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Do iWant the iWatch?

>> Sunday, September 14, 2014

Big news in the technology world - the Apple Watch was unveiled for the first time, and it's expected to arrive on shelves in 2015.  Of the multitude of fascinating features, one aspect that is getting a lot of attention is the iWatch's ability to track physical activity and provide integrated fitness/activity apps to help guide your progress.   You may find yourself asking - is this something that iWant? that iNeed? Will iBenefit?? Can iTrust it??

While there are many fitness apps out there, here's what catches my attention: the iWatch can measure your heart rate, and your total body movements (via an accelerometer).  It also uses the GPS and wifi in your iPhone to track how far you've moved.  There's a little circular icon that fills up each day as you move - even letting you know how many minutes you have stood during the day.

Pretty nifty that you can now track your activity, heart rate, and personal info all together in one internet-linked system.  I also really like the encouraging nature of the movement icons filling up, with Apple's stated goal to be 'Sit less, move more, and get some exercise by completing each ring each day.'

There are rumblings as well that the iWatch will someday be able to check blood sugar without poking the skin.   (Currently, the closest a diabetic can get to this is with a continuous glucose monitor, which still requires that a sensor is worn under the skin, and it has to be calibrated against the standard finger-poke twice a day.  There is also a brand new technology just approved in Europe early this month, whereby a small round sensor is placed on the skin with a small filament that is inserted just under the skin; a reader is scanned over the sensor to get a glucose result. More on this on soon - stay tuned.)      As testing blood sugars can be painful and frustrating for my diabetic patients, this news not only got me sitting up, but also spiked my own heart rate to well over 100.

With real time, painless monitoring of these parameters, I get carried away into a dream land where patients could be monitored in second-to-second real time with internet data transmission to their family members, caregivers, or health care professionals anywhere in the world... do I dare to dream?? (editorial note: there are a number of established glucose monitor companies working on this for blood glucose monitoring, in various stages of development)

Before we get carried away, though, we need a lot of questions answered.  How have they validated their technology?  How accurate is their accelerometer? How accurate is the heart rate monitor?  Can the heart rate monitor pick up irregularities and notify the patient or caregiver?  If they are going to incorporate a blood glucose monitor, how will this be tested and validated for precision and accuracy?  I suspect these details and information will become available as the iWatch unfolds into the marketplace, but if we as people, patients, and health care professionals are going to trust the data, we need to know that the studies have been done to prove that it is worthy of our trust.

Definitely exciting, though - my eyes will be focussed on these interesting developments in health technology.

Thanks to Glenn for the heads' up, and to Anita Dobson for her input!

Follow me on twitter! @drsuepedersen © 2014


Bariatric Surgery - More Long Term, High Quality Data Needed

>> Monday, September 8, 2014

Based on the available evidence, bariatric (obesity) surgery is effective to improve upon complications medical conditions related to obesity (such as type 2 diabetes and sleep apnea) and helpful for weight loss.  However, most of this data is based on shorter term results, and there is a concern regarding gaps in high-quality knowledge as to the benefits and risks of bariatric surgery over the long term.

In a recent literature review by Puzziferri and colleagues in Journal of the American Medical Association,  the current status of long term high quality data in bariatric surgery research was assessed.  They examined the literature to see just how much high quality longer term data is out there (defined as studies of 2 years or more, with follow up data on at least 80% of patients by the 2 year mark).

They found that only 29 studies total (less than 3% of studies identified) had 80% or more of patients followed up past the 2 year mark (7,971 patients total).  On analysis of available data in these studies, they found that the average excess weight loss was 66% for gastric bypass surgery, vs 45% for gastric band.  Type 2 diabetes remission rates (based on 6 studies) were 67% for gastric bypass, vs 29% for gastric band.  Remission of hypertension (high blood pressure, based on 3 studies) was 38% for gastric bypass and 17% for gastric banding. There wasn't enough data to analyze these parameters for sleeve gastrectomy.  No study had data past 5 years.  Concerningly, only half of the studies reported on complications at least 2 years after surgery.

So, while the existing high quality long term data is encouraging, we are still lacking in quantity of good quality data (clinical trials with low long term dropout rates) to have a thorough understanding of long term effects of bariatric surgery.  While we do have encouraging observational studies to guide us on longer term benefits vs risks of bariatric surgery (encouraging particularly for gastric bypass surgery and sleeve gastrectomy), randomized controlled clinical trials ideally need to be done and patients followed long term (with less dropouts) to have a more comprehensive understanding of long term effects.

The above being said - as discussed in a recent study by Courcoulas and colleagues, and as I can certainly attest to from my own research experiences - this is a tall order to fill.

Follow me on twitter! @drsuepedersen © 2014


Low Salt Intake - Good Or Bad For Your Heart Risk?

>> Tuesday, September 2, 2014

High blood pressure, called hypertension, is a major risk factor for cardiovascular disease.  Because we know that high salt intake is associated with a higher risk of having high blood pressure (especially in those who are genetically prone to hypertension, and those who carry other medical conditions that increase risk for hypertension such as obesity), huge efforts have been made around the world to try to get the general population to eat less salt.  Interestingly, recent studies have raised the question as to whether too little salt may be associated with higher heart risk as well.

This issue was addressed in a recent issue of the New England Journal of Medicine, with two studies (3 articles) and an accompanying editorial.

The first study, called the PURE study, looked at urine samples from over 100,000 adults in 18 countries, and found that 96% of people studied exceed the current US guidelines for sodium intake. They found that the relationship between blood pressure and salt intake was strongest in those with high salt intake.  They also found that people with both high and low sodium excretion had a higher risk of cardiovascular disease.

Interestingly, high salt intake was more strongly associated with high blood pressure in people with lower potassium intake, and there was a lower risk of cardiovascular events and death in people who had higher potassium intake.  These findings suggest that higher potassium diets might achieve better blood pressure reduction and cardiovascular protection than sodium reduction alone.

The second study, called the NUTRICODE study, looked at global salt intake based on surveys from 66 countries, analyzed data from 107 published clinical trials, and found a strong relationship between sodium intake and cardiovascular events.  They estimated that a whopping 1.65 million cardiovascular deaths in 2010 were attributable to excess sodium consumption.

So where does this leave us?   One major take home message is that 96% of people studied are eating more salt than what is recommended.  We know that excess salt intake is linked to increased risk of high blood pressure and heart disease, so for the vast majority of us, cutting back on our excess salt intake is needed.  There is much added salt in our food supply, especially in processed foods, so cutting back on manufactured food is one of many steps in the right direction!

Second, it appears that eating more potassium may be beneficial - BUT - there are many people in whom it could be dangerous to up potassium intake, such as patients with kidney problems.  There are also many medications (especially some blood pressure meds) that can increase potassium levels.  Too much potassium in the blood can be dangerous, so it is VERY important to discuss with your doctor before making any changes to your potassium intake.

As to whether low salt intake could increase the risk of heart disease - the question has definitely been raised by the above data.  The American Institute of Medicine has evaluated the data, and concluded that current data is not sufficient to make conclusions on this.  Now, we need a high quality clinical trial to give us a definitive answer to this provocative question.

Follow me on twitter! @drsuepedersen © 2014


What Does 200 Calories Look Like?

>> Monday, August 25, 2014

While we often talk about how many calories a person needs in a day to maintain or lose weight, it's often difficult to grasp what these numbers mean in real life.

Here's a really interesting graphic from the Huffington Post, with some great examples of what 200 calories looks like.  (You can access a higher resolution version in the original article).  Notice how much 'good stuff' (eg veggies and fruit) you can get for 200 calories, compared to how little of some other foods adds up to 200 cal.  You can think of calories like a daily budget (similar to the Weight Watchers' program) - when you are preparing to pop something in your mouth, think about that budget and ask yourself... is it worth it?

Also interesting is the section on 'Ways to Burn 200 Calories'.  The point is that it takes a loooong time to burn off those 200 calories that may have taken only seconds to eat - 37 minutes of dancing, 25 minutes of running stairs, or 40 minutes of badminton.  (Note that this calorie burn does vary greatly depending on intensity, body weight, gender, etc.).   Again, think about that daily calorie budget - most people don't realize how the calorie burn from a long bout of exercise actually takes very little food to make up again.

Please note that the 'recommended calorie intake' part of the infographic below is not correct - this number varies widely depending on age, weight, gender, and activity level.  You can calculate an estimate of your approximate calorie requirement in the right hand panel of my main page here.

Thanks to Bob for the heads' up on this graphic!

Follow me on twitter! @drsuepedersen © 2014


Raw Food Diet - Dr Sue's Review

>> Tuesday, August 19, 2014

The premise of the raw food diet is just that – eating only foods that are uncooked and unprocessed.  This includes raw meat, fish, veggies, fruit, nuts, seeds, eggs, and non pasteurized dairy products.

The philosophy behind this way of eating is that cooking can deplete foods of useful nutrients (which is true eg for veggies, though depending on how they are cooked – boiling veggies brings some of the nutrients into the water, whereas steaming retains the nutrients inside the vegetable).  Raw foodists also wish to avoid potential carcinogens that can be present in cooked/processed food (eg heterocyclic amines that are found especially in burned meat (eg BBQ’d), and a long list of environmental pollutants that could make their way into our processed foods (BPA being just one example)). Chemicals and stimulants (such as coffee and tobacco) are also avoided.

Good things about this diet are that one does truly decrease exposure many chemicals that are ubiquitous in our food supply.  Foods that are raw are in their purest form, and highest in nutritive value (especially if wild/organic foods are sourced, as rawists tend to do). 

However, a major risk of eating in this way is food poisoning.  There is a reason why we pasteurize our dairy products and cook our eggs and meat.  Processes such as pasteurization have allowed us to function in urban society, enabling us to keep food longer, to feed the masses living in a relatively small space, as we were perhaps not meant to do, but which is a part of modern life for most people.

While some raw foods are very easy to prepare (eg salads), others are very time consuming.  For example, to eat rice or other grains, they have to be sprouted and/or soaked overnight to be digestible. 

And finally, the question that is central to the discussion of any diet:

Is It A Permanent Change?  I would submit that this is very difficult to adhere to over the long term – but this concern is overridden by my greatest fear which is that of the unsafe consumption of uncooked foods and risk of food poisoning that may ensue.

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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