Sunday, March 16, 2008

Diabetes and hunger

I can vaguely remember being hungry, way back before LC eating. The sort of day when you would get home at 5.30 and you HAD to have to have two doorsteps of wholemeal bread, spread with peanut butter (to avoid the saturated fats) and filled with a sliced banana, because there was NO WAY you could wait the hour it was going to take you to get supper ready. In the door, slice the bread. I remember hopping on the scales at work once and thinking that skipping a meal here and there might drop that pound or two around my tummy. Then trying it!

At the time my need to eat didn't seem like greed.

We all know that if you are a type 2 diabetic you must have been greedy for years before getting your just comuppance (thinks your GP). It's self evident that fat people get fat by eating too much food and obviously it's the dietary fat which is the main factor. Obesity is clearly the cause of type 2 diabetes (except in skinny type 2s and those naughty extremely skinny people with lipodystrophy, duhh). It's also self evident that once you have a serious blood sugar regulation problem you should eat as much sugar as possible and avoid fat like the plague because otherwise you might get even fatter, which gives you more blood sugar problems (ADA advice).

So a type 2 diabetic should eat a diet which is as carbohydrate based as practical and make sure they loose weight, lots of it. I think it's reasonable to say that that's current diabetes advice.

One day I found this paper on diabetic rats. I'm not really sure how similar streptozotocin induced diabetes in lab rats is to type 2 diabetes in humans. Insulin production is blunted but not eliminated, so perhaps it is the equivalent to fairly late type 2, when the pancreas has finally started to give up under the strain of the ADA carbohydrate based diet. The paper was quite interesting from the point of view of hunger.

Lab rats don't generally get described as being lazy glutttons. Sitting in a cage all day limits your trips to the gym. You eat what the investigator gives you. It seems quite reasonable that rats eat to satiety and no more. Beyond that would be gluttony. But if you make a rat diabetic, then feed it a carbohydrate based diet, it exhibits "hyperphagia". It eats a LOT. And it becomes fat. Perhaps a little bit of streptozotocin and some lab chow equals gluttony.

Obviously no self respecting rat wants to be either diabetic or hyperphagic. Luckily rats are not stupid and, given a choice of macronutrients after its streptozotocin, a lab rat will automatically dump the carbs, eat the fat and keep both its waistline slim and its blood glucose within acceptable limits. Given the ADA diet they don't, or rather they can't. Why can't they?

Because they're hungry. Very, very hungry.

This looks to be what is happening, from the abstract:

"When maintained on a HC [high carbohydrate] diet, diabetic rats also exhibit increased gene expression of the orexigenic peptide neuropeptide Y (NPY) in the hypothalamic arcuate nucleus, and reduced expression of the anorectic peptide corticotropin-releasing hormone (CRH) in the paraventricular nucleus, and these changes are hypothesized to contribute to diabetic hyperphagia"

Orexigenic means hunger generating. Anorectic is the opposite.

Diabetic rats on the ADA diet are RAVENOUS. Oops, sorry, gluttenous. Diabetic rats on a genuine high fat diet are not. They're not very diabetic either.

Now take that to humans. I don't think humans are particularly different to rats. Telling a human diabetic to eat a carbohydrate based diet will bump up their neuropeptide Y levels and will drop their corticotropic releasing hormone levels. They'll be ravenous. Bit of a cruel trick really.

But here's the really funny bit.

You then tell them they MUST lose weight. When they fail to lose weight, you underline the bit in their case notes where it says glutton/failed to comply.

Don't laugh too much, it's not funny really.

Peter

21 comments:

Stephan said...

Hey Peter,

Nice post. I think the connection between insulin, hunger and obesity is not really appreciated in mainstream medicine.

Gary Taubes has a nice discussion of it in "Good Calories, Bad Calories".

I'm working on a post about obesity that touches on this; I'll probably post it within a week or so.

Charles R. said...

Great post Peter. I've already forwarded it to a few people who need to read it. You sum up the science with a great story.

Dr. B G said...

Sooooo so true! And we're not even on toxic streptozotocin... just wheat, fructose and other chronically-lethal carbs! (thank GOD I no longer live it)

I love your observations on animals, and the two-legged ones too :)

Hey, have you ever read Camuti 'All my patients are under the bed'? It's one of my favorites...

Paul said...

Hi Peter,

In other parts of the blog, you seem to draw a distinction between glucose and fructose, and you have also mentioned that there are tribal peoples eating high-carbohydrate diet but not having diabetic type problems. A study like this on the other hand is giving a simple picture of high carb diet -> obesity and type II diabetes. Do you have any thoughts about possible layers of complication beyond the main picture?

Paul.

migraineur said...

No wonder there's a Fat Acceptance movement. "Here, Fatso, eat this food that will make you obese, diabetic, and hungry (not necessarily in that order). Oh, and lose some weight, will you?"

No wonder so many obese people have given up on maintaining healthy weights.

Peter said...

Hi Paul,

I suspect that the origin of type 2 diabetes is horribly, horribly complicated but undoubtedly involves carbohydrate somewhere along the line. Bear in mind that in this study the rats had to be made diabetic BEFORE they exhibited carbohydrate induced hyperphagia. Whether humans with impaired glucose tolerance behave the same way seems likely but I've not seen any studies to show this. The technique used for measuring NPY gene expression in this study is not transferable to humans!

Peter

Peter said...

Hi Dianne, (migraineur)

There was a poster for quite some time on Dr Bernstein's forum who was highly Fat Acceptance promoting, heavy herself, but practiced strict normoglycaemia as Dr B teaches (I have no problem with this, given the normoglycaemia). Under these circumstances I suspect that obesity should disappear as a risk factor for any sort of disease, particularly in someone aware of the problems associated with excess PUFA. Of course the number of normoglycaemic people with BMI above 30 is quite small I suspect. The other interesting point I noticed was that she was accidentally loosing weight, with absolutely no intention of doing so. Normoglycaemia probably does this. But perhaps a little galling to a Fat Acceptance activist?

Peter

Peter said...

Just googled Dr Camuti. If my wife was in clinical practice that's her field! I was always a mixed cat/dog person, but the cats have taken over! To the point where cat owning clients seem to know........

Peter

gallier2 said...

Good post. Just a nitpick, the verb "to lose" is written with one o only. It undermines the credibility of your blog if you don't get this basic word right. Sorry to come like that as I would not even be able to write a tenth of what you have written on this blog and that I'm not even an english speaker.
Thank you for your insight and the perspective you give in your posts.

Dr. B G said...

OMG cute pict!!!! (and the chocolate looks good too...)

I don't mind hyperlipidosis or catattractiveosis... but don't think all that hair is appealing on us girls :)

-g

Bruce K said...

I don't see the relevance of giving rats diluted fat and proteni in the second study. That has no relevance to humans, unless they are diluting their food with cellulose (or water perhaps). Also, most of the studies feed rats refined sugar and/or PUFA oils. They also use casein protein, which is known to stimulate insulin overload, esp combined with refined sugars or starches.

All in all, the studies have little relevance to a diet of whole foods, like Joel Fuhrman suggests. Most of the diabetics don't listen to ADA's advice, which says to limit refined sugars and oils. They instead binge on Entenmann's fat-free donuts, and Snackwell's low-fat cookies, frozen yogurt, diet soft drinks, and other toxic processed garbage.

Dr. Joel Fuhrman claims to get fast weight loss, even in morbidly obese patients. His diet differs from the ADA in that he tells people to base their diets on green vegetables and fruits and beans, with potatoes and whole grains more limited. In short his diet is very nutrient dense and focuses on low-calorie low-glycemic foods. Unlike the Food Pyramid with grains at its base.

Peter said...

The dilution is unimportant. Give them the choice, they eat fat... Actually, some choose protein, but guess what they avoid...

Peter

Peter said...

Hi gallier2,

The problem is that comments to posts can't be edited on this blog without the original poster deleting and reposting a new but corrected comment. So no one can easily edit comments, not the commenter and certainly not me.

If you pull up typos in the main text do shout as I am possibly the world's worst for grammar/spelling. Common problem is a repeat of a word which my brain edits out. Just occasionally I check through a few old posts and see errors there that I missed at the time...

Peter

migraineur said...

"Also, most of the studies feed rats refined sugar and/or PUFA oils. They also use casein protein, which is known to stimulate insulin overload, esp combined with refined sugars or starches."

!!!!

Wow. That really blows the China Study out of the water then, doesn't it? I'd been suggesting all along that what Campbell's rat studies show is that if you add casein to rat chow, rats get cancer. It doesn't show, as Campbell claims it does, that animal protein causes cancer. And if rat chow is largely refined sugars and starches, and you add casein to it, and the combination causes hyperinsulinemia, well, than Campbell's conclusions are questionable. He seems never to have thought that it is the nutrient combination, and not a single macronutrient, that is the problem.

Bruce, do you have a reference for your statement? I would love to learn more.

Peter said...

Hi migraineur,

Lots of standard lab diets here. You can have what you like, really. Most are wheat flour or cornflour for their carbs, often with glucose, sucrose or maltodextrin if you want diabetes etc, usually with corn oil and/or soy oil as the sole fat. As I say, there's a whole choice. Casein seems quite common as the protein source. Click on the pdfs down the right hand side for examples.

Poor Dr Campbell! No one ever told him......... (told him what? Now be polite!)

Peter

rnikoley said...

Peter:

Since I don't have you email, I figured to let you know about a recipe for pork loin. Take a look:

http://www.honestylog.com/root/2008/03/food-blogging.html

Now, the thing is, the sauce is almost totally fat, a combination of butter, cream, and coconut milk ("heaping" tablespoon because it came from an open can in the fridge).

I have been having wonderful success making great tasting sauces for meat by degalzing the dripping with a little red or white wine, then slightly thickening with heavy cream, coconut milk, or even cream cheese, or a combination of all.

I have a leg of lamb in the oven right now. That'll be a red wine suace, and I'm planning to nuke a bit of blueberries and red grapes to sweeten the sauce a bit. I'll let y'all know how it turns out (with pics).

Erratica said...

Well, this post makes a lot of sense to me. I was diagnosed diabetic a little over a month ago, and started by giving up all refined sugars and grains. Ate lots of veggies and greens and protein. Not a lot of fat, although I already ate butter and whole milk. I was very hungry for about 2 weeks!

Since I began eating high fat in the form of virgin coconut oil, rendered pork fat (made it myself), duck fat, and butter, I haven't been hungry at all, and have a lot more energy. I still keep my carbs limited, but added back in potatoes and oatmeal or a small slice of sourdough bread, with lots of fat with them, and usually only 1 type per day.

My blood glucose is slowly coming down, without meds. Hooray! I feel great and am not starved anymore.

Erica

Bruce K said...

migraineur: "I'd been suggesting all along that what Campbell's rat studies show is that if you add casein to rat chow, rats get cancer. It doesn't show, as Campbell claims it does, that animal protein causes cancer."

Most of the studies inducing cancer use high-calorie diets and are usu. high-PUFA, as Gary Taubes noted. If they feed a saturated fats, animals don't get cancer, but if they add a little PUFA oil, they do. Here is a review showing this clearly.

http://cancerres.aacrjournals.org/cgi/reprint/45/5/1997

"And if rat chow is largely refined sugars and starches, and you add casein to it, and the combination causes hyperinsulinemia, well, than Campbell's conclusions are questionable."

The effects are cumulative, or even multiplicative, based on what I've read. They have a diet that is 100% synthetic and doesn't satisfy them, so they over-eat when they have the opportunity. The diet's effect upon hormones is also important. I doubt they would get these results if the rats were fed cheese or meat.

"Bruce, do you have a reference for your statement? I would love to learn more."

My comments were based on reading a lot of studies, esp the "materials and methods" where they detail what "foods" were used. Most of them use refined sugar or starch, high PUFA oil, and casein. The combination is probably very unwise. I would argue that a better combination would be honey, cheese, butter, taters, etc.

Purple said...

I randomly found your blog while searching for low carb info. It's well-written, funny, and insightful!!

I've bookmarked your blog and look forward to reading more of it.

Peter said...

's cool

Peter

jfarmermd said...

Hey Peter,

Thanks for this! I played football for ten years; I was once 390 lbs. I trained, ate a strict low fat, high carb and high protein diet for years. The diet was to help build muscle and always have plenty of energy. Looking back, I think I was pre-diabetic years before I traded my shoulder pads for corporate america. Years later, I am 260 lbs - much smaller, but the same size I was in 8th grade. I struggle with the diabetic diet. I have okay sugar readings (av. 125). I still sport an A1C of greater than 14. I am ALWAYS hungry. My girlfriend is trying to help me. She says I am "long-eyed and greedy" and that I need to deny myself more. I go to bed starving and wake up with sugars greater than 350! My faithful liver is dumping sugar in my blood stream at night because my brain says I'm starving . . . when does it end. Well, I know when - trying to delay it a bit though. I am just so happy that you put information out here, coupled with enough nuts and bolts to show the validity, that a layperson can understand. This particular silent killer caused many other problems to the point that I am compelled to stay the course (lots of meds and copays) until my change comes.