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