Your Body in Balance

The New Science of Food, Hormones, and Health


By Neal D Barnard, MD, MD, FACC

Contributions by Lindsay Nixon

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This nationally bestselling book explains the shocking new science of how hormones are wreaking havoc on the body, and the delicious solution that improves health, reduces pain, and even helps to shed weight.

Hidden in everyday foods are the causes of a surprising range of health problems: infertility, menstrual cramps, weight gain, hair loss, breast and prostate cancer, hot flashes, and much more. All of these conditions have one thing in common: they are fueled by hormones that are hiding in foods or are influenced by the foods we eat.

Your Body in Balance provides step-by-step guidance for understanding what’s at the root of your suffering-and what you can do to feel better fast. Few people realize that a simple food prescription can help you tackle all these and more by gently restoring your hormone balance, with benefits rivaling medications. Neal Barnard, MD, a leading authority on nutrition and health, offers insight into how dietary changes can alleviate years of stress, pain, and illness. What’s more, he also provides delicious and easy-to-make hormone-balancing recipes, including:
  • Cauliflower Buffalo Chowder
  • Kung Pao Lettuce Wraps
  • Butternut Breakfast Tacos
  • Mediterranean Croquettes
  • Apple Pie Nachos
  • Brownie Batter Hummus
Your Body in Balance gives new hope for people struggling with health issues. Thousands of people have already reclaimed their lives and their health through the strategic dietary changes described in this book. Whether you’re looking to treat a specific ailment or are in search of better overall health, Dr. Neal Barnard provides an easy pathway toward pain relief, weight control, and a lifetime of good health.


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A Note to the Reader

This book will introduce you to the power of foods to protect and restore your health. It’s easy to put that power to work, and the payoff is huge, as you will soon see! Even so, let me mention two important points:

If you have a health condition or use medications, see your health care provider. Often, people need less medication when they improve their diets. This is common for diabetes or high blood pressure, for example. Sometimes, they can discontinue their drugs altogether. But do not change your medications on your own. Work with your clinician to reduce or discontinue your medicines if and when the time is right.

Get complete nutrition. Plant-based foods are the most nutritious foods there are. Even so, you will want to ensure that you get complete nutrition. To do that, include a variety of vegetables, fruits, whole grains, and legumes in your routine, and I would suggest a special focus on green leafy vegetables. And be sure to have a reliable source of vitamin B12 daily, such as a simple B12 supplement, fortified cereals, or fortified soymilk. Vitamin B12 is essential for healthy nerves and healthy blood. You will find more details here.


Some of the most troubling health problems have a surprising solution. Weight problems, infertility, menstrual cramps, diabetes, thyroid problems, acne, hot flashes, and many others are related to the foods you eat. In each case, whether you know it or not, foods are changing your hormones, making you feel great or terrible, vigorous or lethargic, pain-free or miserable.

The key is this: You can control your hormones—and the problems they cause—by the food choices you make every day. It is surprisingly easy, and I will show you how to do it.

Like many women, Robin had menstrual cramps that were off the scale for a day or two every month, until she learned of a straightforward dietary shift that eased her pain and allowed her to function again.

Elsa had given up on raising a family, until she found that her fertility had been affected by what she had been eating. After tuning up their diet, she and her husband now have three children.

Ray had assumed that erectile dysfunction was his new normal, until an easy diet change gave him back his sex life.

Nancy’s thyroid gland was underperforming, keeping her overweight and fatigued, until she learned a new way of getting back in balance—all based on a menu change.

Kim was chronically down in the dumps with a serious and unremitting depression, but was finally able to lift the black cloud hanging over her when she learned the connection between food and mood.

Twin sisters Nina and Randa were embarrassed about their severe acne, until a nutritional adjustment tackled it nearly overnight.

Nutrition was the surprising answer to Tony’s prostate cancer, Katherine’s endometriosis, Mike’s thyroid problems, Bob’s diabetes, and Mary-Ann’s menstrual misery.

All of these people have something in common: Their hormonal systems had been chronically malfunctioning. Yours may be, too.

So let me encourage you to run—do not walk—to a healthier way of eating. I’ll show you how foods cause hormones to go haywire and how the right foods can fix that.

Hormones? Really?

Your body’s hormones direct how your organs work. Like a conductor directing a symphony orchestra—quicken the tempo or slow it down, more violin, less bass—your hormones turn your metabolism up or down, alter your moods, control your reproductive function, and affect how you store body fat and how you burn it.

The people I described above all suffered from hormone haywire. They had no idea what was wrong, much less how to fix it.

Their answer was in foods. Yours may be, too. Your hormonal systems respond to changes in your diet, and the range of health problems that are caused by hormones—and that can be successfully treated by using foods in a smarter way—is truly surprising. Equally surprising is how fast things can improve with a menu adjustment: Cramps gone in the very first month after a diet change. Fertility restored within a few months. Diabetes starting to improve in a matter of days. While everyone’s experience is different, these are all things we have seen routinely.

Estrogens and testosterone—the female and male hormones—can be ratcheted up or down based on the foods you eat. In turn, that affects fertility for both men and women, as well as a woman’s monthly cycle, menopausal symptoms, and the risk of certain cancers.

Insulin is the hormone that is off-kilter in diabetes, and it also struggles to do its job in women with polycystic ovary syndrome. With the right foods, insulin works much better.

Research also shows that foods can influence thyroid function—which affects weight, mood, the resilience of your skin and hair, and many other aspects of health. We are now coming to understand how to change the diet to get the thyroid gland in balance.

If you thought that erectile dysfunction was caused by performance anxiety, I will show you the real cause and the easy, healthful solution that has nothing to do with pills or gadgets and all to do with what you had for breakfast.

Some of the most serious conditions we face—weight problems, diabetes, and cancer of the breast, ovary, uterus, or prostate—are related to foods that are causing hormone haywire. And for less serious conditions—the health of your skin and whether you keep a full head of hair—hormones play a key role, too. Foods turn the dials on virtually every biological function.

Why Didn’t My Doctor Tell Me?

If you were hoping to learn about these effects from your personal physician, you may end up frustrated. Much of the information we will present in this book is a new scientific frontier. It is possible that your doctor may not have heard of it or may not realize the extent to which problems can be solved with nutritional adjustments.

In other areas, solid research was published long ago but has been ignored by most doctors. Let’s face it: A focus on nutrition takes doctors out of their comfort zone. Part of the blame goes to the chronic lack of nutrition education in medical schools. Another part goes to the fact that most continuing medical education programs are sponsored by drug companies, which have pushed to the sidelines anything that is not sold at the pharmacy counter. This is not a problem just for cramps and fertility, but also for diabetes, heart disease, cancer, migraine, and inflammatory conditions like rheumatoid arthritis, where a diet change can be powerful, even lifesaving.

Sometimes doctors are unduly skeptical about whether their patients are really interested in improving their eating habits—even when their patients tell them loudly and clearly that, yes, they would much rather improve their diets than take drugs for the rest of their lives. Many doctors are much more comfortable with a prescription pad than with a knife and fork.

At the Physicians Committee for Responsible Medicine, a nonprofit organization that I founded in 1985, we are working to change that. Our research is teasing apart the relationships between foods and health and giving doctors and patients new and powerful tools. Our continuing medical education courses, conferences, mobile apps, and books give doctors the nutrition knowledge they need. More and more health professionals are using this knowledge to empower their patients.

It should be said that all the health issues covered in this book are still under active exploration. There are many areas where our scientific journey is far from over. I will share with you what we know now and will also give you a glimpse into the new possibilities that are being tested.

How to Use This Book

Looking at the table of contents, you may be tempted to go straight to the chapter that describes your most pressing health issue. Feel free to do that. But I would encourage you also to read this book from cover to cover—including sections on conditions that may not be yours at the moment—because, as you will see, certain themes emerge again and again. The same nutritional solutions that help cramps or infertility can also have a powerful influence on thyroid problems or even cancer.

My hope is that, with guidance from this book, you will achieve a whole new level of vitality. I also hope that you will pass this information along to family members, friends, and others who can benefit from it.

I wish you the very best of health.

Part I



Foods for Fertility

I have good news and bad news,” Elsa said. She was going to leave our research study, and I could tell she wasn’t the slightest bit sad about it.

When she volunteered for our research, she did not imagine that it would change her life forever. The study was a test of how foods could reduce menstrual cramps. It followed up on my observations that a menu tune-up sometimes makes cramps go away. (More about that here.) Elsa had suffered with menstrual pain for years and was eager to see how a diet change might help.

Like all the volunteers, she was asked not to use birth control pills during the study, because birth control pills are hormones that could obscure the effects of the diet change. That was not an issue for her, she told us. She didn’t actually need birth control at all; she and her husband had long since given up the idea of having a baby. They had been evaluated medically, and the problem was hers. She was infertile.

Joining the study, she followed our advice on how to choose foods, which you will read about shortly. It was not especially complicated. And soon, something unexpected happened.

“Good news and bad news?” I asked. “Tell me! What is it?”

“Well, the bad news is that I have to drop out of the study,” she said. “I’m sorry about that, but the good news is that I am pregnant!

Yes, her so-called infertility was over. She was indeed pregnant and soon gave birth to a beautiful, healthy baby. She never imagined, after all the medical tests, monitoring, and treatments she and her husband had been through, that a simple diet change would set things right.

Years later, I was giving a lecture in the Midwest, and I was surprised to see Elsa in the audience. She had heard that I was coming to town and wanted to let me know how she was doing and to introduce me to her three children.


Katherine grew up in Louisiana. As an aerospace engineer for the Air Force, she was one of the first to be deployed to Iraq in 2003.

In the war, government rations were limited, to say the least. And when Katherine’s tour of duty ended and she went back home to Louisiana, her friends were eager to reunite her with her old favorite foods: cheeseburgers, macaroni and cheese, shrimp, and gumbo.

Not surprisingly, she gained weight. And as time went on, she experienced something else—pain in her abdomen. The pain gradually worsened and came in waves, waxing and waning with her menstrual cycle, returning month after month.

She saw her doctor to try to find out what was wrong. After several tests, her gynecologist recommended a laparoscopy. He made a small incision in her abdomen, inserted a scope, and looked around. And he spotted the cause of her pain. She had endometriosis, a condition in which cells that normally line the uterus have migrated to other parts of the abdomen, where they implant and cause pain that can be excruciating. Because the out-of-place cells become inflamed and can disrupt the anatomy of the ovaries and fallopian tubes, endometriosis can also lead to infertility.

Finding the cause of her pain was one thing. Curing it was another. Typical treatments include painkillers, hormone treatments, and laparoscopic surgery. They may or may not work. When all else fails, doctors can perform a hysterectomy.

Things were not going well for Katherine. The pain worsened over time to the point where she was essentially out of commission for a day or two every month. None of the treatments helped. Eventually she had to make a decision. Although she and her husband had hoped to raise a family, she could not live like this, and she scheduled a hysterectomy.

But before she had the surgery, a friend made a helpful suggestion. Why not try a diet change? After all, foods can influence the body’s hormones, which is why many women with breast cancer change their diets. Maybe it would work for endometriosis, too. So, she made an appointment for some nutrition guidance and revamped her diet. Following her nutritionist’s advice, she eliminated animal products and explored the world of vegetables, grains, beans, and fruits and all the meals they turn into.

Her new foods turned out to be tasty. But more importantly, she started feeling better. She lost weight, her energy improved, and the pain started to loosen its grip. With each passing week, she felt more like her old self.

Six weeks later, her doctor repeated the laparoscopy. Again, he made a small incision in her abdomen, inserted the scope, and carefully looked around. He then sewed up the incision, sent Katherine into the recovery room, and walked out to the waiting room to find her husband. The doctor explained that, to his surprise, her endometriosis was practically gone. So much so, in fact, she no longer needed a hysterectomy at all.

Her husband was not so surprised. He told the doctor about how Katherine had revamped her diet and how it had helped her enormously. She had been feeling better and better.

The doctor was having none of this. Foods do not cause endometriosis, he explained. And there is no way that a diet change could make it go away. There was only one possible explanation, the doctor said. This was a miracle!

Katherine laughs about that today. But it did feel pretty miraculous. She lost fifty-five pounds in six months, her pain went away completely, and her emotional ups and downs smoothed out, too. Most miraculous of all, she never had the hysterectomy. She and her husband now have three children.

Foods and Fertility

This may not be a time of life when fertility is an issue for you. And these days, many people are opting not to have children anyway, because of time, finances, concerns about overpopulation, or other reasons, and the days when people were pressured to have children have mostly gone. Nonetheless, let me encourage you to read this chapter, as its lessons extend to many other conditions as well.

In theory, fertility is simple. An egg from Mom meets a sperm from Dad, and they cozy up in a place where they can unite and grow. But things can go wrong, both for Mom and for Dad.

For about 10 to 15 percent of couples trying to conceive, it just does not happen after more than a year of trying. Many spend a fortune on medical evaluations and treatments of all kinds. Beyond the financial cost is the burden of medical visits, examinations, treatments, and the risk that romance will turn into a sterile medical exercise.

The most common reason for infertility in women is a lack of ovulation. The ovaries are stubbornly refusing to release an egg. For men, abnormalities of the testes, the hormones that control them, or the ducts that carry sperm along can all limit fertility.

There can also be problems with bringing the egg and sperm together: At the bottom of the uterus, the cervix admits sperm while, at the top, the fallopian tubes are where the egg is fertilized. Sometimes these structures do not form properly. Other times, infections interfere. Or perhaps trauma or other abdominal problems intervene. Yet foods have surprising effects on fertility for both men and women. And if food choices are causing the problem, the solution can be straightforward. Let’s start with ovulation.

Foods and Ovulation

The ovary is an amazing structure. One of the most amazing things about it is that, by the time you were born, your ovaries were already developed, with millions of eggs just about ready to go. That’s right. While you were still a baby in your mother’s womb, your own tiny ovaries had already developed the eggs that could become your babies. That means that things your mother was exposed to during pregnancy could easily have affected you, your ovaries, and your eggs.

During your reproductive years, your ovaries are ready to release an egg each month. But that process is easily derailed. If your hormones are out of balance, ovulation may not occur at all.

Millions of Hormone Factories

Pinch a bit of flesh on your thigh. If you could reach into your thigh and pull out one single fat cell and examine it, what would it look like? We tend to think of fat cells as lifeless little bags of stored calories. The truth is very different. Fat cells are busy hormone factories. Every minute of every day, they crank out hormones. Starting with hormones produced by your ovaries and adrenal glands, fat cells turn these raw materials into the male hormones and female hormones that control your basic biology.*

The more body fat you have, the more hormones they produce. That can get your hormone balance out of kilter and interfere with your fertility.

Having extra body fat will not help your fertility one bit. In Harvard’s Nurses’ Health Study II, researchers examined fertility in a large group of women, based on their body weight.1

Fertility was greatest for those who were a bit on the thin side of the normal weight range. At even slightly higher weights—even for women within what we would consider a healthy body weight—infertility was more common. For seriously overweight women, fertility problems were nearly three times more common.

The reason, we believe, is that fat cells cause hormones to go haywire. They actually do this in two ways:

First, as we have seen, fat cells produce extra female sex hormones (estrogens) and also extra male sex hormones (androgens) and send them into a woman’s bloodstream.

Rich-Edwards JW, Goldman MB, Willett WC, et al. Adolescent body mass index and infertility caused by ovulatory disorder. Am J Obstet Gynecol. 1994;171(1):171–177.

Second, body fat reduces the amount of sex hormone–binding globulin, or SHBG, in the bloodstream. SHBG is a very helpful protein molecule. It circulates in your bloodstream and holds on to sex hormones, keeping them inactive until they are needed. Think of SHBG as a fleet of microscopic aircraft carriers and estrogens as tiny fighter planes. So long as the “planes” stay on the “carrier,” they remain inactive. If you have plenty of SHBG in your bloodstream, your sex hormones will not be overactive, and that is good.

So if your fat cells are producing extra hormones and, at the same time, are reducing the amount of SHBG that would rein those hormones in, you’ll end up with too much hormonal activity. So carrying extra weight can reduce fertility.

That said, thinner is better only up to a point. Below a BMI of about 18 kg/m2 (i.e., 108 pounds for a woman who is five-five), infertility starts to creep upward again. Being overly lean can lower estrogen levels too much and can shut down ovary function. So for optimal fertility, it helps for heavier women to lose weight and for overly thin women to gain weight.

Getting your body weight into the right zone will help fertility. Here, I will show you how to do it.

Fiber for Fertility

If excess hormones cause problems, can you get rid of them? The answer is yes. In fact, your liver is trying to do that for you right now. All day long, your liver filters your blood, removing things that do not belong there: toxins, medications, and other things, including hormones. Your liver sends them into a small tube, called the bile duct, which leads to the intestinal tract. There, fiber soaks them up and carries them out with the wastes. You are literally flushing away unwanted hormones.

There is plenty of fiber in beans, vegetables, fruits, and whole grains, and this healthy fiber escorts unwanted hormones out of your body. But animal products do not have fiber. If chicken, fish, dairy products, and eggs are a prominent part of your diet, you may not have enough fiber to soak up and remove unwanted hormones. That means hormones end up being reabsorbed back into your bloodstream. This process is called enterohepatic circulation (entero refers to the digestive tract, and hepatic refers to the liver). Hormones are ejected from the liver into the intestine, but then pass into the bloodstream and eventually back to the liver, where the whole process repeats, several times a day. Instead of flushing away unwanted hormones, your body keeps “recycling” them, leaving you with more hormones than you need.

What is the answer? Chuck out the animal products and bring in the vegetables, fruits, beans, and whole grains. Their fiber will capture the hormones in the digestive tract and carry them away once and for all. Instead of recycling unwanted hormones in your bloodstream, you will send them down the toilet. You will still have enough hormones for normal functioning, and getting rid of the excess is a big help.

Fiber does the same for cholesterol, as you may have heard from television commercials for breakfast cereals made from oats. The oat fiber carries cholesterol out with the wastes, gently lowering your blood cholesterol levels.

Would this really work? The answer came from studies at Tufts University, UCLA, and the American Health Foundation. Women volunteers changed the fat and fiber content of their meals under controlled conditions and, yes, high-fiber, low-fat diets trimmed estradiol levels by anywhere from 10 to 25 percent. Estrone was tamed to about the same degree, and testosterone was reduced, too.3,4,5

Fiber is not all there is to it, though. Researchers have long taken an interest in the “Mediterranean diet” of southern Italy, emphasizing fruits and vegetables and favoring olive oil when oils were to be used, while de-emphasizing meats and dairy products. In 2006, Sicilian researchers bemoaned the influx of meat, dairy products, and animal fat into the region’s diet, a phenomenon they called “Northernization.” They decided to see what a return to a more traditional diet would do. Inviting 115 postmenopausal women to join a research study, 58 women were asked to cut back on meats, dairy products, and animal fat and favor plant-based foods, while the remaining women were asked to stick with their usual diets. Neither group increased their fiber intake. But, measuring estrogens excreted in urine samples, the researchers found that the women who cut back on animal products reduced estrogen levels by 40 percent.6

So the evidence is in: A higher-fiber, lower-fat diet brings a woman’s hormones to a healthier level. While researchers are most excited about the reduction in breast cancer risk these changes can bring, they also help women struggling with other hormone-related issues.

Go Dairy-Free

Another threat to fertility may come from dairy products. This is not entirely surprising, because milk and cheese have plenty of unnecessary calories and lots of fat. Typical cheeses are 70 percent fat, as a percentage of calories. So, as these products bring on extra weight, those growing fat cells contribute to hormone haywire. And, of course, dairy products are not plants, so they have zero fiber.

But dairy products have two more attributes that could aggravate hormone problems. First, in order to maximize their milk production, dairy cows are artificially inseminated every year. During their nine-month pregnancy, cows produce estrogens that get into milk. When milk is turned into cheese, these estrogen traces are more concentrated.

Second, the milk sugar, lactose, may be harmful to the ovaries. In 1994, Dr. Daniel Cramer at Boston’s Brigham and Women’s Hospital reported that the more milk women drink, the faster their decline in fertility as the years go by.

Normally, fertility declines bit by bit as women get older. In Thailand, where milk is not a traditional part of the diet, fertility declined by only about 25 percent as women passed from their late twenties to their late thirties.7 In Finland, however, where dairy products are a major part of the diet, women had a much greater decline in fertility—around 80 percent—during the same age range. Statistics for New Zealand were similar, and Denmark, the United States, and the UK were not far behind.

Dr. Cramer reasoned that the problem may be lactose. During digestion, lactose breaks apart, releasing two smaller sugar molecules, glucose and galactose. It turns out that galactose can be toxic to the ovaries, damaging the germ cells that turn into eggs. There is plenty of lactose in milk and ice cream, ready to release galactose into your bloodstream.

You will find “lactose-free” cow’s milk in stores, but that does not solve the problem. The fact is, it has just been treated so as to break the lactose into glucose and galactose in advance, so galactose is waiting for you right in the carton. Skip it. Plant milks are free of lactose naturally and are much better choices: soymilk, rice milk, oat milk, almond milk, hemp milk, and other varieties are now widely available. Most other plants are galactose-free, although traces do show up in dates, papayas, bell peppers, tomatoes, and watermelon.8


  • Praise for Your Body in Balance:

    "In Your Body in Balance, Dr. Neal Barnard distills the latest nutritional science down to bite-sized truths that will quickly transform nearly any life plagued by hormone dependent illness into one of vibrant wellness. Whether it's cramps, cancer, infertility, impotence, moodiness or menopause, Dr. Barnard masterfully navigates a clear path to your healthiest self."—KristiFunk, MD, FACS, breast cancer surgeon, co-founder of Pink Lotus BreastCenter, and bestselling author of Breasts: The Owner's Manual
  • "Dr. Neal Barnard is one of the most important authorities of our time on nutrition, diet, and health, and Your Body in Balance is the book that can and will finally change your health for good. Dr. Barnard walks us through the most common and troublesome ailments which so many of us struggle with: hormone fluctuations, thyroid conditions, chronic and terminal illness, and mood disorders-with an eye towards research and solutions based in foods commonly available to us. We have the power to heal our bodies with the foods we eat, and Your Body in Balance is the resource with the wisdom to get us there. With recipes included, this may just be the only book you need on your shelf in order to change your body, your health, and your life."—Mayim Bialik, PhD, neuroscientist and actor
  • "Finally, an intelligent guide book that speaks up about the potent role our hormones play in every aspect of our lives. As an Olympic athlete, I never really thought of this connection until I dropped all animal foods from my diet and turned to whole plant foods to fuel my training. Almost overnight, my adaptation to training sped up (which is a function of our immune system directed by hormones), my PMS subsided, my breakouts cleared up, and my ability to focus and calm my nerves greatly improved. Dr. Barnard takes the reader on a revealing journey to uncover what's really behind some of our most common physical ailments and how to fix them in the blink of an eye."—Dotsie Bausch, Olympic silver medalist, 8X U.S. National Champion, former worldrecord holder, 2x Pan American Gold, and founder of Switch4Good
  • "Your Body in Balance is an incredible resource. If you have ever wondered how the food you eat impacts your fertility, erectile function, thyroid function, skin, hair, and so much more, wonder no longer. This book shows us how the food we eat can literally change our hormones, our mood, and our health! Happy eating!"—Robert Ostfeld, MD, MSc, FACC, director ofPreventive Cardiology at Montefiore Health System in New York

On Sale
Feb 4, 2020
Page Count
352 pages

Neal D Barnard, MD, MD, FACC

About the Author

Dr. Neal D. Barnard, FACC, is a faculty member of the George Washington University School of Medicine and President of the Physicians Committee for Responsible Medicine. Dr. Barnard is editor-in-chief of the Nutrition Guide for Clinicians, a nutrition textbook given to all second-year medical students in the U.S. He is also editor of Good Medicine, a magazine with a circulation of 150,000. He is the New York Times bestselling author of Dr. Neal Barnard’s Program for Reversing Diabetes, The Get Healthy Go Vegan Cookbook, Power Foods for the Brain, The 21-Day Weight-Loss Kickstart, and most recently The Vegan Starter Kit, among many others.

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