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Bariatric Surgery For Type 1 Diabetes?

>> Thursday, April 28, 2016




In parallel with the obesity epidemic in our general society, so too do many type 1 diabetics struggle with excess weight.  I am often asked whether patients with type 1 diabetes could benefit from bariatric surgery.

First, a review on the difference between Type 1 vs Type 2 diabetes:
  • Type 1 diabetes is an autoimmune condition, where the immune system mounts a response against the pancreas, causing the pancreas to stop producing insulin.  Type 1 diabetics require insulin as treatment.
  • Type 2 diabetes is a condition where the body is resistant to the effects of insulin.  This means that the pancreas has to work harder to make enough insulin to put sugar into cells for use as energy.  Over time, the overworked pancreas gets tired, its ability to produce enough insulin to control blood sugars declines, and diabetes develops. Some Type 2 diabetics are treated with lifestyle modification alone, some with pills or injectable medication, and some require insulin because their pancreas is too tired to make the insulin they need.
About 10% of diabetics have type 1 diabetes, and 90% have type 2 diabetes.  Traditionally, we used to think of type 1 diabetes being the kind of diabetes that has onset in thin kids or young adults, and type 2 diabetes as having onset in people with obesity later in life.  It turns out that type 2 diabetes can come on in childhood (the youngest type 2 diabetic recorded in Canada was 5 years old at diagnosis), and type 1 diabetes can sometimes have onset later in life.  Some people with type 2 diabetes have an ideal body weight, and some people with type 1 diabetes struggle with obesity.

There is lots of evidence to support the efficacy of bariatric surgery (especially gastric bypass surgery and sleeve gastrectomy) to improve control of type 2 diabetes, or even send it into remission (meaning the type 2 diabetes goes away - though it may reoccur later).

For type 1 diabetes, there is very little data.  However, a recent review summarizes the literature available for us, and what it found is that while bariatric surgery can be of benefit to help people with type 1 diabetes lose weight and reduce risk factors for heart disease, diabetes control does not seem to improve overall.

So, while bariatric surgery can be an appropriate treatment strategy for type 2 diabetes in people who struggle with obesity, the evidence does not support it for the improvement of diabetes control in type 1 diabetes.


Follow me on twitter! @drsuepedersen


www.drsue.ca © 2016

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Caffeinated Peanut Butter?

>> Thursday, April 21, 2016





Here's the latest and greatest in potentially dangerous caffeinated products out there on the market.


Steem peanut butter is marketed as a natural peanut butter, no artificial sweeteners, bla bla bla.... and just for that extra 'boost', it contains 150mg of caffeine per 2 tbsp serving.  That's a little more caffeine that you would find in a small Tim Horton's coffee.

While this may not seem like an over-the-top amount of caffeine for an adult, in reality many people eat more than 2 tbsp of peanut butter when they get into it - why, just as Steem's website encourages:

"Just jam a knife or a spoon or a finger into the jar and eat it like you do when no one's looking.  Yes you do. Yes, you do."

I am SO not impressed!

More importantly, peanut butter is popular with children, and children should NOT be ingesting caffeine. I notice that Steem warns against giving their product to animals, but they say nothing about dangers to children.   Energy drinks (which are dangerous) are heavily marketed to teens, so it wouldn't surprise me if Steem has teens on their radar to target as well.

 The FDA is not happy about Steem's caffeination of their peanut butter either, and has asked the company for more information about their product.

Steem peanut butter joins a long list of other caffeinated products out there, which have their potential dangers - but this one is perhaps particularly dangerous as watching for caffeine intake isn't really on anyone's radar when they are cracking open their peanut butter jar.

There is no role or need for caffeination of any food product.  Until the FDA starts regulating natural food products (which may not ever happen), there is no safety guard protecting consumers against this or any other natural food product or supplement.



Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016






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The Paleo Man Did Not Drink Soda (And Why This Matters)

>> Thursday, April 14, 2016






For hundreds of thousands of years, humans have evolved drinking two beverages only - breast milk and water.  More recently (in evolutionary terms), we are faced with thousands of liquid beverages to choose from on store shelves, and as a consequence, US data shows that 400 calories per day are consumed per person on average as liquids, with soda being the biggest piece of that pie.  (That's about a third of the total calorie intake per day for a typical woman who is trying to lose weight, and about a quarter for a man.)

The reality of liquid calories is that we compensate very little in our food intake when we consume calories as a beverage.  This is true whether the drink is fat, carb, protein, or alcohol based.  While studies do show that we can feel a sense of fullness from some beverages, we do not reduce our food intake over the course of the day, and the liquid calories end up being additional calories.  This makes a lot of sense from an evolutionary perspective: the water drinking human would not want to have a lower drive for search of food and eating after drinking water, as water itself has no nutritional value.

Sugar sweetened beverages (eg pop, or any other drink with added sugar) has a number of nasty effects on our health.  These drinks increase the risk of type 2 diabetes and metabolic syndrome, both because of the weight gain that comes with drinking them, but also because this sugar is very rapidly absorbed into the blood stream.   Our bodies are simply not evolutionarily designed to handle a rapid influx of liquid sugar.  As healthy as it may seem, fruit juice actually has similar metabolic effects as pop and other sweet beverages.  

Alcohol is the other beverage that has unwanted effects on metabolism, including putting the brakes on metabolism of all other substances (including fat) to give preferential attention to getting rid of the alcohol.

Unfortunately, the current market trends for liquid calorie consumption are disturbing.  Milks are being artificially sweetened and flavoured like never before; fruit juice marketed heavily as being super healthy (but why not eat the fruit rather than drink the juice?) and is often plugged with a bunch of added sugar to make it even tastier; and the variety of sugary beverages continues to increase.

While artificially sweetened beverages are probably better than sugary beverages (read more about the controversy of artificial sweeteners here), the best path for most people is to focus on two beverages only: water and milk.

PS just a note on the title of this post: While we should follow the paleo man's avid water consumption, I do not recommend the Paleo diet itself - more on why not here.


Follow me on twitter! @drsuepedersen


www.drsue.ca © 2016






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World Health Day - Eyes On Diabetes

>> Thursday, April 7, 2016






Today is the World Health Organization's World Health Day, and for the first time, the focus is on Diabetes and its global impact.

In Canada, it is estimated that 11 million Canadians are living with diabetes or prediabetes, with 20 Canadians being diagnosed with diabetes every hour.

As per the press release from the Canadian Diabetes Association:

Diabetes increases a person’s risk for many serious complications such as heart attack, stroke, kidney failure leading to dialysis, and blindness. Nevertheless, for many people it is possible to live a healthy, full life with diabetes.
“People with diabetes play a critical role in ensuring the best health outcomes with the disease. Working closely with their health-care team, they manage blood sugar levels, foot care, eye care, physical activity and healthy eating,” says Dr. Jan Hux, chief science officer at the Canadian Diabetes Association (CDA). “Self-management is the cornerstone of diabetes care and people affected by it need the knowledge and skills to properly manage diabetes.”
According to the CDA’s Report on Diabetes: Driving Change, access to diabetes education is vital for learning more about nutrition, physical activity, blood sugar monitoring, medication and ways to make even little changes that can lead to success.
Some tips to keep on top of your diabetes include: taking action to learn as much as possible and using diabetes programs and services when needed; setting your targets and goals to maintain optimal average (A1C) and daily blood sugar levels; performing self-checks for foot problems; and scheduling regular eye exams. For more information, visit diabetes.ca/takecharge


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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Flavour Country! Baked Salmon with Olive Tomato Tapenade

>> Wednesday, March 30, 2016




Salmon is a very versatile fish to cook with, as it takes well to a seemingly endless variety of flavourings.  That being said, this is probably one of the tastiest salmon recipes I have ever come across -  I made this at home and it was dubbed 'Flavour Country' with the first bite!  Mmmm.  You will be hailed as a gourmet cook - and it's so easy to make!

I found the original recipe here, but I have modified it, including a marked decrease in the amount of oil - only a little olive oil is needed to sauté the onion and garlic.  There is lots of healthy fat (polyunsaturated and monounsaturated) to be had in the salmon and olives.    On that note, you could cut down the calories and fat further by using wild salmon and less olives.  (I used farmed atlantic salmon to calculate the calories as this is what is most commonly available.)  Note also that there is quite a lot of salt in the ingredients (capers, olives etc) - so if you are on a salt restricted diet, you may consider a tapenade with just tomato, garlic, herbs and onion (also delicious). 

Ingredients:


  • 1 tablespoon extra-virgin olive oil
  • 1 medium onion, finely chopped
  • 4 garlic cloves, finely chopped
  • 2 pounds plum or cherry or grape tomatoes, coarsely chopped
  • 1 tablespoon chopped oregano
  • 1/2 cup pitted kalamata olives, sliced
  • 1/3 cup drained capers
  • 1/3 cup sliced pickled jalapeños
  • Four servings of salmon (3 oz (85g) each)
  • Salt and freshly ground pepper


Directions:

1.  Preheat the oven to 375°. In a large saucepan, heat the olive oil until shimmering. Add the onion and garlic and cook over moderately high heat, stirring occasionally, until softened, about 5 minutes. Add the tomatoes, oregano and cook, stirring occasionally, until the tomatoes are just beginning to break down, about 5 minutes. Stir in the olives, capers and jalapeños and simmer for 2 minutes longer. 

2. Place the salmon on a foil covered baking tray. Season the salmon with salt and pepper. Bake for 15-20 minutes until cooked through. Transfer the fish to plates, spoon the sauce all around and serve.



Makes 4 servings.  Per serving: 

Calories: 305
Fat: 19g
Carbs: 15g
Protein: 20g

**note: there are variations in estimates of nutritional info for kalamata olives out there - I have used a middle ground between estimates in calculating the nutritional info.

**note: bed of rice and greens in the picture is not included in nutritional info. 



Follow me on twitter! @drsuepedersen


www.drsue.ca © 2016

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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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