Optimizing Metabolism

by Ingrid Kohlstadt MD, MPH

Weight

… Don’t Tell Me!

How Women Can Create a Dieting Advantage

Introduction

Women gain weight more easily than men, and shedding the extra pounds is more difficult. In other words, being a woman means double diet trouble. This month’s column gives women straightforward ways to use feminine design to their dieting advantage!

Pay Attention to Appetite

Dieting is about appetite. As humans, we are designed to eat when we are hungry and choose the foods that taste good.

Many people advocate differently, emphasizing willpower instead of appetite. While making healthful choices is important and healthful choices tend to be the more difficult choices in our society, I encourage dieters to put their energy into harnessing appetite, not tightening willpower.

Appetite usually trumps willpower. The brain is designed for appetite to drive our choices. The primary appetite centers of the brain are located in the reflexive, quick-responding old brain. Willpower, in contrast, is located in the higher-reasoning, slow-to-respond new brain, called the neocortex. The rational and reflexive work together most of the time – until we start dieting. Then we can be completely unaware that we ate an entire bag of popcorn at the movies, happened to visit our neighbors just as the steaks are coming off their barbecue, or ate a sticky bun at the shopping mall, completely forgetting our gluten-reduced diet.

What if a few weeks of willpower does not readjust appetite? In other words, if a month of 24/7 vigilance leaves a dieter with her appetite for sweets, salt, saturated animal fats, and calories unchanged? It gets tiring, and there are no willpower reserves for the times when willpower is most needed to prevent overeating, be they due to stress, holidays, onset of menses, smoking cessation, or medication-induced appetite. Dieting can also become pitted against other important activities: Should I resist carbohydrate cravings and feel foggy-brained? Or should I eat chips and chocolate to be fully alert for an executive meeting? I suggest that neither is a solution.

A Woman’s Appetite Is More Complex

Conquering appetite is more difficult for women than men. The appetite centers of the feminine brain are more complex, which makes cravings more frequent and more difficult to satisfy.

A woman’s appetite is hardwired differently than a man’s. The added complexity is likely attributable to a woman’s ability to conceive, bear children, and nurse. Each of these functions requires different amounts of food, nutrients, and calories, which nature has not left to chance alone. In other words, appetite and food cravings are scripted into the brain. And a woman does not have to have children in order to experience the dieting downsides. They come with the XX-chromosome package. One could draw an analogy to my infant son’s high chair. Turn it around and it is a desk. Flip it over and it is a rocking horse. The 3-in-1 design, while perhaps not perfect, is wonderfully clever.

Women can “turn the table” on appetite and use what is holding them back to help them succeed. The following five steps are important to consider. If there is room for improvement in even one area, an appetite-curbing change can lead to dieting success before willpower necessarily runs out.

1. Correct Hormone Imbalances.

A study dating back to the 1970s showed that a woman’s appetite changes throughout the phases of the menstrual cycle. Food intake during the premenstrual phase was 270 calories greater per day than during the preceding periovulatory phase. Estrogens, progesterone, and prolactin are among the hormone messengers that lead appetite through its monthly phases. Among the causes of hormone imbalances are:

• Medications to prevent fertility and medications to promote fertility alter the hormone balance and promote weight gain.

• Diseases such as polycystic ovary syndrome and some forms of liver disease wherein the female hormones are not in balance make appetite difficult to curb.

• Toxins that mimic estrogen can impair hormone balance and are associated with alterations in appetite.

• Mental stress, which elevates cortisol, interferes with the action of hormones in tissue and is one of the ways that stress promotes weight gain.

Restoring hormone balance, usually by addressing the underlying problem and also by lab-guided hormone replacement, can help achieve dieting success.

2. Hydrate

Women are more susceptible to dehydration. In part this is because women, at optimal weight, have a larger percentage of body fat and therefore a lesser percentage of body water. Additionally, menstrual blood loss is dehydrating. New imaging studies may also show that the complexity of the feminine appetite may make women more susceptible to overeating to quench thirst.

3. Detect Autoimmune Diseases Impeding Weight Loss

The feminine 3-in-1 design includes mechanisms that protect the fetus from the mother’s immune system. The immune-gut-brain connections, while not yet well elucidated, may contribute to why women more frequently develop autoimmune thyroid disease. Antibody tests rather than routine thyroid exams and thyroid stimulating hormone (TSH) are needed to detect Hashimoto’s thyroiditis when the disease first reduces energy and alters appetite.

4. Don’t Shut Stomach Acid Down

The human body produces stomach acid at great physiologic cost. Without stomach acid, animals in the wild don’t live very long. So maybe there are some delayed downsides of the nation’s top-selling, acid-blocking medications. Without stomach acid, the gut is less able to absorb protein, minerals, and vitamin B12 from food. While each of these effects on digestion can interfere with dieting, mineral status absorption shapes a women’s appetite. National studies suggest that most women have suboptimal mineral levels: deficiencies in iron, zinc, sodium, chromium, and possibly iodine affect appetite. An increase in appetite is a side effect of lithium (a metal that is not a mineral but a prescription medication), mediated in part by how it alters mineral status. When reducing stomach acid is medically indicated, I suggest the following to restore mineral balance: a diet rich in sea vegetables, nuts, seeds, spices, and herbs; a multivitamin supplement; and sufficient vitamin D for calcium absorption.

5. Avoid High-Intensity Sweeteners

It is currently debated whether high-intensity, artificial sweeteners are associated with certain medical conditions. In these discussions, the more obvious problems seem to have been given short shrift.

First is that artificial sweeteners are so sweet that they overshoot the taste bud runway. It is well established that sweeteners create the market for sweet tastes. In other words, when sweeteners are not available, people respond by eating sweeter foods. Readjusting the palate to a more healthful range of sweet requires willpower, possibly an extra dose of willpower for women and girls. Artificial sweeteners’ safety for the developing brain appetite centers has not been studied. There is precedent for concern. For example, monosodium glutamate (MSG) is now established to increase appetite and promote weight gain.

Also well established is that artificial sweeteners do not promote the uptake of water in the intestines the way that glucose does. Additionally, some artificial sweeteners actively promote fluid loss.

Conclusion

Women have more complex appetite signals, which are more susceptible to

breakage, yet can be repaired. Solution: repairing appetite improves dieting success.

Ingrid Kohlstadt MD, MPH, has been elected a Fellow of the American College of Nutrition and the American College of Preventive Medicine, and is an associate at the Johns Hopkins Bloomberg School of Public Health. She recently completed a two-year appointment at the FDA working in the Office of the Commissioner, and published one of Medscape Public Health’s “Top Ten CME’s for 2010.” Dr. Kohlstadt is the founder and chief medical officer of INGRIDients Inc., editing Food and Nutrients in Disease Management (CRC Press; Jan 2009) and Scientific Evidence for Musculoskeletal, Bariatric and Sports Nutrition (CRC Press; 2006).