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