Lecture given by me and Dr Jason Gruss at the Elk Grove Library in May 2011

1. Eat to be FIT,not FULL Dr. Jason Gruss, M.D. Dr. RicSaguil, M.D. Spring 2011 We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

3. Cares what I have to say

4. Doesn’t Keep Me Waiting

5. Gives Me OptionsWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

6. The First Health Approach We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

7. Your Community of Care Ric Saguil, MD Jason Gruss, MD Tom Jordan, RD Katrina Christie, LCPC Jennifer Green, ND Joe Musolino, DC Amy Iaquinta, DC Nick Nowicki, DC Emery Paredes, PT Courtney Day, EP Yu Zhu, MD China Mike Blumberg, LCPC You

8. Today’s Goals Learn what hunger is Discuss what ‘BEING FULL’ means Explore what SATIETY is, and how that is DIFFERENT than ‘FULLNESS’ Learn how to be SATISFIED, without stretching your stomach and packing on Calories

9. Before we begin . . . Look around The room The village The airport The country The world? 2/3 of the US is either Obese or overweight. That number is GROWING! Since 2006 Obesity is the #1 cause of preventable death Ahead of cigarettes

10. Obesity is a Disease There is NO CURE No pill / surgery / magic potion will take away obesity There is SUCCESSFUL TREATMENT The treatment is creating a healthy life, through whatever means YOU need Everybody is different, not all the tips work for everybody Take whatever tips work for YOU! Ask for help if you need it

11. What is Hunger? Physiological Response (Survival mechanism) Secondary Responses: Psychological Response coping mechanism It is easier to EAT than it is to admit you have a problem Stress Response? Ever eat when you are: Bored? Procrastinating? Nervous?

12. The Hormonal Tsunami Break down of the physiologic response: Stress Response- fight or flight Hans Selye 1975 Relaxation Response- eat or reproduce Herb Benson, MD 1975

13. Epinephrine, adrenaline, cortisol increased in stressful, dangerous environment Prolactin, oxytocin, NPY all increased in relaxed, protected environments. Stress/Relaxation = Sympathetic/Parasympathetic

14. Godzilla VS Ghandi

15. Why can’t we just co-exist? Athletes. In a state of relaxation response but … can turn on an abnormally high stress response

16. Know Your Enemy Sun Tzu To keep the herd alive; Starvation mode=Stress response Hunger will start the hormonal cascade Hunger/Stress

17. What Causes Hunger? Low Blood Sugar Erratic Blood Sugar Binge eating Fasting Stress Fatigue Lack of sleep Emotional/Physical Binge Eating (Holiday Meals) Junk Food Diet Dehydration Stress/Emotions

18. What Causes Fullness? Stomach Distension FULLNESS can happen as fast as you can eat

19. What Causes Satiety? Smell/taste Conscious eating Environmental cues Satiety cannot be rushed The brain works slower

20. Satiety Strategies Avoid Distraction Disrupts brain-to-stomach satiation signals No eating at Car…. TV…. Reading…. Conscious eating Goal: satisfaction not fullness The brain is our most powerful tool, if we use it!

21. Stress is a Distraction Kathy 204# Cholesterol: 245 Kathy 141# (in the 120s today) Cholesterol:191 Weeks 1-4: 3 Pounds Lost (0.75# per week) INTERVENTION: counseling to address stress Weeks 5-28: 48 Pounds Lost (2# per week)

22. Satiety Strategies 2) Pack in the Protein Solid food Soups ok, but not beverages Stimulate CCK slow gastric emptying FEEL full longer Prevent Glucose Spikes Prevents the body from going into STORAGE MODE Prevent nutrient deficiencies (B1, B12, Fe…) Your body will have cravings for what it’s missing, but your brain will just get the signal to EAT Provides Amino Acids (building blocks) ‘Dieters’ lose fat AND muscle, eating more protein helps save the muscle and lose more FAT

23. Satiety Strategies 3) Fill Up on Fiber 6g Soluble Fiber has the same satiating effect of 260 calories (ADA study 2009) Refined Carbs=Satiety killers (insulin spike blood sugar crash  store the excess Cal as fat) Whole Grain Carbs ‘100% whole grain’ 25-35g Fiber Per day Eat more often, avoid hunger by having 3 meals and 2 snacks a day But avoid eating more than 600 Cal at any one sitting Goal is 400 for a meal and 100-200 for a snack

24. Protein and Fiber for Satiety Bill 254# Triglycerides: 338 Bill 189# Triglycerides:68 Bill’s Meal PlanB: High FiberOatmeal Sn: Cottage Cheese L: TurkeySandwich + Carrot Sticks Sn: 2 String Cheese D: 4oz Protein, 1c Carb, 2-3c Veggies

25. Satiety Strategies Know What (and when) to Drink Think of stomach like a balloon… full balloon=signals to stop Liquid Calories = NO EFFECT on Satiation, they don’t spend enough time in the stomach to register a signal Water Rich Foods (soup, salad, fruit, veg’s) = + Satiety Drink water 30 min before meals, sip during Avoid dehydration

26. Satiety Strategies 5) Savor the Flavors Chewing food increases “oro-sensory” factors Smell / Taste are slower to process (2009 Study) Chewing food for an additional 3 seconds reduced calorie intake

27. Satiety Strategies 6) Downsize your Snacks Small Frequent meals are good…. But 400 calories every 3 hours though Goal of snack= 100-200 calories decreases binge eating or overconsumption at following meal High Protein/Fiber options: beef jerkey, nuts, cottage cheese, Greek yogurt, fiber one bar, fruit

28. Balancing Blood Sugars w/ Small Snacks Pillars of Blood Sugar Management Nutrition Physical Activity Weight Control Stress Management Medical Monitoring Mary 292# Fasting Blood Sugar: 107 Mary 227# Fasting Blood Sugar:93

29. The Glycemic Index Concept David Jenkins initially studied effects of multiple small meals vs 3 large meals (lower LDL and insulin levels) New England Journal of Medicine 1989 Further studies lead to classification system of foods….

30. Absorption of the carbohydrate

31. Spaghetti White Bread

33. Food studies using the GI When a proper breakfast is taken “Second meal effect” with low glycemic index meals vs 81% more calories by end of day with high GI breakfast (just from hunting the remainder of the day) The gut stress response is turned on: Catecholamine, glucagon, cortisol, growth hormone hormone. Blood sugar below baseline occurs “reactive hypoglycemia” Craving starts instinctively for starchy foods, feel ravenously hungry= out of control eating

34. Other rating systems Meijer = NuVal Marianos = Nuval Whole Foods Market = ANDI MANDI Jewel Osco = Color Code/Index Please see a profesional- A Registered Dietician!!

35. Satiety Strategies Key Components: Avoid Distractions Pack in the Protein Fill Up on Fiber Know when (and what) to Eat Savor the Flavors Downsize your Snacks Hara Hachi Bu (stop when 80% full)

36. Bonus Round 1) Have food ready to eat: Melon, Berries, Apples, Carrots, Cucumbers, Broccoli Green Peppers, Tomatoes, Mushrooms 2)Double the veggies in any recipe 3) Egg white omelets + onion, tomato, green pepper 4) Add Flavor/Spice: herbs, pepper, cayenne, ginger

37. Bonus Round 2 Hidden Gems: Iced Tea (unsweetened) Low Cal/No Cal Drinks HEAT! Cayenne, Cumin, Chili powder, paprika Flavor! Oregano, Dill, Lemon Fresh Seafood Vinegar: white, red, balsamic, cider

38. Bonus Round 3 Plan ahead! Do you go grocery shopping hungry? Do you bring a list? Use the same strategies with food: Write down TOMORROW’S meals TONIGHT before bed Meal or snack coming up soon? Drink a glass of water before getting the food ready

39. The Satiety King Paul 191# “Eat until I’m stuffed” (FULLNESS) Paul 173# “Eat Until I’m Satisfied”

40. What I’ve Learned If controlling your weight was easy, everybody would be in great shape. If I could have done this by myself, without help, I never would have gotten overweight in the first place.

41. QUESTIONS? RESOURCES Food Log: www.sparkpeople.com Weight Control: www.FHAWeightCenters.com Medical: www.FirstHealthAssociates.com