Ghrelin: The “Hunger Hormone” Explained

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Posted on: 24 June, 2016

Young Woman Hungry and FrustratedWeight loss can be tough, but maintaining your weight after a diet is even harder.

Research shows a large percentage of dieters regain all the weight they lost within just one year (1).

Weight re-gain is partially due to your body’s appetite and weight-regulating hormones, which try to maintain and even re-gain fat (2, 3, 4, 5).

Ghrelin, the “hunger hormone,” plays a key role because it signals your brain to eat (6, 7, 8).

Its levels increase during a diet and intensify hunger, making it hard to lose weight (9, 10).

Here’s everything you need to know about this hormone and how to keep it in check.

What is Ghrelin?

Ghrelin is a hormone produced in the gut. It is often termed the hunger hormone, and sometimes called lenomorelin.

It travels through your bloodstream and to your brain, where it tells your brain to become hungry and seek out food.

Ghrelin’s main function is to increase appetite. It makes you consume more food, take in more calories and store fat (7, 11).

The graph below shows how rats injected with the hormone had a rapid increase in weight (12).

Ghrelin Weight Gain Graph

In addition, it affects your sleep/wake cycle, reward-seeking behavior, taste sensation and carbohydrate metabolism (7, 11).

This hormone is produced in your stomach and secreted when your stomach is empty. It enters the bloodstream and affects the part of the brain known as the hypothalamus, which governs your hormones and appetite (11, 13).

The higher your levels, the hungrier your get. The lower your levels, the more full you feel and the easier it is to eat fewer calories.

So if you want to lose weight, lowering your ghrelin levels can be beneficial.

Ghrelin may sound like a terrible, diet-wrecking hormone. However, in the past it played a role in survival by helping people maintain a healthy level of body fat.

These days, if you under-eat or struggle to gain weight, higher ghrelin levels may help you consume more food and calories per day.

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Bottom Line: Ghrelin is a hormone that sends a signal to your brain to feel hungry. It plays a key role in regulating calorie intake and body fat levels.

What Causes Ghrelin to Rise?

Hungry Man Sitting at a Table With an Empty Plate

Ghrelin levels typically rise before a meal, when your stomach is empty. Then they decrease shortly after, when your stomach is full (14).

While you might assume obese people have higher levels, they may just be more sensitive to its effects. In fact, some research shows their levels are actually lower than in lean people (15, 16, 17).

Other research suggests that obese people may have an overly active ghrelin receptor, known as GHS-R, which leads to increased calorie intake (6, 7).

Yet regardless of how much body fat you have, ghrelin levels increase and make you hungry when you start a diet. This is a natural response by your body, which tries to protect you from starvation.

During a diet, your appetite increases and your levels of the “fullness hormone” leptin go down. Your metabolic rate also tends to decrease significantly, especially when you restrict calories for long periods of time (18, 19).

For obvious reasons, these adaptations can make it significantly harder to lose weight and keep it off.

Your hormones and metabolism adjust to try to re-gain all the weight you lost.

Bottom Line: Ghrelin levels can rise during a diet, increasing hunger and making it harder to lose weight.

How Your Levels Change During a Diet

Within a day of beginning a diet, your ghrelin levels will start to go up. This change continues over the course of weeks.

One study in humans found a 24% increase in ghrelin levels on a 6-month diet (20).

In another 3-month weight loss diet study, researchers found the levels nearly doubled from 770 to 1,322 pmol/liter (21).

During a 6-month bodybuilding diet, which attains an extremely low level of body fat through severe dietary restrictions, ghrelin increased by 40% (22).

These trends suggest that the longer you diet — and the more body fat and muscle mass you lose — the higher your levels will rise.

This makes you hungrier, so it becomes much harder to maintain your new weight.

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Bottom Line: Ghrelin levels have been shown to increase significantly on a weight loss diet. The longer the diet, the more your levels will increase.

How to Lower Ghrelin and Reduce Hunger

Fork and Knife on Green Scales

Ghrelin seems to be a hormone that can’t be directly controlled with drugs, diets or supplements.

However, there are a few things you can do to help maintain healthy levels:

  • Avoid weight extremes: Both obesity and anorexia alter ghrelin levels (23, 24)
  • Control calorie intake: Both high-fat and high-carb meals reduce your levels. Therefore, total calories matter more than the composition of your diet (25).
  • Prioritize sleep: Poor sleep increases your levels, and has been linked to increased hunger and weight gain (26, 27).
  • Increase muscle mass: Higher amounts of fat-free mass or muscle are associated with lower levels (28, 29, 30).
  • Eat more protein: A high-protein diet increases fullness and reduces hunger. One of the mechanisms behind this is a reduction in ghrelin levels (31).
  • Maintain a stable weight: Drastic weight changes and yo-yo dieting disrupt key hormones, including ghrelin (32).
  • Cycle your calories: Periods of higher calorie intake can reduce hunger hormones and increase leptin. One study found 2 weeks on 29–45% more calories decreased ghrelin levels by 18% (33).

Bottom Line: Maintaining a stable weight, avoiding long dieting periods, eating more protein and getting more sleep can help optimize ghrelin levels.

Take Home Message

Ghrelin is a very important hunger hormone.

It plays a major role in hunger, appetite and food intake. Because of this, it can have big effects on your success with weight loss and maintenance.

By having a sustainable and enjoyable diet plan, you can avoid large hormone changes that may lead to yo-yo dieting and weight re-gain.

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About Herbs: an app to avoid

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Posted on: 24 June, 2016

Medicine has an intellectual hierarchy. Supposedly the best and the brightest are in the academic medical centers and are the thought leaders in their field.

Those of us lower in the hierarchy are well aware of some of the warts present on our betters, but I would expect those at the top would adhere to the highest intellectual and ethical standards. People being, well, people, expecting exceptional standards is admittedly an unrealistic expectation.

It would appear that many academic centers are doing their best to avoid meeting my expectations, attempting to abandon all standards.

I mentioned over at SfSBM that Dana-Farber is spending 2 million dollars on a renovation to, in part, offer the unmitigated steer manure that is reiki and reflexology to their cancer patients. Yes. Reiki. Reflexology.

Those are not fracking earthquakes in Kentucky, those tremors are the result of the tremendous kinetic energy of Flexner spinning in his grave as his life’s work becomes a farce.

Dana-Farber is just one of many academic medical centers who are putting their imprimatur on nonsense.

Memorial Sloan Kettering Cancer Integrative has released  About Herbs, an iPad/iPhone guide to Botanicals, Supplements, Complementary Therapies and More. Spoiler alert:  the ‘More’ does not include critical thinking. This guide is not anywhere as ludicrous as offering reeky, sorry, reiki, but at times it comes close.

My bias does kick in looking at the Sloan Kettering guide. I have my own compendium of infectious diseases, so I have strong opinions about what does and does not make for a good medical guide.

In my opinion a good medical guide should take a complex topic and interpret the evidence. A given study is often within the context of a broader literature and needs to be understood in context.

The About Herbs approach to evidence seems to be if there is any evidence, good, bad or indifferent, then mention and reference it. But don’t explain or advise. The approach renders the guide next to useless.

For example, Zhong Jie Feng.

It is a traditional Chinese-pseudo-medicine used for

bruises, bone fractures, arthritis, nausea, internal pain, and cough.

Those are 6 processes with similar physiologies. I can see how Zhong Jie Feng would work for all six.  That, btw, is sarcasm.

But Zhong Jie Feng is “hepatoprotective and cytotoxic.”

Hmm. It protects cells and it kills cells.  What exactly are they referring to?

The hepatoprotective is

against D-galactosamine-induced toxicity in WB-F#44 rat hepatic epithelial stem like cells

and the cytotoxicity was

some of the new isolates exhibit significant cytotoxicities when tested against a small panel of tumor cell lines.

But probably not liver tumor.

So for a patient, or a clinician, a fundamentally useless hodgepodge of unrelated information once the references are reviewed.

Zhong Jie Feng is perhaps useful for idiopathic thrombocytopenia purpura AND protective against viral pneumonia. In mice.

And Zhong Jie Feng relieves fatigue in cancer patients AND decreases mucositis. In non blinded, non placebo controlled trial with a p of <0.05 if you hunt down the reference.  Hardly impressive data.

It sounds like Zhong Jie Feng is the wonder drug that works wonders from the text and until a look at the supportive literature yields an unimpressive result.

It seems they just throw whatever material is available at the wall and see what sticks. But if you go to the references the ‘evidence’ is not impressive and my interpretation of Zhong Jie Feng is that if it contains bioactive compounds the evidence to support its effects in vivo are minimal and in vitro even less.

That is all from the “Professional” side of the app, as if patients are not going to go though this laundry list of poorly reported information. The “Consumer” side is not referenced, but gives similar, if watered down, information on its purported uses with no final recommendations.

I would tell patients to save their money on Zhong Jie Feng, but About Herbs is no Consumers Reports.

But I knew nothing going in about Zhong Jie Feng. How about the entries for products about which I know something?

Shark cartilage?  About Herbs suggests shark cartilage has no effect on any process for which it has been tested. Yet nowhere do they explicitly say don’t take it, it is leading to the decimation of shark populations.

Echinacea? It doesn’t prevent colds and it does not have any clinically relevant effects on cold symptoms. Sure, patients had their cold symptoms shortened by 0.16 days, or 3 hours, 50 minutes, and 24 seconds. Anyone besides me think this is noise in the data? Not the authors of About Herbs.

Saw Palmetto? The best study and meta-analysis shows no benefit for the symptoms of benign prostatic hypertrophy, a result echoed in the Cochrane Reviews.

Of course, that’s if you look at all the data. If you a cherry pickin’ daddy, like About Herbs, you report on some data, as is disingenuously noted in

Several clinical trials and meta-analyses have shown that saw palmetto improves urinary tract symptoms associated with BPH

and, of course, several have not. That the better quality studies and meta-analysis point to lack of efficacy isn’t mentioned.

All three of these products have a “Mechanism of Action” section. But the products don’t do anything, so how can they have a mechanism of action? I suppose the title is shorter and more to the point than the more descriptive “Random Results of Pointless Studies by Those Who Use Why Most Published Research Findings Are False as a ‘How To’ Rather Than a Warning.”

Besides herbs they also report on a hodgepodge of other SCAMS.

Magnets? They recognize as bunkum.

The Gonzalez Metabolic Therapy is noted to be dangerous and useless. Which is nice. As in many the analyses in, About Herbs itself offers no recommendations or analysis. Instead they note

The American Cancer Society urges cancer patients not to seek treatment with metabolic therapies.

But not About Herbs? I would wonder if those who mistrust modern medicine could construe these weasel words as, if not an implicit approval, then at least a ‘do as you want, you will anyway’ shrug.

Vitamin O? They note it to be nonsense.


Proponents of Traditional Chinese Medicine contend that qigong works to promote a healthy, balanced flow of energy – called “qi” – within the body. Many believe that a disturbed or blocked flow of qi produces discomfort and illness within an individual; conversely, with a balanced, free flow of qi, one is believed to be in better health.

About Herbs is nonjudgemental, failing to suggest this explanation is gibberish.


They repeat every canard about this useless theatrical placebo. For every assertion about acupuncture, there is probably an SBM article that refutes it. They ignore the vast contradictory literature on acupuncture as well.

There is evidence that acupuncture can reduce symptoms such as depression, facial pain, headache, peripheral neuropathy, lower back pain, nausea and vomiting, neck pain, postoperative pain, shortness of breath, chronic fatigue, hot flashes and side effects caused by radiotherapy and/or chemotherapy. It may also assist with lifestyle changes such as smoking cessation.

Not mentioned is the evidence is all biased and of poor quality whose efficacy vanishes as the quality of the study improves.

It is as if the entire acupuncture literature were put into a Nutri-Matic machine and it produced an analysis of acupuncture that that is almost, but not quite, entirely unlike the truth.

Unlike other interventions, they downplay acupuncture complications with only three references, unlike other entries were every complication is  often noted.

And then.


There is the entry on homeopathy.

There is some evidence that homeopathy may benefit individuals with chronic conditions.

Homeopathy, developed more than 200 years ago, is based on the Law of Similars, or “like cures like.”

Clinical studies have been conducted to evaluate benefits of homeopathy, but data are limited and results, inconclusive. More research is needed.

No, no a thousand times no. Maybe I should have started with homeopathy, as any guide that finds homeopathy even remotely reasonable is produced by those who evidently have no understanding of reality-based medicine.  And that the Australians and English both have produced extensive analysis that demonstrate the worthlessness of homeopathy is somehow not mentioned.

If you judge a article by the company it keeps, these articles hang out with medical unicorn tears.

I looked at the Sloan Kettering Integrative Medicine website. They offer acupuncture, reflexology and reiki, what I would consider fraudulent magic. They charge a pretty penny for the acupuncture. I can’t see it in their interest to be critical of the practice.

About Herbs is a mixed bag.

Some good information, some sketchy, some positively BS. And if you do not have the background in medicine, critical thinking and SCAM, how are you going to know which is which?  Much of the information is presented in a shruggies Gish Gallop of often cherry picked information and the occasional lie by omission.

For consumers? It isn’t worth the price. Look elsewhere.

For health care professionals?About Herbs does not contain enough explanation to allow you to separate the good from the bad from the ugly. Every referenced statement needs to be evaluated for veracity and context as they can’t be trusted or even understood.

For SBM advocates? It is an excellent example of how not to present pseudo-medical information.  Or any information for that matter.

About Herbs will appeal most to true believers in pseudo-medicine who wish for the patina of scientific validation without the need for a real understanding and who cannot or will not apply Feynman’s admonition.  That would be Integrative Medicine practitioners and Naturopaths I suppose.


I got a call from my sister that my dad had taken a turn for the worse, and I needed to get home right away. I wasn’t ready for that. When I got to the hospital, he had already slipped into a coma. I had missed all the dramatic goodbyes that were said because everyone knew he was not gonna make it. So that was upsetting.

He was in a coma for a while. It was that weird place where everybody is connected by this thing and it’s killing us. After two weeks, I brought up the idea that maybe we should pull the plug. I don’t know where that saying comes from, ’cause nobody pulls a plug. Everybody stays plugged in.

But it was time. We all knew. I thought it would happen like on Days of Our Lives. I thought you would pull the plug, and there’d be a lot of crying for ten to 15 minutes, and then the person would pass, and you would be sad, but it would be over.

Instead, we waited for four, then five, hours. And you wanted to scream, ’cause it’s crazy. Right in the middle of this, they wheel another woman into our room, a woman who had just had heart surgery. I remember thinking, That’s not a good idea. My dad is dying. Why are you bringing in a woman who’s had heart surgery? That doesn’t make any sense. It’s bad management.

The woman was on a lot of medication and saying crazy things. She’s 80 and naked and kicking her covers off. I’m on this side of the room, with a curtain that is not very soundproof, sitting by my dad, saying, “I love you, Dad. I’m really going to miss you.”

From the other side, we hear, “Cinnamon.”

“You were such a great dad to me.”


“Dad, you were wonderful—”


Finally, you can’t help laughing, because your life is exploding in front of your eyes, and it’s that moment where you’re crying and laughing. Then my husband says, “Thirty ccs of cinnamon, stat!” It killed me, and we all stopped crying for a moment and laughed really hard.

Four hours later, the nurse says, “It’s probably time. His heart rate is lowering.” We are holding his hand, and she says, “Maybe if you tell him it’s OK to go, he’ll go.”

So we all say, “Daddy, it’s OK” and “We love you,” and my mom says, “John, you were such a great dad, and I love you, and it’s OK, I’ll take care of the girls.” And across the room from the old lady in the bed, we hear, “Don’t go, John.”


And I remember thinking, That’s what I feel. That was what was inside me. I think I gave that woman my words: “Don’t go, John. Don’t go.”

But he did. I had my hand on his chest and his heart stopped.

Later, we found out Cinnamon Lady—that’s what I call her, Cinnamon Lady—didn’t have anyone in her life named John. I thought, Wow, that’s crazy. But we also learned she was a baker. So we understood the cinnamon part.

*Told live at a Moth show at the Echoplex in Los Angeles, CA

vending machine

Here’s a picture from a diabetes clinic in Oxford (source).

Eating these “foods” will keep the patients’ blood sugar levels on a roller coaster, causing blood sugar swings that can only be controlled with much insulin. This is potentially dangerous in type 1 diabetes, and in type 2 it leads to a vicious cycle of weight gain, more insulin and a chronic progressive disease.

This is really not that different from a cigarette vending machine in the waiting room of an asthma clinic. It’s a sign of complete ignorance.

Instead, eating a low-carb diet stabilizes patients’ blood sugars and decreases the need for diabetic medications.

Another example

Lunch at the Diabetes Conference

Try it

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