Mythbusting Garcinia cambogia

There are a kajillion substances, herbs, and naturopathic remedies that are all over the internet, purporting their magical abilities to cause weight loss, but which do not have evidence to support that they actually work.  You can add Garcinia canbogia to this list.

Garcinia cambogia extract comes from a type of tamarind tree native to Asia.  In addition to being available as an extract, it is also an ingredient in Hydroxycut, which has been associated with cases of liver toxicity.  Now that Dr Oz has been throwing his weight behind Garcinia, it's getting more attention than ever before.  (More on my thoughts re Dr Oz here.)

We can put to rest the controversy behind Garcinia simply by looking at the science.  A randomized controlled trial was conducted long ago, back in 1998, showing that Garcinia cambogia failed to produce significant weight loss compared to placebo.

Friends, today's blog is short and not so sweet: Garcinia cambogia has been proven NOT to work, and it may be harmful.

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Obesity Prevention Starts In Your Mother's Belly

With the struggles our societies face in the battle against obesity, we need to look not only at treatment strategies for people who already struggle with their weight, but also at how we can prevent obesity in the first place.  As we look earlier and earlier in life, risk factors have emerged going all the way back to not only infancy, but even to before we were born, when we were just lil' wee blobs of cells inside our mothers' bellies.

The New England Journal of Medicine recently published an excellent article describing the power of some of the risk factors during fetal life and infancy on obesity later in childhood.   They discuss a study that looked at 4 risk factors for childhood obesity in a group of children aged 7-10 years:

• mother smoked in pregnancy
• mother gained excessive weight during pregnancy
• breast feeding for less than 12 months
• slept less than 12 hours per day during infancy

They found that only 6% of kids who had none of these risk factors were obese, compared to 29% of kids who had all four of these risk factors. 

So how can factors before we are even born influence our risk of obesity?  These observations can be explained at least in part by epigenetic changes - in other words, changes to our DNA that happen while we are growing inside our mother's belly.  (Exposure to toxins besides smoking in the environment play a role as well - read more about this here.)

While not every mother is able to breastfeed, it is recommended to try, as there are a number of health benefits including a lower risk of obesity later in childhood - read more on this here.

As for sleep, there is a rapidly expanding body of evidence teaching us about the powerful connection between sleep deprivation and obesity - go to my main page www.drsue.ca and type 'sleep' in the search box for more reading on this. 

Another interesting risk factor for childhood obesity is being born by C-section.  This may be partly due to the fact that the infant's gut is colonized with normal, healthy bacterial at the time of passage through the vaginal birth canal.  We are learning that the type of bacteria we have in our gut have an influence on our body weight as well, so it may be that the healthier bacteria acquired during vaginal birth leave us less prone to developing obesity later in life. 

The good news is that some of the above risk factors are at least partially under our control - especially not smoking during pregnancy - and some of them can often be improved upon, with the appropriate care, support, and education of expecting mothers and new parents.  

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Sugars 101 - Fructose, Glucose, Sucrose, Agave, and High Fructose Corn Syrup Demystified

There is so much information (and misinformation) out there about sugar, sweeteners, high fructose corn syrup, and so on, that it's hard to know which way is up sometimes. ...

A question that has come up frequently is whether fructose is better or worse for you than regular sugar.

A few key points:

1.  Table sugar is sucrose.  Each sucrose molecule is made up of one glucose and one fructose molecule.

Sucrose (table sugar) = glucose + fructose

2.  High fructose corn syrup (HFCS) is not much different from table sugar.

Sucrose (table sugar) = 50% fructose + 50% glucose

HFCS = 55% fructose + 41% glucose + 4% other sugars

The calorie content of table sugar and high fructose corn syrup are about the same.


3.  Fructose is handled differently by the body than glucose.

Glucose causes a rise in blood sugar (when we say 'blood sugar', we actually mean 'blood glucose' - I know, confusing, right?).  This causes us to release insulin to deal with the glucose - insulin allows our cells to take up glucose to use as fuel or as energy storage.

Fructose does not cause a rise in blood sugar (as it is not glucose) and does not stimulate us to release insulin.  Fructose goes to the liver, where it it used to store energy in the liver in the form of glycogen, or, if there is enough glycogen in the liver already, the liver turns fructose into triglycerides (a form of fat).  Triglycerides can accumulate in the liver, potentially causing damage; triglycerides in the blood stream can contribute to build up of plaque on the walls of your arteries.  (Note: the science is still sorely lacking on the exact nature and extent of the effects of fructose on the liver in humans. Scientists who want to read some of the biochemical and proposed mechanistic details can start here.)


So, because the calorie content of sugar and fructose containing sweeteners are similar, you are not doing your waistline any favors by selecting fructose sweeteners.  Agave syrup, which is a popular sugar substitute in the raw food community, is another example of a sweetener heavy in fructose compared to glucose (the proportion varies by brand).   Agave is still calorie containing and is not going to benefit you from a weight loss perspective.  I have seen sites on the internet advertising agave syrup with as much as 92% fructose - this would be of particular concern to me given that excess fructose could be damaging to the liver (as above).

 (agave plant)

Fructose is often touted as a preferred sweetener for diabetics because it does not cause blood sugar or insulin to rise.  Again, because of the concerns of the effects of fructose on the liver, this is NOT a recommended approach.  Also, again, fructose is still calories and will not be an improvement to a weight struggle.  And, remember that 'fructose' sweeteners are still almost identical to table sugar in their composition (see above #2).



The bottom line is this:  We get more than enough carbohydrates through a regular diet.  We should avoid adding additional carbohydrate calories to our food (be that table sugar, high fructose corn syrup, agave, or other) on top of the sugars and carbohydrates we already get.  Period.


PS This post is dedicated to my mom - thanks for asking the great questions! :)



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Do Hormones Play A Role in Weight Loss Failure After Bariatric Surgery?

Obesity surgery is currently the most effective treatment available for severe obesity.  While the smaller stomach reservoirs that are created by these surgeries play a major role in the weight loss seen, it is becoming increasingly evident that there are many other contributors at work, one of which is thought to be alterations in various hormone levels after surgery.

I was asked to write a review article discussing what we know about hormone changes in relation to weight loss failure and weight regain after bariatric surgery, which was recently published in the journal Gastroenterology Research and Practice.  In the article, I review eight of the key hormones thought to be involved in the weight changes after bariatric surgery (from GLP-1 to PYY to oxyntomodulin, bile acids, and others), as well as what we know about the hormone changes that occur after the four main types of bariatric surgery (gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion).

In summarizing what we know about hormonal associations with weight loss failure and weight regain after bariatric surgery, there was painfully little to discuss - there is unfortunately very little data in this area.

What became poignantly clear to me from compiling this review is that more research is desperately needed to help us understand how hormones may contribute to weight loss failure or regain after obesity surgery.  As I noted in the article,

In the future, with a better understanding

of this complex arena, assessment of hormone status

could potentially be helpful in understanding the hormonal

contributors to a patient’s postoperative weight loss failure

or recidivism, potentially aiding the clinician in utilizing

appropriate targeted hormone therapy to help them achieve

successful or sustained weight loss.

This is probably not a wish I should expect to see fulfilled anytime soon - after all, pinpointing hormonal predictors of weight regain after 'regular' dietary-induced weight loss has proven evasive as well.  However, with a dedicated body of bariatric researchers worldwide, I hope that we will learn more about this important area with time. 

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The Interactive!! Flavor Connection Taste Map

I know, this graphic looks boring, complex and frankly overwhelming... but I promise you, it's so cool!  Read on...

Ever wonder why certain foods just seem to belong together?  For example, fish tastes great with lemon; beef goes well with potatoes.  It turns out that these foods share flavor related chemical compounds, and a new interactive map from Scientific American can show you which foods and flavors may mix best together when you are experimenting in the kitchen!


On this map, you'll find around 200 commonly used foods, spices, drinks and other ingredients, with bigger dots on the map representing ingredients with greater popularity based on a recipe database.  The higher the food is on a page, the greater number of foods that are connected to it by having flavor related chemicals in common.  Click on one of your favorite ingredients on the map, and the program will show you not only which other foods are connected to it, but also how strong that connection is (see the program's excellent explanatory guide that pops up when you first open the page).

Have fun!  My motivation in sharing this, of course, is to encourage more cooking from the home - there are no 'hidden ingredients' (such as loads of extra oil) in home cooked food that can sabotage a healthy lifestyle!

Thanks to my friend Priti for the heads' up on this awesome program!

Follow me on twitter: @drsuepedersen

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Are Calcium Supplements Bad For Your Heart?

It is well known that adequate calcium intake is important for bone health at all ages.  Calcium supplementation is common, with 43% of American adults (and 70% of postmenopausal women) regularly taking calcium supplements.  However, there is a lot of confusing information out there, with some studies suggesting that calcium supplements may increase the risk of heart disease.

A recent article in the New England Journal of Medicine provides an excellent discussion around the controversies of calcium supplementation and heart health.   Here are some key points:

1.  The recommended daily calcium intake for Canadian adults:

• age 19-50: 1,000 mg of elemental calcium per day (see #4 below re the meaning of 'elemental' calcium)
• men age 51-70: 1,000 mg
• women age 51-70: 1,200 mg
• adults over 70 years: 1,200 mg

2.  The evidence suggesting that calcium supplements may increase the risk of cardiovascular disease is inconsistent - in other words, we still don't have a definitive answer to this question.  Compiled data from several studies pooled together (called 'meta-analyses') have suggested increased risk, while a large randomized controlled trial called the Women's Health Initiative (WHI) did not show an increased risk.  (Randomized controlled clinical trials provide more trustworthy evidence than meta-analyses do, so the fact that the WHI didn't show an increased risk carries weight.).  

It has been speculated that a sharper increase in blood calcium levels after eating a calcium supplement may result in increased cardiovascular risk, but this has not been proven. 

3.  Given that it is still not clear whether calcium supplements increase cardiovascular risk or not, getting the recommended calcium intake from food and beverages is the preferred approach.  

We consume about 300mg of elemental calcium per day from non dairy sources.  Here are some examples of dairy and non-dairy calcium sources: 

• 1 cup of milk: 300 mg
• 1 serving of yogurt (100g): 100 mg
• 1 oz cheddar cheese: 200 mg
• 1 cup low fat cottage cheese: 200 mg
• 1 cup raw broccoli: 43 mg
• 1 cup raw kale: 100 mg
• 1 slice bread (commercially prepared): 30-70 mg
• fortified breakfast cereal - varies widely - check the label!

4.  If you need to use calcium supplements over and above dietary intake to reach your recommended calcium intake, check the label for the mg of elemental calcium, as this is the value that is important.  Calcium supplements come in many different forms (calcium carbonate, calcium gluconate, calcium citrate etc), and each type of calcium supplement contains a different percentage of elemental calcium.  If your supplement doesn't say how many mg of elemental calcium it contains, here is a guide: 

• calcium carbonate: contains 40% elemental calcium (so, if your supplement is 750mg of calcium carbonate, it contains 300 mg of elemental calcium)
• calcium citrate: contains 21% elemental calcium
• calcium gluconate: contains 9% elemental calcium

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Risk of Cancer After Nuclear Accidents

With the recent Fukushima disaster (pictured above), the topic of nuclear disasters is at the forefront of all of our minds.  Nuclear accidents are a terrible tragedy on so many levels, from the damage done to the environment, to the effects on wildlife, the people, the society, and the economy of the country affected.    Once the initial period of damage control and clean up is tended to, the work and surveillance of the population from a health standpoint has only just begun.  A recent article in the Canadian Medical Association Journal provides a poignant reminder of this fact.

The article by Dmytriw and Pickett describes the case of a man who developed a glioblastoma brain tumor which occurred 24 years after his exposure to the Chernobyl nuclear disaster in 1986.  The Chernobyl power plant disaster remains the worst accident at a nuclear power plant in history, resulting in radioactive fallout covering large parts of the western former Soviet Union.  While the studies in the 4 years after Chernobyl found an increased incidence of leukemia, thyroid cancer did not show to be significantly increased until 16 years after the Chernobyl accident, at which time the risk was found to be 4.3 times that of the general population.  These papillary thyroid cancers were also found to be more aggressive in their behavior than typical papillary thyroid cancers.

Going beyond this time frame into today, now 27 years after Chernobyl, it is hard to quantify the risk of tumors caused by Chernobyl, as follow up of people who lived in the affected area becomes very difficult.  An increased risk of breast cancer and brain tumors has been suggested, but difficult to prove definitively.  In terms of distance from Chernobyl that can put a person at risk, the United Nations Scientific Committee on the Effect of Atomic Radiation (UNSCEAR) has indicated that individuals who lived as far as 2,000 km away from Chernobyl may develop cancer beyond the minimum latency times normally associated with exposure to radiation.

The bottom line?  As health care providers, we must remember to ask about exposure to nuclear accidents, remembering that tumors can develop more than 20 years after exposure.  If you are a person that has been exposed to a nuclear disaster such as Chernobyl or Fukushima, make sure your health care providers over the long term are aware.

Finally, cases of cancer that arise among people who were exposed to nuclear accidents should be reported to the appropriate authority, with the patient's consent.

The Fukushima Registry for cases of cancer amongst people who were living in Japan at the time of the Fukushima disaster is accessed by emailing ftiiki@fmu.ac.jp.

The Chernobyl Registry for cases of cancer amongst people who were living in Ukraine, Belarus or Russia around the time of the Chernobyl disaster is accessed by emailing info@nrer.ru (for Russia or Belarus) and moz@mov.gov.ua (for the Ukraine).

Twitter @drsuepedersen

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Aircraft Noise Exposure May Increase Heart Disease and Stroke Risk

Regular readers will know that I often talk about pollutants and chemicals in our environment that may adversely affect our health (from water bottles to soup cans to the soap we use, and many more).  I came across some interesting articles in my reading this week that add to the literature suggesting that even noise pollution may be dangerous to our health.

In the recent edition of the British Medical Journal, there are two studies and an editorial review discussing the risk of stroke and heart disease for people who live in proximity to airports.

As Dr Fiona Godlee, editor in chief of the journal writes:


The first study compared hospital admissions and mortality rates for stroke, coronary heart disease, and cardiovascular disease from 2001-05 in 12 London boroughs and nine districts west of London. The researchers found increased risks of stroke, coronary heart disease, and cardiovascular disease for both hospital admissions and mortality, especially among the 2% of the study population exposed to the highest levels of daytime and night time aircraft noise.

In the second study, researchers at the Harvard School of Public Health and Boston University School of Public Health analysed data for over six million older American Medicare recipients (aged 65 years or more) living near 89 US airports in 2009.
The researchers found that, on average, zip codes with 10 decibel (dB) higher aircraft noise had a 3.5% higher cardiovascular hospital admission rate. The association remained after adjustment for socioeconomic status, demographic factors, air pollution, and roadway proximity.

An accompanying editorial says the results have implications for planners when extending airports in heavily populated areas or planning new airports.


As noted in the editorial by Professor Stansfeld, 

These studies provide preliminary evidence that aircraft noise exposure is not just a cause of annoyance, sleep disturbance, and reduced quality of life but may also increase morbidity and mortality from cardiovascular disease. The results imply that the siting of airports and consequent exposure to aircraft noise may have direct effects on the health of the surrounding population. Planners need to take this into account when expanding airports in heavily populated areas or planning new airports.


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Do Group Classes Work to Improve Diabetes Control?

As the sheer numbers of people who develop diabetes continues to climb, we as health care providers need to look at creative ways to provide the in depth information and teaching that is required to help patients take the best possible care of their diabetes.   One of these approaches is to teach about diabetes in the form of group classes.  The question is, has the group teaching approach been proven to improve diabetes control?

Many studies have actually been done on this subject, ranging from observational studies to randomized controlled trials.  A meta-analysis in the Canadian Medical Association Journal by Housden et al, which looks at all of the literature on this topic to date, found that the class teaching approach improves hemoglobin A1C (a marker of overall diabetes control) by -0.46%.  While this is only a modest improvement in diabetes control, it is not much different than the A1C improvement we may expect to see in a patient who is close to A1C targets but not quite there, following addition of another oral medication.  

Anecdotally, I have often had my patients report back to me that they have really enjoyed being part of a diabetes education class, as it not only provides excellent information, but it also provides the opportunity for diabetics to support each other, and talk to each other about their experiences.  Knowing that you are far from alone in your diagnosis of diabetes can often go a long way to feeling secure and empowered in your journey towards improving upon your health!

If you are a diabetic and interested in group education classes, ask your doctor what is available.  Most centres of diabetes care (including our own) offer group classes free of charge.  Give it a try!


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www.drsue.ca © 2013

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Ending The Diet Debate

If you're a person looking for dietary advice to embark on a successful weight management journey, it can be an overwhelming and confusing task to try to navigate all the information that is out there.   I am often asked by my patients about the Zone, Atkins, Paleo, South Beach Diet, and many others.  The question is, is there a certain type of food, or proportion of protein, carbohydrate, and fat that makes up the magical formula to successful weight loss?

The answer to this question, as summarized in a recent article by Dr Sherry Pagoto in JAMA, is that research does not support that any one diet composition is better than another to result in successful weight loss.  As Dr. Pagoto notes,

"The ongoing diet debate exposes the public to mixed messages emanating from various trials that have yielded little but have heavily reinforced a fad diet industry."

What does matter is adherence - in other words, when you start a food plan, can you stick to it in the long term?   I don't use the word 'diet' when I'm counselling my patients - I use the words 'permanent lifestyle change'.    Don't bother making a change unless it is a change that you can stick to for the rest of your life - doing a certain program for the short term may help you to lose weight, but when you stop the program, what will happen?  The reality is that about 95% of people will regain the weight, and then some.

Remember that it's not about dropping weight fast - a plan that results in rapid weight loss is probably quite drastic, and is unlikely to be a permanent lifestyle change.  Successful weight management is about gradually losing weight (1-2lb per week) with permanent lifestyle change, and keeping it off by making those changes permanent.

Remember that for someone with obesity, losing 5% of your body weight and keeping it off decreases the risk of developing complications of obesity and prolongs lifespan - the greatest success of all!

@drsuepedersen

www.drsue.ca © 2013

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Could Obesity Surgery Increase the Risk of Colon Cancer?

As for any medical treatment or surgery, the decision to undergo bariatric surgery requires that the benefits and risks are carefully evaluated by the patient and the health care team.  Amongst the list of benefits, several studies have suggested that bariatric surgery decreases the risk of cancer amongst women.   Now, a new study suggests that the risk of colorectal cancer may actually be increased after obesity surgery.

The study was an evaluation of the population database in Sweden, looking at the colon cancer incidence rates amongst men and women who had obesity surgery (gastric bypass, gastric banding, and an older procedure called vertical banded gastroplasty), compared to patients with obesity who did not have bariatric surgery.  They found that amongst those who had had bariatric surgery, the risk of colon cancer was 60% higher than those who hadn't had surgery (though the absolute numbers were fairly low - 70 out of 15,095 patients, or 0.46% of patients who had obesity surgery developed colon cancer).  Ten years after bariatric surgery, the risk of having colon cancer was double compared to people with obesity who hadn't had bariatric surgery.

These results need to be taken with a grain of salt, as there are a number of limitations to this database analysis - for example, other risk factors associated with colon cancer such as smoking, diabetes, family history etc were not available (the interested reader can read more about this here).  The study does seem to contradict the overall protective effect that bariatric surgery is thought to have on cancer risk (for women, at least) - but then again, most previous studies have not followed up patients for as long as this one, and colon cancer is known to be a very slow growing tumor.

Following gastric bypass surgery, it has been suggested that the lining of the intestine may change (called 'mucosal hyperproliferation'), and an increase in a pro-tumor chemical has been found (a cytokine called 'macrophage migration inhibitory factor'), though other tumor inducing chemicals (such as TNF alpha and interleukin 6) have been shown to decrease after bariatric surgery.  The population of intestinal bacteria change after surgery as well, and there is still much we don't know about the effects of these changes (though there appear to be metabolic benefits of these post-surgery bacterial changes).

So where does this leave us?  Well, there are still many questions to be answered about the long term efffects of bariatric surgery, which only time will teach us.  In the meantime, we must continue to carefully weigh the benefits and risks of obesity surgery, and for patients who have had bariatric surgery, colon cancer screening and surveillance should be undertaken.

@drsuepedersen

www.drsue.ca © 2013

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Weight Discrimination and Bullying

I really have to hand it to my fellow author Dr Rebecca Puhl for writing a fantastic chapter in our ‘Complications of Obesity’ textbook, about the effect of obesity stigmatization and bullying on both children and adults.  Here are some jaw-dropping and very sobering statistics and facts that she shares with us:

Discrimination in the workplace:  for the same work performed, obese women earn 6% less than healthy weight women, and obese men earn 3% less than thinner men.

Some studies have shown that managers are more willing to hire a less qualified thinner candidate, than a more qualified overweight candidate.

Health care discrimination: 69% of women report being stigmatized about their weight by their own doctor (eg feeling disrespected, dismissed, and/or upset about comments made by their MD)

One study reported that 68% of women with obesity delayed their medical care due to feeling embarrassed about being weighed, disrespected by health care providers,  and because gowns, examination tables, and other medical equipment were too small for them.

A vicious cycle:  79% of women in one study reported coping with weight stigma by eating more food.

People closest may hit the hardest: 60% of overweight people report friends, and 47% name their own spouses, as perpetrators of weight bias.

And the two that hit me the hardest:

Suicide risk in youth: over 50% of girls who experienced weight based bullying by peers or family contemplated suicide.

Suicide risk in youth: 13% of boys who were teased by family members about their weight reported attempting suicide (more than three times the risk compared to those who were not teased).

As I have blogged many times before, the stigmatization against people with obesity desperately needs to STOP.  As Dr Puhl concludes:

The stigmatization, bullying, and discrimination of obese children and adults are pervasive and lead to damaging consequences for individuals who are targeted… The adverse psychological, social, and health consequences resulting from weight stigmatization must also be prioritized in efforts to prevent and treat obesity.

@drsuepedersen

www.drsue.ca © 2013

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How Does Exercise Affect Your Hunger?

Each of us is created as a unique and beautiful person - and with that uniqueness, there is also a 'Best Weight' for each of us - a realistic weight goal (which is different for everyone) that optimizes metabolic health and overall wellbeing.  This Best Weight is at least partially genetically determined, with a number of factors likely to be players, including the weight at which the balance of our hunger and satiety hormones leave us feeling satisfied.

In keeping with this hypothesis, a new study shows us that exercise affects hunger hormones and feelings of fullness differently in people who are thin, compared to people who struggle with their weight.

The study had lean and obese participants walk for an hour on a treadmill in the evening, and served them a meal the following morning.  On a separate day, they offered the participants the same breakfast, but without exercising the night prior.

In the lean people, they found that the hunger hormone ghrelin was decreased the morning after exercise.  When the lean people were served breakfast, they felt just as full from the breakfast whether or not they had exercised the night before.

In the people with obesity, there was no decrease in the hunger hormone ghrelin after exercise (as there was for the lean people), and they felt markedly less full after breakfast when they had exercised the night prior.

The Bottom Line: another study to add to the list that teaches us that weight struggles are SO much more than calories in and calories out.

www.drsue.ca © 2013 @drsuepedersen

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Crinkle, Pop, Fizz...

Did you ever stop to consider whether the act of actually opening a wrapper, or stirring a drink, made a difference as to how much you enjoy the food or beverage?  Here's an interesting bit of human food psychology - a recent study shows that these actions actually do enhance the pleasure of the food or drink itself.

The study found that a group of people who unwrapped a chocolate bar following a specific set of instructions enjoyed the chocolate more than those who were not given specific unwrapping instructions.  They also found that if there was a longer time between the food preparation 'ritual' and consumption of the food (time to drool?), the food was enjoyed more.  Finally, they found that enjoyment was higher if the food was prepared by another person, it was not enjoyed as much as if the food was 'ritualized' by the person eating the food.  So for example - watching someone else mix a pitcher of lemonade does not make the lemonade as tasty as when you do the mixing yourself.

So, it seems that the rituals of food preparation enhance the enjoyment of consumption because we are more involved in the food experience.  This comes back to the principle of avoiding Mindless Eating  - we end up feeling more satisfied with less food if we are involved in, and thinking about, the process of eating, from start to finish!

www.drsue.ca © 2013 @drsuepedersen

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Seven Risk Factors for Obesity at Age 3

A recent study looked for risk factors that influence a child’s likelihood of being overweight by age 3.  The study looked at over 13,000 children aged 6-12 months in the UK, and followed their data to age 3 to determine whether any factors could predict the risk of being overweight at age 3. 

Out of 33 different possibilities studied, they found seven characteristics that were associated with an increased risk of childhood obesity at age 3.

The 7 factors that are associated with a higher risk of a 3-year-old being overweight are:

• Mother smoking in pregnancy increased the rate of the 3-year-old being overweight by 33%
• Children who are not breastfed were 25% more likely to be overweight at age 3 than those who were ever breastfed
• Mom being overweight before pregnancy
• Dad having obesity
• A higher weight at birth
• Gender: girls were more likely to be overweight at age 3 than boys
• Early weight gain: babies who rapidly gained weight during their first year were 4 times more likely to be overweight at age 3 than those who grew at an average weight

So why do we care if a 3 year old is overweight?  Doesn’t the weight just balance out over time?  While many kids will go through different phases of body fat storage as they grow, it is a fact that overweight in childhood does increase the risk of that individual being overweight in adulthood.  So while it would not be appropriate to get carried away with intense weight management of a three year old, what we can learn from this study is that there are things we can look at in our own lives that could be modified to improve the health of our offspring. 

While some of the above risk factors are modifiable (eg smoking), others are not.  Knowing that there are many benefits to breastfeeding, most mothers these days do choose or try to breastfeed, but it isn’t always successful.  Parental obesity has been shown to be associated with weight struggles in their offspring, both in childhood and as those children become adults, so it is important to reach out for help with a weight struggle not only for a person's own health and well being, but also for that of their kids.  

Dr Sue Pedersen www.drsue.ca © 2013 drsuetalks@gmail.com

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Breakfast Like a King.... Will It Help You Lose Weight?

As part of weight management counseling, we often advise patients to eat 'breakfast like a king, lunch like a prince, and dinner like a pauper'.

A new study, by Jakubowicz and colleagues, tested this approach in a clinical trial.  They randomly assigned a group of overweight women to have more of their daily food intake at breakfast (700 calories at breakfast, 500 calories at lunch, and 200 calories at supper), or to have more of their daily food intake at supper (200 calories at breakfast, 500 calories at lunch, and 700 calories at supper) for three months.

Not only did the women eating more at breakfast lose more weight than the women eating more at supper, but the breakfast group also had a greater improvement in blood sugars, insulin resistance, and a type of cholesterol called triglycerides.  In addition, the breakfast group reported less hunger and more fullness after a meal, and their ghrelin (hunger hormone) levels were lower than the supper group.

So why does eating more food at breakfast work?  Previous studies have shown that eating breakfast may help to regulate brain activity to control eating behaviours later in the day, especially if the breakfast is high in protein. Contrast this with a day we have probably all experienced at some point, where you skipped breakfast, ate very little for lunch, and upon coming home at the end of the day, you were just so hungry that you had to eat and eat NOW - does that feeling sound familiar?   In that setting of intense hunger, we often overeat, as food is often eaten quickly - remember that it takes 10-15 minutes for the fullness hormones to start to kick in.  So, people who don't eat enough during the day will often eat their entire day's calories (and then some) at the end of the day.

So, prepare your shopping list to include healthy, bodacious, proteinaceous breakfast foods, like Egg Beaters, skim milk, no-salt-added cottage cheese, and lean cuts of deli meat - and enjoy!

Thanks to Obesity and Energetic Offerings for the heads' up on this study!



Dr Sue Pedersen www.drsue.ca © 2013 drsuetalks@gmail.com

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Could Soap Increase Our Risk of Diabetes?

What!? we exclaim as we race into the bathroom to grab the bottle or bar that we use without thinking every day.  It's not like we're eating it.  But it may be true - chemicals called phthalates, which are found in soaps, hair spray, nail polish, creams, perfumes and other beauty products, may increase our risk of diabetes.

A recent study, published in the journal Environmental Health Perspectives, lends more suggestive evidence to this interesting area.  They measured the urine phthalate levels in over 2,000 women, and found that women who were in the top 25% for urine phthalate levels were nearly twice as likely to have diabetes, compared to women in the bottom 25% for urine phthalate levels.

While the association between higher urine levels of this chemical and diabetes doesn't necessarily mean that one causes the other, the overall collection of studies in this area is certainly suggestive.

While scientists are busy sorting out what phthalates actually do to our metabolism and risk of diabetes, it makes sense to try to avoid perfumes and other scented beauty products, which often contain higher levels of this chemical.

Dr Sue Pedersen www.drsue.ca © 2013 drsuetalks@gmail.com

Follow me on Twitter for daily tips! @drsuepedersen 

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Does Obstructive Sleep Apnea Cause Low Testosterone in Men?

I've been thoroughly enjoying my second day of completely geeking out at The Endocrine Society meeting in San Francisco!  I've been attending session after session until it feels like my head is going to explode (and loving every minute!).  As always at this conference, my head is swimming with new ideas, new research findings, and as always, important clinical pearls.

One of the most interesting talks I went to today was about the link between obstructive sleep apnea (OSA) and low testosterone levels in men, given by Dr Gary Wittert from Australia.  We know that men with OSA are at risk of having low testosterone, and Dr Wittert helped to clarify this relationship for us.  

The summary of Dr Wittert's presentation is that the common link here seems to boil down to obesity.  We know that both sleep apnea and obesity are associated with low testosterone levels, and when you pick apart the data, obesity appears to stand alone as a risk factor for low testosterone.  In other words, sleep apnea itself is not a risk for low testosterone levels - the risk is mediated by obesity.  We often see low testosterone levels in men with obesity - while there are many possible causes that need to be checked for, we often end up with the finding that the pituitary's control of testosterone seems to be relatively suppressed in obesity, for reasons that remain somewhat unclear.

Dr Wittert described that when you treat a patient who has sleep apnea with a CPAP machine, use of the CPAP in and of itself does not result in improved testosterone levels. However, weight loss in the patient with obesity and low testosterone does clearly improve testosterone levels (and improves sleep apnea as well).  By the way, untreated sleep apnea can be a barrier to effective weight loss, so CPAP may well be needed to start the cycle of weight loss, thereby improving the sleep apnea and, by virtue of the weight loss, helping to normalize the testosterone levels.

So, the bottom line here is that weight loss is the important key to treatment in the man who has sleep apnea and low testosterone levels, as that weight loss can improve both conditions.

You can read about whether you are at risk of obstructive sleep apnea here.


Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen

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Food Porn - How it Affects Your Hunger Hormones

It's a funny term, but it's out there - there's even a wiki definition - food porn is a very real entity that permeates our daily life.  It's tough to get through an hour, let alone a day, without being assailed by all manner of delectable, touched-up photos of mouth watering food in a magazine, on TV, at the grocery store, or just walking by a billboard on the street.


An interesting study from Germany evaluated the response of 8 healthy men to pictures showing food, compared to pictures showing something other than food.  They found that the only known human hunger hormone, ghrelin, was higher during the 30 minutes after the food pictures were presented, compared to the 30 minutes before the pictures were presented; and, that the ghrelin levels after the food pictures were presented were higher than after non food pictures were presented.

So, this shows us that there is a very real hormonal effect to flashy food photos, that drives our hunger and tells us to eat.  As for avoiding them... well, that's the tricky part.  Choosing active pursuits over TV is a good one.   Please leave a comment at the bottom of this blog post to share your ideas!

Dr Sue Pedersen www.drsue.ca © 2013 

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How Can We Know if Dietary Supplments are Safe?

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

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Is There a Fountain of Youth?

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

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Is Total Genome Testing the Answer?

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

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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