Livingwell A SPECIAL PUBLICATION CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING
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HEALTHCARE NEWS YOU CAN USE FOR YOUR WHOLE FAMILY
JANUARY 2015
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SPECIAL REPORT
T H E P H YS I O LO G Y OF HUNGER
THE
WEIGH WE ARE
Thinkstock
HUNGER HORMONES MAY BE OUTSMARTING US
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| ARTICLE BY DEBRA GELBART | PHOTOGRAPHY BY RICK D’ELIA
he difference between true hunger — when your body tells you that you need to fuel
it so it can perform all of its functions — and appetite — when you feel the urge to eat but you don’t necessarily have the physical need to eat — can be difficult to distinguish, thanks to a hormone called ghrelin.
A hormonal gremlin
Ghrelin is produced when the stomach is empty, signaling the body that it’s time to eat. But appetite also can be stimulated by “smelling food, seeing food or even by hearing knives and forks clinking together,” said James Swain, M.D., a bariatric surgeon with Scottsdale Healthcare Bariatric Center. “I tell my patients that they can’t watch ‘Diners, Drive-ins and Dives’ on the Food Network when they’re trying to eat healthy because hormones released when you do that make it much harder to lose or maintain weight.” Ghrelin is manufactured mainly in the cells of the stomach, explained Hilario Juarez, M.D., a bariatric surgeon and medical co-director of the Bridges Center for Surgical Weight Management at St. Luke’s Medical Center in Phoenix. “In bariatric surgery, when we make the stomach smaller, ghrelin levels dive,” he said, adding that ghrelin is one of many hormones produced in the body that influence hunger and satiety, or a feeling of fullness.
Metabolizing calories
As counter-intuitive as it may sound, new research has shown that leaner people don’t use calories efficiently, but heavier people’s bodies have become adept at absorbing nearly every single calorie in their food. “That may be yet another reason that it can be so difficult to lose weight on your own,” Swain said, referring to obese individuals, “because your body has become accustomed to metabolizing every calorie that you consume, while a leaner person doesn’t necessarily process food the same way.” If you weigh more than what is considered optimal, that can mean you’re less sensitive to the release of the satiety hormones in your small intestine (two of which are called GLP-1 and PYY) as your stomach fills and the contents begin to move toward the small intestine. “People who are obese are not satisfied as soon as those with a normal body weight,” Swain said. Doctors used to think that a protein called leptin — another satiety indicator released as the stomach gets fuller — held the promise of a solution to obesity.
James Swain, M.D., a bariatric surgeon with Scottsdale Healthcare Bariatric Center, tells his patients that they can’t watch “Diners, Drive-ins and Dives” on the Food Network when they’re trying to eat healthy because hormones released when you do that make it much harder to lose or maintain weight. “But leptin has lost its luster,” Swain said, noting that doctors have determined that a higher level of leptin in the body doesn’t always tamp down appetite. Indeed, leptin levels appear to be high in obese patients, according to David Podkameni, M.D., a bariatric surgeon at Banner Gateway Weight Loss Institute in Gilbert. “We think heavier people may be resistant to its effects,” he said. “Researchers are now
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Hilario Juarez, M.D., a bariatric surgeon and medical co-director of the Bridges Center for Surgical Weight Management at St. Luke’s Medical Center in Phoenix, said that ghrelin, which is manufactured mainly in the cells of the stomach, is one of many hormones that influence hunger and satiety, or a feeling of fullness.
investigating whether the receptor cells in obese patients can be modified to respond to leptin.” Podkameni also said researchers are looking into whether adiponectin, a protein released from adipose (fatty) tissue that seems to produce a sensation of satiety as well as potentially protecting against cancer, can be more effectively harnessed than leptin. HUNGER , continued on page 3
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