Commusings: Eat for Your Hormones by Sara Gottfried, MD

Jan 20, 2023

Hello Commune Community,

I’ve prattled on interminably in this newsletter and (on IG) about how I reversed my insulin resistance through the adoption of intermittent fasting, “keto-tarianism” and cold-water therapy. But to say that I have reversed this grievous condition is to misspeak. More accurately, I am “reversing” it because my body is not a thing, it’s a process. 

In fact, I am more like a candle flame or a waterfall than an old shoe (despite my daughter’s claims). You might recognize me by my form but all of the molecules of my organism have moved on. ATP burned away. Glucose metabolized. Bacteria now navigating the labyrinth of the Los Angeles sewer system. And on. We are impermanent beings – a cosmic soup of animated information, hormones, proteins, enzymes, bones, muscle, organ cells – all in flux. 

The idea that there is no reliable stable self might, at first blush, evoke some anxiety. But, in truth, the fluctuations of our organism should be comforting because it underwrites an important idea: We are not fixed! We have agency over much of our physiology (and psychology). We exist along a spectrum — moving toward wholeness (healing) or toward illness (ailing). In wholeness, our body plays like an orchestra, reassembling the music from the cue sheets into a symphony. In illness, the systems of our organism act like separate egos, all soloing at the same time. In sickness, we are dismembered. In health, we re-member our distinct parts into a unified, if tenuous, harmony. 

My brilliant friend, doctor and today’s essayist, Sara Gottfried, is an instrumental voice ushering in this “age of agency.” She pairs clear explanations of mechanism with concrete protocols such that you can engage in the process of healing – of moving toward ease, not dis-ease. If you enjoy this essay I also encourage you to watch her free 30-minute Commune master class on Women, Food, and Hormones or dig into her course on Navigating Perimenopause and Menopause.

Here at [email protected] and waxing and waning on IG @jeffkrasno.

In love, include me,

• • •

Eat for Your Hormones
by Sara Gottfried, MD

Excerpted from her book Women, Food, and Hormones

Many of my patients want to know what to eat to stay healthy, but they feel confused. I don’t blame them as there’s so much conflicting information out there. Over time, the answer has changed. In the 1980s, fat was villainized; later, sugar. Often my patients come to me having tried various plans, only to find they gained weight, or they are so overwhelmed with choices, they stay in the same food rut because they aren’t sure which plan is right for them.

My answer to this age-old question of what to eat? Eat for your hormones. Food is the backbone of many of the hormones that you make.

To start, consuming healthy fat is especially critical to long-term hormone balance. Healthy fat makes you feel more satisfied, and it slows down or eliminates the spikes in blood sugar that can make you accumulate fat. You need moderate protein — not so much that it turns into sugar, but not so little that your muscles start to break down. Some guidelines you’ve likely heard about before are important too, such as avoiding sugar and excess refined carbohydrates, enjoying healthy fats like extra-virgin olive oil and avocado oil, and even following fasting protocols. 

This is the foundation for Women, Food, and Hormones.

My personal struggle to balance my hormones has informed my career as a physician and writer. I come to this topic as a doctor and scientist, but also as a case study.

In medical school, I was taught to advise patients to exercise more and eat less if they wanted to lose weight. When I followed that advice, I made my hormone imbalance worse because the essential role of metabolic hormones, and how they function in women, was missing from the equation. 

In my thirties, I began to battle depression, premenstrual syndrome, and belly fat. I wrestled with my weight because my levels of testosterone, growth hormone, estrogen, and progesterone were too low, and my insulin and cortisol were too high. That made me get stressed about the small stuff. I’d work out for hours with nothing to show for it on the bathroom scale or in my musculature. I was on a mostly vegan diet, and I wasn’t getting the healthy fat I needed to synthesize these hormones in my body. 

Seemingly overnight, my triceps area became flabby. There were longitudinal lines on my nails, and I noticed weird fatty “cushions” at my knees. What?! Worst of all, I felt frazzled and overwhelmed much of the time; I lacked inner peace. If you’re like me or my patients, you may not notice that your hormones are off kilter. Instead, you may observe difficulty with sleeping, with losing the baby weight, or with low sex drive. Maybe your workouts don’t seem to have an impact.

After being offered an antidepressant and the birth control pill to address my afflictions, I just felt they were not the right treatment. Then, with a simple blood test, I discovered my hormones were out of balance. As I corrected my hormones, I learned they were the root cause of my troubles. I began seeing hormone imbalance in nearly all of my patients who were medicated by their well-meaning doctors. 


Keto: Not One-Size-Fits All


As described by the medical journal The Lancet, we are witnessing an “overabundance of information — some accurate and some not — that makes it harder for people to find trustworthy sources and reliable guidance when needed.” The situation is complicated by the fact that diet programs don’t work the same way for every person and that many such programs have been created by men and tested on male bodies, not female ones.

Based on the scientific data, the ketogenic diet is not a one-size-fits-all quick fix. It’s more of a mixed bag: On classic keto, some women lose weight. Some develop better focus, or perhaps avoid certain types of cancer. On the other hand, some women develop thyroid dysfunction. Some find the diet physically stressful, though they may not consciously notice this; nonetheless, stress-related hormones may block weight loss. 

For just under half of the women on a ketogenic diet, changes to menstrual hormones and loss of the monthly cycle occur; the quality of studies reporting these results is, however, uneven. Some women actually gain weight on diets like keto, and for the most part, no one is warning them about the effects on hormones.

This is the keto paradox: Why does classic keto help men lose weight and cause some women to gain it? Why does classic keto reverse some diseases and exacerbate others? When does keto clear inflammation, and when does keto cause it? I keep finding the same answer: hormones!

High-fat, low-carbohydrate diets cause weight loss for many reasons, but probably not quite in the way you’re thinking. Many people think, If I go keto, I can eat lots of satisfying fat, lose weight, and fit into that cute dress I wore in college. Well, maybe. 

The classic ketogenic diet, as practiced most commonly today, doesn’t work for many women (and the cute dress stays in storage) because the ketogenic process is misunderstood and, therefore, not managed for success. Most people think that a low-carb diet causes weight loss simply because eating fewer carbs reduces insulin levels and burns fat. If it worked like that, switching from regular soda to diet soda would cause weight loss, but it doesn’t; if you replace one hormonal calamity (sugar) with a potentially worse one (artificial sweeteners), your hormonal messaging gets thrown further out of whack. A common result of switching to diet soda is weight gain. Furthermore, if you starve your body of carbohydrates over the long term, you may lose weight but cause additional problems.

I have seen up close the frustration the classic keto diet can cause. I meet a large number of “keto refugees” in my office and in my online courses. Some women are too stressed to perform classic keto successfully (stress affects hormones), or they don’t get the carbohydrates they need to promote normal hormonal regulation. They gained weight on keto, or didn’t lose weight, or started to doubt the high-animal-fat and high-calorie food plan. They’ve experienced more inflammation and more mood crashes, and they even whisper about the dreaded keto crotch (if you need to ask what that is, consider yourself lucky).

The truth is, classic keto has mostly been studied in men, and it needs to be modified for many women in order to be successful.

We aren’t totally sure why women respond to keto differently. But experts have some ideas. Hormones play a primary role. There’s the stress gap — the fact that women are twice as likely than men to suffer from stress, anxiety, and depression. Women more commonly experience thyroid problems and autoimmunity. Women are more sensitive to carbohydrate restriction and calorie restriction than men are; these restrictions may activate an alarm that shuts down menstruation and increases inflammation — and may explain why so many women on keto lose menstrual regularity. Experts suggest that, compared to men, women are more likely to experience a plummet in blood sugar. Maybe a combination of these issues causes the problem.

There is one thing we know for sure: your hormones dictate your success or lack thereof on the classic ketogenic diet. You won’t see the results you want if you don’t factor hormones into the equation. 

We all have these hormones. We may have different levels at one age versus another, or one woman may have more or less compared to another. These hormones juggle function a bit differently (for instance, you need both growth hormone and testosterone for bone strength, but they strengthen the bone in different ways), but all of them are influenced by what we eat.

For example, studies show that higher fat in the diet, and polyunsaturated fatty acids specifically (the fat found in many nuts, flaxseed, and fish), contributes to increased concentration of testosterone in women. Once again there is a gap in the research: the effect of the ketogenic diet on testosterone has not yet been studied in healthy women.

Meet the Hormones

Hormones decide what the body does with the fuel you eat. Your hormones exist in delicate balance, playing alongside one another like instruments in an orchestra. Throughout the day, your hormones fluctuate in rhythm, going up and down like crescendos in a symphony. Each hormone is like a specific instrument that must play on time, at the right volume, and in the correct cadence. In combination, your hormones create a beautiful harmony, which serves as your stable sense of well-being and grace.

What are the hormones of metabolism? Thousands have been detected and researched, but the key hormones to focus on are insulin, cortisol, leptin, ghrelin, thyroid, estrogen, testosterone, and growth hormone. Metabolic hormones are involved in thousands of micro communications and processes in the body. To name a few, hormones are involved in satiety (leptin, insulin), hunger (ghrelin, cortisol), female qualities (estradiol), more masculine qualities (testosterone, the most abundant hormone in women, and involved in vitality, muscle mass, and agency), and fat burning (insulin, growth hormone, and cortisol). These are the hormones that govern your response to food, but the relationship is bidirectional.

Metabolic hormones regulate your response to food, and in turn, food regulates metabolic hormones. Insulin is the most influential. It’s like a bouncer at a club that either opens the door to glucose or not. If the bouncer doesn’t open the door to usher in the glucose, the glucose in your blood rises and over time can lead to insulin block and fat accumulation. That’s the central problem of insulin resistance, and it can be identified way before a diagnosis of diabetes.

I won’t get mired in explaining every hormone in detail, but what’s important to know is that these hormones are at work in the background, either helping you lose weight and feel great, or not.

Writing about hormones is about telling the truth, especially the difficult truths about being female and over the age of thirty-five. The levels of many hormones start to drop in our twenties (testosterone, DHEA), thirties (growth hormone, progesterone), and forties through fifties (estrogen). At the same time, other key metabolic hormones, insulin and leptin (and its cousin, ghrelin, the hunger hormone), can rise. These combined hormonal shifts can make life feel more difficult. Why?

Metabolism slows down yet appetite increases, which means belly fat accumulates seemingly overnight, increasing inflammation. Your weight climbs.

The liver, the primary organ that regulates fat loss, loses reserve. It is busy metabolizing hormones, clearing toxins, dealing with your latest alcoholic beverage, adjusting cholesterol levels, trying to sort out what fuel you are eating now (carbs? protein? fat?), and generally trying to run the show for the rest of the body.

The rest of the gut, including the intestines, suffers too. Your gut is involved in regulating your hormones. Most of my patients have one or more problems with their gut that can impede fat loss, such as an imbalance of gut microbes (dysbiosis) or leaky gut syndrome (increased intestinal permeability, which can occur when the tight junctions between the cells lining the small intestine become disrupted).

On a related note, most of my patients have a substantial fiber gap. What you eat has a major influence on the microbes in your gut, a relationship known as the host-microbe interaction. You need the right prebiotic fibers to feed the benevolent bugs, thereby improving immune function and hormone balance. You may not be getting enough of these key fibers.

When you follow the Gottfried Protocol, you’ll specifically address each of these challenges, from metabolism to gut health. 


What Is the Gottfried Protocol?

The hormone-balancing Gottfried Protocol has three tenets: detoxification, nutritional ketosis, and intermittent fasting. After experimenting with the Gottfried Protocol for the past five years, I’ve discovered the essential sequence of these three tenets to activate fat loss for women over the age of thirty-five.

Detoxification. Activating your body’s detoxification pathways is essential to prevent the problems that women commonly experience in ketosis, so we do that first. Why? Detoxification clears out your liver and eliminates any recirculating, tired hormones that are clogging up your metabolism.

Nutritional ketosis. You enter nutritional ketosis when you follow a food plan that is low in carbohydrates, moderate in protein, and high in fat. I have adjusted the classic ketogenic diet to make it more effective at restoring insulin levels in women and helping you lose weight. To cut a long story short, you will be eating more plants; consuming tablespoons of extra-virgin olive oil, the occasional spoonful of medium-chain triglyceride oil (associated with weight loss, improved satiety, and removal of alcohol), prebiotics, and probiotics; and tracking net carbs, among other macronutrients. You will use your macronutrients to calculate your ketogenic ratio, and then measure your glucose-ketone ratio. More about this can be found in my book.

Intermittent fasting. This type of fasting means you don’t eat for twelve to twenty-four hours in a single day. Data show that intermittent fasting is particularly effective at encouraging weight loss because it improves the balance of many hormones (including insulin, ghrelin, leptin, and afternoon cortisol) and leads to metabolic switching, as reviewed recently in the venerable New England Journal of Medicine. (Metabolic switching is when you use fasting and other techniques to suppress insulin and glucose to a level that triggers a switch from burning carbohydrates to burning fat in the body.) Fasting helps regulate inflammation, increases brain function so you feel sharper, lowers blood pressure, and may modulate leptin so you feel more satisfied.

You Are Never a Lost Cause

You are never too old to balance your hormones. Yet on social media and elsewhere, I hear women say, “I’m in menopause — it’s too late for me.” Not true. Many of the hormones addressed, especially insulin, growth hormone, testosterone, and estrogen, are modulated by food, detoxification, ketosis, and timing of meals. There is no upper limit on the best age to achieve hormonal balance.

Similarly, you are never a lost cause. Even if you’ve been frustrated by a lack of results and feel like your metabolism is the slowest of your life, you can still make progress — I have the case studies to prove it — though it may take longer. 

When you learn the basics of what to eat and when, and how your food talks to your hormones, you can create a hormonal symphony that makes you feel energized throughout the day, without those p.m. dips. You’ll burn fat instead of storing it at your waist, where it increases your risk for most chronic diseases. You’ll fit into your clothes, so that picking an outfit will take ten seconds, not ten hours — because all of your clothes will look great. You’ll feel physically, psychologically, and emotionally satisfied, so you won’t eat two dinners every night because you feel like you deserve it. You’ll have more time for the things you love. You will learn to eat in a manner that works for your hormones, that connects the dots between nutrition and hormones for your body, and that adds way more life to your years.


To learn more about the Gottfried Protocol, read Dr. Gottfried’s book Women, Food, and Hormones or watch her free 30-minute master class on Commune.

Dr. Sara Gottfried, MD is a Harvard-educated, board-certified physician, researcher, and teacher. She is a global keynote speaker who practices evidence-based integrative, precision, and functional medicine. Dr. Gottfried has spent her career demystifying hormones and helping patients improve their health more broadly with personalized medicine. Her four New York Times bestselling books include The Hormone Cure, The Hormone Reset Diet, Younger, and Women, Food, and Hormones. She is a wife, mother, and an advocate for nutrient-rich, non-boring salads. You can follow her on instagram at @saragottfriedmd.

This excerpt is from Women, Food, and Hormones by Sara Gottfried, MD. Copyright © 2021 by Sara Gottfried, MD. Reprinted by permission of Harvest, an imprint of HarperCollins Publishers. All rights reserved.

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