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My Approach
Many people eat when their digestion is compromised because they eat in the absence of hunger. RCTs have demonstrated that when taught to recognise hunger, overweight people lose weight and insulin sensitivity improves in apparently normoglycaemic people.
These and related studies are described here and have implications for the prevention and treatment of type 2 diabetes.
Moreover, clinical experience suggests improvements in inflammatory disorders including gastritis, early rheumatoid arthritis and inflammatory bowel disease, perhaps mediated by an improved microbiome following hunger-induced Phase III contractions of the Migrating Motor Complex.
To help standardise instruction both in the clinical and research setting, I have developed and tested a support programme, known as the DigestionReady Programme.
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The programme involves interactive questions emailed to the patient on a daily, weekly and monthly basis. Helpful tips are also sent by text relating to particular mealtimes. Patient feedback has been positive.
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Referrals
Referrals can be made using either SR Referrals or ERMS. On receipt of your referral I will contact the patient within 1-3 day during when we can decide whether my programme will be a good fit for him or her.
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The programme inovlves doctor patient contact (in person and in groups via telemedicine) and automated texts and interactive emails. Naturally they are referred back to their usual GP for their overall care.
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Why DigestionReady?
Not only do many people not recognise hunger, they tend to confuse the word with the desire to eat (more properly termed appetite) or with a variety of somatic symptoms including pain, tightness, heaviness or anxiety.
This leads them to eat inappropriately to their body's needs and leaves them vulnerable to illnesses of over-consumption.
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Here are how some authorities in the field have regarded the word hunger:
"The uses of the word hunger seem nearly as varied as the food used to satisfy it" - Mattes and Friedman
Hunger and appetite should be banished for the sake of linguistic peace" – Janowitz
"A babble of terms" -Grossman
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I therefore decided to drop the term altogether and refer only to what I take to be the essential characteristic of physical hunger - the readiness to digest food. In choosing readiness to digest as the essential characteristic of hunger I found I was in step with Walter Cannon for whom hunger was an exhibition in the digestive organs of readiness for prompt attack on the food swallowed by the hungry animal.
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Will my patients need to measure their BG to properly recognise hunger?
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No, although some will find it helpful. Although low blood glucose appears to be a concomitant of digestion readiness in those with a robust pancreas, its measurement is not needed in order to train a patient in hunger recognition. Subjects can be trained to recognise the subjective experience of hunger without the need of an objective marker. Of course, in type 2 diabetes the Continuous Glucose Monitor is invaluable and I make full use of it with these patients.
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Couldn't I just tell my patients to get hungry?
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Yes, and I encourage you to do that. I have found over the years though that many patients do require training in hunger recognition. Moreover even when trained, it is one thing for a patient to know intellectually what to do, it is quite another to integrate that knowledge into their daily lives. Most patients require a good deal of ongoing support. It is to provide that training and support that I have created the programme.
You can refer patients to me using either SR Referrals or ERMS. Just search on my name and refer in the usual way.
David Lovell-Smith