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A recent article in Pediatrics demonstrates that using a Very Low Carbohydrate (VLC) diet for Type I diabetics (T1D) improves their outcome. While this is not an objective study, the study indicates that a dietary approach to diabetes, with its lack of side effects, may be quite effective at reducing the need for continuous infusion of insulin.

From an appetite perspective, I applaud the study yet provide a cautionary tale: Societal norms will make this hard on the kids to be compliant. Sugar-in food, hidden or not, with its inherent addictive qualities, and the ease and low costs in which it’s available, will be the real obstacle in the long term help that a VLC diet provides. Family members of the T1D will have to pitch in to reduce the pressures of over consuming sugars. Parents can do a lot for younger kids, as they have the ability to control their child’s environment. Education and support, perhaps even modeling modern addiction protocols, can help the T1D overcome the persistent temptation to eat carbohydrates. It’s the classic long term gain vs the short term hits of pleasure.

If you or someone you love has diabetes, the VLC diet is the best bet. It’s a no-brainer that reducing the need for insulin is an obviously smart choice. And that is accomplished by removing the biggest inducer of insulin, sugar. Remember that sugar is found in anything made from a grain: wheat, corn, barley, rice -and oats. And of course we’ll add table sugar to the list. If you are prediabetic or diabetic, or even if you want to be healthy, you can help yourself immensely by a VLC diet. And you’ll have to learn how to overcome the sugar temptations everywhere you go. It’s a battle worth fighting–everyday.

Humans are indeed compelled to eat food.  Strongly compelled in fact.  The lack of anorexigenic (peptides nervous signals that stops the behavior of eating AKA satiety) primarily drives the sensation of hunger just as increased blood osmolarity increases the sensation of thirst as well as increasing the release of ADH (vasopressin) while decreasing aldosterone.   The compulsion to eat (hunger) is a behavioral component that is an outcome of physiological and not behavioral need.

Clearly carbohydrates are not drugs in the same way that heroin is.  They are indeed nutrients.  Yet they activate the dopaminergic mesolimbic pathway (so called rewards or saliency pathway depending upon the neurobiologist you happen to be talking to…), in the same way heroin, nicotine, and alcohol do.  To that end that, it has drug-like capacity.  The neurobiologist perspective to addiction is that down-regulation of receptors MUST occur and that withdrawal syndromes occur.  Heroin and opiates are addictive under that qualification as the opiate receptors downregulate via intracellular Ca++/phosphorylation events, decreased receptor expression and receptor withdrawal mechanisms.  In a sense alcohol can also be considered addictive, but not because of brain chemistry, but rather because the liver gets better at processing the alcohol.  So by this definition, carbohydrates may indeed be considered addictive because of the insulin receptor down regulation (AKA insulin resistance) that occurs with chronic hyperinsulinemia.  Since insulin is considered an anorexogenic peptide, then you would need progressively more carbohydrate to induce satiety as more and more insulin is needed to bind to insulin receptors to achieve the same results.  This particular description might well merit the term addiction in the down-regulation sense.

Addiction by a behavioral definition is different.  It suggests that anything (drugs (carbs, alcohol, sex, gambling, food) that is patently ‘bad-in-excess” or to the point that it affects health or work or relationships and is difficult to stop would be an addiction by psychologists.  In these cases there is neuronal reinforcement of the behavior by the compulsion.  This neural plasticity is accompanied by specific changes in neurotransmitter release and receptor organization across the synapse.  Indeed, increased numbers of synapses occur with such compulsions.   Again this is a function of the behavior causing neuronal rewiring in the dopaminergic mesolimbic pathway that supports the compulsion.  In this manner and definition, carbohydrates by a psychological definition would also be considered addictive.
Addiction is a funny thing biologically and a not so funny thing in human life.
What this means to you is that there are two potential stories regarding carbohydrate so-called addiction.  The act of the reward of eating sweet carbohydrates is a behavioral addiction.  Once you get into this type of behavioral addiction, you’ll need to generate ways to change your environment around you:  Support groups, removing grains and sugars from the pantry.  Limiting intake but not necessarily removing all sugars.   The main problem for you is that you really WANT to eat those sugars.  The further in time you are from eating them, the easier it is for you to control.
You must develop a mind set that makes eating a conscious decision.  Make the habit to think consciously about your food intake.  Know that when you eat sweet, your brain WANTS to eat more of it.  This is indeed the basis for the so-called yo-yo phenomenon.
Then there’s the insulin receptor resistance model of addiction  In this case, your body thinks you HAVE to eat them to feel satiated.  This is likely happening if you’ve become obese or morbidly obese.  Not only do you WANT to eat carbohydrates, you literally have to eat more for the receptors to function normally.   You HAVE to have them.
How do you stop this?  You have to eat.    Right?
It turns out the proteins and fats are much better are making you feel satiated.   So especially if you’re obese, then this can be a lifesaver from overeating.   Indeed, I suggest that you do in fact eat!  You can eat green vegetables (which doesn’t include corn nor green beans, btw) almost in unlimited quantity.  They won’t take care of those pesky carbohydrate cravings, but you’ll feel full soon enough.   If you can just get to that, it’s far less likely that you’ll turn to the carbs and sugar.   In fact, if you can just let 10 minutes go by, according to the models for cigarette cessation, the cravings will reduce dramatically.   Eating some eggs, meat or vegetables will help you get control.
I know it’s a rough 10 minutes.  Sometimes we all fail at this.  I certainly do myself.  So call a friend during that time.   Tell them you’re reaching for a cookie!  Just that act will help as well.  This is why support groups can help some people with their addictions.
Its an ongoing struggle with eating!  You can do this.
Dr D


Paleo Smart Commandments

Check this out: Paleo Smart Commandments: The Simple Divine Guide to Optimal Health…

Kansas City Fox 4 News on the Paleo Diet

The physiology and biochemistry of the Paleolithic Diet AHS 13 with markingsDear Reader,

I just gave a talk at the Ancestral Health Symposium on the potential role of transient receptor potential vanilloid 1 in obesity. Here’s the entire video for you to watch! Watch out for the sing a long at the end, though, you might be singing alone at your desk!




I enjoyed my time in Boston at Harvard University Law School at the Ancestral Health Symposium. Much obliged to the leadership of the conference for allowing me to speak there!

The talk was recorded, but unfortunately it won’t work well because there was no way to record my live writing on the Powerpoint slides! It will seem that I am merely talking about this very complicated slide without reference! That’s the problem!

So, in order to reproduce the talk, I gave a seminar lecture to my students that are taking my seminar on Appetite Regulation as part of an overview. I even got to pontificate a bit more on this version since I wasn’t limited to just 40 minutes in my class! So, I spoke for nearly 1 hour and 42 minutes! I hope you’ll enjoy the talk. I would certainly love the feedback!



To access the talk go to:

You will need JAVA to run the program!


I Don’t vs I Can’t

A recent study in the Journal of Consumer Research, Inc. by Drs. Vanessa Patrick and Henrik Hagtvedt  was really interesting to me.   Although it doesn’t seem to quite fit with appetite regulation, I decided that it did indeed.  So I report to you!

In the study, participants were given the task of using two different phrases, “I don’t” vs. “I can’t.”   Very interestingly, the use of the phrase “I don’t” helped with internal motivation!  Translated, if you want to maintain weight loss because you are personally motivated to loss weight AND not for the purpose of getting ready for a wedding or worrying about what other people think (these are external motivations!), then using the phrase “I don’t” becomes much more empowering to help you maintain yourself in the face of temptation vs. using the “I can’t” phrase.  

To be complete, if you ARE trying to lose weight before a wedding or a reunion and that’s your only goal, then “I can’t” apparently would work better.   “I can’t” phrase seems to help one with motivations that are external!  

BUT for you folks that need long-term control or your diet, use “I don’t” eat processed carbohydrates. ” I don’t” eat starches.  “I don’t” eat cake!   This will make you feel more in control!

I would have liked to see some MRI studies in cingulate gyrus getting if the “I don’t” phrase works better there than the “I can’t” phrase.  The cingulate gyrus is considered to be the anatomical seat for “willpower.”   I hypothesize that the “I don’t” phrase lights up this section of the brain more than the “I can’t” phrase.

I must say that for myself, a long-time sugar-addicted guy, the “I don’t” phrase works for me personally.  I had defaulted to saying “I can’t” eat carbohydrates for many years.   I felt deprived.   Since reading this study, I’ve converted to saying “I can’t” instead.   Amazing how well “I don’t” worked better than I can’t.  I simply feel more empowered! 

Especially when confronted with those Passover chocolate covered matzo and matzo ball soup and the chocolate bunnies of Easter.   Or the kitchen at work with the leftover chocolate chip cookies.   Those were there just last Thursday and I said “I don’t” to them.  

Reference:  Journal of Consumer Research, Inc.
“I Don’t” versus “I Can’t”: When Empowered Refusal Motivates Goal-Directed Behavior
Author(s): Vanessa M. Patrick and Henrik Hagtvedt;contentBody

Excellent piece and very pleased to see 60 Minutes tackle such a difficult subject. Thank you for breaking through what many of us have been trying to tell our dietitians and physicians for years: The 60+ carbohydrate percent recommended by the so-called Food Pyramid/Plate and the USDA is patently incorrect.

If I may make a few corrections, your piece says that all cells REQUIRE glucose. This is incorrect! ONLY axons of certain neurons and rapidly acting fast twitch muscles require glucose. Indeed, this is why glucose needs are actually so minimal and why sugars are not essential compounds! Ketones (which are natural breakdown products of fats) are utilized more efficiently by all cells except those listed above. In particular cardiac cells prefer ketones for efficiency over glucose.

Second, while I agree with Dr. Lustig that fructose is a particularly bad player, excess glucose enters into the same pathway that fructose does and causes the same damage. Thus, the pastas and the breads, which are all converted to glucose, worsen the damage by the added sugar.

Third, glucose is addictive as indicated in your piece. Thus you have to deal with your addiction. The conclusion that you can have “some” sugar is therefore not a good recommendation. It IS a good start to the final recommendation to stop eating sugar! Isn’t this akin to saying to a cocaine addict that “some” cocaine is OK?

Stimuli such as advertisements can override your brains’ signal that you are satiated. This means that the advertisement of sugary cereals on Saturday mornings is, in addition to the aforementioned addictions, causes overeating of such sugary cereals and is a great contributor to childhood obesity. The pizza commercial precisely at 5:15 pm invokes the phone call to the local pizza chain. The link of television watching and obesity is now clear: Such advertisements directly increase eating behaviors.

Perhaps as a follow-up, 60 Minutes might ask the following question: Why does the USDA continue to support the now debunked Food Pyramid/Plate? Answering that question might get you into a 100 billion+/year industry that encompasses not only lobbyists for food and soda industries, but also the diet and fitness industry, bariatric and plastic surgeries industries, pharmaceutical industries, advertising agencies and anything that makes money on our human physiological vulnerability to sugars and its direct link to obesity.

Excess sugar, both fructose and glucose, activate high glucose sensing neurons in brain hypothalamus that cause you to activate hunger (orexigenic) pathways. This causes you to eat more! And if what you eat is sugar, then you have again activated those neurons! In science and medicine this is called a positive feedback mechanism almost always associated with pathophysiology and disease!

AND if the taste of starches (sugar polymers) and sugars causes dopamine to increase in rewards pathways then you can also add sugar addiction to the mix. This makes it difficult to maintain a low carbohydrate diet in the same manner as alcohol and drug addictions make it difficult to stay alcohol and drug free.

AND that visual, auditory and olfactory (sight, sound, and smell, respectively) cues can override satiety to cause you to eat more explains why advertisement of sugary foods adds a third component to obesity.

All three separate neuronal pathways result in overeating of sugars. The excess sugars cause the phenomen of glycation of proteins. That is, the sugars are chemically bound to the proteins. This changes the shape of the proteins. This changes the function of the proteins. So if that protein was a transporter that was supposed to help nutrients get into a cell, and glycation causes that protein to stop functioning properly, then you just stopped a nutrient from getting to a cell!

That would indeed be an example of toxicicity!

Biochemistry 101

I hosted a discussion of the fates of glucose, proteins and fats by using a biochemical model to explain.  Questions answered were about carbohydrate cycling, carbohydrate refeeding, and the importance of muscle and liver glycogen.

To see the recording of the video go to: