New Data on Type 2 Diabetes and Obesity Surgery

At the European Association for the Study of Diabetes (EASD) meeting in Berlin today, I had the pleasure of sitting in on a session discussing the effects of obesity surgery on type 2 diabetes.  Whereas previous years of diabetes meetings have seen very sparse attendance at bariatric surgery talks, this session was absolutely packed. 

At this session, a number of fascinating studies were
presented.  Highlights included: (be warned - it's a very science-heavy blog this week!)

A study by S. Steven and colleagues (UK) looked at a group of 92
patients who had type 2 diabetes prior to having gastric bypass
surgery, with the aim of determining which factors were associated
with a greater chance of diabetes remission after surgery. One of
their findings was that the degree of weight loss achieved post op was
the main determinant of diabetes remission - controversial, as the
bulk of currently available evidence suggests that remission of
diabetes is independent of weight lost.

A study by Pournaras and colleagues found that a nifty removable liner placed
inside of the first 60cm of small intestine (called a duodenal-jejunal
bypass liner) improved type 2 diabetes control over a 1 year trial period.
This introduces the question as to whether, in the future, we can
consider less invasive alternatives to bariatric surgery (such as
these) to help control type 2 diabetes.


A couple of elegant studies out of Denmark (including colleagues Jens Juul Holst and Sten Madsbad who I collaborate with on research studies personally) and Sweden were presented, designed to give us a better understanding of just how obesity surgery improves type 2 diabetes (with a lot of arrows pointing to the increase in the hormone GLP-1 that is seen after surgery).

Finally, there was a neat study from Finland showing that the insulin resistance of fat in femoral bone marrow improves with bariatric surgery (I personally had not previously thought about bone marrow being insulin resistant!).  

Overall, a very exciting day, and a very exciting meeting!

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

Follow me on Twitter for daily tips! @drsuepedersen

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Sweeteners - Friend or Foe?

Artificial sweeteners have long been available, as a way to sweeten drinks and food while avoiding the calorie impact of sugar.  Recently, sweeteners have been on the hot seat, as it has been questioned whether these chemicals are friend or foe in the battle of the bulge.


There are several sweeteners currently available (as blogged previously), and the first thing that bears saying is that each of these chemicals is a very different compound, so the effects of each one could be different.   (to jump over the scientific part of this discussion, skip to The Bottom Line below)

Interestingly, in recent years, we have learned that sweeteners can activate not only the sweet receptors in our mouths, but also in our intestines and our pancreas (though it's only the receptors in our mouths that give us the feeling of eating something sweet).  It has therefore been suggested that artificial sweeteners may have an effect on the production of appetite regulating hormones, leading to weight gain.

As recently reviewed, some 'test tube' (in vitro) studies have shown that artificial sweeteners can affect the production of appetite hormones from gut cells, while other test tube studies have shown no effect.  In human and animal studies, most have NOT shown an effect of sweeteners on appetite hormones.  Thus, overall, the research suggests that sweeteners do not have an effect on appetite - though the research is far from complete, and there is still a lot of ongoing study in this area. 

In addition, several studies have shown that a higher consumption of sweeteners is linked with a higher risk of obesity.  However, what these studies are not able to separate is whether higher sweetener consumption is seen in people who are overweight because they are drinking the sweeteners in an attempt to lose the weight, or whether the sweeteners are actually causing the weight struggle.   There is much research being actively done in the area to give us an answer to this question.

The Bottom Line: As it stands now, there is not enough evidence to convince us that sweeteners lead to weight gain, while the evidence that excess sugar leads to weight gain is very clear.  There are many excellent clinical trials underway in this area, which will hopefully give us more clarity on the subject.

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

Follow me on Twitter for daily tips! @drsuepedersen

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Bisphenol A Exposure from Canned Soup

There is mounting evidence that exposure to a widely used chemical called bisphenol A is associated with an increased risk of obesity, diabetes, and metabolic syndrome.  A recent study reveals that eating canned soup for just 5 days can dramatically increase exposure to this potentially dangerous chemical.

Bisphenol A is a widely used chemical, found in a variety of products ranging from plastics to cash register receipts.  Most of our exposure is thought to be through food; in addition to being present in many water bottles and plastic food storage containers, it is also present in the interior epoxy coatings of many canned goods used to prevent corrosion.

The study was eloquently simple.  Seventy-five students and staff at the Harvard School of Public Health were each asked to eat soup for lunch for 5 consecutive days, and were randomly assigned to eating either canned soup, versus homemade soup from scratch. The following week, they ate soup each day for lunch once again, but they ate the opposite kind of soup from what they had eaten the week previously (researchers: thereby providing a randomized, single blinded, crossover design). 

The results were, in my opinion, quite astonishing: the researchers found that the bisphenol A levels in the urine were nearly twenty times higher after a week of canned soup consumption, compared to after homemade soup consumption.  Further, the urine bisphenol A levels after the canned food week were 60% higher than the higher end of urine bisphenol A levels noted in the general population. 

The study did not test the bisphenol A levels in the blood, so we don’t know if these people quickly cleared the bisphenol A from their systems, or whether the bisphenol A levels in their blood or other tissues was also elevated, or for how long.  That being said, the study does clearly show that just 5 days of eating canned soup dramatically increases exposure to this potentially harmful compound. 

Let’s hope that this study gives an extra push towards using bisphenol A – free linings to canned goods, as well as yet another reason to cook and enjoy healthy food made at home!  

Thanks to my friend and colleague Jon for pointing out this study!

Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

Follow me on Twitter for daily tips! @drsuepedersen 

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Abuse in Childhood Increases Risk of Obesity in Adulthood

The struggle with weight is very complex, and goes so much deeper than simply a balance between calories in and calories out. For many people, there is an emotional contributor to the weight struggle, and for some, a history of abuse in their childhood.

An ongoing study called the ACE (Adverse Childhood Experiences) study has done much to educate us on the important relationship between childhood abuse and obesity later in life.  This study, which includes data from over 17,000 people, is one of the largest studies ever conducted to help us understand the associations between childhood maltreatment, and health and wellbeing later in life.

The obesity substudy surveyed adults by mail about their first 18 years of life, and looked for associations between their answers and their body weight as adults.

An alarming two thirds of the study population reported some sort of abuse during their childhood years.  Physical and verbal abuse were most strongly associated with obesity.  People who reported being 'often hit and injured' had a 40% increased risk of obesity.  Furthermore, the risk of obesity was higher with the number of different types, and severity, of abuse.

This study shows us that some people's struggles with obesity may be deeply rooted in a history of abuse in their childhood.  It is of the utmost importance for health care providers to do everything they can to help people identify, understand, and manage these complex and serious issues.

Taken as a whole, the ACE study suggest that certain childhood experiences such as abuse, neglect, and family dysfunction are risk factors for several illnesses as well as poor quality of life.  The ACE study is still ongoing, and is now looking at the relationship between these childhood experiences, the use of health care resources, and causes of death.

As the ACE study website notes: Progress in preventing and recovering from the nation's worst health and social problems is likely to benefit from understanding that many of these problems arise as a consequence of adverse childhood experiences.

Thank you to my friend and colleague, Margaret, for bringing this important study to my attention.

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

Follow me on Twitter for daily tips! @drsuepedersen 

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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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