DrSue.ca

How You Taste Fat May Be Genetically Determined

2012-01-29T08:41:00.002-07:00

As the human genome is being explored in more detail, the genetic contribution to obesity is becoming increasingly recognized. While we know of at least 45 genes that contribute to obesity, little is understood about how they work. A new study has discovered a gene that affects how we sense and taste fat in our mouths, and postulates that this gene may be one more mechanism that contributes to the development of obesity in people who are genetically prone.

The study, conducted by MY Pepino and colleagues at Washington University, looked at 21 people with obesity and different variants of a gene called the CD36 gene. They found that people who had two copies of a certain variant of the CD36 gene had an 8 fold lower threshold for sensation of fat than people who had no copies of this gene variant. In other words, people with two copies of the gene variant were far more sensitive to the taste of fat than people without this gene variant.

Exactly how these genetic differences affect food intake is not known. It may be, for example, that people who are less sensitive to the taste of fat need to eat more fat to feel satisfied. Further study is needed to understand how the difference in sensitivity to the taste of fat may affect food intake and body weight.

What is increasingly clear is that genetics have a powerful role in the risk of obesity, in the context of the toxic enviroment in which we live.

Note: you can read more about the genetics of obesity here.

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How Plate and Tablecloth Color Can Curb Your Portions!

2012-01-21T07:44:00.001-07:00

It is well known that we tend to serve up larger portions of food on larger plates - decreasing dinnerware size is often recommended as one strategy for weight management. However, new research suggests that it is not only the size of our plates that we should pay attention to. It turns out that color contrast from both plate and tablecloth can affect how much we ladle up as well - and in opposite ways!

The first study, conducted by Koert Van Ittersum and Brian Wansink, asked 47 students from Georgia Tech University to serve up a target amount of cereal on small and large white plates, using black or white tablecloths as a background. As expected, larger portions were served up on the larger plates. What was very interesting was that when the large white plates were placed on a black tablecloth, the students served up nearly 10% more on their plate, compared to when the white plate was placed on a white tablecloth. Also interesting was that when small white plates were used on a black tablecloth, serving sizes were underestimated. In other words, serving sizes were more accurate when the plate and tablecloth color were the same.

The second study examined the effect of plate color on serving size. Participants were asked to serve up pasta with a red (tomato) or a white (alfredo) sauce on red or white plates. When the color of the pasta matched the plate, the amount of food that was ladled up was 28% larger than when the plate color contrasted with the food color.

A visual illusion, known as the Debouef illusion, is thought to be behind these findings. The premise behind this is that sizes (eg of food portions) appear different to us, depending on background shape sizes and colors. Interesting!

The take home messages from these studies are to have a contrast in color between your food and your plate, but keep the color of tablecloth and plate the same.

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Are Diabetic Men at Risk of Fertility Problems?

2012-01-15T05:56:00.001-07:00

Although diabetes is known to be associated with many complications, infertility amongst men is not traditionally thought of as being one of them. Similarly, when a couple presents to a fertility clinic, diabetes in the man is not typically on the list of conditions to rule out. As it turns out, diabetes in men can have an impact on fertility from several perspectives, right down to the DNA of the sperm themselves.

As reviewed by Sandro De Vignera and colleagues, the prevalence of subfertility or infertility amongst men with diabetes has been reported to be as high as 35-50% in some series, and is significantly higher than sub/infertility amongst men without diabetes. Smoking and obesity appear to be the strongest risk factors for infertility amongst diabetic men.

There are several mechanisms by which diabetes can be associated with fertility problems. It is well known that diabetes can be associated with erectile dysfunction, lower testosterone levels (particularly in cases of severe insulin resistance or obesity), and retrograde ejaculation (ejaculation ‘backwards’, into the bladder).

More recently, it has been discovered that diabetes can also be associated with damage to the DNA of sperm. Studies suggest that diabetic men have a higher percentage of sperm with DNA damage compared to non diabetic men, and it has been postulated that this may be due to increased concentrations of ‘advanced glycation end products’ throughout the reproductive tract (proteins with sugar stuck to them, which is a consequence of elevated blood sugar over time), leading to more ‘stressed’ metabolic processes (known as ‘oxidative damage’) and thereby DNA damage.

While several of the above mentioned elements can occur in both type 1 and type 2 diabetes, there are some differences as well. While type 2 diabetics are more likely to suffer from the insulin resistant mechanisms of infertility (obesity, low testosterone), men with type 1 diabetes have an increased risk of concomitant autoimmunity against the developing sperm or related structures.

While this topic can be discussed in far more detail than I have presented here, the key take home message today is that diabetes may play an important role in male factor infertility. Fertility concerns or desires should be addressed in the evaluation of the diabetic male patient, and the possibility of diabetes should be considered in a man presenting with fertility concerns.

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Canada AM Interview: Effect of GLP-1 Analogs to Treat Diabetes and Cause Weight Loss

2012-01-11T06:27:00.000-07:00

Dr. Sue Pedersen, an endocrinologist and metabolism specialist, says the gut hormone has proved useful in patients with diabetes, and explains the side effects of the drug.

http://www.ctv.ca/canadaAMPlayer/index.html?video=598794

How N.E.A.T. Are You - And Could It Be Affecting Your Weight?

2012-01-08T01:37:00.002-07:00

While the factors contributing to obesity and weight change are extremely complex, it is a truth that an increase in body weight is the result of a higher caloric intake compared to caloric expenditure (ie calories in is more than calories out). One major risk factor for obesity appears to be our individual tendency to engage in NEAT ('non exercise activity thermogenesis'), and by making changes to one's NEATness, one may find themselves a giant NEAT leap ahead in the struggle against the bulge.

Calories Out (ie, caloric expenditure) is made up by the following constituents:

Basal Metabolic Rate: This is your baseline metabolism at rest, and comprises about 60% of total daily calorie burn in a relatively sendentary person. It is determined primarily by your body size and body composition - in particular, your fat free (lean) body mass (as muscle, which is lean, is more metabolically active than fat).
Thermic Effect of Food: This refers to the calories burned by the process of digestion of food, and is responsible for about 10% of your total day's calorie burn. This varies a little depending on what you eat, as protein takes about 25% more energy to digest than carbs or fat.
Activity Thermogenesis: These are the calories you burn by moving around.

Activity Thermogenesis is further broken down into:

Exercise thermogenesis (from purposeful exercise: playing hockey, going to the gym, etc); and
Non Exercise Activity Thermogenesis (N.E.A.T. - there it is!). NEAT refers to any calories burned by moving around during the day that is not related to focused exercise: this can be walking to work, moving around at the office, doing chores at home, painting a fence, playing a piano, etc.

As most people around the world do not specifically exercise, and because those that do exercise typically engage no more than a couple of hours per week, NEAT is far and away the greatest component of the total number of calories that we burn by moving around.

If we look at the explosion in obesity around the world in the last century or so, we can see that there has been a parallel decrease in our daily NEAT activities. We have become a society that can shop online, drive to work, and purchase a self powered vacuum to clean up the crumbs around the couch from last night's TV marathon. We have also become a society that is much more efficient in the workplace, with machines that do much of our manual labor for us, technology that allows transfer of information in an instant rather than by hand, and workplaces moved to the home as there is often no longer a reason to physically relocate oneself to an office on a daily basis. Unfortunately, this caloric 'efficiency' has taken a toll on our health as a society, making it all too easy to pack on extra pounds from the larger portion sizes and unhealthy choices that plague our marketplace.

Add to this another level of complexity: genetics. As suggested by JA Levine, an authority on the topic of NEAT from the Endocrine Research Unit at the Mayo Clinic, it may be some of us are genetically endowed to be NEAT activators (who would have gone out to hunt in the face of famine in the 'olden days'), while others are NEAT conservers (who would tend to lay low, conserve energy, and weather out the famine until food became more plentiful again).   In modern day, a NEAT activator may be a person who is more likely to fidget, or may choose the stairs instead of the escalator; a NEAT conserver may be genetically more inclined to sit at their desk rather than stand, or may choose to drive to work rather than ride a bike in the interests of time (though the transportation issue is clearly much more complex and often environmentally determined - read more here).

So, how can we increase our NEATness? As proposed by Dr Levine, try the STRIPE approach:

S:   SELECT a NEAT-activity that you enjoy and start it (walking to work, standing while talking on the phone, going dancing rather than to a movie);

T:   TARGET specific goals for your NEAT activity and follow through on them

R:   REWARD yourself for reaching your identified goal (eg treat yourself to a new song on iTunes to listen to after your first month of walking to work)

I:    IDENTIFY barriers & remove them (eg go to the mall to walk and talk with a friend if it gets too cold to walk outside);

P:   PLAN NEAT-activity sessions,

E: EVALUATE yourself: have you stuck to your plan, and has it been effective in reaching your goals?

When you choose your NEAT activities, be sure that they are activities that you enjoy! Make moving fun. :D

Thanks to my friend and Danish research colleague Mads Rosenkilde for the inspiration to write this blog, and for the heads' up on a great review article by Dr Levine.

Dr Sue

www.drsue.ca © 2012 drsuetalks@gmail.com

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Science Behind Curbing Your Appetite With Small Frequent Meals

2012-01-01T11:34:00.003-07:00

With the holidays behind you and New Years' Resolutions in tow, take the opportunity to reevaluate your meal structure! As part of a weight loss or weight management lifestyle strategy, it is often recommended to eat small, frequent meals, rather than having three squares a day.   A recent study, which examined the 24 hour trends in an important hormone called PYY, sheds some new light on why small frequent meals may be so effective to curb hunger and help prevent overeating.

PYY is a hormone secreted by the gastrointestinal tract in response to a meal. When released, PYY stimulates a sense of fullness by slowing down the emptying of the stomach, and stimulating the 'fullness centre' in the hypothalamus of the brain. Additionally, PYY may also increase overall metabolic rate, thereby increasing our overall calorie burn.

The study, conducted by Brenna Hill and colleagues at Pennsylvania State University, looked at levels of PYY in normal weight young women over a 24 hour period. Study participants were fed standardized meals as breakfast at 9:00AM, lunch at 12:00PM, supper at 6:00PM, and a snack at 9:00PM. There was no significant difference in caloric content of the three main meals.

As expected, the results showed that PYY peaks after each meal. Interestingly, over the entire 24 hour period, the highest level of PYY was seen after lunch. On further examination, it became evident that this high lunch time peak was due to the fact that there was an additive effect leftover from the PYY increase following the breakfast meal, which was consumed just 3 hours prior to lunch. In other words, PYY levels had not had the chance to decrease back to baseline following breakfast by the time that study participants ate lunch. As the supper time meal was consumed 6 hours after lunch, there was a longer duration of time for PYY to settle out, such that the peak level achieved after supper was not as high as the post lunch level.

It would follow, then, that if a person ate frequently throughout the day, that the PYY may remain elevated throughout the day, thereby keeping hunger at bay and helping to control food intake. This is a hypothesis only, and needs to be tested in further study; other factors such as the caloric content and composition of each meal would need to be considered as well.   In order to make small frequent meals work in the battle of the bulge, these frequent meals need to be substantially lower in calorie count compared to the eating pattern of eating three squares, such that the overall calorie consumption should ideally be lower over 24 hours compared to eating three full meals.

The current study lends support to the idea that eating small frequent meals is a better eating strategy than eating three major meals, and I look forward to seeing what evolves in this interesting area of research!

Note for patients taking medication to treat diabetes: It is important to discuss any possible change in eating habits with your doctor, before making any dietary changes. Some medications that treat diabetes, including some oral medications as well as insulin, are dosed to control your blood sugar after a meal. These medications may need adjustment with a change in eating plan. For patients using meal time insulin, some types of mealtime insulin are easier to incorporate into a smaller, more frequent meal plan than others - talk to your doctor and your diabetes health care team to work out a plan especially for you!

Dr. Sue © 2012 www.drsue.ca     drsuetalks@gmail.com

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Holiday Pumpkin Pancakes

2011-12-24T07:47:00.002-07:00

Here's a neat twist on pancakes to try over the holidays. As regular readers will know, I'm a big fan of pumpkin recipes - they are an excellent low calorie way to add moistness and flavour to many baked products and desserts.

Ingredients

1 1/4 cups whole grain flour
3 tbsp brown sugar Splenda
2 tsp baking powder
1 1/4 tsp pumpkin pie spice
1 tsp cinnamon
3/4 tsp salt
1 cup skim milk
3/4 cup canned pure pumpkin
3 large eggs
2 tbsp melted butter or margarine
1 tsp vanilla extract

Simply make these pancakes as you would any other pancake. Whisk the dry ingredients in a large bowl. Whisk the wet ingredients in a separate bowl. Add the wet to the dry, and whisk just until smooth (batter will be thick).

Heat a non stick pan over medium-high heat. Pour 1/4 cup of batter onto the pan. Cook until bubbles form on the top of the pancake and bottoms are a bit brown, about 1 minute. Flip and cook for about another 30 seconds or until they are cooked.

Delicious with some cinnamon and Splenda sprinkled on top!

Makes about 15 pancakes.

Per pancake: About 80 calories, 3g fat (if made with butter), 9g carbohydrate, 3g protein.

Thanks again goes to Deb's Kitchen for this creation.

Happy Holidays!

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The Global Impact of Diabetes

2011-12-17T07:14:00.003-07:00

Though the prevalence of diabetes is alarming in every country, the Middle East has come on the radar more recently, and is in fact home to six of the top 10 countries for diabetes rates worldwide. It is thus very fitting that this year's World Diabetes Congress, hosted by the International Diabetes Federation, was held last week in Dubai, United Arab Emirates. I had the pleasure of hearing diverse speakers from around the globe at the conference, and what I would like to share with you this week are some hard numbers and facts about the impact of diabetes around the planet (with reference to the excellent speakers, as well as the International Diabetes Federation's Diabetes Atlas, 5th edition).

Did you know that:

1. There are currently 366 million people in the world with diabetes (including about 8.3% of the world's adult population). By 2030, this number will be 552 million.

2. There is little gender difference in diabetes rates, with 185 million men and 181 million women affected worldwide.

3. All nations are suffering the impact of the diabetes endemic; there is no country in the world where diabetes rates are not increasing.

4. Fifty percent of people who have diabetes - don't know it. In Africa, 78% of people with diabetes are undiagnosed.

5. There are more people with diabetes living in urban areas compared to rural areas. (The reasons why are probably several: urbanites tend to have more access to fast/Western unhealthy food choices, and tend to be less active, to name two.)

6. The greatest number of people with diabetes are in the 40-59 age group.

7. In addition to the people who already have diabetes, an additional 6.4% of the world's adults are estimated to have impaired glucose tolerance (a form of prediabetes). That's a total of nearly 15% of the world's adults who currently have prediabetes or diabetes.

8. Rates of gestational diabetes (diabetes in pregnancy) are on the rise worldwide as well; further, women who have had gestational diabetes are at very high risk of developing type 2 diabetes.

9. 80% of people with diabetes live in low and middle income countries, who often have little or no access to medications needed for control of blood sugars.

10. The country with the highest diabetes prevalence is the Pacific island nation Kiribati, at a staggering 25.7%.

Food for thought. (pun intended)

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The Vote is In, but the Jury is Out - Is Bariatric Surgery Appropriate For Treatment of Type 2 Diabetes?

2011-12-08T01:37:00.000-07:00

At this week's World Diabetes Congress in Dubai, hosted by the International Diabetes Federation, I had the opportunity to listen to a fantastic debate as to whether bariatric (weight loss) surgery is an appropriate treatment option for Type 2 Diabetes.

The argument in favor of bariatric surgery was presented by Dr Francesco Rubino, a bariatric surgeon and leading authority on the issue from Cornell University, in New York. He highlighted key points of evidence regarding the benefits of bariatric surgery in terms of improving diabetes, noting that bariatric surgery provides a powerful potential opportunity to reverse the course of an otherwise progressive disease. While the current criteria for bariatric surgery in diabetics include a Body Mass Index (BMI) ≥35, he presented for us the International Diabetes Federation position statement on the role of bariatric surgery, which suggests that surgery should also be considered in people with BMI 30 to 35 when diabetes cannot be adequately controlled by medical therapy, especially in the presence of other cardiovascular risk factors. (BMI can be calculated here)

Dr Rubino noted that bariatric surgery stands apart from some other medical treatments of diabetes, in that many medications cause weight gain, whereas bariatric surgery can result in substantial weight loss. He noted that patients who are most likely to have the greatest improvement (or complete remission) of diabetes include those with a shorter duration of diabetes, and lower preoperative medication requirements; in other words, earlier intervention appears to produce the best results. He noted that not only does bariatric surgery improve diabetes, but can also be very effective to prevent new cases of diabetes. Other benefits include some improvement in cholesterol profile and blood pressure, which are also risk factors for cardiovascular disease. Gastric bypass is superior to gastric banding in achieving these effects. (Sleeve gastrectomy was not discussed in particular - I enter my own editorial comment here, that sleeves are proving to be quite effective to treat type 2 diabetes as well, somewhere between gastric bypass and banding in terms of efficacy, but so far appearing to be closer in efficacy to gastric bypass).

In discussion of the very limited accessibility to bariatric surgery, Dr Rubino provocatively noted:

"If there were a pill or a shot that can control blood sugars, improve body weight, cholesterol and blood pressure, and improve survival, would it be acceptable that >99% of people do not have access to the treatment? "

He concluded with the comment that we should not be using BMI as the most important criteria or cutoff in choosing the right patient for bariatric surgery; rather, we should be considering the metabolic disease (in particular, diabetes) that each patient carries, and stratify our decision re surgical candidates based on cardiovascular risk profile, as the BMI does not tell the whole story.

The negatives for bariatric surgery in the treatment of type 2 diabetes was presented by Dr John Pinkney, professor of diabetic medicine from Plymouth, UK.

Dr Pinkney opened with a discussion of the treatment goals for type 2 diabetes, including increasing life expectancy, reducing cardiovascular disease, reducing small vessel complications of diabetes (eye, kidney, and peripheral nerve complications), and improving quality of life, using treatment modalities where the benefits exceed the risks. Many of these health goals are achieved by optimizing control of vascular risk factors (diabetes control, blood pressure, and cholesterol).

In terms of treatment targets for diabetes, Dr Pinkney notes that several recent diabetes trials have suggested that tight glucose control may not actually prevent cardiovascular events, compared to slightly less tight glycemic control. He wondered, then, whether getting diabetes into excellent control with bariatric surgery would really be of that much benefit (and worth the risk?) in patients who had reasonable control of their diabetes in the first place.

He noted that while the improvements in blood pressure and cholesterol with bariatric surgery are statistically significant, that the absolute improvements are not that big. From the prevention of small vessel diabetes complications perspective, he noted that there is not yet much study in this area, and the question as to whether bariatric surgery prevents these diabetes complications in the long term remains unanswered.

While improvements or remission of diabetes is certainly impressive, the long term durability of diabetes remission was discussed, in that the most recent literature is now suggesting that a substantial proportion of diabetes that initially goes into remission, recurs years down the road.

The downsides of bariatric surgery require very serious consideration, and the risks vs benefits must be weighed carefully. The risk of death due to the surgery itself was discussed, though Dr Rubino noted that this risk is approximately that of a gall bladder removal surgery (ie, fairly low as far as surgeries are concerned). Although the need for diabetes medications may decrease with surgery, these treatments are 'traded in' for the need for a new array of lifelong nutritional supplements (the exact array of supplements needed depends on the type of surgery). Not taking these supplements or not having them monitored carefully can result in life threatening complications. The removal of the freedom to 'eat as I wish' and the potential impact on quality of life was also noted.

Dr Pinkney noted that type 2 diabetes is a complex disease that is very common, and suggested that it may not be feasible or productive in general to consider a treatment (surgery) that is very expensive, requires lifelong follow up, and is therefore not accessible for any but a small sliver of the people with diabetes worldwide.

Both presenters were grateful for the opportunity to present this important topic, noting that the topic of bariatric surgery has only been taken seriously as a potential therapy for diabetes in the last few years.

At the conclusion of the presentations, a show of hands of the audience was requested as to how many people were in favor vs against the use of bariatric surgery to treat type 2 diabetes (this was an auditorium containing several hundred diabetes health care professionals from around the world) - to my eye, the vote was roughly evenly split.

My feeling on this issue is reflected in an underlying theme to both of these presentations: the decision for bariatric surgery is a highly patient specific decision. Each patient must be considered on a case by case basis, with the benefits and risks carefully weighed and discussed in exquisite detail. For the right diabetic patient, bariatric surgery can provide an appropriate treatment option.

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Tips for Surviving the Holidays!

2011-12-03T19:35:00.012-07:00

If there is one time of year that is a test of our willpower and our waistlines, this is it - the holiday season! Delights abound on every table and countertop, and in almost every home and office we walk in to. Although this environment can be difficult to control, there are many things we can control to make healthier choices and a healthier home environment during the holidays. Here are just a few suggestions:

1. Think simple. Don't have a whole bunch of different dishes, as calorie intake increases with the variety of a meal. Also, keep the ingredients simple: steamed broccoli has less calories than a cheesy broccoli casserole. If you are doing holiday baking, bake perhaps 1 or 2 different things rather than a half dozen selections. This will free up time for you to get outside and be more active as well.

2. Look for ways to cook healthier choice alternatives. For example, try these fantastic chocolate espresso brownies instead of a heavy chocolate cake or Christmas cookies. Use skim condensed milk in baking. Substitute splenda instead of sugar.

3. Go for a walk after a meal. This helps to work off some of the calories, prevents second helpings, and in the case of diabetics, helps to control blood sugar after the meal.

4. Watch out for sauces and gravies. These are a major contributor to calorie intake at holiday meals. If you want them, make low fat gravy, and consider dipping your fork in it rather than drowning your plate.

5. Don't allow weight gain over the holidays, with a plan to lose it later. When we allow our weight to fluctuate up and down, we are doing our metabolism harm. Our bodies remember the maximum weight we have ever weighed, and from then on, the body exerts mechanisms to try to get back up to that previous weight. Metabolism is downregulated with weight loss, and hormonal triggers stimulate the drive to eat our way back up to our previous weight. It is harder for a 200lb person who previously weighed 240lb to keep their weight stable, compared to an otherwise identical 200lb person who has never weighed more than that. Therefore, not only is it difficult to shed excess pounds after they have come on, but it is also harder to maintain your weight if you have previously weighed in higher.

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Deb's Oatmeal Fruit Bake

2011-11-26T21:40:00.002-07:00

From the kitchen of my best friend Deb comes a delectable low calorie treat! A fantastic healthy baked treat choice for the holidays - super comfort food in the cold!

Preheat oven to 350 F. Spray a standard loaf pan with non stick spray, and construct your oatmeal bake in three delightfully simple steps:

BOTTOM LAYER: Simply spread a single layer of your favorite fruit or berries on the bottom (about 1.5 cups). My personal favorite is raspberries (pictured in the loaf) as it gives a nice tart flavor; blueberry banana is pictured in the slices below.

MIDDLE LAYER: Mix the following ingredients in a bowl, and then spread evenly on top of your fruit layer:

1 cup oats
1 tsp baking powder
3 tsp cinnamon
1/3 cup splenda

TOP LAYER: Mix the following ingredients in a bowl, and pour evenly over the middle layer.

2 cups milk
3 tbsp egg whites
1 tsp vanilla

Bake at 350F for 45 minutes. We suggest placing a cookie sheet covered in tin foil underneath the loaf pan, as Deb has noted that once in a while it has a tendency to expand over the top of the loaf pan.

TOPPING: Deb's secret is to froth 1/8 cup of skim milk and spoon on top. I enjoy sprinkling a bit of Splenda and cinnamon on top of the froth. Delish!!

Makes 4 substantial servings, or 8 smaller snacks.

If you split it into 8 servings, per serving (with raspberries as fruit):

100 calories
6g protein
17g carbs

Enjoy! I also encourage you to share recipes and healthy cooking ideas with your friends - it's a great way to have fun and support each other in leading a healthy lifestyle - Deb and I have a blast doing this together!

I'd also be thrilled to hear about any modifications you come upon with this recipe, or others on my website (posted here).

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Childhood Obesity and Cardiovascular Risk in Adulthood

2011-11-18T17:44:00.000-07:00

It is well known that obesity in all age groups is associated with increased cardiovascular risk. However, for people who struggle with obesity in childhood but become normal weight in adulthood, it has not been clear whether the risk factors accrued in childhood extends to an increased risk in adulthood. A new study suggests that for these people who achieve a normal body weight in adulthood following childhood obesity, several risk factors for cardiovascular disease are no longer elevated, and are similar to the cardiovascular risk factors of people who were never obese.

The study, published yesterday in the New England Journal of Medicine, analyzed data from over 6,000 people in USA, Australia, and Finland, followed for an average of 23 years. They evaluated several cardiovascular risk factors, including cholesterol profiles, blood pressure, presence of diabetes, and thickness of the wall of the carotid artery (which is a marker for cardiovascular disease), and looked at how these risk factors varied depending on whether individuals were overweight or obese in childhood and/or adulthood.

They found that for people who were obese in childhood and adulthood, the risk of having each of these risk factors for heart disease was several fold higher than for people who were normal weight in childhood and in adulthood.

Importantly, they also found that for people who were obese in childhood but normal body weight in adulthood, their risk factors in adulthood were no different than for people who were never obese.

While the ideal management of childhood obesity is prevention on a societal level, the treatment of obesity in childhood is clearly crucial as well. This study lends strong support to the importance of treating childhood obesity, as improving body weight towards a normal BMI reduces cardiovascular risk.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Does Your Genetic Background Result In Your Diabetes or Weight Struggles being Unmodifiable?

2011-11-12T09:21:00.001-07:00

In my post last week, I discussed the large and important contribution of genetic background towards the tendency to develop type 2 diabetes or obesity. Since that time, I've had a couple of people ask me whether there is any point to undertaking lifestyle intervention (ie changes in eating patters and/or activity) if their genetics have already dictated that they are going to have a lifelong struggle with these conditions.

As I noted last week:

While it is true that eating well and exercising are the cornerstones of the management of type 2 diabetes, and can certainly improve diabetes control, it is not possible for most people with diabetes to make it go away with these lifestyle changes.

This week I would like to bring the focus to the first part of this statement - ie, that lifestyle changes can certainly improve diabetes control, and improve obesity as well. Just about everyone with type 2 diabetes or weight struggles can see some improvement with permanent lifestyle change. How much improvement that is seen is going to depend on several factors, including:

For those who struggle with their weight or eating patters: Have the root causes of that struggle been addressed? (emotional eating, depression, medications causing weight gain, untreated sleep apnea.... the list of possibile contributors is long)
What is the degree of motivation to change?
What permanent lifestyle interventions have been undertaken, and are they in line with the genetically determined tendencies and ethnic/cultural considerations of the patient?

On the last two points - yes, it's true - our genetic makeup plays a part in determining which lifestyle changes will work best for us, and may even play a role in our levels of motivation to do so. For example, studies have shown genetic differences in the natural tendency to exercise than others, so for some, exercise will play a greater part in the success of their permanent lifestyle changes than for others. As another example, each of us has our own unique balance point of hunger and satiety hormones, such that some of us need more food or a higher body weight to feel full than others. For those people, medications that are directed towards modifying these hormone balances may be a great leap forward in helping them lose weight (such medications are available to treat type 2 diabetes, but not to treat obesity per se).

Again on the line of genetics, it is important that practical goals are set, with regards to controlling type 2 diabetes or managing obesity with lifestyle changes. For diabetics, there may be only a certain amount of glucose control that can be obtained by making lifestyle change - the pancreas gets tired over time (genetics and stress on the pancreas caused by overweight both play a role here), and for many, medications need to be started despite the very best efforts on the part of the patient.

From a weight stance, the goals must be practical as well. Remember that even a 5% body weight reduction (in those who are overweight or obese) decreases the risk of a whole host of complications associated with excess body weight.

The key in maximizing lifestyle success is in finding the form, or forms, of permanent lifestyle change that work for you - the bulk of this blog is dedicated to just that, in an attempt to help provide you lots of different lifestyle options to try on your journey towards permanent lifestyle change. And don't be afraid to ask your healthcare providers for help - remember, there is no shame.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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There Should Be No Shame in Having Diabetes

2011-11-04T12:01:00.000-06:00

I came across this excellent article online yesterday on msnbc.com, which discusses the stigma often associated with having diabetes. The personal stories made me sad, then made me mad, and then I decided to take matters into my own hands and discuss this very important topic as this week's blog.

Mary's story is one that I hear from my patients on a regular basis - there is often a feeling of shame associated with having type 2 diabetes. Because type 2 diabetes is often seen in association with overweight, there is a stigma upheld by many members of the general public that people who have diabetes are lazy, eat too much, don't exercise, and are not interested in their health.

What people need to realize, is that it is not the fault of the individual that they have diabetes. There is a very strong genetic basis for developing diabetes (as blogged previously), and a very strong genetic basis for obesity as well (read more here), which we are learning more about every day as new genes involved are continuously being discovered. Furthermore, there are many people out there with type 2 diabetes who are not overweight or obese - this speaks to the very strong genetic tendency towards developing diabetes in these individuals. While it is true that eating well and exercising are the cornerstones of the management of type 2 diabetes, and can certainly improve diabetes control, it is not possible for most people with diabetes to make it go away with these lifestyle changes.

When I am discussing optimization of diabetes control with my patients, they often tell me that they feel embarrassed to check their blood sugars in public, or to administer medications or insulin in front of other people. As a result, they may choose to forgo checking sugars or administering medications at times like lunch, when they are often out in public. It breaks my heart each time I hear this - how can our society be so cruel and judgemental?

It's high time that our society gets a grip on what it actually means to have type 2 diabetes. This disease has a strong genetic predisposition; our extremely toxic, fast food, sedentary enviroment is conducive to bringing it out in many people who are genetically prone.

People with diabetes who are seen checking blood sugars or administering insulin in public are showing committment and motivation to watch their numbers, and to do everything they can to optimize their glycemic control and their health - they deserve a HIGH FIVE! from all of us!

And a High Five to msnbc.com for writing this fabulous article - I hope their far reach will do well to get this message out to many. Feel free to pass on this article as well, to everyone you know!

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Pumpkin Banana Spiced Custard

2011-10-29T08:00:00.001-06:00

As Hallowe'en is soon upon us, many of our houses are undoubtedly filled with tempting treats to hand out to the kids on Monday night. Here's a tasty dessert alternative from the Heart & Stroke Foundation, perfect for fall! I'd be interested to know how you think it compares to the Crustless Pumpkin Pie recipe from Hungry Girl that I suggested previously.

INGREDIENTS:

1 egg
2 egg whites
1 cup (250 mL) canned pure pumpkin
1/3 cup (80 mL) mashed banana - about 1 medium
1 cup (250 mL) evaporated skim milk
1/4 cup (50 mL) packed brown sugar
1/2 tsp (2.5 mL) ground cinnamon
1/4 tsp (1 mL) ground ginger
1/8 tsp (0.5 mL) allspice
6 walnut halves

*editorial comment: I would personally use a little extra cinnamon and allspice for a stronger taste - I often find myself doubling these spices in pumpkin recipes

DIRECTIONS:

1. Preheat oven to 325F (160C).

2. Place 6, 1 cup (250 mL) ramekin bowls (also known as bouillion bowls) in a glass 13 x 9 inch (3.5L) baking dish.

3. In a large bowl, combine all ingredients except for the walnuts. Pour into the ramekins. Pour boiling water around the ramekins in the aking dish to a depth of 1 inch (2.5 cm). Place 1 walnut half in the centre of each custard.

4. Bake for 40 minutes. Serve warm. Consider sprinkling some extra cinnamon and allspice on top!

Makes 6 custards. Each custard contains:

111 calories
6g protein
20g carbohydrate
1g fat
83mg sodium
1g fiber

Enjoy! Thanks to my friend Patti for the heads' up on this great recipe.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Denmark's Saturated Fat Tax - Should We Follow Suit?

2011-10-23T09:12:00.002-06:00

There is much discussion in Canada and globally as to what approaches can be taken to try to curb the obesity endemic. Many are of the opinion that regulations must be implemented at the government level in order to be effective. Denmark has become the first nation to implement a hotly debated tax on saturated fat - should Canada and the rest of the world follow suit?

As of October 1st, Danes now face a 'fat tax' when they get to the checkout of the grocery store or pay up at a restaurant. (Of note, Denmark was also the first country in the world to restrict trans fats in 2003.) The fat tax varies depending on the percentage of saturated fat in a particular product, and equates to about $3.00 CDN per kilogram of saturated fat. The resultant cost increase is about 15 cents CDN on a burger, or $1.20 on a pound of butter. The overall cost is expected to increase annual food costs by the equivalent of about $190 CDN per family.

As expected, there are numerous criticisms to this approach to try to curb obesity. First of all, taxing saturated fat does not necessarily mean healthier eating, as it depends on what alternate food is selected by people who make other choices to avoid the tax. Purchasing highly processed white bread as an alternative, for example, would not be subject to the tax, but is not a healthy alternate choice. Dark chocolate, which has antioxidant properties with possible health benefits in limited quantities, is subject to the tax, where as some gummy candies (also very popular in denmark), which have no putative health benefits, are not. (This is all aside from the fact that Danes stocked up with mass amounts and record sales of saturated fat containing products in the weeks leading up to implementation of the tax - the thought of kilos of butter flying off of shelves makes me shudder!)

There are also criticisms that this approach, or any approach that comes from a government level for that matter, is a direct infraction of our freedom as consumers to choose what we want to buy and consume. The tax may also have a particularly challenging financial impact on low income families, as the tax may preferentially affect many lower cost food items.

The global response to Denmark's leading step on the fat tax issue is varied. France was quick to follow one week later with an announced tax on sugary soft drinks, and debate is now at an all-time high in many other countries.

So what is the right answer to this very difficult question? Personally, I think that government-level regulations are necessary to curb obesity in our society over the long term, as our environment is extremely toxic and conducive towards weight gain, and unlikely to change substantially unless those changes come from above. However, the changes that are made have to be selected and cultivated carefully, so as to ascertain that the impact is the intended one. In Canada, many different regulations are being considered, including taxation of junk food, banning certain ingredients or foods outright, regulating sodium content of foods, and regulating the number and density of fast food restaurants (these considerations are nicely summarized in an article by Dr MJ Eisenberg in the Canadian Medical Association Journal last month - a free download).

I'm interested to hear what my readers think about this very controversial issue.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Genetics Influence Response of Body Weight to Gastric Bypass Surgery

2011-10-15T13:00:00.001-06:00

Gastric bypass surgery is an increasingly utilized treatment option for severe obesity worldwide. While this surgery can be very successful to result in substantial and sustained weight loss over the long term, individual results from person to person are highly variable. A recent study suggests that a person's genetics may be the primary factor responsible for this variation.

The study, just published in the Journal of Endocrinology and Metabolism by Ida Hatoum and colleagues, examined the DNA of 848 patients undergoing gastric bypass surgery at the Massachusetts General Hospital. Amongst these patients were 13 pairs of first degree relatives, none of whom were living together. An additional 10 pairs of patients were identified who were living together but not related (thus allowing a comparison of the effect of environment on the efficacy of surgery). The remaining 794 people in the study were randomly paired for a non-genetic, non-environmentally connected comparison group.

Interestingly, the study found that first degree relatives had a similar response to surgery, with an average of only 9% difference in the excess weight lost between members of each pair. In contrast, there was a 26% difference in excess weight lost between cohabitating, unrelated individuals, which was no more similar than unrelated randomly paired individuals, who had a 25% difference in excess weight.

These results suggest that genetics have a strong influence on the effect of gastric bypass surgery on body weight. Interestingly, they also suggest that the home environment does not have an influence on the efficacy of gastric bypass surgery.

We are certainly becoming increasingly aware of the strong genetic influence in obesity. Dozens of genes which contribute to obesity risk have been identified so far, and this number continues to climb as our knowledge base grows. It is therefore perhaps unsurprising to learn that genetics play a strong part in the response to bariatric (weight loss) surgery as well.

The current study examines the influence of genetics on the lowest weight reached (called the 'nadir') after gastric bypass. I would be very interested to know if genetics has an equally strong influence on the risk of weight regain after hitting the nadir weight postoperatively, as there is also quite a substantial variation in weight maintenance vs weight regain in the long run after bariatric surgery. More study is needed in this area.

Although this study was too small to be able to identify the specific genetic contributors to weight loss success after gastric bypass surgery, larger scale studies could be undertaken to examine the entire human genome to try to identify the relevant genes. It is likely that there are many genes involved here, and their interactions are likely to be extremely complex. Discovery of new genetic mechanisms involved in the response to surgery may teach us something not only about surgery but about obesity in general, possibly leading us down the path to other discoveries that will assist us in non-surgical treatment of obesity as well.

As for people currently contemplating gastric bypass surgery, this study is too small to make definitive conclusions, but if you have a first degree relative (parent, sibling, or child) who has had the surgery, the success they experienced may be predictive of your own.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Video Blog - Highlights from American Obesity Society Conference

2011-10-07T16:29:00.000-06:00

In this video blog, Dr Sue discusses just a few of the many highlights from this week's Obesity Society meeting in Orlando, Florida.

Some of the highlights include:

1. A focus on learning more about the genetics of obesity;

2. Food Reward: Do differences in how we desire, and how we enjoy, food, affect our risk of weight gain?

3. Lifestyle interventions: a focus on building environments that are conducive to more exercise and healthy eating

4. Medications: nothing new currently, but many interesting possibilities on the horizon...

5. Bariatric surgery: more data on longterm success rates, and novel technologies being studied.

Watch to learn more!

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Video Blog - Childhood Obesity

2011-10-01T10:25:00.001-06:00

In this video blog, Dr Sue discusses the childhood obesity epidemic we are facing, which is the focus of the Fall 2011 Conduit magazine, a publication of the Canadian Obesity Network. (available as a free download here: http://www.obesitynetwork.ca/conduit_landing.aspx?menu=50&app=206&cat1=568)

Dr Sue discusses the important contribution of genetics to the childhood obesity epidemic, and the serious consequences of the stigma of obesity to the child. She talks about things that we can do, from avoidance of smoking in pregnancy to decreasing TV time, to help our kids grow up with a more healthy weight!

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Chemicals in our Environment that Contribute to Obesity

2011-09-24T02:13:00.000-06:00

It's no secret that the environment we live in is a major contributor to the obesity endemic, for several reasons: oversized portions, easy accessibility of unhealthy food choices, motorized transport, just to name a few. Another important aspect to add to this list is a host of chemicals in our daily environment, for which there is mounting evidence linking them to the risk of obesity.

These substances, collectively referred to as 'endocrine disrupting chemicals', are synthetic substances that are widely used in production of products that are present in our daily environment, which may have an effect on the synthesis or function of our hormones when we are exposed to these agents. We become exposed to these chemicals through inhalation of polluted air, food or water contamination, or by absorption through the skin.

As recently summarized in the journal Obesity Reviews by JL Tang-Péronard and colleagues, a link has been drawn between obesity and a number of these agents. Just to give a couple of examples (there is a much more extensive list and discussion in the referenced article):

Dichlorodiphenyldichloroethylene (DDE) has perhaps one of the strongest links with obesity. It is the main metabolite of DDT, and was used as an insecticide before its prohibition in the 1970's and 80's. Not only has DDE exposure been shown to be associated with obesity, it has also been demonstrated that exposure to a fetus before birth increases the risk of obesity later in life (eg, in childhood or puberty).

Polychlorinated biphenyls (PCBs) were used in many electrical appliances prior to being banned decades ago, but they are still found in the environment and in humans as well. Some PCBs have been found to either activate or inhibit our steroid hormone receptors, and some have been shown to stimulate specific metabolic pathways. PCB exposure has been shown to be associated with obesity in some studies, and appears to vary depending on timing and dose of exposure. PCBs may also have a bigger impact on weight development among girls than boys.

Bisphenol A, which is used in the production of epoxy resins and polycarbonate plastics and found in products ranging from contact lenses to water bottles to DVDs to dental sealants, has been linked to an increased risk of diabetes, metabolic syndrome, polycystic ovary syndrome, and cancer, and may increase the risk of obesity and excess body fat as well.

Other agents found in everything from flame retardants to burning coal tar to plastics, from children's toys to food packaging materials, have also been suggested to increase the risk of obesity.

Not only may some of these agent contribute to the risk of obesity, but they may also make it harder for a person to keep weight off following weight loss. Some of these compounds (called 'organochlorines') are actually stored away in fat tissue, and may leech out into the circulation as weight is lost. Increases in plasma organochlorine levels found during weight loss have been shown to decrease energy expenditure, potentially via a decrease in thyroid hormone levels.

So, what can we do to minimize our exposure to these agents? Given that many of these agents are so widely used, restriction in many cases will have to come from governmental agencies (as has already been done in the case of several of the chemicals listed above). We can take simple steps ourselves, such as:

avoiding food and drink containers that contain bisphenol A (particularly avoid microwaving them, as this releases the BPA into your food)
minimizing use of perfumes and scented deoderants and aftershave (which often contain phthalates, another endocrine disrupting chemical that has been linked to obesity risk);
researching the toys we buy for our children.

Through promotion of public policy and awareness, taking our government to task as research reveals more information to us, and keeping as informed as we possibly can about how to minimize our exposure, hopefully we can all work together to minimize our society's exposure to these agents.

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Restaurants Taken to Task on Calorie Counts

2011-09-17T14:52:00.001-06:00

It can be frustrating to impossible to know what we are getting on our plates when we eat out. Butter or oil is often applied to the healthiest sounding salmon fillet to make it glisten; mysteriously delicious dressings are poured over our salads; breads are drenched in melted cheese or pesto... the calories can add up quickly and sabotage the most enthusiastic attempts at healthy eating. Eagerly anticipated regulations expected to be implemented by the American FDA by years' end will provide a big step in the right direction: calorie counts on menus will make it much easier to keep track of the calorie currency of eating out.

A version of the anticipated FDA rules, which are expected to require posting of calorie content on menus for any restaurant chain with 20 or more stores, is already in place in some areas of the US, including New York City and parts of California. What is really impressive about bringing these restaurant chains to task on their calorie counts, is that it has already forced many of them to take a long, hard look at what they are actually serving to customers. As nicely outlined in an LA Times article, several restaurants have become seemingly quite embarrassed to post their astronomical calorie totals for some food products, and as a solution, they are creating new, healthier alternatives to add to their food repertoire. I noticed myself in several Canadian Starbucks locations, there are now mini-cupcake snacks with calorie counts listed (around 190 cal)... though I noticed also that the calorie counts on the regular size are still sorely lacking (though available online - check out the double chocolate brownie, which weighs in at 410 cal!)

Though this is a great step in the right direction, much more needs to be done. All restaurants should be responsible for making nutritional information readily available on their menus, and these rules clearly need to be disseminated outside of American borders as well. In the meantime, the only way to ensure that your weight loss efforts are not being sabotaged is to follow the principle of: If you don't know what's in it, don't eat it.

Thanks to the Canadian Obesity Network for the heads' up on the LA Times article.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Portion Size and the Obesity Endemic

2011-09-10T16:05:00.001-06:00

As blogged previously, portion control (or more appropriately stated, lack thereof) is one of many factors contributing to our obesity endemic. The consumer marketplace is often an enemy in the battle against portion excess and obesity, as there is most often a drive to provide the best value (= the most food) for your buck. I'd like to share a little anecdote from some of my recent travels south of the border to illustrate.

I visited a deli for lunch on a recent sojourn to the US - nothing special, but very popular, and apparently known for its Montreal Smoked Meat sandwiches. In an effort to see what all the hype was about, I looked around, and soon enough I laid my eyes on the deli's biggest selling item:

Hmmm. Not for me. For a family of four? Maybe.

As much as I love smoked meat, I returned to my study of the menu, and found a delicious sounding, lean turkey breast sandwich on rye that I decided I'd like to enjoy instead. Here is what I was served (half of the full serving is viewed here):

I proceeded to a) wonder how the delicious, high fibre European rye bread I had expected had turned into a fiber poor, taste poor alternative; b) place the other half of the sandwich (not viewed) into a to-go box; and c) consume almost the entire portion pictured above. Why? I'd already put away half, which seemed very reasonable... and the turkey was a very lean, healthy source of protein. And darn it, I'd PAID for it! So I fell to the pressures of consumerism - I ate far more than I needed to, and while it initially seemed good that I had made it worth my dollar.... the overstuffed feeling in my belly suggested that it may not have been worth it at all.

While portion sizes vary by country, by city, and by restaurant, I can't help but see a correlation with the enormous portion sizes often found in the US compared to Canada, and the parallel variation in obesity rates (currently 34% in USA, 24% in Canada, and only 11% in a country like Denmark, where portion sizes are scaled down even further).

So I suggest caution, fellow consumers: just halving portions may no longer cut it.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Survival Guide to Eating On The Run!

2011-09-03T11:24:00.008-06:00

In today's busy world, it is just about impossible to eat strictly from your own kitchen; inevitably, there will be some times when you have to grab your food on the run. Unfortunately, many of these on-the-go venues can be the worst traps for unhealthy eating. Here's a few tips to help you keep your intake healthy!

1. Ask for the nutritional information.

At most fast food restaurants, nutritional information is readily available behind the counter (or increasingly, on napkins, or even posted on the wall!). Ask for a printout to help you make your selection. A reasonably portioned meal should contain 300-400 calories.

2. Go for the greens - carefully!

Most quick-fix restaurants are aware of the general impetus to improve availability of healthy food choices, and many have provided quality options on their menus. For example, McDonalds' Oriental Chicken salad has 290 calories and 5 grams of fat; the Bacon Ranch salad with balsaming dressing has 330 calories and 16 grams of fat.

Be careful, though, as there are some imposters too: the McDonald's Chicken Caesar has 550 calories and 36 grams of fat, and switching the balsamic for Ranch dressing on your Bacon Ranch salad adds a whopping 200 calories and 19 grams of fat!

3. Portion Control.

At Subway, go for the 4 inch or 6 inch sandwiches (not the 12"). Supersize only your diet pop! A regular hamburger at McDonalds is not an unreasonable treat at 250 calories, but a Big Mac is over double that at 550 calories.

4. Avoid liquid calories.

It is generally advised to eat your calories rather than drink them, as liquid calories are less satiating and leave you hungering for something else. For example, it is better to eat an orange than to drink a glass of orange juice. There are also many hidden calories in beverages; consider that a Grande White Hot Chocolate from Starbucks comes in at 490 calories! For a typical woman who is trying to lose weight, that is almost half her daily Calorie Prescription. If you are a Timmy's fan, avoid the Double Double, and opt for a bit of skim milk and some sweetener - you'll save yourself over 200 calories!

5. Sauces on the side.

This goes for mayo, butter, dressings, and anything else that could be lathered on your food. If you're not sure what comes on top of (or under) what you've ordered, ask, or just ask for any dressings/sauces on the side just in case.

Mustards are lower calorie (some are calorie free!) and don't usually need to be omitted; soya sauce in moderation is low calorie (but high salt); balsamic vinegar is low calorie and tastes great on a salad.

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

Physical Activity Alone Doesn't Prevent Weight Gain for Most Women

2011-08-27T08:14:00.032-06:00

I am often asked by my patients if it is possible to prevent weight gain by maintaining high activity levels, without giving special consideration towards food intake. An important study from the Journal of the American Medical Association tells us that physical activity is not enough to prevent weight gain for most women.

The study by I-M Lee and colleagues surveyed over 34,000 American women over a 16 year period, and asked them to report their weight and physical activity levels. They were classified into one of three levels of activity:

less than 150 minutes of moderate intensity exercise per week
150-420 minutes of moderate intensity exercise per week
420 or more minutes of moderate intensity exercise per week (at least 1 hour per day)

The study found that for women who were overweight, there was no difference in weight gain over time between each activity group. It did not seem to matter how much exercise overweight women engaged in; weight gain was the same regardless.

Interestingly, they found that physical activity was helpful to prevent weight gain in some women who were not overweight (ie, with a Body Mass Index of ≤ 25; you can calculate your own BMI here, in the right hand column). It is no cake walk, though (so to speak) - in order for normal weight women to prevent weight gain with exercise, they had to engage in at least one hour of exercise per day.

The take home messages, as I see them, are:

1. For most women, exercise alone is not enough to prevent weight gain. Weight management is more about watching what you eat, rather than how much you exercise.

2. Regardless of whether or not exercise will prevent further weight gain, it is still very important to exercise for its other health benefits! Exercising for 150 minutes per week has been clearly shown to lower the risk of chronic diseases, so it remains of crucial importance to continue to exercise for the benefit of your overall health. (Before engaging in, or stepping up, an exercise program, be sure to speak with your doctor to make sure you are making changes safely.)

3. For normal weight women, at least an hour a day of moderate activity is necessary for exercise alone to prevent weight gain over the long haul.

You can read about the Canadian Physical Activity guidelines here to find out how much exercise is recommended. Check out Health Canada's website for further details, and some great ideas as to how you can work exercise into your daily life!

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

Alcohol Abuse Risk After Gastric Bypass Surgery

2011-08-20T08:21:00.001-06:00

Following gastric bypass surgery, there are many tribulations, but also many trials that a patient may encounter. One of the challenges that has become apparent is the increased risk of alcohol abuse that has been observed in this population.

There are several important aspects to consider regarding the risk of alcohol abuse after gastric bypass surgery:

1. Food addiction looking for a new outlet. For some people who struggle with their weight, one of the central issues at hand is a true food addiction. Research has shown us that some people truly feel an euphoria or a 'high' after eating, particularly from eating calorie laden, tasty foods. This euphoria is caused in part by a high release of, or robust response to, opioids and other neurotransmitters in the brain, and parallels the response seen in people addicted to other substances.

After gastric bypass surgery, the capacity to eat is greatly diminished, and food preferences may change as well. The euphoric sensation and response is often decreased or lost, such that many people find a significant decrease in the satisfaction they get from eating. The hormone and neurotransmitter alterations that occur can result in something that can psychologically even feel like a drug withdrawal.
Thus, without being able to satisfy their food addiction after surgery, some people turn to other forms of addiction and self-medication, and a common place to turn is unfortunately alcohol (or other drugs).

2. Need for a coping mechanism. Big changes happen in the life of an individual who's had gastric bypass surgery. Many of these changes are for the better, no doubt, but there can be struggles as well. Depression can ensue for a host of reasons, ranging from the loss of food as a coping mechanism, to negative feelings about the excess skin that becomes apparent after substantial weight loss, to changes in that person's relationship with their spouse or family (which are not always good changes). Some may turn to alcohol or other substances as a way to cope with these changes.

3. Alcohol absorbs faster. Because alcohol reaches the small intestine faster after gastric bypass surgery, there is a high and swift peak in blood alcohol levels. While this effect is uncomfortable for many patients, others may find it enjoyable, and may find them searching for more.

The number one way to minimize the risk of alcohol abuse after gastric bypass surgery is knowledge and education about the potential risk, both on the part of the patient, as well as on the part of all of the health care providers that are involved in the pre and post operative care of the patient.

Having a psychologist closely involved every step of the way is absolutely essential. Any food addiction or tendency towards addictive behaviors must be assessed and managed prior to surgery. The risks vs benefits of surgery must (as always) be carefully weighed; surgery may not be the best choice for patients with a true food addiction that has proven difficult to break.

Patients must be followed and supported closely postoperatively, as they undergo often dramatic changes both physically and psychologically.   Multidisciplinary follow up must continue long term, often for a lifetime, to provide ongoing support and assistance. In this way, any difficulties encoutered can be met swiftly with support and appropriate interventions, to help these individuals stay on the right track of a successful long term outcome and a healthy long term lifestyle!

Dr. Sue © 2011   www.drsue.ca     drsuetalks@gmail.com

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Does the weight of those you eat with influence your diet?

2011-08-13T13:10:00.002-06:00

An interesting study in the Journal of Consumer Research says yes - the way in which another person heaps (or doesn't heap) up their plate can affect the eating habits of those eating with them.

In this study from the University of British Columbia, a study participant (who did not know the intent of the study, and thought they were participating in a study of movie viewing) was paired up with a researcher who was thin on one visit, and disguised wearing a 'fat suit' on a second visit. Each pair was offered a snack of granola or M&Ms.

In the first round of study, the thin researcher went first, and took a big helping of the snack. Participants were found to heap their own plates in response, taking even more food than they did when they were in the room alone. When the researcher dressed up in a fat suit and took a large helping, the study volunteers took a smaller amount of food, though they still took more than when they were alone.

In the second round of study, the thin researcher took a tiny amount of food; the result was that study volunteers cut down on their own portions. When the obese researcher took only a little food, study participants indulged a little more.

So what is the psychology behind these findings?

1. When we see thin people taking large helpings, it may provide some (false) reassurance that it is OK to heap up too. The thinking is that if they can do it and stay thin, then it must be ok. What is not seen, however, is what that thin person is eating for the rest of the day, nor what they are doing for physical activity to burn off the excess calories.

2. When we see an obese person taking a large helping, an association is drawn between that person's obesity and their excess caloric intake, which may motivate others around them to scale back their own eating, so as not to gain weight with extra calories themselves.

3. When a thin person takes a small helping, an association is again drawn between that person's appropriate weight and appropriate intake, encouraging others to do the same. When the overweight person takes a small helping, however, the perception is that that person must be on a diet, and if someone around them is not on a diet themselves, the subconscious conclusion may be that it is OK to take a little more on their own plates.

The solution? Don't let other people's eating habits influence your own; remember that when you are meeting someone and eating together over a one hour lunch, that is only a snapshot, and not necessarily representative of what that person is doing or eating for the rest of the day. Stay true to your goals, and what you know you need to do in order to accomplish them!

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

Chatelaine Interview: The Latest News and Research in Obesity

2011-08-06T08:21:00.001-06:00

A few months ago, I was asked to provide an overview of the undertakings at this year's Canadian Obesity Summit in Montreal, by James Fell, fitness columnist, certified strength and conditioning specialist, and the man behind Body For Wife.

The complete article can be found at this link. Below are some excerpts regarding elements of the Summit that I felt were important to highlight. As some very controversial issues were raised and discussed, I thought I would post these items, and I'd really like to survey my readers as to their thoughts on these issues! Please feel free to post a comment by clicking on the envelope icon at the bottom of this post - this is how we can get a good dialogue going, and stimulate change in our society!

1. Genetics: “There are least 45 obesity-related genes that have been discovered and each one contributes 2-3kg to body weight. We don’t understand a lot about how they work; some create a different balance in hunger hormones and others cause fat storage. It’s not that some people are genetically fixed to be obese, but it can set the stage.”

Dr. Pedersen also mentioned how a woman who is obese while pregnant increases the prevalence of the child being obese through epigenetic changes that take place in utero.

2. Environment: “There was a lot at the conference about guiding Canadians to lead healthier lives. For example, should there be a junk food tax? Can we create programs to get Canadians to focus on weight loss and healthy eating and getting more exercise?”

3. Childhood obesity: “Eight percent of Canadian adolescents are obese, so how do we create good family-based programs to help them lose weight? These have to be focused on the parents because if they lose weight, then the kids lose weight by default.”

Sue also had some interesting comments about adolescents and bariatic surgery. “Lap banding is favoured in kids [in extreme cases where it is deemed necessary] because it is the least invasive and is reversible. The Hospital for Sick Children in Toronto is the only place in Canada that is doing it right now. The decisions for bariatric surgery with children are very challenging.”

4. Adult obesity management: “There was a big focus on weight-loss surgery for people with Type 2 diabetes because the surgery can put it into remission. Having the surgery is done when the benefits of it outweigh the risks. Bariatric surgery can be the appropriate decision for a patient who has failed in all other attempts to lose weight.” Dr. Pedersen stated that such patients require psychological counseling as well, and that this is never a decision to be entered into lightly.

In regards to bariatric surgery, there is not enough funding so the wait list is about five years. Some provinces allow people to pay for it themselves, allowing lap banding for about $16-20 thousand for those who don’t want to wait.

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

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Decreasing Food Variety May Help Control How Much You Eat

2011-07-31T14:51:00.003-06:00

We all know it to be true: by day 2 or 3 of eating the same leftovers, most of us are good and tired of that meal and ready to enjoy something new. Most of us look for different things to eat each day, to enjoy a constantly changing taste sensation. Perhaps we should not be too quick to switch up our meals, as research suggests that eating in a more repetitive pattern may be beneficial in controlling our food intake.

A recent study tested the difference in food intake patterns in a group of women served macaroni and cheese every day for 5 days, versus once a week for 5 weeks. They found that the women who received the meal once a week ate about the same amount each week, whereas those who received it every day had a gradual decline in the number of calories they consumed. These results were consistent for subgroups of both obese and non obese women.

Thus, it appears that eating in a more repetitive fashion may be beneficial for prevention of weight gain and as a weight loss strategy as well. As discussed in an accompanying editorial to the article, public health policy planners and school lunch menu planners should take this information into careful consideration - a plethora of variety on the menu may not be a virtue.

Of course, eating the same meals every day would be detrimental if there is not enough variety, as a varied food intake is crucial in ensuring that we obtain all of our necessary vitamins and minerals. Consider a strategy such as this: If you were planning to make seven different dinner meals in a week and you were planning to repeat this menu each week for a month, consider instead eating the same meal for four days in a row, then switching to the next one (you may need to re-cook the same meal to ensure your food is fresh). This would also simplify the grocery shopping!

I'm interested to hear what my readers think!

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Why We Hit a Weight Plateau (and then Regain)

2011-07-24T14:49:00.001-06:00

It's a common occurrence: After weeks of following a successful diet plan, with weight coming off surely and steadily, the rate of decline in the numbers on the scale starts to almost imperceptibly slow...slow.... and stop. Welcome to the weight plateau, and the frustrations that come with it. Even worse, the weight plateau is most often followed by a tipping of the scales in the opposite direction, and the ultimate frustration as the pounds begin to add up again. Let's take a look at why this weight plateau happens, why weight regain most often ensues, and what we can do about it!

The short answer and hard truth of the matter is that our bodies and brains are evolutionarily wired to allow us to collect energy, and to restore energy (in the form of fat) if energy stores are depleted (as in the case of weight loss).

As nicely reviewed by Paul MacLean and colleagues, here are some of the mechanisms that may be involved (and this is not an exhaustive list!):

Leptin levels drop proportionally more than fat mass. Leptin is a hormone secreted by fat tissue, whose primary effect is to tell our brains that we feel full (it is therefore a 'satiety' hormone). Because leptin is made by fat, we could expect that leptin levels drop as fat mass declines, which is true; however, the leptin levels drop lower than expected, leaving us feeling even hungrier, and giving us more drive to eat and regain weight.
There is a small drop in adrenaline levels and thyroid hormone levels with weight loss, which results in a lowering of metabolic rate and 24 hour calorie burn.
There may be a reduced biological drive to be physically active, following weight loss.
When we lose weight, we inevitably lose some lean body mass (muscle tissue) along with the fat. This can be minimized by increasing physical activity, but some muscle will be lost nonetheless. People who lose proportionally more lean body mass with weight loss will have a lower 24h calorie expenditure, making it easier to hit a weight plateau.
Our brains do not appear to reset our appetites to account for the lower energy needs with a lower body weight. Instead, our brains are wired to try to bring us back to the weight we were previously. The sensitivity of our brains to hunger signals appears to be increased, and sensitivity to fullness hormones decreased, following weight loss.
There may be genetically ingrained processes in the muscle, liver, and fat tissue of people who have previously been obese, that work in favor of promoting weight regain, that are not present in individuals who have never been overweight (as they have never had this genetic tendency).
Animal studies and some human studies suggest that weight loss results in an increase in the number of fat cells, which drives weight regain.
A different type of bacteria inhabit the intestines of obese individuals compared to lean individuals, and these bacteria may have a different influence on our metabolism. It is not yet well understood what happens with these bacteria after weight loss, but it is thought that they may play a role in promoting weight regain as well.

Taken together, the sum of the evidence to date suggests that that there are many factors (many of them being genetically determined) that permissively allow us to gain weight in our toxic, sedentary, easy food access environment. Once an individual has become overweight or obese and loses weight, changes occur in their physiology which try to prevent weight from coming off, and actually promote weight regain.

These mechanisms evolved over millions of years, while the human species was fighting to survive periods of famine interspersed with periods of feast. The trouble with the current day situation in most countries around the world, is that there is a continual feast. Food surrounds us at every turn, and often these are foods that are poorly satiating with high caloric content to boot!

So, what can we do about this? Well, the first step is to understand why the plateau and weight regain often happen, as this can help to decrease some of the frustration associated with it (knowledge is power!). The good news and next step is, that these elements that promote weight regain are not insurmountable, and can often be counteracted with constant attention towards:

eating a more satiating (higher protein, lower carbohydrate) diet;
making a conscious effort to be active in daily life; and
programming and planning regular dedicated exercise.

Remember to speak with your doctor about what is right and safe for you, before making any changes. Also remember to view any lifestyle changes as permanent; there should be no such thing as a temporary 'diet'.

Hopefully we will also move forward in our development of medications that may be helpful to maintain weight loss and prevent weight regain.

And, of course, it goes without say that on an individual and population level, prevention of obesity in the first place is a Number One priority.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Berry Sorbet Lemon Cups

2011-07-16T03:42:00.001-06:00

Here is a fantastically healthy dessert recipe that is aesthetically pleasing, low calorie, and diabetic friendly! I've seen different variations of this on many websites; I think it tastes wonderful with blueberries, blackberries, or raspberries. You decide which is best!

INGREDIENTS:

6 lemons
2 cups frozen blueberries or blackberries (or both!)
1/2 cup Danone Silhouette 0-Plus berry flavored yogurt
1 1/2 tsp lemon juice
1 packet of Splenda sweetener

Cut a slice from the stem end of each lemon about 1/5 of the size of the entire lemon. Cut a sliver of peel from the opposite end so the lemon has a base to stand on. Carefully scoop out the flesh from inside the lemons, keeping the peel intact. Put the shells in a resealable freezer bag and freeze for at least 3 hours.

Just before serving, put the frozen berries directly into a food processor, and pulse until finely chopped. Add the yogurt, lemon juice, and Splenda, and process until smooth.

Spoon the sorbet into the lemon shells and serve immediately!

Makes 6 servings. Per serving: only 40 calories, and 9g of carbohydrate!

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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The Trials and Tribulations of Urban Transport

2011-07-09T12:05:00.003-06:00

In last week's post, I blogged about the sad state of some rural Canadian roads - the shoulders being too narrow and covered in rumble strips, with no option for a cyclist to safely enjoy a day on the road. This week, allow me to rant about the problems that plague urban North America, making it difficult, and sometimes impossible, to get around on our own steam!

For the first time since I started working at my current clinic location (and that's a year and a half!), I decided to brave the roads and cycle to work one day last week. I live 5km from my office, so it would seem on the surface that it would actually be very convenient to cycle there. Well, let me tell you... I am not sure how many lives I'm going to get, but I think I used up about a dozen of them during that 10 km round-trip adventure. Although Calgary is known as a city with one of the best cycling path systems in Canada, this system is only useful for daily transport if you are so lucky to both live and work somewhere along its length. Most of us are not so geographically lucky to have both work and home on the system, so we're exposed to the elements of regular traffic if we want to ride.

Obstacles/health hazards encountered on my adventure to and from work included:

no cycling lanes
drivers who did not show any interest in yielding to, or even minding, the cyclist;
sidewalks did not have graded curbs on the corners (making these areas highly inaccessible to people in wheelchairs, never mind bikes)
many through roads were blocked off by industrial companies with fences around their properties, necessitating back tracking and finding curcuitous routes
random hubcaps, broken glass
the same train track had to be crossed three times before reaching my destination

So for me, some big changes would have to be made before I would consider riding my bike to work again. Our new mayor has made it a priority to improve cycling access and safety, so let's see what happens. Contrast this with the year I spent working at the University of Copenhagen, where the society is so geared towards bike travel that it actually dissuades one from wanting a car. Coincidentally, I lived the exact same distance from work in Denmark that I do here in Calgary (5km), and when I calculated the calorie burn over a year of cycling to work - it equated to 18 pounds of body fat! This focus on self powered transport is one contributor to the lower obesity rates seen in Denmark (11%, compared to 25% in Canada, and 34% in USA).

This week's biggest hats off goes to the people of the Netherlands, who are turning to cycle powered school buses to help their children stay active and safe (pictured above)! I love it. It appears that the company that makes these buses, De Caferacer, also makes these buses for adults (if there are any Dutch speakers out there who can help me out with the website, please feel free to comment on this post - my Danish is not saving me here!).

For those of us back in North America - we'd sure love to incorporate these self powered buses as transport, but the reality is that our entire society will require an infrastructural overhaul before that would even be possible. Fair enough to say that our climate is not as permissive of this form of travel, but for half the year, it would still be a blessing!

Thanks to my friend Brian at marketinghits.ca for the heads' up on the great photo!

Dr Sue

www.drsue.ca © 2011 drsuetalks@gmail.com

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Ready to RUMBLE??

2011-07-02T00:49:00.000-06:00

North America suffers some of the highest rates of overweight in the world, with 66% of American adults and 59% of Canadian adults affected. Although the list of contributing factors is long and complex, there is no doubt that an infrastructure and attitude that promotes sedentary living is clearly a major issue.

I took the above photo at last year's meeting of the American Diabetes Association in Orlando, FL, USA. This is one of the largest gatherings of health care providers interested in the treatment and prevention of diabetes on earth, and yet, when offered the option, the escalator was usually preferred to the stairs. Part of the problem here was the construction of the conference centre: while an escalator is certainly important for accessibility for people unable to take the stairs, are two sets side by side really necessary?

For people who try to engage in more healthy leisure activity, golf has really taken off as a popular activity. Golf can provide fantastic exercise; within the space of an afternoon, several kilometres can be walked and enjoyed with friends or colleagues. Sadly, many golf courses now don't allow patrons to walk the course, insisting that they use a buggy so that more players can be moved through! While golf courses were previously built to walk, many are now developed with the goal of maximizing real estate property on the course, which results in an enormous golf course which may not even be practical to walk.

The tipping point which stimulated me to write this blog on this particular week was a recent experience I had on the rural highways in Southern Alberta. I was out for a fantastic ride on my road bike on a fairly quiet highway, with beautiful views and great weather to accompany me on my journey. The shoulder was narrow, but I felt comfortable.... until I came upon a long stretch of rumble strips that had been planted in the middle of it! Unfortunately, there was no cycle path alongside for cyclists to move to; the choices were to brave the traffic, or turn around. This is in stark contrast to many other countries around the world, where there is a priority on accessible and safe self-powered transport, which not only helps to keep people active, but also saves on CO2 emissions and keeps road traffic more manageable. I certainly understand the need to alert drivers with rumble strips if they get distracted and are edging towards the side of the road, but this should not be at the sacrifice of others who are trying to enjoy the road under their own steam.

As North Americans, it is upon each of us to work exceptionally hard to find ways to stay active in our environment. Maybe it's time to rumble with policy makers to make our infrastructure more conducive to physical activity.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

How Big is the Problem of Obesity in Canada?

2011-06-25T18:12:00.001-06:00

A few days ago, a report on Obesity in Canada was released by the Canadian Institute for Health Information and the Public Health Agency of Canada. The sixty-two page document is a great read for geeks like me, and I'd encourage anyone who is interested in obesity treatment or research to have a read through the entire document (it's a free download). In this blog, I have chosen some interesting facts and excerpts to share with you. This is not meant to be a review of the key points of the article - more of a collection of 'did you know?' facts about obesity in our country.

1. Twenty-five percent of adults in Canada are obese. (Obesity is defined by a Body Mass Index of 30 or more; you can calculate your own BMI here, in the right hand column).

2. In the last 30 years, rates of obesity have approximately doubled amongst most age groups, amongst both males and females.

3. The variation in obesity rates across the country is huge, from a low of 5.3% in Richmond, BC, to a high of 35.9% in the Northern Athabasca region of Saskatchewan. Urban centres tend to have lower obesity rates than rural areas, with Montreal, Toronto, and Vancouver all having obesity rates below the national average.

4. The causes and contributors to obesity are numerous and complex (understatement of the century!) - the report does go in to quite a lot of detail on this. One interesting fact is that while a higher income (or socioeconomic status) is associated with lower rates of obesity for females, there is no relationship between income and obesity for men.

5. The cost of obesity to the health care system is about $4.6 billion per year.

The final pages of the report are dedicated to a very important discussion of just how we can combat and prevent obesity in our country. Potential interventions are categorized into individual person-level interventions, community based interventions, and public policy changes. Numerous specific interventions are discussed and put forth as potential avenues that we could expand upon in our pursuit of a healthier Canada - now let's see if policy makers, politicians and health care providers take more aggressive action based on these suggestions.

Treatment and prevention are our biggest struggles in our understanding of obesity; as the review cogently notes: 'There is unlikely to be a single solution that will reverse the rising prevalence of obesity in Canada; rather, a comprehensive, multisectoral response may be needed.'

Dr Sue

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Can Watching TV Kill You?

2011-06-18T17:32:00.001-06:00

That may sound a little melodramatic, but this is what recent research suggests, bluntly put: watching TV for more than 2 hours per day is linked with an increased risk of death.

TV watching is the number one sedentary activity of our time. Sixty percent of American adults watch TV for more than two hours per day on average, with a slightly lower number of hours logged for our western european counterparts.

Several studies have examined the association between TV watching and risk of diabetes, heart disease, or death. The data from several of these studies was recently brought together in a meta analysis by Grøntved and colleagues in the Journal of the American Medical Association. Upon evaluation of all prospective cohort studies in this area in the last four decades, they found that over 7-8 years of follow up, watching TV for two hours per day is associated with:

a 20% increased risk of getting type 2 diabetes;
a 15% increased risk of cardiovascular disease;
and a 13% increased risk of death.

Put another way, for every 2 hours of TV watched daily, the authors found that per 100,000 people, there would be 176 cases of type 2 diabetes and 104 deaths per year. For mortality (death) risk, they found the risk really started to accelerate above 3 hours per day of TV watching.

It may not seem like rocket science that a sedentary activity like TV watching is associated with increased risk, but it turns out that the relationship is much more complex than that. As blogged previously, as many as 25% of the day's calories are consumed in front of the tube, and TV watching results in a preference for calorie laden foods (advertising may be partly to blame here). In addition, emotion, adrenaline, and/or stress generated from watching your favorite, riveting TV program, may result in increased hunger as well.

It is more clear than ever before: let's work to keep our tube time to a minimum and spend the time being active instead!

Dr Sue

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USA Moves from Food Pyramid to MyPlate!

2011-06-11T02:08:00.003-06:00

Despite attempts to engender healthy eating strategies in North America with Canada's Food Guide and the USDA MyPyramid, obesity rates are higher than ever before. On June 2nd, the United States introduced a revolution of sorts to their recommendations - they have thrown out their Food Pyramid and replaced it with a simple, effective strategy: a portion controlled plate!

USDA's MyPlate is the most recent piece in the evolution of America's dietary counseling history (a fascinating history, which you can read more about here). On the MyPlate plan, Americans are asked to portion our meal on our plate into four categories: vegetables, fruit, proteins, and grains. Aside the plate is a circle called 'Dairy', which is meant to represent a portion of dairy product with your meal, such as a glass of skim or 1% milk.

On the website, you can hover over and click on any part of the plate to read more about what each food group should entail.

Some of the guiding principles of the MyPlate system include:

vegetables and fruits should take up half of your plate
vegetables and fruit can be raw, cooked, frozen, or canned, but should not be in oil or with extra high calorie containing sauces
at least half of the grains eaten in a day should be whole grains
eat at least 8 ounces of cooked seafood per week (adults)
enjoy your food, but eat less
avoid oversized portions
drink water instead of sugary drinks

The MyPlate website contains an absolute wealth of information, including interactive links where you can look up caloric information of your favorite foods with MyFood-a-pedia, find out how much you should eat of each food group in order to achieve your personal goal of weight loss, weight maintenance, or weight gain; and even get help in creating a personalized meal plan! I really encourage you to have a look around their website, as there are all kinds of fascinating nooks and crannies of extra reading, and lots of user-friendly downloadable one-page summaries of healthy eating hints that are designed to post right on your fridge.

I've long been a big believer in the power of portion control. In my own research, we've shown that a simple portion control tool is useful even to help insulin using type 2 diabetics lose weight - a group in whom it is particularly challenging to achieve weight loss, as insulin is a hormone that can directly lead to weight gain.

I really take my hat off to the United States for taking this extremely user friendly and pragmatic approach to health eating in America. Though there are some elements that I would change (for example, I would not recommend dried fruit as it is much more calorie dense than fresh fruit), overall, it is an excellent, practical approach that everyone can access (online or in paper form). While this plate approach is only a small step forward, and does not address the plethora of contributors to obesity in our society, our sedentary lifestyles, or the psychological contributors to obesity, in my opinion it is a great way to help people formulate their eating patterns into a healthier approach on a daily basis.

As it currently stands, the Canada Food Guide remains our only standardized tool to guide healthy eating in Canada. We are in desperate need of a more practical approach, as the guide can be confusing to follow, can lead to weight gain amongst older adults, and offers no suggestions for modification for people who need to lose weight (making our Food Guide applicable to only a minority of the population, given that 59% of Canadian adults are overweight). We need to move forward as a nation and follow the good example that the United States has set with the MyPlate program.

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

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Apartment Building Combats Obesity

2011-06-04T11:26:00.002-06:00

The sedentary nature of our society is a key contributor to the endemic of obesity that we face today. In North America especially, every aspect of our daily life encourages a maximum time efficiency, minimum effort approach. Cities are engineered for optimum motorized traffic flow with little to no regard for cyclists; many streets have sidewalks only on one side, if at all; elevators and escalators abound. Hats off to a new apartment building in the Bronx that is designed to promote an active home lifestyle!

The Melody apartment complex, unveiled for the first time earlier this week and due to be inhabited this summer, is a 63 unit complex with several features designed to increase calorie burn. The stairwell is a simple, yet important feature of this building. Decorated with bright colors and inviting artwork, they have even installed speakers spouting funky jazz music (yes - dance your way home!). The stairs are a central and prominent feature, whereas the single elevator is available, but much more subtly placed, and sans music.

I take a moment to contrast this with my own condo complex: several elevators centrally placed, and it's not even possible to use the stairs to go upward upon entry into the building - the stairs are emergency exit only, with a one way door that locks from the outside.

I pause for another moment as a recollection of a recent hotel stay flits through my mind: a lavishly decorated elevator with thickly cushioned walls to lean against, and a flat screen TV built into the wall to keep me rooted to the spot! I looked for the stairs for a while, but I couldn't find them.

There is also a beautiful backyard with a collection of brightly colored exercise equipment for adults, and climbing equipment for children. Having parent and child exercise facilities in one place makes it easier for all family members to get exercise simultaneously, and the central location facilitates the easy meeting of friends to get in a workout together - support and group activity promotes dedication to an ongoing exercise program. For rainy days, there is also an indoor gym with big windows to allow lots of natural lighting and keep energy levels high.

Apartments in this complex are reasonably priced between about $105,000-220,000 USD, and is the first building to be designed in concert with suggestions from New York City's Active Design Guidelines, which provides a guide for developing buildings with exercise in mind.

While not every apartment complex will have the finances to support gym facilities, putting a few more dollars into the stairwell and placing it/them more centrally is surely affordable for any builder, particularly if costs are cut on the number or luxury of elevators installed.

Simple things with a big impact - now we're talking.

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

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Eat Breakfast - and Make It High Protein!

2011-05-28T05:51:00.006-06:00

We have long extolled the virtues of eating breakfast as an important weight loss and weight maintenance strategy: we often counsel patients to 'eat breakfast like a king, lunch like a prince, and dinner like a pauper'. A recent study gives us more insight as to just how eating breakfast affects our brain activity and helps us control weight - especially if we load it up with a good dose of protein!

Heather Leidy and colleagues looked at the effects of breakfast eating in overweight, breakfast-skipping adolescent girls. Ten girls were provided a normal protein (18g) and a high protein (50g) breakfast (each containing 490 calories) for a week each, and their appetite, feelings of fullness, and brain activation responses (using functional MRI scans) were compared to their baseline values in their usual breakfast-skipping habits.

The study found that the addition of breakfast resulted in significant reductions in brain activation responses to food stimuli several hours later, in areas of the brain that are associated with hunger, desire to eat, food motivation, and reward. Decreased brain activation in these areas (including the hippocampus, amygdala, and others) were associated with lower appetite scores and higher sense of fullness as ranked by study participants.

In addition, the high protein breakfast led to even lower activation in some of these important food intake regulating areas of the brain, compared to the normal protein breakfast.

Therefore, this study shows that eating breakfast may help to regulate brain activity to control eating behaviours later in the day, especially if the breakfast is high in protein.

So, get out your Egg Beaters, your no-salt-added cottage cheese, your skim milk, and your lean cuts of deli meat - there are lots of options to create a high protein, healthy start to your day!

(Please note that if you have any kidney problems, that you should speak with your doctor about how much protein in your diet is right for you, before making changes to the protein in your diet.)

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

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Video Blog - Managing the Munchies at Work!

2011-05-21T20:20:00.008-06:00

In this video blog, Dr Sue reviews simple tricks to help manage hunger during a long day at the office. Consider baking some chicken breasts on the weekend, which can then be taken to work each day and eaten in various healthy ways for lunch. Bring Ziploc bags packed with healthy greens and store them in the fridge at the office (celery and carrots can make it for a number of hours outside of the fridge)! 100 calorie packs of snacks are available in many varieties at the grocery store as well. Diet pop or sugar free candy is good to have on hand to fight off a craving for sweets!

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Are We Getting Our 10,000 Steps A Day?

2011-05-14T17:59:00.002-06:00

As part of living a healthy lifestyle, it's important to make a point of being active on a daily basis. Though this used to come naturally to our ancestors, we have to make a purposeful point of moving these days, as our society is built to promote a sedentary lifestyle where we can get most of our daily tasks accomplished without moving much at all. Thus, one piece of counseling that health care providers often give (including myself!) is to take 10,000 steps a day. To confirm that I am practicing what I preach, I donned a pedometer a couple of weeks ago to check out my own daily steps.

I must admit to you that prior to this little self-experiment, I was confident that I was well over my requisite 10,000 steps. I rush around all day long in a whirlwind of activity as many of you do as well - there was no doubt in my mind that I was making the cuts!

Well....was I wrong!

In a crazy day in my clinic, running literally up and down the halls all day, it turns out that I bag only 2,000 steps. This was a disappointing realization! The first day I discovered this, I thought, no matter, I still have errands to run at the grocery store... those laps up and down the aisles will be sure to get me there. Nope - just 600 steps more. (I even took a couple of extra trips down the veggie aisle to buff this up a bit.) A walk to the gym and back (from the parking lot) gets me another 1,200 steps... and then there's about another 500-1000 steps around the house between the start and end of the day.

My grand total for a typical, very busy day, ranges between 3,000-4,500 steps. Not even half!

This is why we all need to have a purposeful focus on activity on a daily basis. Other than those lucky few of us who truly engage in physical exercise at the workplace (manual labor, or a self-propelled transport/delivery job such as newspaper delivery), we simply do not get enough exercise in our day.

There are two ways to solve this dilemma:
1. Focused physical activity (workouts at the gym, running, cycling, skiing, etc)
or
2. Modification of daily life to accomplish those 10,000 steps!

The science behind the 10,000 steps is that walking this distance (about 8km or 5 miles) is equivalent to about a 500 calorie burn (though this amount will vary depending on how much you weigh). If you have a 500 calorie deficit per day, this would result in one pound of weight loss per week - but remember that this has to be 500 calories above and beyond what you take in. Also remember that if your weight is stable, you'd have to walk an additional 10,000 steps above and beyond what you already do, without eating anything extra, in order to lose weight at that rate. Sound difficult? - It is!! This is why the studies show overall that exercise alone does not result in weight loss - unless it is accompanied by a calorie reduced diet. However, exercise remains crucially important as it has many health benefits, and is very important for weight maintenance as well.

Modification of daily life to increase your daily steps can include any number of things:

park at the far end of the parking lot (it is interesting to observe people circling the lot at the gym to get the spot closest to the door!)
walk into the the store instead of using the drive-thru
go to the mall instead of shopping online
take the dog for a longer walk
get off the bus one or two stops earlier
and the list goes on!

Wearing a pedometer is a great way to monitor and motivate yourself - studies show that it is those of us who walk the least, who benefit the most from this wonderful little tool.

For me, I'll keep up my workouts at the gym to make sure I top my 10,000 steps worth of activity each day....and I'll take our dog for a few more trips around the block!

I'd love to hear about your experiences with your pedometer, and how you've modified your life to increase your steps!

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

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Should Adolescents Have Bariatric Surgery?

2011-05-07T05:30:00.001-06:00

Obesity is a serious problem amongst all age groups, and we are seeing obesity affect younger individuals in higher numbers. It is estimated that 18% of American adolescents and 9% of Canadian adolescents are obese. In adults, bariatric (weight loss) surgery is increasing recognized as an important treatment option for adults who suffer from severe or complicated obesity, in whom all other treatment options have been unsuccesful. As such, the question is being raised as to whether adolescents with severe obesity should be considered for weight loss surgery.

This complex issue was discussed at the Canadian Obesity Summit last weekend in Montreal. I had the pleasure of hearing several speakers from both the US and Canada, sharing their experiences on this issue.

Dr Evan Nadler, pediatric surgeon at the George Washington University School of Medicine & Health Sciences, discussed the various types of weight loss surgeries and the known data to date. So far, preliminary evidence suggests that lap banding may be the most appropriate surgery to consider in this age group. Early data suggests that the risks of gastric bypass surgery may be unacceptably high amongst teens, and there is little data regarding sleeve gastrectomy. All three of these surgeries are being actively studied.

Dr Jill Hamilton, pediatric endocrinologist at the Hospital for Sick Children in Toronto presented the STOMP (SickKids Team Obesity Management Program), an innovative program which provides multidisciplinary support to adolescents with obesity, and for the appropriate candidate, bariatric surgery. Five patients have been operated so far (with the first ones being done in October 2010), and this is the only pediatric Canadian site that is currently exploring this area.

Dr Beth Dettner, PhD and psychologist who works with the adolescents in the STOMP program, provided a poignant review of the psychological complexities of this population. There are several challenges involved in selecting the appropriate teen for bariatric surgery: assessing for psychological conditions like depression, anxiety, and eating disorders, assessing family functioning and support for surgery, patients' and parents' understanding of the surgery and required diet and activity behaviours, the teen's coping skills, and their motivations for surgery are all key components.

I found this to be an absolutely fascinating workshop, and I have a deep and renewed respect for the challenges that face adolescents with obesity, and their health care professionals as they work with these patients to find the most appropriate and successful treatment options. Elements ranging from the high prevalence of binging and purging behaviours (as high as 30%), to the potential impact of gastric bypass surgery on accrual of peak bone mass, to the possibility of parental coercion to have the surgery, to the challenges of compliance with follow up, to specific motivations for desired weight loss (and the list goes on) all need special consideration in this population, and must be very carefully weighed against the potential weight, health, and psychosocial benefits that can result from successful bariatric surgery.

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

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What We Don't Know about Absorption of Medication after Gastric Bypass Surgery

2011-04-29T15:18:00.000-06:00

Although there are now over 160,000 gastric bypass surgeries being performed on an annual basis world wide, there is still much that we are still learning about postoperative management of concomitant medical conditions. One area in which we know very little is in regards to the effect of gastric bypass surgery on the absorption of medications taken orally.

Because gastric bypass surgery causes food to bypass about the first 1.5m of small intestine, the absorption of some medications may be significantly impaired as well. One medication that is particularly relevant in the gastric bypass population is metformin, as it is the first line of treatment to treat type 2 diabetes, and is also used to prevent diabetes in patients who have prediabetic blood sugars. Although gastric bypass surgery results in remission of type 2 diabetics in about 80% of people initially, about half of these cases of diabetes recur by 5 years postoperatively, so metformin use may be considered at some point in a signficant number of these patients.

At the Second Canadian National Obesity Summit in Montreal today, Dr Raj Padwal of the University of Alberta presented the results of a recent study that were published in the journal Diabetes Care, looking at the absorption and bioavailability of metformin in patients who have had gastric bypass surgery.

In this study, 16 patients who had gastric bypass surgery were administered a single dose of 1,000 mg of metformin, and their absorption of metformin was compared to 16 gender and BMI matched control subjects who had not had gastric bypass surgery. Surprisingly, they found that metformin absorption was actually increased in patients who had had gastric bypass surgery - exactly the opposite of what was expected.

Although this was a small study and tested only a single dose of metformin, it raises some interesting questions. Does the absorption of medications after gastric bypass vary depending on the normal absorption rate of a medication? Does the surgery have some effect to alter transporters in the lining of the gut to accelerate absorption?

Other medications which are very relevant in this population include birth control pills (we currently recommend against using them to prevent pregnancy after gastric bypass because we don't know if their absorption is altered) and antidepressive agents (a slightly increased risk of suicide is seen after gastric bypass surgery - is this due to changes in the patient's environment, a difficulty in breaking the emotional bond with food - or, as Dr Padwal questioned in his commentary today, could impaired absorption of antidepressive medications play a role?).

Further studies clearly need to be done to improve our understanding of medication absorption after gastric bypass surgery.

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

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115 Calorie Chocolate Espresso Brownies as a Holiday Treat!

2011-04-23T08:18:00.004-06:00

It's holiday weekend! Families and friends are gathering to celebrate the occasion, often with heaping trays of food, snacks, and desserts in tow. The sweets enjoyed at the end of the meal are a significant contributor to the total caloric intake of a meal, and can easily provide as many or more calories as the meal itself.

As such, I would like to share with you one of my very favorite recipes. These chocolate espresso brownies are absolutely delicious - they are moist and satisfying, and you'd never guess that they contain only 115 calories per square! The secret that makes this recipe low calorie yet very flavorful is that cocoa powder is used instead of chocolate. And no, the brownies are not microscopic - they are appropriately portion controlled at 1/16 of an 8x8" pan.

For diabetics, please note that the carbohydrate content is about 17 grams per square. This is not a lot of carbohydrate, but they are simple carbs (sugar and flour), making this a high glycemic index food (a deviation from the recommendations of choosing complex carbohydrates with a low glycemic index). Therefore, these squares may cause blood sugars to rise a little more than a complex carb food would. Having said that, one square as a special Easter dessert would be a much better choice than many other desserts, which can easily contain several fold higher carbohydrate and calories.

Ingredients:

2/3 cup unsweetened cocoa powder
1/3 cup all purpose flour (or try whole wheat flour for a more complex carb)
1/2 tsp baking powder
1/3 cup canola oil
1/2 cup packed dark brown sugar
1/2 cup granulated sugar
4 large egg whites
1 tbsp instant espresso powder (I like to use a Starbucks Via!)
1 tbsp hot water
1 tbsp coffee flavored liquor
1 tsp vanilla extract

Heat oven to 350F.
Whisk together cocoa, flour and baking powder.
In a separate bowl, stir together canola oil and sugars.
In a small bowl, whisk the egg whites until they are foamy.

In a small cup, dissolve the espresso powder in 1 tbsp hot water. Stir coffee, coffee liquer and vanilla extract into the canola/sugar mixture, along with the egg whites. Gradually stir this into the cocoa mixture, until well blended.

Pour the batter into an 8x8 inch baking pan lined with foil and coated with cooking spray. Bake 25 minutes, or until a skewer inserted into centre comes out clean.   Cool completely before cutting into squares.

Makes 16 brownies.

Per brownie:
115 cal, 2g protein, 17g CHO, 5g fat, 1g fiber.

Note that these brownies don't have any icing - they don't need it, as they are so rich on their own. For decoration, consider adding one dark chocolate chip to the top of each one while they are still warm (for an additional 2.5 calories!).

It can be a challenge to maintain a healthy dietary pattern on weekends like this! Remember to practice portion control at all aspects of the meal as well, and to make healthy food choices wherever possible!

Dr. Sue © 2011   www.drsue.ca     drsuetalks@gmail.com

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FDA Gives Thumbs Up to Broader Lap Banding Indications While Research Gives Thumbs Down to Long Term Outcomes

2011-04-16T02:48:00.002-06:00

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 drsuetalks@gmail.com

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Dangers of the Very Low Calorie Diet

2011-04-09T12:45:00.000-06:00

For people struggling with overweight and obesity, there are an overwhelming number and variety of diet strategies that are available in the commercial marketplace. With the wide diversity of options available, it can be confusing to sort through them, and to know if some are better than others. One thing is certain: any diet plan that includes a very low calorie diet can be downright dangerous.

A 'Very Low Calorie Diet' is defined as any diet providing less than 800 calories per day. These diets aim to supply very little energy, while trying to supply essential nutrients. They often seem very attractive because of the rapid weight loss that often occurs on these diets. However, there are several safety concerns with these Very Low Calorie Diets, including the following:

1. Potentially fatal heart rhythm disturbances may occur. These diets cause a rapid shift in water balance, especially in the early phases, which can lead to dangerous alterations in the balance of electrolytes that are important to normal heart function and rhythm (especially potassium). Over the longer term on these diets, even after the initial fluid shifts settle down, these electrolyte imbalances and heart rhythm disturbances can still occur.

2. Very low calorie diets are likely to be nutritionally insufficient. Because so little food is being taken in, it is very difficult to obtain sufficient amounts of the important vitamins and minerals that are needed for the daily function of our body and cells.

3. Due to the rapid weight loss that is seen on these diets, there is an increased risk of gallstone formation. (Any intervention that causes rapid weight loss can cause gallstone formation - weight loss surgery is another example of this.)

In addition to the safety concerns above, the very low calorie diet is highly unlikely to result in successful and sustained weight loss over the long run. Though they can result in a substantial and rapid weight loss, they teach nothing about how to modify dietary habits in the long term. Therefore, when an individual stops one of these diets (and they do stop at some point, as they are simply not sustainable over the long term), a rapid weight gain most often ensues, as that person returns to their old habits and way of life.

In addition, a number of studies have shown that a diet providing 500-600 calories per day does not produce a greater weight loss compared to diets comprising 800 calories per day. It has been suggested that the body may go in a 'starvation mode' on the very low calorie diets, downregulating its metabolic rate and calorie burn, as an evolutionary tactic designed to survive times of starvation. In other words, these diets may negatively affect your baseline metabolism while on the diet, such that your calorie burn is lower, thereby leaving you with no greater weight loss benefit, but putting you at all of the risks that come with these low energy diets.

In order to successfully lose weight, the calories in must be less than calories out - no doubt. However, a permanent lifestyle change that results in a more moderate rate of weight loss is much safer, much more enjoyable, and sustainable! We generally recommend a weight loss of 1 pound per week, which can be achieved by a typical woman on about 1,200 calories per day, or by a man on about 1,700 calories per day, though this number can vary substantially from person to person. You can calculate your own caloric requirement for weight maintenance or weight loss using the BMR calculator here.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Iced Pumpkin Fiber Muffins!

2011-04-03T15:41:00.000-06:00

Pumpkin is a fantastic ingredient to consider for use in your baking. It weighs in as a low calorie food at only 30 calories per cup, and it lends a fantastic moisture to your baking that makes it easy to bake without oil or butter. I have scoured the internet to find a good, healthy, pumpkin muffin recipe, and here it is: The Hungry Girl does it again!

These muffins are delightful! They are made with one of my favorite sources of fiber, that being Fiber One Cereal (All Bran is my other favorite source). They taste great with or without icing. Should you choose the 'with icing' alternative, consider sprinkling a little cinnamon (and maybe just a little extra Splenda) on top.

Ingredients:
Muffins
1 cup Fiber One Original bran cereal
1 1/2 cups whole-wheat flour
1/2 cup Splenda No Calorie Sweetener (granulated)
1/4 cup brown sugar (not packed)
1 tbsp. baking powder
2 tsp. cinnamon
1/2 tsp. pumpkin pie spice
1/4 tsp. salt
One 15-oz. can pure pumpkin
1 cup club soda
1/2 cup fat-free liquid egg substitute (like Egg Beaters Original)
1/4 cup sugar-free pancake syrup
1 tsp. vanilla extract
1/4 cup raisins, chopped

Icing
1/4 cup Cool Whip Free, thawed
3 tbsp. fat-free cream cheese, room temperature
1 tbsp. Splenda No Calorie Sweetener (granulated)

Directions:
Preheat oven to 350 degrees. Line 10 cups of a 12-cup muffin pan with baking cups and/or spray with nonstick spray. Set aside.

Using a blender or food processor, grind cereal to a breadcrumb-like consistency. Transfer crumbs to a large bowl.  Add flour, Splenda, brown sugar, baking powder, cinnamon, pumpkin pie spice, and salt. Mix well and set aside.

In another bowl, combine pumpkin, soda, egg substitute, syrup, and vanilla extract. Mix thoroughly. Add mixture to the large bowl and stir until blended to form the batter.

Slowly sprinkle and stir chopped raisins into the batter. Evenly distribute batter among the 10 prepared cups of your muffin pan. (Batter may be piled high... This is OK!)

Bake in the oven until muffins are golden brown and a toothpick inserted into the center of one comes out mostly clean, about 30 minutes. Set aside to cool.

Meanwhile, combine all icing ingredients in a small microwave-safe bowl. Mix until smooth and blended. (Refrigerate icing if you don't plan to serve muffins right away.)

Remove cooled muffins from the pan. Just before serving, warm icing in the microwave for a few seconds and drizzle it onto the muffins (or simply spread it on evenly). Enjoy!

MAKES 10 SERVINGS

Serving Size: 1 iced muffin

APPROXIMATE:
Calories: 150
Carbs: 30g
Fiber: 4g

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Lap Banding May Have Poor Long Term Outcomes

2011-03-26T16:02:00.000-06:00

As weight loss surgery gains popularity globally, there is much debate as to which of the several surgeries available is the best option. As we get more years of experience under our belts (so to speak), it seems that laparascopic adjustable gastric banding may be a poor choice of surgery over the long term.

A study was published last week in the Archives of Surgery by Dr J Himpens and colleagues, examining the long term outcomes of lap banding. This study comes out of Saint Pierre University Hospital in Belgium, which is the first site to ever perform the procedure in 1992.

With a long term follow up of 12 years or more, the study found the average excess body weight loss with laparscopic adjustable gastric banding was 43%, though this varied greatly from person to person (excess body weight is defined as the amount of weight OVER a Body Mass Index of 25 that a person carries, so in other words, they found that patients lost an average of 43% of the total amount of body weight that they would need to lose in order to get to a 'normal' body weight).

In terms of complications, they found that 22% of patients experienced minor complications (such as infection of the access port or incisional hernia) from their lap band, while 39% experienced major complications (such as erosion of the band through the wall of the stomach, or slippage of the band). Sixty percent required at least one additional operation (often to fix a complication), and 17% percent of patients had their procedure switched to gastric bypass surgery (a more complicated weight loss procedure where the stomach is made permanently smaller, and the intestines are rerouted such that food bypasses the first 1.5m of small intestine). Only 51% of patients still had their band in place at the 12+ year mark. Having said the above, the majority of patients still rated their satisfaction with the band as good, though there was no overall change in quality of life scores.

In terms of obesity related complications, one in particular that I found interesting is their observations in regards to diabetes. Over the shorter term (eg 2 years), data suggest that weight loss surgery is dramatically effective to put many cases of diabetes into remission. In this study, they found that while only 5 of their patients had type 2 diabetes before surgery, 11 of them had type 2 diabetes at the 12 year follow up. While it is very possible (and probably likely) that more of these patients would have developed diabetes had they not had the surgery, I think the point is that weight loss surgery should not be considered a lifetime 'cure' or prevention of diabetes, though it can certainly provide some disease-free years or lessen the severity of the disease. I would also point out that more complex bariatric surgery procedures such as gastric bypass are superior to banding in their effect on diabetes, though cases of diabetes are often shown to recur over the long term post bypass as well.

This study is subject to several limitations, including the fact that they were only able to follow up with just over half of the patients that were contacted for full evaluation. Newer techniques for lap banding are now currently being utilized that may have lower complication rates than the methods used 12+ years ago. Successes, failures, and complication rates may differ from centre to centre as well. However, this is the first study exploring outcomes of lap banding after more than 10 years post surgery, so they are important and must be taken into consideration. This study, and other experiences accumulating around the world, is likely to lean surgeons away from performing lap band surgeries.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Retail Giant Walmart Joins Fight Against Obesity

2011-03-19T13:04:00.002-06:00

As governmental and health care organizations strive relentlessly to find new and innovative ways to battle obesity, it often seems like a bit of a David vs Goliath battle, in that one of the main combatants is the overwhelmingly wealthy and powerful commercial food industry. The retail and food giant Walmart now promises to take steps to improve the quality of the food on their shelves, as a contribution to a healthier America.

Walmart is one of the biggest grocery retailers in the US, accounting for about 15% of the American grocery industry. As a move to align itself with Michelle Obama's anti-obesity campaign, they have pledged to reduce sodium, sugar, and fat in their store brand products by year 2015, and plan to push their suppliers to do the same. They are also working on a front-of-package label that will identify more healthful products. It is noted that other industry players have made similar pledges, but Walmart's promised changes are particularly noteworthy in light of their substantial market share of the US grocery industry.

There is no doubt that we need the commercial food giants to be on board to help us shape a healthier society, and it is encouraging to see changes like this taking place! Perhaps in a world where there are conscientious members of the food industry on our side, and where Subway has now surpassed McDonalds as the world's largest restaurant chain, we will start to see lasting impact in our fight against obesity and related diseases.

Thanks to Brian at marketinghits.com for the heads' up!

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Preventing Radiation Induced Thyroid Cancer with Iodine in Japan

2011-03-13T09:02:00.000-06:00

The consequences of the tsunami that struck Japan on March 11, 2011 are truly devastating, with hundreds confirmed dead and many more still missing. Unfortunately, the potential dangers that stem from this tsunami may stretch long into the future, as the Fukushima Nuclear Power Plant sustained damage from the tsunami as well. Health authorities are now preparing to distribute iodine to individuals potentially exposed to radiation for the prevention of thyroid cancer, and I thought I'd take a moment to explain why.

Thyroid tissue is among the most radiation-sensitive tissues in the body. The link between radiation exposure and thyroid cancer was better understood in the aftermath of the Chernobyl nuclear accident in 1986, where an increased risk of a common type of thyroid cancer called papillary thryoid cancer was found in people exposed to the disaster. It appears that the Chernobyl radiation may have caused rearrangement of a cancer gene called the RET gene in the thyroid cells of these patients, leading to ongoing expression of this gene (this gene is normally not active in thyroid cells).

In the event of a nuclear accident, potassium iodide can be taken to decrease the thyroid's uptake of radioactive iodine, thereby protecting the thyroid from developing these radiation-induced genetic alterations. The ability of the iodine to protect the thyroid decreases within hours after the exposure, such that the iodine's ability to protect decreases to 80, 40, and 7 percent at 2, 8, and 24 hours following exposure, respectively. As potassium iodide prophylaxis may have a small risk of causing hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid), particularly in people with enlarged thyroid glands, and because the risk of radiation-induced thyroid cancer is higher in younger people, the benefit is greatest in younger individuals.

In terms of medical radiation exposure, there is an increased risk of thyroid cancer in some patients who have received external beam radiation treatment (for example, for treatment of a cancer in the head or neck area), particularly if that exposure was at a younger age. There is no evidence that radioactive iodine used for diagnosis or treatment of hyperthyroidism is associated with increased cancer risk.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Social Marketing and the Impact of Now

2011-03-12T20:17:00.001-07:00

I'm sure many of you have heard it from your doctor before, and for health care providers out there, I'm sure you've said it many times: even though you feel perfectly well and have no symptoms, take this medication now, because it will decrease the risk of disease decades down the road. These words are often met with reluctance on the part of the patient - why take a medication when you are feeling well today?

At the inaugural International School for Obesity Research and Management this past week, I had the opportunity to both discuss my own research, as well as interact with colleagues who share my passion for obesity research, treatment, and prevention. One session that really stands out was about social marketing, presented by Dr Sameer Deshpande from the University of Lethbridge. Dr Deshpande dealt with this very issue of the human tendency to focus on NOW, in the context of the food industry's marketing of unhealthy food products. Have you ever noticed how junk food is most often marketed with messages of instant gratification, such as McDonald's 'I'm Lovin' It', 'Snickers Really Satisfies', 'Pop Your Hunger with Pizza Pops'? Or how about the messages that promise an instant catapult into the world of glory, coolness, or success: 'Pepsi: The Taste of a New Generation' and 'Red Bull Gives You Wings' are shining examples of this.

These selling strategies are taken because marketing research has shown time and time again that messages that promise an instant benefit are the most appealing to consumers. In the battle against obesity and related diseases, these considerations must also be taken into account in the promotion of healthier food choices. For example, reduced salt products are preferable to the full salt variety, to decrease the risk of conditions such as high blood pressure, which is a risk factor for heart disease and stroke. To appeal to the 'NOW', such a product should be marketed with a slogan such as 'just as satisfying as the high salt original', rather than 'decrease your risk of high blood pressure by eating the low salt brand'.

The appeal of NOW is much harder to target when it comes to preventative medications. For example, we often advise patients to take cholesterol lowering medication in order to prevent heart disease and stroke. In most cases, high cholesterol is without symptoms for years until problems related to narrowing of the arteries (atherosclerosis) start to manifest. I'm very keen to hear what my readers may think about this issue, and how they might suggest that health care providers could better approach the use of preventative medication.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Sedentary Activity Promotes Obesity More Ways Than You Might Think!

2011-03-06T13:23:00.001-07:00

Sad to say, but true: the modern way of life is centered around sedentary activity. We take motorized transport most places we go, and we go less places. We sit at our computers for hours on end; we often relax in front of the TV to unwind in the evenings; and the current generation of children is crazier about video games than ever before. Clearly, this lack of activity contributes to the obesity epidemic by way of decreasing energy output overall. However, the story goes much deeper than that: it turns out that certain types of sedentary activities have other important effects on the Energy In (food intake) side of the equation!

As reviewed by my University of Copenhagen colleagues and led by Dr Chaput, there is evidence to suggest complex effects of the following sedentary activities on food intake and obesity:

1. TV Viewing. Excess TV time is a problem that plagues our society, with nearly 60% of American adults watching TV for more than 2 hours per day. Not only is this a sedentary activity, but studies suggest that as much as 25% of the day's calorie total is consumed in front of the screen, and TV watching also results in a preference for high calorie, tasty foods. People who are more distractable may be particularly susceptible to the weight-increasing effects of TV time (it's the classic: open the bag of chips, start snacking as you sit down to a movie, and before you know it, you're reaching into an empty bag and are surprised that they are gone!). Not surprisingly, distractibility has been associated with overweight and obesity.

2. Video Games. Although many adults enjoy video games, perhaps the most important impact is amongst our children, who are estimated to spend 2 hours gaming on average per day. Not only are most video games sedentary, but they have also been shown to result in an increase in food intake later in the day. This may be due to hormones released during the mental stress or excitement of the game, advertisements for high calorie food seen during online gaming, or other factors. As for the higher energy games like the Wii, it is not yet known where the energy balance pans out. Even decreasing a child's sedentary video game time by an hour a day could have an important impact, as each hour per day spent at gaming doubles the risk of obesity.

3. Cognitive Activity. As technology progresses, we as a society are spending more and more time engaged in sedentary brain-heavy activity, and less time doing physical work. Computer work is the primary offender in this area. Mental work is fueled by glucose, which is in fairly short supply in the body (versus muscle activity which can also be fueled by fat). The increased use of glucose by the brain may alter feeding patterns towards consumption of more carbohydrate and/or more calories. Mental work can also be stressful, causing the release of stress hormones such as cortisol, which is also associated with increased food intake.

4. Music. Believe it or not, the tunes you have pumping from your iPod or stereo may be impacting your weight as well. Listening to music while eating results in longer meals and a higher calorie consumption; faster and louder music increases food consumption as well. Unfortunately, soft, comforting music isn't the answer either, as this has been shown to result in an increase in liquid calorie consumption (particularly alcohol!).

So, how do we combat all of these factors in our struggles against obesity? Well, the answer is clearly not to stop working at the computer, stop listening to music, or to refrain from enjoying the occasional movie or TV program to unwind after a hard day. The first step is to think about the above points, and think about how they could perhaps be modified within your own life in a positive way. For example, consider:

standing while talking on the phone at work - even better, try standing on a balance board (provided this is safe for you to do - it may not be if you suffer medical problems such as diabetic neuropathy or other issues that could impact your balance)
cutting TV time in half
investing in a desk that mechanically raises and lowers, such that you can stand at your desk
encourage your child to engage in a physical activity rather than play video games

As for music....? Not sure what to say about this one. Should we turn off the music while we're eating? Or perhaps it's enough to just keep it in mind. I'd be interested to know what my readers have experienced or may suggest?

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Does the 'time of the month' affect your dieting success?

2011-02-26T06:24:00.002-07:00

Ladies, picture it: It's 10 pm, and you are just about to go to bed. You've had a reasonable day, but your mood has been a bit under the weather, for which a concrete reason does not seem quite at hand. You've been craving chocolate all day despite eating a healthy and filling breakfast and lunch, and you've given in to the craving once already in the afternoon.... but the other half of that unforgettable chocolate bar is still in your cupboard and calling your name..... You run to the kitchen, you eat... you smile.

The cycle repeats for a few days, following which comes the explanation for the seemingly unexplainable: Aunt Flo makes her monthly appearance (on a Saturday morning when you were on your way to the pool, the lake, or the beach - naturally!).

I'm sure there are many ladies out there who can relate to this story.

Here are some interesting facts about the relationship between menstrual cycle and dieting:

1. Clinical trials have frequently shown that females are less successful than males at losing weight and keeping it off.

2. In the second half of the month (the luteal phase of the menstrual cycle), women's energy intake AND energy expenditure are both increased.

3. In the luteal phase, women also experience more frequent cravings for food, particularly those that are high in carbohydrate and fat, compared to the first half of the menstrual cycle (called the follicular phase).

4. The rate of emptying of food from the stomach may be slower in the first (follicular) phase of the menstrual cycle than the second (luteal) phase, based on findings from a recent study. This slower stomach emptying may be part of the reason for less hunger and food intake during the first phase of the cycle.

5. Some studies have suggested a tendency towards greater use of fat as a fuel source (with less use of carbohydrates) in the second half of the month. Women are also able to exercise at a high intensity for a longer period of time during this phase.

6. Chocolate is the food item most craved by premenstrual women!

These facts make a lot of sense, when you consider the purpose of the menstrual cycle. In the follicular (first) phase, which starts on the first day of menstrual bleeding, your body has essentially realized that it is not going to conceive that month, so the lining of the uterus is shed. About two weeks later, another egg is released, which marks the beginning of the luteal (second) phase. So, your body turns it up a notch (under the influence of changes in your reproductive hormones), to be in the best stead to begin growing a new life: you intake more energy (food), your body kicks your metabolism up a notch (increased energy expenditure), and your ability to exert yourself at a high niveau is augmented as well.

The hormonal stimulus to intake extra energy is probably what fuels the food cravings during this time. Why chocolate? Well, it is the prototype of a food high in carb and fat... not to mention that it may simply be the most delectable food product on Earth!... in some people's opinion, anyway :)

Empowered by this knowledge, what can you do to put your monthly rhythm to your best advantage?

1. Try aiming for heavier workouts in the latter half of the month.

2. Understand the reasons for the seemingly 'unreasonable' cravings - and perhaps give into them, a little (in a portion controlled fashion!). You may find more success in adhering to your diet plan if you allow yourself a little freedom to enjoy the finer things.

3. With the increased intensity of workouts in the second half of the month, you may allow yourself a few more Calories In per day (perhaps 100-200), but not more than that. Again, working with your body's rhythm may increase your ability to adhere to your weight loss plan, and give you greater success in the long run!

Dr. Sue © 2011 www.drsue.ca drsuetalks@gmail.com

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Unraveling the Mystery Behind Weight Gain in Menopause

2011-02-19T17:08:00.001-07:00

It is a well known fact that menopause is often accompanied by unwanted weight gain. In my clinical practice as an endocrinologist, I meet many women struggling with this exact issue. While we are far from understanding all of the exact mechanisms involved in this weight gain, there is much that we do know about it, and a recent study brings us one step closer to understanding the intricate steps involved.

At the time of menopause, the reproductive function of the ovaries cease, and with that, levels of estrogen, progesterone, and testosterone naturally decline to low levels. As these hormones (particularly testosterone) are involved in maintaining lean body mass, one change that we seen in menopause is an increased tendency towards increasing fat mass and decreasing muscle mass, even if the total body weight remains stable. We also see an increased predisposition towards accumulation of 'visceral' fat, which is fat surrounding the abdominal organs. Visceral fat is metabolically active fat, and therefore associated with a higher risk of developing conditions such as diabetes, high blood pressure, high cholesterol, and heart disease.

Further to that, it is also thought that the natural estrogen deficiency that occurs with menopause may cause weight gain by promoting increased food intake. Studies in rodents and humans suggest that estrogen supplementation may decrease food intake, as well as increase metabolic rate (the latter may be due to the effect on muscle mass described above, as muscle burns more calories per kg than fat).

An interesting study published by SS Dhillon and colleagues in the International Journal of Obesity brings us one step closer to understanding how estrogen may inhibit food intake. In a study of rodent neuronal cell cultures from the hypothalamus (one of the key areas of the brain involved in regulation of food intake), it was demonstrated that estrogen decreased the secretion of a hormone called neuropeptide Y, which is the most potent known hormonal stimulator of food intake. Therefore, the natural loss of estrogen production at and after menopause may result in loss of suppression of neuropeptide Y, thereby leading to increased hunger, increased food intake, and weight gain. This hypothesis, based on the above study, now needs to be explored further to see if it holds true in humans.

So, what might this mean for the woman who is combating weight gain during and after the menopausal transition? Well, it is my firm belief that understanding these natural changes are the first step towards being better equipped to deal with them. We do not recommend hormone replacement therapy as the answer, as this has been shown to be associated with an increased risk of potentially fatal diseases, such as heart disease, breast cancer, and blood clots in the legs or lung. However, maintaining an appropriate level of physical activity is crucially important to maintaining the more metabolically active muscle mass (see my previous blog to find out how much activity is recommended by the new 2011 Canadian Guidelines for Physical Activity). The increased tendency towards hunger can be countered by actions such as increased attention towards eating small, frequent meals; drinking water before meals; and eating lots of FreeVeg to decrease your overall calorie intake!

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Tips for Eating Savvy at Restaurants

2011-02-12T20:40:00.003-07:00

Although it is usually best to prepare as much of one's own food as possible, this is simply not practical in many situations. A vacation or a busy work week can result in the frequent need to eat out. Here are a few tips to help maintain a calorie controlled diet while you are on the go! (with pictures from my personal photo journal)

1. Choose a restaurant that serves healthy choices. It doesn't have to be expensive - Subway will do just fine. Ask for nutritional information at the counter, as they will often have this available for your reading pleasure, but only if you ask for it. A restaurant like the one pictured above should generally be avoided!

2. Actively consider ways to reduce the calorie count on the meal you've ordered. Dressings, for example, are often a substantial source of calories. Just one tablespoon of oil contains a whopping 135 calories, and many dressings have oil as their first ingredient! Order your dressing on the side and dip the tip of your fork in it - that is often all you need for the taste sensation!

3. When coffee time rolls around after the meal, think twice about what you are adding to that otherwise calorie free drink. Many restaurant chains will only have sugar packets presented on your table, as sweetener often cannot be repackaged to match the branding of the restaurant chain and therefore doesn't look as nice on the table as the branded sugar, salt, and pepper packages. Don't hesitate to ask if there is sweetener available - they will most often be able to produce some for you.

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2011 Canadian Physical Activity Guidelines - Are You Getting Enough?

2011-02-05T13:45:00.000-07:00

In today's society, most of us do not exert ourselves physically unless we make a conscious effort to set aside special time dedicated towards physical activity. As such, it is important that we are all making sure that we do get enough exercise, and Canada now has brand new guidelines. Are you getting enough?

On January 24th, the Canadian Society for Exercise Physiology published the 2011 Canadian Physical Activity Guidelines, which are easily downloadable for free online. There are four sets of guidelines for different age groups, each on an easy-to-read one page summary sheet. Here is a summary of what is currently recommended:

Children aged 5-17 years:

at least 60 minutes of moderate to vigorous intensity physical activity per day:
this should include vigorous activity at least 3 days per week;
this should include activity that strengthens muscle and bone at least 3 days per week

Adults:

at least 150 minutes of moderate to vigorous intensity aerobic physical activity per week, in bouts of 10 minutes or more
add muscle strengthening activities using major muscle groups, at least twice a week
for adults aged 65 and older, those with poor mobility should perform physical activities to enhance balance and prevent falls

It is noted for all age groups that more daily physical activity (above what is recommended) provides greater health benefits. Specific helpful suggestions are also provided for the different age groups for possible activities to engage in.

Take a moment and review these guidelines with your family - are you and your loved ones getting enough exercise? If not, think about how you can work some extra activity into your daily life. Remember that before you engage in any new exercise program, it is important to speak with your doctor to review the safety of any planned changes in physical activity in the context of your personal health; in some cases, a heart checkup (possibly with additional testing) is important before engaging in any new exercise. No different that getting your bike checked after some time in storage, before you take it for a ride!

Have fun!!

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Smoking and Diabetes: A Deadly Combination

2011-01-30T10:09:00.001-07:00

It comes as no surprise to anyone reading this blog that smoking is bad for your health. Interestingly, the risk goes far beyond cancer risk and heart disease - smoking has an important impact on diabetes as well.

As reviewed by Patasi and Hall, several studies have demonstrated that smoking increases the risk of developing type 2 diabetes 2- to 3- fold. The likely reason behind this fact is that smoking decreases the body's ability to use insulin. In fact, smoking 1 cigarette reduces the body's ability to use insulin by 15% for an entire day! We also see that amongst patients with type 2 diabetes, smokers have higher blood sugars than nonsmokers.

Vascular disease is a complication of both smoking and diabetes, so it should come as no surprise that having both risk factors compounds the risk. Smoking diabetics are more than 10 times more likely to develop peripheral vascular disease than nonsmoking diabetics, and also have a higher risk of small vessel diabetic complications such as nerve, eye, and kidney damage. Smoking can also lead to impotence amongst diabetic men. And that's not all - the list goes on.

Given that we know that smoking increases the risk of several cancers as well as the risk of vascular disease, and that 80% of diabetics will die as a result of heart disease or stroke, smoking and diabetes are truly a deadly combination.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Are Genetics Important in Diabetes?

2011-01-22T16:58:00.002-07:00

In a world where the epidemic of diabetes threatens to spiral out of control, our understanding of the influences that put people at risk of developing the disease is crucial. As a second part to my recent blog about the important genetic influence on the development of obesity, it is also very important to consider the genetic contribution towards diabetes.

In North America, approximately 80% of diabetes is caused by Type 2 Diabetes, which is a condition of elevated blood sugars caused by resistance of the body's organs and tissues to the effects of insulin, to the point where the pancreas is not able to produce sufficient insulin to overcome this state of insulin resistance. Insulin resistance and Type 2 Diabetes worsen with weight gain and improve with weight loss; however, there are a subset of people with Type 2 Diabetes who are normal weight. About 10% of diabetes is Type 1 diabetes, where the immune system attacks the pancreas and causes it to fail to produce insulin. The final 10% of diabetes is causes by various rare genetic disorders.

The evidence for a strong genetic tendency towards developing Type 2 Diabetes is strong. For example:

some ethnic groups residing in North America (such as Hispanic, South Asian, and Aboriginal) are at 2-6 fold higher risk of developing Type 2 Diabetes compared to North American Caucasians
a twin of a person with Type 2 Diabetes is at 90% risk of developing the disease (as compared to Type 1 diabetes, where the risk is lower at 50%)
nearly 40% of patients with Type 2 Diabetes have at least one affected parent (whereas in Type 1 Diabetes, the risk of the child of a Type 1 Diabetic parent getting the disease is only 6%)
the lifetime risk of a person getting Type 2 Diabetes is 5-10 times higher if they have a first degree relative with the disease, compared to not having a relative with the disease

As reviewed by Dr McCarthy, the search for genes connected to Type 2 Diabetes has really taken off with the ability to search the entire human genetic makeup (called the 'genome') in recent years. In fact, there are at least 40 genetic spots (called 'loci') in the human genome that have been found to be associated with a susceptibility to developing Type 2 Diabetes. These genetic variants are associated with a variety of disturbances that affect the risk of developing Type 2, including alterations in the development of the pancreas, insulin synthesis, and insulin secretion. The genes that contribute to development of obesity (as blogged previously) likely contribute to the risk of type 2 diabetes as well, as the insulin resistance that characterizes type 2 diabetes worsens with weight gain.

In terms of the influence of these genetic variants on the risk of Type 2 Diabetes, it appears that in some cases, having two abnormal copies of these genes may as much as double the risk of getting diabetes, compared to having two normal copies of these genes.

For some individuals, the eventual development of Type 2 Diabetes may be unavoidable, due to their genetic makeup. However, many cases of Type 2 Diabetes are preventable, as many people develop sufficient insulin resistance to generate full blown diabetes only when they reach a state of overweight or obesity. While obesity in itself has some genetic predisposition as well, both obesity and type 2 diabetes can be improved with dedicate attention towards a healthy lifestyle.

As for obesity genetics, our understanding of the genetic basis for Type 2 Diabetes is essential, as it will help us in better understanding the disease, finding new targets for treatment, and hopefully allowing us to improve individual strategies towards treatment and prevention.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Are Genetics Important in Obesity?

2011-01-16T07:21:00.000-07:00

With obesity affecting one third of American adults and one quarter of Canadian adults, there is a critical need to improve our understanding of how obesity develops, including the relative importance of genetic and environmental factors. As we explore the human genome, we are learning more and more about the important role of genetics in the battle of overweight.

As reviewed by Dr McCarthy in a recent issue of the New England Journal of Medicine, studies of the full complement of human genes (called the ‘human genome’) are full speed ahead in the last few years. The search strategy that has been the most successful in finding genes linked to obesity has been to search the genome for DNA sequence patters that are seen in association with people who have a higher Body Mass Index (a calculation that assesses weight based on body height, and is used to classify obesity; you can calculate yours here, in the right hand column).

These genome wide studies have identified at least 30 spots (called genetic ‘loci’) on our DNA which influence body weight. Many of these involve alterations of a gene called the FTO (fat mass and obesity related) gene, which appears to be particularly important in its influence on body mass index.

In addition, there are at least 15 loci identified that affect where body fat is deposited in the body. This is important, as we know that body fat deposited around the organs and around the midline is more metabolically active than fat that is deposited under then skin or to the chest and hips. Interestingly, these 15 genetic spots that affect body fat deposition patters show stronger associations in women than in men.

There are exceptionally rare cases of obesity that are caused directly by a single gene or chromosome abnormality, such as leptin deficiency, or distinct genetic syndromes such as Prader-Willi sydrome. However, these are not players in the common case of overweight or obesity.

So, how much does having one or several of the common genetic variants influence the likelihood of being, or becoming, obese? Well, each individual genetic variant does not appear to have a profound effect; the genes with the greatest impact may make a difference of only 2-3 kg of body weight (4-7lb). However, having a number of the obesity-predisposing genetic variants may have an additive effect. As we learn more about these genes, it may be possible in the future to predict or assess one’s risk of obesity based on their full genetic complement, taking into consideration all of the obesity-predisposing genetic variants that they may have.

It is also important to note that an individual is not destined or guaranteed to become obese because of these genetic variants, but these genes may certainly help set the stage for development of obesity, and difficulty in losing weight, in the context of our toxic, obesity promoting environment. It is poorly understood exactly how these genes are expressed, but it is thought that they may have an impact on fat and cholesterol metabolism, appetite regulation, taste preferences, and tendency towards engaging in physical activity.

The future of obesity genetics research is bright: in addition to giving us a better understanding of mechanisms of development of obesity, this research may present to us new targets for treatment and prevention of obesity, as well as the potential for personalized treatment and prevention, depending on each individual’s particular genetic makeup.

In my opinion, one of the most important opportunities this research gives us is ammunition with which to combat the stigma of obesity, both in the general community and amongst medical professionals. Each of us has a different baseline genetic risk of developing obesity, which may result in different trigger points of hunger and satiety, differences in willpower and cravings, and differences in our genetic drive to exercise. Through a better understanding of these genetics and the mechanisms by which they work, it is my hope that we will become better empowered to understand, prevent, and treat obesity in a patient specific, caring, compassionate, and understanding manner.

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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After Gestational Diabetes: What's Next?

2011-01-09T06:59:00.000-07:00

Gestational diabetes, or diabetes diagnosed for the first time during pregnancy, is a common condition, affecting approximately one in 25 pregnant women in Canada. After the baby is born, women who had gestational diabetes may be eager to leave their blood sugar concerns behind, but beware: women who have had gestational diabetes are at high risk of developing type 2 diabetes.

In pregnancy, there are several factors that contribute to the development of gestational diabetes, including increased food intake, weight gain, decreased exercise, and the production of several hormones by the placenta that make the mother more resistant to the effects of insulin. As the development of gestational diabetes identifies women whose pancreas is not able to keep up in the face of the stress of pregnancy, it also identifies women who are at future risk of developing full blown type 2 diabetes (outside of pregnancy). In fact, having had gestational diabetes increased the risk of developing type 2 diabetes later in life by up to 12 fold. Further, some cases of gestational diabetes were likely type 2 diabetics before the pregnancy started, but they did not come to medical attention until the pregnancy began.

Because the impact of undiagnosed type 2 diabetes postpartum is of serious consequence to the mother's health, and also has implications for future childbearing, it is essential that these women undergo screening for type 2 diabetes postpartum. Blood sugars will be checked following delivery in the hospital, but this alone is not enough, as diabetes can return after discharge home when normal life and eating patterns resume.

All women who have had gestational diabetes must undergo a glucose tolerance test within 6 weeks to 6 months postpartum. This involves drinking a glucose containing drink, with measurement of blood sugar before and 2 hours after the drink is taken. Checking fasting blood sugars is not enough, as this will miss 40% of type 2 diabetes in the postpartum population.

Additionally, women with previous gestational diabetes must be screened for type 2 diabetes:

before any future pregnancies
every 3 years, or more often, depending on other risk factors

Unfortunately, as few as 25% of women who have had gestational diabetes complete this important postpartum testing. Having undiagnosed type 2 diabetes can cause injury to blood vessels supplying vital organs including the heart, kidneys, and eyes. Having undiagnosed type 2 diabetes at the time of the next pregnancy can have devastating consequences to the fetus, including congenital malformations and miscarriage.

If you have or have had gestational diabetes, speak to your doctor to be sure that you have undergone, and continue to undergo, the appropriate screening.

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

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Video Blog: Portion Control Your Breakfast!

2011-01-02T08:11:00.001-07:00

Breakfast is an important start to your day, so consider a new breakfast strategy in your 2011 weight management program!

In this video blog, Dr Sue emphasizes the importance of eating breakfast in maintaining a healthy body weight or losing weight. She describes three ways you can easily portion control your breakfast: use of a portion control tool such as The Diet Bowl (which Dr Sue studied in a research trial); storing a measuring cup directly into your cereal container; or using a coffee mug as your breakfast bowl!

Dr Sue Pedersen www.drsue.ca © 2011 drsuetalks@gmail.com

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Holiday Trick: Water Before Meals Enhances Weight Loss

2010-12-26T10:40:00.000-07:00

Especially during the holiday season, any little tips to help maintain (or even lose) weight can be a great help. Here's an easy one to consider through the holidays, and onward into the New Year - it's as simple as H-2-0!

Drinking calorie-free, refreshing water before meals is often recommended to help fill the stomach before eating. A recent randomized controlled clinical trial strengthens this point, showing the benefits that drinking water can have towards helping you slim down.

This trial, conducted by Davy and colleagues at Virginia Tech University, was the first randomized, controlled clinical trial to address this issue. Forty-eight adults were included in the trial, all of whom were provided with calorie-restricted diets to follow. Half of participants were required to drink two 8oz glasses of water about 20 minutes before each meal.

After 12 weeks, the participants consuming water before meals lost an average of 5lb more than the control group, who did not consume water before meals.

The way in which the strategy of drinking water before meals works is two-fold:

1. The physical presence of water in your stomach sets off the 'stretch sensors' in your stomach, releasing hormones that tell your brain that your stomach is filling up.

2. Mixing water with your meal decreases the energy density of your meal (ie the number of calories per gram of material ingested). As blogged previously, a lower energy density diet is beneficial because you feel more full after ingesting a larger mass of food with fewer calories, than if you ingested a high energy density, smaller meal such as a high fat food or dessert. Eating lots of FreeVeg operates under the same principles, as these are very low energy density foods. In fact, one of the contributors to the low energy density of FreeVeg is the very fact that they have a high water content!

Happy New Year to All!!

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

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A Christmas Hit: Crustless Pumpkin Pie!

2010-12-18T08:16:00.002-07:00

Due to the popularity of last week's Blueberry Crisp recipe, I have decided to one-up myself with the help of my sleuthing friend Deb, who has located a fantastic, even lower calorie dessert recipe for us. Thanks go to the Hungry Girl for this invention!

Ingredients:
One 15-oz. can pure pumpkin
One 12-oz. can evaporated fat-free milk
1/2 cup fat-free liquid egg substitute
3/4 cup Splenda (granulated)
2 tsp. pumpkin pie spice

Directions:
Preheat oven to 350 degrees.

Combine all ingredients in a bowl, and mix thoroughly.

Place mixture in an 8" x 8" baking dish sprayed lightly with nonstick spray, and bake in the oven for 45 minutes. (It will remain a little soft, like pie filling.)

Once ready to serve (it's delicious eaten hot or cold), cut into 9 pieces.

Makes 9 servings. Per serving: only 65 calories!

Tip: I made this for my better half last night, and his feeling was that a 4 tbsp puff of light whipped cream on the top was worth the extra 30 calories to make this dessert a little richer tasting. The total for this delicious treat still comes in just under 100 calories. I'll let you decide!!

Happy Holidays!!

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Blueberry Crisp Yuletide Dessert!

2010-12-12T06:57:00.003-07:00

The wonderful holiday season is upon us!! It's a joyous time to spend time with friends and loved ones, with much hosting done from home. Large, filling, high calorie meals are the norm during the holidays, and dessert can often double the total calorie intake of the meal. Here is a suggestion for a fabulous dessert that is not calorie free by any means, but is at least reasonable at 256 calories per serving. My suggestion is to scale down to a half portion for only 128 calories! Eating a half portion also scales down the carbohydrate count (attenntion, diabetics!) to a very reasonable 24 grams.

This recipe comes from my favorite Canadian chefs Janet and Greta Podleski, from their fabulous cookbook, Eat, Shrink, and Be Merry!

Blueberry Crisp (aka Rhapsody in Blueberry)

Filling:

6 cups blueberries (best if fresh)
1/3 cup granulated sugar
2 tbsp cornstarch
2 tbsp freshly squeezed lemon juice
2 tsp grated lemon zest

Topping:

1 cup quick-cooking rolled oats (not instant)
1/2 cup all purpose flour
1/3 cup lightly packed brown sugar
1/2 tsp ground cinnamon
1/4 cup margarine, melted
2 tbsp apple juice or orange juice

1 cup low fat vanilla yogurt

Instructions:

1. Preheat oven to 375F. Spray a 9 x 13 inch baking dish with cooking spray. Add blueberries. Sprinkle bueberries with granulated sugar, cornstarch, lemon juice, and lemon zest. Mix well and set aside.

2. To make topping, combine oats, flour, brown sugar, and cinnamon in a medium bowl. Add melted margarine and juice. Using a fork, stir until mixture resembles coarse crumbs. Sprinkle crumb mixture evenly over coated blueberries.

3. Bake for 30 minutes, until blueberries are bubbling around edge of pan and crumb topping is golden brown. Cool for 10 minutes before serving.

4. Serve with a dollop of low fat vanilla yogurt, if desired.

Makes 8 servings. Per serving:

256 calories
6.9g fat
3g protein
48g carbohydrate

Divide the above numbers by 2 for half servings (recommended!).

To further cut calories, I'd be interested to see how this recipe turns out with Splenda as a substitute for granulated sugar, and/or Brown Sugar Splenda as a substitution for brown sugar. Try it out, and leave a comment to let our readers know how it turns out!

Happy Holidays!

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

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Video Blog on Measuring Metabolism: Step Inside a Respiration Chamber!

2010-12-04T11:44:00.000-07:00

In this video blog, Dr Sue takes you right inside the respiration chambers at the Department of Human Nutrition, University of Copenhagen, which are used to measure metabolism in a research setting.

By simply measuring oxygen consumption, carbon dioxide output, and nitrogen production over a 24 hour period, we can measure exactly how many calories a person burns over 24 hours, and how much of that calorie burn comes from protein vs fat vs carbohydrates as the fuel source.

These chambers are currently being used in a study of gastric bypass surgery patients that Dr Sue is involved in, as well as study of the effects of sleep deprivation on metabolism in kids.

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

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Higher Protein, Lower Glycemic Index Diet is Better for Weight Maintenance

2010-11-26T08:13:00.008-07:00

Attention 'yo-yo' dieters! While many people are able to shed pounds with a variety of dietary and lifestyle interventions, the obstacle that is the largest for many is keeping the pounds off. Many studies have tried to find the optimum diet for weight control and prevention of weight regain, but these studies have been small and conflicting in their results. A new study finally provides some larger scale guidance, showing that a higher protein, lower glycemic index diet is beneficial in prevention of weight regain. (Learn more about what 'glycemic index' means here.)

The DIOGENES study, led by my colleague Thomas Meinert Larsen at the Department of Human Nutrition, University of Copenhagen, where I worked on research sabbatical last year, was published in this week's issue of the New England Journal of Medicine. This is a large study of 773 participants in 8 European countries, testing the effect of five different diets on weight maintenance:

a high protein, high glycemic index (GI) diet
a high protein, low GI diet
a low protein, high GI diet
a low protein, low GI diet
a control diet (typical to the country's usual diet; moderate protein, with no GI recommendations)

Following a period of weight loss on a low calorie (800 cal/d) diet, participants were randomized to one of the five diets above. In two of the research centres, including the Copenhagen site, participants shopped for free in the research supermarket, so that the exact composition of food intake could be strictly monitored. (This is the same research supermarket that I have video blogged from previously.)

Participants were not limited as to the amount of food intake (food intake was 'ad lib'), but were instructed to try to keep their body weight stable (though further weight loss was also allowed).

Among the 548 patients who completed the six month study, weight regain was seen only in the low protein, high glycemic index diet. The high protein component of the diets spared about 1.4kg (3 lb) of weight regain, and the low glycemic index component spared 1.1 kg (2.4 lb) of weight regain. Participants in the high protein, low glycemic index diet were the only group that continued to lose weight through the study period.

Dropout rates were also highest in the low protein, high glycemic index diet, suggesting that this poorly satiating diet may be harder to adhere to.

Interestingly, these differences in results and adherence were seen with only a small difference achieved in dietary composition between groups. The differences that were achieved in the study were 5.4 percentage points of total energy in protein content between the high-protein and the low-protein groups, and 4.7 glycemic index units between the low glycemic index and the high glycemic index groups.

The study concludes that a diet moderately high in protein intake and slightly reduced in glycemic index improved maintenance of weight loss and compliance with the diet, and is therefore ideal to prevent weight regain.

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

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Dental Disease and Diabetes: What's the Connection?

2010-11-20T09:30:00.001-07:00

It is well known that diabetics are at an increased risk of vascular complications, and that control of blood sugar, cholesterol, and blood pressure are important to prevent these complications from developing. One often overlooked risk factor in diabetics is periodontal disease, a chronic bacterial infection affecting the gums and bone that support the teeth.

Periodontal disease is known as gingivitis in its mildest form, presenting as tenderness, redness, and swelling of the gumline. If untreated with proper oral hygiene (adequate brushing and flossing), this can evolve to a chronic condition with gum recession, plaque accumulation and bone loss, called periodontitis.

The relationship between periodontal disease and Type 2 Diabetes is something of a vicious cycle. First of all, it is known that diabetics are at higher risk of developing periodontal disease, and that it is more severe than in non diabetics. The elevated blood sugars increase the susceptibility to infection - bacteria thrive on the excess sugar that is available.

On the other side of the coin, having periodontal disease is associated with an increased risk of developing diabetes, and is also associated with poor blood sugar control in patients with diabetes.

A key factor responsible for the relationship between periodontal disease and diabetes appears to be inflammation. As discussed by Dr Tenenbaum and colleagues in a recent publication by the Canadian Diabetes Association, periodontal disease produces a low grade inflammatory state, with increased levels of inflammatory chemicals in the blood stream. These inflammatory mediators are known to be associated with increased risk of vascular disease, and true to that, an increased prevalence and incidence of cardiovascular disease has been observed in patients with periodontal disease. We also know that Type 2 Diabetes and the complications that develop are partially mediated by inflammatory changes in the blood vessel wall, so this may be part of the link between the two conditions.

To minimize your risk of periodontal disease, follow these important tips from the Canadian Dental Association:

Brush your teeth and tongue twice a day with toothpaste and floss once a day to remove plaque between teeth. When choosing oral health care products, check for the Canadian Dental Association (CDA) Seal of Recognition.
Products bearing this Seal have been reviewed by CDA and have demonstrated specific oral health benefits.
Check your gums regularly. Look for the warning signs of gingivitis and report them to your dentist right away.
See your dentist for regular check ups, and schedule a professional cleaning to remove stains and built-up tartar.
Eat healthy foods for your oral health as well as your overall health. Eating excess sugar is one of the primary causes of dental problems. With the proper nutrients that come from healthy eating and proper oral hygiene, you can fight cavities and gingivitis.
Don't smoke. Smoking is a major contributor to dental problems and may cause oral cancer.

Overweight and Undernourished?

2010-11-13T10:09:00.004-07:00

It seems like a contradiction in terms, but the truth of the current state of affairs is that while most North Americans are overweight, many of us are simultaneously undernourished, being deficient in essential nutrients that are key to disease prevention and optimum cellular function.

As extensively discussed in the 2010 Dietary Guidelines for Americans, published by the Dietary Guidelines Advisory Committee (DGAC), the root of the problem lies in the fact that we tend to eat food that is high in calories, but low in nutritional value. Americans currently consume 35% of their total daily caloric intake as Solid Fats and Added Sugars (SoFAS), which results in excessive saturated fat and cholesterol intakes, with insufficient intake of dietary fiber and other nutrients. The big offenders in the SoFAS category are:

grain based desserts, including cakes, cookies, pies, doughnuts, and granola bars;
cheese, sausage, bacon, franks, ribs;
pizza
french fries and hash browns
dairy desserts such as ice cream
soda, fruit drinks, and candy

On the note of beverages, US adults drink an average of 394 calories per day! For a typical woman trying to lose weight, this amounts to about one third of her desired total daily caloric intake. Major sources of liquid calories include soda, coffee/tea (with added milk or sugar... a large Double Double contains 230 cal), milk, fruit juices, and alcohol. (Note that while obesity rates in Canada are not quite as staggering as they are in USA, the principles still apply.)

While the typical American eats almost three times the recommended maximum intake of SoFAS, they eat only 15% of recommended whole grain intake and 59% of recommended veggie intake.

The Dietary Guidelines for Americans recommend that intake of SoFAS be dramatically reduced, with an increased focus on consumption of nutrient dense foods that will provide adequate vitamin and mineral intake, including vegetables, fruits, high fiber whole grains, low fat milk products, seafood, lean meat and poultry, eggs, soy products, nuts, seeds, and oils. With the right balance of this food list, the end result should also be a less calorically dense diet (eg with increase in FreeVeg consumption), which should result in less weight gain, if not weight stability or even weight loss.

An issue I have with these DGAC guidelines is that it still leaves the average American lost in a sea of recommendations, without enough concrete instructions and guidance to truly be of help in making permanent lifestyle changes. They are also too open for (mis)interpretation, potentially resulting in continued nutritional deficiencies. There is also danger of these guidelines leading to continued weight gain with little room for error: adding two tablespoons of a 'healthy' oil to your diet will add 260 calories, which for many women amount to 20% of their total daily caloric goals - and you haven't eaten anything yet! (The Canada Food Guide is guilty of making this recommendation as well.)

Thus, I am not optimistic that there will be great adherence to these guidelines, nor am I optimistic that they will go far in our battle against obesity.

Further, these DGAC guidelines anticipate that in adherence to their recommendations, that there should be no need for a multivitamin in the general, healthy population. While it may be true that adherence to their dietary recommendations could preclude the need for a multivitamin, in the practical world, it is likely that adherence to their dietary recommendations will be suboptimal. Until the DGAC has confirmed good compliance with their dietary recommendations, it may be a bit premature to recommend against multivitamin consumption.

It is important for all of us to do our best to decrease consumption of SoFAS and to focus instead on nutrient rich foods. There are several issues that must be weighed in consideration of whether a particular individual should consume a multivitamin, and if so, which one; speak with your doctor about your own situation.

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

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Bariatric Surgery: Patient Guide to Endocrine and Nutritional Management

2010-11-06T08:48:00.005-06:00

As blogged previously, bariatric (weight loss) surgery is a treatment options for people with severe obesity that has proven to be resistant to treatment with more traditional and conservative measures. The treatment does not end with the surgery itself, however - the story is far more complex than that.

As beautifully summarized in the Patient Guide to Endocrine and Nutritional Management after Bariatric Surgery in the Journal of Clinical Endocrinology and Metabolism (a free download!), there are several aspects which require close attention and follow up in order to minimize the chance of weight regain after surgery, to minimize the risk of developing a complication of bariatric surgery, and to ensure that complications of obesity are well managed postoperatively.

To decrease the chance of weight regain after surgery, a lot of the preventive work actually has to happen before the surgery is even done. It must be recognized, as with any 'diet', that the lifestyle change being made has to be a permanent one. This is not about eating smaller portions or altering food choices for a short period of time - this is forever. It is also absolutely critical that the relationship with food is thoroughly explored and managed well before the surgery takes place. There are many contributing factors to overeating, many of them emotional: eating in sadness, in joy, to comfort, to alleviate stress, even to service a true addiction to food. People who have not had help in dealing with these aspects of their weight struggles, or who have not worked through these issues prior to surgery, are not appropriate candidates for bariatric surgery, as they stand a high risk of weight regain postoperatively if those habits and coping mechanisms are not managed beforehand.

The risk of nutritional deficiencies is very real after bariatric surgery, particularly after gastric bypass surgery (pictured above), which involves a re-routing of the small intestine such that about 1.5 meters of small intestine is no longer exposed to food and the enzymes required to digest it. Patients who undergo gastric bypass surgery are at risk of life threatening complications if they do not adhere to their supplement regimen, which for most patients includes a specific multivitamin, calcium, vitamin B12, vitamin D, and often iron. An individual who is committed to having gastric bypass surgery must be equally committed to taking supplementation for the rest of their lives. Protein malnutrition is a potentially severe complication of any type of bariatric surgery due to decreased intake; it is essential to follow the protein consumption recommendations provided by the bariatric program's dietician (usually at least 90 grams of protein intake per day).

Because bariatric surgery often has a profound beneficial impact on several obesity-related complications such as diabetes, high blood pressure, obstructive sleep apnea, cholesterol, and osteoarthritis (to name a few), it is important to have physicians involved both pre- and post-operatively who can help to manage changes in medications and treatment approach that are often necessary.

While bariatric surgery is a very appropriate treatment option for some people, it must always be remembered that bariatric surgery is not a quick fix or a cure; it is the exchange of one set of medical issues for another (though usually in a positive direction), and it is most certainly a permanent lifestyle alteration.

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

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Sleep Deprivation is Strongly Linked to Obesity

2010-10-30T10:23:00.006-06:00

I'm sure that everyone reading this blog will be familiar with the phenomenon of sleep deprivation - it is something that all of us have experienced, and for some of us, it plagues our daily lives. It turns out that the effect of sleep deprivation goes much farther than just feeling tired; it can actually have a profound effect on body weight and the risk of obesity.

Dr Jean-Phillipe Chaput, a Canadian colleague of mine who also spent time researching at the Department of Nutrition at the University of Copenhagen, Denmark, is an expert in the area of sleep research. For the scientists among you, he provides an excellent video presentation (the website is from Denmark, but Dr. Chaput's presentation is in English - just press play to watch the video. References to the data below can also be located in Dr Chaput's presentation.)

Along with the epidemic of obesity, we have seen a decrease in the overall amount of sleep we get. According to the National Sleep Foundation, the proportion of young adults getting less than 7 hours of sleep per night was 16% in the year 1960; in 2001, this number increased to 37%.

A study from Quebec showed that children with short sleep were more than 3 times more likely to be overweight, and this association was stronger than other risk factors examined such as parental obesity, television viewing time, and physical activity. Amongst adults age 18-65, the same association was found, with short sleepers (5-6 hours) being 3.8 times more likely to be obese than adults sleeping 7-8 hours per night. Again, this risk factor was stronger than the association of obesity with high fat intake in the diet or physical inactivity. It should also be noted that too much sleep is also associated with obesity; the sleep duration with the lowest body mass index in adults is at 7.7 hours per night.

One obvious factor responsible for this association is that we are simply awake for more hours where we may be inclined to eat. More hours awake equates with a longer period of time per day where we are exposed to our toxic environment that pushes food at us everywhere we look. We may also be more inclined to eat during these extra waking hours due to the activities we undertake during those late night hours - often sedentary activities such as computer time or TV, which often results in snacking on unhealthy foods.

However, the story is much more complex than simply being awake for more hours in a day.

There are several hormonal variations with decreased sleep: we see lower leptin levels (a hormone that normally tells us we feel full and also works to stimulate energy expenditure). We also see higher levels of the hunger hormone, ghrelin, in shorter sleepers, thereby increasing the sense of hunger and desire to eat. Some studies also suggest that the stress hormone, cortisol, increases with shorter sleep duration.

There is also evidence to suggest that decreased sleep may decrease basal metabolism; for example, it has been found that there is a decrease in core body temperature with acute sleep deprivation (lower body temperature being associated with a lower basal calorie burn). We also see a decrease in fidgeting and other behaviours such as our body posture when we are sleep deprived, resulting in a lower calorie burn. Think of how you sit when you are well rested - perhaps sitting in a straight backed chair while you work - versus when you are exhausted, you may be more inclined to assume a more relaxed pose on the couch. These differences may be small, but they matter! Also on the energy expenditure side of the equation, we are less likely to engage in active physical activity when we are tired.

For individuals who struggle with their weight, and also for prevention of weight gain, it is important to include a good night's sleep as part of the overall management approach. The optimum amount of sleep appears to be between 7-8 hours for an adult - be sure to set this as a lifestyle priority!

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

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Lemon Parmesan Broccoli!

2010-10-23T08:47:00.000-06:00

Here is a great way to shake up your broccoli! Broccoli on its own is a Free Veg, meaning that you can eat it in generous amounts without taking in many calories (it's only 30 cal per cup!). It is not quite free with the addition of a little bit of Lite Parmesan... but it's pretty darn close!

INGREDIENTS:

6 cups of broccoli (about 4 heads)
1 lemon
3 tbsp light powdered Parmesan cheese

Cut your broccoli into florets. The broccoli needs to be dry - if you wash it, be sure to dry it thouroughly. Arrange in a 9x13" baking dish.

Zest your lemon and finely chop the pile of zest you get. Chop your lemon in half.

Spray broccoli briefly with an aerosol sprayer such as Pam (a great alternative to oil!). Add a bit of salt & pepper to taste, and squeeze the juice of one half of your lemon on the broccoli. Put your dish of broccoli in a preheated oven at 400C for 20-25 mins. The goal is for the tips of the broccoli to be a little crispy, but not burned.

Remove from oven, sprinkle with the lemon zest, squeeze the juice from your other half of lemon all over the broccoli and top with the parmesan cheese. Return to the oven for 1-2 mins until the parmesan melts, then serve!

Makes 6 servings. Per serving:

50 cal
only 1g fat!

Benefits to Barley and Buckwheat? The Low Glycemic Index Diet

2010-10-16T09:01:00.001-06:00

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 drsuetalks@gmail.com

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Thriving Through Thanksgiving!

2010-10-08T11:10:00.006-06:00

The Canadian Thanksgiving long weekend is here! It's a fantastic opportunity to get together with family and friends to enjoy some quality time, rest and relaxation. Along with the gatherings, and in line with tradition, we can also expect to see tables heaped with delectable food and seasonal treats. Here are some tips to help your waistline and healthy lifestyle program survive the holiday!

1. Portion Control. Naturally, all of us will want to participate in enjoying the delicious treats on offer this weekend. Avoiding the pumpkin pie completely is an option, but it may also leave you with a 'bad taste' (so to speak) in your mouth, as depriving yourself completely on a special holiday can result in resentment for your diet plan, and make it less likely that you'll stick with it in the long term. On a special occassion, consider allowing yourself that special treat in a smaller portion (eg half the usual size), so that you can enjoy that special something in moderation.

For those of you who are calorie counting: 1/6 of an 8" comercially prepared pumpkin pie (109g per slice) contains about 229 calories, though this can certainly vary substantially depending on the recipe.

2. Use a Smaller Plate. Studies show that the larger the plate we serve our meals on to, the larger the number of calories that are consumed. This is simply due to the fact that more food can be accomodated on a larger plate - no one likes the look of a plate that does not appear full. Consider using a portion control plate such as The Diet Plate to help you portion your meal components appropriately, or alternatively, grab a lunch plate to serve up your meal and forgo the larger dinner plate.

3. Pass on the Sauces (or Dip the Tip). Salad dressings and gravies are two examples of high calorie additions to a meal. There are 130 calories in one tablespoon of oil, for example - that is over 10% of the total daily caloric intake recommended for the typical woman who is trying to lose weight - and nothing has actually been eaten yet! A salad dressing that contains a lot of oil can therefore add a lot of calories to your day. Gravies are another big offender, as it is very difficult to know how much fat or how many calories they contain, and they are often prepared with the fat drippings from the bird or roast being prepared.

An alternative to skipping the sauces completely is to have a small bowl of the sauce on the side, in which you can dip the tip of your fork before piercing the food. That way, you still get the taste sensation, without a heap of accompanying calories.

4. Festive Foul: Remove the Skin! Poultry, such as turkey, is often served at Thanksgiving dinners, and is actually a very healthy, protein rich, low fat food source. The skin of a bird, however, can be crispy and delicious but also contains a lot of calories from fat (particularly for duck or chicken). Removing the skin will cut your calories substantially. Also, go for the white meat rather than the dark meat to ensure you are getting the leanest meat possible (for example, there are 20% more calories in dark turkey meat than in light meat).

5. Take Only One Serving, and Eat Slowly! The festive family gatherings are much like a buffet-type meal: the food sits on the table for the duration of the meal, and it is accepted (and in many cases, expected!) to take several helpings. Eating slowly is a great way to combat the tendency to take twice. Fullness hormones first take effect after 10-15 minutes, so be sure to give yourself at least 15 minutes after you finish your first helping before you consider a second - most often, you'll find that you have changed your mind and no longer need the additional serving. Eating slowly also means that you are likely to still have food on your plate when second helpings are offered; this enables you to politely say that you are not ready for seconds yet, without affending your hosts. By the time others are finished their second helping, you will be finished your first, and the fact that you didn't go back for seconds will be unlikely to register!

Happy Thanksgiving!!

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

Follow me on Twitter for additional tips and pearls! drsuepedersen

Video Blog: The New Nordic Diet!

2010-10-03T07:55:00.006-06:00

On a research trip to Denmark this week, Dr Sue took the opportunity to bring you to the research supermarket where an innovative new diet called the New Nordic Diet is being studied. In an interview with Sanne Poulsen, PhD student at the Department of Human Nutrition, University of Copenhagen, we learn about the New Nordic Diet Study, which compares the effects of this diet with the traditional Danish diet on body weight, body composition, and cardiovascular risk factors.

The New Nordic Diet focuses on healthy foods that are cultivated in Scandinavia, such as whole grains (rye, barley, oats), berries, root vegetables, and fish. There is also an emphasis on choosing foodstuffs that are produced in an environmentally sustainable fashion.

Thanks to my friend Brian at www.marketinghits.com for technological support!

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

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Video Blog: Test Tubes Illustrate High vs Normal Blood Sugars

2010-09-26T03:03:00.000-06:00

In this video blog, Dr Sue shows you two mock test tubes, illustrating what normal blood looks like and how it flows, compared to blood when blood sugar is high. It is important to control blood sugars (keeping levels as close to normal as possible) to prevent or delay the complications of diabetes over time, including damage to the eyes, heart, kidneys, nerves in the feet, and blood vessels throughout the body.

Dr Sue Pedersen www.drsue.ca © 2010 drsuetalks@gmail.com

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Avandia Use Suspended in Europe, Continued in USA

2010-09-23T12:56:00.006-06:00

It has been an absolute whirlwind week at the European Association for the Study of Diabetes Meeting in Stockholm, Sweden, and I have many interesting thing to share with my readers over a series of upcoming blogs. The week's biggest news is pretty much uncontested, however, and it regards the future of a commonly used diabetes medication called rosiglitazone, or Avandia.

Both the European Medicines Agency (EMEA) and the American FDA released statements regarding the future of Avandia on September 23, 2010. While the EMEA has suspended the use of Avandia in Europe, the FDA has allowed Avandia use to continue, while restricting access and adding additional safety labeling.

Avandia has been under mounting scrutiny since a meta analysis of data suggested that Avandia use may be associated with an increase risk of cardiovascular events. By controlling blood sugars, one of the major complications of diabetes that we are aiming to PREVENT, of course, is heart disease. While more than one such analysis of data has suggested there may be an increased cardiac risk with Avandia, no 'gold standard' randomized, controlled, clinical trial has proven this to be the case. The RECORD trial, which was a randomized clinical trial, did not demonstrate a significantly increased cardiovascular risk (though this data is subject to several criticisms).

With these analyses in hand, then, regulatory agencies have had a very difficult and controversial decision to make, and it is due to this uncertainty that the EMEA and the FDA have leaned in slightly different directions this week.

The European Medicines Agency concluded that the benefits of rosiglitazone no longer outweigh its potential risks. They indicate that Avandia will no longer be available in Europe in a few months' time, and advise patients to book an appointment with their physician to plan cessation of Avandia and to discuss other suitable medication to treat their diabetes. The suspension will remain in place unless convincing data can be provided to identify a group of patients in whom the benefits of Avandia outweigh their risks.

The FDA, on the other hand, has allowed Avandia use to continue, but has restricted its use to those who cannot control their diabetes on other medications. The FDA will also require a Risk Evaluation and Mitigation Strategy program with additional measures to ensure the safe use of the medicine. This includes a reevaluation of data from the RECORD trial mentioned above.

In addition, the FDA has put the TIDE trial on hold, which was designed to compare Avandia to a drug in the same class called Actos, with regard to effect on cardiovascular outcomes in high risk patients with type 2 diabetes.

For any patients who are taking Avandia and are either affected by it suspension (ie, living in Europe) or unsure of how to proceed, be sure to book in with your doctor to discuss before making any changes.

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FDA Advisory Committee Rulings on Obesity Drugs Not Favorable

2010-09-18T09:21:00.002-06:00

The FDA has been busy this week, with meetings to discuss the future of two obesity drugs, one of which is currently available, and one of which is in the pre-approval phase. Overall, the future for both looks bleak.

Sibutramine (Meridia) is an obesity drug that works as an appetite suppressant, and has been available in Canada for a decade. It has come under scrunity in the past year following the results of the SCOUT trial, which was a study examining the effects of sibutramine vs placebo in over 10,000 participants who had preexisting heart disease, diabetes, or both. This study, which was published in the New England Journal of Medicine a couple of weeks ago, showed that there was a 16% increase in risk of heart attack and stroke. The increased risk was seen only in patients with known cardiovascular disease; patients with diabetes but no known history of heart disease did not have an increased risk of these events.

In response to these data, which were made available earlier this year, sibutramine was pulled from the market in Europe, but it has remained available in North America. An FDA Advisory Meeting held this week (with Alberta's own Dr Arya Sharma being one of the presenters to the committee) resulted in a 50/50 vote as to whether to recommend that the drug be pulled from the American market. Eight members voted that the drug be removed from the market, while the other 8 voted that it remain on the market with new labelling restrictions.

The following day, the FDA held another advisory meeting, this time to discuss a new obesity medication called lorcaserin. The panel voted 9 to 5 against its approval for use in USA, stating that the modest weight loss seen did not make up for several unanswered questions about its safety.

Thus, the struggle to find effective and safe weight loss medications is still underway. A newer class of injectable medication used to treat type 2 diabetes, called GLP-1 analogs, assist with weight reduction, and are currently in trials for weight loss (though not yet approved for this purpose) in non-diabetics. In September 2010, these seem to be the brightest spot on the horizon.

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Inspiration to Exercise!

2010-09-12T13:20:00.004-06:00

Although it seems that summer has all too rapidly come to a close in western Canada, race season is still in full swing. I competed in the bike leg of a team triathlon in Banff on Saturday (a personal first), and I spent Sunday as the physician on call for the Dinosaur Valley Half Marathon in Drumheller, AB (www.dinosaurhalf.com). During the weekend, I had the opportunity to observe and be inspired by the athletes, and to think about the variety of ways in which people motivate themselves to exercise and stay active.

One key theme was that people were often found to be competing in groups. At the marathon, I met mothers and daughters, friends, and neighbors who had banded together to train up for race day. Although triathlons are traditionally a solo sport, there were many groups who enrolled as a three person team, with one person assigned to each of the swimming, cycling, and running legs of the race. For myself, it was a great opportunity to enrol as a family and cheer each other on at our respective sports. For all of these groups, the important message that shone through each time was that having the common goal of the race in mind provided an excellent opportunity to support each other through the months of training before the race. It's true - exercise programs are often more successful in a group support setting than when a person tries to go it alone. Consider planning workouts with a group of at least 3 people, such that if one person cancels, the other two can still provide mutual motivation to burn some calories!

Another theme was the sense of accomplishment that arose from participation in these events. At the Dinosaur Valley marathon, I had the great joy of watching contestants of all ages and abilities walk or run anywhere from 5km to a full half marathon (26km). I was equally inspired by every individual who competed, because I knew that each person was challenging themselves personally to accomplish their goal. Aspiring towards a personal best provided sufficient motivation for many an athlete to train towards their goal in the preceding months. I came across a number of athletes this weekend who were going it solo, and felt that the drive to succeed was motivation enough!

One interesting theme I heard time and time again, was that people who were racing were doing it to set a good example for their children. Childhood overweight has become a serious problem, and although there are many contributory factors, a key contributor is the increase in sendentary behavior that has been noted (TV watching, internet, etc). At the Banff Triathlon, there was many a child cheering on their parents as they crossed the finish line. At the marathon, I was thrilled to see whole families running the 5km race together!

These are just a few ideas to consider to increase motivation and adherence to exercise. To all this weekend's competitors - hats off to you!

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What We Can Learn from Elephants: The Low Energy Density Diet

2010-09-04T11:40:00.000-06:00

On a safari in Kruger National Park, South Africa, last week, I had an amazing experience learning all about the abundant wildlife we encoutered: giraffes, lions, leopards, zebras, wildebeest, hippos, crocs, and the like. One thing that stands out in my mind is the astounding eating capacity of the elephants: they eat a whopping 250 kilograms of food each day!

For an adult male elephant, weighing about 5500 kg, this equates to 1kg of food per 22kg body weight. The weight of food consumed by a human per day will vary substantially depending on what type of food is consumed, but is considerably less, proportional to body weight, compared to what an elephant consumes to maintain body weight.

So - how do the elephants do it?

The secret is in the low energy density of the food that the elephants are consuming; in other words, the caloric content of their food is very low. Elephants are herbivores, meaning that they eat only vegetation: leaves, grass, twigs, roots, bark, and small amounts of fruit, seeds, and flowers. In addition, only about 40% of their ingested food is actually digested; the remaining 60% is excreted in the stool without absorbing the caloric content. In human terms, this would be equivalent to eating a very, VERY high fiber diet - too high for human physiology - but the principle still applies.

The take home message here is that eating larger amounts of Free Veg (vegetables that have minimal calories - green leafy vegetables especially) and aiming for 25-30 grams of daily dietary fiber can decrease the overall energy density of your diet, allowing you to enjoy a more generous amount of food while maintaining a calorie-controlled diet!

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Multivitamin Results in Weight Loss in Chinese Women

2010-08-29T04:12:00.001-06:00

As my readers and patients know, I often emphasize the importance of vitamin and mineral supplementation (see previous blogs about multivitamins, and vitamin D). A recent randomized clinical trial has now shown that supplementation with a multivitamin was effective in inducing weight loss in a group of Chinese women.

This clinical trial, published in the International Journal of Obesity, enrolled 96 overweight or obese Chinese women, and randomized them to receive either a multivitamin & mineral supplement, a calcium supplement, or placebo. After 6 months, they found that women taking the multivitamin lost 8lb, compared with 2.5lb on calcium, and 0.5lb on placebo. Note that the weight loss seen with the multivitamin is similar to that seen with the weight loss medication orlistat (Xenical). The multivitamin group was found to have a higher metabolic rate compared with placebo, and both the vitamin and the calcium groups enjoyed some improvement in their cholesterol levels.

As noted in the accompanying editorial by my colleagues Drs Astrup and Bügel at the Department of Human Nutrition, University of Copenhagen, Denmark, the rather impressive degree of weight loss seen in this study with a multivitamin is intriguing, and the study needs to be repeated, in greater number and in other ethnic groups, before we can draw any broad conclusions. However, there are some physiological mechanisms that can support the weight loss seen. Several vitamins and minerals are known to have a key role in the function of the mitochondria, which function as the 'power plants' of our cells. Therefore, repleting important nutrients with a multivitamin may improve mitochondrial function and result in increased caloric burn by each of our cells.

The bottom line is that it is difficult to obtain all necessary vitamins and minerals in our nutritionally deplete food supply, and therefore, a multivitamin is recommended for most people. The potential for weight loss is one more item to add to the list of potential benefits. Speak to your doctor to find out which multivitamin is best for you!

Dr. Sue Pedersen © 2010 www.drsue.ca drsuetalks@gmail.com

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