Should Sugar Be Removed From The FDA's 'Safe' List?

Sounds ridiculous, doesn't it - the notion that sugar, which was originally revolutionary in sustaining humankind, should now be considered unsafe (in excess).  There is in fact a longstanding strong outcry from public health advocates to the FDA to pull sugar from its 'generally regarded as safe' list, and a recent study adds to the data to tell us why.

The study, published by Yang and colleagues in JAMA Internal Medicine, examined data from the NHANES database to understand the relationship between added sugar consumption and risk of death from cardiovascular disease.

The study found that:

• The risk of death from cardiovascular disease (CVD) starts to rise when intake of added sugar makes up over 15% of total daily calorie intake. (15% of daily calories in a 2,000 calorie diet is equivalent to a 600mL bottle of pop)
• People who consume 1/3 or more of their daily calories as added sugar are at a 4 times increased risk of death from CVD. (According to the study, about 10% of Americans were consuming this amount)
• Drinking one 355 mL can of soda per day increases the risk of CVD death by almost one third, independent of total calories consumed and other cofactors.
• These findings were largely consistent, regardless of body weight, age, or physical activity levels.

As the excellent accompanying editorial by Laura Schmidt, PhD, notes:

"Physicians may want to caution patients that, to

support cardiovascular health, it is safest to consume less than

15% of their daily calories as added sugar."

The authors are picking on soda and other sugar sweetened beverages in particular for good reason - these beverage constitute 37% of the total added sugar intake in the American diet.  So, without a doubt, beverage consumption is the first place to look for an easy place to cut back on unneeded extra sugar.

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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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