The Hormone Reset Diet (18 page)

Fructose is potentially risky if you have blood sugar problems. It’s the number one source of sugar in our diet, and it’s a molecule responsible for our addiction to sweet foods. The rise in fructose consumption is highly correlated with obesity, diabetes, and a liver problem called nonalcoholic fatty liver disease, which now affects one in three Americans. Yet I want to be careful not to demonize fruit across the board for all people. The issue is more nuanced.

Here’s the problem as I see it: vegetables are the best medicine when it comes to healing hormone imbalances that cause broken metabolism. When experts tell women to eat seven to nine servings of fresh fruits and vegetables each day, many women who are overweight simply eat more fruit—and don’t lose weight. That’s because existing blood sugar problems, found in half of U.S. women, make fructose a problem. If you’re a normal eater and lean, with no blood sugar problems, fruit is fine. For the rest of us, there are shades of gray when it comes to eating whole fruit, avoiding juice, and limiting total fructose. When you heal your metabolism, you can eat more fructose without causing weight gain, but let’s review cases for and against fructose. (For citations, go to www.HormoneReset.com/bonus.)

If you’re normal in weight, you may not be as healthy as you think. You might be a “skinny fat” person, a term used to describe the one in four normal-weight individuals with increased fat mass. Skinny fat is a problem of body composition: you have too much fat mass relative to muscle mass, and the fat could be making you sick.

Let me give you a visual. Skinny fat women look thin but have very little muscle definition. They may look good in a T-shirt, but when naked, the belly appears doughy. When you touch their skin, you sink into fat rather than feel the firmness of muscles in the space between their skin and bones. They are thin people who are actually high in fat
mass, especially around the belly, and low in muscle mass. They are at risk of the same kinds of diseases as obese people: prediabetes, diabetes, heart disease, and metabolic syndrome.

The clunky official medical term for this is “normal weight obesity,” which means “Honey, you may look normal from the outside, but inside you have too many fat cells (especially at your waist) and not enough muscle mass.” Shockingly, skinny fat people may have double the mortality rates of overweight or obese people.
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How do you know if this is you? An optimal body fat range is 20 to 28 percent (14 to 20 percent for athletes). Fit and lean women have a body fat of 21 to 24 percent; 32 percent and higher is considered obese, according to the American Council on Exercise.
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Just as both fat and thin people can have insulin resistance, both fat and thin people can have leptin resistance, although rates are higher when you’re obese.

Inflammation is at the root of why skinny fat, overweight, and obese people have altered chemistry. It’s like a bad neighborhood for the cells of your body—and excess fructose adds more violence and despair. People with minimal inflammation tend to be lean, happy, and in hormonal balance.

Women are more likely to be skinny fat than men, because we have fat cells that are more relentless; we’re wired to stay chubby so we can be fertile. We all know that we are targeted by the cultural ideals of thinness, and that makes some women restrict food excessively and become skinny fat. As we’ve learned, this is also damaging to your metabolic fire.

In summary, wellness is more than just about ideal body weight; it’s about achieving your best lean body mass and health.

When insulin and leptin and their receptors are optimal, you have normal lean body mass and are fit. The muscle and fat are evenly distributed. You are fine with showing off your upper arms and belly. You don’t cower at the thought of going to the beach or wearing a sleeveless dress. But when your receptors are having trouble mating,
you could experience health problems, poor metabolism, and “sick fat”—even if you are technically skinny. What’s a girl to do? Follow my twenty-one-day Hormone Reset so that you can lose fat mass and, over time, aim for an optimal body fat range.

Leptin resistance causes hunger in two extremes of the range: high and low. Your hypothalamus in your brain interprets both low leptin (less than 4 ng/mL) and high leptin (greater than 10 ng/mL) as an indication of starvation and revs up your appetite. Levels of leptin in your blood rise with your body fat.
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When leptin is high, your brain is convinced you’re starving, even though your body may have more than enough food. You feel hungry but never satisfied when you eat. So, you keep eating and keep gaining weight. Sound familiar? While leptin is playing a cruel joke on your body, insulin works against you too. Because insulin blocks effective action of leptin in the hypothalamus of your brain, high insulin begets high leptin. So, your brain believes you are starving and encourages you to overeat. This is another example of how normal physiology can turn against you. But it doesn’t have to be a repeat performance playing out on an endless loop. Carefully following the Hormone Reset can help bring you back into a state of balance.

Obesity is a fat accumulation problem, and the locus is your belly. When you experience a roller coaster of blood sugar extremes, and you make too much insulin and estrogen, you deposit extra fat in
your belly, mostly deep visceral fat. (You also deposit subcutaneous fat, which is just beneath the skin—the main point is that belly fat is worse for you.) Not only do you increase your waist size but you also deposit more fat inside your organs, such as in the liver, pancreas, kidneys, and intestines. Remember, fat cells manufacture excessive leptin, which floods the brain until it short-circuits and refuses to receive the satiety signal when you’re full. It’s like the assembly line gone awry: your brain can’t keep up with the supply.

Fat deposits elsewhere—at your hips, buttocks, and arms—are not as dangerous as visceral or belly fat. They don’t make high levels of leptin and other potentially harmful chemicals.

Your visceral fat, however, is a 24/7 factory that produces toxic chemicals called adipokines (inflammatory mediators made in your fat cells), which cause harm to your metabolism, hormone receptors, immune system, and joints. A protective hormone, adiponectin, which manages fat, may be abnormally low in obese people with certain genetic tendencies and further contributes to the dysfunctional pattern and increased inflammation.

Up to 60 percent of adults cannot digest fructose properly and get gassy from certain rapidly fermentable (gas-producing) carbohydrates, such as the fructose in apples, apricots, cherries, mangos, nectarines, peaches, pears, and watermelon. The problem with absorption occurs in the small intestine, and researchers have found it extends beyond fructose to other related carbohydrates. Collectively, these problem foods are known as FODMAPS, which stands for “fermentable oligosaccharides (fructans and galactans), disaccharides (lactose), monosaccharides (fructose), and polyols (such as sorbitol, mannitol, and xylitol).” When these foods adversely affect you, it’s called “FODMAPS malabsorption.”

When this happens, these carbs travel to the large intestine, where they ferment, create gas, distend the bowel, cause bloating and pain, and may affect movement of food through the gut (i.e., diarrhea or constipation).
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One of the reasons that many people don’t digest fructose well is that the transport mechanism across the bowel wall is slow and low in capacity.

Healthy individuals can absorb about 25 to 50 grams of fructose, and most people with FODMAPs malabsorption difficulty can digest less than 25 grams during a meal. You can assess your ability to absorb FODMAPs with a hydrogen breath test. Limiting FODMAPs has been shown to help prevent gas, irritable bowel syndrome, and other functional gut disorders. People with fructose malabsorption have altered gastrointestinal motility, a mucosal biofilm, and altered microbiome.

Restricting fructose improves both insulin resistance and leptin levels.
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While I don’t believe in a single magic bullet, I have seen amazing results when my patients get their leptin levels in check by eliminating fructose and increasing their protein intake, especially within thirty minutes of getting out of bed in the morning. Not only do they lose fat, normalize their appetite, and feel relieved, they stop blaming themselves for their weight gain.

Our goal together in this reset is to normalize leptin. When leptin is signaling normally in your body, you stop getting a feel-good dopamine hit from the brain after you’ve taken in the right amount of food. (Dopamine is the brain chemical of pleasure and satisfaction.) You put down your fork when you’re full. But when you are resistant to leptin, food doesn’t stop tasting scrumptious, regardless of quantity—and that’s why many overweight people find it nearly impossible to stop eating. When you reset leptin, you suppress dopamine and food stops tasting addictively good. When you do Fruitless, you reset your relationship to food, and that cupcake stops calling your name.

For long-term fat loss, you must flip the hunger switch—starting now. Just as you need to take a break from work to take a vacation, your receptors need a vacation from the wrong foods you’ve been throwing at them. In the following Fruitless reset guide, your first task is to upgrade your food choices so that you clear fructose from your system. I’m excited to show you how!

FRUITLESS RULES: DO THESE EACH DAY

To get leptin back on your team, follow these rules:

1.
Start your day with protein.
Eat protein within thirty minutes of awakening, which reduces cravings for fructose and other sugars.
Over the course of the day, consume a moderate amount of protein: approximately 75 to 100 grams per day. Two eggs contain 13 grams of protein; 4 ounces of chicken breast has 36 grams of protein.

2.
Eat your pound of low-fructose veggies.
Veggies contain lots of fiber and good antioxidants but can also contain fructose. Consume one pound of vegetables per day, or about two cups of vegetables at lunch and at dinner, with an emphasis on vegetables that are low in fructose. Choose vegetables that contain less than 1 gram of fructose per 200-calorie serving, such as artichokes, sauerkraut, spinach, alfalfa sprouts, and peas. Because of the fiber content, vegetables that contain less than 5 grams of fructose (including sweet potatoes, broccoli, squash, and carrots) can also be consumed, as long as you keep your total fructose each day to less than 20 grams.

3.
Forgo alcohol.
In the previous chapters, I outlined the many reasons to take a break from alcohol. In addition to the reasons I’ve already stated, your favorite cocktail is likely loaded with fructose. Then there’s the liver issue. With leptin and the liver so delicately entwined, I implore you to be kind to your liver by eliminating alcohol for the full twenty-one days of the Hormone Reset plan.

4.
Stop snacking.
For my leptin-resistant patients, snacking becomes a habit because they are disconnected from true hunger. You have to break the snacking habit in order to reset your leptin. Eat three meals per day following the guidelines I’ve described (refer again to the reset guidelines in chapter 2 if necessary, page 41), but don’t snack. Time your meals every four to six hours. When leptin is normal—not too high and not too low—you don’t feel hungry between meals.

5.
Eat good fats.
Most people, in order to heal their metabolism, need more healthy fat in their diet for optimal health. Good sources include coconut and coconut oil, avocados, butter, nuts, and animal fats (see page 62).

6.
Avoid nightshade fruits and vegetables.
Some people respond to nightshade fruits and vegetables with increased inflammation. Nightshades contain a chemical named solanine, which may interfere with enzymes in your muscles, leading to pain and stiffness, and cause digestive problems. You may be exquisitely sensitive and may never have realized that nightshades are the source of your gut problems and joint discomfort. For three days remove all nightshades, including potatoes, tomatoes, eggplant, bell peppers, and tomatillos. Avoid American-grown soy, which has been hybridized with petunia, a nightshade, to be pesticide resistant.