It's November and Thanksgiving is on the horizon. On Thanksgiving Day, questions abound. Whose house are we going to? How is the traffic? What are we bringing for dinner? Which station is airing the football game? The question from mothers and grandmothers in kitchens all across America, “Are you hungry?". The other question Americans will be asking on Thanksgiving is, "What is my cardiologist eating today?". According to the National Turkey Federation, about 88% of Americans eat turkey on Thanksgiving, consuming 46 million turkeys each year on that day. Is your cardiologist eating turkey or tofurkey, a plant-based substitute for turkey made from tofu or wheat protein served at a vegetarian or vegan Thanksgiving gathering? Let’s carve into those big questions, “What is hunger? What is on the cardiologist’s dinner table?”
Why are you so hungry? As the obesity epidemic rages on, one out of eight people worldwide had obesity in 2022 with the number continuing to rise, more and more research is being dedicated to understanding hunger. Researchers have identified three distinct mechanisms of hunger. The first type of hunger is called homeostatic hunger. This is a very basic system which involves the brain (specifically an old part of the brain called the hypothalamus) and the gut. There are feedback mechanisms between the brain and the stomach that regulate hunger and satiety (when we have enough food). An empty stomach and low blood sugar triggers secretion of an appetite hormone. The hormone and nerve signals are relayed to the brain where the hypothalamus conveys to the person that they need to eat, they are hungry. With food intake, the stomach enlarges, another signal is sent to the brain and the hunger sensation is suppressed. In addition, when the stomach is full, the gastrointestinal tract secretes different hormones (including glucagon-like peptide 1, GLP-1) which leads to satiety. Homeostatic hunger is tightly regulated providing a balance between hunger and satiety. There is no excess calorie intake. On the other hand, hedonic hunger is not stimulated by the lack of food or energy. Hedonic hunger is driven by pleasure, not an empty stomach. Various hunger triggers (anger, fear, depression, lifestyle, psychology, emotions) stimulate the reward centers in the brain, leading to consumption of high fat, high sugar, energy dense foods subsequently resulting in weight gain, diabetes and heart disease. The reward centers are targeted by food advertisers who prey on eating related thoughts and desires. In 2009, the Power of Food Scale (PFS) was developed. It quantifies the psychological effect of hedonic hunger. It can assess a person’s susceptibility to food in a world where food is plentiful. Currently, the PFS is purely a research tool, but we do know this. People with high PFS scores are more likely to eat for pleasure, while those with low PFS scores don’t have the same reward center activation. Homeostatic hunger is a survival instinct driven by the need for food and energy. Hedonic hunger is more complex and more prevalent in a society where tasty food is easy to obtain and calories are consumed irrespective of the physical needs of the body. The third type of hunger is microbiota driven hunger. Bacteria that normally reside in the gastrointestinal tract influence hunger. The gut bacteria break down food producing metabolites such as short chain fatty acids. These fatty acids decrease hedonic hunger by inhibiting the brain reward center. In addition, the metabolites can activate hunger stimulating hormones as well as hunger inhibiting hormones (such as GLP-1). As we can see, GLP-1 is a key hormone. One of the ways GLP-1 agonists (for example, Ozempic, Mounjaro, Wegovy, Zepbound) promote weight loss is by mimicking the effect of GLP-1 subsequently suppressing hunger.
What is your cardiologist eating on Thanksgiving? To answer that question we turn to a survey conducted by the American College of Cardiology in 2024. The group polled 166 U.S. cardiologists and tabulated their answers. About 41% of cardiologists recommend a whole food plant-based diet for their patients. However, only 8% of cardiologists follow a plant-based protein diet. So, with 92% probability, your cardiologist is having turkey on Thanksgiving. Prior to Thanksgiving dinner is your cardiologist going out for a run or sitting on the couch, watching football and smoking a cigarette? 91% of cardiologists recommend exercise to their patients but only 69% meet physical activity guidelines. In addition, 92% of cardiologists avoid tobacco (8% of heart doctors smoked in 2024? Really?).
On Thanksgiving Day, start with a turkey trot. Then feed your homeostatic hunger. Join the 88% of Americans and 92% of cardiologists enjoying a turkey dinner. Try to deny that hedonic hunger! Then on Black Friday you can go back to your whole food, plant-based diet.
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