The ghrelin and leptin responses to short-term starvation vs a carbohydrate-free diet in men with type 2 diabetes; a controlled, cross-over design study.

Frank Quentin Nuttall,Mary Carol Gannon,Rami Mahmoud Almokayyad

doi:10.1186/s12986-016-0106-x

Abstract

BackgroundWe recently have reported the 24-hour glucose, insulin and glucagon responses to a 72-hour fast compared to a 72-hour macronutrient-sufficient, carbohydrate-free diet in men with type 2 diabetes. The 72-hour time period was used because it is the time required for the major metabolic adjustments to a lack of food to be instituted. As part of that study, ghrelin and leptin responses were monitored.MethodsTwenty-four-hour total ghrelin and overnight fasting leptin concentrations were determined in males with type 2 diabetes when ingesting a standard, mixed meal diet (control), followed by a carbohydrate-free diet for 72 h or were starved for 72 h, using a crossover design.ResultsA rise in ghrelin concentration before and a decrease after meals was present when the standard diet was ingested. However, in contrast to literature reports in normal subjects, a circadian variation was not apparent. Meal related changes were absent with starvation. A carbohydrate-free diet resulted in a daylong decrease in ghrelin. It also resulted in a 19 % decrease in the overnight fasting leptin concentration. Leptin was decreased 54 % with total starvation.ConclusionIngestion of a typical mixed-meal diet results in meal-related changes in ghrelin similar to those reported in normal subjects, although the circadian rhythm was not apparent. Except for the lack of meal-related changes, starvation did not change the concentration. A carbohydrate-free, high fat diet resulted in a daylong suppression of ghrelin. The leptin concentration was decreased by both the carbohydrate-free diet and starvation.Trial registrationClinicalTrials.gov Identifier: NCT01469104.

Highlights

We recently have reported the 24-hour glucose, insulin and glucagon responses to a 72-hour fast compared to a 72-hour macronutrient-sufficient, no-carbohydrate diet in men with type 2 diabetes [1]
Ghrelin Several years ago, the 24 h circulating total ghrelin concentration was determined in normal subjects (9 females, 1 male) when typical (45 % CHO, 35 % fat, 20 % protein) mixed meals were ingested throughout the day [6]
Current literature data indicate that there remains considerable uncertainty, both in people without and with type 2 diabetes, regarding the quantitative ghrelin response to specific macronutrients and/or their combinations

Summary

Introduction

We recently have reported the 24-hour glucose, insulin and glucagon responses to a 72-hour fast compared to a 72-hour macronutrient-sufficient, carbohydrate-free diet in men with type 2 diabetes. We recently have reported the 24-hour glucose, insulin and glucagon responses to a 72-hour fast compared to a 72-hour macronutrient-sufficient, no-carbohydrate diet in men with type 2 diabetes [1]. Nuttall et al Nutrition & Metabolism (2016) 13:47 the glucose response and 72 % of the insulin response to short-term starvation could be attributed to removal of carbohydrate from the diet. As part of that study, ghrelin and leptin responses were monitored. Ghrelin and leptin are considered to be important in fuel metabolism

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