Weight loss from a functional medicine perspective
The most common reasons people struggle with losing weight are hormone-mediated and ultimately driven by (what else?!) Crap Food, Toxins, and Stress. Hormonal drivers include insulin resistance, hypothyroidism, estrogen dominance, and chronic stress.
Insulin resistance – both a high glycemic diet and chronic stress can increase the glucose load on the body. Over time, increases in blood sugar can lead to insulin resistance. In this case, cells are suffering from low energy, organs and the cardiovascular system are suffering from too much sugar, and the body is storing more and more fat. You want to check both Fasting glucose and HbA1c lab markers. However, usually years before fasting glucose or HbA1c begin to rise at all, fasting insulin begins to rise and will be suboptimally in the upper half of the normal reference range. Some strategies to address insulin resistance are:
Eliminate sugars and sweeteners. After a couple of initial, transitional weeks, this should also include elimination of all natural substitutes e.g. stevia, erythritol in order to allow taste buds to adapt over time to stop expecting most foods to be artificially sweetened. Instead, try whole fruit or starchy vegetables (e.g. sweet potato) to satisfy our natural desire for sweet flavors.
Eliminate All grains for a while – or at least foods made with Any grain flour (especially gluten but preferably All grain flours). In many people, especially those with insulin resistance, they cause the same types of blood sugar spikes (and insulin surges) as sugars. Stone-ground, whole wheat flour can spike blood sugar worse than table sugar.
Eat a breakfast that includes protein and healthy fat every day. Our blood sugar stability and cravings throughout the rest of the day are highly influenced by what we eat for our first meal of the day. To best support weight loss, start with at least 15 grams of protein in your first meal of the day. This is the equivalent of two whole eggs. If eggs cause an inflammatory response you can relate this with meat protein. Protein intake increases satiety and promotes the secretion of a hormone in the body called glucagon which promotes fat-burning.
Front-load the day’s food. I don’t believe in counting or tracking anything that can be counted (e.g. calories, fat grams, sugar grams) because I think it makes people obsessive about their food. Instead, I recommend consuming about 80% of your day’s food by mid-afternoon and eat nothing 3+ hours before bedtime. For most people, this will include a medium-sized breakfast, a large hearty lunch around 1pm, and a mid-morning and/or afternoon snack. The average American eats a small (or skips entirely) breakfast, a medium-sized lunch, and then arrives home ravenous to consume a rather large dinner. As people begin to follow this routine, they become less and less hungry for dinner, and their evening meal can become quite small. This allows the body to burn body fat for fuel throughout the night. The average American consumes nearly 50% of the day’s calories after 5pm. As you might imagine, this is a metabolic disaster area for those looking to lose weight. In general, the food we don’t burn for fuel for energy within about three hours of eating is stored as fat (regardless of the type of food!). After dinner, most of us are not going to head out for a run to burn a lot of calories – but rather we are likely to hit the couch and wind down.
Overnight fasting of 12-14+ hours to encourage fat loss If a person is generally in good health and sleeping well.
Hypothyroidism – a sluggish thyroid can cause sluggish anything. Fatigue can result in moving less and sluggish metabolism can cause weight gain. Importantly, you must check a full thyroid panel – TSH, Free T4, Free T3, Reverse T3 and thyroid antibodies (TPO and TG) to look for various types of hypothyroid function (note that sub-clinical hypothyroidism can still have *dramatic* effects). You may find autoimmune (Hashimoto’s), nutrient-impaired (e.g. low T4 from insufficient iodine), stress-impaired (e.g. high conversion of T4 to Reverse T3), and/or inflammation-impaired (e.g. poor conversion of T4 to T3) hypothyroid function. Typically only TSH is checked, this is not an assessment of cellular thyroid function, as TSH is a brain chemical, not a thyroid hormone.
Sex Hormone Imbalance, such as estrogen dominance or testosterone deficiency – an issue in both men and women. Testosterone is important for many functions including libido and joint health, and it is well-known to be important for building muscle and decreasing body fat. Testosterone can be low due to stress, excessive exposure to estrogen or excessive alcohol intake, for example. Deficiency can lead to low motivation, irritability, insulin resistance and weight gain. Much of our androgens are produced in the adrenal gland, so if the adrenal gland is busy pouring out stress hormones, testosterone production can suffer, but in addition, cortisol blocks testosterone receptors. In addition, with excess body fat, adipocytes (fat cells) may lead to excess estrogen and low testosterone because adipose tissue is endocrine tissue and can convert androstenedione and testosterone into strong estrogens in a process called aromatization. Estrogen can still be an issue in menopause since fat tissue creates estrogen. Read my post on estrogen dominance for more information.
Estrogen dominance is a common dynamic that leads to symptoms such as PMS (usually with cramps), heavy, lengthy, clotting periods, and stubborn weight gain. Most often, estrogen dominance is caused by blocks in estrogen metabolism or clearance or increased estrogenic load from endocrine disrupting chemicals also called xenoestrogens (pesticides, herbicides, parabens, phthalates etc.). A good opportunity in this case would be to clean up personal care and cleaning products and eat as much as possible 100% organic.
Stress! Chronic stress is often a major driver of stubborn, excess weight. Cortisol is a catabolic hormone which is released under stressful conditions, breaking down muscle to generate blood sugar in the process of gluconeogenesis. It does this, while increasing insulin resistance. High cortisol also reduces thyroid action by increasing T4 conversion to Reverse T3. Many people trying to lose weight try excessive exercise and calorie restriction. This increase their cortisol (and thus their Reverse T3) which will stall weight loss. Conversely, sustained low cortisol due to prolonged stress or burnout can also reduce thyroid action by reducing cellular uptake of thyroid hormone. Sources of stress that may lead to trouble losing weight include:
Ongoing physical trauma
Ongoing chronic pain
Chronic dieting/insufficient calories
Lack of rest and/or inadequate quality sleep
Too many stimulants
Allergen exposure – environmental, food…even food sensitivities, see below
Toxicity e.g. heavy metals, mold, chemicals
Food sensitivities can cause symptoms of all kinds, including general inflammation and weight gain. First try eliminating gluten and dairy 100% for 4+ weeks as a trial. A further elimination diet may be tried from there, and if appropriate, consider food sensitivity testing. None are comprehensive but total IgG with complement (not IgG4) or a combo IgG/IgA are best to help eliminate false positives.
Many toxins are stored in adipose tissue and can be a common reason for weight loss resistance. Common toxins we are exposed to are endocrine disrupting chemicals (personal care products, cleaning products and food packaging), pesticides, herbicides, fungicides, VOCs, heavy metals and mold. We not only need to reduce exposure, we often need to remove stored toxins from the body as well. For example, mold is a toxin that can lead to weight gain or trouble losing weight. Getting it out of the body will only help so much if you constantly being exposed. Full healing can’t take place until you are removed from the toxic/allergenic environment sustainably.
Regardless if it’s a driving root cause or not, it’s important to be mindful of the fact that as we lose weight, we free up toxins from adipose tissue and put them back in circulation (more here and here). This dynamic is seen with weight loss via diet and via surgery. This can cause an increase in physiologic stress (and cortisol), which will in turn, slow weight loss.
So, before any intensive weight loss efforts, there are a few important things to ensure before proceeding:
Ensure good hydration (in order to be able to dilute and eliminate toxins via the urine)
Ensure consistently good bowel movements (in order to eliminate toxins via the feces)
Ensure good bile flow – bile helps us excrete fat soluble toxins
Ensure good sleep as cerebrospinal fluid (CSF) clears metabolic waste products from the brain during sleep
Toxin avoidance – cut out pesticides, herbicides, etc. by eating 100% organic during weight loss efforts. Identify other sources of toxins in personal care products and throughout the home. The less toxins coming in, the more toxins the body can focus on getting out. See my post Skin care ingredients to avoid.
Ensure Phase 1 and 2 Detox pathway are being supported
Organic green tea can help support detoxification but also can support metabolism and help calm stress hormones due to the L-theanine.
Eat fresh cilantro and parsley – a lot of it. These are both great herbs to support detox.
Eat lots of organic vegetables, especially things like alliums and cruciferous vegetables, which greatly aid detoxification processes in the body.
Utilize a methylated B complex such as Thorne Basic B or Pure Encapsulations B Complex.
Binders should be used to avoid re-toxification as the toxins are released back into circulation during weight loss. Binders can be natural, such as a large increase in fibers and vegetables, or they can be supplements such as the following. Take these 1-2x/day (AM and PM) on an empty stomach at least an hour before (or 3+ hours after) food or other supplements (importantly, with a glass of water, not just a few sips):
Modified citrus pectin
Chlorella (this is one exception that can be taken on an ongoing basis and without regard to timing with food)
Many combination formulas are available, Bio Botanicals GI Detox, Quicksilver Ultra Binder.
Finally, it’s also important to take breaks from intense weight loss efforts to work on healing the gut intermittently. All the toxins released can damage the GI tract lining, so to avoid causing other downstream issues, it’s important to take some time to heal the gut after each approximately 20-25 pounds lost. If you need help with food elimination and toxin elimination, I recommend the Shape ReClaimed program. It is extremely helpful to jump start your weight loss journey.