Awaremed Medical Institute

Obesity & Diabetes U turn

There are multiple causes of obesity. Some studies point to genetic factors that regulate one’s appetite or their metabolism and many blame poor nutrition and physical inactivity. By understanding how these factors combine to cause the dramatic weight gain and increased rates of obesity seen today, Dr. Akoury will be better able to find a treatment that will curb hunger, increase metabolism, cause permanent weight loss and be free of any potential health risks or adverse side effects.

Overall, the body is very successful at matching caloric intake to energy expenditure, and day-to-day differences in activity levels or food intake tend to balance long-term. This is simply a manifestation of the first law of thermodynamics, and as long as energy input is equal to energy expenditure, body weight will remain constant. If, however, there is even a small shift in this balance it can have large consequences if persisting over extended periods of time.

Factors that affect energy expenditure and ultimately obesity include the neurotransmitters we routinely attribute to mood and behavior issues including serotonin, dopamine, epinephrine, and histamine, as well as other factors that relay messages about food intake and energy levels such as leptin, cholecystokinin (CCK), neuropeptide Y (NPY), ghrelin, agouti-related peptide (AgRP), and adiponectin.

These chemicals are some of the messengers that constantly relay information regarding the body?s levels of available and stored energy to the brain, and there is significant redundancy in their effects. For example, cholecystokinin, adiponectin, leptin, serotonin, and histamine all suppress appetite, whereas ghrelin, agouti related protein, and neuropeptide Y all increase appetite. It appears that the brain maintains a unique position in this system. Because the brain itself is completely dependent on circulating energy sources and stores essentially no energy itself, it must constantly monitor energy needs to ensure that all cells in the organism have adequate fuel supplies, and ensure that its own needs for fuel are met. This places the brain in a powerful position physiologically. Because the brain can sense current energy levels, energy stores, energy needs of the various organs, how energy is being acquired, and generate appetite signals to initiate energy intake if needs are unmet, the brain can essentially override signals from any other part of the body.

In most cases, if there is food available when the brain increases the appetite signals telling a person to eat, they eat. When this occurs, calorie consumption can easily exceed demand and the excess will be stored as triacylglycerol in adipose tissue. If this imbalance continues for a prolonged period, it will cause obesity.

From this observation, it becomes very clear that the brain and body must be able to monitor energy stores appropriately to prevent weight gain. Many of the factors that communicate information about appetite require neurotransmitters for proper signaling. Because neurotransmitter imbalances are common, it is not surprising that weight gain is also common. Likewise, since the causes of neurotransmitter imbalances are multifactorial with both environmental and genetic influences, it is not surprising that obesity is also multifactorial with both environmental and genetic influences. While there have been significant discoveries regarding the chemicals that are involved in regulating appetite, very little has changed regarding its treatment and most drugs still focus on neurotransmitters.

The role of neurotransmitters in appetite regulation is well established, and drugs that affect neurotransmitters can increase or decrease appetite. Weight gain for example, is a very common reason why patients discontinue some psychotropic medications. The medications lithium (Eskalith) and clozapine (Clozaril) may be the worst offenders, causing obesity in more than half of patients that use them. Some other drugs that cause significant weight gain include paroxetine (Paxil), isocarboxazid (Marplan), and escitalopram (Lexapro).

Most of the drugs that are currently used for weight loss affect the neurotransmitters serotonin, dopamine, or norepinephrine.

Weight Loss Drugs and the Neurotransmitters Affected:

Unfortunately, many of these medications lose their effectiveness after a generally short period of time and cause only modest weight loss. While the amount of weight lost by patients taking weight loss drugs can be significant by statistical standards, a 5 to 10% reduction in overall weight, translates into only 10-20 lbs of weight loss for a 200 lb person. Any weight loss is beneficial and can reduce the health risks associated with obesity, however, this modest weight reduction may leave many overweight patients very disappointed. A number of medical research studies have also examined the roles of neurotransmitter precursors in weight loss, food selection, and meal size. Among these, the precursors to the catecholamines (epinephrine, norepinephrine, dopamine), serotonin, and histamine, have been found to affectively reduce food intake and cause weight loss. Nutritional support of neurotransmitters has been used extensively to address mood related changes, but given the role that these same neurotransmitters play in appetite regulation, it is not surprising that nutritional neuroscience has also been used to affect appetite. Specific neurotransmitter precursors that have been shown to reduce food intake include L-dopa, 5-HTP, tyrosine, phenylalanine, and histidine.

Precursors and the Neurotransmitters Affected:

While each of these amino acids has been reported to reduce appetite and food intake on their own, they have also been implicated in the action of hormones and peptides closely related to appetite regulation. A number of overlapping mechanisms appear to be involved in the effects of these neurotransmitter precursors. While the 5-HTP is usually considered a factor in mood-related disorders like depression, oral supplementation with this serotonin precursor decreases food intake with a preferential decrease in carbohydrate-rich food. It is believed that serotonin, formed via 5-HTP decarboxylation, stimulates receptors in the hypothalamus to cause this effect. Additionally, animal studies have found that 5-HTP also acts to increase the levels and effects of leptin, indicating that 5-HTP has multiple appetite suppressing actions. This type of overlapping regulation appears to be the rule rather than the exception for factors regulating appetite.

Histamine, the neurotransmitter generally associated with wakefulness, also affects appetite. Supplementation with histidine has also been observed to reduce food intake and body fat in animal studies, similarly, studies using histamine analogs that block the actions of histamine suppress the effects of leptin.

Tyrosine, phenylalanine, and L-dopa are precursors to the catecholamine neurotransmitters. This includes dopamine, a neurotransmitter involved in the pleasure/reward cascade, which helps to generate the feelings of pleasure associated with our day-to-day activities and accomplishments. Addictive and compulsive behaviors have been associated with disturbances in the dopamine pleasure/reward system and overeating or food addictions are associated with these imbalances as well. Additionally, dopamine and another catecholamine, norepinephrine, have direct roles in appetite regulation. Epinephrine, the last of the three catecholamines, regulates metabolism and increases the breakdown of lipids and glycogen to convert stored energy into available energy.

Current pharmacological treatment protocols fail to address the multiple pathways involved in monitoring energy levels and supplies and this may explain their limited effectiveness. New research is exploring in much more detail the hormones, peptides, and transmitters that are involved in regulating the mechanisms in energy status and energy balance. This research provides more insight and a better understanding of the suspected culprits, which overtime will provide new approaches for the optimal care to this diverse group of patients. Factors that are currently being evaluated for their role in obesity and weight gain include:

Leptin,  Adiponectin, Insulin, Pro-opiomelanocortin, Pancreatic Peptide, Neuropeptide Y, Ghrelin, Glucagon-like Protein 1, Cholecystokinin

These chemicals are important components of the regulatory mechanisms that provide information about food intake and fat stores as well as important signals during the digestive process. Many of these molecules have short half-lives and some would be degraded when ingested orally. As such, many of these would not serve as effective treatments to control appetite or facilitate weight loss. Research efforts are underway to find compounds that would mimic their effect or regulate their production and/or release. Advancements in this area could help control obesity and its accompanying health risks.

There are a significant number of mechanisms in the body that monitor energy availability and energy supply. Under normal conditions, these naturally occurring orexic and anorexic molecules work to regulate appetite and balance metabolism to maintain body weight within a fairly narrow range. However, if this mechanism is impaired, even a very small imbalance, in any part of this system, can change the balance of energy supply vs. storage, and lead to serious weight gain or loss.

Environmental factors, including the obesogenic nature of our lifestyle, appear to have a significant impact on one’s propensity to gain weight. 

A final aspect that seems to make a significant contribution to the regulation and sensing of energy balance are the neurotransmitters. Our diet, stress levels, and lifestyles can affect the levels of serotonin, dopamine, and epinephrine. Neurotransmitter testing and the high incidence of mood-related disorders reveal that neurotransmitter imbalances are common. The high rate of obesity and mood disorders and this apparent link with neurotransmitter function helps explain the effects psychotropic drugs have on weight, as well as, the tendency to eat ?comfort foods? When we feel down or under stress. 

Adding appropriate neurotransmitter testing to the evaluation of patients that have weight problems provides an additional tool that is valuable in assessing the biochemical imbalances that may underlie one’s symptoms. Urine neurotransmitter testing offered at Awaremed Medical Institute also provides a rapid, non-invasive means to evaluate which modes of treatment are most likely to be beneficial.

Through its Lifestyle 101 Dr. Akoury will empower you with all the tools you need to fully embrace wellness as you experience the benefits of healthy living first-hand. Our initial program lasts six weeks, with shared learning and support. Each person begins by meeting with Dr Akoury, where lab work and the program itself are tailored to fit individual needs and concerns. Then, groups of 16-20 people will engage in four-hour sessions twice a week, in a stress-free setting situated the beautiful and modern Cinzia Spa, complete with a kitchen and exercise facilities.  What makes Lifestyle 101 stand apart is its blend of evidence-based medicine and a group wellness experience. Our medical and beauty wellness experts will guide you as you set specific, achievable goals for your personal health and well-being. You will benefit from the expert feedback they provide, helping you to progress to your own optimal level of wellness.Dr. Dolly will help you restore your Neurotransmitters balance and ultimately restore the brain ability to control feeding behavior and achieve healthy energy balance.