Abdulla A. Damluji, MD, PhD
Abdulla A. Damluji, MD, PhD

@DrDamluji

21 Tweets 2 reads Feb 07, 2025
The Physiology of Hunger: @NEJM
🥸 So this is not in CV medicine, but:
(1) it is interesting and (2) it has implications for CV
😱 Good job @NEJM - Summary
👇👇👇 x.com
🥸 1️⃣ Hunger is an ancient survival mechanism that evolved to keep humans alive in times of food scarcity.
🥸 2️⃣ Early humans were hunter-gatherers, who faced unpredictable food supplies. Their bodies adapted to store energy efficiently, to help with survival during famine.
🥸 3️⃣ Over millions of years, hunger regulation became deeply embedded in the brain and gut, relying on complex hormonal and neural pathways.
🥸 4️⃣ The human body recognizes two types of hunger: homeostatic hunger, which signals a true need for calories, and hedonic hunger, which is driven by pleasure rather than necessity.
😱 very interesting!
🥸 5️⃣ When the stomach is empty, it releases ghrelin, a hormone that signals your brain to seek food. This system evolved to prevent starvation.
🥸 6️⃣ Ghrelin stimulates hunger by activating pathways in the hypothalamus, the brain’s control center for energy balance.
😱At the same time, signals from the vagus nerve reinforce the drive to eat.
🥸 7️⃣ Once eating is started, the brain receives sensory input—smell, taste, and vision—which helps regulate appetite. Even seeing food can suppress hunger signals.
🥸 8️⃣ Unlike homeostatic hunger, hedonic hunger is influenced by emotions, stress, food availability, and past experiences. It makes humans crave calorie-dense, highly palatable foods even when not truly hungry.
🥸 9️⃣ The modern food environment is designed to exploit hedonic hunger, making processed, sugar-laden, and high-fat foods easily accessible and difficult to resist.
🥸 🔟 Another key player in hunger regulation is your gut microbiota—the trillions of bacteria in the digestive system that interact with your metabolism and brain.
🥸 1️⃣1️⃣ These microbes influence hunger by modulating hormones like GLP-1, PYY, and insulin, which help regulate appetite and satiety.
🥸 1️⃣2️⃣ Most recents it was have found that changes in gut bacteria can affect food cravings, energy balance, and even how much people eat. But their exact role in hunger control is still being studied.
🥸 1️⃣3️⃣ Here’s a quick breakdown of how gut microbes impact hunger:
😱Ghrelin Changes: Boosts eating drive
😱PYY & GLP-1: Suppresses appetite
😱Short-Chain FAs: Alters gut–brain signals
🥸 1️⃣4️⃣ Genetics also play a role in hunger regulation. Rare mutations in genes related to hunger signaling can lead to extreme food-seeking behavior.
🥸 1️⃣5️⃣ Prader–Willi syndrome is a genetic condition that causes relentless hunger and severe obesity due to a disruption in brain signaling.
🥸 1️⃣6️⃣ When hunger pathways malfunction, it can lead to disorders like anorexia nervosa (severe food restriction) or obesity (chronic overeating).
🥸 1️⃣7️⃣ In anorexia, ghrelin levels rise to stimulate hunger, but the brain seems to block these signals, possibly due to metabolic adaptations.
🥸 1️⃣8️⃣ The global rise in obesity is largely due to hedonic hunger overriding homeostatic hunger, especially in environments with constant food availability.
🥸 1️⃣9️⃣ GLP-1 receptor agonists, like those used for weight loss, help regulate appetite but may have unintended effects, particularly in younger individuals.
🥸 2️⃣0️⃣ Understanding the intricate balance between evolution, environment, and neurobiology may help develop better strategies to regulate hunger and prevent metabolic diseases. x.com

Loading suggestions...