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

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

8. Fat LL EPTIN ●R●Released by adipocytes ●L●Leptin normally circulates proportionate to body fat ●I●Increased leptin can contribute to cancer and can contribute to fibromyalgia (associated with more fat) ●I●Increases inflammation and oxidative stress ●D●Decreases fertility ●A●Acts on receptors in hypothalamus to regulate appetite ●K●Known best for s ss 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

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

12. Brown Adipose Tissue (BAT)

13. White Adipose Tissue (WAT)

14. Body Fat Distribution

15. 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

16. sodexoUSA.com Gut

17. 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

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

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

20. 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

21. sodexoUSA.com Brain

22.  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

23. 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

24. 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 appetiteEATING

25. Other Influences  Viruses  Genetics  Dietary  Environmental

26. Brain – Gut – Fat Connection

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

28. Other Considerations  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 Focused on the CNS to aid with weight loss & keep us happy

29.  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.