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Continuing professional development
David Lovell-Smith PhD, MBChB
Christchurch
New Zealand
Publications
Weight loss
Ciampolini et al. Nutrition & Metabolism 2010, 7:4
http://www.nutritionandmetabolism.com/content/7/1/4
Sustained self-regulation of energy intake.
Loss of weight in overweight subjects.
Maintenance of weight in normal-weight subjects
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Mario Ciampolini, David Lovell-Smith, Massimiliano Sifone
Abstract: 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 premeal
(IHMP) improved insulin sensitivity, HbA1c and other cardiovascular risk factors. Here we report the effect
upon weight in overweight and normal weight subjects.
Objective: To investigate whether the IHMP is associated with sustained loss of weight in overweight subjects
over a 5 month period.
Methods: 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.
Results: 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.
Conclusion: 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.
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Insulin Sensitivity
Journal of Nutrition and Metabolism, 2010, Article ID 286952,
doi:10.1155/2010/286952
Sustained Self-Regulation of Energy Intake: Initial Hunger Improves Insulin Sensitivity
Mario Ciampolini, David Lovell-Smith, Riccardo Bianchi,
Boudewijn de Pont, Massimiliano Sifone, Martine vanWeeren,
Willemde Hahn, Lorenzo Borselli, and Angelo Pietrobelli
Abstract: 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.
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Review Article
International Journal of General Medicine. 2013; 6: 465–478.
Published online 2013 Jun 17. doi: 10.2147/IJGM.S40655
Hunger can be taught: Hunger Recognition regulates eating and improves energy balance
Mario Ciampolini, H David Lovell-Smith, Timothy Kenealy, and Riccardo Bianchi
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.
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Eating Pleasure
Medical Hypotheses 2010; 75: 172–178
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Eating when empty is good for your health
David Lovell-Smith, Timothy Kenealy, Stephen Buetow
Abstract: It is hypothesised that eating is regulated when eating pleasure fulfills (and thus extinguishes) the desire
to eat and that eating pleasure is maximised when eating is prompted by an Empty Hollow Sensation
(EHS). Absent, unrecognised, misinterpreted or false hunger sensations may account for non-regulated
eating in many so-called normal eaters, not only in anorexic or obese people. As a regime in which the
EHS is present before most meals, the EHS Meal Pattern (EHSMP) is suggested. Existing evidence to support
its efficacy is reviewed. Obesity, diabetes and heart disease are among a range of conditions associated
with excessive caloric intake owing to poorly regulated eating. If upheld, the EHSMP could assist
people to maintain their own well being and could help to prevent and treat some of the major scourges
of Western society.
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Helicobacter Pylori
Physiology & Behavior 2000; 70: 287–296
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Attention to metabolic hunger and its effects on Helicobacter pylori infection
Mario Ciampolini, Lorenzo Borselli, Valerio Giannellini
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A significant decrease in the bacterial count of small intestinal mucosa has been observed in children with recurrent diarrhea or abdominal pain in the time that has elapsed from the previous meal. Humans may be trained to recognize metabolic feelings of hunger that are associated with a steady and slightly lower glycemia than baseline, between 4.7 and 3.9mmol/L (intervention). An eating habit associated with a decrease in preprandial glycemia prevented diarrhea relapses, and was expected to impair intestinal microflora growth, including Helicobacter pylori in the stomach. The development of Helicobacter pylori infection might be prevented during childhood, and recovery from infection may be expected with intervention. The improvement in attention to metabolic feelings consisted of acquiring a predictive ability of glycemia by distinction between unsolicited hunger feelings (metabolic hunger) and those associated with external cues. Matching intake to the inbetween energy needs served to predict the subsequent emergence of the metabolic hunger. The matching was further compensated for the early or late emergence of metabolic hunger at the subsequent meals. Fruit and vegetables were increased to avoid abrupt glycemia lowering. This intervention was trained in 5-month periods. Subjects (209, 44, and 58) completed their training during 4-year periods between 1982 and 1994, and were enrolled in a prospective, controlled, randomized, interventional, preventive, and cohort study. The “prevention” hypothesis was tested in a subgroup of 86 healthy infants who were recalled in the years 1996 to
1998. A “recovery” study of approximately a 1-year intervention was investigated in 47 healthy subjects between ages 5 and 25, who were positive for anti- H. pyloriand had no need for an immediate antibiotic treatment at entry. The following behavioral factors were recorded in a 7-day home diary and calculated: the fraction of meals induced by metabolic hunger out of 21 main mealtimes; average preprandial glycemia (DAP glycemia); daily intakes, activity; and bedtime hours. The decrease in preprandial glycemia was the objective measure of compliance with the recognition of “metabolic” hunger. Anthropometric measures and blood tests were obtained for nutritional and functional verifications. Average preprandial glycemia was 8.5 and 8.6% lower in the intervention groups than the control groups in the “prevention” and “recovery” studies, respectively, at the end of follow-up ( p < 0.05 and < 0.001, respectively). A 4.7% seroprevalence of H. pylori infection was observed in the intervention group, with 30.2% in the control group at a mean age of 10 years after approximately an 8-year follow-up in the “prevention” study (p < 0.0005). The seroprevalence decreased to 9 of 24 (37.5%) under intervention as opposed to 20 of 23 controls (87%) in the recovery study (p < 0.002). A significant positive correlation was found between DAP glycemia and the anti- H. pylori serum antibody concentration (r = 0.52; P = 0.0002). A decrease in the level of immune stimulation by H. pylori infection
was observed due to the intervention, which may have a preventive and therapeutic role on the infection.
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Blood Glucose Premeal
Nutrition & Metabolism 2006; 3: 42 doi:10.1186/1743-7075-3-42
Training to estimate blood glucose and to form associations with
initial hunger
Mario Ciampolini and Riccardo Bianchi
Abstract
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.
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