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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ENC at FNCE 2014

 Almost a month has passed since the 2014 Academy of Nutrition & Dietetics’ Food & Nutrition Conference & Expo (FNCE®), the world’s largest gathering of registered dietitian nutritionists (RDNs), held on October 18-21 in Atlanta, GA, and the month after gives practitioners time to digest what they’ve learned and put it into practice. As a registered dietitian nutritionist, I enjoyed seeing the emerging science, food, and practice come together, helping practitioners to think outside the box and coming away with evidence-based, yet practical tips for their clients.

ENC team members had the opportunity to share credible science and practical nutrition solutions with members of the Academy by sponsoring the Weight Management Dietetic Practice Group (WM DPG) member breakfast, featuring an educational session and a breakfast for WM DPG members and other invited DPGs including Healthy Aging, Diabetes Care and Education, Nutrition Education for the Public, Women’s Health and Medical Nutrition Practice Group. The educational session featured a presentation on the “Strategic Use of Protein Quality and Quantity to Enhance Satiety and Weight Management,” by Nikhil Dhurandhar, PhD, Professor at Pennington Biomedical Research Center and President-Elect of The Obesity Society.

Dr. Dhurandhar provided an overview of a series of studies that have testing the satiating properties of a number of different protein sources under acute conditions, and suggest a distinct satiating property of high-quality protein sources, such as eggs, that may promote body weight management. Aimed at providing advice on how to help their clients manage weight effectively with protein, Dr. Dhurandhar reminded the audience that obesity is not caused by just eating one big meal, nor is it combatted by just one small meal, and that long term voluntary control of food intake to treat or prevent obesity is highly challenging. Thus, one strategy may be to harness the satiating properties of foods, particularly protein.

Current evidence shows that that the satiating effect of proteins can be maximized by including protein as part of a reduced-energy diet for weight loss.1 Including a high-quality protein source at the breakfast meal may promote satiety during the day, increase dietary adherence, and enhance weight loss.2,3 His current evidence suggests that the quality of the protein may enhance its satiating effect without a significant increase in the amount of food/calories consumed. In addition, his studies have demonstrated that a breakfast containing eggs may enhance weight loss by prolonging satiety, decreasing energy intake and reducing body weight and waist circumference.4-6

FNCE-placemat

To help attendees translate the science provided by Dr. Dhurandhar, we created a handout summarizing the session.

See everyone next year in Nashville, TN.

 
 

 
 
References

  1. Layman DK. Protein quantity and quality at levels above RDA improves adult weight loss. J Am Coll Nutr 2004; 23(6):631S-636S.
  2. Layman DK. Dietary Guidelines should reflect new understandings about adult protein needs. Nutr Metab (Lond). 2009 Mar 13;6:12. doi: 10.1186/1743-7075-6-12.
  3. Leidy HJ, Ortinau LC, Douglas SM, Hoertel HA. Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast-skipping,” late-adolescent girls. Am J Clin Nutr. 2013 Apr;97(4):677-88.
  4. Vander Wal JS, Marth JM, Khosla P, Jen KL, Dhurandhar NV. Short-term effect of eggs on satiety in overweight and obese subjects. J Am Coll Nutr. 2005;24(6):510-5.
  5. Vander Wal JS, Gupta A, Khosla P, Dhurandhar NV. Egg breakfast enhances weight loss. Int J Obes (Lond). 2008;32(10):1545-51.
  6. Bayham BE, Greenway FL, Johnson WD, Dhurandhar NV. A randomized trial to manipulate the quality instead of quantity of dietary proteins to influence the markers of satiety. J Diabetes Complications. 2014; E-pub ahead of print.

Complexity of Individual Variability in Nutrition

close-up-summer-2014-tnToday’s post comes from the Summer Issue of the Nutrition Close-Up, ENC’s newsletter that provides information on current nutrition and research trends and upcoming presentations. Please visit eggnutritioncenter.org to access the current and previous issues of the Nutrition Close-Up.

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. The athletic students in the class barely saw much rise in glucose, whereas several of the overweight students saw a dip in glucose below baseline in the late postprandial period (often called reactive hypoglycemia).

In conducting human nutrition intervention trials, I have gained an even greater appreciation for the inter-individual variability that occurs in response to diet and lifestyle interventions. However, this variability is often overlooked or unexplored. Mots scientific papers only report means for the subject population. The standard deviation of the mean can provide some insight into the variance of the dataset, but it does not provide descriptive information, such as the percent of the subject population that responded to a particular treatment. Yet in some cases, inter-individual variability may be important to our understanding of human health.

For example, there is a growing appreciation for understanding inter-individual variability with respect to achieving and maintaining an optimal body weight (i.e., specific genes, environmental factors, epigenetic effects, etc.). McClain et al. recently reported that women with insulin resistance were less successful in adhering to a low-fat weight loss diet and therefore, less likely to lose weight compared to those following a low-carbohydrate diet (1). The investigators hypothesize that higher carbohydrate intakes as part of a low-fat diet negatively influence glucose homeostasis, leading to greater levels of hunger. In an environment where highly palatable food is pervasive, it is easy to quell hunger the minute the urge strikes, compromising diet adherence.

In recent years, the gut microbiome has emerged as another factor that influences responses to diet and lifestyle factors, likely contributing to inter-individual variability in nutrition studies. There is a growing body of evidence that the diversity of bacteria within the gut microbiome is particularly important (2). For example, Santacruz et al. showed greater weight loss in a subset of individuals who showed more marked alterations in the diversity of gut microbiota in response to a calorie-restricted diet (3). Whether there are specific diet-microbiome relationships that further influence weight loss, as well as alter other aspects of physiology, remains to be determined. But based on the research to date, it seems highly likely that we are only beginning to understand the complex set of factors that not only make us who we are, but influence our responses to our environment, including diet.

If there is a theme in this issue of Nutrition Close-Up, it is this concept of “one size does not fit all” when it comes to nutrition. Differences between people, whether on a macro level (e.g., age, race, athletic status, dietary preferences, culture, etc.) or micro level (e.g., genetics, diversity of the gut microbiota, etc.), influence responses to diet. Given the increasing complexity of such differences, it may be decades before research provides solutions to prevent and manage chronic disease. In the near term, keeping abreast and appreciating such differences may be the best we can do.

 

References:

  1. McClain AD, Otten JJ, Hekler EB, Gardner CD. Adherence to a low-fat vs. low-carbohydrate diet differs by insulin resistance status. Diabetes Obes Metab. 2013; 15:87-90.
  2. Erejuwa OO, Sulaiman SA, Ab Wahab MS. Modulation of gut microbiota in the management of metabolic disorders: the prospects and challenges. Int J Mol Sci. 2014; 15:4158-88.
  3. Santacruz A, Marcos A, Warnberg J, Marti A, Martin-Matilas M, Campoy C, Moreno LA, Veiga O, Redondo-Figuero C, Garagorri JM, Azcona C, Delgado M, Garcia-Fuentes M, Collado MC, Sanz Y; EVASYON Study Group. Interplay between weight loss and gut microbiota composition in overweight adolescents. Obesity (Silver Spring). 2009; 17:1906-15.

Two Things You Didn’t Know About Dietary Protein

T-Rains-headshotAfter years of standing in the shadows of carbohydrate and fat research, there’s been an influx of publications in recent years on the benefits of dietary protein. Much of this new science has focused on satiety and preservation of lean mass and how these characteristics facilitate weight loss. Protein, particularly at the expense of carbohydrate, has also been consistently shown to reduce risk for high blood pressure.1 But researchers have now begun exploring the impact of protein on endpoints beyond body composition, weight management, and vascular health, revealing some new and interesting benefits of dietary protein.

Researchers at the University of Missouri recently published results from a randomized, controlled crossover study which compared appetite, satiety, and evening snacking in adolescent girls who consumed either a normal-protein breakfast (13 g), high-protein breakfast (35g), or no breakfast.  Results of the primary outcomes were published last year, and showed that the high-protein breakfast elicited greater feelings of fullness than the normal-protein breakfast.  Further, only the high protein breakfast reduced evening snacking of high-fat foods, a finding that had not been previously explored.2

In late August, Hoertel and collaborators published additional findings from this main study, evaluating food cravings and homovanillic acid (HVA), a metabolite of dopamine.3 [Dopamine is a neurotransmitter associated with motivation, reward, and well-being.  Because dopamine is unable to leave the brain, HVA is typically measured as a surrogate since it correlates with dopamine activity in the brain.]

Results showed that while both the normal- and high-protein breakfasts reduced cravings for savory foods compared to no breakfast, the response was much greater for the high protein breakfast.  In addition, levels of HVA were higher for the high-protein breakfast, suggesting that participants found the higher protein breakfast more rewarding.  How it produces this effect remains to be determined.  One hypothesis presented by the investigators is that increased protein leads to higher concentrations of the amino acid, tyrosine, a precursor to dopamine.  Additional research is needed to better understand the mechanisms involved.

The bottom line is that the benefits of a protein-rich meal for breakfast may extend beyond fullness, impacting food cravings later in the day and substances in the brain that promote feelings of well-being.  Only time will tell what other benefits of protein remain to be discovered.

References:

  1. Buendia JR, Bradlee ML, Singer MR, Moore LL. Diets Higher in Protein Predict Lower High Blood Pressure Risk in Framingham Offspring Study Adults. Am J Hypertens. 2014 Sep 6. [Epub ahead of print]
  2. Leidy HJ, Ortinau LC, Douglas SM, Hoertel HA. Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast-skipping,” late-adolescent girls. Am J Clin Nutr. 2013 Apr;97(4):677-88.
  3. Hoertel HA, Will MJ, Leidy HJ. A randomized crossover, pilot study examining the effects of a normal protein vs. high protein breakfast on food cravings and reward signals in overweight/obese “breakfast skipping”, late-adolescent girls. Nutr J. 2014 Aug 6;13:80.

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.