Struggling with weight is a challenge that many of us can relate to. The desire to shed those extra pounds, improve our health, and enhance our overall well-being often leads us down various paths in search of effective solutions, some of them healthy, some of them risky and almost all of them difficult to sustain.
In this issue of The New Nutrition Newsletter I focus on the latest hot topic in the world of weight control – ground-breaking medications like Ozempic that have emerged as potential game-changers in the battle against obesity. What are they? How do they work, and can we mimic their effect naturally, using diet rather than drugs?
Weight and health
Like all developed countries, Canada is facing an obesity crisis. Throughout history there have always been individuals who suffered from obesity (think Henry Vlll or Queen Victoria), but current rates have reached epidemic proportions, and are growing year on year. A study published in the Canadian Medical Association Journal in 2019 predicted that if current trends continue, almost 1 in 2 adults in Canada could be classified as obese by 2040.
The cost to Canada’s health care service is almost incalculable. Being obese increases the risk of most of the major health conditions affecting us today, including type 2 diabetes, heart disease and stroke, cancers, like breast, colon, and brain cancers, with parallel increases in health care spending.
Obesity is a complex condition
While the causes of obesity are complex, unhealthy diets are a major factor. Anyone who watched the movie Super-Size Me saw how easy it was for someone – initially fit and slim and with no history of weight problems – to gain weight rapidly on fast food. But genetics, environment and lifestyle also factor in. So does overeating.
Our everyday environment is designed to encourage overeating. Indeed, eating has become almost a continuous all-day pastime. We are surrounded by highly palatable, calorie-dense foods, available on every street corner 24/7. This constant exposure to food cues triggers the desire to eat even when we are not hungry, and makes it difficult to control overeating through willpower alone.
Enter Ozempic, currently the weight loss drug of choice, not just of the overweight and obese but of the rich and famous with normal healthy body weights who want to be skinnier. The drug has been hailed as a game changer in the battle to lose weight.
Ozempic, serendipity and appetite
Originally prescribed to manage type 2 diabetes, Ozempic and a number of similar new drugs that are coming on to the market, works by regulating insulin and blood glucose, critical for diabetics. But an incidental and unexpected finding from early clinical trials in diabetics was that those taking the drug not only regulated their blood sugar levels, they also lost significant amounts of weight.
Pharmaceutical executives were ecstatic! They had not set out to find a weight loss drug, but accidently they had. And it wasn’t just diabetics who experienced weight loss. Non-diabetics also benefitted. The weight loss was largely because of a dramatic reduction in appetite. Some patients even found they didn’t want to eat at all. So, no need for willpower; no particular diet necessary. The weight simply melted off.
How does Ozempic work?
Ozempic (generic name semaglutide) and other similar drugs coming on to the market belongs to a class of drugs called GLP-1 (glucagon-like peptide-1) receptor agonists. These drugs mimic a natural hormone, glucagon-like peptide or GLP-1.
One role of GLP-1 agonists is to increase levels of incretins – molecules normally released in the gastrointestinal tract in response to food intake. Incretins manage insulin and blood sugar levels, and so help to control diabetes. Because they slow down the rate at which the stomach empties, we feel full for longer. One pivotal role for incretins is to signal the brain that we have eaten enough, and switch off the desire for more food. Thus, incretins play a vital role in regulating appetite.
Food chatter
A new term has recently entered the nutrition vocabulary: food chatter. Food chatter, or noise, is defined as intrusive and distracting thoughts about food – an on-going awareness of food, unrelated to meal times or hunger.
It starts as soon as you wake up. “What am I going to have for breakfast today? For lunch; for snacks?” As soon as lunch is over you are thinking about dinner. Even when you have eaten a substantial evening meal and shouldn’t be hungry, you visit the fridge to see what else you can eat. If you battle weight and are health conscious, you wonder what you can snack on that doesn’t contain too many calories. Whatever you eat, satisfaction is short-lived and the food chatter continues.
This obsession with food is one key reason that most diets are difficult to maintain. Studies show that more than half of the weight lost by dieting is regained in two years, and that more than 80% weight loss is regained after 5 years. Indeed, according to some researchers, many have even given up on the battle of the bulge and have kissed dieting goodbye.
But for those taking Ozempic, reports suggest that food chatter disappears. The desire for food diminishes. Excess weight simply evaporates.
Is Ozempic a game changer?
Drugs like Ozempic clearly work, but not for everyone. Some patients just don’t respond to them, or they may get side effects that are severe enough that they stop the drug. These include nausea, diarrhea, abdominal pain, constipation and vomiting.
One drawback I see to the long-term use of GLP-1 receptor agonists is their potential to cause malnutrition. The drugs don’t change the requirement for nutrients – the vitamins, minerals, protein and essential fats need for body maintenance and functioning. When eating less food, less of these essential nutrients will be consumed, and intake may be insufficient to meet the body’s daily metabolic needs.
To reduce the risk of malnutrition if using weight loss drugs, it is crucial to obtain guidance on proper nutrition and advice on how to eat a balanced diet that meets nutritional requirements, despite having less appetite. Supportive nutrition counselling and regular monitoring of your nutritional status can help identify any potential nutritional shortfalls or imbalances and address them promptly.
Natural alternatives to Ozempic
Most drugs that are effective work because they mimic natural biological functions, either by boosting a metabolic process that isn’t working efficiently, or by inhibiting a chemical pathway in the body that’s overactive.
That got me thinking. If incretins are released in the gastrointestinal tract in response to food, are some foods better than others at stimulating incretin release? If so, could creating a diet based mainly on such foods naturally limit appetite. And, like Ozempic, effortlessly reduce food chatter and help with weight control?
On the flip side, I wondered if there were foods that evoked only a weak or negligible incretin response. If so, would a diet mainly composed of these foods lead to incessant food chatter, chronic over-eating and weight gain?
Foods that stimulate incretins
A close scrutiny of the medical and scientific literature shows that indeed there are many foods that can enhance incretin secretion. Eating a diet rich in these foods has the potential to help us battle food cravings and control overeating without resorting to drugs.
The following are some foods with the potential to control appetite naturally.
- Protein-rich foods, like lean meats, eggs, fish and dairy, tofu and legumes. Whey protein supplements have been shown to have a particularly powerful effect.
- Good fats: Foods containing healthy fats, particularly monounsaturated fats, have been associated with increased GLP-1 secretion. Examples include avocados , nuts (almonds, walnuts), seeds and olive oil. Eggs are also potent stimulators of appetite-suppressing hormones.
- Coffee and tea, including green and black tea, and the south American herbal tea, yerba mate.
- Dietary fiber, found in vegetables and fruits, whole grains and legumes, has been linked to increased GLP-1 levels.
- Phytochemicals from vegetables and fruit, spices and herbs stimulate incretin release. Cinnamon, turmeric, ginger, and fenugreek are among the spices that have been associat-ed with increased GLP-1 production.
- Resveratrol – a powerful phytochemical found in grapes, red wine, peanuts, cocoa, blue-berries and cranberries – also stimulates GLP-1 production.
Sounds very like a Mediterranean Diet, doesn’t it – the same diet that is now linked to multiple health benefits, reducing the risk of most major chronic diseases? From heart disease to diabetes and many cancers, the Mediterranean Diet seems to be one of the best at promoting better health.
A recent large observational study of more than 60,000 adults showed that greater adher-ence to a Mediterranean diet was associated with up to a 23% lower risk of developing dementia over an average of 9 years. And this was regardless of whether individuals were genetically prone to developing the disease.
What not to eat
Highly processed foods, also known as ultra-processed foods, such as packaged snacks, fast food, and ready-to-eat meals, contain refined ingredients, and excessive fat, sodium, and added sugars. While the healthy fats listed above support incretin hormone release, a high fat diet, espe-cially one high in saturated fats, may do the reverse.
So what are ultra-processed foods? These are food that are factory-processed from whole natural foods. In the factory they are deconstructed – refined, stripped of their natural nutrients – and then reconstructed. They are usually packed with additives, preservatives, and artificial flavors. Many of our favourite foods and drinks are ultra-processed, like soft drinks, white bread, white rice, sugary snacks, biscuits, muffins and pastries, breakfast cereals and bars, sweetened yogurts. Generally, these foods lack the beneficial nutrients and fiber that stimulate incretin hormone release.
If a diet is high in ultra-processed foods it will be less satisfying, and lead to food cravings and eventually, more obesity.
The bottom line
When it comes to preventing overeating, focusing on the quality of food we are eating may natu-rally limit the quantity we consume. Weight loss diets that simply reduce calories without any consideration of the quality of the food eaten are likely to be impossible to sustain in the long term. This is precisely because they fail to stimulate incretins, and the brain never receives the message: Stop eating.
Try limiting your daily eating to whole, unprocessed foods: Choose fresh fruits and vegetables, lean proteins, healthy fats like olive oil and avocados, eggs, and whole grains, nuts and seeds. This approach to eating should stimulate a healthy incretin response, and not only help with weight loss but should also be sustainable in the long term.
Recipe: Breakfast Bowl
Here’s a recipe for a delicious and nutritious breakfast bowl incorporating foods known to stimu-late incretin release and make a filling and satisfying start to the day.
The recipe can be made in bulk and will store for up to 3 days in the refrigerator. It also makes a good snack or lunchbox addition. Make it the night before it is needed so that the oats have time to soften.
Ingredients:
- 3/4 cup full-fat yogurt
- 1/2 cup blueberries (crushed slightly)
- 1 tablespoon rolled oats (not quick cook)
- 25g whey protein, plain or vanilla flavoured
- 1/4 cup chopped nuts or pumpkin seeds
- 1 tablespoon ground flax seed or 1 tablespoon unsweetened shredded coconut
- ½ teaspoon cinnamon or other spice
Instructions:
- In a bowl, add the whey protein to the full-fat yogurt and crushed blueberries.
- Mix in all the other ingredients
- Store in the fridge for up to 3 days.
You can scale up this recipe and customize it by adding different fruits, nuts and spices. Try grated or finely chopped apple and cinnamon, or pear with freshly grated ginger. Chopped or-ange with a little of the grated orange zest and added cocoa powder can also make a tasty alter-native.
For those who want a little extra sweetness, only stevia has so far been seen to be without nega-tive effects on digestion and the gut microbiome.