Episode 190:
Show Notes
In their podcast conversation, Dr Mary Barson and Dr Lucy Burns discussed the intricacies of hunger and satiety hormones and their impact on weight management and metabolic health. They emphasised that sustainable weight loss is not simply about calorie restriction but involves understanding and working with the body's hormonal mechanisms.
Key points discussed include:
Satiety Hormones
- Peptide yy and cholecystokinin are satiety hormones.
- Peptide yy is released in response to consuming protein.
- Cholecystokinin is released in response to consuming dietary fat.
- Meals containing protein and fat are more satiating than those with mainly carbohydrates.
Hunger Hormone
- Ghrelin is a powerful hunger hormone.
- Ghrelin levels fluctuate throughout the day and are linked to the circadian rhythm.
- Spikes in ghrelin signal hunger, regardless of whether food has been consumed.
- Ghrelin levels eventually dissipate, indicating hunger is not solely driven by an empty stomach.
Addressing Hunger
- It's crucial to address physiological hunger with real, nutrient-dense foods.
- Processed foods, low in protein and fat, can exacerbate hunger.
- Intermittent fasting, when approached with the right mindset, can help regulate hunger hormones and promote metabolic health.
Emotional Hunger
- Emotional or psychological hunger also plays a role in eating behaviour.
- Managing emotional hunger and understanding willpower are important aspects of achieving sustainable weight loss.
- Emotional eating can undermine efforts to control weight, even after bariatric surgery or other interventions.
Overall, they emphasised the importance of nurturing the body with proper nutrition, understanding hormonal cues, and adopting sustainable lifestyle practices for long-term weight management and overall well-being.
They hint at discussing emotional hunger and willpower in the next episode to provide further insights into managing hunger and achieving sustainable weight loss.
For more information about Real Life Medicine and our programs and special offers: https://www.rlmedicine.com/
Episode 190:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I'm Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:23) Hello, my lovely friend, how are you today? I am super, super and even more super because I'm joined with my gorgeous friend, colleague and business bestie, Dr Mary. Hello, gorgeous one, how are you this morning?
Dr Mary Barson (0:35) I'm tired business bestie, but I'm alright. I'm tired because my baby only let me get five hours of sleep. I'll be fine, fine, fine. But I am a little bit more hungry. Because of far being tired. Good, does it may or may not be a segue into today's topic. How are you?
Dr Lucy Burns (1:00) I am great, really great. Just had a few days off, which was lovely. Again, connecting with my, you know, my besties and spending some time out in nature. So all of those are just really wonderful things to do. And it's interesting because we were all talking about, we booked this trip away like 12 months ago. And if we hadn't booked it, we probably wouldn't have gone because you know, life gets busy in time. So I think it's always good to schedule things that you, that potentially seem a bit indulgent or a bit, you know, like a luxury, when really they're not.
Dr Mary Barson (1:36) Yes, connection. Vitamin C, the other vitamin C. So, so good for you. Absolutely.
Dr Lucy Burns (1:42) Absolutely! But today, we're going to be talking about something that I think is really super important. Because, look, I spend a reasonable amount of time just having a look in Facebook groups and on Instagram and just looking at what other people, not necessarily health professionals are saying around weight loss and health. And there is still a massive myth perpetrated that is just, you know, calorie restriction, eat less calories, and you will lose weight. And so I thought today we'd talk a bit about calories, about hunger, about macros, about all of the things that actually contribute hormones that contribute to our metabolic health and well-being. I love it.
Dr Mary Barson (2:32) Beautiful back to basics. Yes, this, the perpetuating of this myth that sustainable weight loss is all about eating less energy and burning more energy. I hate it because it's so overly simplified, it's actually wrong. And it can create this enormous amount of stigma because it suggests that we are in conscious control of those two things. We're consciously in control of how much energy we consume. And we're in conscious control of how much energy we burn. Therefore, if you've got a problem with your way, well, you know, you're just, you know, a lazy slob.
Dr Lucy Burns (3:15) Greedy, lazy, greedy, slob.
Dr Mary Barson (3:18) Lazy greedy slob. Exactly, which is not at all true and not at all what the science says. And the very important reason is that actually, weight gain, it's not a problem of eating too much. It’s really is a problem of hormones. And a problem of hunger and hunger is hormonally controlled. So you can't actually consciously decide to be less hungry. And also we can't consciously decide to burn more because we think that burning, you know, burning more energy are we just gonna go for a run. It's gonna go for a run, it's gonna go move, you know, don't be don't be lazy. Yeah, but actually no. What determines how much energy we burn, exercise actually has a pretty small role in this, exercise great for you, by the way, I'm not dissing exercise for healthy activity. But what actually determines how much energy we burn is our metabolic rate and we cannot consciously choose to have a faster metabolism. We can't consciously choose to have a metabolism that works more efficiently, quickly, and at a higher rate. So we're not consciously in control of our hunger or our metabolic rate. And if you are hungry, it's not a character flaw, it doesn't mean that you're greedy.
Dr Lucy Burns (4:44) No, it's interesting, isn't it? I think there are a couple of little concepts to unpick here. So the first one I'd just love to start with is metabolic rate. So for anybody who may not be aware of your metabolic rate, I like to describe it, it's the amount of fuel that your body needs to just function. So you know, when you're just lying around, or you're just sleeping, or you're just, you know, walking from your desk to the toilet, or whatever it is, it's the amount of fuel that your body uses to run your body. To beat your heart, to create your enzymes, to puff your lungs in and out. All the things that we just do on autopilot. And unfortunately, there are things that we perhaps have done to reduce our metabolic rate. And what I mean by that is, we know that prolonged calorie restriction, aka dieting, will reduce metabolic rate if done long enough, and particularly extremely enough. That's well known. And I think this is probably where the exercising gets mixed up a little bit in it because as you said, we're not dissing exercise by any stretch. But we do know that as we get older, all of us no matter who we are, as a human as you get older, it is our body's natural predisposition to lose muscle mass. So it's called sarcopenia. It's normal. It is kind of natural, but just unhelpful. Fine when we all kept it at 60. But now that we're all living to, you know, the late 80s, our muscle mass is diminishing, and the less muscle you have, the lower your metabolic rate. So, as you said, you can't sit on the couch and just tell your body to burn more fuel, burn more calories body, make, you know, heart beat a bit faster. But we're just yeah, you're completely right. It's outside of our control.
Dr Mary Barson (6:52) That's about conscious control. There are very healthy and helpful changes that you can make to your life that will both reduce your hunger and get your hunger, your natural normal hunger back online and also improve your metabolism and boost your metabolism, but I'd love to start with hunger, Lucy. I think that until I discovered, like the actual hormonal cause behind weight gain, behind obesity. I was always hungry. I had polycystic ovarian syndrome. As a child and adolescent and young woman, I had high insulin hyperinsulinemia I was health conscious, I would see the dieticians, I would do what they told me, I would eat my whole grains and my legumes and my low-fat meals. And I would have my three meals, and I'd have my three snacks, and I was always, always hungry. And I did think that this was a character flaw, especially as a young woman, you know, who was carrying extra weight. You know, whenever I was eating, I would feel self-conscious, particularly in public. And I can remember when I was a medical student, I stayed in this was at the rural medical school in Ballarat, and we, with all the other medical students, we stayed in this big hostel, it's actually quite fun. I was a, I was a graduate student, I was in my 20s. And I was living in this big hostel with 30 other medical students all in their 20s as well. And we did everything together. Because we lived together, we studied together, and we ate together. And I would just see these people have the little meal, you know, and then stop and not be ravenously hungry and needing more and needing more and constantly fighting the urge to go back to the fridge. And I was really struck by how different my hunger as an overweight woman was compared to my friends and colleagues who weren't overweight and we just had a significant difference in our hunger.
Dr Lucy Burns (8:59) Mm hmm. And it's interesting, isn't it? Because what happens with hunger is people will comment on it. What you can't be hungry again. Like this idea that you know, you're just wanting over desire. You know, you just need to control yourself and stop being so hungry. Stop growing so much. eating so much. Stop being so hungry.
Dr Mary Barson (9:29) Yeah, I think I was told about one point the dietician said all right, Mary, you just need to go on the Elf diet. I mean, what is the Elf? What's this Elf diet? And she just smiled at me this thin woman dietician telling me what to do and just said ate less food! Ahaha, it's so funny –punch in the guts. I could have possibly went home and cried that day. Yes. So my attempts at living on the ageless food diet the elf diet were unsuccessful because you actually can't fight hunger, you can for the short term, over the short term, you could definitely white-knuckle your way through, and I certainly did. And I would lose weight for a little while. But over time, your hunger will win.
Dr Lucy Burns (10:14) Yes.
Dr Mary Barson (10:15) But, what I've discovered, you can reduce your hunger, you actually really can't heal the underlying metabolic cause that's making your hunger dysregulated in the first place.
Dr Lucy Burns (10:25) Yes, absolutely. And I think that it's really important to do that, rather than, because the other thing that grinds my gears is when people are told to reduce their portion sizes. I think there are a couple of ways that we've again, nuance, nuance is always the key to everything, would you think portion sizes? It's like, well, hang on, do we need to do that? Because people are, if you're hungry, then you're allowed to eat like it's a basic human desire that needs to be fulfilled. If you're not honouring your hunger, and maybe people don't know about it, people have never tuned into it, people are often detached from their body's physiological needs. But if you're in touch with them, and you're hungry, for God's sake, eat, the nuance is going to be what you eat. And again, this is not a judgement. I don't care what you eat, you're human. You're the boss of you. But we can help you with what is helpful to eat. If you want to manage your hunger.
Dr Mary Barson (11:29) Yes. I can be useful to myth bust to things that are really unhelpful for managing your hunger, because I was certainly told, and I believe, perhaps you were too, let's see that the best way to control your hunger is to eat all the time, have three meals and three snacks, and just constantly shoving food into your face and that will control your hunger. Except that it doesn't. I don't know who made this up. I suspect it may have been a snack food company, but it doesn't, that actually is not how human physiology works at all.
Dr Lucy Burns (12:08) Especially because for the last 50 years, it was always low-fat snacks. So yes, if you're hungry, have a low fat, something, you know, processed cruskits, cruskits, God.
Dr Lucy Burns (12:29) Or a piece of fruit is the other thing that was supposed to help with your hunger.
Dr Mary Barson (12:33) Maybe the white bread nibble on a white bread roll. So this doesn't reduce your hunger. In fact, it increases it. I mean, you know, or devoir anybody are rubbish like we have known for a long time, that appetisers, small amounts of food actually make you more hungry, that eating regularly whets your appetite. If anything, it doesn't decrease it. And once we start eating, especially if we are hungry, it's going to be an unnatural human inclination to want to keep eating, you know, Newton's first law of motion, an object in motion will remain in motion. And I like to think of it as thirst because there's no stigma with this. There's no emotional overlay with thirst. I'm thirsty –Oh, yes such a weak person back up, you know, just control yourself. Good. You just ride the wave of thirst. That's it. No, yeah. So if you're thirsty, can you imagine that you think the best way to control your thirst is to not have a full drink of water? Oh, no, no, no. It says to take tiny little sips. Often, of course, we're not going to do that. If you get thirsty, you have a big drink of water. Depending on what you're doing, you're probably not going to be thirsty again for a few hours, you slake your thirst and then your thirst is done. Well, a similar thing happens with hunger except that what we eat and you elicit it, alluded to this, Lucy. What we eat strongly influences our hunger and hunger is hormonal. It's not driven by moral virtues or character strength. It's hormonal.
Dr Lucy Burns (14:12) Or even by an empty stomach. I think that's the other thing people think it's driven by an empty stomach. So, therefore, if you've just eaten you can't be hungry because you've just eaten. The biggest myth of all.
Dr Mary Barson (14:27) That's why the cabbage soup diet doesn't actually usually help result in sustainable weight loss. So many of our beautiful clients Lucy, have had gastric surgery of various types, and they are people who suffer from increased hunger problems with hunger, just like I did. And very reasonably the thought would be that by reducing the size of your stomach, you'll reduce your hunger. Except that that really doesn't work because it doesn't address the actual hormonal cause. horses that derive the hunger and only address one small aspect of hunger and might not even do that very well, depending on the type of surgery that's been done. What actually does, what actually heals our hunger? What helps us get back in tune with our normal natural hunger, so that we could just fuel our body for fuel just like, we water our body for thirst?
Dr Lucy Burns (15:25) Yeah. Well, first of all, I think it's important for people and again, particularly if you're a bit older, like I am, or even older than me, it's hunger hormones or the hormones that control our hunger and our fullness or satiety. They hadn't been discovered, like, back in the 80s,
Dr Mary Barson (15:45) even in 1999. Yeah. And it was, Yep.
Dr Lucy Burns (15:49) And even more recently, are the little peptide’s peptide yy, All of those ones are still and I'm sure there's probably a few others out there that still haven't been discovered because as humans, we are incredibly complex. Although, sometimes quite simple. So yeah Mary, I would love to hear you know, you're the biochemist. I would love to hear your, you know, discussion on hunger hormones and how we can work with our body, not against it. Yeah, in order to minimise hunger. And again, no, it's nothing wrong with hunger. But when we have, I guess, a dysregulated hunger drive that then contributes to obesity and weight gain and all of those things.
Dr Mary Barson (16:39) Absolutely. And getting back natural control of your hunger is crucial for sustainable weight loss and metabolic health. And that popular advice of eating six times a day just doesn't work. Because that's a main satiety hormone, that satiety means that just feeling for the most powerful ones are peptide yy, great name, and that is released in response to us eating protein, and cholecystokinin, another great name, is released in response to us eating dietary fat. And that combination of a bit of protein and a bit of fat is highly satiating, where, as you know, cruskits, an apple and some white bread, which contain mostly carbohydrates are not very satiating. So meals that contain fat and protein are going to fill us up and we know this, you know, you've gone out and you've had, you've had dinner and you're nice and full, and someone comes out with the most delicious pork chop imaginable. And would you like this pork chop Dr Lucy? And you’re like no way. But if someone comes out with some carbs, that's right, exactly, you know, I'll give you 50 bucks if you eat this pork chop. No, I just don't think I can. I'll give you 50 bucks if you ate the same amount of calories in these cruskits, you know, crispbreads, you might not want to but you actually could. You could eat the the carbohydrates after you're completely full because they do not stimulate satiety and nearly to the same extent as protein and fat. The feeling of fullness in our stomach is not negligible. We do have a stretch fibre within our stomachs. Our stomachs are these little stretchy bags, quite extraordinary logon. And if it's stretched to capacity or a little bit beyond capacity, they stretch fibres will send neuronal signals to your brain, which will just say—Don't eat anymore. So that feeling of a full stomach will actually stop us from eating more. We might not necessarily feel satiated, there's not quite so thing but we will, we will it will prevent us from eating more food, definitely. Some types of, you know, bariatric surgery can actually sever those nerves though, so it can actually destroy that aspect of satiation. Not all of them but some of them can. So that's the main thing. There is also another important player that can go awry for many, many people, which is leptin and insulin. So I've told you that if you have a meal that's got a good amount of protein and some nice, normal, a nice amount of fat, you'll feel nice and full. And you know, so if you had, you know, a lovely piece of salmon and an egg for breakfast, then you're not going to be starving hungry at 10:30am but if you had some white bread toast, an apple and some orange juice, you probably will be starving hungry by 10:30am Even if you ate more calories than was in the fish and eggs or whatever.
Dr Lucy Burns (19:44) Oh absolutely or a bowl of cereal like absolutely, you know processing as well in there.
Dr Mary Barson (19:53) There is another layer to this. It's it is it is very complex. But you know humans are complex and simple at the same time. Another really complex layer is that if you've got problems with your metabolic health, like I was I was obese or had polycystic ovarian syndrome. If you've got obesity problems with high insulin and insulin resistance, then you are in a state where it's going to be, you are primed to feel more hungry because if you've got elevated insulin, insulin’s job, one of its main jobs is to store our fuel. So it takes the fuel, particularly the sugar from the food that we've eaten, and it stores it as fat, and you're in a fat storage mode. And if you're in this highly primed fat storage mode, then you're going to be taking fuel away from your liver, your muscle, your brain, you could just have eaten but with a high insulin, it's all going to be going off and being stored. And your poor organs, your poor liver, your poor brain, your poor muscle don't actually have any feel that they can use, because it's all been locked away in that metaphorical woodshed. And yet another layer, but that's that's reversible, which is painful, and we will talk about how. But another layer is leptin. So leptin is another relatively recently discovered hormone that's made by our fat cells. And it's released in response to us how our fat cells getting a bit bigger, so get some stored fat into our fat cells so plump up a little bit, and then they send the signal to our brain saying– Hey, we've just been fed, here's some leptin, just this leptin is just letting you know that we've just been fed. So we're good, don't eat any more fuel for a little while. And leptin can reduce appetite, except for when you've got leptin resistance, and your brain is unable to respond to that leptin signal. So your fat cells could be getting bigger and bigger and bigger and bigger, because your insulin is elevated, elevated and elevated can be storing more and more and more and more fat. And you could be making more and more and more and more leptin, but you brain just can't hear it. And so those appetite-reducing effects of the elevated leptin just don't happen.
Dr Lucy Burns (21:59) No, no, and they become it's hard because, yes, people with leptin resistance also don't feel full. So you know, the natural off signal that you get with eating. And again, there's genetic drivers in this as well, people who, you know, look, I am a fast eater. And I thought that it was behaviourally driven. But I've since learned that there's genetic, there's genes for fast eaters and slow eaters. So frequently, I would do something where I'd fast eat, overeat, and about maybe 20 minutes after I finish go–Oh, my God, I've eaten too much. But I didn't, there was like the off switch just was a bit slow. So I have realised over time that I have to consciously moderate that behaviour because it's not my natural inclination. And yeah, that's genetic. Who knew?
Dr Mary Barson (22:58) I actually, I have to say Lucy, I didn't know that I am a fast eater too. And I know you’re a fast eater. I always assumed it was a product of my medical training. I can't actually remember how I ate before in medical school, but you know, you're on a 14-hour shift. You don't have time to wait, let alone eat. And if you can't shove that food down your face in negative 20 seconds, then you don't eat. So that's how I thought that I'm a fast eater., I thought it was entirely a learned response.
Dr Lucy Burns (23:24) I'm sure that there’s some some abilities to enhance our natural response, just as there are techniques that you can employ to negate that natural response. And I think it is helpful to do that. It is helpful to slow your eating down to allow the, you know, the hormones to catch up the peptide yy, the cholecystokinin, all of those ones to have their effect because hormones are not necessarily instant, like nerve fibres, which are much more instant. So I think that's helpful but it's yeah, I found that interesting. I thought so again, not a character flaw that you're Wolfer food.
Dr Mary Barson (24:09) Oh, yeah. So all right. I talked about satiety hormones. I haven't talked about our hunger hormones, which I just need to talk about right now. Well, one in particular ghrelin, Don't you just love that name?
Dr Lucy Burns (24:21) I know. Yeah.
Dr Mary Barson (24:22) Yeah, absolutely.
Dr Lucy Burns (24:25) Great. Is it to remember because it's kind of like grumble? It is. Yeah, ghrelin and grumble, grambling along. Relevant.
Dr Mary Barson (24:34) So ghrelin is one of our most powerful hunger hormones. I talked about the satiety hormones that make you feel like– oh, great, not hungry anymore. But what about the hormones that make you hungry? The fascinating little hormone called ghrelin. The interesting thing about ghrelin is there was a study by Natalicci et al in 2005, which showed that people, it was a small study but a powerful study, that we all get natural spikes in our hunger throughout the day. And they are linked to our circadian rhythm. And the fascinating thing about this is that they spike and will resolve even if we don't eat. So we're looking at individuals who were eating regularly and individuals who are fasting and and tracked their ghrelin levels in their blood throughout the day. And everyone's ghrelin levels were at their lowest at about 9am whether or not they'd eaten breakfast or not. And this is interesting, because the people who hadn't eaten breakfast, had probably not eaten for about 14 hours. And yet, they weren't hungry, they weren't hungry, was fascinating. And then people got a bit of a spike of ghrelin around about midday. And so triggers people to sort of eat lunch, and the ghrelin levels dissipated. After an hour or two, whether people ate lunch or not. So the people who are fasting, their ghrelin levels went down. Anyway, same thing happened at dinner, around about 8pm, there was a higher spike in ghrelin, and people were hungry. And again, the ghrelin and the associated hunger dissipated, whether or not they ate or not. So it's fascinating that ghrelin is intricately linked to many other hormones, including our circadian hormones. And it will, it will go away, whether or not we eat or don't act, and intermittent fasting is something we've discussed before if done well, with the right mindset, and in a nurturing, self-loving way. It's a great powerful tool to heal your metabolic health and to boost your metabolism and to lose weight. It's great for many, many reasons. And when you intermittently fast Lucy, you know this, you did get hungry, but it doesn't hunger doesn't build and build and build and build and build and build and build and build and build to the point where, you know, you will just devour all the food in the fridge, including the fridge itself. It comes in it goes in weights.
Dr Lucy Burns (27:08) Indeed, again, I think that there's some nuance in that because dieting, queen of dieting here, I spent a lot of time being hungry, and just I ran out of points for the day. So I just had to grin and bear it. The difference I now realise particularly you know, was that the dieting I did involve a lot of processed food, a lot of you know, diet, chocolate mousse, a lot of diet, yogurt, bars, muesli sort of bars, anything with, you know, Weight Watchers on it, basically, I ate prepackaged meals that were you know, Weight Watchers eat this, and it's six points or something. None of those, and it was low fat. So none of those techniques that I used had any, you know, minimal protein, and minimal fat. So no wonder I was hungry.
Dr Mary Barson (28:06) Absolutely. Also minimal fiber. So you know, the effect of that some extracts that you get, you're not getting that, and also they're not healing that they show I talked about previously with the elevated insulin, meaning that your body just isn't able to access the fuel source that it has. So if you've, you could be fed, but also, your individual organs are starving, because the elevated insulin is preventing them from being able to access their fuel. So so much of traditional diet foods is not going to reduce our hunger and is actually going to make our hunger worse. Whereas intermittent fasting when you've got that metabolic healing and you've got your insulin levels normalising your leptin signalling is normalising your body is in a much more natural and healthy state you're able to utilise your stored fat stores, hunger is and much much greater control and how you get your hunger to undergo to control is with real food.
Dr Lucy Burns (29:10) Yeah, absolutely. And I reckon that that is one of the biggest mistakes that people make with intermittent fasting. Fast and Furious. They try too hard too long too soon. So your body, it doesn't have fuel, like if it doesn't have fuel, it's just going to conk out. You need to make sure your woodshed is open. And if you're new if you're listening to this conversation, I would listen to last week's because that we talk a lot about the woodshed but it's really about making sure you have access to your fuel first. So making sure that these dysregulated hormones are reregulated, rebalanced, and then if you want to for therapeutic purposes, introduce intermittent fasting, yes,
Dr Mary Barson (30:01) Breaking up with processed foods, reducing the sugar and starches and only eating at regular mealtimes starting off with, you know, two or three meals a day of real food -this is what will heal your hunger. And you can lose weight without being hungry.
Dr Lucy Burns (30:25) Absolutely, absolutely. I think we need to point out and maybe, we will cover this next week even, is the idea that there's hunger, physiological hunger, which we've just gone through that that is a, you know, it's a hormonal process that's driven out of your conscious control. And then just to confound it all, there's what we love to call the psychological hunger or our desire or our emotional hunger or stress hunger or whatever, whatever phrase you might be used to, but so many people don't address that. And that I think, is such a big issue because you can have bariatric surgery, and still, emotionally eat and know whatever weight you've lost gets put back on.
Dr Mary Barson (31:18) And I mentioned right at the very start, I'm sleep deprived, which means that I'm stressed, I'm stressed both physiologically and emotionally stressed. And this increases my hunger, both my physiological hunger. So my ghrelin is actually increased because of the sleep deprivation and stress on my body. And also more likely to have emotional hunger to soothe all of that fatigue and stress and like feeling quite sorry for myself.
Dr Lucy Burns (31:45) Absolutely I think weightless next week, why don't we chat about emotional hunger and willpower? Because it's also interesting, you know, what is willpower? All of those things, lots of myths around willpower, but also some truths around what it is and what it isn't. And I would love because that's one of my favourite things. Let's talk about that next week.
Dr Mary Barson (32:05) Sounds fabulous. It's a date, Lucy!
Dr Lucy Burns (32:09) Excellent. All right, my gorgeous friends. Have a beautiful, beautiful day. Enjoy the rest of your week. I will talk to you next week. Bye for now lovelies!
Dr Mary Barson (32:19) Bye bye!
Dr Lucy Burns: (32:33) The information shared on the Real Health and Weight Loss podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
Natalucci G, Riedl S, Gleiss A, Zidek T, Frisch H. Spontaneous 24-h ghrelin secretion pattern in fasting subjects: maintenance of a meal-related pattern. Eur J Endocrinol. 2005 Jun;152(6):845-50.
