HEALTH with Paul L. Hester, M.D.

You're not imagining it: Your hormones are making you hungrier. Here, the facts on hormonal weight gain and how to prevent it.

Hormonal Weight Gain

Many of my midlife patients 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.

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.
• 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. By Louann Brizendine, MD

BEAUTY with Chasity Hester, PA-C

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BALANCE with Paul L. Hester, M.D.

Hormone Fear from Misleading Study Conclusions 

I am pleased to introduce Alan Altman, MD, clinical professor at Harvard Medical School. Hehas assembled the real facts on the Women’s Health Initiative (WHI), a landmark women’s health study that when reported by the government had wide (and detrimental) impact – creating mass fear for women about hormones, and forever changing practitioners prescribing of hormones. Even though this study has had far reaching impact, less than one-third of women are even aware of the WHI, a recent study by Stanford researchers have found, and many doctors still are unaware of the real findings that have emerged over time and through critical analysis.

So, here are the facts on the WHI from an expert who understood from the beginning what the study showed and did not show.

What the WHI (erroneously) “concluded."

- Hormones are BAD for women
- Hormones increased breast cancer risk
- Hormones increased heart attack risk
- Hormones caused dementia
- Hormones should not be used for prevention of heart disease
- Only use hormones for symptom relief at the lowest dose and the shortest time (WIB note: currently there is no research on this recommendation)

What the WHI CAUSED after their “conclusion”

- Primary Care Providers took their patients off all hormones
- Women stopped taking their hormones
- Media driven hysteria and panic among hormone users
- FDA change language from HRT to HT (hormone therapy)

WHI – Here are the Facts – Straight Talk from Alan Altman, MD

- The WHI did not study all “hormones." In fact, the ONLY hormones studied were Prempro© and Premarin© (non-human identical hormones and only pill form)

- The WHI Study was not really about “all women”…average age of the women studied were 12 years after menopause…averaged 64 years old at outset of study

- What WHI actually did show was that a 72-year old woman should not be started on oral Prempro© to protect her heart.

- Also, there appears to be a risk of breast cancer concerned with use of the potent synthetic progestin (or Medroxyprogesterone Acetate - MPA) that was used in the WHI

- Oral estrogens increase the risk of blood clots and of strokes related to blood clots. (We’ve known this for 30+ years, however we see no increase in clots or strokes on non-oral estrogen.)

- Any small increase in dementia was seen only in women ages 75 to 80! (Numerous studies of women starting HT at the appropriate age close to their final menstrual period have demonstrated a 50% to 65% decrease in the risk of Alzheimer’s disease.)

- Women saw no quality of life benefits from taking these hormones, because 88% of the women in the study had no menopausal symptoms to begin with.

- There was a slight increase in breast cancer risk when on Prempro© (estrogen and progestin) and slight decrease on Premarin© (estrogen therapy).

Key Facts:

- Non-oral estrogen (specifically estradiol via transdermal patch, gel or transvaginal ring) AND natural micronized progesterone taken orally is presently safer, healthier and more “natural” for use in hormone therapy.

- There is a serious lack of consensus in the data looking at estrogen use and breast cancer risk.

- Testosterone can be useful in the appropriate patients post hysterectomy.

Alan Altman, MD is Assistant Clinical Professor of OB/GYN and Reproductive Biology at Harvard Medical School. He is a practicing gynecologist, specializing in peri and post-menopausal health, hormone replacement therapy and female sexuality.