effect of protein content on weight loss success based on this study.

The heart of the problem is that it is very difficult for study participants to adhere to a hard and fast dietary regimen for the duration of a study.  Although people in this study were asked to eat different amounts of protein, they ended up eating much the same.   Much better is to design dietary trials which point participants towards consumption of certain types of foods, without a fixed caloric intake or diet composition assigned.  That way, we can study how different types of foods affect weight via their natural effects on hunger and satiety.  This is a much more practical way to address the obesity epidemic from a research perspective, as it more accurately represents eating patterns in real life!

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen  


Photos in Lunch Trays Increase Veggie Consumption in Kids

>> Saturday, February 4, 2012

While the focus of healthy eating tableware tends to be on limiting portions of carbs and proteins, a study group out of Minnesota took a different slant with a group of kids by putting photos of vegetables in their lunch trays - and it worked!

The study, recently published in the Journal of the American Medical Association, looked at the consumption of carrots and green beans at a school cafeteria, comparing eating patterns on a day with pictures of carrots and green beans placed in the bottom of the tray, to a day when there were no pictures placed in the tray.   Kids helped themselves on both days to these vegetables as they wished, and were not aware that their selection or eating patterns were being recorded.

They found that the number of kids who selected green beans more than doubled (from 6.3% to 14.8%), and the number who selected carrots more than tripled (from 11.6% to 36.8%).  However, the number of kids choosing these vegetables overall was still low; further, the amount consumed was low, and did not meet government recommendations.

What this study teaches us is that the power of suggestion can have an impact on helping kids make healthier choices, with minimal additional cost above other much more expensive interventions such as structured classroom teaching.  While the classroom teaching is a crucial part of teaching our kids to eat healthy, let's not forget that a picture speaks a thousand words!

Dr Sue Pedersen © 2012 

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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