BIO SCI 35 Lecture Notes - Lecture 22: Ghrelin, Disordered Eating, Dieting

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24 Feb 2018

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But when you avoid your favorite foods, you start to crave them. And no specific diet has been shown to be more effective than any other, in the long term. But when you eat less, your body reduces its _metabolism_ The most reliable way to gain weight is to go on a _diet_ // dieting often leads to weight gain. Abnormal pattern of _food intake_ in the overweight/obese. People respond to restrictive diets, missing meals, or rapid meal consumption by failing to experience satiety and therefore they remain very hungry. They rarely feel satiated and they therefore continue to feel hungry, eat, and gain weight. Satiation occurs when the gut hormone pyy goes up and ghrelin goes down. These hormone levels start to change 12-15 min into the meal. Obese individuals eat too quickly to feel satiated. Normalizing eating rate increases pyy and decreases ghrelin to terminate meals.

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Based on âMorgan: A case of Diabetesâ by Lisa Rubin and Clyde Freeman Herreid (National Center for Case Study Teaching in Science)

The Patient:

Morgan Water is a 27-year old Native American that lives on a reservation in Oklahoma. Nearly Â¼ of Morganâs tribe has diabetes but she has no direct family history of diabetes, heart disease, or other serious conditions. She is however obese (BMI = 32) and leads a sedentary lifestyle. Morgan has been suffering from an increasing persistence of symptoms including unusual thirst, dizziness, blurred vision, and numbness in her right foot. The symptoms have been developing over several months but as she is planning her wedding she attributed them to nerves. She is finally persuaded to see her family doctor. Her non-fasting blood glucose level was elevated so the doctor has her return the next morning for a fasting blood sample so they could more accurately measure her blood glucose and insulin. Her blood results are below:

Test	Morganâs values	Normal range	Pre-Diabetic range	Diabetic range
Plasma glucose, mg/dl	260	70 -139	140 - 199	â¥ 200
Fasting glucose, mg/dl	140	â¤ 99	100 - 125	â¥ 126
A1C, %	7.6	~ 5	5.7 â 6.4	â¥ 6.5
Fasting Insulin, mIU/ml	34	2 - 10	10 - 20	â¥ 20

The recommendation of Morganâs doctor was to improve her exercise, good nutrition, and weight loss. He recommends meeting with a nutritionist to assist Morgan in her weight loss goals. When Morgan got home and told her family the diagnosis they however had LOTS of suggestions on how she can lose weight. Below is a description of the advice given to her by three family members.

Best friend Savannah:

âYou know how Iâve been losing weight? Well, Iâve been on the Atkinsâ Diet. I heard about it on TV. Itâs great! You get to eat steak, chicken wings, and all the good stuff. All you have to do is limit carbohydrate intake. You should definitely give it a try. This diet has been around for years and it has worked for lots of people, including me.â

*Note: Atkinâs Diet recommends: 10% carbohydrates, 55% fats, 35% protein

Brother Alan:

âI think the best thing for you to do is exercise and stop eating all of that pizza and candy and food filled with fat. Our people never used to eat that junk. I say eat meals that are nutritionally balanced and high in fiber and low in refined sugars and saturated fats. And run a lot. Stop sitting around the house.â

Grandfather:

âMorgan, it is true that it is best to live in harmony and balance â to eat a nutritionally balanced diet that includes carbohydrates, proteins, and âgoodâ fats to meet your bodyâs needs. That is good. But look to your heritage. Our people were never overweight before we started eating âcivilizedâ food. Look to our native diet. I think you should look to traditional herbal remedies for help. What Alan says is true. Exercise is good. But it is sometimes not enough. Our people have always looked to natural medicine for cures. They will lift your spirits and energize you. Then you will lose weight and you will be healthy again. I hear the herbs from the diet shop are safe and good. But you must take them like the medicine label says. It canât hurt to try them.â

*Note: these herbal supplements Morganâs grandfather is recommending contain the herb

ephedra (ephedrine).

Question 5:

Given Morganâs metabolic state, what is the primary fuel source for her cells currently?

A. Carbohydrates (glucose)

B. Fats

C. Proteins

D. It is a balance of all three

Question 6:

Metabolic ketoacidosis is a common problem with diabetics, which is caused by which of the following?

A. Excessive oxidation of fatty acids, leading to an accumulation of ketone bodies in the blood.

B. Excessive oxidation of glucose, leading to an accumulation of ketone bodies in the blood.

C. Excessive oxidation of proteins, leading to an accumulation of ammonia in the blood.

D. Hyperglycemia.

Question 7:

Which weight loss suggestion is designed to achieve some level of ketosis?

A. Atkins Diet

B. Exercise

C. High fiber diet

D. Herbal treatments

Question 8:

One major side effect of the herbal supplement can be hot flashes and increased perspiration due to increased thermogenesis, what is the likely cause of the heat production?

A. Increasing the activity of phosphfructokinase-1.

B. Increasing the activity of the pyruvate dehydrogenase complex.

C. Increasing the activity of citrate synthase.

D. Increasing the activity of uncoupling proteins.

Question 9:

Would substituting fiber and complex carbohydrates (larger % cellulose) for the simple sugars and starches (high sucrose and amylose/amylopectin) help Morgan lose weight, why?

A. Yes, because complex carbohydrates like cellulose are largely indigestible so they pass through

the digestive tract without being absorbed.

B. Yes, cellulose contains less glucose residues than amylose or amylopectin.

C. Yes, because the fructose in sucrose is much more responsible for weight gain than the glucose.

D. No, because cellulose, amylose, and amylopectin are all composed of glucose so it doesnât

matter.

Question 10:

Which weight loss suggestion will lead to an increased need for gluconeogenesis?

A. Atkins Diet

B. Exercise

C. High fiber diet

D. Herbal treatments

1. How does prenatal body weight influence theamount of weight a woman should gain during pregnancy?

2. At what week of gestation does the embryonicperiod begin? When does the fetal period begin? When is the mostlikely time a teratogen can do the most damage, during theembryonic or fetal period?

3. What risks are there to a baby if the mothergains too little weight during the pregnancy? What risks are thereto a baby if the mother gains too much weight during thepregnancy?

4. What is the relationship between mercury,fish and pregnancy?

5. What are some of the common gastrointestinaldistresses pregnant women experience? What remedies are availableto manage them?

6. What is fetal alcohol syndrome? How can itbe prevented? When can it be most accurately diagnosed?

7. How does the MyPlate food guidance systemsupport a healthy pregnancy?

8. Why is a prenatal dietary supplementrecommended throughout pregnancy?

9. What benefits are there to exercising duringpregnancy? How should exercise be modified during eachtrimester?

10. What is one of the best ways to trackgrowth in children? What are you looking for when you trackgrowth?

11. What benefits to the infant are provided bybreastfeeding?

12. What benefits to the mother are provided bybreastfeeding?

13. What nutrients are vital for supportingdental health in infants and children?

14. Although breast milk has advantages overformula, breastfeeding not recommend if the nursing mother haswhich conditions?

15. At what age is it safe to switch fromformula or breast milk to cowâs milk?

16. Which solid foods should be introducedfirst and at what age and why: cereals, vegetables, andfruits?

17. Do infants have the same AMDRs as adults?If not, how are they different? Is the grams/kg body weight forprotein higher or lower for an infant compared to a teenager oradult?

18. Does eating sugary foods lead tohyperactivity in children? If not, what does?

19. What is the division of responsibilitybetween caregivers and children for feeding?

20. How would you outline a healthy dailyschedule and meal/snack pattern to follow for a preschooler and aschool-aged child?

21. Can the MyPlate tool support childhoodnutrition? How? What other tools can be used?

22. What are the consequences of obesity inchildhood? How can childhood obesity be prevented?

23. How can food allergies be prevented andmanaged in childhood?

24. The rapid weight gains that girlsexperience during adolescence begin at what ages? Forboys?

25. Are the AMDR guidelines for adults the sameas for teenagers? What are these guidelines? (Percent calories fromfat? Carbohydrate? Protein?)

26. Why are calcium and iron the most importantminerals for teenagers? Does gender make a difference?

27. If teens are overweight and it isunrealistic to believe they will grow into their current weight?What rate of weight loss is recommended in terms of pound(s) perweek?

28. Describe the typical diets of teens thatsmoke?

29. What is the nutritional consequence alcoholfor teens?

30. Adolescences should be physically activefor how many minutes/day?

31. How does body composition change over theyears? Is there anything one can do to affect this change?

32. Does Basal metabolic rate increase ordecrease with age? Why? Will the elderly need more or fewercalories per kilo body weight than those who are middleaged?

33. Do the elderly need more or less fluid percalorie intake than younger adults? Why?

34. If an elderly person has osteoporosis, canhe or she do anything to improve this condition?

35. How can a poverty-stricken older adult beassured of eating healthy meals on a regular basis?

36. Why is exercise important for theelderly?

37. How many calories are there in a gram ofalcohol? Why does consuming 2 alcoholic drinks in a man has thesame physiological affect as one drink for a woman?

38. What practices will decrease the rate ofalcohol absorption into the blood?

39. Define moderate alcohol intake in terms ofdrinks per day for men and women and say how it relates to HDLcholesterol.

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BIO SCI 35 Lecture Notes - Lecture 22: Ghrelin, Disordered Eating, Dieting

BIO SCI 35 Full Course Notes

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