Let’s start with the low hanging fruit. Research in the 90’s determined that the overwhelming majority of women— 89%—want to lose weight and 3% wanted to gain weight. In contrast, 22% of the men who were dissatisfied with their weight wanted to gain weight. Today Americans are eating more calories than we ever did in the past. More importantly refined sugars and flour make up the larger part of the pie when compared to whole foods i.e. vegetables, fruits, meat, poultry, seafood.
The average woman in the US today weighs 168 pounds. This is approximately the same as an average man in the 1960’s (CDC). Men are up 30 pounds and 20% of children are obese.
As a nation we are addicted to convenient, hyper-palatable large portioned options and it is taking its toll in more ways than one. The prevalence of non-alcoholic fatty liver, diabetes, obesity and cancer move in lockstep with a dysfunctional metabolism. It would be an understatement to say Americans are confused about food choices. Most are perplexed and making personal choices that provide the knockout punch to a struggling metabolism.
Yes, food choice matters! Deciding to have repeat bagels or cereal instead of eggs and avocado or a shake with healthy fats and protein for breakfast negatively affects your liver and blood sugar. The effects may be less dramatic for some (those with a healthy weight and insulin sensitivity) and accelerate the negative effects for those that are overweight or prediabetic. A perpetual cycle of overeating chokes the liver and creates the perfect environment for systemic inflammation, high triglycerides (TAGs), elevated LDL- particle number, leptin resistance, dyslipidemia, and insulin resistance.
Having a clogged liver is serious business. The liver is responsible for detoxifying the body. In today’s world it is under constant assault from toxicants. In addition to the liver’s detox duties it plays a large role in the conversion of fuel to energy. An overloaded liver creates a slow metabolism. Even worse it fails to recognize insulin signaling and continues to unload sugar into the blood stream. When your liver is struggling and you consume a high carb meal it is estimated that 80% of the sugar in the blood stream has its origin in the liver and not a spike from recently consumed food.
If your liver is clogged it may continue down four stages of disease progression:
NAFL - nonalcoholic fatty liver
NASH - nonalcoholic steatohepatitis
Fibrosis - inflammation causes scar tissue
Cirrhosis - function impaired and can be life threatening
Eat the standard American diet for 5 years and chances are you may fit the criteria for Metabolic syndrome (MetS). MetS comes with a host of risk factors including cardiovascular risk. Click here to read more about the risk of cardiovascular disease.
Abusing stimulants such as caffeine can disconnect you from your natural circadian rhythm and disrupt cortisol patterns. Some people are better at metabolizing caffeine than others. Alcohol in excess can hijack restorative sleep and boost cortisol as well. Everyone is different and women typically produce less alcohol dehydrogenase that breaks down ethanol into acetaldehyde. If you have heard of alcohol flush this is due to accumulation of acetaldehyde and deficiency in aldehyde dehydrogenase 2. The point is you are taxing your metabolic resources.
If you are having gut issues, with intestinal symptoms or not, your metabolism and hormonal health may suffer. The renewed interest in our microbiome is a breath of fresh air. The microbes that inhabit the human GI tract play a role in human health and disease. For a tube whose contents are actually outside the body it plays a role in nutrition, digestion, immune processes, the central nervous system and energy homeostasis.
The disruption of the microbiome-gut-brain axis has a wide array of implications. You may be familiar with the term “leaky gut”, irritable bowel syndrome, metabolic endotoxemia or small intestinal bacterial overgrowth (SIBO). Those that have intestinal permeability or a leaky gut may develop food intolerance and fat loss resistance. Give the book Wheat Belly or The Plant Paradox a read if you want to learn more. For those that want the deep dive check out The Mind-Gut Connection.
When the microbiome is restored to a healthy set-point it trains and regulates our immune system. It keeps gut inflammation at manageable levels, limits pathogenic growth, helps prevent allergies, reduces gas and has anti-tumor properties. You may not be aware that 20-25% of T4 is converted to T3 (active thyroid hormone) in the gut.
What can disrupt the gut:
Medications (PPI’s, antibiotics, Birth control, corticosteroids)
Alcohol and high sugar intake
Parasites and infection
Low stomach acid
Poor intestinal motility
Sleep and Stress
4.Stress and sleep debt
When we are stressed our brain knows. Specifically the HPA axis (hypothalamus, pituitary and adrenals) is busy preparing the body to adapt to the four types of stress:
Perceived stress e.g.mental/emotional and anxiety and depression)
Inflammatory signals e.g. GI, allergies or cardiovascular signals
Glycemic dysregulation e.g.insulin resistance and obesity
Circadian disruption e.g sleep issues (pain/apnea) or light dark disruption
When we experience stress that lasts for weeks and months chronic levels of high cortisol are stuck in the redline position. There is evidence that chronic stress changes food preferences and leads to insulin resistance. Some researchers have found that people with sleep disturbances, high stress, depressed mood and anxiety are strong predictors of low back pain.
A good night’s sleep will improve glucose metabolism, boost growth hormone secretion, and help normalize and help regulate cortisol levels. Because cortisol is released in a rhythmic fashion it’s not uncommon to see dysfunctional 24 hour cortisol patterns. This can contribute to fatigue throughout the day and difficulty sleeping in the evening. For example if a person has a disrupted cortisol rhythm but otherwise normal cortisol production symptoms may include fatigue, sleep disturbances, and higher perceived stress.
Inflammation is a normal response to injury. We rely on inflammation to signal the immune system for cell injury and repair or defend us against bacterial or viral infections. When inflammation becomes chronic - metabolic disease begins to take hold.
Inflammation may be the most important mechanism driving “diabesity” (the one-two punch of diabetes and obesity). Elevated inflammatory markers are predictive of weight gain and insulin resistance. Those with higher levels of inflammatory cytokines and liver inflammation have an increased risk for diabetes. Inflammation of the brain leads to leptin resistance. Women suffering from endometriosis may be surprised to learn that it is best defined as an inflammatory disease. Are you beginning to see why we want to minimize nonessential levels of inflammation?
Food allergies are quite different than food intolerances. Many Americans have food intolerances and unknowingly consume these foods. For example men and women respond differently to grains when it comes metabolic dysregulation. Some may be completely free of intestinal issues while other exhibit a constellation of symptoms such as a thick waist, abnormal cholesterol, high blood pressure, and or problems with blood glucose. Because you need special enzymes to break down gluten, a protein found in wheat and grains, some researchers think that up to 80% of the population lack the necessary enzymes to properly digest gluten. Dairy sensitivity is also common however it seem more problematic when patients have a leaky gut, dysbiosis and consume low-fat non organic dairy products.
In the 90’s we were told to eat more grains and cut the fat. According to the CDC the diagnosis of diabetes has tripled. Even more concerning is the increasing trend in autoimmune disease in general. This includes Hashimoto’s/ Graves disease, Sjogren’s, irritable bowel disease (IBD), rheumatoid arthritis , lupus and celiac’s disease. The unsettling truth is that these autoimmune diseases are on the rise and in some cases are 2-3 times more common than a few decades ago. Experts believe that symptoms of autoimmune disease may be prevented by re-establishing intestinal barrier function.
An improper diet can lead to increased levels of inflammation. This includes diets low in calories i.e. 40% or greater caloric deficits over a 6 week period. Diets that lack comprehensive nutrient profiles such as veganism, fruitarian or vegetarianism are at higher risk of elevated inflammation in the long term.
6.Too much or too little exercise
Regaining metabolic flexibility is directly tied to your diet. Too much exercise, with a sluggish metabolism, is a big stressor. This is especially true if your performing long workouts on a low calorie diet. However, the right amount of exercise can provide some amazing benefits including increased insulin sensitivity, fuel expenditure, muscle health, glycogen production and mitochondrial health. If you are too sedentary and maintain a poor diet your muscles atrophy and you body composition will creep to higher fat and lower % of lean muscle. When that happens your resting metabolism slows down.
It’s very important that you sort out your “chemistry” before exercise is able help you in maintaining a healthy weight. Don’t forget your liver has to process all the calories and fuel you burn up during exercise.
Whether you have adrenal fatigue, more correctly referred to as HPA axis dysregulation, excess estrogen, low testosterone, PCOS or diabetes it alters your metabolic machinery. That new metabolism you’re fighting for through diet and lifestyle changes will seem recalcitrant.
Books are written on this topic so let’s touch on the thyroid since it’s a major player in regulating your metabolism, and assuring good general health. Most people wrestling with weight need to address their relationship with grains. In addition to providing high amounts of calories they may lead to intestinal permeability and the body’s immune system attacking itself. For example, people with Hashimoto’s disease are usually put on thyroid hormones. Dr. Kresser uses an analogy of bailing water.
People with low thyroid may need thyroid hormone as a necessary part of the treatment. But unless the immune dysregulation is addressed (plugging the leaks), whoever is in that boat will be fighting a losing battle to keep it from sinking. Meanwhile, that person will struggle with weight loss resistance.
8.Ignoring key body measurements
Time to move away from BMI as it’s not as predictive as other measurements. Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio have larger effects on increased CVD risk compared with body mass index (BMI).
For most of us we get an up close look of our bodies in the shower and when we are dressing. Measurements looking at central obesity, fat deposits in the abdomen, and around the viscera organs are better independent predictors of cardiovascular disease, fatty liver and diabetes.
9.Not testing basic biomarkers
Looking at the blood is an imperfect proxy, but it is one of the better ways to see whats going on under the metabolic hood. Below is a list of biomarkers that I would recommend for a baseline functional medicine workup.
CBC with differential
CMP (includes liver enzymes)
Fasting blood glucose, fasting insulin and HgA1C
Full thyroid panel ( TSH , T4 reverse T3, w/Antibodies)
Perhaps a Urinary DPD (assesses bone resorption rates)
Earlier in the article I mentioned Metabolic syndrome or MetS. So what is MetS? The criteria have changed over the years, but here is the general consensus.
ANY three of the 5 Criteria below:
Obesity -- Waist circumference >40 inches for male and >35 inches for females
Hyperglycemia -- Fasting glucose ≥ 100 mg/dl or pharmacologic treatment
Dyslipidemia – Trigylcerides ≥ 150 mg/dl or pharmacologic treatment
Dyslipidemia (separate criteria) – HDL cholesterol < 40md/dl male, < 50 mg/dl females; or pharmacologic treatment
Hypertension -- >130 mmHg systolic or > 85 diastolic or pharmacologic treatment.
*Note: LDL particle (LDL-P) number appears to be the most accurate marker for predicting metabolic syndrome. How do you test LDL-P. A test called NMR lipoprofile.
If you have questions regarding any of the topics covered in this article email them to firstname.lastname@example.org