|Dr. Jack Kruse|
Here are the basics:
1. First, make sure you really are Leptin Resistant (LR) to begin with.
The easiest way to do so, if you're heavy, is to look in the mirror. If you're overweight, you definitely are LS. If you still have a large appetite and crave carbohydrates, especially at night, these are also signs that you are likely LR. If you are fit or in decent shape and not sure based upon the above symptoms I would tell you to go get a blood test and check your Reverse T3. If you are LR, it will be elevated. I also recommend simultaneously checking a salivary cortisol level. With LR, you will always see higher cortisol levels later in the day.
2. To regain LS follow a strict paleolithic diet as outlined in The Paleo Solution or the Primal Blueprint.
The type of fuel is important in eliminating the foods that cause Leptin receptors to become nonfunctional. These two books clearly outline a solid reference point to achieve this.
A. Try to eat as soon as possible upon rising in the morning. Make sure that breakfast has little to no carbs and has a lot of protein and fat. I use, as a general rule, 50-75 grams of protein with most patients. Some patients can use less and some need more. The key point of knowing how much for you is your hunger later in the day. If you remain ravenous you need to eat more protein in the morning. If you can hold off eating until dinner, you probably are at homeostasis for you. If you can skip both meals your likely are overdoing it at breakfast. As for sources of protein, I suggest pastured or organic eggs first, then leftover dinner scraps of grass fed meats/poultry/fish and a third option would be whey protein or protein shakes.
B. Try to limit carb intake to 25 grams if your are overweight by greater than 30 lbs. If you are fit and have a small amount of weight to loss (less than 30 lbs) you can titrate up your carb loads. Even then, I do not advocate potatoes or rice as some paleo diets allow for. You will be able to eat them eventually, but try to avoid starches until you have mastered your cravings and hunger. Do not count calories. It is not needed at this point. Any time I eat carbs, I use liberal amounts of butter, heavy cream, coconut oil and palm oil. I do not recommend other oils initially like olive oils or industrial seed oils. I would also avoid nut oils at the initial stages. My personal favorite is coconut oil because of the great metabolic effects of MCT and how it helps heal the guts of LR folks.
3. How you eat that fuel is MORE IMPORTANT than any other factor including the food itself.
A. Never snack at all. This is meant initially and forever. Snacking completely stresses the liver’s metabolism and is just not recommended. Your liver needs to relearn how to use gluconeogenesis normally again when you sleep and awake. Snacking just destroys timing and circadian clocks that work in unison with Leptin.
B. Try to eat three meals per day initially, but as your hunger and cravings fade, you can adapt to two meals per day.
C. Try to eat breakfast as early as possible from rising.
D. Do not work out before or after breakfast.
E. Try to allow 4-5 hours between dinner and bedtime.
F. If you decide to incorporate working out, do it after 5 PM.
G. Within an hour of sunset try to make your surroundings as dark as possible.
H. If you have trouble falling asleep, I suggest 3-5 minutes of body weight exercises right before bed (push ups or air squats are fine). Avoid this if your PM cortisol are high.
I. If you're inclined to, try becoming mindful when you first lay down. I use transcendental meditation techniques to help me clear my mind and concentrate on improving my thinking. (Optional, but is awesome if your PM cortisol are high)
4. Most people will notice a change in their cravings and hunger within 4-6 weeks.
Other changes I ask of my patients is to supplement with prescription-grade fish oils. The dose depends upon their HS CRP and salivary cortisol levels.
5. Signs that you are becoming Leptin Sensitive (LS) again:
Men will notice quick weight loss. Women will notice mood changes first (calmer/sleepy), and their sleep will improve. Their clothes will fit differently, but weight may not change drastically initially because of effects on the pituitary. This will change, too, if they continue moving forward. Both men and women: You will notice a change in your sweating pattern. You will also notice you have better recovery from exercise and your energy levels seem to have risen. Your hunger is gone and so are your cravings. And when you awaken you will feel very refreshed like you slept well. Generally, when the signs are all present, I then really push HIIT exercise with heavy weights.
I had a couple of questions of Dr. Kruse, so I posted them on his blog. Here was my first post:
My reverse T3 is elevated, but my cortisol is not elevated in the evening, by blood and saliva tests recently. I have 15 pounds to lose that just won’t budge even after eating low carb for 2 years and Paleo for the past year. My body fat is 35%. I am a 55 year old female, peri-menopausal and on bio-identical thyroid, progesterone and testosterone. With elevated T3 and normal cortisol, could it still be LR?
Here is his answer:
If your Reverse T3 is up and you have 35% body fat, there is no doubt that you're Leptin Resistant. I'll bet that you likely have Pregnenolone Steal at the same time to get that result. 25 grams of carbs it is until your Reverse T3 falls and weight loss starts.
I also asked him this, but I have not had an answer yet:
Thank you so much! I guess that 25 carbs is total carbs and not net carbs. Lately, I have only been eating 80 grams of protein per day, split evenly between lunch and dinner – I have been skipping breakfast all together. I see that you say not to do that.
I have been thinking that it was too much protein that was causing the high body fat, and that is why I have cut it down to 80 grams. (I am only 5’3″ tall). I have never eaten more than 25 net carbs per day. I noticed that you said that people should eat 50 grams of protein within 30 minutes of waking, but that some people need less than that. I’m afraid that if I start eating higher protein, I will gain weight. By the way, I do not have carb cravings. I do, however have a huge appetite for a woman my size. I always feel like I want more to eat. I do not snack – I only eat at meals. I do not eat after dinner.
I already lift weights (HIT), but I only do it once a week and I will start doing that after dinner per your suggestion.
I guess my main concern is that if I increase my protein I will start gaining again. How is a person to know if they are one of the ones who needs less than 50 grams of protein at breakfast? Do you suggest that I just jump in and give it a try with the 50 at breakfast and then lunch and dinner without counting grams except for carbs to keep it under 25?
So here is what I am going to do, and I'm going to try to stick with it for eight weeks:
Eat 50 grams of protein with liberal fat and little to no carbs for breakfast, immediately upon rising.
Eat a normal lunch, limiting total carbs to 12.
Eat a normal dinner, limiting total carbs to 13.
Eat nothing between meals.
Eat dinner no later than 6 pm.
On weight lifting days, do it after dinner.
Try really hard to be in bed reading by 9-9:30 pm and lights out by 9:30-10 pm.
As I mentioned, I did this for the first time today. I have not been hungry. I will post my menu tomorrow as part of my Daily Stats and Menu.