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How Can We Know if Dietary Supplements Are Safe?

>> Friday, May 31, 2013





I opened this week's JAMA Internal Medicine table of contents to find a short editorial note that I would like to share.  It's written by Dr Michael Katz, in response to this study by Zarel and colleagues, which reviewed dietary supplement recall data in the US over the last decade (sexual enhancement, body building, and weight loss products were amongst the high hitters on the recall list).


Dr Katz writes:

Americans spend over $20 billion annually on
dietary supplements. Although supplements
are regulated by the US Food and Drug
Administration (FDA) under the Dietary Supplement
Health and Education Act, there is no requirement for
supplement manufacturers to demonstrate efficacy or
safety of their products prior to marketing them. However,
companies may not include unapproved ingredients.
It turns out that even this minimal requirement
is not fulfilled. Harel et al identified 237 dietary
supplements that were recalled by the FDA owing to
inclusion of unapproved drug ingredients. Given the
limited regulation of these products, it is likely that
the number of recalls grossly underestimates the number
of products on sale with unapproved ingredients.
Dietary supplements should be treated with the same
rigor as pharmaceutical drugs and with the same goal:

to protect consumer health.

The mechanism by which the FDA identifies and recalls potentially dangerous dietary supplements is haphazard: either through spot inspection of manufacturing plants; tips from retailers; or reporting of adverse events by patients or physicians.  The stringent regulatory process required for prescription medications to be approved is not in place for dietary supplements.

As the Zarel article writes:

To protect the health and
safety of the public, increased efforts are needed to regulate
this industry through more stringent enforcement
and a standard of regulation similar to that for pharmaceuticals.
Keeping the status quo may taint the dietary

supplement industry as a whole.

The bottom line:  As it stands now, we cannot know if dietary supplements are safe. 

Dr Sue Pedersen www.drsue.ca © 2013

Follow me on Twitter for daily tips! @drsuepedersen

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Hint of Citrus Couscous Salad

>> Tuesday, May 28, 2013






Couscous is easy to cook with and fun to eat!  Couscous is semolina, tiny granules of durum wheat, and it's an integral part of many North African and Middle Eastern food cultures.  I remember it being ubiquitous when I travelled Morocco with my sister a number of years ago - delicious! The traditional way in which couscous is made is quite interesting and labor intensive - wiki (where else? :) has an interesting review of the process.

I have been looking for a tasty, fresh dish to enjoy in the warming weather, and this side fits the bill perfectly!  I suggest using it as your carb for a meal (eg with poached fish or grilled chicken breast).    The recipe comes from skinnytaste , and for once I didn't have to healthify an over oiled recipe with unneccessary calories.  I have, however, simplified the ingredients and directions.    


Ingredients:
  • 6 oz dry couscous 
  • 3/4 lb thin asparagus spears, tough ends trimmed
  • 1 1/2 cups small tomatoes, cut into quarters
  • 1/4 cup red onion, minced
  • 1-1/2 lemons, juiced
  • 1 tbsp extra virgin olive oil
  • 2 tbsp fresh parsley, minced
  • salt, to taste
  • fresh cracked pepper, to taste

Directions: 

1.  Steam asparagus over boiling water until tender, about 4 minutes. 

2.  Cook the couscous according to package directions.

3.  When cooled, chop the asparagus into 1/2 inch pieces. 

4.  Mix all ingredients into a large bowl and enjoy!


Makes 5 servings.  Per serving (approximate): 

  • calories:  166
  • protein:  6g
  • carbs:  29g
  • fat: 3g

Thanks to Deb for the heads' up on the recipe!

Dr Sue Pedersen www.drsue.ca © 2013

Follow me on Twitter for daily tips! @drsuepedersen




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Is There a Fountain Of Youth?

>> Friday, May 24, 2013





We are all looking for it - the key to youth and eternal health.  Does it exist??  Well, there's no such thing as a fountain of youth per se, but a recent study teaches us that there are some things that we CAN do to age successfully.

The study looked at over 5,000 people in the United Kingdom, to try to figure out what sorts of behaviors were associated with successful aging, which they defined as good mental, physical, cardiovascular, and respiratory functioning, absence of disability, and absence of diseases such as heart disease, cancer, stroke, and diabetes.

They found that people who engaged in all of the following four healthy behaviours had a 3.3 times greater chance of successful aging:

  • never smoking; AND
  • eating fruits and veggies daily; AND
  • physical activity (≥ 2.5 hours per week of moderate activity or ≥ 1 hour per week of vigorous activity); AND
  • moderate alcohol consumption
The last of these 4 is a bit of a touchy one - while the health benefits of a small amount of alcohol daily (in particular red wine, eg 1 glass per day) are known, we as doctors do not make a point of recommending alcohol, as this can be a slippery slope for some people, and of course there are negative consequences to health of too much alcohol consumption.   However, if a person is consuming a glass of red wine per day safely, it would not usually be recommended to stop doing so.

Hmm... I think I'll throw my sneakers on this evening and walk out in search of a healthy salad to enjoy on the patio!   

Dr Sue Pedersen www.drsue.ca © 2013

Follow me on Twitter for daily tips! @drsuepedersen


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New App for Troubleshooting Statin Intolerances and Other Cholesterol Gems

>> Tuesday, May 21, 2013





The University of British Columbia has come out with an excellent tool for physicians to help assess cardiovascular risk and manage cholesterol issues, which is a free app which can be downloaded here.

This is a fabulous program which has a number of highlights:

1.  Framingham risk score can be calculated with recommendations based on the 2012 Canadian Guidelines provided;

2.  Statin doses likely to be required to achieve the target LDL are suggested;

3.  There is a drug dosage chart which also shows the LDL lowering expected with all of the various cholesterol treatments at all of the available doses;

4.  Statin Adverse Effect/Intolerance support - this is my favorite part of this app - you can enter characteristics of your patient that is not tolerating their statin, and the program will summarize relevant factors to consider, as well as make suggestions for a possible management approach.

Thanks to my friend Kwene for the heads' up on this app!

Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


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Health Benefits of Nordic Walking!

>> Wednesday, May 15, 2013







Think those people who look like they are walking outdoors with ski poles look a little goofy?  Well, think again - those people are taking strides towards better health.

It's called Nordic Walking - quite simply - walking with poles.  It was originally developed in Scandinavia as an off-season ski training activity, and didn't become an official sport until 1997.

A recent review looked at studies of Nordic walking in over 1,000 study participants, and found beneficial effects on blood pressure, heart rate, and exercise capacity.  They also noted that studies have shown that compared to walking briskly without poles, Nordic walking burns about 20% more calories.    Health and quality of life benefits were also found in people with a wide range of chronic diseases, from cardiac rehab patients, to fibromyalgia, emphysema, peripheral arterial disease, and pain in general.

So why would Nordic walking result in better heart health and higher calorie burn than walking without poles?  Simply because, by using the poles as you go, you are engaging your upper body muscles, increasing your cardiac and respiratory response, and boosting your energy burn.

So, add a pair of poles to your exercise regimen and enjoy the health benefits!  Remember to speak to your doctor before making any changes to your workout routine.

Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen

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Let Cows Eat Candy?

>> Monday, May 13, 2013






Due to last summer's droughts, some farmers have had to resort to feeding cows with - believe it - candy and cookies to keep them from losing weight and keep their milk production up.

Hands up if you are grossed out right now?  Hands up if you feel this is truly unrighteous and unfair to the cow?

As pointed out in Wired magazine, this is not exactly the diet that nature intended cows to eat, although it is apparently possible for cows to draw calories out of candy.

When I asked around to hear what others thought about this, one person said to me that it is disgusting to think that the beef she is eating might come from a cow that was fed candy.

I think the giraffe in the room here is pretty obvious.

That's it for today, folks - I'm putting away my M&Ms and heading to the gym. ;)


Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


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Grilled Fish Tacos!

>> Tuesday, May 7, 2013





Here's a delicious Mexican-inspired recipe, with thanks to Pamela Salzman - I've modified the recipe to keep the calories low but the taste factor high!


INGREDIENTS:


1 pound halibut fillets
8 6-inch corn tortillas, warmed either on grill or heated griddle pan until pliable
1 fresh lime, cut into wedges



White sauce:
  • 3 Tablespoons low fat mayonnaise
  • 7 Tablespoons plain light unsweetened greek yogurt
  • 1 Tablespoon freshly squeezed lime juice
  • 1 teaspoon hot sauce or ¼ teaspoon ground chipotle powder (optional) 
  • pinch of sea salt


Dry Rub:
  • 2 teaspoons paprika
  • 1 teaspoon garlic powder
  • 1 teaspoon chili powder
  • 1/2 teaspoon sea salt


Veggie filling for tacos: as you wish-
  • shredded napa cabbage
  • coleslaw
  • radishes
  • red onion
  • salsa



DIRECTIONS:

1.  Whisk together ingredients for white sauce, and refrigerate until ready to use.

2.  Mix dry rub spices together and sprinkle on both sides of the fish.

3.  Preheat grill to medium-hot.  Brush grate grill very lightly with oil, minimum necessary to prevent sticking. Grill fish until fish is just cooked through, about 3-5 minutes per side.

4.  Remove fish from grill and break into pieces.

Makes 8 soft shell tacos!

NUTRITIONAL INFO:    I have calculated the nutritional info here to include the fish, the soft shell taco, the dry rub, and the white sauce.  The number of calories, carbs etc in the veggies and salsa that you decide to include is going to depend on how much and what kinds you choose.  However, the calories in these veggies is almost negligible.  Salsa can vary, and I'd suggest going easy on salsa because it is very high in salt (ever wonder if you eat too much salt in a day - calculate your intake here).

It's also extremely difficult to estimate how much of the oil brushed on the grill absorbs into the fish - one of the limitations of using oil to create a non stick surface.  As it's almost impossible to estimate, I have not included the oil used to brush the grill in my calculations.  If you bake your fish in the oven instead, you can use a bit of non stick cooking spray on tin foil and avoid this problem.

Per taco: (approximate, including fish, dry rub, soft taco, and white sauce)

CALORIES: 163
CARBS:        13 g
PROTEIN:    17.5 g
FAT:             4.6 g

Enjoy!

Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen

  

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Excess Skin After Bariatric Surgery

>> Monday, May 6, 2013








On the second day of the Canadian Obesity Summit, I had the honor of being asked to act as a judge for a number of excellent research presentations during the poster session.  First, a heartfelt congratulations to all of the presenters - I was truly impressed by all of your efforts and studies, and I enjoyed each of our stimulating conversations!

A study that really struck a chord with me, and which I feel is really important to share, was a study looking at the impact of excess skin on physical activity in women who have had bariatric surgery.  The reason for doing this study is that over 70% of patients who have bariatric (obesity) surgery are left with excess skin that interferes with physical and social functioning. The research, conducted by A Baillot and colleagues at the University of Sherbrooke in Quebec, administered questionnaires to 26 women who had had bariatric (obesity) surgery at least 2 years prior, asking women about how their excess skin impacted them physically, psychologically, and socially.

They found that 77% of patients reported that their excess skin was making mobility during physical activity difficult, and that almost half were avoiding physical activity because of their excess skin.  What really hurt my heart was that when these women were asked why the excess skin caused them to avoid physical activity, the most common reason cited was that they were concerned about people staring at them (other reasons were hygiene concerns, weightiness of the excess skin, and a feeling of 'sloshing' of the skin).

My take home message from this study is that the likely development of excess skin after obesity surgery is something that needs to be discussed in detail with patients prior to having surgery, such that they are prepared for the physical, psychological, and social challenges that they may perceive or encounter.

And, as always, it is my hope that with education of our society, that any obesity related stigma that may exist out there will continue to decrease until it disappears entirely.  I was asked a lot at the summit as to why I blog - this reason would be amongst the highest.

Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen

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Nutritional Support After Bariatric Surgery

>> Saturday, May 4, 2013




Today, I would like to kowtow to my friend and colleague Dr Priya Manjoo, endocrinologist at the University of Victoria, who gave a fantastic talk about nutritional support of the bariatric patient at the Canadian Obesity Summit


I'll highlight a few of the key points here: 

1.  Prior to obesity surgery, many patients are already often deficient in nutrients; for example, one study showed that 65% of patients were deficient in vitamin D before surgery, and 27% were deficient in iron.  Therefore, it is imperative that these levels be checked and corrected before surgery is undertaken. 

2.   Following obesity surgery, there are a number of reasons why nutritional deficiencies can occur,  including insufficient intake due to dietary restrictions and food intolerances, anatomical causes due to changes made in the intestinal anatomy, and a disconnect between the timing of release of digestive enzymes and entry of food into the intestine. 

3.  Dr Manjoo then went through a fabulous review of the various vitamins and nutrients that we need to be on the watch for after bariatric surgery.  Adequate protein intake, and monitoring and supplementation (depending on the type of surgery) of calcium, vitamin D, iron, vitamin B12, folate, thiamine, zinc, copper, and selenium are all things that we need to think about.

Finally, as previously blogged, she pointed us towards the 2013 American Bariatric Guidelines for some guidance on this complex topic. 

Thanks Priya for a fabulous session!

Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen

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Is Total Genome Testing The Answer?

>> Friday, May 3, 2013





Today has just started, but I already have a highlight from the Canadian Obesity Summit to share - this one is about whether personal DNA genome testing brings any positive health benefits. 

The riveting and entertaining talk, provided by Timothy Caulfield of the University of Alberta, reviewed some of the purported benefits of DNA testing that exist out there  - everything from tailoring your diet to 'scientific' matching on dating websites. There are a lot of outfits out there that charge a lot of money for genome analysis, stating that they can provide you with a comprehensive risk assessment for various diseases, plus help you tailor your diet and lifestyle to minimize your genetic risk. 

While there are certainly certain specific genes that are clearly associated with risk (eg the BRCA2 mutation that is associated with breast and ovarian cancer), Professor Caulfield's main point was that based on current data, we do not have any significant ability to make a difference to health or outcomes with total DNA genome analysis.  

For one, our technology is not at a point where it actually provides comprehensive, useful information about genetic risk.  For everything we learn about the genome, the picture becomes more complex and muddied rather than becoming clearer - for every answer, a dozen new questions are generated.  

For another, there is very little consistency in genome analysis - he pointed out that when one person's DNA is sent to 5 different companies for analysis, they will often get 5 different sets of results as to what they are at risk for. 

Also, the 'life-changing' advice that a lot of these genome analyses give you are remarkably familiar - advice like 'eat well', 'exercise', and 'stop smoking'.  Yeah... I think we already knew that.  

As far as appetite and obesity goes, the story is so very complex - it's not one that can be told with the primitive understanding of the human genome that we currently have.

The bottom line is that only 1 in 1000 of us actually stick to all of the Simple Seven steps to leading a healthy life - it seems that here is where our focus should be. 


Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


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Excess Skin after Bariatric Surgery

>> Thursday, May 2, 2013







On this second day of the Canadian Obesity Summit, I had the honor of being asked to act as a judge for a number of excellent research presentations during today's poster session.  First, a heartfelt congratulations to all of the presenters - I was truly impressed by all of your efforts and studies, and I enjoyed each of our stimulating conversations!

A study that really struck a chord with me, and which I feel is really important to share, was a study looking at the impact of excess skin on physical activity in women who have had bariatric surgery.  The reason for doing this study is that over 70% of patients who have bariatric (obesity) surgery are left with excess skin that interferes with physical and social functioning. The research, conducted by A Baillot and colleagues at the University of Sherbrooke in Quebec, administered questionnaires to 26 women who had had bariatric (obesity) surgery at least 2 years prior, asking women about how their excess skin impacted them physically, psychologically, and socially.

They found that 77% of patients reported that their excess skin was making mobility during physical activity difficult, and that almost half were avoiding physical activity because of their excess skin.  What really hurt my heart was that when these women were asked why the excess skin caused them to avoid physical activity, the most common reason cited was that they were concerned about people staring at them (other reasons were hygiene concerns, weightiness of the excess skin, and a feeling of 'sloshing' of the skin).

My take home message from this study is that the likely development of excess skin after obesity surgery is something that needs to be discussed in detail with patients prior to having surgery, such that they are prepared for the physical, psychological, and social challenges that they may perceive or encounter.

And, as always, it is my hope that with education of our society, that any obesity related stigma that may exist out there will continue to decrease until it disappears entirely.  I've been asked a lot this week as to why I blog - this reason would be amongst the highest.

Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen





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Powerful Marketing Unveiled - Sugar Sweetened Beverages

>> Wednesday, May 1, 2013




On this first day of the Canadian Obesity Summit, I had the pleasure of attending a workshop discussing the impact of sugar sweetened beverages on our health, and the impact that the powerful marketing of beverage companies has on the choices we make.

We harp on sweetened drinks as a source of 'empty calories', meaning that sugary drinks provide carbohydrates in the form of simple sugars, without providing much in terms of other nutritional value.  Dr Tom Warshawski pointed out to us that studies show that when a person drinks a sugary drink, they do eat less calories than they would have if they had consumed water instead, but this compensation is incomplete - meaning that the overall calorie intake is still higher with the sugary drink than it would have been if the person had consumed water.  He also pointed out that sugary drinks do not help us to feel full, meaning we are likely to eat sooner (and therefore more overall) than if we had eaten something (healthy) instead of drinking the sugary drink in the first place.

Perhaps some of the most poignant information that came out of this session was the discussion about the powerful marketing campaigns that push sweetened beverages upon us.  In 2004, the US junk food industry spent nearly 1200 times more money than the government campaign promoting the '5 A Day' fruit and vegetable campaign.  In 2006, $4 billion dollars was spent in the US on soft drink advertising - imagine if this kind of funding could be put towards dietary counseling for people who struggle with their weight!  There is a particular drive by the industry to target youth, as this 'ensures the future' of their brand. :(    From color to name to font to location of vending machines to where/when/how they advertise ... it's all a premeditated psychological orchestra geared to make us consume more.

Consumer warfare abounds in other ways, too.  Over the last 30 years in Canada, fresh fruits and veggies have gotten more expensive, whereas sweetened beverages have gotten cheaper.  When deciding between purchasing pop vs water, one can't help but notice that 1L of pop costs an average of $1, much less than the average of $2.50 per L of bottled water (how exactly does taking water and adding sugar and chemicals to it make it cheaper??).

The industry had their say during this meeting as well - in fact, many employees of Coca Cola were in attendance at the workshop, and this served to generate quite interesting debate!  On that note, there has been a lot of discussion as to whether or not it's appropriate to have food industry members like Coke and McDonald's present (and supporting) the Canadian Obesity Summit.  In my opinion, it's important to have all stakeholders at the table as we discuss obesity in Canada, especially the food industry - for without their cooperation, our struggles against our toxic obesigenic environment are unlikely to change.

Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen













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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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