Ellen Schur, MD, MS, Associate Professor of Medicine and Clinical Research Director at UW Medicine Diabetes Institute talks about how a high fat diet changes the brain.
Interview conducted by Ivanhoe Broadcast News in August 2019.
To start all of this off, how big of an issue is obesity here in the U.S.?
ELLEN SCHUR: Data from the Centers for Disease Control tell us that about a third of American adults are in the obese range, about another third in the overweight range. And so this is a widespread problem that affects all people across the country, in different age groups and also sexes and races.
Is there any sort of data showing how many people are trying to lose weight because of this?
ELLEN SCHUR: In large surveys, the number of people losing weight or stating that they have tried to lose weight over the past year is about 50 percent, more women than men. And also people who are heavier tend to be trying to lose weight more often than people who are at a lower weight.
Why is it so tough for somebody to lose weight?
ELLEN SCHUR: I believe the main problem is our physiology. When people are losing weight, there are responses by hormones in the body that will tend to slow metabolism, stimulate appetite and also make our muscles more efficient in using the calories that we have. Some of these hormones will make us less likely to feel full when we eat or even make high-calorie foods more appealing. All those things add up to make it really hard to keep that weight off once you’ve lost weight.
Folks who are suffering from obesity, is it usually because of overeating or, what’s the main reason?
ELLEN SCHUR: When I think about overeating, I think about how overeating is in some ways a natural phenomenon. So think about a bear. There are times when they have to eat as much as they can because nutrition is abundant and they need to build up their energy stores. Well, now those foods that make us add extra energy are around us all the time. And our brains are designed to bring our attention to those kinds of foods. So anytime we’re hungrier, anytime we’ve skipped a meal, our brains will literally be paying more attention to those Quick Calorie kinds of foods in our environment, will be more motivated for them. And these are very powerful urges because they’re there to help us survive. To me, it’s really the way our brains are programmed that put us all at risk for eating maybe a little more than what we need in the current food environment.
At what point or is there a certain kind of food that will tell our brain, hey, we need more and more and more high calorie, kind of turn off that that signal in our mind that says, hey, you’re your full you probably don’t need any more energy?
ELLEN SCHUR: Right. There are signals that come from the gut and go to very particular areas of the brain that give us that feeling that we’re full. Those signals also kind of turn down the appeal of the foods we’re eating. Think about that feeling of being full when you look down your plate and the food doesn’t really look good anymore. That’s what satiety is about. After a weight loss, some of those hormones actually become less effective. And so it turns the volume down on the signal that we are full. And that’s one of the things that makes it hard to keep weight off.
Is there something that we’re eating to turn off that signal as well?
ELLEN SCHUR: There’s some interesting research about what happens in rodents when they’re given a very high-fat diet that’s also highly caloric. So recent research shows that an area of the brain that is involved in telling us that foods rewarding and stimulating us to eat more of it. After a long period of feeding where mice become obese on that kind of a diet, those signals are reduced – the signals that slow the feeding of tasty foods. There’s other research done here at the UW diabetes institute that has shown areas of the brain where that type of diet stimulates even inflammation or potentially scarring. And this is associated with the animals eating more and gaining weight. So there’s a good amount of evidence accumulating that sometimes very high fat diets can alter the way the brain responds to food over time and even alter the neurons or the tissue structure within the brain.
If someone’s brain has been altered by these high calorie foods, what can someone do to get their brain back to normal?
ELLEN SCHUR: That’s a great question. We’re not quite at the point where we have a specific intervention that reverses those changes. For patients, there are a couple of things that can mitigate that drive to eat. Behaviorally, people can lean towards foods that lower hunger hormones for longer periods of time. And those are foods that are higher in protein or higher in fat. We know that when people skip meals, it’s going to worsen that drive to eat through those kinds of changes in the brain that make quick calorie foods more tempting. So not skipping meals can help people make healthy choices. And now there are a number of FDA approved medications that act at different points in those pathways that can kind of turn the volume down on peoples drive to eat and also make it easier to make healthy choices.
In summary could just give me those three points again?
ELLEN SCHUR: So quick bullet points. A lot of patients tell me they struggle with overeating or cravings. A couple of things can help with that. One is not getting too hungry. A second is avoiding skipping meals. Because when you go a long period of time without eating, your brain becomes more attracted to those quick calorie foods in the environment. And for some people, it might be appropriate to try a medication that can turn the volume down a little bit on those urges and make it easier to lose weight and keep it off in the long term.
What was your reaction when you saw that research about how overeating can turn off those signals in your brain?
ELLEN SCHUR: That research is really interesting. I think it adds information about one particular set of neurons that might be involved in sort of shutting down our responses to – in this case, sweets after eating. And it is an intriguing glimpse into how complex our system is in terms of regulation of food intake. So it does open up some new possibilities of a different type of a pathway that might assist people in managing their appetite if we can push forward with a little more research.
Is this going to change how you treat patients?
ELLEN SCHUR: It’s an important step that could lead to developments that will help us in our patient care. We’re not there yet, but it adds to a body of research that’s really telling us that over time there are significant changes in the way appetite is regulated that might be related to some of our diets. And those changes could be part of what’s making it harder for people to lose weight and keep that weight off.
What sort of research is being done here at UW Medicine Diabetes Institute?
ELLEN SCHUR: The UW Medicine Diabetes Institute has both laboratory research as well as clinical studies involving humans. We are trying to understand how body weight and glucose are regulated normally and also what’s going wrong in situations, such as obesity or diabetes, and then trying to take that into the clinic and into patients to test interventions or medications that might end up helping them with their medical problems and protecting their health.
Is there anything else you wanted to say about this topic?
ELLEN SCHUR: One of the things that is important to understand is that the response to weight loss happens regardless of whether a person is carrying extra weight or is at what would be considered a normal weight. And we don’t completely understand why that is. So it seems like there’s something in the brain that is resetting our system of energy balance to that higher weight. For my patients who are trying to manage their weight in order to improve their health, it can be really frustrating because their body is responding to slow the weight loss and stimulate appetite even though they’re carrying extra weight. But the body thinks, oh, my God, I’m losing the energy stores I need to survive. And that really is part of what makes it so hard to keep the weight off especially.
The types of diets that are used in these rodent studies are both highly caloric and very high in fat, about 60 percent fat. So whether those directly translate to what people are doing we’re not sure yet. We’ll need to understand what it is in people that put them at risk for these kinds of brain changes, whether it’s similar to what happens in mice or whether it’s different.
Do you think it’s possible that when people binge eat those hormones are shut down so they don’t feel full?
ELLEN SCHUR: Binge eating can have a wide variety of causes. People who are under eating or skipping meals can be at risk for binge eating. And people who are having psychological conditions such as binge eating disorder also experience binge eating. The treatments vary depending on the causes of the bingeing. For people who have binge eating disorder, it would be recommended that they undergo counseling or some medications are also approved for that. For people who are having overeating that isn’t to the degree of a binge eating disorder sometimes behavioral strategies such as regular meals can assist them. And those are the kinds of things they could work on with their doctor or with a dietitian or nutritionist.
I just wondered if that’s possible. I just talked to my friend’s daughter and she said she never felt full.
ELLEN SCHUR: Some of my patients do describe the feeling that they just never are getting full. And when that happens, we look at their medication list because there are common medications that can enhance appetite as a side effect. We also look at the structure of their eating pattern to see if maybe they’re under eating during the day and then getting this strong drive to eat in the evenings. And then we look at their food choices to make sure they’re getting adequate protein. And some fat also can help with your appetite. The types of medications that can lower the urge to eat. Some are FDA approved medications for weight loss. And there are others in classes, for instance, that treat diabetes where they tend to also enhance a person’s fullness. So for someone who’s carrying extra weight and has a health problem like diabetes, there might be a way to optimize their medications to enhance their sense of fullness.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Bobbi Nodell, PR
206-616-0703
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
