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Food, Fat, Satiety and Diabetes Care

Crystal Cates RD, LD, CDE Crystal.Cates@sodexo.com. Food, Fat, Satiety and Diabetes Care. Mmmmm – questions to ponder. Why are we hungry at the site or smell of food? Why are we suddenly hungry after having a few sips of beer?

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Food, Fat, Satiety and Diabetes Care

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  1. Crystal Cates RD, LD, CDE Crystal.Cates@sodexo.com Food, Fat, Satiety and Diabetes Care sodexoUSA.com

  2. Mmmmm – questions to ponder • Why are we hungry at the site or smell of food? • Why are we suddenly hungry after having a few sips of beer? • Why do we have those SKINNY friends that never gain weight and we do gain weight even eating the same calories?

  3. Objectives • Determine what influence the seeking, consuming and storing of calories • Investigate various types of fat • Describe the connection between fats, the gut and the brain as it relates to satiety, calorie absorption/metabolism and glycemic control • Discuss meds used for the management of obesity and diabetes

  4. Brain – Gut – Fat Connection

  5. Food, Fat, Satiety and Diabetes Why is obesity on the rise?

  6. Fat sodexoUSA.com

  7. Fat • Adipose Tissue is • PRO inflammatory • PRO thrombotic • PRO growth • Fat triggers insulin resistance and begets more fat… increasing insulinemia and hunger

  8. Fat • LEPTIN • Released by adipocytes • Leptin normally circulates proportionate to body fat • Increased leptin can contribute to cancer and can contribute to fibromyalgia (associated with more fat) • Increases inflammation and oxidative stress • Decreases fertility • Acts on receptors in hypothalamus to regulate appetite • Known best for satiety

  9. Fat – Leptin • Absence of leptin or its receptors (leptin deficient) = uncontrolled food intake and obesity • Leptinemia = leptin resistant • Blood test is used to measure leptin levels • Balance is important

  10. Fat – Adiponectin • Opposite of Leptin • Decreases inflammation • Decreases CRP • Decreases TG • Increases insulin sensitivity (muscles and liver) and lowers glucose

  11. Brown Adipose Tissue (BAT)

  12. White Adipose Tissue (WAT)

  13. Body Fat Distribution

  14. Fat Stores – Not Equal MAT SAT VAT 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 visceral stores to subcutaneous stores; protection

  15. Gut sodexoUSA.com

  16. Gut Peptides that Regulate Appetite • Stomach • Ghrelin: hunger and growth hormone release • Sight of food • Smell of food • Gastrin: acid secretion • Fore Gut • CCK: gall bladder contract, GI motility, pancreatic exocrine secretion • Secretin: pancreatic exocrine secretion • GIP: incretin activity • Motillin: GI motility • Pancreas • Insulin and Glucagon: glucose homeostasis • Pancreatic Polypeptide: gastric motility, satiety • Amylin: glucose homeostasis, gastric motility

  17. Gut Peptides that Regulate Appetite • Hind Gut • GLP-1: Incretin activity, satiety • GLP-2: GI motility and growth • Oxyntomodulin: satiety, acid secretion • PYY3: satiety

  18. Gut - Ghrelin • Increased GI motility • Influence on gastric acid secretion • Reduced insulin secretion • Decreased blood pressure • HUNGER

  19. Small Intestine Hormones – appetite & energy regulation • CCK • Releases digestive enzymes and bile • Released early when protein & fat are eaten • Increases satiety, slows gastric emptying • GIP • Inhibits GI motility; attenuates satiety to the brain • CHO loaded kcals, increases insulin • Promotes STORAGE • GLP-1 • 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 • Slows gut emptying • Increases satiety • Shrinks storage capacity

  20. Brain sodexoUSA.com

  21. Brain • Fat hormones and gut hormones talk to the brain • Reward center = turns on dopamine • Obese: • 30-40% of food addicts have low levels of dopamine • May have less dopamine receptors – meds can help

  22. Brain • 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 Rimonabant

  23. Other Influences • Culture/Family/Social Influences • Sensory: taste, smell, texture, sight • Variety, palatability, food availability • Cognitive Factors: rational, control, beliefs about food • Advertising + • Satiety and Hunger Signals • Fat & Gut hormones • Gastric distention • Brain Mechanisms • Satiety signals = reward, value, and appetite EATING

  24. Other Influences • Viruses • Genetics • Dietary • Environmental

  25. Brain – Gut – Fat Connection

  26. What To Do? • Get Moving • Have PROTEIN 1st, FAT 2nd, CHO 3rd at meals • More Fiber, More Water • Eat Slowly • Portion Control

  27. Other Considerations Focused on the CNS to aid with weight loss & keep us happy • Incretins • Byetta and Victoza • Symlin • Satiety agents • E-cannabanoid blockers • SSRI • HOODIA • Anti-Obesity Drugs in Research • Seratonin 2c receptor agonists • Leptin sensitizers • Ghrelin blockers

  28. 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.

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