How Eating Can Make You Hungryby David Mendosa Patient Advocate
When we eat a meal, we have a reasonable expectation that the food will make us feel full. But we know from our experience that this expectation is not always fulfilled.
It depends on what we eat even more than on how much we eat.
Feeling hungry after a meal does seem to be counterintuitive. So much so that I didn't believe it until I experienced what it was like not to feel hungry for many hours after eating.
I'm certainly not asking you to take what I write on faith. Only experience counts.
It is carbohydrates that can make you hungry. And, unless you are consciously trying to starve yourself, when you are hungry, you eat more. And when you eat more, you gain weight.
In his important new book, Good Calories, Bad Calories (Alfred A. Knopf, 2007) science writer Gary Taubes carefully reports on the studies that trace the connection running between carbohydrates to hunger and then to insulin and on to weight gain. The chapters there on "The Carbohydrate Hypothesis" are well worth the consideration of anyone with diabetes.
For example, Taubes records on page 379 a study showing that giving insulin to patients increases their appetite specifically for carbohydrates. Those carbohydrates in turn stimulate the patients' own insulin production. That creates what is certainly a vicious cycle.
We gain weight when we eat lots of carbs because they stimulate the production of insulin. And it is this high level of insulin that makes us hungry.
That is precisely the reason why when we take injections of insulin, these shots usually lead to weight gain. Two careful studies demonstrate this unfortunate fact.
The United King Prospective Diabetes Study (UKPDS) is the longest randomized, controlled study ever of people with type 2 diabetes. One part of that study tracked 2,078 people newly diagnosed with type 2 diabetes for six years. This part compared how well they did on insulin, suflonylureas, and metformin. It turned out that people in two subgroups using insulin gained 22 or 23 pounds in that time and that most of the weight gain came in the first year.
The experience of 9,546 members of Kaiser Permanente Northwest, one of the country's largest health maintenance organizations, is similar. Those who started insulin between 1996 and 2002 and continued to use it for at least a year without adding any other diabetes medication, gained an average of 7 pounds.
I mentioned this carb-insulin-hunger-weight problem in passing at the very end of one of my recent articles here. But that article emphasized a different point - that when we don't consume many carbohydrates, then consuming fat does not lead to weight gain.
"As long as we respond to the carbohydrates by secreting more insulin," Taubes writes (page 445) and I quoted in that article, "we continue to remove nutrients from our bloodstream in expectation of the arrival of more, so we remain hungry, or at least absent any feeling of satiation. It's not so much that fat fills us up as that carbohydrates prevent satiety, and so we remain hungry."
The key to reducing our hunger has to be minimizing our carbohydrates. But I don't know exactly what amount of carbs it takes in a meal or in a day for the hunger to kick in.
Certainly a good level to consider is that recommended by Dr. Richard K. Bernstein, the famous endocrinologist who controls his own diabetes and that of his patients with a low-carb diet. In his book, Dr. Bernstein's Diabetes Solution, (third edition, 2007, pages 169 and 172) he recommends no more than 6 grams of slow-acting carbohydrates at breakfast, 12 grams each at lunch and at dinner, plus 12 grams for a snack.
Substantially limiting my carbs to this level works for me to control my hunger and therefore how much I eat. Consequently, I continue to lose weight. It could work for you too, if you need to lose weight, as most of us with type 2 diabetes do.