Training to estimate blood glucose and to form associations with initial hunger

BACKGROUND: The will to eat is a decision associated with conditioned responses and with unconditioned body sensations that reflect changes in metabolic biomarkers. Here, we investigate whether this decision can be delayed until blood glucose is allowed to fall to low levels, when presumably feeding behavior is mostly unconditioned. Following such an eating pattern might avoid some of the metabolic risk factors that are associated with high glycemia. RESULTS: In this 7-week study, patients were trained to estimate their blood glucose at meal times by associating feelings of hunger with glycemic levels determined by standard blood glucose monitors and to eat only when glycemia was < 85 mg/dL. At the end of the 7-week training period, estimated and measured glycemic values were found to be linearly correlated in the trained group (r = 0.82; p = 0.0001) but not in the control (untrained) group (r = 0.10; p = 0.40). Fewer subjects in the trained group were hungry than those in the control group (p = 0.001). The 18 hungry subjects of the trained group had significantly lower glucose levels (80.1 ± 6.3 mg/dL) than the 42 hungry control subjects (89.2 ± 10.2 mg/dL; p = 0.01). Moreover, the trained hungry subjects estimated their glycemia (78.1 ± 6.7 mg/dL; estimation error: 3.2 ± 2.4% of the measured glycemia) more accurately than the control hungry subjects (75.9 ± 9.8 mg/dL; estimation error: 16.7 ± 11.0%; p = 0.0001). Also the estimation error of the entire trained group (4.7 ± 3.6%) was significantly lower than that of the control group (17.1 ± 11.5%; p = 0.0001). A value of glycemia at initial feelings of hunger was provisionally identified as 87 mg/dL. Below this level, estimation showed lower error in both trained (p = 0.04) and control subjects (p = 0.001). CONCLUSION: Subjects could be trained to accurately estimate their blood glucose and to recognize their sensations of initial hunger at low glucose concentrations. These results suggest that it is possible to make a behavioral distinction between unconditioned and conditioned hunger, and to achieve a cognitive will to eat by training

Sustained self-regulation of energy intake. Loss of weight in overweight subjects. Maintenance of weight in normal-weight subjects

<p>Abstract</p> <p>Background</p> <p>Dietary restraint is largely unsuccessful for controlling obesity. As an alternative, subjects can easily be trained to reliably recognize sensations of initial hunger (IH) a set of physiological sensations which emerge spontaneously, not necessarily at planned mealtimes, and may be the afferent arm of a homeostatic system of food intake regulation. Previously we have reported that IH is associated with blood glucose concentration (BG) below 81.8 mg/dL (4.55 mmol/l), (low blood glucose, LBG), and that a pattern of meals in which IH is present pre-meal (IHMP) improved insulin sensitivity, HbA1c and other cardiovascular risk factors. Here we report the effect upon weight in overweight and normal weight subjects.</p> <p>Objective</p> <p>To investigate whether the IHMP is associated with sustained loss of weight in overweight subjects over a 5 month period.</p> <p>Methods</p> <p>Seventy four overweight subjects (OW: BMI > 25) and 107 normal weight (NW) subjects were randomly allocated to either trained (OW: N = 51; NW N = 79) or control (OW: N = 23; NW: N = 28) groups. All subjects were allocated post-randomization into either low or high mean pre-meal BG groups (LBG and HBG groups) using a demarcation point of 81.8 mg/dL.</p> <p>Results</p> <p>A significant longitudinal decrease was found in body weight (trained NW: -2.5 ± 4.6 kg; OW -6.7 ± 4.5 kg; controls: NW +3.5 ± 4.0 kg and OW -3.4 ± 4.0 kg; P = 0.006 and 0.029) and in energy intake, mean BG, standard deviation of diary BG (BG as recorded by subjects' 7-day diary), BMI, and arm and leg skin-fold thickness in (OW and NW) HBG subjects. OW LBG subjects significantly decreased body weight (trained: -4.0 ± 2.4 kg; controls: -0.4 ± 3.7 kg; P = 0.037). 26 NW LBG subjects showed no longitudinal difference after training as did 9 control subjects.</p> <p>Conclusion</p> <p>Over a 5 month period the IHMP resulted in significant loss of weight in OW subjects compared to controls practicing dietary restraint. NW subjects maintained weight overall, however NW HBG subjects also lost weight compared to controls.</p

Recovery of Hunger Sensations Associated with Low Preprandial Blood Glucose: An Easy Exit from Diabetes?

Abstract Background: Obesity, diabetes, asthma, autism, birth defects, dyslexia, attention deficit-hyperactivity disorder and schizophrenia have increased in children in the last half century. These increases may depend on the widespread, well known error in energy balance: the unremitting addition of fat at any will (decision) to eat. In most (60%) but not all people, the decision arises as conditioned before energy exhaustion of the energy available from previous meals. After meal suspension for few hours (up to 48 hours), healthy subjects identified the arousal of sensations of hunger that we named Initial Hunger (IH). After this identification, subjects distinguished IH from conditioned sensations before subsequent meals by mental comparison of the current arousal with the remembered IH. BG decreased to 76.6 ± 3.7 mg/dL and hunger sensations (Initial hunger, IH) arose spontaneously and corresponded to the complete exhaustion of the previous meals. Objective: Not Insulin Dependent (NID) diabetic people differ from fattening people in this: after meal suspension, they do not develop any hunger sensation nor the associated low blood glucose (BG). Methods: Meal suspension lets IH arise and after no arousal, reduction of energy intake. The two subjects consumed meals that provided at least 20 grams of animal protein and up to one kg of not-starchy vegetable (NSV) for 6 to 12 months. At reappearance of IH, we implemented an Initial Hunger Meal Pattern (IHMP). Results: We tried to implement IHMP training in two obese (BMI of 39 and 33) adults out of two consecutive recruitments of subjects who showed high fasting BG. We found an absence of BG decline to 76.6 ± 3.7 mg/dL and an absence of any hunger sensation after eating suspension. Both subjects lost 13% -20% of their body weight and recovered 76.6 ± 3.7 mg/dL of BG and hunger sensations, i.e., went off diabetes. IHMP maintained the decreased body weight in the subsequent months. Conclusion: Diabetes develops for inveterate conditioned intake (when previous energy intake has not been fully exhausted before meals), excessive fattening (with presumed excessive post-absorption emission of fatty acids from fatty tissues), permanent loss of BG decline to 76.6 ± 3.7 mg/dL and permanent loss of physiological signals o

Advanced active pixel architectures in standard CMOS technology

This paper aims at exploring and validating the adoption of standard fabrication processes for the realization of CMOS active pixel sensors, for particle detection purposes. The goal is to implement a single-chip, complete radiation sensor system, including on a CMOS integrated circuit the sensitive devices, read-out and signal processing circuits. A prototype chip (RAPS01) based on these principles has been already fabricated, and a chip characterization has been carried out; in particular, the evaluation of the sensitivity of the sensor response on the actual operating conditions was estimated, as well as the response uniformity. Optimization and tailoring of the sensor structures for High Energy Physics applications are being evaluated in the design of the next generation chip (RAPS02). Basic features of the new chip includes digitally configurable readout and multi-mode access (i.e., either sparse of line-scan readout). © 2005 IEEE

Sustained Self-Regulation of Energy Intake: Initial Hunger Improves Insulin Sensitivity

Background. Excessive energy intake has been implicated in diabetes, hypertension, coronary artery disease, and obesity. Dietary restraint has been unsuccessful as a method for the self-regulation of eating. Recognition of initial hunger (IH) is easily learned, can be validated by associated blood glucose (BG) concentration, and may improve insulin sensitivity. Objective. To investigate whether the initial hunger meal pattern (IHMP) is associated with improved insulin sensitivity over a 5-month period. Methods. Subjects were trained to recognize and validate sensations of IH, then adjust food intake so that initial hunger was present pre-meal at each meal time (IHMP). The purpose was to provide meal-by-meal subjective feedback for self-regulation of food intake. In a randomised trial, we measured blood glucose and calculated insulin sensitivity in 89 trained adults and 31 not-trained controls, before training in the IHMP and 5 months after training. Results. In trained subjects, significant decreases were found in insulin sensitivity index, insulin and BG peaks, glycated haemoglobin, mean pre-meal BG, standard deviation of diary BG (BG as recorded by subjects' 7-day diary), energy intake, BMI, and body weight when compared to control subjects. Conclusion. The IHMP improved insulin sensitivity and other cardiovascular risk factors over a 5-month period

What is Damaging Our Tissues and Lives?

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