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In her twenty-five year-long gynecology and functional medicine practice, Gottfried has revealed that weight loss resistance is almost always hormonally based in females. Here, she explains the hormone imbalances that have the greatest impact on our weight—not to mention our mood and happiness—along with what to do if hormones are out of whack, how to reset your metabolic rate, break painful food addictions without self-blame, and the most important things we all should know about hormones—in spite of of what we may weigh.

A Q&A with Dr. Sara Gottfried


From time to time diet and efforts at the gym just don’t pay off on the scale—do you believe that weight loss comes down to one calorie in, one calorie out?


So the solution was to fix my hormones—and when I did, something amazing happened: I not only lost weight more easily, my mood improved. I was more kind and patient with my children. I wanted to go to yoga at night, not to the wine bar. I am a graduate from couple’s therapy! I connected again to my vital nature of joy. My every day outlook was no longer identified by the bathroom scale and my battle of the bulge; I had more energy for bigger things.

“I found out that the calorie-in/calorie-out hypothesis has been widely disproven and remains the biggest misconception people have about diet and weight loss. Calories matter, more to some individuals than others, but hormones matter more.”


What is the common hormonal imbalance that causes us to hold onto, or have trouble relinquishing weight?


Ninety percent of the time, I find that the main hormone that’s out of whack is cortisol (which ends up affecting other hormones, too). Your body makes cortisol in response to stress, however most of us run around stressed too much of the time, and our cortisol is off as a result. High or deregulated cortisol levels wreak havoc over time, depleting your happy brain chemicals like serotonin, disturbing your sleep, and making you store fat—particularly in your belly. High cortisol is likewise associated with depression, food addiction, and sugar cravings.


Can you break down the other hormones that are complex for people?


INSULIN: Insulin is a fat-accumulating hormone. Insulin resistance or block means your cells can’t soak up the extra blood glucose your body generates from the food you eat—when that happens, your liver converts the glucose into fat. Insulin resistance often causes weight gain and sugar addiction.

LEPTIN: High leptin triggers weight gain and excessive hunger. Leptin is a natural appetite suppressant. When you’ve had enough to consume, leptin signals your brain to stop eating. When you are overweight, your fat cells produce extra leptin.

ESTROGEN: Estrogen dominance is when you have surplus estrogen compared with its counter-hormone, progesterone. Having too much estrogen in the body leads to a number of symptoms, including weight loss resistance, moodiness, PMS, and heavy periods.

THYROID: Your thyroid functions as the gas pedal of your metabolism, managing how fast or slow you cut calories. When the thyroid is sluggish, it can trigger weight gain, fluid retention, hair loss or thinning, depression, and constipation, among other problems.


Can emotional conditions affect hormone levels and thus weight?


Absolutely! We tend to think first of the physical aspects of weight loss resistance, like diet and workout, yet the emotional, mental, social, and spiritual factors may be even more important. I believe hormones have effects onto all of these domains.

“A daily struggle with the bathroom scale can cause shame, judgment, suffering, and obsession with weight—contributing further to weight loss resistance.”


How do you “restart” your hormones, or jump-start your metabolism? Can you do it with diet alone?


You have to change the way you drink and eat. Avoid processed foods, refined carbohydrates, sugars and sugar substitutes from your diet. Eliminate alcohol for 21 days (even a single serving can lower a woman’s metabolism by more than 70 percent—it’s a temporary effect, however can add up over time if you drink most nights).

TARGETED EXERCISE. Make sure that you keep moving, and choose forms of movement that you love, but exercise smart. Say no to the chronic cardio (more on why coming). Burst training and adaptive exercise (i.e. Pilates) are more likely to normalize cortisol than running a half marathon. Burst training involves short periods of high intensity workout with moderate-level exercise as recovery.

Take supplements to maintain your hormone levels. Here are a few of my ideas:

Cortisol Manager: You need 7 to 8.5 hours of sleep to break through weight cut resistance. My favorite supplement for improved sleep—and less stress—is called Cortisol Manager, a mixture of phosphatidyl serine and ashwagandha. It dials down the HPA so that you don’t feel stressed and can wind down for a nice night of sleep. Extra cortisol raises blood sugar and deposits fat at night. Take one tablet by the bedtime.

Berberine is the most proven supplement to reset insulin and support weight cut in females. It activates a vital enzyme called adenosine monophosphate-activated protein kinase, or AMP, nicknamed the “metabolic master switch.” Take 300 to 500 milligrams one to three times a day. It is more powerful when combined with milk thistle.

Di-Indole Methane (DIM): I know it doesn’t sound appetizing; however it’s very good for you. This supplement is similar to eating 25 pounds of steamed broccoli. Many females with weight loss resistance have estrogen dominance, a problem that affects 75 to 80 percent of women over thirty-five. Particularly, DIM reduces 2-hydroxy-estrone and 2-hydroxy-estradiol, so that you have more protective estrogens and fewer bad estrogens. Dose is normally 200 mg/day but must be adjusted to the individual. (Alternatively: Consume more lightly steamed cruciferous vegetables, which can sustain your good-to-bad estrogen ratio by 30 percent.)

Try genetic testing. It can guide the best ways for you to eat, move, think, and supplement for hormonal harmony and weight cut. I started genetic testing for my patients (and myself) more than a decade ago, and it can really help break through hormonal chaos and weight loss resistance. For instance, changing your food strategy can reset the way particular genes are expressed: You can lower your carbohydrate intake to reset the ADRB2 gene, which controls your weight changes in response to workout.


But, what causes hormones to go haywire? Is it the natural aging process, stress, having babies…is there a main culprit?


The main culprits of haywire hormones include:

Nutrient deficiencies. For instance, vitamin C deficiency can lower your progesterone. Progesterone is nature’s Xanax, so a shortage makes you feel overwhelmed and anxious.

Excess toxins. Bisphenol A is an excellent example: It can interfere with the estrogen, insulin, thyroid, and testosterone messages in your system.

Poor stress handling. I put myself in this group. Again, the main cause is that the alarm system in the system doesn’t turn off, so you make too much cortisol at the expense of other hormones.

Age. Women’s hormone levels change throughout their reproductive years and through perimenopause, menopause, and more than that. Common life conditions, such as menstruation and pregnancy, can throw your hormones off balance, as can medications like birth control pills.

Inadequate sleep. Only 3 percent of the people do well on less than 7 hours of sleep. Sleeping 7 to 8.5 hours every night keeps cortisol as normal. Alcohol raises estrogen and cortisol levels, steals deep sleep, and lowers metabolism by nearly 70 percent, as mentioned earlier. I always recommend my patients get off alcohol entirely for a minimum of two weeks, twice per year, to give the liver a break.

While workouts are the essential part of balancing your hormones, it can also throw them further out of whack if not managed properly. For females, I rarely advise CrossFit or Orangetheory unless your form and adrenals are impeccable. Some exercise (such as running) place so much stress on the body that cortisol shoots sky-high. Think of a Tibetan monk against a marathon runner. Which one ages more rapidly? The runner; because of higher load of cortisol, a wear-and-tear hormone.


How can you know if your hormones might be out of whack? Are there particular tests that you can ask your doctor to order, or is it something that people can handle on their own by addressing their diet?


When your hormones are in balance, neither too high nor too low, you look and feel your maximum. However when they are imbalanced, you feel miserable, with a range of symptoms that include fatigue, sugar cravings, weight loss resistance, bloating, belly fat, trouble sleeping, anxiety or irritability, and regular stress.

You can assess your hormones with my free of charge Questionnaire. However, you won’t actually know if your hormones are to blame for your symptoms until you get some basic blood work done. So, document your symptoms and check in with your physician to ask for blood work.

Below is a list of the tests I most usually recommend for my patients. Once you have your test results, you and your doctor can see the areas that need the most improvement.

Blood panels to ask your doctor to order (for a morning test after an 8-to-12-hour fast):

  • DHEA
  • Cortisol
  • TSH, free T3, reverse T3, free T4
  • Insulin
  • Testosterone: free, bioavailable, and total
  • Leptin
  • Hemoglobin A1C
  • ALT (to check the liver)
  • Glucose

If overweight: leptin, IGF-1 (growth hormone)

ALT (to check the liver)

If menopausal: estradiol, FSH

If you still have your menstrual period: Day 3 estradiol, Day 3 FSH, Day 21-23 progesterone

Urine test. Try the Complete Hormones profile test from Genova Diagnostics or the DUTCH test from Precision Analytics. Either will tell you about your adrenals (both short- and long-term function), and your estrogen metabolic rate, which can tell you if you have too much wear and tear from cortisol as well as if you have a modifiable tendency toward breast cancer or not, or a risk of osteoporosis. I recommend reviewing the results with an informed, functional medicine clinician.

A genetic test such as 23andMe. There are seven key genes that are significant when it comes weight loss, hormone balance, and feeling younger; and they can all be tested via 23andMe (and interpreted with my new book, Younger.).


Besides weight gain, or holding onto stubborn pounds, are there other methods imbalanced hormones impacts the way we feel? Can you be at your perfect weight and still need a reset?


Yes, you can. High levels of the major stress hormone, cortisol, will deplete your happy brain chemicals, such as serotonin and dopamine; 50 percent of individuals with depression have high cortisol. Past the age of thirty-five, disordered estrogen (extra or low) can lead to depression and low libido. The resulting drop in serotonin can at times lead to depression or mood swings. Low thyroid levels can trigger moodiness—about 20 percent of people with depression have low thyroid function or hypothyroidism.

“To slow down aging process, it’s important to sustain or improve your lean body mass, since aging begins in your muscles. So, yes, you can be at your wished weight and still need a reset.”

You can also be at your planned weight however have extra fat, a phenomenon known as “skinny fat.” The issue here can be surplus cortisol, insulin block, and/or low growth hormone. To fight aging process, it’s important to maintain or improve your lean body mass, since aging begins in your muscles. So, yes, you have your wished weight and still need a reset.

If this feels disappointing: Eat a square of extra-dark chocolate (which has been proven to minimize cortisol in randomized trials, as mentioned above).


Any other tips on fighting food addictions?


The most familiar food addiction issues are sugar, flour, and quantity. There is also orthorexia, an unhealthy obsession with healthy food (a condition that I used to have). As a recovering food addict, I believe the main cause of food addiction is complex and multifactorial—so the solution requires nuance and feedback.

Crowd out the unhealthy stuff with more nutrient-dense food. The amount of food you eat impacts the balance of brain chemistry, hormones, and blood sugar levels. Over- and under consumption creates unstable blood sugar, low functioning thyroid, food allergies, and amino acid and fatty acid deficiencies that can weaken neurotransmitter mechanisms.

Restart your neurohormonal dashboard. Connect with your internal divinity; control your cravings by accessing the true you that’s in your mind and in your heart. Consider a ten-minute morning meditation. Sign up for a yoga class. Find a way to feed your soul in non-food methods. Close your eyes and fully focus on your breathing, forget the world problems. In case you can control stress with mindfulness and self-care, you have another tool to help break the habit of reaching for food when what you actually need is to calm yourself.

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