Diet tweaks to tackle your tiredness

Lockdown has led to soaring insomnia. Here, a Harvard doctor shares her new hormone-boosting solution

TEN years ago, a car accident changed my life. Nobody was injured but it happened because I was exhausted, preoccupied and juggling a million thoughts at once. Like many women, I was running on empty. In my case, I was raising two children while trying to study for exams and build a career in medicine.

I was overtired, overworked and overextended. I was putting on weight, permanently grumpy and my energy levels were through the floor. It didn’t help that everyone around me told me it was just because I was busy.

Even if you’re not trying to keep on top of work and home-schooling, the chances are you probably feel similarly frazzled at the moment, constantly tired, lacking in energy and piling on the pounds.

And it’s likely that everyone around you is telling you that is inevitable because we are living through a global pandemic and everyone is feeling overstretched and overwhelmed. Fatigue, fogginess, moodiness, it’s all part and parcel of what we’re living through, right? Well, no actually. Ten years ago, I might have accepted this. But since then I’ve done a lot of research and discovered that not only are women more likely to feel this way — one study found that 15 per cent of women reported they often felt very tired or exhausted, compared with 10 per cent of men; and women between the ages of 18 and 44 were almost twice as likely as men to often feel very tired or exhausted — but that throughout medical history, women and their medical issues have been neglected by research.

But not on my watch. I’m a doctor and I’ve studied at some of the world’s most prestigious institutes, including Cornell, Harvard and Columbia. I never planned on this being my area of expertise but, over the past ten years, I have managed to get to the bottom of what is making women feel so perma-tired and developed a way of eating that, combined with a few lifestyle tweaks, can combat it.

I promise that following my plan — which I call the WTF Plan, as in ‘ Why The Eff am I so tired?’ — will change your life in as little as two weeks, improving every aspect of your health and giving you back the energy and spark you thought you’d lost for good.

When I started delving deep into women and tiredness, I came across a condition called ‘adrenal fatigue’. Early in my medical training, I had studied the adrenals — two small glands that produce several hormones, cortisol (the stress hormone) being one of them. But no one teaches you about ‘adrenal fatigue’ in medical school because it isn’t recognised as an established health diagnosis.

When we are stressed, short bursts of cortisol are released into the bloodstream. Advocates of adrenal fatigue claim that prolonged exposure to stress drains the adrenals of cortisol, causing brain fog, low energy, depressive mood, salt and sweet cravings, light-headedness and other symptoms. But actually the opposite happens and when you’re stressed, the adrenal glands keep on producing cortisol.

So what’s happening is a cortisol imbalance. And when you have an imbalance in one of your hormones, you have an imbalance in all of them, which is a problem.

We have many hormones in our body, that act as its ‘ signal system’ and regulate most of its basic functions. Think of the hormone system as a complex and interconnected hormonal motorway, like a big city’s busy road system. In the same way that Rebalancing act: Dr Amy Shah an accident at a roundabout on one side of town can cause traffic congestion miles away as everything backs up, so can one hormone being out of whack affect your whole body. Because our bodies are a complex of connected and integrated systems, dysfunction in hormones has a knock-on effect on other parts of the whole apparatus, including the immune system. Like brave infantry, the cells of your immune system are triggered to fight any invading virus or bacteria. After that inflammation response, the soldiers are supposed to go back to base and turn off the alarm. But in the modern world, for myriad reasons, they never get the signal that the emergency is over — or the threat keeps coming back in the form of toxins. This leads to ‘ negative chronic inflammation’, which sends signals to the brain and the rest of the body that there is a threat. But it’s not just the immune system that is affected by a hormonal imbalance. It’s your gut too, because hormones and the gut have a symbiotic relationship — hormones affect the gut; bacteria in the gut modulate and produce hormones. Gut bacteria not only create hormones, they also help to balance, or bind, excess hormones. When your digestive system is out of kilter, it can affect nutrient absorption, which causes malnourishment and can lead to chronic problems including acid reflux, indigestion, irritable bowel syndrome and more. These three systems — hormones, immune system and gut — work so closely together and are so key to our health that I call them the ‘energy trifecta’: if one is out of balance, your body is working so hard to right itself, it has little energy for anything else. And when this happens over a long period of time, you become susceptible to allergies and disease. The good news is that when you fix one system, the other two will improve — and once things are in balance, your energy levels will shoot up.

THE PLAN

THE WTF plan has a three-pronged approach that focuses on what you eat, when you eat it and easing stress.

WHAT TO EAT: STOP COUNTING CALORIES

THIS health plan is less about counting calories and more about counting fibre. Loving your gut means upping the amount of fibre

and fermented foods you eat. Aim to eat 6-8 servings a day of fibrous foods. Potatoes, ginger, leek and beans, for instance, nourish good gut bacteria, while fermented foods — sauerkraut, kimchee, miso and, if you can handle dairy, yoghurt and cottage cheese — raise the levels of good gut bacteria.

Also look out for what I call gut superfoods because of their nourishing benefits: coconut, apple cider vinegar and turmeric, and magnesiumrich foods including raisins, bananas and spinach.

Eating fibre-rich, prebiotic vegetables such as leeks, artichokes, garlic and asparagus, and cruciferous vegetables such as bok choy, broccoli, brussels sprouts, cauliflower and cabbage will have a tremendous positive impact on your gut and consequently your hormone levels.

But while this diet is predominantly plant-based as well as gluten- free and dairy- free — because we know this is most likely to result in a healthy gut — I also want the plan to be flexible, so if you can tolerate gluten, meat and dairy, adjust it. Just make high-quality choices — buy as fresh and as organic as possible. My rule of thumb is to follow 90 per cent of my plan, eating mostly a plant-based diet with prebiotic foods at every meal, leaving about 10 per cent ‘ wiggle room’ for your own tastes.

SNACK ON POPCORN

SUGAR tends to feed the gut bacteria we don’t want to nourish, so keep your intake of ‘treats’ to about 10 to 15 per cent, or 200 calories (such as 1-2 servings of dark chocolate chips). If you want a snack, choose from the following: 10-15 dark chocolate chips, a small handful of nuts, 100g hummus and carrots, 2 tbsp peanut butter and celery, a small bowl of air-popped popcorn, a small bowl of berries or watermelon.

NO COFFEE PAST MIDDAY

EXCESSIVE caffeine raises your cortisol and slows down your thyroid. It also aggravates acid reflux and gut disorders. That’s not to say you can’t have a cup of coffee or tea, though (and some people are genetically better at processing caffeine than others).

But when you are actively trying to fix your hormones, gut and inflammation levels, try reduced or zero caffeine — and avoid any caffeine intake after noon, when it can interfere with your circadian rhythm.

As for alcohol, drinking moderately — meaning three drinks a week or so — is a way to enjoy wine without wrecking your hormones.

GO EASY ON THE EXERCISE

FORGET the idea of no pain, no gain. Pushing yourself to the limit every day on top of a stressful lifestyle can lower your thyroid function and increase cortisol production and inflammation.

So ease off on long cardio sessions and try yoga and gentler exercise instead. Aim to walk 8,000-12,000 steps outside every day — getting outside and away from screens will ease stress and give you a shot of vitamin D even when it is cloudy.

WHEN TO EAT: TIMING IS EVERYTHING

DIET is as much about when you eat as what you eat. you may have read about the health benefits of intermittent fasting — what I advocate is something less restrictive, called circadian fasting. This means only eating when your body — and gut — is naturally primed to deal with the process of digestion (that is, not late at night).

The idea is for you to stop eating by 8pm and fast for 12 hours. So you’ll have breakfast at 8am, lunch at midday and dinner at 6pm. If you need to shift the hours later or earlier because of your schedule, do so, but try to make sure you don’t eat too late.

The number one no-no is eating late in the evening, which has a hugely disruptive effect on our cells. When you eat late at night, your cells are not optimised to expect glucose at that time.

If you cause cortisol to spike in the middle of the night because you are super- stressed or digesting food, your body can’t do the necessary repairs during its downtime.

getting a good night’s sleep is also key — aim for seven to nine hours most nights, ideally being in bed before 11pm.

Aim to do six days of circadian fasting. Depending on the dayto-day demands of your life, try to fast for 12 hours overnight for four or five days, then take one day off.

Stick to this plan for two weeks and you should notice positive changes to your energy levels, mood and gut. While we know that the digestive tract can change its epithelium (the gut lining) within five to seven days, getting used to a new routine takes longer.

The major changes in your health markers — cholesterol, blood pressure, inflammation and weight — will definitely take longer. So continue on the journey, ideally for three months, if not for ever.

ADAPTeD by Claire Coleman from I’m so effing Tired, by Amy shah (£14.99, Piatkus), out March 2, © Amy shah 2021. To order a copy for £13.19 (offer valid to 8/3/21; UK P&P free on orders over £20), visit mailshop.co.uk/books or call 020 3308 9193.