Article by Dr Manasa S, B.A.M.S
Introduction to Polyphagia
Polyphagia, also known as hyperphagia, is a medical term for experiencing extreme, insatiable hunger. This intense hunger persists despite eating and is often a symptom of underlying health conditions.
While normal increases in hunger can occur due to fasting or strenuous exercise, polyphagia signifies a more serious issue that requires medical attention, such as diabetes or low blood sugar i.e. hypoglycaemia. Polyphagia is one of the “three Ps” of diabetes, along with polyuria – increased urination and polydipsia – increased thirst.
Excessive eating due to polyphagia may or may not result in weight gain, depending on the cause. In some cases, it can even lead to unexplained weight loss. Understanding and addressing the underlying condition is crucial for managing polyphagia effectively.
Causes of Polyphagia
Polyphagia, characterized by extreme and insatiable hunger, can result from various underlying conditions. Here are some key causes grouped under different categories:
Relationship Between Polyphagia and Diabetes
Diabetes mellitus is a condition that affects how your body regulates blood glucose (sugar) levels. There are two main issues in diabetes: the body either doesn’t produce enough insulin or doesn’t use insulin properly. Insulin is a crucial hormone that helps cells absorb glucose from the bloodstream for energy.
When there isn’t enough insulin or the body can’t use it effectively, glucose accumulates in the blood, leading to hyperglycaemia (high blood sugar). Despite high levels of glucose in the blood, the cells are starved for energy because they can’t access the glucose. This energy deficiency signals the body to increase hunger, leading to polyphagia.
In short, in diabetes, the inability to use glucose for energy effectively triggers a constant feeling of hunger, resulting in polyphagia. Managing diabetes with proper medication and diet is essential to control this excessive hunger.
Hormone-Related Conditions
Hyperthyroidism or Graves’ Disease
– Mechanism: In these conditions, the thyroid gland releases excessive thyroid hormone, which regulates metabolism.
– Effect: Elevated thyroid hormone levels speed up metabolism, causing the body to use calories faster than normal. This can lead to constant hunger and weight loss.
Premenstrual Syndrome (PMS)
– Mechanism: PMS involves hormonal fluctuations, particularly spikes in oestrogen and progesterone and decreased serotonin levels.
– Effect: These hormonal changes can trigger symptoms including polyphagia, typically occurring one to two weeks before menstruation.
Insulinoma
– Mechanism: Insulinoma is a rare tumour in the pancreas that produces excess insulin.
– Effect: The overproduction of insulin leads to low blood sugar (hypoglycaemia), causing insatiable hunger as the body seeks to restore normal blood sugar levels.
Mental Health Conditions
Atypical Depression
– Mechanism: Atypical depression differs from traditional depression, with distinct symptoms.
– Effect: One significant symptom is an increase in appetite, often resulting in weight gain.
Stress
– Mechanism: Stress triggers the release of the hormone cortisol.
– Effect: Cortisol increases blood sugar levels and can stimulate hunger, leading to polyphagia.
Anxiety Disorders
– Mechanism: Anxiety also causes elevated cortisol levels.
– Effect: Increased cortisol can lead to frequent hunger, and eating may become a coping mechanism for dealing with anxiety and negative emotions.
Rare Medical Conditions
Prader-Willi Syndrome (PWS)
– Mechanism: PWS is a rare genetic disorder affecting metabolism and behaviour.
– Effect: Children with PWS typically develop polyphagia around age two, leading to significant weight gain.
Kleine-Levin Syndrome
– Mechanism: This extremely rare condition causes intermittent episodes of prolonged sleep.
– Effect: During these episodes, individuals experience various symptoms, including polyphagia.
Other Causes of Polyphagia
Malnutrition
– Mechanism: Malnutrition, specifically undernutrition, occurs when there is a deficiency of essential nutrients.
– Effect: Undernutrition can result from an inadequate diet or the body’s inability to absorb enough nutrients from food. This deficiency prompts the body to signal increased hunger, leading to polyphagia.
Certain Medications
– Corticosteroids: These medications, often prescribed for inflammatory conditions, can increase appetite and cause polyphagia.
– Cannabinoids: Cannabis-related drugs can also stimulate appetite, resulting in excessive hunger and polyphagia.
Lack of sleep:
Lack of sleep can lead to polyphagia, which is excessive hunger. When you don’t get enough sleep, your body struggles to regulate hunger hormones, making you feel hungrier and often leading to eating more high-calorie foods. Poor sleep quality from conditions like sleep apnoea can also increase your appetite, causing you to eat more than usual.
Dietic reasons
Diet can be a major cause of polyphagia, or excessive hunger. Consuming foods high in unhealthy carbs and fats, like white bread and fast food, can make you feel hungry soon after eating. These foods lack filling nutrients such as fibre and protein. To reduce excessive hunger, try incorporating more protein, beans, vegetables, fruits, and lean meats into your meals.
Symptoms of Polyphagia
The primary symptoms associated with this condition include:
A Strong Desire or Need to Eat: Individuals with polyphagia experience an overwhelming urge to eat, often finding it difficult to control their hunger.
Overeating: Due to the persistent need to consume food, affected individuals frequently engage in overeating. This behaviour can occur even shortly after having a meal.
Not Feeling Full or Satisfied: Despite consuming large quantities of food, individuals with polyphagia often do not feel satiated. This lack of satiety drives continuous eating.
Weight Gain (Although Not Always): While excessive eating typically leads to weight gain, this is not a universal outcome for all individuals with polyphagia. Some may maintain a stable weight due to underlying metabolic or health conditions.
Binge-Eating: Episodes of binge-eating, where large amounts of food are consumed in a short period, are common in individuals with polyphagia. These episodes are often uncontrollable and can lead to significant physical discomfort.
Thinking About Food Constantly: A preoccupation with food is a hallmark of polyphagia. Those affected may spend a considerable amount of time thinking about their next meal, planning what to eat, or feeling anxious about food availability.
Diagnosis and Tests for Polyphagia
Medical History Assessment:
– Your doctor will conduct a thorough medical history review.
– Inquire about accompanying symptoms to assess the context of polyphagia.
– Determine the duration of polyphagia episodes.
– Evaluate dietary habits and patterns.
– Explore family medical history for relevant hereditary conditions.
Initial Diagnostic Steps:
– Based on the medical history, the doctor may identify potential causes of polyphagia.
– If the cause is unclear, further diagnostic tests are typically recommended.
Blood Tests:
Blood Glucose Test:
– Used to screen for diabetes mellitus, a common cause of polyphagia.
– Determines if blood sugar levels are elevated beyond normal limits.
Thyroid Function Tests:
– Assess thyroid hormone levels (T3, T4, and TSH).
– Helps identify hyperthyroidism, which can be associated with increased appetite.
Additional Tests as Needed:
– Serum Cortisol Levels – measures cortisol levels to evaluate for Cushing’s syndrome.
– C-peptide Levels – assesses pancreatic function and insulin secretion.
– Gastrin Levels – Checks for conditions like gastrinoma causing increased gastric acid production.
Imaging Studies:
– Depending on initial findings and clinical suspicion, imaging such as abdominal ultrasound or MRI may be ordered.
– Helps visualize organs like the pancreas or pituitary gland for structural abnormalities.
Specialized Tests:
– In cases where initial tests are inconclusive, specialized tests such as glucose tolerance test (GTT) or oral glucose tolerance test (OGTT) may be performed.
– These tests provide more detailed information on glucose metabolism and insulin response.
Referral to Specialists:
Depending on suspected underlying conditions, referral to endocrinologists, gastroenterologists, or other specialists may be necessary for further evaluation and management.
Monitoring and Follow-up:
Continuous monitoring of symptoms and periodic blood tests may be required to track response to treatment and disease progression.
Treatment and management
Treatment of polyphagia focuses on addressing the underlying cause: Polyphagia, or excessive hunger, is often a symptom of underlying medical or psychological conditions. Addressing these underlying causes is crucial to managing polyphagia effectively.
Conditions like diabetes, hyperthyroidism, and premenstrual syndrome can be treated with medication: For polyphagia caused by medical conditions such as diabetes (where blood sugar regulation is impaired), hyperthyroidism (overactive thyroid gland), or premenstrual syndrome (hormonal fluctuations), specific medications can be prescribed to manage these conditions. Controlling these underlying conditions can help reduce excessive hunger.
A healthy diet and exercise plan can help control hunger and benefit underlying conditions: Adopting a nutritious diet rich in fibre, protein, fruits, and vegetables, and engaging in regular exercise can aid in controlling hunger levels. This approach not only helps manage polyphagia but also supports overall health, potentially improving the management of underlying medical conditions contributing to excessive hunger.
If polyphagia is due to a mental cause like anxiety or depression, a referral to a mental health specialist may be needed: Sometimes, excessive hunger can stem from psychological factors such as anxiety or depression. In such cases, consulting with a mental health specialist is important. They may recommend therapies like cognitive behavioural therapy (CBT) or other talk therapies to address underlying psychological issues contributing to polyphagia.
Cognitive behavioural therapy, other talk therapies, antidepressants, or antianxiety medications might be recommended: Depending on the diagnosis and severity of the mental health condition contributing to polyphagia, treatments such as cognitive behavioural therapy (CBT), which focuses on changing patterns of thinking and behaviour, may be recommended.
Additionally, antidepressants or antianxiety medications may be prescribed to alleviate symptoms and reduce excessive hunger associated with these conditions.
In summary, treating polyphagia involves identifying and addressing its root cause, whether medical or psychological, through targeted treatments and lifestyle adjustments aimed at improving overall health and well-being.
Polyphagia: Ayurveda Understanding
Seeing through the description of polyphagia and studying it through Ayurveda lens, it fits into many basics discussed in Ayurveda treatises. It fits into the description of related aspects of the below mentioned conditions –
– pitta vriddhi / pitta prakopa – abnormal increase of pitta
– teekshnagni – digestive fire influenced by aggravated pitta,
– vishamagni – digestive fire influenced by aggravated vata,
– bhasmaka roga – a high pitta condition wherein the food is burnt out instead of being digested,
– anashana – obsessive fasting, not eating for long periods of time, as a habit
– ati langhana – lightening therapies or apatarpana – depleting theapies
– dhatu kshaya – severe depletion or destruction of body tissues,
– sthoulya – obesity, medo roga – diseases caused due to errors of fat metabolism
Interventions would be to keep away the etiological factors and also to address the doshas or disease conditions which cause polyphagia.
Related Reading – ‘Polyphagia – Ayurveda Understanding’
