Holistic weight reduction - Part17 - Reasons for failure in weight reduction

UNDERSTANDING AND DEALING WITH ‘HUNGER’

The first type of ‘hunger’ is related to the emptiness of the stomach. When empty, the stomach tends to produce acid and contract intermittently in anticipation that it is going to be filled with food that needs to be digested. This type of hunger is often called ‘hunger pangs’. Due to the cultural tradition of eating three times a day that is prevalent in western societies and to which most individuals are habituated from childhood, during waking hours the stomach starts producing acid regularly about once every 4 hours. This is a conditioned reflex of the Pavlovian type. The irritation induced by stomach acid and the resulting ‘hunger pangs’ is easily counteracted by food every four hours. Thus the pattern of three to four meals daily becomes a habit of almost every individual. Some even experience this in the form of ‘night hunger’ that leads to the raiding of the refrigerator and food pantries at night!

If hunger pangs return more frequently than the normal interval between meals, then the possibility that the stomach is emptying too fast must be considered. This may be dealt with quite satisfactorily by adding low calorie fillers such as vegetable salads to every meal with a tiny amount of olive oil that delays the emptying of the stomach. In fact, gradually increasing the volume of the salad as the first item of the meal will reduce hunger pangs as well as provide an opportunity to reduce the calorie content of the rest of the meal, since the stomach fills up quite quickly with the salad, but empties slowly because of its fat content. If the symptom persists a medical consultation to exclude a stomach ulcer or gastro-esophageal reflux is also appropriate. Highly spiced foods also tend to induce hunger pangs by inflaming the stomach lining and are to be avoided while on a weight reduction program.

The second type of ‘hunger’ occurs when the brain recognizes that blood glucose levels begin to drop below which it cannot extract adequate amounts of glucose, the only fuel it can use on a sustained basis. The resultant signal increases the urge to eat something that is sweet. When glucose is absorbed into the blood stream it elicits secretion of insulin from the pancreas in proportion to the level to which the blood sugar has risen and the rate at which it rises. Hence when foods that are rich in readily absorbed sugars are present in a meal, it causes secretion of large amounts of insulin soon afterwards. A vicious cycle that consists of an accelerated rise of blood glucose levels, a consequent large release of insulin from the pancreas, and a subsequent sudden lowering of blood sugar levels is established very easily. The body attempts to reverse the lowered blood sugar level (hypoglycemia) by release of adrenaline and noradrenaline, which leads to transient nervousness and anxiety. Individuals learn very quickly that this nervousness can be corrected by sugar containing foods. A physical addiction results, where repeated intake of foods with high sugar content becomes essential to maintain physical and mental well-being. This yo-yo pattern of high and low blood sugar levels can become damaging to the central nervous system and blood vessels.

This is a relatively easily reversed physical addiction, once the symptom complex is recognized and simple sugars are withdrawn from the diet and replaced with complex carbohydrates and proteins. Occasionally a change from a three meal dietary habit to a six-meal regimen with significantly reduced carbohydrate content and slightly increased protein and fat content may be necessary to rectify the problem.

The third kind of ‘hunger’ or addiction is what may be called ‘palatal tolerance’. In simpler words, it is the need to provide greater stimulation to the taste buds for an individual to experience the same pleasure as when the tongue was first exposed to a particular taste. When a person likes a new taste, the enjoyment that is derived from it causes the brain to seek that taste again, but it now requires a larger stimulus to achieve the same intensity of pleasure. This phenomenon is called ‘development of tolerance’. It is a physiological phenomenon common to many sensory mechanisms, especially when the sensor is repeatedly exposed to the same stimulus at higher strengths and at shorter time intervals. Applied to taste buds and food, exposure to a desired taste requires greater quantity of food at shorter intervals to produce the same sense of pleasure. This leads to inappropriate higher intake of the particular food, irrespective of any consideration for the energy content and storage consequences of the excessive amount of calories consumed. This also may lead to dilatation of the stomach, which then requires higher volumes of food to have the sense of fullness and satisfaction after a meal, mediated by a stretch effect on the lining of the stomach. This is the opposite effect of what most individuals notice when after having been on a restricted diet consisting of small meals, they experience a sense of undue fullness when eating a normal meal. The antidote to this addiction which is partly physiological and partly emotional is to vary the content and taste of meals in such a way that the same essential ingredients of a nutritious meal are presented in different culinary preparations to prevent development of tolerance. That is perhaps how the art of ‘cuisine’ was born and developed into one of the great pleasures of civilization.

Palatal tolerance or fatigue must be avoided by varying the mode of preparation and presentation of meals. Often a program of desensitization by gradually reducing the amount of the food article to which the palate is addicted becomes essential. It also becomes necessary to reduce the frequency of exposure to the addictive food such as chocolate, steak, and potato chips. Sometimes total prohibition of the food for a period, followed by gradual reintroduction in smaller amounts may be necessary. Once again a low calorie filler of the stomach before the addictive food is ingested can fool the brain to accepting smaller portions as gratifying.

A fourth kind of ‘hunger’ or food addiction can be described as ‘sociological’. This is the phenomenon where one loses track of the amount of food eaten, because it is ingested at social events such as parties during which other pleasurable stimuli, such as alcohol or even the pleasure of meeting old friends or new acquaintances, distract the higher levels of the brain from adequately monitoring food intake. ‘Partying’ or ‘feasting’ can become the norm of life when the process of procuring food resources in the form of hunting or the many agricultural responsibilities necessary to produce food in edible form is replaced by the purchase of food, often in precooked or ready to eat form, and its subsequent consumption. The stimulation of appetite by alcohol and by the exquisitely attractive presentation of food that is common at social events can easily override the reflexes and rational faculties that normally indicate the upper limit for adequate consumption. This is all the more so when the food articles contain significant amount of sugar, salt or spice. Miniature versions of this are found in the form of ‘business lunches’, ‘munchies’ at discussion groups or ‘refreshments’ at committee meetings. No wonder those who are ‘forced’ into such situations or become addicted to them have their maximum body measurements at the ‘spare tire’ level of the abdomen!

While it may seem that the solution to this situation is somewhat puritanical, it is based on good science as well. Alcohol on an empty stomach inflames the lining quite quickly and induces the sense of hunger. No wonder restaurants serve cocktails before taking the orders for the entrées! A diluted alcohol drink produces less of an effect on the stomach lining and may be one way of dealing with the situation. Becoming a teetotaler is another way of coping. Avoiding spiced and salty appetizers can also be very effective. For those who are really serious about losing adipose tissue mass, vegetable appetizers and low calorie dips are a must.

Another factor that causes a craving for food, when there is no immediate energy needs for a meal occurs when the smell, sight and talk about food results in an almost uncontrollable desire to eat something, especially the kind of food article that was associated with these stimuli in the prior experience of an individual. This association between the urge for a specific kind of food and a previous memory track in the brain is most likely an emotionally induced neurological reflex associated with pleasant experiences from the past.

Surrender to such a craving is often difficult to avoid, except by the exercise of an extremely strong commitment to one’s goal of weight loss, because the neurological reflex is extremely primitive and requires a major volitional input to overcome. If removing oneself from the geographical location of the smell, sight and sound is impossible, occasionally a substitute such as chewing sugarless gum may be helpful. However chewing gum itself can occasionally increase the sense of hunger due to another alimentary reflex that increases production of saliva in the mouth.

The last form of ‘hunger’ is entirely psychological and emotional in origin. This arises from the use of food as a form of reward during stressful periods in early childhood. The distressed newborn finds displaced satisfaction in the comfort of food ingestion instead of the love associated with the caring and protective cuddling by the mother. This pattern is often reinforced during childhood and if not reversed by appropriate intervention fairly early becomes a neurological reflex mediated by the emotional brain by the time the child becomes an adolescent. When this emotional trait is carried into adulthood, it can become a major physiological problem resulting in increasing obesity and often translates into pathological disease caused or precipitated by morbid obesity. Such behavior may manifest itself in addiction to food at social parties and by the need to eat repeatedly during periods of stress that is induced by work demands, marital conflicts or any other psychological pressures.

This type of emotional addiction to food may require major behavior modification and psychological counseling. Appetite suppressants, which are often resorted to by individuals and sometimes even by physicians are not recommended because of their side effects, especially on the cardiovascular and nervous system. The underlying stress producing situations have to be explored and resolved before success can be achieved.

A personalized analysis of each individual’s sense of ‘feeling hungry’ is essential to understand the almost reflexive behavior of food ingestion without a legitimate reason for it. This is equally important in the consumption of liquids containing calories, such as beer and other alcoholic drinks as well as soft drinks that are often very high in carbohydrate calories and salt substitutes, which also predispose to uncontrolled ingestion. Corrective action for this type of food habits must involve a clear review of the circumstances under which inappropriate intake of food occurs and the logical countermeasures necessary to reduce caloric input into the body. The conclusion after such an evaluation may well be that in most individuals who experience significant difficulties in losing weight and who remain obese, food ingestion and hunger may have close similarities to addiction and associated withdrawal symptoms. Under those circumstances, it may be necessary to mobilize all the resources that are known to be effective in the management of drug addiction including behavior modification, desensitization, and prolonged psychological therapy. Recidivism after even after extensive interventions may occur. Where such methods fail, surgical intervention to reduce the size of the stomach or decrease intestinal absorption of nutrients containing large amounts of calories may be the last resort to prevent the major ill effects of morbid obesity. But such interventions are not without their own medical and psychological problems and should not be undertaken without an adequate evaluation of the psychological suitability of the candidate for such procedures.

About the Author : Abe Kurien MD, is a proponent of holistic medicine. He writes profusely on subjects of Weight reduction. His enlightening articles can be found on the smatix weight reduction section : Health and Nutrition Guide