I see a lot of my patients who complain that they get food cravings on and off when they really feel like they need to eat carbs. They often end up binging during these episodes. These cravings are a major barrier for those trying to control their calorie intake and lose weight. I will discuss a case and the underlying causes of these cravings. Below is a common scenario that will help us understand the connection between food cravings, weight gain, and cortisol
Case 1
A 35-year-old female experienced food cravings during the evening and night. She was progressively gaining weight especially around her belly. She was under a lot of stress due to family issues and work. She also had complaints of brain fog and fatigue. It took her more than 30 minutes to fall asleep and she often woke up in the middle of the night.
In order to understand the root cause of this patient’s problem, we need to understand how the hormone Cortisol works.
Cortisol is an essential hormone that is released by the adrenal glands. It is responsible for helping our bodies deal with stress through its action on multiple systems. It promotes the formation of glucose in the liver and the a breakdown of protein to release amino acids that can be used for forming glucose. It also impacts the immune system, the sleep-wake cycle, bone formation, electrolyte and water excretion, memory and mood. This hormone has a particular rhythm called the circadian rhythm that it follows to regulate the body’s different functions. The highest level of Cortisol is in the morning, and the lowest is at night time.
Individuals undergoing a lot of stress or an inflammatory condition are likely to release a lot of cortisol that can adversely affect the circadian rhythm. Excessive cortisol and abnormal cortisol rhythm is associated with food cravings including cravings for carbs and fatty foods. In addition, these individuals have also been found to have symptoms of insomnia, weight gain especially around the belly area, and muscle wasting. A prolonged period of cortisol exposure leads to suppression of the immune system with increase in allergies and infections. Cortisol also affects the function of the thyroid gland including the conversion of the inactive thyroid hormone T4 to the active thyroid hormone T3. Women can have infertility issues, and men will have decreased libido from excess cortisol due to the inability to form progesterone and testosterone respectively. Insulin resistance, Metabolic Syndrome, obesity, polycystic ovary disease, Diabetes, and high blood pressure are associated with excess cortisol production.
The cause of our patient’s food cravings was found to be an abnormal cortisol rhythm. In addition, her insulin and HBA1C (a marker of diabetes) levels were also high possibly from the high cortisol level. This case’s most important part was determining the root cause of abnormal cortisol. She had a lot of bowel issues including an overgrowth of bacteria in her small intestine, which was the main source of inflammation causing the high cortisol. Her insomnia was related to high cortisol at night. Her fatigue was due to decreased active T3 from the high cortisol. Her brain fog was due to the alteration of cortisol and insulin levels.
The first step in understanding your food cravings is to keep a weekly diet diary where you can identify when and how often you get food cravings. The second step is completing the Medical Symptoms Questionnaire, which provides you with an overview of all other symptoms that can also be part of the problem. The third is evaluating the cortisol rhythm, insulin, and blood sugar levels followed by a root cause analysis of the problem.