August 8, 2007

Hunger is a Symptom

Our fat-hating society has transferred all the loathing we used to feel for blatant displays of greed, lust, and pride to a single sin, gluttony. The rest of those erstwhile sins now have transformed into the characteristics of the celebrities we admire.

This has had the unfortunate side effect of making people who find themselves feeling extremely hungry believe that they are suffering a moral lapse--gluttony--rather than recognizing that they are experiencing a medical symptom.

But the raging muchies--the kind of hunger that leaves you at the open fridge shoveling in everything in sight--is a symptom. You can induce it in an otherwise normal person with a couple of tokes of pot. You also see it in millions of otherwise normal women a few days before they get their period.

And sadly, it is a symptom that often emerges along with insulin resistance in people who have the genetic make up that leads to Type 2 diabetes because insulin resistance is a prime factor that leads to raging hunger.

Exactly why isn't completely understood, but we do know that one of the main things that can cause hunger is swiftly moving blood sugar of the type that happen when blood sugar goes way up after a meal and then plummets back down as it does in hypoglyemica.

People with Type 1 diabetes who are prone to severe hypos can tell you all about the hunger that comes with dropping blood sugars. In fact, someone on Tudiabetes.com recently described waking up with a very low blood sugar and attempting to eat their clock radio. This sounds funny, but it isn't, first of all because it really happened to a real person and secondly because it shows how powerful the brain's response to a hunger signal can be. Hunger is the single strongest drive in any living being, far stronger than sex, because without food we all die.

But there are other metabolic changes that also cause raging hunger. Swift changes in insulin levels in the presence of normal or high blood sugars can also do it. Fluctuations in female hormones are yet another known cause. Cortisone drugs and our own adrenal hormones when they are out of whack can produce raging hunger. Abnormal levels of various brain hormones like Leptin and proteins like GLP-1 can cause relentless hunger, too.

Unfortunately, when most people start feeling hungry, they respond by getting angry at themselves. They get drawn into power struggles with their body and declare, "You glutton, you're going to do what I tell you and go on a diet!" And they do. But if they are hungry on their diet, it is only a matter of time until the brain has had enough and responds, "You're going to eat that stale donut, all those potato chips, and the three containers of left over Chinese food that have been sitting at the back of the fridge for a week!" And most likely you will. Because billions of years of evolution have made sure that when the brain says, "Eat!" You do, because if you don't you die, and organisms that were good at ignoring hunger symptoms mostly didn't live to reproduce.

But the good news is that once you realize that your raging hunger just means you are experiencing a medical symptom that is no more a moral failure than is a sore wrist or a weak knee you can get to work on figuring out what is causing that hunger symptom and make it go away.

First Line Defense Against Hunger

1. Flatten out your blood sugars. If your blood sugars are going W-A-Y up and then plunging down, you need to flatten them out. The easiest way to do this is to cut down on the foods that raise blood sugar, which are those containing starches and sugars.

In an early edition of his book, Dr. Bernstein's Diabetes Solution,, Dr. Richard K. Bernstein pointed out that people don't get out of control with fat alone and no one finds themselves longing to chug down a nice frosty pitcher of oil. It is excess sugars and starches that cause hunger cravings because they are what raise blood sugar. For many people, cutting way back on the carbs is all it takes to cure out-of-control hunger. It's important to note that it usually takes about 2 to 3 days to flush high carbohydrate foods out of your system, during which you may be more hungry, but if you can hang through those first couple days and confine your snacking to carb-free foods like cheese and meat most people will experience a dramatic decrease in hunger.

2. Work on your insulin resistance. High levels of circulating insulin can make people hungry, so try adding some exercise which often can curb this insulin resistance. If exercise isn't possible or if it isn't enough, and if you have a history of high blood sugar, talk to your doctor about taking Metformin or Byetta. (As I've written elsewhere, only keep taking Byetta if you do experience dramatic relief from hunger symptoms as otherwise it is an expensive waste.)

3. Hormones can make you hungry. Female hormones can have a dramatic effect on hunger both when you take them, as in birth control pills or ERT or when you don't take them, in menopause. Corticosteroid hormones whether taken as medications or produced by out of whack adrenal glands also can lead to overwhelming hunger, partially because they raise blood sugar, and partially because they upset so many other hormones.

If you think your hormones are part of the problem, work with your doctor to change your regimen if at all possible.

Sometimes with hormonal hunger there isn't anything you can do except to tell yourself, "This isn't about food, nothing I eat is going to help." Once you realize that the hunger you feel is symptom of a hormonal imbalance, not a signal you really need to eat, it can be easier to deal with. If you do eat, observe the effect it has on your hunger. If eating doesn't help your hunger, you know that you are suffering a medical symptom and the cure is not going to be more food.

4. Change what you are eating. You may notice you are a lot hungrier after eating certain kinds of breakfast than others. Note what you eat and how your hunger patterns respond during the next 12 hours. You may be able to eliminate some foods that cause hunger.

Some foods people think of as "healthy" that may be prime culprits in causing hunger are things like noodles, oatmeal, fruit smoothies, bananas, fruit spritzers, fruit juices no matter how organic, and whole grains. Eating these foods for breakfast can set you up for a whole day of relentless rollercoaster blood sugars. Try eating eggs for breakfast for a few days instead and see if it makes a difference.

5. If you inject insulin, you may need to take a careful look at your dosing or what insulin you are using. I have noted that I consistently get hungry a couple hours after using Novolog no matter what I eat. I'm not sure if it is because Novolog is a bit too fast for me or what, but if I feel hungry a few hours after using it I test my blood sugars and when I see they are normal, which I usually do, I know the hunger is a side effect of the insulin not a sign I need to eat anything else. That is one reason I prefer R insulin even though it isn't as convenient because I don't get hungry when I use it.

Some people find that Levemir causes them less hunger than Lantus. So if you are on Lantus and having a hunger problem talk to your doctor about trying Levemir.

6. Stay away from any foods containing these ingredients that are known to provoke hunger: MSG, and substances that contain MSG but are labeled "Hydrolyzed plant protein," "Hydrolyzed soy protein," and soy sauce. Other substances that can cause hunger are high fructose corn syrup and the Maltitol and Lacitol found in "low carb" or "no sugar added" products.

21 comments:

renegadediabetic said...

I know what you mean. I tried to follow the low fat dogma for years and just suffered from insatiable cravings, which caused me to constantly overeat. It was impossible to stick to a low calorie diet. I was insulin resistant for God knows how long and ended up type 2. Now that I've gone low carb, my cravings are all but gone.

I have to laugh every time I see the add for lap band surgery where the lady describes her hunger as a roaring lion. I tamed my roaring lion without surgery. :)

Lady Em said...

Now I know why I am STARVING after eating an orange. Hunger kicks in thirty minutes to an hour after. Is that normal?

Jenny said...

Lady Em,

Hunger in the time frame you describe is not "normal," but it is a common reaction when a person has an abnormal glucose metabolism.

Anonymous said...

I am so glad I read this. I know nothing about diabetes but have had it for two years. Your blog is full of useful info. Thank you!

Anonymous said...

all the doctors say is be careful of what you eat.but nobody sujjests how to find out what fills our stomach ,&which doesnot.i am a thyriod patient &type 2 diabetic.i have tried various diet charts,still unable to find which can suit me

Anonymous said...

This is the best article I have ever read on glucose levels and their effect on hunger. Keep it up! Good job!

Doris said...

Speaking of annoying people - a certain doctor in my town was available when my own doctor was away for two months. This Doctor
finally took away every med I had taken and of course added his ideas - which really messed up
my body. He put me on Januvia which cost $4.00 per pill and
the the wheels fell off. (he also mentioned that they cost $l.00
per pill. Ever since then I have had nothing but trouble. I even tried Bacon and eggs this morning
and toast and of course felt sick
later on. I just finished eating
a crumpet with maple syrup. I
never do but I felt pretty rotten.
I have had diabetis for 20 years and not once did I have problems.
My sugar is happier when My blood is in the 789 range because of my age. Of course he ignored me and
decided that one shoe fits all.
I finally told his nurse that I
will not return and that I thought
he was a terrible person. My old
doctor has returned and I will be
seeing him soon.-
one shoe does not fit all -
D.W.

Jenny said...

Doris,

I'm not sure what you mean by your blood sugar being happier in the 789 range. A reading that high in mg/dl would put you into the hospital. If you mean 7%-9% A1c, the age those are safe readings is the age when you know you won't live ten more years.

No matter how old you are, life is a lot better without intense nerve pain, kidney failure, and blindness, and the risk of all these go up when you let your blood sugar run high.

I agree that Januvia is a completely inappropriate drug, though. It is very unsafe and doesn't do much for the blood sugars of people who have had diabetes for any significant period of time.

Jenny said...

Harold,

Many people can eat those "low glycemic" foods if they still have a decent second phase insulin response. (Explained HERE).

The pattern for many people is to lose first phase response, so fast carbs are a problem, but second phase remains. Unfortunately, if you eat a high carb diet (including low GI high carb foods) over time you often lose that second phase response and then you will see the highs.

But it is because they work for some people that the nutritionists have the illusion they work for all. And of course, that's why I tell people to use their meters to find out what works for THEM. We are all different.

Cati said...

Hi there, I see this is one blog where I might actually got an answer for my health problems :-) I also have terrible hunger cravings, but they are coming and going. I had them for months in a row last year, went to the doctors, checked glycemia, thyroid, etc., nothing seemed to add up. I went to nutrition doctors, read books, etc. It stopped after a while and everything seemed OK, I lost 10 pounds in the meantime, so it should have helped, right ? Wrong. It started again a few days ago (after a pause of 5-6 months) and it's terrible. I can sleep at night, but as soon as I open my eyes, this extreme hunger overwhelms me and I can't get to the kitchen fast enough. The awful thing is that I know this is not a normal hunger, I don't feel like eating in my conscious brain, sometime I even dislike to look at food, but have to eat it anyway, otherwise I feel like fainting, like losing consciousness is right around the corner.
I tested my glycemia during these bouts of hunger and after I ate and the hunger hadn't go away and it's always good and within normal ranges.

It's time to say something about myself here:
- I'm 50 year old female
- had a breast cancer surgery in 2007, went well, had only radiotherapy, no comeback until now
- have been on Tamoxifen and Zoladex since then, I'm in my 4th year now (planning to stop this treatment soon) and I suspect that the Tamoxifen determines a high level of cortizone, which could be cause of these hunger bouts --> could I be right ?
- no diabetes history in my family
- when hungry I sometime have nausea too
- diziness could also be determined by cervical spondylosis which I have
- I feel energy drained all the time, I sleep cca 7 hours per night and go to bed around midnight

This morning I had one of these hungers again and ate the following: black chocolate (2 squares), 2 slices of a cake (cooked by dr. Dukan's directions with cheese, starch and sweetener), a few mouth fuls of cottage cheese, 1 teaspoon of honey, 2 mouthfuls of smoked salmon. And then I decided to stop, could not look at food anymore and I was feeling as bad as in the beginning. It took me 1 hours to feel better.

I apologise for the long post, I just try to provide as much info as possible from the start.

Thanks a lot in advance for any advice you might give me.

Jenny said...

Cati,

You're right that this sounds like this kind of hunger must be caused by something physiological.

Hunger within the normal range can still make you hungry if it is going up to the high normal range and then plummetting.


Try eating NO starch or sugar of any kind when you're hungry--just protein and/or fat for a few days. If after 2 days of not eating starch and sugar you are still getting that ravenous, you will have ruled out blood sugar being the cause.

Also, have a look at any meds or supplements you are taking. Have you made any changes in them lately? Could they be contributing?

Cati said...

Dear Jenny,
My glicemia levels were never lower than 98 before eating and not more than 150 after. Today, after eating, while still feeling horrible, it was 136.
I don't take any other medication than the 2 meds which I already wrote in my first message. I found a study done by an Italian university on the side effects of Tamoxifen and it showed how the cortisol levels are pushed up over time. Don't forget I'm in my 4th year since taking it and its effect is cummulative over time.

Thanks for your advice.

Jenny said...

Cortisol typically will push blood sugars way up. It's possible that you are getting a big insulin release to fight cortisol if that is what is happening. But if that is what you think is happening, can you talk to your doctor about testing your cortisol levels and if needed adjusting the dose? High cortisol levels are very hard on your body.

Unknown said...

I was eating breakfast midmorning and then getting hungry again after a couple of hours. You know breakfast, the one the doctors say should be whole grain cereal and fruit? I had to be on an antibiotic for a couple of weeks, it was one I had to take 4 times a day and I had to eat food with it or feel really sick. I had to get up and eat right away so I could take it. Eating earlier than usual seemed to triple my appetite and I complained about it to the doctor who just shrugged his shoulders (probably because my fasting was in the normal range for the times.) That was at least 5 years before I was diagnosed with diabetes.
Anyway, when I switched to meat and eggs for breakfast my appetite was cut to a fraction of what it had been.

Luis A. Colon said...

Four years ago—around 2008—I was diagnosed with type-2 diabetes after going partially blind from the disease. In 2010, I had a heart attack; the diabetes probably had a hand in it, but I had to watch my diet for both my diabetes, as well as, my heart disease. The problem I’m having is that I’ve been having excessive hunger immediately after eating. It wasn’t until reading this article that I realize what the problem might be. I’m going to see about flattening my sugar levels. Thanks.

N said...

Hi
Thanks for this. I had a gastric sleeve done 18 mo ago and it helped me drop 115 lbs. I'm still at 220 and would like to drop 30 more lbs but I've developed a rare side effect - post bariatric post prandial hypoglycemia. Testing shows my pancreas pumps out about 5 times the insulin it needs to digest what I give it and my sugar on a "balanced" meal containing protein, carb and fat of about 300 calories goes from fasting at 90 to 195 in 30 min and down to 55 in another 45 min. It's miserable. I'm under a special dietician's care and we're working on menus that work for me but I'm always hungry and thought it was that my sleeve was stretched out but testing shows it's at about 9 oz so that's not it. But now I understand better why the hunger shows up about 45 min after I eat which is so frustrating! Thank you Jenny for posting this. I've printed it out to put on the fridge to remind me why it's happening and to just drink some plain tea once I get to an hour after eating (you don't drink and eat at the same time with a sleeve)... thanks again for the sane thoughts.

Jenny said...

N,

Because your hypoglycemia is caused by an artificially modified physiology, and because you are dropping into the 50s which is true hypoglycemia, you will have to be VERY careful.

Over time, people who are hypoglycemic a lot develop something called "hypo unawareness" where they stop feeling crappy when their blood sugars drop. This is extremely dangerous because the stress hormones that are produced in response to a normal hypo raise blood sugar. With hypo unawareness they don't get secreted and blood sugar can continue to drop into the range the causes unconsciousness without any warning.

To prevent this from happening, you might experiment with using small amounts of pure glucose to raise your blood sugar back to the 80s or 90s during the time when they start to drop. The approach here is to use as small a dose as possible to avoid stimulating another insulin release that would lead to another low.

At your size, 6 g of pure glucose should raise your blood sugar 10 mg/dl. You might try experimenting to see what happens if you take a small dose of glucose one hour after you eat--before your blood sugar has dropped into that very low range. Your goal is to end up with a blood sugar no lower than 80 mg/dl to preserve your hypo awareness.

Test fifteen minutes after later. If your blood sugar is under 80 mg/dl, take another smaller dose of glucose--remembering that 6 grams raises you 10 mg/ld--and test 15 minutes later again.

This is what Dr. Bernstein teaches people with Type 1 to do to respond to hypos without making them worse by causing a second high.

Alternatively, you should discuss with your doctor and/or nutritionist cutting back on the carbohydrates in your meal to a level that doesn't cause your blood sugar to spike so high. I know there are special issues with your surgery, but I have read discussions on the Low Carb Friends board in the section among people who have had WLS. Many are eating very low carb following their doctor and/or nutritionist's advice for long periods of time.

If your doctor and/or nutritionist is afraid of low carb, it is possible he or she is operating with outdated dietary beliefs.

There is enough evidence that at least 1 year of very low carb is completely safe that the ultra conservative American Diabetes Association has admitted in its treatment guidelines that a very low carb diet is a reasonable approach for people with diabetes to take and that it does not promote heart disease.

The health problems with LC diets come from people not actually following them, since a high fat, moderate carb diet is not healthy.

In your case, since eating carbs causes such problems, you will be far more motivated than most people to stick to such a diet.

Wishing you the best!


Don't use starchy or sugary food to preven hypos as it acts more slowly and is harder to get a precise dose with.

Bruce Christian said...

I take lantus, and humalog insulin and am constantly hungry, i do not gain weight at all.. I just ate a meal and had to go to subway to suplement my hunger. I got a foot long BMT. People are impressed at what i eat. i have always had this problem with good or high blood sugars...

Jenny said...

Bruce,

Have you measured your blood sugars 1 and 2 hours after eating? It is possible they are going way up and then crashing. I found Humalog did that to me. Novolog was better, and Apidra was much, much better, though my insurer at the time wouldn't cover it.

Lee E. said...

Jenny,

I have noticed that when I'm hungry, my blood sugar is around 120-140, even fasting. I end up getting hot, dizzy and simply feel 'icky'. When I eat (eggs, bacon, sauerkraut), it drops 20 points within 30 minutes, and then continues to drop until it normally hits about 95 2 hours after eating and stays there until I start to get hungry again, and that's when it starts to increase. Even when I don't feel hungry, when I start to feel 'icky' I know my sugar is increasing. This goes against everything I have been taught. I do follow LCHF for about 18 months just because I feel it's the best way to eat. I take no medication, yet; just supplements. I will be contacting my physician in the near future to get a battery of blood tests, including A1C. Can you possibly describe the physiological mechanism that would cause hunger to indicate an INCREASE in blood sugar?

Jenny said...

The hormones that govern hunger are not at all well understood. There are several of them and though we know they work in the brain, we don't understand all the connections. Stress hormones can cause rising blood sugar and hunger--ask anyone who has been on prednisone for any period of time.

Some people experience stress hormone releases especially when they are in the fasting state. It is also possible that you are dropping low prior to the rising blood sugar and hunger. In that case you would be getting a burst of stress hormone to raise your blood sugar out of the low, but by the time you feel anything the stress hormones are active and they have raised your blood sugar. It is almost impossible to locate the lows that cause these reactive highs.

Unfortunately, busy doctors rarely understand or even know about the blood-sugar-related reactions that are well understood. So you aren't going to be getting any help there with this problem.

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