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Holiday Recipes III - Kale Cranberry Yuletide Salad!

>> Friday, December 27, 2013







Need a lighter meal this week?  Here's a festive, healthy salad to enjoy for a break between heavier meals this holiday season.  I've modified from the original recipe, to give less calories but even more flavor!


Ingredients:

1 bunch of kale (about 6 cups)
¼ cup slivered or crushed toasted almonds
½ cup dried cranberries
¼ cup finely shredded parmesan cheese
¼ cup breadcrumbs
2 tablespoons apple cider vinegar
2 tablespoons freshly squeezed lemon juice
1 tablespoon extra-virgin olive oil
1 clove garlic
salt and pepper


DIRECTIONS:

1.  Remove the tough inner ribs on the kale, slice into ribbons and place in a large bowl.

2.  Smash the garlic with the back of a knife, add a sprinkle of salt and crush the garlic until a smooth paste forms.  Add the vinegar and lemon juice to the garlic and then slowly whisk in the olive oil.  Season with salt and pepper to taste.

3.  To dress the salad, pour the dressing over the kale and using your fingers work the dressing into the leaves making sure that everything is well coated.  Add the cranberries, parmesan, almonds and ¾ of the breadcrumbs to the mixture and toss to combine.  Garnish the salad with the remaining breadcrumbs when you are ready to serve.  

Makes 4 servings.  Per serving (approximately):

  • 200 calories
  • 25g carbs
  • 9g protein
  • 10g fat

Thanks to my best friend Deb for the heads' up on this great recipe!

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www.drsue.ca © 2013

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Happy Holidays!

>> Tuesday, December 24, 2013





Wishing all of my readers the very best this holiday season!  May your life be filled with health, love, and happiness, and may the New Year bring much joy, adventure, and fulfillment to all.

Follow me on twitter: @drsuepedersen

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Holiday Recipes II - Dr Sue's Dessert Collection

>> Wednesday, December 18, 2013





As the second of my three-part series of holiday recipes, I've brought together a collection of the top 5 DrSue holiday desserts that I've gathered over the years on my website.   Enjoy!

Baked Pears with Walnuts & Cranberries  - throw a little arugula under this one and it doubles as a salad!

Holiday Pumpkin Pancakes - a Christmas morning crowd pleaser

Chocolate Espresso Brownies (pictured above) - can't beat this, at only 115 calories each!

Crustless Pumpkin Pie - skipping the crust on your pie brings this recipe down to a slim 65 calories per slice!

Blueberry Crisp Yuletide Dessert - a healthy version of a traditional favorite!


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Holiday Appy - Cheesy Stuffed Mushrooms!

>> Monday, December 16, 2013





Searching for a healthy appetizer to dazzle guests this holiday season?  Try out these delicious stuffed mushrooms - for once, I have not needed to 'doctor' this recipe - it is fabulous as is!  At around only 20-25 calories per mushroom (yes, you read that right), you really can't beat it.   The original recipe can be found here - but you can use any brand of cottage cheese, of course. :)


INGREDIENTS:

1/4 cup chopped sun-dried tomatoes (not oil packed)       
1 cup low fat Cottage Cheese      
1/4 cup chopped chives        
2 tablespoons chopped fresh basil       
1/8 teaspoon salt        
1/8 teaspoon ground cayenne pepper       
16 medium to large button mushrooms, stems removed  
3 tablespoons fresh whole wheat bread crumbs


Directions: 

Place the sun-dried tomatoes in a glass measuring cup. Pour 1 cup of boiling water over the tomatoes; soak for 5 minutes or until softened. Drain the tomatoes. Heat the oven to 375 degrees. Spray a baking pan with cooking spray. In a medium bowl, stir together the drained tomatoes, the cottage cheese, chives, basil, salt and pepper. Place the mushrooms, stem-side down, on a baking pan; spray with cooking spray. Turn the mushrooms back stem-side up. Spoon a scant tablespoon of filling into each mushroom cap. Top each with about 1/2 teaspoon of bread crumbs. Bake the mushrooms for 10 minutes or until the bread crumbs are toasted and the mushrooms are heated through. Let stand 5 minutes before serving. 

Tip: 1/4 cup chopped fresh parsley can be substituted for the basil. 


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Mythbusting Garcinia cambogia

>> Sunday, December 8, 2013





There are a kajillion substances, herbs, and naturopathic remedies that are all over the internet, purporting their magical abilities to cause weight loss, but which do not have evidence to support that they actually work.  You can add Garcinia canbogia to this list.

Garcinia cambogia extract comes from a type of tamarind tree native to Asia.  In addition to being available as an extract, it is also an ingredient in Hydroxycut, which has been associated with cases of liver toxicity.  Now that Dr Oz has been throwing his weight behind Garcinia, it's getting more attention than ever before.  (More on my thoughts re Dr Oz here.)

We can put to rest the controversy behind Garcinia simply by looking at the science.  A randomized controlled trial was conducted long ago, back in 1998, showing that Garcinia cambogia failed to produce significant weight loss compared to placebo.

Friends, today's blog is short and not so sweet: Garcinia cambogia has been proven NOT to work, and it may be harmful.


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Obesity Prevention Starts In Your Mother's Belly

>> Monday, December 2, 2013




With the struggles our societies face in the battle against obesity, we need to look not only at treatment strategies for people who already struggle with their weight, but also at how we can prevent obesity in the first place.  As we look earlier and earlier in life, risk factors have emerged going all the way back to not only infancy, but even to before we were born, when we were just lil' wee blobs of cells inside our mothers' bellies.

The New England Journal of Medicine recently published an excellent article describing the power of some of the risk factors during fetal life and infancy on obesity later in childhood.   They discuss a study that looked at 4 risk factors for childhood obesity in a group of children aged 7-10 years:

  • mother smoked in pregnancy
  • mother gained excessive weight during pregnancy
  • breast feeding for less than 12 months
  • slept less than 12 hours per day during infancy

They found that only 6% of kids who had none of these risk factors were obese, compared to 29% of kids who had all four of these risk factors. 

So how can factors before we are even born influence our risk of obesity?  These observations can be explained at least in part by epigenetic changes - in other words, changes to our DNA that happen while we are growing inside our mother's belly.  (Exposure to toxins besides smoking in the environment play a role as well - read more about this here.)

While not every mother is able to breastfeed, it is recommended to try, as there are a number of health benefits including a lower risk of obesity later in childhood - read more on this here.

As for sleep, there is a rapidly expanding body of evidence teaching us about the powerful connection between sleep deprivation and obesity - go to my main page www.drsue.ca and type 'sleep' in the search box for more reading on this. 

Another interesting risk factor for childhood obesity is being born by C-section.  This may be partly due to the fact that the infant's gut is colonized with normal, healthy bacterial at the time of passage through the vaginal birth canal.  We are learning that the type of bacteria we have in our gut have an influence on our body weight as well, so it may be that the healthier bacteria acquired during vaginal birth leave us less prone to developing obesity later in life. 

The good news is that some of the above risk factors are at least partially under our control - especially not smoking during pregnancy - and some of them can often be improved upon, with the appropriate care, support, and education of expecting mothers and new parents.  


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Sugars 101 - Fructose, Glucose, Sucrose, Agave, and High Fructose Corn Syrup Demystified

>> Monday, November 25, 2013




There is so much information (and misinformation) out there about sugar, sweeteners, high fructose corn syrup, and so on, that it's hard to know which way is up sometimes. ...

A question that has come up frequently is whether fructose is better or worse for you than regular sugar.

A few key points:

1.  Table sugar is sucrose.  Each sucrose molecule is made up of one glucose and one fructose molecule.

Sucrose (table sugar) = glucose + fructose




2.  High fructose corn syrup (HFCS) is not much different from table sugar.

Sucrose (table sugar) = 50% fructose + 50% glucose

HFCS = 55% fructose + 41% glucose + 4% other sugars



The calorie content of table sugar and high fructose corn syrup are about the same.


3.  Fructose is handled differently by the body than glucose.

Glucose causes a rise in blood sugar (when we say 'blood sugar', we actually mean 'blood glucose' - I know, confusing, right?).  This causes us to release insulin to deal with the glucose - insulin allows our cells to take up glucose to use as fuel or as energy storage.

Fructose does not cause a rise in blood sugar (as it is not glucose) and does not stimulate us to release insulin.  Fructose goes to the liver, where it it used to store energy in the liver in the form of glycogen, or, if there is enough glycogen in the liver already, the liver turns fructose into triglycerides (a form of fat).  Triglycerides can accumulate in the liver, potentially causing damage; triglycerides in the blood stream can contribute to build up of plaque on the walls of your arteries.  (Note: the science is still sorely lacking on the exact nature and extent of the effects of fructose on the liver in humans. Scientists who want to read some of the biochemical and proposed mechanistic details can start here.)


So, because the calorie content of sugar and fructose containing sweeteners are similar, you are not doing your waistline any favors by selecting fructose sweeteners.  Agave syrup, which is a popular sugar substitute in the raw food community, is another example of a sweetener heavy in fructose compared to glucose (the proportion varies by brand).   Agave is still calorie containing and is not going to benefit you from a weight loss perspective.  I have seen sites on the internet advertising agave syrup with as much as 92% fructose - this would be of particular concern to me given that excess fructose could be damaging to the liver (as above).



 (agave plant)

Fructose is often touted as a preferred sweetener for diabetics because it does not cause blood sugar or insulin to rise.  Again, because of the concerns of the effects of fructose on the liver, this is NOT a recommended approach.  Also, again, fructose is still calories and will not be an improvement to a weight struggle.  And, remember that 'fructose' sweeteners are still almost identical to table sugar in their composition (see above #2).



The bottom line is this:  We get more than enough carbohydrates through a regular diet.  We should avoid adding additional carbohydrate calories to our food (be that table sugar, high fructose corn syrup, agave, or other) on top of the sugars and carbohydrates we already get.  Period.


PS This post is dedicated to my mom - thanks for asking the great questions! :)



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Do Hormones Play A Role in Weight Loss Failure After Bariatric Surgery?

>> Tuesday, November 19, 2013




Obesity surgery is currently the most effective treatment available for severe obesity.  While the smaller stomach reservoirs that are created by these surgeries play a major role in the weight loss seen, it is becoming increasingly evident that there are many other contributors at work, one of which is thought to be alterations in various hormone levels after surgery.

I was asked to write a review article discussing what we know about hormone changes in relation to weight loss failure and weight regain after bariatric surgery, which was recently published in the journal Gastroenterology Research and Practice.  In the article, I review eight of the key hormones thought to be involved in the weight changes after bariatric surgery (from GLP-1 to PYY to oxyntomodulin, bile acids, and others), as well as what we know about the hormone changes that occur after the four main types of bariatric surgery (gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion).

In summarizing what we know about hormonal associations with weight loss failure and weight regain after bariatric surgery, there was painfully little to discuss - there is unfortunately very little data in this area.

What became poignantly clear to me from compiling this review is that more research is desperately needed to help us understand how hormones may contribute to weight loss failure or regain after obesity surgery.  As I noted in the article,

In the future, with a better understanding
of this complex arena, assessment of hormone status
could potentially be helpful in understanding the hormonal
contributors to a patient’s postoperative weight loss failure
or recidivism, potentially aiding the clinician in utilizing
appropriate targeted hormone therapy to help them achieve
successful or sustained weight loss.

This is probably not a wish I should expect to see fulfilled anytime soon - after all, pinpointing hormonal predictors of weight regain after 'regular' dietary-induced weight loss has proven evasive as well.  However, with a dedicated body of bariatric researchers worldwide, I hope that we will learn more about this important area with time. 

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Sochi Subway Squats!

>> Friday, November 15, 2013





A little Friday Fun.  Check it out - as part of a campaign to make Russians healthier, and also to promote the Sochi Olympic Winter Games, the Moscow Metro is offering metro tickets for 30 squats (instead of the usual price of 30 rubles).  I love it!!

Thanks to both Mark and Erin for the double heads' up on this awesome campaign.

Have a great weekend!

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The Interactive!! Flavor Connection Taste Map

>> Wednesday, November 13, 2013





I know, this graphic looks boring, complex and frankly overwhelming... but I promise you, it's so cool!  Read on...

Ever wonder why certain foods just seem to belong together?  For example, fish tastes great with lemon; beef goes well with potatoes.  It turns out that these foods share flavor related chemical compounds, and a new interactive map from Scientific American can show you which foods and flavors may mix best together when you are experimenting in the kitchen!


On this map, you'll find around 200 commonly used foods, spices, drinks and other ingredients, with bigger dots on the map representing ingredients with greater popularity based on a recipe database.  The higher the food is on a page, the greater number of foods that are connected to it by having flavor related chemicals in common.  Click on one of your favorite ingredients on the map, and the program will show you not only which other foods are connected to it, but also how strong that connection is (see the program's excellent explanatory guide that pops up when you first open the page).

Have fun!  My motivation in sharing this, of course, is to encourage more cooking from the home - there are no 'hidden ingredients' (such as loads of extra oil) in home cooked food that can sabotage a healthy lifestyle!

Thanks to my friend Priti for the heads' up on this awesome program!

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Portion Sizes - Coca Cola from 1974 to 2008

>> Friday, November 8, 2013






I love this - my friend and colleague Dr Pam Downey found a couple of Coke collector's glasses in her home, one of which she purchased in 1974, and another in 2008.

A picture speaks a thousand words, doesn't it.

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Barefoot Running - A Help or Harm?

>> Monday, November 4, 2013





Barefoot running has become popular in the running world in the last few years.  Advocates of barefoot running feel that since our bodies were evolutionarily designed to run long distances, it must be better for us to run barefoot as nature intended us to do.  So, what does the science tell us about barefoot running - is it really good for us, or does it set us up for further injury?


Let me ask first of all, were we actually designed to run long distances in the first place?  The theories are actually pretty convincing in this regard.  Some humans in the world still use our design for its proposed main evolutionary purpose of persistence hunting (check out my previous blog post on this, along with David Suzuki's documentary on it, here).


As for whether running bare foot is good or bad for us, a recent review summaries the research currently available on the topic.  The review is extremely detailed and I will be the first to admit that I am not a biomechanics expert - for those who want the in depth discussion, I encourage you to read the full article.  However, I would like to share the bottom lines of the article with you, as the question of barefoot running has become relevant for many people who run and aren't sure what is best.

The bottom lines are:

1.  There is still very little known about barefoot running and its relationship with injury and performance; whether barefoot running prevents or promotes injury is still unclear.   As the authors note,

The current promotion of barefoot running is
based on oversimplified, poorly understood, equivocal and in
some cases, absent research, but remains a trend in popular
media based solely on an evolutionary/epidemiological hypothesis

and anecdotal evidence.


2.  Barefoot running is not an instinctive skill, but likely to be one that requires practice to master.  Optimizing the foot strike is one key component to efficient barefoot running, and is different than the foot strike in a running shoe.  It is also not clear whether every runner is capable of optimizing barefoot running. 

3.  The actual running technique is probably more important than whether or not the runner is wearing shoes. 

So in summary:  A lot more research needs to be done to establish whether barefoot running is actually a good thing, and it is premature for the practice of barefoot running to be a disseminated practice for athletes. 


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Are Calcium Supplements Bad For Your Heart?

>> Tuesday, October 29, 2013








It is well known that adequate calcium intake is important for bone health at all ages.  Calcium supplementation is common, with 43% of American adults (and 70% of postmenopausal women) regularly taking calcium supplements.  However, there is a lot of confusing information out there, with some studies suggesting that calcium supplements may increase the risk of heart disease.

A recent article in the New England Journal of Medicine provides an excellent discussion around the controversies of calcium supplementation and heart health.   Here are some key points:

1.  The recommended daily calcium intake for Canadian adults:

  • age 19-50: 1,000 mg of elemental calcium per day (see #4 below re the meaning of 'elemental' calcium)
  • men age 51-70: 1,000 mg
  • women age 51-70: 1,200 mg
  • adults over 70 years: 1,200 mg

2.  The evidence suggesting that calcium supplements may increase the risk of cardiovascular disease is inconsistent - in other words, we still don't have a definitive answer to this question.  Compiled data from several studies pooled together (called 'meta-analyses') have suggested increased risk, while a large randomized controlled trial called the Women's Health Initiative (WHI) did not show an increased risk.  (Randomized controlled clinical trials provide more trustworthy evidence than meta-analyses do, so the fact that the WHI didn't show an increased risk carries weight.).  

It has been speculated that a sharper increase in blood calcium levels after eating a calcium supplement may result in increased cardiovascular risk, but this has not been proven. 


3.  Given that it is still not clear whether calcium supplements increase cardiovascular risk or not, getting the recommended calcium intake from food and beverages is the preferred approach.  

We consume about 300mg of elemental calcium per day from non dairy sources.  Here are some examples of dairy and non-dairy calcium sources: 
  • 1 cup of milk: 300 mg
  • 1 serving of yogurt (100g): 100 mg
  • 1 oz cheddar cheese: 200 mg
  • 1 cup low fat cottage cheese: 200 mg
  • 1 cup raw broccoli: 43 mg
  • 1 cup raw kale: 100 mg
  • 1 slice bread (commercially prepared): 30-70 mg
  • fortified breakfast cereal - varies widely - check the label!

4.  If you need to use calcium supplements over and above dietary intake to reach your recommended calcium intake, check the label for the mg of elemental calcium, as this is the value that is important.  Calcium supplements come in many different forms (calcium carbonate, calcium gluconate, calcium citrate etc), and each type of calcium supplement contains a different percentage of elemental calcium.  If your supplement doesn't say how many mg of elemental calcium it contains, here is a guide: 
  • calcium carbonate: contains 40% elemental calcium (so, if your supplement is 750mg of calcium carbonate, it contains 300 mg of elemental calcium)
  • calcium citrate: contains 21% elemental calcium
  • calcium gluconate: contains 9% elemental calcium


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White Wine Poached Salmon with Quinoa and Arugula

>> Thursday, October 24, 2013





Isn't the title just enough to get your mouth watering?!  I came across the original recipe on Epicurious, and I have modified it below to trim down on the calories while maintaining the flavor.  

Sometimes when I come across a great looking recipe, all it takes is one esoteric ingredient that I have to hunt for to make me lose interest.  This recipe calls for harissa, a North African hot chili sauce.  Instead, you can use a generic hot sauce; in that case, you can also play with the recipe below by adding a little garlic, caraway seed, and/or coriander to get a little closer to the flavor of harissa.


Ingredients: 


  • 1 cup white wine
  • 4 skinless salmon fillets (3 ounces each)
  • 1 white onion, sliced
  • 3 sprigs thyme
  • 1/2 cup quinoa 
  • 1/2 cup canned chickpeas, rinsed and drained
  • 1/4 cup raisins
  • 1 teaspoon turmeric
  • 1 teaspoon ground cumin
  • 1 teaspoon ground cinnamon
  • 1 teaspoon paprika
  • 1 teaspoon cayenne pepper
  • 2 cups arugula
  • Juice of 2 lemons
  • 4 tablespoons harissa (or generic hot sauce)
  • 1/2 cup cilantro leaves

  • Directions: 


    1.  In a large pot, boil wine and 4 cups water.

    2.  Add salmon, onion and thyme. Reduce heat to simmer; poach salmon until cooked through, about 7 minutes.   Remove salmon; cool. 

    3.  In another large pot, boil 4 cups water. Add quinoa and cook until tender, about 11 minutes (or according to package directions); drain.

    4.  Mix quinoa, chickpeas, raisins and spices in a bowl; cool.

    5.  Toss quinoa-chickpea mixture with arugula. Dress salad with lemon juice. Season with salt and freshly ground black pepper.

    6.  Divide salad and poached salmon among 4 plates. Top each salmon fillet with 1 tablespoon harissa, and garnish with cilantro.  



    Makes 4 servings.  Per serving: 

    • calories: 388
    • fat: 12g
    • protein: 24g
    • carbs: 33g


    Enjoy!


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    Risk of Cancer After Nuclear Accidents

    >> Monday, October 21, 2013





    With the recent Fukushima disaster (pictured above), the topic of nuclear disasters is at the forefront of all of our minds.  Nuclear accidents are a terrible tragedy on so many levels, from the damage done to the environment, to the effects on wildlife, the people, the society, and the economy of the country affected.    Once the initial period of damage control and clean up is tended to, the work and surveillance of the population from a health standpoint has only just begun.  A recent article in the Canadian Medical Association Journal provides a poignant reminder of this fact.

    The article by Dmytriw and Pickett describes the case of a man who developed a glioblastoma brain tumor which occurred 24 years after his exposure to the Chernobyl nuclear disaster in 1986.  The Chernobyl power plant disaster remains the worst accident at a nuclear power plant in history, resulting in radioactive fallout covering large parts of the western former Soviet Union.  While the studies in the 4 years after Chernobyl found an increased incidence of leukemia, thyroid cancer did not show to be significantly increased until 16 years after the Chernobyl accident, at which time the risk was found to be 4.3 times that of the general population.  These papillary thyroid cancers were also found to be more aggressive in their behavior than typical papillary thyroid cancers.

    Going beyond this time frame into today, now 27 years after Chernobyl, it is hard to quantify the risk of tumors caused by Chernobyl, as follow up of people who lived in the affected area becomes very difficult.  An increased risk of breast cancer and brain tumors has been suggested, but difficult to prove definitively.  In terms of distance from Chernobyl that can put a person at risk, the United Nations Scientific Committee on the Effect of Atomic Radiation (UNSCEAR) has indicated that individuals who lived as far as 2,000 km away from Chernobyl may develop cancer beyond the minimum latency times normally associated with exposure to radiation.

    The bottom line?  As health care providers, we must remember to ask about exposure to nuclear accidents, remembering that tumors can develop more than 20 years after exposure.  If you are a person that has been exposed to a nuclear disaster such as Chernobyl or Fukushima, make sure your health care providers over the long term are aware.

    Finally, cases of cancer that arise among people who were exposed to nuclear accidents should be reported to the appropriate authority, with the patient's consent.

    The Fukushima Registry for cases of cancer amongst people who were living in Japan at the time of the Fukushima disaster is accessed by emailing ftiiki@fmu.ac.jp.

    The Chernobyl Registry for cases of cancer amongst people who were living in Ukraine, Belarus or Russia around the time of the Chernobyl disaster is accessed by emailing info@nrer.ru (for Russia or Belarus) and moz@mov.gov.ua (for the Ukraine).



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    Aircraft Noise Exposure May Increase Heart Disease and Stroke Risk

    >> Tuesday, October 15, 2013





    Regular readers will know that I often talk about pollutants and chemicals in our environment that may adversely affect our health (from water bottles to soup cans to the soap we use, and many more).  I came across some interesting articles in my reading this week that add to the literature suggesting that even noise pollution may be dangerous to our health.

    In the recent edition of the British Medical Journal, there are two studies and an editorial review discussing the risk of stroke and heart disease for people who live in proximity to airports.

    As Dr Fiona Godlee, editor in chief of the journal writes:


    The first study compared hospital admissions and mortality rates for stroke, coronary heart disease, and cardiovascular disease from 2001-05 in 12 London boroughs and nine districts west of London. The researchers found increased risks of stroke, coronary heart disease, and cardiovascular disease for both hospital admissions and mortality, especially among the 2% of the study population exposed to the highest levels of daytime and night time aircraft noise.

    In the second study, researchers at the Harvard School of Public Health and Boston University School of Public Health analysed data for over six million older American Medicare recipients (aged 65 years or more) living near 89 US airports in 2009.
    The researchers found that, on average, zip codes with 10 decibel (dB) higher aircraft noise had a 3.5% higher cardiovascular hospital admission rate. The association remained after adjustment for socioeconomic status, demographic factors, air pollution, and roadway proximity.

    An accompanying editorial says the results have implications for planners when extending airports in heavily populated areas or planning new airports.



    As noted in the editorial by Professor Stansfeld, 

    These studies provide preliminary evidence that aircraft noise exposure is not just a cause of annoyance, sleep disturbance, and reduced quality of life but may also increase morbidity and mortality from cardiovascular disease. The results imply that the siting of airports and consequent exposure to aircraft noise may have direct effects on the health of the surrounding population. Planners need to take this into account when expanding airports in heavily populated areas or planning new airports.


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    Taking On Dr Oz And His 15 Superfoods

    >> Monday, October 7, 2013



    My colleague Dr Yoni Freedhoff pointed out a great article on his blog this week, speaking out against Dr Oz and his health claims. The article is written by pharmacist Scott Gavura, who started his own blog in response to frustrations with the growing use of pseudoscientific products and practices - in other words, use of (usually expensive) supplements and products for betterment of health that do not actually have any substantial science to support their use.

    Scott goes on to do a reality check on all 15 items on Dr Oz's list of Superfoods, from raspberry ketones to green tea to chia, acknowledging the benefits of some of these substances, but also pointing out where data are lacking, and where there may also be some potential harms.

    Scott echoes my own concerns about Dr Oz:

    What frustrates me the most about Dr. Oz is that he should know better. He’s a heart surgeon, (who continues to treat patients), an academic, and a research scientist, with literally hundreds of publications to his name. He has gone through the peer review process more times than most health professionals. There is little reason to expect, based on his pre-television history, that he’d be willing to build a platform to offer demonstrably bad health advice. And that’s a shame, because with a show in 118 countries that reaches over 3 million viewers in the USA alone, it could be a powerful tool for providing good health information to those seeking it. And more often than not, that opportunity is squandered.

    Out of respect for a colleague, I think, our profession has been quiet about Dr Oz for too long.  However, more and more, we are seeing all manner of health care professionals speak out about his inappropriate use of his title as a physician to tout supplements and substances that do not have scientific evidence behind them, and in some cases (such as in the case of the HCG diet) could do harm (read here about the potential harms of HCG).  

    The sad reality is that the voice of medical bloggers speaking out against these practices is diminutive in comparison with Dr Oz's capital backing and marketing power.

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    Do Group Classes Work to Improve Diabetes Control?

    >> Monday, September 30, 2013





    As the sheer numbers of people who develop diabetes continues to climb, we as health care providers need to look at creative ways to provide the in depth information and teaching that is required to help patients take the best possible care of their diabetes.   One of these approaches is to teach about diabetes in the form of group classes.  The question is, has the group teaching approach been proven to improve diabetes control?

    Many studies have actually been done on this subject, ranging from observational studies to randomized controlled trials.  A meta-analysis in the Canadian Medical Association Journal by Housden et al, which looks at all of the literature on this topic to date, found that the class teaching approach improves hemoglobin A1C (a marker of overall diabetes control) by -0.46%.  While this is only a modest improvement in diabetes control, it is not much different than the A1C improvement we may expect to see in a patient who is close to A1C targets but not quite there, following addition of another oral medication.  

    Anecdotally, I have often had my patients report back to me that they have really enjoyed being part of a diabetes education class, as it not only provides excellent information, but it also provides the opportunity for diabetics to support each other, and talk to each other about their experiences.  Knowing that you are far from alone in your diagnosis of diabetes can often go a long way to feeling secure and empowered in your journey towards improving upon your health!

    If you are a diabetic and interested in group education classes, ask your doctor what is available.  Most centres of diabetes care (including our own) offer group classes free of charge.  Give it a try!


    Follow me on twitter! @drsuepedersen

    www.drsue.ca © 2013




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    Garlic & Thyme Oven Braised Artichokes

    >> Wednesday, September 25, 2013




    Artichokes are a delicious vegetable, and well worth the small effort required to prepare them fresh. Purchased in a jar, they are usually soaked in oil, so you end up taking in many unnecessary extra calories.   Just one medium sized fresh artichoke provides a whopping 7g of fiber - one of the few foods that competes with my all time favorite source of fiber, All Bran Buds!  They seem daunting in their fresh form (pictured above) to prepare, but it's actually pretty easy.

    I have modified this delicious recipe from its original form to cut back on the calories from the oil, and have added a little water to compensate for the fluid volume.

    Ingredients:

    • 1/8 cup extra virgin olive oil
    • 1/8 cup water
    • 1/4 cup lemon juice
    • peel from one of the lemons
    • 1/4 cup white wine
    • a few sprigs of thyme
    • 2 bay leaves
    • 3 small garlic cloves, chopped
    • 1 tsp salt
    • 1/2 tsp fresh ground pepper
    • 4 large artichokes
    • 2 tbsp chopped parsley

    Directions: 

    1.  Preheat the oven to 400F. 

    2.  Combine all the ingredients except for the artichokes and parsley in a roasting pan. 

    3.  Remove the thick outer leaves of the artichokes by bending them back and pulling them down toward the stem (remove leaves that are dark green, but do not remove leaves that are green at the top and yellow on the bottom).

    4.  Snip off the tops of the leaves (at the point where the green and yellow come together) and trim around the base of the artichoke heart to smooth the sides and peel the stem.

    5.  Cut in half and scoop out the fuzzy choke with a small spoon. As each artichoke heart half is completed, add to the pan with the braising liquid, turning them to coat completely and prevent browning.

    6.  Cover the pan with a lid and cook until the hearts are tender when pierced with a knife, 30 to 40 minutes.

    7.  Remove the pan from the oven, uncover, and let the artichokes cool in the braising liquid.

    8.  Garnish with chopped parsley.

    Makes 4 servings.  Per serving (approximate): 
    • calories: 134
    • fat: 7g
    • carbs: 15g
    • protein: 4g
    • fiber: 7g 

    @drsuepedersen

    www.drsue.ca © 2013






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    A Horrifying National Post Article - Dr Sue's Radio Interview on Obesity Stigma

    >> Wednesday, September 18, 2013






    I was asked to interview on the Kingkade & Kelly radio talk show this week, in response to a recent article in the National Post.  The article, titled (brace yourself) 'Fat acceptance is not the answer to obesity', states that (AND I QUOTE):

    "Doctors rightly resent spending time and expertise helping people whose health problems are self-inflicted"

    and 

    "health professionals who judge their patients are doing them a favour"

    Really??  REALLY??  The National Post should be categorically ashamed of themselves for publication of such complete and utter trash.  I had a mouthful of things to say about this topic (as I'm sure you can imagine) - check out the recorded interview here!

    I welcome your comments.

    Follow me on twitter! @drsuepedersen

    www.drsue.ca © 2013





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    Food Fun in Finland!

    >> Monday, September 16, 2013





    When I travel, I love to observe the local food culture, to see how things differ from home, and what we can learn from eating habits in foreign destinations.  On a recent trip to Finland, there are definitely some learning points for us North Americans as to what constitutes a 'healthy' diet.

    The main message I got from Finnish food culture is: Organic is the rule, not the exception!

    Imagine my joy and pleasure to dig into a cornucopia of organic eggs, organic porridge, organic bread, organic veggies, and a sliver of wild salmon - and that was just breakfast!   When I exclaimed to the server how great it was that these foods were organic, she replied - 'Naturally.'  Indeed.  What a different taste experience it is to enjoy organically produced food!

    Perusing a travel guide, I learned that home cooking is so revered that Finland has a Restaurant Day four times a year, where anyone can turn their own home into a restaurant - neat idea!  What a great way to promote home cooking, exchange recipes, and generate a sense of community with healthy eating.

    In terms of food choices, Finns love their fiber - rye bread predominates, from breakfast to lunch to even snacking (pictured below are rye bread crisps):



    While fish is enjoyed by Finns, so are lean red meats like reindeer - I'll leave it to you to decide whether you think you'd be able to nosh on Rudolph or not.


    And while tap water is drinkable in most European countries, Helsinki's tap water is so clean that it is bottled and sold to countries such as Saudi Arabia.

    The proof of the benefits of Finnish food culture is in the numbers, with obesity rates being about half that of the USA.


    @drsuepedersen

    www.drsue.ca © 2013


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    Ending the Diet Debate

    >> Monday, September 9, 2013








    If you're a person looking for dietary advice to embark on a successful weight management journey, it can be an overwhelming and confusing task to try to navigate all the information that is out there.   I am often asked by my patients about the Zone, Atkins, Paleo, South Beach Diet, and many others.  The question is, is there a certain type of food, or proportion of protein, carbohydrate, and fat that makes up the magical formula to successful weight loss?

    The answer to this question, as summarized in a recent article by Dr Sherry Pagoto in JAMA, is that research does not support that any one diet composition is better than another to result in successful weight loss.  As Dr. Pagoto notes,

    "The ongoing diet debate exposes the public to mixed messages emanating from various trials that have yielded little but have heavily reinforced a fad diet industry."

    What does matter is adherence - in other words, when you start a food plan, can you stick to it in the long term?   I don't use the word 'diet' when I'm counselling my patients - I use the words 'permanent lifestyle change'.    Don't bother making a change unless it is a change that you can stick to for the rest of your life - doing a certain program for the short term may help you to lose weight, but when you stop the program, what will happen?  The reality is that about 95% of people will regain the weight, and then some.

    Remember that it's not about dropping weight fast - a plan that results in rapid weight loss is probably quite drastic, and is unlikely to be a permanent lifestyle change.  Successful weight management is about gradually losing weight (1-2lb per week) with permanent lifestyle change, and keeping it off by making those changes permanent.

    Remember that for someone with obesity, losing 5% of your body weight and keeping it off decreases the risk of developing complications of obesity and prolongs lifespan - the greatest success of all!

    @drsuepedersen

    www.drsue.ca © 2013

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    Could Obesity Surgery Increase the Risk of Colon Cancer?

    >> Tuesday, September 3, 2013




    As for any medical treatment or surgery, the decision to undergo bariatric surgery requires that the benefits and risks are carefully evaluated by the patient and the health care team.  Amongst the list of benefits, several studies have suggested that bariatric surgery decreases the risk of cancer amongst women.   Now, a new study suggests that the risk of colorectal cancer may actually be increased after obesity surgery.

    The study was an evaluation of the population database in Sweden, looking at the colon cancer incidence rates amongst men and women who had obesity surgery (gastric bypass, gastric banding, and an older procedure called vertical banded gastroplasty), compared to patients with obesity who did not have bariatric surgery.  They found that amongst those who had had bariatric surgery, the risk of colon cancer was 60% higher than those who hadn't had surgery (though the absolute numbers were fairly low - 70 out of 15,095 patients, or 0.46% of patients who had obesity surgery developed colon cancer).  Ten years after bariatric surgery, the risk of having colon cancer was double compared to people with obesity who hadn't had bariatric surgery.

    These results need to be taken with a grain of salt, as there are a number of limitations to this database analysis - for example, other risk factors associated with colon cancer such as smoking, diabetes, family history etc were not available (the interested reader can read more about this here).  The study does seem to contradict the overall protective effect that bariatric surgery is thought to have on cancer risk (for women, at least) - but then again, most previous studies have not followed up patients for as long as this one, and colon cancer is known to be a very slow growing tumor.

    Following gastric bypass surgery, it has been suggested that the lining of the intestine may change (called 'mucosal hyperproliferation'), and an increase in a pro-tumor chemical has been found (a cytokine called 'macrophage migration inhibitory factor'), though other tumor inducing chemicals (such as TNF alpha and interleukin 6) have been shown to decrease after bariatric surgery.  The population of intestinal bacteria change after surgery as well, and there is still much we don't know about the effects of these changes (though there appear to be metabolic benefits of these post-surgery bacterial changes).

    So where does this leave us?  Well, there are still many questions to be answered about the long term efffects of bariatric surgery, which only time will teach us.  In the meantime, we must continue to carefully weigh the benefits and risks of obesity surgery, and for patients who have had bariatric surgery, colon cancer screening and surveillance should be undertaken.

    @drsuepedersen

    www.drsue.ca © 2013


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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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