Weight Management & Satiety

Obesity is a multi-factorial and complex health issue. Current guidance for weight management encourages physical activity along with consuming an overall healthy eating pattern which includes whole grains, fruits, vegetables, lean proteins, low-fat and fat-free dairy products. A growing body of research suggests that dietary protein, specifically, can help promote satiety, facilitating weight loss when consumed as part of reduced energy diets.

Several clinical trials have specifically assessed the effects of high-quality protein from eggs on satiety and weight loss. For example:

  • In a study in overweight adults, calorie-restricted diets that included either eggs or a bagel for breakfast were compared; the people who consumed eggs for breakfast lowered their body mass index by 61%, lost 65% more weight, and reported feeling more energetic than those who ate a bagel for breakfast.
  • Men who consumed an egg breakfast versus a bagel breakfast showed that appetite hormones were suppressed following eggs at breakfast, as was energy intake over the course of the day.
  • A study of overweight premenopausal women that evaluated satiety responses to eating a turkey sausage and egg breakfast sandwich versus a low-protein pancake breakfast showed better appetite control and few calories consumed at lunch following the egg-based breakfast.
  • In a 3-month trial among subjects with type 2 diabetes, those who consumed 2 eggs per day for 6 days a week reported less hunger and greater satiety than those who consumed less than 2 eggs per week.

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Another Look at the Low-Carbohydrate vs. Low-Fat Study

Annals-IM-LOGO-150x150The media has been buzzing over the low-carbohydrate vs. low-fat headline that stemmed from a recent study in the Annals of Internal Medicine, so as discussed in earlier posts, let’s read beyond the headlines.

The randomized, parallel group study looked at a low-carbohydrate vs. low-fat diet on body weight and CVD risk factors. Some positive attributes of this study were that it included a fair amount of black participants and had a sample size of 145 obese but otherwise healthy individuals (although skewed, with 88% being women).

Participants in the study received a handbook with instructions and recipes, a meal replacement [low-carbohydrate or low-fat, based on assigned group], and counseling sessions from a registered dietitian (individual for the first four weeks, every other week group counseling for the next 5 months and monthly during the last 6 months). No calorie limit was set for the groups, and participants were encouraged not to change physical activity during the intervention. Emphasis was placed on fiber and types of fats (trans fats to be decreased and MUFAs increased) for both groups. Dietary recalls were used (one weekend/one week day) at baseline, 3, 6 and 12 months, and labs and anthropometrics were measured by trained staff using procedures set forth by AHA, NHLBI and CDC.

Results showed that energy intake dropped in both groups from baseline. Notable is that the low-carbohydrate group consistently reported consuming 100+ fewer calories than the low-fat group throughout the study. Interestingly, the low-carbohydrate group consumed optimal amounts of protein, 81-90 g protein daily, whereas the low-fat group dropped to 60-70 g protein daily. Both groups consumed inadequate intakes of fiber – about half of what was recommended for the study – but this matches typical intakes for Americans.

Weight loss was greater for the low-carbohydrate group and remained significant throughout the 12-month study. LDL-cholesterol and triglycerides decreased in both groups; HDL increased, and CRP decreased in the low carbohydrate group. In addition, 10-year Framingham risk decreased for the low-carbohydrate group.

Although the study has been criticized by some, it does add to the current body of evidence on low-carbohydrate diets. Unlike many of the previous low-carbohydrate studies, this trial looked at free-living individuals. Participants in both groups were able to make dietary changes that shifted macronutrient intake and reduced calories overall. Unfortunately, the paper did not report actual foods consumed, which would have been interesting. In addition, there were no apparent negatives with the low-carbohydrate diet on measured outcomes. Although no one study is perfect, the results of this present trial build on prior evidence that a reduced carbohydrate diet may be a feasible option for those wanting to improve their weight and health without the “fear of fat” dogma.

Nutrition in the Spotlight for Health Professionals: Lessons from the AANP Conference and NNPS


Dixie-Harms-2Today’s post comes from Dixie Harms, DNP, ARNP, FNP-C, BC-ADM, FAANP. Dr. Harms is a board-certified family nurse practitioner, employed full-time at Mercy Family Medicine of Urbandale, practicing in family practice and internal medicine. In addition to family practice, her specialties include diabetes care and bio-identical hormone replacement therapy. She is also board certified in Advanced Diabetes Management. Dixie obtained her diploma in nursing from Iowa Methodist School of Nursing, Bachelor’s and Master’s of Science of Nursing from Drake University, Post-Master’s FNP Certificate from Clarkson College and her Doctorate of Nursing Practice from the University of Iowa. She is also adjunct clinical faculty at the University of Iowa College of Nursing. Dr. Harms has been involved in numerous activities with the American Association of Nurse Practitioners and the American Academy of Nurse Practitioners Certification Program.  She was inducted into the Fellows of the American Association of Nurse Practitioners in 2005 and received the State Award for Excellence in 2005. She is also on the Board of Directors of the American Nurse Practitioner Foundation and is a Health Professional Advisor with the Egg Nutrition Center.  In her spare time, Dr. Harms teaches taekwondo two nights a week and is a 6th degree black belt.

In order for health care professionals to maintain their licenses/certifications, we must maintain our level of education to stay current on the most up-to-date information. Recently I attended the American Association of Nurse Practitioners (AANP) National Conference in Nashville, Tennessee, an event that was attended by over 6,000 nurse practitioners from across the United States and many countries overseas. I was fortunate enough to earn over 30 hours of continuing education in five days. While attending lectures, I found that there seemed to be a common theme amongst many of the presenters: they included information about how nutrition can have an impact on chronic illness.  Key nutrition information presented at the conference that I thought to be most useful for health professionals is outlined below.

Benefits of Consuming Omega 3 Fatty Acids:

Helps reduce pro-inflammatory effects
Reduces risk of heart arrhythmias
Helps prevent blood clots
Slightly lowers blood pressure

American Heart Association recommendations for Omega 3 Fatty Acid Intake:

Eat a variety of fish at least twice weekly
Include oils such as flaxseed, canola and soybean
Patients with heart disease should consume about 1 gram of EPA & DHA daily
Patients with high triglycerides should consume 2-4 grams EPA & DHA daily

American Heart Association recommendations for Patients with Heart Disease:

Overweight or obese patients can reduce cardiovascular risk factors with 3-5% weight loss or more
Calorie reduction diets should range from 1200-1500 kcal/day for women and 1500-1800 kcal/d for men
500-700 kcal/day calorie intake deficit along with increased physical activity can lead to weight loss

Obesity

Obesity is a multifactorial problem caused by:

Genetics
Increased quantity of food
Gastrointestinal responses to various nutrients
Neuropeptides–hunger/satiety/mood
Brain responses to nutrients
Sedentary lifestyles

Hormones (peptides) that affect appetite regulation:

Ghrelin (stomach)
Cholecystokinin & GIP (small intestine)
GLP-1, Oxyntomodulin, PTT (large intestine)
Insulin/Amylin (Pancrease)
Leptin (fat)

Suggested interventions for obesity treatment:

Food/dietary intervention
Exercise/activity
Life coaching
Pharmacologic interventions
Surgery/bariatric interventions

Following the AANP conference, I had the opportunity to go to the National Nurse Practitioner Symposium (NNPS) in Keystone, Colorado, another very well-attended conference.  At NNPS, I presented with Dr. Mitch Kanter on the topic, Changing Paradigms Regarding Macronutrient Intake and Health: Translating Science into Meaningful PatientCommunication.  Even after three full days of continuing education, over 200 nurse practitioners attended our nutrition-focused evening session, making it quite obvious that nutrition is very important to health care providers in any setting.  Dr. Kanter shared with the audience several important points on the topic, including:

High carbohydrate diets and insulin promote inflammation, obesity and CVD
Replacing carbs with higher protein foods may create a more healthfully balanced diet that:
Promotes satiety
Suppresses food intake at subsequent meals
Stimulates the intestinal “satiety hormone” cholecystokinin (CCK)
Inhibits the “Hungry Hormone” ghrelin

Though nutrition science is ever-evolving, information presented at the latest health professional conferences continues to point to similar conclusions. While there may not be anything fancy about good health or weight loss, research consistently shows that eating a healthy, protein-rich, low carbohydrate diet along with physical activity may help people avoid many chronic illness like heart disease, diabetes and obesity.

 

Sources:

  1. Fitzgerald, M. (2014).  The Role of Inflammation in Chronic Conditions:  Prevention, Assessment & Treatment.  Presented at AANP National Conference, Nashville, TN.
  2. Kessler, C. (2014).  Fat Chance:  A realistic “Mosaic” Approach to Weight Management.  Presented at AANP National Conference, Nashville, TN.
  3. Roberts, M.E. (2014, June 20).  An Update on the 2013 Cardiovascular Guidelines.  Presented at AANP National Conference, Nashville, TN.

Leucine: Promoting Muscle Anabolism at Breakfast

Muscle Illustration

Protein is a critically important fuel source for muscles, and branched chain amino acids (BCAAs) are particularly so. Leucine is the most abundant BCAA found in muscles, and as the body of leucine research continues to grow, so does the evidence pointing to several benefits that leucine imparts, including the regulation of skeletal muscle protein synthesis. This was demonstrated in a study where leucine supplementation in a low dose of whey protein stimulated postprandial human myofibrillar protein synthesis as effectively as a much greater dose of whey protein (1). Similarly, a low-protein mixed macronutrient beverage supplemented with a high amount of leucine was found to be as effective as a high-protein beverage at stimulating muscle anabolism (2). Furthermore, results of another study on muscle recovery suggest that increasing the concentration of leucine in an essential amino acid supplement during moderate intensity exercise may increase post-exercise skeletal muscle metabolism (3). In addition to tissue protein synthesis, leucine in combination with vitamin B6 also increased fat oxidation and insulin sensitivity and reduced oxidative and inflammatory stress, thus suggesting a potential approach in the management of obesity (4).

Leucine-3D

Leucine is an essential amino acid, and as such, it must be obtained from dietary sources, since our bodies cannot produce it. Animal proteins in general are among the best sources of dietary leucine. Eggs contain 1.086g of leucine per 100g weight, which translates to approximately 9% of its total protein content (5). When compared to other foods commonly consumed for breakfast, eggs are not as high on a gram for gram basis as oats or cheese (see figure below). However, when a comparison of leucine content is made on a per calorie basis, eggs come out looking better than most other common food sources. At only 72 calories, with 6.3 grams of protein and a high leucine content, eggs are a nutritionally- and protein-dense food source, perfect for those trying to get a little more protein, leucine and other essential micronutrients in their diets.

Charts_Leucine-in-Breakfast-Protein

As noted in the dialogue from the recent fourth meeting of the Dietary Guidelines Advisory Committee, protein is notoriously under-consumed at breakfast. Given their robust nutrient profile and leucine content, eggs can be an easy fix to this nutritional shortcoming and an important protein source to consider when helping patients and clients build healthful diets.

References:

  1. Churchward-Venne TA, Burd NA, Mitchell CJ, West DW, Philp A, Marcotte GR, Baker SK, Baar K, Phillips SM. Supplementation of a suboptimal protein dose with leucine or essential amino acids: effects on myofibrillar protein synthesis at rest and following resistance exercise in men. J Physiol. 20012; 590(Pt 11):2751-65.
  2. Churchward TA, Breen L, Di Donato DM, Hector AJ, Mitchell CJ, Moore DR, Stellingwerff T, Breuille D, Offord EA, Baker SK, Phillips SM. Leucine supplementation of a low-protein mixed macronutrient beverage enhances myofibrillar protein synthesis in young men: a double-blind, randomized trial.Am J Clin Nutr. 2014; 99(2):276-86.
  3. Pasiakos SM, MClung HL, McClung JP, Margolis LM, Andersen NE, Cloutier GJ, Pikosky MA, Rood JC, Fielding RA, Young AJ. Leucine-enriched essential amino acid supplementation during moderate steady state exercise enhances postexercise muscle protein synthesis. Am J Clin Nutr. 2011; 94(3):809-18.
  4. Zemel MB, Bruckbauer A. Effects of a leucine and pyridoxine-containing nutraceutical on fat oxidation, and oxidative and inflammatory stress in overweight and obese subjects. Nutrients. 2012; 4(6):529-41.
  5. USDA National Nutrient Database for Standard Reference. U.S. Department of Agriculture, Agricultural Research Service, USDA Nutrient Data Laboratory Website. Updated Dec 7, 2011.http://ndb.nal.usda.gov/. Accessed July 28, 2014.

Nutrition Close-Up, Summer 2014

close-up-summer-2014-tn
Nutrition Close-Up, Summer 2014 (pdf, 1.5 MB)

Articles in this Issue…

The role of the brain, ‘food cues,’ in overeating

By Kerri Boutelle, PhD

Obesity is a serious and refractory problem that is associated with multiple medical and psychological comorbities and risks. Recent data suggest that in the United States, two out of every three adults are overweight or obese, and one out of three children is overweight or obese. Obesity is associated with cardiovascular disease, type 2 diabetes, cancer, osteoarthritis, psychological impairment, poor quality of life, and all-cause mortality.
Read More >>

Vitamin D: a stronger link to health

By Taylor C. Wallace, PhD, CFS, FACN

Getting adequate vitamin D and calcium is essential for children, who need to grow strong bones, and for adults, who need to maintain strong bones and prevent bone loss. New findings
from the Women’s Health Initiative, the largest clinical trial of >36,000 postmenopausal women, confirm the safety and synergistic benefits of these two nutrients, showing a 35-38 % reduction
in hip fracture incidence 1. If you don’t get enough vitamin D, you are less likely to efficiently absorb calcium in the gut and may lose bone as you age. The development of low bone density
and/or osteoporosis later in life, which affects approximately 54 million Americans over the age of 50 years 2, is highly linked to suboptimal nutrition and physical activity patterns during young adulthood. After the age of 20-25 years, when bone growth reaches its full genetic potential, bone “withdrawals” can begin to exceed “deposits” (except in the skull, which increases in mass throughout the lifespan).
Read More >>

Complexity of individual variability in nutrition

By Tia M. Rains, PhD

One size does not fit all when it comes to health. Be it diet, exercise, or prescription medications, what works wonderfully for one person may produce little effect or even the opposite
effect in others. This is not surprising given metabolic differences between individuals. I remember observing this first-hand as an undergraduate student in a clinical chemistry course. Each
student underwent some basic blood tests and we compared results across the class. For some tests (e.g., liver enzymes), there was little variability among the students. But in others, there was quite a bit of diversity in results. For example, the blood glucose and insulin responses to an oral glucose tolerance test varied dramatically student to student.
Read More >>

New research in fight against childhood obesity

By Jamie I. Baum, PhD

The prevalence of obesity in the United States has more than doubled in adults and more than tripled in children and adolescents since the 1970s. Roughly one in three children ages 2-19 years is overweight or obese. Obese individuals have an increased risk of developing type 2 diabetes mellitus (T2DM), hypertension, and dyslipidemia. Once restricted to adults, these metabolic diseases are now being diagnosed in children. Increasing protein in the diet has been linked to improvements in glucose and insulin control, blood cholesterol, body composition, energy metabolism, as well as increased weight loss in adults. However, very little research has been focused on determining if increasing protein in the diet of school-aged children has comparable health benefits.
Read More >>

Low-carb training getting mileage with endurance athletes

By Dave Ellis, RD, CSCS

Training low” has nothing to do with altitude and everything to do with intentionally training with low glycogen stores to enhance fat metabolism. It is the latest craze for endurance athletes who seek to preserve glycogen stores by optimizing utilization of fat stores through an adaptive process during their training. This is typically accomplished by lowering carb feed rates to <3 g / kg / d for five days or more 1. Fat intake is increased to compensate for lower carb calories with the idea that intramuscular triglyceride stores go up along with enzymes necessary for fat oxidation.
Read More >>

Re-evaluating What Constitutes a Healthy Diet

The-Big-Fat-Surprise-209x300The ongoing, seemingly endless nutrition debate about what constitutes a healthy diet just got a little hotter. In recent weeks a new book entitled The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet [1] hit bookstore shelves, and was followed by an article in the current issue ofTime magazine called “Ending the War on Fat.” The primary message of both the book and the article is that the past fifty years or so of diet advice dispensed by various health agencies, and countless research studies performed on the diet/heart disease relationship, have been mostly flawed.  And before you discount these two recent sources as the work of lay authors, it should be pointed out that a couple of well-done, albeit controversial, meta analyses out of UC-Berkeley [2] andCambridge University [3] in England largely support the principal conclusions of the book and the Time article -that current evidence does not support low consumption of saturated fats or cholesterol as antidotes to cardiovascular disease (CVD).

How did this change in thinking come about, and where might it lead us in the future? Regarding the former, the realization that fifty years of dietary advice (that was mostly adhered to by a large segment of the population) suggesting we eat less red meat, fewer eggs and less dairy products has done little to limit the rate of CVD in the U.S. and that at the same time we were becoming more and more overweight and obese as a nation, has caused many health experts to re-evaluate the data on which these recommendations were based. And what this re-analysis indicates, among other things, is that the majority of the studies on which macronutrient intake recommendations are based were epidemiological studies, which are great for hypothesis generation but marginal for establishing cause-and-effect. Worse yet, information gleaned from some of these studies have been extrapolated or inferred to help create a story that may not exist. Both the aforementioned book and Time article tell the story of how some of the data from Ancel Keys’ well-known Seven Countries Study was apparently cherry-picked so that only data from countries that supported a saturated fat/CVD relationship were included in Keys’ analysis, and countries that did not fit this paradigm were excluded.

Another point worth noting is the possible unintended consequence of food substitution: if a person adheres to dietary advice suggesting less saturated fat and cholesterol consumption, what would he/she likely add into the diet to make up for the nutritional and caloric shortfall created by removing fats? The answer is, of course, carbohydrates. Primarily refined carbs and sugars. And newer research indicates that many of the consequences of a low fat/high refined carb diet – elevated triglycerides, decreased insulin sensitivity, more small, dense LDL particles, greater vascular inflammation, increased body weight, etc. may be the real culprits in elevated CVD risk. Ironic, isn’t it, that the foods once promoted as a healthier alternative to higher fat fare may turn out to be “the bad guys” after all?

Where will this new information lead? Still too early to tell. As any nutrition professional can tell you, diet research is fickle, and alternative hypotheses on what constitutes the healthiest diet will undoubtedly change many times in the future as new data become available. One thing that seems obvious is our need for more diet-based studies, and less single-nutrient research. When single nutrients are studied outside the context of the entire diet, misinterpretations are bound to occur. For example, dietary cholesterol as a part of a diet loaded with fruits and vegetables, whole grains, and various healthy fats and proteins may be largely innocuous; the same amount of cholesterol in a high calorie, high sugar and refined carb diet may be disease-promoting.

A healthy re-evaluation of the data on which we’ve based many of our dietary beliefs is certainly in order if we’re ever to move closer to understanding what constitutes a truly healthy diet.

 

References:

1.            Teicholz N: The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet.Simon & Schuster; 2014.

2.            Siri-Tarino PW, Sun Q, Hu FB, Krauss RM: Saturated fat, carbohydrate, and cardiovascular disease. The American Journal of Clinical Nutrition 2010, 91:502-509.

3.            Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, Franco OH, Butterworth AS, Forouhi NG, Thompson SG, et al: Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Annals of Internal Medicine2014, 160:398-406.