CHAPTER
16

Hunger

In This Chapter

• How your body reacts to hunger
• Learning to recognize hunger and satiety cues
• What to eat to fight stress
• The harmful effects of fad diets
• Your emotional relationship with food

Every day, your body requires food in order to function properly. How and when you fuel your body will affect your short-term performance and longevity. Your thoughts and practices involving food can be quite strong and may have taken years to form your routines or habits. Sometimes these old habits haven’t been the best in relation to your health, and occasionally they can lead to serious health issues and eating disorders.

In this chapter, we’ll discuss how your body communicates with you about food both in positive and negative ways using hunger and satiety cues. We’ll also examine how people use food to deal with stress and emotions. You’ll also learn about fad dieting and the physical and biochemical impact on the body.

Hunger Regulation in the Body

Your body is designed to alert you when it needs food. It may try to communicate this to you by a feeling of light-headedness, a headache, nausea, an overall lack of concentration, or even stomach grumbles. Hunger is a complex process regulated through hormonal actions controlled by your brain.

The hypothalamus controls hunger and satiety in your body. The lateral hypothalamus controls hunger, and the ventromedial hypothalamus controls satiety. Research has shown that when the lateral hypothalamus is destroyed or damaged, it causes a lack of desire to eat or anorexia to occur. Conversely, when the ventromedial hypothalamus is damaged, it causes an uncontrollable urge to eat all the time. Hunger and satiety work together to provide the fuel and nutrients for your body to function properly.

The Physical Need for Food

We discussed a few of the physical symptoms associated with hunger, such as lightheadedness. However, your brain receives all sorts of neural data from your body on the status of blood sugar levels, hormones, circulating fats, and proteins that are used to control your desire to eat or not eat.

Your body needs to eat every 3 or 4 hours and especially after an all-night fast while you slept. Eating every three to four hours tells the body that there’s a regular source of nearby nutrients. When the body doesn’t get food regularly, it goes into starvation protection mode, which sets off a cascade of events and leads to weight gain.

After a refreshing night of sleep, you awake and your blood sugar levels will be toward the low end of the scale if you're healthy. A signal is then sent to your brain to report the need for energy. Your body may also be receiving a signal from your empty stomach. The epithelial cells located in your stomach release ghrelin, which is a hormone that stimulates appetite and leads to those physical hunger pangs. Ghrelin can be released in response to low blood sugar levels and high stress levels, too. Upon receiving a hunger signal from the body, most people would seek out food and eat. However, due to busy schedules we can override those helpful signals on occasion, which is not necessarily a good thing and can lead to a negative impact on your health.

As you eat, your stomach expands and the amount of ghrelin begins to decrease because the stomach is stretching and food is now present. Stretch receptors in the stomach also communicate back to the brain that food has been received and it’s now satisfied so the hunger alert can subside.

NOTABLE INSIGHT

Researches at Yale performed a study in which they served college students two identical chocolate milkshakes on two separate occasions. However, participants were told that one shake was a high-calorie “indulgent” shake and the other was a low-calorie “health” shake. Blood levels revealed that ghrelin decreased when they consumed what they believed to be the decadent shake and ghrelin levels remained constant after consumption of the healthier shake. Researchers concluded that the hormone might be able to be altered by your mind-set.

As food is digested, absorbed nutrients are distributed throughout the body and bloodstream. The hormone cholecystokinin (CCK) is released to digest fat and protein, and it informs the brain that it’s no longer hungry. The brain then senses these levels and can further inhibit hunger by increasing glucose levels.

Leptin is a hormone produced from fat cells in your body. It tells the brain that fat stores are low and you need more fat now. Once you eat and digest the fat, it gets stored away, which then causes the fat cells to secrete more leptin. The brain then recognizes the increased level of circulating leptin and tells you to stop eating. Leptin’s primary role in the body is to help prevent starving or overeating in order to keep you alive and functioning.

When there’s a problem with leptin (called leptin resistance), the body doesn’t recognize the high circulating levels of leptin. It then also slaps us with a weight gain whammy by reducing our energy expenditure, placing us in the “conserve energy” mode, and burning fewer calories while at rest.

This is one reason why diets don’t work—because as we lose body fat, the body is working behind the scenes in conservation mode to use less energy and replace the lost fat stores. Additionally, researchers believe leptin may actually compel us to eat and regain the weight that was lost. In people with leptin resistance, research has shown that it may be due to inflammation, elevated fat levels in the blood, and a high circulating level of leptin.

Stress can also instigate hunger. The body’s normal reaction to stress is the fight or flight response, where your body gets pumped full of epinephrine (adrenaline) which allows you to get out of the way of whatever frightened you. Your appetite actually shuts down and blood is directed away from the digestive tract and into your extremities. Prolonged periods of stress can also cause another stress hormone, cortisol, to be released from the adrenal glands. Cortisol causes you to seek out foods to calm you down, such as those consisting of sugar and fat. This hormone also regulates other hormones like neuropeptide Y, leptin, and corticotrophin-releasing hormone (CRH), all of which act to stimulate appetite and lead to overeating and weight gain.

Some foods can help you negate stress. Complex carbohydrates such as warm oatmeal, warm milk, turkey, walnuts, dark chocolate, oranges, spinach, and fatty fish like salmon high in omega-3s can help even out those stress hormones. The physical act of chewing on crunchy foods like carrots and celery sticks can also have a calming effect. Stress is a part of modern life. You need to find a healthy way to deal with it, whether it be a combination of stress-fighting foods or regular exercise and meditation.

The Psychology of Hunger and Emotional Eating

As we discussed previously, your hormones play a big role in your response to hunger and satiety, but many other factors contribute, such as cultural influences, the social aspect of eating itself, and what you were taught as a child.

Growing up, you may have learned that you must clean your plate in order to have dessert, or perhaps food was used as a reward for good behavior. Whatever the case, those food rules stay with you and can be very difficult to change as an adult.

Your eating habits are affected by culture. The constant barrage of media depicting underweight males and females drive the public toward unrealistic weight goals. This leads to a mentality that you must be extremely thin in order to be likable and successful in today’s society. These subliminal messages influence your eating habits and force you to make a choice of constant restriction with a feeling of “never being good enough” or overeating and a “screw it” attitude, both which lead to dysfunctional eating habits.

FOODIE FACTOID

When visiting China, you should note the host will be embarrassed if food is not left on your plate or if there are not leftovers on the table, as it’s a sign that the guests didn’t get enough to eat.

The social aspect of eating affects how and what you eat. For instance, men and women generally eat less in the presence of the opposite sex. Everyone tends to eat more or less depending on the actions of others in the group. In a study in The American Journal of Clinical Nutrition, obese children were paired with friends who were also obese. They were allowed to eat as many snack foods as they wanted. The results showed that the children consumed an additional 300 calories as opposed to when the obese children were paired with strangers.

Body image also has a huge influence on your eating habits. Your body image is your mental picture of your body, which is a completely subjective image. You can have a negative or positive body image. It’s usually influenced by the reactions of others about one’s body and self-observation. Your body image includes aspects such as weight, height, shape, how you feel in your body, and what you believe about your appearance. A person’s body image can influence several aspects of their life. For example, it can impact our mental and physical health, and how we treat ourselves. Body image can also influence how we relate to and interact with other people.

A negative body image can be described as having a distorted perception of size and shape, and it can develop from various external influences. It comprises feelings of being uncomfortable, awkward, ashamed, self-conscious, and anxious. In Western culture today, a big factor in perceiving your body image is the media. Women are idealized for their petite figures and men for their sculpted muscles. It can be hard to deal with constant reminders of your body size if idealistic bodies appear on social media, television, billboards, the internet, and in magazines. Other influences include frequent comparison to others, abuse, prejudice/discrimination, and negative comments from other people.

The most severe form of negative body image is referred to as body dysmorphic disorder (BDD). Individuals with this disorder become obsessed with their perceived flaws. BDD can adversely create problems in work, school, and relationships with friends or family. It can also cause depression, anxiety, or thoughts of suicide. Although serious, there is treatment for BDD with a combination of psychological therapy and medication.

Positive body image is a true and clear perception of your body’s shape and size. You can enjoy your body because you’re proud and appreciative, and accept your body the way it is. People with a positive body image know that bodies come in all shapes and sizes. They can determine value and character without the influence of physical appearance. Having a positive body image means your self-esteem is not affected by your weight or height. Everyone has their own assessments of their body.

Disordered Eating Patterns

Disordered eating differs from diagnosed eating disorders like anorexia nervosa because the symptoms are less frequent and less severe. The Academy of Eating Disorders defines disordered eating as “when food and eating create psychological pain and suffering.” However, it still puts a person at a greater risk of the behavior developing into a true eating disorder. When a person’s social life is adversely affected by the inability to eat with friends or family due to avoidance of certain foods or if the event conflicts with exercising, there is need for concern.

NOTABLE INSIGHT

The National Association of Anorexia Nervosa and Associated Disorders state that 1 out of 10 people diagnosed with eating disorders is male. Males tend to be overlooked by family members and health professionals, which can lead to serious health issues due to delayed treatment.

As with all dysfunctional eating, it’s simply not just about the food. There’s a deep underlying cause that must be dealt with for the person to have a healthy relationship with food. If the person is unable to move away from these disruptive patterns, it may be necessary to seek professional help.

Examples of disordered eating patterns are:

• Preoccupation with and avoidance of certain foods
• Strong sense of self-esteem attached to body image
• Chronic yo-yo dieting
• A strict and excessive exercise regimen
• Use of purging or laxatives to maintain weight
• Compulsive or emotionally driven eating

Eating Disorders

The primary types of eating disorders are anorexia nervosa, bulimia, binge-eating disorder, and disorders not otherwise specified. It’s estimated by the National Eating Disorder Association that over 10 million Americans—men and women—experience an eating disorder in their lifetime. All of these disorders involve an unhealthy relationship with food, abnormal self-body image, and low self-esteem, along with extreme control and manipulation of weight.

Eating disorders are complex and involve genetics, metabolism, and psychological and social issues. Certain eating practices can trigger or intensify an eating disorder. Skipping meals, religious fasting, cleansing types of diets, and excessive calorie counting can all be triggers in people predisposed to an eating disorder. Each will require a combination of therapies to rebuild a healthy relationship with food.

Where to Find Help

Eating disorders require a multifaceted approach, which may involve psychological and/or nutritional counseling, and prescribed medications, because it isn’t really about just the food or weight. People suffering from an eating disorder may require admission to an in-patient facility with 24-hour monitoring, depending on the severity of the disorder. Most can be treated through outpatient settings and support groups.

If you suspect someone may have an eating disorder, keep in mind that you can’t just force a new way of eating on them and make it all better. However, you can be supportive and encourage them seek help to deal with the problem.

To locate treatment centers, practitioners, and/or a support group in your area, contact the following organizations:

National Association of Anorexia Nervosa and Associated Disorders: 630-577-1330 from 9 A.M. to 5 P.M. CST Monday through Friday or email [email protected]

Overeaters anonymous: www.oa.org

NOTABLE INSIGHT

Approximately 45 million Americans go on a diet each year, with the majority being women.

Why Diets Don’t Work

With each new year there’s the birth of a new fad diet that’s been popularized by the media or a celebrity. These diets typically focus on eating or the avoidance of certain types of foods like the cabbage soup diet, the grapefruit diet, the baby food diet, and the lemonade diet. They typically suggest you can lose 5 to 10 pounds in a week and they always sound too good to be true.

Regardless of the kind of diet, you’ll lose weight on any diet when you alter your normal eating habits. The bad news is these short-term unhealthy diets can do more damage and make future weight loss even more difficult than it already is.

Most fad diets are extremely low calorie, which will negatively impact your metabolism as your body transitions into starvation mode. Additionally, it will become more efficient at utilizing calories, so your metabolism will slow down. As with any low-calorie diet, the scale will drop a couple of pounds daily, but this is typically due to water loss.

Short-term low-calorie diets typically have a diuretic affect. People believe they’re losing body fat, which keeps them motivated to remain on the diet. Keep in mind that approximately 3,500 calories equals 1 pound of body fat. As your body stays on this low-calorie plan, you can bet the diet is nutritionally inadequate in a variety of essential nutrients. This will lead to alterations in cell metabolism, and it may not be able to prevent free radical oxidization. Therefore, the diet may actually be increasing inflammation in your body, which is not a good thing.

NOTABLE INSIGHT

If quick-fix fad diets actually worked, the weight loss industry profits wouldn’t be in the billions and the majority of the population would be skinny.

Protein is metabolically active, meaning your muscles burn calories. When you’re on a very low-calorie diet, you’re not taking in those essential amino acids. You're forcing your body to digest its very own muscle tissue to use for various body processes. You have essentially further reduced your energy-burning capacity while your body is at rest by lowering your basal metabolic rate.

Additionally, following these extreme fad diets for extended periods of time can also cause:

• Cardiac stress
• A decreased sex drive
• Depression
• Fatigue
• Hair loss
• Heart palpitations
• Irritability
• Sagging skin/increased wrinkles
• Shortness of breath
• A weakened immune system

There are no magic formulas when it comes to weight loss. You didn’t gain the weight overnight; therefore you shouldn’t expect it to come off that quickly. A sensible, healthy approach to eating that includes whole foods along with regular exercise is the only long-term solution.

One reason people often gain back weight after losing it may be related to the set point theory. This theory suggests that everyone has a predetermined weight the body wants to maintain. This theory was developed from research performed in 1982. The body’s desire to maintain this “set point” is attained by increasing hunger, using fewer calories, and storing more fat. This point may be preset due to genetics, disease, stress, and dieting.

The set point is the body fat’s thermostat. The theory suggests that despite your efforts to control your weight, the body will gravitate toward its set point. Your body has a 10- to 20-pound range at any given time that it feels comfortable at and will fluctuate between. This range is set to help your body maintain optimal functionality. Your body will fight to regain weight if you fall under your set point by conserving energy in ways such as slowing down metabolism and decreasing body temperature. Conversely, if you begin to exceed your weight’s set point, your body will increase its metabolic rate and body temperature in an attempt to burn extra calories. The only thing that seems to lower the set point is regular sustained exercise over time.

Breaking Free from Old Eating Patterns

The first step in changing any type of pattern or habit is to acknowledge that it exists. Once it’s acknowledged, you can make a conscious decision to change the behavior. Next, it’s important to determine why you do what you do. Do you find that you follow a certain pattern because it’s what you learned as a child, or is there another underlying cause? Whatever the case, you need to explore your feelings associated with the behavior you want to change.

Once you’ve determined what you want to change, you need to establish small steps to make the change possible. For example, let’s say you’ve decided you would like to increase your servings of vegetables from one to five per day because it will help you lose weight by replacing higher-calorie items you are eating. It will also provide you with essential nutrients you were missing out on like phytonutrients, vitamins, minerals, and fiber. These are a few of the steps you might take toward this goal:

1. Identify one new vegetable you want to eat this week.

2. Determine where you’ll purchase it.

3. Select a mealtime in which you want to include it.

4. Decide on a recipe to prepare it.

5. Eat and enjoy your new vegetable.

6. Determine if you’d like to eat more of this vegetable and how frequently you could work it into your meals each week.

7. The following week, add an additional new vegetable and begin the inclusion steps again.

Many people may think if one vegetable is good, then more is better. It is; however, it’s much easier to incorporate small changes over time in order to developing healthier long-term eating habits. Keep in mind it takes about a month to change a habit and periods of stress can interrupt your progress and make you fall back on old routines. Don’t despair; just start again, because one day of not-so-healthy eating won’t negate a month’s worth of healthy eating habits.

NOTABLE INSIGHT

In 1925, the Lucky Strike cigarette campaign suggested one way to get slim was to grab a smoke instead of eating something sweet. Of course, back then the negative health effects of smoking were not known.

Clean Plate Club

Have you ever observed a friend or family member who will not let you remove his or her plate from the table until every scrap of food is eaten? This is what is referred to as the “clean plate club,” which is a learned habit. Ironically, this originally started as a government campaign by President Woodrow Wilson in 1917. President Wilson created the U.S. Food Administration to help ensure that food staples didn’t go to waste.

A study by Cornell University reports that the average adult eats 92 percent of everything on his or her plate. The same study also looked at meals eaten by males and females across seven different countries, and the results were the same: if it’s on the plate, it was eaten!

Be a Good Role Model

Children are ever watchful of adults and model all their behaviors after adults. The best thing you can do if you have children is to help them develop good eating habits that will last a lifetime. Studies have consistently shown that a large percentage of obese children will grow up to become obese adults.

Try to involve children in the whole process when it comes to food, from shopping to preparing and cleanup, based on age appropriateness. At the table, children should be able to chose what to eat and how much. Make sure you offer appropriate size portions based on their age. The American Pediatrics Association suggests you follow these golden rules of eating:

1. Divide responsibilities. Allow children to choose what to eat and how much to eat.

2. Teach your children to notice natural body cues for hunger and fullness. Eat when you’re hungry, and stop when you’re full.

3. Don’t make children clean their plates. There should never be any pressure associated with eating

4. Eat together as a family. Use this time to model the eating behavior you want to see in your child.

I’m Not Hungry

Going without breakfast is a learned habit that’s hard to change, but you can gradually work in a small balanced meal of protein, fat, and fiber (complex carbohydrates). Remember, your body has been fasting for 6 to 8 hours, and it needs nutrients to get going and function at its best. Try waiting an hour or two after you wake up and then have a hot beverage like coffee or tea. Select a small amount of oatmeal with dried fruit and nuts, a little bit of yogurt and granola, or even an ounce of cheese with high-fiber crackers for your morning meal. Each of these options provides fiber, protein, and a fat to fuel your body for the morning.

This meal will help you be a little more alert and think more clearly, and you also won’t be so ravenous when lunchtime comes. You’ll automatically eat less because you aren’t trying to compensate for a missed meal.

In 2013, a study from the Harvard School of Public Health found that men who skipped breakfast tended to eat more at night and also had a 27% higher risk of heart attack and coronary heart disease. In the 2010 American Journal of Clinical Nutrition, a study found that people who skipped breakfast as children and on into adulthood had increased levels of LDL and total cholesterol when compared to regular breakfast eaters.

If you don’t already eat breakfast, it’s time to start. Remember, it’s best to take small steps in order to change a behavior. You’ll be healthier in the long run.

WAKE-UP CALL

Europeans eat their largest meal at lunch, as opposed to Americans who have it at dinner. This may be part of the reason why Europeans have lower obesity rates when compared to Americans.

Eating on a Schedule

Regularly scheduled meals throughout the day can help you feel better, lose weight, and think more clearly. It’s a good idea to have breakfast, lunch, dinner, and two snacks between meals depending on your schedule. Doing so will help your body know it’s going to get fed and food isn’t a scarcity, so there will be no need for it to go into starvation mode. It will also help you eat less at each meal because you won’t be overly hungry. You might also find you’re much more productive because you’re more mentally alert and feel much better. However, don’t get stuck eating at the exact same time of day. Check in with your body and listen to its hunger cues. It will tell you when it’s physically hungry.

Intuitive Eating

Intuitive eating is a mind/body approach toward foods. It’s about developing a healthy relationship with food and learning the differences between the physical need for food and emotional ones. Intuitive eating follows these basic principles:

• Eat when you’re physically hungry.
• Stop eating when you feel full.
• Focus on the food you eat, along with the taste and sensations associated with it.
• Eat slowly and in a relaxed environment.
• Eat foods you enjoy.
• Acknowledge your feelings (tired, needing comfort, irritated) and don’t use food to soothe your emotions.
• Exercise regularly.
• Resist labeling food as “good” or “bad.”
• Don’t diet.

One key tool that intuitive eaters use is to evaluate their hunger level by using a hunger scale. Rate your hunger on a scale of 1 to 10 and see where you are before your next meal. These are merely suggestions of how you may feel, so I encourage you to devise a scale of your own.

WAKE-UP CALL

Research has shown in studies on twins that those who dieted were two to three times more likely to become overweight than their twin who did not diet.

The Hunger Scale 1-10

1: Starving, famished, weak, irritable.

2: Extremely hungry, hunger pangs, tummy grumbling.

3: Hungry—ready to eat now!

4: Still a little hungry and able to eat a bit more.

5: Neutral—not really hungry anymore but could eat more. Distracted from eating the meal.

6: Sense of fullness in stomach, slowing down, feeling of satiety.

7: Really full—ate one bite too many!

8: Uncomfortably full—need to unbutton my pants!

9: Painfully full—stomach hurts and I’ve got to go find the sofa and digest all this food for the rest of the day.

10: Overly full—you’re ready to vomit.

A good rule is to never let your hunger go below a 3. Try to eat at a 3 when you’re hungry and stop when you’re full at a 6. You should be hungry between meals if you’re listening to your body. Pay attention to what your body is telling you and respond to it appropriately.

Another tool you may want to use is a food log to help monitor your eating habits. In a food log you can also record the times you ate, the foods you consumed, your hunger scale readings, and your emotional state of calmness, stress, tiredness, etc., all associated with that particular mealtime. Journaling your meals in a food log will help illuminate any areas you need to work on and will show you if you use foods to deal with emotional states. Food logs can be the old-school style of pen and paper, or they can be kept electronically through apps you can find online. Food logs can be a great help towards making healthier food choices.

Satisfying Foods

Everyone has a certain meal they feel really “sticks to your ribs” and fills them up after a hard day’s work. As it turns out, certain foods are actually more satisfying. The more satisfied you are, the less you’ll eat. It’s important that you take the time to think about what foods will satisfy your physical hunger based on your taste preferences. The following list will help you get started.

Satisfying Foods

• Apples
• Baked, broiled, and steamed potatoes with the skins on
• Beans and legumes
• Dried plums
• Eggs
• Hot soup
• Lean proteins like chicken, beef, pork, and lamb
• Nuts
• Oatmeal
• Popcorn
• Salmon
• Yogurt

Food Cravings

Everyone gets food cravings now and then. They can be triggered by an emotion, a biochemical change in the body, or by the season of the year. It’s okay to seek out and enjoy those foods on occasion. The problem is that when you restrict yourself from having any of these foods, it will lead to overeating when you do get your hands on them. One way to deal with food cravings is to acknowledge the request, then wait a couple of hours and see how you feel. Do you still need that particular food, or can you wait and purchase it later in the week? The good news is that you only need a small portion to satisfy that craving, as research has shown your taste acuity declines rapidly after the first few bites.

FOODIE FACTOID

During pregnancy, women have strong food cravings and many crave nonfood items such as dirt, cornstarch, and ice. The eating of nonfood items is called pica. Eating dirt, which commonly occurs in the Deep South and also African countries, is typically associated with low iron levels in the blood of residents of those areas.

The Least You Need to Know

• Be kind to yourself and your body by never going too long without eating between meals.
• Get out of the “diet” mentality and choose to eat healthy foods you enjoy.
• Intuitive eating is part of the mind/body connection to food.
• There are no magic formulas for weight loss. You must create a personalized plan to eat healthier.
• Listen to your body’s hunger and satiety cues, and eat by following the cues.