Weight Control Update and the Skinny on Fat...Weight Control Update and the Skinny on Fat Erin...

Weight Control Update and the Skinny on Fat

Erin Lommen, NDCEO, Labrix Clinical Services

Successful Dieting

But first…• 91% of weight loss programs fail!!• Studies reports that up to only 9% of the people that try to lose weight through conventional methods (dieting) succeed in losing significant weight for sustained periods of time.

• Nationwide research study on American bodyweight and weight loss efforts reveals statistics on the success of various weight control strategies, with 20% indicating they were "very" or "extremely" successful within the first year…

Wing RR, Phelan S. Long‐term weight loss maintenance. Am J Clin Nutr. July 2005. vol 82, No 1, 2225‐2255.

Successful Dieting?

• The perception of the general public is that no one ever succeeds at long‐term weight loss. This belief stems from Stunkard and McLaren‐Hume's 1959 study of 100 obese individuals, which indicated that, 2 years after treatment, only 2% maintained a weight loss of 9.1 kg (20 lb) or more.

• The New England Journal of Medicine, 2006 study echoed this bleak projection: nearly all people who participate in weight‐loss programs “regain about one‐third of the weight lost during the next year and are typically back to baseline (or more) in three to five years.”

Four‐Year Weight Losses in the Look AHEAD Study: Factors Associated with Long‐Term SuccessThomas A. Wadden, Ph.D., Rebecca H. Neiberg, M.S., [...], and the Look AHEAD Research GroupObesity (Silver Spring). Author manuscript; available in PMC 2011 October

…that means 80‐91% of people are regaining most, if not all, of their weight back.

Int J Obes (Lond). 2010 Nov;34(11):1644‐54. doi: 10.1038/ijo.2010.94. Epub 2010 May 18.Long‐term weight loss maintenance in the United States.Kraschnewski JL, Boan J, Esposito J, Sherwood NE, Lehman EB, Kephart DK, Sciamanna CN.

Int J Obes (Lond). 2010 Nov;34(11):1644‐54. doi: 10.1038/ijo.2010.94. Epub 2010 May 18.Long‐term weight loss maintenance in the United States.Kraschnewski JL, Boan J, Esposito J, Sherwood NE, Lehman EB, Kephart DK, Sciamanna CN.

Successful Weight Loss/ Diet Programshave three characteristics

1. They educate and emphasize that weight management is a commitment to healthy patterns/routines of exercise and eating… NOT strict dieting alternating with carelessness about eating patterns

2. They are tailored to each person’s age, general health, living situation and other individual characteristics

3. They recognize that the emotional, psychological and spiritual facets of human life are equally as important to maintaining a healthy lifestyle as medical and nutritional facets

“Healthy Patterns of Exercise”

• Aerobics, basketball, canoeing, netball, baseball, bikram yoga, hiking, boxing, cross fit, cycling, dancing, football, gymnastics, interval training, mixed martial arts, Pilates, rock climbing, running, soccer, skiing, snowboarding, spin classes, swimming, racquetball, rowing, rugby, tennis, walking, weight training, rock climbing, Zumba

Diets A–ZAfrican MangoAlkaline DietAlliAtkins DietBaby Food DietBelly Fat CureBest Life DietBig Breakfast DietBiggest Loser DietBiggest Loser Simple SwapsBody for LifeBrown Fat RevolutionCabbage Soup DietThe Carb Lovers DietThe Caveman (Paleo) DietCheater's DietCinch DietCookie DietDetox DietsDHEAThe Diet SolutionDr. Oz Ultimate DietDr. Phil's Ultimate Weight SolutionDukan DietThe Eat- Clean DietEat More, Weigh Less?

The Kind DietLA Weight LossLemonade DietLiving Low-CarbMacrobiotic DietMartha's Vineyard Diet DetoxMaster Your MetabolismMayo Clinic DietMedifast DietMediterranean Diet Morning Banana DietNaturally Thin DietNew Atkins for a New You New Beverly Hills DietNutriSystem Diet02 DietPark Avenue DietPerricone DietPersonality Type DietP.I.N.K. MethodPritikin Principle PProtein PowerRaspberry KetonesRaw Food Diet

“Healthy Patterns of Eating”

…it’s not that simple

Eat Right for Your TypeEat This, Not ThatEat What You LoveEco Atkins DietFast Food DietFat Smash DietFlat Belly DietFlexitarian Diet5 Factor DietFlavor Point Diet4 Day DietFruit Flush DietFrench Women Don't Get FatFresh DietThe FullBar DietG Free DietGene Smart DietGlycemic Index Diet Grapefruit DietHallelujah DietHGG DietHigh School Reunion DietThe Hormone DietHydroxycutInstinct Diet JJenny Craig T

Rice Diet SolutionThe 17-Day DietShangri-La DietSkinny Vegan DietSlim-Fast PlanSonoma DietSouth Beach DietSouth Beach Diet SuperchargedThe SpectrumStep Diet SugTar BustersThin for Life This Is Why You're Fat3 Day Diet 3-Hour DietUltraMetabolism DietVolumetricsWhat Color is Your Diet? The Weigh DownWeight Loss CureWeight WatchersDr. Andrew WeilYou – On a DietThe Zone

Do you have an emotional relationship with food?Do you have an emotional relationship with food?

1. Yes2. No3. Maybe ‐ Sometimes

1. Yes2. No3. Maybe ‐ Sometimes

“No”

• Whole foods Plant‐focused• Low Glycemic Index Diet• Anti‐Inflammatory Foods

“Maybe ‐ Sometimes”

• When?• What foods?• Design diet to include those foods but only at certain times and in limited quantities

“YES”

• Eating Disorders• Overeating• Bulimia• Anorexia nervosa• Other addiction

Add to/not take away from Nutritional Program Do not remove food groups.(Caution; triggering deprivation mentality)

One green/raw veggie saladOne whole grainOne quart filtered water

Hedonic eating

• Eating for pleasure rather than to satisfy a biological need

• A growing body of evidence suggests that how much you weigh and controlling eating are linked

• Hedonic hunger is driven by signaling of hormones and neurotransmitters, including dopamine, and involves the reward centers of the brain

• Obesity appears to dampen the pleasure response to dopamine… and it takes increasingly greater amounts of foods to activate reward centers

Addicted to food

• Weight gain.• Eating more food than the body can physically tolerate.• Continuing to eat past the point of feeling full.• Eating in secret and seclusion.• Heart palpitations.• Taking extreme measures to obtain food.• Decreased energy or extreme fatigue.• Difficulty concentrating, insomnia, restlessness and general• irritability.• Suicidal thoughts.

Meule, A. Frontiers in Psychiatry, Nov. 3, 2011.Volkow, N. Trends in Cognitive Science, January 2011.Gearhardt, A. Archives of General Psychiatry, August 2011.Rudd Center for Food Science and Policy, Yale University: "Yale Food Addiction Scale."Rudd Center for Food Science and Policy, Yale University: "Food and Addiction."

Question is whether low dopamine or receptor levels contribute to obesity… by causing individuals to attempt to feel good—or whether obesity leads to a dampened dopamine response.

It has been shown that dopamine receptor levels in the brain increase after weight loss.

Vucetic Z, Reyes TM. Central dopaminergic circuitry controlling food intake and reward: implications for the regulation of obesity. Wiley Interdiscip Rev Syst Biol Med. 2010 Sep-Oct; 2(5):577-93

Times have changed…

Desserts from the year: 1822“…there was found likewise a whole dessert of fruit, chestnuts, raisins, bread eggs, wine & oil...”

Pompeii, p 67

Desserts from the year: 2015

How many pounds of sugar do Americans eat?

• In 1822 the average American ate 2 tsp. per day (6.4 lbs a year) • In 1890 the average American ate 10 tsp. per day (32.3 lbs a year) • In 1905 the average American ate 20 tsp. per day (64.6 lbs a year) • In 1974 the average American ate 33 tsp. per day (106.5 lbs a year) • In 1995 the average American ate 40 tsp. per day (129.2 lbs a year)

1 lb. = 113 tsp.

By John Casey, WebMD Weight Loss Clinic‐Exclusive Feature Reviewed by Kathleen M. Zelman, MPH, RD, LD © 2007 WebMD, Inc. All rights reserved.

In 2005 the average Americanate 56 teaspoons per day.

130‐180lbs of sugara year!

Hidden sources of sugar

• Only about 29lbs of this comes directly from the sugar bowl. The rest of the 130‐180lbs of sugar comes from foods.

• Most people recognize that sugar is an ingredient in candy, soda, and junk food, but sugar hides in unexpected places:

• Bread, multi‐grain crackers, flavored yogurt, sausage, lunch meats, bouillon, mayonnaise, ketchup, spaghetti sauce, salad dressing, peanut butter, canned fruits and vegetables, even fish sauce!

Casey, John. “The Hidden Ingredient that can Sabotage Your Diet”. www.medicinenet.com. Accessed January 14, 2014.

Eating the Caveman Diet was once much easier

•Availability of high calorie food and drinks

•Emotional eating

And then we’ve got our heredity?• He’s “stocky” like his Dad…”• She’s got a “slow metabolism” like her Mom…

What if we’re…

• Programmed for plumpness• Wired for weight gain• Fated for fatness• Polymorphed to be portly

DNA testing

Numerous clinical trials have been published in peer‐reviewed journals reporting the connection between the SNP and BMI or other measures of body fat.

SNP-single nucleotide polymorphismAnalysis of genetic variation…that is connected to an adverse health outcome

DNA Testing for Obesity ‘Genes’

• Of importance: • Genes play a plausible biological role in weight management

• Gene variations produce a change in the amount of absorption

• Gene variations produce a change in metabolism

• Evidence based• Response to diets or physical activity

DNA Testing Criteria

• Several clinical trials regarding the SNP and weight management published in peer‐reviewed journals

• The SNP must be associated with a gene that has an established connection with metabolism, fat storage, nutrient absorption or some other area that is of physiological importance in weight management1.Rankinen T et al. The human obesity gene map: the 2005 update. Obesity. 2006;14:529-6442.Cheung MKM et al. FTO biology and obesity: why do a billion of us weigh 3 kg more? Frontiers Endocrin. 2011;2:1-93. Lu Y et al. Obesity genomics: assessing the transferability of susceptibility loci across diverse populations. Genome Med. 2013;5:55

FTOVariant of the Human Fat Mass and Obesity Gene

• One of the strongest genetic risk factors for obesity• Reduced satiety, increased calorie intake, preference for calorie‐dense foods

• Respond well to lifestyle changes• Respond to high intensity exercise• Greater loss of weight to high‐protein diet• Adverse to high SFA

Cheung MKM et al. FTO biology and obesity: why do a billion of us weigh 3 kg more? Frontiers Endocrin. 2011;2:1‐9Frayling TM, et al. (2007) A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity. Science 316: 889–894.Lu Y et al. Obesity genomics: assessing the transferability of susceptibility loci across diverse populations. Genome Med. 2013;5:55Rankinen T et al. The human obesity gene map: the 2005 update. Obesity. 2006;14:529‐644

FTO• A study of 38,759 participants in 2007 showed that adults who were homozygous for the A allele (risk allele) weighed an average of 3 kg more and had a 1.7‐fold increased risk of developing obesity compared to those not carrying the risk allele.

• Studies have shown that the effects of the FTO gene mutation can be reversed with diet and lifestyle changes. The Pounds Lost Trial showed that carriers of the FTO risk allele exhibited greater weight loss and regional fat distribution in response to a high‐protein diet compared with non carriers. When placed on a low‐protein diet, the opposite effect was observed. There is evidence that the FTO risk allele is significantly associated with the type of fats and carbohydrates consumed as well as with BMI. A 2011 study found that carriers had a higher BMI than other genotypes only when they consumed a diet high in saturated fats.

Frayling TM, et al. A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity. Science. 2007 May 11;316(5826):889‐94.

FTO

• Rarely feel full or satisfied after meals• Have difficulty controlling cravings• Have strong desire for calorie‐rich foods• Have higher likelihood of child onset obesity• More likely to become obese from consuming saturated fat

Cheung MKM et al. FTO biology and obesity: why do a billion of us weigh 3 kg more? Frontiers Endocrin. 2011;2:1-9Frayling TM, et al. (2007) A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity. Science 316: 889–894.Lu Y et al. Obesity genomics: assessing the transferability of susceptibility loci across diverse populations. Genome Med. 2013;5:55Rankinen T et al. The human obesity gene map: the 2005 update. Obesity. 2006;14:529-644

FTO Strategies

• Avoid saturated fats• Avoid sedentary lifestyle

• Exercise has shown to limit the effects of this genetic pattern

• Mediterranean style diets have shown to be effective in clinical studies

• High protein diet most effective• Always eat breakfast and include protein• Pre‐portioning meals and snacks throughout the day will help to avoid overconsumption

• Eat five smaller meals throughout the day

Is all DNA testing for obesity ‘equal’?

• The SNP must be associated with a gene that has an established connection with metabolism, fat storage, nutrient absorption or some other area that is of physiological importance in weight management

• The minor allele of each SNP must be present in at least 20% of the population to assure relevance to the tested individuals

• Each SNP has to have been investigated in at least 10 publications including at least 5000 individuals of varying ethnicities

Psychological Effects of Genetic Testing for Risk of Weight Gain

Obesity gene testing does not put people off weight loss and may help to reduce self‐blame, according to a new study by researchers from the Health Behavior Research Centre at University College London.

UCL News. Psychological effects of genetic testing for risk of weight gain. Sept 4, 2013. http://www.ucl.ac.uk/news/news-articles/0913/04092013-Psychological-effects-of-genetic-testing-for-risk-of-weight-gain-Meisel . Accessibility verified Jan 8 2014

• FTO has two variants, one associated with greater risk of weight gain (A) and one associated with lower risk (T).

• One in two people carries at least one copy of the A variant. • People who inherit two A variants (one from their mother and one from their father) are 70% more likely to become obese than those with two T variants.

• Even those who inherit one have a higher weight than those with two T variants.



• It was not known how people would react to finding out the results of the FTO genetic test.

• Researchers found that the volunteers were very enthusiastic about receiving their genetic test result. Those who struggled with their weight said that the genetic test result was helpful because it removed some of the emotional stress attached to weight control and relieved some of the stigma and self‐blame



• Susanne Meisel, who led the study said: “These results are encouraging. Regardless of gene status or weight, all the volunteers recognized that both genes and behavior are important for weight control. The results indicate that people are unlikely to believe that genes are destiny and stop engaging with weight control once they know their FTO status. Although they knew that FTO’s effect is only small, they found it motivating and informative. We are now doing a larger study to confirm whether more people react in the same way.”



Where do we go from here?Remove obstacles to weight reduction and subsequent weight management

• DNA testing helps give reference point for how best to proceed.

• Treat neuroendocrine imbalances• Neurotransmitter, Hormones, Adrenal and Thyroid

• Altered glucose/insulin • R/O sleep dysfunction• Address poor gut health• Dashed hopes and depleted motivation

Best Diet for Weight Loss?

NO ONE DIET FITS EVERYONE!

But generally the HEALTHY Plans eliminate/limit the inflammatory foods (SAD):• Citrus: oranges, grapefruits, lemons limes grapes• Gluten: wheat, barley, spelt, rye, oat • Grains: corn, soy• Meats: beef, pork, cold cuts, frankfurters, sausage, canned meats, eggs shellfish

• Nuts: peanuts, pistachio• Dairy: milk, cheese, cream, ice cream, frozen yogurt• Vegetables: canned or creamed any kind and nightshades• Fats: margarine, shortening, processed and hydrogenated oils, salad dressings, mayonnaise spreads

• Beverages: soda pop, alcohol, coffee, tea, and caffeinated beverages• Sweeteners: white, brown or refined sugar, high fructose corn syrup

Based on the individual, heredity, geographic area,circumstances and condition you are treating etc.

Insulin Resistance

• Low glycemic index• Anti‐inflammatory diet

Shopping list for anti‐inflammatory dietProteins Chicken, Turkey, Lamb, Wild game, Fish: Cod, Halibut Mackerel, Salmon, Tuna, Trout, Dried beans,

Dried peas, Lentils

Soy Tofu, Tempeh, Soy milk, Soy yogurt (casein free)

Grains Whole Grains, Gluten free ; Brown Rice, Tapioca, Amaranth, Millet, Teff, Quinoa

Vegetables Alfalfa sprouts, Artichokes, Avocado, Asparagus, Beets, Bok Choy, Broccoli, Brussels sprouts, Cabbage, Carrots, Cauliflower, Celery, Cucumber, Daikon radish, Endive, Escarole, Green or yellow beans, Green‐mustard, turnip, chard, Jicama, Kale Kohlrabi Leeks Lettuce Mung Beans Okra Onions Parsnips Radishes Rutabaga Sea weed, kelp Snow peas Spinach Squash‐summer, winter Sweet potatoes Taro Turnips Water Chestnuts Yams Zucchini squash

Sweeteners Brown rice syrup, Fruit sweetener, Molasses, Stevia

Fruit Apple, Applesauce, Apricot, Avocado, Banana, Blueberries, Cherries, Kiwi, Mango, Melon, Nectarine, Papaya, Pear, Peach, Pineapple, Plum, Prune, Raspberries, Strawberries

Nuts, Seeds, Oils Almond oil, Almonds, Canola oil, Cashews, Flax oil, Hazelnuts, Olive oil Pecans, Pumpkin oil, Pumpkin seeds ,Safflower oil, Sesame oil, Sunflower oil, Sunflower seeds, Walnut oil, Walnuts, Butters of these nuts and seeds

Spices Anise Bay leaf, Basil, Cardamom, Celery seed, Cinnamon, Cumin, Dill, Dry mustard, Fennel, Garlic, Ginger, Marjoram, Oregano, Parsley, Rosemary, Saffron, Savory, Tarragon, Thyme, Turmeric

The Anti‐Inflammation Diet and Recipe Book – Jessica Black, ND 2006

Cinnamon

• 60 patient study conducted in Pakistan... All the patients had been treated for type 2, adult onset diabetes for several years and were taking anti‐diabetic drugs to increase their insulin output. But they were not yet taking insulin to help process their blood glucose. The subjects were given small doses of cinnamon ranging from as little as a quarter teaspoon to less than 2 teaspoons a day for 40 days.

The results: Not only did the cinnamon reduce their blood sugar levels and increase their natural production of insulin, it lowered their blood cholesterol as well. Even 20 days after the cinnamon treatment had ended, the patients continued to see beneficial effects.

Khan A. Safdar M Ali Khar MM Khattak KN Anderson RA. Cinnamano improves glucose and lipids of people with type 2 diabetes. Diabetes Care 2003 Dec, 26 (12):3215‐8

Vitamin D• It has been estimated that 1 billion people worldwide have vitamin D deficiency or insufficiency. It is well known that vitamin D deficiency causes osteoporosis, increases the risk of fracture and causes muscle weakness.

• But there is now evidence that calcium malnutrition and hypovitaminosis D are predisposing conditions for various common chronic diseases such as malignancies (particularly colon, breast and prostate) chronic inflammatory and autoimmune disease (inflammatory bowel disease, multiple sclerosis) as well as metabolic disorders (metabolic syndrome, hypertension).

• It has also been reported that vitamin D deficiency may predispose to glucose intolerance, altered insulin secretion and type 2 diabetes mellitus.

Sponsors and Collaborators: University of Aarhus, Aarhus University Hospital, Silkeborg Hospital, DenmarkInformation provided by: University of AarhusClinicalTrials.gov Identifier: NCT00695474

Vitamin D

• Regular dosing of vitamin D (2000 IU/day) in early childhood has been shown to reduce the risk of developing Type 1 Diabetes (up to an 80% reduction projected over the next 30 years)

• Additionally, vitamin D treatment has improved glycemic control and insulin sensitivity in people with Type 1 Diabetes, Type 2 Diabetes, and normal individuals

Schwalfenberg, Gary. Vitamin D and diabetes – Improvement of glycemic control with vitamin D3 repletion. Canadian Family Physician, Vol 54: June 2008, p. 864-866.

The Clinical Importance of Vitamin D Research

• Higher vitamin D status has been correlated with 60% improvement in insulin sensitivity. (clinical trial using 1332 IU/day vitamin D for 30 days in 10 women with type II diabetes improved 21 %)

• Metformin was shown to give a 13% improvement in insulin sensitivity

Alternative Therapies Sept/Oct 2004 vol. 10, no 5

Insulin ResistanceTreatment Options‐Herbal

Fenugreek (85%) Reduces blood sugar and insulin following a meals, and lowers cholesterol; LDL, TG and total cholesterol

750 mg, 2 bid

Guar Gum lowers cholesterol, TG, and blood pressure, and helps regulate appetite

2.5 gm qd

Apple pectin, beet powder and oat fiber

slows the absorption of glucose into the blood stream (which also lowers insulin)

Insulin ResistanceTreatment Options‐Herbal

Milk Thistle lowers fasting glucose, mean daily glucose and fasting insulin levels

200‐400 mg

Gymnema Sylvestre lowers glucose and improves insulin sensitivity, and regenerative to beta cells in pancreas

400 mg bid

Bitter melon (10:1) suppresses blood glucose spike in response to sweets

250 mg bid

Fenugreek

• Moderates the metabolism of glucose in the digestive tract (specifically, galactomannan becomes viscous and thickens the intestinal contents helping maintain glucose absorption)

• Fenugreek also helps to moderate metabolism of lipids in the digestive tract (appears it may also support healthy triglyceride levels)

Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber officinale Rosc) and fenugreek (Trigonella foenumgraecumL) on blood lipids, blood sugar, and platelet aggregation in patients with coronary artery disease. Prostagland Leukotrienes Essential Fatty Acids 1997;56:379Ð84. Sharma RD, Raghuram TC, Rao NS. Effect of fenugreek seeds on blood glucose and serum lipids in type I diabetes. Eur J Clin Nutr 1990;44:301Ð6.Madar Z, Abel R, Samish S, Arad J. Glucose‐lowering effect of fenugreek in non‐insulin dependent diabetics. Eur J Clin Nutr 1988;42:51Ð4. Raghuram TC, Sharma RD, Sivakumar5.) Sharma RD, Raghuram TC, Dayasagar Rao V. Hypolipidaemic effect of fenugreek seeds. A clinical study. Phytother Res 1991;5:145Ð7. 6.) Sharma RD, Sarkar DK, Hazra B, et al. Hypolipidaemic effect of fenugreek seeds: A chronic study in non-insulin dependent diabetic patients. Phytother Res1996;10:332Ð4. B, Sahay BK. Effect of fenugreek seeds on intravenous glucose disposition in non‐insulin dependent diabetic patients. Phytother Res 1994;8:83Ð6.

Sleep Dysfunction

• Leptin and ghrelin are hormones that help the body control appetite and weight gain. Leptin suppresses appetite, while ghrelin increases appetite and may prevent a person from losing weight.

• When lack of sleep becomes a chronic problem, levels of ghrelin increase, causing greater appetite, and levels of leptin decrease. Regardless of diet and exercise, some obesity is caused, or made worse, by sleep deprivation.

Good Night’s Sleep

• REM 25% of sleep time• Higher sympathetic activity

• Non REM (3 stages): Parasympathetic dominance during NREM.

• Stage N1 sleep, or the transition from wakefulness to deeper sleep. This is the lightest stage of sleep, and people may not always perceive they are asleep when in this stage.

• Stage N2 sleep is a true sleep state, and accounts for 40% to 50% of sleep time.

• Stage N3 sleep has been called deep sleep, delta sleep, or slow wave sleep. This stage accounts for about 20% of sleep in young adults.

Sleep is Sleep... isn’t it?

• Slow wave sleep, is thought to have an inhibitory influence on the HPA axis and cortisol secretion

• The amount of REM sleep, a state of central nervous system activation that resembles unconscious wakefulness (paradoxic sleep), appears to be associated with a higher activity of the HPA axis.

• Normal sleepers show that the amount of REM sleep was positively correlated …free cortisol.

Less than 7 hours of sleep a night?

• Lower BMI than <7.7 hrs a night• 14.9% higher appetite stimulating hormone: ghrelin• 15.5% lower leptin

• 2‐4 hrs a night: • 73% more likely to be obese

• 5 hrs a night: • 50% more likely to be obese

• 6 hours: • 23% more likely to be obese

Spiegel K, Tasali E, Penev P, Van Cauter, E. Brief communiation: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels and increased hunger and appetite. Ann Intern Med. 2004 Dec 7; 141 (11):846-50.

Pearl: REM Sleep

• Continuous administration of ACTH produced a marked reduction in REM sleep.

• A study in Addisonian patients recently demonstrated that an evening replacement dose of hydrocortisone was necessary for proper expression of REM sleep, (vide infra) suggesting that glucocorticoids have some permissive action for this sleep parameter, possibly reflecting an inverse u‐shaped dose response curve.

Treatment: Sleep Dysfunction

• Normalize your sleep• Balance NT’s and hormones, adrenalsand estrogen/progesterone

• Sleep more‐Sleep later (until 8:30 or 9 am)

• Sleep at the right and regular times (light dark circadian rhythms)

• Book: Lights Out by T.S. Wiley

Firmicutes Causes More Fat Storage

Researchers have found that each body extracts different calorie amounts from the same exact food, depending on your own particular combination of intestinal microflora.

For example, you and your friend could eat the same steak dinner, but depending on your gut flora, you could extract more calories from the same meal.Pasarica M, Dhurandhar NV. Infectobesity: Obesity of infectious origin. Adv Food Nutr Res. 2007 52: 61-102.

Infectobesity

• Researchers have also discovered this phenomenon in animals… chickens infected by a certain virus were obese and most of their fat was concentrated around the stomach!

• Doctors tested a random group of both obese and normal weight people. The resulting data showed that 30% of the obese subjects had antibodies to the virus, while only 11% of the normal weight subjects had the antibodies. This significant difference indicates that certain viral infections are directly contributing to obesity!

Pasarica M, Dhurandhar NV. Infectobesity: Obesity of infectious origin. Adv Food Nutr Res. 2007 52:61‐102. Reduced expression of mitochondrial frataxin in mice exacerbates diet‐induced obesity. CHUV, Lausanne. [email protected]

Restoring Gut Health

• Cleansing and detoxification (as appropriate)

• PROBIOTICS 10 Billion Organisms / Day

• L‐glutamine 3 g tid• Digestive enzymes as needed

Dashed Hope and Depleted Motivation

• No more “Diets”• Add to lifestyle don’t deprive• Increase fun/joy/laughter

Seven Steps to Slim™By Erin Lommen ND LLC

1. Gain Insight and Strengthen Ability to Succeed2. Lose Negative Thinking3. Gain Control Over Portions and Cravings4. Lose Rigidity and Have a Plan B5. Gain Momentum through Movement6. Lose Bad Habits 7. Gain Contentment

1. Gain Insight and Strengthen Ability to Succeed

• Access Motivation and Ease “emotional eating”• Homeopathic “compulsive eating” drops• Or appetite‐dulling botanical formulas

• Hoodia• Green tea• Dark cocoa• Garcina gambogia• Opportunia• Triphalia• Ginger

2. Lose Negative Thinking

• Happy for No Reason, Marci Shimoff• Positive Intelligence, Shirzad Chamine• Learning to Love Yourself Workbook, Gay Hendricks

You are what you think?

• According to scientists we have about 60,000 thoughts a day. (That’s one thought per second.)

• 95% of these 60,000 thoughts are the same… habitual thoughts you had yesterday, …and the day before, …and the day before that…

• 80% of these habitual thoughts are negative which means:

• Everyday people have more than 45,000 negative thoughts.

Shimoff, Marci. Happy for No Reason. Simon and Schuster, 2009. Print

3. Gain Control Over Portions and Cravings

An excellent program to raise consciousness and successfully guide and manage portion control: • ADD 14 g fiber• Drink one to two 8 ounce glasses of water prior to meals• Eat veggies and protein first

4. Lose Rigidity and Have a Plan BPlan on ‘slipping’

Write the plan ahead of time…here’s what it will look like…

5. Gain Momentum through Movement

‘Move a muscle …Change a thought’

6. Lose Bad Habits, Address Cravings

• Gain Awareness• Observe• Accept• Let Go

7. Gain Contentment…the state of being happy or satisfied

Practice

Remember

• To design and encourage “doable” programs‐meeting patients where they Are…(Not where they need to be)

• Successful baby steps are better than extreme program adherence coupled with extreme carelessness and bingeing

Summary

• Successful treatment strategies for weight loss employ solutions that target and address its many causes and the ‘gravity ‘of each individual case

• These programs will focus on the whole person and utilize BHRT, nutrition, herbal medicine, other supplements, and lifestyle counseling

• Hormonal ,adrenal, neurotransmitter and DNA testing provide excellent roadmaps to pinpoint and focus your clinical treatment strategies and successfully help change lives…

“Show me a day when the worldwas not new”.

Weight Control Update and the Skinny on Fat...Weight Control Update and the Skinny on Fat Erin...

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