Why It’s So Hard to Lose Weight for Women 40+ and How to Optimize Hormones During Perimenopause and Menopause with Dr. Sara Gottfried
Nov 16, 2023
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Dr. Sara Gottfried, an expert in women's health, discusses the hormonal changes women face after 40, including weight redistribution, insulin resistance, and cortisol imbalances. She explores the dissatisfaction with conventional medical approaches to perimenopause symptoms, emphasizes the importance of hormone balance, and offers practical tips for optimizing hormones through diet and lifestyle interventions. The podcast also covers the impact of stress on sleep, the interplay between cortisol and thyroid hormones, and the need for a holistic approach to women's health.
Managing cortisol is crucial for hormonal health in women, especially those in their 40s with high cortisol levels, as it can lead to brain shrinkage and memory issues.
Perimenopause, which can begin as early as 35, is characterized by symptoms like weight gain, cramping, insomnia, and hormonal imbalances, often caused by estrogen decline, cortisol imbalance, and thyroid dysfunction.
A science-based approach is necessary to navigate the hormonal imbalances that occur before and during menopause, as conventional medicine often dismisses women's symptoms during this phase of life.
Strategies such as managing cortisol levels, exercising to strengthen the body, increasing fiber intake, and prioritizing self-care through practices like meditation and yoga, can restore hormonal balance and enhance overall well-being in women.
Cortisol plays a significant role in hormone regulation, and testing cortisol levels, especially through diurnal cortisol testing, along with addressing other hormone imbalances like hypothyroidism, can guide treatment priorities for patients with hormone imbalances.
Deep dives
The Impact of Cortisol on Women's Health
Women in their 40s with high cortisol levels may experience brain shrinkage and memory issues. Managing cortisol is crucial for hormonal health.
Hormonal Changes in Perimenopause and Menopause
Perimenopause can start as early as 35, with symptoms such as weight gain, cramping, insomnia, and hormonal imbalances. Estrogen decline, cortisol imbalance, and thyroid dysfunction are common during this time.
Misconceptions About Hormonal Changes
Menopause is not a sudden event, with hormonal changes starting years before menopause itself. Conventional medicine often dismisses women's symptoms, but a science-based approach can navigate the hormone imbalances.
Addressing Hormonal Imbalances through Lifestyle Changes
Strategies like managing cortisol levels, strengthening the body through exercise, increasing fiber intake, and prioritizing self-care, such as meditation and yoga, can help restore hormonal balance and improve overall well-being.
The Impact of Cortisol and the Importance of Testing
Cortisol plays a significant role in hormone regulation, and about 80% of patients with hormone imbalances start with cortisol management. Testing cortisol levels can provide insights into the highest priority area for treatment. Saliva tests, especially diurnal cortisol testing, can provide a comprehensive picture of cortisol fluctuation throughout the day. Additionally, cortisol levels can be affected by other hormones, such as hypothyroidism, which should be addressed alongside cortisol management.
Sleep, Cortisol, and Hormonal Health
Sleep disruption, especially in perimenopause and menopause, is a common concern for women. Poor sleep hygiene can impact cortisol levels and hormone balance. The demands and responsibilities of the sandwich generation, managing both parents' health and children's needs, can increase stress and negatively affect sleep. Prioritizing sleep and addressing underlying issues like acid reflux can help improve cortisol levels and overall hormonal health.
Thyroid Function and Micronutrients
Thyroid function is another crucial aspect of hormonal health. Testing thyroid function through a comprehensive panel, including TSH, free T3, free T4, reverse T3, and thyroid antibodies, can provide valuable information for diagnosis and treatment. Micronutrients like vitamin D, copper, zinc, selenium, and iodine also play significant roles in thyroid function. Optimal thyroid health can have a positive impact on overall hormone balance and well-being.
Importance of Monitoring Insulin Levels
Monitoring insulin levels is crucial for metabolic health. Insulin changes first before glucose levels, so it's important to consider insulin changes that may occur years before glucose changes. Conventional doctors often focus solely on glucose levels, but looking at insulin levels through tests like fasting insulin and glucose challenge tests can provide valuable information about metabolic health and potential insulin resistance. Advanced testing, such as an insulin resistance score and measuring biomarkers like uric acid and ALT, can further assess metabolism. Understanding insulin status is vital for overall health, as it affects energy levels and how well individuals feel.
The Significance of Balanced Blood Sugar
Balancing blood sugar is essential for overall well-being, especially for individuals in their 40s, 50s, and beyond. Many people rely on a diet that causes spikes and crashes in blood sugar levels, leading to fatigue, mood swings, and other symptoms. The key is to transition to a blood sugar-balanced diet that includes more vegetables, adequate protein, and fiber while reducing refined carbohydrates, processed foods, and excessive sugar consumption. Continuous glucose monitoring can provide valuable insights into how different foods affect blood sugar levels and help individuals make informed choices. By optimizing blood sugar balance, individuals can experience improved energy levels, reduced cravings, and better overall health.
As women approach their mid to late thirties, they often suffer symptoms that are ignored or dismissed by conventional medicine. Insomnia, weight gain, irritability, reduced memory, and brain fog are all symptoms that can drastically change the quality of life for women. Today’s guest is here to show us that there is hope and that it doesn’t have to be this way.
Today on The Dhru Purohit Podcast, Dhru sits down with Dr. Sara Gottfried for a deep dive into women’s health, specifically the changes that occur in perimenopause and menopause. Dr. Gottfried shares the symptoms women in these categories face and the science behind why they occur. She shows us the critical tests that need to be addressed, offers practical tips women can implement to address these changes and balance key hormones, and inspires women to empower themselves on their road to longevity.
Dr. Sara Gottfried is a board-certified physician who graduated from Harvard and MIT. She practices evidence-based integrative, precision, and Functional Medicine. She is a Clinical Assistant Professor in the Department of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University and Director of Precision Medicine at the Marcus Institute of Integrative Health. Her three New York Times bestselling books include The Hormone Cure, The Hormone Reset Diet, and Younger. Her latest book is Women, Food, and Hormones.
In this episode, Dhru and Dr. Gottfried dive into (audio version / Apple Subscriber version):
The metabolic crisis that women in their 40s go through (2:30 / 2:30)
How conventional medicine often dismisses these symptoms 10:18 / 7:37)
The top misconceptions or misunderstandings about the interplay between hormones (16:12 / 12:46)
Common symptoms of perimenopause and menopause as they relate to aging (22:05 / 18:30)
The environmental and lifestyle factors that impact women’s hormones (31:40 / 26:20)
The top 3 hormones to balance and correct: cortisol, estrogen, and thyroid (41:38 / 36:10)
How Dr. Gottfried started her hormonal journey by testing her cortisol (51:10 / 47:00)
Dealing with insomnia during perimenopause (1:03:20 / 57:54)
Testing thyroid levels and the connection between thyroid and autoimmune disease (1:16:00 / 1:11:12)
Bringing hormones in harmony (1:22:00 / 1:17:02)
The key to feeling better by addressing glucose levels (1:33:00 / 1:28:10)
The role of post-traumatic stress and the use of psychedelics (1:54:15 / 1:49:45)
Dr. Gottfried’s message of how it doesn’t have to be this way (2:12:30 / 2:07:40)
