Minutes of the Columbia University Seminar on Appetitive Behavior(#529)

Date: September 3rd, 2008

Speaker's Name and Affiliation:

Joanna Hlebowicz
Lund University, Malmo University Hospital, Sweden

Seminar Title: "Glycemic Response in Relation to Gastric Emptying and Satiety"

Presiding Chair: Harry R. Kissileff, Ph.D.

Rapporteur: Kathleen L. Keller, Ph.D.

Attendees and their Affiliation:

Kathleen KellerColumbia/Obesity Research Center
Harry KissileffObesity Research Center
Tony SclafaniBrooklyn College
Allan GeleibterNY ORC
Karen AckroffBrooklyn College
Sae J. KimColumbia
Monica PurohitColumbia / IHN
Victoria SquissatoColumbia / IHN
Julie PearsonMSPH
Camille DunkleyColumbia / IHN
Angelie SinghColumbia / IHN
Jon MadowitzCornell
Katherine HalmiCornell
Ilene FennoyColumbia - Morgan Stanley Children's
Eva ConiccicaoORC - CU
Hannah BruehlNYU
Ray BaxterColumbia / IHN
Carolyn WuColumbia / IHN
Sally Ann LedermanColumbia / IHN
Sharon AkabasColumbia / IHN
Ellen McCormickColumbia / IHN
Joy WangColumbia / IHN
Katherine WertColumbia / IHN
Erin PaxsonColumbia / IHN
McKenzie FiskColumbia / IHN
Chris OchnerNew York Obesity Research Center
Jarrett SchanzerColumbia IHN
Silke VogelColumbia / IHN
Ernestine MitchellColumbia / IHN
Mertalaine MulatreColumbia / IHN
Michael DevlinColumbia / NYSPI

Summary: (Prepared by the Rapporteur)

The glycemic index (GI) is defined as the incremental area under the blood glucose response curve for a food divided by the corresponding area of a equicarbohydrate portion of a reference food. Clinically, the GI is of interest because there is some evidence that foods with lower GIs may be beneficial for regulating blood sugar, and possibly, body weight. In a recent report in AJCN, Hlebowicz et al. (2007) found that adding 6 g of cinnamon to a rice pudding significantly lowered the GI of that food, compared to the same rice pudding without the cinnamon. Other resent data (Anderson RA, 2008) suggests that cinnamon polyphenols may also improve insulin sensitivity, suggesting a therapeutic role for this spice. In addition, the speaker also noted that gastric emptying rate (computed as the % change in the antral cross sectional area between 15 and 90 minutes) was lower after consumption of the cinnamon adulterated pudding, although these did not translate to significant differences in perceived satiety.

The speaker also discussed experiments to determine if lesser doses of cinnamon (1 and 3 gram doses) would produce the same effect as 6 grams of cinnamon. Although satiety responses again did not differ, plasma GLP-1 (a satiety peptide) was increased at 60 and 90 minutes in both the 1 and 3 gram doses of cinnamon, compared to the no cinnamon control. Plasma insulin was lower in the group that got the highest cinnamon dose. Gastric emptying rate, blood glucose, and ghrelin were not affected by either cinnamon dose.

The effect of different breakfast cereals was also tested to determine influences on GI and satiety responses. Results suggested that intake of commercially available breakfast cereals did not affect postprandial blood glucose or satiety. However, gastric emptying rate was slowed down slightly after the ingestion of all bran flakes (compared to whole meal oat flakes and corn flakes).

Finally, the speaker presented data on the effects of vinegar added to white bread on postprandial satiety responses. Results showed that intake of white-wheat bread or whole meal bread with vinegar did not affect post-prandial blood glucose, gastric emptying rate, or satiety. Furthermore, intake of whole-kernel bread with vinegar did not affect postprandial blood glucose or gastric emptying rate. However, intake of whole-kernel bread with vinegar increased satiety and this may be explained by increased antral distension.

In closing, the speaker suggested that further research is needed the determine the post-prandial satiety effects of typically consumed meals with mixed macronutrients. In addition, discussion time was given to discuss the limitations of the scaling procedures used, and how they may have limited the ability to see differences in perceived satiety.

References:

  1. Hlebowicz J, Darwiche G, Bjorgell O, & Almer LO (2007). American Journal of Clinical Nutrition, (6), 1552-1556.
  2. Anderson RA (2008). Proceedings of the Nutrition Society, 67,48-53.

Discussion:

Q. How do you measure the area of the stomach?
A. Ultrasound

Q. Why do you only use the antral area?
A. In studies where they have measured the entire stomach volume, it doesn't correlate well with gastric emptying of solid or semi-solid meals.

Q. Can you relate these antral areas to the percent of food left in the stomach?
A. Yes

Q. How much rice pudding did your subjects ingest?
A. 300 grams with 6 grams of cinnamon (a lot).

Q. Is that the amount of cinnamon needed for the effect, or have you tried with less?
A. I will show that data later. When we compared 1 g vs 3 g, we found no difference in blood glucose and satiety.

Q. Did you measure insulin levels?
A. In this study yes, and it was lower for 1 gram of cinnamon and even lower for 3 grams.

Q. Did you look at CCK levels?
A. No

Q. Did you look at the correlations between GLP-1 and insulin in individual subjects?
A. No

Q. Has anyone thought of using cinnamon to treat diabetes?
A. Yes, in Pakistan they have tried that.

Q. Did the cinnamon affect the palatability of the rice pudding?
A. No, but the subjects said it was "spicy"

Q. There are some studies that say that oatmeal increases CCK release. Do you think that is a factor in lowering gastric empyting?
A. That wasn't what we found. We actually found increased gastric empyting.

Q. In your concluding slide, you said that glycyemic index was related to satiety. Can you explain which findings led you to conclude this?
A. We actually didn't show this in our studies, but I'm not sure why. Maybe our scale was not sensitive enough.
Comment: Satiety can be measured by the area under the curve.

Q. Have you analyzed that?
A. Yes

Q. Why did you choose the scale that you did?
A. Because our lead investigator was using this scale.

Q. One of the issues with the scale is that the numbers do not relate 1:1 with the descriptors/adjectives on the scale. A labeled magnitude scale or an end-anchored analog scale might produce different results.
A. We have thought about using different scales, as well as scales to assess the pleasantness of the food or the taste aspects of the food. We have not actually done it yet.

Q. Is there any possibility these results could be caused by cephalic phase response differences from different foods?
A. It's possible.

Q. Individual differences in the size of people may effect the glucose or insulin response. Should they be adjusted for individual differences in size?
A. We correlated results to BMI and did not see any differences.

Q. What are some of the unanswered questions you would like to address in the future?
A. Mixed meals need to be tested. Other spices might have an effect. Also, it is unclear exactly what the connection is between antral distension and satiety, so I would like to investigate that further.
Comment:Isn't it somehow uncomfortable or strange to be lying down on a table and having measurements taking (ultrasound to measure antral distension) while you are eating? The measurements were made 15 and 90 minutes after the end of meal ingestion. All subjects were studied lying down. Between the examinations the subjects rested in a chair.

Q. Are there any practical conclusions that you might suggest?
A. I think that if you eat a lot of fiber with maintenance of the botanical integrity, it might give you more post-prandial satiety.

Q. Do you have any idea what the long-term effects of cinnamon might be?
A. Not sure about the long-term effects yet.

Q. How much cinnamon do you get in a piece of cinnamon gum?
A. Not sure.