Get to know your hormones
“Most people would like to have more energy and be leaner,” says Prof David Ray, an endocrinologist at the University of Oxford who also provides NHS services. “There is a connection between how we choose to live, what our bodies look and feel like, and the hormones that are going around the body. What endocrinologists deal with is disorders of either a lack of hormones, or too much of a hormone.”
Hormones impact almost all bodily functions, from skin, to the gut, to our moods. “During an average day, the hormones in our body will vary depending on what time it is and what we’re doing,” he says. “For example, have we recently had something to eat or are we hungry? Are we having a stressful day or a calm and quiet day?”
Be mindful of your metabolic rate
“Metabolic rate refers to metabolism, which describes how the body uses different components from the foods that we eat and turns those into all the various things that it needs to fuel the body, build proteins and other essential molecules,” says Dr David Cavan, a consultant endocrinologist specialising in diabetes and weight management at University Hospitals Dorset and the London Diabetes Centre, and author of A Guide to Weight Loss Injections, published on 29 January. “If you have a very slow metabolic rate, then you will use up less energy and gain weight more than if you have a faster metabolic rate, in which case you’re burning the energy up more quickly.
“Insulin regulates glucose metabolism and levels of sugar in the blood,” Cavan continues, “but if we have too much insulin in our body, it can lead to weight gain, high blood pressure and type 2 diabetes. Critically, because insulin is a fat storage hormone, high levels of insulin actually slow down the metabolic rate, and you get into a vicious cycle. The slower your metabolic rate, the less energy you use [and] the more you can store.”
According to Cavan, it is no surprise that the huge increase in obesity, type 2 diabetes and related conditions in the last 30 years has happened at the time that our food environment has been transformed by ultra processed foods high in energy, sugar and refined carbohydrates – leading to elevated insulin levels. Matters are made worse by the reduced physical activity characteristic of modern lifestyles – which means that while we consume more energy, we use up less.
Don’t rely on weight loss jabs alone
Weight loss injections influence the levels of hormones that affect metabolism in a number of ways, says Cavan: “They slow down the rate at which food is absorbed from the gut, and affect the brain and satiety. The net effect is that insulin levels will begin to come down and help people to lose the excess fat that they are storing.”
At present, “they are very restricted on the NHS, so most people are buying them privately through online pharmacies”, says Cavan. “Some people seem to get quite a lot of support, others get none at all. I would encourage people, if they are buying them online, to make sure that they’ve got access to good quality information about how to increase the dose and manage side effects.”
Up your protein
“If you have metabolic syndrome – which is characterised by being overweight, and brings an increased risk of pre-diabetes or type 2 diabetes, high blood pressure and sleep apnoea, the underlying problem is too much insulin,” says Cavan. “The trouble is, every time you eat carbohydrates, whether it is sugar or starch, it increases insulin. Moving away from carbohydrates is tackling the root cause and is so important. That is why I encourage my patients to base their meals on protein and vegetables first and foremost, rather than carbohydrates.” Cavan suggests a focus on natural or minimally processed proteins including meats, fish, cheese, pulses, tofu, plain Greek yoghurt and eggs. “So many people are still under the impression that eggs are unhealthy, even though it is more than 20 years since the advice changed,” he says. “Eggs are very nutritious, high in protein, contain almost zero carbohydrates and are very filling. It is a natural fast food.”
Dr Anjali Amin, an endocrinologist at Imperial College healthcare NHS trust, has researched the effect of protein on appetite regulation and says that a high protein diet may be helpful in the control of our appetites: “It is not going to boost metabolism but, from an appetite and energy perspective, it is the macronutrient that makes people feel most full.”
Get lifting
“It is not just about what you put into your body – it is what you do with all that energy you are consuming,” says Amin, which is why exercise, especially resistance training, is advisable to improve muscle mass. This is helpful once women enter menopause, she explains. “Their levels of oestrogen decline which impacts bone health. Resistance training helps strengthen muscle and bone.”
“Very simple strength training to maintain your muscle bulk is helpful,” agrees Cavan, “and that can be as simple as doing some squats or press ups.” This is “particularly important for people on weight loss injections, because we know that about 40% of the weight lost is muscle”. Exercise isn’t the route to weight loss itself though, as Cavan explains: “I say to people, ‘If you want to lose weight, then exercise does not do it. Focus on what you eat,’” which many of his patients find surprising. There are some caveats: “I encourage people to walk as much as they can, because moving does burn off more energy than if you’re sitting down.” If people are very overweight, there is a real risk of injury through exercise, and it can also increase appetite, Cavan adds.
Work in an inefficient office
“Studies have shown that if we sit down for longer than an hour, our metabolism goes into a sort of ‘sleep mode’ to conserve energy, like a computer,” says Cavan. “I encourage people not to sit down for longer than an hour: get up, move around. If you work in an office, make it as inefficient as possible, so you’ve got to get up or walk to the other side. Literally any excuse to get on your feet can really help.”
Sort out stress
Dealing with stress plays an important role in managing weight. “Cortisol is the body’s stress hormone and it has metabolic effects,” says Cavan, “not least on pushing up your glucose and insulin levels, so it worsens metabolic health. Any type of stress can increase cortisol levels, be it emotional or work-related, which adds to metabolic ill-health.” Stress can also lead to comfort eating, he says: “It drives hunger and we can crave sugar if we are stressed. Poor sleep adds into that, because when we sleep, cortisol levels naturally go right down, which is key to a healthy metabolism. But if your sleep is disturbed, or if you’re not sleeping, they stay up, promoting poor metabolic health.”
Prioritise sleep
“Circadian rhythm is fundamentally tied to the regulation of energy metabolism,” says Ray. “People often don’t realise how much sleep is necessary for adults: between seven and nine hours a night. If you consider yourself, or ask your friends if they are getting seven to nine hours sleep a night, you’ll find that at least 50% won’t be. This is an immediate, highly prevalent cause of poor health and can lead to an increased risk of disease. If you’re not sleeping well, and you’re very tired during the day, that affects the kind of food you choose to eat and how full you feel after eating, which can lead to weight gain that further disturbs sleep. The heavier you are, the worse you sleep, and there are hormonal consequences that flow from that.”
“We all know the consequences of trying to live against our circadian clock,” Ray continues. “If you’ve ever had jetlag or worked a night shift, do you remember how horribly disruptive it is on how you’re thinking, your appetite, what you want to eat and when you want to eat? About one in five in the UK work some form of shift; as in, working outside core work hours – either early starts, late finishes or a night shift. And we know that increases, dramatically, the risks of obesity and diabetes. We can take healthy individuals and deprive them of a good night’s sleep for between one and three nights, and we see that their energy metabolism drastically shifts very much closer to the metabolism we see in people with type 2 diabetes.”
Exercising early, in natural light, can have a positive impact on circadian rhythm. “Try to ensure that you get enough physical exercise, ideally in external light,” says Ray.
Dine early
“If your body is busy digesting food, it is going to be difficult for it to get into sleep mode, so eating late at night is not a good idea,” says Cavan. “There are also metabolic health benefits to time-restricted eating, by having a prolonged fast overnight. That is a very effective way of pushing your insulin levels down low, which helps burn off excess fat. You don’t need to go for days without eating. But try to have your evening meal as early in the evening as possible, no later than 7pm, and you can go into a fasting state before going to bed.”
Watch out for signs of an imbalance
Amin says to look out for “unexplained changes” that could be the sign of a hormonal issue: “Persistent fatigue, weight changes without trying, heat or cold intolerance, irregular periods, difficulties getting pregnant or sexual dysfunction, hair loss or unusual hair growth. Diabetes, which may indicate there is a problem with the hormone insulin, can often present with thirst or excessive urination.”
Treatment can initially focus on lifestyle. “Type 2 diabetes can respond well to diet and lifestyle interventions; ensuring a healthy, balanced diet and regular exercise, may have an impact on the hormone insulin,” says Amin. Other treatments include hormone replacement therapy but there are also medications that modify hormone action rather than replacing it – and very occasionally, there are surgical interventions for some hormonal conditions, too.
Use hormone tech cautiously
There has been a rise in home testing tech related to hormones – but how useful is this? “It is great that it increases awareness of hormonal conditions,” says Amin, “but I think it has the potential to oversimplify a very complex system, and you can take things out of context. I use wearable technologies such as glucose monitors a lot with my patients who have diabetes, and they are helpful to understand the changes in glucose that patients get on a daily basis. But in somebody who does not have diabetes, they actually haven’t been shown to have any scientific benefit. In fact, they could promote unnecessary health anxiety and you can end up restricting foods that might actually be quite good for you.”