Leptin, the little brother of Ghrelin

Okay, so yesterday I ranted about ghrelin and importance of enough sleep to make sure you ghrelin stays manageable.  Ghrelin is what lets you know that you are hungry.  Leptin is opposing force of ghrelin.  Sort of like a little brother, it is always in competition with ghrelin.  But leptin does oh so much more.  Years back I recall a study being done with mice that showed those mice who didn't produce enough leptin were obese, and almost overnight people were trying to figure out how to gives themselves some more to help with weight loss.  Here's what we are learning about leptin.  Leptin is a hormone produced in our fat cells (adipose) that signals the brain that we are satisfied.  Leptin tries to help us maintain a leaner figure.  So, the more fat cells we have, theoretically the more leptin we are producing and thus the more satisfied we should feel.  Leptin also sends out a signal when we are eating.  So ghrelin tells us we are hungry, we eat something, and leptin tells us we are satisfied.  Seems simple enough.  The problem comes when we eat too frequently and/or we have too much fat tissue.  It seems that putting out large amounts of leptin would help us to lose weight because we would constantly be telling that part of the brain that we are satified - this is why everyone was so excited when the research first came out with those obese mice.  The problem is that the satiety center of the brain gets tired of listening to leptin yelling at it, and it starts to desensitize.  I liken this to when my boys are screaming/whining about pretty much anything and I start to tune them out.  This doesn't stop the boys from doing it, and it doesn't stop leptin from doing it either but it does make it harder to sense that we are satisfied.  So you would think we could just overcome this by continuing to send the brain more signals.  But our body is a wonderfully, mysterious thing.  While leptin is screaming at our brain, it's also working to tell our pancreas that we don't need quite so much insulin.  After all, we need insulin to process any carbohydrate we just ate, and if we're telling the brain that we are satified, then theoretically there won't be more carbs coming in and thus there won't be a need for more insulin.  You would think this is harmless, however constantly telling our pancreas that we don't need more insulin just keeps it alert.  It would be like putting a pot on the stove instead of keeping it in the cupboard - it's ready to be used even though you haven't called upon it to heat something yet.  So when food does enter our system and needs insulin to allow for utilization of all that nice energy, our pancreas has been sitting there, chomping at the bit - ready for action!  At a moments notice, it overwhelms the system with a push of insulin in an attempt to drive that nice sugar (glucose from carbohydrate) into our cells.  Too bad all that fatty tissue around our bellies makes it harder for insulin to get the job done.  Ah well, we'll just produce some more insulin (hyperinsulinemia) to bring down our blood sugar (hyperglycemia) all the while telling leptin to respond more because we are really satisfied but having trouble sensing it.

Phew, I'm out of breath just thinking about it.  Our body really is miraculous in the ways it tries to keep us on track.  Too bad we are so pig-headed that we constantly feel the need to work against it.  So what does all this mumbo jumbo above mean?  In order for us to improve the sensitivity of our brain, we are going to have to cut down on some of that fatty tissue we carry around, and stop constantly encouraging our pancreas to pump out more insulin... in other words, how about a little exercise and maybe no snacking between meals??  Seriously, everytime you put food in your system you are activating this pathway - don't you think it could use a little down-time between meals?  And... stop looking for that quick fix.  I mean really, if you're looking for a quick way to satisfy that part of the brain that leptin works with, I've heard a little crack/cocaine will do the trick too (note, I do not advise use of crack/cocaine for dieting purposes, just maybe for a hard day at work - hahahaha, okay not for that either).

Miraculous Trick for Weight Loss

Got your attention, didn't I?  Do people really believe this crap?  I see advertisements for it everywhere so clearly someone is eating this stuff up.  I truly believe it was my frustration with patients and their intense desire for a quick fix that caused me to become burned out when I was still working full-time at the hospital.  They would come into my office for some diet education, but they weren't there to be educated, they wanted me to tell them the big secret.  That miracle food to eat... the secret exercise trick that could be done in 3 minutes without sweating or getting off the couch.  Couldn't I give them a pill?  They had, after all, tried "everything"!!  I mean why wasn't the weight coming off?  They were making at least 20 laps to the fridge every single night after eating dinner.  Doesn't that distance count for exercise?  Ooooh, I was right - some of my the bitterness still exists today.

So I would ask them what they ate on a typical day, and they would either lie to me, or be completely honest.  There was no in between.  Those that lied to me, were obviously smart enough to recognize what they were eating that I was going to tell them to modify, "I only eat a salad with light dressing for the whole day."??  Those that were completely honest had not yet come to understand how poor their choices were, and thus saw no issue with 3 ice cream sandwiches after their 16 ounce steak and loaded mashed potatoes.  So we would start talking about my recommendations, the first of which was always to avoid snacking between meals.  I would get looks of desperation.  What?  What did you say?  No snacking?  But the magazine I read at the grocery store said to eat 5-6 small meals and the lady on the cover has lost weight!  I believe I had one outpatient that actually followed this advice and reported back to me about it, because she had lost weight.  The rest were not strong enough to craft their meals to be satisfying nor could they avoid the temptation mid-morning and mid-afternoon.  Why no snacking?  Well, if we give our bodies and opportunity to use stored fat for energy... it will!  If we eat every time we have a little dip in our blood sugar, then it doesn't need to use the stored fat because you're shoveling more energy into your mouth.  Plus, we can only fit a certain amount of food in our bellies before we feel uncomfortable.  So if you filled up your stomach at your meal, the odds are you would be eating less total calories than if you ate some at your meal and then added in snacks. 

When did we become such weak individuals?  There are so many things that play into whether we gain, lose or maintain our weight.  Food and exercise are two of the primary things we do have some control over so why are we unable to make the right choices?  Why are we so quick to choose surgical procedures?  Liposuction?  Honestly, those that look at this as an option are typically too large to utilize this for the type of results they want.  You can only remove so much volume before you have major life-threatening issues.  Gastric bypass entered the scene a while back, and actually is a great option for those who were morbidly obese or with co-morbidities like Diabetes.  This has become one option that has improve life-expectancy and health for those patients - but not without huge lifestyle changes and occasional complications.  Gastric banding entered the scene afterwards. 

Now what is the difference?  Gastric bypass is cutting and stapling the stomach.  The intestine is then re-routed to a new outlet from the stomach.  The procedure creates a smaller stomach pouch, and also removes a portion of the small intestine from the digestion line.  It works because you can't eat as much at one time, and you have to think harder about eating methods and your food choices.  Eat too much?  You'll throw up.  Eat too much sugar?  It will dump from the stomach into the intestine and you'll start sweating and feel like you're going to pass out.  Manage your diet well?  You'll lose weight because you're eating less and you're missing that part of the intestine, thus causing some malabsorption.  Gastric banding?  Honestly, my least favorite.  Still a surgical procedure, where they essentially put a belt around your stomach.  Shrinks the available size of your stomach, but is completely reversible as no cuts are made.  No removal of part of the intestine, so no malabsorption.  With gastric banding, they have made it so you can't eat as much at one sitting, so weight loss occurs because you are eating less.  What?  What did I just say?  "Weight loss occurs because you are eating less."  Holy crap!  It's a miracle!  You are forced now, to eat less, and weight loss happens.  Imagine if we could toughen up and do it on our own?  Would we get the same results, without an expensive procedure?  YES!!!  What's the difference?  If you make the changes on your own, you'll stick to it.  If you have the procedure done yet don't make changes in your habits, you will lose weight initially, but the stapled stomach can stretch back out after a few years and the lap band can be removed, and then what are you going to do?

The rewards are sweeter when we toughen up and make those hard choices.  Is it a long road ahead of you.  Most definitely.  But so worth it.

Halloween Treats - The "Fun Size" Candy Bar

Ooooh, I love Halloween.  My pants don't, but for some reason I can convince myself that eating a dozen fun size snickers bars isn't really like eating a couple regular size ones.  I recently heard a story regarding the use of a small candy bar that is going to make it impossible for me to eat these in a couple months.  First let me throw out a little background nutrition information.  There is a growing incidence of Diabetes in this country.  Type 2 (previous called "adult onset") is expanding exponentially, to the point where adolescents are being diagnosed.  Type 2 diabetes is preceded by insulin resistance where if left unmanaged will lead to an individual's inability to maintain regular blood sugars.  The next step may be an attempt to manage it with changes in diet and exercise, but a large number of people are not identified early enough and often have to start taking oral medications immediately.  Some have let it progress too far, or the oral medications are no longer effective, and find themselves with daily insulin injections.  Okay, so for people who are maintaining their blood sugars with diet/exercise and/or oral medications the risk of running a low blood sugar is minimal, whereas those who take insulin injections need to be more careful and be sure to adjust insulin levels depending on what foods they are eating and when exercise is being done to avoid this.  Alright, enough with boring background crap.

So my friend tells me this story of 30-40 year old man who was told that since he has diabetes (we are assuming non-insulin dependent based upon his physical makeup and age) and is doing some extra exercise, he needs to be careful to avoid a low blood sugar.  In an attempt to prevent going into a diabetic coma (highly unlikely with non-insulin dependent diabetes) he must carry around with him a ziploc with a little tube of lube and a fun size candy bar.  He informed my friend's husband that if he passes out, they should turn him over and insert the candy bar into his colon.  ............  pffffft....  Excuse me a moment, I had to get a good laugh out again about this.  He was dead serious!!  He claimed his doctor had told him to follow this procedure.  My friend is going to school for nursing and had never heard of such a thing, but she wanted to see what my response was since I had worked with so many diabetics.  My initial response was to wonder why he needed the lube.  I mean really, if you're inserting a chocolate bar, like a Twix, won't the chocolate melt and become easy to insert?  Next I wondered who was going to step up and handle that particular task if this guy passed out.  And on top of that, was someone going to shove this tiny "fun size" treat all the way up to jejunum (small intestine)?  It wouldn't be as simple just popping it in his butt?  Your rectum doesn't do much, but put stuff out, and your colon (next up the line) isn't going to absorb carbohydrates.  Finally, if someone is passed out because of a low blood sugar, the first thing you want to get into their system is some pure high-octane sugar.  You don't want a candy bar because it has a nice combination of carbohydrate, protein and fat (which slows down the absorption rate of the sugar).

Take home message??  Sometimes your doctor might have a sense of humor and it helps if you do to!  Oh, and if you have diabetes and you want to carry around something in case your blood sugar runs low, how about some Gluco-Tabs or Glucose Gel packs - not a sandwich baggie with a Milky Way and lube.