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Works independently of Gemini apps. Check responses for accuracy. Alright, so gonadal hormones definitely have a very complicated effect on appetite. Now there's a lot of different reasons why people binge eat. Some of that is habit, some of that is boredom, some them of some of that is stress. But without a doubt there is absolutely some influence of gonadal hormones on appetite. For example, estradiol generally suppresses appetite, whereas progesterone opposes estradiol's action and especially if it's a nortestosterone type of progestin can actually stimulate some appetite, especially in women. In men it's a little bit more complicated because testosterone actually appears to be a appetite suppressant in men, but it seems to increase appetite in women. All to say is that estradiol and progesterone and testosterone and 19 or testosterone derivatives do have some kind of complicated interplay with appetite. Hence in some reports, I mean going back 20 years to 30 years, there have been these publications that possibly combination oral contraceptives have an in increased risk in some vulnerable individuals of binge eating. So eating quickly, especially in the old triphasic formulations where the third week tend to have very high levels of hormones. Now most people use monophasic, which is definitely the way to go. But this issue of the effect of oral contraceptives on binge eating behavior is nothing new and it's very controversial and it's very conflicted. And this has been going on for several decades. Well now now as of June and July of 2026 there are two back to back separate publications. All right, the one in June was from Jama network open. The one from July was in the journal Appetite. Yeah, there's actually a journal called Appetite. And look how interesting this is. The publication From June of 2026 is from Michigan State University, whereas the publication From July of 2026 is from University of Michigan in Ann Arbor. Those are different places. All right, so very interesting that out of Michigan, two different locations, one month apart, June and July, both of these are looking at the same thing in different ways. Okay, so the one in June looked at interpersonal differences, meaning within the same person intrapersonal differences, how they act in terms of binge eating when on active birth control pills versus placebo over a two pill pack cycle. Okay. Looking at one person individual's changes based on actopill versus placebo. So they served as their own control. Whereas the one in July looked at different groups including binge eating behavior in men in natural spontaneous cycles, meaning not ovulatory suppressed and in those with contraception. Very interesting. So while one, the one from June of 2026 was from the Michigan State University, the publication from July is from University of Michigan. Crazy. And they found what seems to be conflicting results. All right, so one result says maybe there's an association. The other one says we don't find an association, but there's an easy explanation for that. And I'm going to tell you why. These seem to be at opposing ends. I'm going to tell you why that is in this episode. So we're going to tackle two separate publications. One is from JAMA Network, open again from Michigan State University. And just as disclosure, there is an author from that June of 2026 publication from my institution, which is Texas A and M University here in Texas. But, but we have no affiliation. I was not involved with this study. I just found this interesting that this was done together with Florida State University as well as a investigator from Canada. But this mainly comes from the department of Psychology out of Michigan State University. So that's one in June. And then we're going to get group differences, if any, from the journal Appetite from this month, July of 2026 from the University of Michigan. Super interesting, because this is what patients want to know, right? If you're going to start them. A combination birth control is. Well, is this going to affect my eating? Is that going to make me hungrier? Well, we're going to get into it. The bigger question is does that appetite. Do birth control pills, combination birth control pills actually have some kind of causative effect on weight gain? That's a separate issue. And I'm gonna tell you that as well in this episode. So we're Tackle2 publications very quickly and then we're gonna wrap it up with does birth control pills, specifically combination birth control pills, do they affect weight of an individual? So that's where we're going. So get your favorite chips, get your favorite binge eating snack, and we're gonna talk about that when we come back. All right. That's disgusting. We'll be right back. We're just trying to fulfill our life calling and our mission. This is Dr. Chapa's OBGYN no Spin podcast. All right, one more. Just one more. Because as annoying as it is, we're all going to partake in this annoyance. Listen to that. That is one of my pet peeves. Oh, my God. I don't want to hear you eat. I don't want to see you. I don't want to see the food in your mouth. It's one of my pet peeves. And that includes for close friends, family members and loved ones. I don't want to hear you chewing. It's kind of gross. Chew with your mouth closed. Oh, my God. All right, let's cut that out. All right, so here's what we're going to talk about. Remember, there's two publications here. The first is from June. The second one is from July, back to back months, oddly enough, from authors in the same state of Michigan, even though the one from June also includes authors from my institution of Texas A and M, both looking at the effect of contraception and eating behavior, mainly emotional eating or binge eating. Okay. Now the one from June used patients within as individual differences like their own control. In other words, they followed women over two birth control packs, so over two cycles comparing their eating behavior when on active pills and then went on placebo. So I like this because that's basically comparing them within themselves. All right, this is nice because even though it is longitudinal, it's population based. The nice thing is that it compares within person changes in eating behavior. That's fine. The second publication looks at eating behavior among groups including men and including women with spontaneous cycles. Right. Not just those who are hormonally suppressed, but those who have irregular periods just by themselves to see if there is any change in eating behavior among those groups. So birth control, pill use, iud, men, and then naturally occurring cycles. So two different publications. But oddly enough, what they do share in common is that they're from the state of Michigan, which seems to have opposing results. Okay. Kind of conflicting results. But I'm going to explain why in this episode? Now the bigger issue, as I mentioned in the intro, is does binge eating behavior, because that is controversial, you're going to see in this episode, does that actually affect, affect true body weight? Does that lead to a change in the recipients in the birth control pill takers weight gain over time? Now let me just say this right now, I was going to say it at the end, but I'm just going to knock this out now. Unlike historic birth control, that was 50 micrograms and 100 micrograms of estrogen, very high dose. So of course some of that was fluid retention and possibly had a bigger effect on appetite stimulation because they were very high dose. Today's current birth control formulations, let me say right now, anything 35 micrograms and below, there is no cumulative evidence. Here it is, guys, sorry. Of a causal relationship. Meaning what? This causes that between combination birth control pills and significant clinical weight gain in the user. There just isn't. When this has been looked at longitudinally, comparing those who aren't on birth control and those who are, people tend to gain and lose weight in a cycle. So that's just part of natural progression of time. But there is no solid evidence that today's modern birth control pills, even though it may affect binge eating behavior, we can get into that in a minute. There's no net effect on clinically significant weight gain. We know that. That's been Cochrane review over, Cochrane review, prospective study over prospective study, population based data and population based data that say there is changes to a person's weight over time, but that's just natural fluctuations. So that's not controversial. We don't have any good data of that. Unlike Depo Provera, that is the prototypical birth control that can cause weight gain with prolonged use. And depo's having its own issue of course, with the risk, rare occurrence and increased risk of meningioma. Even though the number needed to treat both in patients in their 20s and 30s and even those in their 40s is still exceedingly high. Right. The number needed to harm or number needed to treat in order to get a meningioma is one in several hundred thousand. Okay, so it's still a very small finding in absolute numbers, although the relative risk is higher for Depo and meningioma. But Depo Provera with prolonged use has been linked to weight gain. Okay, but we're talking about Here in the June 2026 JAMA Network open publication on oral combination birth control pills. Now this followed women over two birth control cycles all right, so over 49 days. So tracking their eating behavior called emotional eating, when they're on the active pill, when they're on the placebo and then again on the active pill. So they served as their own within person comparison. I like this. This is very smart. It was population based longitudinal data collection out of a database from Michigan State University. Okay. Remember this is June 2026. The total number of N for, I mean it wasn't thousands, but it's still a respectable number was 422 women. Okay. So 4 22. And said, hey, let just track based on a validated scale how your eating behavior or emotional eating is impacted by the active pill compared to placebo. Now I'm just going to tell you very quickly the highlights here because I want to move on and compare it to the July 2026 publication, which is kind of looking. That's the same thing in a different way. That's why they got different results. Okay. Short of it is even though this was only 422 women and there's a lot of different things that can affect eating behavior. Yeah. This found that it is possible that there is a, there was an association between binge eating behavior when patients were on these monophasic birth control pills in the active pills compared to the placebo. Remember it was 49 days. So active pill, placebo and then active pill. Now questions also remain here. What if they could use continuous. I use continuous birth control. I don't have patients do a placebo unless they really want to have a cycle because it's much better to just skip the placebos and go continuous. That wasn't looked here. And this was only, remember over 49 days or two pill packs. So does this level out? Does this normalize after three months? We don't know. This is short term in 422 women. Right. So that's some of the questions on this. But let me just read you the conclusions. Quote, this intensive daily survey of combination oral contraceptive use found a specific association of active combination oral contraceptive pills with the risk for emotional eating. Further studies are needed to identify for whom combination birth control pills are most likely to risk this effect. So we need to personalize medicine. That's the take home message, end quote. Okay, so if somebody's prone to binge eating already, maybe something to discuss with them. All right, see how nuanced this is. So again, a lot of questions here. Only over two cycles, only 422 women. Does this even out. This was monophasic cyclic use of the pill. What about monophasic continuum continuous use, as most people do. Most people don't use triphasic pills anymore, which is where every week the birth control pill dose increased. That, that's very old school. Most people don't do that because we're trying to get away of hormonal flares. We want things to be constant and even keel for a variety of reasons, even for like endometriotic implants. So most people do monophasic pills, which is what was used in this publication. Okay, so yes, in this very short study of 49 days in 422 women, there was some effect here of active pill use influencing eating behavior. All right, so that's not hard to figure out. Right. Some women with natural spontaneous cycles, they have a tendency to crave certain foods based on where they are in their menstrual cycle. That's not stereotype. Don't be mad. That is proven. And there are some endocrine and neurohormonal changes that can lead to that. That's fine. We get that there is an association between gonad hormones and appetite. Although it is complicated. But in its purest form, estradiol inhibits and progesterone stimulates. And From a synthetic standpoint, 19 or testosterone derivatives like norethindrone can stimulate a little bit more, even though, as we've already stated, does not seem to influence weight gain. Okay, relax. You're like, oh my gosh, I don't want my patients to emotionally eat on their monophasic birth control pill. Relax. It's just give them education. That's called personalized and nuanced counseling. That's all that this study is saying to do. From JAMA Network open from June of 2026. Okay, so very quick. That small cohort over two birth control cycles. That's it. Over two months, two packs of pills found. Yes, there is potentially an impact, an influence on appetite based on your active pill use. Okay, now let's stop there for a minute. Let's go to this month because this is July 2026 when we're recording this. This is out of the journal Appetite. Right? So the first one was JAMA Network. This is Appetite. The title of this one is Associations between Reproductive Hormonal Milieu and Binge Eating. The role of sex and hormonal contraceptive Use. Now it means sex in terms of biological sex, men and women, not sex as in the act. All right, the role of sex and hormonal contraceptive use. So this is looking at the exact same thing. Do gonadal steroids and combination birth control affect eating behavior, emotional eating, binge eating. Those are used entertainment tangibly based on what a patient is using. And this included. I like this because this included men as kind of like as a separate comparator group slash control. All right, now let me just read you this very quickly and then we're going to talk about this and we're going to be done. Now I like this because as these authors state, quote, no study has systematically examined binge eating and hormonal intracon. Sorry. And hormonal intrauterine devices. So These are progesterone IUDs which differ in formulation and delivery from other hormonal contraceptives. So this is looking at the effective eating behavior in 401 females, 181 of which were naturally cycling, 152 were on oral contraceptives and 53 were IUDs. Now remember, these were hormonal influences. So this is hormonal intrauterine devices. Okay. And then they also had 159 males. So everybody good. So let's look at 401 women, some naturally cycling, some on oral contraceptives, some on hormonal IUDs and throw in their men just to see what happens. I like this. So this is looking at big groups here. Let me read you the conclusion. Now remember, June said yes, in women, combination birth control pills, monophasic tends to influence eating behavior. Let me show you this result here. This episode is brought to you by Google Chrome. You think you know a browser, but Gemini and Chrome, that's new. It can help you with practically anything on the web, like restoring a vintage motorcycle from a 50 page restoration block. Or finally break down that long article you've had open for weeks. Gemini and Chrome is here for it, ready to make anything online make sense. There's no place like Chrome. Check responses. Setup required compatibility and availability. Various 18 plus. Your summer run's just got a boost of energy in Lululemon's Shake it out shorts. Made in our ultra breezy, lightweight swift fabric, the Shake it out shorts have a flowy layered hem and a comfy built in liner. These shorts keep you locked in for miles with distraction, free storage and a waistband that doesn't budge. They might just be the shortcut to your summer goals. Shop the Shake it out shorts now@lululemon.com's in this comparative group. Okay, here it is. In this comparative group, quote. Females reported higher binge eating than males. That's the first thing that that shouldn't surprise Anybody for. We've known this for many, many decades that males tend to not have as much emotional eating as females. Please don't be mad at me. That's not stereotype. I'm not being chauvinistic or whatever this is. This is the data, right? Females tend to have higher binge eating than males and that's what was seen here. But listen to this. Here it is. Quote, but. Oh, but binge eating did not differ across hormonal contraceptive groups, nor did it vary with oral contraceptive activities. In other words, ActoPills versus placebo, end quote. So here they go. Hey, when you put patients into big groups, birth control pill, hormone iud, naturally occurring cycles, let's leave men out of this for now. There's no change in eating behavior as groups. So they say, quote, these null results may reflect true group level similarities in binge eating or individual differences in vulnerability to hormonal exposure, end quote. That's a scientific way and a fancy way of saying, look, we cannot rule out that there are some within person differences within each group themselves and between each group. However, when you throw them all into the mix, those differences are no longer significant. So they leave the door open saying there may be some within person changes. Which is exactly what June said. All right, so let me just summarize this very quickly because I don't want to get too technical. June using within person differences across two birth control packs said, yeah, there's definitely an influence here of active birth control pill use and appetite stimulation, binge eating and emotional eating when they're on the active pill. But it only happened, remember, in 422 women over 49 days. The second publication said, look, we don't find any differences when you look at the data in big groups, birth control pill, hormonal IUD or naturally occurring cycles. However, we cannot say that there isn't some within person differences because they kind of get washed out when you all chunk them up together in the same boat. All right, so when somebody asks you, are there any group differences on binge eating between the oral birth control pill and say, hormonal iud? Not according to the July data, but that doesn't take into account individual differences that may be missed when you take a look at a bigger group. All right, so everybody, very quickly, because I don't want to belabor this, two publications back to back by two different groups out of Michigan and other locations, but very interesting. JAMA Network open showed, yes, combination of birth control pills may have a stimulant effect on Binge eating. Another one from July of 2026, exactly one month later said, we don't see any big group differences, but we cannot rule out that there is some within person differences that we didn't see here. That was in the journal Appetite. So what do we do with this? Okay, so a couple of things. Three things. Number one, fit the birth control that best fits the patient. If you've got a patient who is very prone to weight gain for whatever reason, Depo Provera may not be the best for them because they're going to gain weight with prolonged. Then you don't want to introduce the very rare issue of meningioma. Okay. If they got other issues going on. Second, if you've got a patient who is very prone to binge eating by herself without any birth control, maybe birth control pills, maybe not the best. This all goes into nuanced counseling. So the three things. Number one, tailor the birth control to the patient. Number two, absolute weight gain. Absolute, clinically significant weight gain with birth control pills has not been documented with prolonged use. Number three, the only birth control that has been linked to weight gain is what we've already talked about with prolonged uses. Depo Provera. Okay, so I do find this fascinating. We should be talking about this. There is an absolute association between appetite influence, emotional eating, binge eating based on a woman's natural cycle and based on what kind of hormones she is taking. Because estrodial tends to suppress and progesterone tends to stimulate. And so both of these have an effect. Effect pull the patient one way or the other in addition to traditional life stresses, habits, boredom, and social cues and culture. Okay, Sometimes maybe you just go out a lot and want to binge eat with your friends. I mean, whatever. And that doesn't necessarily mean that it's gonadal related. Okay, see how complicated this is? But when I saw these two articles back to back, and one of them had ties to Texas A and M University, which is my affiliation, that's the one from June of 2026. I'm like, I gotta put this out there. So do birth control options have an effect on appetite? Yeah, possibly, but it's complicated. And that should never discourage appropriate birth control use in the appropriate recipient podcast family. As always, we're thankful for you. We're glad you're part of our podcast community. And now that we've done all that, Michael, let's take it home. This is Dr. Chapma's obgyn no spin podcast. Sam.