Diet is not the solution!

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

48 clinical trials attest; diet is not the solution.

For the umpteenth time, researchers have published proof that no matter what diet a person chooses (Paleo, Wheat Belly, Atkins, Weight Watchers, Jenny Craig, NutraSystem, etc.), the chances for success are the same. Whether the plan focuses on low fat or low carbohydrate, the study, involving 48 clinical trials and 7000 patients, resulted in an average weight loss of 18 pounds over 6 months. From one diet program to another, the differences were minimal. Basically, the difference between Jenny Craig, Atkins, NutraSystem, and you name it, was not enough to matter. Among scientists, the study was confirming, leading scientists to conclude that there is nothing magical about cutting carbohydrates or fat or adding protein.

These findings are not particularly new, but with every new fad diet that bursts on the scene, there’s an implicit challenge to the conclusion. The more interesting and persistent question is why test subjects in the reviewed studies had begun to gain weight back by the one-year mark – to wit, in all 48 trials, the participants started gaining weight back by one year. This caused the authors of the study to call out the true challenge for diet research: the need to understand how people can maintain their initial weight losses.

A total mind-body-spirit solution

A total mind-body-spirit solution

The authors reached an obvious conclusion, that the best dietary plan is one you can live with for a long time (i.e. the rest of your life).

The long view should be considered when comparing ways to lose weight and gain health. Considering the long view means choosing an approach that gives you the fewest challenges. And though the medical community often focuses on shedding pounds as a goal-oriented metric for improving health among the the obese, the root of the problem is rarely found in weight loss and weight control. FitRx focuses on health and well-being rather than the number of pounds. We consider the gold standard for longevity is an approach that offers encouragement and insight on attuned eating, healthy choices, image empowerment, physical wellness, joyful movement, mindfulness, and stress reduction.


References:

Johnston BC et al Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis JAMA (2014) 312: 923 – 933.
Van Horn L et al Diet by any other name is still about energy JAMA (2014) 312: 900 -901.

Am I hungry or just not full?

Pleasure Overrides “Fullness”

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Hedonics trump homeostasis

There is a belief that tuning into physical and mental “fullness” signals, when eating, will decrease the likelihood of mindless over-consumption. However, “research is continually finding that regardless of how full a person may feel, the body is hard wired to chemically reward itself by overeating” when faced with highly palatable foods (*Monteleone ’12).  Two gut compounds are credited with causing us to indulge in goodies well beyond the point of caloric need. One of these is a stomach hormone called ghrelin, which helps regulate the motivation and drive to eat as well as the capacity to experience reward or pleasure.

The other is the endocannabinoid 2-AG (2-arachidonoylglycerol) which is involved also with appetite and drive to eat. When a person wants a particular kind of food, these chemicals team up to override the sense of fullness. In other words, we are programmed to stuff ourselves for a rainy day. In one study, individuals originally planned to eat significantly more of their favorite food, than they planned to eat of a bland or unappetizing selection, despite the feeling of being satiated. When participants ate their favorite food, their blood levels of ghrelin increased significantly and stayed high for as much as two hours post-ingestion. (*Monteleone ’12)

BrainFix-DrRalphCarson

“The plasma levels of ghrelin and 2-AG increased during hedonic eating, with the favorite foods, but not with non-hedonic eating,” Science Daily said of Monteleone’s work.

After eating an unappetizing nutritionally equivalent item, the ghrelin levels went progressively down. Levels of the compound 2-AG decreased after eating both the favorite and the unappetizing food. However, exposure to and consumption of a favorite food allowed 2-AG levels to remain higher for up to two hours compared to the non-favorite food.

Many treatments for obesity attempt to curb eating by recreating the feeling of fullness, either mechanically or surgically. But the work of Monteleone and Mozes suggests that in dealing with binge eating behavior, a focus on the hedonic (pleasure-center driven) response will be more efficacious than a focus on “fullness.” (Monteleone ’12; Mozes ’12)

At FitRx, we use the technique of “attuned eating,” which approaches the problem from the angle of meal satisfaction rather than fullness. The distinction between these two hypotheses is important when looking at treatment facilities because they result in different treatment approaches.

Next time: Highly palatable foods trigger continuation of eating whether or not one is full or recently finished a meal.


References:

*Monteleone P et al Mozes A Why You Overeat Even When You’re Full: Small study explores how body reacts when aroused by tempting treats HealthDay: A Pilot Study Journal of Clinical Endocrinology and Metabolism (2012) 97(6):E917-24.

Mozes A Why You Overeat Even When You’re Full: Small study explores how body reacts when aroused by tempting treats HealthDay (May 3, 2012).

obesity begets obesity

Obesity Begets Obesity

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Caught in a Vicious Cycle

People who struggle with size have high levels of leptin, the “satiety hormone.” But at the same time, they are leptin resistant. When functioning correctly, leptin will promote production of the appetite suppressant α-MSH after a meal. This is how the average person knows they are full and stops eating. In those struggling with obesity, there’s an abundance of leptin, which originates from large fat cells. And yet it has been found, counterintuitively, that this over-abundance of leptin does not produce an abundance of the α-MSH needed to increase metabolism and lower appetite. Essentially, these obese individuals lack a proper leptin response after a meal. There is no suppression of food-seeking behavior and no increase in TSH, which increases metabolism and therefore spurs caloric burning.

In a sense, there are so many leptin signals the brain shuts down to them. But for the more accurate picture of this disruption of healthy processing, we begin by looking at PC2, an enzyme necessary for making POMC, which eventually converts into α-MSH (to increase metabolism and lower hunger). The leptin overload in people of size stresses the POMC’s nucleic endoplasmic reticulum serving as the assembly line for making PC2. By mishandling PC2, the POMC protein leaves the POMC nucleus unfolded (useless and needing to be discarded) and impairs α-MSH production. Some people of size are 53% lower in PC2 and have 50% less α-MSH.

Vicious cycle of obesity

Vicious cycle of obesity

Any way you look at it, the normal feedback system is impaired in people of size, and it disrupts the body’s mechanism for maintaining one’s natural weight. What this means for obesity programs: Leptin should work to keep us at our natural weight. With leptin resistance that often occurs in people of size, the leptin is unable to tell the brain to eat less and burn more calories. As a result, the buildup of excess leptin stresses the manufacturing of the messenger that tells u, s to eat less and produces one that is useless. There is then no message to tell us to stop eating and/or increase activity. The result is that excess fat continues to accumulate as a consequence of gaining weight. To put it simply: “obesity begets obesity.”

At some point a simple solution to the leptin issue was sought in TUDCA (Tauroursodeoxycholic Acid), a chemical that eliminates ER stress and increases α-MSH in obese mice, but not normal mice. However, TUDCA is not readily applicable in treating excess fat in people of size. So while the leptin issue can be addressed, the most workable solution to date is programmatic and diet-related as opposed to organ or site-specific and treatable with a pill or procedure.

A total dietary program would include things like cutting out the fructose, the processed foods, the refined and simple starches, and adding things like oily fish, whole grains, etc. Once again, the evidence supports a whole-system or global approach to obesity. It also suggests the need to address complex dietary interactions, rather than narrowing in on simplistic solutions such as “portion control” or “calorie control.”

Next Week: Pleasure Overrides Fullness; Hedonics Trump Homeostasis


References:

Cakir I et al Obesity induces hypothalamic endoplasmic reticulum stress and impairs proopiomelanocortin (POMC) post-translational processing J Biol Chem (2013) 288: 17675 – 17688.

How Diet & Hygiene Alter Gut Microbiota, Influence Our Health

The “Healthy Choice” Food Plan

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Retrain the brain to stop craving food

As humans, we do not start out loving French fries, potato chips and Oreos and hating whole wheat pasta, raw vegetables, and grilled salmon. It took years of consuming highly palatable recipes (high fat, high sugar, and high salt) to establish these unhealthy brain circuits. The good news is, the brain is mutable, and you can retrain it to stop craving calorically dense, unhealthy impulse foods. The even better news is that you can do this in a matter of months. By making healthy choices, even the brain with years of bad food training can be rewired in six months. In fact, studies report seeing some changes in as early as 2 weeks.

In a Tufts University study, scientists imaged (fMRI) obese individuals’ brains at the beginning of the study and again six months later. While the subjects observed pictures of healthy and unhealthy foods, the researchers noted activity in the reward centers of their brains. On initial screening, the reward center sparked activity only after highly palatable foods were viewed. This was true for all participants. In the ensuing months, the group was divided in half, with the control group eating whatever it wanted and the Healthy Food Choice group working with brain retraining.

Six months later, brain images of the group in the Healthy Food Choice program demonstrated activity in the reward center when they saw healthy, low calorie foods. The brain circuitry had changed. Conversely, that same area now also showed decreased sensitivity to unhealthy, high caloric foods.

This is excellent news for those who, due to long-standing habits of sugar or fat consumption, may feel daunted by the idea of retraining their food choices.

The Tufts study showed a clear delineation all around between those who received the Healthy Choice retraining and those who didn’t. Over the six-month period, people on the Healthy Choice plan lost 14 pounds, and those who continued to eat solely what they desired gained 5 pounds.

This study lays the groundwork for comprehensive programs in the treatment of obesity (such as the FitRx program) that include brain retraining along with exercise and the other components. Healthy Choice brain retraining could turn out to be simpler and more long-lasting than many of today’s popular, but desperate, measures.

For example, the healthy choice group outperforms those on restrictive diets because deprivation sets the restricted individuals up to feel hungry and miss eating their favorite foods. Unconsciously, the fat-sugar-salt-trained brain tells the individual not to continue restriction. Eventually, the individual gives in to these messages and returns to old ways.

Another drastic measure, gastric bypass surgery, generally decreases the amount of enjoyment the person derives from food. While this invasive procedure works, it works by a sort of forced deprivation. Taking away food enjoyment becomes pretty hard to justify when you can make healthier food more appealing through brain retraining, leave intact the individual’s ability to savor food, and avoid an invasive (and costly) procedure all at the same time.

Next week: Caught in a Vicious Cycle: Obesity Begets Obesity


References:

Deckersbach T et al Pilot randomized trial demonstrating reversal of obesity-related abnormalities in reward system responsivity to food cues with a behavioral intervention Nutr Diabetes (2013) 4:e129.

Fit-for-duty-first-responders

Fit for Duty: Healthy Habits for First Responders

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

It has been said that being a fire fighter is not a job; but a way of life that invokes passion and dedication. The requirements involved are highly demanding, hazardous and risk filled. This “Call to Duty” unfortunately takes its toll on the body, mind and soul. Therefore, it is critical that one commit themselves to a lifestyle of healthy practices so as to avoid becoming a statistic of the fire service (Selndelbach ’14)

Sudden cardiac deaths:

  • Account for the largest proportion of on duty deaths (48%) amongst fire fighters annually (Eastlake ’13)
  • The strenuous duties of a fire fighter interact with a pre-existing risk profile (Kale ’09)

…..78% of firefighters know at least one fellow firefighter who has suffered a heart attack (Jerrard ’13)

Factors that contribute to unhealthy practices in the life of a fire fighter:

  • Shift work
  • Overexertion (Serra ’12)
  • Chaotic work environment (Smith ’12)
  • Irregular work hours
  • Unhealthy eating patterns; Less than 10 % have a healthy diet (Elliot ’07)
  • Sleep deprivation
  • No time or facilities to participate in moderate to high intensity non-work related activity
  • Exposure to a soup of chemical agents: smoke, toxic fumes and dangerous products of combustion that predispose one to cancer (Smith ’11; Serra ‘12)
  • Encountering high temperatures and noise levels (Serra ’12)

…..Each year, approximately 80,000 firefighters are injured and about 100 firefighters lose their lives in the line of duty (Smith ’11)

Body Composition Concerns: Disease Producing “Belly Fat”

  • More than 70% of US firefighters are overweight or obese (Haddock ’11)
  • Firefighters have the third highest prevalence of obesity among 41 male occupational groups in the United States (Choi ’11)
  • Excess fat is positively associated with frequency of:
  • 75% have prehypertension or hypertension (Tsismenakis ’09; NSCA ‘11)
  • Greater incidence of heart attacks and strokes (Beach ’14)
  • Abnormal blood lipid profile (cholesterol; LDL; triglycerides) (NSCA ’11)
  • Absenteeism in the workplace (Haddock ’11)
  • Less able to perform essential job duties (Beach ’14)
  • Increased risk of job related disability and musculoskeletal injuries (Jahnke ‘13a,b; (Mayer ’12)
  • Reduced muscular strength and increased back pain (NSCA ’1; Mayer ’12)

…..Yet surveys conclude that most firefighters underestimate the risk of added pounds and doctors often do not address the problem or offer a viable and long lasting solution such that the trend continues to worsen (Bauer ’12; Wilkinson ’14)

Sleep deprivation and excess daytime fatigue often cause: (Mehrdad ’13; Haddock ’13)

  • Depression (Carey ’11)
  • High injury rates (Elliot ’07)
  • Musculoskeletal pain (Lim ’14)
  • Accidents (Elliot ’07)

Firefighters experience both occupational and emotional stress (Gomes ’13)

  • Exposure to human suffering, injury and death (Serra ’12)
  • Self-blame (Meyer ’12)
  • Inadequate sleep
  • Financial challenges
  • Relationship problems

Few outlets are available to seek support and to learn coping skills (Meyer ’12)

  • Fire fighters consider themselves “stronger” than the problem and are unable to conduct “self-rescue” (Meroney ’13)
  • Fire fighters rarely speak out and ask for help
  • Details of their shift are not shared with family members

The high cost of Stress (McDowell ’13):

  • High risk factor for cardiovascular disease and other health problems (National Fallen Firefighters Foundation (NFFF); McDowell ’13)
  • Physical aches and pains
  • Sleep Deprivation
  • Obesity, inactivity, and poor eating habits
  • Depression or anxiety
  • Post Traumatic Stress Disorder
  • Suicidal thoughts and feelings (McDowell ’13)
  • Substance abuse including smoking
  • Marriage and Family problems
  • Anger issues

“The Solution”

FitRx (A prescription for finding inner transformation) is an intensive outpatient program with an individualized holistic approach that addresses wellness from a medical, therapeutic, nutritional and physical wellness perspective

Medical:

  • Complete Medical assessment
  • Improved metabolic health profile (Cholesterol, high blood pressure, reduction of inflammation, blood sugar control)
  • Smoking cessation guidance
  • Sleep interventions for insomnia
  • Improved body composition and reduction of disease-producing abdominal fat
  • Access to physical therapy support

Therapy:

  • Therapeutic interventions to address trauma, relationship issues, depression, anxiety, anger, etc.
  • Psychotherapy that focuses on the underlying causes and treatment of binge eating, compulsive overeating, and night eating syndrome
  • Stress management
  • Interpersonal skills
  • Mindfulness and relaxation techniques

Nutritional Guidelines and Meal Plans:

  • Emphasis on fitting a food plan into one’s lifestyle that includes convenient, economical, and healthy choices
  • Revealing that healthy doesn’t have to mean that it’s not great-tasting food
  • Recommendations for fire station meals away from home as well as suggestions for family cuisine
  • Healthy, convenient and alternative snacks to maintain vitality and alertness and replenish energy stores
  • Learning to be “satisfied” without battling cravings and hunger by practicing attuned and mindful eating
  • Avoiding gimmicky, extreme or difficult to follow plans that will not lead to permanent habits and good health
  • Sound nutritional advice that dispels nutritional  myths and educates one to make healthy choices

Physical Wellness: Create your own wellness plan

  • Comprehensive assessments upon admission and discharge
  • Cardiovascular fitness, aerobic fitness and endurance training
  • Anaerobic capacity; muscular strength and core muscle endurance
  • Flexibility and yoga
  • Fitness on a budget while off duty:  Activities that fit into daily routine
  • Job specific functional exercises
  • Safe & applicable programs that can be done by all (rookies; 20 year veterans; individuals of size; and those rehabilitating from injury)

Maintenance and Follow-up:

  • A strong alumnae support system
  • Tracking devices to collect hard data that enhance accountability and long term success

 

Click here for References

Obesity-In-America

Will the American government ever accept that weight is not the issue and obesity is not the problem?

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Experts doubt that obesity among preschoolers has fallen as much as the CDC reports based on a paucity of supporting evidence and few signs of behavioral change…

The CDC claims that there is a significant decline (43%) in preschooler (ages 2-5) obesity (Ogden, C et al JAMA February 2014). This data is based on the National Health and Nutrition Examination Survey or NHANES study which has been conducted annually since the 1960s and involves in-person interviews and physical exams. You need to have a healthy degree of skepticism about the validity of this finding.  The 2011-2012 version of the survey included 9,120 people; 871 of them were 2 to 5 years old. This would be considered a small survey size to make such a bold national claim because of the statistical limitations and potential for marked fluctuations. Such a change is at best fleeting in that rates have bounced around over the last decade

Anti-obesity campaigners credited everything from changes to the federal nutrition program for low-income women and children to the elimination of trans-fats from fast food, more physical activity in child-care programs and declining consumption of sugary drinks. First Lady Michelle Obama and others seized on the finding as a sign that efforts to combat the national obesity epidemic were paying off. The programs that have been implemented, from changing what’s in vending machines to the Let’s Move program (exercise initiative championed by Michelle Obama), target school-age children more than preschoolers.

This plunge may be a statistical fluke since other studies have not shown a comparable decline

A study of preschoolers in the federal WIC (Women, Infants and Children) program, which provides food vouchers, nutrition classes and counseling to low-income families, found virtually no change in obesity rates. The WIC study included more than 200,000 children while the CDC research looked at only a small population of 2 – 5 year olds. A larger set of data would most certainly be significantly more valuable.

Researchers found that the prevalence of obesity among 3 and 4 year olds in California’s Los Angeles County worsened from 2003 – 2011. Obesity rose from 17% to 20.4% (CDC’s Morbidity and Mortality Weekly Report 2013). There was a drop of 4% (19.5% – 15.5%) in the New York WIC study, though much less than a 43% drop CDC reported nationally. CDC’s Morbidity and Mortality Weekly Report 2013). An earlier CDC study of data collected at public health clinics, reported in JAMA in December 2012, found that the prevalence of obesity among 27.2 million children 2-to-4-year olds in low-income families fell (< 1%) to 14.9 percent in 2010 from 15.2 percent in 2003.

For obesity rates to drop, young children would have to eat differently, become more active, and sleep better. It turns out that research shows few signs of these changes among 2 – 5 year olds. In 2010 Whaley and her colleagues examined the effectiveness of WIC classes and counseling to encourage healthy eating and activities for women and children in the program. Television watching and consumption of sweet or salty snacks actually rose, while fruit and vegetable consumption fell – changes that could lead to weight gain. One positive was a rise in physical activity.

These statistical arguments emphasize decades of futility on behalf of the CDC, USDA and other government agencies that are determined to get under control the wrong enemy…WEIGHT. The problem may be part and parcel of the American Government expending too much energy, time and tax dollars on the ‘weights’ of preschool and young children by emphasizing statistical analysis of weight change and promoting the media hype that fuels a nation of dieters and creates a general obsession with being thin. There needs to be an acceptance of size diversity, emphasis on health, and incorporating lifestyle activity combined with appropriate measurements that support these initiatives rather than focusing on the weight on the scale. Habit changes should take the form of personal responsibility, mindful behaviors, stress reduction and reducing negative bias regarding size to counter the food industries’ infinite supplying our nation with an abundance of highly palatable foods designed to trigger overconsumption. If we cannot expect our country to limit the use of proven mind altering drugs such as marijuana, alcohol, tobacco and caffeine; do we honestly believe that there will ever be a successful campaign to remove pleasurable food choices from society? Not even in the Fairy Tale of Cinderella could they remove all the spinning wheels.

  1. CDC’s Morbidity and Mortality Weekly Report 2013
  2. (Ogden, C et al JAMA February 2014)
  3. Whaley, S (Public Health Enterprises Foundation) WIC Study

Ogden Journal of the American Medical Association 2014 focused on more than 9,000 adults and children in 2011-2012 and compared them to five previous obesity analyses dating back to 2003-04 We found overall that there was no change in youth or adults More older women are obese, but very young children seem to be slimming down Prevalence of obesity in children that age dipped from 14 percent in 2003-2004 to about 8 percent in 2011-2012 obesity prevalence ticked up in women 60 and older, from less than 32 percent in 2003-2004 to more than 38 percent in 2011-2012. Overall, more than two-thirds of adults are either overweight or obese, and more than 6 percent are extremely obese. There hasn’t been a big impact on prevalence in the last eight years, but at least there’s a leveling off.

 

Sitting-Bad-For-Your-Health

Sitting Can Be Detrimental to Your Health and it is not offset by Exercise!

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Modern man sits more than he sleeps. Studies report that most individuals spend an average of 9.5 hours sitting and 7.7 hours sleeping (Healy ’07; Owen ’09). And 5.5 of those sitting hours are spent watching television (Nielson ‘10). Being sedentary (sitting for extended periods of time) can be detrimental to your health.

Being extremely sedentary makes the blood flow sluggishly, produces swollen ankles, shuts off electrical activity to the legs, and ultimately deteriorates cells. When you are sitting for extended periods of time the enzymes that break down fat are reduced by 90%, muscles utilize less fat, you burn less than one calorie per minute and fat rapidly accumulates. Sitting reduces metabolism which eventually contributes to obesity and significantly causes fat accumulation around the heart. Resting on your derriere can lead to poor posture and disability resulting in even greater inactivity. Being sedentary disrupts metabolic function producing resistance to insulin culminating in diabetes as well as increasing blood pressure, triglycerides and bad cholesterol (LDL) leading to cardiovascular disease. All of this sitting around can ultimately result in premature death.

Regardless of how much time you spend in moderate exercise, it does not counterbalance the harmful consequences of prolonged sitting. Leisure-time physical activity or daily bouts of “super-exercising” alone may not be a sufficient public health approach to prevent obesity. It’s a bit like smoking. Smoking is bad for you even if you get lots of exercise

We need to take walking breaks every hour, stand while talking on the phone, perform chair exercises at our desk, and take several trips to the rest room on long flights. Regularly standing up from a seated position was in fact found to be more effective than walking (Verikos ‘11). Interrupt watching TV with 10 minute sparks to rake leaves, garden, sweep, play with your children, run in place, or climb stairs. Utilize a motion sensor (accelerometer) to track activity and be mindful of the frequency with which you interrupt prolonged inactivity. A consistent body of emerging research suggests it is entirely possible that sitting is its own risk factor. So don’t just sit there, MOVE!


ReferencesBauman A et al Leisure-time physical activity alone may not be a sufficient public health approach to prevent obesity—a focus on China Obes Rev (2008) 9: 119 – 126
Dunlop D et al Sedentary Time in U.S. Older Adults Associated With Disability in Activities of Daily Living Independent of Physical Activity J Physical Activity and Health (February 5, 2014)
Ekblom-Bak E et al The importance of non-exercise physical activity for cardiovascular health and longevity Br J Sports Med (Sept 13, 2013)
Healy GN et al Objectively measured light-intensity physical activity is independently associated with 2-h plasma glucose Diabetes Care (2007) 30:1384–9
Larsen BA et al Associations of Physical Activity and Sedentary Behavior with Regional Fat Deposition Med Sci Sp Ex (2014) 46: 520 – 528
Nielsen Company Three Screen Report: Television, Internet and Mobile Usage in the US Vol 8 1st Quarter (2010)
Owen N et al Too much sitting: a novel and important predictor of chronic disease risk? Br J Sports Med(2009) 43: 81 – 83
Seguin R et al Sedentary Behavior and Mortality in Older Women American Journal of Preventive Medicine(2014) 46: 122- 135
van der Ploeg HP et al Sitting Time and All-Cause Mortality Risk in 222 497 Australian Adults Archives of Internal Medicine (2012) 172:494-500
Veerman JL et al Television viewing time and reduced life expectancy: a life table analysis British J Sports Med(2012) 46: 927-930Vernikos J Sitting Kills, Moving Heals Quill Driver Books (2011)
Smart-Snacking

Smart Snacking: Small portions and wait 15 minutes

Written by Leah Miranda on . Posted in Blog, From the Desk of Dr. Carson

In addressing cravings, there is often a controversy whether one should resist and abstain from snacking on tasty foods or to honor and satisfy the urge. Brian Wansink provides some interesting insight on this dilemma.

Individuals were presented either large or small portions of tasty snacks. The large portion consisted of 100 grams of chocolate chips, 200 grams of apple pie and 80 grams of potato chips totaling 1370 calories. The smaller portion consisted of 10 grams of chocolate chips, 40 grams of apple pie and 10 grams of potato chips totaling 195 calories. The participants were given as much time as needed to consume the snacks. Individuals were asked to rate hunger and cravings before the food was presented and 15 minutes after the taste test ended.

Individuals with access to smaller amounts had similar feelings of satisfaction as those exposed to larger amounts as both reported significantly less cravings. However, those presented larger portions had a mean intake of 103 (77%) more calories. This suggest that smaller portions can lead to a decline in hunger and desire and would help people limit food intake. Eating a smaller portion of palatable snack foods satisfies you just as much as a large portion. A small amount satisfies and does not magnify hunger and craving tendencies.

The message is to take a few bites, wait 15 minutes and your head and stomach will remember you had a tasty snack. This study does not address the emotional state of the participants nor their history of binge eating. It does provide some insight as to how a more flexible and permissive approach to satisfying cravings may eventually be implemented.


Reference: Van Kleef , Shimizu M and Wansink B Just a bite: Considerably smaller snack  portions satisfy delayed hunger and craving Food Quality and Preference(2013) 27: 96-100

The Second Brain: Beyond Gut Feelings (Part III)

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Mood food connection

A MET receptor gene is found in brain regions tied to our socialization skills. Social withdrawal, irritability and repetitive behavior are symptoms of autism. A disruption of the MET signal or decreased MET protein expression contributes to an increased risk of autism spectrum disorder.

In autistic children, MET receptor function decreases brain development and gastrointestinal repair (Campbell-McBride ’09). Discovering why behavioral issues are exacerbated by gastrointestinal disturbances could provide insights to treatments for autism (Chaidez ’13).

The mood and food connection

In one study, individuals with nasogastric tubes were subjected to MRI scans. Researchers focused on parts of the brain that are active during stress. When melancholy music was played through earphones and saline was pumped through the tubes, there was no dampening of the neural response. Decreased neural activity was observed when fatty acid solutions were pumped through the tubes. Mood improved and hunger decreased with the presence of fatty acids in the gut (van Undenhauer ’11). This is a prime example of the connection between mood and food intake.

To compensate for these negative reactions to food ingredients, some foods contribute to healthy brain function. Live cultures in yogurt can create less activity in the emotional hyperactive brain regions. However, it is not known if this effect is beneficial. Sulfates serve a useful purpose by detoxifying metabolites of brain neurotransmitters. Toxins that originate in the gut, thus making the sulfate unable to perform a valuable function, can consume sulfates. Bacteria can also metabolize food sulfates into sulfite, as hydrogen sulfite is a toxic compound.


References:
Campbell-McBride Put Your Heart in Your Mouth Medinform Publishing (2007)
Campbell DB et al Distinct genetic risk based on association of MET in families with co-occurring autism and gastrointestinal conditions Pediatrics (2009) 123: 1018 – 1024
Campbell-McBride N Gut and Psychology Syndrome (GAP Syndrome or GAPS) http://www.gaps.me/?page_id
Campbell-McBride N Gut and Psychology Syndrome: Natural Treatment for Autism, Dyspraxia, A.D.D., Dyslexia, A.D.H.D., Depression, Schizophrenia Medinform Publishing (2010)
Chaidez V et al Gastrointestinal Problems in Children with Autism, Developmental Delays or Typical Development J Autism Dev Disord (2013 Nov 6)
Kang DW et al Reduced incidence of Prevotella and other fermenters in intestinal microflora of autistic children PLoS One (2013) 8:e68322
Labus JS et al Impaired Emotional Learning and Involvement of the Corticotropin-Releasing Factor Signaling System in Patients with Irritable Bowel Syndrome Gastroenterology (2013 august 13)
Neufeld, F Effects of gut microbiasota on the brain: Implications for Psychiatry Rev Psyciatr Neurosci (2009) 34: 230 – 231
Neufeld, F Effects of gut microbiasota on the brain: Implications for Psychiatry J Psychiatry Neurosci (2009) 34 (3): 230 – 231
Rodriguez T Gut Bacteria may Exacerbate Depression: Microbes that escape the digestive tract may alter mood Scientific American Mind (Noverber/December 2013) 24:9
Rodriguez T Ulcer Bacteria Linked to Cognitive Decline Scientific American Mind (November/December 2013) 24:9
Tack J et al A controlled crossover study of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome Gut (2006) 55: 1095 – 1103
Tillisch K and Labus JS Advances in imaging the brain-gut axis: functional gastrointestinal disorders Gastroenterology (2011) 140: 407 – 411
Tillisch K et al Consumption of fermented milk product with probiotic modulates brain activity Gastroenterology (2013) 144: 1394 – 1401
Van Oudenhove et al Fatty acid – induced gut brain signaling attenuates neural behavioral effects of sad emotions in humans J Clin Invest (2011) 121: 3094 – 3099

The Second Brain: Beyond Gut Feelings (Part II)

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

gut feeling

Image via http://www.ipgcounseling.com/growing_4.html

Foreign microbes that are known as clostridia are often present in the foods we eat. Clostridia are capable of escaping the defense mechanisms of our digestive tract and enter the blood stream though leaky gaps. This can activate the immune system and an inflammatory response. Additionally, these contaminants can cross the blood brain barrier, triggering depression and fatigue (Rodriguez ’13).

Studies reveal up to 85 percent of depressed patients experience leaks in their intestinal barriers. Bacteria also digest foods that produce toxins that are absorbed into the blood stream and enter the brain, which alters production of neurotransmitters and affects regions of the brain associated with emotions (Tillisch ’13; Labus ’13). Autoantibodies that attack the nervous system are also created from foreign invaders.

Gluteomorphins and casomorphins are byproducts of wheat and dairy that are similar in structure to opiates (morphine and heroin). These opiates are capable of crossing the blood brain barrier and interfering negatively with brain function. Children with autism and schizophrenia often do not digest milk and gluten properly and their guts are full of abnormal microbes.

Gut microbes and mental development

Several phenomenon related to gut microbes have been linked to autism (Kang ’13). For example, there are fewer types of gut bacteria in autistic children. Typically, 30 percent of children with autism experience lots of gastrointestinal problems, such as chronic diarrhea, constipation, esophageal reflux, IBS and ulcers that last into adulthood (Campbell-Mc’10). This association could result from damage to the gut lining, which allows neuron toxins to penetrate and enter the brain and affect mental development. An unusual dietary pattern results in 8 percent greater sensitivity to certain foods, which may also explain these abdominal symptoms.

Last week: The Second Brain: Beyond Gut Feelings (Part I)

Next week: The Second Brain: Beyond Gut Feelings (Part III)


References:
Campbell-McBride Put Your Heart in Your Mouth Medinform Publishing (2007)
Campbell DB et al Distinct genetic risk based on association of MET in families with co-occurring autism and gastrointestinal conditions Pediatrics (2009) 123: 1018 – 1024
Campbell-McBride N Gut and Psychology Syndrome (GAP Syndrome or GAPS) http://www.gaps.me/?page_id
Campbell-McBride N Gut and Psychology Syndrome: Natural Treatment for Autism, Dyspraxia, A.D.D., Dyslexia, A.D.H.D., Depression, Schizophrenia Medinform Publishing (2010)
Chaidez V et al Gastrointestinal Problems in Children with Autism, Developmental Delays or Typical Development J Autism Dev Disord (2013 Nov 6)
Kang DW et al Reduced incidence of Prevotella and other fermenters in intestinal microflora of autistic children PLoS One (2013) 8:e68322
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Rodriguez T Gut Bacteria may Exacerbate Depression: Microbes that escape the digestive tract may alter mood Scientific American Mind (Noverber/December 2013) 24:9
Rodriguez T Ulcer Bacteria Linked to Cognitive Decline Scientific American Mind (November/December 2013) 24:9
Tack J et al A controlled crossover study of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome Gut (2006) 55: 1095 – 1103
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Van Oudenhove et al Fatty acid – induced gut brain signaling attenuates neural behavioral effects of sad emotions in humans J Clin Invest (2011) 121: 3094 – 3099