What if we told you that sugary foods aren't the only driver of insulin resistance? Many people attribute weight gain solely to a slowed metabolic rate, but the reality is that weight is influenced by dozens of other lifestyle factors.
The media often misrepresents the term ‘hormone balance,’ leaving women without adequate advice to address menopausal symptoms. In fact, certain foods can mitigate hot flashes, yet they are the same foods often torn apart by the media.
Insulin, weight management, hormone balance, and so much more are covered in today’s episode of Longevity by Design. Join Dr. Lovejoy and the InsideTracker team as they delve deep into the most common misconceptions surrounding hormone health, metabolic health, and weight gain.
About Dr. Jennifer Lovejoy
Dr. Jennifer Lovejoy has spent her career focused on personalized nutrition and lifestyle behavior change. Dr. Lovejoy earned her PhD in Biological Psychology from Emory University and completed a postdoctoral fellowship in Endocrinology and Metabolism at Emory University School of Medicine. During her academic career, she was a professor of Diabetes at the Pennington Biomedical Research Center of LSU and served as Dean of the School of Nutrition and Exercise Science at Bastyr University. She’s a Past-President of the Obesity Society and has published over 90 peer-reviewed research papers. More recently, Dr. Lovejoy was Chief Translational Science Officer at Arivale, a scientific wellness startup integrating multi-omic data with behavioral coaching, and Head of Science at Seven.me, a digital health startup developing a behavioral AI platform. She currently runs Integral Science, LLC, a consulting company.
Defining hormone imbalance
“Hormone imbalance” is a popular term, yet there is no scientific consensus on its definition. It typically refers to changes in a hormone level that causes it to become too low or too high for a healthy body. And because humans have over 50 hormones, hormone balance may be more complicated than meets the eye.
Dr. Lovejoy explains that hormone imbalance can be naturally experienced during a woman’s life or caused by external factors.
- A woman’s life: Females naturally experience hormone imbalance at three points throughout their lives: puberty, pregnancy, and menopause.
- External factors: Lack of sleep, chronic stress, certain medications, and medical conditions can lead to hormone imbalances.
Symptoms associated with hormone imbalance
Hormone imbalances can present uniquely in individuals, depending on the specific hormone leading to the imbalance and personal health factors. Here are a few examples of hormones that commonly contribute to hormone imbalances and their associated symptoms:
- Estradiol and progesterone: After the transition into menopause, women experience a sharp decline in the hormones estradiol and progesterone. This sharp decline is associated with physical symptoms like hot flashes and night sweats.
- Thyroid hormones: Low levels of thyroid hormones can be associated with fatigue, changes in weight, and dry skin.
Exercise for hormone balance
Hormone balance is crucial for optimal healthspan, and certain lifestyle habits can promote hormone balance, or mitigate the side effects associated with hormone imbalance. Exercise can uniquely benefit hormone levels in women, according to Dr. Lovejoy. Here are two examples:
Too much estradiol can increase a woman’s risk for breast cancer. Regular exercise, particularly higher intensity exercise, helps to improve estradiol levels.
Exercise helps to manage cortisol, the stress hormone. Chronic stress can lead to elevated cortisol levels, making the transition into menopause much more difficult due to the interaction between cortisol, estradiol, and progesterone. Moderate exercise is a brilliant way to keep cortisol levels optimal, according to Dr. Lovejoy. "However, vigorous exercise can actually raise cortisol levels," she explains.
Estradiol: A key hormone for women's reproductive health
Estradiol is the primary form of estrogen in a woman’s body during her reproductive years. Estradiol is produced in the ovaries and helps to maintain the integrity of a woman’s eggs and uterine lining, aiding in pregnancy.
“Estradiol is just the most amazing hormone—it affects so many parts of the body,” she says. Dr. Lovejoy shares the top three timepoints at which a woman should measure her blood estradiol levels:
- Fertility: Understanding how estradiol levels fluctuate across the course of the menstrual cycle can provide insights into pregnancy and fertility in women.
- Premenstrual syndrome (PMS): An imbalance in estradiol can contribute to intense symptoms that coincide with a woman’s menstrual period.
- Perimenopause: Estradiol levels can fluctuate readily during perimenopausal years and are associated with increased severity of menopausal symptoms.
Thyroid-stimulating hormone (TSH): A key regulator of weight and heart rate
Thyroid-stimulating hormone (TSH) is produced by the pituitary gland and causes the thyroid gland to secrete thyroid hormones. Thyroid hormones are responsible for many important functions throughout the body. When TSH levels are imbalanced, the thyroid gland may secrete too much or too little thyroid hormone.
Measuring TSH levels can be especially insightful for women, as they are more prone to thyroid problems. In fact, Dr. Lovejoy shares that women are 5-8x more likely to have a thyroid problem compared to men.  While tracking TSH can be beneficial for everyone, Dr. Lovejoy explains it's particularly helpful for women to track this hormone during their 40s and perimenopausal years because the symptoms of thyroid hormone deficiency mimic the symptoms of menopause. “Many women experience fatigue, weight gain, trouble concentrating, brain fog, and hot flashes, which are very common symptoms of menopause. However, these are also symptoms of low thyroid levels. That’s why it's really important to understand what's causing the symptoms and not to just assume you’re feeling this way because of menopause,” she explains.
Weight gain and "waist gain" at menopause
Weight gain and “waist gain” are common changes that occur during the menopause transition. Even for women who effectively managed their weight prior to menopause, hormonal changes during menopause can make it difficult for women to maintain their body weight.
Estradiol has a regulatory effect on both appetite and on metabolic rate. A premenopausal woman with higher levels of estradiol may have a maintained appetite because estradiol helps to increase and maintain metabolic rate. Estradiol declines with menopause and can contribute to weight gain. Dr. Lovejoy says being prepared is the best thing a woman can do to prevent or combat menopause-related weight gain. “In order to try to maintain a calorie balance, try adding a bit of additional physical activity to burn more calories. Adding more strength training can build muscle mass which will help boost basal metabolic rate a bit as well,” she says.
Dr. Lovejoy notes that “waist gain” or waist circumference can be challenging to maintain after menopause. This is primarily because estradiol and testosterone control where fat gets distributed. In premenopausal years, fat tends to be preferentially distributed in the hips and thighs, helping with pregnancy. During menopause, estradiol drops and testosterone increases, leading to fat accumulation in the abdomen and causing abdominal fat gain.
How to manage symptoms associated with menopause
Every woman experiences perimenopause a bit differently. Dr. Lovejoy shares some of the hormonal changes associated with menopause and tips to manage menopausal symptoms.
Insulin resistance, increased blood glucose, and prediabetes
Insulin is a hormone that allows the body to use glucose (sugar) as fuel or save it as energy. Insulin brings glucose into the cells to be stored and utilized by your liver, muscle, and fat tissue. As glucose enters your cells, blood glucose returns to its baseline level, and blood insulin levels follow suit. Insulin resistance occurs when your cells become less responsive to the hormone insulin, resulting in increased blood glucose levels. Women are more likely to become insulin resistant postmenopause, increasing their risk of developing prediabetes and diabetes.
To combat insulin resistance, Dr. Lovejoy recommends the following tips:
- Increase aerobic exercise: Aim for a minimum of 150 minutes per week of moderate to vigorous activity. This can include walking, running, jogging, biking, hiking, or any other form of aerobic exercise.
- Focus on nutrient quality: Aim for a diet high in fiber and low in saturated fat.
Dr. Lovejoy shares lifestyle tips for minimizing hot flashes. Every woman experiences hot flashes in a differing frequency and severity, so experimenting with various protocols can help women to understand what works best for their bodies. Here are three tips backed by science to manage hot flashes:
- Eat soy: Soy contains a phytoestrogen that provides enough estrogen to reduce the severity of hot flashes for some women. Consider trying roasted soybeans, edamame, tofu, or soy milk.
- Try cognitive behavioral therapy (CBT): A specific form of CBT was developed for hot flashes, and research confirms its effectiveness through its impact on a woman’s physiology.
- Limit or avoid trigger foods: Spicy foods, alcohol, and excess caffeine can trigger hot flashes.
Changes in the gut microbiome
Did you know that the female microbiome changes after menopause? As a woman’s hormones decrease during menopause, the diversity of gut microbes decreases as well. Dr. Lovejoy’s tip to combat this decrease is to eat plenty of fiber, including whole food sources like vegetables, fruits, and whole grains.
Addressing misconceptions about diet and exercise
It is difficult to lose weight, especially for individuals with obesity. There are many misconceptions around losing weight, two of which Dr. Lovejoy addresses in this episode.
- Weight gain is not only caused by a slow metabolism. Body weight results from many components in addition to metabolic rate. Genetics, lifestyle, age, gender, environment, diet, and exercise all impact weight loss and weight status.
- As you age, you need to adjust your diet and exercise. Every aspect of physiology changes as we age. To maintain optimal health and a healthy body weight your diet and exercise regimen must adapt to internal changes. Consider incorporating more strength training and increasing your daily step count.
One of the most common misperceptions about insulin is that insulin resistance is driven solely through excess carbohydrates and sugar consumption. This process isn’t quite so simple. Excess dietary fats also contribute to insulin resistance.
What is metabolism?
Metabolism encompasses all of the biochemical reactions that occur within your cells to sustain life. Metabolism determines how efficiently your body converts the food you eat into energy it can use. Prioritizing optimal metabolic health confers benefits like maintaining a healthy body weight, and improving energy levels, mood, and mental clarity.
How metabolism impacts hormones
Multiple hormones impact metabolic processes in the body.
- TSH: Levels of TSH impact the levels of key hormones from the thyroid that regulate metabolism. Thus, either high or low TSH can impact metabolism and body weight.
- Testosterone: Testosterone promotes healthy metabolism through maintaining muscle mass. Testosterone aids in muscle building which boosts metabolic rate.
- Insulin: Insulin regulates glucose metabolism. Proper insulin function is crucial for maintaining balanced blood sugar levels and supporting efficient metabolic processes.
- Estradiol: Estradiol plays a role in regulating appetite and is associated with increased energy expenditure. Fluctuations in estradiol levels, such as those experienced during the menstrual cycle, can influence hunger levels and cravings. Estradiol also influences the distribution of body fat, promoting fat storage in subcutaneous areas (such as hips and thighs) rather than visceral areas (around organs).
Diseases of poor metabolic health
Poor metabolic health impacts both healthspan and lifespan. Risk of cardiovascular disease, diabetes, dementia, can be attributed to poor metabolic health.
Similarly, obesity is a disorder of metabolism. “It's not as simple as people eating too much and exercising too little. It's a physiological state of abnormal metabolism that has genetic components, brain hormone components, body hormone components, and more,” explains Dr. Lovejoy. This is why obesity is a foundational cause of so many other diseases.
To close the episode, Dr. Lovejoy discusses insulin. She explains the major function of insulin in the body, its importance for metabolic health, and how tracking this hormone can be useful. Tune in to find out more!
Top tip to improve mental health
Dr. Lovejoy’s top tip for improving health is to know yourself as best you can by tracking your health in all ways possible. She says your approach to health optimization is highly unique to you—you must know your body from the inside out to optimize anything going poorly. Some people need to improve their diet, others need to change or increase their exercise, and others have to work on stress management. Knowing your body and tracking yourself over time is the best way to optimize your health.