Dr Ritamarie
If your body's supposed to make GLP-1 every time you eat, why does it always work? Why can someone eat a full meal and still want more? Why can the stomach feel physically full, but the brain says, I'm not satisfied? And why do so many people struggle with cravings, grazing, nighttime eating, and blood sugar swings, even when they're trying to eat the right foods?
This is the part of the GLP-1 conversation almost no one's talking about, because GLP-1 is not just about making the stomach feel full. It's about a much larger communication network between the gut and the microbiome down there, the pancreas, the liver, the brain, the nervous system, and the muscles. When that communication network is disrupted, fullness in the stomach does not always become satiety in the brain.
That's what we're going to unpack today. Why GLP-1 may not be working the way it should, why appetite isn't a willpower problem, and how practitioners can begin looking for the root causes underneath the hunger, the cravings, the poor satiety, and metabolic dysfunction.
Today we're continuing our GLP-1 discussion and asking a deeper question.
If the body is designed to make GLP-1 naturally, why isn't that signal always getting through?
In our last episode, we talked about how the body naturally stimulates GLP-1 through protein, fiber, resistant starch, plant diversity, polyphenols, movement, sleep, and parasympathetic activation. If you missed that episode, go back and listen to it before continuing with this episode, because that last episode raises a really important next question.
DrRitamarie (02:28)
What if someone's doing many of those things and still doesn't feel satisfied? What if they eat protein and fiber and still crave sugar? What if they feel full but not done? What if their stomach is stretched but their brain hasn't received the message? That's where we need to move beyond the simplistic idea that appetite is only about how much food is in the stomach.
Appetite is communication. Satiety is communication. Cravings are communication. When the communication breaks down, people often blame themselves. They say, I have no willpower. I just love food too much. I can't control myself, especially at night. I know what to do, but I can't seem to do it. I'm sure you've heard those before.
From a nutritional endocrinology perspective, those statements are clues. Like everything else that a client tells us, they're clues. They tell us that there may be dysregulation in the signaling network.
Before we dive in, I want to tell you about my free guide Beyond Protocols: The Practitioner's Guide to Read Cause Pattern Recognition, because this is a very helpful document for you in this situation. It's exactly the kind of situation where we need to go beyond the protocols.
If someone is hungry all the time, the answer is not simply eat less, have better willpower. We need to ask what pattern is driving the hunger. Is it blood sugar instability or poor sleep or low protein or disruption in the microbiome? Is it their stress physiology or are they in fear mode? Is their nervous system not feeling safe? Is it inflammation or poor digestion or insulin resistance?
You can download the guide from the show notes.
Let's dive into why GLP-1 may not be working for you or a client or patient you're working with. The first concept you need to remember is this: fullness isn't the same as satiety.
We can have a very full signal coming from the stomach, from the stretching, but it may not be getting to the brain, and we're still wanting more. It may come from delayed gastric emptying. It may come from volume fluid, or bloating, but that's not satiety. Satiety is actually very different. It's the deeper sense that the body has received what it needs. It's the feeling of, “I'm feeling nourished.
I'm feeling complete. I can stop eating now. I'm not thinking about food anymore.”
We sometimes call this food noise. This is a brain-based, hormone-based, nutrient-based, nervous system-based experience, not a stomach experience. And this distinction matters very much, because many people are physically full but not satisfied. They may say, I'm stuffed, but I still want something. I'm sure you've heard that.
Usually that something is sweet, salty, crunchy, creamy, or stimulating. That tells us the stomach may be full, but the appetite regulation system hasn't completed the conversation. The brain is still looking for a signal. Maybe it's protein, maybe it's minerals, maybe it's essential fats, maybe it's blood sugar stability rather than the ups and downs. Maybe dopamine is low. Maybe we're looking for comfort or safety because a lot of people eat when they're feeling unsafe or out of balance.
Maybe it's just rest or simply a pause long enough for the signals to arrive, because we tend to eat and eat and eat and eat and eat and then go beyond that full feeling.
Instead of asking, “Did this meal fill the stomach?” We need to ask, “Did this meal create satiety?” and that's very different from a clinical perspective.
One reason GLP-1 signaling may not work well is that the meal doesn't send a strong enough nutrient signal? Remember, GLP-1 is raised in response to nutrients. Protein matters, fiber matters, fatty acids matter, fermentation products matter, bitter compounds and polyphenols matter. All of these things are important. Food structure matters. A meal that's containing lots of refined carbohydrates and processed foods and sweeteners and oils may have lots of calories, no doubt about that, but it may not deliver the kind of information the gut needs to generate strong satiety signals.
DrRitamarie (07:01)
Food is not just calories, it's information. Protein, fiber, resistant starch, they're all information. The polyphenols in the foods, those are information. The microbiome helps translate that information into the things we need. Hormones, metabolites, and messages that the whole body can understand.
That's why someone can eat a high-calorie processed meal and still feel unsatisfied. The body receives energy, but it doesn't have the signal that it's nourished. It may not have received enough amino acids. It may not have received enough fiber to feed the microbiome. It may not have received enough minerals. It may not have received the phytonutrient signals that help regulate inflammation and insulin sensitivity.
The brain says, keep looking, and what does that translate to us? I want more. The person interprets that as a lack of discipline, but the body may simply be asking for a better signal.
A second reason that GLP-1 may not be working well is inadequate protein or poorly timed protein. Protein's one of the strongest satiety signals we have. It helps stimulate GLP-1, peptide YY, and CCK. We'll talk about these in a little bit.
It helps reduce ghrelin. It provides amino acids needed for muscle, neurotransmitters, detoxification, immune function, tissue repair, and metabolic health.
When people undereat protein early in the day, they often struggle later. They may be fine in the morning, and they push through with coffee. They may have fruit and toast and oatmeal or a smoothie that's mostly fruit or salad without much protein.
Then later in the day, the appetite system becomes louder. The cravings intensify. The snacking begins. Nighttime eating shows up, and they think, why do I have no control in the evening?
One question I always want practitioners to ask is, was the body adequately nourished earlier in the day? Because often the evening craving didn't begin in the evening. It began at breakfast or right after. Or it began at lunch. Or it's coming from years of undernourishing the body while expecting it to run on willpower. It doesn't work that way.
For plant-based clients, plant-based eaters, it's especially important, because it takes a little bit more attention to get enough protein in a smaller amount of food.
DrRitamarie (09:39)
That's where things like lentil tofu and fava bean tofu and tempeh and edamame and hemp hearts and pumpkin seeds, legumes, and well-designed protein powders can be incredibly useful. We're not just trying to hit a protein number, we're trying to send a satiety signal to the brain.
A third reason GLP-1 may not be working well is blood sugar instability. We know 93% of the population has some sense of blood sugar instability.
If the glucose rises quickly, drops quickly, the brain interprets it as a threat. Even if the person ate enough calories, the brain may say, we need food now. This shows up as shakiness, irritability, anxiety, fatigue, cravings, urgent hunger, that feeling of I need something sweet.
When blood sugar swings are happening repeatedly, appetite signals get distorted.
Insulin's involved, and glucagons involved, and cortisol may get involved. The nervous system gets involved here, and the person may start eating in response to glucose instability rather than true nourishment needs. That's why meal composition matters so much.
Have proteins before starch, fiber before starch, healthy fats in the right amount, resistant starch instead of refined starch.
A walk after meals helps. Strength training helps. Getting enough sleep is super important. All of these create a more stable metabolic environment. When glucose is more stable, appetite becomes more stable. That's one reason I love continuous glucose meters as a teaching tool, not to get everybody fanatical and obsessing over every number and every rise but because people can start to see patterns.
Patterns are so important in interpreting health and what to do about it. They can see that the meal they thought was healthy may create a spike and then a crash, or just a spike, or just a crash. They can see that a walk after meals changes the curves. They can see that poor sleep changes the next morning's and the next day's glucose response.
They can see that stress changes the response to the exact same food two days in a row. The body's constantly listening. It's listening to the food, but it's also listening to the context.
The fourth reason that GLP-1 may not be working well is insulin resistance and metabolic inflammation.
When the body's insulin resistant, the entire metabolic conversation becomes distorted. We know that. The pancreas needs to produce more insulin to handle the same amount of glucose. The liver might be constantly releasing glucose when it shouldn't. It really doesn't need to. The muscles may not clear glucose sufficiently. The brain may not receive energy signals clearly.
Inflammation interferes with hormone signaling. It can mess up the microbiome, it may be altered, and appetite regulation becomes less precise. That's why GLP-1 cannot be separated from the larger metabolic picture.
We can't say, let's just increase GLP-1 while ignoring insulin resistance, inflammation, fatty liver, poor muscle mass, sleep disruption, and stress physiology. These are all important.
The goal is not to make as much GLP-1 as possible or to get it from the outside. The goal is to restore healthy GLP-1 signaling at the right time and the right amount as part of a healthy metabolic conversation. That means we need to work on the terrain. We need to work on muscle and mitochondria and inflammation. We need to work on glucose regulation, and we need to work on sleep and stress, of course.
We need to look at gut health and the microbiome balance and having the right microbiome. We need to look at food quality. That's a really big one. That's why practitioners need to use and be really, really good at pattern recognition.
A person with poor post-meal glucose spikes, low muscle mass, poor sleep, and high stress needs a different plan than someone with digestive inflammation, low protein intake, constipation, or poor bile flow.
The symptoms might look similar. I'm hungry all the time, but the root pattern may be very different, which means that the way we approach it is very different.
DrRitamarie (14:07)
The fifth reason why GLP-1 may not be working well is microbiome disruption.
The microbiome isn't just sitting there passively, it's metabolically active. It ferments fibers, it produces short-chain fatty acids. It influences bile acid metabolism. It communicates with intestinal cells. It affects inflammation. Need we say more?
There's more. It interacts with the immune system. It influences the gut barrier integrity, and it helps to shape appetite and satiety signaling.
If the microbiome becomes disrupted by low-fiber diets, antibiotics, chronic stress, infections, food intolerances, poor sleep, alcohol, environmental toxins, or years of processed foods. Sound familiar? Lots of people are doing this. Then the body may not be producing the same microbial metabolites that help support the GLP-1 signaling.
That's one reason why simply adding GLP-1 or GLP-1 food may not work. If the ecosystem is not ready, the response may be limited. The gut may need rebuilding. It might need more plant diversity, or it may need gradual fiber increases and fermented foods as much as tolerated.
Also important are things like polyphenols and digestive support and stress reduction. Need I say that again?
Addressing constipation is very common. Miralax is a very common supplement for people. Addressing dysbiosis and supporting motility moving. Sometimes people say I tried beans, but they make me bloated. That might be true, but it doesn't mean beans are bad.
It means that the microbiome isn't adapted to those particular sugars and fibers. It may mean that the person needs to start slowly, as with anything when you're changing a person's diet. It may mean that they need smaller portions, different preparation methods, digestive support, or a broader gut healing strategy. Again, we don't want to force physiology. We want to restore communication.
The sixth reason GLP-1 may not be working well is stress and impaired vagal tone. This is huge.
You can eat the perfect meal, but if your body's in fight-flight mode, digestion and nutrient sensing aren't optimized. The vagus nerve is a major communication pathway between the gut and the brain. It's involved in digestive secretions, motility, nutrient sensing, satiety, and metabolic regulation.
If someone eats while rushing, driving, scrolling, arguing, working, or worrying, the body receives mixed signals. The food's coming in, but the nervous system says we're not safe. That changes the digestion. It changes the motility. It changes the secretions. It changes the glucose response. It changes the way the brain listens to the signals from the gut.
That's why the parasympathetic pause before meals is so powerful. It's not just a mindfulness trick, it's a metabolic intervention, it's a digestive support strategy. Take a breath, look at the food, smell the food, chew, chew, chew, chew, chew. Slow down, put down the fork, let the body receive the message. The body is constantly listening. What are we saying? It's listening to what you eat and how you eat and whether you feel safe.
How many of us sitting in front of the news shoveling down food actually feel safe? GLP-1 is one of the ways it responds.
The seventh reason that GLP-1 may not be working well is poor sleep and circadian disruption. We know that this is serious, and it's one of the most overlooked appetite drivers. Poor sleep increases hunger. Have you ever experienced that? I have, very much so. It increases cravings.
We're not craving broccoli, we're craving chocolate and other things. It worsens insulin resistance, even if it's temporary. It changes the glucose response, increases inflammation, and alters decision making. It makes the brain more reactive to the high reward foods.
When someone says, “I can't stop eating,” we have to ask, how are they sleeping? Are they staying up too late? Are they waking during the night? Are they exposed to blue light at night? Are they eating too close to bedtime? Most people are doing all of these things. Are they getting morning sunlight? Are they waking up unrefreshed, running on stress hormones? It's very rampant.
A tired brain wants quick energy. A sleep-deprived body becomes less metabolically flexible, and appetite signals become louder and louder and louder, less precise, harder to regulate.
That's why I never want practitioners to reduce cravings to personality. Cravings are physiology. They can be a sleep signal, a glucose signal, a stress signal, a nutrient imbalance signal, a microbiome disruption signal, an inflammation signal, a signal from the nervous system.
When we understand all this, we stop blaming and start investigating. They just have no willpower. No.
DrRitamarie (19:35)
How do we help them? And what do we do with all this information?
First we have to stop asking, what diet should this person follow? And start asking better questions. The power of questions. Is the person getting enough protein? Is protein coming early enough in the day to signal properly? Are they getting fermentable fiber and resistant starch? Most people aren't if they're eating a lot of processed foods.
Can they tolerate those fibers? Because if not, we have to go slow. Is the microbiome able to translate those into beneficial metabolites? Is blood sugar stable, or are they spiking and crashing? Do they have insulin resistance? Do they have enough muscle? Are they sleeping? Are they eating in fight-flight? Are they constipated? Are they inflamed? These are the questions we need to be asking. Are they absorbing nutrients?
We are not blaming them for not following the plan but are looking at all these factors. Are they truly nourished, or are they just full? The last question is one of the most important. Are they truly nourished, or are they just full?
Fullness in the stomach does not always become satiety in the brain. When you understand that, you can approach appetite in a much more compassionate and effective way.
That's why I created the Beyond Protocols: The Practitioner's Guide to Root Cause Pattern Recognition, because no two clients are alike. Two of them can say, I'm hungry all the time, and they may need completely different support. That's why we need to go beyond protocols and personalize.
One may need more protein, and one may need balanced blood sugar. One may need gut repair, and another one might need sleep restoration, or they may need stress and vagal support, getting the nervous system out of fight-flight and out of fear mode. One might need strength training and one might need help with inflammation.
If we give them all the same protocol, we miss the personalization, and we miss getting results. The guide will help you think more clearly about the patterns underneath the symptoms, and you can download it from the show notes.
Let's pull it all together. If GLP-1 is not working the way it should, the issue may not be that the body is broken. It may be that the signals are disrupted. Meals may not be sending a strong enough nutrient message to the brain, the hypothalamus.
Protein might be too low, or fiber might be too low. The microbiome might not be producing the proper metabolites for satiety and signals to come through, and blood sugar may be unstable. Insulin resistance may be distorting the whole conversation. Inflammation can interfere with the signaling, even if all the other things are intact. Stress can block digestive communication and turn off some of the secretions. Poor sleep definitely disrupts appetite hormones. The brain may not be receiving the message that the body's been nourished. That's why appetite is not just about discipline anymore.
We can't blame people for this and say they don't have willpower. It's about communication. Our job as practitioners is to find out where the communication is breaking down.
In the next episode, we're going to widen the lens even more and because GLP-1 is important. It's not working alone, and we have to look at the other things like leptin, ghrelin, insulin, cortisol, peptide YY, CCK, thyroid hormones, sex hormones, and the nervous system as part of the whole appetite story.
In the next episode, we're going to look at the bigger endocrinology of appetite and why hunger, cravings, and satiety are controlled by way more than willpower. Every craving is a clue. Every hunger pattern is a clue. Every glucose swing is a clue. Every evening snack attack is a clue. The body is always communicating. Our job is to listen more carefully to the signals.
This is the future of healthcare. Not blaming people, not telling them to try harder, not handling everyone with the same protocol but understanding the physiology underneath it all and restoring the conditions that allow the body to work in the way it was designed to work.
If this episode gave you a new way to think about hunger, cravings, GLP-1, and satiety, share it with a colleague, client, friend, or family member who needs a more compassionate and root cause perspective. And remember, we are the future of healthcare. And until next time, shine on.
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