I'm up at 4 a.m. and I just had a bowl of raisin bran with 1% lactose-free milk (organic).
Why?
I was hungry.
I am hungry. I have been hungry. By all estimations, I'm likely to continue to be hungry.
I ate pretty normally for me yesterday, in the sense of what I do when I'm not completely overwhelmed and I plan well. Plenty of fresh fruits (including freshly picked blackberries from my friend's farm-like property) and vegetables (including yummy small carrots from the farmer's market, tender, crisp, sweet and a little peppery, very unlike the ones that come in little finger-sized chunks in the plastic bag at the supermarket). Mr. Rounded made dinner -- chicken in a mild fresh tomato, yellow and green bean and potato curry with brown rice. Breakfast*, lunch, dinner, with snacks in between. So why was I hungry at 4 a.m.?
Maybe hunger isn't something I can prevent.
I ran across this at work yesterday while reading a Medscape (requires registration) article on "
Polycystic Ovary Syndrome, Obesity and Reproductive Implications: Hyperandrogenism and Insulin Resistance" by Swedish physician and researcher Angelica Linden Hirschberg, MD, PhD, and nearly dropped my spoon:
Many women with PCOS suffer from a craving for sweets, a reduced feeling of satiety and a tendency toward binge-eating.
[33] We have demonstrated that women with PCOS have reduced meal-related secretion of the gastrointestinal 'satiety peptide', cholecystokinin, compared with BMI-matched controls.
[34] Furthermore, patients with PCOS display dys-regulation of ghrelin, a hormone secreted from the
gastric mucosa, which stimulates hunger and food intake.
[35] Thus, there is evidence of disturbed appetite regulation in patients with PCOS, which, together with the characteristic endocrine/metabolic abnormalities, may explain why these women have to struggle to maintain normal bodyweight. Increased appetite in patients with PCOS may be part of an anabolic constitution that predisposes an individual to obesity and insulin resistance. It seems likely that this constitution, probably of genetic nature, provides evolutionary advantages in times of nutrition shortages. Furthermore, we have demonstrated that the constitution of women with PCOS may be an advantage for physical performance.
[36] However, in times of unlimited food supplies it may, together with a
sedentary lifestyle, lead to the development of obesity and reproductive failure.
I really like the part where they've "demonstrated that the constitution of women with PCOS** may be an advantage for physical performance." Now, if only I could become a full-time endurance athlete in training... (this article also stated that exercise alone had a similar treatment effect as losing weight through dieting.)
But, it does really back up the feeling I've had most of my life that I'm really hungry. Hungrier than my life circumstances would lead me to expect to feel. Hungrier than other women of the same height and physical activity levels. Compounded with other things, I think this is about as close to an explanation for "why I am fat" as I'll ever get. Not an excuse, and not that I need to explain myself, but it does explain
to me why I experience the world as it relates to food and hunger the way I do.
So, armed with the compassionate (if still weight-loss focused) perspective of
Angelica Linden Hirschberg, MD, PhD, what do I do with this knowledge?
I don't rightly know.
I know that if I eat as much as I'm hungry for in a casual way, without some planning, I gain weight. Gaining weight isn't bad, per se, but for me, it gets me into a place where my blood sugar is harder to manage, I don't sleep well, and since life is cruel this way, I feel hungrier and more tired. If I eat in a way that is geared toward allowing me to feel satisfied and stay about a half step ahead of my hunger, I can basically manage to stay where I am. Where I am is okay... but I do have a "grass is greener" maybe a little less weight would bring my blood sugars down a tad more to where I was having a beautiful little reading on my blood sugar meter each morning without having to add in any other medications to manage diabetes.
And, how is this not dieting?
Right now, I'm focused on experimenting. What can I do to be treating myself in a loving, caring way, with all of the demands of life swirling around me, to provide my body with what it needs in a proactive way?
In the meantime, I'm going to try to not be annoyed when I feel hungry. I'm instead going to remind myself that it's my "constitution." It's how I'm made. It's not all bad. It mostly just is.
* Dairy yogurt gives me a very bad tummy ache (even though it's supposed to be lactose free). But lately, I've been eating soy yogurt at breakfast. As a result, I feel
so much more feminine.
** I was told I had PCOS when I was 20 years old.
Comments (8)
This is a very valuable commentary. My daughter has pcos and we are both obese, but I never get that hungry, like you were talking about. So I know there is a difference between us. My daughter has given up on the idea of dieting, and is angry if we even try to discuss it with her. I don't really believe in dieting to lose weight either, but I do believe in learning to eat how and what will be most beneficial to her. So far, I am concluding that she should eat as normally as possible, avoid processed foods, and get exercise every day, but I don't believe that it will do anything to lose weight - or that losing weight will do anything to control her insulin resistance. So what is there to do? How can a young woman with no health insurance be as healthy as possible?
I don't know. Is the equation really "if I weigh X, my fasting blood sugar will be Y"? It does seem to me that with age (since your pancreas gets older along with the rest of you), and with number of years since diagnosis, it gets harder to manage blood sugars with diet alone, or even diet + only one med. It doesn't necessarily mean you did anything wrong. Even if you got your weight back to where it was when you had the "beautiful" readings, it doesn't necessarily follow that the rest of your body returns to its former state. A lot of people with diabetes have to restrict carb intake a lot more than they used to, and also exercise more, but that's not dieting as such, even if weight loss follows that (which for some people, it does). Being hungry all the time because you think you're not "supposed" to be eating -- that's dieting.
@lstba - Regarding your question -- I don't think there's anything my parents could have told me when I was in my early 20s that I would have listened to regarding my body, or eating, or weight. I think the less pressure you put -- the more you focus on what's going well in her life, that's probably going to keep the door open if she wants some support for changes in the future.
The advice I wish I had received (and taken) was that weight doesn't have to be the focus, and that eating doesn't have to be "strict," and that activity can be fun.
If there's some physical activity she's interested in getting involved in and she can't afford the fee, that's a great way to support her. Or if she wants to eat healthier foods and feels she can't afford them, maybe going grocery shopping together and picking up the pricier healthy things (like the more expensive fruits & veg, chicken) and she can get the less expensive staples (beans, rice and less expensive vegetables & fruits).
Dancing, hiking, walking around are all low-cost ways to get movement in.
I remember having this sense when I was in my 20s (before I was diagnosed with diabetes) that I knew it wasn't good for me to be gaining weight fast, but I didn't know how to turn it around. It felt like the choices were between dieting or eating whatever I wanted, I hadn't yet been able to conceive of a middle ground. I had this sense that I probably couldn't go on forever having tuna melts and french fries for lunch (oh, that sounds delicious but I know my stomach would be killing me by about the 6th bite) but I didn't know how to make the shift.
I wish there were good doctors who specialized in treating people in their 20s. I actually found a very compassionate and easy to work with OB/GYN who was a guy, who was so sweet and encouraged me to get a physical, and that's how I found out I had type 2 diabetes. But without his kindness and lack of judgement for my weight, I probably wouldn't have taken that next step. He ended up being my doctor for about 10 years.
Long answer!!! Provocative question! I wish you and your daughter the best possible health!
@Meowser1 - I think for me it works like this.
Less hunger = fewer carbs and less food overall
Fewer carbs and less food overall = better blood sugar control and weighing slightly less
weighing slightly less = sleeping better
sleeping better = less hunger and more energy and more activity
more activity = better blood sugar control and ability to maintain a very slightly lower weight.
There does seem to be a relationship between weighing less and blood sugar control for me, but I think the eating fewer carbs and less overall is the confounder.
It all goes back to hunger for me. At the moment, going directly after eating fewer carbs feels harder than just eating less overall, and fewer carbs as part of that.
It's hard to know what's within my control regarding how hungry I feel. Not very much in my control, is how it feels.
Does this make sense? Thanks for asking.
Yeah, I think I get it. I'm not sure there's a reliable way to make yourself become "less hungry" than you are, though, and stay that way. (I'm sure if anyone ever came up with a way that worked for most people who tried it, without compromising their health otherwise, they'd become a trillionaire.) It could be that certain kinds of food are less satisfying than other kinds and it takes more of them to feel full, and that for people who are IR, higher-GI meals are less satisfying. (Chris, I would guess, eats a diet that's about 80% carbs; if I did that, I'd be ravenous all the time.)
I don't think my hypothalamus "knows" how fat I am, or much gives a crap, really. What's in my thighs, contrary to popular belief, is not going to fill my stomach. Not when I probably have five times as many fat cells as a thin person and likely always have.
Fat cells are pretty hungry things. My best understanding is that you can reduce fat cells that are stuffed beyond capacity to normal size, but once the cells are filled below normal size, it's very difficult to keep them smaller than that. It would be a lot easier if we could figure out just how many fat cells we actually have and how full they are, that way we'd have a realistic picture of what's possible or likely to change with diet.
@Meowser1 - Yes, I feel like I'm in a bit of uncharted territory (and not trying to become a trillionare) -- I am staunchly avoiding anything that even vaguely resembles a diet, while "tinkering" with the inputs as they seem to impact my hunger. I am not looking for a big change, and I don't really want to "outsmart" my body. I really just want to sleep the best I can for a 40 year old with type 2 diabetes and an insanely busy life. I want to have enough energy to dance and get through a workday and still be excited to see SuperHeroPrincess at the end of the day. My weight, ultimately, doesn't matter to me. My blood sugar is actually just a proxy measure, too. How I feel is probably the most important metric. And I want to feel better, but it could be that it's not going to get better than this (unless I can cut back on my work hours and spend that time swimming/strength training/dancing).
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