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Flavour Country! Baked Salmon with Olive Tomato Tapenade

>> Wednesday, March 30, 2016




Salmon is a very versatile fish to cook with, as it takes well to a seemingly endless variety of flavourings.  That being said, this is probably one of the tastiest salmon recipes I have ever come across -  I made this at home and it was dubbed 'Flavour Country' with the first bite!  Mmmm.  You will be hailed as a gourmet cook - and it's so easy to make!

I found the original recipe here, but I have modified it, including a marked decrease in the amount of oil - only a little olive oil is needed to sauté the onion and garlic.  There is lots of healthy fat (polyunsaturated and monounsaturated) to be had in the salmon and olives.    On that note, you could cut down the calories and fat further by using wild salmon and less olives.  (I used farmed atlantic salmon to calculate the calories as this is what is most commonly available.)  Note also that there is quite a lot of salt in the ingredients (capers, olives etc) - so if you are on a salt restricted diet, you may consider a tapenade with just tomato, garlic, herbs and onion (also delicious). 

Ingredients:


  • 1 tablespoon extra-virgin olive oil
  • 1 medium onion, finely chopped
  • 4 garlic cloves, finely chopped
  • 2 pounds plum or cherry or grape tomatoes, coarsely chopped
  • 1 tablespoon chopped oregano
  • 1/2 cup pitted kalamata olives, sliced
  • 1/3 cup drained capers
  • 1/3 cup sliced pickled jalapeños
  • Four servings of salmon (3 oz (85g) each)
  • Salt and freshly ground pepper


Directions:

1.  Preheat the oven to 375°. In a large saucepan, heat the olive oil until shimmering. Add the onion and garlic and cook over moderately high heat, stirring occasionally, until softened, about 5 minutes. Add the tomatoes, oregano and cook, stirring occasionally, until the tomatoes are just beginning to break down, about 5 minutes. Stir in the olives, capers and jalapeños and simmer for 2 minutes longer. 

2. Place the salmon on a foil covered baking tray. Season the salmon with salt and pepper. Bake for 15-20 minutes until cooked through. Transfer the fish to plates, spoon the sauce all around and serve.



Makes 4 servings.  Per serving: 

Calories: 305
Fat: 19g
Carbs: 15g
Protein: 20g

**note: there are variations in estimates of nutritional info for kalamata olives out there - I have used a middle ground between estimates in calculating the nutritional info.

**note: bed of rice and greens in the picture is not included in nutritional info. 



Follow me on twitter! @drsuepedersen


www.drsue.ca © 2016

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Just How Much (And For How Long) Does Metabolism Slow Down After Weight Loss?

>> Wednesday, March 23, 2016







Many people who struggle with excess weight find that they are able to get weight off, but keeping it off seems next to impossible.

So what exactly happens to our metabolism when we lose weight?  And are any changes in our metabolism temporary, or there for the long term?

A very elegant study was conducted that answers this question – and you may be surprised by the results.

The study enrolled people in groups of three, all three of which were of the same gender and weight: one who was weight stable at their maximum lifetime weight (ie had not had any weight loss); one who had lost at least 10% of body weight and kept it off for at least a year; and one who lost at least 10% of body weight over the most recent 5-8 weeks (using a liquid diet for 1-2 months before the study testing was performed).  The average body weight of people in the study was 98 kg (216 lb), and the age range was 19-41 years. All participants lived at the research centre for the duration of the study, and were fed only a liquid formula diet, to ensure their weights were stable for at least 2 weeks before measurements of metabolism were taken.  (a very impressive and dedicated protocol for both participants and investigators, wow!)

They found that in these study participants, the 24h calorie burn was about 450 calories lower for the people who had previously lost weight, regardless of whether that weight loss was just weeks ago, or whether it was years ago (and similar for males and females in the study).  Many full meals come in under 450 calories - I googled this recipe website to give you an idea (though I have not reviewed the recipes per se).  So this means that the person who has lost weight has to eat this much less, EVERY DAY, for years (and possibly forever) in order to maintain that body weight, compared to someone who weighs the same but has never weighed more than that.

Here's an example from that website: it's a lot of food!


While this 450 calorie drop in 24h calorie burn was partly due to a drop in energy burn at rest, the biggest drop was seen in the energy burned by activity (called non-resting energy expenditure). (Read more about all components of daily energy expenditure here). 

So does this mean that people who have lost weight simply exercise less?  No.  Actually, the literature overall suggests that it is energy burn during low-grade activity that declines (ie activities of daily living), because our muscles become more efficient at low levels of physical activity with weight loss. 

So what can you do to combat this reduction in energy burn that happens with weight loss?  Two things.

1.  Be NEAT! NEAT, or non exercise activity thermogenesis, is low grade activity of daily life.  Give up your parking pass and take public transit (which involves more physical activity than driving). If you do drive, park at the far end of the parking lot.  Stand while you talk on the phone.  Take the stairs instead of the elevator.   Read more on NEAT here!

2.  Exercise more.  Easier said than done, and not all may be able to do this because of physical limitations - but it is because of this drop in metabolism that the US Obesity Guidelines recommend more moderate physical activity to prevent weight gain (200-300 mins per week) than they do for weight loss (150 mins per week).  We have only to look at the National Control Weight Registry to see the proof – 90% of Americans who have lost 30 lbs or more, and kept it off for more than a year, exercise for at least an hour each day.


***Be sure to talk to your doctor before starting or ramping up your exercise program, and also to help you find assistance to learn about modified exercises that may work for you if you have physical limitations.***


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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What Kind Of Protein Should (Or Shouldn't) We Eat?

>> Tuesday, March 15, 2016


In a recent blog, I talked about the importance of having enough protein in our diet.

The natural next question is... what KIND of protein should we eat?

Protein is composed of amino acids, which are the important building blocks from which we make our own proteins, which are essential components of all of our organs and body parts.  Body protein is made up of 20 different amino acids, ten of which are considered to be 'essential', in that we cannot make them ourselves, and we therefore have to get them from our diet.  The other ten are 'nonessential' and can be synthesized by our bodies from other amino acids.


The most obvious source of protein is animal protein.  However, there are lots of different approaches to diets out there.... some people enjoy a wide range of animal products; others are vegetarian with many different permutations (piscatarians, lacto-ovo, etc), and some people choose to go the vegan route, avoiding any food product derived from animal sources.


Animal proteins are considered 'complete proteins' as they contain all of the essential amino acids.  Plant proteins are considered 'incomplete' as they generally don't contain all of the essential amino acids, but they can be combined to provide the full complement of essential amino acids.  Soy is the only non-animal protein that actually contains all of the essential amino acids (though it is low in lysine, which is one of the essentials).   Vegan diets are often lacking in two of the essential amino acids: valine and lysine.  

The most recent dietary guidelines on this continent are the American 2015 Dietary Guidelines.  They recommend eating a variety of protein food sources, including dairy, seafood, and meat; they also include protein food from plants, to allow vegetarian options to be accommodated (further details are available here).  Meat selections should be lean, and in my opinion, minimizing processed meats is a good idea, given the increased risk of colon cancer with consumption of certain quantities of processed meat (read more here).

So, for whichever type of dietary pattern you have chosen to follow, do make sure that it is one that provides you enough of all of the essential amino acids, with a focus on lean and clean (less processed or unprocessed) options as your protein sources.


Follow me on twitter! @drsuepedersen


www.drsue.ca © 2016

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Liraglutide Reduces Heart Disease In People with Type 2 Diabetes

>> Monday, March 7, 2016



BIG news in the diabetes world was released on Friday - for the first time, a medication in the class called GLP-1 receptor agonists, called liraglutide (trade name Victoza), has been shown to reduce cardiovascular events in people with type 2 diabetes.

The LEADER trial enrolled over 9000 people with type 2 diabetes, who were at high risk of cardiovascular disease, and randomized them to receive either Victoza vs placebo with usual standard of care.

They found that Victoza was better than placebo to reduce the combination of death from cardiovascular disease, non-fatal heart attack and non-fatal stroke. A reduction in all three of these components contributed to the benefit that was seen.   The numbers and details are not yet available - we'll have to wait until the American Diabetes Association meeting in June to find out more.

Here's why this is ground-breaking news: 

We have long been uncertain whether we are actually preventing cardiovascular disease by treating diabetes - we know that the higher sugars are, the higher the risk of heart disease, but it has been evasive to actually prove that lowering blood sugars prevents heart disease. The next question is whether some medications to treat type 2 diabetes could be better (or worse) than others to protect from heart disease.  LEADER has now shown us that treating type 2 diabetes with liraglutide does indeed protect patients from cardiovascular events.

Within the GLP1 receptor agonist group of medications, a study of lixisenatide (called the ELIXA study) showed that it did not increase the risk of cardiovascular events, but it didn't prevent them either.  Studies of the other GLP1 receptor agonists available are currently underway.

As far as other type 2 diabetes medications go, the only other medication that has clearly been shown to reduce cardiovascular disease is empagliflozin, which you can read more about here and here.  Metformin, which is the #1 treatment advised for type 2 diabetes worldwide, has some weak evidence that it prevents cardiovascular events as well.

We will be waiting in anticipation for more details from the LEADER trial in June!


Disclaimer: I have been involved in research trials of liraglutide.  I receive honoraria as a continuing medical education speaker and consultant from the makers of liraglutide (Novo Nordisk). I am involved in research of medications similar to liraglutide for the treatment of type 2 diabetes.



Follow me on twitter! @drsuepedersen


www.drsue.ca © 2016


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The Power of Protein In Your Diet!

>> Wednesday, March 2, 2016




A question I often get asked is - what is the best source of energy in our diet?

Well, when we talk about energy in our diet, we are talking about calories (calories = energy).   The four main calorie sources are protein, carbohydrates, fat, and alcohol.  A balance of protein, carbs, and fat is important.  Most people are a little (or sometimes a lot) low in protein content in their diet, and should be eating more.  

Following are some interesting points about protein and metabolism.  I have framed these points in the context of a person who is struggling with weight (as the majority of Canadian adults are), and therefore, I am writing along the lines of keeping calorie intake down while ensuring a balanced diet.

Also please note I am not recommending the consumption of alcohol - I am including it here to be complete (and practical, as many people do have some alcohol in their diet).

1.  The number of calories (kcal) per gram of each source varies:
  • protein: 4 kcal/g
  • carbs: 4kcal/g
  • fat: 9 kcal/g
  • (alcohol: 7 kcal/g (this is pure alcohol; if you consider one ounce (28g) of a 40% alcohol such as vodka, then the calories are calculated as 28g x 7kcal/g x 40% = 78 calories))
So far, protein and carbs come out looking the best - ie lower calories per gram than fat (or alcohol).


2.  Protein makes you feel fuller than carbs, which in turn make you feel fuller than fat.  And alcohol does not make you feel full at all.   It's not completely clear exactly how protein makes us feel more full, but mechanisms may include increased glucose production (gluconeogenesis), and a decrease in ghrelin (the hunger hormone).


3.  The energy required to digest protein is highest (called the 'thermic effect of food'): 
  • protein: about 25% of the calories consumed are used to digest it
  • carbs: about 7%
  • fat: 1-2%
  • alcohol: 22%  (Hang on.  Don't take this as a good thing.  When you consume alcohol, your body stops burning all other fuels (eg fat and carbs) to preferentially burn the alcohol. See here for more on this.)
4.  Protein intake helps to retain lean body mass (muscle), which gives you a higher basal metabolism compared to having less muscle and more fat. 

5.  Protein also stimulates the burn of fat (called 'fatty acid oxidation'). 


So as you can see, there are a number of metabolic benefits to eating protein.

Next question: How much protein should we eat?

Well, the acceptable range as per the American Food And Nutrition Board of the Institute of Medicine  is between 10-35% of total daily calorie intake for healthy adults.    A high protein diet is considered to be 25% or more of total calorie intake. 

How do you convert these numbers into calories?  Well, for example, if your calorie needs are 2000 calories per day, and you are aiming to eat 20% of your daily calories as protein, then about (2000 x 20% =) 400 calories of your day would be protein.  Since protein is 4 calories per gram, this would equal about (400/4 = ) 100 grams of protein per day.

Is it possible to eat too much protein? While an upper limit of protein intake that could cause harm hasn't been clearly identified, there are a few possible concerns: 
  • Protein metabolism results in excretion of nitrogen based waste products in the urine, which could potentially cause damage in excess (science: by increasing glomerular pressure and hyperfiltration).  I have had kidney specialists tell me that for people with healthy kidneys, they recommend a maximum of 1.5 grams of protein per kilogram of ideal body weight per day (though this isn't clearly supported by dietary clinical trials).

    I know. It's getting complicated.

    *** For people with kidney problems, it is very important to talk to your doctor about how much protein is safe for you.***
  • The acid load of high protein diets can increase blood pressure.  Also, the excess acid load is buffered by bone, which may increase the draw of calcium from bone.

Bottom line: Most of us don't eat enough protein, and trading up some carb in our diet for protein is a good idea (most of us are overeating carbs, which is why the tradeoff for most people should come from carbs).

It's pretty tough to overdo protein with natural food sources - but don't go chugging volumes of protein shakes as this may overdo it.  Talk to your doctor or dietitian to ensure you are getting an appropriate balance of protein (vs carbs vs fat) in your diet.

As for what kind of protein we should be eating.... stay tuned!


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016










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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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