Leptin Prescription by Dr. Jack Kruse


1. First make sure you really are Leptin resistant (LR) to begin with.
The easiest way to do this if you are heavy is to look in the mirror. If you’re overweight you definitely are Leptin resistant. If you still have a large appetite and crave carbohydrates, especially at night, these are also signs that you are likely Leptin resistant. 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. 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 Leptin Sensitivity (LS) follow a strict Epi-Paleolithic diet.
The type of fuel you eat is important initially in eliminating the foods that cause Leptin receptors to become nonfunctional.
• Try to eat as soon as possible upon rising in the morning, ideally within 30 minutes of waking. Make sure that breakfast has little to no carbs (less than 50 grams), 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 is right for you is your hunger later in the day. If you remain ravenous throughout the day, 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 you likely are overdoing it at breakfast. As for sources, I suggest pastured or organic eggs first, served with left over dinner scraps of grass fed meats, poultry, or fish. A third option, although less ideal, would be whey protein or protein shakes.
• Try to limit carb intake to 25 grams if you are overweight by more than 30 lbs. If you are fit and have a small amount of weight to lose, (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 or palm oil. I do not recommend other oils initially such as 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 and when you eat your fuel is more important than any other factor, including the food itself.
• 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 re-learn how to use gluconeogenesis normally again when you are asleep and awake. Snacking just destroys the timing and circadian clocks that work in unison with Leptin.
• Try to eat three meals a day initially; but as your hunger and cravings fade you can adapt to two a day.
• Try to eat breakfast as early as possible from rising.
• Do not work out before or after breakfast.
• Try to allow 4-5 hours between dinners and sleep time.
• If you decide to incorporate working out, do it after 5 PM.
• Within an hour of sunset try to make your surroundings as dark as possible.
• If you have trouble falling asleep I suggest 3-5 minutes of body weight exercises right before bed (pushups or air squats are fine, but avoid this if your evening cortisol is high).
• 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 this is awesome if your evening cortisol is high).

4. Most people will notice a change in cravings and hunger in 4-6 weeks.
Other changes I advise 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 (huge clue). 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.
• You will notice a change in your sweating pattern.
• You will notice you have better recovery from exercise and your energy levels have risen.
• Your hunger is gone and so are your cravings.
• 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.