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 

Follow me on Twitter for daily tips! @drsuepedersen

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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

Follow me on Twitter for daily tips! @drsuepedersen

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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

Follow me on Twitter for daily tips! @drsuepedersen

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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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Longer Sleep (In Short Sleepers) Can Prevent Weight Gain

It is well known that both too little sleep, and too much sleep, are associated with obesity.  Reduced sleep in particular is a problem in modern society - I'm sure we can all attest to this!   The optimum amount of sleep is between 7-8 hours for adults.

A recent study led by my colleague Dr Chaput looked at people who habitually slept less than 6 hours per day, and divided them into two groups: those who increased their sleep to a healthier 7-8 hours per day, and those who kept their usual sleep habits.

At 6 years, they found that those who kept their short sleep patterns gained 2.4kg more fat mass than those who changed their habits to longer sleep.

So, for those of us who are certain that we can thrive on less than 6 hours of sleep - it may not be the best for our health in the long run.

Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen

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