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Holiday Pumpkin Pancakes

>> Saturday, December 24, 2011





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!  

Dr Sue Pedersen www.drsue.ca © 2011 


drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen  


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The Global Impact of Diabetes

>> Saturday, December 17, 2011






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)



Dr Sue Pedersen www.drsue.ca © 2011 

drsuetalks@gmail.comFollow me on Twitter for daily tips! @drsuepedersen  



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

>> Thursday, December 8, 2011




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.


Dr Sue Pedersen www.drsue.ca © 2011 

drsuetalks@gmail.comFollow me on Twitter for daily tips! @drsuepedersen  

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Tips for Surviving the Holidays!

>> Saturday, December 3, 2011



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. 


Dr Sue Pedersen www.drsue.ca © 2011 

drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen  

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Deb's Oatmeal Fruit Bake

>> Saturday, November 26, 2011








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

Follow me on Twitter for daily tips! @drsuepedersen 




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Childhood Obesity and Cardiovascular Risk in Adulthood

>> Friday, November 18, 2011




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?

>> Saturday, November 12, 2011









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

>> Friday, November 4, 2011




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

>> Saturday, October 29, 2011




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?

>> Sunday, October 23, 2011





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

>> Saturday, October 15, 2011




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

>> Friday, October 7, 2011




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!

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

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Video Blog - Childhood Obesity

>> Saturday, October 1, 2011








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!

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

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Chemicals in our Environment that Contribute to Obesity

>> Saturday, September 24, 2011



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-PĂ©ronard 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. 

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

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Restaurants Taken to Task on Calorie Counts

>> Saturday, September 17, 2011





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

>> Saturday, September 10, 2011


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!

>> Saturday, September 3, 2011





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

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

>> Saturday, August 27, 2011



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


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Alcohol Abuse Risk After Gastric Bypass Surgery

>> Saturday, August 20, 2011





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?

>> Saturday, August 13, 2011


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







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A HEARTFELT WELCOME!

I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!


Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!




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