Have you ever felt like your body is resisting your weight-loss efforts? You count calories, pound the pavements and reduce your afternoon snack to six Brazil nuts… and still the pounds won't shift.
That was Dr Sara Gottfried's story. Despite her best efforts, the Harvard-trained integrative physician just couldn't lose the weight she had gained after having children.
"My defining moment came in my mid-30s," she explains. "I had an extra 25lbs of baby weight I couldn't shake and my old diet tricks no longer worked."
Her work-life balance was compounding the issue. "I was seeing 40 patients per day and I felt I couldn't get to know my patients and really listen to them the way I wanted.
"Like many women, I was burning the candle at both ends - I had two kids, a husband who travelled a lot, and I was a working mother, trying to be all things to all people."
When the fatigue became unmanageable, she visited her GP. He told her weight loss was a matter of simple mathematics.
"Eat less and exercise more," he said, before suggesting an antidepressant and birth control pill.
"At first, I was humiliated," she recalls, "but then I got angry, because I knew in my gut that he was wrong. It didn't feel right to fill that prescription, so I turned my medical training on to myself because my hunch was that my hormones were out of whack, and that's why I was suffering with my weight, low energy and generally feeling lousy."
Her next stop was the lab where her blood test results confirmed her hormones were in chaos. "My cortisol was high and responsible for my growing muffin top and sugar cravings. My thyroid was borderline, making me depressed and causing my hair to fall out. My oestrogen was too high - very common after 35 - and that made it hard to lose weight."
A complete overhaul of her diet ensued.
"It took me 21 days to turn the ship around, but when I did, I felt like myself again - happy, free and curious about the world instead of angry and resentful. I realised hormones dictate what your body does with food and that realisation changed everything."
Sara (48) is now on a one-woman mission to help women balance their hormones, reclaim their lives and finally lose those stubborn pounds. She has written two New York Times bestselling books, The Hormone Cure and The Hormone Reset Diet, and runs an integrative medical practice in San Francisco.
"When you can't lose weight, despite trying the usual sound methods, your metabolism is broken, and 99% of broken metabolisms are related to hormonal misfires," she explains.
"Your hormones govern nearly all aspects of fat loss, from where you store fat (and how much) to your cravings, appetite, gut bacteria and even your addictive patterns with food.
"When misfiring hormones are allowed to spiral downwards, you're left with hormone anarchy and, ultimately, a broken metabolism.
"You store fat no matter what - even when you try popular diets.
"If you struggle to get and stay lean, I promise that your hormones are to blame."
What's more, she believes that a slow metabolism can be speeded up, even after the age of 30. "You can significantly change your metabolism at any age," she assures me, "but keep in mind that it's easier to prevent your metabolism from getting broken than to cure it once it's slow."
Those who embark on the programme outlined in The Hormone Reset Diet have to be willing to make lifestyle changes alongside dietary changes.
Avoiding processed foods and sugars is just as important as lowering stress and getting more sleep. Alcohol also has to be omitted for 21 days.
"Alcohol raises your oestrogen and cortisol (also known as the 'stress hormone') levels, and slows down metabolism by up to 70%. The decrease in metabolism is temporary, but if you're drinking every night, the habit can pack on the pounds, especially at the waist.
"Regular alcohol consumption after about age 35 can also clog the liver, which is like the traffic cop in the body for all your hormones. So when your liver is busy processing all that wine, it can't do its other detox tasks like get rid of your oestrogen and make you feel refreshed each morning."
Sara suggests opting for alcoholic drinks that are less likely to cause hormonal imbalance, including organic red wine and kombucha.
She also recommends taking a 5g-10g dose of fibre before drinking alcohol. "It will stabilise your blood sugar and slow down your absorption of alcohol."
Sara, whose patients are mostly female, says she can now spot hormonal imbalances prior to blood tests with almost 95% certainty.
"Thinning hair, including eyelashes and the outer third of the eyebrows, signal a slow thyroid," she explains. "Sunken tear troughs can indicate waning oestrogen in the second half of perimenopause and menopause. Fat around the middle can indicate hormonal imbalance, specifically leptin resistance, high cortisol and insulin resistance."
According to Sara, the three major factors curbing weight loss in women are oestrogen dominance, insulin resistance and cortisol overwhelm.
"Oestrogen dominance is when you have too much oestrogen compared with its counter-hormone, progesterone," she explains.
To lower your oestrogen levels, she recommends eating one pound of vegetables per day. "The fibre from the vegetables will help excrete oestrogen, so it doesn't keep circulating in your body."
To reset your insulin levels, she suggests drinking filtered water with apple cider vinegar. "A recent 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."
The unholy trinity concludes with cortisol. "This is released in response to stress, but most of us run around stressed all the time," she explains.
"All those stress hormones wreak havoc over time, and make you store fat - especially in your belly.
"High cortisol is also linked to depression, food addiction and sugar cravings."
To reset your cortisol levels, Sara recommends curbing your caffeine intake.
"Slowly wean off caffeine over three days, and notice how your sleep and stress levels improve."
There are of course certain times of the month when a woman's appetite naturally spikes.
Appetite is controlled by the hormone leptin which tells the brain you are satisfied after eating.
"When leptin levels are high, you will feel satisfied, and when they are low, you will feel hungry," explains Sara.
"Researchers found that leptin levels are low in the follicular phase of the menstrual phase (days 1-14 in the average woman), peak mid-cycle (around day 14), and continue to remain at higher levels in the luteal phase (days 15-28).
"In fact, women with PMS report insatiable hunger and tend to eat 275% more refined carbohydrates the week before their period compared with women without PMS."
Unlike many popular diet plans, Sara doesn't advise the no/low carbohydrates approach.
"I believe that carbs, in moderation, are necessary and beneficial to any food plan," she explains. "Women need carbs to keep the thyroid and adrenals - where you produce cortisol plus other sex hormones - working.
"You also need carbs if you are trying to conceive, pregnant or post-partum."
In The Hormone Reset Diet, she recommends curtailing your net carb intake to below 49g per day.
Elsewhere, she investigates what many consider to be the holy grail of anti-ageing and weight loss: human growth hormone (GH), which is responsible for cell growth and regeneration. Levels of this hormone taper off as we age, but studies outlined in The Hormone Reset Diet explain how we can boost it naturally.
"Studies show that high-intensity interval training (HIIT), or burst training, is your best prescription to naturally boost GH levels," she says.
She also recommends spending more time under the duvet - "only during your deepest (stages 3 and 4) sleep can your body make GH" - before citing a study published in the journal Metabolism, which found that elevated insulin in obese people inhibited GH release.
"Opt for a whole, unprocessed diet that includes plenty of clean protein, healthy fats and high-fibre veggies, nuts and seeds, low-sugar fruit and legumes," she concludes.
Some exercises, such as running and spinning, place so much stress on the body that cortisol shoots sky-high. My advice is to stop exercising so hard in an obsessive desire to burn calories, and start exercising smarter. Practise yoga, meditation or guided visualisation several times a week and add burst training to your routine
OPTIMISE YOUR SLEEP CYCLE
Humans are designed to rise with the sun and to sleep when it's dark. Sure, there are morning people and night owls, but your hormones are released according to your sleep/wake cycle. Get your circadian rhythm in order, and your body will produce the hormones you need when you need them
Yoga has been shown to raise serotonin levels, the happy brain chemical responsible for mood, sleep and appetite. For women, this is especially important, as we have 52% less serotonin than men. I also believe yoga is the best form of exercise for stress relief and getting your cortisol to a sweet spot
BEAT MENOPAUSAL GAIN
Many women find it very difficult to lose weight after they reach menopause. They often find that the same tricks to lose weight no longer work. This may be because your thyroid is slowing down or your testosterone fell off a cliff. To counteract weight gain, cut out sugar from your diet and make sleep a priority, which will put your growth hormone production back on track
BETTER BIRTH CONTROL
Birth control pills deplete your B vitamins, so make sure to add a vitamin B complex if you are on the pill. If you have PMS and want a birth control pill, choose one containing drosperinone as long as you do not have an increased risk of blood clots
Adaptogens are unique herbs that help the body deal with stress and lower cortisol. I'm a huge fan of maca and other adaptogens, and I highly recommend them. Maca is a superfood powerhouse, an ancient wonder food that your grandmother's grandmother's grandmother probably used to cure "female" problems way back in the day
To reduce mood swings, avoid alcohol and sugar substitutes. Alcohol consumption raises cortisol, lowers metabolism, and is linked to premenstrual anxiety, mood problems and headaches. Diet sodas and aspartame lower serotonin, the feel-good neurotransmitter responsible for buoyant mood
TEST YOUR CORTISOL
There are several ways to test your cortisol levels, and the most accurate are dried urine, blood and saliva. Most traditional doctors only recognise the merits of blood testing - it's considered the universal language of conventional medicine - yet the latest techniques favour dried urine testing
TAKE VITAMIN D IN THE WINTER
Ramp up your vitamin D supplementation during the winter. Vitamin D deficiency can cause low oestrogen in women, which means low sex drive. It also causes low testosterone in men. So, if you tend to feel more frisky during the summer than the winter, there's a very good reason for it - increased vitamin D causes your hormones, and your libido, to peak during summer months