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“I think my wife is cheating.”
This was a comment a husband once relayed to me about his wife’s participation in my Keto Clean program.
“She’s saying she eats the same things as me, but she has only lost 2 lbs only, and I’ve lost 15 in the 2 weeks we’ve been on your program…can you talk to her?”
After speaking with the wife, who shared her meals, her portions, and her fasting regimen, it became clear to me that not only was she following the plan to a T, but she was, if anything, following it more closely than her husband.
From his perspective, he (logically) deduced if he and his wife ate the same foods, at the same time, in the same environment… the weight loss experienced by both of them should crudely approximate.
However, it is much more complex than that, and I want to shed light on some of the distinguishing characteristics between male and female metabolism.
Ask any woman who has tried a diet before with a male partner and she will tell you the same thing.
“We ate the exact same thing!”
“We worked out together!”
“Counted our calories together!”
“Doc, we even fasted together!”
“…and yet, somehow he was able to effortlessly lose [insert obscene weight amount here: 10, 20, 30 lbs.] and I only lost 1–2 pounds.”
So, what gives?
The answer is complicated, and I’m going to unpack it here as best I can to not only give you an understanding of why women are more resistant to weight loss, but also strategies to circumvent the inertia of said lag.
Simply stated, women have a more complex and ever changing hormonal landscape than our male counterparts.
That is to say there are more moving parts that make up a woman’s metabolic fitness.
And hormones rule metabolism. Period.
With women specifically, there have been some patterns I have teased out when it comes to weight loss (I’ll break each one down in a moment):
- Women experience bigger monthly (and lifetime) swings in hormones (and are much more sensitive to these swings)
- Females have a bigger swing in leptin response (aka — you’re never full)
- Women are more likely to develop cortisol resistance via HPA dysregulation (aka — your cells stop responding)
- The female body is more defensive of its fat stores
Pattern #1 — Bigger Monthly & Lifetime Swings Hormones
“Over half the world menstruates at one time or another, but you’d never know it. Isn’t that strange?” — Margaret Cho
For most of my ladies, this is universally understood.
Females experience hormonal fluctuations that occur…
In fact, you are almost a different women throughout the month if we look at the changes of your hormones.
Women experience surges and dips in estrogen and progesterone, and we are also more sensitive to these changes than men are to changes in their hormonal environment.
Fortunately or unfortunately, depending on which way you look at it, women tolerate much less when it comes to changes in our hormones.
- are hotter (or colder)
- retain water (or not)
- are moody (or not)
- are tired (or not)
…all depending on what point of our cycle we are in.
Men, on the other hand, can approximate oblivion to changes in their testosterone levels.
I’ve seen men in my practice with testosterone levels considered 2 standard deviations below normal and he is just beginning to feel tired.
As men are typically less sensitive to fluctuations in their hormonal environment, they can theoretically go for years without presenting with sleep disturbances, changes in muscle mass, or sexual drive.
In other words, he is less sensitive to changes in his hormonal environment compared to a female, and can feel pretty normal even with lowered testosterone.
A woman (assuming she is in her reproductive years) experiences surges in her estrogen levels in the beginning of her monthly cycle, followed by a massive, surge and then rapid decline in progesterone levels in the days leading up to her period.
And this hormonal roller coaster happens every 28–31 days.
These cyclical changes in estrogen and progesterone every month will concordantly effect a bigger change in neurotransmitters serotonin and dopamine — with the biggest drop in the week leading up to menstruation.
Serotonin — nicknamed ‘the happy hormone’ is a major player in mood regulation, and a large portion of serotonin is manufactured in the gut.
Dopamine is our motivator — it keeps us engaged, motivated, and passionate.
So when these neurotransmitter levels drop, it would be reasonable to suggest that brain fog, moodiness, and cravings would be rampant.
In other words, moodiness, fatigue, and even productivity in the week leading up to your period is NOT because you are a sloth and there is something wrong with you.
Your brain chemistry is different.
(Here is your gentle reminder to be easy with yourself ladies. I’ve heard people call themselves beasts, monsters, barking mad, crazy, and the list goes on. Who would you ever speak to like that?)
And to finalize the cherry on the cake, somewhere around the 5th decade of life, a woman’s estrogen, progesterone, and testosterone levels are all but shut off within in a matter of years.
This leaves her susceptible to losing precious lean body mass, and bone density — both of which are intimately related to weight loss, longevity, and brain health.
Women are just more complex when it comes to metabolism.
There are way more ways for a woman’s metabolism to become deranged, both on a monthly basis in reproductive years, and over the course of our lives.
So, no, you’re not a moody, crazy, sweaty bitch.
One of the solutions I like to suggest to patients who experience brain fog, moodiness, and fatigue in the days leading up to her period is to consume more carbohydrates (in the form of vegetables — particularly green leafy vegetables) and resistant starches through the month.
Cravings tend to be at their most pronounced in the week before menstruation, so increasing foods like…
- dark chocolate,
- broccoli & broccoli sprouts
I like to allow for 20–30g of extra carbohydrates per day in the week leading up to your period.
In other words, around day 22, or day 23 of your cycle, increasing your green leafy vegetables, and resistant starches will help improve cravings, sleep, and moodiness.
Pattern #2: Leptin Sensitivity (AKA You’re Never Full)
“It is a hard matter, my fellow citizens, to argue with the belly, since it has no ears.” — Plutarch
Leptin is the hormone that signals you to stop eating.
It is the ‘satiety’ or ‘feel full’ hormone.
Secreted from our adipose tissue, when leptin is working normally it should look something like this:
→Eat Appropriate Amount Of Food
→ Adipose Tissue Releases Leptin
→ Brain Picks Up Leptin Signals
→ You Stop Eating
However, with metabolic derangement, excess adiposity, and insulin resistance — which females are particularly susceptible to — you will lay the foundation for developing leptin resistance.
What this means is when you are eating, your adipose (fat) tissue is secreting higher levels of leptin, but your brain is not picking up the signalling.
So instead it looks like this:
→Eat An Appropriate Amount Of Food
→Adipose Tissue Releases Leptin
→Brain Does NOT Pick Up Leptin Signals
→You Continue To Eat
→Weight Gain Ensues
When we look at the prevalence of decreased leptin sensitivity across sex, there is a marked difference.
This study looked at sex differences for leptin. They observed men exhibit lower leptin levels at any given measure of obesity.
Compared with those in men, female leptin levels rose 3.4-fold more rapidly as a function of BMI in women.
This study suggests there are important sex-based differences in the regulation and action of leptin between men and women.
One of the most important finding of this study was that while leptin levels increase with progressive obesity in both men and women… for any given measure of obesity, leptin levels are higher in women than in men, which is consistent with a state of relative leptin resistance.
These findings have important implications regarding differences in body composition in men and women.
One way I like to approach this with my female patients is, again, to use resistant starches in their diet.
Resistant starches are starches (carbs) that essentially “resist” digestion.
Meaning, they are not absorbed the way a typical carbohydrate is absorbed.
The enzymes in the stomach or the small intestine cannot break these starches down, and they end up acting as a food source (or a prebiotic) for the bacteria in the large intestine.
The bacteria will produce something called butyrate (I’ve discussed its benefits at length in this article).
Butyrate’s benefits include improving leptin sensitivity in the brain, improving microbiome and colon health, and better sleep.
The more I go down the butyrate rabbit hole, the more I love it.
Here is a study demonstrating an improvement in both insulin and leptin sensitivity with resistant starch (and therefore butyrate production).
Congrats for getting this far along, you are definitely part of my nerd army. You’re about 1/2 way through. If you want the simple supplementary Adrenal Health Quiz as a PDF download, get it right here. It’s free.
Pattern #3 : Cortisol Resistance (aka Your Cells Stop Responding)
“What we’re not adapted for is the chronic, unrelenting stress that has become so common in modern life. This type of stress provokes feelings of hopelessness and helplessness — what psychologists call a “defeat response”. And it’s the defeat response that leads to increased fat storage, abdominal obesity, tissue breakdown, suppression of the immune system.” — Chris Kresser
Anytime there is an effort to calorie restrict — whether it be through fasting, or some variation of macronutrient restriction (the ketogenic diet comes to mind), for females there tends to be a wilder swing in cortisol compared to our male counterparts.
If you think about it, this makes a lot of sense.
Most women today(especially those with children) are already tired, sleep deprived, and stressed.
In practice I tend to see my female patients who do not tend to engage in a lot of self care.
They are typically last on their list of people to take care (if they even make their own list at all!).
As females, there is this intangible need (self-induced pressure?) to try to do everything flawlessly — the career, the family, and to always be perfectly put together with a smile.
This game is rigged for you to fail.
In families where both parents work, national surveys across the US, Canada, and Britain reveal the same thing: females not only put in hours at work, but they spend the most time doing unpaid work.
Meaning, she is the primary caregiver for their children, she takes on most of the household responsibilities, and if she so chooses, pursues a career whilst attempting to balance this house of cards.
A recent Canadian survey revealed Canadian women perform 50% more household duties.
In Britain the number climbs to 60%, and a super interesting American survey revealed that sex in heterosexual couples and femininity in same-sex couples determined who did the lions share of the household chores.
This overworked, under rested life leaves most women in a state of chronic, low grade inflammation.
Meaning, there is too much cortisol being released chronically.
Normally cortisol should be released in a pulsatile fashion, in response to some kind of stress — be it physical, emotional, or chemical.
The hypothalamus picks up on the stress, and through a complex hormonal symphony, the end result is cortisol is released to combat the inflammatory stimulus.
You see, cortisol, is a counter regulatory hormone.
Meaning, its main function is to serve in an anti inflammatory response.
Cortisol is designed to counteract stress. (Ever have a corticosteroid shot? It is the exogenous version of cortisol).
The problem is, as the stresses of modern life build up, cortisol is released more frequently with the end result mimicking that of insulin resistance.
The adrenals are pumping out more cortisol, and yet it becomes less effective over time.
With increased cortisol, we start to see increased catecholamine output — which will continue the spiral of sleep disturbances.
To add insult to injury, in order to continue producing cortisol at this elevated rate, a woman will start to sacrifice the production of her sex hormones at the expense of continued elevated cortisol production…something known as Pregnenlone steal:
This is especially true of women who have had multiple pregnancies.
This will have important knock on effects to her thyroid, metabolism, and health of her adrenals overall.
To help with the immediacy of a good night’s sleep (and the beginning of normal cortisol production), I have found a nightcap of chamomile tea with 1 tsp of honey to work wonderfully well.
Sleep is the nectar of the gods for someone with adrenal derangement and cortisol resistance.
Not being able to sleep is a special kind of torture.
Honey is my solution to a sweet, restful sleep.
Those of us who are chronically stressed often wake up overnight because our adrenals are whacked and too much cortisol is being prematurely released.
Honey, with its perfect glucose:fructose ratio, will help replete liver glycogen, stimulate serotonin and melatonin production.
In other words, it will prevent waking and allow for a restful sleep.
Pattern #4 — Females Fiercely Defend Fat Stores
“A cultural fixation on female thinness is not an obsession about female beauty but an obsession about female obedience.” — Naomi Wolf
When we look at evolution, this makes sense.
Fertility, and the ability to carry a baby to term should, ideally, happen in the presence of food.
Our environment has often dictated long periods of time wherein there was not an abundance of food. The female would then draw on her adipose tissue as a source of energy for the growing baby.
So of course it is entirely possible to get pregnant and have children by being in a state of ketosis.
But… is it ideal?
I would think it isn’t.
Most proponents of fasting or a ketogenic diet discuss being in ketosis permanently. Most of these proponents are also men.
I disagree. Especially when it comes to women.
I do not advise that women should be aiming to be in ketosis permanently.
(Truthfully I am not convinced this is ideal for men either.)
Ketosis as a therapeutic intervention? I am all in.
It is an important tool for weight loss, energy management, and up regulating brain health.
For women, it seems, at least from a clinical perspective, more appropriate to have metabolic flexibility.
That is to say, have the ability to switch between using sugar and fat as fuel sources.
To be fat adapted.
To be able to initiate ketosis when need be.
This secondary fuel source (our adipose tissue) is precisely why we defend out fat stores more vigorously than men —if, in our history, there was a situation when food was scarce, the ability to draw on and use the energy harboured in adipose tissue makes sense.
Today, as we do not live in a world where we are 30 minutes from food at any given point of any day, it manifests as stubborn weight loss.
When really, it is an antiquated defence strategy of our fat to maintain fertility and the option to reproduce.
Here is what I continue to learn when building programs that work for women:
- Women usually require robust testing to gain an accurate picture of their genetics, hormonal status, microbiome and other proxies to have a greater understanding of her biology
- To elevate and support brain health, mood and energy, I will often tap into strategies that address adrenal support because most women have impaired adrenal health
- These can look like:
- Integrating higher carbs (usually in the form of green leafy vegetables) in the week before menstruation to support the change in progesterone levels and the cravings and moodiness that can ensue
- Daily resistant starches to help with hunger and microbiome health to blunt both leptin and insulin insensitivity
- Supplements to support aromatization and clearance of estrogen where appropriate
- Helping with appendicular strategies like daily and monthly rhythms through habit modifications: light exposure, sleep schedule, napping, meal timing/consistent eating window, type and frequency of exercise
- Specific training strategies like HIIT (not long drawn out cardiovascular activity)
All is not lost. You can lose weight, and begin to have a normal stress response. You do, however, need to understand where you are right now so that you can start making changes today.
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