Certain foods have fat-promoting actions, causing changes in hormones and metabolic activities that increase the risk for fat accumulation and obesity; whereas, other foods have fat-fighting actions. Fat-promoting foods, if avoided and replaced with items that reduce the risk for fat accumulation, would help to maximize weight loss success and long-term maintenance post-surgery. Over the next several issues of the Silhouette, the research section will examine foods that promote fat and those that may help to reduce the risk for obesity. The first of this series of articles discusses why processed grains increase the risk for obesity and why, calorie for calorie, processed grains are so much more fattening than whole grains. 

Whole Grains vs. Processed Gains
Do you know the difference between the terms ‘whole grain’ and ‘processed grain’? A whole grain is the seed of the plant and consists of 3 major components. The first of these is the bran or outer layer of the seed, which is high in fiber, vitamins, minerals, and phytonutrients. The center of the seed is the germ and it, too, is high in vitamins, minerals, as well as protein and fat. The third part of the seed is the kernel and consists primarily of carbohydrate. Whole grains, then, contain all the components of the plant seed, along with its high fiber content and nutrients.

Refined or milled grains are those that have had the bran and germ removed through high-heat roller mills. Such processing removes the nutrient and fiber content of the grain, leaving behind the carbohydrate kernel. The advantage to refining or milling is to increase the shelf life of the product. Processed grains vs. whole grains have a much longer shelf life and are resistant to pests, such as rodents who prefer to eat the nutritious parts of the grain. To increase the nutrient value of the processed grains, manufacturers ‘enrich’ or, in other words, add back to the refined grain some but not all of the lost vitamins. Until recently, most grain products in the grocery market were processed or refined including bread and baked goods, cereals, crackers, and rice products. 

Calorie-for-calorie processed grains are more fattening than are whole grains and for several reasons. First, processed grains contain mainly carbohydrate and, when consumed, are rapidly absorbed, resulting in an increase in blood sugar. The rise in blood sugar results in a concomitant increase in the production of insulin, the hormone that regulates sugar in the body. Insulin lowers blood sugar levels by promoting the uptake of sugar into tissues and by stimulating its metabolism or storage. However, insulin can also increase body fat. 

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Why Taking Your Vitamins May Also Help to Prevent Weight Regain
By Cynthia K. Buffington, Ph.D.

Micronutrient ‘repletion’, the state of fulfilling your body’s vitamin and mineral requirements through a wholesome diet and/or supplementation, may help to maximize weight loss success and maintenance. Vitamins and minerals are essential factors and co-factors for numerous biological processes that regulate body size, including appetite, hunger, nutrient absorption, metabolic rate, fat and sugar metabolism, thyroid and adrenal function, energy storage, insulin action and blood sugar levels, neural activities and much more. Thus, micronutrient ‘repletion’ is likely to be essential for maximal weight loss success and long-term weight maintenance.
 
According to a recent study1, a ‘micronutrient replete’ diet, even one that is not low in calories, induces weight loss.   In the study, a group of obese females were required to eat prepared meals that were complete in all the necessary vitamins and minerals. The study participants could eat additional foods only if they had consumed all of the food provided which, by the way, averaged 2100 calories. The data showed that such a diet, although not low in calories, was capable of inducing significant weight loss, particularly in the abdominal region of the body where fat accumulation is most significantly related to the development of diseases, i.e. diabetes, hypertension, heart disease, liver disease, and more.
 

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Morbid obesity affects approximately 9 million Americans and it is on the rise and an increasing problem for our society. It negatively affects those that suffer from it medically, emotionally and even socioeconomically. If you are over 100 pounds overweight or have a BMI (body mass index) of over 40, you are considered morbidly obese. The chances of premature death are quite high in comparison to those at normal weight. This has been shown to be the case statistically, but it is also a logical outcome of its association with so many medical conditions. If there is any good news here, it is that effective treatment for a morbidly obese person can lessen these risks dramatically.

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Another recent news story on the potential for a new experimental surgery to cure type 2 diabetes. Please feel free to share your comments on this article courtesy of ABC News.

Be well,
The Focus28 Team

_______________________

A Surgical Cure for Diabetes?

Doctors Think Cutting Off Part of the Small Intestine May Regulate Blood Sugar

By JUJU CHANG, TRACEY MARX and IMAEYEN IBANGA

April 13, 2008 —

A new, experimental surgery could make type 2 diabetes disappear in some patients. While doctors have refrained from calling it a cure, some believe a duodenal jejunal bypass may be the first step in finding a surgical solution to the country’s diabetic epidemic.

“We have started the ball rolling as far as surgical treatment of diabetes, and I think [it’s] going to pick up speed,” said Dr. Mahdu Rangraj of Sound Shore Medical Center in New Rochelle, N.Y.

Rangraj and Dr. Leonard Maffucci performed the surgical procedure as a part of a clinical trail on type 2 diabetes patient Rocco Turso.

For more than six years, Turso couldn’t go anywhere without a lot of medicine to treat his condition, which included three insulin shots daily and digesting several pills. Still, his condition continued to worsen.

“I could see my vision was getting a little blurry. I saw in my feet that my toenails, some got a little bit yellow,” he said. “The diabetes was winning, not me.”

Turso fought back by becoming the first man in America to undergo the surgery for diabetes.

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Since the Focus28 office lines have been ablaze with phone calls over the last week relating to the recent publicity relating to the potential of obesity surgery being a potential cure for diabetes we felt it was most appropriate to reference an article published earlier this year by the Associated Press relating to the subject.

Obviously this news is monumental and could change the lives of many of those who have been battling both obesity and diabetes for years. Please stay tuned as we continue to report the latest news on the Focus28 expert blog and remember - everyday is a journey and is worth celebrating.

Be well,
The Focus28 team

Obesity surgery seen as potential diabetes cure

CHICAGO, Illinois (AP) — A small new study gives the strongest evidence yet that obesity surgery can cure diabetes.

Obesity is a major risk factor for diabetes; rates for both are climbing.

 Patients who had surgery to reduce the size of their stomachs were five times more likely to see their diabetes disappear over the next two years than were patients who had standard diabetes care, according to Australian researchers.

Most of the surgery patients were able to stop taking diabetes drugs and achieve normal blood tests.

“It’s the best therapy for diabetes that we have today, and it’s very low risk,” said Dr. John Dixon of Monash University Medical School in Melbourne, Australia, lead author of the study, which involved 55 patients.

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The omega 3 fatty acids are a family of essential fatty acids that are necessary for life and health (for review see references 1, 2).  The omega 3 family includes: 1) ALA (alpha-linolenic acid) found in flax, canola oil, soy, walnuts and other nuts, and 2) DHA (docosahexanoic acid) and EPA (eicosapentanoic acid) found primarily in fatty fish (fish oil) and breast milk. All three fatty acids have important health benefits but DHA and EPA are believed to be the most biologically active.
 
Recent studies suggest that the omega 3s, particularly DHA and EPA, have anti-obesity actions3-14. In animals, weight gain and fat accumulation caused by high fat diets are significantly reduced with DHA and EPA7-8, and, in humans, an inverse relationship exists between body size and the omega 3 fatty acids9. The omega 3s may protect against obesity by reducing the body’s capacity to store fat, by increasing fat utilization, and by reducing appetite 3-14.
 
The omega 3 fatty reduce blood lipid levels3-6 (triglyceride and fatty acids) so that less fat is available in the circulating blood to be taken up by and stored in adipose tissue. In addition to lowering lipids in the blood, omega 3s also reduce insulin levels4,5. Insulin increases fat uptake and prevents its breakdown. A decrease in insulin would, therefore, reduce the capacity for adipose tissue to accumulate fat.

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Obesity is a progressive disease, in part, because weight gain increases the body’s capacity for fat accumulation and reduces its ability to utilize fat. A diet high in fat, sugar and processed grains, further exacerbate these conditions. Regular aerobic exercise, as well as daily consumption of fiber (fruits, vegetables, legumes, whole grains, nuts), dairy or calcium-rich foods, and sufficient amounts of omega 3 fatty acids in appropriate proportion to omega 6, may help to counteract these obesity-promoting changes in fat metabolism.
 
In addition to anti-obesity foods, certain teas, such as green tea, oolong, and black tea, may be effective in correcting those defects in fat handling that cause obesity progression or weight regain. Caffeine is one of the ingredients in teas that is believed to have anti-obesity actions1-3.   Caffeine stimulates the sympathetic nervous system and enhances its actions, causing fat breakdown in adipose tissue and increasing fat oxidation and total energy expenditure (calories burned).

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How many meals do you eat in a day? 1 large meal? 2 large meals? 5 or more small meals?   Studies have found an inverse relationship between the number of meals a person eats in a day and the prevalence of obesity 1-4. People who eat a number of small meals throughout the day, i.e. those who are ‘nibblers’, are less likely to become obese than are ‘gorgers’ who eat far less frequently but consume large amounts of food at the meal.
 
Weight maintenance after a diet also seems to be affected by the number of meals a person eats. The National Weight Control Registry (NWCR) consists of individuals who have lost at least 60 pounds and have been able to keep their weight off for 6 years or longer.   NWCR members are being studied to determine what weight control behaviors they have that help them to maintain their weight loss5.   An increase in meal frequency is one of these weight control behaviors. NWCR members that are most successful in maintaining their weight loss consume 5 or more small meals throughout the day (including breakfast) instead of 3 or fewer large meals.   

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Do you take your calcium supplements daily?   Do you eat your yogurt, cheese or drink your milk regularly? Calcium deficiencies may readily occur in individuals not taking daily calcium supplements following bariatric surgery. Studies have reported signs of calcium deficits for periods of one to two years1-2 following the adjustable gastric band and for a number of years after Roux-en-Y gastric bypass, the duodenal switch, or the biliopancreatic diversion3-5.
 
An intake of appropriate amounts of calcium is important following surgery to help reduce bone loss, prevent teeth from becoming brittle, and lower the risk for heart disease, hypertension and colon cancer. Calcium is also necessary for muscle contractility, including that of the heart, nerve conductance, and the actions of numerous hormones and enzymes. In addition, dietary calcium is believed to play a role in the regulation of body size. Low dietary calcium intake increases the risk for weight gain; and high dietary calcium, particularly from dairy foods, cause favorable changes in body composition (less body fat and more lean tissue) and fat distribution (preferential reduction of abdominal fat) 6-8

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A chronic state of sleep loss is believed to be one of a multitude of factors responsible for the alarming rise in obesity prevalence that has been occurring over the last several decades. According to the Center for Disease Control, this rise in obesity prevalence has been mirrored by a decline in sleep duration(see reference 1 for review).    A generation ago, Americans slept for 8 to 9 hours per night2. By the mid-1990’s, however, sleep duration had declined to 7 hours or less3. More recent data (2004) show that a substantial number of Americans are now sleeping for 6 hours or less each day4.

Epidemiological studies from the U.S. and other countries find negative associations between sleep duration and overweight1,5-14. According to these studies, the lowest risk for obesity in adults occurs with a sleep duration of 7 to 8 hours. Periods of sleep that are less than 7 hours, however, are inversely related to body size. In other words, the shorter the duration of sleep, the higher would be a person’s body mass index and their accumulation of body fat. One study reported a 2.8% increase in body fat for each hour of sleep that is less than 7 hours per night14.  Two additional long-term studies15-16 found that individuals who obtain the least amount of sleep are those who gain the most weight over time.

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