This is one of the top concerns of women in Perimenopause. Perimenopause usually occurs in women between the ages of the late ’30s to late ’40s. An important note here is, Perimenopause is not Menopause. And while both Perimenopause and Menopause may have some of the same symptoms. There are also many differences between the two. It is of value to know this because treating and working with Perimenopause can be quite different from Menopause. The hormone changes in Perimenopause can cause a lot of unwanted symptoms. If you are interested in more in-depth information, and healthy options to deal with Perimenopause, check out our course, The Perimenopause Masterclass. 

But for this podcast, we focused on the unexpected, unearned weight gain that can happen in Perimenopause. In Perimenopause, it is common to hear women complain of feeling like they have gained 10-20 pounds almost overnight. They are stumped because they are unsure of where his added weight came from. We have many patients exclaim that they have not changed their diet or exercise routine, yet keep putting on weight. And this weight gain is almost always focused in the stomach and waistline. I cannot tell you how many patients I have had that say, they have never had a belly before. And now they have grown a gut for no reason. Well, there is a reason, it’s your hormones. 

What do women do when they start gaining weight?  

Common response to weight gain is to eat less and exercise more. Bluntly put, this is the wrong response. There might be an initial drop in weight when you restrict your food and jump on the treadmill. But more often than not, in Perimenopause, restricting your calories and increasing your exercise will either result in no weight loss or even more weight gain.

But this is what we have always been taught. 

Less calories in + exercise(calories out) = weight loss.  

Well, maybe in your 20’s this might work. This will not work in your 40’s. There is nothing more frustrating than to workout like crazy, eat like a rabbit, and not lose weight. Not to mention this not a realistic way of living. When you start to eat like a normal human, you will gain the weight back plus more at a rapid pace.  

Why doesn’t eating less and exercising more in Perimenopause not work?  

It is about the cortisol-glucose-insulin love triangle. Yes, it is like an awful drama that results in the fatty belly that you never had.    

When you do intense cardiovascular exercise, it will raise your cortisol. When cortisol rises, it will mobilize glucose. When glucose rises, then your pancreas will release insulin. Insulin is a fat-storing-hormone in the body.  

This is really the real deal. You are doing some crazy intense, cardio exercise. This will cause your adrenals to increase cortisol. The cortisol will then mobilize glucose from your large muscles, such as your gluteus (bum) and quadriceps (thighs). The increase in glucose will cause your pancreas to pump out insulin. The insulin opens the door cell and allows glucose to enter. Now the glucose that is mobilized from your muscles gets turned into fat. That is why in Perimenopause, you will see a change in body distribution. The thighs and bum shrink and the belly grows.   

If I can’t do cardio exercise, what do I do? 

Resistance training and building muscle is the best thing you can do for your metabolism. No, cardio will not build muscle. By working on resistance training builds muscle but not increase your cortisol or insulin. Hence, building muscle will blocks that cortisol-glucose-insulin response that cardio can cause. The result is less belly-fat.  

Another awesome form of exercise is walking. I know, Dr. Maki says that walking is not really exercise. But that is where we beg to differ. Walking is great for the adrenals. It is not stressing the adrenal by releasing a bunch of cortisol and glucose. It is great for bone density and all the muscles in the body. Not to mention, walking is very relaxing and is a great way to focus on yourself for a moment as opposed to focusing on all the commitments and demands made of you. 

If I can’t starve myself to lose weight, what can I do?  

Eat more. Don’t freak out, eating more calories will increase your metabolism, reduce cravings, balance your blood sugar, and help your hormone imbalance in Perimenopause.  

You need to eat more. What? If I eat more, won’t I gain weight? No, in fact, eating less can slow your metabolism and make you gain weight. That doesn’t mean, lets hit up Crispy Creme and mow down on donuts. But eating more by balancing your macronutrients, such as protein, complex carbohydrates, and healthy fats. There are so many diets, weight loss plans, food options for healthy eating. I know the vast information on the many diet plans out there can be overwhelming. We do feel that balancing your macros and incorporating a ketogenic diet with carbohydrate cycling with intermittent fasting is a great way to lose weight in Perimenopause. I know that the last sentence was a mouthful.  

We have written a program that is realistic to follow to help with Perimenopausal weight gain. We call it the Keto-Carb-Cycling-Program (KCCP) and it is a free download on our website and included in the Perimenopause Masterclass. This will give you so much more information on what hormones are involved with weight gain and weight loss. There is also a program to follow to help you lose weight in a healthy manner.  

Sleep!

Yes, sleep is super important for your weight. A lack of sleep is the best way to gain weight, especially belly fat. Unfortunately, in Perimenopause, you can have a really difficult time staying asleep. This is also one of the most common complaints of Perimenopause. No trouble falling asleep, but a horrible time staying asleep. This lack of rested sleep, not only makes in Perimenopause tired during the day but will help cause the gut. One of the first things we address in Perimenopause is sleep. Not with sleeping meds or habit-forming medications. But address with nutritional, lifestyle and supplementation components to help you stay asleep in Perimenopause.   

I know we talked about a lot of information here. Perimenopause can really disrupt your hormonal balance causing a lot of unwanted symptoms. In this podcast, we only addressed the weight gain associated with Perimenopause. If you have more interest, please check out our Perimenopause Masterclass for more options and information. Hope you enjoyed the podcast! 

PYHP 059 Full Transcript: 

Download PYHP 059 Transript

Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I’m Dr. Maki.

Dr. Davidson: And I’m Dr. Davidson.

Dr. Maki: So in this episode today, we are going to talk about weight gain, you know- weight loss. But specifically in women that are in perimenopause.

Dr. Davidson: So perimenopause, of course, as it sounds is right before menopause. But it’s actually a really underserved, I guess, age demographic. Because perimenopause can be anywhere from your late 30’s to your late 40’s, because typically menopause is supposed to be in a perfect world at 51 and a half, so a lot of women can deal with these perimenopausal symptoms, one of them being in particular which is probably the number one complaint in perimenopause, is the weight gain. Women say they feel like they gained 10 to 15 pounds almost like overnight.

Dr. Maki: Yes, right. They’re just- life is the same. They’re still just kind of doing their thing. And before they know it, they get this weight particularly around the midsection`, right? Women don’t typically develop spare tire necessarily, and also they have this weight that they can’t get rid of. And regardless of what they do to try to lose the weight, the weight just keeps- either it doesn’t budge, doesn’t go down, or the weight just keeps going up over time.

Dr. Davidson: And of course, people try to chuck it up to say, “Hey, you’re getting older. This is supposed to happen.” Well no. It’s not supposed to happen and why did it all of a sudden happen? Because I’ll have women- and this is so true, will say they have never had a belly even when they were pregnant. Afterward, they have never had a belly and now they literally have this belly fat that they don’t know where it came from because the diet hasn’t changed, the exercise regime hasn’t changed. If anything, I have women in perimenopause that try to do the opposite way, which we’ll get into. And be very strict with dietary and exercise. And if anything, it doesn’t go away or they gain even more.

Dr. Maki: Yes, now. The reason why we’re going to talk about this is that this is of course, a very common issue that women are having. But a lot of times, the strategy that people are employing to lose the weight actually ends up making the situation worse. And this is something that we see all the time, so we felt like it was a good idea to deal with it contrary and from our observation of what we see people are doing to try to lose that weight, in some ways they’re doubling down. But they’re doubling down in a way that actually makes them end up gaining more weight in the long run.

Dr. Davidson: Exactly. And we get it. Putting on weight when you didn’t even earn it is not fun, and a lot of women- these perimenopausal women are super healthy. It’s not like the way it is causing them ill health, but they might go to their doctor, they go to their GP, gynecologist, they don’t have any answers for them. They’ll say, “Oh, you’re just getting older. Your blood work looks great.” But it’s not fun to feel like you’re gaining 5 pounds every few months. Then all of a sudden, who knows when is that going to stop. It’s kind of terrifying sometimes when you feel like you have nothing to stop it. So of course, when you think about gaining weight, what do we all learn since we were kids, was just stop eating.

Dr. Maki: Yes, right. The proverbial eat less and exercise more–

Dr. Davidson: Which is terrible advice.

Dr. Maki: Which really- the take-home message for today is that eat less, exercise more idea really does not work. Okay? Because that is the approach that almost all of our patients come to us, utilizing that strategy trying to lose weight. It worked when you were 25, right? It certainly- and you can eat just a little bit less, exercise a little bit more, and your body will respond appropriately. But once you get to quote and quote, literally perimenopause, there are some physiologic changes that are happening- inevitable physiologic changes. Your body is producing less of very particular hormones that buffer the stress that we all would agree, more than likely, that we have more stress in our mid 40’s than we did when we’re 25. But we don’t have the hormones to buffer that stress. So now that, the things that we are doing as we talked about in the last episode, the things that make us not sleep very well, kind of get magnified a little bit, and now our bodies just don’t really- are not as resilient as they used to be.

Dr. Davidson: Exactly. And it really is about those stress hormones having an impact because you don’t have some of the reproductive hormones that you did when you were on your 20’s. And granted, sure, there’s a lot of different kinds of stressors when you’re in your 40’s than you did when you’re in your 20’s, but, you know? I have a lot of women in their mid to late 40’s and they’ll say, “I don’t know what’s wrong with me, because my life is actually better now than it was 15 years ago when the kids were young and I had to work full time and I was getting a divorce. My life is so much better now, but I feel so much worse.”

Dr. Maki: Yes, right. Yes. Some of that maybe, a little bit, as we’re talking about, a little self-induced. Not that they create their own stress, but their ability to handle the stress is so much less. So they feel more stressed or more overwhelmed and that’s because of the inevitable hormonal decline, particularly in the beginning of this process. Like you said, late 30’s to early 40’s is when you start losing some progesterone.

Dr. Davidson: Yes. So really, not to get into too much physiology here so you don’t get super bored, is when we make estrogen and progesterone- we’re females. We make estrogen and progesterone. Men do too, but we make a lot of it. But we cycle it, which is why you get a period every ideally 28 days or whatnot. But the progesterone is what drops first when you hit perimenopause. So everybody knows about menopause. Menopause, the ovaries have decided to retire, they justly deserve have got to retire. They’re not making any more estrogen and progesterone, but in perimenopause, it’s a little bit different. Because you’re still cycling, if you have a uterus, you’re still having a period. But you’re just not making as much progesterone if anything, a lot of times, the progesterone is almost non-existent in perimenopause.

So as Dr. Maki said, having changes in those hormones doesn’t allow you to buffer some of those stress hormones, so things seem like they’re way more chaotic than they might be. Because I have a lot of women that say, “I don’t know why I don’t feel well given the circumstances really aren’t that big a deal.”

Dr. Maki: Yes, right. Now, we’re not blowing people off like a lot of times women go to their gynecologist, to their primary care, or whatever. They get blown off a lot, right? Because those doctors, unfortunately just don’t have the tools to be able to help them effectively. So in some ways, and we’ve heard this from a lot of patients, they kind of blame it on the patient like it’s the patient’s fault. Right? Or on paper, on a lab test, because that doctor does not know how to interpret the lab test, then there’s nothing wrong with them. Because they don’t class- perimenopause, unfortunately, is not a disease, right? It’s this limbo land, as you always call, the limbo land of hormones where women- there are millions of women across the country that are in this demographic. But really, there are very few practitioners that know how to effectively help them.

Dr. Davidson: Exactly. And especially with the weight gain, when you look at people, there are some not so great weight loss medications out there that you wouldn’t want to take. But who are the women that are taking them? The women in perimenopause. Because that’s when they feel like they don’t have any control over their metabolism and how to stop this weight gain. So like we alluded on, we said the worst advice in the world is what we learned when we were kids which was you can’t under-eat and you can’t over-exercise. Because that’s just going to exacerbate that whole hormonal cascade of particularly- one hormone in particular, is that cortisol, or as we always call it, kind of the cortisol insulin interaction.

Dr. Maki: Yes, right. Cortisol is where that a midsection, the muffin top, the spare tire, the belly fat that nobody wants to develop, it’s happening because of cortisol. Your body literally is redistributing fat, and it’s all happening because of the stress response. Now if you take that eat less, exercise more approach, and we talk to women all the time, they’re trying to exercise three to six times a week, but yet their bodies are not changing at all. If some cases and this is an observation or reflection for a lot of you listening, if you’re exercising multiple times a week and your weight has not changed in the last 90 days, then you need to reevaluate your exercise strategy. All right? If your weight is not budging based on your dietary and your exercise regimen, if it’s not changed at all, then you need to reevaluate. Because- or if during that same time frame, if your weight has gone up during that same time frame, so you’re technically eating at a deficit and expending a bunch of energy on a weekly basis, your energy balance is completely off. You’re just exacerbating this cortisol response and really in a sense, you’re making the problem worse.

Dr. Davidson: Exactly. Now there’s lots of hormones and you’ve probably had Googled them, read them and heard about them. With leptin and ghrelin and as we’re talking about insulin and cortisol. So not to bore you with the physiology, but we really feel like when you’re doing that intense cardiovascular exercise so frequently, is will raise up your cortisol. And of course, what does cortisol do?

Dr. Maki: Cortisol- by category, cortisol is classified as what they call a glucocorticoid. Gluco meaning glucose or blood sugar. Cortocoid meaning, cortical steroid, because it’s

made from cholesterol. All hormones that are made from cholesterol, which is cortisol and all the sex hormones are made from cholesterol. That’s what makes it a cortical steroid. Its job in the body literally is to raise blood sugar. Okay? As we’ve talked about on another episode, you go to exercise trying to lose body fat, right? And you go to exercise, your cortisol goes up because your brain thinks that you’re starving to death and running from a tiger. Now, as a result of your cortisol goes up, it tells your liver as you mentioned a minute ago, gluconeogenesis- I think that was maybe, you mentioned gluconeogenesis in the last episode.

Gluconeogenesis is where your liver makes blood sugar, and as a response to the rise in blood sugar, now your pancreas has to release some insulin. But now, you’re in a situation where you don’t really need any of that extra energy, so now your body has to do something with it, and now it redistributes that blood sugar and stores it as fat around the midsection.

Dr. Davidson: And the same thing happens with stress. One thing with estrogen and the progesterone, when the progesterone drops in perimenopause, the estrogen really doesn’t drop a lot. But it can drop a little bit. Actually you’ll see in a lot of women’s- one month it drops, the other month it goes through the roof. It can- estrogen is the best hormone in the entire world, but she can be like a runaway train. So when you don’t have the progesterone reining that negative effect of estrogen, that can actually exacerbate feeling moody. So you feel irritable, you feel moody, and then you get stressed out really easy, which again when you get stressed out, what does that do? It raises up your cortisol.

Dr. Maki: And if you think about it in our late 30’s to early 50’s, that’s when we have real responsibility. We have jobs, we have families, we have mortgages, we have taxes. We have all the things that make us stressed in America. When we’re 25, we have all the hormonal capacity to handle lots of stress. We don’t really have stress. I mean we do, but not nearly compared to what it is to have the adult responsibilities. And then in order to try to lose weight, we stress ourselves out even more. And then as we’ve been talking about in perimenopause, sleep quality becomes affected as well. That’s why we said in the last episode and we reiterate it here, that your number one thing, to try to lose weight is improving your sleep quality. Whenever we work with a new patient, our first month is devoted to really get them sleeping better. Because if you’re not sleeping well at night, losing weight is going to be next to impossible.

Dr. Davidson: Which is a huge issue in perimenopause, is having trouble staying asleep. Either you’re waking up multiple times in the night, or you’re waking up for a good solid hour to two hours in the middle of the night, and by the time you can fall back asleep, it’s timed to actually get up for the day. So that is probably number one. And that again is about that cortisol. Because the cortisol’s coming up in the evening and then it’s staying down to low during the day, which is why you’re trouble staying asleep at night but then also feeling tired the next day.

Dr. Maki: Yes, right. So that kind of cycle just really starts to ingrain itself and the body gets really good at what it’s forced to do all the time. So, when you’re always trying to push and push and push and push and keep going and keep going and keep going all the time, the brain just gets used to that. So these patterns kind of get stuck. I know you wrote an article before about adrenal issues and you talked about the vampire, right? The proverbial night owl, the one that stays up too late, can’t get up in the morning, that’s a very classic example of this flipped cortisol curve. We’re not born that way, right? These things just kind of develop. Now, we might all have this [inaudible], we might have hot tendencies. Some people are morning people, some people are night people. But because of society, because of what we talked about last time about electric devices and lights and computers and TV’s, these things become- they just become our own patterns and we develop into them. That doesn’t mean that they’re normal, they’re not necessarily normal. We are supposed to follow a very classic circadian rhythm, we rise with the sun and go to sleep when the sun goes down. But we see these circadian rhythm problems all over the place. Everybody has them to some degree or another.

Dr. Davidson: So in perimenopause, not having those, especially the progesterone to be able to buffer that extra cortisol, that’s where that weight comes on. And it’s not a lot, it’s usually about 10 to 20 pounds. Usually the average is around 12-15, depending on the stature of the female. And it’s not unhealthy, it really is vanity pounds, your health is good, blood sugar’s good, liver function, electrolytes, all that is good. That’s why your doctor will say you’re super healthy, it’s just age. But it’s not age, it’s really your hormones.

So for example, with the cortisol, another thing we talked about is stress will make you fat. That’s why when you’re young, you have those female hormones to buffer it, but when you’re in your mid 40’s, you don’t. So you get a stressful email, yucky phone call from somebody you don’t like or some kind of stressful event happens. But it’s not necessarily a tiger chasing you down wanting to eat you. You just get some bad news, but that automatically raises up your cortisol and your catecholamines, which then, what does that do? Your body thinks you need to run away from whatever predator has assault- trying to assault you. So in that moment, that cortisol raises up, you make some glucose, the pancreas secretes some insulin, and then it takes that glucose and shuttles it into a fat cell because you didn’t run like the wind. You sat in front of your computer or chatted on the phone with that stressor.

Dr. Maki: Yes, right. So in some ways, your body is trying to save you by giving you a whole bunch of immediate energy. But there’s no energy expenditure so now your body has to deal with that somehow. And then that whole cycle continues. So, not sleeping and a lot of stress, that’s kind of a mute point that we all know. Stress causes some weight gain. But the way that people try to remedy that, their first inclination is to go exercise, all the time. I don’t know how many times I’ve encouraged women as they are trying to lose weight, in the process of it, or have failed at trying to lose weight, and they’re just so frustrated. I tell them literally, take a month off. No exercise for a month. They all get nervous, they all get a little bit panicked, because they think they’re going to gain even more weight. And I usually notice, or what I’ve notice is that they do actually gain a little bit of weight as a result of not exercising because they’ve also been under eating in that same process. That’s the number one thing that I see, is women are trying to exercise four to six times a week literally but they are under-eating in some cases by over a thousand calories a day.

So when you have this opposite end, you’re expending a bunch of energy but you are not taking in enough, that alone will raise your cortisol and that again, this whole energy balance process is literally out of balance. And it just makes sure, literally, the fat loss process by under-eating basically shuts itself off. Your body can not burn any more fat. So this is the part a lot of people have a hard time with. You actually have to eat more food in order to keep the weight loss process moving in the right direction.

Dr. Davidson: And I know it sounds- everybody gets a little wide-eyed when you say, “Oh, you need to stop exercising and eat more.” They’re like, “Well, that’s what got me here in the first place. Isn’t it?” Like, no. No, no, no. But at the same time, we don’t- we like to exercise. I mean, exercise is good for the human body. But it’s trying to back off on that intense cardiovascular exercise that raises up your cortisol.

Dr. Maki: Yes. Not only- granted, and you’re right, we’re not complaining about exercise. And general exercise has a myriad of benefits, so don’t take this the wrong way that all exercise is bad. Intense cardiovascular exercise actually also, when that cortisol rises, it actually breaks down your muscle tissue. We want an activity that encourages the preservation of muscle tissue. The more muscle you have, it raises up your metabolic rate. The higher your metabolic rate is, the more you’re going to burn fat at rest. And particularly, we end up burning a lot of fat while we’re sleeping. If we’re not sleeping, we’re not burning any fat. And now, the whole process continues in the wrong direction.

That’s why we always say that sleep is the number one point of that process because now that means your cortisol and insulin which are the two major players in that process, your cortisol and insulin are going to be in a proper balance, and it’s not going to be a runaway freight train. Partially, you have to be a little bit more- and honestly, this is probably good. Because women in America these days are- there’s a lot of expectations for women these days, right? There’s a lot on your plate, a lot of responsibility. There’s no glory in it necessarily, there’s no recognition for it, you have a lot on your plate, we’re just trying to say, “You know what? Be a little gentler on yourself. And don’t try to physically and mentally push yourself so hard all the time because you’ll get the wrong results in the long run.”

Dr. Davidson: Exactly. And one- like you were mentioning about the muscle masses, when we do hit our 40’s and later, it’s harder to preserve the muscle mass. So doing exercise like resistance training or doing some more weight, maybe not doing the running instead of doing some hiking. Something that’s going to help you build muscle is actually better in perimenopause than I think, any kind of exercise.

Dr. Maki: Yes. I would agree. Like I said, if you’re exercising a lot and you’re not sleeping well, then cut back on the exercise. Maybe do more yoga or some more lower intensity. Certainly, weight training so you can preserve some muscle mass. Maybe even gain some muscle. A lot of women I talk to, I want them to change their perspective. Instead of trying to actively lose weight, because if you’re trying to literally fix your problem areas by losing a little bit of weight around the midsection, or a little bit from your here, there, wherever, and you’re trying to lose, let’s say less than 20 pounds, that perimenopausal 20 pounds that you gained, trying to eat less and exercise more to lose that 20 pounds is literally next to impossible.

Anybody if you just change your approach a little bit and focus more on trying to build muscle, not in a bodybuilder sense that you’re becoming big and bulky, but just about your approach. So you’re not too much of a deficit, you’re doing more weight training, not as much cardio. You’re focusing on strength versus how many calories you’re burning, and I promise you in that process you will become leaner and leaner and leaner as time goes on. Because now you’re forcing your muscles to adapt. You’re raising your metabolic rate, you’re preserving your metabolic rate. Now, your body in some ways kind of burning hotter all the time, not figuratively like a hot flush, but facetiously so that where your body can actually utilize the extra energy. And now you’re going to become leaner and leaner as time goes on. So now that translates not the weight on the scale per se, but your body composition, so your percent body fat, your lean muscle mass, all those things are your- literally, weight might not change much. But your body composition could change quite a bit. That I think is a big deal. That’s how our focus should be changing over time.

Dr. Davidson: And to build muscle, we need that energy. So instead of cutting back on calories, we actually want to increase up your calories. But this would be a good point to talk about wor-. Because a lot of women ask me, “Well, what am I supposed to do? There’s paleo, there’s keto, there’s vegan, carbs with no fat-,” I can’t remember what the name of that one is. There’s this diet, they don’t know what to do which I totally get it because there’s so many different things out there. So this would be a good point and maybe finesse a little bit of that.

Dr. Maki: Yes, right. So we wrote a weight loss guide called the Keto Carb cycling program. Keto’s very popular. However, as we are talking about, one of the biggest mistakes that people make on Keto is they under eat. So they’re eliminating a whole macronutrient, carbohydrates- now granted, we do like the idea of low carb in Keto. But again, Keto is meant to be low carb, it is not meant to be low carb and low calorie. The low-calorie part is what gets everybody in trouble. Because literally, your calories are dropping anywhere from 500 to a thousand calories a day. And the body is extremely sensitive to that drop of calories over time.

Dr. Davidson: Exactly. And another part is you don’t want to be afraid of carbohydrates. People get scared of, “I eat those carbs, I’m going to gain weight.” It’s not really about the carbohydrates, of course, it’s about the type of carbohydrates. A complex carbohydrate is a whole lot different than a processed refined carbohydrate. But I don’t think we necessarily have to be afraid of carbohydrates, because if you cut your carbs down too low, that’s actually terrible for our thyroid function, it’s terrible for our female hormones, and it’s not conducive long term. So doing some kind of re-feed or as we say, we did with our KCCP, was doing a little bit of some carb cycling actually is beneficial.

Dr. Maki: Yes, right. And really, the attempt of the KCCP when we wrote it was to, in some ways protect women from themselves, right? Because that’s our patient base. And we see this mistake, we’ve seen these for years. So the Keto Carb Cycling is if you’re going to do low carbo or Keto, do it for short little increments, but then as you just said, make sure you’re adding in those starchy carbohydrates back in. The potatoes, the sweet potatoes, the yams, maybe some rice. You’re Japanese, we eat rice all the time. Maybe some quinoa, some legumes, or some beans. And all the other starchy vegetables. That’s a big difference than eating processed refined carbohydrates. That’s really what low carb is to you and I is really just eliminating the processed refined carbohydrates. That’s really what low carbo is to us.

So low carbo is relatively, literally, it is a relative term. Keto is usually when you drop your carbs on a daily basis less than 30 grams a day. That’s what a ketogenic diet is. But low carb could be anything less than 125 grams of carbs a day. Technically, I think less than 50 grams of carbs is considered to be a very low carbohydrate diet. The average American probably consumes 200-300 grams of carbohydrates a day. Now, granted if that comes from whole food sources, that’s great. That’s really, at the end of the day, whether you’re doing paleo or low-carb or vegetarian or vegan or whatever diet you want to choose if you’re focusing on whole foods- and that eating to your own level of appetite. Because when everything is in sync and you’re sleeping well, then your brain, your adipose tissue, your fat cells, and your liver, should all be able to sing in harmony so to speak so that where your body regulates itself.

If you’re not sleeping then something is off and then now, there are other signals are going to be distorted and now that energy balance is going to be wrong and now your brain isn’t going to be able to quite regulate things well, and you’re going to keep gaining weight.

Dr. Davidson: So I know that’s a lot to throw at you. But if you’re interested in the Keto Carb Cycling Program, or as we abbreviated it, KCCP, is we have an- I think we might have it in the website. I know we have it in our perimenopause masterclasses, a pdf for women to follow. But, is it on the website?

Dr. Maki: We had it up there on a like a content library then I had it set up kind of wrong, whatever. So people couldn’t download it. I don’t know. I kind of screwed it up. So, if you go to- we’ll make it available if you just go to progressyourhealth.com/KCCP, then you’d be able to download it there. Because it is good. It’s really good information. There is a section on there about calories and how to figure out where your calories are. Because like I said, everyone that I talked to, literally is under-eating anywhere from 500 to a 1000 calories a day. The average for a woman is anywhere between, let’s say maintenance calories, is anywhere from let’s say- depending on the size and the age and all that stuff, height and weight. On average, a woman’s maintenance level calorie should be anywhere from let’s say 2,000 to about 2,500 calories.

Dr. Davidson: Isn’t that wild? It works, but I know for a lot of us women, we get wide-eyed and “What? 2,000 calories?” But it does work. You’ve got to eat more.

Dr. Maki: Yes, right. And especially if you’re exercising a lot. If you’re going to a boot camp class or the spin class or this and that and you’re eating less than 1,500, you’re creating too big of a deficit and that throws off your energy balance, and literally the fat loss process basically stops. So you can not lose anymore weight. That’s why when you’re engaging in your process, whatever that is that you’re doing, you lose weight for three months and that plateaus, the plateau is a sign that your body is starving to death, and now it goes in a compensation mode, and it becomes very difficult for you from that point forward. That’s where you should actually eat more food which a lot of people do. They end up eating less food and exercising more to compensate, they’re just magnifying the problem.

And now, granted, this is not an exact science- is weight loss or losing weight, is it a calorie issue or a hormone issue? Well, I think it’s both. I don’t think you can separate one from the other because they both come into play. But eating enough food, that’s where the paradigm shift. We just think if we just eat less food, we’ll be fine. But in reality that is the wrong long term strategy. So every program in the country is always focused on the short term weight loss. Losing weight in the first six months. But every one of them is an attempt that restricting your calories. So in the KCCP, that’s why we encourage people to re-feed on a regular basis, every week, every other week, add in some of those starchy carbohydrates because that’s going to raise up your calories and it’s going to tell your leptin levels, your thyroid and all those things to maintain that you’re not starving to death and running from a tiger, and now the fat loss process can continue. It’s complicated, it’s really, really, complicated but it is not impossible.

Dr. Davidson: No, no. And we do have in that write up a little bit about all the different hormones that contribute to weight loss or weight gain like you mentioned, the leptin. We have the [inaudible] in there, the relin, the insulin, the cortisol and all that jazz, and the hormones on there. So it would be good because I do feel like people want to know what to do and have a little bit of structure which I think we all need. But we also want to learn at the same time and figure out why am I doing this. Like I mentioned, doing hardcore Keto for long periods of time will lower your thyroid function. In the KCCP, we go into a little bit with intermittent fasting, because intermittent fasting is very hot right now. Is intermittent fasting good for you? Good for other people? It can be, it just depends.

Dr. Maki: Yes. A lot of people, they interpret intermittent fasting which really at the end of the day is just a way to manipulate your calories. So even if you’re doing intermittent fasting, you can’t just eat dinner every day and think you’re doing intermittent fasting. You still have to re-feed yourself. Otherwise, you fall into the same trap of lowering your calories too much and that’s why you see plateaus in people’s weight loss journeys. Or their body just goes the other direction and now they just start overeating again, because that’s what the body’s designed to do. That’s why we’re not- our rational brains are not smarter than what the body does. The body is way too smart for that. It is designed for that food scarcity environment so it wants to protect it in every chance that it can.

Now, one other thing before we run out of time, another thing I’d like to say, is when you’re using the scale at home to track your weight loss, that is literally- and all of us know that when you’re looking at the scale trying to see if we’re progressing the right way or not, it is enough to drive you crazy. The scale goes up and down, and up and down, and up and down. If you looked at the scale every single day, some of you we know that you don’t even step on the scale because it’s too much of an emotional trigger for you to be stepping on the scale. But if you did, let’s say for 30 days or for 6 months, every day you step on the scale. It goes up two pounds, down one pound. Up three pounds, down two pounds. Down three pounds, up two pounds. It just fluctuates all the time and we never get a good gauge of what we are doing actually is working or not.

So I would encourage you in your town, in your city, the bigger city you’re in, the easier this will be to find but find a walk-in imaging clinic that has a DEXA scan machine, that’s normally for bone density. But almost all of the new generation DEXA machines can do body composition testing. Or you get literally a very accurate percentage of what your current body fat percentage is. And if you’re trying to lose, let’s say even less 40 pounds or less. 40 pounds is a lot of weight. 180-140, that’s a big deal, right? And I would say that’s probably the majority of where our patients fall into there in that 20 to 50-pound range.

Now granted, is that obesity? Maybe some, whatever. But it’s not the super-obese where they have a hundred pounds or more to lose. And if you’re using the scale to track your progress, that scale is kind of leading you in the wrong direction. So if you go to the DEXA scan place and you get a body fat percentage, check it every so often, and if your body fat percentage is going down, then you’ll know that your strategy is actually working. Then you are able to push through those plateaus, you can make that consistent body fat percentage reduction. Not weight, necessarily, especially if you’re exercising with weights, and doing what we’re talking about, the weight might not change very much. But as long as the body fat’s going down, now your body composition is changing drastically that the eat less exercise more really can not change body composition quite like that. So, that is a different perspective. You’re focusing on something else and you’re seeing true progress as opposed to being lied to by whatever your scale says on a regular basis.

Dr. Davidson: Yes. The scale is evil. Take it in your backyard and bury it and put a nice little grave, spell them. Because you’re never pulling it back out. It’s very deceiving. Especially for women, because we do. We fluctuate up four pounds, down three pounds, it changes. You can also do measurements with the tape measure. Like the bust, the arms. the neck, the quads, the belly, the hips. That’s another way to also track some progress and I have some women that they will not- they get on the scale every single day but most of them I tell them don’t get on the scale. And if you’re going to, maybe once a week or once every two weeks if you really want to see that number. But one thing before I forget is our Facebook page. I’m new to Facebook, I’m 46 years old and I’ve never had a Facebook.

Dr. Maki: You’re like the only one in America that doesn’t have their own Facebook account. You just use mine all the time.

Dr. Davidson: Just to look at things. But now, we actually have the Progress Your Health Facebook page where we talk about hormones [cross talk].

Dr. Maki: We’ve had a page for a while, we’re not necessarily too active on the Facebook page. But now we have because of the perimenopause master class, we have a Facebook group. A private Facebook group. So, it’s just called Progress Your Health, let’s talk hormones, you can search for it on there. And it’s a private group so you have to request to join and one of the admins will certainly allow you in and that’s where we discuss pretty much anything hormones. PMS, perimenopause, menopause, PCOS, hypothyroid adrenals, all these things are kind of fair game and we can all kind of congregate in one particular area. Everyone except you on the planet pretty much has a Facebook group so it will be hopefully a nice place to get to know everybody a little bit better.

Dr. Davidson: Well now I do have one.

Dr. Maki: Yes, yes.

Dr. Davidson: This one.

Dr. Maki: Right. Right. So we are probably going to end up talking a lot more about weight loss, or fat loss, or burning fat. Weight loss is kind of a challenging one, right? There’s a lot of competition, there’s a lot of misinformation out there. And just be a little bit careful with that. Take what we say with a grain of salt as well, and we just learned some things over the years dealing with our patients. But weight loss, we don’t have all the answers, nobody when it comes to weight loss has all the answers. Not even us. But there is a gap between what the research shows and what is being done in everyday life. We want to try to help kind of improve that a little bit so people are actually putting forth all this effort, they are actually able to get the results that they want without having to work so hard.

Dr. Davidson: All right. I think we’re probably good, right?

Dr. Maki: Yes. I think we can wrap this one up. So until next time. I’m Dr. Maki.

Dr. Davidson: And I’m Dr. Davidson.

Dr. Maki: Take care. Bye-bye.

Dr. Davidson: Bye.