Sunday, January 13, 2008

Hypoglycemia, Carbs, and Hunger

Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Via Jimmy Moore's Living La Vida Low Carb blog.

The hardest part of dieting for me is the hunger, or perhaps, the cravings. By cravings, I don't mean just really wanting a candy bar, but intense, nearly overwhelming feelings that I have to eat something now. It's not actual hunger, because I don't have the stomach growling or the feeling of emptiness in my gut, but it is like every cell in my body is just screaming at me to eat. Eventually, I give in.

Since I was a teenager, I've thought that I have reactive hypoglycemia. If I go more than 3 or 4 hours without eating, I start feeling light-headed, and if I have too much sugar or carbs without protein, I get shaky and "hungry" within an hour. Every day of my life since high school has been either a struggle between feeling well and not overeating or feeling pretty well while eating enough to gain up to a pound a week.

By eating small meals or snacks every three hours that I'm awake, including right when I wake and right before I go to bed, I can just barely negotiate that line of feeling well and losing weight. Eat too much at an early meal, though, and there's no way for me to end the day without either going over my calorie limit or feeling like crap.

The only breaks I've gotten from this struggle are the few times I've specifically restricted carbs. Once, I completely abstained from sweets for two months and I felt better than I'd felt in years while simultaneously losing 30 pounds, all with no struggle or serious effort. On several other occasions, I attempted more severe, Atkins-like low carb diets. For the first 2 or 3 days, I felt awful, but by day 4 or 5, I felt amazing -- I had high energy and the near-constant desire to eat was just... gone. I woke up in the mornings without the grogginess that is my constant companion most mornings of my life.

I believed for years that my intense cravings and inability to stick to a diet were due to a condition called reactive hypoglycemia. Now I'm thinking that what I thought of as hypoglycemia could perhaps be more accurately described as a refined carbohydrate addiction. I need my fix every few hours and if I don't get it, I feel like hell. If I remove refined carbs entirely, I feel awful for a couple of days (withdrawal?) and then the cravings just go away.

Unfortunately, the no-sweets period of my life ended with many months of binging on around 1750 calories of chocolate chip cookies per night, leading to the inevitable result of an extra 15 lbs a month. The Atkins-like low-carb pushes never made it to a weak before I decided I couldn't live like that even though I'd already dropped 5 lbs and felt great. I don't think I can go completely low-carb or completely sweets-free.

Anyway, as a New Year's resolution, I'm giving weight loss another serious try. I'm counting calories every day on FitDay and again, I'm running into the problem of hunger or cravings. Usually at this point I would give up, maybe recording my 4000 calorie days for a week or two before giving up the exercise as fruitless. This time, though, I'm more motivated than usual, so I find myself forced to confront this issue. Surely I can find a way to limit myself to 3000 calories without feeling awful, right?

Anyway, I'm coming around to the idea that carbs may be the source of my struggle. First, I read an article called "What if It's All Been a Big Fat Lie?" by Gary Taubes, a science writer. Then I read this interview. And then I got his book, which I have so far only skimmed. Taubes's argument is that there is very little empirical evidence for the low-fat diet that has been pushed for the last few decades by various establishments, and that it is in fact refined carbohydrates that have led to the increase in obesity. He argues that refined carbs stimulate the body to store fat and also to send the signal for more food, resulting almost invariably in overeating.

Taubes, like Atkins, presents a whole bunch of scientific data supporting his view. Unfortunately, as a computer programmer and not an endocrinologist or health professional, I'm not personally qualified to judge whether Taubes and Atkins are following the science better than everybody else. Generally, I'd bet on the establishment when a maverick challenges its accepted wisdom. I believe in science and I'm skeptical about individuals who think they've outsmarted the scientific community.

But here's the thing. Even the establishment cannot seem to point to any evidence that shows a low-carb diet is any worse than a low-fat, or even balanced, diet. I've seen several studies that show that low-carb diets are perhaps even more effective than low-fat ones, and may be easier to stick to. I know personally of several respected physicians who believe in low-carb dieting.

Above all, though, I just know from my experience that carbs mess with me. Of course, if I eat fewer calories than I burn, wherever those calories come from, I will lose weight. I've done it a dozen times. However, I also know that if I cut calories without paying attention to my carbs, I have to struggle with hunger and cravings every day.

This brings me back to the paper that I linked to at the top of this post. It's conclusion: In the short term, high-protein, low-carbohydrate ketogenic diets reduce hunger and lower food intake significantly more than do high-protein, medium-carbohydrate nonketogenic diets. "Reduce hunger and lower food intake." That's exactly what I'm looking for. Trying to force myself to restrict intake while fighting desperate cravings is like hitting my head against the wall. Maybe I can get my body to help me lose weight instead of fighting me.

I'm not ready to go on a program as strict as Atkins. I'm just not a super-disciplined person and I'm not willing to give up that flexibility. But I am going to start paying more attention to my carbs. As long as I'm able to keep my daily calorie intake as low as I need to, I'm not going to worry about my carb intake too much. But when I struggle, as I so often do, I know that I now have a trick up my sleeve to make the cravings stop. I can just cut back on the refined carbs, and the cravings will go away on their own. Instead of eating refined carbs when I'm craving more food than I should eat, I'll have some more protein, or perhaps some complex carbs like old-fashioned oatmeal. Maybe I'll go two- or three-hundred calories over my limit for that day, but I know the next day will be easier. The next day I won't have the cravings, or they will at least be smaller.

Today, I'm sticking fast to my limit, for the first time in months. (I've gone slightly over every day this week, leaving me with enough deficit to lose, but not as fast as I'd like.) I can say that confidently, because I'm going to bed soon, I'm not hungry and I don't have strong cravings, and I still have a big bowl of oatmeal ahead of me. Today I'm managing because I did not substitute a fudge brownie for a sensible snack and try to cram in a 500-calorie cookie as an essential part of my lunch. I did have a small, 200-calorie candy bar, and even two beers, but the majority of my food has been balanced, healthy, and most importantly, low in refined carbs.

Now to my oatmeal. Wish me luck!

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At 2:03 PM, January 14, 2008, Blogger joshv said...

Good lord, you sound like a junky - "just a small little hit, that will be ok". There is no, I repeat NO place for a candy bar, not matter how low calorie, on a restricted carb diet. Until you admit that, and give up sugar entirely, you are going to continue to struggle.

It's really not all that hard. The rules are simple: NO sugar, NO bread, NO pasta, NO starchy vegetables, for fruit, eat berries in moderation. Other than that eat when you are hungry, eat until you are full. You will lose weight, and you'll never be hungry. I think that end result is worth giving up sugar.

At 4:01 PM, January 14, 2008, Blogger GreatnessBlog said...

Thanks for the comment, joshv. I'm aware that I sound like an addict. I'm not sure that I could handle total abstinence, though, even if it is the healthiest way.

In general, I've been unimpressed with the claims of twelve-step programs that abstinence is the only way to beat an addiction. I've never seen any good science that supports that hypothesis and I've seen several meta-studies which appear to argue that pushing abstinence as the only solution may in fact do more harm than good.

At 4:31 PM, January 14, 2008, Blogger joshv said...

Well, then continue on with a candy bar here, some bread there, some pizza, a cookie, and before you know it you are going to be right back where you are right now.

This is where I have failed in the past. I allowed myself "holidays", or I'd cut myself a little bit of slack for one day on the weekend. That one day became the weekend, and then it became the whole week. You can't play these mental games with yourself and win.

My low-carb beliefs reinvigorated and validated by Taubes' book (you should buckle down and read it in detail) I haven't consumed sugar in more than tiny amounts for several months. I don't miss it, don't crave it, and I plan on going the rest of my life like this. I will probably never eat a candy bar ever again and I am ok with that. I just think you have to get over that mental hump and acquiesce to the fact that you were not made to consume sugar. There are some lucky folks out there who can, but you are not one of them. Get over it, be glad that there are tasty substitutes, and do what you know you have to do.

At 6:08 PM, January 14, 2008, Blogger GreatnessBlog said...

I appreciate your concern, but until I see some serious science, I'm not going to just take some random guy on the internet's word for it. :-)

I do plan on reading Taubes book in full at the same time that I attempt a moderate-carb, calorie-restricted diet. Perhaps one or both of those endeavors will change my mind. I'll keep you updated.

At 6:47 PM, February 22, 2008, Blogger shortandsweet said...

I agree completely with joshv. In order to be successful with your weight loss, you need to be on a low carb plan of some sort, ie. Atkins, Protein Power, etc and follow it. Find which one you could live with and then plan to eat this way for the rest of your life. Going back and forth, or cheating will never work.

I have been eating low carb for over 10 years, no sugar, bread, pasta, potatoes, rice, beans, starchy veggies and I don't miss them at all or have cravings. It's amazing, but I eat better than most people I know and I am never hungry. Gary Taubes book, along with many others I have read, are really right on when it comes to carbohydrates. Gary has done more research than any other author on the subject.

The best way to lose the weight and keep it off is to find a plan and follow it. You can do it!!!

At 6:54 PM, February 22, 2008, Blogger shortandsweet said...

I forgot one other thing. You wrote: "The hardest part of dieting for me is the hunger, or perhaps, the cravings". I believe this is because you are restricting your calories. I have found that restricting calories just does not mesh with the low carb way of eating.

Another thing I forgot to mention is that I do not eat grains of any kind, no oatmeal, etc. Try to steer clear of them. They will sabotage your efforts because they are high in carbs.

Good luck!

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