In my medical office, I often hear frustrated comments from my patients about their efforts to lose weight and improve metabolic health. They sound like this…

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• I can’t lose weight no matter what I do
• It takes me way too long to get dressed—nothing fits
• Nothing works! It’s exasperating!
• I’m doing everything right! It just makes me feel so hopeless.
• I need you to find out what’s wrong with me, but no doctor seems to be able to help me solve this issue.

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When patients make these comments in the medical office, I ask: “Have you checked your hormones?”

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Although hormones are complex, there are six that can make weight loss an uphill battle. I had an epiphany about the hormone and weight connection many years ago. In this article, I describe the key hormones, how they regulate your metabolism and weight, and how you can recreate hormone balance.

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Unfortunately, your mainstream physician may not understand the connection between these metabolic hormones and your weight. You may find that after a certain age, maybe 40 or 50, that your concerns about weight and metabolism are minimized, brushed off, or worse, dismissed. That happens regularly to many of my patients. It’s even happened to me and I’m a medical doctor.

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The truth is that the most likely cause of the mid-life issues many of us face—whether it’s unexplained weight gain or anxiety or difficulty sleeping—is hormonal.

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If you’re like me, hormonal problems can even make you doubt your worth. They may make you wonder what’s wrong with you. This is classic gaslighting, and unfortunately, the medical system trains doctors to gaslight women about their weight, hormones, and concerns. I’m not blaming doctors because I trained in the same manner, but it took facing my own whacked hormones to realize how often they are the root cause of women’s mysterious symptoms, how rarely they get tested even when warranted, and how very few doctors know about the food-based and lifestyle-based remedies that are scientifically proven to help.

The Top 6 Metabolic Hormones Everyone Should Know

If you struggle with your weight and metabolism, ask your doctor to run a basic hormone panel. Here’s what I recommend that you test.

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• Cortisol. Your body makes cortisol when you are stressed. However, too much cortisol makes you tired but wired, depressed, and packs on the belly fat. Many of us run around with far higher cortisol levels than we are designed to handle. Excess cortisol can even break down your muscle for energy, and that’s the worst thing for weight loss. As with all hormones, you want the right amount for you: not too much and not too little. I recommend a morning blood test, or get a more comprehensive salivary cortisol awakening response or dried urine test.

• Thyroid. Thyroid hormone is like a gas pedal—it regulates the rate at which calories are burned.Check thyroid stimulating hormone (TSH), free T3, free T4, and reverse T3. The most common cause of low thyroid function is autoimmune thyroiditis, also known as Hashimoto’s, so check thyroid peroxidase antibodies and anti-thyroglobulin antibodies too.

• Testosterone. You may think of testosterone as the male hormone, but it is the most abundant hormone in the female body! It’s an important metabolic hormone responsible for confidence, agency, risk taking, sex drive, and muscle mass. Not seeing a response to your recent weight lifting spree? Could be testosterone. As with all hormones, we want it in the Goldilock’s position. Not too high, like we see in polycystic ovary syndrome, but not too low, either. Measure free and total levels.

• Insulin. Insulin’s primary job is to move glucose into your cells, thereby lowering the glucose in your blood. It’s a key hormone in the treatment and prevention of diabetes. The scientific literature demonstrates that dietary and lifestyle approaches to diabetes—a condition in which cells become numb to the hormone insulin—work better than medications, perhaps because they don’t disrupt normal biochemistry and instead help an individual return to a state of homeostasis, or balance. Yet few physicians (myself included!) learned how to use nutritional intervention or how to guide changes to behavior and lifestyle. I like to check fasting insulin levels, though one of the earliest indicators of a problem with metabolic health is rising postprandial insulin.

• Estrogen. Estrogen can get out of balance after 35, leading to something called estrogen dominance. Higher estrogen levels relative to progesterone can put women at a disadvantage with weight loss, leading to slower or lesser results. On the other hand, estrogen has many positive influences on a woman’s body regardless of age. It’s why we have a lower risk of heart disease before age 52 compared to men. It’s why we tend to store fat around our breasts, hips, and thighs, a far healthier place than the waist. Estrogen also keeps appetite in check, so in perimenopause and menopause, you may notice feeling hungrier and eating more. In cycling women, I check day 3 estradiol levels, or day 21 dried urine together with progesterone levels. After menopause, you can check estrogen any time.

• Growth Hormone. Growth hormone is a build-you-up hormone, meaning that it plays a key role in building muscle and keeping bones strong, while simultaneously breaking down fat. It’s central to weight loss, and problems with growth hormone may be less recognized in women. compared to men. Growth hormone made you became taller as a child. For adults, beyond growth and repair, growth hormone is involved in bone mineralization, protein synthesis, cellular growth, and fat breakdown. We have naturally lower levels of growth hormone as we age, but it drops more precipitously in women at menopause. To measure growth hormone in the blood, we use a test called IGF-1, or insulin-like growth factor 1, which is a proxy for growth hormone. Just like other hormones, we want growth hormone in balance because higher levels may be associated with cancer.

Evidence-Based Tips to Start Balancing Your Metabolic Hormones

Tip #1. Eat for your hormones

Food is the backbone of the hormones you make. To start, consuming healthy fat is especially critical to long-term hormone balance. Healthy fat makes you feel more satisfied, and it slows down or eliminates the spikes in blood sugar that can make you accumulate fat.

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You need moderate protein—not so much that it turns into sugar, but not so little that your muscles start to break down. Get enough carbs for optimal thyroid and adrenal function.

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Some guidelines you’ve likely heard about before are important too, such as avoiding sugar and excess refined carbohydrates, enjoying healthy fats like extra-virgin olive oil and avocado oil, and even following intermittent fasting protocols. In fact, intermittent fasting has been shown to improve hormones such as insulin and growth hormone. Other metabolic hormones such as adiponectin are improved by intermittent fasting. You need to fast for the right amount of time—not so little that it doesn’t improve metabolism, but not so much that it causes stress and raises cortisol.

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I’ve integrated these strategies into a single cohesive approach I call the Gottfried Protocol, which will allow you to switch your metabolism from stuck and inflexible to unstuck and flexible. As you do so, you’ll lengthen your health span (that is, your healthy life span), support your immune system, and improve your overall health.

Tip #2. Get a continuous glucose monitor

Since there’s no ideal diet for everyone, consider getting a continuous glucose monitor. It provides real-time feedback on the foods that best support your metabolic health. Continuous glucose monitoring allows you to look deeper than the simplistic calorie models to help us understand weight loss. In my practice, I recommend mean glucose <100 mg/dL with variability less than 15. This has been shown in multiple studies to be associated with better metabolic flexibility, and in my patients, it helps them lose weight and correct their hormones, including insulin, cortisol, and adiponectin.

Tip #3. My new book: Women, Food, and Hormones

Women, Food, and Hormones offers a groundbreaking new plan to get your hormones back into balance with a clean ketogenic diet, adapted for women. The four-week Gottfried Protocol integrates detoxification, nutritional ketosis using net carbs, and intermittent fasting. You will learn how to get the right dose of carbohydrates personalized for you.

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When you purchase the new book, you can get access to bonus gifts that include recipes, including my favorite—Tahini bread!

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To access the bonus gifts, order the book from your favorite bookseller.

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Then head to the bonus gift link. (If you already preordered my book, this link is for you too!)

Final Thoughts

I’ve learned the hard way how to balance the hormones driving metabolism. Let me save you a lot of time and money. Here’s my process. First, I look for double blind, placebo-controlled clinical studies on human subjects to guide my recommendations. Second, I try what I learn on myself. I perform N-of-1 experiments to find out what works best for me, where I serve as my own control. Third, I test my protocols on people who volunteer to be subjects for my book. After seeing more than 27,000 patients and honing my methods, there are thousands of people who have benefited from the Gottfried Protocol, lost weight, and improved their metabolic health.

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My passion throughout my career has been to help people, especially women, who struggle privately with their weight and metabolism. The epiphany that weight loss is intimately connected to hormone balance has helped many of my patients get to their goal weight and stop dieting. Given the right program, the best sequence, and plenty of healthy food choices, it’s possible for you to get your hormones back in the Goldilock’s position and lose stubborn weight too—and keep it off permanently.

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Sara Gottfried MD is a three-time New York Times Bestselling author and Clinical Assistant Professor in the Department of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University, where she serves as the Director of Precision Medicine at the Marcus Institute of Integrative Health. Her new book called Women Food and Hormones will be published September 21, 2021.