Recently, I interviewed Louise Digby, and we discuss the challenges women in perimenopause and menopause face in losing weight, how thyroid issues impact weight management, why she focuses on addressing underlying health imbalances, the need for adequate protein, fat and carbohydrates in every meal, how to manage sugar cravings, why we need to heal the gut, whether intermittent fasting works, practical steps for starting your weight loss journey, and more. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
I am very excited to chat with Louise Digby, as we will be talking about some of the different factors that can make it difficult to lose weight. There are definitely a lot of different factors. Very excited to have this conversation.
Let me dive into Louise’s bio: Louise Digby is a registered nutritional therapist, women’s weight loss expert, and founder of the Nourish Method to lasting fat loss. Her clients come to her after struggling to lose weight despite eating well and working hard to burn the fat. Louise transforms her clients’ health by identifying and addressing each individual’s unique needs and imbalances, so they can lose weight, optimize their health, and rediscover their sparkle without restrictive dieting or the need for superhuman willpower. Thank you for joining us, Louise.
Louise Digby:
Thank you so much for having me. It’s great to be here.
Dr. Eric:
I’m really excited to talk with you about some of the different things that could make it a struggle to lose weight. A lot of people, as we both know, focus on diet and exercise. We’ll definitely talk about some of that. Many times, it goes beyond just cleaning up your diet and exercise. Before we do that, if we could get a little bit more of your background. How did you start focusing on helping other women lose weight?
Louise:
I graduated in nutrition back in 2012. When I first started, I was seeing everyone and anyone, whatever their health goal or problem was, be it IBS, depression, or eczema, you name it. What I found is that pretty much everyone who I worked with also wanted to lose weight as a side goal. I also had people come to me just for weight loss, not for any other issues or conditions.
What was interesting was that the people who were focusing more on their health and addressing their underlying imbalances actually got way better results when it came to the weight loss side of things than the people who were just focusing on their weight and who were doing more portion control when trying to come up with creative ways to eat less and exercise more.
I also noticed there was a particular group of people—women in their 40s and 50s—who were super disciplined and trying really hard to keep in shape and lose the weight but really not seeing very much progress at all.
I ended up gravitating toward that particular area because it was a bit of a conundrum. It was really frustrating to see these women trying so hard and not really getting anywhere. That helped me to formulate my approach of looking deeper than just how much someone is eating and how much they’re exercising and uncovering the underlying imbalances that affect metabolism and hormones and cause weight to become stubborn, particularly around that time of perimenopause and menopause.
Dr. Eric:
One of the questions I wanted to ask you was some of the biggest mistakes women make when trying to lose weight. You mentioned trying to restrict calories, maybe overtraining. Any other common mistakes that women make when trying to shed pounds?
Louise:
What goes hand in hand with cutting calories and cutting things out is ignoring what your body actually needs. Your typical diet approach just looks at what do I need to avoid? What do I need to cut out? What are the bad foods?
Instead, I find it so much more helpful and a much more positive experience to focus on what your body actually needs to thrive and function properly. Focus on what we need to add into the diet rather than what we need to take out, which might mean looking at: Are you getting enough protein? Are you getting enough carbs?
So often, many of us go straight to cutting out carbs, but they have a function, they have a place. Taking them too low in some circumstances can actually make you gain weight. Making sure you have enough fat, and you are meeting your nutrient requirements are all key things we want to make sure we have in place so our body is able to repair and stay in balance.
You also mentioned overtraining. This is a really key point because most of the women that come to me are trying really hard to lose weight. Sometimes, that looks like being in the gym every day, doing spin classes constantly, doing really long runs or lots of high intensity cardio. That can actually drive up your cortisol levels (stress hormones), which can lead to your storing more fat around your middle. Sometimes, we actually need to scale back the exercise a little bit and essentially take a much more gentle, nurturing approach to weight loss rather than the punishing, deprivation approach that we have been taught.
Dr. Eric:
That makes sense. I want to go back to the carbohydrates. You mentioned some people restrict carbohydrates too much. Obviously, a ketogenic diet is a proponent of doing that. Some people do okay with keto. Not to say people never lose weight when following a ketogenic diet, but it’s not a perfect fit for everyone.
I want to talk about protein as well. When it comes to carbohydrates, does it depend on the person? Or for most of the people who see you, do you recommend not to go below a certain amount?
Louise:
It definitely depends on the person. Particularly if someone has a thyroid issue or if they are very highly stressed, then it’s probably not a great idea to take carbs too low. They are very active. It’s helpful to have at least some carbs in your diet. As to what that specific amount is for each person, it will vary, but I think avoiding taking it below 50-70g per day is best for most women I work with. Taking carbs too low is something that halts their progress.
Like you said, some people do quite well on the ketogenic diet. I have a lot of women come to me who have done well on the ketogenic diet, and then the progress is stopped. The weight has become ultra-stubborn. Just because you’re getting results initially doesn’t mean it’s necessarily the right approach for you in the long term.
Some people have good success with taking a hybrid approach, where they switch between doing keto for a week and doing more of a low GL approach for a few weeks and then back into keto. That can work better. Also, if you know your thyroid is functioning okay.
Dr. Eric:
I agree. Even if keto is working, it’s not in my opinion a long-term solution. You don’t want to stay on keto for long-term. It’s not a permanent diet. Some people might have success losing weight. After a while, it might plateau. There are concerns about the effects on the gut microbiome if you follow keto for quite a long time. I appreciate you bringing that up.
You mentioned thyroid. If someone has a thyroid issue, you want to be careful about doing keto. I know you had some other episodes on other podcasts where you spoke about thyroid and weight gain. What relationship have you seen between those with thyroid conditions and the struggles they have with losing weight?
Louise:
Your thyroid is the master controller of your metabolism. It controls the speed of pretty much everything that’s going on in your body. If your thyroid is underfunctioning, or if it’s sub-optimal, then everything is going to slow down, including fat burning and energy production.
What I so often find is that a lot of people, particularly women, have been to the doctors, have their thyroids tested, and been told it’s absolutely normal. Don’t need to worry about that. There are a few problems with that because the tests that are typically done at the doctor’s, particularly here in the UK, and I think it’s probably the same where you are, are very basic.
They just look at TSH, which is the signal that your brain sends to your thyroid to tell it how hard to work. That is not actually testing the output of the hormones from your thyroid. Occasionally, if you’re lucky, you might get your T4 tested as well, which is your main thyroid hormone. Again, it’s still not enough information for us to see whether the thyroid is working properly. There are other hormones and factors that can be tested. It’s not a full picture.
Also, the ranges that your doctors are looking at for your TSH and T4 are very wide. In terms of what is considered to be optimal, it’s a much narrower range that we should be looking at. Very often, people are coming to me with their thyroid being ruled out, but actually, their thyroid isn’t optimal. When we do a more in-depth test, we see there are other factors like T3 or antibodies that are not where they should be. That can have an impact on your metabolism and how your body burns and stores fats.
Dr. Eric:
Definitely agree about the optimal ranges. Most doctors aren’t paying attention to them. Same here with a lot of doctors just looking at TSH. Some do TSH and total T4 or free T4, but a lot of doctors still don’t do T3. Some will do antibodies. Usually, they’ll do antibodies maybe one time and won’t monitor them at all.
As we both know, the treatment is usually the same regardless, for at least those with Hashimoto’s. Whether or not they have antibodies, it’s usually thyroid hormone replacement, if the TSH is outside of their lab reference range.
Most thyroid conditions are autoimmune. The next question I have is about inflammation, as they are typically associated with inflammation. Does inflammation play a role when it comes to struggles with losing weight?
Louise:
Definitely, it plays a massive role. Inflammation is a term that we often hear banded about and never gets discussed in any real detail. Most problems, whether it’s a symptom or a condition, are usually underpinned or driven by inflammation in some way. It’s the same for stubborn weight.
Inflammation can drive insulin resistance. Insulin resistance is something that can basically make it very difficult for us to get into fat burning mode. Inflammation can be disruptive that way. It can also be very disruptive to your hormones. There are many different ways in which our hormones are involved in how we burn and store fat. Inflammation is definitely a massive factor for many of the people I work with.
Dr. Eric:
When you say “hormones,” are you talking specifically about the sex hormones, like estrogen, progesterone, testosterone?
Louise:
I’m really talking about most hormones. Yes, the sex hormones. Also, your thyroid hormones; your blood sugar hormones, like insulin and glucagon. Your hunger hormones. Even your brain chemicals. They’re all involved one way or another when it comes to your appetite, cravings, fat burning, and speed of your metabolism, and inflammation can be disruptive to all of them.
Dr. Eric:
We spoke about thyroid. You mentioned cortisol earlier, like overtraining. There are emotional stressors that can affect cortisol and make it difficult to lose weight. You spoke about insulin resistance and the hunger hormone, like leptin, resistance. How about the sex hormones? How can the sex hormones influence weight gain?
Louise:
When it comes to the sex hormones, the common problem is there can be many different ways in which they are imbalanced. Particularly in women, as they become perimenopausal, estrogen levels often can become dominant. We can have too much estrogen in relation to progesterone. When we have high estrogen levels, that can be disruptive because it can interfere with the way that insulin works. It can interfere with our histamine levels. Histamine is involved in our appetite. That is one of the key ways in which it can drive weight gain.
Progesterone is a very common hormone. As that declines as we go through that perimenopausal shift, or if we are very stressed, our progesterone levels can be suppressed and low. That can make us more anxious, and that can feed into things like comfort eating and those types of not so helpful eating patterns. Some of it is directly related to the way our body burns fat, and some of it is more psychological.
Dr. Eric:
In the UK, do you have access to the DUTCH test, where they look at the metabolisms of estrogen?
Louise:
Yes.
Dr. Eric:
Some people might have normal estrogen levels but have problems with the metabolism of estrogen, which can be a factor.
Louise:
Something that we see quite a lot. A lot of people would come to us with a blood test from their doctors that says that all their sex hormones are as they should be. Again, when you do a more detailed test that looks more at the tissue levels of your hormones and how you’re metabolizing them, there is a lot more information there to work with.
You mentioning the DUTCH test reminds me I haven’t spoken about testosterone, which is absolutely key as well. Testosterone is the hormone that we tend to think about when we talk about men. It’s very key for women as well. It tends to decline over time, particularly during perimenopause and menopause.
Testosterone is so important for us to maintain our muscle mass. Muscle is so important for helping us maintain a healthy weight because it’s metabolically active. The less muscle you have, the fewer calories you burn, whether you’re exercising or resting. The drop-off in testosterone can be a big issue as well.
Dr. Eric:
Sticking on the topic of muscle mass, protein. We spoke about carbs. Getting adequate protein is also important. What do you typically recommend as far as protein intake per day?
Louise:
It does depend on the individual. Generally, somewhere between 20-30g per meal of protein per day is probably good for most people. To clarify that, when I say 20-30g of protein per meal, some people think that means 20g of chicken or 20g of steak. 20g of protein, which might mean a 100g chicken breast or something like that. It’s not about the total amount of the food; it’s about the protein content within that.
Dr. Eric:
What role does the gut microbiome play when it comes to losing weight, trying to have a healthy weight?
Louise:
The gut plays a massive role in weight management. It’s involved in quite a few different ways. Your gut is very closely linked to your immune system. The vast majority of our immune system is in our gut. Your immune system is very much in control of inflammation in your body. If your gut isn’t balanced and happy, the likelihood is that you probably won’t have a healthy immune response. You will be more prone to chronic inflammation. Controlling or making sure that your gut is happy and healthy is important for supporting a healthy inflammation level in your body.
The gut microbiome can very easily become imbalanced with too many bacteria that are not helpful and not enough beneficial bacteria. When the gut microbiome becomes imbalanced, we can have an increased production of toxins. Those toxins can be absorbed into our system. Our body has to eliminate them. The toxins can be damaging and can drive inflammation.
Also, that extra burden on your liver, having to get rid of those toxins can also drive weight gain. Your body has a really clever way of helping to manage a high toxic load if your liver isn’t detoxing as efficiently as it should be.
One of the ways in which our body protects ourselves from that high toxic load is to store toxins away in fat. Your body may actually slow down fat burning or even upregulate fat storage as a defense mechanism to protect yourself from those toxins. That is one very indirect way that the gut is quite linked to fat burning.
The hormones as well. When we’ve used our hormones, we detox them. We process them via the liver, and then we eliminate them via the digestive tract. If there are imbalances in the gut, some of these hormones can actually be reactivated and reabsorbed into circulation, which contributes to imbalances. The gut is very important for those physiological reasons.
There is also a very strong link between the gut and the brain. If your gut isn’t balanced, if it’s not happy, then that can impact your mood, your cravings, your energy levels. When we’re trying to eat well and maintain healthy habits, having a low mood, having low energy are things that are not helpful for that consistency. It also has an impact on the brain, which can be a massive barrier.
Dr. Eric:
How about refined sugars? What impact do they have on the body, including the gut?
Louise:
Refined sugar has a massive impact on the body, starting with the gut. It can feed the less beneficial bacteria and yeasts in the gut, and that can lead them to overgrow and become a source of inflammation, toxins, and digestive issues. Sugar is definitely not a friend of your gut.
If we have too much sugar in the diet, it can drive sugar spikes in your blood. It’s normal for your blood sugars to go up and down a little bit, but we don’t want to be having massive peaks and troughs in those blood sugar levels. When we have big peaks, that can drive up our insulin levels.
To explain it in an overly simplified way, insulin is essentially a fat storage hormone. If we have insulin being released a lot in high levels in the blood, that will drive fat storage and make it very difficult for you to get into fat burning mode. Too many blood sugar spikes can be a problem for that reason.
After a blood sugar spike, there is usually a blood sugar crash. When our blood sugars crash or dip down too low, that is a time where we’re going to be craving sugar and carbs. It will be very difficult to use willpower to resist those cravings because what your body needs to restore the balance of your blood sugars is sugar and carbs. The cravings are pretty intense and very difficult to ignore.
Also, at that time, you might be feeling tired. You might be struggling to concentrate. You might be feeling irritable or hangry. The blood sugar ups and downs are a bit of a recipe for weight gain.
Dr. Eric:
What do you do if a patient comes to see you, and they have these blood sugar imbalances? Maybe they have insulin resistance, and they have these sugar cravings on top of that. Maybe they even have yeast overgrowth, candida overgrowth.
You just said yourself it’s not always easy to say, “Okay, use willpower, and cut out the sugar.” Obviously, we want people to do that, and you will make dietary changes. Do you have people do that gradually? Do you recommend any supplementation to help with that? What is your approach when someone has these strong sugar cravings?
Louise:
Going back to what I was saying in the beginning in terms of focusing on adding stuff in rather than cutting stuff out. The first thing I’d want to add in is protein, making sure that someone is getting enough protein throughout the day, particularly at breakfast. If we can have a good intake of protein for our first meal of the day, ideally with some fat and fiber, that is going to be very satisfying and satiating. It will keep you full for hours.
It will fill you up without causing an increase in your blood sugars too dramatically, which means you won’t have the blood sugar crash later on. That means that later on in the day, you’re not going to have the cravings and the compulsion to eat sugary things or carby things to pick up your blood sugars and your energy levels.
Something as simple as getting protein into breakfast can make it so much easier to make better food choices without you even needing to talk about cutting out sugar or cutting out “bad foods.” That’s the first thing I would think about.
There’re also other things that impact your blood sugars. Not for everyone, but caffeine can be a driver of raised blood sugars. If you’re having a lot of caffeine in the morning, and you’re noticing a slump in the afternoon, where you’re reaching for sugars or that sort of thing, then it could be driven by the caffeine wearing off in the afternoon. Your energy levels plummet because of that.
I’d also be thinking about sleep. If someone is not sleeping properly, then their appetite will be bigger, and they will be more likely to crave carbier, sugary foods. It’s not all about what you eat; it’s also about making sure that you’re getting enough rest and getting good quality sleep.
You’re also taking steps to manage stress because stress is a massive driver of cravings and wanting more sugary foods. Sometimes, it can be a driver because of comfort eating and wanting to self-soothe with those foods and distract yourself from what you’re feeling.
If someone has more of a gut bacterial issue or a yeast issue that is driving their cravings, I’d still start with those other things I just mentioned. They might need a more targeted approach, which is focused on rebalancing the gut bacteria. That can involve lots of different things.
With my clients, I run tests, so we can identify what those imbalances specifically are. Essentially, we want to get them to the point where they have a healthy level of beneficial bacteria and not too much of the other types of bacteria and yeasts. Their gut lining is nice and healthy, and they’re ultimately digesting their food properly.
Dr. Eric:
That makes sense. Start with adding more things. Make sure they get sufficient protein, healthy fats, fiber. Work on sleep and stress management. In some cases, maybe dig deeper with testing to see what is going on in the gut microbiome.
You mentioned histamine earlier in relation to estrogen. I believe estrogen can inhibit the DAO enzyme, which could make histamine intolerance a factor, or at least a contributing factor. There could be other factors as well that can cause a histamine intolerance. How common do you see that in your patients?
Louise:
It’s definitely not a factor for everyone, but it’s fairly common. We see it fairly often. It can become more common in the age group that I work with, so women in their 40s and 50s, because of their estrogen levels increasing in the early stages of perimenopause. It is something we see, and we do have to be aware of.
The interesting thing about histamine intolerance is that it can cause quite a wide range of different symptoms. It’s not always easy to identify it immediately. It is something we’re always looking out for.
Dr. Eric:
I want to talk about intermittent fasting. A lot of people are doing intermittent fasting these days. Some people do a 16-8 fast. Some incorporate 24-hour fasts. What thoughts do you have as far as using intermittent fasting as a potential tool for losing weight?
Louise:
I think it can be a tool; that’s the right word. It’s a tool that is suitable for some people but not for everyone. There is definitely loads of good research on it in terms of not only helping with weight loss but also helping with all sorts of other things, like the health of your brain, lowering inflammation, gut microbiome.
Particularly with the age group that I work with, them being women, it’s something I’m very cautious around because fasting can exacerbate some problems. If you have underlying imbalances and are not supporting them, you haven’t gotten the core foundations in place, if you have a thyroid problem, if you’re very highly stressed, if your sex hormones are out of balance, then sometimes fasting could make that worse, essentially by driving up the stress hormones in your body.
If you are someone who has got a really good foundation in place, if you’re eating in a way that supports your blood sugar, your thyroid, then it can be a helpful thing to add in to enhance your results. When I use it with my clients, we tend to bring it in months into working with them, once we have done the other things that need to be done to properly support their bodies.
As a general rule, I like most people to be having at least a 12-hour overnight. There is lots of good research on that, particularly for supporting brain health and helping to prevent cognitive decline. Some people will do well with extending that fast to 14 hours, 18 hours.
I know some people, not any clients of mine, who only have one meal per day. Some people only do alternate day fasting, where they eat one day, and they don’t the next. It seems to work well for them. Those people are people who have a very strong foundation in terms of their eating a really good, balanced diet in the first place.
Dr. Eric:
If someone is alternating every other day, are they getting enough protein? Even if they’re not alternating 24 hours, but I’ve had people where they’re fasting for 20 hours every single day. Same thing. It’s a small eating window, so are you getting enough nutrients overall? On top of that, enough protein?
It makes sense what you said. You don’t have everybody do intermittent fasting. If anything, usually you’re doing things to balance the thyroid, balance the adrenals, lower their stress levels, incorporating the foundations. Maybe having them do a minimum of 12 hours, which is reasonable to have most people do that. If you have people do 16 or 18 hours, you want to make sure they’re ready, and their body can handle it. That’s what it sounded like you’re saying.
Louise:
Yeah, exactly.
Dr. Eric:
Going back to exercise. We don’t want people to overtrain. What type of exercise do you typically recommend for someone who is trying to lose weight?
Louise:
It’s good to do a variety of exercises. All different types have different benefits. The thing I want to make sure people are definitely incorporating is strength training.
Going back to muscle mass. We want to make sure we are taking steps to maintain muscle, if not build muscle, so we can make sure we are maintaining our metabolic rate. If we’re losing muscle, we are reducing our metabolic rate, which is going to, in the long term, lead to the weight going back on. Most of that weight going back on being fat tissue. Strength training is absolutely key.
Gentle exercise as well: walking, swimming, Pilates, yoga, things that are good for us because they get the blood pumping, and they move our bodies in terms of mobility and strength. They’re gentle enough to support your body in relieving stress and lowering those cortisol levels.
Dr. Eric:
Variety, it sounds like. Weight-bearing exercise, resistance exercise are important, which I agree.
Speaking of variety: going back to diet. We spoke about intermittent fasting and the pros and cons of keto. Do you, for most people, then recommend to have a good variety of plant-based foods as well? A decent amount of vegetables? Are you more toward a carnivore diet? It sounds like you’re not more carnivore. What dietary factors do you incorporate or recommend to your patients?
Louise:
Eating a diet that has a wide variety of different plant-based foods. Not necessarily vegetarian or vegan. I think it’s fine to include good quality animal protein into your diet. Making sure that we have plenty of plant-based foods and a good variety. Unprocessed as well.
I don’t like to tell people to cut anything out because I think that we can still eat the foods we want to eat and be healthy and move toward our health goals. But one thing that I do feel we need to minimize as much as we can is ultra-processed foods. They are so devoid of nutrients. They are so addictive and moorish.
The ingredients that are in them are made in a lab. They’re not even defined as foods. I can’t remember what the term that was coined was, but something like “food-like substances.” They’re ingredients that are incredibly highly processed. They turn your stomach when you read what they actually do to the foods to turn them into ingredients. They’re not familiar to our bodies, so they can be very disruptive to the microbiome and inflammatory. They don’t actually fill you up, so you are more likely to overeat with them.
If you are going to limit anything in your diet, I would be looking at replacing those ultra-processed foods with whole foods.
Dr. Eric:
Makes perfect sense. Is glyphosate a big problem, or as big of a problem as it is here in the United States? I’m thinking maybe not.
Louise:
I don’t think it’s as big of a problem. It’s always difficult to know because a lot of our stats and facts come over from American research. We’re aware of it, and we recommend people eat organic, particularly organic soy and wheat, if they are going to have wheat. Avoid things like glyphosate. It is very concerning.
Dr. Eric:
Okay. Anything else that I should have asked you that I didn’t ask you? If not, for those who want to get started, what are some things they can do on their own? In a perfect world, they’d be working with someone like yourself. But if someone wants to get started, what are some steps they can take to get on the road to losing weight?
Louise:
The only thing I would add is we are obviously talking about a lot of these imbalances that can cause stubborn weight. These are not things that are a death sentence. They are not things that are going to stop you from getting to where you want to be. They are not an excuse either. They’re things that we can take steps to address. It doesn’t mean that you can’t do anything. It just means your approach needs to be a little bit different to what you’ve been taught in terms of dieting before.
In terms of what you can do to get started, I would make sure you are not overcomplicating things. A lot of people jump straight to things like fasting or meal replacements or supplements. Actually, it’s the simple things that make the biggest difference not only to your weight management but to your health and how easy it is to sustain those changes as well.
We have been talking about making sure you are getting enough protein. That is the best place to start for most people. It sounds like a simple thing to do, but it can take a little bit of effort and planning to make sure you are getting enough protein into all of your meals.
I would start there, alongside other simple things like making sure you’re drinking enough water, making sure you’re getting a variety of different plant-based foods in your diet, making sure you’re sleeping enough, taking steps to manage stress and relieve stress. Doing those things will probably put you ahead of most other people in terms of what people are doing to support their health. On top of that, I’d add in to do some strength training as well.
Dr. Eric:
Wonderful. Louise, where can people find out more about you?
Louise:
If you want to connect with me online, you can find me on Instagram or Facebook by searching @LouiseDigbyNutrition.
My website is LouiseDigbyNutrition.com. On there, you can read about my Metabolism Masterclass that I run very regularly. It’s a free masterclass, where we go a little more into my philosophy and what I do with my clients to get results.
You can also read about my program, which is the Nourish Method, which is what we have been talking about in terms of when I do testing and put together a personalized action plan for each person to get them to their goals.
Dr. Eric:
Also, you have your own podcast, The Thriving Metabolism.
Louise:
Yes, that’s right. If you search for “The Thriving Metabolism” on any podcast platform or YouTube, you will find that there. We really delve into the subjects that we have been talking about today.
Dr. Eric:
Awesome. Thank you so much. This was a really great conversation. I’m sure the listeners learned a lot. I learned a few things as well.
Louise:
Thank you. It’s been great.
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