Decoding Satiety: A Functional Nutrition Perspective on Hunger Hormones After Bariatric Surgery
September 9, 2024Decoding Satiety: Sarah came to me with a perplexing issue that might resonate with you — day after day, she was unable to tell whether she was hungry or not. Years after her bariatric surgery, she often found herself either eating without thinking or skipping meals entirely, struggling to tune into her body’s hunger signals. Reflecting on her past, Sarah realized this sensation was not new. She had long struggled to recognize these cues. In fact, she could not recall a time when she had felt genuine hunger or chosen to stop eating because she felt full. Instead, she would eat until the food was gone, regardless of her body's needs.
While her natural feedback system for satiety had always seemed unclear, after surgery this sense of disconnection deepened, further complicating her health journey. She was dedicated to maintaining the health gains from her surgery but felt unsure how to manage her absent sensations of hunger and fullness. Plus, she was beginning to notice new and confusing symptoms, which she knew she needed to address before they worsened.
Decoding Satiety: It Is Integrated Into Our Psychology
Sarah’s situation is a poignant reminder of how deeply satiety is integrated into our psychology and physiology and how it can become significantly disrupted.
When our biological signals for hunger and fullness are skewed, it can lead to a troubling cycle of nutrition hypo-sufficiency (undereating) or hyper-sufficiency (overeating). Although there is no one-size-fits-all amount of food that is just right — since individual needs can vary widely — persistently leaning toward either extreme can pose significant health risks.
For Sarah, the inability to accurately gauge her hunger led to specific nutrient deficiencies, which then exacerbated her long-standing compulsive eating behaviors. This pattern not only undermined her recovery and quality of life but also impacted her maintenance goals post-surgery. The repercussions were profound, extending beyond weight management to affect Sarah’s mental health and exacerbate her chronic conditions. These complications were primarily fueled by disrupted satiety signals and nutrient imbalances, which in turn led to erratic blood sugar levels and weakened immune responses.
In addition, Sarah’s growing sense of disconnection from her body and its fundamental needs, which she found deeply troubling, were among the multitude of factors that ultimately led her to seek my help.
Functional Medicine Is An Integrated Approach
In a conventional healthcare model, aspects of an individual’s health might be segmented and addressed by different specialists. We might look at body composition with one provider and eating behaviors with another, while simultaneously seeking support for issues such as diabetes or chronic digestive imbalances with additional practitioners. But in Functional Medicine, we recognize the intricate connections between various health symptoms and conditions, advocating for an integrated approach. All of Sarah’s signs and symptoms — from the inability to assess her hunger to the impact of the nutrient deficiencies, to immune dysfunction, to anxiety, to compulsive eating behaviors — are connected. Every single one.
And from a Functional Medicine standpoint, satiety isn’t just a hunger and fullness signal. It’s a gateway to understanding our bodies' deeper needs and responses. This perspective takes into account the complex interplay between our genes, digestion, inflammation, and the gut microbiome. For Sarah and many others navigating similar journeys, comprehending these interconnections is not merely important — it's essential.
Satiety is more than just feeling full. It's about understanding our body's signals for nourishment and satisfaction. It involves complex internal processes that help us decide when to eat and when we have eaten enough, with wide-ranging implications for our overall health. This recognition encourages us to foster a relationship with our body that is informed, compassionate, and respectful of our intrinsic wisdom.
Understanding Satiety
Satiety is a complex interplay of physiological, psychological, and behavioral events that dictate our eating behaviors. The gut-brain axis is central to understanding satiety. This axis is a bi-directional communication system between the two organ systems — the gut and the brain. It plays a crucial role in hunger and fullness cues. Hormones such as ghrelin, often called the "hunger hormone," and peptide YY, a hormone involved in reducing appetite, are key components of this system. Both of these hormones are produced in the gut! And they both signal the brain to influence our feelings of hunger and fullness.
As you know, the structure and function of the gut undergo significant changes after bariatric surgery. These changes can dramatically alter the production and response to these hormones. The surgery often leads to a quicker transit time of food through the stomach and small intestine, which may result in a faster onset of peptide YY and a reduction in ghrelin levels shortly after eating. That said, these changes can be unpredictable, leading to unusual patterns of hunger and satiety that patients like Sarah may find difficult to manage.
In addition to these structural and physiological changes, there are myriad psychological and behavioral aspects of eating that cannot be rectified by surgery. Psychological factors, including stress, anxiety, and emotional states or triggers, can profoundly influence eating habits and perceptions of hunger and fullness. Behavioral factors, including the speed at which we eat, the texture of food, and even the social setting in which food is consumed, can further modify the signals of satiety that we receive. For patients who have had bariatric surgery, these factors can become even more complex due to the altered digestive anatomy and the need to adapt to new dietary habits or restrictions.
Understanding satiety in this comprehensive way helps illuminate why managing diet and hunger can be challenging after bariatric surgery. It underscores the importance of a supportive nutrition strategy that accommodates the altered physiology of the gut, addresses individual psychological needs, and considers a person’s unique lifestyle and eating behaviors. This holistic approach is essential for helping patients like Sarah adapt to their new digestive realities and build and maintain a healthy relationship with food.
Five Influencers of Satiety
Satiety is influenced by five distinct but interconnected categories that dictate our eating behaviors:
- Sensory: The taste, smell, and visual appeal of food can significantly affect our desire to eat and our sense of fullness.
- Cognitive: Our perceptions and expectations about meals can influence eating patterns and satiety.
- Digestive: Changes in the stomach and intestines, as well as the microbiome, during and after eating, play a crucial role in how we process and respond to food.
- Post-ingestive: The sensations that occur after food consumption can affect our ongoing desire to eat.
- Post-absorptive: The absorption of nutrients and the resulting hormonal responses signal our brains that we are full.
In the context of bariatric surgery, where digestive structures and functions undergo significant alterations, these five areas become critical entry points for addressing dietary interventions. By focusing on these influencers, we can tailor nutrition strategies that accommodate the unique challenges faced by individuals adjusting to life post-surgery.
Strategic Nutrition Approaches
In Functional Nutrition, we don’t adhere to a single dietary theory. We do embrace principles that allow us to reshape both our external relationship with food and our internal responses to our body's signals. Starting with the makeup of the food itself, our approach addresses all five influencers of satiety — sensory, cognitive, digestive, post-ingestive, and post-absorptive. This comprehensive strategy ensures that we cater to the unique needs of each individual, particularly after undergoing significant changes such as bariatric surgery.
A functional nutrition approach emphasizes:
- Balanced Macronutrients: Incorporating a balance of proteins, healthy fats, and fibers is essential for stabilizing blood sugar levels and promoting sustained satiety. Post-surgery, it's crucial to adjust macronutrient ratios to support the altered digestive system, potentially requiring smaller, more frequent meals enriched with high-quality proteins and fibers to ensure adequate nutrition without overwhelming the gut. In Functional Nutrition, we emphasize the mantra ofFat/Fiber/Protein.
- Dietary Diversity: Eating the rainbow (foods of every color!) ensures a broad intake of essential nutrients, which supports gut health and hormonal balance. A diverse diet provides a range of vitamins, minerals, fibers, and phytonutrients, crucial for feeding a healthy gut microbiome and aiding overall hormonal regulation related to hunger and fullness.
- Mindful Eating: Encouraging awareness during eating helps us connect or reconnect with our body’s hunger and fullness cues. Identifying yes, no, and maybe foods enables us to discern which foods nourish us physically and emotionally. Mindful eating practices — such as eating slowly and savoring each bite, while also recognizing which foods do or don’t make us feel great — can enhance the perception of satiety and foster a positive long-term relationship with our bodies and food.
By embracing these strategies, individuals’ post-bariatric surgery can manage their new digestive realities more effectively, cultivate a healthier relationship with food, and support holistic recovery and maintenance of health gains. This approach encourages us to honor our bodies' needs and signals without judgment, fostering a culture of self-care and respect that transcends traditional diet-centric views. This focus extends beyond mere weight management to encompass a comprehensive understanding of health and healing, making space for a diverse array of personal experiences and motivators.
Decoding Satiety: Complex Interactions
As was the case for Sarah, satiety was not a standalone phenomenon but rather a complex symptom influenced by various bodily processes and systems. In working with Sarah, we focused on the three key Functional Nutrition interventions: balanced macronutrients, dietary diversity, and mindful eating. We did this slowly, building each skill when she was ready to broaden her toolbox. By balancing her macronutrients, Sarah slowly but surely began to notice a stabilization in her blood sugar levels, which in turn helped moderate her hunger cues. Embracing dietary diversity, Sarah learned to 'eat the rainbow,' which not only enhanced her nutrient intake but also supported her gut health and overall hormonal balance. And through simple yet targeted mindful eating practices, Sarah developed a deeper connection with her body’s signals of hunger and fullness. This newfound self-awareness shifted her relationship with food from one of anxiety and confusion to one of respect and understanding.
By adopting an empathetic, comprehensive, and adaptive Functional Nutrition approach, we can better understand and manage all the complexities of satiety, especially in cases of post-bariatric surgery. This holistic view supports the foundation that everything is connected, and by nurturing our body with nutrient-dense foods and supportive habits, we can achieve a more balanced road forward.
Andrea Nakayama is a Functional Medicine Nutritionist, educator, author, speaker, and award-winning podcast host. Her website is AndreaNakayama.com
 | ABOUT THE AUTHOR After losing her young husband to a brain tumor in 2002, Andrea Nakayama discovered a passion for using food as personalized medicine. This profound experience inspired her to become a Functional Medicine Nutritionist, educator, author, speaker, and award-winning podcast host. Her website is AndreaNakayama.com |
