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Skinny Slow Cooker Chicken Marinara

>> Sunday, March 29, 2015

Love this slow cooker permutation of chicken marinara - SkinnyMom wins the award for an awesomely healthy recipe that didn't need any 'doctoring' to make it approved.  Imagine how much you'll love coming home from work, cracking open the front door to find the delicious scent of your dinner wafting out to great you....

  • 2 pounds boneless, skinless chicken breasts
  • 4 cloves garlic, peeled and crushed
  • 4 tomatoes, chopped or one 14.5-ounce can low-sodium tomatoes, drained
  • 4 medium ribs celery, diced (1 cup)
  • 2 small zucchini, diced (2 cups)
  • 1 bell pepper, cored, seeded, and diced
  • One 18-ounce jar low-sodium marinara sauce
  • 1 tsp dried basil
  • 1 tsp dried thyme
  1. Place the chicken in the slow cooker; add the garlic, tomatoes, celery, zucchini, and pepper.
  2. Pour the marinara sauce over all, and sprinkle the basil and thyme on top.
  3. Set the slow cooker on low and cook for 6 to 8 hours (make sure the chicken is cooked through!).
  4. Before serving, shred the chicken with a fork.

Makes 8 servings.  Nutritional Info per serving (approximate): 
  • calories: 172
  • fat: 3.6g
  • protein: 27g
  • carbs: 7g
Follow me on twitter: @drsuepedersen © 2015


Testosterone Treatment in Men - Risk To The Heart?

>> Sunday, March 22, 2015

At the Endocrine Society’s recent ENDO 2015 meeting in San Diego, I managed to score a seat in a packed-to-overflowing symposium discussing some of the controversies surrounding testosterone therapy in men.

At the heart of the discussion ws the fact that testosterone prescribing in men has dramatically increased over the last several years, primarily due to an increase in prescribing of this hormone to men who do not have a medical reason for failure of testosterone production (ie a testicular or pituitary problem), but rather, are men who have a low-ish testosterone due to aging or obesity, in hopes that they may feel better with testosterone therapy.   The prescribing of testosterone in men without a true failure of testosterone production has raised a number of safety concerns – in particular, whether testosterone may increase the risk of heart attacks or stroke.

The first point that was made in the symposium by Dr Alvin Matsumoto is that men may be labelled as having low testosterone, when, in fact, they don’t.  The problem here lies with a number of concerns with the accuracy of measurement of testosterone levels in men:

  • First of all, testosterone needs to be measured in the morning, as levels are highest in the morning and fall later in the day; 'normal' ranges have been developed based on the early morning measurements.  
  • Second, there are a lot of problems with the accuracy of testosterone measurement - one study looked at over 1000 different labs and found that testosterone levels on the same sample varied by 6 fold (ranging from very low to well within the normal range).  
  • Third, testosterone levels are not the same from day to day in one particular man - in fact, in men who have a low testosterone measured initially, about a third will have a normal level on repeat testing.  

Dr Shehzad Basaria then took us through an excellent review of the conflicting data around the effect of testosterone on cardiovascular (CV) risk.  Population studies suggest that testosterone treatment decreases the risk of CV events, but it is possible that it is men more concerned about/interested in their health that were taking the testosterone, so these results may just reflect that healthier men were tending to take testosterone in the populations studied.  Other retrospective studies, on the other hand, have suggested that testosterone treatment increases the risk of CV events – these studies suggested that it is older men, and those with pre-existing heart disease, who had the highest risk.  This is highly relevant to the discussion of whether it is safe to prescribe testosterone to men with age- or obesity-related decline in testosterone, as this is a group of men who are older and more likely to have pre existing heart disease.

We always look to randomized, controlled clinical trials for the answers to these questions if at all possible – and in fact, a recent study called the TOM study was stopped early because they saw a higher risk of CV events in the group of men receiving testosterone treatment.   The TOM study results have been criticized because they were studying muscle strength as their primary endpoint of interest and not CV events per se – but the results are what they are.

As far as how exactly testosterone treatment could increase the risk of heart attacks, we don’t know, but several possibilities have been suggested, including increase in clotting tendency/inflammation, driving testosterone levels too high with treatment, and fluid retention.

Because of the concerns that testosterone treatment may increased the risk of cardiovascular events, the FDA has now stated that testosterone treatment is only approved for men with true failure of testosterone production caused by certain medical conditions (these would include a primary problem with the testicles such as previous injury, mumps, or chromosomal issues; or the pituitary gland such as a pituitary tumor or radiation damage). They go on to state that the benefit and safety of testosterone has not been established for the treatment of low testosterone due to aging, even if a man's symptoms seem related to low testosterone.  The FDA also now mandates that the labeling for testosterone treatments includes a warning that it may increase the risk of heart attack or stroke.

Clearly, much more research is needed to answer our questions in this controversial area.

Follow me on twitter! @drsuepedersen © 2015


Bariatric Surgery for Diabetes Prevention?

>> Sunday, March 15, 2015

Over the last decades, many modalities to prevent type 2 diabetes have been studied.  Lifestyle changes, particularly if they result in weight loss, can be very powerful to prevent this condition.  Of all of the medications studied, only metformin has so far been recommended to decrease the risk of developing diabetes in people who have prediabetes.  Now, studies are coming out, showing that bariatric (obesity) surgery can be very powerful to prevent type 2 diabetes.

One such study, published recently in The Lancet (Diabetes & Endocrinology),  looked at over 2000 patients who had bariatric surgery, and compared them to a group of matched patients who had not had obesity surgery.  They found that, over a median of 2.8 years and a maximum of 7 years of follow up, patients who had bariatric surgery had an 80% lower risk of developing diabetes compared to people who had not had bariatric surgery.

Another recent study was a systemic review and meta-analysis that looked at the power of different interventions to prevent diabetes. In examination of studies of physical activity +/- diet, anti diabetic medications, obesity medications, and bariatric surgery, they found all of these strategies to be of benefit.  Bariatric surgery stood out as being the most effective to prevent diabetes, with a 90% reduction in risk.

So the question then becomes, should we advocate for obesity surgery for the purpose of prevention of diabetes?  Well, as for any treatment or prevention of any medical condition, it's important to balance the benefits vs risks.  Bariatric surgery is invasive, and the most successful modalities (gastric bypass and sleeve gastrectomy) are permanent procedures.  These procedures have a long list of possible complications that need to be taken into consideration.

While bariatric surgery may be the best treatment option for some patients with obesity and existing type 2 diabetes, obstructive sleep apnea, severe high blood pressure, or severe osteoarthritis, it seems that using surgery solely to prevent these conditions may be outweighed by potential risks.  That being said, a marked reduction in risk of developing type 2 diabetes is certainly an added bonus to the patient having bariatric surgery who is having bariatric surgery for other reasons.

Thanks to my friend Gord for the inspiration for this blog post!

Follow me on twitter! @drsuepedersen © 2015


ENDO 2015: Fun In San Diego!

>> Sunday, March 8, 2015

It's been an amazing week!  I always leave the ENDO conference feeling so inspired and passionate about endocrinology, and I look forward to returning home to my patients with new pearls of information to guide my practice.

The ENDO2015 organizers asked me to publish at least one post this week about fun things I did while in San Diego (to make sure I actually got away from my computer for a little while? ;).

During the week in San Diego, I have taken the opportunity to ponder my new pearls of knowledge while enjoying some great sunrise seaside runs (a great treat for this mountain girl!) - I'm looking forward to putting the skis back on at home, but I must admit the warm sunshine and ocean breeze was a wonderful repose from the Canadian winter.

Lots of interesting things to see on these morning sojourns... the Naval Base:

A sculptural display called Our Silences, described as "an invitation to emotively reflect - or get excited with intelligence - about one of the fundamental human rights: the freedom of expression."

And naturally, lots of fabulous people watching en route - especially impressed by the active lifestyle of both tourists and residents.  It seemed as though there was never a shortage of people going for walks, rolls, runs, laps of stairs of the convention centre.... And I even got to be a faux-participant of today's San Diego Marathon!

It's been a pleasure being a blogger for ENDO2015 - thanks to all my readers for taking the journey with me!  Moving forward, feel free to join me in my now 7th year of blogging - check back for my weekly post, enjoy the search box in the right hand margin, or subscribe to receive my posts automatically.

Follow me on twitter! @drsuepedersen © 2015


ENDO 2015: Medications To Treat Obesity

>> Saturday, March 7, 2015

At the ENDO 2015 meeting this week, I had the great pleasure of sitting in on a session about medications to treat obesity, a presentation provided by Dr Caroline Apovian.  Dr Apovian is the lead author of the Endocrine Society's Clinical Practice Guideline for the Pharmacological Management of Obesity (published in January 2015).

It's an exciting time in the US for treating obesity, as the FDA has now approved a total of 6 medications for the treatment of obesity.   The six medications available are (ordered as they appear in the guidelines):

  • phentermine
  • topiramate + phentermine
  • lorcaserin
  • orlistat
  • naltrexone + bupropion
  • liraglutide (approved, not yet available on shelves)

Most other countries in the world do not have access to so many options to treat obesity with medications - for my Canadian readers, we have only two (orlistat, and liraglutide, which has just been approved by Health Canada but is not yet on shelves).

In her discussion of these medications, Dr Apovian made some poignant points about the use of medications to treat obesity - specifically, that we are far behind in approving and accepting the use of medications to treat obesity, compared to other chronic medical conditions like diabetes or high blood pressure, where we have many different medications to choose from.  While the reasons for this are complex, it stems at least in part from the stigma that still surrounds obesity - the reluctance by both health care professionals and the general public to accept obesity as a chronic disease and not just a symptom or a lifestyle 'problem'.

These medications are intended for use in addition to lifestyle changes, in people who have had unsuccessful attempts at lifestyle changes to lose weight.  Dr Apovian pointed out another contrast in our approach to obesity with other chronic health issues: specifically, that it is interesting that we do not categorically require a patient with high blood pressure to 'fail' a low salt diet before starting medication, and we do not require a patient with high cholesterol to 'fail' a low fat diet before recommending cholesterol lowering medication.

These new Clinical Practice Guidelines (where you can read the details about these medications) is the first of its kind - it recommends that we look at obesity as the central problem to address and treat, rather than focussing only on the complications of obesity, as we have traditionally tended to do.

I couldn't agree more.  We are in need of a Revolution in our thinking – namely, to consider the obesity as the central fulcrum of clinical attention and treatment.  In other words, we need to treat the obesity itself, while simultaneously addressing the complications of obesity that are present.  By targeting treatment towards the obesity, we often see an improvement in many of the complications associated with obesity, thereby improving the overall health of our patient. 

Follow me on twitter! @drsuepedersen © 2015



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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