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Does Weight Loss Improve Fertility Treatment Outcomes?

>> Monday, October 27, 2014



Obesity is a known, and common, risk factor for infertility. Most studies have shown that women with obesity have markedly reduced success with fertility treatments (also called assisted reproductive technology, with examples include artificial insemination and in vitro fertilization).  The next natural question, then, is: does weight loss before assisted reproduction in these women improve pregnancy rates?

This question was addressed in a review article recently published in Obesity Reviews.  Overall, they found that the quality of the available data is weak, with few patients studied and few studies done.  They did find that the majority of the studies, which looked at a variety of means to achieve weight loss before assisted fertility techniques were undertaken, showed improved pregnancy and/or live birth rates.

It is sometimes asked whether a more drastic means of weight loss, such as the very low calorie diet (VLCD) or bariatric surgery is appropriate to improve fertility.   With regards to the VLCD, they found conflicting data the two studies that looked at it, with one study showing improved pregnancy rates, and the other showing particularly poor fertility outcomes.  This may be related to the fact that the successful study had a follow up (less stringent) diet after the VLCD was complete, whereas the other study gave no guidance after the very low calorie phase was complete. (my editorial comment – VLCDs are not recommended in any case – read more here).

They located two studies of women having bariatric surgery before assisted reproduction (note: only 6 patients total), with excellent results for improving pregnancy rates.  (Note that after bariatric surgery, it is important to wait 1-2 years before conceiving for safety reasons.)

Perhaps the most important findings that came from this review is that of six studies that evaluated whether anyone became spontaneously pregnant, five of the studies reported that pregnancies did occur without needing any reproductive treatments, in women who had previously been unable to conceive at a higher body weight.


So, based on current knowledge, it seems that weight loss is of benefit in women who struggle with excess body weight, both for improving spontaneous conception, and also for conception by assisted reproduction.

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Deliciously Healthy Fall Pumpkin Recipes!

>> Monday, October 20, 2014





It's that time of the year again ... time to pull out the turtleneck sweaters and curl up by the fireplace after spending some time in the brisk outdoors.  With fall comes pumpkins - pumpkin carving, Hallowe'en decorating, roasting pumpkin seeds... so much fun!

Pumpkin can be enjoyed in many healthy, delicious ways, without an abundance of excess calories. Below, I've collected for you a few of the healthy pumpkin recipe posts I've shared on drsue.ca over the years:

Crustless Pumpkin Pie (my personal favorite!)

Pumpkin Banana Spiced Custard

Pumpkin 'Cheesecake'

Iced Pumpkin Fiber Muffins

Holiday Pumpkin Pancakes

Mmm mmm... enjoy!



Follow me on twitter! @drsuepedersen


www.drsue.ca © 2014


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Zone Diet - Dr Sue's Review

>> Tuesday, October 14, 2014





The Zone Diet is one of the most popularized diet programs out there.  The premise of the program is to eat 30% of your calories as protein, 30% as fat, and 40% as carbohydrate.  This balance is distributed evenly over the course of the day, provided as 3 meals and 2 snacks.  Portion control is emphasized.

In terms of the science, the Zone diet has been included in at least two clinical trials (links are here and here), neither of which showed it to be superior to the comparators (Atkins, Ornish, Weight Watchers, etc).  As blogged previously, the efficacy of the diet seems to be related more to adhering to the program itself, rather than what the diet actually contains.

Is it a permanent lifestyle change?  While it will always take time and attention to achieve the 30/30/40 breakdown, once you get into the rhythm of it, I think it can be continued over the long term.  It's really about whether it's a balance that is right for you; in other words, whether this balance allows you to include the foods you enjoy, and whether you can stick to it for a lifetime.

Follow me on Twitter! @drsuepedersen

www.drsue.ca © 2014

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Macrobiotic Diet - Dr Sue's Review

>> Monday, October 6, 2014






The foundation of the macrobiotic diet has nothing to do with antibiotics, or probiotics, as the name might lead you to believe.  It’s all about eating whole grains and vegetables as staple foods, and avoiding animal products as well as processed foods.

Macrobiotics has a foundation in Japan, where it is believed that foods in the diet should have a good balance of yin (expansive, light, cold, and diffuse) and yang (compact, dense, heavy, and hot).  It is felt that foods such as barley, spelt, rye, quinoa, and oats have a good balance of yin and yang, as do many vegetables, which is why these build the foundation for the diet.

The typical Japanese style macrobiotic diet looks like this:
       Well chewed whole cereal grains, especially brown rice: 40–60%
       Vegetables: 25–30%
       Beans and legumes: 5–10%
       Miso soup: 5%
       Sea vegetables: 5%
       Traditionally or naturally processed foods: 5–10%
       Fish and seafood, seeds and nuts, seed and nut butters, seasonings, fruits, and beverages may be enjoyed occasionally, 2–3 times per week

The main limitation of the macrobiotic diet is that it is nutritionally deficient.  Not only is it lacking in protein, but it is also deficient in a long list of vitamins and minerals.  


The macrobiotic diet is often touted as being of benefit for people with cancer.  This has not been proven, and in fact, this diet could well be harmful for a cancer patient because of unwanted weight loss due to low calorie intake, plus the nutritional deficiencies noted above.  Neither the American Cancer Society nor Cancer Research UK recommend following the macrobiotic diet.  

And, as is the theme with most diets out there - it's not a permanent lifestyle change. 

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www.drsue.ca © 2014


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Intestinal 'Condom' for Weight Loss?

>> Monday, September 29, 2014






Another interesting approach to less invasive obesity/metabolic surgery that is currently being studied is the duodenal-jejunal bypass liner.  This is a temporary 60-cm liner that is delivered into the upper part of the small intestine endoscopically (ie, by putting a camera and insertion equipment down through the mouth).  It is left in place for a number of months, and then removed.  It's sometimes referred to as the 'duodenal condom' in that... well, you can see the resemblance... but both ends are open to allow food to pass through.

The idea behind this is to mimic (in a shorter version) the intestinal component of the Roux-en-Y gastric bypass surgery, where the intestines are surgically rerouted to bypass about the first 150cm of small intestine.  We think (based on studies) that one of the major reasons why type 2 diabetes often improves dramatically after gastric bypass surgery is the hormone changes that happen when the intestine is rerouted in this fashion; therefore, there is a lot of interest in seeing whether the liner would have an effect not only on weight loss, but also on type 2 diabetes.


                               Gastric Bypass Surgery


A clinical trial was recently done on the liner, where 77 patients with type 2 diabetes and obesity were randomized to receive either the liner, or dietary counselling (control group).  After 6 months, patients who had the liner had greater weight loss, better diabetes control, and required less diabetes medication than the control group.

Patients then had the liners removed, and both groups were followed up for an additional 6 months after liner removal, with 66 patients completing the full study. There was some weight regain in the group who had previously had the liner, though at 1 year they still had greater weight loss than the control group.  At 1 year, there was no longer a difference in diabetes control between the groups.

In the short term, it appears that the liner is quite effective to help people lose weight and improve their type 2 diabetes control.  However, removal of the liner has to happen at some point, because the longer the liner is left in, the higher the risk that it can lose its hold and migrate further down the intestine, or cause bleeding or perforation (a hole in the intestinal wall), which are all serious complications.  So far, the liner has been shown to have a low risk of these complications after 6 months, and a few studies have now been published suggesting the risk is also low after 1 year.

The liner's current temporary nature is reminiscent of many of the 'diets' out there - they do nothing to help make permanent lifestyle changes, so after the diet (or the liner) is gone, the likelihood is that weight will be regained, along with its metabolic complications.  It would be interesting if the liner could be left in safely for a longer period of time - I'll be watching this area with interest, as the duration of study is growing.  In the meantime, while the liner's results look good in the short term, I'm not overly enthusiastic about an intervention if it is only temporary.

Follow me on twitter! @drsuepedersen


www.drsue.ca © 2014


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A HEARTFELT WELCOME!

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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