Traditionally, researchers have distinguished two hunger-related states in the person of normal weight. The first is essentially what the layperson would regard as hunger, the state in which we desire to eat. This desire to eat initiates the eating response, meaning we reach for food to relieve the hungry sensation.

The second state is characterized by the satisfied feeling that follows eating. Satiety signals that the time has come to stop eating, that the desire for food that initiated the eating episode has been appeased.

Those two hunger-related states have been identified as typical of people of normal weight. However, we are finding the sequence is more complicated, especially in the carbohydrate addict.

At the Carbohydrate Addict’s Center and at the Mount Sinai Medical Center, our research has identified four hunger states.

They are as follows:

Generalized or Common Hunger

This is the strong urge to eat food of any kind. Though intense, this hunger passes in time and later reappears. “Normal” hunger belongs in this classification.

Most carbohydrate addicts report that they have the least difficulty controlling their eating responses to this hunger state.

Specific Hunger or Craving

Craving is the strong desire to eat a specific food (or food group). A craving is not likely to disappear for good and often increases in intensity. Although normals as well as carbohydrate-addicted people experience cravings, this hunger state recurs more often and more intensely in the carbohydrate addict. Craving may escalate in intensity and frequency to a point of addiction.

Discomfort or Dissatisfaction Hunger

This may be thought of as the “nibble-need.” It is a less intense sensation than craving, but is nonetheless a persistent desire to snack. There is often a vague accompanying sense of discomfort; there may also be an accompanying belief that just the right food will “hit the spot,” relieving the sense of dissatisfaction, but the “right food” is illusive.

Rarely is there any awareness of which food or food group will be satisfying. The eater in a state of dissatisfaction will often go from food to food in search of satiety. The classic image for this hunger state is the person standing in front of an open refrigerator, just looking for something to eat. In the carbohydrate addict, this hunger state may typically appear more often, though not necessarily more intensely, than in the normal person.

Subconscious Hunger

This hunger often does not enter one’s awareness before the impulse to eat takes over. Subconscious hunger is characterized by a strong and often uncontrollable desire to eat; it results in the consumption of food without plan or anticipation.

Carbohydrate addicts often describe what we call an impulse-eating incident as occurring with only little awareness of loss of control or of psychological conflict on their parts. Normal eaters and lower-level carbohydrate addicts attribute the impulse-eating incidents to habit, though occasionally they admit that they are unable to stop even when they want to. During impulse eating, food is often consumed quickly with little chewing.

Just as some basic researchers are beginning to explain some of the biological and chemical underpinnings of carbohydrate addiction, the clinical research that we and others are conducting is helping us to understand more about the behavioral-biological links of this disorder.

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Stand upright, as erect as you can without any feeling of awkwardness or strain, then swing the

Here there may be a temporary difficulty, because the very movements which can be so effective arms slowly forward and upward until they are level with the shoulders. At the same time, breathe in and draw the tummy upward into the chest. Reverse, breathing out steadily and allowing the abdomen to relax. This movement produces a powerful activation of the ribs, which can in turn improve markedly the composition of the blood.

As a more advanced exercise, extend the same movements so that the arms are carried right above the head, and rise on the toes towards the end of the swing so that everything is raised as high as possible — hands, arms, head, shoulders, chest and abdomen. Repeat until comfortably tired.

Most heart conditions can be improved by intelligently and progressively applied arm and shoulder excesses. These have the double effect of opening out the chest, so that there is more space within for heart and lungs to function, and of inducing a much more active circulation through the ribs. We usually find that after a prolonged spell of depression — physical, nervous or emotional — the whole rib-cage has sagged, giving a flattened and cramped chest. This is the typical attitude of a long-standing heart patient, and there can be a gratifyingly rapid sensation of relief once the more active and open chest has begun to develop.

Here there may be a temporary difficulty, because the very movements which can be so effective  in mobilizing the chest can also cause quite acute distress when first attempted. In this case, patience and perseverance are required. Start with the arms bent, finger-tips on the shoulders, and raise the elbows in time with inspiration for a few repetitions. Gradually increase the number o movements in each session, then try a few with the arms extended. In time the full range of movement, with quite vigorous action, should become possible. In occasional cases, it may be necessary to seek skilled assistance to loosen over-tense neck and shoulder muscles before these exercises can be effectively carried out.

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In 1977 tamoxifen was approved by the Food and Drug Administration (FDA) for use in the treatment of breast cancer, initially only in postmenopausal women with metastatic breast cancer. Of this population approximately one-third responded to tamoxifen treatment. When used in addition to chemotherapy for patients with metastatic disease, a higher response rate, a longer time to treatment failure, and improved survival were reported. In postmenopausal patients tamoxifen appeared to be effective at virtually all stages of disease, with its major contribution in patients who had exhausted most other forms of hormonal therapy.

SHOULD CHEMOTHERAPY BE GIVEN AT THE SAME TIME AS TAMOXIFEN?

Since most tumors are a mixture of estrogen-receptor-positive and estrogen-receptor-negative cells, and tamoxifen specifically inhibits cells with estrogen receptors, combination therapy using both cytotoxic drugs and tamoxifen has been suggested to prevent the recurrence of the estrogen-receptor-negative cells. Clinical trials examining the simultaneous use of chemotherapy and tamoxifen suggest that the drugs probably should not be given at the same time. Although higher response rates were achieved in some studies when the drugs were given together, most analyses have shown that the overall survival of patients is not prolonged by simultaneous administration.

WHAT ABOUT SEQUENTIAL CHEMOTHERAPY AND TAMOXIFEN?

The administration of cytotoxic chemotherapy followed by tamoxifen has been examined in several programs. Sequential administration appears to avoid the problems noted when the drugs are administered simultaneously. Patients treated sequentially seem to have fewer residual side effects from chemotherapy during tamoxifen treatment, which may ultimately improve their quality of life. Sequential use has also been demonstrated to be very effective in the treatment of metastatic breast cancer. In advanced disease the sequential addition of tamoxifen to chemotherapy results in some patients having a higher response rate, a longer time until treatment failure, and improved overall survival.

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