Re-discovering hunger

Re-discovering Hunger
Hunger and satiety manipulations as a
tool for the treatment of obesity
Fabio Piccini MD PhD
f.piccini@univpm.it
© Fabio Piccini 2012 1

Declaration of Interest
The author reports no conflict of interest with
respect to the content of this workshop

About me
• Doctor in Medicine
• Licensed Junghian
analyst (IAAP)
• Eating Disorders
specialist
• Master in Sport and
Exercise Nutrition
• PhD in Food Nutrition
and Health

What mental health professionals
need to know about obesity
In the 21st century, obesity is a health problem affecting rich and poor,
educated and uneducated, Westernized and non-Westernized societies.
The contribution of genes to obesity risk is small, while the
contribution of our toxic food and activity environment is huge

What mental health professionals
don’t know about obesity
• Although most mental health practitioners commonly treat obese individuals,
there exists no consensus on whether or how to address obesity in the patient’s
overall treatment plan
• Although the nutritional therapy of obesity is a daunting problem, it should not
be ignored by mental health professionals
• Ongoing developments in nutrition research are likely to increase the range,
efficacy, and acceptability of treatment options in the years ahead

These are the reasons why I decided
to pursue a PhD in Human Nutrition

Is obesity an eating disorder?
Many papers has argued both for
and against the possibility that
obesity may be considered to be an
eating disorder. In practice these
two lines of evidence are not
mutually exclusive. There is
without doubt a shift in the
population distribution towards
increased body weights which is
unlikely to be due to an “inter-national”
eating disorder, but is the
end-result of numerous
environmental and behavioural
changes within the population

Then, obesity is an eating disorder?!?
However, this hypothesis does
not preclude the suggestion that
there are obese or overweight
people at the top end of the
population distribution of BMI,
who have a clinically-definable
eating disorder based on
physical or psychological
criteria, such as Binge Eating
Disorder or Food Addiction

The Obesity-Eating Paradox
• There is a fundamental problem within western culture that has injured
the way people think about food, exercise, and their own bodies
• Meals are being super-sized, food items heavily processed, and
inactive forms of recreation, such as watching TV and playing video
games, have become the norm
• While the nations of plenty struggles to reduce their intake of cheap
and fatty foods, unhealthy obsessions with weight and body image
persist
• Twenty-five percent of college-aged women report using binging and
purging for weight management. Even amongst those who don’t suffer
from eating disorders, pressures to be thin complicate relationships
with food

Frustrated and fat
As obesity has become more
and more prevalent, the ideal
standard of beauty has not
changed, resulting in a growing
gap between the average person
and his (or her) ideal body
image. A contrast which has led
both genders to become very
concerned about weight and has
further fueled the rise of
obesity-eating disorder paradox

Beware of research on nutrition
Most research conducted
today on food and
nutrition is done simply
for the purpose of food
and drug marketing since
most funds for nutrition
research are tipically
donated by a food or a
drug company

Beware of research on weight-loss
While trying to dissect
current nutritional beliefs
to find track of their
evolution and to evaluate
the research behind them I
began to realize that the
research on weight loss
has become so skewed
with food politics that it
has turned to an oxymoron

Back to the beginning
Very soon in my review I understood I had only one
choice: if I was to avoid all the bias and vested influence in
today’s nutrition research then I had to go back to the
absolute beginning of research on what happens to human
beings when they are in the complete absence of foods,
thus when they fast…

What is fasting?
• Fasting is “the act of
willingly abstaining
from some or all food
for a pre-determined
period of time”
• The word willingly is
the keyword as it
defines the difference
between fasting and
starving

Fed or Fasted?
• By following this
definition a human being
can be either fed or fasted
• For the purpose of my
research, I decided to
focus on short term
fasting
• Thus I studied the
metabolic effects of
fasting between 12 and 72
hours

Benefits of studying short-term-fasting
• People with vested
interests in selling
consumable products have
no interest in fasting (you
cannot put fasting into a
pill and sell it)
• There is a large volume of
research that has been
conducted on fasting

Fasting through history
Through history
various cultures have
used (and still use)
fasting in many
different types of
rituals and
celebrations and all
major religions have a
degree of fasting built
into them

Fasting and calorie balance
• Fasting is the simplest
method our body has for
maintaining its calorie
balance (store a little
when we eat, burn a little
when we don’t)
• The problem is that we
who live in the western
countries spend as much
as twenty hours a day in a
fed state

Living in a constant fed state
• In our countries the Yin
and Yang of fed and fasted
state has been replaced by
a constant fed state
• This is a very scary
scenario when you
consider that our bodies
are designed to store fat
whenever provided with
an amount of calories
beyond its needs

If our bodies are designed to fast
why doesn’t anyone fast anymore?
• Most likeky it is because
the concept of fasting for
weight loss and health has
been villanized in western
countries as it goes against
business
• To the food and drug
industry the idea of people
eating less is bad for
business

Consider that…
• Each day in the USA the
food industry produces
enough food to supply
every single person with
almost 4000 Calories
• This is why the food and
nutrition industry is
willing to suggest many
different theories on how
to lose weight as long as it
means we continue buying
and consuming foods

Fasting in Textbooks
• Why the conventional
texbooks on human
nutrition has so little
to say about fasting?
• If you go check
current standard
nutrition textbooks
you’ll discover they
devote as little as 4-5
pages to fasting

Fasting and flawed research
We currently know that
also the results of the
Seven Countries Study in
Crete could have been
influenced by the practice
(still common) in rural
Greece people of religious
Intermittent Fasting
prescribed by the Greek
Orthodox Church

All of this raises a question…
Have we - the people and the doctors too - been
led to overlook the simplest form of reducing
calories and losing weight - short periods of
fasting - in an effort to keep us consuming?

Fasting is a new/old trick
Fasting makes sense
from an evolutionary
perspective, because
our predecessors
almost certainly went
through regular cycles
where food was either
abundant or very
scarce

IF from an evolutionary standpoint
Cycling between feast and
famine and thus
oscillations in energy
stores as well as exercise
and rest was characteristic
in the past and might have
driven the selection of
genes involved in the
regulation of metabolism

Meals in ancient Greece

Meals in ancient England

A pause for paws

Eating and Survival

Fasting reloaded
Let’s start with some
definition. Intermittent
fasting (IF) is a pattern of
eating that alternates
between periods of
fasting (usually meaning
practicing caloric
restriction or
consumption of water
only) and non-fasting.

What are the practical applications of IF?
There is strong evidence
suggesting that IF
(Intermittent Fasting) may
have beneficial effects on
the health and longevity of
animals—including
humans—that are similar
to the effects of CR
(Caloric Restriction)

IF and insulin sensitivity
During the course of human
evolution, the body may have
established protective
mechanisms to adapt to cycling
eating conditions by sensitizing
insulin receptors when it was
critical that every bit of food be
efficiently used or stored (as in
famine), or by desensitizing
them when there was a surplus,
so the body wouldn’t be overly-burdened
by grossly excessive
calorie intake

Is IF effective for weight loss?
Contrary to popular
opinion, fasting can be a
healthy way to lose
weight. It can reduce
levels of IGF-1 (which
leads to accelerated
ageing), switches on DNA
repair genes and reduces
blood pressure, cholesterol
and glucose levels

Is Intermittent Fasting healthy?
Beyond insulin sensitivity, it
appears that both, caloric
restriction and intermittent
fasting may “turn on” certain
genes that repair specific tissues
that would not otherwise be
repaired in times of surplus.
One could surmise that this
adaptation serves to allow
certain cells to live longer (as
repaired cells) during famine
since it’s energetically less
expensive to repair a cell than
to divide and create a new one

What is the reason? Hormesis
Reducing energy intake
by controlled caloric
restricion or intermitted
fasting increases lifespan
and protects various
tissues against disease, in
part, by hormesis
mechanisms that increase
cellular stress resistance.

Shifting into “repair mode”
Faced with a reduction in
calories, the body instead
of diverting resources to
grow cells, replicate and
all other growth
responses, starts to repair
itself thus starting to
- repair DNA damage
- repair cell membranes
- repair internal structures
- repair cells connections

BDNF up-regulation is also the link
between IF and Binge Eating
• We know that BDNF (brain-derived
neurotropic-factor)
plays a role in regulating eating
behavior
• An association between the
BDNF gene polimorphism and
eating disorders has been
demonstrated
• IF stimulates BDNF production
in the brain

IF can make you healthier
Effects of short-term fasting and refeeding on
transcriptional regulation of metabolic genes in
human skeletal muscle

IF and food addiction
The mesolimbic
dopaminergic system
(MDS) has been shown to
be implicated in feeding
behaviours.
Manipulation of hunger
and satiety may has been
shown to be useful in
resetting the MDS

Eat, fast and live longer

Intermittent Fasting vs. Caloric Restriction
Dietary/Caloric Restricition is
defined as partial or total
abstension from selected foods.
We've known since the 1930s
that mice put on a low-calorie,
nutrient-rich diet live far
longer. There is mounting
evidence that the same is true in
monkeys.
With intermittent fasting it
seems to be possible to get all
the benefits of Dietary/Caloric
Restriction without the pain.

Intermittent Fasting is better than
Caloric Restriction

What does IF looks like?
There are a few ways
to do IF
• Skipping meals
• Condensing eating
window
• Alternating day fasts
• Single 24 hours fast
• Mix and match any of
the above

1. Skipping meals
The simplest way
to start with
Intermittent
Fasting is
skipping one
random meal on
some days

2. Condensing eating window
Example A
Monday you eat normally and stop
at 8PM. Tuesday (your IF or
condensed eating day) you wait
and start eating your 1st meal at
noon and have your last meal at
around 6PM. Then you fast until
Wednesday morning breakfast
Example B
Saturday you eat normally all day
until about 9PM. Sunday (your IF
day) you decide to go for a bit
longer and wait till about 4PM for
your 1st meal and then you eat the
last one at about 8PM

Feeding and Fasting windows

3. Alternating day fasts
It means eating what
you want one day,
then follow a very
restricted diet (fewer
than 600 calories) the
next (it does not seem
to matter that much
what you eat on non-fast
days) and so on

Benefits of alternating day fasts

4. Twentyfour hours fast
It’s when you eat
your breakfast (or
lunch, or dinner)
then you fast for
twentyfour hours
till the same meal
of the next day

5. Advanced IF protocols
Once you understand the mechanisms behind IF
than you can also play around with mixing
protocols or alternating long and short IF windows
during the week and much more

What to eat when using IF
protocols

Intermittent Fasting and body’s signals
Intermittent Fasting (all
protocols) it’s a unique
opportunity to listen to
your body’s signals. It also
serves as a way to prove to
your conscious brain that
you can survive quite
nicely on smaller amounts
of food and that you don’t
need to make up for those
temporarily lost calories

Re-discovering hunger
Fasting allows patients
to unlearn some bad
eating habits and to
become aware of some
of the key cues that
causes them to overeat
thus learning the
difference between
limbic hunger and
somatic hunger

An ounce of prevention is worth
a pound of cure
Teaching people to
experiment, to control
and to manipulate
hunger should become
a routine preventive
health-care strategy
for all the people who
live in the Western
countries

Beware of fasting mis-information
on the Internet
The amount of anti-fasting
mis-information you can
found on the Internet is
astounding
• Fasting is dangerous
• Fasting will kill your
metabolism
• Fasting deprives your body of
nutrients
• Fasting deprives your body of
lean mass
• You must eat every 5 hrs

Believe it or not some stress is good

And this is true for both mice and men

Do learn to pilot hormesis
• Remember that IF is an
hormetic stress you put on the
body
• Learning to manage hormesis
takes time and patience, it’s like
driving sport cars
• Too much of a good thing can
be dangerous and lead to
unwanted effects like
nervousness, mood swings,
loss of overall energy, muscle
weakness, or lowered immune
function

If you need an example…think anorexia

Do not use Intermittent Fasting…
Without strict
supervision in case of:
• Children
• Adolescents
• Pregnant women
• People with ED
history

Why do doctors use obesity
treatments that don’t work?
Currently in Europe only a
few doctors know how to
properly implement and
manage Intermittent
Fasting protocols. This
prevent many people who
suffer from binge eating,
obesity and related
disorders from accessing
these powerful therapeutic
strategies

“Don't be afraid if things seem difficult in the beginning.
That's only the initial impression. The important thing is not
to retreat; you have to master yourself…”

Heredity is not destiny
• In case you’re wondering, the
answer is Yes, I use IF myself
• This is my nutri-genetic profile
• A bad genetics does not mean a
bad fate. The genes you carry
are like a loaded gun but it is
ultimately your environment
and your lifestyle choices that
pulls the trigger.

Thank you for your attention
If you’re interested in hosting IF training for
students or residents in your institution just drop
me an Email:
f.piccini@univpm.it

Re-discovering hunger

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