Thursday, July 6, 2017


I know what ravenous hunger is.

More than 20  years before I was Dx'd with type 2 diabetes, I used to get reactive hypoglycemia, although I didn't realize that's what it was. At the time, I was working at a daily newspaper, and I occasionally did the wire desk, which mean I had to arrive at work at 7 a.m.

I normally didn't eat breakfast, and I wasn't especially hungry for lunch. But because I was a night owl and hated getting up early enough to get to work by 7, I'd reward myself with a chocolate doughnut, in addition to the strong black coffee I usually had.

Then, almost exactly 4 hours later, I'd get the shakes and a feeling that if I didn't eat something immediately, I was going to die. So I'd rush to the candy machine and get a candy bar, and that got rid of the shakes and the feelings of doom.

Now if I go low, which doesn't happen often but it does happen, I have that same feeling that if I don't eat I'm a goner. And because I want to get rid of that feeling that I'm doomed, I sometimes overtreat and then go high for hours.

Of course the official recommendation is to eat 15 grams of carbs, wait 15 minutes and retest, then eat a little more if you're still low. But one thing I really miss on my low-carb diet is fruit. When I was a kid I remember telling my mother, "What I really like is meat and fruit." So I keep canned sugarfree peaches in the cupboard to eat if I go low. They have about 6 grams of carbs in a cup, which is often just right when I'm not very low, and I wolf them down.

So I was wondering if this same 15/15 approach would work not just for lows but for weight loss.

I suspect that many people who have weight problems have something wrong with their appetite controls. When everyone else is feeling just hungry before a meal, they may feel ravenous. And when you're ravenous you tend to wolf down whatever you can reach. It takes about 20 minutes before your body lets you know you've had enough, and if you eat fast, by that time you've eaten a lot more than you need.

It's not enough to tell people to eat slowly. What exactly does that mean? Would it work better to measure out a small amount of food, eat it, and then wait 15 minutes? If you were still hungry, you could eat a second small amount of food. You'd keep doing this until you were no longer hungry.

Of course, if you have only 30 minutes for lunch, this would be difficult. Even with an hour it might be hard if it took four small portions and until you felt full. If so, you could increase the portions until you found an amount that filled you up with one or two servings.

So would this work? I really don't know. I'd try it myself but I no longer get ravenously hungry except when I'm very low, and that doesn't happen very often. I've always had a big appetite. One time a waiter at a Chinese restaurant remembered me two years later. He said they'd all been talking about me, "Because we'd never seen anyone so small eat so much." (This was in the days before they let you take extra food home and I hated to waste food, so I ate my whole meal, including the rice, and then finished what my brother couldn't eat.)

But as I get older my appetite seems to have abated, and "normal" portions now seem dauntingly large. So I no longer have that urge to stuff myself. I sometimes even stop eating when there's still food on my plate and heat it up and eat it at the next meal. So my weight has been steady for a long time.

It's nice to have a normal appetite after all these years, but I do understand what it's like to feel ravenous. I wish we could figure out how to fix that.


  1. When you get older your metabolism slows down naturally and you should eat less.

  2. I also had that reactive hypoglycemia. It was largely thanks to a glucometer, and other sufferers with more clueful doctors, that I discovered by stopping the postprandial highs I was also stopping the post-postprandial lows. Then I learned for the first time in my life that there was a qualitative as well as a quantitative difference between carb cravings and "normal" hunger.

    Now I am mostly fuelled by fats and ketones I can spend most of the day living off stored energy which I replace with one large or sometimes two smaller meals any time from late afternoon to late evening. Breakfast consists of a thickly buttered oatcake (5 - 6g carbs) with smoked salmon, or sometimes ham or turkey, just enough to let my pancreas and liver know my throat hasn't been cut and they don't need to dump a load of glucose into my blood to help me out. After that, what I eat and when is largely dictated by when I *feel* hungry, and that is more like "Oh I'll probably need to eat something soon" rather than the old "Must eat now or I will DIE!!!"

    Maybe an insulin meter would be even more useful. What is NOT useful is telling doctors that reactive hypoglycemia does not exist and they must instead diagnose a "neurotic" condition called "idiopathic postprandial syndrome" which isolates them from comprehending the mechanism or the treatment.

    Some of David Ludwig's work shows this occurring in "nondiabetics" - but are they really, or are they just "not diabetic yet"?

    chris c

    1. Yes, an insulin meter would be useful.

      I think reactive hypoglycemia portends diabetes, but no one know what the time frame is. For me it was 25 years.

      Whether someone with diabetes genes that are expressed only under certain environmental conditions, or someone producing pathological levels of insulin but maintaining normal BG levels, is diabetic is a matter of definition.

    2. Only about half the victims of similar symptoms I know actually went on to be *diagnosed* diabetic, the rest stayed "prediabetic" ie. less than 50% of beta cells lost.

      As Ludwig (again) pointed out, looking at the cardiovascular and other consequences "prediabetes isn't really pre-anything"

      chris c

    3. Yes. But most people don't want to be diabetic (I knew a little girl whose mother taught at a diabetes camp and the little girl wished she were diabetic like all her summer friends), and they're not willing to make major lifestyle changes even if Dx'd as diabetic, much less prediabetic.

    4. Just maybe giving them the RIGHT information, and providing feedback via a glucometer, BP meter, scales and lipid panels so the improvements could be tracked would be useful. Worked for me and N=thousands of others.

      chris c

    5. Yes, what you describe works for motivated patients and should be strongly recommended for all. But too many patients *aren't* motivated. Those on the internet mostly are. I think one of the most important factors is to convince patients that they have to take the disease seriously.

  3. It's been suggested that "prediabetes" and even "metabolic syndrome" should be renamed "Stage 1 Diabetes", that may wake up some of the patients - and some of the doctors too.

    Yes I know not a few unmotivated diabetics In Real Life - but then they aren't really given good information, mainly that they should eat a low fat high carb diet, avoid sugar and lose weight, but they will inevitably progress anyway.

    The last of the Old Guard who were given low carb diets as default are now dying out, but some of them were quite clueful and mostly failed to progress satisfactorily. Many doctors are too young to know this ever happened.

    chris c

  4. In the US, it used to be that they set the BG level for diagnosis high (140 mg/dL) because once you were Dx'd, you became uninsurable. Then that was reduced to 126. Right now, you can't be excluded from insurance because of a pre-existing condition, but Trump and his gang are trying to change that.