Always Hungry? How to Control Your Cravings

Are you one of those women who's hungry all the time? You may be sabotaging your physiology by eating the wrong foods for the wrong reasons ... or the answer could lie in your genes. New research gives us something to chew on.

Laura Lee Anders, a 38-year-old psychiatrist in Chicago, grew up feeling constantly hungry. There was plenty of food in the house, but it never seemed to be enough. not that there wasn't enough food in the house, just that what food there was didn't ever seem to be enough. 

As a little girl she spent her allowance on treats and gobbled them immediately. When she got older, she'd sneak into the kitchen at night hoping her parents didn't hear, and eat whatever she could get her hands on. In high school she started to worry about her endless appetite, so she did what many women do: restricted her food intake during the day, then ate all night. "I felt my whole body was aching for food," she recalls.

As an adult in medical school, Anders was too busy to eat, so she ignored her hunger, but when she began her practice, the hunger came roaring back. After gaining 15 pounds in a year, and when she found herself needing to get a larger wardrobe a second time, she knew she wasn't in control of her appetite. "It scared me," Anders says.

Always on the Prowl
Evolution put gnawing hunger in our gut so we'd have the drive -- no matter the danger from saber-toothed tigers -- to seek food. Today we're less likely to confront wild animals in our quest to eat, but for some of us the beast of hunger is always on the prowl. 

These are the people who say they rarely finish a meal and feel truly full. That every few hours their stomach starts making demands. That they are hungry all the time. In the world in which we live, someone who is hungry is rarely more than a few steps from something fattening to quell the pain.

Hunger is the result of a complicated choreography of physiology. When our stomach empties, our digestive system releases hormones -- including ghrelin, which stimulates appetite -- into the bloodstream, where they signal the brain, specifically the hypothalamus, that we've got to eat. The brain in turn sends a responding signal to our digestive system to get ready for food, thus the rumbling of our stomach preparing itself for a meal. When we're sated, that sets off another brain-to-stomach chemical cascade that tells us to stop.

It's a beautifully self-regulating system, except that nowadays for many of us it's not working as it should. The signals that say "eat" seem to be always on, and the ones that say "enough" are broken. There are several theories that could explain what's disabled our natural mechanisms of hunger: the junky diet or raging stress of modern life have disabled our natural mechanisms of healthy hunger -- or maybe even a gene gone awry.

Are We Really Hungry?
What many of us call hunger is actually "conditioned hypereating," says David Kessler, MD, former FDA commissioner and author of "The End of Overeating: Taking Control of the Insatiable American Appetite."

Fast food and vending machines have opened up a world of tempting options, which give visual and olfactory cues that leave us salivating like Pavlov's dogs. Ever smelled a coworker's french fries and been whipped into a frenzy of desire? That powerful stimulus has hijacked your brain, and a growling stomach is sure to follow. But are we really hungry? "Define hunger. Hunger's the wanting of food," says Kessler, a self-professed overeater. "I'm hungry all the time! We get cued based on past memories."

Furthermore, research shows junk food's magic combination of fat, salt, and sugar stimulates dopamine, a key neurotransmitter in the brain's reward-seeking mechanisms. When we get caught on that chemical treadmill, our unhealthy eating habits have the power to undo healthy ones, says Paul Kenny, PhD, a neuroscientist at the Scripps (Florida) Research Institute, who has demonstrated the corrupting effects of what scientists call "highly palatable" foods on rats. 

Lab rats usually eat a bland diet of chow designed to provide a healthy balance of protein, fats, and carbohydrates. When Kenny and his colleagues gave them unlimited amounts of cheesecake, bacon, and other delectables, soon almost all the rats were doubling their caloric intake and had become obese. 

Kenny said the reward pathways in the rat's brains became less and less sensitive to the food, changes similar to what happens in the brain of a cocaine addict. The more they ate, the less satisfying it became -- which only led them to search in vain for more junk food. When Kenny put the rats back on the chow, they seemed despondent. They starved themselves for weeks before they finally went back to their sensible old diet. 

"If people become obese on these foods," Kenny says, "then regular food may not cut it anymore." 

Faked Out by Stress
Our hunger mechanism can also get a false kick-start from stress. When our ancestors ran into a bear, their bodies churned out the stress-related hormone cortisol, which signaled the release of glucose into our bloodstream --  quick energy so we could run or fight. 

Now we're pinned in our cubicles, worrying over our jobs, but the same bodily mechanisms are in place. Once our body has released glucose, it thinks our energy stores need replenishing, and our appetite perks up. 

"In modern society the stressor is more likely to be psychological, so we're not using that fuel, and it gets deposited as fat," says A. Janet Tomiyama, MD, an obesity researcher at the University of California, San Francisco. 

Tomiyama says that one of the most common and self-defeating stressors women subject themselves to is chronic food restriction. "Dieting causes stress, so we're in this vicious cycle," she says. The dieting itself makes us hungry, the stress of being on a diet adds to our hunger, and when we can't stand it anymore, we comfort ourselves with irresistible bad food choices. 

Who's Most Susceptible?
Women may be particularly susceptible to the overwhelming desire for foods we're trying to avoid. In 2009 scientists at Brookhaven National Laboratory in Upton, New York, had a group of male and female volunteers fast for 14 to 16 hours, then presented them with their favorite foods (cinnamon buns, pizzas) to smell and taste while scanning their brains. 

Predictably, regions of the brain associated with hunger awareness and food craving showed increased activity for both sexes, but more so for the women. After another day of fasting, the two groups were again presented with their favorite foods, but were asked to suppress their desire to eat. 

While men's brains showed decreased activity in the food-stimulated areas, women's brains continued to light up. One theory proposed to explain the result is that women may be programmed to eat when food is available, in order to nourish children. 

Can We Blame Our Genes?
Finally, for some of us, the propensity for hunger could be written into our genes. With the unraveling of the human genome, scientists are finding indications that a whole constellation of genes may be involved in obesity: The best known is the gene FTO, a common variation of which is carried by almost half those of European origin and increases a person's likelihood of being overweight or obese. Overweight people generally have a normal metabolic rate, so scientists speculate the gene variant affects the way its carriers experience the signals of hunger and satiety. 

"These people must have a biological drive to eat more," says Soren Snitker, MD, who studies obesity at the University of Maryland School of Medicine in Baltimore. 

Genes are not destiny, however, he adds, citing a study he conducted of the Amish, a high percentage of whom carry the FTO gene variation. Amish people tend to lead very active lives, and the carriers were no heavier than the noncarriers if they were physically active for about three hours a day. Yes, three hours sounds like a lot, but as Snitker points out, until about 100 years ago almost everybody was that active. He says even moderate activity counts: walking briskly on your lunch hour, taking the stairs, gardening. 

While we may feel like those cheesecake-addicted lab rats, we have a powerful tool they don't have: self-awareness. Judith S. Beck, PhD, a psychologist and author of "The Beck Diet Solution: Train Your Brain to Think Like a Thin Person," says that if we aren't fasting but feel ravenous all day, sometimes what we're experiencing is not physiological hunger, and it's within our power to examine and redirect the urges that send us for the chips. 

"If you label it 'hunger,' it legitimizes it," Beck says. She says many of us have come to believe hunger itself is intolerable; one of her most unexpected pieces of advice is to accept that occasional hunger is not an emergency. After all, Beck notes, "Food tastes better if you're hungry." 

She encourages people in her program to test the idea that their hunger is tolerable by checking in with themselves during the day to monitor how uncomfortable they really are, and to remind themselves that they need not panic before the next regular mealtime. 

Hunger Versus Cravings
Anders took off the 15 pounds with the help of Weight Watchers and is keeping it off using Beck's program. She realized that often her overwhelming hunger hadn't been hunger at all -- she'd always eaten decent meals -- but cravings for the processed foods that gave her a sugar high and a temporary lift. "It's emotional eating," Anders says. " It's soothing for me." 

Jean Kristeller, PhD, a professor of psychology at Indiana State University, believes that even those of us who have spent years fighting the tendency to overeat can "harness the power of mindfulness training to create a better relationship with food." 

For 15 years Kristeller has been teaching "mindful eating," a program that combines meditation, psychological insight, and physical awareness of the difference between hunger and cravings. She has clients intensely focus on savoring each bite, learning to experience the gradual quelling of the desire for food. 

When Deirdre Mahan, 44, who works at Indiana State University, signed up for Kristeller's 12-week program two years ago, she couldn't identify when she was hungry or just bored or upset. Her reintroduction to the sensations in her body has changed her experience of eating. Before the program, "I could fill my plate three times, then be ready for pie," Mahan says. But now the holidays are different. "I'll fill my plate, eat half, and think, I'm uncomfortable. I've become aware of passing the point where it's healthy to keep eating."

Getting a Handle on Hunger 
When your lab-rat brain says your very survival depends on a cupcake, here's how to show it who's boss. Beck and Kristeller help us get back in touch with healthy hunger by cultivating physiological awareness and eating mindfully. 

Ask Yourself, How Hungry Am I, Really? 
Beck has her patients make a chart listing experiences they've had that have been severely uncomfortable (such as surgery), moderately uncomfortable (such as a root canal), and mildly uncomfortable (such as a headache). For just one day she has them eat a solid breakfast, then go all day with no lunch or snacks until dinner. Every hour they rate how uncomfortable they feel, using the chart as a guide. "It's startling to most people," Beck says. "They find their discomfort is never more than mild, and it comes and goes." 

Remind Yourself That Another Meal Is Coming 
Beck encourages each patient to divide the day's food intake into a schedule that seems most sensible for her. That makes it easier to avoid the food cues and traps that can lead to spontaneous munching. "Many people do well with three meals and three snacks per day," she says, "but if evening snacking is a downfall, a different plan might be to eat three good meals and two snacks after dinner. What's important is for people to know that it's normal to get hungry at times, and they'll be able to eat at the next scheduled time." 

Slow Down at Mealtimes 
Kristeller advises her patients that when they eat, they should do nothing else -- no watching TV, no snacking as they drive. As a mindful-eating exercise, she recommends choosing a small serving of a food that you like, one with some texture that you can chew easily. With the food in front of you, take a few deep, relaxing breaths. Now tune in to your experiences of physical hunger at the moment. What are they? Imagine a scale of 1 to 10, with 10 being as hungry as possible, and 1 being not at all hungry. What number is your hunger? How do you know? 

Savor Your Food
Then, Kristeller counsels, take a small bite of that food and begin chewing slowly, savoring the flavor and texture, and noting the level of enjoyment you're experiencing. As you eat small bites carefully and mindfully, note any changes in flavor and gratification. It may take only a few bites before the satisfaction level drops, depending on the food and how hungry you are. You can decide to stop eating when you've had enough. You can extend this practice to a full meal, or eating with other people -- more challenging, Kristeller says, but part of learning to eat mindfully.  


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