What causes increased appetite?

Appetite is controlled by a complex neuroregulatory system.  There are many factors affecting this mechanism to include the composition of your diet, side effect of medications, chronic stress, hormonal imbalances, and even the types of bacteria that live in your gut. 

Cravings result from a combination of social, cultural, psychological, physiological and genetic factors and can be a major obstacle to weight loss and optimizing one's health. As a functional medicine physician, it is important to examine all underlying factors which may contribute to overweight or obesity.

What can I do to improve this?

If you feel that cravings and increased appetite are interfering with your health goals, try addressing the following list of possible factors.

Could my current meds be making me hungrier?

Many drugs have side effects of increased appetite.  It is important to discuss possible alternatives with your doctor or practitioner.

• Drugs for diabetes, such as insulin, thiazolidinediones, and sulfonylureas
• Antipsychotic drugs such as haloperidol, clozapine, and lithium
• Antidepressant drugs like amitriptyline, paroxetine, and sertraline
• Drugs for epilepsy like valproate and carbamazepine
• Steroid hormone drugs like prednisone or birth control pills
• Blood pressure-reducing drugs like beta-blockers

Are sleep and weight connected?

Hormones that regulate appetite and metabolism are profoundly influenced by sleep duration. One such hormone called leptin is released by fat cells and is involved in maintenance of energy homeostasis and body weight.  The level of this hormone is markedly dependent on sleep duration.  Ghrelin hormone stimulates appetite and can be increased when there is not enough sleep.

• Adults should aim for 7.5 to 8 hours of uninterrupted sleep.
• Practice good sleep hygiene
• Consider melatonin before bedtime

Am I actually thirsty?

It is possible that when you have cravings for foods you are actually in need of hydration.

• When the cravings begin, drink a glass of lemon infused water, or herbal tea.
• Try using water tracking mobile apps to keep your intake to about ½ your body’s weight in ounces (ex. 200 pound person should drink 100 ounces of fluids daily).

Am I stressed or bored?

Food, especially high calorie dense foods, can serve as a reward for a tough day on the job or as a way to handle stresses at home with the kids.  Sometimes food is eaten just because it is there even in the absence of hunger. It’s important to have a healthy relationship with food and understand that its purpose is to nourish our bodies. 

• Before you eat that next piece of candy on your co-workers desk or settle in with those chips when the kids are finally asleep - STOP, BREATH and then ask yourself “Why am I about to eat this?”

As kids, many adults were bribed with a “sweet treat” in exchange for good behavior.  This mindset continues into adulthood and can lead to mindless eating and eating for reasons other than true hunger.

• Write down a list of 10 non food rewards (ex: swiping through your cell phone photos of family and friends, getting a massage or facial, watching a movie, taking a nap or planning your next vacation). When you feel the need to treat yourself with food, pull out your list and try one of them instead.

If you do end up eating those evening chips despite your best effort, don’t look at it as cheating or letting yourself down.  It’s called living.  The goal is to be as resilient as possible and get back on track.

Managing your overall stress can play a big role in addressing your daily food cravings.  Stress can cause the release of more cortisol –a hormone that can increase our appetite especially for carbohydrates.

Stress management is a multi-factorial process that can be approached on many levels.

• Laughter (turn on iTunes comedy or treat yourself to a real live show)
• Meditation (try Headspace or Insight Timer apps)
• Heart Rate Variability Apps
• Hormonal balancing (see below)
• Supplements like adrenal adaptogens (Ashwagandha, rhodiola, cordyceps), and CBD oil.
• Consuming adequate nutrients (see diet below)
• Try NOT to multitask (it can stress out our brains and release more cortisol) 

Am I lacking in certain nutrients?

The standard American diet (SAD) lacks many of the high quality nutrients necessary to regulate your appetite. As an example, proteins are made up of amino acids which are used to make several hormones. One such neurotransmitter, called Serotonin, plays a significant role in symptoms of anxiety and insomnia and insufficient levels can contribute to food cravings.

Boosting your protein intake also stabilizes the effects of blood sugars throughout the day.  Steady levels of fuel to the cells can prevent post meal crashes and cravings.

• Focus on high quality animal or plant based proteins for each meal
• Consider supplementing with high quality protein powders if your diet is lacking
• Consider supplements to increase serotonin levels in the brain

Fats can also make you feel more satiated and should be consumed with each meal.  Remember, fat (from the diet) does not make you fat - SUGAR is the culprit!

Focus on getting in healthy fats from nuts, seeds, avocado, extra virgin olive oils and high quality animal proteins. 

• Add coconut or MCT (medium chain triglyceride) oil with your AM coffee. Add cinnamon for added flavor and even more appetite control.
• If you tend to have high early morning blood sugars, you may want to add an evening fat source so that your body has something to burn while you sleep.

Don’t forget to also get in low glycemic load carbohydrates, especially complex carbs from fruits and vegetables.

Micronutrients are needed to support the process of ATP or energy production in the body’s cells.  Carbohydrates and fats are the substrates used for this process.  Some people, however, lack the ability to interchange these fuel sources efficiently and when in a fasting state (in between meals) the body can’t burn fat.  This results in cravings for carbohydrates to support energy production.

Intermittent fasting can train your body to become more metabolically flexible and go without food between meals as the body burns fat as its fuel source. Intermittent fasting can also increase autophagy which allows the body to remove damaged cells (cancer and others causing inflammation). 

• Try and skip breakfast and eat your first meal towards lunch time. Notice how it affects your appetite, weight, mood, productivity, gut function, and other factors. Make sure to hydrate during this time and first talk with your health care provider if you have underlying medical conditions or take certain medications.
• Aim for a 14-16 hour fast with the last meal of the day around 7pm.

If you are not sure what nutrients your body may be lacking, your doctor can order advanced nutritional lab testing so that you can begin to personalize your diet and replace what is missing.

What’s wrong with my artificial sweeteners?

Artificial sweeteners (ex: aspartame, sucralose, saccharin) are chemicals used by the food industry to replace sugar and thereby lower calories in your food and beverages.  Unfortunately, these sweeteners confuse the brain into thinking that something sweet should have calories attached to it.  Trying to correct this balance leads to increased hunger to compensate for the lack of calories.  Artificial sweeteners have also been associated with insomnia and lowering metabolism.

• Try and keep your diet low in simple sugars and eat whole foods and low glycemic load carbohydrates. If you must use a sweetener, chose stevia. 
• Alternative ways to sweeten your food: honey, maple syrup, coconut sugar, and molasses

Am I eating too often and too fast?

If you find yourself snacking throughout the day, it might be due to the consumption of higher simple sugars in your diet.  When you eat these types of food, your insulin (hormone that regulates blood glucose) goes up as it should in order to move the sugar out of the bloodstream into the cell where it serves as a fuel source.  Depending on your current health condition and the type of food consumed, the high insulin released may result in a lower than normal drop in your blood glucose levels.  The body responds by wanting more sugar to balance this effect - hence the cravings that you experience.

• Focus on balancing your meals with protein + fat + complex carbohydrates
• Talk with your health care provider about ruling out insulin resistance syndrome, prediabetes or diabetes
• Consider Berberine for blood glucose regulation

It is also important to digest your food well to release the necessary nutrients into the cells.  Rest and digest occurs when we are in a parasympathetic state. 

• Take a few deep breaths before beginning each meal.
• Chew your food and slow down your eating. Aim to chew until the food is the consistency of a smoothie.        

Are my hormones to blame for my weight?

Hormones in the body help to regulate its function:  from complex systems like reproduction, to basic needs like hunger.  Imbalances in hormones can stimulate appetite.  Correcting this may require targeted supplements, and specific dietary and activity recommendations.  For instance, as men age, testosterone levels decline which can adversely affect lean body mass.  In many cases this can be corrected without using hormonal replacement.  

People who over train their bodies can sometimes cause dysregulation of the HPA (hypothalamic pituitary adrenal) axis.  This affects cortisol and can lead to increased cravings.  Treatment for this would include substitution of more “down” exercises (yoga, Pilate, tai chi).

• Talk with your health care provider and make sure you have checked the following hormones:
  • Thyroid
  • Adrenal (cortisol)
  • Male and Female Sex hormones
  • Leptin

Am I getting enough sunlight?

Humans make several important peptide and hormone “photoproducts” when our skin is exposed to UVB wavelength of sunlight.  Melanocyte-Stimulating Hormone (MSH) can help reduce appetite, increases libido, and is also responsible for increased skin pigmentation.

• During your day, try and get out in the sun. It can also improve mood and lower stress.
• Find a patch of clean grass, take your shoes off and walk around (remember the movie, Pretty Women)
• Consider infrared sauna or infrared light treatments if sunlight exposure is limited. Infrared sauna has other anti-inflammatory, energy producing properties as well.

What does my gut have to do with my weight?

The gut-brain axis is a term used to describe the interrelationship of the brain (central nervous system) and the intestines (enteric nervous system).  The vagus nerve is the longest nerve cell in the autonomic (unconsciously controlled) nervous system and acts as an expressway connecting the two.

Our microbiome (ecosystem in our gut) plays a significant role in our overall health to include its effect on our appetite and metabolism. These good bacteria require certain types of foods called prebiotics in order to exert their beneficial effects on our bodies.  As an example, resistant starches such as green (unripe) bananas and plantains help feed the microbiome.  The microbiome in turn mediates factors to decrease appetite by decreasing blood insulin spikes after meals and potentially affecting our mood which can subsequently alter eating behavior.   Having a diverse microbiome tends to be associated with better overall health and can be achieved with a nutrient-dense diet that includes these types of prebiotic foods. 

Stool testing can be ordered to further define your microbiome and identify ways to optimize the functions of your gastrointestinal tract.

• Try eating fermentable fibers like garlic, onions, and sweet potatoes
• Supplement with resistant starches
• Add probiotics

Satiety can also be achieved by delaying gastric emptying which can in turn influence appetite hormone levels.  Fibers and starches can help with this process and slow the emptying of the stomach contents.

• Consider adding fenugreek or glucomannan

Can I use Medications for appetite control?

Finally, if you have addressed all of these concerns and are still having problems controlling your appetite, there are prescription medications that can be added to your treatment plan.  They mostly work to control appetite via the central nervous system (brain).  The choice of medication will depend on several factors to include: current health conditions, tolerance of side effects, preferences for route of administration, cost and overall response to the medication itself.

Dr. Denia Tapscott, M.D., is board certified in internal medicine and provides personalized treatment with a functional medicine approach to get to the root cause of health issues and begin the journey towards wellness. Her areas of interest include: Functional Medicine, Adult Holistic Primary Care, Obesity Medicine and Weight Loss, Cardiovascular Disease, Diabetes Prevention & Metabolic Syndrome, Executive "functional" physicals, Chronic Disease Management, Pre and Post Bariatric Surgery Care  and Diet and Lifestyle focused care.