Lose Weight By Controlling The Fat Storage Hormone

Trouble Spot Nutrition

Created by Janet Hradil, Trouble Spot Nutrition is a 3 Phase Hormonal Solution That Melts Away Trouble Spot Fat In Less Than 15 Minutes A Day. Leptin, cortisol, and testosterone all have an influence on our weight issues, but not many of us know it. Janet Hradil has created Trouble Spot Nutrition with the intent of teaching people how their hormones affect their weight loss efforts, and how nutrition can easily correct hormone issues and help fight fat faster than ever before. In each of your fat cells, there is an enzyme, 11 beta-hydroxysteroid dehydrogenase-1 (Hsd), that takes inactive cortisone (a hormone) and turns it into cortisol, a fat storing compound. If you have high amounts of Hsd, you will have high amounts of fat storage. While Hsd is genetically determined, you can use nutrition to reduce levels and stop the unwanted fat storage, even on your trouble spots. Continue reading...

Trouble Spot Nutrition Overview

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Cortisol and CRH Expression

Cortisol is secreted under diverse conditions that impact both physiology and behavior. 3 Short-term cortisol release is protective and facilitates normal physiological and behavioral adaptive processes, whereas high levels of cortisol have detrimental effects on various regulatory processes such as immune and neuroendocrine systems. The behavioral and physiological effects of CRH and cortisol are often independent of one another however, cortisol can influence CRH neurons by inhibiting and affecting the responsiveness of CRH neurons. Cortisol can lead to increases in CRH production and expression in various regions of the brain. In fact, behavioral responses are influenced by cortisol, facilitating CRH expression.

Leptin Stimulates Production of Anorexigenic Peptide Hormones

Arcuate Nucleus

The amount of leptin released by adipose tissue depends on both the number and the size of adipocytes. When weight loss decreases the mass of lipid tissue, lep-tin levels in the blood decrease, the production of NPY is diminished, and the processes in adipose tissue shown in Figure 23-32 are reversed. Uncoupling is diminished, FIGURE 23-33 Hormones that control eating. In the arcuate nucleus, two sets of neurosecretory cells receive hormonal input and relay neuronal signals to the cells of muscle, adipose tissue, and liver. Leptin and insulin are released from adipose tissue and pancreas, respectively, in proportion to the mass of body fat. The two hormones act on anorexigenic neurosecretory cells (red) to trigger release of a-MSH this produces neuronal signals to eat less and metabolize more fuel. Leptin and insulin also act on orexigenic neurosecretory cells (green) FIGURE 23-33 Hormones that control eating. In the arcuate nucleus, two sets of neurosecretory cells receive hormonal...

Cortisol Signals Stress Including Low Blood Glucose

A variety of stressors (anxiety, fear, pain, hemorrhage, infections, low blood glucose, starvation) stimulate release of the corticosteroid hormone cortisol from the adrenal cortex. Cortisol acts on muscle, liver, and adipose tissue to supply the organism with fuel to withstand the stress. Cortisol is a relatively slow-acting hormone that alters metabolism by changing the kinds and amounts of certain enzymes synthesized in its target cell, rather than by regulating the activity of existing enzyme molecules. In adipose tissue, cortisol leads to an increase in the release of fatty acids from stored TAGs. The fatty acids are exported to serve as fuel for other tissues, and the glycerol is used for gluconeogenesis in the liver. Cortisol stimulates the breakdown of muscle proteins and the export of amino acids to the liver, where they serve as precursors for gluconeogenesis. In the liver, cortisol promotes gluconeogenesis by stimulating synthesis of the key enzyme PEP carboxykinase (see...

Regulators of Lipolysis and Fat Storage

The processes of lipolysis and fat storage are regulated by hormonal factors, which either enhance or suppress the activities of HSL and LPL. Through the action of glucocorticoid receptors, glucocorticoids enhance LPL activity and promote abdominal deposition of fat. The density of glucocorticoid receptors is greater in the visceral abdominal depot than in the subcutaneous abdominal depot. Therefore, an increase in glucocorticoid secretion is associated with increases in abdominal fat deposition compared to other fat depots. Insulin favors fat storage by increasing LPL and decreasing HSL activity. Insulin has stronger antily-polytic effects in adipose located in the abdominal region compared to the femoral regions in both men and women. Paradoxically, insulin binding is stronger in the gluteal-femoral region than the abdominal region. Therefore, it has been hypothesized that insulin regulates lipolysis at the postreceptor level. Sex hormones, such as estrogen, testosterone, and...

Aldosterone and Cortisol Excess

In situations of aldosterone excess causing hypertension, there is usually an adrenal cortical adenoma (Conn's syndrome) or bilateral adrenal hyperplasia. Aldosterone promotes sodium retention and potassium excretion, leading to slight hypernatremia, extracellular volume (ECV) expansion, hypertension, and hypokalemic alkalosis. Unlike secondary causes of hyperaldosteronism, such as renal artery stenosis, in which aldosterone and renin levels are high, in primary hyperaldosteronism, renin is suppressed due to ECV expansion. In states of Cortisol excess, caused by either adrenal overproduction (Cushing's syndrome) or pituitary stimulation from an adrenocorticotrophin (ACTH) secreting adenoma (Cushing's disease), high Cortisol levels produce aldosterone-like mineralocorticoid effects. Two recently recognized causes of hypertension are apparent mineralocorticoid excess and glucocorticoid suppressible hyperaldosteronism. The first is due to failure to metabolize and inactivate Cortisol...

Leptin Triggers a Signaling Cascade That Regulates Gene Expression

The leptin signal is transduced by a mechanism also used by receptors for interferon and growth factors, the JAK-STAT system (Fig. 23-34 see Fig. 12-9). The lep-tin receptor, which has a single transmembrane segment, dimerizes when leptin binds to the extracellular domain of two monomers. Both monomers are phos-phorylated on a Tyr residue of the intracellular domain by a Janus kinase (JAK). The -Tyr residues become docking sites for three proteins that are signal transducers and activators of transcription (STATs 3, 5, and 6, sometimes called fat-STATS). The docked STATs are then phosphorylated on Tyr residues by the Leptin receptor monomer Leptin) J K) Leptin receptor monomer I Leptin J

The Leptin System May Have Evolved to Regulate the Starvation Response

Although much of the initial interest in leptin resulted from its possible role in preventing obesity, the leptin system probably evolved to adjust an animal's activity and metabolism during periods of fasting and starvation, not to restrict weight. The reduction in leptin level triggered by nutritional deficiency reverses the thermo-genic processes illustrated in Figure 23-32, allowing fuel conservation. Leptin activates AMP-dependent protein kinase (AMPK), which regulates many aspects of fuel metabolism. Leptin also triggers decreased production of thyroid hormone (slowing basal metabolism), decreased production of sex hormones (preventing reproduction), and increased production of glucocorti-coids (mobilizing the body's fuel-generating resources). By minimizing energy expenditures and maximizing the use of endogenous reserves of energy, these leptin-mediated responses may allow an animal to survive periods of severe nutritional deprivation.

Cortisol

The major glucocorticoid is cortisol, which is secreted in response to direct stimulation by adrenocorticotropic hormone (ACTH) from the anterior pituitary gland. Secretion of ACTH is governed by the hormone corticotropin-releasing factor (CRF) from the hypothalamus. This normally occurs with a diurnal rhythm, with the highest levels in the morning and the lowest levels in the late evening. On stimulation by ACTH, the adrenal glands respond in minutes to secrete cortisol in direct proportion to the ACTH concentration. Cortisol is normally secreted at the rate of 20 to 25 mg day. Through negative feedback inhibition, the plasma cortisol level acts to suppress ACTH release. By an undefined mechanism, stress factors such as anoxia, trauma, infections, and hypoglycemia also can trigger CRF and ACTH release and produce cortisol levels several times normal. The release of CRF in response to stress is resistant to suppression through negative feedback inhibition. Cortisol is a potent hormone...

Leptin ob Protein

For 40 years, scientists searched for a mechanism by which the brain could monitor body fat deposition in order to keep an animal's body weight constant. In 1994, a gene that controlled the expression of a protein produced by adipose tissue was identified. Circulating levels of this protein (the ob protein) could be measured in normal weight mice. However, in obese ob ob mice, which display marked overeating, this protein was absent due to a mutation of the ob gene. A series of studies demonstrated that the absence of this protein was responsible for over-consumption and obesity in the obese ob ob. As the ob protein reduces food intake and also increases metabolic energy expenditure, both of which would result in weight loss, it was named leptin from the Greek 'leptos' meaning thin. In general, circulating levels of leptin appear to reflect the current status of body fat deposition and increase with the level of adiposity demonstrating the responsiveness of endogenous leptin to weight...

Humoral and cellular autoimmune responses

Ease or polyendocrine autoimmune syndrome type 2 (Table 1). On the other hand, patients with polyendocrine autoimmune syndrome type 1 (characterized by adrenal insufficiency, hypoparathyroidism and hypogonadism) have antibodies that react with P450 SCC (cholesterol side-chain cleavage) or, as reported by other authors, another enzyme, the microsomal steroid 17a-hydroxylase (Table 1). It is still uncertain whether these autoantigens are expressed on the surface of adrenal cells or are otherwise accessible to adrenal antibodies in vivo. Finally, IgG preparations from patients with Addisons disease have been reported to cause a dose-dependent decrease of in vitro Cortisol production and or DNA synthesis induced by ACTH in guinea pig adrenal segments maintained in organ culture. The blocking effects occurred irrespective of the presence or absence of adrenal cytoplasmic autoantibodies and were attributed to the production of antibodies against the receptor for ACTH. This hypothesis has...

Neuroendocrine Effects of Alcohol

Alcohol activates the sympathetic nervous system, increasing circulating catecholamines from the adrenal medulla. Hypothalamic-pituitary stimulation results in increased circulating cortisol from the adrenal cortex and can, rarely, cause a pseudo-Cushing's syndrome with typical moon-shaped face, truncal obesity, and muscle weakness. Alcoholics with pseudo-Cushing's show many of the biochemical features of Cushing's syndrome, including failure to suppress cortisol with a 48-h low-dose dexamethasone suppression test. However, they may be distinguished by an insulin stress test. In pseudo-Cushing's, the cortisol rises in response to insulin-induced hypoglycemia, but in true Cushing's there is no response to hypoglycemia.

Endocrinology of ageing

The second hormonal system demonstrating age-related changes is the circulating levels of dehydroepiandrosterone (DHEA) and its sulfate (DHEAS), which gradually decline resulting in 'adrenopause' (Ravaglia et al 1996, Herbert 1995). At age 30, DHEAS levels are approximately five times higher than at age 85. The decline in DHEA(S) levels contrasts with the maintenance of plasma cortisol concentrations at the same level, and seems to be caused by a selective decrease in the number of functional zona reticularis cells in the adrenal cortex rather than regulated by a central (hypothalamic) pacemaker of ageing (Herbert 1995).

Alterations in Neurochemical Stress Response Systems in Patients with Anxiety Disorders

Specific alterations in cortisol and HPA axis function are associated with PTSD. An increase in neuronal CRF release is a possible explanation for the clinical findings that have been reported for this disorder, with resultant blunting of ACTH response to CRF, increased central glucocorticoid receptor responsiveness, and resultant low levels of peripheral cortisol due to enhanced negative feedback. Interestingly, nonhuman primates with variable foraging mothers (a model for early life stress) had elevated CSF and CRF and decreased CSF cortisol levels in adulthood, which is more similar to PTSD than to depression. Evidence for dysfunction of CRF or HPA systems in PD has been inconsistent. Normal levels of CRF in CSF of PD patients have been found, blunted ACTH responses to CRF (indicating chronic elevations in CRF) have been reported in some studies, and both normal and elevated rates of cortisol nonsuppression following dexamethasone have been reported. Urinary-free cortisol results...

Tonic Signals The Moderating Effects of Energy Status

Appetite is not only derived from the daily flux of physiology associated with meals and eating behavior but also must respond to the long-term (tonic) energy status of the organism. Factors derived from the processes of energy storage and the status of the body's energy stores must also contribute to appetite and its expression (e.g., indicators of glucose metabolism and fat storage). Blood carries various substances (other than nutrients) generated in organs implicated in nutrient metabolism and energy storage such as the liver, the pancreas and in adipose tissue depots that reflect the body's energy status and that have been shown to have potent effects on food intake (insulin, glucagons, and leptin). The number of potentially active metabolites and by-products produced by energy metabolism of differing nutrients is vast providing a wide range of potential indicator substances.

Susceptibility to Mood Enhancement by Diet

Nevertheless, recent research provides some further support for beneficial effects of carbohydrate-rich protein-poor meals on mood and emotion in some people. When participants were divided into high and low stress-prone groups, as defined by a questionnaire, carbohydrate-rich protein-poor meals prior to a stressful task were found to block task-induced depressive feelings and the release of the glucocorticoid stress hormone cortisol, but only in the high stress-prone group. This finding was replicated using high- and low-tryptophan-containing proteins (a-lactalbumin and casein, respectively). It was argued that, because stress increases 5-HT activity, the poor response to stress of the sensitive group might indicate a deficit in 5-HT synthesis that is improved by this dietary intervention. There is another link between macronutrient intake, stress, and mood. Chronic dysfunction of the stress-sensitive hormone cortisol and its controlling hypothalamic pituitary adrenal (HPA) axis is...

Depression an allostatic disorder with premature mortality

The neuroendocrinology of human depression closely resembles that of chronic stress models in the laboratory (Checkley 1996, Lopez et al 1998). One sees increased central HPA activity, reduced feedback, and adrenocortical hypertrophy. Mean 24 h plasma cortisol concentrations are normal to slightly elevated, as are urinary free cortisol excretion, plasma and cerebrospinal fluid free cortisol concentrations, and salivary cortisol. Nocturnal plasma cortisol concentrations are significantly raised, whereas daytime plasma cortisol concentrations usually are not. Moreover, body temperatures, both nocturnal and diurnal, are significantly elevated in depression by 0.4-0.6 C (Szuba et al 1997, Rausch et al 2000). These are classical allostatic changes.

Health Maintenance And Disease Prevention

The composition of the diet may affect the body's ability to maintain energy (1,11). Especially, diets containing at least 55 of energy from a variety of carbohydrate sources, as compared with high-fat diets, reduce the probability of body fat accumulation. Substantial data suggest those diets high in fat tend to promote consumption of more total energy than diets high in carbohydrates. This effect may be due to the low energy density of high-carbohydrate diets, because total volume of food consumed appears to provide an important satiety cue. Although there are no data to suggest that different types of carbohydrates affect total energy differently, the composition of the diet may affect the proportion of excess energy stored as body fat. The body has a large fat storage capacity, and excess dietary fat is stored very efficiently in adipose tissue. Alternatively the body's capacity to store carbohydrates is very limited, and excess dietary carbohydrates are not efficiently stored as...

Risk Versus Benefit Assessment

A good example of an application of mechanistic modeling in quantitative risk benefit assessments comes from the literature on inhaled corticosteroids (43,44). While inhaled corticosteroids present a viable therapeutic option for asthma, there have been questions on their long-term safety. Specifically, these concerns stem from their potential to suppress development of the adrenal function. Consequently, a clear delineation of the benefit (for asthma) and risk (clinical adrenal suppression) is necessary for development of newer inhaled cor-ticosteroids. Here the benefit is a conglomeration of all favorable attributes of a molecule, including optimal PK properties, drug delivery properties, and increased residence in the lung, which may likely contribute to a more favorable systemic side-effect profile. An assessment of a quantitative risk benefit value would entail the use of cortisol levels in plasma as a biomarker of the suppression in adrenal function. PK PD modeling can then be...

Endocrine Metabolic Effects

Data examining endocrine and metabolic alterations in the patient undergoing laparoscopy are sparse. Ortega et al24 randomized 20 women with uncomplicated, asymptomatic cholelithiasis to open versus laparoscopic cholecystectomy. Hormonal responses were measured and compared for adrenocortical (serum ACTH, cortisol, urinary free cortisol), adrenomedullary (plasma and urinary epinephrine and norepinephrine), thyroid (TSH, thyroxine and triiodothyronine) and glucose (serum glucose, glucagon and insulin) homeostatic axes. Operative time and hospital length of stay were not different between the groups. Pain scores were significantly less in the laparoscopic group. There were no differences in the response of the adrenocortical, adrenomedullary, thyroid and glucose measures. The laparoscopic group had elevated antidiuretic hormone levels during the procedure and postoperatively. Open cholecystectomy was associated with elevated glucose and insulin levels primarily in the postoperative...

Traumatic Stress and Posttraumatic Stress Disorder

One mechanism through which PTSD could lead to increases in immune activity has been examined and provides suggestive results. The majority of studies have found lower 24-h urinary cortisol excretion in patients with PTSD compared to patients without PTSD and normal controls. Cortisol exerts immuno-suppressive effects, so persistently low levels could be associated with increased immune activity. However, future research examining immune levels in less chronic PTSD without comorbid diagnoses is necessary before conclusions can be drawn with any certainty about the relationship between PTSD and immunity.

Mechanisms Of Stressrelated Immune Alterations

The finding that psychosocial stressors can evoke consistent changes in immune measures led researchers to begin searching for the mechanisms through which emotional states could impact immune levels. Results of these studies suggested that stress has both direct and indirect effects on immunity. Direct effects stem from the activation of the two primary stress pathways the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. SNS activation is accompanied by increases in levels of catecholamines in the bloodstream, whereas HPA activation results in increased release of glucocorti-coids. These hormones appear to participate in regulating the immune system both through direct neural innervation of lymphoid tissue and through their activity at relevant receptors on lymphocytes. As mentioned previously, cortisol often acts as an im-munosuppressive agent, and animal research has suggested that genetically low glucocorticoid respon-ders are more susceptible to...

Environment and Nutrition

Amino acid composition leads to lesser growth of skeletal muscle and more deposition of fat. However, provision of a high-quality ration ad libitum leads to excess fat deposition. In pigs fed ad libitum, 92.5 ad libitum, and 85 ad libitum, the carcass protein was 100 , 97 , and 94 , respectively, whereas the fat was 100 , 86 , and 75 , respectively. 6 The groups fed 92.5 and 85 ad libitum required 5 and 10 less feed per unit protein produced. Many experiments indicate the advantage of less than ad libitum feeding. Experimental limit feeding uses individually penned animals or computer-controlled feed delivery systems. Practical implementation of limited feeding is difficult. In group-penned animals fed limited quantities, socially dominant animals eat at greater than ad libitum and submissive animals eat less than required. Biomedical research to understand neural control of feeding behavior may lead to strategies to control feed intake in animals raised for meat production. Leptin, a...

Structure of the CSFs

The CSFs are small polypeptides of Mr around 15 000 which are heavily and variably modified by glycosylation, although the functional significance of this carbohydrate has not been established. IL-3, IL-5, GM-CSF, G-CSF erythropoietin, thrombopoietin and IL-11 are monomers, whereas CSF-1 and SLF are homodimers, linked by disulfide bonds. As discussed below, CSF-1 and SLF also differ from the other CSFs in binding to a different structural class of cell surface receptors. Although there are few similarities in the amino acid sequences of different CSFs, analysis of their three-dimensional structures has revealed that they all belong to one structural family of proteins, characterized by four a helices, bundled in a particular way. This family also includes most interleukins, as well as hormones such as growth hormone, thrombopoietin, erythropoietin and leptin. IL-2, erythropoietin, IL-4, IL-5, IL-6 and IL-7, as well as other cytokines such as LIF, CNTF and leptin.

Total Lipid Recovery

Most of the organic solvents already mentioned will dissolve the triacylglycerols and free the fatty acids of Figure 3.1. The difficulty in total lipid extraction is twofold (1) Some of the solvents are immiscible with water and (2) some are poor solvents for the polar lipids (mostly phospholipids). The triglycerides may be obvious in fatty streaks or layers, or they may exist in the form of adi-pocytes (fat cells) scattered within muscle tissue. A very small fraction will be found in the cell membrane bilayers, which are mostly phospholipids. It is likely that the latter do not exist in the neat arrangements usually shown but are instead hydrated to some extent because of the affinity for water of both the phosphoric acid and amino acid molecules on the 3-position of the glycerol.

Clinical Chronopharmacology

The interpatient variability in 24-h mean level of 5-FU usually required to express each concentration relative to the 24-h mean in the same patient, in order to demonstrate synchronized circadian rhythmicity at a group level (42,44,48). Furthermore, differences in individual circadian time structure, including the prominence of ultradian rhythms, with periods of one to several hours, could not be caught up by sampling times staggered every 4 h for 24 h, as was usually the case. Indeed, approx 30 of the patients with metastatic colorectal or breast cancer displayed a marked damping of their 24-h rhythms in rest-activity or cortisol (53-55). These alterations might influence 5-FU disposition and ablate its rhythmicity especially in patients with extensive tumor burden or poor performance status (49). Interestingly circadian function alteration predicted for poor outcome in advanced cancer patients independently of the known prognostic factors (54-55), and exogenous glucocorticoids...

Underlying Factors Glucocorticoids

Maternal glucocorticoids can also influence birth weight of the offspring. Under normal conditions, fetal exposure to glucocorticoids is relatively low due to the presence of placental 11 3-hydroxysteroid dehydrogenase 2 (11 HSD2), an enzyme that acts as a placental barrier by inactivating maternal glu-cocorticoids before they cross into the fetal environment. Maternal glucocorticoid treatment during pregnancy or inhibition of the placental 11 3HSD2 can therefore increase the amount of active gluco-corticoid crossing the placenta. Excess glucocorti-coid exposure has also been implicated in disturbing the normal growth and development of the fetus with consequential effects on the overall health of the adult offspring. There does, however, appear to be a critical window of sensitivity where the developing fetus is particularly sensitive to glu-cocorticoids. Glucocorticoid overexposure in the 3rd trimester is known to cause reductions in birth weight. Studies in rats have established...

Maternal Total Food Intake

Despite the observed significant reduction in birth weight, adult rats exposed to maternal undernutri-tion (30 of ad libitum intake) whilst in utero have been shown to develop obesity. Compared to the control offspring, the feed-restricted offspring appear to have been inappropriately programed and display hyperphagia and elevated food consumption as a consequence of in utero exposure to an adverse maternal diet. The underlying mechanisms leading to the hyperphagia in these offspring remains to be determined. However, the involvement of leptin resistance has been implied as these offspring also display hyperleptinemia and have significantly elevated fat pad mass as adults.

Maternal Protein Consumption

Recently, evidence has been provided suggesting that taurine supplementation to the maternal low-protein diet may benefit the health outcomes of the rat offspring. Maternal taurine supplementation was found to restore and normalize the vascularization of the offspring's endocrine pancreas. Despite these findings, there is little evidence to suggest that a maternal high-protein intake has overall beneficial effects on the metabolic health of the offspring. Some human epidemiological studies and human trials involving high-protein dietary supplementation have in fact demonstrated that the consumption of a high-animal-protein, low-carbohydrate diet throughout late pregnancy can lead to metabolic disturbances in the offspring when they reach adulthood. It has been suggested that these high-protein diets stimulate the hypothalamic-pituitary-adrenal axis and cause maternal cortisol levels to increase. As a result, the developing fetus is presented with the metabolic stress of being exposed...

Colostrum Composition

The immunoglobulins are further divided into three subgroups, i.e., Immunoglobulin G (IgG), Immunoglobulin A (IgA), and Immunoglobulin M (IgM). In colostrum, IgG is the predominant immunoglobulin, whereas in milk IgA is the predominant immunoglobulin. In addition to immunoglo-bulins, colostrum contains various anti-infection agents (e.g., lactoferrin, lysozyme, lactoperoxidase, live lymphocytes, and oligosaccharides), digestive enzymes (e.g., lipase and amylase), hormones (e.g., insulin and cortisol), growth factors e.g., epidermal growth factor (EGF), insulin-like growth factor I (IGF-I), insulin-like growth factor II (IGF-II), transforming growth factor (TGF)- 1, and TGF- 2 , and other bioactive peptides. More detailed analyses of colostrum composition can be found in the references listed at the end of this article.

Postnatal Growth and Later Risk of Disease

Postnatal growth is clearly related to prenatal growth. Some metabolic changes associated with prenatal nutritional sufficiency may affect postnatal physiology and behavior that, in turn, affect growth. In addition, there is intriguing evidence from animal studies that prenatal nutritional restriction alters appetite and induces hyperphagia, and also reduces physical activity in adult animals (see Figure 2). If true in humans, this would be an important pathway by which disease risk is affected. Suggestive evidence comes from human infants whose cord blood leptin levels at birth were inversely related to weight gain in the first 4 months of life, independent of birth

Adipose Tissue Hormones

The adipose tissue secretes different hormones called adipocytokines. Their secretion seems to vary in relation to the amount of adipose tissue accumulated, although the exact mechanism is not known. During profound weight loss, as in anorexia nervosa, there is a marked decrease in the adipose tissue mass with the typical changes in adipocytokines secretion that occur in these circumstances. One of the most studied adipocytokine changes is decreased leptin secretion. Increased fat mass stores are accompanied by an increased leptin secretion decreased fat mass stores decrease leptin secretion. Low serum levels of leptin reaching the hypothalamus increase the activity of the 'hunger center,' in part by increasing the local activity of neuropeptide Y. Individuals with anorexia nervosa have very low levels of leptin in blood and cerebrospinal fluid, in relation to their decreased adipose tissue. This should cause an increase in hypothalamic neuropep-tide Y content and hunger, but this...

Hypothalamic Control of Hunger in Anorexia Nervosa

In normal individuals fasting and weight loss increase hunger by multiple mechanisms (decreased serum levels of leptin, insulin, and blood glucose and increased levels of ghrelin). At the level of the hypothalamus there is an increase in the potent orexigenic neuropeptide Y and other changes in neurotransmitters secondary to the fasting state. Some of these neurotransmitter changes may be the cause or a mechanism of anorexia nervosa, and for this reason they have received considerable attention in the past several years. It is important to understand that appetite control is a very complex hypothalamic function that involves many local and systemic neuropeptides, amines, and hormones.

Factors Affecting Metabolic Rate

The process of oxidation involves a series of enzyma-tically controlled biochemical reactions leading eventually to the combination of oxygen with the carbon and hydrogen components of the body's fuels to yield the carbon dioxide and metabolically derived water. The incompletely oxidized nitrogen is excreted as urea, which is synthesized by the liver and excreted by the kidneys. The intermediate steps in the metabolism of the body's fuels are linked biochemically to drive the generation of phosphate-containing organic molecules, such as adenosine triphosphate (ATP), which in turn serve as the direct energy sources for all the body's cell activities, including the synthesis of complex molecules, the maintenance of tightly controlled ionic gradients in the cell, and the excretion of ions and molecules outside the cell. Thus, the oxygen being taken up by the lungs reflects the tissue metabolism of the fuels needed to regenerate the ATP used up in either biochemical 'internal' work or...

Macronutrients and Physical Activity Protein

Carbohydrate supplies about 45 of the energy in the typical Western diet this amounts to about 200300 g day-1 for the average sedentary individual, and is the amount that is necessary to get through normal daily activities. In an hour of hard exercise, up to 200 g of carbohydrate can be used, and sufficient carbohydrate must be supplied by the diet to replace the amount used. Replacement of the glycogen stores is an essential part of the recovery process after exercise if the muscle glycogen content is not replaced, the quality of training must be reduced, and the risks of illness and injury are increased. Low muscle glyco-gen levels are associated with an increased secretion of cortisol during exercise, with consequent negative implications for immune function.

Fatty Acid Unsaturation and the Essential Fatty Acids

As noted earlier, the most abundant fatty acids in humans include a saturated fatty acid (16 0) and a monounsaturated fatty acid (18 1n-9). Humans can readily insert a cis-double bond nine carbons from the carboxyl carbon atom of a fatty acid (A9) in a reaction catalyzed by stearoyl-CoA desaturase (SCD1 so-named because the preferred substrate is the CoA derivative of 18 0, stearic acid). Because SCD1 is involved in the synthesis of such an abundant fatty acid, 18 1, the importance of this enzyme in metabolism was initially overlooked. However, 18 1 produced by SCD1 appears to be directed specifically towards triacylglycerol synthesis. Mice in which the SCD1 gene is disrupted have decreased adiposity. Furthermore, genetically obese leptin-deficient (ob- ob-) mice in which the SCD1 gene is also disrupted have significantly reduced body weight compared with ob- ob- mice, leading to the hypothesis that leptin regulates the synthesis of SCD1. Interestingly, dietary 18 1 seems to be more...

Pathophysiology of Uncontrolled Diabetes

Pathophysiology Loss Weight

The pathophysiologic events that affect blood glucose levels in states of mild-to-moderate insulin deficiency are classified into two broad categories. First, the normal pathways for glucose clearance after a meal are ineffective second, body fuel stores are broken down with release of other substrates that lead to inappropriate synthesis of more glucose. These events are brought about by insulinopenia and often are further promoted by the relative abundance of the counterregulatory hormones, glucagon, catecholamines, and, to a lesser extent, cortisol and growth hormone. In addition, hyperglycemia further inhibits pancreatic 0 cell insulin secretion, compounding the problem (''glucose toxicity'').

Decrease In Platelets Ptsd A 2 Receptors Ptsd

Alterations in urinary cortisol + a + Altered plasma cortisol with 24-hr sampling + (decrease) +(increase) aFindings of decreased urinary cortisol in older male combat veterans and holocaust survivors and increased cortisol in younger female abuse survivors may be explainable by differences in gender, age, trauma type, or developmental epoch at the time of the trauma. + indicates the availability of studies NT not tested. controls and patients with other psychiatric disorders. Relative elevations of the NE metabolite, MHPG, were found in their nighttime samples. No differences were found in baseline levels of plasma NE when compared with healthy subjects. This noradrenergic hyperreactivity in patients with PTSD may be associated with the conditioned or sensitized responses to specific traumatic stimuli. Women with PTSD secondary to childhood sexual abuse had significantly elevated levels of catecholamines (NE, E, and DA), cortisol and catecholamine metabolites, metane-phrine,...

TABLE 1253 Clinical Signs of Hypoglycemia

Aberration than a true pathologic syndrome.24 It usually presents in children less than 18 months of age after a period of fasting. Often this is seen on holidays and weekends, when parents sleep late, inadvertently extending the child's usual nighttime fasting period. It is also more common during illnesses preventing normal food intake. These children return to normal after a glucose load and have no suspicious findings in either their history or physical exams. 25 Classically, this problem was thought to arise because these children were small for age, but that idea has been called into question by more recent findings. 24 Currently, alanine, by far the most important amino acid in gluconeogenesis, is thought to play a major role in this disorder. 36 Haymond et al.5 demonstrated lower serum alanine concentrations in these patients as compared with age-matched control groups during fasting. Giving gluconeogenic precursors to these patients during periods of fasting prevents...

Regulation of Transcription by Steroid Hormones

Steroid hormones (estrogen, progesterone, and cortisol, for example), too hydrophobic to dissolve readily in the blood, are carried on specific carrier proteins from their point of release to their target tissues. In target cells, these hormones pass through the plasma membranes by simple diffusion and bind to specific receptor proteins in the nucleus (Fig. 12-40). Hormone binding triggers changes in the conformation of the receptor proteins so that they become capable of interacting with specific regulatory sequences in DNA called hormone response elements (HREs), thus altering gene expression (see Fig. 28-31). The bound receptor-hormone complex can either enhance or suppress the expression of specific genes adjacent to HREs. Hours or days are required for these regulators to have their full effect the time required for the changes in RNA synthesis and

Neuroendocrine Theories

Approximately 40-60 of depressed individuals produce and secrete excessive amounts ofcortisol, primarily during the afternoon and evening. In these patients, cortisol secretion returns to normal levels after the depressive episode remits. This excessive cortisol is thought to be due to the overproduction by the hypothalamus of corticotropin-releasing hormone (CTRH), a compound that is stimulated by norepi-nephrine and acetylcholine, leading some to believe that CTRH and the noradrenergic system may be interconnected. Administration of dexamethasone, a chemical that temporarily suppresses the production of cortisol in nondepressed adults, was at one point believed to be a useful tool in the diagnosis of depression since many depressed individuals did not demonstrate this cortisol suppression. Recent evidence has indicated that many nondepressed psychiatric patients also fail to display a response to the dexame-thasone suppression test, thus limiting its utility in the diagnosis of...

Fructose Consumption Body Weight and Obesity

Data comparing the effects of ingesting fructose-and glucose-sweetened beverages with meals indicate that fructose ingestion results in smaller increases in blood glucose and insulin concentrations following the meals. In addition, circulating leptin concentrations are lower, and the normal suppressive effect of meal consumption on ghrelin concentrations is attenuated with fructose beverages. Glucose, insulin, leptin, and ghrelin are all involved in the long-term control of food intake and body weight regulation through the central nervous system. Since these key signals are absent or weakened with fructose consumption, chronic consumption of a diet high in fructose could contribute, along with dietary fat and inactivity, to increased energy intake, weight gain, and obesity.

Integration of Episodic and Tonic Signals within the CNS

Within these sites numerous neurochemicals (first neurotransmitters and then neuropeptides) have been identified as potent inhibitors and stimulators of feeding behavior. 5-HT has been implicated as a critical CNS satiety factor in the short-term regulation of food intake. Specifically, the 5-HT system appears to be sensitive to meal-generated satiety factors such as CCK, enterostatin, and ingested macronutrients. Moreover, 5-HT drugs appear to enhance satiety, suppress CNS NPY release, and inhibit hunger. 5-HT appears to mediate the effects of episodic meal-generated satiety on appetite. The second CNS system to be involved is that of the melanocortins, which appear integral in the action of circulating leptin on intake and (like 5-HT) its agonists also inhibit NPY functioning. Thus, the melanocortins may mediate the effects of tonic energy status on appetite. The melanocortins are one of the inhibitory systems through which the tonic adiposity...

Humor Elicitation Theory Of

One theory that integrates the diverse findings on hunger, eating, and weight, called the set-point theory (Keesey, 1980), suggests that a homeostatic mechanism that regulates food intake, fat reserves, and metabolism operates to keep an organism at its predetermined weight. According to set-point theory, which was first suggested by research with laboratory rats, no single area in the brain keeps track of weight. Rather, an interaction of metabolism, fat cells, and hormones keeps people at the weight for which their bodies are designed. A common, persistent psychological theory holds that being overweight is a sign of emotional disturbance, but research has failed to support this popular belief. However, tension and irritability can result from constant dieting (being hungry much of the time), and unhap-piness can result from being heavy in a society that discriminates against people who weigh more than the cultural ideal. Culture and ethnic background...

Dairy consumption energy intake and body weight

Over the long term, the hypothalamus regulates food intake in response to hormones that enter the brain from the peripheral circulation and whose plasma concentrations are related to adipose tissue mass (Schwartz et al., 2000). The two major hormones that have been implicated in the long-term regulation of food intake are leptin and insulin (Badman and Flier, 2005). However, it has recently been shown that ghrelin, a hormone secreted by specialized cells in the stomach, also meets the criteria for a long-term regulator of food intake (Cummings, 2006). Leptin is a hormone arising from adipose tissue and its plasma concentrations are directly proportional to the adipose tissue mass. Although insulin does not arise from adipose tissue, its concentration in blood at fasting and after food ingestion is influenced by adipose tissue mass. It has been proposed that both insulin (Biddinger and Kahn, 2006) and leptin (Munzberg and Myers, 2005) resistance in the brain lead to increased food...

Stress Response and Immunologic Parameters

Clinical controlled trials of laparoscopic versus conventional surgery have mostly focused on changes of cytokine levels to describe the influence of pneu-moperitoneum on systemic immunological functions. These studies showed differences in serum cytokine levels between laparoscopic and conventional surgery for IL-l(lb 174 ), IL-6 (lb 36, 135, 165, 176, 254, 320, 322 ), CRP (lb 135, 140, 176, 235, 254, 320 , CRP (lb 133, 138, 174, 233, 252, 318 ) and cell-mediated immunity (lb 224 ) that have not been confirmed by other authors (lb 17, 198 , 2b 89 ). In RCTs, postoperative immunological functions seemed to be better preserved after laparoscopic compared to conventional procedures (lb 13, 45, 151, 176, 235, 276, 284, 308, 321 ) however, some trials found no differences (lb 73, 113, 173, 203, 226, 248, 270, 289, 295 ) and one trial even reported a more pronounced immunodepression after laparoscopy (lb 290 ). Additional RCTs examined perioperative stress response and found adrenaline (lb...

Renal Effects of Anti Diuretic Hormone

In the absence of circulating ADH, water re-absorption in the proximal tubule and LOH remains unchanged, since ADH does not affect water absorption at these sites. However, the collecting tubules become impermeable to water, and the large volumes entering the medullary collecting tubules, pass through and are excreted. In addition, the collecting tubules also become impermeable to urea, preventing the attainment of maximal medullary interstitial osmolality. This in turn also reduces water reabsorption from the descending limb of the loop of Henle. Thus, when no ADH is present (diabetes insipidus), urine volume is about 23 1 day, with an osmolality as low as 60 mosmol kgH2O. Note that adrenal steroids (cortisol) must be present for ADH to have its maximum effect on water permeability.

Step 5 Followup laboratory evaluation

A high serum androgen value may suggest the diagnosis of polycystic ovary syndrome or may suggest an androgen-secreting tumor of the ovary or adrenal gland. Further testing for a tumor might include a 24-hour urine collection for cortisol and 17-ketosteroids, determination of serum 17-hydroxy-progesterone after intravenous injection of corticotropin (ACTH), and a dexamethasone suppression test. Elevation of 17-ketosteroids, DHEA-S, or 17-hydroxyprogesterone is more consistent with an adrenal, rather than ovarian, source of excess androgen.

Development of immunosuppressive therapy

Duct drainage, splenectomy, thymectomy, anti-lymphocyte serum or globulin, and steroids. Corticosteroids are naturally occurring hormones secreted by the adrenal cortex, of which Cortisol (hydrocortisone) is by far the most powerful component known to possess lymphocytolytic activity, particularly with respect to T lymphocytes, to inhibit Ivm-phokine production, and to exert a stabilizing effect on the lysosomal membranes, along with those of other cellular organelles. These effects are dose- or concentration-dependent. Corticosteroids not only intervene at many points of the immune response, such as preventing lymphocyte recirculation and generation of antibody-producing and cytotoxic effector cells, but they also possess a remarkable antiinflammatory potency. They inhibit neutrophil adherence to the vascular endothelium at an inflammatory site and suppress monocytic functions such as microbicidal activity, monocyte response to lymphokines, and release of monokines. Antilymphocyte...

Mct And Smct Transporter Expression

Evidence supporting hormonal regulation of MCT1 transcription has also been reported. In a thyroid cell line (FRTL-5) MCT1 transcription was found to be regulated by thyroid-stimulating hormone (TSH) through cAMP-dependent pathways.36 In a human intestinal cell line (Caco-2), addition of leptin to the apical surface leads to a small but significant increase in MCT1 protein in the apical membrane.37 This increase in MCT1 expression induced by leptin was attributed to increased MCT1 mRNA production and enhanced translocation of the transporter protein to the plasma membrane from intracellular pools.37 Further studies with Caco-2 cells have shown

Summary Episodic and Tonic Factors in the Regulation of Appetite

Endogenous 5-HT and leptin represent two aspects of negative feedback integral to the appetite control system (see Figure 3). Both systems appear to inhibit NPY functioning, the effect of leptin being partly mediated by melanocortins and other excitatory and inhibitory neuropeptides. 5-HT mediates the effect of meal-derived satiety factors derived from pre- and postingestive processes (such as CCK and enterostatin relsease) and promotes meal termination, prolonging the intermeal interval. By such a mechanism the body deals with the daily physiological fluxes that result from meal intake ensuring an approximately appropriate daily energy intake. Circulating leptin accurately reflects the current status of the body's energy store. Leptin levels continually modify total daily and meal food intake to maintain a sufficient but not excessive level of energy deposition. Thus, 5-HT and leptin represent two classes of signals short-term episodic and long-term tonic feedback, respectively. The...

Harnessing the mutant map to ongoing genomics programmes

A draft human genome sequence is expected by year 2000. Plans to provide a draft sequence of the mouse genome have been initiated. In addition, the provision of finished sequence from several defined regions of the mouse genome is already underway. Comparison of human and mouse sequence in any region is expected to improve the identification and annotation of gene sequences and provide an important adjunct to gene prediction software. Indeed, in at least a few cases to date, the provision of mouse and human comparative sequence has underpinned the identification of novel genes and their mutation scanning. One recent example is the identification of the mouse X-linked Bare patches (Bpa) and Striated (Str) mutations (Liu et al 1999), both dominant male lethals having pleiotropic effects on skin morphology and skeletal development. Comparative sequencing of the region in which the Bpa and Str mutations were known to lie aided the characterization and annotation of a novel 3...

Hormonal Control of Secretory Activation

The decrease in progesterone around parturition is generally agreed to be required for the onset of milk secretion. In humans, it is known that removal of the placenta, the source of progesterone, is necessary for the initiation of milk secretion. In swine, timing of the increase in milk lactose correlates closely with timing of the decrease in plasma progesterone at parturition. Exogenous progesterone prevents lactose and lipid synthesis in mammary glands of pregnant rats and sheep after removal of their ovaries, the source of progesterone in these species. Progesterone also suppresses -casein expression in the rat mammary gland during pregnancy and the decrease in progesterone levels is linked to increased -casein synthesis at parturition. Receptors for progesterone are not detected in lactating mammary tissues, which explains why progesterone does not inhibit established lactation. It is likely that the decline in progesterone is insufficient to activate secretion and that the...

Stress And Muscle Metabolism

Preslaughter stress in animals causes release of catecholamines and depletion of muscle glycogen, which influence the extent of postmortem glycolysis and pH decline in muscles. Severe stress in goats prior to harvesting may result in inferior meat quality. Short-term preslaughter stress causes reduction in muscle glycogen levels in young goats, but not in older ones (Fig. 3), although increases in circulating cortisol and glucose concentrations are noticeably less in young goats compared to older ones. 11 Muscle glycogen concentrations and pH values during the immediate postmortem period may indicate the

Programming of Obesity Experimental Evidence

Obesity and related metabolic disorders are prevalent health issues in modern society and are commonly attributed to lifestyle and dietary factors. However, the mechanisms by which environmental factors modulate the physiological systems that control weight regulation and the aetiology of metabolic disorders, which manifest in adult life, may have their roots before birth. The 'fetal origins' or 'fetal programming' paradigm is based on observations that environmental changes can reset the developmental path during intrauterine development leading to obesity and cardiovascular and metabolic disorders later in life. The mechanisms underlying the relationship between prenatal influences and postnatal obesity and related disorders are relatively unknown and remain speculative, as are the interactions between genetic and environmental factors. While many endocrine systems can be affected by fetal programming recent experimental studies suggest that leptin and insulin resistance are...

Experimental Evidence for Programming of Obesity

Several animal models of early growth restriction have been developed in an attempt to elucidate its relationship with adult onset disease and provide a framework for investigating the underlying mechanisms. Animal studies have clearly shown that prenatal undernutrition programs not only postnatal cardiovascular dysfunction but also obesity, elevated plasma leptin concentrations, glucose intolerance, and even activity levels and dietary preferences. In rats hypertension, insulin resistance and obesity have been induced in offspring by maternal undernutrition,46 a low protein diet,7 maternal uterine artery ligation,8 maternal dexamethasone (DEX) treatment9 or prenatal exposure to the cytokines interleukin (IL)-6 and tumour necrosis factor (TNF)-alpha.10 There are also increasing experimental data in other species. In guinea pigs, IUGR caused by uterine artery ligation or maternal undernutrition results in reduced glucose tolerance, increased sensitivity to cholesterol loading11 and...

Transcriptional Control Of Cell Differentiation

Studies have shown that both internal and external factors can regulate differentiation by mediating gene and protein expression. External compounds, such as growth factors, pharmaceutical agents, lipids, hormones, etc., influence cell differentiation through cascades that culminate in transcription factor activation followed by gene transcription. 2 This may be followed by translation of the gene product into a protein that induces the cell's phenotypic change. For example, thiazolidinediones are PPAR ligands that induce the transcription factor PPAR-g2, which induces adipocyte differentiation and protein production, including adipocyte lipid-binding protein (aP2) and leptin. Transforming growth factor (TGF) and bone morphogenic proteins (BMP) are examples of growth factors that induce transcription factors and alter gene expression in various cell types in domestic animals (Table 1). Sma- and Mad-related proteins (Smads) are activated by both the TGF and BMP superfamilies and have...

Skeletal Muscle Growth

Postnatal growth is dependent upon food intake. Appetite is regulated by nerve centers in the hypothalamus, which is influenced by leptin from adipose tissue and by insulin.1-6-1 The quantity and availability of dietary nutrients influence growth rate and body composition. Rapidly growing, muscular genotypes have greater amino acid requirements for maximal growth than slower-growing, less muscular animals of the same species.

Clinical Note continued

Infant Hercules.'' Milder defects may show up simply as growth of excessive facial hair (hirsutism) in women. Overproduction of androgens occurs in the following way. Stimulation of the adrenal cortex by ACTH increases pregnenolone production (see earlier discussion), most of which is normally converted to cortisol, which exerts negative feedback inhibition of ACTH secretion. With a partial block in cortisol production, much of the pregne-nolone is diverted to androgens, which have no inhibitory effect on ACTH secretion. ACTH secretion therefore remains high and stimulates more pregnenolone production and causes adrenal hyperplasia (Fig. 20). Eventually, the hyperactive adrenals produce enough cortisol for negative feedback to be operative, but at the expense of maintaining a high rate of androgen production. The whole system can be brought into proper balance by giving sufficient glucocorticoids to decrease ACTH secretion and therefore remove the stimulus for androgen production.

Clinical Description Dm1

Ninety percent of DM1 patients present at adulthood with delayed muscle maturation, distal muscle weakness, wasting, myotonia, cataracts, cardiac abnormalities, smooth muscle dysfunction, insulin resistance, daytime sleepiness, testicular atrophy (low reproductive fitness), ''difficult'' personality, neuropsychiatric disturbances, and frontal balding. 1 Ten percent of the patients present at infancy with hypotonia (floppy infant), oromotor dysfunction, tent-shaped mouth, feeding and respiratory insufficiency (diaphragmatic hypoplasia), arthrogryposis, and mental retardation in those who survive until adulthood (congenital DM). 1 All manifestations show a progressive course. Usually, creatine kinase is elevated. Muscle biopsy shows type 1 predominance, centrally located nuclei, severe fiber atrophy with nuclear clumps, hypertrophic and angulated fibers, and occasionally, necrotic fibers, fibrosis, or fat deposits. Cardiac involvement comprises conduction defects (mostly HV...

Regulation of Glucocorticoid Activity

The most important stimulus for the secretion of cortisol is the release of ACTH from the anterior pituitary. ACTH release is promoted by hypothalamic release of corticotrophin releasing hormone (CRH) into the hypophyseal portal blood. Cortisol exerts a direct negative feedback control with inhibition of both CRH and ACTH release. Glucocorticoid secretion is also modulated by a normal circadian pattern whereby cortisol levels peak in the early morning and reach a trough in the middle of the night. Stress is also a modulatory factor and the stress associated with the peri-operative period can override the normal negative feedback control mechanism. Large doses of opioids may attenuate the stress response to surgical stimulation. The drug etomidate inhibits cortisol synthesis and has previously been shown to have an adverse effect on outcome when used for sedation on intensive care units. Patients on regular glucocorticoid replacement therapy require increased dosage during periods of...

Deficient Secretion

Hypoadrenalism (Addison's disease) can be either primary or secondary. Primary hypoadrenalism is caused by a failure of the adrenal cortex as a consequence of auto-immune disease, infection or surgery. As a consequence, ACTH levels are high because of a low circulating cortisol level. Melanocytestimulating hormone (MSH) is secreted in conjunction with ACTH leading to the characteristic pigmentation of the skin and buccal mucosa. Secondary hypoadrenalism results from reduced levels of ACTH following damage to the anterior pituitary. The deficiency in both mineralocorticoids and glucocorticoids results in characteristic clinical features Abnormal fat deposits across the upper back (buffalo lump) and in the face (moon face)

Depletion of Muscle Glycogen

The levels of muscle glycogen at slaughter are a result of the cumulative stressors that occur from the farm or feed-lot, through transport and lairage to the point of slaughter. Stressors can be classified as psychological if the levels of glycogen are affected by increased levels of adrenaline, producing a concomitant increase of corticosteroids, or physical if they involve physical exercise, sickness, or inadequate nutrition. In the case of physical exercise such as rounding up sheep and cattle, mounting behavior in cattle, or swim washing for sheep, the muscle glycogen is quickly converted to lactic acid, which is transported away from the muscles by the circulation. This lactic acid ultimately can be resynthesized to muscle glycogen, given sufficient time. Feeding immediately preslaughter helps some species, such as pigs, to replenish their muscle glycogen, as the ingested high energy carbohydrate can rapidly be reincorporated into muscle glycogen. In ruminants, however, the...

Clinical Features

The clinical manifestations of chronic adrenal insufficiency develop gradually with subtle signs and symptoms that provide a diagnostic challenge. The clinical presentation of Addison's disease can be explained on the basis of a deficiency of cortisol and aldosterone and a lack of feedback suppression of ACTH and MSH. Cortisol deficiency manifests clinically with anorexia, nausea, vomiting, lethargy, hypoglycemia with fasting, and inability to withstand even minor stresses without shock. The ability to excrete a free water load is also impaired and can lead to water intoxication. Lack of aldosterone results in impaired ability to conserve sodium and excrete potassium. The patient with aldosterone deficiency presents with sodium depletion, dehydration, hypotension, postural syncope, and decreased cardiac size and output. Renal blood flow is decreased, and azotemia may develop. Hyperkalemia is commonly seen but rarely is severe. Lack of suppression of ACTH and MSH secretion occurs...

TABLE 2082 Pathogenesis of Secondary or Tertiary Adrenal Insufficiency

Ihe mechanism of continued adrenal atrophy following discontinuation of exogenous steroids may be a failure of normal diurnal release of CRF. Stress-induced release of ACIH may remain intact, but the atrophic adrenal glands are unable to secrete sufficient cortisol to meet the physiologic requirements in response to stress. Ihe shortest time interval or the smallest dose at which HPA suppression occurs is unknown. As a general rule, there is no suppression regardless of the dose if its duration of use is less than three weeks. In addition, there is no suppression if the dose is < 10 mg of prednisone regardless of the duration unless it is given on an h.s. timetable. Any patient who is on more than 20 mg of prednisone for greater than three weeks is suppressed and should have the necessary precautions taken.

Nutritional Aspects Of Meat

The major nutritional components of the meat of all species from fish through poultry to pork and so-called red meats are protein and iron. Although the protein contribution is obvious, the iron contribution is often underrated. Iron deficiency is the most common nutrition disorder, and non-anemic iron deficiency is far more insidious in its effects than normally considered. Even contributes to an impairment of cognitive function (124). Meat is one of the main natural sources of iron (Table 1). The fat component of meat provides desirable energy in certain malnourished communities, but it is possibly erroneously becoming increasingly regarded as a useless by-product in our overfed Western societies. Meat should be regarded as a valuable component of a balanced diet, rather than as a food item providing unwanted calories. The fat component may be either nonseparable fat, as is usually found in the lean of meat, or separable fat that is visible and can be trimmed off. As separable fat...

Glucosefatty Acid Cycle

The self-regulating interplay between glucose and fatty acid metabolism is called the glucose-fatty acid cycle. This cycle constitutes an important biochemical mechanism for limiting glucose utilization when alternative substrate is available, and conversely limiting the consumption of stored fat when glucose is available. Fatty acids that are produced in adipose tissue in an ongoing cycle of lipolysis and reesterification may either escape from fat cells to become the free fatty acids, or they may be retained as triglycerides, depending on the availability of -glycerol phosphate (Fig. 1). The only source of -glycerol phosphate for reesterification of fatty acids is the pool of triose phosphates derived from glucose oxidation, because adipose tissue is deficient in the enzyme required to phosphorylate and hence reuse glycerol released from triglycerides. Consequently, when glucose is abundant, -glycerol phosphate is readily available, the rate of reesterification is high relative to...

Refractory shock The role of steroids

The evidence for the use of steroids in the treatment of severe sepsis has gone full circle in the last 20 years, with recent interest focusing on low doses. In patients with severe sepsis there are complex effects on the hypothalamic-pituitary-adrenal axis. On the one hand there is stimulation of the axis and loss of negative feedback control, which usually leads to high adrenocorticotrope hormone (ACTH) and cortisol levels. On the other hand various mediators cause adrenal suppression and glucocorticoid resistance. With time ACTH levels may fall due to inhibition or pituitary depletion - this leads to relative adrenal suppression. Recent studies have shown that patients with sepsis who are dependent on vasoactive drugs may benefit from stress doses of hydrocortisone (50-100 mg intravenously 4 times a day for 7 days). A proportion of these have relative adrenal insufficiency as defined by the short synacthen test and these patients have the greatest benefit in terms of mortality....

Uses of Anthropometric Measurements

In adults and children, anthropometric measurements can be used to estimate body fat and lean body mass and assess their distribution and change over time. Body fat includes storage fat, found inter-and intra-muscularly, around the organs and gastrointestinal tract and subcutaneously, as well as lipids in bone marrow, central nervous tissue, mammary glands, and other organs. Normal-weight men and women have about 10 and 20 body fat, respectively. Lean body or fat-free mass is mostly water and protein with relatively small amounts of glyco-gen and minerals. Inadequate diets are associated with low body fat stores and reduced lean body mass in adults and growth failure of children. Consumption of food greater than requirements results

Linkage of MS data and antibodybased measurements

The analysis of specific proteins showed that certain proteins were always highest or always lowest in certain preparation methods. The fact that some of these alterations were counter to the overall trends noted above shows that blood preparation methods can have variable effects on specific proteins or antibodies. Anticoagulants may in some cases specifically interact with certain proteins or specifically affect the stability of certain proteins. Such effects have been seen in previous studies. In one study, the levels of several hormones were either elevated or reduced between matched serum and EDTA-plasma and between matched serum and citrate-plasma samples 25 . Another study showed that parathyroid hormone is more stable in EDTA-plasma than in serum 26 . The levels of the cytokines IL-6, TNF-a, and leptin were found to be highly variable in citrate-anticoagulated- and heparin-anticoagulated-plasma but not in EDTA-anticoagulated-plasma or serum 27 . In some cases, an anticoagulant...

Features of Plasma Proteins

The main plasma proteins involved in drug transport are albumin and globulin. Other molecules such as alpha1 acid glycoprotein, which binds basic drugs, and specific carriers for cortisol and thyroxine contribute to the transport system. These molecules are large (albumin has a molecular weight of 69 000 Daltons) and have multiple, relatively non specific binding sites. As with all binding sites, the shape and charge of the site are important. The bonds are a combination of any of the relatively weak bonds (hydrogen bonds, hydrophilic bonds and van der Waals forces), which allows rapid dissociation of drugs (determined by concentration) at the site of action and for elimination. A drug will bind to a protein binding site to produce a complex in the following manner

Adrenal Insufficiency And Shock

Laboratory clues to the possible concomitant presence of adrenal insufficiency may be mild hypoglycemia, hyponatremia, hyperkalemia, and eosinophilia. Azotemia is, however, nonspecific and is often present in dehydration from any cause. In suspected cases, a serum cortisol should be drawn prior to steroid treatment.

Hormonal evidence related to fetal growth and later heart disease risk

Fetal growth is also affected by several hormones, growth factors, and genetic factors (fig 27.1). A recently proposed underlying mechanism, based mainly on animal studies, suggests that increased blood pressure in adult life is caused by increased exposure to corticosteroids during fetal life. This might result from reduced placental 11 P-hydroxysteroid dehydrogenase (11P-OHSD) activity or increased corticosteroid release secondary to disturbed nutrition.w9 w49-51 Increased exposure in turn may lead to permanent tissue damage, and programming of adult disease.1 w52 There are data supporting similar mechanisms in humans for example, studies have found that birth weight is correlated with placental 11 P-OHSD activity 50 and cortisol concentrations in adult life correlate with birth weightw53 and adult blood pressure. w54

Normal Glucocorticoid Levels in Late Gestation

Normally, glucocorticoid production by the fetal adrenal gland is high in early gestation and becomes reduced during mid-late gestation.6,7 Maintenance of these normal low levels of glucocorticoids is essential for normal fetal growth and development. The fetus is usually 'protected' from exposure to circulating maternal Cortisol by the presence of the enzyme 1 lPhydroxysteroid dehydrogenase type 2 (11(3HSD2) in the placenta, which converts active Cortisol to inactive cortisone.

Surgical Treatment of Cushing Syndrome

Surgical treatment of Cushing syndrome involves removing the cause of cortisol excess. Transsphenoidal resection of an ACTH-producing pituitary tumor is successful in 80 percent or more of cases of Cushing disease. Treatment of ectopic ACTH syndrome involves resection of the primary lesion. Primary adrenal causes of Cushing syndrome are treated by removal of the adrenal gland containing the tumor. All patients who undergo adrena-lectomy for primary adrenal causes of Cushing syndrome require perioperative and postoperative glucocorticoid replacement because the pituitary-adrenal axis is suppressed.

Obesity Associated with Recognized Medical Condition

Single gene defect affecting leptin metabolism Congenital leptin deficiency Leptin receptor defect Prohormone convertase-1 defect Melanocortin-4 receptor defect Peroxisome proliferators activated receptor POMC deficiency Biemond's syndrome Alstrom's syndrome Bardet-Biedl syndrome Biemond's syndrome (some) Carpenter's syndrome Cohen's syndrome proportion of obese children. With the exception of very rare single gene defects in leptin metabolism, obesity is a secondary feature in these conditions and presentation is usually for some other aspect of the condition. Single gene defects affecting leptin are associated with progressive gross obesity from early life and may respond with dramatic fat loss with leptin treatment. Where obesity is only a part of a spectrum of abnormalities, common associated features are short stature, developmental delay, and craniofacial and other bony abnormalities.

Abnormalities of Hormones and Other Circulating Factors

Syndrome, including abdominal obesity, insulin resistance, impaired glucose homeostasis, hypertension, and lipid abnormalities. These similarities led to the hypothesis that a dysregulation of the HPA axis in the form of functional hypercortisolism could potentially be a cause for abdominal obesity and its different metabolic consequences. High levels of emotional or physical stress are thought to increase cortisol secretion or turnover and thereby increase visceral obesity. Another potential mechanism involves the peripheral metabolism of cortisol. The enzyme 11- -hydroxysteroid dehydrogenase, which converts steroid precursors to cortisol, is expressed in adipose tissue. With increasing obesity, more cortisol is derived from cortisone in adipose tissue due to the increased activity of this hormone. Urine studies in obesity also show an increase in the ratio of tetra-hydrocortisol to tetrahydrocortisone, indicating a relative increase in the pathways leading to cortisol formation....

Excess Glucocorticoids and Direct Effects on Fetal Growth

The normal late gestational slowing of fetal growth in sheep can be abolished by adrenalectomy, and premature increases in Cortisol by exogenous infusion causes the fetal growth rate to slow early. Thus, in many species, intrauterine growth restriction (IUGR) is a direct consequence of late gestation exposure of the fetus to excess glucocorticoids. In contrast to the direct fetal growth restricting effects of maternal betamethasone we have observed, direct ultrasound-guided fetal injections of betamethasone do not cause IUGR11'16 We believe the growth restricting effect of maternal betamethasone is due to the prolonged duration of fetal exposure to betamethasone that occurs after maternal injection.17 Consistent with this, previous studies in which fetuses received intravenous Cortisol infusions demonstrated that fetal growth begins to slow only after approximately a day of exposure.10

Late Gestational Glucocorticoids and Programming of the Hypothalamic PituitaryAdrenal Axis

Normal physiology is dependent on adequate function of the HPA axis, which is responsible for regulating synthesis and release of a variety of corticosteroid hormones. Cortisol is the principle corticosteroid (in mammals other than rodents) produced by the adrenal cortex it regulates metabolic, immune and behavioural processes, and the body's response to stressful stimuli. Cortisol acts through glucocorticoid and mineralocorticoid receptors (GR and MR, respectively), which are present in many organs. Permanent alterations in GR and or MR gene expression have been observed in a variety of organs after manipulation of fetal glucocorticoid exposure26 and such changes are likely to underlie some of the programming effects on HPA axis function of late gestational glucocorticoid exposure. Administration of dexamethasone to pregnant rhesus monkeys, late in pregnancy, results in elevated basal and stress-induced circulating Cortisol concentrations in juvenile offspring.27 Rats born after...

Hypothalamic PituitaryAdrenal Axis

Cortisol has been recognized as a stress-response hormone because plasma levels are altered by environmental stress. Disturbances in the hypothalamic-pituitary-adrenal (HPA) axis due to mood disorders in humans were reported as early as 1943 by Pincus and Hoagland, who observed an elevation of urinary metabolites of adrenocortical secretion related to stress among test pilots. In response to anxiety or depression, an increase in norepinephrine (NE) activates the hypothalamus to release corticotropin-re-leasing factor, which stimulates the secretion of adrenocorticotropic hormone. This hormone stimulates the adrenal cortex, thereby increasing plasma concentrations of cortisol. By a negative feedback mechanism, cortisol lowers the levels of NE synthesis. The best known challenge test related to mood disorders is the Dexamethasone Suppression Test. A level of > 5 mg dl of cortisol at 8, 16, or 24hr after dexamethasone administration is abnormal and indicates a lack of suppression...

Placental Buffering of Maternal Dietary Intake

Some of the maternal nutritional adaptations in pregnancy. For example, placentally derived leptin is a potent stimulator of lipolysis and there is evidence that the rate of export into the maternal circulation is controlled to allow the placenta to modulate its own substrate supply in response to the fetal demand for fats. The various homeostatic mechanisms within the placenta and their interaction with maternal physiological adaptations during pregnancy act to ensure a constant supply of substrate to the fetus, free of large diurnal fluctuations corresponding to the timing of maternal meals, and to protect the fetus against a transiently poor intake during critical periods of fetal growth. These adaptations help the mother to meet the full fetal requirement for nutrients such as LCPUFA and iron whilst consuming apparently poor diets.

Insulin Acts in the Arcuate Nucleus to Regulate Eating and Energy Conservation

Leptin makes the cells of liver and muscle more sensitive to insulin. One hypothesis to explain this effect suggests cross-talk between the protein tyrosine kinases activated by leptin and those activated by insulin (Fig. 23-35) common second messengers in the two signaling pathways allow leptin to trigger some of the same downstream events that are triggered by insulin, through insulin receptor substrate-2 (IRS-2) and phos-phoinositide 3-kinase (PI-3K) (Chapter 12). Leptin receptor

Adrenocortical Cancer

Laboratory findings include elevated urinary levels of dehydroepiandrosterone (DHEA) in the majority of patients. DHEA has minimal direct biologic activity, but is converted into active androgens in the periphery. Elevated plasma and urinary levels of cortisol are frequently seen. Elevated urinary levels of 17-ketosteroids, the breakdown product of both cortisol and androgens, can be found as well. It is rare to find elevated levels of aldosterone alone in adrenocortical cancers. It is more common to find a combination of increased hormone levels. Those tumors that have no hormonal activity usually present at a later, more advanced stage, are usually less differentiated, and portend a poor prognosis. cortisolism, as the remaining gland may be functionally suppressed. A mechanical bowel prep should be performed since the tumor may involve or invade the colon.

Salt Intake and Blood Pressure

The greater storage of fat leads to changes in a range of hormonal secretions from the fat cells including angiotensinogen, a precursor of the renin-angiotensin axis affecting the kidney's excretion of sodium. Adiponectin secretion from expanding adipocytes falls thereby making the blood vessels much more sensitive to plaque formation, medial hypertrophy, and fibrosis. Salt-induced increases in blood pressure also involve an array of other hormonal responses including the potent vasocontrictor endothelin-1 and the vasodilator bradykinin, these being potentially involved in the blood pressure-independent effects of higher salt intake on arterial thickening, cardiac ventricular hypertrophy, and the synthesis of elastin and collagen in the artery. This makes them progressively thicker and less pliable.

The Feeding Fasting Cycle Energy Requirements

Early small increase in catecholamines, glucagon, cortisol, growth hormone then slow decrease Decrease in insulin, leptin Increase in catecholamines, glucagon, cortisol, growth hormone Decrease in insulin, leptin Increase in catecholamines, glucagon, cortisol, growth hormone Decrease in insulin, leptin

Affective disorders of childhood and adolescence

There is much controversy regarding the occurrence of major depressive disorder in prepubertal children. However, several studies in both the United States and Britain have suggested that depressive disorder does exist, although the frequency appears to be lower than in adolescents. There is endocrinological evidence, based on the hypersecretion of cortisol and an abnormal growth hormone response to insulin-induced hypoglycaemia, to suggest that children with major depressive disorder show similar endocrine abnormalities to those of adolescents and adults. However, the number of patients in these studies is small and clearly more thorough investigations must be undertaken before any conclusion may be reached.

High Fat Diets and Obesity Possible Influence of n3 PUFAs

The peptide hormone insulin is produced in the pancreas and secreted in proportion to the degree of adiposity. Similar to leptin, insulin levels are correlated with amount of abdominal fat (Porte et al., 1998 Woods et al., 1996 Woods, Figlewicz Lattemann, Schwartz, & Porte, 1990 Woods et al., 1998). It is transported into the brain where it acts to decrease food intake and body weight (Schwartz, Figlewicz, Baskin, Woods, & Porte, 1992 Woods et al., 1996). High insulin resistance is a characteristic of obesity, hypertension, and non-insulin-dependent diabetes mellitus. There is an inverse relationship between insulin action and triglyceride content. With the ingestion of fat, insulin secretion is increased. Insulin stimulates fatty acid synthase, an enzyme that catalyzes all reactions involved in lipogenesis, and thereby results in the accumulation of triglycerides (Sul, Latasa, Moon, & Kim, 2000). Monounsaturated fatty acids (such as oleate) and saturated fatty acids (such as...

Endocrine and metabolic response to surgery

Surgery represents a major stress, the metabolic effects of which are more pronounced in infants than adults. In response to surgery, there is an increase in plasma concentrations of adrenaline, noradrenaline, insulin, glucagon, glucose, lactate, pyruvate and alanine. The response is directly proportional to the severity of surgical stress. Cortisol and prolactin levels are also increased postoperatively. Cytokines which mediate the host response to injury, are also implicated. Plasma levels of interleukin-6 and interleukin-8 are

Programming of the Adipoinsular Axis and Altered Adipogenesis

It is important to note that very few animal studies have addressed interactions between pre and postnatal nutrition. However, other studies that have investigated diet-induced obesity point to a link between peripheral leptin resistance and insulin resistance in the development of obesity. The physiological role of hyperleptinemia associated with caloric excess has been proposed to relate to the protection of nonadipocytes from lipid oversupply that would lead to steatosis and lipotoxicity.68 Elevated leptin production as a result of short-term caloric excess prevents the up-regulation of lipogenesis and increases fatty acid oxidation, thus reducing lipid supply to peripheral tissue during caloric excess.68 In diet-induced obesity, peripheral leptin function is at first normal. However, prolonged caloric excess results in dysregulation of post-receptor leptin signalling. This causes accumulation of triglycerides and lipid metabolites, providing fatty acid substrate for the damaging...

Homeorhetic Regulation of Metabolic Adaptations to Pregnancy

Currie 11 and, more recently, Bauman. 12 Examples of homeorhetic regulation in pregnant animals have been reviewed previously. 1,4 Several pregnancy-related hormones, including progesterone, estradiol, and placental lactogen (PL) have been suggested as homeorhetic modulators of observed changes in tissue responses to insulin and catecholamines, and associated metabolic adaptations to the state of pregnancy in ruminants. 1 A more recently suggested candidate is leptin, 4 adipose tissue expression and plasma concentration of which increase markedly in ewes during midpregnancy, independent of nutrition and energy balance. These hormones and their proposed actions are listed in Table 1. None of these putative regulators has been shown to have the integrative, pleiotropic influences that growth hormone (GH) has in lactating ruminants. 12,13 Possibly, the combined influence of these hormones is more significant than their varying individual influences at different stages of pregnancy....

Stress and the Endocrine System

One function of the central nervous system is to evaluate and identify situations that can qualify as stress situations. The major components in the brain that are involved are the cortex, the limbic system, and the hypothalamus. The hypothalamus is the brain structure that bridges the nervous and the endocrine systems. In stress situations (fight or flight), the body mobilizes all of its energy to deal with the stress. The sympathetic nervous system, which is part of the autonomic nervous system, coordinates the effort to cope with the stress. The signal to activate the sympathetic nervous system is provided by the hormone epinephrine that is released from the medulla of the adrenal gland. A simplified description of the chain of events can be represented as follows Beginning with encountering a stress situation, hypothalamic production of a cortico-releasing factor (CRF) signals the pituitary to release the hormone ACTH (adreno-corticotrophic hormone), which, in turn, acts on the...

Rodent Models Of Human Diseases

Mapping and crossing of these lines reveal the genetic markers or loci that are linked to the phenotypes. For instance, the obese and insulin-resistant strains of ob ob and db db mice and fa fa mutations in Kolestsky, ZDF, and Zucker rats are shown to be defective in leptin and its receptor (Chen et al., 1996 Chua et al., 1996 Takaya et al., 1996 Tartaglia et al., 1995 Wu-Peng et al., 1997 Zhang et al., 1994). Leptin is an important adipocyte-derived cytokine or adipokine that regulates appetite and energy metabolism. Defects in this system in either the adipokine itself or its receptor leads to obese and insulin-resistant phenotypes. Although genetic defects in the leptin system are rare in humans, rodents provide a platform in which antiobesity or antidiabetic drugs can be tested for their effects on body weight, blood glucose, and insulin levels as well as sensitivity to glucose or insulin challenges. Other spontaneous mutants used as obesity and...

Refining Medication Treatments

Research into new medications for treatment of endometriosis is exciting. Much research centers on targeting specific causes of endometriosis rather than using medications that may sometimes have harmful systemic effects on body systems outside the reproductive system. In the future, scientists may find additional uses for selective estrogen receptor modulators (SERMs). The SERMs can affect the way estrogen interacts with the cell receptors in endometriosis lesions. Aromatase inhibitors (AI) target aromatase, the final enzyme in the estrogen-biosynthesis pathway. These AI medications selectively decrease estrogen production in endometriotic lesions without affecting ovarian function.

The Lipostat Theory Predicts the Feedback Regulation of Adipose Tissue

The lipostat theory postulates a mechanism that inhibits eating behavior and increases energy consumption whenever body weight exceeds a certain value (the set point) the inhibition is relieved when body weight drops below the set point (Fig. 23-30). This theory predicts that a feedback signal originating in adipose tissue influences the brain centers that control eating behavior and activity (metabolic and motor). The first such factor, leptin, was discovered in 1994, and several others are now known. Leptin (Greek leptos, thin) is a small protein (167 amino acids) that is produced in adipocytes and moves through the blood to the brain, where it acts on receptors in the hypothalamus to curtail appetite. Leptin was first identified as the product of a gene designated OB (obese) in laboratory mice. Mice with two defective copies of this gene (ob ob genotype lowercase letters signify a mutant form of the gene) show the behavior and physiology of animals in a constant state of starvation...

Conclusion And Future Prospects

Bullo, M., Garcia-Lorda, P.,Megias, I., andSalas-Salvado, J. (2003). Systemic inflammation, adipose tissue tumor necrosis factor, and leptin expression. Obes Res 11(4), 525-531. Chen, H., Charlat, O., Tartaglia, L. A., Woolf, E. A., Weng, X., Ellis, S. J., Lakey, N. D., Culpepper, J., Moore, K. J., Breitbart, R. E., Duyk, G. M., Tepper, R. I., and Morgenstern, J. P. (1996). Evidence that the diabetes gene encodes the leptin receptor Identification of a mutation in the leptin receptor gene in db db mice. Cell 84(3), 491-495. Chua, S. C., Jr., Chung, W. K., Wu-Peng, X. S., Zhang, Y., Liu, S. M., Tartaglia, L., andLeibel, R. L. (1996). Phenotypes of mouse diabetes and rat fatty due to mutations in the OB (leptin) receptor. Science 271(5251), 994-996. Munzberg, H., Bjornholm, M., Bates, S. H., and Myers, M. G., Jr. (2005). Leptin receptor action and mechanisms of leptin resistance. Cell Mol Life Sci 62(6), 642-652. Naveilhan, P., Hassani, H., Canals, J. M., Ekstrand, A. J., Larefalk, A.,...

Antiandrogenic Effects Introduction

Mineralocorticoid antagonists are weak diuretics that act by inhibiting the effect of aldosterone on sodium transport in the cortical collecting duct of the kidney. In the kidney, mineralocorticoid specificity is a result of the action of 11 3-hydroxysteroid dehydrogenase which converts glucocorticoids to meta

Stressinduced Analgesia

Stress-induced analgesia (SIA) is the phenomenon that certain stressors can induce changes in the pain threshold following the stress situation. The biological basis of SIA is not clear. Some studies showed that SIA is mediated by the opiate system ( Altier and Stewart, 1996 Starec, et al., 1006 Vaccarino, et al., 1999 Yamada, et al., 1995), by P-endorphin (Hawanko, et al., 1994 Herz, 1995, Nakagawassi et al., 1999), substance P (Altier and Stewart, 1998), corticosterone (Filaretou, et al., 1996), or by CRF and cytokines (Laiviere and Melzack, 2000). Other studies found that the effect of SIA gradually decreases over aging ( Laiviere and Melzack, 2000), implicating the hippocampus in SIA. Fish oil protects from SIA (Sutton, et al., 1994), and stressors that induced SIA also induced an increase in cholesterol level(Bernnan, et al., 1992 ). It is of interest to note that PTSD (posttraumatic stress disorder)-induced analgesia was shown to be mediated by the opiate system, but not by...

Behavioural activation

Compared with the effect of the familiar mother's milk odour, the latter appeared more efficient in reducing motor agitation during the painful heel stick (Rattaz el al. 2005), suggesting that human milk may carry compounds which are especially reactogenic to infants. Finally, the physiological response (Cortisol level in saliva) to the stress provoked by a painful procedure can be attenuated by presenting non-biological odours (such as lavender, or 7-dodecalactone thought to mimic milk odour) (Kawakami el al. 1997).

Posttraumatic Stress Disorder

An interesting recent exemplar of an integrated approach is the work by Fisher et al. 58 , in which they reported that, in a small sample of maltreated preschool children, a psychosocial intervention undertaken soon after adoption was able to improve behavioural adjustment and to change hypothalamic-pituitary-adrenal (HPA) axis function (as measured by salivary cortisol). The incorporation of genetic and imaging studies into studies of both preventive pharma-cotherapy and psychotherapy may be useful in delineating moderators and mediators of such interventions.

Why is Weight Loss Maintenance Difficult

Long-term weight loss maintenance may be difficult due to a combination of physiological, environmental, and psychological factors. Proposed physiological factors contributing to weight regain include reduced resting metabolic rate and insulin and leptin resistance. However, investigations examining metabolic factors in individuals who have lost weight have not been able to consistently document changes in physiological characteristics that would explain the tendency for weight regain to occur. Environmental

Well Being and Handling

Physiological measures such as cortisol in the blood can also be used as indicators of fear stress that occurs during nonpainful restraint in a squeeze chute. 4 Cortisol is a time-dependent measure and it takes 10 to 20 minutes for it to reach peak levels. It is important to differentiate between fear and pain stress. Cortisol levels can also rise in response to pain from procedures such as hot iron branding. The variable of the handling stress needs to be separated from the variable of pain caused by a procedure such as castration. Handling stress is mostly fear, and stress from castration is caused by pain and injury to tissues. Fear stress during handling can vary from almost none to extreme. Extensively raised cattle that were not accustomed to close contact with people had much higher cortisol levels when they were restrained in a squeeze chute compared to hand-reared dairy cattle. 5 Taming of an animal may reduce physiological reactivity of the nervous system. Hand-reared deer...

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