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The Low Down on Electronic Cigarettes

>> Monday, March 31, 2014





For many Canadians (and Canadian doctors), e-cigarettes are an enigma wrapped in a mystery.  Though they are not regulated or approved for sale in Canada, they seem to be finding their way across the border in increasing quantities.  The Canadian Medical Association Journal published a couple of great articles about them in a recent issue to teach Canadian doctors what e-cigarettes are all about.   Here are some key points:


1.  What are e-cigarettes?

They are canisters shaped like cigarettes, which release vapor containing flavoring agents, other chemicals, and sometimes nicotine.  They are intended to simulate smoking without exposure to as many chemicals as tobacco.


2.  Are e-cigarettes safer than smoking regular cigarettes?

Hard to say.  Some studies show that e-cigarettes contain some impurities and carcinogens; also, the ones that contain nicotine still promote the nicotine dependence that keeps people addicted to smoking.  Even worse, smoking e-cigarettes could induce an addiction in someone who was previously a nonsmoker.

3.  Are e-cigarettes useful to help someone stop smoking?

Again, hard to say, as they have not been well studied. One randomized controlled clinical trial was not able to show superiority compared to nicotine patches. Contrast this with several other medication and behavioral approaches to smoking cessation which have been proven effective in clinical trials (the list is available here).  Also, I would add to this discussion that stopping the physical behavior of smoking is an important component of stopping smoking as a habit - in other words, the action of e-smoking may be too close to actual smoking to actually help a person to break the behavior.


A concern in the US is that e-cigarette companies are free to tempt American youth with fruit flavored e-cigarettes and celebrity endorsements, effectively resurrecting marketing campaigns that the tobacco industry used to use.  Thus, there is a fear that the e-cigarette industry could lure young people (or anyone for that matter) into nicotine addiction and possibly subsequent tobacco use.

So, while e-cigarettes may seem like a good idea on the surface, they have a dark side: those that contain nicotine propagate the addiction and may not effectively help people quit smoking; and even worse, they may lure non smokers into the dangerous world of smoking addiction.

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#1 Top Post Of All Time on DrSue.Ca - Never Trust A Skinny Chef

>> Friday, March 28, 2014






As much as everyone enjoys eating out, it can really be hazardous for someone trying to lose weight, as restaurant meals are a notorious source of hidden calories and huge portions. As such, research is being done to try to figure out how best to cut back on those calories, while preserving the experience and taste sensation of eating out.


Research presented by Dr. Barbara Rolls and colleagues at the recent Obesity Society meeting asked chefs how they thought the industry could best help out to shave calories in light of the obesity epidemic.


These chefs were more interested in creating new inventions for calorie-savvy customers, rather than changing their existing dishes: 67% thought that introducing a new reduced-calorie item would sell well, whereas only 44% felt reducing the calories in an existing item would be successful.

They were also divided on whether putting calorie information on the menu would hurt or help sales. Interestingly, a separate study from New York examined the effects of mandatory calorie labeling, which went into effect in fast food restaurants in their city in July 2008. It was found that although some people said they were purchasing fewer calories based on this information, there was actually no difference in the average number of calories people purchased before vs after the implementation.

In a previous survey study, chefs also admitted that they ladle up serving sizes that are two to four times the size of recommended servings!

Where does this leave us? Well, it is unlikely that restaurant food will ever be uniformly 'safe' to eat from a dieters' point of view, regardless of how many reduced calorie options show up at your favorite spot. The definition of 'reduced calorie' or 'reduced fat' remains somewhat nebulous, and remember that low fat dishes often replace the missing fat with sugar, which can bring the calorie count right back up to equal or exceed the high fat version! The best thing to do when eating out, is to bring the following principles with you:


  • Cut your portions in half. Ask your waiter to bring half your meal in a take away container before it even hits your plate.
  • Do look for options labelled as 'reduced calorie' or 'low fat' on the menu, as they are probably better options - but cut your portion in half as well. Ask your waitress what changes were made in the dish to make it healthier.
  • Opt for the dishes heavy in fresh greens, such as salads. Get your dressing on the side!
  • Give the menu back to the waiter as soon as you have ordered, to avoid the temptation to order dessert!
  • Choose restaurants that specialize in fresh food - this can be anything from sushi to Subway! It is harder to hide calories (eg cooking oils, sauces) in food that is fresh.

Gone are the days where we should say "Never trust a skinny chef!"


Dr. Sue © 2009 

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#2 Top Post of All Time on DrSue.Ca - Metabolic Syndrome in College Football Linemen

>> Thursday, March 27, 2014






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 www.drsue.ca © 2012


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#3 Top Post of All Time on DrSue.Ca - FDA Gives Thumbs Up to Lap Bands, But Research Gives Thumbs Down

>> Wednesday, March 26, 2014




For some individuals, despite intensive and longstanding attempts at shedding pounds and exhausting every possible lifestyle intervention or medical therapy, weight loss remains elusive.  In some cases, weight loss surgery (called 'bariatric' surgery) may be the most appropriate option.  Bariatric surgery has typically been reserved for the most extreme cases, but recently, the American FDA has lowered the Body Mass Index (BMI) requirements for eligibility to undergo laparascopic adjustable gastric banding ('lap band') surgery.


As blogged previously, bariatric surgery has traditionally been reserved for the most serious cases of obesity, defined as a Body Mass Index of 40 or greater, or, a BMI of ≥ 35 with one or more serious complication of obesity, such as diabetes, obstructive sleep apnea, or high blood pressure (you can calculate your own BMI in the right hand column here).  However, because of the impressive success that bariatric surgery can have to result in weight loss and reduce complications of obesity, the FDA has lowered the required BMI for a patient with a serious complication of obesity to 30 for the lap band procedure.

However, as blogged previously, recent study suggests that lap banding may actually have a poor long term outcome.   It is interesting that the FDA seems to be embracing the most extreme of obesity treatments by expanding indications for bariatric surgery, in a form that may be associated with poor long term outcomes, while simultaneously (and in some experts' opinions, perhaps stringently) rejecting a lineup of three potential new weight loss medications in the last year.


For Canadians, the BMI criteria for bariatric surgery remain unchanged.  If we were to follow our US counterparts with a broadening of the BMI criteria, it would make little practical difference in any case, as the average wait time for bariatric surgery across Canada is over half a decade.  In addition, in light of recent study suggesting that lap banding may have a poor long term outcome, other types of bariatric surgery (such as gastric bypass) may be more appropriate to consider, though these other forms of surgery have a significant risk of complications as well, and long term outcomes of these procedures are not yet well known.


Dr. Sue © 2011   www.drsue.ca  

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#4 Top Post of All Time on DrSue.ca - Benefits to Barley and Buckwheat? The Low Glycemic Index Diet

>> Tuesday, March 25, 2014



Amongst the plethora of weight loss strategies that abound out there, the Low Glycemic Index Diet is touted as yet another way to 'guarantee' substantial weight loss. Let's debulk the mystery - is this fact or fiction?

The Glycemic Index of a particular food refers to the rapiditiy with which the sugars (carbohydrates) in that food are absorbed into our bloodstream. Technically speaking, it is defined by the incremental rise in blood sugar after ingestion of 50 grams of a particular carbohydrate, compared to 50 g of a reference food, which is usually white bread. White bread has arbitrarily been set to have a glycemic index (GI) of 100. A low GI food has a GI of less than 55, while a high GI food has a GI of more than 70.

There has been much controversy as to whether a low GI diet actually results in weight loss. Overall, studies show that a low GI diet is NOT particularly effective, resulting in a 2 lb weight loss over the course of 6-12 months, with a 10-15 GI difference between diets. As low GI diets are usually also high fiber diets, it may actually be the higher fiber content of the low GI diet that is responsible for any weight loss that is seen, as fiber helps to keep us feeling fuller longer, therefore resulting in a lower caloric intake overall.

For diabetics, however, glycemic index is a very important consideration, as a lower GI diet helps to control the rise in blood sugar that is often seen after eating. Having said that, however, the glycemic index has its limitations, as it tells us nothing about the quantity of carbohydrate, only about the quality of carbohydrate.

Therefore, it is not only the glycemic index, but also the Glycemic Load that is important. The Glycemic Load is defined as the GI of a food, multiplied by the number of grams of carbohydrate in a serving of that food, thereby capturing both the quality AND quantity of carbohydrate intake. In other words, if you consume a low GI food (eg brown rice, GI=50) but a large quantity of it (resulting in a high Glycemic Load), the quantity of carbohydrates can contribute not only to a post meal glucose rise, but also to significant weight gain. Thus, it is important to exercise portion control in order to limit the Glycemic Load of a meal.

To improve diabetes control, and to assist in weight maintenance, a few important tips are as follows:

1. Switch up your high Glycemic Index foods for lower GI foods. Examples are to exchange white bread, pasta, or rice, for brown. Try incorporating some interesting carbohydrate alternatives such as pearl barley (pictured above, GI=25-33), lentils (GI 21-30), or buckwheat (GI=50-54).

2. Exercise portion control to limit your Glycemic Load!

3. Balance your meal: including protein, a small amount of fat, or a more acidic content to your meal decreases the Glycemic Index of your meal overall, and can decrease post meal blood sugars by as much as 20%!


Dr Sue Pedersen www.drsue.ca © 2010

Follow me on Twitter for additional tips and pearls! @drsuepedersen

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DrSue.ca Turns Five!

>> Monday, March 24, 2014





This week marks the 5 year anniversary of DrSue.ca!  It's been a wonderful ride so far - in the last half decade, I've enjoyed sharing knowledge on topics ranging from what we can learn from elephants about healthy eating, to the dangers of the very low calorie diet, to inspirational stories about diabetics overcoming their challenges, to a variety of mouth watering recipes (often sent to me by my readers!).

Over the course of this week, I'll post the most read articles of all time from www.drsue.ca - stay tuned!

A sincere thank you to all of my subscribers and readers around the world for allowing me to share this information with you.  I have no doubt that the next five years will be even more interesting and fun!

Follow me on twitter: @drsuepedersen

www.drsue.ca © 2014




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The Air Bag for Cyclists

>> Monday, March 17, 2014




Here's an innovative way that Scandinavians are trying to improve cycling safety in commuter cyclists who don't use helmets (and perhaps also a clandestine effort to maintain some semblance of a hairstyle?!).

Meet the Swedish Hövding Air Bag - it's a zip bag worn around the neck (kind of like a neck warmer) that releases an airbag in a helmet shape upon sudden impact (check out the video to see how it works).

Some view this as potentially even safer than a traditional helmet, because it:

  • Dissipates shock better with an airbag
  • Protects the lower back of the head
  • Does not twist the neck as the head is not locked to the helmet
  • Supports the neck with a collar when inflated

Downsides of the Hövding?  It's expensive - around $500-600 - and from what I can gather, it can only be deployed once.  Also, deployment of the airbag is stimulated by a sudden impact.  So, what happens if you lose balance and just fall off your bike, with no sudden impact causing you to fall?  Will it deploy in time? Or if you fly over your handlebars head first, the head would be the first point of impact and therefore I can't see how there would be a stimulus to deploy ahead of time.  So it may not be a good choice for road riders and certainly not mountain bikes - more for the relaxed cycle commuter that permeates European culture.

Many European countries do not mandate helmet use, and may be hesitant to mandate them due to a fear that this will discourage people from using their bicycles as daily transport.  It seems like this could be a good alternative to the traditional helmet for commuter purposes.... but probably needs some user experience and time before we can know for sure.

And somehow, they've managed to make it look like it walked right off a European fashion runway....




Thanks to my friend Craig for the heads' up! (pun intended, haha)

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www.drsue.ca © 2014


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Help Pomeroy the Penguin Stop Fat Bullying

>> Monday, March 10, 2014




Bullying and stigmatization of people with obesity happens, sadly, at all ages.  One of the most impactful things we can do is teach our children about the harms of bullying, so that this generation grows up understanding that stigmatization of any kind is hurtful and wrong.  
Today's post is dedicated to the children's book project, Pom Pom - A Flightless Bully Tale, by Linnie Von Sky (who has previously held the position of Director of Stakeholder Relations for the Canadian Obesity Network).  It's about a slightly rotund penguin called Pomeroy Paulus Jr III.


Like any boy his age he's busy trying to impress 'the birds', namely one bird: Pia. Pomeroy dreams of a pair of orange swim trunks; the ones that Pete, Pucker and Piper own. The same ones Pia said she loved. There's just one little hiccup. The antAmart doesn't carry his size. 

Stay tuned to learn how mom helps Pomeroy get his orange swim trunks, see that Macaroni penguins are not made of mac'n'cheese, and watch Pia save the day when she puts bullies in their place. 

By supporting Linnie's publication dream, Linnie writes:

♥  You'll help us stand up against bullies and lend your voice to someone so big that his voice has become small: Fat jokes are not funny and they hurt!
♥  You'll allow us to produce (illustrate, edit, scan, post produce, book design & print in Canada) every part of Pom Pom - A Flightless Bully Tale 
♥ You'll own a copy of the book you helped us publish (and maybe even your own custom antarctic character)
♥  You'll help fund Rebecca's 2nd year of Art School. By paying Rebecca (21) real market value for her art work we were able to fund her first year of Art School with Our Canadian Love Story (Linnie's 1st book) without her having to bag groceries. How cool is that?

Click here to join Linnie's campaign against fat bullying - she's already a third of the way to her goal!

Follow me on twitter: @drsuepedersen

www.drsue.ca © 2014


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Could Cinnamon be... Dangerous?

>> Monday, March 3, 2014




Cinnamon first came to my attention over a decade ago, when a randomized clinical trial was published suggesting that cinnamon improved blood sugars and cholesterol levels in people with type 2 diabetes.  Another randomized controlled trial confirmed the improvement in blood glucose as well.  However, the quantities used were quite large, up to 6 grams per day - imagine dumping that amount of powder on your cereal in the morning?!  Ick.

It turns out that taking in generous quantities of cinnamon may in fact be harmful - depending on what kind of cinnamon you consume.  The most common type of cinnamon sold is cassia cinnamon, which contains a natural but toxic component called coumarin, which has been associated with possible liver toxicity. This is contrasted with ceylon cinnamon, which is thought to contain little coumarin.

It actually doesn't take that much cinnamon to exceed the daily tolerable intake of coumarin - as little as a teaspoon (which is just under 3 grams) of cassia cinnamon per day may be too much.

This has lead to an outrage and heartbreak in Denmark, where the cinnamon bun or kanelsnegle (a staple Danish bakery product) has come under attack following the EU's recent moves to limit cinnamon consumption due to the risks noted above.



So, cinnamon is not a great treatment for patients with diabetes - cassia cinnamon must not be taken in the quantities needed to have an impact on blood sugars due to possible toxicity, and eating that amount of ceylon cinnamon every day just isn't practical.

Follow me on twitter: @drsuepedersen

www.drsue.ca © 2014





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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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