Episode 7 Shownotes - How Your Hormones Affect Your Weight

Hello, and welcome back! This is episode 7.

This has been a rough week. I thought last week was rough with kidney stones, but that was just pain in my body. This is pain in my heart. Before we start today, I want to acknowledge what has gone on in the US this last week. This week, as a country, we experienced, up close and personal, the death of George Floyd. All of the country is reeling from this, and I have been just so sad for us as Americans. Because we all are – whatever color, we are one people, and as a society, it is like we have a cancer, where part of our own cells are damaging and destroying other parts of us. As a doctor, I really feel that I took a Hippocratic oath to do no harm. Right now, I feel like being silent makes me complicit. It is doing harm. It makes me part of the problem of white privilege. I am part of a female podcasting group, and they challenged all of us to make a statement on our podcasts this week, and I accept their challenge. I am continuing to think on how I want to be a voice for change in the world, but today, I have all of you. I do not support police brutality in any form against any human. There are many good police men, of all races, who are now risking their lives for us, being in the community with COVID-19, going into homes, responding to accidents, there for us in our communities. Just like there are so many amazing doctors risking their lives. But a few bad doctors, in it just for money, doing things that aren’t right, have soured the public in the past. And a few bad apples in the police force have soured the public against the police. We need to work to have better oversight in all areas that have such power over other humans, and there should be accountability and fair treatment on both sides of the equation. I really and truly believe love and calm and acceptance of all people is the answer. None of us is inherently worth more, which means that none of us is worth less based on the color of our skin. Just like a green forest needs many green trees, a calm world needs many calm people. I am not saying that we accept this, but I am saying that peaceful protest should include ALL of us. I really was able to see this in a conversation I had with another coach, Dr. Milene Argo, last night. We are ALL the problem. Asking the black population to sort this out for themselves would be like asking rape victims to be the only voice for change in laws that did not really punish that years ago. Thanks for letting me have a minute to share with you. Now let’s move on to our work for today.

This month I started a weight loss collective for the month of June on the Facebook page – I am doing lives there many days, and teaching about my weight loss journey, so that is up and running if you are interested in joining us!

Today is going to be my first true weight loss podcast for my cancer patients, and I am so excited for this. First though, you know the drill – I am a doctor, but not your doctor, so always follow the advice of the doctor who knows your problems and story!
There is going to be a lot of science in this episode, and it is a bit challenging, so don’t be surprised if you need to listen to it more than once. There is a lot of information on the web to supplement this and there is also a lot more detail in Dr. Fung’s book, the Obesity Code, so if you want more information and to learn this in more detail, definitely get the book. I will also post some links on the facebook page of places you can go to learn more about the science of hormones, and also some diagrams that I think are helpful to portray this visually for those that learn well by that route.
Today, we are going to talk about weight set point and the hormones of weight. First, what is weight set point? It is the place that your body currently thinks it is supposed to be. If you lose 5 pounds with the flu, when you get better, pretty quickly, you put it back on. If you gain a few pounds on vacation, pretty quickly, you get back to where you were when you come home. Your body has an idea of where it should be, and it either burns off extra or uses less energy to gain back if you lose. I really think that what is missing in so many diets is an understanding of this. If you lose weight, and don’t change your set point, as soon as you stop dieting, you gain the weight back, often with some extra, and that becomes your new set point, higher than you started. We all know someone who has experienced this, and many of us have seen it in ourselves. For years, a lot of blame was put on people that they had no self control, and when they went off the diet, they let it all come back. Shaming went on, with dieticians and doctors insinuating that people binged what they had cut out when they dieted, and that was the cause of the weight gain, and this led to an even more destructive belief that we can’t feel deprivation or it is a guarantee that we will eventually binge on whatever it is. I think this is really off base. I think we are not addressing the weight set point in most diets, so we are doomed to fail from the start. Weight set point is a complex balance between many hormones, but for starters, let’s talk about insulin. Insulin is a hormone produced by our pancreas in response to sensing glucose in the blood. More glucose leads to higher levels of insulin. Insulin allows your body to use the glucose as fuel, or if there is more than we need currently as fuel, it causes our liver to store the glucose for short term use in the form of glycogen. If the liver is full, it signals our cells to process the glucose into fat stores. Insulin is most strongly triggered by sugar and carbohydrates, and any processed food that is very nutrient dense. These foods artificially increase our insulin much higher than eating naturally occurring foods does. To raise our insulin as high as one candy bar, one would have to eat the whole box of strawberries, or maybe even two or three boxes, because the sugar is tempered by the fiber in the berries, which slows down the absorption. But because the candy bar is processed and extremely nutrient dense, we can eat it, and fit that many grams of sugar in our bodies, and still have room in our stomach for more. One box of strawberries would fill us up much more than a candy bar, as well, because of the fiber and fluid in the berries with the sugar, so we would likely naturally stop eating before we scarf down the Costco-size tub of berries. In nature, these concentrated sweets in berries or honey were few and far between and required a lot of effort – picking the berries is time consuming and only available for a short part of the year. Honey requires fighting off a swarm of bees, and there aren’t that many hives full of honey, so once you take their honey, it takes a long time for bees to make more, so in the past the sweetest stuff in nature was hard to come by – maybe we raised our insulin like that a few times a month, but it was never a daily thing, and our systems are not designed to handle daily what we now give them. These huge spikes, especially done many days a week, are very problematic, and we will talk about that more in a few minutes. But before we get into that, I want you to understand which foods raise insulin the most, and which raise it the least. In terms of stimulating insulin, simple carbs and sugars, like candy, any sugar, pasta, bread, are the most stimulating. Let me be clear with you here – whole wheat pasta, whole wheat bread, things made out of alternative flours like almond flour, all count as simple carbs. They may be slightly healthier, as they have more fiber and often more nutrients, and are less processed, but in terms of insulin response, they all stimulate it much more strongly than other foods. This is why so many of us think we are doing the right thing, switching to whole wheat, but see no weight loss with those changes. Next in terms of insulin stimulation is complex carbohydrates, like unprocessed starchy vegetables and some whole grains (quinoa, brown rice, unprocessed oats). Protein follows this, with fat stimulating our insulin the least.

Now back to why high insulin is something we want to avoid. When our insulin is high for long periods of time, meaning months or years, our body becomes resistant to the signal. Just like we stop listening to things that we hear every day and learn to tune them out, like the hum of the air conditioner or traffic on the highway, our body learns to tune out the insulin, and we develop the start of insulin resistance and diabetes. Insulin resistance goes hand in hand with increasing sugar addiction and food cravings. It is the down the drain model of health – more sugar creates more desire and cravings, leads to eating more sugar, which leads to more cravings, with increases in the insulin at each circle of the drain on the way down.

To lose weight, we need to reset our insulin levels. I personally have found that for me, the easiest way to do this is twofold. I have limited my flour and sugar from all processed sources, which was we discussed are the strongest triggers of insulin, and I give my body a break from making insulin by having amounts of time without any food or calories. This is called intermittent fasting. I have been doing fasting for 18 months, so what I do currently is not at all what I would recommend for people starting out. What I think makes sense starting out is the 16:8 plan that they outline in the obesity code. This translates into fasting for 16 of every 24 hours, and eating for 8 of every 24 hours. This would mean you eat all of your meals between 10am and 6 pm, or 12 pm and 8pm if you are on a later schedule. During that time, you can eat either 2 or 3 meals, with NO snacks. I am an advocate of only 2 meals during that time, but you may start at 3 until you get used to this. In the morning, a cup of coffee with 1 tablespoon of heavy cream is ok before the start of your window – this does not significantly increase your insulin (remember, straight fat increases insulin very little). I personally am lactose intolerant, so I use coconut cream, which is sold by the can at Trader Joe’s among other places. This is not the same as coconut milk, which has more carbs and less fat! Make sure you get the right one.

I want to set realistic expectations of what you can expect with intermittent fasting. This does not lead to the quick weight loss that you might expect, because for most people, the total calories are close to the same, just over a shorter time frame – what more commonly happens is that you will stay the same for 7-10 days, and then lose a few pounds when the body resets to a lower set point. What happens then is that your insulin levels lower, and all of a sudden, your body thinks, wow, I am at 200. I don’t really need to be there – I should be at 198, and then it speeds up its metabolism to get those 2 pounds off. After that, you ususally are stable for another 7-10 days, followed by another loss. This is so great, because your body now accepts the new weight as its set point, and it will not be constantly trying to go back up to where it was. It makes the weight loss much less painful – you are still eating the same calories, just over a shorter period. The real challenge with this comes with the cravings that cutting out flour and sugar brings. In the US, many people have sugar and carbs as their primary food source. This leads to their bodies becoming what we call “sugar burners”. This happens when your body is so used to sugar, it completely gets out of the habit of mobilizing our fat stores for food. It knows it can just make you “hangry” and a quick jolt of soda or an energy bar will follow. This leads to only ever being in fat storage mode, and your body completely giving up on trying to use its fat for energy. This is so counterproductive, but goes back to basic biology – from our cells up, we are programmed to conserve energy. If we teach our body that all it has to do is yammer for a snack, and we comply, it will shut down the much harder, more time and energy intense process of turning fat in our body into fuel. It is the equivalent to our body of take out vs. defrosting the meat, preparing a casserole, baking it and then sitting down to eat. Just like our brain wants the “easy button” of takeout, our body wants the “easy button” of a continuous influx of sugar so it can use it in the minute, and then just store the extra, which is easy peasy for it. It takes 2-6 weeks on a reduced carb load diet to reset our insulin and begin fat burning. Once that happens, you are what we call “fat adapted” and the body goes to that much more naturally, with much less complaining. During that time, you WILL have cravings, mood swings, and generally feel like crap – oh yes, you are LOVING me right now, aren’t you??? Yeah, the truth hurts sometimes. It is what you have to get through if you want to lower your weight set point and to take this weight loss journey for the last time. I promise, all of those things will get better. You need to manage your mind around them, though, and not be making yourself the victim of the eating plan and then justifying sneaking carbs all the time. I am going to work on allowing food urges next week, which will be really helpful.

Another hormone that has a big effect on weight gain is cortisol. This is your body’s stress response hormone, and I think this is a big actor in people who experience weight gain after cancer, or during a pandemic. Cortisol is part of the hypothalamic-pituitary-adrenal axis, which is medical jargon for it being a complex feedback loop between the brain and the body. Too much cortisol in the short term leads to a feeling that you are racing inside, irritability and weight gain. It suppresses the hormones in your brain that make you feel good, like serotonin and oxytocin. Like all other hormones, if it is super high for a long time, the body gets burnt out and becomes resistant to it. When this happens, you might experience fatigue, lack of stamina, a less responsive immune system, and a feeling like you are always “cup is half empty”. It makes sense that cancer patients have a high cortisol if they are not managing their mind. I spent the first several podcasts discussing how to manage the mind and think better thoughts. But, I know some people like to know if there is a pill or supplement to fix it quicker. I really like the review of cortisol on the Goop discussion with Dr. Sara Gottfried – I posted a link to this on the facebook page – she gives a lot of information about medications and techniques she has recommended to reset cortisol which you can consider. I tend to be a believer in the old fashioned way, which takes longer but is more permanent, to decrease it, which is managing your mind and controlling your emotions. I have 4 things that I think all work together to really reduce my cortisol. I get enough sleep – 8 hours per night if at all possible. This is actually something new for me – I really prioritized sleep a few years ago when I heard research linking sleep deprivation and alzheimer’s, but it turns out, it is a key player in cortisol and weight, as well! I am not the greatest sleeper, but I think melatonin is a natural remedy that helps in low doses. I meditate – I try to do it daily, but am pretty consistent getting 5 times a week. I do 20 minutes before work with the app Insight Timer, if you are wondering what app I use. I have a gratitude practice where I actively search out things to be grateful for daily, and record them. Finally, I keep a thought download journal, to be aware of my thoughts and what emotions they are bringing. Thoughts that trigger a lot of stress are ones I work the hardest on because they are really damaging for two reasons – they raise your cortisol, and they lead to buffering to avoid them and feel better, which also is counterproductive with weight. Episode one went through types of buffering if you forget what this is or need a review. Finally, cortisol can be effectively reduced by gentle exercise, like yoga, pilates, or walking outside observing nature. One of the things that surprises many people – aggressive workouts often INCREASE cortisol, and because of this, cause more weight challenges, food urges and overeating. Things like marathon running and heavy weight lifting are in that group for sure.

Next in the hormone list is leptin. This is one of the newer hormones that scientists have worked out, and initially, they thought it would be the solution to all of our weight woes as a society. Leptin is a hormone produced by our fat cells. It signals to our brains that we have plenty of stored energy and should stop eating. We definitely want more of this one, right? At first scientists thought we could just inject Leptin and people would not be hungry. But recent research unfortunately has found that chronically high levels of leptin burn out the receptors in the brain, and the brain stops getting the signal to stop eating. Insulin also blocks leptin in the brain, so if our insulin levels are high, it is not letting our fat signal our brain that we don’t need to eat. We need to reset our leptin as we reset our insulin. As the insulin drops, leptin begins to come back on line. As your weight set point drops, you will find that your hunger is just not as intense as it was, you are more able to fast and let your body “dine in” and have its own fat as a snack. It becomes almost a bit shocking, when our leptin kicks in and we realize we are eating less, and just not having as much physical hunger. Often emotional hunger takes longer to change – that is hunger that starts in your brain from desire and our thoughts. I will tackle this in the upcoming weeks as well.
Ghrelin is a hormone that works in conjunction with Leptin. They are opposites – low leptin causes increased Ghrelin and low Ghrelin causes increased Leptin. Ghrelin is a hunger hormone. It is secreted by the stomach lining cells when they sense that the stomach is empty. This hormone is also cyclical and to some degree programmed by your regular routine. It gets used to your schedule, and kicks up when it knows it is a time that you usually eat. In caveman days, it probably kicked up once a day, as they probably ate one big meal. In the 1950’s, it kicked up at breakfast, lunch and dinner, as they ate 3 meals and really didn’t snack much. Today – well, if you are always eating, you are pumping out Ghrelin every time your stomach is empty – the Ghrelin Stomach Growl, every hour if you don’t keep feeding the sugar beast. As you reduce the number of times you eat by limiting your eating window and NOT snacking, Ghrelin will decrease. I get the question all the time if I am starving when I fast. I am hungry for about 20 minutes at lunch when I fast through lunch, which I quiet down with a cup of hot water with lemon, a cup of hot tea or a cup of broth. I am pretty darn hungry when I get to dinner time if I am still fasting, because I eat dinner every day. This is noticeably worse on Monday at dinner if I had carbs over the weekend. I almost always do a 23 hour fast Monday – so I don’t eat from after dinner on Sunday to dinner on Monday. I am busy at work, though, so it is actually really convenient. When I say I fast for 23 hours, please recall – I have been fasting for 18 months, and this is NOT where I want you to start! But the truth is, I am just as hungry for dinner on the days I DO eat lunch, and sometimes, even more, depending on what I ate at lunch. My body gets to lunch and is like “are we eating? No? Ok, just checking, I’ll go get myself a snack and dine in”. I even go into the lunch room where all my staff is eating, food smells everywhere, and they say, Dr. B, do you want a slice of pizza or are you fasting? I just smile and get my hot water.

An important thing to know about Ghrelin as well – it ONLY gets shut off by SOLID FOOD in the stomach. It is not shut off at by liquids, so when you drink your calories, it doesn’t realize how many calories you have ingested and keeps pumping. This is one of the reason shakes don’t help with the hunger for some people, and why alcohol is so dangerous in terms of weight.

One of the final ones I feel I have to mention is Thyroid hormone. If you are a cancer patient, some of the treatments can affect your thyroid. There is an easy blood test for this hormone. Low thyroid causes weight gain, feeling sluggish, dry skin, thinning hair, and cold sensitivity. If you have those symptoms, you could consider letting your primary know you are having them and see if they will check your level. There are easy, well tolerated meds to address low thyroid, and it is clear, if yours is low, you will have a much harder time losing weight than if your thyroid is functioning normally. It is one of those things – I have am always cold, unless I am actively in the middle of a hot flash, I gain weight easily, I have super dry skin, but NOPE – always normal when I check it. We always want the quick, easy fix, don’t we? It is worth checking, but you should know that many people have those symptoms and their TSH levels are perfectly normal.

So – your recap for the week. Insulin is the fat storage hormone. It is strongly raised by flour, sugar, and very dense nutrients, like energy drinks or bars. To lose weight more easily, we have to lower our insulin. You can cut out flour and sugar, and use intermittent fasting. Cortisol is the stress hormone. It also leads to weight gain. I recommend lifestyle modification to normalize this. Leptin is good, you want more, and it makes you less hungry. It is suppressed by insulin, so this is another reason to get your insulin down. Ghrelin makes you hungry and is the Ghrelin Growl, when the stomach is empty. Drinks don’t decrease this, only solid food, so don’t drink your calories. Hope this was not too overwhelming. Head to the best life after cancer FB page if you want more resources or want to ask a question!