Have you ever found yourself eating a cookie without knowing how or when you got it in your hands in the first place? And then, to make things worse, you just keep eating one cookie after another, even though you weren’t hungry and you don’t even really want that next cookie? Maybe you’ve tried different ways of managing appetite only to repeat this scene over and over again and then give up in frustration.
Unfortunately, not only is this cycle detrimental to your health, but also to your self-esteem. Feelings of guilt, shame, frustration, and powerlessness seem to follow you around and infuse one of the most natural things human beings do every day: eating.
The first thing you need to understand is that it’s not a will power issue, and you’re not alone. Only about 8% of people who have lost weight manage to keep it off for two or more years. This creates the disaster of the yo-yo dieting cycle, with the average person trying to diet four times a year.
The failure rate of maintaining weight loss through extreme diet and exercise regimens is actually higher than maintaining sobriety from other addictions. And that’s for good reason.
First of all, you can’t quit food and then avoid it altogether. So you have to maintain a healthy balance where you can still eat and enjoy your food without flipping back to overeating. Secondly, and more importantly, the same mechanism of drug and alcohol addiction can be triggered for eating. This mechanism is called the reward cascade.
This important yet commonly overlooked mechanism is responsible for almost all the participants on programs like “The Biggest Loser” regaining all of their weight despite their best intentions. It is also to blame for the aggravating instructions you get from some doctors about managing appetite without giving you any real resources to do so. It also causes the hopelessness you feel whenever you try your best to get healthy but just can’t keep it up.
But the information we’ll present to you here, with some new tips and methods for managing appetite and losing weight, will give you some hope. You’ll be relieved to know there’s far more in play than just eating healthy and exercising. Although you will still need to apply these to your day to day routine, you’ll find that by addressing other underlying issues, eating healthy and staying active will become much easier to begin and maintain.
For most of human history, malnutrition and starvation were much more common than obesity. However, this is starting to change. This is not found just in high-income countries, but also in middle-income and low-income countries as well.
Obesity has become a worldwide epidemic, and it needs to be treated as such. It’s not just a personal battle you’re fighting at home. The statistics show that not only is it on the rise, it is starting to overtake other mortality risk factors quite quickly, including smoking and being underweight. It thus poses a major challenge for public health.
Obesity affects 35% of the global population, and 50% of the American population. The most worrying statistic of all is that it affects around 17% of children and adolescents in the US.
Concerted efforts need to be made in order to help people overcome this treatable disorder. The problem, however, is that conventional advice is just not working for most people. On top of that, not everyone is properly informed about the causes and dangers of obesity and how to tackle it in day to day life.
Accurate and comprehensive understanding is key. Just like any other long-term project, if you’re looking for options in managing appetite and losing weight, you need to be well informed about the different methods and risks you have in front of you. The first piece of information you should know is that there are actually different types of fat.
Adipose tissue, which is the technical term for fat, is a loose connective tissue made up of adipocytes, or fat cells. These adipocytes store excess fatty acids and then release them when you need more energy.
There are two types of adipose tissues: visceral fat, which is found between your organs, and subcutaneous fat, which is found right beneath your skin. The first type, visceral fat, is actually more dangerous than the fat underneath the skin, though both pose health risks. This is why you may have heard that waist circumference is a bigger predictor of health problems than BMI.
There are several reasons for that.
First of all, it is one of the jobs of adipose tissue to release fatty acids into the system when you need energy. Visceral fat, however, releases fatty acids into the wrong places, like into portal circulation, which is not healthy.
This circulation takes the fatty acids to the liver, where they build up and eventually cause non-alcoholic fatty liver disease. They can also go to the pancreas, where they can cause issues with glucose and insulin, and to the heart, where they can cause issues with blood pressure and cholesterol.
Next, visceral fat secretes adipokines, which are a type of proinflammatory cytokines that signal information back and forth between cells during an immune response. Specifically, visceral fat secretes leptin and adiponectin, both adipokines that are intimately involved in obesity.
Leptin is the hormone that signals to the brain when you’re satiated so you stop eating. If it is out of balance, it can cause inflammation and issues with managing appetite. Adiponectin helps with the breakdown of fatty acids and the regulation of glucose in the system. If it is out of balance, you can develop insulin resistance, which is another common factor in weight gain.
Finally, weight issues can mess with the body’s NeuroEndoMetabolic (NEM) Stress Response and the adrenal glands. While on the other end of the equation, dysregulation of the NEM and adrenal fatigue can cause weight gain, including concentrating the fat around the midsection of the body. Cortisol receptors are more concentrated in the visceral fat than in peripheral fat. It should come as no surprise that many with weak adrenals and subsequent cortisol imbalance often also suffer from excessive fat in the center part of the body. The so-called “muffin top” look is a common result, along with other metabolic imbalances.
The NEM is the body’s global response to stress, and it is composed of six circuits: the hormonal, the metabolic, the cardionomic, the neuroaffect, the detoxification, and the inflammation responses. Part of the hormonal response is the hypothalamic-pituitary-adrenal (HPA) axis, which is composed of the hypothalamus, the pituitary gland, and the adrenal glands.
Any kind of stress, whether a real or perceived threat to the body’s state of homeostasis, will trigger the stress response, starting with the hormone cascade of the HPA axis. Signals from the hypothalamus and pituitary gland in the brain will stimulate the adrenal glands into secreting cortisol.
Cortisol is responsible for many important functions in the body, such as regulating blood pressure and blood glucose, maintaining heart and blood vessel function, suppressing the immune system, and neutralizing inflammation.
Although the adrenals and the rest of the NEM are capable of handling stress, they are not made to deal with a constant state of stress. When stress becomes chronic, these delicate systems can dysregulate, causing Adrenal Fatigue Syndrome (AFS) and other imbalances.
In the beginning stages of AFS, cortisol levels rise, and this can trigger weight gain. In fact, chronic stress has been cited as one of the possible environmental factors that are contributing to the rise in obesity rates, and especially in visceral adiposity.
Chronic stress causes the concentration of energy at the midsection, as well as an increase in the acquisition of energy. This has a lot to do with how cortisol is produced. The production of cortisol occurs through several conversions of other hormones: cholesterol is first converted to pregnenolone, and pregnenolone is then converted into DHEA or progesterone, and then finally to cortisol.
Each of these steps needs energy. That means your system triggers the hunger signal more often when you’re under stress so that you have enough energy to make cortisol. Plus, the fat cells that store the cholesterol that is converted into all these hormones are redistributed to the midsection in order to be closer to the organs involved in the conversion process. That way you don’t need even more energy.
That’s why easily gaining weight and difficulty losing it are two common symptoms of AFS, because your body needs all the energy it can get to deal with stress. Also, the main symptoms of AFS are fatigue and low energy, which makes physical activity even harder. Because of this low energy, you can get sugar cravings. As soon as you eat sweets, your blood glucose will spike, triggering an overproduction of insulin that then leads to a crash, which then turns into a craving again.
These spikes and crashes in blood glucose levels mess with insulin balance in the body, which is another very important factor in managing appetite and weight problems. Later down the line, the risk for insulin resistance and even type 2 diabetes becomes increasingly high. Most who suffer from adrenal fatigue tend to be on the heavy side of the weight scale relative to their height and age, with the exception of those in very advanced stages of adrenal fatigue, where the body is in desperate need of energy. In such cases, the body will start to break down muscle mass for energy, resulting in gradual loss of muscle mass and weight loss. This catabolic phase impacts the body negatively. In extreme states, the sufferer can become very much underweight.
Now that we have a clearer connection between inflammation, stress, and weight gain, the final piece of the puzzle is how these factors tie into what we mentioned as a main obstacle in managing appetite and maintaining weight loss: the reward cascade, particularly the reward deficiency cascade syndrome.
The “reward deficiency cascade” is a term coined by Dr. Kenneth Blum, a neuropsychopharmacological and genetic researcher. According to his research on alcoholism and addiction, he concluded that addictive substances and behaviors have a genetic component to them and are therefore partly hereditary. He also outlined the brain’s reward cascade that lights up when an addiction is engaged in.
The brain systems involved include serotonin and dopamine levels. These levels are also important factors in the reward deficiency cascade system.
For example, dopamine receptors, especially the D2 receptor, are involved in functions like motivation, attention, and motor control. If the D2 receptors are not properly expressing, or if there are just not enough of them, then you become more likely to develop conditions like ADHD, OCD, addiction, and overeating. This lack in number or expression can be due to a genetic variant.
This may be why you see people who have managed to get sober from one addiction easily shifting to another addiction. This may also explain why those who quit smoking tend to eat more, and why managing appetite can lead to smoking more cigarettes or drinking more coffee. Low serotonergic and dopaminergic actions cause imbalances in the reward cascade and are drivers of craving behavior.
Add to these imbalances chronic stress and chronic inflammation, and you lose more serotonin. Serotonin helps you in calming down and is involved in the feelings of craving and satiety. The less serotonin, the more cravings you will experience and the harder time you’ll have in managing appetite.
Another issue that is shared among obese people is a variety of nutrient imbalances, triggered by stress and inflammation, which directly affect serotonin and dopamine. For example, obese people tend to have a low level of tryptophan, which is a precursor to serotonin.
Chronic immune activation and inflammation can create issues with tryptophan, such as:
What’s interesting is that in overweight individuals who have lost weight, their tryptophan pools do not stabilize. So their cravings stay, making managing appetite very difficult to keep up.
Add to that stress, which perpetuates inflammation and the IDO pathway, and you keep losing more and more serotonin. And if you have a gene snip that affects your methylation process, such as MTHR, it will affect any addictions and cravings you have even more because serotonin is methylation-dependent.
Another obstacle obese people face is that they suffer from congested livers. This has implications on the NEM’s detoxification response, on inflammation, and on dopamine and serotonin production.
A congested liver equals an increase in acid aldehyde, which is associated with high levels of uric acid. Acid aldehyde in the brain will block serotonin and dopamine production. As we already saw, low levels of serotonin will trigger cravings, especially for so-called comfort foods, which are usually high in carbohydrates, as well as some combination of fat, sugar, and salt.
As you read, obesity is a big factor in the lack of dopamine receptors. The higher the BMI, the lower the number of receptors. Insulin resistance can also interfere with dopamine clearance, and this may be one of the reasons that type 2 diabetics have weight issues.
But serotonin and dopamine also affect each other. Serotonergic activation influences D2 receptor function. So if you have enough serotonin, your dopamine is spared, but if you don’t, dopamine will down-regulate. As soon as that happens, your cravings come on strong.
When this neurotransmitter pool is blunted, you’ll have a hard time focusing and feeling at ease, so this pool needs to built back up first in order to deal with the cravings and reward behaviors, and eventually help you in managing appetite. Otherwise, there is a danger you will revert to old eating habits very quickly, and will-power alone will not suffice.
Of course, the question of supplementing will come up. The first warning that needs to be given is that taking a medication or supplement to balance dopamine in order to solve focus or reward issues may be a mistake for some, while a necessity for others. Usually, the better route is to fix the serotonin receptor issues first before the dopamine receptor issues. An exception, however, is for people with prefrontal lobe lapses and ADD. In those cases, you first deal with dopamine regulation before serotonin.
What about using appetite suppressants? Unfortunately, appetite suppressants can also deplete dopamine levels, so they’re not a particularly sustainable or pleasant way to lose weight.
One way to improve dopamine levels naturally is through moderate exercise. That’s because exercise up-regulates dopamine and increases nitric oxide levels. But you don’t want to do high intensity exercises, as these can actually lead to excess nitric oxide and a down-regulation of dopamine. Moderate exercise combined with eating nitric oxide rich foods, such as dark leafy greens, and using nitric oxide supplements, like beet products, can be useful.
You’ve probably heard about the gut-brain connection, and maybe how the gut is sometimes called “the second brain.” First of all, the majority of serotonin comes from the gut, and dopamine is also stored in the gut.
Also, the gastric stimulation that occurs when you eat comfort foods activates limbic and cortical regions in the brain. This is doubly so in those who are obese. These are the same regions in the brain that are activated when a drug-dependent person gets a craving for drug consumption.
This is why trying to address obesity simply as a lifestyle issue just doesn’t cut it for most people. The gut-brain connection has to be taken into consideration in managing appetite and in weight loss. Unless the reward deficiency is corrected, fixing the weight problem is a huge struggle that is likely to fail.
In addition to that, if you keep up a strict calorie restricted diet for a while, which is extremely difficult to maintain, you can lose lean muscle mass. And then, of course, the yo-yo back and forth is inevitable. Fix the brain issue first, and you have a much better chance.
Thankfully, because the brain is so intimately connected to the gut, the way to fix the reward imbalance may actually be through the gut. Instead of going down the calorie restriction path, you first can make a few simple changes that can get the rebalancing of the reward system started.
First, take a look at how much fat you’re consuming compared to how much fiber. An excess in dietary fat can lead to a diminishment in dopaminergic function, and a deficiency in dopamine will add to obesity because it will provoke compensatory overfeeding in order to try and restore the reward sensitivity.
High fat consumption will down-regulate oleoylethanolamine (OEA), which is a diet-derived gastrointestinal lipid that is also a satiety messenger, and which helps restore gut-stimulated dopamine release. OEA can also reduce motivation problems concerned with eating healthier foods by increasing their reward value, and it can reduce the craving for fatty foods.
Ketogenic diets are becoming very popular, and they do work for weight loss and other health issues. However, like all other strict diets, you need to stay aware of the possibility of a rebound effect, as the backlash can be very strong.
If you choose to try a high fat diet, you’ll need to make sure you are getting enough fiber from resistant starch like oatmeal or green bananas, so you can maintain the integrity of your microbiome, which is what gives you the gut-brain messengers.
Obese people tend to have imbalances in their microbiomes, a state called dysbiosis. And certain types of gut flora, when in excess, are more energy intensive, which triggers the need to eat more. Basically, the microbes in the gastrointestinal (GI) tract can manipulate their host’s eating behavior for the sake of their own survival and fitness. This illustrates how important gut flora balance is. An imbalance in gut flora will affect the neurotransmitters and enteroendocrine hormones released or stored in the gut.
Enteroendocrine hormones, secreted by specialized cells of the GI tract and pancreas, are intimately linked to the reward cascade. They regulate energy homeostasis, influence energy expenditure, are involved in food reward pathways, and can alter feeding behavior.
If the gut flora is out of balance and your microbiome is not getting enough resistant starch, it can’t make some of the important gut hormones involved in hunger and satiety. For example, it can’t regulate ghrelin, which is known as “the hunger hormone” because it stimulates appetite. This can make managing appetite an uphill battle.
Stress is another important factor to consider when we talk about the integrity of the microbiome, managing appetite and the health of the gut. Once again, it has a lot to do with the gut-brain connection. As you know, cortisol, the immune system, and inflammation are linked.
But the other big link is that the gut contains two-thirds of your immune tissue. So a lot of the immune response and the subsequent inflammation response begin in the gut, and the microbiome acts as a mediator in this process. This supportive relationship between the microbiome and the immune system goes all the way back to its development during infancy, and maintaining this supportive balance is one of the best ways to avoid inflammation.
Healthy gut flora help with the body’s resistance against other harmful microbes, and they help retain more nutrients and energy from the food that goes through the GI tract by fermenting the non-digestible material.
What’s also very interesting about gut flora is their effect on gene snip activation. Although this is still being studied, what we do know is that the microbiome in the gut contains around 100 different species that account for 3 million unique genes combined. That makes the gut’s genome 100 times larger than the host’s genome. Also, the bacterial cells in the GI tract outnumber human cells tenfold.
Soon, as the field of epigenetics grows, we will understand the implications of these numbers on genetic variations and the gut-brain connection even more.
What we do know for sure is that any kind of dysbiosis can lead to intestinal permeability, which can then create leaks in the endothelial cells that line the gut, and that lets particles into the bloodstream that shouldn’t be there.
And what happens when foreign particles enter the bloodstream? An immune system reaction, and with it, the NEM’s inflammation response.
The inflammation response is essential to maintaining health, as it is responsible for eliminating the cause of cell injury, clearing out damaged cells and other by-products, and initiating cell repair. It’s when inflammation is constant that you get a lot of health problems, and a leaky gut is a major factor in chronic inflammation.
Because so many of the body’s neurotransmitters are made in the GI tract, and the microbiome-gut-brain axis is a regulator of the body’s neurotransmitter pool, any inflammation in that area can affect neurotransmitter balance and production.
Plus, the leaks let in substances that can reach the nervous system, triggering inflammation there, which can cause depression, anxiety, and other mental health and neurological issues. SSRI drugs can be useful in treating some of these problems because they are very anti-inflammatory.
Inflammatory cytokines - the proteins, peptides and glycoproteins that are used to help the communication between cells involved in the immune system response - can retract or damage dopaminergic beds. Because dopamine is stored in the beta-cell vesicles in the gut, rather than in the brain, inflammation that begins in the gut can really deplete dopamine levels.
But the GI tract has other important hormones that affect weight and are involved in managing appetite:
Chewing your food slowly gives your gastric acid time to release, and gives you more CKK, which regresses hunger signaling. This helps you feel fuller faster and is one small change you can implement to help with more sustained weight loss.
Incretins are hormones involved in glucose homeostasis. They stimulate a decrease in blood glucose levels by increasing insulin. Dopamine is considered an anti-incretin, so it is anti-insulin by default.
That’s why obese people with low dopamine will have problems with insulin resistance, and insulin resistance is one of the four main conditions that lead to obesity. The other three are an increase in glucocorticosteroid concentrations in plasma (such as cortisol), mutation of leptin receptor (which affects appetite control and insulin), and an increase in neuropeptide Y (NPY), mRNA, and NPY release.
NPY comes from the hypothalamus. It stimulates hunger and decreases the urge for physical activity. It is triggered by low blood glucose and is inhibited by leptin and PYY. Obese people secrete less PYY and have leptin resistance, which then creates more NPY. Plus, when their microbiomes are off balance, they don’t make PYY, and so gain more weight and increase their insulin resistance, up-regulating NPY.
Low blood sugar, or hypoglycemia, is a common symptom in AFS, and as such, AFS can increase NPY release, which then stimulates hunger and decreases the urge for physical activity.
This cycle, combined with low dopamine (which lowers motivation), plus insulin resistance (which decreases energy as the cells are not getting the glucose they need), plus already carrying a lot of weight, will also naturally lead to a decrease in physical activity. Less physical activity will create a problem with gastric emptying.
Physical activity improves gastric emptying. Improved gastric emptying impacts dopamine levels and the reward system, and it alters the gut-brain axis. It is also one way to manage stress. But how do you start moving when you’re suffering from all of the above?
In AFS recovery, we outline exercises that are very gentle, meant to take you from the most fatigued and weakened state up to a point where you can do other types of exercise. You will first start with adrenal breathing exercises and slowly, very slowly, move to adrenal yoga exercises.
As your adrenals get stronger, you will find that your energy levels improve and you are capable of doing more. The more active you become, the better your gastric emptying gets, and the healthier you’ll start to feel, enabling a rebalance in your reward system and helping you in managing appetite and weight.
With a correction in dopamine and serotoninergic drive, your chances of managing appetite, modifying your behavior, and addressing the stresses in your life increase a lot.
We just outlined one way to help you in managing appetite and gaining more balance in your physical energy and health. But AFS recovery is actually focused more on diet than exercise, and the adrenal fatigue diet is one of the best diets for gradual and sustainable changes in weight.
First of all, it is not a calorie-restricted diet that is difficult to maintain. It is a lifestyle change that you take on gradually so that you can keep it up long term. Even more importantly, it is low in sugar, processed foods, and other inflammatory foods, so it is anti-inflammatory by default. Reducing inflammation is already a huge step in restoring health and vitality, as well as in balancing the reward cascade.
Also, it will help a lot with insulin resistance. Insulin helps regulate dopamine signaling as well as reward behavior. Insulin resistance, on the other hand, can get in the way of dopamine turnover and clearance, leading to imbalance in the dopaminergic reward circuitry. Increasing insulin sensitivity will give your cells the energy they need, prompting you to be more active, and staving off the sugar cravings that come from hypoglycemia.
Increasing your consumption of resistant starch, such as 30-60 g of Hi-Maize, can lead to a 33-69% increase in insulin sensitivity starting at just 20 minutes after ingesting it. This can provide a significant improvement in blood glucose levels and body mass index, and can be a great help in managing appetite.
Also, resistant starch has been shown to upregulate GLP-1 and PYY in a sustained manner in rodents. If you remember, GLP-1 influences incretin activity and satiety, and PYY induces satiety, increases the efficiency of nutrient absorption, and slows motility.
Although increasing resistant starch intake is a small change with big rewards, if you have AFS, especially in the more advanced stages, you’ll want to first check with your doctor if this might interfere with your digestion. Some people with AFS experience constipation, and so slowed motility due to an increase in PYY may aggravate this. Generally, however, increasing resistant starch intake is safe and good for your health.
Other products and supplements that have been found very useful for managing appetite and balancing the reward cascade include:
There are endless other supplements that can help with blood sugar control, adaptation to stress, reduction of inflammation, weight loss, managing appetite, balancing neurotransmitters, and balancing gut flora. So the trick is not to just take a bunch of different supplements, hoping that something will work. At best, you’ll never know what works and what doesn’t and will have to keep taking that shotgun approach to maintain your results. At worst, you may end up with adverse effects and experience a crash.
This is especially the case if your body is inflamed and you suffer from adrenal fatigue.
So, although balancing the reward cascade is a much more sustainable way to lose weight and keep it off, you have to approach this endeavor with caution, as you will be playing with important, mood-and-health altering chemicals in your body. If something doesn’t go well, and your adrenals are too weak to respond to this stress properly, it may lead to a lot more harm later down the line.
The best method is to start with the basics, which are diet and stress management. Following the adrenal fatigue diet, as we said, is the best way to ensure lower inflammation and increased adrenal strength. Stress management can include the use of therapy, meditation, support groups, journaling, and breathing exercises.
Once you have your new diet in place and you feel comfortable with it, you can explore some of the different supplements suggested above, but only do so under strict supervision. Try one at a time and then wait to see how it affects you. Make sure you note down the changes before you move onto another.
Finally, adding light to moderate exercise, as well as improving sleep quality and getting enough rest, will round out your health regimen to make it as holistic as possible.
It is understandable that you want to lose weight quickly, but give yourself the time to do it without damaging your health and without falling into the dieting trap that has defeated 90% of all those who have tried to lose weight. With such a big undertaking, you’ll want to put your focus on taking small steps, one step at a time.
The same reward centers in the brain that light up when a drug addict feels a craving light up when an overweight person craves comfort foods. Dealing with this imbalance first can help in managing appetite, increasing physical activity, and losing weight.