Posts Tagged ‘obesity’

Compulsive eating and dopamine receptor dysfunction

Tuesday, May 11th, 2010

Nature NeuroscienceAs most of you well know, the neurotransmitter dopamine and its receptors are critical to the brain’s reward pathways, and dysfunction of these pathways is associated with addictive behaviors. This paper recently published in the journal Nature Neuroscience elucidates the role of dopamine receptors in compulsive eating with obesity. The authors first noticed that…

“…development of obesity was coupled with emergence of a progressively worsening deficit in neural reward responses. Similar changes in reward homeostasis induced by cocaine or heroin are considered to be crucial in triggering the transition from casual to compulsive drug-taking.”

On investigating the underlying mechanism they found that compulsive feeding was present in obese but not lean rats because…

“Striatal (corpus striatum of the brain) dopamine D2 receptors (D2Rs) were downregulated in obese rats, as has been reported in humans addicted to drugs.”

What did they conclude from their data?

“These data demonstrate that overconsumption of palatable food [which produces insulin resistance] triggers addiction-like neuroadaptive responses in brain reward circuits and drives the development of compulsive eating. Common hedonic mechanisms may therefore underlie obesity and drug addiction.”

Journal of NeuorendocrinologyA paper published in the Journal of Neuroendocrinology adds further support to the importance of dopamine in appetite regulation. Ghrelin is a peptide produced in the stomach that increases appetite by stimulating a part of the brain (VTA = ventral tegmental area) that is rich in dopamine producing neurons:

“Interestingly, ghrelin infusions into the VTA increase food intake dramatically, and stimulate dopamine release from the VTA…ghrelin increases food intake by modulating the activity of dopaminergic neurones in the VTA.

The author offers this conclusion:

“On the basis of these data as well as the fact that VTA dopamine cells respond to other metabolic hormones such as insulin and leptin, it is proposed that VTA dopamine cells…are first-order sensory neurones that regulate appetitive behaviour…”

Pharmacology Biochemistry Behavior Blood sugar and insulin have such a powerful effect on the brain and energy (nutrient) seeking behavior it’s no wonder there’s abundant evidence that they are associated with dopamine in the regulation of appetite. This paper published in Pharmacology Biochemistry and Behavior notes that:

“The hormones insulin, leptin, and ghrelin have been demonstrated to act in the central nervous system (CNS) as regulators of energy homeostasis…CNS circuitry that subserves reward and is also a direct and indirect target for the action of these endocrine regulators of energy homeostasis.”

Their research demonstrates that insulin and leptin can dampen reward satisfaction through an effect on dopamine signaling:

“Specifically, insulin and leptin can decrease food reward behaviors and modulate the function of neurotransmitter systems and neural circuitry that mediate food reward, the midbrain dopamine (DA) and opioidergic pathways.”

Acta DiabetologicaAnother study published in Acta Diabetologica also confirms the profound effect of insulin on dopamine signaling:

“Administration of various doses of glucose to rats produced a significant decrease of dopamine turnover…a close connection between 3,4-dihydroxyphenylacetic acid (DOPAC) (metabolite of dopamine) variation and insulin plasma level was demonstrated. However, glucose did not affect dopamine metabolism in starved or streptozotocin-treated rats (rats made to be diabetic). This indicates that the effect of glucose on the central dopaminergic system is mediated by pancreatic insulin, even in the presence of endogenous brain insulin.”

Journal of Biological ChemistryMoreover, dopamine gives the message that the cells are satisfied and shuts down pancreatic production of insulin as described in this paper published in The Journal of Biological Chemistry:

Both dopamine and insulin actions in the brain modulate appetite and feeding behaviors. In this work we show for the first time that pancreatic beta cells express dopamine receptors mediating inhibition of glucose-stimulated insulin secretion.”

They go on to further describe the close association of dopamine with insulin and problems related to blood sugar regulation and obesity:

“Moreover, antipsychotic (neuroleptic) drugs blocking dopamine receptors may cause hyperinsulinemia, hypoglycemia, increase appetite, and obesity and are associated with diabetes. Therefore, dopamine action on beta cells (of the pancreas that secrete insulin)might have relevant implications for the study of obesity and diabetes, in particular in situations where dopamine transmission is altered.”

PLoS BiologyAs if that wasn’t enough, the effect of insulin on dopamine signaling is so strong that it can even block the effects of amphetamine as described in this study published in PLoS Biology:

Amphetamines mediate their behavioral effects by stimulating dopaminergic signaling throughout reward circuits of the brain. This property of amphetamine relies on its actions at the dopamine transporter (DAT)…we and others have revealed the novel ability of insulin signaling pathways in the brain to regulate DAT function as well as the…actions of amphetamineby depleting insulin, or…insulin signaling, we can severely attenuate amphetamine-induced dopamine release and impair DAT function. Our findings demonstrate in vivo the novel ability of insulin signaling to dynamically influence the neuronal effects of amphetamine-like psychostimulants.”

The bottom line: compulsive eating (and other addictive behaviors) occurs when the reward (satisfaction) circuits are not functioning. To feel satisfied, we need adequate dopamine production and healthy insulin regulation. For the former we have natural precursor therapy to replenish exhausted dopamine resources. Healthy insulin and blood sugar regulation is, of course, a fundamental to any health strategy.

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Mechanisms that link inflammation, obesity and cancer

Wednesday, May 5th, 2010

Journal of the National Cancer InstituteThe latest issue of the Journal of the National Cancer Institute comments on recent research investigating how the inflammatory cytokines (cell signaling molecules), which are increased under various conditions that include obesity, can turn healthy liver cells into malignant ones:

“As obesity’s ties to multiple cancers strengthen, a new study suggests that inflammation may be the primary culprit in at least one malignancy: liver cancer.”

CellThe study itself was recently published in the journal Cell. The report that…

“We now demonstrate that either dietary or genetic obesity is a potent bona fide liver tumor promoter in mice…Obesity-promoted HCC (hepatocellular carcinoma = liver cancer) development was dependent on enhanced production of the tumor-promoting cytokines IL-6 and TNF, which cause hepatic inflammation and activation of the oncogenic transcription factor STAT3.”

Readers here will not be surprised that they also assert…

The chronic inflammatory response caused by obesity and enhanced production of IL-6 and TNF may also increase the risk of other cancers.”

Three important points: (1) nothing increases the storage of fat in the liver like the high levels of insulin associated with insulin resistance (remember the link between insulin and fatty liver disease). (2) Chronic inflammation, whatever the cause, is a component of most chronic degenerative diseases. (3) Those of us who are health care professionals should be using the available laboratory tests for inflammatory cytokines in the care of our patients when appropriate; readers who are patients should be asking about them.

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Normal weight obesity: heart disease from being fat without looking fat

Saturday, May 1st, 2010

European Heart JournalThis study published not long ago in the European Heart Journal is consonant with my findings for certain patients (using bioelectric impedance analysis for body composition determination) who were slim in appearance but turned out to be metabolically obese. They had a proportionately large amount of fat packed around the internal organs that wasn’t apparent externally. High levels of visceral fat are associated with the chronic inflammation that is a fundamental cause of cardiovascular and other diseases. The authors of this paper suspected this phenomenon:

“We hypothesized that subjects with a normal body mass index (BMI), but high body fat (BF) content [normal weight obesity (NWO)], have a higher prevalence of cardiometabolic dysregulation and are at higher risk for cardiovascular (CV) mortality.”

They thoroughly evaluated 6171 subjects with body composition measurement, blood tests and cardiovascular risk factors. Their data showed that…

“The highest tertile of BF (>23.1% in men and >33.3% in women) was labeled as NWO. When compared with the low BF group, the prevalence of metabolic syndrome in subjects with NWO was four-fold higher. Subjects with NWO also had higher prevalence of dyslipidaemia, hypertension (men), and CV disease (women). After adjustment, women with NWO showed a significant 2.2-fold increased risk for CV mortality in comparison to the low BF group.”

This means that excessive levels of body fat can be present in someone of normal weight and appearance (“metabolic obesity”), contributing to cardiovascular damage in both men and women. In women there is a stronger association with death from cardiovascular disease.

The author’s conclusion:

Normal weight obesity, defined as the combination of normal BMI and high BF content, is associated with a high prevalence of cardiometabolic dysregulation, metabolic syndrome, and CV risk factors. In women, NWO is independently associated with increased risk for CV mortality.”

Important: There are consumer devices such as scales marketed as bioelectric body composition instruments but these do not give accurate or reliable results. Dependability requires a medical-grade device that utilizes electrodes on both the lower and upper extremities along with validated algorithms.

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Coffee protects against fatty liver disease

Sunday, March 28th, 2010

Digestive Diseases and SciencesThere seems to be one study after another about the benefits of coffee. This paper just published in the journal Digestive Diseases and Sciences verifies that coffee protects against Non-alcoholic Fatty Liver Disease (NAFLD), the most common cause of non-infectious hepatitis and a growing cause of liver failure. I very often see elevated liver enzymes on laboratory tests; no wonder, since this is commonly fueled by insulin resistance. The authors of this study began by observing…

“The benefits of coffee on abnormal liver biochemistry, cirrhosis and hepatocellular carcinoma have been reported…this study aims to investigate if coffee use has any relationship with bright liver, measured by ultrasound bright liver score (BLS), in patients with non-alcoholic fatty liver disease (NAFLD), and which relationship, if any, is present with BMI and insulin resistance.”

‘Bright liver’ refers to the appearance of a fatty liver on ultrasound imaging, and a higher BLS measurement means more fat deposits in the liver. What did they find?

Less fatty liver involvement is present in coffee vs. non-coffee drinkers. Odds ratios show that obesity, higher insulin resistance, lower HDL cholesterol, older age and arterial hypertension are associated with a greater risk of more severe BLS; to the contrary, coffee drinking is associated with less severe BLS…Coffee use is inversely associated with the degree of bright liver, along with insulin resistance and obesity…”

Their conclusion is similar to numerous other studies:

“A possible opposite, if not antagonistic, role of coffee with regard to overweightness and insulin resistance, similar to that reported in hepatocarcinoma and cirrhosis, is envisaged in the natural history of NAFLD.”

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Childhood obesity and blood sugar, not cholesterol, predict premature death

Monday, February 15th, 2010

The New England Journal of Medicine just published this disturbing study concerning childhood risk factors for cardiovascular disease on later death as adults. They set out to determine which risk factors including “body-mass index (BMI), glucose tolerance, and blood pressure and cholesterol levels predicted premature death.” Their cautionary conclusion: “Obesity, glucose intolerance, and hypertension in childhood were strongly associated with increased rates of premature death from endogenous causes in this population. In contrast, childhood hypercholesterolemia was not a major predictor of premature death from endogenous causes.”

New England Journal

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Low vitamin B6 associated with chronic inflammation

Thursday, February 11th, 2010

Am Journal Clin NutritionThis study just published in The American Journal of Clinical Nutrition adds further evidence to the importance of evaluating Vitamin B6 for chronic inflammation, cardiovascular and otherwise. As the authors state, “Low vitamin B-6 status has been linked to an increased risk of cardiovascular diseases. The cardioprotective effects of vitamin B-6 independent of homocysteine suggest that additional mechanisms may be involved.” Their data demonstrated a powerful link: “We measured plasma pyridoxal-5′-phosphate (PLP), C-reactive protein (CRP), and an oxidative DNA damage marker, urinary 8-hydroxydeoxyguanosine (8-OHdG)…There was a strong dose-response relation of plasma PLP concentration with plasma CRP. Increasing quartiles of PLP were significantly associated with lower CRP concentrations and with lower urinary 8-OHdG concentrations.” Of equal importance was their finding that Metabolic syndrome, obesity, and diabetes were also significantly associated with low plasma PLP concentrations.” It is important to note that they measured the  metabolically activated form of B6, not the one found in foods and most supplements. Many people have a genotype that does not allow them to accomplish this activation efficiently, which is why we supplement with the activated form when indicated.

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The brain’s role in obesity and the importance of dopamine

Saturday, January 9th, 2010

JAMAJAMA (the Journal of the American Medical Association) reports on research recently presented at the annual meeting of the Society for Neuroscience where researchers discussed their studies of the biological causes of overeating and obesity. One interesting comment of great practical importance: “Brain imaging of volunteers drinking a shake suggests that overweight persons with a gene variant associated with fewer dopamine receptors may be prone to impulsive eating.” Functional medicine patients know better than most people how important dopamine signalling is for calm contentment, focus, satisfaction, etc. and how deficits can result in compensatory compulsive behaviors and addictions that are in fact attempts to self-medicate. How do we fix dopamine signalling? By restoring the resources the body needs to manufacture its own dopamine and the brain’s capacity to respond to its stimulus.

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Insulin and cognitive disorders

Wednesday, December 23rd, 2009

Insulin receptors are found throughout the central nervous system. Fascinating fact: “insulin affects distinct cognitive processes, e.g. by triggering the formation of psychological memory contents.” As the authors of this paper published recently in the journal Diabetologia state: “metabolic and cognitive disorders such as obesity, type 2 diabetes mellitus and Alzheimer’s disease are associated with resistance of central nervous structures to the effects of insulin…” They go on to conclude: “Enhancement of central nervous insulin signalling…has yielded encouraging results that bode well for the successful translation of these effects into future clinical practice.” Targeted tests are available to determine how you can best take care of your brain by managing blood sugar and insulin.

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Undernutrition during pregnancy and obesity, type 2 diabetes in your child

Tuesday, December 1st, 2009

This paper in Current Diabetes Reports discusses how the so-called ‘thrifty gene’ effect (the tendency to conserve calories in the form of fat during times of famine, established through gene selection over thousands of years) occurs not only through this selection process, but can also manifest as a ‘thrifty phenotype’ when eating too little during gestation is followed later by overnutrition. This means that eating too little during your pregnancy can promote obesity and type 2 diabetes in your child if they consume excess calories later. Like with most everything else, moderation is key.

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Erectile dysfunction and insulin resistance

Thursday, November 12th, 2009

Here is more evidence of the strong correlation between erectile dysfunction and insulin. This paper recently published in the Journal of Andrology clearly discerns  the “correlation between erectile function and IR and abdominal obesity.” [IR = insulin resistance. Waist circumference is a metric for abdominal obesity.] Moreover, “IR also appears to alter testosterone production.” Important: a careful reading of this paper also discloses what functional medicine practitioners and Lapis Light patients know: “a negative correlation [with erectile function] was shown only between BT (biologically active fraction) and abdominal obesity. (BT is also termed free-fraction testosterone, measured in our salivary profiles. Total testosterone is not a reliable indicator.)

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