Hormones act as the body's chemical messengers, facilitating numerous bodily processes, including metabolism, hunger, and feelings of fullness. Because of their influence on appetite, certain hormones also play a significant role in body weight. When weight loss occurs, the body undergoes various hormonal adjustments. This article delves into the phenomenon of hormone dumping, particularly in the context of weight loss, and explores related conditions like dumping syndrome, as well as strategies for maintaining hormonal balance.
What is Dumping Syndrome?
Dumping syndrome is a medical condition in which your stomach empties its contents into your small intestine more rapidly than it should. It’s also called rapid gastric emptying. When your stomach empties too quickly, your small intestine receives uncomfortably large amounts of poorly digested food. This can cause symptoms of nausea, bloating, abdominal cramps and diarrhea. It can also cause sudden blood sugar changes.
Dumping syndrome after gastric bypass surgery is when food gets “dumped” directly from your stomach pouch into your small intestine without being digested. There are two types of dumping syndrome: early and late. Early dumping happens 10 to 30 minutes after a meal. Late dumping happens 1 to 3 hours after eating.
Early Dumping Syndrome
Early dumping syndrome can occur because of the dense mass of food that gets dumped into your small intestine at an earlier stage of digestion. The intestines sense that this food mass is too concentrated and release gut hormones. Your body reacts by shifting fluid circulating in your bloodstream to the inside of your intestine. As a result, your intestines become fuller and bloated. Diarrhea often occurs 30 to 60 minutes later.
Late Dumping Syndrome
Symptoms of late dumping happen because of a decrease in blood sugar level (reactive hypoglycemia). Reactive hypoglycemia is low blood sugar caused 1 to 3 hours after a large surge of insulin. You are more likely to have dumping syndrome if you eat a meal heavy in starches or sugars. The sugars can be either fructose or table sugar (sucrose).
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Prevalence and Causes
Dumping syndrome occurs in approximately 20% to 50% of those who have had gastric surgery. Most people have early dumping symptoms. About 1 in 4 people have late dumping symptoms, which occur 1 to 3 hours after a meal.
Your stomach usually releases digestive contents into your small intestine in a gradual, controlled manner. The way your stomach moves food along through the digestive process is sometimes called your “gastric motility." Many things are involved in gastric motility: muscles, nerves and hormone signals coordinate together to tell your stomach how and when to empty. If any of these things are impaired, it can throw this coordination off.
Uncontrolled gastric emptying means that the valve at the bottom of your stomach, the pyloric valve, simply opens and dumps everything out, before your stomach has finished digesting. When your small intestine receives this mass of under-digested food, it makes adjustments to try and accommodate it. It draws in extra fluid volume and releases extra hormones. These adjustments cause the symptoms that people experience shortly after eating.
Some people experience another set of symptoms a few hours later. This happens because of blood sugar changes. If your small intestine receives a concentrated serving of sugar content, it may set off alarms in your digestive system. Your small intestine may signal your pancreas to release extra insulin to regulate your blood sugar. This can cause your blood sugar to drop sharply (reactive hypoglycemia). This drop can cause faintness, shakiness and heart palpitations.
Dumping syndrome most commonly happens as a complication of surgery on your stomach, or on your esophagus where it connects to your stomach. An estimated 20% to 50% of people who have had stomach surgery develop some symptoms of dumping syndrome. It's most common in people who have had surgeries that remove or bypass large portions of the stomach, such as gastrectomy or gastric bypass surgery. Occasionally, it can also occur with certain gastrointestinal diseases.
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Management and Treatment
The main treatment for dumping syndrome is changes in your diet. Another choice is to slow gastric emptying by making your food thicker. Your healthcare provider may advise adding 15 grams of guar gum or pectin to each meal. If dietary changes don’t help, your healthcare provider may give you some slow-release prescription medicines. In rare cases, these may help, but they often don’t work.
The symptoms of dumping syndrome can be so distressing that some people severely limit the amount and type of food they eat. This can cause more problems and can even lead to malnutrition.
Hormonal Imbalance Due to Excess Weight
If you’re overweight, everything is harder. It’s harder to stay active. It’s harder to find clothes that fit. It’s harder to eat a healthy diet. It’s harder to lose weight. Why so many difficulties? One reason is that those extra pounds throw your hormones out of balance.
Key Hormones Influencing Weight
Insulin
Insulin is secreted by your pancreas in small amounts throughout the day and in larger amounts after meals. This transfers glucose from food into muscle, liver, and fat cells to use as energy or storage.
Insulin resistance causes cells to stop responding to insulin, resulting in high blood sugar. It’s been linked to obesity, which can play a role in other conditions, such as type 2 diabetes and heart disease.
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Improving Insulin Sensitivity
To improve insulin sensitivity, focus on lifestyle habits like:
- Exercise regularly: Research supports exercise at both high and moderate intensities as a means of improving insulin sensitivity and decreasing insulin resistance.
- Improve your sleep habits: Not getting enough or quality sleep is linked to obesity and insulin resistance.
- Get more omega-3 fatty acids: Omega-3 supplements may improve insulin sensitivity in people with metabolic conditions such as diabetes. You can also try eating more fish, nuts, seeds, and plant oils.
- Change your diet: The Mediterranean diet - which includes many veggies and healthy fats from nuts and olive oil - may help reduce insulin resistance. Examples include whole grains, fruits, vegetables, and legumes.
Leptin
Leptin is produced in body fat. It is a hormone that tells our brain how much body fat we have and helps keep our weight steady and in normal range. When we gain weight, our leptin level goes up. This reduces our appetite and promotes energy expenditure to cause weight loss bringing us to our previous weight. If we lose weight, our leptin level goes down and, likewise, we eat more food and our metabolism slows.
Leptin works by telling your hypothalamus - the portion of your brain that regulates appetite - that you’re full.
Leptin resistance occurs when the message to stop eating doesn’t reach your brain, eventually causing you to overeat. In turn, your body may produce even more leptin until your levels become elevated.
The direct cause of leptin resistance is unclear, but it may be due to inflammation, gene mutations, or excessive leptin production, which can occur with obesity.
Lowering Leptin Levels
Although no known treatment exists for leptin resistance, a few lifestyle changes may help lower leptin levels:
- Maintain a moderate weight: A decrease in body fat may help reduce leptin levels.
- Improve your sleep quality: Leptin levels may be related to sleep quality in people with obesity. Although this association may not exist in people without obesity, there are numerous other reasons to get better sleep.
- Exercise regularly: Research links regular, consistent exercise to a decrease in leptin levels.
Ghrelin
Ghrelin is produced in the stomach. It is our hunger hormone and therefore essential for our survival as it drives us to eat. When we skip a meal our ghrelin level becomes very high so that we eat more food at the next meal and can sometimes overeat. What we eat also affects ghrelin. Carbohydrate is the most effective macronutrient to lower our ghrelin level. Protein is less effective but works to keep ghrelin suppressed for longer.
Ghrelin is essentially the opposite of leptin. Its main function is to increase appetite by sending a message to your hypothalamus indicating that your stomach is empty and needs food. Ghrelin levels are usually highest before eating and lowest after a meal. Curiously, research indicates that people with obesity have low ghrelin levels but are more sensitive to its effects. This sensitivity may lead to overeating.
Lowering Ghrelin Levels
Here are some tips for lowering ghrelin to help reduce appetite:
- Maintain a moderate weight: Obesity may increase your sensitivity to ghrelin, increasing your appetite.
- Practice good sleep hygiene: Unfavorable sleep may lead to increases in ghrelin, overeating, and weight gain.
- Eat regularly: Ghrelin levels are highest before a meal, so listen to your body and eat when you’re hungry.
Cortisol
Known as the "stress hormone," cortisol is produced by the adrenal glands (which also produce adrenaline) in response to stress.
When you’re stressed, your adrenal glands release cortisol, which triggers an increase in heart rate and energy levels. This is commonly called the “fight or flight” response.
Persistently high levels may lead to many health concerns, including heart disease, diabetes, high blood pressure, sleep disturbances, and weight gain.
Certain lifestyle factors - including lack of sleep, chronic stress, and a high intake of high-glycemic foods - may contribute to high cortisol levels.
Plus, not only does obesity raise cortisol levels, but high levels may also cause weight gain, creating a negative feedback loop.
Lowering Cortisol Levels
Here are some lifestyle changes that may help manage cortisol levels:
- Optimize sleep: Chronic sleep disturbances, including insomnia, sleep apnea, and irregular bedtimes, may contribute to high cortisol levels. Focus on developing a regular sleep schedule.
- Exercise regularly: Cortisol levels temporarily increase after high intensity exercise, but regular exercise generally helps decrease levels by improving overall health and lowering stress levels.
- Practice mindfulness: Regular mindfulness practice can help lower cortisol levels, though more research is needed. Try adding meditation to your daily routine.
- Maintain a moderate weight: Because obesity may increase cortisol levels and high cortisol levels can cause weight gain, maintaining a moderate weight may help keep levels in check.
- Eat a balanced diet: Diets high in added sugars, refined grains, and saturated fat may lead to higher cortisol levels. Following the Mediterranean diet may help lower cortisol levels.
Estrogen
Estrogen regulates the female reproductive, immune, skeletal, and vascular systems.
High levels of estrogen circulating in your bloodstream are associated with a number of health issues, including an increased risk for breast cancer and liver cancer. In fact, many of the symptoms associated with aging in men, such as erectile dysfunction, are due to low testosterone and excess estrogen.
High estrogen levels are associated with an increased risk of certain cancers and other chronic diseases. Low levels may affect body weight and body fat, also increasing your risk of chronic ailments.
People with low estrogen levels often experience central obesity, which is an accumulation of weight around the trunk of the body. This can increase the risk of high blood sugar, high blood pressure, and heart disease.
Maintaining Healthy Estrogen Levels
To keep estrogen levels at a healthy equilibrium, try some of these techniques:
- Maintain a moderate weight: Weight loss or maintenance may reduce the risk of heart disease due to low estrogen levels in perimenopause. Research also supports maintenance to reduce your risk of other diseases.
- Exercise regularly: During periods of low estrogen output, such as menopause, regular exercise is important to aid weight management.
- Eat a balanced diet: Diets high in red meat, processed foods, sweets, and refined grains have been shown to increase estrogen levels, which may raise your risk of chronic disease. Limiting your intake may help.
Neuropeptide Y (NPY)
NPY is produced by cells in the brain and nervous system. It stimulates appetite and decreases energy expenditure in response to fasting or stress.
It’s activated in fat tissue and may increase fat storage and lead to abdominal obesity and metabolic syndrome, a condition that can increase the risk of chronic diseases.
The mechanisms that lead to obesity may also cause an inflammatory response, further worsening health conditions.
Maintaining NPY Levels
Here are some tips for maintaining healthy levels of NPY:
- Exercise: Some studies suggest that regular exercise may decrease NPY levels, though research is mixed.
- Eat a balanced diet: Although more research is needed, high fat, high-sugar diets may increase NPY levels. Lowering your intake of foods high in sugar and fat may help.
Glucagon-Like Peptide-1 (GLP-1)
GLP1 is one of several “nutrient sensing” fullness hormones produced in the intestine when we eat. It makes us feel full and satisfied so that we stop eating. It is also important for managing our sugar levels. When our sugar level rises after eating, GLP1 brings it down. Individuals vary in how much hormone they produce, making it easy or more difficult to determine fullness and satisfaction. When ghrelin is high, we produce less GLP1, making us eat more food.
GLP-1 is produced in your gut when nutrients enter your intestines. It plays a major role in keeping blood sugar levels stable and making you feel full.
Research suggests that people with obesity may have problems with GLP-1 signaling. As such, GLP-1 is added to medications - particularly for people with diabetes - to reduce body weight and waist circumference.
Maintaining GLP-1 Levels
Here are some tips to help maintain healthy levels of GLP-1:
- Eat plenty of protein: High-protein foods such as whey protein and yogurt have been shown to increase GLP-1 levels.
- Consider taking probiotics: Preliminary research suggests that probiotics may increase GLP-1 levels, though more human research is needed. Consult with a healthcare professional before starting a new supplement.
Cholecystokinin (CCK)
CCK is another fullness hormone produced by cells in your gut after a meal. It’s important for energy production, protein synthesis, digestion, and other bodily functions. It also increases the release of leptin.
People with obesity may have a reduced sensitivity to CCK’s effects, which may lead to chronic overeating. This may further reduce CCK sensitivity, creating a negative feedback loop.
Increasing CCK Levels
Here are some tips for maintaining healthy levels of CCK:
- Eat plenty of protein: A high protein diet may help increase CCK levels and, therefore, fullness.
- Exercise: While research is limited, some evidence supports regular exercise for increasing CCK levels.
Peptide YY (PYY)
PYY is a gut hormone that decreases appetite. PYY levels may be lower in people with obesity, and this may lead to a greater appetite and overeating. Sufficient levels are believed to play a major role in reducing food intake and decreasing the risk of obesity.
Increasing PYY Levels
Here are some ways to keep PYY at a healthy level in your body:
- Eat a balanced diet: Eating plenty of protein may promote healthy PYY levels and fullness.
Other Hormones
Glucagon is produced in the pancreas when we have a low sugar level a few hours after eating. It helps bring our sugar level back to normal by making the liver release stored sugar to our body. This allows us to have more time between meals so that we don’t have to eat all the time. Glucagon also suppresses our appetite and increases our metabolism, favoring weight loss.
Insulin is the principal hormone that regulates our blood sugar levels and is also released by the pancreas. This hormone delivers sugar to all our organs for normal health. Insulin can influence hunger and fullness. High insulin levels can cause, and be caused by, obesity leading to weight gain. However, insulin interacts with many other hormones and can have different effects, including loss of appetite, depending on these interactions.
The thyroid gland produces hormones that regulate metabolism. Certain thyroid conditions can impair the thyroid's production of these hormones, which can lead to either weight gain or weight loss. Treatment of an overactive thyroid generally causes weight gain, however treatment of an underactive thyroid has not been shown to cause weight loss.