What can increase cravings and appetite?

From the Guidelines

Megestrol acetate is the most effective medication for increasing cravings and appetite, particularly in patients with cancer-related anorexia and weight loss, as evidenced by a recent systematic review and meta-analysis 1. Several factors can increase cravings and appetite, including stress, sleep deprivation, and certain medications.

• Stress triggers cortisol release, which stimulates hunger, particularly for high-calorie foods.
• Sleep deprivation disrupts hunger hormones like ghrelin and leptin, increasing appetite.
• Certain medications, including antipsychotics (like olanzapine), antidepressants (such as mirtazapine), corticosteroids (prednisone), and antihistamines (diphenhydramine), can significantly increase hunger.
• Marijuana use stimulates appetite through THC activation of cannabinoid receptors.
• Alcohol consumption can temporarily increase hunger by lowering blood sugar and inhibiting judgment.
• Highly processed foods with refined carbohydrates cause blood sugar spikes and crashes that trigger more cravings.
• Dehydration is often mistaken for hunger, leading to unnecessary eating.
• Boredom or emotional eating can increase food consumption unrelated to physical hunger.
• Hormonal changes during menstruation, pregnancy, or menopause can intensify cravings. The use of megestrol acetate, a progestin, has been suggested to increase appetite in anorectic cancer patients with advanced disease, but it is essential to be aware of potentially serious side effects, such as thromboembolism 1. Other medications, such as cannabinoids, antidepressants, and neuroleptics, have been tested in various patient groups suffering from anorexia and weight loss, but their effects on appetite and weight gain are not as well-established as megestrol acetate 1. The most recent and highest quality study recommends megestrol acetate as the primary medication for increasing appetite in patients with cancer-related anorexia and weight loss, with a minimum efficacious dose of 160 mg/day 1.

From the FDA Drug Label

Gastrointestinal ... increased appetite and weight gain The increased appetite can increase cravings.

• Olanzapine and prednisone can increase appetite and weight gain 2 3.

From the Research

Factors that Increase Cravings and Appetite

• Certain medications, such as mirtazapine, can increase appetite and cravings 4
• Stress and high levels of cortisol can also increase cravings and appetite 5
• Hormones such as ghrelin, insulin, and leptin play a role in regulating appetite and cravings 6, 5
• Food cravings can be associated with poor dietary intake and metabolic health, including lower diet quality, higher eating frequency, and longer daily eating intervals 7
• Certain factors, such as a "toxic food environment" and the obesity epidemic, can contribute to increased cravings and appetite 8

Biological Mechanisms

• The hypothalamus is a critical region in the brain that regulates food intake and appetite 6
• Neural circuits in the hypothalamus produce peptides that influence food intake, including orexigenic peptides such as agouti-related protein and neuropeptide Y, and anorectic peptides such as alpha-melanocyte-stimulating hormone and cocaine- and amphetamine-related transcript 6
• Circulating factors, such as leptin, insulin, and ghrelin, also play a role in regulating appetite and cravings 6, 5

Psychological and Environmental Factors

• Stress and emotional states can increase cravings and appetite 5
• Environmental factors, such as the availability and marketing of high-calorie foods, can also contribute to increased cravings and appetite 8
• Poor eating patterns, such as eating frequently or having a long daily eating interval, can be associated with increased cravings and appetite 7