A Denver Doctor’s Guide to Food Cravings

Food cravings are an intense desire for a specific food, characterized by a strong urge to consume it. Unlike general hunger, which can be satisfied by eating various foods, cravings are usually for a particular taste, texture, or nutritional content. Hunger can be alleviated by eating, but cravings often persist even when you're full.

Food cravings can be driven by various physiological, psychological, and environmental factors. They involve physiological responses such as increased salivation and activation in the reward system of the brain. Cravings include a cognitive component(thinking about the food) and emotional component (desire to eat it and mood changes around it), often leading to food-seeking behavior.

Do Cravings Indicate Nutrient Deficiencies?

While it's not common, severe nutrient deficiencies can lead to specific cravings, a phenomenon known as "pica." For instance, an iron deficiency might lead to cravings for ice, starch, or even dirt. Magnesium deficiency can cause chocolate cravings, as chocolate contains magnesium. Sodium deficiency might make you crave salty foods to balance electrolytes.

Common Cravings: Sweets and Salty Snacks

Sweet Cravings: Humans have an innate preference for sweetness, which evolutionarily signaled energy-dense food sources (like berries and other fruits) vital for survival. However, psychological factors now play a significant role in sweet cravings. Many people reach for sweets like candy bars during stress or boredom, as these provide comfort. Sugar has a powerful impact on the brain's reward system. Consuming sugar releases dopamine, a neurotransmitter associated with pleasure and reward, reinforcing our desire to consume more and creating a viscous cycle similar to addictive behaviors.

Salt Cravings: Many people crave salty foods. Sodium is a nutrient that is needed to maintain fluid balance in our body, it is required for nerves to function and for muscles to contract. Our natural craving for salt is due to its importance for survival as well.

Cultural factors, such as food cues in our environment can increase cravings and lead to overeating and weight gain. This contributes to the obesity epidemic in America, as food advertisements and cues are pervasive.

Hormonal Influences on Cravings

Let’s break down a few key hormones that play a role in food cravings and weight.

Ghrelin: Known as the hunger hormone, ghrelin stimulates appetite and increases cravings for high-caloric foods. Higher levels of ghrelin can lead to increased caloric intake. Interestingly, many people with obesity have lower ghrelin levels than lean people which leads us to wonder, are people with obesity just more sensitive to ghrelin?

Leptin: Produced in fat cells, leptin inhibits hunger and promotes feelings of fullness or satiety. Low leptin levels can increase cravings. The amount of leptin in your blood stream is proportional to the amount of fat cells you have. People with obesity have have higher levels of leptin which can cause the body to have a lack of sensitivity to it, a condition known as leptin resistance. Leptin resistance can also increase cravings.

Insulin: Fluctuations in insulin, in response to high-sugar foods, can lead to further sugar cravings. Exercise after eating can increase your insulin sensitivity and can help your body use insulin to lower your blood sugar more efficiently.

Cortisol: The stress hormone cortisol influences appetite, increasing cravings for high-calorie foods. Poor sleep and stress can elevate cortisol levels, affecting metabolism and leading to weight gain.

During menopause, hormonal changes like increased ghrelin and decreased leptin can intensify cravings. Studies suggest there is gender bias with weight and cravings with women having more difficulty resisting cravings than their mail counterparts. Understanding these changes helps remind us that obesity as a disease and hunger aren't about willpower; they’re about hormonal dysregulation.

GLP-1 Medications and Cravings

GLP-1 medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) help regulate appetite by mimicking the GLP-1 hormone. Tirzepatide also works on glucose-dependent insulinotropic polypeptide (GIP) receptors triggering insulin creation and sensation of feeling full resulting in improved blood sugar control and weight loss. These medications are a helpful tool for people interested in losing weight as they slow gastric emptying, enhance satiety (feeling full), and reduce hunger signals, leading to decreased food cravings. In my practice, I've seen food cravings substantially decrease with these medications, combined with personalized nutrition recommendations focused on high protein intake and whole foods like organic vegetables and fruits.

Strategies to Manage Food Cravings

Here are nine holistic strategies I use as a Denver primary care doctor to help patients manage food cravings:

1. Practice Mindful Eating: Be present while eating, focusing on your food and feelings. Avoid distractions during a meal like TV or social media, which can lead to overeating.

2. Protein-Rich Diet: A diet high in protein, healthy fats, and fiber can increase fullness cues and reduce cravings. Start your day with 30 grams of protein to limit cravings later.

3. Regular Meals: Eating at regular intervals helps stabilize blood sugar levels and prevent cravings. Avoid letting hunger reach extreme levels, which can lead to impulsive eating.

4. Stay Hydrated: Thirst can be mistaken for hunger or cravings. Aim for at least eight glasses of water a day unless otherwise directed by your doctor.

5. Reduce Stress: Engage in activities like exercise, meditation, or hobbies to prevent emotional eating.

6. Prioritize Sleep: Consistent sleep (7-9 hours) helps regulate hunger hormones and reduce cravings. Go to bed and wake up at the same time every day if you can.

7. Avoid Restrictive Dieting: Restrictive diets can increase cravings. Caloric restriction for weight loss, however, might decrease cravings over time by extinguishing conditioned responses. Focus rather on flexible restraint to make healthy food choices 80% of the time.

8. Cognitive Behavioral Therapy: Working with an obesity specialist or dietician can reshape your mindset about food.

9. Healthy Substitutions: Keep healthy options like Greek yogurt, fruits and nuts at home to satisfy cravings without derailing your nutrition.

Understanding food cravings and employing these strategies can help you manage your eating habits and improve your overall health. It's not about restriction but gaining a deeper understanding of our food choices and how they make us feel. If you’d like to learn more, tune in to our podcast "Lean in: Change Your Size, Change Your Life" for our episode on food cravings and how to manage them.