Blue Light From Your Electronic Device - Keeping You Up At Night?

Most of us have one, and most of us do it - we use our computers, iPhones, tablets, and other devices until right before sleep. Heck, most of us bring them into the bedroom with us (it's our alarm clock too, right?).  If you are a person who struggles to get to sleep, rethink your actions - the blue light emitted from these devices may be making it harder for you to fall asleep.

Blue light is part of the spectrum of normal light, and it's abundantly emitted from the screen of your computer and your portable device.  Blue light stimulates a special sensor in our eyes called melanopsin, which is thought to regulate our sense of night and day by affecting levels of melatonin (a sleep hormone) in our brains.  When we see blue light, melanopsin is stimulated, which suppresses melatonin levels, effectively telling our brains that it is daytime and not the time to sleep.  So, if you're using your electronic device before bed, it may take a while after you shut it off for your brain to realize it's night time and fall asleep.

The makers of these devices are hard at work to develop features that limit the amount of blue light emitted from screens at night.  For iPad and iPhone users, you can dim the screen in the Settings menu, which helps to decrease the overall (and therefore also the blue) light emitted.  There are also funky orange tinted glasses and screen filters available out there that help to decrease the amount of blue light you see, and even computer software that can be installed to decrease the amount of blue light coming from your screen.

Knowing that sleep deprivation increases the risk of obesity, here's one more item we can add to the long list of contributors to weight struggles in modern society.

Not to mention that reading those palpitation-inducing work emails right before bed probably isn't the best idea, either. :)

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

Follow me on Twitter for daily tips! @drsuepedersen 

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Dangers of Herbal Remedies

Many people take some form of naturopathic or alternative remedy for a wide variety of reasons - a whopping $14.8 BILLION has been spent in the United States on herbal remedies in a single year.  For most people, it's the idea that the product is 'natural' that is attractive - it makes it seem as though these substances can only do good, and can do no harm.  Be warned - it is due to the unfortunate lack of regulation of these products that this 'do no harm' idea has been successfully disseminated - but it is not true at all.

As nicely summarized in a recent article which I highly encourage you to read, dietary supplements are exempt from the usual medication regulation by the American FDA.  This means that a product does not have to be proven effective or safe before it is put on the market.  The only information we have about potential side effects of a herbal remedy is from voluntary reporting after the product is in use, which only represents a small fraction of the side effects that are happening but not being reported.

As an example from the world of herbal treatments of obesity, the article notes:

Even when the agency identifies an unsafe product, it lacks authority to mandate its removal from the market because it must meet the very high legal requirement to demonstrate “significant or unreasonable” risk. That is why it took the FDA more than 10 years to remove from the market ephedra-containing herbal weight-loss products that had caused hundreds of deaths and thousands of adverse events.   


Other problems that limit the ability to understand these chemicals and herbs include:

• Inadequate labeling of the supplement - in other words, it's not clear exactly what the product contains. 
• Frequent unsound and illegal claims made by websites - a study investigating this found that staff at retail outlets have even been caught telling patients to take their herbs instead of prescription medications - which could have life threatening consequences.
• Herbal remedies can be tainted with undeclared prescription drugs and heavy metals - as noted in the recent article - “These tainted products can cause serious adverse events, including strokes, organ failure and death.”

The internet and TV media tend to overblow the potential benefits and downplay potential harms of herbal supplements, while the reverse publicity is true for prescription medications.  As such, many people have a trust in herbal remedies that they don't have for prescription medications. 

The bottom line is that just like for a prescription medication, the decision to take a herbal remedy should be made with a careful evaluation of the benfits vs the risks.  The unfortunate reality is that this information for naturopathic remedies is just not available, so it's impossible to make this assessment.  

The only solution to this problem is much stricter regulation of these substances, with careful evaluation of their benefits vs risks, before they are put on shelves.  The FDA has recently issued a draft proposal to gain authority to regulate supplements - let's hope that this goes through.  

As a final note - the beautiful, naturally occuring plant pictured above is the digitalis plant.  The extract from this plant (also called Digoxin) is a cardiovascular drug that is used to treat certain heart problems.  When digoxin is prescribed to patients, levels are monitored very carefully, as high levels can cause very dangerous side effects, including heart rhythm disturbances, which can be life threatening.  This example reminds us that just because a substance is natural, does not mean that it is free of possible side effects.

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

Follow me on Twitter for daily tips! @drsuepedersen 

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Colored Potato Chips Curb Snacking

I'm pretty sure that most of us have had that experience where we open a package of our favorite (insert: candy, chips, chocolate) for a little taste... and the next thing you know, it's gone!  In an effort to discover ways to help us curb our snacking habits, researchers have discovered that inserting the occasional red potato chip into a stack of regular chips helped to curb snack size by over 50%!

The study, just published in the journal Health Psychology, asked a group of American undergraduate students to eat chips from a tube while watching a movie.  Red chips were inserted at regular intervals (eg every 5th chip) in one group, with no red chips in the tubes of the other group.

They found that when red chips were inserted, the number of chips consumed was reduced by more than 50%.  Further, when participants were asked how much they ate, they were more accurate in their estimates when the red chips were inserted, compared to when there were no red chips inserted.  

So what does this teach us?  It seems that having a natural 'break' in a snack, in this case created by a different color, helps us to curb our portions.  This may be because the alternate color gives us pause to actually think about the fact that we are eating (ie avoiding Mindless Eating), or to think about how much we have eaten, or how much we should be eating.  It is also possible that the color gives us a subconscious cue to portion control.

Perhaps in the future, we will see a new wave of colored snack products on the shelves in response to this study.   In the meantime, think about what your favorite snacks are, and how you could adapt them to take advantage of these findings.  I'd be thrilled to hear your ideas!

Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

Follow me on Twitter for daily tips! @drsuepedersen

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Liposuction Increases Bad Fat

While liposuction is a commonly performed cosmetic procedure, the long term health effects are not well understood. A recent study reveals that not only is there regain of fat after liposuction, but that fat regain is in the form of ‘bad fat’ – the fat that increases the risk of diabetes and heart disease.

The study evaluated 36 healthy, normal weight women, who underwent abdominal (tummy) liposuction at the University of Sao Paolo, Brazil.  Two months after surgery, participants were randomly allocated to two groups: one group was put into a 4 month exercise program, and the other group was not put onto an exercise program.

At 6 months after liposuction, while fat did not reaccumulate in the area of liposuction, the group that was not in the exercise program had a 10% increase in visceral fat – this is the fat that surrounds our organs, which, in excess, is the ‘bad fat’ that secretes hormones and inflammatory chemicals that increase our risk of getting diabetes and heart disease.  The ‘bad fat’ did not increase in the exercise group, suggesting that the physical activity was sufficient to keep the bad fat at bay.

So, what this study teaches us is that although the lipo-sucked areas do not reaccumulate fat, the body’s compensation mechanisms do kick in to reaccumulate fat in more dangerous places around the organs, thereby increasing the risk of health complications of excess fat.  While exercise kept the bad fat away in this study, it would be very interesting to see what happened to these women six months or a year after the study was complete – if they stopped exercising, did they regain bad fat too?  Yet another research study that needs to be done.  

Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

Follow me on Twitter for daily tips! @drsuepedersen

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Breast Feeding and Obesity Risk Later in Childhood

There is a long list of established benefits of breast feeding, including benefits to baby's immune defenses, gastrointestinal function, nutrition, and psychological well being.  It is controversial as to whether breast feeding decreases the risk of obesity later in life, but the evidence is mounting, with another new study lending support to this claim.

The study by Cathal McCrory and colleagues examined data from nearly 8,000 Irish children and their families, to see if breast feeding vs formula feeding had an impact on the risk of obesity later in childhood.  They found that kids who had been breast feed for 3 to 6 months were 38% less likely to be obese at 9 years of age, compared with kids who were exclusively formula fed.  Those who were breast fed for 6 months or more had half the risk of obesity at age 9, compared with formula fed kids.

While the mechanism responsible for these findings is still up for debate, the study lends further credence to the mantra we already know: Breast is Best!

Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

Follow me on Twitter for daily tips! @drsuepedersen 

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Healthy Obesity - Is There Such A Thing?

In this era where obesity is so prevalent, the question has arisen as to whether everyone with obesity is at risk of developing complications of their excess weight, such as heart disease.  It turns out that all obesity is not equal, and that Healthy Obesity is a very real phenomenon.

A recent study that adds to our growing knowledge on this topic examined data from over 22,000 people in the United Kingdom, and compared the risk of developing cardiovascular disease, or death, in people who were obese vs not obese, according to whether they had other metabolic risk factors for cardiovascular disease or not (including high blood pressure, low levels of good cholesterol, diabetes, waist circumference, and a blood marker of inflammation called CRP).

Over an average of 7 years, the obese people who were metabolically healthy (with 0 or 1 of the above risk factors) were not at increased risk of cardiovascular disease, compared with metabolically healthy people who were not obese.  Amongst people who were metabolically unhealthy (with 2 or more of the above risk factors), body weight didn't make a difference in risk - it was the metabolic factors that mattered, not the body weight.   Amongst people with obesity, those who were metabolically unhealthy were at 72% increased risk of death compared to those who were metabolically healthy.

The bottom line here is that it is not body weight that is the primary determinant of health, but rather, it is the risk factors for disease that may or may not be present (or develop) in the person who carries excess body weight that are the key.  In this study, one quarter of the people who were obese were metabolically healthy, and were therefore not at increased risk.

Once again, we learn that it is not about 'curing' obesity.  Rather, it is about each individual achieving their Best Weight - a realistic weight goal (which is different for everyone) that optimizes metabolic health and overall wellbeing.

Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

Follow me on Twitter for daily tips! @drsuepedersen 

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Medications vs Bariatric Surgery for Treatment of Type 2 Diabetes

It has become clear that bariatric (obesity) surgery can result in substantial improvement, or even remission, of type 2 diabetes for some people.   Two new articles from the New England Journal of Medicine now add to our knowledge on this topic.

(For the non-scientists in the audience, feel free to skip down to 'So what does this mean?' below.)

One of these studies, by Mingrone and colleagues, looked at 60 patients randomized to receive either gastric bypass surgery, biliopancreatic diversion surgery (BPD), versus their usual diabetes care with medications, and examined how many people would be in remission from their diabetes 2 years later.  They found that 75% of the patients who had gastric bypass and 95% of the patients who had BPD were in remission, whereas none of the control group was in remission.  Interestingly, none of age, gender, baseline body mass index, nor duration of diabetes were predictive of remission.

The other study, by Schauer and colleagues, randomized 150 patients to receiving either gastric bypass surgery, sleeve gastrectomy, versus usual medical care of type 2 diabetes, with the goal being to see how many patients from each group could achieve very tight control of their diabetes (defined by A1C of 6% or less) at one year.  They found that more patients who had surgery achieved this goal (42% of gastric bypass patients and 37% in sleeve gastrectomy patients), compared with 12% of patients receiving medications alone.  At one year, the mean A1C in the medication group was 7.5%, compared to 6.4% in the gastric bypass group and 6.6% in the sleeve gastrectomy group.

While each of these studies could be discussed with chapters of detail, for purposes of brevity I'll highlight just a couple of important caveats.  While a strength of these studies is that they are randomized clinical trials (very hard to do in the area of bariatrics), both studies are small.  In the Mingrone study, BPD was used as a surgical technique, which is a fairly drastic surgery (it bypasses more of the bowel than gastric bypass), and is currently only experimental.  The longer term follow up of these patients is important, as other studies now suggest that at 5 years after bariatric surgery, about half of the diabetes cases that initially went into remission come back (though the diabetes-free years are undoubtedly still of substantial health benefit).   In the Schauer study, one could argue that the diabetes control goal (A1C 6% or less) was too tight and not appropriate for routine clinical care, given that we no longer strive for this tight control in most cases of type 2 diabetes because of the potential risk of harm (see the ACCORD trial).  What is interesting to me, however, is that the overall control was better in the surgical groups compared to the control group.

So what does this mean?  These studies show us that bariatric (obesity) surgery can put type 2 diabetes into remission, and can improve control of diabetes in those who don't go into remission.  However, it must be noted that remission does NOT mean cure - each patient must be followed on a lifelong basis and monitored for possible recurrence of diabetes down the road.  These surgeries have significant risk associated with them, and the balance of benefit versus risk has to be considered on a patient-by-patient basis.  The improvement in diabetes does not appear to depend on how much the person weighs before surgery, implying that the current body mass index (BMI) critieria for selecting patients for surgery may not be the right way to determine who would benefit the most. (More research needs to be done to figure out what does predict best success with bariatric surgery.)

Overall, (and as noted in the accompanying editorial), studies such as these suggest that bariatric surgery should perhaps not be a 'last resort' in the treatment of patients with obesity and type 2 diabetes.

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

Follow me on Twitter for daily tips! @drsuepedersen 

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