Not too long ago I read an interesting article in the New York Times entitled In Dieting, Magic Isn’t a Substitute for Science. It starts with a question that deserves a thoughtful answer:
Is a calorie really just a calorie? Do calories from a soda have the same effect on your waistline as an equivalent number from an apple or a piece of chicken?
The reason the NYT is even asking this question now is because of the research that recently came out that seems to indicate that high protein or Atkins-like diets have a small metabolic advantage over simply calorie-counting.
Now – the study was small – it is really, really hard to do this sort of research. Expensive and time-consuming – and unless you do these studies on prisoners, it’s hard to be sure exactly what these subjects ate exactly. Nonetheless, it is an interesting finding, when put into perspective as less than definitive.
The NYT talked to Dr. Jules Hirsch, emeritus professor and emeritus physician in chief at Rockefeller University, who has been researching obesity for nearly 60 years, who quickly dismissed this study as so much hogwash.
Now, I don’t want to be accused of taking a cheap shot at a gentleman I do not know, but the good doctor has been involved in research for 60 years, during which time the population has only gotten fatter. Something’s going on here:
It sure is nice to have a medical professional to bounce questions off of – but that usually isn’t your doctor. He or she is too busy running from exam room to exam room to see all the people scheduled for them that day. You’re lucky if you can remember all the questions, and even if you prepare a list, you might not get to them all.
A new website and iPhone app might not be a silver bullet in addressing this issue, but it can help to fill a gap in optimizing your health.
Healthtap is a place where you can ask questions to real doctors – and they answer. I’ve asked maybe a dozen questions and most are answered within 2 hours. There are challenges in this. You are only allowed a small amount of characters so you need to think clearly about what your question is. You also need to understand your audience. Doctors need specifics, and also need you to be somewhat familiar with the jargon. It helps them understand you better and avoids you being told you are being vague. I also don’t see how to establish a real dialog yet, but the company behind this seems to have added new features quickly, so who know what will be there the next time I visit.
This site is also a search engine of sorts containing the Q&A from other individuals. Your identity is hidden on the site, so your Q&A might help someone else – and your own question might have already been asked.
Take a look.
For most people, a low carb diet is not their first diet. We come to low carb after failure with isocaloric diets, where we starved while eating tiny portions that were supposedly ideal for our bodies, but not for our appetite. In between meals we watched the clock, counting the hours, minutes, and seconds until the next unfulfilling meal awaited. In between we sipped (or gulped) water, maybe ate carrot sticks or celery, and looked forward with a combination off desire and dread of the next low-calorie meal, hoping this one would fill us up, and usually disappointed that it didn’t.
We got used to hunger if we kept with it long enough. Hunger was just a part of dieting that couldn’t be avoided.
Then someone came along and told us about low carb – and the promise that you can lose weight and not be hungry. Hard to believe, but for many of us, that’s exactly what happened. Low carb diets – especially ketogenic ones, can kill an appetite dead.
It’s a dieter’s Shangra-La. Eat til full and lose weight. Months pass, and we change in two ways. First, the appetite suppression lessens simply because we begin to build a tolerance to it. I believe the power of Ketosis has the most impact on someone who has been high carb all their lives, but that appetite suppressant naturally lessens with time on the diet and the gradual reintroduction of carbs that is usually the natural progression of these diets.
The second change is we grow less tolerant of hunger. We’re less used to it, and as the ketogenic aspects of the diet lessen, through acclimation or through the gradual introduction of carbs, our lessened tolerance of hunger gets us in trouble as we eat greater quantities of low carb food, and the weight loss stops.
I’m wondering if building a ‘hunger practice’ into a low carb diet from the outset – periods where we practice being hungry for short periods of time – might prove beneficial as we progress to long-term weight loss and maintenance.
Just my own theory – does this resonate with any of you?
This is a very long story that at the moment I will keep very short.
At my annual physical 4 days ago I asked for a prescription of metformin – a diabetic drug. This is a treatment that the American Diabetic Association believes to be reasonable in the treatment of prediabetes to slow the onset of the actual disease.
Clinical trials have shown that people at high risk for developing diabetes can be given treatments that delay or prevent onset of diabetes. The first therapy should always be an intensive lifestyle modification program because weight loss and physical activity are much more effective than any medication at reducing diabetes risk.
Several drugs have been shown to reduce diabetes risk to varying degrees. No drug is approved by the U.S. Food and Drug Administration to treat insulin resistance or prediabetes or to prevent type 2 diabetes. The American Diabetes Association recommends that metformin is the only drug that should be considered for use in diabetes prevention. Other drugs that have delayed diabetes have side effects or haven’t shown long-lasting benefit. Metformin use was recommended only for very high-risk individuals who have both forms of prediabetes (IGT and IFG), have a BMI of at least 35, and are younger than age 60. In the DPP, metformin was shown to be most effective in younger, heavier patients.
I don’t think my doctor would have given it to me otherwise, but because I referenced the ADA’s view on it, he agreed, though maybe, just maybe, with a little annoyance. Note that my BMI is lower so I don’t exactly fit the profile.
My blood sugar, which hung out in the prediabetic range of 100 to 125 most of the time now resides mostly in the 80s.
Instantly, my appetite has changed. I feel like how I imagine ‘normal’ people feel when they eat. I eat, I am full, and I don’t think about food after. It is very, very early in all this, and I am not exactly thrilled to be on another medication, but what once seemed hard – avoiding the goodies – that pizza that calls my name from the kitchen at night – seems to have been quieted.
Continue reading “Metformin and Appetite”