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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 © 2013


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.


  • 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


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 © 2013


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"


"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 © 2013


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 © 2013


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 © 2013


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 © 2013



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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