Deborah, age sixty-two, was really struggling when she came to me. “I just don’t feel right,” she said. “My energy is down, and my weight is up. No matter what I do, I can’t seem to fix my energy or lose the weight.”
She felt sad all the time, and her moods swung all over the place. “I’ll be somewhere and suddenly burst into tears or anger for no reason.”
Deborah suffered through many sleepless nights too, unless she used sleep aids, but even with those, she did not wake feeling rested. Her hot flashes were so severe that her body felt like a steam vent, and she’d perspire all over.
“This has been going on so long, I can’t remember the last time I felt well. I’m beginning to think that my life is over,” she said.
Rita, forty-four, was in a state of physical and mental chaos. “I have unbelievable hot flashes, brain fog, and dry skin. I am emotional all the time and piling on weight. Hair is growing on my face and I’m losing it from my head! I feel like I am losing my identity, because I no longer feel feminine.” Hormone changes were hitting home, and hitting hard. “It is hard to see a light at the end of the tunnel when your body is changing,” she said. “I try to tell myself it won’t last forever. But what will I be like after menopause? I’m too young to feel this way.”
At age fifty-three, Tina had to drag herself out of bed in the morning. Her eyes stung from crying all the time, and she was totally exhausted. “I have a rough time losing pounds, no matter how hard I diet. Nothing works.” She sighed. “I look awful, feel awful, and have no desire to be intimate with my husband. I’m not living my life. I can’t cope with feeling this way forever.”
In my twenty-plus years in medicine, I’ve met many women like Deborah, Rita, and Tina. I’ve heard their stories and their pleas. They are plagued by hormonal imbalances, which may have begun around age thirty-five when levels of progesterone, a crucial reproductive hormone, begin to decrease. Estrogen, vital to numerous functions including bone protection and brain function, starts falling off in your forties and fifties, increasing your risk for osteoporosis and other problems. Testosterone also begins to decline in midlife, and dehydroepiandrosterone (DHEA) starts decreasing in our twenties. A deficit of DHEA contributes to loss of sex drive, vaginal dryness, osteoporosis, and lots more. Altogether, these and other hormonal pendulum swings create a perfect storm for menopausal miseries, including weight gain, mood swings, and crashing libido—and what is worse, a sense that you no longer know or like your body or yourself.
Deborah, Rita, and Tina are women who were scared, troubled, and beaten down by seemingly out-of-control symptoms brought on by declining hormones and advancing age. They felt miserable and hopeless. And obviously, that is a bad place to be.
Although these women had different experiences, their symptoms and problems were resolved through a common route: the Hormone Fix, a program that I developed over years of testing and have now been using with clients for years. It is a practical way to transition into and from times of fluctuating hormones while minimizing or eliminating many of the miseries and ensuing critical health conditions. It helps you gently change your lifestyle, while enhancing your life. It leads you to embrace the kind of positive habits that will start transforming your body, even in the midst of the often confusing but natural and beautiful life stage of menopause.
Deborah, for example, decided she was ready to change. She got serious with my Keto-Green Diet and lifestyle. Within weeks, her troublesome, life-limiting symptoms of hot flashes and sleeplessness practically vanished. She lost ten pounds, two inches from her waist, and three inches from her hips.
Rita is now loving life again. Her mind is clearer, her moods are better, and she has more energy than ever. The excess fat began melting off. Her symptoms of early menopause disappeared. She loved it when the attendant at her usual service station remarked that she looked like she was eighteen. She’d regained bounds of youthful energy too!
Tina lost twenty-eight pounds with the Keto-Green Diet and lifestyle and pared inches off her figure—something she had not been able to do in a very long time. Her cravings for fattening foods were eliminated. And she was back to her energetic self—and a loving, vibrant sex life with her husband, for which she is ever grateful.
Their renewed health and success can be yours too.
Each day, more than 150 chemicals called hormones run through your body. They act as chemical messengers, orchestrating an intricate symphony of messages telling your organs what your brain wants them to do. Hormones are really exciting because they influence many bodily functions, including metabolism, reproduction, blood sugar levels, blood pressure, energy levels, kidney function, sleep patterns, aging, appetite, sex drive, and more.
Hormones are secreted by organs called endocrine glands, which include the pituitary, thyroid, hypothalamus, ovaries, and testes. Other organs and tissues emit hormones too—namely, the kidneys, heart, small intestine, and even your own fat tissue.
Your body employs a feedback system to keep hormones in precise balance. That is, when one hormone is present in abnormally high or low levels, the body sets in motion a chain of reactions that balances the system. You can think of this feedback system as being like the thermostat in your house. You set it at a desired temperature, and when the internal thermometer senses an increase or decrease of a few degrees, it immediately sends a signal to turn on the air conditioner or heater to cool or heat up the room.
In your body, the control mechanism is the pituitary gland. It sits at the base of your brain and detects changes in the levels of these chemicals in the body. Sensing changes, the pituitary increases or decreases its gland-specific stimulating hormones to bring the body back in balance. Numerous factors can throw off this delicate balance, including a lack of nutrients, aging, diseases, alcohol and drugs, sleep problems, and stress, both physical and emotional.
The beautiful and natural biological patterns in your life are governed by your hormones. When you were a teenager, the arrival of your menstrual cycle opened the door to your womanhood. During each menstrual cycle, the pituitary gland releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH). They are responsible for the development of follicles (cells that contain immature eggs, known as ova). They also produce estrogen and progesterone, which stimulate the uterus to build up its lining with extra blood and tissue. This process thickens and cushions the uterine walls in preparation for pregnancy.
About once a month, a tiny egg departs from one of the ovaries (ovulation) and heads to the uterus through one of the fallopian tubes. If the egg is fertilized by a sperm cell, it settles in the uterus and attaches to its cushiony walls, where it slowly develops into a baby. If the egg isn’t fertilized, it won’t affix to the uterine wall. When this happens, the uterus sloughs off its extra lining. The blood, tissue, and unfertilized egg exit the uterus, passing through the vagina on the way out of the body. This is your period. For the next few decades of your life, it will arrive as regularly as your bank statement, unless you get pregnant.
Hormonally, in your twenties you’ve shed the chrysalis of your teen years and spread your adult wings. You’re packing on bone mass, developing lean muscle, and pumping out estrogen, progesterone, testosterone, DHEA, and other reproductive hormones at peak levels. Your monthly cycle is a reminder of your fertility.
By the time you reach your midthirties, your metabolism starts slowing down. It gets a little easier to gain extra pounds, even if you stick to the same exercise program and nutritional diet of your twenties. Your body fat is about 25 percent, and your hips and thighs are spreading a bit.
In both your twenties and thirties, your sex drive is likely high, thanks to elevated sex hormones. And that’s as it should be. You want to be nice and frisky in your primary childbearing years.
Each of us is born with a finite number of eggs, and those eggs are aging with us. Therefore, and naturally, as you get closer to your forties, your fertility begins to drop sharply. You’ll also have a decline in the level of estrogen in your blood, which shrinks the amount of collagen and elastin in your skin, reducing its firmness and springiness. You might notice a few wrinkles here and there when you look in the mirror.
Your forties are the transitional years between childbearing and menopause, and therefore the decade in which you go through perimenopause (though perimenopause can last anywhere from five to fifteen years). The first main reproductive hormone to start its descent is progesterone, followed by estrogen and others. You’ll have symptoms that foreshadow menopause: missed periods, PMS, breakthrough bleeding, palpitations, migraines, hot flashes, vaginal dryness, insomnia, and anxiety, among others. During perimenopause, some of you may feel like your body isn’t your own anymore, like something is seriously wrong. Do migraines mean a brain tumor? Do palpitations signal a heart attack? No…it is just nature messing with your hormonal balance.
I tell my patients that if you hate your husband or partner only two weeks out of the month, it is your hormones, not your spouse or partner. This whole cascade of crazy hormones at this time often results in a lack of self-care—which, in turn, causes resentment toward yourself and loved ones. At no time in your life is self-care more important than when you are approaching the transition of menopause. Take care of yourself now, and you will cement habits that will serve you well into your golden years.
Next comes menopause. Even though we often speak of menopause as the part of your life in which your period has ceased, it’s actually technically defined as the date twelve months after your last period. Thereafter, you are actually postmenopausal. When I use the words “menopause” and “menopausal” in this book, I am referring to the entire transitional time before and after menopause. The average age of menopause for most women is approximately fifty-one, but much younger if you smoke. Menopause is when your body is shutting down its reproductive capacity, drastically affecting just about every organ.
Hormonally, what does menopause look like? Your estrogen levels, which fluctuated wildly during perimenopause (the time prior to menopause), drop 75 percent or more from their peak. For some, this major change is easy and trouble-free, with few problems and manageable symptoms. For others, there are unpleasant, often debilitating symptoms like hair loss, acne, aches and pains, crashing fatigue, and weight gain. As estrogen falls off, fat shows up in certain areas—the tummy, thighs, butt, chin, and under-eye area.
Sexually, menopause presents a mixed bag. The loss of estrogen makes the vaginal walls less elastic, resulting in dryness, loss of lubrication, decreased sensation, and sometimes pain during intercourse. The labia shrink a bit too, exposing more of the clitoris, which can become less sensitive with age. (I’ll give you strategies in Chapter 9 on how to improve these vaginal issues.)
Meanwhile, you might look in the mirror or at your hands and see that your skin is thinner and more crepey. At fifty, you might have gray hair—a lot or a little. It might also be noticeably thinner and drier than it used to be.
With the onset of menopause, you may lose bone mass quite rapidly. The declines in estrogen, progesterone, testosterone, and DHEA cause a change in the absorption of skeletal calcium. You can help prevent this with vitamin D and K supplementation, strength training, and eating a high-mineral and alkaline diet. If you haven’t been doing most of this, you face a high risk of developing osteoporosis.
Despite these changes, menopause is not a disease—far from it. It’s another natural stage in your life, when your hormones are in flux once again.
As menopause ends, you enter postmenopause—which can actually be quite liberating, a new place of centeredness, and a potentially very rewarding phase of life. You begin to reassess your life and goals. You’re more inclined to say, “What shall I do in the next season of my life?” After all, you do have a lot of living left to do! You still have dreams to fulfill—perhaps an entrepreneurial idea, a trip around the world, a volunteer commitment to your favorite cause, a run for office. You are more independent than ever and can move in the direction of new hopes and goals—especially if you have your health.
A favorite quote of mine is: “When you have your health, you have a million wishes, when you don’t, you only have one wish…and that is to have health.”
Despite your continued decline in metabolism, you don’t gain as much weight when you are postmenopausal because your appetite may decrease. But any extra pounds added to your waist in your forties and fifties have increased your risk of high blood pressure, heart disease, memory loss, and diabetes (the extra weight around the midsection can also be a sign of insulin resistance). It is not too late, however, to implement healthier practices in your life.
Happily, the probability of living well into your postmenopausal years is greater than ever before—and growing all the time. Modern women could reasonably expect to enjoy a vibrant quality of life at least into their eighties—a gain of thirty years of life compared to women born in the 1800s! Wiser now, you can enjoy the life that you worked so hard to create, while being able to educate, inspire, and instruct those around you and the generations that follow.
Each stage of your life can be a doorway to discovery, where you can find out what gives you joy, recognize what you are grateful for, and explore opportunities to fulfill your dreams, even the ones yet unrealized. As you leave one journey, you begin another, not with a sense of regret, but with a new appreciation of change and what the future holds.
You might think that estrogen, progesterone, testosterone, and other sex hormones are the major players during these life changes. But they are not. Specifically, when it comes to menopause, the three hormones that we need to be concerned with—the ones that are the major players—are insulin, cortisol, and oxytocin. When these are balanced, all the other hormones in your body fall into line. My program—including my unique Keto-Green Diet—focuses on these key hormones.
Each hormone is intimately involved in how you feel, how you think, and how you look. If you feel less than whole as your body goes through its natural age-related changes, it is likely because you have an imbalance of these hormones. Correcting the imbalances through diet and lifestyle can restore you not only to your previous healthy self but to a younger, sexier, and fitter version of yourself that you and others really love.
Insulin is a major hormone, and it can affect many other hormones, including the sex hormones (estrogen, progesterone, and testosterone). So when it is unbalanced, other hormones go out of kilter too.
Women can become insulin-resistant as they approach menopause mostly because their bodies can no longer deal with high amounts of carbohydrates, nor with snacking. Which means that the carbs you once ate—even healthy ones like fruits, whole grains, potatoes, or brown rice—will affect your waistline. When cells can’t soak up the extra glucose because of insulin resistance, the liver has to deal with it by converting it into fat.
Insulin resistance lurks beneath many of the most common symptoms you experience during menopause: hot flashes, fatigue, difficulty concentrating, and weight gain. All of these are early symptoms of insulin resistance, but we often don’t make the connection, because no one has pointed it out to us.
On top of all this, insulin resistance is closely linked to many other serious health problems such as diabetes, polycystic ovary syndrome (PCOS), high blood pressure, abnormal cholesterol, breast cancer, and endometrial cancer, and has been implicated in Alzheimer’s disease.
My combination of keto and alkaline eating—the Keto-Green Diet—helps regulate insulin and reverse insulin resistance in one important way: it shifts you into ketosis, which restores your body to an insulin-sensitive state.
The ketogenic component of the diet works by keeping the body’s carbohydrate stores almost empty. Your body starts burning its own body fat for energy, helping you lose weight quickly. It will also burn fat that you’re consuming through your diet, assuming you are eating healthy fats (not trans fats, for example).
When you’re insulin sensitive, all sorts of metabolic miracles happen. You stay slimmer and fitter. You lower your risk of cardiovascular disease, Alzheimer’s disease, and dementia. You tend to not have hot flashes or night sweats. You rebuild your bone health so that you’re at less risk for frailty and osteoporosis. Cravings become a distant memory. And you feel, look, and act healthy and energized.
Cortisol is the key stress hormone and one of the lifesaving hormones. It is an immediate responder in times of danger and stress. Following a stressful event, your adrenal glands pour out cortisol. Cortisol boosts the amount of blood sugar available for fuel and revs up your heart rate so you can fight off or escape a threat, or otherwise deal with the stress.
After the danger passes, cortisol also functions as the “cleanup crew” to lower inflammation, a damaging side effect of the stress response. Cortisol, then, serves as the body’s natural anti-inflammatory hormone.
So all the intentions of this hormone are good. But often cortisol stays elevated in the body for too long due to chronic, unresolved stress (real or perceived). Over time, its efforts to reduce inflammation stall and suppress immunity, leading to an increased susceptibility to colds and other illnesses. Chronically elevated cortisol can actually damage our body. It increases acidity, throws our gut flora out of whack, and causes “leaky gut,” when the gut becomes so permeable that substances and nutrients actually seep out through the intestinal wall. In short, cortisol knocks our bodies out of balance. It becomes the Rocky Balboa of hormones!
Chronic high cortisol can also lead to rapid aging, depression, adrenal fatigue, feelings of loneliness and burnout—all due to a domino-like sequence of events. Just look at photographs of any president before taking office and after leaving office, and you can see the effects of stress on aging in just four to eight years.
So, what’s happening? First, the presence of elevated cortisol activates the paraventricular nucleus (PVN) in the brain—a control center regulating stress, metabolism, growth, reproduction, immunity, and other functions. Second, the PVN tells the adrenal glands, which produce cortisol and other hormones, to stop making so much cortisol because its mass production is frying the body. If this cascade of events goes unchecked, inflammation then takes over. And that segues into more rapid aging, emotional problems, and other bodily disasters. Sadly, as we get older, there is less automatic regulation of cortisol. It can continue to circulate, increasing our risks for dementia, heart disease, osteoporosis, metabolic syndrome, cancer, and more.
Also, the secretion of high amounts of cortisol robs your body of DHEA, progesterone, estrogen, and testosterone. The net effects are increased glucose production, decreased lean muscle production, imbalances of estrogen and testosterone, low sex drive and desire, and burnout.
Chronic elevation of cortisol can pack on pounds in three ways. One way has to do with visceral fat cells (the ones in our abdomen and around our vital organs). Cortisol triggers a fat-storing enzyme in those fat cells, causing many of us to put on more belly fat. Belly fat cells seem to attract cortisol too. They have four times as many cortisol receptors as regular fat cells.
A second way in which cortisol is involved in weight gain has to do with the blood sugar/insulin problem. When cortisol hangs around 24/7, it raises your blood sugar levels and keeps them high. This creates insulin resistance. Glucose can’t get into cells the way it normally would. Eventually it is stored as fat.
The third connection is cortisol’s effect on appetite and cravings for high-calorie foods. When cortisol levels rise, you’re likely to have food cravings. In women, those cravings tend to be strongest for carbs, especially sweets when you’re feeling sad or moody, and crunchy, salty chips when you’re feeling stressed and irritated.
During menopause, the body’s reduced ability to control that spiking cortisol (with its effect of reduced insulin sensitivity) is what contributes to hot flashes, night sweats, weight gain, mood swings, anxiety, insomnia, and more.
Cortisol is directly related to weight gain. Switching to more alkaline foods and lifestyle habits curtails levels of cortisol, which is one reason that both actions help you lose body fat. There is a definite and positive connection between following an alkaline diet, lowering cortisol, and burning fat. If you want all that—and I know you do—you’ve got to stay in an alkaline environment. To make sure, you can easily check your urine pH (more on how to do that on this page).
Mood swings
Irritability
Depression
Irregular periods
Hot flashes
Vaginal dryness
Water retention
Weight gain in hips, thighs, and tummy
Poor sleep quality
Decreased libido
Headaches
Fatigue
Short-term memory loss
Poor concentration
Thinning of scalp hair
Dry, thin, wrinkly skin
Increased facial hair
Bone mineral loss
Osteoporosis
Aches and pains
Mental fogginess or forgetfulness
Depression
Anxiety
Moodiness
Hot flashes
Night sweats
Fatigue
Decreased libido
Dry eyes, skin, and vagina
Loss of skin radiance
Sagging breasts
Pain during intercourse
Weight gain
Increased back and joint pain
Heart palpitations
Headaches
Gastrointestinal discomfort
Poor sleep quality
Increased insulin resistance
21-hydroxylase deficiency (a short supply of an enzyme needed to convert cholesterol into cortisol)
Increased activity of lipoprotein lipase (an enzyme that increases fat storage)
Loss of muscle tissue and muscle strength
Decreased production of growth hormone
High cortisol levels in the blood
Sugar cravings
Lower calorie expenditure
Weight gain
Estrogen deficiency symptoms (see above)
Luteal phase defects (abnormal endometrial development)
Infertility and ovulation problems
Breast tenderness
Depression
Anxiety
Fatigue
Poor concentration
Endometriosis
Fibrocystic breasts
PMS/mood swings
PCOS
Headaches
Fibroids
Water retention and bloating
Weight gain
Breast and uterine cancer
Cold body temperature
Menstrual flow changes
Acne
Hair growth
Aggression
Temporary hair loss
PCOS
Infertility
Diabetes
Heart disease risk
Possibly poor prognosis in breast cancer
Decreased libido
Early senility
Memory problems
Reduced mental power
Poor concentration
Moodiness
Depression
Fatigue and weakness
Passive attitude
Irritability
Less interest in normal activities
Hypochondria
Produced by the hypothalamus and secreted from the pituitary gland and other tissues, including the heart, uterus, and ovaries, oxytocin is my favorite hormone—the powerful hormone of love, bonding, and connection. It’s the hormone that floods us during childbirth as we cradle our newborn. It also surges with orgasm, laughter, play, hugging, caressing your pet, and giving. It’s an anti-aging hormone too.
Physiologically, oxytocin and cortisol have a love-hate relationship. They oppose each other. They are like two boxers in a ring, or the two kids on a seesaw. When one goes up, the other is forced to go down. I know this firsthand. The chronic stress and PTSD I endured from losing my son triggered the cortisol-oxytocin disconnect and made me unconsciously shun the things and people I loved. Simply put, I walked away because cortisol won. There is a definite physiology behind all this—you’re not going crazy! If you ever experience burnout, emotional disconnection, or withdrawal from things and people you love, it is probably due to cortisol knocking oxytocin down.
Thankfully, oxytocin helps counterbalance cortisol’s negative effects. That’s why I sometimes say that you can “hug your belly fat away”—loving hugs are a great way to produce lots of oxytocin.
But wait, there’s more! Oxytocin also helps regulate body weight and appetite. This makes sense when you remember the early stages of falling in love and having no appetite, right? In 2008, Japanese researchers demonstrated that if you take a mouse and knock out the oxytocin receptors on its cells, the mouse becomes obese, even without eating any more food than it usually does. Another study, reported in 2013, showed that if you give humans or mice extra oxytocin, the hormone prevents insulin resistance and triggers weight loss.
All of this adds up to the fact that there is a strong connection between oxytocin and eating. Oxytocin is very involved in satiety—the happy feeling of being full and satisfied after a meal. When you eat, various hormones are stimulated, including insulin, leptin, and cholecystokinin (CCK). As digestion begins, leptin and CCK signal the brain via the vagus nerve, the neural “highway” that runs up and down the trunk of your body and shuttles hunger and appetite impulses between your brain and your gut. In response, the hypothalamus (the appetite control center in the brain) releases oxytocin, which then helps produce that happy, full feeling in your tummy. Suddenly you’re less hungry.
The reason oxytocin is an anti-aging hormone is that it increases cellular regeneration and health, plus prevents microbes from invading cells. You’ll learn more about this wonderful hormone in Chapter 11.
Though there are not specific foods that help release oxytocin, research does show that chronic sugar intake reduces the amount of oxytocin that your body makes in response to food. So eating too much sugar suppresses oxytocin in your body. That’s not good for weight control and is another reason why the Keto-Green Diet is low in sugar.
Neurotransmitters are powerful chemical messengers, just like hormones, and their levels are affected by hormonal imbalances. So when neurotransmitters are out of balance, this affects mood, cognition, attitude, coping skills, energy, sleep, overall health, and more.
Serotonin is the relaxing and calming neurotransmitter. It makes us feel good. When estrogen falls, levels of serotonin drop. As a result, we tend to feel moodier, easily irritated, and our appetite increases. What you eat can help this imbalance. That’s because certain gut bacteria help boost brain levels of serotonin—so you want to eat plenty of probiotic rich foods, such as pickles, sauerkraut, yogurt with active cultures, and kefir. These foods promote healthy gut bacteria, which in turn increase serotonin. The spice turmeric, a well-known anti-inflammatory, also prolongs the activity of serotonin in the brain. Foods containing the amino acid tryptophan such as turkey, dairy, dates, and sunflower seeds, to name a few, and foods with high levels of omega-3 fatty acids, such as cold-water fish, flaxseed oil, and walnuts, are also thought to boost serotonin levels.
Dopamine is a powerful neurotransmitter that affects pleasure and motivation. High levels of dopamine give you enthusiasm and drive. Falling levels are linked to a sense of emptiness, sadness, irritation, and boredom. When dopamine is released, it triggers the production of testosterone, which is critical for sex drive in both men and women. To ensure a steady production of dopamine—and higher testosterone—you need to supply your brain with the nutrient building blocks of dopamine. One important building block is phenylalanine, found in beets, edamame, nuts, eggs, dairy, and meat. If you really need a quick mood boost, chocolate can bump up dopamine and serotonin. This is because it contains anandamide-like molecules, a fatty acid that acts like the active substance in marijuana.
Gamma-aminobutyric acid (GABA) gives your brain the peace and calm it needs. Progesterone acts on GABA receptors in the brain, but as progesterone declines with age, so does GABA. You’re then prone to anxiety, depression, and poor sleep. Fortunately, there are GABA-boosting foods that can help counter this imbalance: cherry tomatoes, kefir (also a probiotic food), shrimp, green tea, lemon balm, ashwaganda, and any food high in omega-3 fats, such as salmon. GABA supplements taken at night can also be used to promote deeper sleep if needed.