Quality Low Carb Science?

A while back I asked if anyone had any evidence that insulin blocks leptin action in the brain.  There were many responses both here and on Twitter -- thanks!! -- one of which referenced the following study:  Suppression of insulin secretion is associated with weight loss and altered macronutrient intake and preference in a subset of obese adults, PA Velasquez-Mieyer, PA Cowan, KL Arheart, CK Buffington, KA Spencer, BE Connelly, GW Cowan, and RH Lustig.  If you're the person pointed me to this, I apologize for not naming you.  Ahhhh Robert Lustig.  Haven't spent much time on him here, but as he muscles his way into the (misguided) War on Insulin, this too shall change.  

I will have much more to say about that study on the whole at some future date.  They gave some people an insulin-lowering drug (a drug that does more than just suppress secretion) and some lost "significant" weight, some lost a wee bit, and some even gained weight.  In reading the intro, I'm becoming increasingly dejected over the quality of peer review these days ... but that too will be part of the subsequent analysis of this study as a whole.

But what caught my eye was this idea of specific cravings and/or addiction to carbohydrates being essentially an accepted premise in the study.  One of the "scientific assessments" made in this study was for carbohydrate craving.

Carbohydrate craving was measured using the carbohydrate addiction scale developed by Heller and Heller.26 The questionnaire consists of 17 weighted questions with a total score of 60. Based on scores, individuals were classified as being a doubtful carbohydrate craver (score < 21), having mild carbohydrate addition (score 22–30), moderate carbohydrate addiction (score 31–44) or severe carbohydrate addiction (score >45).

Reference #26:  Heller RF, Heller RF. Are you a carbohydrate craver? The carbohydrate addict’s diet. Signet, New York, NY. 1991. 

ARE YOU KIDDING ME???   They make this scale sound like it's some sort of scientifically developed scale or diagnostic criteria, like for clinical depression or somesuch.   This is why I asked if anyone knew what the questions are, and in short order we have it!  (Thanks Aging Hippie & Frosty)

1. _____ I frequently get tired and/or hungry in the mid-afternoon. (4)

2. _____ About an hour or two after eating a full meal that includes dessert, I often want more of the dessert. (5)

3. _____ It is often harder for me to control my eating for the rest of the day if I have a breakfast, containing carbohydrates, than it would be if I had only coffee or nothing at all. (3)

4. _____ When I want to lose weight, I find it easier not to eat for most of the day than to try to eat several small diet meals.(4)

5. _____ Once I start eating sweets, starches, or snack foods, I often have a difficult time stopping. (3)

6. _____ I would rather have an ordinary meal that included dessert than a gourmet meal that did not include dessert. (3)

7. _____ After finishing a full meal, I sometimes feel as if I could go back and eat the whole meal again. (5)

8. _____ A meal of only meat and vegetables (no potato) often leaves me feeling unsatisfied. (3)

9. _____ If I’m feeling down, a snack of cake or cookies makes me feel better. (3)

10._____ If potatoes, bread, pasta, or dessert are on the table, I will  often skip eating vegetables or salad. (3)

11._____ I get a sleepy, almost “drugged” feeling after eating a large meal containing bread or pasta or potatoes and dessert, whereas I feel more energetic after a meal of only meat and salad. (4)

12._____ When I am not eating, the sight of other people eating is sometimes irritating to me. (4)

13._____ I sometimes have a hard time going to sleep without a bedtime snack. (3)

14._____ I sometimes wake in the middle of the night and can’t go back to sleep unless I eat something. (3)

15._____ Before going to dinner at a friend’s house, I will sometimes eat something in case dinner is delayed. (5)

16._____ Now and then I think I am a secret/sneak eater.  (3)

17._____ At a restaurant, I almost always eat too much bread, even before the meal is served. (2)

Carbohydrate cravings/ addiction -- specifically -- really???  Gotta love #8, here I thought meat and veggies were the bomb!  But c'mon, who at a restaurant hasn't eaten too much bread before the meal is served on occasion.  Addiction?  Craving?   Have you been to Red Lobster and eaten those biscuits?  I don't think the carbs are the addictive component there ....  This reminds me of the Leptin Questionnaires.  What's next,  Cosmo relationship quizzes?!  This is seriously used in a paper in the International Journal of Obesity &  Related Metabolic Disorders?  A survey from a diet book?   This makes me want to scream!

So, let's see, there's even weighted point scores -- in ( ) -- and this presumes we're all a bunch of carb craving addicts.  Because even if you score <21 you're only a "doubtful craver" -- there's still the possibility ya know.   But it gets better:

For the entire cohort, significant insulin suppression was achieved with simultaneous improvements in insulin sensitivity, weight loss, and body mass index (BMI). Leptin, fat mass, total caloric intake, and carbohydrate craving significantly decreased.  ...  Carbohydrate intake was markedly suppressed in HR {high responders} only, while carbohydrate-craving scores decreased in HR and LR {high and low responders}. 

For the entire cohort, the average score was 27.3 (SD 1.54) and the final average score was 19.2 (SD 1.78).    So, according to the Hellers, the entire cohort was smack dab in the middle of, at worst, mild carbohydrate addiction -- MILD.  (Soooo, remind me again how carbs make us fat if this is the case?).  Administering this drug lowered them into upper doubtful range.  This is so silly when you think about it.  I do not want to go into the possible reasons for reduced intake and all of that -- that will have to wait for the full analysis -- but let's look at what 8 points on this scale is.  It's not sometimes feeling like you could eat another meal immediately after finishing one and no longer thinking you're a sneak eater.  

Eight points on an arbitrary scale for which there's no evidence such behavior is linked to an intrinsic preference/liking/craving for carbs in particular.   Sigh.  The dumbed down science of slim??

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You might be interested in my analyses of the insulin drug suppression trials:

Hyperinsulinemia, Insulin-Suppressive Drugs & Obesity (and Lustig)
More Hyperinsulinemia, Insulin-Suppressive Drugs & Obesity (and Lustig)