Hormonal Weight Gain and the Midlife Woman
Many of my midlife patients at the Women’s Mood and Hormone Clinic at the University of California, San Francisco, complain about weight gain even though they feel as if they aren’t eating any differently. They haven’t changed, but their brains have.
As you enter perimenopause, your brain becomes less sensitive to estrogen. This, of course, can trigger a cascade of familiar symptoms: hot flashes, fatigue, depression, changing libido. But in many women, it can also cause raging hunger. Estrogen affects your brain’s levels of serotonin, dopamine, norepinephrine, and acetylcholine — neurotransmitters that control eating, mood, and memory — so changes in estrogen wreak havoc on your appetite control.
Your appetite is controlled by your brain’s energy thermostat, located in the hypothalamus. There, hormones and neurotransmitters signal your appetite to turn on or off. So the easiest way to control your hunger — whether you want to lose weight or just maintain it — is to work with your hormonal currents rather than to fight them. To help you understand how to do this, I’ve created composites of my real patients. The woman I’ll refer to as Liz is a Girl Scout when it comes to hunger management; she does pretty much everything right. And Donna — well, we’ve all had days when we are Donna. Here’s how they navigate the hormonal ups and downs of a typical day.
Hormonal Hunger in the Morning
Early Morning: Rise, Shine — and Eat
The simple act of waking up and getting on with your day can become challenging in the perimenopausal years. That’s because sleep is often interrupted by one or more nighttime awakenings, perhaps accompanied by a hot flash or two.
Once you’re out of bed and moving around, your stomach begins to produce the hunger hormone ghrelin, which signals your brain that your body needs food.
This is the time of day when you should listen to your body and feed it properly.
Liz, 47, turns off the alarm and gently stretches. Whether or not she has slept well, she gets up at the same time every morning, because she knows this will keep her sleep, mood, and appetite cycles regular.
Liz heads to the kitchen for a breakfast of an egg white omelet, then takes her dog on a brisk one-mile walk. She won’t have time for a full-fledged workout today, but by sneaking in 10- to 15-minute bouts of activity, she can meet her goal of getting at least 30 minutes of cardio a day. Liz lost 15 pounds last year and credits exercise with helping her do it, so she’s committed. (The perimenopausal body functions better when muscles are active and fit: They release endorphins, feel-good chemicals that travel to the brain, giving you a sense of well-being.)
Meanwhile, Donna, slightly overweight at 46, hits the snooze button and pulls the covers over her head. After a restless night of tossing, turning, and hot flashes, she’s exhausted. She drags herself out of bed at 7:45 and makes coffee. She’s so cranky that the thought of food doesn’t even cross her mind. Symptoms of irritability, lack of focus, and fatigue can be caused by low estrogen during perimenopause, and lack of sleep only makes them worse.
Liz drops her son off at high school on her way to work. In her purse are several sticks of low-fat string cheese — some days it’s a high-fiber energy bar. She knows this will stave off her midmorning doughnut craving, should it strike.
After Donna dresses and gets her kids off to school, her stomach starts growling. It’s pumping out ghrelin, and her brain gets the message loud and clear: Eat now, or else! (Alas, this signal seems to be stronger in women than in men.) So she makes a quick stop at the deli en route to the office and has a bagel with jam and a large latte. The carbs quickly turn to sugar, and her brain starts releasing feel-good neurochemicals like noradrenaline and dopamine, which dampen her hunger and give her a mood and energy boost that is only temporary.
Midmorning: The Leptin Lull
After we eat, our fat cells pump out leptin, the hormone of satisfaction. Leptin travels through the blood to the hypothalamus, signaling it to suppress hunger. Leptin also causes the brain to produce less dopamine, a neurotransmitter that’s released when you experience something pleasant. Dopamine is released with the first bite of food; it’s the little voice that urges us to eat more. Leptin quiets that impulse.
Production of leptin decreases two to three hours after a meal, signaling your brain that it’s time to eat again. This is why midmorning is an appetite danger zone.
10:30 a.m. Donna can’t concentrate. Since all she’s had to eat this morning is caffeine and carbs, her energy level and mood are low. She goes to the cafeteria for more coffee and picks up a chocolate croissant. Her brain gives her another shot of dopamine and noradrenaline, and it gets a big dose of insulin. It’s the wrong combination for a perimenopausal woman: Eating sugar and caffeine increases the hunger-pang hormone ghrelin and decreases the stop-eating hormone leptin, so it won’t be long before she’s hungry again.
Liz isn’t hungry yet, but she knows that by 11:00 or 11:30 she will be. So she has a small snack — a piece of low-fat cheese and half an apple — that has just the right amount of protein and complex carbs to keep her ghrelin level down.
In the 30 minutes since she ate her chocolate croissant, insulin has been coursing through Donna’s body, grabbing all the glucose and shoving it inside her cells. Unfortunately, this means her brain, which needs glucose to function, soon won’t get enough of it. Her stomach starts growling again, and this time her appetite center gets a double whammy: ghrelin spiking and leptin falling, both urging her to eat more.
Liz feels good. As she digests her snack, her ghrelin level drops rapidly, and satisfaction hormones are released. She stops thinking about food and focuses on her work.
Hormonal Hunger in the Afternoon
Early Afternoon: Beware the Feeding Frenzy
Donna is so hungry she has a headache. She considers ordering a salad, but the morning was rough, she’s behind in her work — and she wants comfort food. She orders a meatball sandwich, which comes with a side of fries. She eats everything. But she hasn’t conquered her appetite yet.
After the meal, her fat cells release leptin, telling her brain everything is okay. Her ghrelin level begins to decrease — but it will take about 20 minutes for her brain to get the message, so she still feels hungry. Donna buys a couple of cookies and a diet soda before heading back to work. Even drinking the diet soda is a bad move. Artificial sweeteners seem to switch on appetite the same way sugar does.
Liz, meanwhile, is tempted by lasagna, but knows it will make her feel sleepy. Her protein snacks have kept her ghrelin level from increasing, so she’s not starving and can override her craving for carbs; she orders the chicken Caesar salad with low-fat dressing on the side.
Midafternoon: The Cortisol Crash
Our level of cortisol, a stress hormone, naturally drops at this point in the day. For women in perimenopause, this is also the time when our testosterone level drops, and that can make us feel worn out and moody. Scientists think this is a major reason for weight gain at this stage of life, because feeling tired and cranky stimulates cravings for sweets and comfort foods. Another reason may be that in our mid 40s, the brain’s response to glucose can change dramatically, giving us uncharacteristic energy surges and drops, as well as cravings for sweets and carbs.
Liz yawns and thinks about eating a candy bar to get her through the last couple of hours of work. She knows it’s not a good idea, but her taste buds are clamoring for something sweet. She’s not hungry, so she decides to have a cup of mint tea and wait 30 minutes to see whether she still wants the sugar buzz.
Donna can’t believe she’s feeling hungry again, and she’s so tired she can barely keep her eyes open. Then a coworker reminds her of the boss’s birthday celebration — chocolate cake and ice cream. It would be rude not to go, and besides, she’s really hungry. She rationalizes that she’ll skip dinner to make up for the extra calories.
Liz makes a detour on her way to the boss’s party. She buys a bottle of spicy vegetable juice to go with her low-fat string cheese from home. The protein curbs her craving and the juice turns off her sweet tooth so she can go to the party and be satisfied with a bite of cake, not a whole piece.
Donna skips her workout and joins a friend for a drink to blow off steam after an unproductive day. She figures that exercise will just make her feel hungrier and take her last remnants of energy. She’s wrong. Exercise is more likely to increase her energy level and lift her mood. And the alcohol she’s drinking is metabolized as sugar, so Donna is heading for another high, followed by another low.
Liz fast-walks two miles on the high school track, finishing in time to pick up her son at soccer practice. She feels energized and happy about the calories she has just burned. But when she asks her teenager how his day was and he snaps at her, she feels upset. Mood instability and irritability are common during perimenopause, and this can trigger stress eating. Instead of turning to food, Liz takes the dog for a quick walk.
Hormonal Hunger at Night
Early Evening Dealing with Dinner (and Dessert)
Why do you always seem to have room for dessert? Since glucose is the fuel your brain needs to keep your body alive and functioning, your taste buds respond most favorably to sweet foods and beverages, even when your stomach is full.
Donna nibbles on bread while she makes dinner for her family. While they eat chicken, rice, and vegetables, she eats only the vegetables. For dessert, her husband and kids have birthday cake that the boss insisted she take home. She resolves not to eat any of it.
Liz makes salmon, broccoli, and a high-fiber grain called quinoa (high in iron, which many women in their 40s need because of heavy periods.) After dinner, everyone wants dessert. She scoops up chocolate soy ice cream and sprinkles toasted almonds on top. Eating soy protein can keep your ghrelin level down; it also has phytoestrogens, which may help reduce hot flashes. But Liz is mindful of her portion, because soy is high in fat.
Late Evening: Curbing Emotional Eating
As the rush of the day recedes, emotional eating issues come to the fore.
Donna pops a pretzel into her mouth as she cleans up after dinner. There’s a skirmish or two about homework and plans for the weekend. Before she knows it, she has eaten a few handfuls. She opens the refrigerator to put away the leftovers and spies the last hunk of birthday cake. As she pulls it out, she chalks it up to PMS. "I’ve already blown it today," she figures, "so I might as well finish the cake." She tells her husband to walk the dog and sits down to watch the news.
Although Liz has had a good day, she suddenly feels a little down. Her periods have been so erratic that she doesn’t know if it’s PMS or just another weird hormonal mood swing. She thinks about eating but then decides to take a walk around the block instead. When she returns, she keeps herself busy and away from the kitchen. She does a 15-minute yoga routine, listening to a relaxing tape; takes her calcium supplement (which can help her sleep); and starts preparing for bed.
The perimenopausal brain operates best on a schedule. Estrogen changes can disturb the brain’s sleep clock. Going to bed and getting up at the same time not only helps train you to sleep when you should, it provides the most available energy to your brain and body. It can also help control your appetite. When you’re tired, you’re vulnerable to eating more and making less-healthy food choices. Liz is all set for another day.
Donna is wired from the cake, so she has a glass of wine while she continues to watch TV. Several hours later, she wakes up. She’s fallen asleep on the couch. By the time she brushes her teeth and washes her face, she’s wide awake because of alcohol rebound, which occurs two hours after drinking. She gets into bed and resolves to stare at the ceiling until she nods off. Donna has unwittingly set herself up for another day like the one she just had.
Your Hormonal Hunger Chemistry
Hormones, neurotransmitters, and other chemical signals circulating among your brain, your fat cells, and your stomach control your urge to eat (and to stop eating). Here, a look at the major players.
LEPTIN is a protein produced by fat cells that tells your brain that you are full.
GHRELIN is a hormone that’s secreted in your stomach. It signals the cells in your brain’s appetite center that you are famished.
DOPAMINE, a neurotransmitter, plays a major role in motivation, addiction, and reward; it may prompt you to keep eating even though you’re not hungry anymore.
CORTISOL, a stress hormone, is produced by the adrenal glands and waxes and wanes throughout the day. When it’s low, it may stimulate hunger.
Three Ways to Work with Your Hormones — Not Against Them
- Start a diet on the day you start menstruating. During the first two weeks of your cycle, your ovaries are not producing progesterone, which means your brain is not signaling you to eat more food to prepare for a possible pregnancy. These are the perfect two weeks to eat less without feeling deprived.
- During the two weeks before ovulation (the two weeks after your period), reduce or eliminate sugar and other simple carbs (white bread, pasta, etc.). During the second half of your cycle, increases in your progesterone level stimulate the brain to crave sugars and carbs. So the best time to train your taste buds to say no is before the progesterone spikes.
- Exercise more during the second two weeks of your menstrual cycle. This will help derail your desire for carbohydrates during the progesterone surge. Keeping your carb intake in check during these 26 weeks of the year can make a significant difference when it comes to weight loss.
Managing Hormonal Weight Gain
Don’t Cut Calories; Redistribute Them To curb your appetite and lift your mood, you want to keep your ghrelin level low and your leptin level high. Eating five small high-protein meals a day will accomplish that. Be sure to eat them at about the same time each day.
By having mini meals every few hours, you also give your body a chance to switch over to the "reserve fat" tank — the fuel stored in fat cells — without feeling as if you’re starving. When you feel just a bit hungry between meals, your body and brain will get fuel from your reserve tank of fat. And because you have to wait only another hour or less before you eat again, you can better resist being seduced by ghrelin’s siren song.
Mix Your Meals Don’t cut complex carbohydrates from your diet. Doing so can actually make you cranky, sad, or even depressed. A carb-free diet also makes you prone to hunger. A better strategy is to pair complex carbohydrates with high-protein foods. Complex carbs (such as high-fiber vegetables) take more time and energy for your body to digest, so they don’t prompt your pancreas to pour out insulin, setting off the vicious cycle that makes your brain crave sugar again.
Don’t Wait to Have Dessert That is, eat dessert right after a meal. If you’ve eaten a dinner of carbs and protein with a little fat, you’ve slowed down your digestion. Protein and fat in your system dampens the insulin impact of a sugary dessert. Dopamine, the reward neurotransmitter, will egg you on to eat more. Ask yourself if you’re enjoying this bite as much as the first; when you’re not, stop.
Fill Up on Endorphins Your estrogen output may be sputtering, but you’re still capable of producing plenty of endorphins. When your brain is pumping these out, you’re less likely to fixate on food. Good endorphin releasers: exercise, laughter, and orgasms.
Originally published in MORE magazine, July/August 2007.
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