Gut Hormones and the Brain

Course Description

In the past few years our understanding of the processes leading to obesity, insulin resistance, diabetes and cardiovascular disease has expanded. We were introduced to multiple hormones and new factors in energy management and disease development. We recognize that the brain has an important role in regulating and managing energy. In the past 2-3 years, several new treatment modalities based on gut hormones, incretins, and bile acids for diabetes were approved. Our understanding of their exact role in human physiology and human disease is limited. Therefore, this symposium will examine the role of gut hormones, incretins, and bile acids in various metabolic conditions, and their potential effect on gut hormones. This program will focus on the role of gut hormones and their energy balance system. It will cover cholecystokinin, ghrelin, glucagon-like protein-1, and protein YY as they interact with insulin and leptin to regulate food intake and body with, with a particular attention on the CNS mechanisms.

Activity information

  • Duration: 2 hours - you will earn 2 FREE AMA PRA Category 1 Credit(s)™

  • Based on Satellite Symposium held on September 26, 2008 in association with the 6th Annual World Congress on the Insulin Resistance Syndrome

  • Date of release: March 20, 2009

  • Date of expiration: March 19, 2010

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CME information


Faculty information (CV)

Course presentations

To Receive a Certificate for This CME Activity

Complete the evaluation. Your certificate will be mailed to you Upon satisfactory completion of these documents. Upon program completion you will be able to download PDF of all the lectures.

Needs Assessment

Identification of new metabolic pathways and cellular receptors have recently been linked to pathophysiologic processes that ultimately impact the progression of type 2 diabetes. Despite this new knowledge, which has lead to the development of a number of therapeutic choices for treating patients with type 2 diabetes, many of these patients are not meeting targeted lipid or glycemic goals. This gap between targeted and accomplished goals has serious implications for reducing the complications of diabetes, particularly cardiovascular disease. Currently-available treatment options offers the potential to overcome these challenges by giving clinicians a strategy to achieve both lipid and glycemic goals by incorporating bile acid sequestrants into existing diabetes treatment regimens. These agents exploit a unique metabolic pathway through the liver and intestine, which has the potential to lower both low-density lipoprotein cholesterol and blood glucose levels closer to targeted goals. As a result, the cardiovascular risk of patients may be reduced.

Educational Objectives

  • Summarize the role of gut hormones in energy homeostasis.

  • Discuss the hormonal mechanisms that signal the brain for energy.

  • Discuss how this knowledge may lead to control of obesity & weight management.

  • Discuss the data implicating gut hormones in cardio metabolic conditions.

  • To review bile acid metabolism.

  • Recognize the role of bile acids in the regulation of glucose homeostasis as well as control of hypercholesterolemia

  • Recognize the role of gut hormones, leptin & insulin in food intake

  • Translating pathophysiology of bile acids & incretins into clinical practice.

  • Discuss the potential role of gut hormones in the treatment and prevention of obesity, diabetes and cardiovascular disease.

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Target Audience

This course is designed for Endocrinologists, Cardiologists, Gastroenterologists, Internists, Diabetologists, OB-GYNs, Pediatricians, Educators, and healthcare professionals interested in metabolic diseases, diabetes, cardiovascular disease, and their effects on health and society.

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Interaction of gut hormones, bile acid, incretins & the brain -Overview
Yehuda Handelsman, MD FACP, FACE-Chair
1. Outline of the scope of the program
2. Define the goals
3. Introduce the speakers

Nutrients as messages: Bile acids and their receptors
Zachary T. Bloomgarden, MD
1. To review bile acid metabolism
2. To explain bile acid signaling effects on nuclear receptors
3. To review the G protein-coupled membrane receptor responding to bile acids
4. To summarize signaling effects of bile their implications for metabolic homeostasis

Liver pathophysiology of bile acid and cardiovascular disease
Arun Sanyal, MD
1. The role of the liver in energy metabolism
2. The pathophysiology of bile acids in controlling flow of nutrients
3. The liver heart relationship

Gut hormones and the CNS regulation of energy balance
Daniel Porte Jr, MD
1 Understand the role of gut hormone in energy balance
2. Recognize the role of gut hormones, leptin & insulin in food intake
3. Focus on the function of CNS mechanism in energy regulation and body weight

Clinical implications of gut hormones and bile acids in CVD and DM
Philip Levy, MD
1. Translating pathophysiology of bile acids & incretins into clinical practice
2. The unique role of colsevelam in diabetes and hypercholesterolemia
3. Combination therapy in the treatment of cardiovascular disease and Diabetes
4. Recognize the safety of gut hormones & bile acids based treatment

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Presentations by

Yehuda Handelsman, MD FACP, FACE 10
Solo, Private Practice
Senior Scientific Consultant
Metabolic Endocrine
Education Foundation
Medical Director
Metabolic Institute of America. Tarzana, California

Zachary T. Bloomgarden, MD
Associate Clinical Professor of Medicine
Mount Sinai School of Medicine
Assistant Attending in Medicine
Mount Sinai Hospital
Consultant in Endocrinology
Lawrence Hospital
New York, New York

Philip Levy, MD, MACE
Clinical Professor of Medicine
University of Arizona
College of Medicine
Phoenix Endocrinology Clinics, Ltd.
Phoenix, Arizona

Daniel Porte Jr, MD MACE
Clinical Professor of Medicine
University of California San Diego
Scholl of Medicine
Staff Physicians, VA San Diego Health Care System
San Diego, CA

Arun J. Sanyal, MD
Professor of Internal Medicine
Chairman, Gastroenterology And Hepatology
Virginia Commonwealth University
Richmond, Virginia

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Faculty Disclosures and Conflicts of Interest

It is the policy of PESI LLC to ensure balance, independence, objectivity and scientific rigor in all of its CME activities. Presentation content may include discussion of an unlabeled or an investigation use of a product. PESI LLC requires that participating faculty disclose to the audience any product(s) and its uses(s) discussed in the educational activity that are unapproved/unlabeled for the use by the FDA or still considered investigational in nature

Everyone who is in a position to control the content of an educational activity must disclose all relevant financial relationships. “Relevant financial relationships” are financial relationships in any amount occurring within the past 12 months that create a conflict of interest. PESI, LLC requires speakers, faculty, CME Committee, and other individuals who are in a position to control the content of this educational activity to disclose any real or apparent, conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly evaluated by PESI,LLC for fair balance, scientific objectivity of studies mentioned in the presentation, and educational materials used as a basis for content, and appropriateness of patient care recommendations.

The intent of this disclosure is not to prevent a speaker with commercial affiliations from presenting, but rather to provide learners with information from which they may make their own judgments. Informed learners are the final safeguards in assuring that a CME activity is independent from commercial influence.

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Last Name

First Name





  • Merck, Novo Nordisk & Lilly (S)

Peer Reviewed



  • Abbott, Amylin/Lilly, AstraZeneca, Bristol-Myers Squibb, Daiichi-Sankyo Inc, GlaxoSmithKline, King Pharmaceutical, Merck, Novartis, Novo Nordisk(S)

  • Abbott, Amylin, Daiichi-Sankyo Inc, GlaxoSmithKline, Medtronic, Merck, Sanofi-Aventis, Tethys, Xoma (C)

  • Daiichi Sankyo, GlaxoSmithKline, Novartis, Sanofi-Aventis, Takeda (G)

Peer Reviewed



  • Amylin, Novartis, Pfizer, (G)

  • Daiichi-Sankyo Inc, GlaxoSmithKline, Lilly, Merck, Novo-Nordisk, Takeda (S)

Peer Reviewed

Porte Jr.


  • Bristol-Myers Squibb, Five-Prime Therapeutics, GlaxoSmithKline, Johnson & Johnson, Kowa Research Inst Inc., Mannkind Corp, Metacure, Sankyo, Shionogi USA, Sanofi-Aventis (C)

  • Abbott, Amcyte Inc, Diamedica Inc (M, C)

  • Amylin, Novo Nordisk, Novartis (C, S); Merck (M, C, S)

Peer Reviewed



  • No Financial Relationship  


Renee S. Asp, who is employed with PESI, LLC (provider of CME accreditation for this program) has no financial relationships to disclose.

G=Grant/Research Support; C=Consultant/Scientific Advisor ; S=Speaker ’s Bureau; M=Major Stockholder

Faculty information (CV)

Yehuda Handelsman, MD, FACP, FACE
Yehuda Handelsman, MD, FACP, FACE, is an Endocrinologist in solo private practice in Tarzana, California, where he developed and successfully utilizes a comprehensive and unique, multiple interventions and method to preventing...

Philip Levy, MD, FACE
Philip Levy, MD, FACE is an Endocrinologist with the Phoenix Endocrinology Clinic, LTD in Phoenix, Arizona. He is board certified in Internal Medicine, Endocrinology and Metabolism, and Nuclear Medicine. Dr. Levy, MD, FACE, graduated...

Zachary T. Bloomgarden, MD, FACE
Zachary Bloomgarden is a Clinical Professor in the Department of Medicine and is active in the Division of Endocrinology & Metabolism of the Mount Sinai Medical Center New York, NY,. Dr. Bloomgarden has a national...

Daniel Porte, Jr., MD
Dr. Porte is Professor of Medicine at the University of California San Diego and staff physician at the VA San Diego Health Care System. Dr. Porte is also Emeritus Professor of Medicine at the University of Washington where for many...

Arun Sanyal, MD
Arun J. Sanyal, M.D., is professor of medicine and chairman, Division of Gastroenterology, at Virginia Commonwealth University Medical Center in Richmond, Virginia. Charles Caravati Chair and Professor of Medicine Division of

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CME Accreditation

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education, through the joint sponsorship of PESI, LLC, and the Metabolic Endocrine Education Foundation (MEEF). PESI, LLC is accredited by the ACCME to provide continuing medication education for physicians.

AMA PRA Designation Statement
PESI, LLC designates this education activity for a maximum of 2 AMA PRA Category 1 credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

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CME information

To receive a maximum of 2 category 1 credits toward the AMA PRA Category 1 Credit(s)™ , you should:

  • View the presentations in this CME activity

  • Complete the CME Activity Evaluation

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Program Sponsored By

This program is sponsored by Metabolic Endocrine Education Foundation (MEEF) & PESI LLC Administrated by Metabolic Institute of America.

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Acknowledgement of Support

This CME activity is supported by an educational grant from Daiichi Sankyo

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No part of this publication may be reproduced or transmitted in any other form or by any other means, electronic or mechanical, without first obtaining written permission © 2009 MEEF
For questions regarding this CME activity, please contact:

Renee Asp

Phone: (715)796-5573

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