Saturday, March 8, 2014

The Nutrition Debate #190: “Can (sic) I ask you a personal question?”

I had walked up to the bar at the jazz club to get a refill of my glass of red wine, and a “young” woman (in her 40s), sitting at a nearby table with her mother and her mothers friend, struck up a conversation with me. I engaged the brazen hussy, gave her my “business” card (The Nutrition Debate) and began almost immediately to proselytize about my Very Low Carb lifestyle. She indulged me, with indifference bordering on insouciance, and then said, “Can I ask you a personal question?”

Two thoughts crossed my mind immediately: How much had she had to drink? And why am I feeling on the defensive? Anyway, I said “sure.” It could be interesting, and I (as my regular readers here know) do not guard my health and medical information. I am not only willing, I am anxious to share the “good” news (and the bad, if it should be) about how changes in what I eat over the last 12 years have transformed my health.

I wont repeat all the statistics here; I will just say (for new readers) that I have been a type 2 diabetic for 28 years, and 12 years ago I weighed 375 pounds. After changing what I ate from the Standard American Diet (“balanced” and very high in carbs), I lost 170 pounds, my blood glucose went from “uncontrolled” on 3 oral meds to well-controlled (“non-diabetic”) on a minimum dose of Metformin. My blood lipids (cholesterol panel) also improved very dramatically, my blood pressure improved (on the same meds) and my inflammation markers also dramatically improved. So, I was ready. Ask away!

To my surprise, she asked, “How can you drink on your diet?” Relieved, I went into a boring explanation of how many carbs are in 2 glasses of wine (my “limit”), how much ethyl alcohol, etc. It must have sounded like a rationalization, but she was satisfied. Once again, however, like so many other questions I have fielded over the years, the question and my answer lingered on with my answer improving each time I revisited the subject. Final answer: I am not an ascetic; I am a hedonist. I do not eat (or drink) to survive; I eat and drink for pleasure. Bottom line: I had better like what I eat (and drink) or 1) I wont like doing it and 2) I wont be able to do it indefinitely as a “lifestyle change,” which is needed if I am to succeed long term.

Okay, I said it: I like to eat. But this is not just about my former licentious and libidinous lifestyle. I had to give them up to save my health, and my marriage. (I got married about the same time.) But, as I said, I am not an ascetic, so I had to find an “alternate” lifestyle with equal or greater gustatory rewards. This is not about volitional eating. This is about a driving force that controls the urge to “consume food just for pleasure” and not to “maintain energy homeostasis.” This is called “hedonistic hunger.” Im not making this up, folks. Check out this piece in the Journal of Clinical Endocrinal Metabolism.

The title, “Hedonic eating is associated with increased peripheral levels of ghrelin and the endocannabinoid 2-arachidonoyl-glycerol in healthy humans: a pilot study,” tells the story: the hunger hormone (ghrelin) and opioid receptors in the brain regulate eating behavior based on palatability. As I said, its not volition or will power. So, the “trick” to sidestep cravings is to transition from a high-carb dietary engineered by processed food manufacturers for maximum palatability, to an equally hedonistic lifestyle based on energy homeostasis. Eat for pleasure, but just enough to be healthy. The key is to avoid feeling hungry. Cravings, as we know them, are signals from the brain (and ghrelin from the stomach) telling us to eat low energy density foods (carbohydrates) with high palatability. They are, frankly, sometimes almost impossible to resist.

But, if you eat a breakfast that enables you to go all day long without feeling hungry, because your blood glucose has been stable all day long, you will not have cravings. The body will regulate energy homeostasis using different mechanisms. You body is “happy” to burn body fat for energy if you dont feed yourself carbs. It is designed to work that way. We didnt evolve eating “three squares” a day. We ate “catch as catch can” and sometimes went days working off stored energy from a previous feast. It is completely natural.

This PubMed Abstract comes to a thought-provoking conclusion: “The present preliminary findings suggest that when motivation to eat is generated by the availability of highly palatable food and not by food deprivation, a peripheral activation of two endogenous rewarding chemical signals is observed. Future research should confirm and extend our results to better understand the phenomenon of hedonic eating, which influences food intake and, ultimately, body mass.”

Ive been working on this “future research” for years, long before this paper was published. I always ate for pleasure, for sure; that is, I was hooked on carbs. I craved carbs; now, I still eat for pleasure, but I am not craven. I eat foods that satiate (fat and protein), and so I am not hungry between meals. I will often skip lunch, like today when we plan to eat dinner around 5PM. I will even have a glass or two of wine occasionally, for pleasure, for sure.
Its not a perfect solution. The body has other mechanisms that drive us to eat (besides pleasure and short-term energy depletion). One of them is the hormonal stimulation that comes from seeing or smelling food. I call it “opportunistic” eating, and it is definitely a driving force to which I am especially susceptible. Like the other driving forces, I suspect it is a genetic thing, and I am “blessed” with this survival gene. The 2 glasses of red wine, though, is purely hedonistic.

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