Cessation weight gain and weight control were covered in Chapter 6. Here, our focus is upon two sensations commonly labeled as withdrawal symptoms: an increase in appetite and hunger.
Although often used interchangeably, hunger is the body's physical need for food, whereas appetite reflects the desire we feel for it.
Hunger
Common hunger symptoms include feelings of stomach emptiness, stomach contractions that may be accompanied by growling or rumbling sounds, abdominal discomfort, pain ("hunger pangs"), and a need for fuel induced by a drop in the level of glucose (sugar) in the blood passing through the hypothalamus in the brain.[1]
A drop in blood sugar can result in difficulty concentrating, irritability, light-headedness, faintness and/or dizziness.[2]
One of recovery's greatest challenges is learning to listen to our bodies. Once use ends, nicotine is no longer controlling refuelings by activating our body's fight or flight response, which in turn pumped stored calories from our liver into our bloodstream.
Once use ends, we need to recognize the need to eat prior to experiencing full-blown hunger pangs. Having rarely experienced true hunger, we also need to relearn when it's time to stop eating, even if not yet feeling full, and develop the self-control to do.
As for eating, satiety or fullness is the opposite of hunger. It's the "quality or state of being fed or gratified to or beyond capacity."[3] Satiety hormones (CCK, GLP-1, and PYY) are released by the GI-tract.[4] They signal the brain's satiety center, located in the hypothalamus, that we've eaten enough and are full.
Unfortunately, it can take up to twenty-minutes after eating before the digestive system turns food to glucose, causing GI-tract satiety hormones to signal the brain, and the desire to eat diminishes and then stops.[5]
"If you have this 20-minute disconnect, you always have that moment of 'I can have just one more'. How many times is it that you then sit down after the meal and you feel like you've eaten way too much?" asks Professor Zane Andrews, a food neuroscientist.[6]
Appetite
Primarily psychological, like conditioned nicotine use cues, an increase in appetite can be triggered by the sight, smell, taste, or thoughts about food, or by a specific activity, location, person or time. Increased desire or food cravings are accompanied by the flow of saliva in the mouth and gastric juice in the stomach. The stomach wall also receives an extra blood supply in preparation for its digestive activity.[7]
Again, quoting Professor Andrews, "As humans, we very rarely eat because our brain is telling us to eat. That's only really when we're starving. We eat because we come home at a certain time and that's when we have dinner. We eat because we're out with our friends, because we're at family gatherings. We have all these conditions, cues and learned associations with food intake."[6]
"We have that learned association to sit in front of the TV and eat. We go to the movies and we have a learned association to eat popcorn and soft drink. Or you sit down at home and watch TV, and you feel like some lollies or chips." "We're overriding those satiety cues based on cultural expectations or social norms," he contends.
Nicotine's stimulant effects and metabolism issues aside, nicotine also decreased appetite by activating acetylcholine receptors within the hypothalamus.[8] Although the frequency and intensity vary from person to person, an increase in hunger and appetite is common following nicotine cessation.[9] The good news is that a 2017 study found that an increase in appetite was not associated with an increased risk of relapse. [10]
The obvious question becomes, once nicotine use ends, how long does an increase in appetite last?
As reviewed, appetite is primarily a conditioned response. Hopefully, we'll never relapse and our enhanced sense of smell and taste, and our metabolic and hypothalamic changes, are permanent. Isn't the more important question, how will you respond? Will your eating habits and patterns change so that daily calorie consumption becomes greater, less, or remains unchanged?
There, if concerned about weight gain, findings from short-term studies can be rather demoralizing. But what about longer-term studies?
A 2019 study followed 5,809 men between the ages of 40 to 69 for up to 4 years. First, let's put aside the 3,014 who were either never-smokers or who continued smoking. What about the 2,795 who had stopped smoking for up to 4 years? Interestingly, 25% (697) actually lost weight, 54% (1,522) had no cessation weight change, and 21% (576) gained weight.[11]
As for shorter studies, a second 2019 study followed 348 smoking patients, 161 (46.2%) of whom achieved continuous abstinence for 1 year. "Of those 161 patients, 104 (64.6%) maintained their initial weight or had a weight change of no more than 5% in relation to their baseline weight, whereas the remaining 57 (35.4%) had a weight gain of more than 5%, 18 of those patients showing a > 10% increase over their baseline weight."[12]
The study's conclusion? "Weight gain is not necessarily associated with smoking cessation, and smokers who are motivated to quit should be informed of that fact."
Brain dopamine sensitivity needs 2 to 3 weeks to readjust to nicotine's absence. While normal to attempt to satisfy wanting for nicotine with extra food, the extra pounds can be demoralizing.
Instead of creating new eating cues, why not instead generate a healthy dopamine surge such as felt after taking a slow deep breath, while drinking a nice cool glass of water, or an accomplishment "aaah" sensation following yard work, a walk, or when crossing off another item on your to-do list.
Learning to minimize hunger while developing healthy appetite cues, discovering how activity and food choice modify health and weight, this is life, this is what humans do.
A journey from daily poisoning our body to wanting it to be as healthy as possible, what an extraordinary turnaround.
References:
2. Spitzer J, Minimizing the Most Common Side Effects to Quitting Smoking, 2001, Joel's Library, WhyQuit.com https://whyquit.com/joel/Joel_03_21_blood_sugar.html
3. Merriam Webster Dictionary, satiety, March 2019, https://www.merriam-webster.com/dictionary/satiety
4. Klaassen, T et al, Intraintestinal Delivery of Tastants Using a Naso-Duodenal-Ileal Catheter Does Not Influence Food Intake or Satiety, Nutrients 2019, Volume 11(2), 472.
5. Malagelada, C et al, Cognitive and hedonic responses to meal ingestion correlate with changes in circulating metabolites, Neurogastroenterology Motility, December 2016, Volume 28(12), Pages 1806-1814. https://www.ncbi.nlm.nih.gov/pubmed/27271780
6. Steen J, We Found Out If It Really Takes 20 Minutes To Feel Full, Huffington Post, November 10, 2016 https://www.huffingtonpost.com.au/2016/11/09/we-found-out-if-it-really-takes-20-minutes-to-feel-full_a_21602736/
7. The Free Dictionary's Medical Dictionary, appetite, March 2019, https://medical-dictionary.thefreedictionary.com/appetite
8. Mineur, YS et al, Nicotine Decreases Food Intake Through Activation of POMC Neurons, Science, 10 June 2011, Volume 332, Issue 6035, Pages 1330-1332.
9. Hughes JR and Hatsukami D, Signs and symptoms of tobacco withdrawal, Archives of General Psychiatry, March 1986, Volum 43(3), Pages 289-294
10. Hausherr Y et al, Smoking cessation in workplace settings: quit rates and determinants in a group behaviour therapy programme, Swiss Medical Weekly, September 2017, Volume 13;147:w14500.
11. Kim K et al, Weight change after smoking cessation and incident metabolic syndrome in middle-aged Korean men: an observational study, Scientific Reports, February 2019, Volume 28;9(1):3103.
12. Jeremias-Martins E and Chatkin JM, Does everyone who quit smoking gain weight? A real-world prospective cohort study, Journal Bras Pneumol, February 2019, Volume 25;45(1)
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