title: 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.
abstract: BACKGROUND
  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. 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.
  
  
  METHODS
  Twenty-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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Ingestion 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.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT01469104.
authors.affiliation: Section of Endocrinology, Metabolism & Nutrition, and the Metabolic Research Laboratory (111G), Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN 55417 USA ; Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, 516 Delaware Street, SE, MMC 101, Minneapolis, MN 55455 USA.
authors.forename: Frank Quentin
authors.initials: FQ
authors.lastname: Nuttall
authors.affiliation: Section of Endocrinology, Metabolism & Nutrition, and the Metabolic Research Laboratory (111G), Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN 55417 USA ; Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, 516 Delaware Street, SE, MMC 101, Minneapolis, MN 55455 USA ; Present address: Park Nicollet Health Care System, Minneapolis, MN USA.
authors.forename: Rami Mahmoud
authors.initials: RM
authors.lastname: Almokayyad
authors.affiliation: Section of Endocrinology, Metabolism & Nutrition, and the Metabolic Research Laboratory (111G), Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN 55417 USA ; Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, 516 Delaware Street, SE, MMC 101, Minneapolis, MN 55455 USA ; Department of Food Science & Nutrition, University of Minnesota, 1334 Eckles Avenue, St Paul, MN 55108 USA.
authors.forename: Mary Carol
authors.initials: MC
authors.lastname: Gannon
keywords: 24-hour profile; Carbohydrate-free diet; Dietary carbohydrates; Dietary fats; Ghrelin; Leptin; Type 2 diabetes