Eat to be FIT,not FULL<br />Dr. Jason Gruss, M.D.<br />Dr. RicSaguil, M.D.<br />Spring 2011<br />We didn’t invent the prac...
First Health Associates<br />2010 S. Arlington Heights Rd<br />LL Suites<br />Arlington Heights, IL<br />My Doctor:<br /><...
Cares what I have to say
Doesn’t Keep Me Waiting
Gives Me Options</li></ul>We didn’t invent the practice of medicine….<br /> 		we’re just changing the way it’s provided.<b...
The First Health Approach<br />We didn’t invent the practice of medicine….<br /> 		we’re just changing the way it’s provid...
Your Community<br /> of Care<br />Ric Saguil, MD<br />Jason Gruss, MD<br />Tom Jordan, RD<br />Katrina Christie, LCPC<br /...
Today’s Goals<br />Learn what hunger is<br />Discuss what ‘BEING FULL’ means<br />Explore what SATIETY is, and how that is...
Before we begin . . .<br />Look around<br />The room<br />The village<br />The airport<br />The country<br />The world?<br...
Obesity is a Disease<br />There is NO CURE<br />No pill / surgery / magic potion will take away obesity<br />There is SUCC...
What is Hunger?<br />Physiological Response (Survival mechanism)<br />Secondary Responses:<br />Psychological Response co...
The Hormonal Tsunami<br />Break down of the physiologic response:<br />Stress Response-               fight or flight<br /...
Epinephrine, adrenaline, cortisol increased in stressful, dangerous environment  <br />Prolactin, oxytocin, NPY all increa...
Godzilla VS Ghandi<br />
Why can’t we just co-exist?<br />Athletes.<br />In a state of relaxation response but …<br />can turn on an abnormally hig...
Know Your Enemy Sun Tzu<br />To keep the herd alive;<br />         Starvation mode=Stress response<br />          Hunger w...
What Causes Hunger?<br />Low Blood Sugar<br />Erratic Blood Sugar<br />Binge eating<br />Fasting<br />Stress<br />Fatigue<...
What Causes Fullness?<br />Stomach Distension<br />FULLNESS can happen as fast as you can eat<br />
What Causes Satiety?<br />Smell/taste<br />Conscious eating<br />Environmental cues<br />Satiety cannot be rushed<br />The...
Satiety Strategies<br />Avoid Distraction<br />Disrupts brain-to-stomach satiation signals<br />No eating at Car…. TV…. Re...
Stress is a Distraction<br />Kathy<br />204#<br />Cholesterol: 245<br />Kathy<br />141# (in the 120s today)<br />Cholester...
Satiety Strategies<br />2) Pack in the Protein<br />Solid food <br />Soups ok, but not beverages<br />Stimulate CCK slow ...
Satiety Strategies<br />3) Fill Up on Fiber<br />6g Soluble Fiber has the same satiating effect of 260 calories (ADA study...
Protein and Fiber for Satiety <br />Bill<br />254#<br />Triglycerides: 338<br />Bill<br />189#<br />Triglycerides:68<br />...
Satiety Strategies<br />Know What (and when) to Drink<br />Think of stomach like a balloon… full balloon=signals to stop<b...
Satiety Strategies<br />5) Savor the Flavors<br />Chewing food increases “oro-sensory” factors<br />Smell / Taste are slow...
Satiety Strategies<br />6) Downsize your Snacks<br />Small Frequent meals are good….  But 400 calories every 3 hours thoug...
Balancing Blood Sugars w/ Small Snacks<br />Pillars of Blood Sugar Management<br />Nutrition<br />Physical Activity<br />W...
The Glycemic Index Concept<br />David Jenkins initially studied effects of multiple small meals<br />vs 3 large meals (low...
Absorption of the carbohydrate<br />
Spaghetti<br />White Bread<br />
Food studies using the GI<br />When a proper breakfast is taken<br />“Second meal effect” with low glycemic index meals vs...
Other rating systems<br />Meijer =                          NuVal<br />Marianos =                     Nuval<br />Whole Foo...
Satiety Strategies<br />Key Components:<br />Avoid Distractions<br />Pack in the Protein<br />Fill Up on Fiber<br />Know w...
Bonus Round<br />    1) Have food ready to eat:<br />Melon, Berries, Apples, Carrots, Cucumbers, Broccoli<br />Green Peppe...
Bonus Round 2<br />Hidden Gems:<br />Iced Tea (unsweetened)<br />Low Cal/No Cal Drinks<br />HEAT!  Cayenne, Cumin, Chili p...
Bonus Round 3<br />Plan ahead!<br />Do you go grocery shopping hungry?<br />Do you bring a list?<br />Use the same strateg...
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DrRic Fit not Full (slide share edition)

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

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  • Based on a survey of our patients, we found a consistent theme of what frustrates them about conventional medicine practices and why they felt First Health was different. Since identifying these 4 key areas, we have made a consistent effort to offer our absolute best to:Listen attentively to Patients concernsMake the patient the driving force as the center of careMinimize wait timesExplain all the options for treatment, and give the patient choices (medications, alternative medicine, nutritional medicine/supplementation, psychological medicine)
  • Design notes: list of providersWe want this to look much more inviting—these chairs are way too cold.Had thoughts about putting the actual providers in the chairs. Could be an actual live picture with a sample patient in the red chair or could be a group of providers sitting around the table.
  • What you’re doing while you eat might be as important as what you’re eating. You’re likely to consume much more food and eat for longer periods of time when you’re distracted by television, music, or a computer. Eating while distracted interrupts brain-to-stomach satiation signals, making it harder to monitor your food intake. Takeaway: Grab a seat, focus on your meal. If you pay attention to your first plate of food you might find that you don’t go back for seconds.
  • When it comes to weight control, we can explain pretty much everything down to a T. STRESS is the one X-Factor. Kathy is a great example of this. She struggled in the first 4 weeks of the program (when everyone else was putting up huge numbers). What was holding her back was stress from her job, family, and further compounded by not losing weight. She started seeing the LCPC and went on a tear more consistent than we’ve ever seen. She lost 2# per week over 24 consecutive weeks.
  • DrRic Fit not Full (slide share edition)

    1. 1. Eat to be FIT,not FULL<br />Dr. Jason Gruss, M.D.<br />Dr. RicSaguil, M.D.<br />Spring 2011<br />We didn’t invent the practice of medicine….<br /> we’re just changing the way it’s provided.<br />
    2. 2. First Health Associates<br />2010 S. Arlington Heights Rd<br />LL Suites<br />Arlington Heights, IL<br />My Doctor:<br /><ul><li>Listens to my concerns
    3. 3. Cares what I have to say
    4. 4. Doesn’t Keep Me Waiting
    5. 5. Gives Me Options</li></ul>We didn’t invent the practice of medicine….<br /> we’re just changing the way it’s provided.<br />
    6. 6. The First Health Approach<br />We didn’t invent the practice of medicine….<br /> we’re just changing the way it’s provided.<br />
    7. 7. Your Community<br /> of Care<br />Ric Saguil, MD<br />Jason Gruss, MD<br />Tom Jordan, RD<br />Katrina Christie, LCPC<br />Jennifer Green, ND<br />Joe Musolino, DC<br />Amy Iaquinta, DC<br />Nick Nowicki, DC<br />Emery Paredes, PT<br />Courtney Day, EP<br />Yu Zhu, MD China<br />Mike Blumberg, LCPC<br />You<br />
    8. 8. Today’s Goals<br />Learn what hunger is<br />Discuss what ‘BEING FULL’ means<br />Explore what SATIETY is, and how that is DIFFERENT than ‘FULLNESS’<br />Learn how to be SATISFIED, without stretching your stomach and packing on Calories<br />
    9. 9. Before we begin . . .<br />Look around<br />The room<br />The village<br />The airport<br />The country<br />The world?<br />2/3 of the US is either Obese or overweight.<br />That number is GROWING!<br />Since 2006 Obesity is the #1 cause of preventable death <br />Ahead of cigarettes<br />
    10. 10. Obesity is a Disease<br />There is NO CURE<br />No pill / surgery / magic potion will take away obesity<br />There is SUCCESSFUL TREATMENT<br />The treatment is creating a healthy life, through whatever means YOU need<br />Everybody is different, not all the tips work for everybody<br />Take whatever tips work for YOU!<br />Ask for help if you need it<br />
    11. 11. What is Hunger?<br />Physiological Response (Survival mechanism)<br />Secondary Responses:<br />Psychological Response coping mechanism<br />It is easier to EAT than it is to admit you have a problem<br />Stress Response?<br />Ever eat when you are:<br />Bored? Procrastinating? Nervous?<br />
    12. 12. The Hormonal Tsunami<br />Break down of the physiologic response:<br />Stress Response- fight or flight<br />Hans Selye 1975<br />Relaxation Response- eat or reproduce<br />Herb Benson, MD 1975<br />
    13. 13. Epinephrine, adrenaline, cortisol increased in stressful, dangerous environment <br />Prolactin, oxytocin, NPY all increased in relaxed, protected environments.<br />Stress/Relaxation<br />=<br />Sympathetic/Parasympathetic<br />
    14. 14. Godzilla VS Ghandi<br />
    15. 15. Why can’t we just co-exist?<br />Athletes.<br />In a state of relaxation response but …<br />can turn on an abnormally high stress response<br />
    16. 16. Know Your Enemy Sun Tzu<br />To keep the herd alive;<br /> Starvation mode=Stress response<br /> Hunger will start the hormonal cascade<br />Hunger/Stress <br />
    17. 17. What Causes Hunger?<br />Low Blood Sugar<br />Erratic Blood Sugar<br />Binge eating<br />Fasting<br />Stress<br />Fatigue<br />Lack of sleep<br />Emotional/Physical<br />Binge Eating (Holiday Meals)<br />Junk Food Diet<br />Dehydration<br />Stress/Emotions<br />
    18. 18. What Causes Fullness?<br />Stomach Distension<br />FULLNESS can happen as fast as you can eat<br />
    19. 19. What Causes Satiety?<br />Smell/taste<br />Conscious eating<br />Environmental cues<br />Satiety cannot be rushed<br />The brain works slower<br />
    20. 20. Satiety Strategies<br />Avoid Distraction<br />Disrupts brain-to-stomach satiation signals<br />No eating at Car…. TV…. Reading….<br />Conscious eating<br />Goal: satisfaction not fullness<br />The brain is our most powerful tool,<br /> if we use it!<br />
    21. 21. Stress is a Distraction<br />Kathy<br />204#<br />Cholesterol: 245<br />Kathy<br />141# (in the 120s today)<br />Cholesterol:191<br />Weeks 1-4: 3 Pounds Lost (0.75# per week)<br />INTERVENTION: counseling to address stress<br />Weeks 5-28: 48 Pounds Lost (2# per week)<br />
    22. 22. Satiety Strategies<br />2) Pack in the Protein<br />Solid food <br />Soups ok, but not beverages<br />Stimulate CCK slow gastric emptying<br />FEEL full longer<br />Prevent Glucose Spikes<br />Prevents the body from going into STORAGE MODE<br />Prevent nutrient deficiencies (B1, B12, Fe…)<br />Your body will have cravings for what it’s missing, but your brain will just get the signal to EAT<br />Provides Amino Acids (building blocks)<br />‘Dieters’ lose fat AND muscle, eating more protein helps save the muscle and lose more FAT<br />
    23. 23. Satiety Strategies<br />3) Fill Up on Fiber<br />6g Soluble Fiber has the same satiating effect of 260 calories (ADA study 2009)<br />Refined Carbs=Satiety killers<br /> (insulin spike blood sugar crash  store the excess Cal as fat)<br />Whole Grain Carbs<br />‘100% whole grain’<br />25-35g Fiber Per day<br />Eat more often, avoid hunger by having 3 meals and 2 snacks a day<br />But avoid eating more than 600 Cal at any one sitting<br />Goal is 400 for a meal and 100-200 for a snack<br />
    24. 24. Protein and Fiber for Satiety <br />Bill<br />254#<br />Triglycerides: 338<br />Bill<br />189#<br />Triglycerides:68<br />Bill’s Meal PlanB: High FiberOatmeal<br />Sn: Cottage Cheese<br />L: TurkeySandwich + Carrot Sticks<br />Sn: 2 String Cheese<br />D: 4oz Protein, 1c Carb, 2-3c Veggies<br />
    25. 25. Satiety Strategies<br />Know What (and when) to Drink<br />Think of stomach like a balloon… full balloon=signals to stop<br />Liquid Calories = NO EFFECT on Satiation, they don’t spend enough time in the stomach to register a signal<br />Water Rich Foods (soup, salad, fruit, veg’s) = + Satiety<br />Drink water 30 min before meals, sip during<br />Avoid dehydration<br />
    26. 26. Satiety Strategies<br />5) Savor the Flavors<br />Chewing food increases “oro-sensory” factors<br />Smell / Taste are slower to process<br />(2009 Study) Chewing food for an additional 3 seconds reduced calorie intake<br />
    27. 27. Satiety Strategies<br />6) Downsize your Snacks<br />Small Frequent meals are good…. But 400 calories every 3 hours though<br />Goal of snack= 100-200 calories decreases binge eating or overconsumption at following meal<br />High Protein/Fiber options: beef jerkey, nuts, cottage cheese, Greek yogurt, fiber one bar, fruit<br />
    28. 28. Balancing Blood Sugars w/ Small Snacks<br />Pillars of Blood Sugar Management<br />Nutrition<br />Physical Activity<br />Weight Control<br />Stress Management<br />Medical Monitoring<br />Mary<br />292#<br />Fasting <br />Blood Sugar: 107<br />Mary<br />227#<br />Fasting <br />Blood Sugar:93<br />
    29. 29. The Glycemic Index Concept<br />David Jenkins initially studied effects of multiple small meals<br />vs 3 large meals (lower LDL and insulin levels)<br /> New England Journal of Medicine 1989<br />Further studies lead to classification system of foods….<br />
    30. 30. Absorption of the carbohydrate<br />
    31. 31. Spaghetti<br />White Bread<br />
    32. 32.
    33. 33. Food studies using the GI<br />When a proper breakfast is taken<br />“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)<br />The gut stress response is turned on:<br />Catecholamine, glucagon, cortisol, growth hormone hormone. <br />Blood sugar below baseline occurs <br /> “reactive hypoglycemia”<br /> Craving starts instinctively for starchy foods, feel ravenously hungry=<br /> out of control eating<br />
    34. 34. Other rating systems<br />Meijer = NuVal<br />Marianos = Nuval<br />Whole Foods Market = ANDI MANDI<br />Jewel Osco = Color Code/Index<br />Please see a profesional-<br />A Registered Dietician!!<br />
    35. 35. Satiety Strategies<br />Key Components:<br />Avoid Distractions<br />Pack in the Protein<br />Fill Up on Fiber<br />Know when (and what) to Eat<br />Savor the Flavors<br />Downsize your Snacks<br />Hara Hachi Bu (stop when 80% full)<br />
    36. 36. Bonus Round<br /> 1) Have food ready to eat:<br />Melon, Berries, Apples, Carrots, Cucumbers, Broccoli<br />Green Peppers, Tomatoes, Mushrooms<br />2)Double the veggies in any recipe<br />3) Egg white omelets + onion, tomato, green pepper<br />4) Add Flavor/Spice: herbs, pepper, cayenne, ginger<br />
    37. 37. Bonus Round 2<br />Hidden Gems:<br />Iced Tea (unsweetened)<br />Low Cal/No Cal Drinks<br />HEAT! Cayenne, Cumin, Chili powder, paprika<br />Flavor! Oregano, Dill, Lemon<br />Fresh Seafood<br />Vinegar: white, red, balsamic, cider<br />
    38. 38. Bonus Round 3<br />Plan ahead!<br />Do you go grocery shopping hungry?<br />Do you bring a list?<br />Use the same strategies with food:<br />Write down TOMORROW’S meals TONIGHT before bed<br />Meal or snack coming up soon? Drink a glass of water before getting the food ready<br />
    39. 39. The Satiety King<br />Paul<br />191#<br />“Eat until I’m stuffed” (FULLNESS)<br />Paul<br />173#<br />“Eat Until I’m Satisfied”<br />
    40. 40. What I’ve Learned<br />If controlling your weight was easy, everybody would be in great shape.<br />If I could have done this by myself, without help, I never would have gotten overweight in the first place.<br />
    41. 41. QUESTIONS?<br />RESOURCES<br /> Food Log: www.sparkpeople.com<br /> Weight Control: www.FHAWeightCenters.com<br /> Medical: www.FirstHealthAssociates.com<br />
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