Obesity Flashcards
Drivers of Obesity
Sedentary lifestyle
Sleep disruption
Chronobiology (shift work)
Processed foods
Long-term high cortisol
Microbiome disruption
Genetic factors
Adipose tissue
Adipose tissue (AT) is a metabolically active organ which regulates whole body energy homeostasis.
* AT changes in quantity and distribution with age.
– White adipose tissue (WAT): Long term energy storage.
- Subcutaneous adipose tissue (SAT): Situated under the skin.
- Visceral adipose tissue (VAT): Intra abdominal.
– Brown adipose tissue (BAT): Abundant in early life.
– Beige white a dipose tissue: Similar actions to BAT.
* Adipocytes and other cells of adipose tissue produce lipids, steroids, inflammatory cytokines and peptide hormones (e.g., leptin).
* number and size of adipocytes = WAT expansion = obesity.
WAT
- Chronic energy imbalances with increased storage results in increased adipocyte numbers (hyperplasia) and size (hypertrophy).
- Hypertrophy is strongly associated with dyslipidaemia, IR, T2DM and NAFLD
- Hyperplasia tends to be associated with fewer serious health effects.
- Consider fasting as a starting point for all obese clients. Research for 800 kcal / day.
Leptin
Leptin is a ‘satiety’ hormone produced by adipocytes.
* Acts as a signalling factor from adipose tissue to the CNS, regulating food intake and energy expenditure.
* Released in a diurnal pattern.
Leptin resistance (LR)
Leptin resistance (LR) is a reduced sensitivity or failure in response of the brain to leptin.
* Leptin acts on the leptin receptor in the hypothalamus.
* In obesity, leptin levels are high but cannot function due to leptin resistance. Over time this leads to changes in metabolism, abdominal weight gain, chronic fatigue, sleep dysregulation, metabolic diseases. ↑ adipose tissue = ↑ leptin resistance.
Ghrelin
Ghrelin functions as an appetite stimulating signal.
* Plays a role in long term regulation of energy metabolism and the short term regulation of feeding increasing food intake and body weight.
*↑ before a meal and ↓ to lowest levels within 1 hour of eating.
* In obesity, we usually see ↓ ghrelin, but a reduction in body weight ↑ ghrelin
(hunger associated with dieting)
Adiponectin
Adiponectin is the most abundant circulating adipokine.
* Increases glucose uptake and β oxidation of fats. Increases insulin sensitivity. Anti inflammatory.
* Reduced adiponectin is associated with: IR, T2DM, obesity and CV disease. BMI and visceral fat are significant predictors of plasma adiponectin levels.
* A low adiponectin:leptin ratio (sign of dysfunctional adipose tissue) may increase oxidative stress and inflammation.
Boost adiponectin naturally
Consider the following reported to boost adiponectin levels naturally: Blueberries (anthocyanidins) and turmeric (curcumin) plus omega 3, 40 50 gm fibre per day, green tea (catechins), cold water therapy, and daily HIIT.
Insulin resistance: Causes and risk factors
- High oxidative stress, e.g., poor sleep, environmental toxins.
- Reduced physical activity
- Chronic stress
- Mitochondria dysfunction
- Poor methylation
- Dysbiosis
IR: Signs and symptoms
- Lethargy.
- Hunger.
- Brain fog.
- Overweight.
- ↑ waist to hip ratio.
- ↑ blood pressure
- ↑ cholesterol / ↑ triglycerides.
- ↑ blood glucose
- Acanthosis nigricans.
- Skin tags.
Naturopathic approach to IR
- Stabilise blood glucose levels
- Reduce inflammation
- Optimise insulin sensitivity
* Meal timing and frequency is key to ensure appropriate insulin and glucagon secretion.
‒ Time Restricted Feeding (TRF); elimination of snacks
‒ Eat last meal earlier in the evening then fast overnight.
* Increase moderate exercise ——↑ insulin sensitivity by acting directly on muscle metabolism.
* Vitamin D, magnesium, zinc, α lipoic acid, CoQ10, chromium, Gymnema sylvestre , cinnamon, bitter melon, fenugreek,
* Prebiotics inulin and FOS have been shown to modulate appetite, blood glucose and insulin levels.
Reducing Obesity
- Eating 3 meals a day with no snacking.
- Smaller portions
- Protein based breakfast
- Protein with each meal
- Keep meals simple
- Leave 4 hours + between meals.
- Chew food well
- Mindful eating
- Addressing micronutrient deficiencies
Stimulating fat loss: - Meal composition educate, e.g., low GL; macronutrient balance.
- Breakfast is vital and should include protein and only low GL carbs.
- Protein at each meal postprandial thermogenesis was increased 100% on a high protein / low fat diet vs. high carb / low fat diet.
- Exercise daily 35 minutes low intensity.
- Food diary and frequent practitioner contact.
Calorie restriction
Caloric restriction triggers several biological adaptations designed to prevent starvation:
*↓ leptin levels during weight loss signals to the brain feeding and ↓ energy expenditure.
* Pre-adipocyte proliferation occurs, fat storage capacity.
* Changes occur in the circulating levels of several gut hormones involved in the homeostatic regulation of body weight.
* These adaptations are often potent enough to undermine the long term benefits of lifestyle modification, particularly in an environment replete in highly calorific foods.
Obesity: Supplements
5- Hydroxy tryptophan (5- HTP)
Green Tea
L-Carnitine
Conugated linoleic acid (CLA)
Chromium
Gymnema sylvestre
Obesity: 5- Hydroxy tryptophan (5- HTP)
- 5-HTP can aid weight loss by increasing feelings of satiety
- Promotes sleep by enhancing melatonin production.
- Has free radical scavenging activities.
Dosage: 50-100 mg twice daily.
Start at lower dose build up to minimise possible nausea.
