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Hormone Treatments for Weight Loss?

>> Monday, April 28, 2014

In our toolbox of obesity treatments, there is very little available as far as medications go.  We know that there are many hormones involved in the the sensation of feeling full (called 'satiety'), so current research is now exploring these hormones, to see if they can ultimately be developed into obesity treatments.

My colleagues and I at the University of Copenhagen have just published one such study in the American Journal of Physiology.  We studied two hormones, GLP-1 and PYY3-36, both of which are hormones that are released when we eat, working to slow down our stomachs and tell our brains that we feel full.  We looked at intravenous infusions of these hormones, to try to understand how they may work together, and how they may affect a person's desire to eat when given in combination.

We found that when GLP-1 and PYY3-36 were given together, the inhibitory effect on food intake was synergistic - ie, more than then sum of each hormone individually.  We found that these hormones together elicited a decrease in a hunger hormone called ghrelin, as well as a slight increase in nausea (due to the stomach slowing effect), but in further analyses, we found that neither of these factors was responsible for the lower amount of food that participants elected to eat after the infusions were complete.

So, this study shows us that these two hormones in combination work together in some way to give us a sense of satiety or fullness, but exactly how they work together is not clear.  One small step forward in the big picture of understanding the complex web of hunger and fullness!

Follow me on twitter: @drsuepedersen © 2014


A Different Kind of STAMPEDE

>> Tuesday, April 22, 2014

Obesity (bariatric) surgery has become accepted as an option for the treatment of type 2 diabetes by most diabetes guidelines around the world. The data on which these recommendations are based are from shorter studies, from weeks to months to up to 2 years. 

Now, in a landmark randomized controlled trial published in the New England Journal of Medicine, 3 year data shows us that the benefit of bariatric surgery to diabetes control is sustained out to at least 3 years.

The study, called the STAMPEDE study, randomized 150 people with type 2 diabetes, to receive either intensive medical treatment of diabetes alone (with a goal A1C of 6.0%), vs medical treatment plus gastric bypass surgery, vs medical treatment plus sleeve gastrectomy.

The study clearly shows that gastric bypass surgery and sleeve gastrectomy are superior to intensive medical therapy alone, to have control of type 2 diabetes at 3 years. Thirty-eight percent of patients who had gastric bypass surgery had tight control at 3 years, compared to 24% after sleeve gastrectomy, compared to only 5% receiving medical treatment alone. (The difference between the gastric bypass and sleeve groups was not statistically significant.)

With the above being said, I do take issue to how this study was structured, in that the goals for control of diabetes were too tight. We no longer recommend an A1C of 6.0% as a goal, as a landmark study (the ACCORD study) showed that control this tight was associated with an increased risk of death. It would be interesting to know how the numbers would have panned out if the commonly accepted A1C target of 7.0% was used instead.

However, the point of the article remains that gastric bypass and sleeve gastrectomy results in control of type 2 diabetes in significantly more patients than medical treatment alone. There is no doubt that Bariatric surgery is an important tool in our toolbox of diabetes therapy in the 21st century.

Follow me on twitter: @drsuepedersen © 2014


Quiche with a Spaghetti Squash Crust!

>> Monday, April 14, 2014

In pie-style foods, it is often the butter-laden and carb-heavy crust that comes with most of the caloric burden, while the contents can often be quite healthy.  I love this solution to make quiche easier on the waistline - using spaghetti squash to make the crust!  

I've taken the original recipe and modified to lose the egg yolks and I've cut down on the milk a bit as well, as I like to use lots of veggies and the extra moisture requires a little less fluid in the recipe. You can also try a leaner cheese, though the kick of the swiss cheese really tastes great.


  • 1 lb Asparagus
  • ½  of a small yellow onion
  • 2 cloves of garlic
  • 1 teaspoon olive oil
  •   1 cup of egg whites
  • 3/4 cups skim milk
  • 1 cup swiss cheese
  • ½ teaspoons salt
  • ¼ teaspoons pepper
  • 3 cups cooked spaghetti squash (about 1 small squash)
(You can cook your spaghetti squash by preheating your oven to 400ºF, lining a baking sheet with foil or parchment paper, slicing the squash in half, placing it face down and putting it the oven for about 20 minutes. Or if you are in a pinch, you can cook it in the microwave - but take it from me, that's a whole lot messier!)


1.  Preheat oven to 400ºF.

2.  Cut off the woody ends of the asparagus. Chop the onion, mince the garlic, and cut the asparagus spears into 1-inch pieces. Heat the olive oil in a pan over medium heat, and saute onion and garlic for several minutes, until the onion is soft. Add the asparagus and continue to saute until the asparagus has turned bright green and is soft but not limp.

3.  Whisk together the egg whites, milk, cheese, salt, and pepper.

4.  Grease a pie pan. Press the cooked spaghetti squash to the sides and bottom of the pan, forming an even crust. Pour the egg mixture into the pan. Add the asparagus, onion, and garlic on top of the egg mixture; be sure it sinks in.

5.  Bake for 40 minutes until quiche is firm. Enjoy!

Makes 6 servings.  Per serving, approx:
  • Calories: 135
  • Fat: 6g
  • carbs: 9g
  • protein: 11g

Thanks to my brother in law's mom (and my dear friend) Bridgette for the heads' up on this awesome recipe!

Follow me on twitter: @drsuepedersen © 2014


Landmark Study Shows Physical Activity Decreases Heart Attack Risk

>> Monday, April 7, 2014

We have all heard before that physical activity is important for overall health.  Believe it or not, it is now for the first time that we have solid evidence to prove that being more active in daily life decreases the risk of cardiovascular events (eg heart attacks) in particular.

The study, recently published in Lancet, assessed pedometer data (recording # steps per day) in over 9,000 people with prediabetes from 40 countries around the world.  They examined how many steps per day each person took at the beginning of the study and again at 1 year, and then followed them up for an additional 6 years.  They found that:

  • people who were more active at baseline (start of the study) had a lower risk of cardiovascular events
  • people who became more active over the course of a year had a lower risk of cardiovascular events at 6 years
  • for every 2,000 steps/day increase in activity over a year (about one mile or 1.6 km), there was an 8% decrease in cardiovascular events!

Prior to this study, the studies suggesting that being more active decreases the risk of cardiovascular events have been based on less rigorous data and study design.  Also, previous studies have generally been based on self reported data (ie the person in the study gauges how active they are), whereas this study objectively measured number of steps per day with pedometers.  For these reasons, this study is considered a landmark trial in that it has shown us, very objectively and in a high quality study design, that being active really does decrease heart risk in a group of high risk individuals.

See if you can find ways to take more steps in your day!

Follow me on twitter: @drsuepedersen © 2014



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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