Weight Loss Surgery: Neurology And Noshing

Ever wonder why you can't stop at just one chip, M&M, or 10 cent hot wing?


We know as dietitians or well, just regular people that obesity is caused by too much (food) and not enough (activity).  This post will focus on the appetite center and hormones.  For the sake of sanity and brevity this will provide brief insight about the function of appetite and how weight loss surgery relates to these functions This post is meant to educate and not discourage or encourage someone from undergoing weight loss surgery which is a personal and medical decision.  


What really causes us to eat?  Appetite control comes from the hypothalamus, arcuate neurons located here control hormone and lipid levels, along with metabolites which affect metabolism and hunger.


"The hypothalamus controls appetite and coordinates this with energy utilization. It is, therefore, responsible for maintenance of body weight, carefully adjusting food intake to physical activity. Loss of sensitivity to hormones and metabolites in the arcuate nucleus can lead to unbalanced energy intake and use, resulting in overweight and obesity." (1)


The arcuate nucleus has two different neurons: primary neurons that stimulate appetite with neuropeptide Y and agouti-related peptide; the arcuate also has neurons called proopiomelanocortin that depress appetite.  So therefore the body has a sense of checks and balances to a point.




Some additional factors that contribute to appetite are hormones.  They are insulin, leptin, ghrelin, and a crazy gut hormone called PYY 3-36.


We know about insulin with the diabetes epidemic, this hormone from the pancreas shuttles glucose (blood sugar, i.e. energy) into the cells so they can do their thing (reproduce, work, whatever).


Grehlin and PYY both come from the stomach and digestive track.  Ghrelin stimulates neuropeptide Y and agouti-related peptide (mentioned above). PYY comes from endocrine cells located in the intestines.  It basically shuts off Grehlin and it's pro-eating peptide buddies.  The only drawback is that it takes 20 minutes to work and some of us know how much we can shovel in during that period.


Additional hormones that come from the digestive track that regulate appetite/weight functions are also: Cholecystokinin (CCK), Glucose-dependent Insulinotrophic Peptide and Glugagon-Like Peptide (GLP-1).


CCK comes from the intestine and is triggered by protein and fat.  It decreases gastric emptying (you feel full longer) and slows hunger.  It acts when food enters the duodenum of the intestine.


Glucose-dependent Insulinotrophic Peptide  also comes from the intestine besides being a long word.  It is released when glucose (carbohydrates) and free fatty acids come through.  It helps the body move energy-rich foods or Twinkees into storage, i.e. fat.  This is a good example of our caveman (and cave-woman) ancestors tracking down a mastodon and converting Calories into energy and for storage.  Since you might not know when the next woolly mammoth will come down your street.


Glugagon-Like Peptide (GLP-1) also causes a 'full' sensation by preventing calorie loss in the stool and comes from the illeum (again another function from our caveman ancestors).  It also stimulates insulin and it believed to act as a key player in diabetics who have gastric bypass done.  This is when health professionals may say that it "cures" Type II Diabetes.  On the other hand, it can also cause hypogylcemia in these individuals where their blood sugar drops out of the normal range.  

"Obesity and metabolic surgeries initially were thought to restore balance to the system primarily by minimizing intake of excess calories through restriction or malabsorption. However, while these operations can limit the quantity of food consumed, they each bring on a different change in GI hormone profiles following surgery. As more enterohormonal mechanisms are discovered and understood, operations or drug therapies may be tailored to maximize the treatment of obesity and diabetes, achieving optimal results with minimal metabolic complications." (2)




1.  "Appetite and Metabolism and Obesity."  <http://www.medbio.info/Horn/Time 5/Appetite and weight control Nov06 v2.htm>.
2.  Daniel J. Rosen, MD; and Alfons Pomp, MD, FACS, . "Gastrointestinal Hormones and their Relationship to Bariatric Surgery." . Bariatric Times, 04/2009. Web. 20 May 2012. <http://bariatrictimes.com/2009/04/17/gastrointestinal-hormones-and-their-relationship-to-bariatric-surgery/>.


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Gina Lesako RD, LD.  Gina is an Ohio based dietitian and SCAN contributing blogger.  You can follow her blog: Dietitians Eat Chocolate Too.

Yoga for Weight Loss

Yoga has been around for ages. Its popularity ebbs and flows; however, everyone practices for various reasons- stress relief, improved flexibility, balance, digestive health…the list goes on. The best part about yoga is that anyone can practice. It doesn’t matter if you’re overweight, male, female, elderly, or nonathletic. Recently, I have read more about yoga for weight loss. It’s not that yoga necessarily burns more calories than cardiovascular exercise or strength training. Indeed, yoga taps into a different area of physical activity- ‘body awareness’. If you have ever practiced yoga, be it once, only a handful of times or daily, you quickly realize how your practice focuses on becoming ‘in tune’ with your body, positive thoughts and mental clarity. Depending on how concentrated you are during your practice, it can also enhance your feelings of self-control and foster a sense of personal empowerment. Points of interest from several studies have shown the impact of yoga for weight loss:

•Over a course of 4 years, a study of about 15,000 middle aged(55 years old) adults studied weight gain fluctuation. Those adults who incorporated yoga in their physical activity experienced less weight gain, especially overweight participants.

 •Yoga incorporated into a treatment program for obese women with binge eating disorder had significant effects. The 12-week program included personal journals from each participant and ‘qualitative analysis’ of these journals indicated a positive shift in their eating habits and perspectives. According to the journals, these participants developed self-empowerment, a healthy reconnection with food and cultivated an awareness of self. All of these factors translate to better health and positive strides in an eating disorder treatment.

 •Another eating disorder treatment program that incorporated yoga for weight management found that participants who practiced for 16 weeks had significantly decreased body weight, body fat percentage, BMI, waist circumference, and visceral fat.Wow! If reading this little blurb isn’t incentive enough…

 I would be remiss to stop here without mentioning that yoga isn’t just one style. There are certain types of yoga, which range from low-impact to higher activity. Patients with injuries or less mobility might find a slower paced practice rewarding, while an athletic person looking for a cardio workout might enjoy Vinyasa or Bikram. Vinyasa is a faster paced series of poses and Bikram focuses on generating an internal heat by performing poses in an extra hot room. Depending on the activity level of the practice, more or less calories will be burned. However, all the benefits mentioned above related to mental health are reflective of all yoga practices, in general. So, if yoga doesn’t burn more calories than other strenuous exercise, how can you lose weight? The studies emphasized they did not know the specific mechanism involved with weight loss. But it seems quite simple- the combination of physical activity, body awareness and healthy eating are probably responsible for the results. When you are more aware of your hunger and body cues, you’re less likely to overeat. Developing this awareness helps to control mindless eating, which is a culprit for weight gain. Therefore among weight control, yoga promotes many healthy behaviors. If you regularly practice, you know the sense of rejuvenation. If you’re new to yoga- give it a chance to positively change your body. Any of these benefits will have you feeling better!

 Reference: http://www.todaysdietitian.com/newarchives/030612p18.shtml Drop Those Pounds With Yoga — Studies Show Yoga Stimulates Weight Loss
By Jennifer Van Pelt, MA
Today’s Dietitian
Vol. 14 No. 3

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Sara Shipley, Nutrition, Dietetics and Food Management, University of Central Oklahoma BS Student- Projected graduation May 2013

I am a nutrition and dietetics student at the University of Central Oklahoma. I am a career changer after studying and graduating with a BS in fashion merchandising and working in corporate retail buying in New York City for several years. I am now studying to become a registered dietitian because I enjoy the science of nutrition and want to share my passion for balanced eating and healthy living with others. I love helping people make educated decisions about nutrition. Eating flavorful, delicious food does not have to be compromised by choosing to eat healthy. I love to cook and eat all types of food. I am an avid runner and I enjoy writing, reading and learning about anything related to nutrition, sports, food and wellness. I practice yoga and enjoy being outdoors doing anything active,- hiking, running, walking or biking.

Diet Drug Disasters

Kate Moss once said, "Nothing tastes as good as skinny feels."  Anna Nicole Smith used to lounge in cars or pose for paparazzi while promoting Trim Spa.  'Detox' pills and colon cleanse products are lining the shelves and you can never seem to avoid the latest diet pill gimmick.  


So what are a few of the latest drugs are clientele are being inundated with?


Adipex-P Oral (from WebMD): "Phentermine is used along with a doctor-approved, reduced-calorie diet, exercise, and behavior change program to help you lose weight. It is used in people who are significantly overweight (obese) and have not been able to lose enough weight with diet and exercise alone. Losing weight and keeping it off can reduce the many health risks that come with obesity, including heart disease, diabetes, high blood pressure, and a shorter life."  Some of the side effects are depression related withdraw, the usual GI issues (nausea, vomiting, diarrhea, dry mouth), headache, blurred vision, and seizures.


Qnexa (from WebMD): "Qnexa the only prescription appetite suppressant approved for long-term use available in the U.S. The only other widely marketed prescriptionweight loss drug, orlistat -- sold by prescription as Xenical and over-the-counter as Alli -- works by blocking dietary fat absorption."  Some of the side effects are  increased heart rate, heart attacks and arrhythmias.  It is not recommended for the masses ans long term use is not yet known.  It is not recommended for women of childbearing years as it can cause birth defects. 

The table shows common weight-loss pills and what the research shows about their effectiveness and safety.

Product	Claim	Effectiveness	Side effects
Alli — OTC version of prescription drug orlistat (Xenical)	Decreases absorption of dietary fat	Effective; but weight loss is even more modest than that with Xenical	Loose stools, oily spotting, frequent or hard-to-control bowel movements; reports of rare, but serious liver injury
Bitter orange	Increases calories burned	Probably ineffective	Similar to ephedra: raised blood pressure and heart rate
Chitosan	Blocks absorption of dietary fat	Probably ineffective	Uncommon: upset stomach, nausea, gas, increased stool bulk, constipation
Chromium	Decreases appetite and increases calories burned	Probably ineffective	Uncommon: headache, insomnia, irritability, mood changes, cognitive dysfunction
Conjugated linoleic acid	Reduces body fat	Possibly effective	Upset stomach, nausea, loose stools
Green tea extract	Decreases appetite, and increases calorie and fat metabolism	Insufficient evidence to evaluate	Dizziness, insomnia, agitation, nausea, vomiting, bloating, gas, diarrhea
Guar gum	Blocks absorption of dietary fat and increases feeling of fullness	Possibly ineffective	Abdominal pain, gas, diarrhea
Hoodia	Decreases appetite	Insufficient evidence to evaluate	Insufficient information available

Sources: U.S. Food and Drug Administration, 2011; Natural Medicines Comprehensive Database, 2011

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Gina Lesako RD, LD is a Columbus, Ohio based dietitian.  She is the SCAN volunteer blog coordinator and also writes for her own blog, Dietitians Eat Chocolate Too. 

Organic Fitness

Just last Thursday I attended the annual NAND (Nebraska Academy of Nutrition and Dietetics) conference at the Lied Lodge in Nebraska City, Nebraska.  It was a great event - multiple knowledgeable speakers, delicious food and networking with fellow dietitians.  I wanted to share some of what I learned with you and hopefully inspire you, as I was, to make more healthy lifestyle choices. 

The speaker I enjoyed the most, was Dr. James H O'Keefe, MD a Board Certified Cardiologist at Cardiovascular Consultants and Mid America Heart Institute.  He spoke to our group about getting back to the roots of good nutrition vs. opting for fad diets or quick fixes.  

Sounds like something we have all heard over and over again right?  Well Dr. O'Keefe spoke about why he thinks we have become an obese society  in the first place and gave us his top tips for living a long, healthy life.

Over the past 50 years, our nation has turned into a country high in overweight and obese individuals.  There has been multiple theories as to why this occurred.  Is it due to our soda intake, high fructose corn syrup, or fast food?  Though it may be easier to point blame at one reason, this just isn't the case.  It really does come down to our ancestry. 

Hundreds of years ago our ancestors survived only on what they hunted and gathered.  They were often on their feet because if they didn't move they didn't eat.  Foods higher in fat and calories helped to keep them alive and therefore we evolved to seek high fat and calorie foods.  High sugar foods gave immediate energy leading to its enticing qualities as well.  However, none of them were overweight.

Jump ahead to present day and we still crave high fat, high sugar foods.  This is because our DNA has not changed much from the days of the hunters and gatherers.  In fact, Dr. O'Keefe pointed out that it takes thousands and thousands of years for our DNA to change even a little bit.  So, therefore, we are left with the DNA of a hunter but the lifestyle of someone much different.  We don't need to hunt our food.  We can drive through a fast food restaurant and take in 1,000 calories easily in five minutes.  So you can see how all of our convenience and low-activity lifestyle all contributes to the current weight battle many of us fight.

Dr. O'Keefe presented us all with his tips for a healthy life.  Many you have heard of and may even already follow yourself.  However, there were a couple of tips that were even intriguing to me.

*Incorporate vegetarian protein into your diet.  Examples include tofu, seitan, tempeh, beans & nuts.  I am a big fan of at least trying to do one vegetarian meal a week such as a meatless Monday.

*Increase your fruit and vegetable intake to 9 servings per day.  One serving of fruit is a small piece of fruit, half a cup of low-sugar canned fruit, or 1 cup chopped fruit or berries.  One serving of vegetables is 1 cup cooked greens, 2 cups raw greens or 1 cup raw vegetables.

* Drink 3 cups of green tea per day.


* Fast for 12 hours at least 4 days per week.  Dr. O'Keefe recommends to stop eating after dinner and just have tea, water or sparkling water until breakfast the next morning.


*Aim to eat as close to the earth as possible.  In other words, try to avoid long ingredients lists and keep packaged food intake to a minimum.


*Increase your fiber intake.  If you are eating 9 servings of fruits and vegetables per day, however, you shouldn't have much trouble.


*Exercise, but not too much.  Dr. O'Keefe advocates getting out and moving for an hour a day most days of the week.  But he is not a big proponent of constant marathons or ultra-marathons.  Even with exercise there such a thing as too much of a good thing.


*Dr. O'Keefe believes in avoiding gluten.  He suggested checking out the book "Wheat Belly" which overviews the toxic effect of wheat.  He tends to only eat barley, quinoa, steel cut oats and wild rice for grains.


* Don't overdo supplements.  Get 1,000 mg EPA and DHA in a fish oil capsule and 2,000 IU Vitamin D3 especially during the winter months.

I really wish I had a recording of Dr. O'Keefe's talk because he told a lot of interesting stories about his family's health history.  Hopefully, though, this overview will give you some good insight into how you can improve your own nutrition and wellness for a long, happy & healthy life.

[Editor's note: For more information please see Dr. O'Keefe's original article here]

--Lindsay Lannan

Lindsay was awarded her bachelor’s degree in nutrition and food science with a dietetic specialization from South Dakota State University. She completed an internship program at the University of Nebraska Medical Center and experienced many areas of dietetics including intensive care, solid organ transplant, weight loss and management, and long-term care. She is an active member of the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). She can be followed at: http://hyveehealthstateofmind.wordpress.com.  

and on Twitter www.twitter.com/lindsaylannanrd. 

Is Sugar Toxic?

A recent study led by a California endocrinologist has once again thrust sugar into the limelight. Why? Because this doctor claims that sugar is toxic. WOW. Bold statement? Apparently he thinks so too, but has evidence to support his argument.

                Dr. Lustig, who led the research and has published scientific work on sugar, was interviewed for the CBS article. Lustig says the American lifestyle is killing us and 75% of the diseases in this country linked to sugar are preventable.

                In short, Lustig is reporting that sugar is evil yet Americans continue down the path of obesity, type II diabetes, hypertension and heart disease by consuming more than 130 pounds of refined sugar, per person a year.

                The rest of the article is interesting and insightful into Dr. Lustig’s theory of sugar. Another study at the University of California is highlighted in the article, which links excess high fructose corn syrup to increased risk for heart disease and stroke. Kimber Stanhope, a nutritional biologist, leads the study and her work rejects the age-old statement that ‘a calorie is a calorie’. In a tightly controlled environment, Stanhope completely decreased sugar levels and then slowly increased consumption of sugary beverages. Her interview included some of these statements:

Kimber Stanhope: ‘We found that the subjects who consumed high fructose corn syrup had increased blood levels of LDL cholesterol and other risk factors for cardiovascular disease.”

Dr. Sanjay Gupta: How quickly did these changes occur?

Kimber Stanhope: Within two weeks.

Kimber Stanhope's study suggests that when a person consumes too much sweet stuff, the liver gets overloaded with fructose and converts some of it into fat. Some of that fat ends up in the bloodstream and helps generate a dangerous kind of cholesterol called small dense LDL.                

The purpose of sharing this article is not to say that I too, think sugar is evil. BUT, I do think that the average American consumes too much refined sugar (baked goods, sugary beverages and processed junk food). This study poses an extreme perspective, and yet there is a hint of truth. This doctor is just trying to help people, especially children as he is a pediatrician.

Take home message: Watch your intake, cut the sugary beverages and be aware of the research developments. Stay informed.

Have a great day!

Sara Shipley

University of Central Oklahoma

Nutrition and Dietetics Student