Eat to be FIT,not FULL

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Dr. Jason Gruss, M.D.Dr. Ric Saguil, M.D.

Spring 2011

My Doctor: Listens to my concerns Cares what I have to say Doesn’t Keep Me Waiting Gives Me Options

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

First Health Associates

2010 S. Arlington Heights RdLL Suites

Arlington Heights, IL

The First Health Approach

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Your Community of Care

Ric Saguil, MDJason Gruss, MDTom Jordan, RD

Katrina Christie, LCPCJennifer Green, NDJoe Musolino, DCAmy Iaquinta, DCNick Nowicki, DC

Emery Paredes, PTCourtney Day, EPYu Zhu, MD China

Mike Blumberg, LCPC

You

Today’s Goals

• Learn what hunger is• Discuss what ‘BEING FULL’ means• Explore what SATIETY is, and how that is

DIFFERENT than ‘FULLNESS’• Learn how to be SATISFIED, without stretching

your stomach and packing on Calories

Before we begin . . .

• Look around– The room– The village– The airport– The country– The world?

• 2/3 of the US is either Obese or overweight.– That number is GROWING!

• Since 2006 Obesity is the #1 cause of preventable death – Ahead of cigarettes

Obesity is a Disease

• There is NO CURE– No pill / surgery / magic potion will take away

obesity• There is SUCCESSFUL TREATMENT

– The treatment is creating a healthy life, through whatever means YOU need

– Everybody is different, not all the tips work for everybody

– Take whatever tips work for YOU!– Ask for help if you need it

What is Hunger?

• Physiological Response (Survival mechanism)

• Secondary Responses:– Psychological Response coping mechanism

• It is easier to EAT than it is to admit you have a problem

– Stress Response?• Ever eat when you are:

– Bored? Procrastinating? Nervous?

The Hormonal Tsunami

• Break down of the physiologic response:

• Stress Response- fight or flight Hans Selye 1975

• Relaxation Response- eat or reproduce Herb Benson, MD 1975

• Epinephrine, adrenaline, cortisol increased in stressful, dangerous environment

• Prolactin, oxytocin, NPY all increased in relaxed, protected environments.

Stress/Relaxation

Sympathetic/Parasympathetic=

Godzilla VS Ghandi

Why can’t we just co-exist?

In a state of relaxation response but …can turn on an abnormally high stress response

Athletes.

Know Your Enemy Sun Tzu

• To keep the herd alive; Starvation mode=Stress response Hunger will start the hormonal cascade Hunger/Stress

What Causes Hunger?

• Low Blood Sugar• Erratic Blood Sugar

– Binge eating– Fasting– Stress

• Fatigue– Lack of sleep– Emotional/Physical– Binge Eating (Holiday Meals)– Junk Food Diet

• Dehydration• Stress/Emotions

What Causes Fullness?

• Stomach Distension• FULLNESS can happen as fast as you can eat

What Causes Satiety?

• Smell/taste• Conscious eating• Environmental cues

• Satiety cannot be rushed– The brain works slower

Satiety Strategies

1) Avoid Distraction

a) Disrupts brain-to-stomach satiation signalsb) No eating at Car…. TV…. Reading….c) Conscious eating

Goal: satisfaction not fullnessThe brain is our most powerful tool,

if we use it!

Stress is a Distraction

Kathy204#

Cholesterol: 245

Kathy141# (in the 120s today)

Cholesterol: 191

Weeks 1-4: 3 Pounds Lost (0.75# per week)INTERVENTION: counseling to address stressWeeks 5-28: 48 Pounds Lost (2# per week)

Satiety Strategies2) Pack in the Protein

• Solid food – Soups ok, but not beverages

• Stimulate CCK slow gastric emptying– FEEL full longer

• Prevent Glucose Spikes– Prevents the body from going into STORAGE MODE

• Prevent nutrient deficiencies (B1, B12, Fe…)– Your body will have cravings for what it’s missing, but your brain will just get the

signal to EAT• Provides Amino Acids (building blocks)

– ‘Dieters’ lose fat AND muscle, eating more protein helps save the muscle and lose more FAT

Satiety Strategies3) Fill Up on Fiber

• 6g Soluble Fiber has the same satiating effect of 260 calories (ADA study 2009)

• Refined Carbs=Satiety killers (insulin spike blood sugar crash store the excess Cal as fat)

• Whole Grain Carbs– ‘100% whole grain’– 25-35g Fiber Per day

• Eat more often, avoid hunger by having 3 meals and 2 snacks a day– But avoid eating more than 600 Cal at any one sitting– Goal is 400 for a meal and 100-200 for a snack

Protein and Fiber for Satiety

Bill254#

Triglycerides: 338

Bill189#

Triglycerides: 68

Bill’s Meal PlanB: High Fiber OatmealSn: Cottage CheeseL: Turkey Sandwich + Carrot SticksSn: 2 String CheeseD: 4oz Protein, 1c Carb, 2-3c Veggies

Satiety Strategies

4) Know What (and when) to Drink

Think of stomach like a balloon… full balloon=signals to stop

Liquid Calories = NO EFFECT on Satiation, they don’t spend enough time in the stomach to register a signal

Water Rich Foods (soup, salad, fruit, veg’s) = + Satiety

Drink water 30 min before meals, sip duringAvoid dehydration

Satiety Strategies

5) Savor the Flavors

• Chewing food increases “oro-sensory” factors

• Smell / Taste are slower to process

• (2009 Study) Chewing food for an additional 3 seconds reduced calorie intake

Satiety Strategies

6) Downsize your Snacks

• Small Frequent meals are good…. But 400 calories every 3 hours though

• Goal of snack= 100-200 calories decreases binge eating or overconsumption at following meal

• High Protein/Fiber options: beef jerkey, nuts, cottage cheese, Greek yogurt, fiber one bar, fruit

Balancing Blood Sugars w/ Small Snacks

Pillars of Blood Sugar Management1) Nutrition2) Physical Activity3) Weight Control4) Stress Management5) Medical Monitoring

Mary292#

Fasting

Blood Sugar: 107

Mary227#

Fasting

Blood Sugar: 93

The Glycemic Index Concept

• David Jenkins initially studied effects of multiple small meals vs 3 large meals (lower LDL and insulin levels) New England Journal of Medicine 1989

• Further studies lead to classification system of foods….

Absorption of the carbohydrate

Spaghetti

White Bread

Food studies using the GI

When a proper breakfast is taken• “Second meal effect” with low glycemic

index meals vs 81% more calories by end of day with high GI breakfast (just from hunting the remainder of the day)

• The gut stress response is turned on: Catecholamine, glucagon, cortisol, growth hormone hormone.

Blood sugar below baseline occurs “reactive hypoglycemia” Craving starts instinctively for starchy foods, feel ravenously hungry= out of control eating

Other rating systems

• Meijer = NuVal• Marianos = Nuval• Whole Foods Market = ANDI MANDI• Jewel Osco = Color Code/Index

• Please see a profesional- A Registered Dietician!!

Satiety Strategies

Key Components:1) Avoid Distractions2) Pack in the Protein3) Fill Up on Fiber4) Know when (and what) to Eat5) Savor the Flavors6) Downsize your Snacks7) Hara Hachi Bu (stop when 80% full)

Bonus Round

1) Have food ready to eat:Melon, Berries, Apples, Carrots, Cucumbers, BroccoliGreen Peppers, Tomatoes, Mushrooms

2)Double the veggies in any recipe

3) Egg white omelets + onion, tomato, green pepper

4) Add Flavor/Spice: herbs, pepper, cayenne, ginger

Bonus Round 2

Hidden Gems:Iced Tea (unsweetened)Low Cal/No Cal DrinksHEAT! Cayenne, Cumin, Chili powder, paprikaFlavor! Oregano, Dill, LemonFresh SeafoodVinegar: white, red, balsamic, cider

Bonus Round 3

• Plan ahead!– Do you go grocery shopping hungry?– Do you bring a list?– Use the same strategies with food:

• Write down TOMORROW’S meals TONIGHT before bed• Meal or snack coming up soon? Drink a glass of water

before getting the food ready

The Satiety King

Paul191#

“Eat until I’m stuffed” (FULLNESS)

Paul173#

“Eat Until I’m Satisfied”

What I’ve Learned

• If controlling your weight was easy, everybody would be in great shape.

• If I could have done this by myself, without help, I never would have gotten overweight in the first place.

• RESOURCES

Food Log: www.sparkpeople.com Weight Control: www.FHAWeightCenters.com Medical: www.FirstHealthAssociates.com

QUESTIONS?