All of you commenters have done your job.  You’ve brought up several issues that I neglected to address in my last post.  Let me address them now.

First and foremost is the question about peri- and post-menopausal hormonal balance.  From long experience I can tell you that it is difficult for many women to lose weight in the peri- and post-menopausal years, especially the peri-menopausal years, without some hormonal balancing. It can be done, but it is more difficult.  MD keeps promising to post on the subject in detail, but right now she’s up to her eyes in another couple of projects that are consuming most of her time.  That time not consumed by her projects is consumed by little ole me, who needs his fair share.

There is a book on balancing hormones that I feel is the best one of the bunch out there right now.  It is by an acquaintance of mine, whom I run into at medical meetings all over the place.  His name is Uzzi Reiss, M.D, and he is the gyn doc to the stars.  I’m not kidding.  He probably takes care of half the peri- and post-menopausal Hollywood crowd.  He has an enormously busy practice.  I pushed him to write a book early on, but he deferred saying that he couldn’t afford the time away from his practice.  But he finally did come out with one.  It was published about 7 or 8 years ago, and so isn’t completely up to date, but, as I said, I think it’s the best of the bunch out there, written by someone who certainly knows what he’s doing.

At the time he wrote this book, he was using Tri-Est, which is a blend of all three forms of estrogen found in the normal female.  MD prefers more estradiol than found in Tri-Est for weight loss purposes; in fact, she, herself, uses only estradiol.  At the time Dr. Reiss’s book was written compounding pharmacies weren’t as common as they are today, so it wasn’t as easy to get estrogen compounded so specifically.  I think for those of you interested, Dr. Reiss’s book will give you a lot of information to get you started on your own quest.  Many women – MD included – started out on Tri-Est and starting fiddling from there.  The most important thing is to work with a physician who knows what he/she is doing to get your hormones working for you instead of against you.

Another subject I left off is sleep.  Numerous studies have shown that more good quality sleep will help with weight loss.  As we age, it becomes more and more difficult to get good quality sleep.  Often regaining the formerly lost weight brings on acid reflux and GERD, which tend to cause awakening in the middle of the night.  And once we get going again on a low-carb diet, we usually get into a little ketosis, which makes falling asleep a little more difficult yet.  There are a few things to be done.  First, the low-carb diet – even the second time around – typically gets rid of the reflux and GERD pretty quickly.  (I’ve got another post that I’ll probably put up next week about a supplement that will knock reflux on its head quickly.)  You can help with falling asleep, which is what most people are troubled with, by doing a couple of things.  First, get some low-dose sublingual melatonin tabs.  These you can dissolve under your tongue as you turn in.  It’s important that you take the melatonin right before you turn out all the lights – don’t take it and stay up and watch TV or read.  You want the room to be dark.  The pineal gland releases melatonin as a response to darkness, and its function is to help you get to sleep.  It has antioxidant properties, along with many other functions, but you will be taking it to sleep.  There is a fall off in melatonin release by the pituitary with aging, which is one of the reasons people have more difficulty sleeping as they get older.  So, try the melatonin if you’re having trouble.   The other thing you can do is to have a cup of herbal tea right before bedtime.  And sweeten the tea with either sugar or honey.  That’s right.  Real sugar.  A teaspoon of sugar is about 5 grams of carb, which won’t do a lot to hinder your weight loss, but it will be enough to shut down ketone production long enough to get you to sleep.  And if you think a teaspoon of sugar isn’t all that much, remember, it’s the total amount circulating in your blood if you have a normal blood sugar.

Another reason people have difficulty losing as they get older is that their livers don’t function as well.  As we get older we tend to have more aches and pains, and we take more Tylenol and Advil and similar OTC medications for them.  These drugs are metabolized in the liver, and, consequently, they consume some of the liver’s capacity.  Same goes for coffee.  No one likes coffee more than I.  But when I want to pick up my weight loss after I’ve gone off the wagon for a while, I cut back on my coffee.  Why?  Because caffeine is metabolized in the liver just like the above drugs.  It also consumes some of the liver’s capacity.  I switch to decaf for a few days whenever I’m getting back on the straight and narrow.  If you can’t stomach the thought of decaf coffee (and I don’t like it, myself) drink decaf Cafe Americano.  (Here is a YouTube on how to make an Americano starring yours truly.)  There is not as much difference (at least to my palate) between decaf and regular espresso than there is between decaf and regular coffee.  Finally, as we age, we tend to drink more.  Most people drink like fish during college, then slack off.  They start to pick it back up (never to college levels, though, thank God) as they drift into middle age.  Alcohol is detoxified in the liver just like caffeine and OTC pain relievers.  All these things add up to put quite a load on the liver.  And if you’ve regainded weight, you’ve probably got some fatty accumulation in your liver and it’s not working at peak levels anyway.  All these added substances that compromise the liver even more don’t help.

Insulin stays in the circulation because it is put there by the pancreas and because it isn’t metabolized in the liver.  A liver that isn’t functioning up to snuff won’t break down insulin as rapidly as it should.  Consequently, higher levels of insulin mean more difficulty in losing weight.  Plus, since the liver is the major organ involved in the entire metabolic process, it works a whole lot better to stabilize everything when it is unhindered by having to detoxify a lot of unnecessary stuff.  Which is why you need to baby your liver when you restart your low-carb diet.

I’m sure I’ve still forgotten some other factors, and I’m sure you all will remind me.  I think I’ve got some of the smartest readers in the blogosphere.  Thanks for chiming in.