Transcript Food, Fat, Satiety & Diabetes Management Care

Crystal Cates RD, LD, CDE
[email protected]
Food, Fat, Satiety
and Diabetes Care
sodexoUSA.com
Mmmmm – questions to ponder
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Why are we hungry at the site or smell of food?
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Why do we have those SKINNY friends that
never gain weight and we do gain weight even
eating the same calories?
Why are we suddenly hungry after having a few
sips of beer?
Objectives
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Determine what influence the seeking,
consuming and storing of calories
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Investigate various types of fat
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Discuss meds used for the management of
obesity and diabetes
Describe the connection between fats, the gut
and the brain as it relates to satiety, calorie
absorption/metabolism and glycemic control
Brain – Gut – Fat Connection
Food, Fat, Satiety and Diabetes
Why is obesity on the rise?
Fat
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Fat
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Adipose Tissue is
● PRO inflammatory
● PRO thrombotic
● PRO growth
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Fat triggers insulin resistance and begets more
fat… increasing insulinemia and hunger
Fat
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LEPTIN
● Released by adipocytes
● Leptin normally circulates proportionate to body fat
● Increased leptin can contribute to cancer and can
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contribute to fibromyalgia (associated with more fat)
Increases inflammation and oxidative stress
Decreases fertility
Acts on receptors in hypothalamus to regulate appetite
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Known best for satiety
Fat – Leptin
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Absence of leptin or its receptors (leptin
deficient) = uncontrolled food intake and
obesity
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Leptinemia = leptin resistant
Blood test is used to measure leptin levels
Balance is important
Fat – Adiponectin
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Opposite of Leptin
● Decreases inflammation
● Decreases CRP
● Decreases TG
● Increases insulin sensitivity (muscles and liver) and
lowers glucose
Brown Adipose Tissue (BAT)
White Adipose Tissue (WAT)
Body Fat Distribution
Fat Stores – Not Equal
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MAT
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What about liposuction?
● Removing SAT, increases cytokines
● Increases risk of PE, stroke
● SAT is needed to act like a filter that cycles the fat from
SAT
VAT
visceral stores to subcutaneous stores; protection
Gut
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Gut Peptides that Regulate Appetite
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Stomach
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Ghrelin: hunger and growth hormone release
– Sight of food
– Smell of food
Gastrin: acid secretion
Fore Gut
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CCK: gall bladder contract, GI motility, pancreatic exocrine secretion
Secretin: pancreatic exocrine secretion
GIP: incretin activity
Motillin: GI motility
Pancreas
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Insulin and Glucagon: glucose homeostasis
Pancreatic Polypeptide: gastric motility, satiety
Amylin: glucose homeostasis, gastric motility
Gut Peptides that Regulate Appetite
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Hind Gut
● GLP-1: Incretin activity, satiety
● GLP-2: GI motility and growth
● Oxyntomodulin: satiety, acid secretion
● PYY3: satiety
Gut - Ghrelin
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Increased GI motility
Influence on gastric acid secretion
Reduced insulin secretion
Decreased blood pressure
HUNGER
Small Intestine Hormones –
appetite & energy regulation
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CCK
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Releases digestive enzymes and bile
Released early when protein & fat are eaten
Increases satiety, slows gastric emptying
GIP
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Inhibits GI motility; attenuates satiety to the brain
CHO loaded kcals, increases insulin
Promotes STORAGE
GLP-1
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Any type of kcals “turn it on”; inhibits gastric secretion and motility
Causes CHO to be slowly digested & absorbed and increases satiety
Increases insulin secretion and suppresses glucagon
Works with PYY3
PYY3
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Slows gut emptying
Increases satiety
Shrinks storage capacity
Brain
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Brain
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Fat hormones and gut hormones talk to the
brain
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Reward center = turns on dopamine
Obese:
● 30-40% of food addicts have low levels of dopamine
● May have less dopamine receptors – meds can help
Brain
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Hypothalamus
● Determines metabolic rate
● Impairments like injury can cause rapid wt gain
(hypothalamic obesity)
– Causes: meningioma, head trauma, radiation, surgery,
sarcoidosis, aneurysm
Endocannabinoids = lipid messengers
● Increases hunger
Cannabinoid receptor antagonist
● Blocks the endocannabinoid receptor selectively
● Decreases food intake and regulates body-weight gain
● Those taking this lost weight but were depressed
Other Influences
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Culture/Family/Social Influences
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Satiety and Hunger Signals
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Sensory: taste, smell, texture, sight
Variety, palatability, food availability
Cognitive Factors: rational, control, beliefs about food
Advertising
Fat & Gut hormones
Gastric distention
Brain Mechanisms
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Satiety signals = reward, value, and appetite
EATING
Other Influences
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Viruses
Genetics
Dietary
Environmental
Brain – Gut – Fat Connection
What To Do?
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Get Moving
Have PROTEIN 1st, FAT 2nd, CHO 3rd at meals
More Fiber, More Water
Eat Slowly
Portion Control
Other Considerations
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Incretins
Focused on the
● Byetta and Victoza
CNS to aid with
● Symlin
weight loss &
Satiety agents
keep us happy
● E-cannabanoid blockers
● SSRI
● HOODIA
Anti-Obesity Drugs in Research
● Seratonin 2c receptor agonists
● Leptin sensitizers
● Ghrelin blockers
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American Association of Diabetes Educators
National Convention & Exhibition 2011
Food, Fat & Satiety: Exploring the “New” Entero-Endocrine-Brain Axis
Presented by Christine Kessler MN, CNS, ANP, BC-ADM
Department of Endocrinology & Metabolic Medicine, Walter Reed Army Medical Center
Washington D.C.