What are Hormones?

 

Thank you to multiple contributors for this portion. Erin likes to describe them to her clients as little keys with wings that fly through the body looking for the right lock on cells. If the key finds the right lock… it releases the hormone into the cell.  

 

Hormones and Menopause:

 

“KEE” Players of the important hormones involved in Menopause:

 

Estrogen:

~Plays major roles in body functions

~Thickens the lining of the uterus/Influences how your body uses calcium/Maintains healthy blood cholesterol/Keep the vagina healthy/ Prevents osteoporosis

~3 main endogenous estrogen hormones are estradiol, estriol, and estrone.

 

Estradiol: 

~Produced in developing follicle in large amounts as it is meant to enter the bloodstream and have effects on many tissues

~It is also made in smaller quantities in adipose (fat), the lining of the uterus (endometrium), the brain, bone, liver and muscle.

~Levels can be as low as 30pg/ml at start of follicular phase and bump way up to 200-300 pg/ml prior to ovulation.

~During menopause levels may at first be erratically high and then after drop to about 10-25pg/ml.  This blood measurement shows the estradiol made from other tissues (fat and muscle) vs the developing follicle.

 

Estriol:

~Made in placenta not a kee player in hormones and menopause transitions

 

Estrone:

~Weaker than estradiol

~Made in developing follicle and converted by tissues into estradiol  or visa versa

~The cells can fine tune in the conversion between estradiol and estrone with estradiol being the one that really drops with menopause

 

Testosterone:

~Made in the developing follicle, the actual ovary and the adrenals glands on the kidneys.

~The majority of testosterone is made in the adrenal gland so when the final menstrual period is present … testosterone is not the main dropper. Testosterone declines over the life span due to age related changes in the adrenals.

 

Progesterone:

~Made by the corpus luteum (tissue that forms in the follicle after ovulation)

~During the menopause transition the corpus luteum becomes less efficient at progesteron production due to more time between ovulations and irregularity

~Progesterone plays a role in many body functions: Helps prepare your uterus for implantation of a fertilized egg and maintains a womens pregnancy, progesterone regulates blood pressure, regulates mood and sleep. 

 

Androstenedione:

~Hormone made from cholesterol-precursor hormone made in the follicles that is converted to either estrone *then into estradiol or testosterone. 

~Made in the stroma of the ovary and the adrenals- so with menopause transition there is a drop but not as grand of a drop because it is not as needed to make high levels of estradiol

 

Sex hormone binding globulin (SHBG):

~This is a carrier protein that holds onto hormones- hormones can be free in the flood or bound to SHBG.  It is the free hormone that can interact with cells and tissues. Less SHBG means more free reign hormone, more SHBG means less hormones running around. Testosterone binds to SHBG better than estrogen so lower levels of SHBG often reveals more free testosterone. 

 

Common Hormone Supports Provided to Women, Pro/Cons of HRT should be personalized and individulized:

 

As we all know, the decision to take hormone therapy needs to be a very personalized one. Hormone therapy is not for everyone. Clients should discuss the risks and benefits of hormone therapy with their primary care physician/ healthcare provider at an office visit specifically dedicated for this conversation. It may take time for patients to find providers that address all the issues and answer questions in order to arrive at a decision that is best for you. Factors providers often consider:

~age

~ family history

~ personal medical history (HRT with estrogen not great for those with hx of breast or endometrial cancer), abnormal bleeding historty, risk of blood clots or other cardiovascular issues, history of liver disease. 

~the severity of your menopausal symptoms. 

Clients should find providers that are present and clear about the pros and cons of the different types and forms of HT as well as non-hormonal options such as dietary changes, exercise and weight management, meditation and alternative options. This is where several of our practitioners can be very helpful. Check out Elena’s beautiful Thyroid Health Protocol:

 

Thyroid Health Protocol 

Since the thyroid is involved in nearly every process in the body, it greatly influences overall health and quality of life. Balanced thyroid hormones are critical when it comes to balanced health. 

The following recommendations can be helpful for generally strengthening the thyroid. Remember, if you have or suspect you have a thyroid disorder, these are serious medical conditions that require a doctor’s evaluation and treatment. Always consult with your healthcare provider before taking any supplements or making any changes to your diet. 

Improve gut health 

The following dietary practices can help improve gut function: 

Consume fermented and probiotic-rich foods daily. 

Crowd out sugar – especially the refined and processed kinds. Increase your dietary fiber intake. 

Crowd out gluten from your diet. 

Consume foods that support the thyroid 

Foods that support the thyroid include: 

Cooked cruciferous vegetables – such as broccoli, cauliflower, kale, bok choy, and brussels sprouts 

Organic wild-caught fish – especially salmon 

Brazil nuts 

Sea vegetables – such as arame, dulse, kombu, nori, kelp, and wakame 

Elena Stophel, NBC-HWC

Maintain adequate iodine levels in the body 

The thyroid is dependent on iodine to make thyroid hormone. Thyroid dysfunction worsens when iodine levels in the body are 

low. Iodine is added to table salt, but the best form of iodine is that which occurs naturally in foods. 

The best sources of dietary iodine are: 

Sea vegetables 

Ocean fish 

Eggs 

Raw dairy 

Strawberries 

Taking an iodine supplement is generally not necessary or recommended. The daily recommended dose (150 micrograms per day) can be obtained through diet. Too much iodine can also be problematic. Unless your doctor tells you otherwise, stick to food sources of iodine, only. 

Consume mineral-rich foods 

The following trace minerals are necessary for adequate production of thyroid hormones and conversion of T4 to T3: 

Zinc is required for maintaining adequate levels of thyroid hormones in the body. It can be found in beef, shrimp, kidney beans, spinach, and flax seeds. 

Selenium is required for converting thyroid hormone T4 into T3 in the body. It also increases levels of glutathione – an antioxidant that helps boost the immune system and lower thyroid antibodies. People with digestive issues, such as Crohn’s disease or leaky gut, are more likely to be deficient in selenium. 

The best food source of selenium is organic brazil nuts. Eating just one or two of these daily is enough to maintain selenium levels. 

Iron deficiency signals your thyroid to conserve energy, leading to lower thyroid hormone production. Iron can be obtained from animal sources, like beef, lamb, and liver. Individuals who eat a plant-based diet should talk to their doctor to see if iron supplements are right for them. 

Magnesium deficiency is related to goiter, or an enlarged thyroid gland. Abundant sources of magnesium include dark leafy greens, nuts, seeds, and whole grains. Vitamin D helps protect the body from autoimmune diseases. It’s found in some fatty fish including mackerel, salmon, and tuna. It’s also in cod liver oil. 

Elena Stophel, NBC-HWC

Reduce EMF exposure 

The thyroid is particularly sensitive to exposure to electromagnetic fields (EMF’s). While it’s impossible to avoid all sources of EMF without moving to Antarctica, clients can limit exposure by: 

Turning off computers and cell phones when not needed. 

Switching off the wireless network and the bluetooth devices at night. 

Keeping electronics out of the bedroom. 

Avoiding use of microwave ovens, and staying away from it when others use it. Using a wired headset to talk on the phone. 

Watch out for environmental toxins 

The poly-chlorinated and brominated chemicals, like PCBs and flame retardants, block iodine from doing its job. They are present in drinking water and many foods. Other environmental toxins include BPA and other plastic softeners like phthalates. To reduce exposure to environmental toxins, you can: 

Consider installing a high quality home water filtration system, or at least purchasing a drinking water filter. 

Use only natural cleaning and personal care products. 

Eat organic fruits and vegetables, grass-fed meats, and sustainably caught wild fish. 

Avoid plastics, including water bottles and food packaging, BPA-coated receipts, and plastic flip flops. 

Promote menstrual regularity and estrogen balance 

Some of the best ways to promote a healthy balance of estrogen in the body include: Exploring alternatives to hormonal birth control pills with your doctor. Non hormonal birth control options include the Paragard IUD, Femcap or diaphragm, or a fertility awareness method-based birth control. 

Crowding out soy and estrogen mimickers or xenoestrogens, such as BPA. Reducing or eliminate consumption of alcohol, which impairs the liver’s ability to process estrogen effectively. 

Talking to your doctor about taking a daily B-complex vitamin (one with activated B6, B9, and B12). 

Avoiding antibiotics when possible, to maintain healthy gut flora. Unhealthy intestinal bacteria cause estrogen to be recirculated in the body. 

Elena Stophel, NBC-HWC

Consult a certified herbalist or healthcare 

professional to explore herbs that are known to be helpful for thyroid dysfunction 

Herbs that are directly supportive of the thyroid include ashwagandha and schisandra. Ashwagandha is an Ayurvedic herb that can help improve thyroid function. Ashwagandha helps stimulate healthy production of thyroid hormone. It also acts as an excellent anti-inflammatory, so it helps to reduce antibodies to the thyroid. Also, it’s supportive of normal adrenal function, which helps keep the thyroid functioning optimally. 

Ashwagandha can improve exhaustion, anxiousness, brain fog, and memory problems. Another benefit of ashwagandha is its ability to increase sex drive, which is often very low in people with thyroid issues. 

Ashwagandha is widely available as tea, liquid extract, tablets, and capsules. Schisandra helps to support production of glutathione. Glutathione, a potent antioxidant, protects the liver from damage and boosts detoxification and immune system function. This helps to decrease antibodies to the thyroid. It also supports the adrenals which improves mental focus and energy, and relieves anxiety. Schisandra is available in capsules or liquid extract. 

LEGAL DISCLAIMER 

The information provided in this handout is for educational purposes only, and is not meant to replace the care and supervision of a doctor. This protocol is not intended to treat or cure any health conditions or diseases. It is important to see a doctor for proper testing and diagnosis before taking any supplements or making changes to one’s diet. 

Elena Stophel, NBC-HWC

 

Dietary Changes

Eat at least 3 meals per day focusing on portion size, not calories, and including protein with each meal & snack.

•  Skipping meals and severe caloric restriction only lower metabolic rate which can lead to weight gain (Eating breakfast actually jumpstarts your metabolism for the day.)
•  Metabolic rate naturally peaks at noon and slows after that, so the food you eat at night is more likely to be stored as fat.
•  If you cup your hands in front of you that is how big your stomach capacity is. Limit your intake to no more than that at each meal and snack.
•  Smaller more frequent meals containing protein will normalize insulin secretion and limit fat being stored as fat instead of burned energy.
•  A snack around 4:00 p.m. (protein or unprocessed fat), when blood sugar, mood, and serotonin tend to drop, can keep you from overeating at night.
• 
  Cut down on refined and high glycemic index carbohydrates.
  · • This includes alcohol which is nothing but sugar in a form that is so absorbable its effects are felt in the brain in minutes.
  • Alcohol also interferes with estrogen metabolism and causes almost an immediate hormone imbalance, increasing estrogen in the blood relative to progesterone.
  • Carbohydrate sensitive individuals may find that eating whole grain products (whole wheat, whole rye, whole oat, millet flour) triggers binge eating, so consume grains with caution.
  • Eatatleast5servingsoffruitsandvegetablesperday(1serving=4ouncesor1/2cup)rememberthe healthiest are the most colorful and highest in antioxidants, especially blueberries.
  • L-glutamine 1 gram per day with lunch can help with sugar cravings as can artificial sweeteners like Stevia and Acesulfame.
  • Water helps the body eliminate the breakdown products of fat (other options iced tea, decaf green tea, diluted fruit juices).
• 
  Eat healthy fats. .

• Essential fatty acids (EFAs), namely omega-3 and omega-6 fats, are needed to assist the body in many

important functions, including those of the brain and nervous system. Good sources of EFAs include eggs, high-quality flax seeds, soybeans, walnuts; and cold water fish harvested from the wild. Again, the best way to obtain nutrients is in your food, but if your diet is lacking, high quality EFA supplements are widely available.

• Avoid trans-fats and partially hydrogenated fats and oils that are not found in nature and are pro-inflammatory. • Recommend ratio of Omega 6/0mega 3 (2:1-4:1)

  Rev up your metabolic fat and carb burners.

• Fat eaten with low glycemic index carbs or no carbs will not cause insulin to be secreted so it will not be stored as fat unless your body is overproducing insulin as a result of stress or an excess of food.
• Fatty acids cannot get into the mitochondrial furnace without L-carnitine (500-2000 mg/day) which also prevents toxic fatty acid metabolites from building up in the heart. Some individuals do not make enough L-carnitine to burn their fat effectively.
• Chromium helps make insulin receptors more sensitive,helping burncarbsmoreeffectively200-400mcg/day.

Low Glycemic Foods

Black beans, broccoli, cherries, chickpeas, leafy vegetables, milk, peanuts, peanut butter, pears, plums, soybeans, tomatoes, tomato soup, wild rice, yogurt

Low to Moderate Glycemic Foods

All-bran, apples, garbanzo beans, ice cream, navy beans, oranges, peas, pinto beans, potato chips

Moderate to High Glycemic Foods

Bananas,candybars(most),potatoes,pitabread,oatbran,oatbread,raisins,carrots,brownrice,and kidneybeans

High Glycemic Foods

Bagels, basmati rice, cakes, Cheerios, corn, corn flakes, pies, pretzels, durum wheat pasta, white bread

 

Exercise and Hormones: Thank you Heather and Erin

There is a decline in physical well-being with advancing age, which includes an increase in body fat, loss of muscle mass and bone density, and a decrease in strength and functional capacity. This decline in well-being coincides with signifi- cant changes in the endocrine system, and it has been recognized that many of the symptoms associated with aging are similar to those observed in young adults with hormone deficiencies. For example, growth-hormone deficiency in young adults and adolescents results in an increase in body fat and decrease in muscle mass (Hulthen et al., 2001). There are three main hormone systems that show significant changes with age: the gonadal hormones (menopause and andropause); the main

adrenal steroids, dehydroepiandrosterone and dehydroepiandrosterone-sulphate (adrenopause); and the growth hormone/insulin-like growth factor-I axis (somatopause; Kamel, Mooradian, & Mir, 2000; Lamberts, van den Beld, & van der Lely, 1997).

Although aging is a complex, multifactorial process that cannot be fully explained by any one theory or isolated system, it is clear that a decrease in anabolic hormone levels can play a significant role in the development of many of the symptoms of aging. It is not surprising, therefore, that use of exogenous hormone supplements is increasing. In some cases these supplements have been shown to have a positive effect on older adults (Hennessey et al., 2001; Morales, Nolan, Nelson, & Yen, 1994; Rudman et al., 1990; Sorensen, Rosenfalck, Hojgaard, & Ottesen, 2001). Hormone supplementation can have negative side effects, however. Recently, combined estrogen and progestin therapy has been shown to increase the risk of breast cancer, coronary heart disease, and stroke in postmenopausal women (Writing Group for the Women’s Health Initiative Investigators, 2002). The side effects associated with long-term use of other types of hormone supplements have not been well studied, but available research suggests that the potential risks may outweigh the benefits

 

Women experience significant changes in endocrine function during aging. Decreasing levels of anabolic hormones may be associated with musculoskel- etal atrophy and decrease in function that is observed in older women and, as a result, there has been an increase in the use of pharmacological hormone therapies. It is difficult to distinguish, however, between physiological changes that are truly age related and those that are associated with lifestyle factors such as physical activity participation. Some research has shown that circulating levels of anabolic hormones such as DHEA(S) and IGF-I in older women are related to physical activity, muscle function, and aerobic power. Exercise- intervention studies have generally shown that increasing age blunts the acute hormonal response to exercise, although this might be explained by a lower exercise intensity in older women. There have been relatively few studies that examine hormonal adaptations to exercise training. Physical activity might have an effect on hormone action as a result of changes in protein carriers and receptors, and future research needs to clarify the effect of age and exercise on these other components of the endocrine system. The value and safety of hormone supplements must be examined, especially when used in combination with an exercise program.

 

Weight Management and Hormones: Thank you Dr Poz!

It is estimated by 2030 that 1 in 2 adults will be obese (BMI ≥ 30), with 1 in 4 having Class II obesity (BMI ≥ 35).  Populations who will be most affected include women, non-Hispanic black adults, and lower socioeconomic classes. 

Obesity is a chronic, relapsing, multi-factorial, neurobehavioral disease resulting in chronic inflammation. 

Why does excess fat mass (adiposity) matter?  Excess fat mass results in pathogenic adiposity.  Pathogenic adiposity is the combination of sick fat disease (altered endocrine and immune responses) and fat mass disease (abnormal physical forces) resulting in adverse metabolic, biomechanical, and psychosocial health consequences.  Weight loss shouldn’t be about treating the number on the scale but more about preventing the diseases that are a consequence of obesity.

Obesity bias is rampant and results in social, psychological, and medical consequences.  People with obesity are often viewed as weak-willed, lazy, and non-compliant.  Women who are overweight make 15% less on average than their counterparts.  Weight stigma has been shown to increase eating and cortisol levels, as well as decrease exercise and self-regulation.  Unfortunately, weight bias in healthcare often results in avoidance of medical care, mistrust in medical providers, poor communication, and decreased adherence to recommendations. 

Body weight regulation is not as simple as energy in versus energy out.  Energy storage is controlled by hormonal signals that regulate fat storage versus fat burning.  Hunger and appetite are controlled by the brain, gut, adipose (fat) tissue, and pancreas via a multitude of neurochemicals and hormones.  Two of these regulators are ghrelin and leptin.  In simple terms, ghrelin stimulates hunger while leptin stimulates satiety. 

In short, hunger, energy homeostasis, and metabolism are COMPLEX and are dysregulated in obesity.    

What is metabolism?  Metabolism is the process in which nutrients are used to build tissue, regulate body functions, and provide energy.  The largest portion is our basal metabolic rate (BMR).  This is the basic amount of energy required to keep your body running.  Adding to BMR, to calculate total energy expenditure, is thermoregulation, the thermic effect of food, physical activity, and NEAT (non-exercise activity thermogenesis).  An individual’s metabolic rate is affected by numerous variables including genetics, muscle mass, weight, level of fitness, sex, age, and environmental factors such as temperature.

Historically, the human body was built to survive famine, store energy when needed, and respond to acute stress.  When famine (or decreased caloric intake) was detected, the human body was designed to go into survival mode.  This often results in what we term metabolic adaptation.  Metabolic adaptation means the ability of the body to adjust its metabolism for survival.  There are strong biologic forces resisting weight loss, and weak ones resisting weight gain.

Metabolic adaptation contributes to weight gain, or plateau, after weight loss.  As we decrease our caloric intake, our BMR will decrease accordingly.  This results in increased ghrelin (appetite-stimulating hormone) and decreased leptin (appetite-suppressing hormone).  Other agents of satiety (CCK and PYY) are also decreased.  These hormonal adaptations have been noted to persist for greater than a year following severe energy restriction and weight loss. 

Metabolic adaptation is also one of the risks of consecutive dieting.  With each diet, weight loss may be achieved but BMR will also decrease.  While weight often goes back on after the diet, BMR does not increase.  And it will potentially continue to decrease with each ensuing dieting endeavor.

Other, just as equally important, influencers on weight management include sleep, emotions, stress, endocrine, insulin dysregulation, medications, the gut microbiome, environmental stimuli, immune, and genetic/epigenetic expression. 

 

A focus on the Thyroid Gland: 

Signs Dr Woller and Dentists often see that clues them there may be an issue in the thyroid?

macroglossia, glossitis, dysgeusia, compromised periodontal health, salivary gland enlargement, and delayed dental eruption and wound healing

The thyroid gland is located at the front of the neck just below the Adam’s apple, this is the larynx. It is butterfly-shaped and consists of two lobes located either side of the windpipe (trachea). A normal thyroid gland is not usually outwardly visible or able to be felt if finger pressure is applied to the neck.

The thyroid gland produces hormones that regulate the body’s metabolic rate controlling heart, muscle and digestive function, brain development and bone maintenance. To function best the thyroid depends on a good supply of iodine from the diet. Cells producing thyroid hormones are very specialised in extracting and absorbing iodine from the blood and incorporate it into the thyroid hormones.

The thyroid gets it signal to make hormones from the pituitary gland in the brain (and the pituitary gland responds to signals from the hypothalamus (sits on top of the pituitary).  The hypotalamus release thyrotropin-releasing hormone (TRH) that stimulates TSH from the pituitary which then signals to the actual thyroid gland- telephone tag anyone? This whole network is also referred to as the hypothalamic-pituitary-thyroid axis (HPT) and it adapts to metabolic changes and your body’s needs.

The thyroid itself produces: T4 (thyroxine) (a relatively inactive prohormone) and T3 (triiodothyronine). Collectively, a typical thyroid produces 20% of the active T3 and 80% of the prohormone T4.  Once T4 is out and about, specific enzymes in other tissues transform T4 into active T3. 

Normally the thyroid gland produces the exact number of hormones needed to keep your body’s metabolism in balance. As described earlier, hormones secreted by the pituitary gland (TSH) stay constant in your blood circulation, but their levels may increase or decrease when T4 levels in the blood are changing. This hypothalamic-pituitary-thyroid feedback loop keeps the levels of T4 in your blood stable and reacts to small changes immediately.

However, there are several disorders associated with the thyroid gland with most problems concerning the production of thyroid hormones. Either the thyroid gland produces too much hormone= HYPERTHYROIDISM (BODY USES ENERGY FASTER THAN IT SHOULD) OR not enough hormone=HYPOTHYROIDISM (BODY USES ENERGY SLOWER THAN IT SHOULD).  

Symptoms for HYPERTHYROIDISM  is weight loss, fast heart rate, high irritability/nervousness, muscle weakness and tremors, infrequent menstrual periods, sleep problems, eye irritations and heat sensitivity.

Hypothyroidism:This  is when the thyroid is underactive and the gland is not producing enough thyroid hormones (T4 and T3); often triggering the pituitary gland to produce more TSH. Symptoms for HYPOTHYROIDISM  is the contrary of hyperthyroidism such as weight gain, slower heart rate, fatigue, more frequent and stronger menstrual periods, forgetfulness, dry skin and thinning hair, hoarse voice, painful joints,  and intolerance to cold. In addition, hypothyroidism is often accompanied by an enlargement of the thyroid gland known as goiter. 

What causes thyroid disease? There are various different factors causing hyper- and hypothyroidism.

The following conditions cause hypothyroidism:

Thyroiditis is an inflammation of the thyroid gland. This can lower the number of hormones produced.

A special form of thyroiditis is Hashimotos.. This is a genetic disorder caused by diseases of the immune system and can be passed from one generation to the other. In addition, thyroiditis can occur in women after giving birth also referred to as postpartum thyroiditis. It is usually a temporary condition and occurs only in 5-9% of woman giving birth.

Nutrition also impacts your thyroid functions. Iodine deficiency can cause hypothyroidism. This is a worldwide problem affecting approximately 100 million people. As mentioned earlier, iodine is used by the thyroid gland to produce hormones.

The following conditions cause hyperthyroidism:

Grave’s Disease:  is a condition where the entire thyroid gland might be overactive and produce too much hormone. Your thyroid gland might be enlarged. 

Thyroiditis (inflammation) can also cause the opposite and trigger the release of hormones that were stored in the thyroid gland. This uncontrolled release of thyroid hormones causes hyperthyroidism for a few weeks or months. It may occur in women after childbirth.

In contrast to iodine deficiency, excessive iodine intake may have negative effects on your thyroid. Excessive iodine is found in a number of drugs such as Amiodarone, Lugol’s solution (iodine) and some cough syrups. This might cause the thyroid to produce either too much or too little hormone in some individuals.

The before mentioned problems affect the production of thyroid hormone (either too much or too little). However, problems concerning the thyroid gland can be very distinct. Swelling and lumps can occur within the thyroid gland. Jeff sees a handful of people a week for this. These nodules are often harmless, but some can cause the production of hormones or even be cancerous. In some cases, such as cancer, the thyroid is removed. You can live without your thyroid, but you need to take medicine daily to substitute the hormones produced by your thyroid gland.

Collaborative Gain through KEE and ENT: Iodine is most essential to maintain a healthy thyroid. Iodine is the critical ‘ingredient’ for the production of thyroid hormones. We don’t need a lot of iodine, it is said that “one teaspoon of iodine is enough for a lifetime”. Nonetheless, the daily and constant supply of this micronutrient is important. Too much iodine at once is counter-productive and causes your thyroid to produce less hormones. The best way to get your daily dose of iodine is through eating healthy foods like seafood – Dr Chain is so glad he has KEE to refer to his patient willing to make dietary changes, review their blood sugar balance, lifestyle changes, that support their thyroid. 

Supplements to Consider/ be curious about with Hypothyroidism: Probiotics, magnesium, Fish Oil, Selenium, Zinc, Methylated B, Apple Cider Vinegar (do acid testing) 

 

Eating behaviors, such as binge or emotional eating, are often a result of intrinsic physiologic mechanisms controlled by brain neurotransmitters.  For example, dopamine controls the reward circuit, or addictive quality, of food.  Conscious decisions are driven by its effects.  Dopamine is released even at the sight of food and is strongly triggered by sugar.  In individuals with obesity, down-regulation of dopamine receptors blunts the reward response leading to compulsive overfeeding.

Sleep

Most people underestimate the importance of quality sleep for weight management.  Prolonged sleep restriction of less than 6.5 hours a night has been associated with unhealthy dietary patterns.  This is mainly characterized by increased consumption of food and beverages with a high glycemic index (measurement of the rise in blood glucose after consumption of a particular food). 

Sleep deprivation also results in hormonal imbalances in cortisol, insulin, ghrelin, leptin, and melatonin.

What nutritional elements can affect sleep?  A diet with decreased fiber, increased saturated fat, and processed simple sugars has been shown to prolong sleep latency and decrease slow wave sleep and overall sleep quality.

Individuals with obesity may have GERD and OSA.  Both of which contribute to poor sleep quality.                 

Getting sunshine (to the eyes) earlier in the day not only helps establish an appropriate circadian rhythm, but can also increase production of MSH (melanocyte stimulating hormone).  MSH results in a rise of the hormone CCK, causing satiety.  This partially explains why people feel less hungry during the summertime when outside consistently.                                                                                                                                          

Stress

Psychosocial stress is positively associated with body mass index gain over 5 years.  Stress results in sleep problems, inflammation, decreased immune system functioning, and increased cortisol and catecholamine production. 

Chronically elevated cortisol can lead to insulin resistance, trigger inflammation, and increase fat storage.  Cortisol lowers our metabolism, triggers central weight gain, and leads to cravings for sugary/fatty foods due to a rise in insulin. 

Catecholamines, such as adrenaline and noradrenaline, are usually released in a “fight or flight” response and mobilize energy stores. However, with chronic release from stress, catecholamine resistance occurs. This results in a decreased response to these hormones and poor fat mobilization.

Environment

Social ties have been shown to influence weight loss intentions and weight control behaviors, including healthy eating and physical activity. Having friends that are overweight makes an individual 60-70% more likely to be overweight.  This is in comparison to only a 40% increased risk if an individual’s siblings are overweight. 

We also live in an obesogenic food environment where portion sizes are large, foods high in fat, sugar, or sodium are readily accessible and inexpensive, and advertising of these unhealthy foods leads to induced demand.

Genetics/Epigenetics

There are currently over 1000 genes that have been identified that control appetite, weight regulation, and body composition.  While there is likely a strongly genetic component to obesity, in most individuals with obesity, no single genetic cause can be identified. 

In most cases, however, our genes are not our destiny.  Epigenetics is how our environment interacts with our genes to turn them on or off.  This includes MANY aspects of our lives including stress, food, sleep, emotions, adverse childhood events, in utero exposure, physical activity, age, and time in nature.  Interestingly, weight gain itself can change the expression of our genome.

Sex Hormonal Changes

Peri-menopausal hormonal shifts can alter body weight and fat distribution.  On average, 5 pounds of weight are gained during this transitional period, with the range from 3-30 pounds.  Weight gain appears to be inversely associated with starting BMI.  Individuals with a lower BMI tend to gain more.  Increased BMI and visceral (central) adiposity are associated with all-cause mortality.  Menopausal women have 2-4 times higher rates of cardiovascular disease and can also see an increase in blood pressure and LDL cholesterol.  Women also tend to have a loss of lean muscle mass. 

Hormone replacement therapy may not prevent weight gain, but it can minimize central adiposity redistribution, enhance insulin sensitivity, improve cardiovascular health, and preserve muscle mass.

Lower testosterone levels in men can increase central adiposity and weight gain, as well as make it more difficult to lose weight or build muscle mass.  In turn, excess central adipose tissue will increase the activity of an enzyme (aromatase) which converts testosterone to estradiol, resulting in a vicious cycle.  Estrogen also increases the production of a binding protein (sex hormone binding globulin) that ties up free active testosterone.  Stress can also decrease free active testosterone by stealing the precursor cholesterol to make cortisol rather than testosterone.

Physical Activity

Decreased energy expenditure, from lack of physical activity and sedentary behavior, is predictive of weight gain. Low levels of physical activity and recreation are strongly related to weight gain in both men and women.

Physical activity alone, however, has only a small impact on weight loss. 

The Physical Activity Guideline for Americans to prevent weight gain is 150 minutes/week of moderate physical activity.  Unfortunately, to maintain normal body weight, individuals over the age of 40 may need closer to 420/minutes a week!  

Physical activity, however, does decrease the risk of weight gain, after loss, as well as cardiovascular risk.  It also helps preserve skeletal muscle mass with weight loss which will help with BMR. 

Therefore, it is essential in weight maintenance.

It’s many other benefits include improved glucose regulation, lipid levels, blood pressure control, sexual function, and sleep.  It also decreases mood disorders, some cancers, and overall all-cause mortality.

NEAT

Non-exercise activity thermogenesis is energy expended on activities that are not sleeping, eating, or exercise.  This includes fidgeting, standing, walking, and climbing stairs.  Incorporating NEAT can increase energy expenditure as much as 2000 kcal a day!  NEAT also improves insulin resistance and metabolic parameters.  Taking a walk after eating will improve your body’s glucose/insulin response to caloric intake. 

Any amount of physical activity has health benefits.  Move more, sit less!

Gut Microbiome

There are many hypothesized reasons why the gut microbiome plays a role in weight management. 

The gut microbiota is involved in many metabolic pathways, as well as energy extraction and storage.  Certain gut bacteria also have greater caloric extraction abilities. 

Short chain fatty acids (SCFAs), metabolites of healthy gut microbiota, are intricately involved in energy balance and nutrient sensing.  SCFA signaling generally improves energy utilization by increasing expenditure, as well as insulin sensitivity. 

The gut microbiome interfaces with several appetite hormones and is part of the gut-brain axis.  The gut-brain axis is a two-way thoroughfare for communication between the brain and the gastrointestinal system. Specific chemosensory cells are influenced by the gut microbiome, and their metabolites, resulting in chemical and hormonal communication with the brain and other organs.

Energy-dense foods (rich in saturated fat and simple sugars) alter energy homeostasis through a change in the gut microbiome.  This occurs by decreasing diversity, increasing the abundance of pathogens, and altering the hormones and microbial components involved in signaling.  The “Western diet” ultimately leads to overstimulation of the sensing pathways resulting in hyperphagia and obesity.  Saturated fats impair the enteric detection of glucose while simple sugars affect the hedonic and homeostatic brain circuits related to glucose sensing.  Consumption of ultra-processed food changes the gut microbiome resulting in increased absorption of calories. 

Nutrition

No single nutritional intervention works for everyone.  In the battle of diets or eating plans, different people gain and lose weight on every single one.

Everyone should focus on nutrient-dense foods and avoid ultra-processed ones.  The emulsifiers in ultra-processed foods strip the lining of the gut. This limits the gut’s ability to detect food and send signals to the brain for satiety, resulting in increased intake of food. The hidden sugars in ultra-processed foods also send a signal to the brain via the vagus nerve triggering dopamine activation and the desire to eat even more.

Increase healthy protein consumption.  Protein exerts an increased thermic effect on food, helps maintain lean mass, and increases satiety.  While the recommended dietary allowance of protein (RDA) is a minimum of 0.8 grams of protein/kg/day, this need is variable depending on age, body composition, physiological state, sex, weight loss, and level of physical activity. 

Decrease simple sugars and foods with a high glycemic index.  Insulin, which rises with blood glucose, promotes storage of fat, and prevents breakdown.  Nutritional therapy that lowers insulin levels may decrease fat deposition and improve metabolic syndrome. 

This is likely the premise behind intermittent fasting for weight loss. Unfortunately, intermittent fasting is no longer intermittent if it’s being done every day.  Eventually the body will change its hormonal responses to a fast to preserve itself (again back to metabolic adaptation).  Intermittent fasting also places a large stress on the body and can increase cortisol.  Chronically elevated cortisol can lead to insulin resistance, trigger inflammation, and increase fat storage.

Complex carbohydrates increase satiety.

Decrease saturated fats.  For adults, there is no other required function in the body for saturated fat except as an energy source.  Increase mono and polyunsaturated fats such as fish, olive oil, nuts, seeds, and avocados.

Increase fiber.  This increases satiety and decreases caloric intake.  It also results in increased SCFA production.

The order in which you eat may help in blunting your glucose/insulin response.  Eating carbohydrates after fiber and protein often slows the sugar rise.

Certain foods/supplements may cause a release of the hormone CCK, causing satiety.  These include omega-3 fatty acids, CLA (conjugated linoleic acid), and glutamine.  Glutamine can also decrease sugar cravings for some individuals.

Yerba mata tea increases leptin and other appetite-suppressing hormones.  While it also contains electrolytes, it does contain higher levels of caffeine than other teas.

Don’t drink your calories.  Added sugars in drinks are empty calories.  Should you substitute with high-intensity sweeteners?  Probably not.  There is good evidence to show that artificial sweeteners can increase cravings for food and sugar.  They also potentially worsen insulin resistance and alter the gut microbiome. 

 It’s not just the quantity, but the quality of the food.

What helps us be successful with preventing weight regain?  Successful people from the National Weight Control Registry Data do the following:

•   98% modified their food intake (changed their eating habits)
•   78% eat breakfast every day
•   75% weigh themselves at least once a week
•   62% watch less than 10 hours of TV per week
•   90% exercise, on average, about 1 hour per day
•   Maintainers expend on average 2000 kcal/week in physical activity

 

Weight loss is not a destination.  It’s a lifestyle.

Successful weight loss is often slower than you expect.  Plateaus are common.  There are physiologic drives to restore “lost” energy stores.  Maintaining weight loss is difficult without an intervention plan.  Obesity is a chronic disease, and the disease of obesity is incurable but manageable.

It’s not all about willpower and you are not alone.  Work with a trained obesity medicine provider to find what is right for you. 

 

Meditation / Stress Management and Hormones