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10/17/2016

Defining “Intestinal Starvation”: Its Relevance to the Multifactorial Model of Obesity

From an evolutionary biology perspective, humans and many other animals are thought to have developed mechanisms to cope with intermittent food shortages over long periods of evolution. Because periods of abundant food were limited, the ability to store energy in the liver, skeletal muscles, and adipose tissue was likely favored by natural selection.

From this viewpoint, obesity can be seen not merely as a consequence of overeating, but as a form of adaptive response in which the body stores energy when it perceives a risk of scarcity.

   
The concept of “intestinal starvation” adds a new perspective to the discussion of how our bodies perceive a lack of food, moving beyond the traditional focus on energy intake alone.

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Why Does the Body Perceive That It Is More Starved than in the Past?

1.The definition of intestinal starvation 

In this work, I use the term “intestinal starvation” to describe a physiological state in which all ingested food has been fully digested along the entire intestinal tract (*1). In this condition, the body interprets the absence of undigested material as a signal of “no food,”regardless of how much food was actually consumed.

This state should be distinguished from severe energy deficit or true food shortage. Unlike those extreme conditions, intestinal starvation may arise under ordinary living circumstances in relatively affluent societies, particularly when diets are dominated by easily digestible foods such as refined carbohydrates, fast-digesting proteins, and various ultra-processed foods (*2)

In this sense, it can be understood as a form of “modern hunger”: a perceived starvation—a signaling state—mediated by the gut–brain axis rather than by a lack of available food in the environment.

(*1) It is unclear whether intestinal starvation is sensed throughout the entire gut or only in the small intestine, which is sometimes referred to as the "second brain."

(*2) Since fats take longer to digest, consuming them every 4 to 5 hours may help prevent the onset of intestinal starvation (e.g., olive oil in the Mediterranean diet). However, during digestion, fats are emulsified into tiny droplets, and once fully digested, they leave no residual material in the gut. In individuals with strong fat-digesting capacity, especially when fats are consumed together with refined carbohydrates, this may not effectively suppress intestinal starvation (e.g., simple hamburgers, potato chips, donuts).

【Related articles】Eating Fat/Oil Can be a Deterrent to Gaining Weight

                


<Detailed explanation of “how much you eat”>

Even if you consume a large amount of food, a diet composed mostly of refined carbohydrates and other easily digestible items (including certain protein sources and small amounts of fat)—combined with long gaps between meals, such as eating only twice a day—can induce an intestinal starvation state or a condition very close to it.

When carbohydrates are consumed with water, they expand in the stomach (“balloon effect”), dilute the nutrient density of the meal (“dilution effect”), and then pass rapidly from the stomach into the intestine (“push-out effect”).

Because of these combined effects, the body may interpret all ingested food as being “fully digested,” even when a small amount of undigested material technically remains in the intestinal tract.

【Related articles】
The Dilution Effect/ Pushing Out Effect of Carbohydrates

Refined carbohydrates

(Refined carbohydrates)

Even when overall food intake is small, a diet composed mainly of easily digestible foods such as refined carbohydrates and certain protein sources (e.g., ultra-processed foods such as simple burgers or sandwiches, or instant noodles) may still trigger intestinal starvation. 

Due to recent dieting trends, many people try to keep breakfast or lunch light in an effort to lose weight, but this approach may end up being counterproductive in the long run.

In contrast, when you eat a balanced diet including fiber-rich vegetables, and minimally processed foods three times a day, some fraction of undigested material remains in the intestinal tract continuously throughout the day, making it less likely for intestinal starvation to be induced.

2. Obesity’s multifactorial roots and intestinal starvation

Recent increases in obesity are often attributed to overeating and lack of physical activity.

However, even in environments with abundant food, some people maintain a slim body without dieting, while severe obesity is also observed even among low-income populations in developed countries and in Pacific Island nations with limited resources. 

    
These observations suggest that obesity is a multifactorial condition that cannot be explained by a single factor[1,2]. Genetic factors, diet, physical activity, gut environment, and hormones all interact to influence body weight.

Obese person and slim person

(Source: Freepik)

Since human genes are unlikely to change dramatically over just a few decades, changes in lifestyle and food environments since the 1970s are thought to have played a major role in the recent global rise in obesity[3].

Strictly speaking, four factors(*1) need to overlap for intestinal starvation to be triggered, which may explain why obesity is more likely to occur at the intersection of multiple factors, including genetic, environmental, and physiological factors.

(*1) The four factors are “what you eat,” duration of hunger, digestive ability, and continuity.



(1) Genetic factors

Genetic traits related to intestinal starvation include the secretion capacity and receptor sensitivity of enzymes and hormones that regulate digestion and appetite. In particular, populations or ethnic groups with a greater ability to digest proteins and fats rapidly may be more susceptible to intestinal starvation.

These characteristics may also change as a result of acquired conditions, such as obesity or gastric reduction surgery performed for weight loss.


(2) Environmental factors

Since the 1970s, one of the most notable environmental changes, I believe, has not merely been the increase in energy-dense foods, but rather the rise in easily digestible foods resulting from industrialized food production. Examples include refined carbohydrates, certain protein sources, and ultra-processed foods.

In vegetables and grains, the less digestible parts have been removed (e.g., refined grains), and some are now mashed or strained (e.g., mashed potatoes and potage soups). Meat and fish are often minced or ground, making them easier to digest.

Ultra-processed foods

(Author: brgfx / Source: Freepik)

These foods are digested and absorbed more rapidly than traditional, minimally processed foods. As a result, the body can obtain energy more efficiently with less effort, which may also contribute to increased hunger and reduced satiety.

This trend is observed not only in developed countries but also in emerging economies, where the increased consumption of refined carbohydrates and ultra-processed foods has been linked to rising obesity rates.

【Related article】 

The Rise in Obesity is Closely Linked to the Consumption of Ultra-Processed Foods

<Lifestyle>

Intestinal starvation is related not only to what people eat but also to "how they eat."

Since the 1970s, changes in lifestyle have been accompanied by dramatic shifts in eating habits. In Japan, for example, the traditional rice-based breakfast has gradually been replaced by a Western-style breakfast consisting of toast, coffee, and fried (or boiled) eggs, etc.

    
In addition, many people now tend to eat light breakfasts and lunches, while consuming the majority of their daily calories at dinner. Such eating patterns may promote intestinal starvation,
because our intestines are about seven to eight meters long, and all ingested food may be completely digested while traveling through the intestinal tract. 


(3) Physiological factors

Intestinal starvation represents an adaptive physiological response related to intestinal processing and hormonal secretion, and may prove that people who eat a balanced diet every day are likely to be less prone to weight gain 

Although intestinal starvation may not be directly associated with the gut microbiota, the types of foods consumed have a significant impact on the intestinal environment.

Individuals who eat a wide variety of foods in a well-balanced manner are less likely to induce intestinal starvation, which may indirectly suggest a relationship that those with a healthier gut microbiota are less susceptible to obesity.

<References>

[1]Flores-Dorantes MT, Díaz-López YE, Gutiérrez-Aguilar R. Environment and Gene Association With Obesity and Their Impact on Neurodegenerative and Neurodevelopmental Diseases. Front Neurosci. 2020 Aug 28;14:863. 

[2]Khan MJ et al. Role of Gut Microbiota in the Aetiology of Obesity: Proposed Mechanisms and Review of the Literature. J Obes. 2016;2016:7353642. 

[3] Jason Fung. The Obesity Code. Greystone Books, 2016, Page 21-2.