Food cravings during acute hypoglycaemia in adults with Type 1 diabetes Mark W.J. Strachan a , Fiona M.E. Ewing a , Brian M. Frier a , Alison Harper b , Ian J. Deary b, * a Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, Scotland, EH16 4SA, United Kingdom b Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, Scotland, United Kingdom Received 14 April 2003; received in revised form 13 October 2003; accepted 1 December 2003 Abstract Background: Food craving is defined as an intense desire to eat a specific foodstuff. It may be distinguished from the sensation of hunger, which is relieved by nonspecific foodstuffs. No controlled studies have examined the effects of hypoglycaemia on food cravings. Thus, the aim of this study was to examine change in cravings for eight specified food types during euglycaemia and insulin-induced hypoglycaemia. Methods: Thirteen adults with Type 1 diabetes attended two experimental sessions where acute hypoglycaemia was induced with either insulin aspart or human soluble insulin. Food cravings were assessed, using a questionnaire, at baseline and at the onset of the autonomic reaction to hypoglycaemia (‘‘R’’). Results: The mean arterialised blood glucose concentration at baseline was 6.0 F 0.3 mmol l À 1 and at R was 1.9 F 0.4 mmol l À 1 ( P < .01). Fifteen percent of subjects reported having a craving for food during euglycaemia. The prevalence increased to 65% during hypoglycaemia ( P < .01). Cravings for seven of the eight food types increased during hypoglycaemia, but the greatest effect sizes (>1.0 standard deviations) were observed for three food types that had a high carbohydrate content. Conclusions: In people with Type 1 diabetes, acute hypoglycaemia produces a highly reliable generalised increase in cravings for food, particularly foodstuffs with a high content of carbohydrate. The mechanisms behind this response remain to be elicited. D 2004 Elsevier Inc. All rights reserved. Keywords: Food cravings; Hypoglycaemia; Type 1 diabetes; Autonomic reaction 1. Introduction Food craving is generally defined as an intense desire to eat a specific or particular foodstuff [1]. It may be distin- guished from the sensation of hunger, which is relieved by nonspecific foodstuffs. In scientific terms, food craving is a hypothetical construct that is neither directly observable nor measurable. The assessment of food craving, therefore, tends to be based around arbitrary, self-report scales with variable definitions as to what actually constitutes ‘‘food craving.’’ As a consequence of differences in definitions, wide- spread variations exist in the reported prevalence and frequency of food cravings. A retrospective questionnaire survey of 1138 male and female Canadian college under- graduate students found that 97% of women and 68% of men experienced food cravings, and that these occurred with a modal frequency of one to four times per month [2]. By contrast, only 28% of women and 13% of men experienced food cravings in an investigation of 1044 French adults, but in this study the food cravings had to occur at least once per week to meet the inclusion criteria [3]. Gendall et al. [4] reported that 58% of 101 women had ever experienced food cravings, but only 4% had experienced strong cravings, with what might almost be described as ‘‘addictive’’ features, i.e., sensations associated with difficulty in resisting craved food, anxiety or discomfort when abstaining from eating the craved food and change in speed of consumption of the craved foodstuff. While there is little consensus on the prevalence of food craving, there is virtual unanimity that the most commonly craved foodstuff is chocolate [3–5]. Women in particular tend to crave chocolate, but chocolate craving is also common in men. Other foods that are craved frequently include crisps, pizza, biscuits and cakes [3–5]. The aetiology of food cravings is not well established. In women, food cravings tend to increase during the peri- menstrual period [6–9] and during pregnancy [10]. There also appears to be an association between mood and food cravings, with low mood and anxiety tending to promote an increase in food craving [9,11]. A biopsychosocial theory of food cravings suggests that attempts to restrict intake of 0031-9384/$ – see front matter D 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.physbeh.2003.12.003 * Corresponding author. Tel.: +44-131-650-3452; fax: +44-131-651- 1771. E-mail address: I.Deary@ed.ac.uk (I.J. Deary). Physiology & Behavior 80 (2004) 675 – 682