•Hunger as a Symptom: Am I Really Hungry?
Hunger is a challenging sensation to define. For most people hunger is only considered to be that physical gnawing or pang felt in their stomachs. But is that hunger’s only form? Are cravings a form of hunger? How about eating more than you planned once you started? Our experiences working with thousands for patients over the course of the past 2 decades would describe those as hunger as well. After millions of years of evolution during times of extreme dietary insecurity and a scarcity of calories, physiologic mechanisms that drive eating behaviour were crucial to us being here today to write about and are varied in their sensation.
There are thousands of genes and dozens of hormones involved in the regulation of our eating behaviours. These genes and hormones, produced in different parts of our body and targeting different aspects of our physiology, influence everything from our own personal levels of classic physically felt stomach gnawing hunger, to what foods we crave, to the time it takes for us to feel full after eating, to how long we feel full for, and also of course to our metabolisms and to the emotional impact food has on us whereby for some of us, it’s impact is far more powerful.
These days one of the most talked about pathways involving hunger, cravings, fullness, and physiology is the glucagon like 1 polypetide pathway , which is the pathway that our current generation of anti-obesity medications mimics, where GLP1 is a hormone produced by our intestines when there is food in our stomachs and where there’s a receptor for that hormone in the appetite control centre of our brains, the hypothalamus, which when bound leads to the firing of a collection of neurons called POMC neurons which in decreases hunger, decreases cravings, and leads to a more rapid sense of fullness - all of which of course are very useful in weight management.
No doubt many people will self-identify as emotional eaters whereby when facing strong emotions - most often of depression or anxiety - they turn to food for comfort. It’s not at all surprising in that we know that food, and perhaps especially sugary food, when consumed, decreases our body’s primary stress hormone cortisol’s level and so people use food when facing emotions because it helps, if even just temporarily.
What’s interesting though is that many people who find themselves to be emotional eaters, can reduce that challenging behaviour by focusing on dietary patterns that in turn promote satiety, or by way of antiobesity medications that do that same.
It would seem that some people who struggle with emotional eating, tend to do so so when faced with a combination of the emotion along with internal physiologically driven hunger and when the latter is removed from the equation suddenly find themselves in far greater dietary control even when faced with strong emotions.
For a great many, it’s missed meals and snacks that distort and amplify hunger cues. In this day and age, missing those meals and snacks is often borne out of necessity or the busyness of our hectic lives. Giving the body more time and space to produce and circulate hunger hormones, which a person may at their outset ignore, often leads to increasing degrees of difficulty as their days progress . Meaning allowing the body the time to produce more and more hunger hormones leads to increasing difficulty as the day goes by which is why for many, their most challenging eating times of the day tend to start in the later afternoon and proceed on through evening.
The types of foods that we eat also influence hunger and fullness. Part of this may be consequent to the different effects macronutrients have on fullness (whereby proteins and fats tend to be more filling than carbohydrates), and perhaps too to the degree of processing of the food (though this may just be a reflection of macronutrients). And though meal skipping is now referred to by some as time restricted feeding or intermittent fasting, missed meals often lead to greater challenge with both portions and choices as our bodies don’t crave green leafy salads when we’re hungry.
It’s possible too that exercise has a role to play in hunger with some studies suggesting exercising can help to reduce hunger. The challenge with that is simply that “exercise” is a very broad term and certainly can itself increase hunger depending on duration and intensity.
Sleep may play a role as well, perhaps most especially for those who have untreated sleep apnea in that untreated sleep apnea will lead people to have increased hunger and also increased cortisol levels which in turn might as noted earlier have a role to play in emotional eating.
No doubt you will find many people suggesting different approaches to trying to overcome or outsmart hunger. You’ll hear about mindful eating which involves paying greater attention to the experience of eating, including the taste, texture, and sensations of each bite, while trying to connect with your body's hunger and fullness cues and certainly there’s nothing wrong with that and it may well enhance the enjoyment of your food. Other people suggest the adoption of efforts at distraction or challenging whether or not you’re really hungry by creating a system of alternative behaviours to try to adopt when hungry (have a shower, go for a walk, clean a drawer, etc) - and again nothing wrong with getting more steps in your day or doing a bit of extra cleaning.. But if you’re a person who struggles with dietary restraint despite your own desire to be in greater dietary control, it might be worth a try at preventing hunger. Take some time, ideally with a means to track your hunger and craving levels, to try on different patterns of eating to see if you can cultivate one that sees you not ever getting hungry or fighting cravings. For some this may be the addition of purposeful meals and snacks which would have been otherwise skipped. For others it might involve changes around sports nutrition. Having a journal to detail your experiments can be helpful. Know that though there is no one right pattern, what appears over and over again in studies is that the inclusion of protein with the meals and snacks you’re consuming is important to fullness.
Try becoming a hunger detective. Using some means of tracking, whether an electronic food diary or a simple notepad, keeping track of the times of day that you’re hungry, cravings, or feeling like your choices are beyond your control, along with the timing and ingredients of your meals and snacks can help you lay out the data you need to see what changes help. Play with the frequency and number of your meals and snacks (you can try consuming smaller more frequent amounts, or larger less frequent amounts), play with the types of foods you’re eating and the distribution of protein carbs and fats. By keeping track of how you respond to different patterns you can find the pattern that works best for you.
Despite the popular zeitgeist, there is no evidence that fasting can “reset” a person’s hunger cues. Fasting has not been shown to have any broad advantages over other forms of dieting for weight management and while it absolutely works wonderfully for some, for those who find hunger a challenge to manage, especially later in the day, fasting runs the risk of amplifying that challenge. The easiest way to determine if fasting is a beneficial strategy for yourself is to try it, which is true for any dietary strategy. But if you’re planning on fasting for long periods of time it may be wise to chat with your primary care provider in case they have any concerns about the impact of fasting on your medical conditions.
Once you’ve found a pattern that works best, you can then build in electronic help. Reminders, alarms, and grocery lists all can serve a role in ensuring the cultivation of your anti-hunger plan. Remember that it takes time, often months if not years, to truly establish new patterns of behaviour. Build a system to continually remind you of the new behaviours you're trying to cultivate and you’ll be far less likely to drift back into older established, comfortable, but hungrier, patterns.
Bottom line is that hunger isn’t our friend when it comes to dietary choices and control. Go to the supermarket hungry and you’ll see what I mean. Hunger’s power over us is the reason we’re here today as a species and while for most of us it’s a huge challenge if not impossible to face off hunger regularly and win. But for most of us, hunger is avoidable. Whether by way of dietary modifications in terms of timing of meals and snacks as well as by way of changing their macronutrient distribution, or with the help of medication, or both, hunger is no longer unbeatable.
The best way to fix hunger cues is to prevent them. Using a food diary to track them while making changes to dietary patterns and choices is a great way to personalize hunger prevention
Fasting doesn’t reset hunger cues, though some people may do well with infrequent large portions as a means of weight management. That said, if you are someone who struggles greatly with nighttime hunger and cravings, and you’d like to try fasting, pay close attention to whether or not doing so leads to increased challenge or struggle or the perception of suffering.
Ideally you should never be pushed around by hunger. Hunger may well be the world’s best condiment but once hungry your body will be making choices for you.
Anytime you’re making choices (either food types or quantities) that fly in the face of your health goals and it’s not a conscious choice (for instance on your birthday, or traveling, or some other celebration) consider the possibility that it’s just your body doing its best to ensure you eat, and even if you don’t feel classing gnawing in the pit of your stomach sensations, that doesn’t mean it’s not hunger.