Hunger: It’s Not All in Your Head and The Daily Bite

Today’s food choices:

Today’s food choices, from upper left: homemade lettuce wrap filling x3; 12 ounces Isopure Zero Carb; multivitamin and calcium supplements x2. I forgot to snap a photo of the homemade BBQ turkey meatballs I made and ate as a snack. 😦
Today’s food was not exciting as we are getting ready to go out of town, and I wanted to make a dent in the lettuce wrap filling so that it wouldn’t go bad while we were away. I’ll finish the last of it tomorrow morning–there is one serving left.

Hunger is insolent, and will be fed. –Homer

You’re damn right, hunger is insolent.  Hunger is like a spoiled child who acts out until he gets his way.  Hunger, whether perceived or real, is what drives us to eat–many times past the point of satisfaction to the realm of uncomfortably full.  You know the kind of fullness I’m talking about too–the kind that forces you to sit up a bit straighter, maybe loosen your belt a bit and remain still for a while.

But once you’ve had sleeve surgery, this drive to eat changes quite a bit.  The portion of the stomach that is removed is responsible for producing ghrelin, one of the several hormones that regulates hunger.  My surgeon gives a brief explanation below (skip to 1:03 for the explanation):

And here’s an abstract from a paper published in the journal Obesity Surgery that provides evidence that VSG surgery does indeed lower circulating ghrelin levels in the plasma.

In short, the vertical sleeve gastrectomy blunts the appetite since ghrelin is no longer produced by the portion of the stomach cut out by the surgery.  However, over time, other hormones such as leptin will upregulate and the hormonal drive to eat will eventually return.  But long before the hormonally-driven hunger returns, another type of hunger is ever-present.  It’s present even before you have surgery, and it’s a type of hunger that’s a bit more tricky to deal with:  head hunger.

This head hunger is one that I fight on a daily basis.  It is one that is always with me, regardless of whether or not I have eaten a meal or snack.  My head hunger has grown slightly more intense over the past week, and I’m unsure if it is related to hormonal changes I’m going through with the hormones that regulate my menstrual cycle.  Pre-op, during certain times of my menstrual cycle if certain foods were not nailed down, I would eat them whether or not I was hungry for them.  The head hunger I’m struggling with could also be more intense this week because I’ve been eating soft solids for the past week, and now because I’m able to chew and bite, if I see something, I want to bite it, taste it and eat it.  I’ve also been at a few events this week that were at restaurants where everyone around me was eating things that smelled good (and probably tasted good too), and of course, the physical response to food doesn’t change–you still salivate at the sight and smell of good food.

I also think that the Fat Girl who resides in my subconscious brain is trying to lure me back into my old habits, and the Thinner Girl is very consciously trying to form new eating habits that are more in line with my new anatomy and lifestyle.  So far, Thinner Girl is winning, but it’s a hard-fought and constant battle.

I’m not feeling physical hunger at all, and it is tough to describe what that is like.  My husband asked me not too long ago, “What is it like not to be hungry?”  I had a hard time describing what it felt like.  There really isn’t an internal cue to eat–I just don’t feel physically hungry.

Does this mean that my stomach no longer growls?  No.  It does, but only periodically.  When it does, it generally means that it is producing a bunch of gastric juices, including HCl (hydrochloric acid, the stomach acid we all make), and this action can mimic hunger.  When this happens, I make sure that I’ve taken my Pepcid, an H2 receptor inhibitor that prevents the cells responsible for producing HCl from making quite so much.  I was prescribed this for 3 months post-op to ensure that my stomach would not overproduce acid so that my staple line had a chance to heal up thoroughly.

I eat more or less on a schedule now because I have to in order to get in my protein requirements for the day.  Eating is now a task to be completed, rather than something I do because I want to.  I am now reliant on external cues (a clock) to tell me when to eat.   Since school is getting ready to start, I felt that putting myself on some kind of schedule was also necessary because I get so busy with my students and what we’re doing that I know I would forget to eat otherwise.  I am hopeful that eventually I will find some kind of rhythm with my eating and that the clock won’t serve as my guide, but right now my body isn’t telling me it’s chow time.  I guess I need to be patient with myself.

I saw this great graphic on Facebook earlier this week (I don’t remember what page) that sums up the difference between physical hunger and head hunger (they call it emotional hunger here):

The head hunger I’ve been feeling is definitely of the “emotional” variety.  Here are some ways I’ve elected to deal with it:

• Keep a glass of water close by.  At Rotary meetings I make sure my glass is filled at every opportunity.  We meet at restaurants, and right now there is nothing on any menu that is appropriate for me to eat.  Couple this with the fact that I’m still learning to eat and socialize, and I’m really just better off having a snack beforehand at home and sipping water throughout the meeting.  It has worked for me so far at the three meetings I’ve been to post-op.  Also, did you know that being thirsty can mimic hunger as well?
• Remind myself that whatever it is I’m craving will not help me achieve my health and fitness goals.  Tonight our Rotary group met at a Greek restaurant.  The guy sitting next to me ordered hummus, which came with fresh pita bread that smelled freaking AWESOME.  I kept smelling it, my brain kept wanting it, but I kept telling myself, “No…this will not feel good in your tummy and it’s not going to help you.  It might taste good but it won’t feel good.”  And that killed whatever desire I had for the pita at that moment.  I don’t like feeling icky, and I knew that while the bread would taste oh so good, it would definitely feel gross in my new stomach.  Maybe someday I can have a bite of fresh pita and hummus, but not now.
• Remember that hunger is not an emergency.  If I don’t eat the thing I want, I’m not going to die because I didn’t get to eat it.  I’ll go on living and everything will be okay if I don’t get to eat whatever my brain thinks it needs to feel better.  And hey, added bonus, my stomach will still feel good!

I knew going into this process that the head game would be the toughest part.  I also knew it would be a constant work in progress.  It is turning out to be something I have to be super vigilant about so that I can stay on track and reach my health and fitness goals.  Thinner Girl is trying really hard to teach Fat Girl new habits and behaviors, but Fat Girl is proving to be a recalcitrant student.  I am hopeful that eventually she’ll pick up on the fact that these new behaviors are here to stay and that to live in harmony with Thinner Girl, Fat Girl will have to learn to behave in new and strange ways that really are better for her in the long run.