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It Is Mealtime and I Do Not Feel Like Eating

Dr. Dr. Heo Ji-young, Director of Kyunghee Meerae Korean Medicine Clinic, Gwangjin
Written by Dr. Heo Ji-young Representative Director · KMD

The short answer

I do not look at a lost appetite first as a matter of will or mood. Hunger is a signal that comes up when the stomach empties, so I begin with how fast the stomach is emptying.

"I'm not hungry. I eat because it's mealtime, that's all."

Quite a few people say this. Nothing hurts, and the tests say nothing much either. So those around them either take it as nothing to mind, or say the opposite — that eating well is what makes you better.

I do not look at appetite first as a matter of will or mood. Hunger is not a sensation you produce by resolving to; it is a signal that comes up when the stomach empties. If the signal is not coming, what has to be looked at first is how the stomach is emptying.

Hunger comes once the stomach is empty

When the stomach empties, the stomach wall releases ghrelin, the hunger hormone. This hormone tells the brain it is time to eat, and at the same time switches on the sweeping movement that runs down the gut. It rides a rhythm — rising before a meal, falling after one.

When gastric emptying slows, that rhythm goes dim. The stomach does not empty, so there is no place for the signal to come up from. Mealtime comes and there is no hunger; eat a little and it fills at once. A lost appetite being the result rather than the cause is something I see often.

Emptying is not one single thing

Emptying the stomach is not one action. At least four things move together.

When food comes in, the upper part of the stomach stretches to make room. The lower part squeezes rhythmically to push it on into the duodenum. There are cells in the stomach wall whose work is to set the beat, raising a wave about three times a minute, and on top of that hormones such as ghrelin and motilin switch the wave on and off.

These four do not switch on at the same moment. Each works at a different point and they affect one another. If the side that makes room is stiff, then however hard the pushing side works, only the pressure rises. If the beat is disturbed, the forces point in different directions. This is why "a weak stomach" is hard to bundle into one phrase. Which hand is pushing less differs from person to person.

If you are emptying your stomach slowly on medication

Some people use an injectable for weight control. This medicine slows the speed at which the stomach empties. That is not an unexpected event but the very work the medicine sets out to do. With the stomach full for longer, you eat less, and so weight comes down. The principle is clear.

Only, when the same action comes out a little strongly for a given person, it leads to nausea or early fullness and daily life becomes uncomfortable.

What I look at then is not a place to contend with the medicine. It is the side of helping you pass more comfortably through the slow emptying the medicine has set up. Assist the force with which the stomach makes room and the beat that pushes downward, and you may be less uncomfortable while staying on the same medicine. What to do about the medicine is for you and the doctor who prescribed it to decide; I take on the discomfort in between.

The places old medicinal materials touched

What is interesting is that these places were already being touched, separately, by old prescriptions.

The compounds in tangerine peel block part of the serotonin receptors in the stomach lining. Under tension those receptors press down ghrelin release, so this eases off that brake. The ginsenosides in ginseng raise sensitivity so that the ghrelin already released binds better to its receptor. Making more of the signal and receiving the signal better are divided between them.

Magnolia bark sits in a different place. By way of the nitric oxide path it lowers the tension in the upper stomach so that room is made. Rather than building up the force that pushes, it is the side that makes the space to receive.

It is not one compound doing one thing strongly. It is closer to several compounds each pushing a different place a little, so that the stomach comes back to its own rhythm.

When to see a doctor first

If appetite is low and weight is falling of itself, if there is a catching feeling on swallowing, if stools come out black, or if vomiting repeats — do not put it down to a functional problem; get tested first. All the more so if you are older or if it began suddenly.

Appetite is not a personality trait

Hunger is not a personality. It is the body letting you know the stomach has emptied. If that signal is not coming, it is often not that you have grown lazy but that the stomach has not emptied yet. Before lifting the appetite, I look first at the speed at which the stomach empties. That is the order of it.


Sources

Written by Dr. Heo Ji-young (Ph.D. in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)

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Dr. Dr. Heo Ji-young, Director of Kyunghee Meerae Korean Medicine Clinic, Gwangjin

Dr. Heo Ji-young Representative Director · KMD

Kyunghee Meerae Korean Medicine Clinic — Jayang-dong, Gwangjin-gu, Seoul (Guui Stn. Exit 4)

A graduate of the College of Korean Medicine at Kyung Hee University, with master's and doctoral degrees in pathology — the mechanisms of disease — from its graduate school. Later served as a research professor in the university's Herbology department, studying medicinal substances. Studying both disease and medicine from both sides is the foundation of this practice: explaining "why a given medicine works for a given illness" in the language of both pathology and pharmacology.

Explains autonomic, chronic, and intractable conditions — and structural problems of the body — in the language of modern science, and proposes treatment matched to the cause. Has taught prescribing and clinical practice to Korean medicine doctors for over ten years, and is a co-author of "Korean Medicine, Explained by Korean Medicine Doctors," selected for the 2018 Sejong Books list (general category).