There are 5 types of hunger that ideally should be taught to all patients with obesity
Without cultivating an awareness of appetite, hunger and cravings, a patient with obesity will not know what they are fighting against
So Letâs start!
Without cultivating an awareness of appetite, hunger and cravings, a patient with obesity will not know what they are fighting against
So Letâs start!
We are going to start with some easy onesâŠ
The Cephalic phase response aka food cues - this is hunger stimulated when in presence of food.
These signals are deeply ingrained and can be conditioned
Think of Pavlov & commercials - these arenât going away quickly or ever
The Cephalic phase response aka food cues - this is hunger stimulated when in presence of food.
These signals are deeply ingrained and can be conditioned
Think of Pavlov & commercials - these arenât going away quickly or ever
Second up is appetite triggered by Social cues to eat
our social lives, whether they are business meetings, family dinners or birthdays
Unless you are going monk mode - this cue to eat is also not going away & requires attention to manage
our social lives, whether they are business meetings, family dinners or birthdays
Unless you are going monk mode - this cue to eat is also not going away & requires attention to manage
Third up is the fat+carb combination. The brain rewards carb+fat combinations. It does rewards added fats alone like putting oil on a salad or like adding butter & sour cream to a baked potato.
But our reward systems are truly paired to carbs alone or carb+fat combinations
But our reward systems are truly paired to carbs alone or carb+fat combinations
For example, youâll eat plain pasta. You wonât eat a bowl of melted cheese but youâll LOVE Mac and cheese.
Youâll eat baked potato, you wonât drink oil, but youâll love chips or fries
Brains reward:
Carbs & fat > carbs alone > fat alone
Youâll eat baked potato, you wonât drink oil, but youâll love chips or fries
Brains reward:
Carbs & fat > carbs alone > fat alone
Fourth up is hunger induced by glycemia changesâŠ
Have you ever eaten pizza and 2-3 hours later find yourself eating cold pizza and it tastes better? Maybe the same with Chinese food?
This is likely post-prandial glycemic dipping ⊠follow me on this one.
Have you ever eaten pizza and 2-3 hours later find yourself eating cold pizza and it tastes better? Maybe the same with Chinese food?
This is likely post-prandial glycemic dipping ⊠follow me on this one.
We know that even 20mg/dL downshift in blood sugar can stimulate the reward centers of the brain.
Think of a diabetic patient that just dosed too much insulin & their blood sugar goes low⊠what do they say?
Think of a diabetic patient that just dosed too much insulin & their blood sugar goes low⊠what do they say?
They say âgive me chocolate, ice cream, cookies, candy or soda⊠â
what drives this? Likely those reward centers are getting stimulated⊠Iâve never heard a hypoglycemic patient ask for diet vegan broccoli đ
what drives this? Likely those reward centers are getting stimulated⊠Iâve never heard a hypoglycemic patient ask for diet vegan broccoli đ
When that post-prandial glycemic downshifts occur the brain reward centers are activated, the brain is saying âget me awesomeâ
Thatâs why cold pizza tastes better 3 hours later even though you just ate and feel gross!
Thatâs why cold pizza tastes better 3 hours later even though you just ate and feel gross!
You could have had an anvil in your stomach but if your brain sees lowering sugar in the setting of high insulin, the brain is getting activated to get awesome food. These downshifts in sugar have been shown to lead to increased intake & hunger
This is also possibly why gastric bypass pts gain weight âŠthe brain signals donât care much about your stomach surgery đ€
Nonetheless, we know from @davidludwigmd by keeping carbs low you decrease hunger & increase âmetabolismâ by 200-300kcal/day
Nonetheless, we know from @davidludwigmd by keeping carbs low you decrease hunger & increase âmetabolismâ by 200-300kcal/day
5th is one of the most important - stress-induced hyperphagia
We have seen stress lead to massive changes in blood sugar on CGM without food intakeâŠ
We have also seen that stress is one of the leading causes of weight regain in our practice
Coincidence? Possibly
We have seen stress lead to massive changes in blood sugar on CGM without food intakeâŠ
We have also seen that stress is one of the leading causes of weight regain in our practice
Coincidence? Possibly
Stress causes a number of physiologic changes, heart rate, blood pressure, blood sugar, blood flow changes in the brain. Itâs not typically during acute stress that humans seek to eat more. Itâs after
After a tough dayâŠ
âI put the kids to sleepâ
âI was watching TVâ
After a tough dayâŠ
âI put the kids to sleepâ
âI was watching TVâ
When patients are in that subacute stress phase, their blood sugars are coming down, but pragmatically speaking stress is a comfort deficiency
Patients needs to be educated on the fact that stress is literally a willpower deficiency through involuntary blood flow & hormonal changes and if they donât have defenses in place to defend their lifestyle, they will likely regress to whatâs easy and available
And what is easy and available is the obesogenic food environment & thus weight gain
@KevinH_PhD showed that processed foods lead to eating 600kcal more per day versus unprocessed.
@KevinH_PhD showed that processed foods lead to eating 600kcal more per day versus unprocessed.
The last type of hunger patients need to be educated on is the dessert effect aka sensory specific satiety
This explains why when grandma leaves everything on the thanksgiving table, why despite being ridiculously full people find themselves picking food they didn't eat at dinner
And why despite being full when grandma puts out dessert everyone is able to eat that amazing pie.
This is also a deeply ingrained signal and transcends any diet. Variety and different food taste/texture profiles will make you eat more whether you are vegan or Keto
This is also a deeply ingrained signal and transcends any diet. Variety and different food taste/texture profiles will make you eat more whether you are vegan or Keto
Okay. Thatâs all for today. I hope you found this helpful!
I realize that when many see this graph below they become paralyzed because it says a lot, yet doesnât say much at allâŠ
Like Einstein said, if you canât explain it to a 6 year oldâŠ
You know the rest
I realize that when many see this graph below they become paralyzed because it says a lot, yet doesnât say much at allâŠ
Like Einstein said, if you canât explain it to a 6 year oldâŠ
You know the rest
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