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Endocrine Society Recommends Against Testosterone Treatment in Women

>> Sunday, December 14, 2014

There is a lot of conflicting information out there for women who seek answers about testosterone.  To answer many important questions around this issue, the Endocrine Society has recently released an updated Clinical Practice Guideline about testosterone treatment in women.

Key points in these guidelines:

1. They recommend against diagnosing 'testosterone deficiency' in women.

Reason: The data out there is unclear as to whether low testosterone levels correlate with symptoms or not.  Also, it is normal for testosterone levels to decrease with reproductive aging.

2.  They recommend against treatment of women with testosterone.   The only exception to this is postmenopausal women who have been formally diagnosed with Hypoactive Sexual Desire Disorder (HSDD).   They specifically recommend against treating with testosterone for reason of: infertility; cognitive, cardiovascular, metabolic, or bone health; sexual dysfunction (other than HSDD); or general well being.

Reason:  It has not been proven that testosterone treatment is of clear benefit for uses other than in HSDD; government approved and monitored preparations of testosterone for women are not readily available; and, there is not evidence to prove long term safety of testosterone treatment.  Further, there is a concern that testosterone treatment could stimulate hormone responsive cancers to grow.

3.  They recommend against treatment of women with DHEA.

Reason: It has not been proven that DHEA treatment is of clear benefit; and, there is not evidence to prove long term safety.  This holds true for women with and without adrenal insufficiency.

Follow me on twitter! @drsuepedersen © 2014


Are All Milks Created Equal?

>> Saturday, December 6, 2014

Alternatives to cow’s milk are growing ever popular, due to aggressive marketing campaigns suggesting that these other milks may be healthier.  Many options are available, from goat to almond to soy to coconut, hemp, flax or oat.  Not only are a growing number of adults drinking these milks, but parents may choose to provide these milks to their kids because of a perceived health benefit. 

Because these alternative milks are not required to be vitamin D fortified (whereas it is mandatory that all cow’s milk in Canada is fortified with vitamin D), the concern has been raised as to whether Canadian kids who drink non-cow’s milk are getting enough vitamin D.     

A recent Canadian study looked at this question in children age 1-6, using the TARGet Kids research network in Toronto.   They found that kids who drank non-cow’s milk were almost three times more likely to have insufficient levels of vitamin D, compared to kids who drank cow’s milk.   (Remember that most Canadians do not get enough vitamin D naturally, because we live too far from the equator to get enough sun exposure to make vitamin D.  There are a few natural dietary sources of vitamin D, including salmon, trout, tuna, and egg yolks.)

In addition, research has suggested that we may not absorb dietary calcium as well from non-natural calcium sources, compared to calcium occurring naturally in food such as cow’s or goat's milk, other dairy products, and green leafy veggies like spinach and kale.  Alternative milks are often (but not always) fortified with calcium – in other words, calcium is not naturally occurring in these alternative milk products.  (Recommended intake of calcium from Health Canada can be found here, and more on my thoughts re dietary vs supplemental calcium here).

Another plus of cow’s milk (and goat’s milk) is that it contains about 9 grams of protein per cup, whereas many alternative milks contain only 1-3 grams of protein per cup.

So, it seems that the health benefits of protein and naturally occurring calcium put cow’s milk (or goat’s milk) on top as the healthier milk. 

We will likely see a growing number of alternative milk products containing vitamin D as the manufacturers catch on that this is important, and perhaps legislation will someday mandate fortification of alternative milks in addition to cow’s milk.  Until then, it’s important that Canadian kids who drink non-cow’s milk are getting adequate vitamin D through supplementation (read more about vitamin D needs at all ages from Health Canada here, and my summary from the 2010 Osteoporosis Canada guidelines regarding adults here).   

Sporting my Dairyland milk moustache..... 

Follow me on twitter! @drsuepedersen © 2014

Disclaimer: I have no conflicts of interest in writing this post.


The Unsweetened Truth About Sugar

>> Sunday, November 30, 2014

It can be tough to navigate one's way through all the information (and misinformation!) out there about nutritional health in general.  To de-muddy the waters on added sugars and the dangers of added sugars to human health, physicians and scientists at three American universities have gotten together to produce an authoritative resource to learn about the dangers of added sugar.

The website is fantastic, well worth a good read.  They have reviewed over 8,000 research articles, and distilled the information down to inform us about how added sugar contributes to heart disease, type 2 diabetes, and liver disease.

They have a page of new research alerts and a resource kit to help you share research-supported facts about sugar with others.

Images in this post come directly from their website.  Big Kudos to SugarScience!

Follow me on twitter! @drsuepedersen © 2014


Could Coffee Protect Your Liver?

>> Monday, November 24, 2014

Despite being one of the most commonly consumed beverages worldwide, the effects of coffee on our metabolism is surprisingly poorly understood.  (You can read about the controversial effects of coffee on blood sugars on my previous blog post here.)

Recently, there has been interest in understanding the effects of coffee on the liver.  Several studies have shown that liver enzyme tests are lower (which is good) with increasing coffee consumption ('inversely associated' in statistical terminology).  Some studies have suggested that coffee consumers have a decreased risk of having a fatty liver, liver cirrhosis (scarring), and even liver cancer.  An article from the American NHANES study has even suggested that people who drink 2 or more cups of coffee per day have half the risk of developing chronic liver disease, compared to those who drink less than 1 cup per day.

If coffee really is protective to the liver, an important question arises: is it caffeine that is protective, or something else in coffee?  This question was addressed in a recent study published in Hepatology, again utilizing the NHANES database.  They found that higher intake of coffee, regardless of whether it was caffeinated or decaffeinated, was associated with lower liver enzyme levels.  Components of coffee such as polyphenols, cafestol, and kahweol may be the protective elements, but no one really knows for sure.

While the findings of this study were consistent regardless of body weight or presence of diabetes, I would be interested to know what the non-coffee drinkers were drinking instead.  For example, if non coffee drinkers were consumers of Coca-Cola instead, could the soda be having a negative impact on the liver, rather than coffee having a positive impact?    More research is needed on many fronts before we will have a good understanding of exactly what is happening here.

Enjoying my java..... :)

Follow me on Twitter! @drsuepedersen © 2014


Myths and Misconceptions About Obesity

>> Sunday, November 16, 2014

Some of the biggest barriers to successful management of obesity in our society are the myths and, frankly, garbage, that pervade popular culture, media, and even medical publications. Recently, Dr Chaput and colleagues reviewed both popular media and scientific journals to bring to light the Top 7 Misconceptions about obesity: 

1.  Obesity is primarily caused by a lack of physical activity or by unhealthy dietary habits. 

Clear scientific evidence has shown us repeatedly that the picture is FAR more complex than this.  Factors such as insufficient sleep, stress, environmental chemicals, and exposures during fetal life have evidence that is as compelling, if not more compelling, than the traditional concepts of eating the wrong foods and not exercising enough. 

2.  Obese individuals are less active than their normal weight counterparts. 

This is a particularly harmful myth, as it paints the picture that people with obesity are lazy, and creates a harsh platform for weight discrimination and bias.  Recent data from the Canadian Health Measures Survey, which used accelerometers to document physical activity, shows that youth with obesity have similar levels of physical activity as youth without obesity.  Canadians in general do not exercise enough, and we as a society would benefit from increased physical activity, regardless of body size. (read about Canada's physical activity guidelines here)

3.  Diets work in the long term. 

Studies have shown that almost all people who lose weight on a diet will regain it within the next 5 years, with the majority regaining it within the first year.  The harmful follow up myth from there is that people who regain weight do so because they lack willpower.  NOT. TRUE.  The truth of the matter is that our genetics have been developed evolutionarily to very powerfully defend body weight, as a survival strategy built over thousands of years of regular famine.  The problem is that now, in our society, there is only feast. 

4.  Weight loss does not have significant adverse effects. 

While weight loss certainly has a long list of health benefits, there are potential downsides as well.  Weight loss that is too fast increases the risk of gall stones.  Weight loss reduces energy expenditure, meaning that less calories are burned by basic metabolic functions in a day, thereby defending body weight and promoting weight regain.  Weight loss in some people can increase psychological stress and depressive symptoms.  Failed weight loss attempts or weight regain can also lead to issues with self esteem as well as body image issues.  

The message is still that weight loss in people with obesity is still most definitely a good thing for health, but these weight loss efforts need to be gradual, sustainable, and partnered with the support that each individual needs to make these efforts a long term success!

5.  Exercising is better than dieting to lose weight. 

Exercise alone has generally not been found to result in significant weight loss.  Think about it this way: if you exercised as hard as you could for 1 minute, you might burn 15 calories.  If you ate as fast as you could for 1 minute (picture a big milkshake), you can down 2,000 calories or more.  The reality is that because it takes so little food intake to make up for a long period of exercise, exercise alone doesn't usually work.  As I say to my patients: focus 90% on the food side of the equation, and 10% on the exercise. 

6.  Everyone can lose weight with enough willpower. 

Untrue.  Remember that each of is built differently, with very different genetics either working with us, or in most cases against us, to maintain a healthy body weight.  There are also many medical issues and medications that can make it exceptionally difficult to lose weight. 

7.  A successful obesity management program is measured by the amount of weight lost. 

Rather than focusing on the numbers on the scale, a successful obesity treatment program should be focused on the improvement in health.  With a permanent lifestyle change, did that person's quality of life improve?  Did their diabetes get better? Do their joints hurt less? Did their sleep apnea improve?  Does the individual just feel better? These are the bars by which a successful treatment program should be judged.  

Follow me on twitter! @drsuepedersen © 2014



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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