How To Master Hunger And Cravings

Mark Hyman, MD

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Dr. Mark Hyman: Welcome to the Doctor's Farmacy. I'm Dr. Mark Hyman, that's Farmacy with an F. F-A-R-M-A-C-Y. A place for conversations that matter. And if you ever hungry, or hungry all the time, or can't figure out why you can't stop eating or binging. You better listen up, because this is a podcast that's going to help you understand why and what to do about it. And it's with none other than my friend, colleague and medical director at the UltraWellness Center, Dr. Elizabeth Boham. And one of our special episodes called House Call. And today, we're so excited to have you back to talk about this really vexing problem, which is hunger. And if we all didn't struggle with eating and overeating and obesity, it wouldn't be a big deal. But our hunger regulation is something that most of us don't think about. We think we're at the effect of our hunger and not at the cause of our hunger and that we can't really do anything about it. That if we have cravings and we want to eat bagels and muffins and donuts, and we just have to have them, then there's just nothing we can do. Dr. Mark Hyman: Because willpower certainly can't fight those cravings and urges. And we think that's just how our bodies work. But I can tell you, and you can tell me, and we can tell each other after seeing so many thousands of patients that this isn't true. That we do understand the science of hunger and we're going to talk about hunger today in a particular way. Because I think there's so much we can do to regulate our appetite so we're not starving and overeating. And I found that for myself, if you don't eat right, you definitely feel your blood sugar swing all over the place. You go hungry and you feel out of sorts and you tend to overeat. So none of us want to do that. So how do we naturally regulate our appetite? And I think most people don't understand that if you have an inherent, that you have an inherent wisdom in your body that knows how to regulate the hormones that control your weight and your metabolism and appetite. Dr. Mark Hyman: If you're off just by a hundred calories a day in your, and by the way, nobody can count calories because it's kind of a ridiculous effort in the sense that you can guesstimate. But if you're off a hundred calories a day that over the course of 20 or 30 years, that's 30 or 40 pounds of weight gain in terms of the cumulative effect of those hundred calories that you're off every day. So it's really about letting your body's own intelligence come back to find out how to regulate these. So, let's tell us about the sort of biology of hunger and particularly about this particular hormone ghrelin, which is, maybe people heard about it. Don't really know what it's abut. That's really an important appetite regulator. And it's the key to its appetite regulation is regulating this particular compound ghrelin, which is so prevalent and so dysregulated in our bodies. Dr. Elizabeth Boham: Yeah. Oh, Mark. It's great to be with you and everybody again today. So thanks for having me. And I think it's such an important topic, like you said, because with when our, when we're, when our hunger is out of control, it is very hard to control what we eat and why we eat. And so it's important to understand how all of these hormones work together. And like you mentioned, taking a step back and listening to the natural intelligence of our body is really important for maintaining a healthy weight and having great energy and vitality. And so ghrelin is really an interesting hormone and it is secreted from the stomach, mostly stomach and part of the small intestine. And it goes to the brain and then it says to the brain, okay, you better eat, you're hungry. So it is that hormone that makes us feel hungry. Dr. Elizabeth Boham: And so when we eat, typically our ghrelin levels go down. And we'll talk about this a little later, sometimes our food composition, what we eat in a typical meal impacts our ghrelin levels differently. So, when we eat typically, our ghrelin levels go down and it says, okay, now you're full and you can stop eating. And so what are the reasons people always say, don't eat too fast, or if you're hungry, take a few minutes to make sure you still want to get seconds, is just to give the body time for that, for the hormones to shift. So, and for that ghrelin level to go down. So, the other reason we know a lot about ghrelin, is because when people lose weight, they often feel more hungry. Dr. Elizabeth Boham: And I always explain this to my patients. I'm like, they need to and want to lose weight, and when they do, sometimes they feel more hungry for a period of time. And I think that's a really natural and normal thing. And we sometimes have to work through that to continue to get to our goal if we're working to lose weight. So we've got a lot of hormones that have an influence on what we choose to eat and when we choose to eat. Dr. Mark Hyman: Yeah. It's so critical because if we don't, if we don't understand how those are regulated, it's really a big deal. I think when you, when you're not eating and when you're losing weight and when you're having been for a while, that way your body will naturally produce this hormone in your stomach, that makes you hungry, which is a good thing. Dr. Elizabeth Boham: So we don't starve to death, right? Dr. Mark Hyman: Right. And so, it goes down if you eat and so forth. But if you have a diet that's causing a dysregulation of that hormones and it can really create a problem. And I think, we mentioned the microbiome, which also is key. But the, if you're overweight, it seems like the hunger is so dysregulated. So people are literally overeating and they're already so obese. And it just seems to be counter-intuitive. Why would people feel like they need energy if they're already overweight and they have so much energy in their body? But it really is about this particular hormone rate that's being dysregulated. Dr. Elizabeth Boham: I mean, one of the things we know with ghrelin is when people, when they do gastric bypass surgery on people, their ghrelin levels do decrease. And one of the reasons why that surgery can be successful, I say that with some caution, because there's, it depends on how you define success. And there's a lot of issues with the surgery that, important for us to talk about. But where they can be successful for some people is decreasing that ghrelin levels and helping their hunger. And not that I recommend the surgery necessarily for people, but that is one way that it works because it decreases your hunger. Dr. Mark Hyman: Yes. So, tell us about how from a lifestyle perspective we're affecting ghrelin? And what we can do with our diet, with our timing of eating, with sleep and other factors that are really driving a lot of issues. Dr. Elizabeth Boham: Yeah. One of the things we know this, when we have a meal that has sufficient amount of protein in it that our ghrelin levels decrease, and we feel less hungry with that type of a meal. So it's really important. You know, we've talked a lot about how insulin can trigger hunger too, right, but ghrelin also. So when we eat a meal that's balanced, that has sufficient protein and fats along with all the good, healthy carbohydrates that helps with making us feel more full and not as hungry. So it's really important to think about each of your meals in your day and say, okay, did I have sufficient protein there? And remember protein is like your eggs and fish and chicken and beef and beans and legumes and nuts and seeds. And that protein will help when you consume it, help that ghrelin go down and make you feel more satiated after a meal. Dr. Elizabeth Boham: And ghrelin is one of those reasons that that occurs. You mentioned also with lifestyle, sleep. Sleep is critical. When people are sleep deprived, ghrelin levels go up and they're more hungry. And so we're seeing an epidemic of sleep deprivation in this country and worldwide, even, right? So we're seeing this epidemic of sleep deprivation, which is one thing that's driving higher levels of ghrelin. And we want to make sure that we're getting adequate sleep. If somebody has a process called sleep apnea, if somebody has interrupted sleep where they are, they're having episodes where they're not getting oxygen into the body. That's what sleep apnea is. They're having episodes where either the, there's somewhere in their nasal area there, the back of their throat, that's preventing oxygen from getting into the body. Then the body has to wake itself up to take a deep breath. Dr. Elizabeth Boham: So people will often be snoring, and then will stop breathing for a period of time and then take this really big, deep breath. They might not even realize they're having these episodes of apnea or not getting oxygen into the body. But what we're learning is that when you have sleep apnea, ghrelin levels are higher. So people who have sleep apnea have higher levels of ghrelin. And again, one reason why that drives this vicious cycle of weight gain, obesity, weight gain, obesity, fatigue, hunger, hunger, hunger, right? So it drives this vicious cycle. Dr. Elizabeth Boham: They know that when people are, have sleep apnea, their levels of ghrelin are higher than the same group of people that even have the same body weight. So even if both groups are overweight or obese, if you have sleep apnea, your level of ghrelin will be higher. And so it's really important that we pay attention to the sleep, work with our patients and find out are they getting adequate sleep, first of all. And is adequate hours of sleep, that is. And of the hours of sleep that they're getting, are they restful? Are they sufficient? Is there any concern about apnea or something that would be disrupting their sleep? Dr. Mark Hyman: But, Liz, it's really true that sleep apnea is a big factor. I remember a patient I had, who was a lawyer, and tell me about his struggle to lose weight and he needed to lose about 50 pounds. He says, nothing you can do about it. I said, well, tell me about your life. What do you do? I'm a lawyer. I'm like, what do you do? I'm going to do this now, but I have to stand up on my desk every day to work. Otherwise, I fall asleep at my desk. I'm like, oh, well, maybe you have sleep apnea. So we tested him. He had severe sleep apnea and we put him on a C-PAP machine and he lost 50 pounds like that. And I think most people don't understand the connection between sleep. But it's not just sleep apnea, if you're not getting enough sleep. Dr. Mark Hyman: And you and I both as doctors know that when we were on call or working all night, or we don't sleep, that we tend to crave more food. We crave carbs, we crave sugar. And our appetite is so screwed up. And I remember this one study, it was healthy young 20 year olds who weren't overweight, who were sleep deprived on purpose, compared to a control group. And they found that the sleep deprived group were much hungrier and they were craving more carbs and sugar. So, that's an interesting phenomenon. That's why we see such an incredible consumption in this country of these products who were sleep deprived as a nation. And we have poor quality sleep. And there's 70 million people that suffer from some type of sleep issue, which is a lot of people. I think maybe even more actually. It's a lot of people. And so, its not just sleep apnea, but it's all the sleep deprivation. Dr. Mark Hyman: And so, what about when, what about sugar and carbs and stuff and artificial sweeteners? How did that affect ghrelin and how do we should be thinking about our diet in terms of railing your appetite when we eat those things? Dr. Elizabeth Boham: Yeah. You know, so it's interesting that foods will, when our stomach is empty, we produce more ghrelin. And then when we eat our ghrelin level decreases and we feel more full, right? So, or we're not as hungry. So we know that carbohydrates, as well as protein and fat, can all result in a lower ghrelin release. And as I mentioned earlier, it's really important to have that meal that's balanced with good protein and fat and fiber to feel full and cause that suppression of ghrelin. But one study that was really interesting, many studies that are interesting, they're looking at these non caloric sweeteners and how they impact the ghrelin. And so they've been able to show that artificial sweeteners don't suppress ghrelin in the body. So we think that when we are reaching for these low calorie sweeteners, these artificial sweeteners, that, okay, we're not getting any calories, but we're getting this substance that is going to, is going to make us feel more satiated, but actually not at all. Dr. Elizabeth Boham: So artificial sweeteners don't suppress the ghrelin levels in the body like food does, like whether it's carbohydrates or protein. And so, people who consume artificial sweeteners actually feel more hungry a lot of the time. And that's a concern in terms of food regulation and what you were mentioning before about listening to our body's natural hormone levels and the natural things that drive us to eat are naughty. And I think that's really important when it comes to these artificial sweeteners. There's, we think, some people will come in and be like, okay, that I can, it's like a free food. But it's really not in terms of how it's impacting our hunger and satiety. Dr. Mark Hyman: Yeah, that's true. I mean, I think so, you think that, oh, meaning of something that's makes you mimic sweetness, like the artificial sweetener would sort of suppress your appetite, but it doesn't. You drink artificial sweeteners then you want more and more and more food, which is really concerning. And there are a bunch of other things that affect, you mentioned stress, sleep deprivation, lack of sleep in any way, but also stress plays a huge role in your ghrelin. Dr. Elizabeth Boham: Stress has a huge impact. Stress can, high levels of stress will cause us to have higher levels of ghrelin and eat more. And isn't that fascinating. You know, it kind of probably makes sense from an evolutionary perspective, that if we're going through a stressful time, we want something to be triggering us to make sure we're getting enough food so we are staying alive. Right. So that probably makes sense evolutionarily, but it's important for us to pay attention to that when we're working with our patients. And help them understand that this chronic stress that they're under can really be disrupting their hunger cues. And so, we know that as I mentioned, ghrelin can cause, or stress can cause high levels of ghrelin. And for some people, cause them to eat. We feel more and more hungry and want to eat all the time. Dr. Elizabeth Boham: And so in order to help them feel less hungry, one of the things we have to talk about is that chronic stress that they're under. And what can we do to help with managing that chronic stress. Whether it's getting outside and enjoying nature and doing regular exercise. Getting on a good meditation program, doing your breath work every day. Journaling, gratitude, working with a therapist, doing some other types of treatment like EMDR, or other ways to help release some of this chronic stress from the body is really important for many people. Dr. Mark Hyman: No, that's huge. That's huge. So the other thing that you know, people talk about with ghrelin, is other things that regulate appetite, so stress we talked about. What about other foods like protein and fiber and fat? How do those affect ghrelin? Dr. Elizabeth Boham: Well, they'll trigger ghrelin levels to go down after you consume them. So it's really important. You know, we work with all of our patients to say every meal, each meal you have, make sure you've got a good source of protein, a good source of fiber, which has all your vegetables and beans, legumes, nuts, and seeds, ground flax seed, and healthy fat, at every meal. Because that's going to help you feel more satiated. It's going to help those ghrelin levels, go down. I mean, we also know things like cannabis, right, can cause ghrelin to increase and that may be why people get the munchies. Right. And so it's important to understand what things you're doing and how they're impacting your hunger in your body. Dr. Mark Hyman: Yeah, I think that's right. And I think, obviously people smoke pot, they get the munchies for sure. And that drives appetite. So how do we work with people who have these problems? How do we sort of help? And by the way, one of the things that I wanted to mention was it was sort of the theory about gastric bypass. One of the theories about gastric bypass is since ghrelin is produced the stomach, that when you have a gastric bypass, it shuts down the ghrelin levels. But I'm not sure, I'm not sure if that's the only thing that's going on. Dr. Mark Hyman: And I think the reason I say that it was a recent randomized control trial, comparing people who had gastric bypass with those who were matched to them, but who didn't have a bypass, but just went on the bypass diet and they both lost the same amount of weight. Now, I don't know what their appetites were like, or if there was a difference, but they basically went and lost the same amount of weight. I'd be very curious, actually to look at the fine print of the study, to see if the people who didn't have the bypass ere hungry, or they just starved them in lost weight, or if it was actually cut down their diet and they actually were able to accommodate to a lower caloric intake. Dr. Elizabeth Boham: Yeah. I think it's really important. What you just said is that, and prior, actually, prior to working with you at both Canyon Ranch and the UltraWellness Center, I worked in a practice where we worked with surgeons who were doing gastric bypass surgery. So I saw a lot of patients who were going through the surgery and I saw a lot of the side effects and the negative side effects of the surgery as well. And what I think is what you mentioned is really so critical to understand, is that when we can help people get off of this vicious cycle of hunger and eating and hunger and eating and hunger and eating, when we can help them break that cycle, they can be successful at getting to where they want to be in terms of their intake of food. So, you're right. Maybe at the beginning, when, for that group of patients who didn't have the surgery that first couple of weeks may have been really hard of saying, okay, I'm going to really cut back on the amount of calories, the types of calories that I'm eating, the balance of my nutrients. Dr. Elizabeth Boham: And they might have felt really hungry for those first couple of weeks, but we see this all the time. Once people get through that time, they start to feel better. They don't have those, that hunger anymore. That drive to constantly eat and snack and choose unhealthy foods. And then they can kind of start to be successful. That the surgery prevents, makes it so you can't eat for those first few weeks, and then that just spirals into, yeah. But then of course, you're dealing with all the side effects of the surgery, unfortunately. So, you know, that is an interesting thing that we see. Right. Dr. Mark Hyman: Fascinating. And you've seen patients with this and you've had no... I remember many patients who've had struggled with this and you get their numbers dialed in and you kind of sort through everything with them and they do so much better. So can you tell us about this patient is a 45 year old guy was hungry all the time was overweight and struggling with this sort of appetite and hunger. Dr. Elizabeth Boham: Yeah. You know what I mean? So he came to see me and he was really trying to be healthier. I mean, he was working hard to be healthier. And really frustrated that he couldn't get his weight to where he wanted it to be. And he had gained 25 pounds over the last couple of years. He was feeling hungry all the time. He didn't have the same level of vibrancy anymore. He was just feeling kind of sluggish and low energy. He, we noted when we did his vitals and his physical exam, that he had really gained a lot of weight around his abdomen, around his belly, right. That visceral adiposity. That belly fat that's really causes a lot of inflammation in the body, causes high levels of insulin. And is associated with all of those negative things like heart disease and stroke and cancer. Dr. Elizabeth Boham: So he had gained a lot of weight around his belly. His waist to hip ratio was one, which is higher than it should be. And we knew his diet. He was trying to be healthier. But he was grabbing coffee drink for breakfast. At lunch, he was having orange juice. He had switched that out instead of soda, sandwich and chips. You know, he did have a few beers at dinner. Maybe snacked on crackers and popcorn after dinner. And so, he was trying, he felt like he was trying to make the healthier food choices, but we saw a lot of issues when we really delve deeper in terms of his diet, where we needed to do some work. And we also, when we got his full history realized that he was a snorer. So, he was snoring frequently. And we talked about how snoring can be a sign that you may have sleep apnea. I mean, there's lots of other signs to high blood pressure, weight gain fatigue, falling asleep during the day or when you don't want to fall asleep. Dr. Elizabeth Boham: So, but because of all this, I really encouraged him to get a sleep study. And we found out that he did end up having sleep apnea. So, but what we saw with his blood work, we saw high levels of fasting insulin. They were, they were 10. We saw a C-reactive protein, that marker for inflammation is really high. We saw that his, he had low levels of vitamin D and we know vitamin D is critical for so many things in our health, including insulin sensitivity. We saw that his omega-3 fat levels, you can do something called an omega quant, which looks at the amount of omega threes in the red blood cell membrane. And we saw that his omega-3 levels were low. And we know that omega threes are really important for resulting in helping lower inflammation in the body. Dr. Elizabeth Boham: We can also do some special testing of something called an organic acid testing. And we did that for him. And we saw that his mitochondria, which are the powerhouse of your cells, needed a lot more support. And one of the reasons that people develop problems with hunger and weight gain and insulin resistance, is when you, with issues with their mitochondria. And we, so we saw that we needed to really support that. He had high levels of free radicals or oxidative stress. And so there were a lot of things we needed to work on with him. One of the first things we did is we got him, his sleep apnea treated. He got a C-PAP machine, and he started to feel better right away. You know, patients resist this a lot, but we see that when they really do jump on board and start using that C-PAP machine and it's fitted right, many times they just feel so much better. Dr. Elizabeth Boham: Their energy is better. And one of the reasons and their hunger decreases because that ghrelin decreases, because remember we said that if you have sleep deprivation or sleep apnea, your ghrelin is going to be higher. And you're just going to just be wanting to eat and eat and eat. So that was one of the first things we really helped him do. And it really was very helpful for that decreasing his hunger and that drive to just eat and eat. We also really supported him nutritionally with cutting way back on his carbohydrates, getting more vegetables in his diet, more nutrient dense foods. We gave him some supplements that supported his mitochondria, like CoQ10 and B vitamins and alpha-lipoic acid. And he did really well. I mean, with some of these simple shifts, he started to lose weight. After like six months, he got down to his ideal weight. Dr. Elizabeth Boham: After about four months, his weight waist to hip ratio got to 0.9, which is really where we wanted to see it. And he just started feeling better and he was having more energy and not hungry all the time. And he really understood what foods to choose. And then most importantly, from my perspective, was that we just really decreased his risk of all sorts of diseases, right. Because we know that insulin resistance pattern drives heart disease and stroke and cancer and dementia and diabetes. And so we really, that that was really great that we were able to intervene at this age. And I think help prevent a lot of diseases for him in the future. Dr. Mark Hyman: A hundred percent. So, hunger is complicated, because it's not, and we talked about a lot of the aspects that regulate hunger, right? The protein you eat, the fat you eat, how much starch and sugar you eat, those make it worse. Artificial sweeteners, whether you use substances like cannabis, for example, sleep deprivation, stress. And so even hormones are, levels of insulin, which goes along with carbohydrate intake, all drive our appetite. And so if we begin to understand how to regulate our appetite, we can really have a huge impact on our metabolism and health. Why do you think people's hunger is so dysregulated and what are the other sort of strategies from a functional medicine perspective that we can use to help people get into the place where they're feeling even and not swinging all over the place with hunger and cravings and sugar? Dr. Elizabeth Boham: I mean, I think the biggest reason that people are so dysregulated is from our food supply. You know, I think it's hijacked, as you always say, our taste buds and our drive for food. And just helping people get onto, getting off of processed foods and onto real whole foods that natural ability for us to regulate our hunger just happens. So one of the biggest things we can all do is just stop eating things with labels on them, right. And stop eating processed food because so many things, even if they're sort of marketed as being more healthy, have things in it that contribute to hunger and dysregulated hunger signals in our body. So I think that's probably the first thing we should be focused on with everybody, Dr. Mark Hyman: So, our diet and then sleep, right? Dr. Elizabeth Boham: Yep. Absolutely. Absolutely. The other, like we said, people are just sleep deprived in this country. We're living this lifestyle of sleep deprivation and chronic stress. And all of that is just driving our hunger. And we're not really able to listen to our body if we're just going, going, going, looking at our phone, checking an email, rushing, eating quickly, not taking the time to our food digest and signal that we're full. You know, we're just rushing, rushing, rushing, and not sleeping and not managing stress. You know, we're not paying attention to what our body naturally knows how to do. Dr. Mark Hyman: So true. So with people who are struggling with hunger and cravings, I think one of the books that I really loved about this is called Always Hungry by David Ludwig, who's a friend of ours. Dr. Elizabeth Boham: Oh, that's brilliant. Dr. Mark Hyman: Brilliant book. He's a Harvard professor and he's really studied the biology of hunger. And he showed that you can literally retain the brain to not be hungry by regulating what you're eating by increasing fat, protein, decrease our sugar, time your eating, when you're eating. Not eating late at night, making sure you have a little period of fast. Snacking is probably the worst thing in the world. When you go to the grocery store. I mean, most of the food is snack food, which is crazy. And I, it's just like, I don't even go into those isles, but it's mostly just snack food. Dr. Mark Hyman: And it's just striking to me how we've kind of gotten this culture of eating all the time and snacking and hunger and ups and downs. And its something that we can really manage by addressing these underlying biological systems and paying attention to the simple daily rhythms that we need to follow in order to regulate our appetite. And then, I just noticed in my own biology, when I am dysregulated, I get hungry. I get cravings. I want this, I want that. When I'm eating well, and I'm eating whole foods and I'm giving myself the nutrients I need. I don't feel hungry. I don't want, [inaudible 00:28:09] before dinner, I'll get all hungry and that's fine. Or if I'm working out a lot, I'll get a little hungry, but it's not this crazy, oh, I want to eat a muffin or I have to have something bad. Dr. Mark Hyman: So I think there's a real science of hunger and [inaudible 00:28:20] more on this topic, I'd encourage them to read his book called Always Hungry. He's got a great cookbook, goes along with it, but you know, this is something we see all the time, Liz. We see so many people struggling with weight and with metabolism and hunger and cravings and feel discouraged. But I found people live it within days can change quickly their biology and get rid of the cravings, get rid of the hunger. And I remember this one woman who came to one of my workshops years ago at Ultra Metabolism, I think. And we basically put people one a really simple whole foods diet. We'd give them brats and protein shakes and lots of vegetables and good quality protein, good fats. And she was like, look, I'm never going to be able to do this. Dr. Mark Hyman: I'm I've been craving sugar my whole life. I have to eat it. I don't know what to do. I'm really worried about it. I'm so stressed. I'm like, look, just try it for a couple of days, see what happens. And the design of the program was really designed to regulate these hormones, to regulate the ghrelin and to regulate the insulin, to regulate the blood sugar and the brain chemistry. And within two days she was like, I can't believe it. I don't have any cravings anymore. I don't want this. I don't want that. So she's like so happy. And I think people don't realize just how close they are to feeling good. And you're bringing them all those cravings that are really driving their behavior. And you can't do it really without using the science of understanding all that. Dr. Elizabeth Boham: Absolutely. Absolutely. It's so powerful. And like people's bodies change really quickly. I mean, and they can start to feel better really quickly with just some simple changes. I agree. I love that book. Always Hungry. Question mark. I recommend it to so many of my patients. Dr. Mark Hyman: So, thank you Dr. Boham, for joining us again on the Doctor's Farmacy podcast and talking about another challenging topic. We're all struggling with, which is weight and hunger. I think, giving the science of functional medicine and our approach here at the UltraWellness Center, we really help people do the right kind of testing, navigate these problems, get to the root of them and help them restore balance. So we're happy to see you. We've got now five physicians and we're just kind of growing because you guys keep asking for more. We'd love to see you, but ultrawellnesscenter.com. If you love this podcast, please share with your friends and family on social media. Leave a comment, we'd love to hear from you. Maybe how you've conquered your hunger. Subscribe every day to hear podcasts, and we'll see you next week on the Doctor's Farmacy. Dr. Elizabeth Boham: Thank you, Mark.