Hunger can be taught: Hunger Recognition regulates eating and improves energy balance

Abstract

A set of spontaneous hunger sensations, Initial Hunger (IH), has been associated with low blood glucose concentration (BG). These sensations may arise pre-meal or can be elicited by delaying a meal. With self-measurement of BG, subjects can be trained to formally identify and remember these sensations (Hunger Recognition). Subjects can then be trained to ensure that IH is present pre-meal for most meals and that their pre-meal BG is therefore low consistently (IH Meal Pattern). IH includes the epigastric Empty Hollow Sensation (the most frequent and recognizable) as well as less specific sensations such as fatigue or light-headedness which is termed inanition. This report reviews the method for identifying IH and the effect of the IH Meal Pattern on energy balance. In adults, the IH Meal Pattern has been shown to significantly decrease energy intake by one-third, decrease preprandial BG, reduce glycosylated hemoglobin, and reduce insulin resistance and weight in those who are insulin resistant or overweight. Young children as well as adults can be trained in Hunger Recognition, giving them an elegant method for achieving energy balance without the stress of restraint-type dieting. The implications of improving insulin sensitivity through improved energy balance are as wide as improving immune activity.

Keywords: diabetes; energy balance; energy intake; food intake regulation; hunger; inflammation; insulin resistance; obesity; prevention; risks.

Figure 1

Estimated versus measured blood glucose of trained subjects (hollow red circles; n = 18) and control (untrained) subjects (hollow black circles; n = 42) reporting to be hungry at the final laboratory investigative session. Notes: Linear correlation was significant for the trained data (red dashed line; r = 0.92; P = 0.0001) but not for the control data (black dashed line; r = 0.29, P = 0.06). Image courtesy of Ciampolini M, Bianchi R. Training to estimate blood glucose and to form associations with initial hunger. Nutr Metab (Lond). 2006;3:42.

Figure 2

Estimated versus measured blood glucose of trained subjects with measured blood glucose < 87 mg/dL at the final session. Notes: Below this value, 18 subjects reported the EHS (hollow red circles) and 14 subjects reported inanition only but not EHS (filled black squares). These 14 subjects showed an average estimation error of 4.5% ± 3.1% of the measured blood glucose, which did not significantly differ from the estimation error of the 18 trained subjects who reported the EHS (3.2% ± 2.4%; P = 0.20). Linear regression was significant for the hungry subjects reporting EHS (dashed red line; r = 0.92; P = 0.0001) but not for those not reporting EHS (solid black line; r = 0.18; P = 0.54). Image courtesy of Ciampolini M, Bianchi R. Training to estimate blood glucose and to form associations with initial hunger. Nutr Metab (Lond). 2006;3:42. Abbreviation: EHS, Empty Hollow Sensation.

Figure 3

Difference of mean preprandial BG after training versus BG at recruitment for each trained subject. Notes: Column height shows 5 months after pretraining mean BG difference in each trained subject. Significant increases are indicated by blue bars, significant decreases by red bars, and not significant changes by black bars. Mean BG is reported in sequentially increasing order at recruitment, not in linear correlation with segment length on the X-axis scale. The range of mean blood glucose values at recruitment is indicated by the minimum and maximum values for the first and last subjects (large arrows). The vertical dashed line indicates the most significant division between subjects who showed no mean BG decrease after training (low BG group, n = 34) and those who showed significant decrease of mean BG (high BG group, n = 55; Chi-squared analysis: P = 0.00001). This threshold blood glucose at recruitment (demarcation point) is 81.8 mg/dL (4.5 mmol/L) at recruitment in the randomized controlled studies. Subjects above this threshold accounted for most of the improvements in weight and insulin resistance., Copyright © 2011, Dove Medical Press Ltd. Reproduced with permission from Ciampolini M, Sifone M. Differences in maintenance of mean blood glucose (BG) and their association with response to “recognizing hunger.” Int J Gen Med. 2011; 4:403–412. Abbreviations: BG, blood glucose; HBG, high blood glucose; LBG, low blood glucose.