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Calgary Flooding and The Calgary Spirit!

>> Saturday, June 29, 2013

It's been just over a week since a devastating flood caused the evacuation of 100,000 Calgarians, destroying thousands of homes and businesses in the city.  I have been in the heart of it all, with our own personal home being affected.  While this may be viewed as very unlucky by many, I choose to find the positive in the situation, and here it is:  Through the last 9 heart wrenching days, I have seen kindness, generosity, and the true spirit of Calgary as I have never experienced it before.

Firstly, we have experienced kindness, generosity, and love from our family, friends, and colleagues that has truly gone over and above anything we could ever have expected or dreamed.  We have had dozens of people at our home, day and night, helping us destroy what was damaged, clean up what remains, and supporting us emotionally as well.  Our entire block teamed up together as one huge demolition crew, everyone working together for the greater cause of getting our community cleaned up and making sure everyone was taken care of.  We have shared in everything from cleaning supplies, to lifting muscle, to food and drink to even toilet paper!

On the second day, a minimum of 100 orange clad volunteers from Samaritans' Purse showed up on our street and by the end of that day, almost every basement had been stripped down to the concrete.  We have encountered dozens of total strangers bringing us more food than we could possibly eat, drinks, cleaning supplies, tools, and anything else needed in a constant flow.

Overarching all of this is Mayor Nenshi, who has done a more than exceptional job in handling this enormous disaster.  In usual Nenshi style, he has used the power of social media to keep Calgarians informed and updated of any dangers, new developments, or procedures requiring adherence such as initiating evacuations, notifying of road closures, limiting water and electricity use.  In addition to handling all elements on a municipal level with extreme competence, expediency and grace,  Nenshi has also been hard at work on the street level to assess the situation and bring some positive spirit along with him - he knocked on my door last night just to see how I was doing - what mayor does that?! 

So - has Flood 2013 been a devastating event?  Absolutely.  But are we fortunate to be proud Calgarians?  More than ever before.

And PS - Yes, the Calgary Stampede will go on!!

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Flooding in Calgary

>> Saturday, June 22, 2013

My heart goes out to everyone in my city who is suffering during this time.  We are a strong city, and strong people, and we'll make it through.

My house is in that picture somewhere, so will be offline for a while.

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


An App For Helping Doctors Choose Type 2 Diabetes Treatments - From the Canadian Diabetes Association!

>> Wednesday, June 19, 2013

As blogged previously, the Canadian Diabetes Association released the 2013 Diabetes Guidelines in April this year.  As part of the excellent CDA 2013 website, there is an app that can help health care providers choose the best medications to treat each patient with type 2 diabetes.

The reason for this app being developed is because after metformin (which is considered the best first line treatment), all other treatment options for type 2 diabetes are on an even spectrum without one in particular favored over another, with the best choice made in a patient-specific fashion.  It is important to think about each patient's individual characteristics, and medication characteristics, in choosing the next best treatment for your patient.

The app starts by asking the health care provider what the glucose control target is for their patient (A1C).  Next is a quick yes/no checklist asking about other medical conditions that can impact the best choice for medication (eg bone disease, heart failure, pancreatitis history). The health care provider then clicks 'INDIVIDUALIZE', and the app will remove undesirable treatment options from the lengthy list of choices.   The remaining agents in the table are the medications that you can then consider discussing with your patient.  Under the table, the agents that have been removed as choices are listed, and the reason why they were removed is stated.

With all of the different medications available to treat type 2 diabetes (with new drug classes likely just around the corner as well), after metformin, it can seem a daunting task to choose the best agent(s) for our patient.  This app lends a hand to help doctors narrow down the choices in a patient specific manner.

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Does Obstructive Sleep Apnea Cause Low Testosterone in Men?

>> Sunday, June 16, 2013

I've been thoroughly enjoying my second day of completely geeking out at The Endocrine Society meeting in San Francisco!  I've been attending session after session until it feels like my head is going to explode (and loving every minute!).  As always at this conference, my head is swimming with new ideas, new research findings, and as always, important clinical pearls.

One of the most interesting talks I went to today was about the link between obstructive sleep apnea (OSA) and low testosterone levels in men, given by Dr Gary Wittert from Australia.  We know that men with OSA are at risk of having low testosterone, and Dr Wittert helped to clarify this relationship for us.  

The summary of Dr Wittert's presentation is that the common link here seems to boil down to obesity.  We know that both sleep apnea and obesity are associated with low testosterone levels, and when you pick apart the data, obesity appears to stand alone as a risk factor for low testosterone.  In other words, sleep apnea itself is not a risk for low testosterone levels - the risk is mediated by obesity.  We often see low testosterone levels in men with obesity - while there are many possible causes that need to be checked for, we often end up with the finding that the pituitary's control of testosterone seems to be relatively suppressed in obesity, for reasons that remain somewhat unclear.

Dr Wittert described that when you treat a patient who has sleep apnea with a CPAP machine, use of the CPAP in and of itself does not result in improved testosterone levels. However, weight loss in the patient with obesity and low testosterone does clearly improve testosterone levels (and improves sleep apnea as well).  By the way, untreated sleep apnea can be a barrier to effective weight loss, so CPAP may well be needed to start the cycle of weight loss, thereby improving the sleep apnea and, by virtue of the weight loss, helping to normalize the testosterone levels.

So, the bottom line here is that weight loss is the important key to treatment in the man who has sleep apnea and low testosterone levels, as that weight loss can improve both conditions.

You can read about whether you are at risk of obstructive sleep apnea here.

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Why Are Obesity Medications So Few?

>> Saturday, June 15, 2013

At the Endocrine Society meeting in San Francisco which I am thrilled to be attending, I began today by listening to Dr Caroline Apovian of the Boston Medical Centre describe the background behind why there are so few medications available to treat obesity.

Worldwide, there are only a few meds available to treat obesity - contrast this with the several dozens of medications available to treat high blood pressure or type 2 diabetes.

The first issue Dr Apovian talked us through is the history of medications previously used to treat obesity, which were subsequently withdrawn from the global market due to safety concerns.   'Fen-Phen', a combination of fenfluramine and phentermine, was withdrawn in 1997 as it was found to cause valvular heart disease (attributed to the fenfluramine component); rimonabant was withdrawn due to concerns regarding potential psychiatric side effects and suicide risk; sibutramine was withdrawn in 2010 due to concerns that it may increase the risk of cardiac events in high risk patients.  This track record made the FDA reluctant to approve any new medications for obesity for a full 13 years until two new medications were ultimately approved by the FDA in 2012 (you can read about these approvals here, and here).  

Another reason why the FDA is extremely hesitant to approve obesity medications is because of the large number of people that could potentially be exposed to these medications, with 33% of American adults currently meeting the BMI criteria for obesity (you can calculate your own Body Mass Index in the right hand column here).  For example, the recently FDA-approved medication for obesity called Qsymia, which is a combination of the migraine and antiseizure medication topiramate (Topamax), and the stimulant phentermine, was originally rejected by the FDA, despite both medications being available for years individually.   One of the reasons why the FDA rejected this combination initially was due to the fact that topiramate can cause birth defects.  Given that this drug has long been used for years in reproductive aged women for migraines or epilepsy, it would seem that the same precautions would apply (eg to ensure adequate contraception is used).  Presumably, the FDA was worried about the sheer numbers of women that would be exposed to topiramate as an obesity treatment with the concomitant risk of birth defects.  They ultimately did approve the combination therapy for obesity, in 2012.  (There are other safety concerns as well, which you can read about here).

A final reason that needs important emphasis, is that there is still sadly a strong stigma around obesity, in general society but also sadly within the medical community.  For example, it is only recently that obesity was even formally recognized as a chronic disease by the medical community.  

Put all of these issues together, and the context becomes one of extreme difficulty in gaining approval for new obesity treatments.  Clearly, safety is paramount and always the #1 concern, but each medication should surely be evaluated on its own merits, and not on the basis of fear generated by other medications that failed in the past.  On an individual level, side effects should be considered equally important, regardless of whether 100 people or 100,000 people are candidates for treatment.  Finally, there is no place for a stigma of any kind against any medical condition, and stigma must not stand in the way of moving forward in developing new ways to treat the chronic medical condition of obesity.

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Google's New Nutrition Search

>> Thursday, June 13, 2013

This week, Google has added a new feature to its search engine - a new nutrition database.

Now, if you type in for example 'chicken breast nutrition', you'll see the usual list of links pop up, but now, in the right of the screen, you'll also see nutrition information automatically pop up.  From there, there is a drop down menu if you want to select a different type of chicken (eg chicken thigh), and there's also a drop down box to select the desired portion size (eg per 100g, per half breast, etc).

The data is pulled mainly from the US Department of Agriculture's database.

My review so far?  Mixed at best.  It appears to be a fairly accurate (based on my searches so far) and convenient resource for searching singular/simple food products such as 'halibut', 'orange', and so forth.   However, if you search for example 'hamburger', it spits out 354 calories for 1 burger.  Of course, we know that the number of calories in a burger varies wildly, depending on the size, patty thickness, where it is purchased from, etc.  They have also not yet added any brand information, so if you try to search 'All Bran nutrition' or 'Starbucks nutrition', nothing comes up (other than the usual links).

I do give kudos to Google for taking this step in helping the public find nutritional information, but their database is currently only really useful for ingredients for recipes or very simple, singular food products.  I'd suggest not relying on any meal information (eg burger, burrito, taco etc), as these cannot be relied on due to the huge variation in the marketplace.

I know Google is working hard to improve the database, and hopefully it will become more useful for combination meals as their hard work continues.

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Born To Run!

>> Monday, June 10, 2013

This week, I'd like to share with you a really cool documentary that I just watched, called The Perfect Runner, on The Nature Of Things by David Suzuki.  I think it gives a very real context to the obesity endemic that we currently face.

The Perfect Runner is about the bipedal (walking on 2 feet) nature of humans, and the contrast to most other land animals who walk on 4 feet.  They describe how humans are very unique in that we were designed for endurance running, whereas most other animals were designed for sprints.  They show video footage of the last of 'persistence hunters' in the world, essentially, humans who hunt animals by chasing them, and catching them successfully - it's true!

This is how persistence hunting works:  Running creates heat generated from muscle energy, and the only way that an animal can release this heat is by panting.  Thus, after a sprint, the animal's body temperature starts to climb, and they have to stop to allow themselves to cool off again.  However, if they are chased long enough, there is not enough time for them to cool off between sprint burts.  Contrast this with humans - we are able to sweat, so we can keep our body temperature the same while we run, and therefore, we can run for much longer periods without having to stop.

So, the persistence hunter basically jogs after the animal for hours, and ultimately it gets such a high body temperature from the repeated sprinting without having enough time to cool off, that it just stands there and watches while the jogging human throws spears at it from a few feet away.  Pretty powerful stuff.  Scientists believe that we were all persistence hunters in the past, until we invented tools and arms that allowed us to hunt from a distance, with progressively less effort involved to catch our prey.  (Fast forward to the current time, where Homo sapiens can often be spotted in the wild, catching our prey at a drive through window.)

What this documentary really impressed upon me was just how different our current environment is, compared to how we were meant to live.  We were evolutionarily designed to exercise for hours on end to chase our food, and now we not only don't have to chase our food, but we don't have to move much at all in our daily activities of life if we don't make a conscious choice to do so.

Our toxic environment is perhaps the most formidable opponent that humankind has ever encountered.

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


What the World Eats

>> Thursday, June 6, 2013

I'm excited to share with you an article from The Daily Mail UK which very poignantly shows the difference in how different families eat (and what they spend on food) around the world.   Journalists visited 30 countries and asked regular families to take photos of what they would bring home from the grocery store to eat in a typical week.

One of the top scores for a balanced diet, in my books, goes to the Egyptian family pictured above.  Note the proportion of veggies relative to meat!  Leaner cuts of meat (or fish) would be preferred, and I'd switch up the pop for water (or diet pop at least), but overall they are doing pretty well.  I must say that when I travelled Egypt years ago with my best friend Deb, I remember enjoying lots of healthy (and very tasty) meals - it's amazing what Bedouins can whip up in the middle of the desert under a starlit sky.

Now let's visit a family in Bhutan (above).  Again, lots of veggies, but definitely lacking in protein sources, likely due to lack of accessibility.  (Thankfully, the WHO Bhutan program has been working on improving nutritional issues in this country including anemia and protein energy malnutrition.)

Family Japan (above) is doing a great job, with excellent protein sources (lots of fish), though they could go a little heavier on the vegetables.  Japan has one of the lowest obesity rates in the world. There are many things we can learn from how the Japanese prepare their food as well, and how this thoughtful preparation can result in lower calorie intake - see my thoughts re the bento box here.

Now let's contrast family USA (above) with family Egypt (at the top).  Note the dramatic difference in prepackaged foods, sore lack of vegetables in the US family's weekly shop, and the carbs, fat, and fast food that dominate the American diet.  Notice also how much food the US family of 4 consumes in a week, compared to the food consumed by Egyptian family of 12!  USA has one of the highest obesity rates on the planet.

And how did family Canada do?  Interestingly, the journalists chose a family from Nunavut, represented above.  I'm pleased to see not too much packaged food, some great fish protein, but again, vegetables fill far less of the table than many other countries' families studied.

Clearly, these families are just one from each country, and what different families consume in each country will vary greatly.  What families around the world are able to purchase also depends heavily on both physical accessibility, as well as the cost of food.  Note from the article that the cost of family Egypt's food was 43 GBP (about $66 USD) for the week, whereas the green peppers and tomatoes on that table alone would cost at least that much in Canada. (This cost has to be balanced against the typical income in each country as well, so.... it's complicated!)  However, it is very interesting and educational to have a flip through all of the countries studied in the article itself, and to ponder how the typical food choices of each family relate to the prevalence of obesity in each of their countries.


Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Food Porn - How It Affects Your Hunger Hormones

>> Tuesday, June 4, 2013

It's a funny term but it's out there - there's even a wiki definition - food porn is a very real entity that permeates our daily life.  It's tough to get through an hour, let alone a day, without being assailed by all manner of delectable, touched-up photos of mouth watering food in a magazine, on TV, at the grocery store, or just walking by a billboard on the street.

An interesting study from Germany evaluated the response of 8 healthy men to pictures showing food, compared to pictures showing something other than food.  They found that the only known human hunger hormone, ghrelin, was higher during the 30 minutes after the food pictures were presented, compared to the 30 minutes before the pictures were presented; and, that the ghrelin levels after the food pictures were presented were higher than after non food pictures were presented.

So, this shows us that there is a very real hormonal effect to flashy food photos, that drives our hunger and tells us to eat.  As for avoiding them... well, that's the tricky part.  Choosing active pursuits over TV is a good one.   Please leave a comment at the bottom of this blog post to share your ideas!

Dr Sue Pedersen © 2013 

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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