Reset your hormones and shed pounds, says integrative physician Sara Goffried.
Have you ever felt like your body is resisting your weight-loss efforts? You count calories, pound the pavements and reduce your afternoon snack to six Brazil nuts… and still the pounds won't shift.
That was Dr Sara Gottfried's story. Despite her best efforts, the Harvard-trained integrative physician just couldn't lose the weight she had gained after having children.
"My defining moment came in my mid-30s," she explains. "I had an extra 25lbs of baby weight I couldn't shake and my old diet tricks no longer worked."
Her work-life balance was compounding the issue. "I was seeing 40 patients per day and I felt I couldn't get to know my patients and really listen to them the way I wanted.
"Like many women, I was burning the candle at both ends - I had two kids, a husband who travelled a lot and I was a working mother, trying to be all things to all people."
When the fatigue became unmanageable, she visited her GP. He told her weight loss was a matter of simple mathematics.
"Eat less and exercise more," he said, before suggesting an antidepressant and birth control pill.
"At first, I was humiliated," she recalls, "but then I got angry, because I knew in my gut that he was wrong. It didn't feel right to fill that prescription, so I turned my medical training on to myself because my hunch was that my hormones were out of whack, and that's why I was suffering with my weight, low energy and generally feeling like crap."
Her next stop was the lab where her blood test results confirmed her hormones were in chaos. "My cortisol was high and responsible for my growing muffin top and sugar cravings. My thyroid was borderline, making me depressed and causing my hair to fall out. My oestrogen was too high - very common after 35 - and that made it hard to lose weight or want to love up to my husband."
A complete overhaul of her diet ensued.
"It took me 21 days to turn the ship around, but when I did, I felt like myself again - happy, free and curious about the world instead of angry and resentful. I realised hormones dictate what your body does with food and that realisation changed everything."
Sara (48) is now on a one-woman mission to help women balance their hormones, reclaim their lives and finally lose those stubborn pounds. She has written two New York Times bestselling books, The Hormone Cure and The Hormone Reset Diet, and runs an integrative medical practice in San Francisco.
"When you can't lose weight, despite trying the usual sound methods, your metabolism is broken, and 99pc of broken metabolism is related to hormonal misfires," she explains.
"Your hormones govern nearly all aspects of fat loss, from where you store fat (and how much) to your cravings, appetite, gut bacteria and even your addictive patterns with food.
"When misfiring hormones are allowed to spiral downward, you're left with hormone anarchy and, ultimately, a broken metabolism. You store fat no matter what - even when you try popular diets.
"If you struggle to get and stay lean, I promise that your hormones are to blame."
What's more, she believes that a slow metabolism can be speeded up, even after the age of 30. "You can significantly change your metabolism at any age," she assures me, "but keep in mind that it's easier to prevent your metabolism from getting broken than to cure it once it's slow."
Those who embark on the programme outlined in The Hormone Reset Diet have to be willing to make lifestyle changes alongside dietary changes. Avoiding processed foods and sugars is just as important as lowering stress and getting more sleep. Alcohol also has to be omitted for 21 days. I tell her Irish women are particularly fond of their vino. "I can relate because I'm Irish, and I love a nice glass of red wine," she laughs. "But I've had to get more strategic about how much I can drink and how often, and I urge readers to do the same.
"Alcohol raises your oestrogen and cortisol (also known as the 'stress hormone') levels, and slows down metabolism by up to 70pc. The decrease in metabolism is temporary, but if you're drinking every night, the habit can pack on the pounds, especially at the waist.
"Regular alcohol consumption after about age 35 can also clog the liver, which is like the traffic cop in the body for all your hormones. So when your liver is busy processing all that wine, it can't do its other detox tasks like get rid of your oestrogen and make you feel refreshed each morning."
Sara suggests opting for alcoholic drinks that are less likely to cause hormonal imbalance, including organic red wine and kombucha ("it's not going to pack a punch, with approximately 0.5pc alcohol per serving").
She also recommends taking a 5g-10g dose of fibre before drinking alcohol. "It will stabilise your blood sugar and slow down your absorption of alcohol."
Sara, whose patients are mostly female, says she can now spot hormonal imbalances prior to blood tests with almost 95pc certainty.
"Thinning hair, including eyelashes and the outer third of the eyebrows, signal a slow thyroid," she explains. "Sunken tear troughs can indicate waning oestrogen in the second half of perimenopause and menopause. Fat around the middle can indicate hormonal imbalance, specifically leptin resistance, high cortisol and insulin resistance."
According to Sara, the three major factors curbing weight loss in women are oestrogen dominance, insulin resistance and cortisol overwhelm.
"Oestrogen dominance is when you have too much oestrogen compared with its counter-hormone, progesterone," she explains.
To lower your oestrogen levels, she recommends eating one pound of vegetables per day. "The fibre from the vegetables will help excrete oestrogen so it doesn't keep circulating in your body."
Women should aim for 35g-45g of fibre per day, while men should aim for 40g-50g. "Slowly increase in 5g increments each day to get to the goal without gas or bloating," she adds.
"Insulin resistance means your cells can't absorb the extra blood glucose your body keeps generating from the food you eat," she continues, "and your liver converts the glucose into fat. Insulin resistance causes weight gain and sugar addiction."
To reset your insulin levels, she suggests drinking filtered water with apple cider vinegar. "A recent study found that consuming two tablespoons of apple cider vinegar before a high-carb meal significantly reduces blood glucose levels in people with insulin resistance."
The unholy trinity concludes with cortisol. "This is released in response to stress, but most of us run around stressed all the time," she explains.
"All those stress hormones wreak havoc over time, and make you store fat - especially in your belly. High cortisol is also linked to depression, food addiction and sugar cravings."
To reset your cortisol levels, Sara recommends curbing your caffeine intake. "Slowly wean off caffeine over three days, and notice how your sleep and stress levels improve."
There are of course certain times of the month when a woman's appetite naturally spikes. Appetite is controlled by the hormone leptin which tells the brain you are satisfied after eating.
"When leptin levels are high, you will feel satisfied, and when they are low, you will feel hungry," explains Sara. "Researchers found that leptin levels are low in the follicular phase of the menstrual phase (days 1-14 in the average woman), peak mid-cycle (around day 14), and continue to remain at higher levels in the luteal phase (days 15-28).
"In fact, women with PMS report insatiable hunger and tend to eat 275pc more refined carbohydrates the week before their period compared with women without PMS."
She also proposes a "new and promising" link between leptin and libido. "Leptin is the satiety hormone, which means it tells you to put down the fork when you're full from eating. But you can apply that sense of satiety to other aspects of your life as well.
"Most of the research on leptin and sexual behaviour is in animals, so it's not quite ready for prime time, but I can tell you from helping women reverse leptin resistance for the past decade, when they fix leptin, they become more interested in sex.
"They have more energy in general, and the surplus spills over into their intimate relationships."
Unlike many popular diet plans, Sara doesn't advise the no/low carb approach. "I believe that carbs, in moderation, are necessary and beneficial to any food plan," she explains.
"Women need carbs to keep the thyroid and adrenals - where you produce cortisol plus other sex hormones - working. You also need carbs if you are trying to conceive, pregnant or post-partum."
In The Hormone Reset Diet, she recommends curtailing your net carb intake to below 49g per day.
"Net carbs are calculated by determining your total carbohydrate intake (in grams) and deducting the total fibre intake (in grams)," she adds.
"In general, I aim to keep my total carbohydrate intake at approximately 75g per day when I'm trying to lose weight, and 100g-150g when I'm maintaining my weight."
Elsewhere, she investigates what many consider to be the holy grail of anti-ageing and weight loss: human growth hormone (GH), which is responsible for cell growth and regeneration. Levels of this hormone taper off as we age, but studies outlined in The Hormone Reset Diet explain how we can boost it naturally.
"Studies show that high-intensity interval training (HIIT), or burst training, is your best prescription to naturally boost GH levels."
She also recommends spending more time under the duvet - "only during your deepest [stages 3 and 4] sleep can your body make GH" - before citing a study published in the journal Metabolism, which found that elevated insulin in obese people inhibited GH release.
"Opt for a whole, unprocessed diet that includes plenty of clean protein, healthy fats and high-fibre veggies, nuts and seeds, low-sugar fruit and legumes," she concludes.
The Hormone Reset Diet is like a spring clean of the endocrine system. Meat and alcohol, sugar, fruit, caffeine, grain, dairy and toxins are omitted for initial three-day bursts in order to reset the seven hormones of metabolism.
"Once the 21 days are over, the real work of maintaining your newfound clean body and weight loss begins," explains Sara.
"When you remove sugar from your diet, you can reset insulin in as little as 72 hours, but you can ruin it in just as much time."
This is a diet plan for those that want to find out how to work with their body, rather than against it. Sara, who is also a yoga teacher, has coupled pioneering research with an integrative approach. When we understand the biological processes that occur in our bodies, we're better able to make informed decisions about the food we put into them.
'The Hormone Reset Diet' by Dr Sara Gottfried is published by Harper One.
Some exercises, such as running and spinning, place so much stress on the body that cortisol shoots sky-high. My advice is to stop exercising so hard in an obsessive desire to burn calories, and start exercising smarter. Practise yoga, meditation or guided visualisation several times a week and add burst training, also known as interval training, to your routine.
Burst training involves short periods of high-intensity exercise with moderate-level exercise as recovery. It is incredibly efficient and comes without the cortisol-raising side effect of a long run. Not only that, but it is incredibly effective at raising growth hormone levels.
OPTIMISE YOUR SLEEP CYCLE
Humans are designed to rise with the sun and to sleep when it's dark. Sure, there are morning people and night owls, but your hormones are released according to your sleep/wake cycle. Get your circadian rhythm in order, and your body will produce the hormones you need when you need them.
Try to wake up and go to sleep at the same time every day, and to expose yourself to sunlight. There's no better way to tell your body it's time to wake up. Go to sleep by 10pm as many nights as possible. The ratio of catabolism (wear and tear) to anabolism (growth and repair) shifts while you sleep, and the hours before midnight are especially auspicious. In other words, this is how you can avoid botox.
Yoga has been shown to raise serotonin levels, the happy brain chemical responsible for mood, sleep and appetite. For women, this is especially important, as we have 52pc less serotonin than men. I also believe yoga is the best form of exercise for stress relief and getting your cortisol to a sweet spot.
BEAT MENOPAUSAL WEIGHT GAIN
Many women find it very difficult to lose weight after they reach menopause. They often find that the same tricks to lose weight no longer work. This may be because your thyroid is slowing down or your testosterone fell off a cliff. Be sure to get your levels checked with your healthcare professional.
To counteract weight gain, cut out sugar from your diet and make sleep a priority, which will put your growth hormone production back on track.
BETTER BIRTH CONTROL
Birth control pills deplete your B vitamins, so make sure to add a vitamin B complex if you are on the pill. If you have PMS and want a birth control pill, choose one containing drosperinone as long as you do not have an increased risk of blood clots.
Adaptogens are unique herbs that help the body deal with stress and lower cortisol. I'm a huge fan of maca and other adaptogens, and I highly recommend them. Maca is a superfood powerhouse, an ancient wonder food that your grandmother's grandmother's grandmother probably used to cure 'female' problems way back in the day.
The sweet, somewhat chalky tasting fruit, has been shown to help with insomnia, energy, hot flashes, vaginal dryness, libido and even anxiety and depression. You can pick up maca extract at your local health-food store in capsule, liquid or powder form. The common dose is 2,000 mg/day.
To reduce mood swings, avoid alcohol and sugar substitutes. Alcohol consumption raises cortisol, lowers metabolism, and is linked to premenstrual anxiety, mood problems and headaches. Diet sodas and aspartame lower serotonin, the feel-good neurotransmitter responsible for buoyant mood.
I also recommend phosphatidylserine (PS) - 300mg a day has been shown to improve mood under stress. PS is one of those supplements that makes you feel dramatically better in one hour, and it makes you call three girlfriends to share the good news.
TEST YOUR CORTISOL
There are several ways to test your cortisol levels, and the most accurate are dried urine, blood and saliva. Most traditional doctors only recognise the merits of blood testing - it's considered the universal language of conventional medicine - yet the latest techniques favour dried urine testing. Measuring both gets around the problem of acute stress, such as rushing to the clinic or laboratory. Remember that cortisol rises after you wake up in the morning [known as the 'Cortisol Awakening Response'] and should be at its lowest before bedtime.
TAKE VITAMIN D IN THE WINTER
Ramp up your vitamin D supplementation during the winter. Vitamin D deficiency can cause low oestrogen in women, which means low sex drive. It also causes low testosterone in men. So, if you tend to feel more frisky during the summer than the winter, there's a very good reason for it - increased vitamin D causes your hormones, and your libido, to peak during summer months. Similarly, oestrogen helps boost serotonin and GABA, critical neurotransmitters, which help keep you calm and happy. Vitamin D also has other, more direct, effects on your mood.
Vitamin D activates the genes that release dopamine and serotonin and the lack of these neurotransmitters is commonly linked to depression.