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The Legacy Effect - Good Control of Diabetes Prevents Heart Disease 30 Years Later

>> Wednesday, February 24, 2016

A lot of people with diabetes wonder why their doctors and diabetes educators are seemingly obsessed with keeping blood sugars as close to normal as we can.  After all, blood sugars that are only mildly elevated usually don't come with much in the way of symptoms.

The point to keeping sugars as well controlled as possible is to prevent complications of diabetes developing over time - this includes damage to the eyes, heart, kidneys, and nerves in the feet and elsewhere in the body.

And - a new paper published has now shown us that the benefit of good control of diabetes to prevent cardiovascular disease persists for at least thirty years!

The study, which was recently published in the journal Diabetes Care, evaluated patients 30 years after their initial participation in the famed (well, famous in the diabetes world anyway) DCCT trial.  This was a clinical trial that enrolled 1,441 patients with type 1 diabetes, and assigned them to receive either more intense, or less intense, control of their blood sugars for a mean of 6.5 years.

During the 30 years of follow up, they found that the people who were in the tightly controlled group 30 years previously had a 30% reduction in the risk of developing cardiovascular disease, and a 32% reduction in the likelihood of having a heart attack, stroke, or dying from a cardiovascular cause, compared to those who were in the less tightly controlled group.  The tighter blood sugar control during the time of the original 6.5 year study was statistically responsible for all of the difference in cardiovascular disease between the two groups.

This data really impresses upon us the power of what we call the 'legacy effect' - good control of diabetes early on prevents complications later in life.  (Note: there is a similar trial in type 2 diabetics called the UKPDS study, which also showed that the legacy effect exists 10 years later.)

I think it is challenging for all of us to look forward 30 years into the future, and think about the importance of what we are doing now to our future self.  That being said, if you think about it, we actually spend a lot of our lives planning for our 30+ year future self.  Take financial planning, for example - most of us structure our home purchases, savings structures, and investments with the goal of planning for the distant future.  As I see it, planning for our health in the future is actually no different - and for people with type 1 diabetes, we now have very long term data to back this up.

Follow me on twitter! @drsuepedersen © 2016


Natural Remedy Star Fruit Causes Kidney Damage

>> Thursday, February 18, 2016

It is often in my day that people tell me that they are taking natural remedies for any number of medical conditions - for aches and pains, diabetes, obesity, cancer prevention... the list goes on.  The thinking that often underlies the decision to take these remedies is that they are natural, so how could they possibly be harmful?

I worry about my patients taking natural or naturopathic products, because rigorous clinical trials are not done to show benefit, nor (most concerning) to understand potential harms.  So, when I came across two very serious case reports of kidney damage from the seemingly innocent star fruit, I wanted to share it to illustrate the potential dangers of natural remedies.

Star fruit comes from a tree native to India and southeast Asia.  In addition to eating them as a fruit (I've enjoyed them myself on occasion while traveling to these areas), they are also touted as a herbal remedy for various ailments (including diabetes) in these countries.

Recently, two cases of star fruit toxicity were published.  One case was that of a woman with type 2 diabetes who consumed 200 mL of star fruit juice (less than a cup) from six star fruits, which resulted in kidney failure due to an inflammatory reaction in the kidneys (acute interstitial nephritis) caused by the high oxalate content of star fruit.  Thankfully, with medical treatment, her kidneys recovered.

The second case was that of a man with a history of moderate kidney dysfunction, who developed kidney failure after eating four star fruits over four days.  Thankfully, he also recovered after about 2 weeks.

In addition, like the grapefruit, star fruit also inhibits a group of liver enzymes (cytochrome P450 isoforms) which are important for metabolism of medications such as statins (cholesterol medications).  This is why it is advised for patients on statins not to eat grapefruit - star fruit should be included in this counselling as well.

So, take these cases into consideration the next time you think about reaching for a herbal remedy - remember that we simply do not know enough about these remedies to know if they are safe.

As a patient, be sure to tell your doctor about any natural remedies you are taking.

As a health care professional - remember to ask.

Follow me on twitter! @drsuepedersen © 2016


Is There A Stigma Against Obstructive Sleep Apnea?

>> Thursday, February 11, 2016

One of the most common complications of obesity is obstructive sleep apnea (OSA).  In my daily discussions with patients around testing and treating sleep apnea, I have often noticed that sometimes, people seem to be a little resistant towards considering that they may suffer from this condition. 

In follow up from last week’s post

Sadly, obstructive sleep apnea is not tested for often enough.  In my practice alone, I diagnose sleep apnea at least a half dozen times a week.  Amongst those in whom I suspect OSA, I have noticed that only about two thirds agree to go for testing, and only about half of those diagnosed agree to treatment.  I have also noticed that the way I start the conversation can have us ending the conversation in two totally different places.…

If I start by asking ‘Have you ever been tested for sleep apnea?’, the answer I often get is ‘No, but there is no way I have it’, or ‘No, no way, no one has ever said I snore.’  And from there I find it is often very difficult from there to convince my patient to get tested.

However, if I start by asking ‘How do you sleep?’, the answer I often get is ‘Terribly, and I am so exhausted’.  If I ask ‘Do you wake feeling unrested?’, the answer is often ‘YES!’, and at that point I start sensing perhaps even some gratitude or relief that finally, someone cares enough to ask about sleep. From there, I then suggest that we test for sleep apnea, and I find that people are often more likely to agree (though often still reluctantly) to testing.  

When I ask my patients about why they may be reluctant to consider whether they have sleep apnea, there is sadly often a feeling of shame that comes through.  They say that they feel embarrassed that their weight struggle could have led to this condition, and they do not like the idea of possibly having to wear a machine at night (called CPAP) as part of their treatment. Some have said that they see it as a label of being 'really sick' with their obesity and would be embarrassed to use the CPAP machine around their family or people they live with.

I want to put it out there for anyone that this may resonate with, that there is absolutely no shame in having sleep apnea.  This is a medical condition, just like diabetes, hypertension, or obesity, which is important to treat. People of all shapes and sizes can suffer with sleep apnea.  For people struggling with excess weight, untreated OSA is a major barrier to successful weight loss, because of the hormone changes that occur.  Not only is treating obstructive sleep apnea important for decreasing the health risks associated with it, but it is also an important part of a successful weight reduction plan in those who carry excess weight. 

Follow me on twitter! @drsuepedersen © 2016


Why Is Obstructive Sleep Apnea Dangerous?

>> Thursday, February 4, 2016

Sleep apnea is a condition where breathing becomes intermittently obstructed while we sleep.  This can be caused by having a narrowed upper airway (for example, due to large tonsils or a smaller lower jaw), but most commonly, carrying excess body weight is the culprit.  Excess tissue around the neck puts additional pressure on the upper airway structures, and excess weight on the chest and around the abdomen results in lower lung volumes and therefore less 'pull' (negative intrathoracic pressure) generated to suck air through the airway and into the lungs.  

While estimates vary, studies have suggested that about a third of adults with a BMI of 30 or greater, and about half of people with a BMI of 40 or greater, have sleep apnea (and it affects kids with obesity too).   

Obstructive sleep apnea has many negative health consequences.  Because people with sleep apnea are not getting enough oxygen while sleeping, sleep is inadequate and the body become stressed, leading to increases in cortisol, decreases in leptin, and increases in the hunger hormone ghrelin, to name a few. This promotes a vicious cycle of weight gain, which makes the sleep apnea worse.  Along with these hormone changes and stresses on the heart, there is an increased risk of stroke, heart failure, diabetes, and many other serious health conditions.   People with severe untreated sleep apnea have a 2-3 fold increased risk of death compared to people without sleep apnea, independent of other risk factors such as obesity or heart disease.

Sadly, obstructive sleep apnea is not tested for often enough.  I think this is due to health care professionals not thinking about it often enough, and, based on my clinical experience, possibly due a resistance on the part of patients themselves to consider or admit that they may suffer from this condition.  More on this next week - stay tuned.

Follow me on twitter! @drsuepedersen © 2016



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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