What I Tell My Patients Who Want To Lose Weight: A Hormone Expert Explains

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In this piece, Dr. Sara Gottfried, hormone expert and Harvard-trained MD, explains how hormonal imbalances can hold you back from weight loss. If you're interested in learning more, check out her course: How To Balance Your Hormones For Glowing Skin, Deeper Sleep & Better Digestion.

When working with patients in my practice and online community, I hear a lot of similar comments. In particular:

  • I follow all the rules, but I still can’t lose the weight.
  • I’m just getting old and my metabolism is slow. It’s genetic. There’s nothing I can do about weight loss.
  • These last 10 pounds just won’t go away—I feel like I should give up!
  • There are certain foods I can’t stop eating even though I suspect they’re bad for me.
  • Don’t you have a weight loss pill you can give me?
  • I’ve tried everything to lose weight. Maybe I need to accept myself as fat, and give up my skinny clothes.
  • Nutrition and diet strategies that work for others don’t seem to apply to me.
  • I lose five pounds, and then I regain seven. It’s so frustrating!

Do those statements also resonate with you? If so, you might not know an important secret: the reason you struggle with your weight is that your hormones are out of whack.

As a board-certified gynecologist, I am uniquely qualified to understand the private suffering that women experience with weight gain and body shame. But even more important, I used to be fat. So I applied my medical knowledge to my own body to free myself of weight gain. And now I want to share my knowledge with you.

Although hormones are complex, there are four that make losing weight close to impossible when they’re out of balance, particularly for women. Here, I'll share what they are, how they affect your weight and fat burning, and at least one simple action you can take to bring each hormone back into balance.

Weight-loss blocker #1: estrogen imbalance

Estrogen is the female hormone that gives women breasts and hips and keeps joints lubricated. Men have it too, although at far lower levels. But both men and women are at risk of estrogen overload, which means having too much estrogen in the body—even in menopause. Estrogen is still made in the ovaries after menopause, as well as in the adrenal glands. (While estrogen levels are lower after menopause, if your progesterone levels are super low, you can still have estrogen dominance.)

Estrogen, along with other hormones, is responsible for how you respond to food, drink, and supplements. Put simply, estrogen dominance is the main reason women have a harder time losing weight regardless of age, when compared with men.

How To Heal: To lower your estrogen levels (and thus, help lose weight), I recommend eating a pound of vegetables per day. The fiber from the vegetables helps to excrete estrogen so it doesn’t keep circulating in your body like bad karma. Aim for 35 to 45 grams of fiber per day for women (40 to 50 grams per day for men), but slowly increase in 5-gram increments each day to get to your goal without gas or bloating.

Plus, eating more plants will crowd out the meat. That's important for two reasons: One, meat is a major contributor to climate change. Second, rapid changes in industrial agriculture and cultural expectations over the past century have outpaced the ability of our genes to adapt. Put simply, our DNA-driven biology hasn’t yet adjusted to modern meat—and women are particularly at risk from the effect of meat on their estrogen. The connection between meat and estrogen is profound. When you eat conventionally raised red meat, estrogen overload is more likely.

I’m not saying you have to give up all meat forever—but there are powerful arguments to limit your consumption of conventional meat. Paleo works for some but not all women, and I’ve seen far better results in men. We lack randomized trials for or against eating meat, even pastured. Sadly, we don’t have a body of high quality evidence suggesting that eating meat is better for you than eating plant-based protein, seafood, and poultry.

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Weight-loss blocker #2: excess insulin

It's estimated that one in two Americans have some degree of diabesity, which is diabetes plus obesity. When you’re overweight or skinny fat (normal weight but you have too much fat mass), insulin becomes imbalanced and your cells become numb to the hormone. As a result, you experience blood-sugar highs and lows, and you store fat because your glucose regulator is broken. Insulin isn’t working. Your hormone and weight loss are off track.

How To Heal: There are many ways to reset your insulin, but a personal favorite is to drink filtered water with two tablespoons of apple cider vinegar. A 2004 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.

Of course, there are many ways to reset insulin—you probably already know to give up sugar and artificial sweeteners. Keep in mind that if your metabolism is broken, your hormones are misfiring, and insulin is the most likely to be a problem.

Weight-loss blocker #3: excess cortisol

You make cortisol in response to stress, but many of us run around stressed most of the time. I’ve written about this problem extensively in my bestselling books, because I believe it is the root cause of many women’s battle with the bulge. When it comes to hormone imbalance and weight gain, all roads lead back to cortisol.

Most of us know that cortisol overload is bad for vanity and sanity, but common knowledge is not common practice. Bathing the poor body in all those stress hormones wreaks havoc over time, and makes you store fat—especially in your abdomen as visceral fat, the most deadly type of fat.

High cortisol is also linked to food addiction and sugar cravings, so that you overeat the wrong foods like cookies and processed foods.

Net result? You get fat.

How To Heal: To reset your cortisol, you need to hit the pause button on your caffeine intake. Wean off of caffeine over the next week, and notice how your sleep and stress levels improve.

Go first from coffee to half caf. Then from half caf to green tea. Then, if needed, green tea to white tea, then off. Substitute your cuppa joe with a steamy mug of hot water with lemon and a pinch of cayenne. Drinking one to two cups in the morning will help stimulate the gastro-colic reflux so that you poop each morning, and allow toxic hormones to be released.

There are many more targeted suggestions for reversing cortisol dysregulation in my new mindbodygreen course, but kick the caffeine first.

Weight-loss blocker #4: insufficient adiponectin

Adiponectin is one of the key hormones that tells your body to burn fat. Encoded by the ADIPOQ gene and secreted by fat cells, its role is to regulate glucose levels and fatty acid breakdown. Some people are genetically programmed to not make enough of this fat-burning hormone, and as levels decline, fat composition in the body increases.

When it comes to weight loss resistance, the brain plays an important role, and there exists a secret conversation between fat tissue and the central nervous system. Adiponectin is one of the chemical messengers in this secret conversation, and regulates inflammation and oxidative stress, both of which contribute to weight gain.

How To Heal: To reset adiponectin, I recommend eating pistachios. It blows me away when a single food intervention can affect a hormone level significantly. In a study of 60 people with metabolic syndrome, eating pistachios daily (20 percent of total energy) improved adiponectin. Plus, improvements were also seen in waist circumference, fasting blood sugar, total cholesterol, LDL (the so-called “bad cholesterol”), high sensitivity C-reactive protein, among other biomarkers.

What else raises adiponectin? Intermittent fasting. The easiest way to intermittently fast, also known as a mini fast, is to extend the period of time that you don’t eat overnight. For men, 16 hours seems to be the minimum effective time without eating, and for women, it’s 18 hours. That means if you stop eating at 6 p.m., you should wait to eat again at 10 a.m. for men, and noon for women.

Plus, exercise helps, along with eating other monounsatured fats besides pistachios, such as avocados and dark chocolate.

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The bottom line

When I battled my weight every morning, and mentally obsessed over the number on the bathroom scale, I thought my way into a hormonal mess. As I gently reset one hormone at a time, my mess became my message. My greatest wish is that you also feel empowered to listen even more closely to your body and make the best decisions about which foods and lifestyle tweaks most serve you.

Understanding that permanent weight loss occurs as a result of hormone balance has helped so many of my patients finally get their weight under control and break through weight loss resistance.

Women and weight is a big topic, and it’s about so much more than weight loss. It’s about mastery over your life and feeling whole starting within. When you feel energetic, strong, and in touch with your body, wonderful things can happen. You no longer feel bloated and cranky, obsessed and neurotic, or guilty and self-loathing about your body—you can finally focus on your deepest hopes and dreams, your purpose in life. You can discover what makes you feel most alive and awake.

Psst! If you're interested in learning more about hormones, check out Sara's full course How To Balance Your Hormones For Glowing Skin, Deeper Sleep & Better Digestion.

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