One of the most common patient concerns voiced in the office is “I want to lose weight.” Most patients have already tried a combination of various medications, crash diets, surgeries and exercise regimens with limited, if any, success. Success rates are so low is because there are many complex pathways and chemical messengers mediating the body’s ability to optimize metabolic processes and body composition.
The majority of weight loss resistance is centered in the regulation of hormones. The calorie-in/calorie-out theory has been widely disproven, yet remains a dominant misconception regarding diet and weight loss. Calories do matter, but the updated research supports the concept that hormones matter more. The majority of patients struggling with weight have an underlying hormone imbalance.
Some of the primary hormonal contributors are described below. While these contributors can all act individually, the body is interconnected. It is likely that if one hormonal imbalance exists, there are other discrepancies as well.
Insulin is a fat-storage hormone. Insulin resistance means the cells cannot absorb the blood glucose the body generates from food. Therefore, the liver converts this excess glucose into fat. Insulin resistance can often lead to weight gain and even contribute to sugar addiction.
Leptin is known as “nature’s appetite suppressant.” However, individuals who are overweight produce excess leptin. When the brain is flooded with leptin signals, the receptors stop functioning. This means the body stops getting the “full” indicator. The loss of these signals contributes to eating unhealthy foods in a detrimental pattern and continued weight gain.
Estrogen dominance occurs when there is too much estrogen compared with its counter-hormone, progesterone. Having too much estrogen in the body causes a number of symptoms, including weight loss resistance, moodiness, PMS, and heavy menses.
The thyroid is generally accepted as the “gas pedal” of metabolism, adjusting how fast or slow we burn calories. When the thyroid is sluggish, weight gain, fluid retention, hair changes, depression, constipation, and other symptoms can occur.
Cortisol (HPA axis)1
Predominantly known as the “stress” hormone, cortisol is secreted from our adrenal glands. In the short term, cortisol secretion can strengthen our cellular response and promote survival. However, chronically taxing this system can shorten the lifespan. Cortisol is well known for depositing fat around the midsection.
This is a complex set of direct influences and feedback interactions among three endocrine glands: the hypothalamus, the pituitary gland, and the adrenal glands. This combination is often the root cause of metabolic and weight loss resistance. Therefore, the key to weight reduction is to reset this axis, starting with cortisol.
Cortisol is one of the main hormones that disrupts the function of other hormones. Elevated cortisol suppresses the reproductive hormone progesterone, contributing to estrogen dominance. Cortisol dysfunction also triggers the hypothalamus, a small regulator in the brain, to decrease its activity, reducing metabolic rate, leading to suppression of the thyroid gland.
Optimizing Hormones and Balancing Cortisol
Losing unwanted weight and keeping it off requires a variety of deliberate life adjustments. Quick fixes and “miracle cures” do not facilitate lasting or nourishing change.
The key to better nutrition is to eat more real food. Make a goal to crowd out the “bad” foods with more nutrient-dense options. Removing processed foods, refined carbohydrates, trans fats, sugars and sugar substitutes from your diet can decrease inflammation and supporting optimal hormone levels.
Reducing alcohol intake further benefits body composition. Even a single serving of alcohol can reduce metabolism by more than 70 percent. While this is a temporary effect, it has the potential to add up over time.
Avoid or limit stimulants such as coffee. This can deplete magnesium, strains the nervous system, and can alter gut bacteria. It has been found that even decaf can do this! Making the switch to green tea, which contains the amino acid L-theanine reduces stress without causing sedation.
It has been found that obesity has a microbial component. Gut bacteria and proper digestive health is vital to harmonizing hormones.2 Cortisol makes it more difficult to digest proteins because it decreases stomach acid, increases intestinal permeability and alters gut flora, leading to weight gain and bloating. Additionally, the birth control pill decreases gut bacteria, decreases liver clearance of estrogen and causes pituitary insensitivity. It can take up to a year to clear and reverse these effects. Probiotics in the form of food or supplementation are vital to promoting weight loss.
Omega-3 fatty acids have been shown to increase adiponectin and improve leptin sensitivity.3 Adiponectin is a hormone secreted by fat cells that helps regulate metabolism of fats and sugar.
Deficiencies of vitamin B3, vitamin B6, and magnesium can adversely affect healthy fat metabolism. These are powerhouse nutrients helping to convert food into fuel. When your vitamin levels are lacking, the body doesn’t have adequate capability to trigger efficient fat burning, thus hampering weight-loss efforts.
Berberine is the most researched supplement to reset insulin sensitivity to support weight loss. It activates an important enzyme nicknamed the “metabolic master switch.”
Di-Indole Methane (DIM) reduces harmful estrogen excess while promoting protective estrogens. You can also improve your good-to-bad estrogen ratio by eating more lightly steamed cruciferous vegetables.
Exercise with Intention
Movement is equally vital for metabolic optimization, especially forms of movement that bring enjoyment. It is important to exercise intelligently. It is best to avoid chronic cardio as this can further disrupt the HPA axis and elevate cortisol levels. Burst training and adaptive exercise are more beneficial for stabilizing cortisol and reproductive hormones.
Burst training involves short periods of high intensity exercise with moderate-level exercise as recovery. It is incredibly efficient without the cortisol-raising side effect of a long run. Moreover, it is extremely effective at raising growth hormone (GH), which maintains lean body mass. Adaptive exercise is even more beneficial for those diagnosed with thyroid conditions, and includes practices such as yoga and Pilates. Incorporating muscle activation with body weights or light resistance is great for the HPA axis and helps to prevent injuries.4
In summary, move frequently. Aim for between two and five hours per week of moderate aerobic exercise. Combine this with one to three brief, intense sessions of full-body functional movements and practice meditation or yoga regularly.
Make a goal of eight hours of good quality sleep every night. Too much cortisol raises blood sugar and deposits fat at night. Insufficient sleep increases insulin resistance, increasing the risk of obesity. One study demonstrated that even one night of sleep deprivation (four hours) induced insulin resistance in multiple metabolic pathways among healthy participants.5
Adding plant medicine to the regimen can further support lifestyle interventions and restore proper function to many body systems. Ashwagandha is a wonderful adaptogen that helps to reset cortisol balance. Ashwagandha dials down the HPA so you feel less stressed and prepare for a good night of sleep.6
We tend to primarily target the physical aspects of weight loss resistance, yet the emotional, mental, social, and spiritual factors are equally, if not more, important. Psychological factors act as a barrier to many who would like to manage their weight.
Emotions can interfere with maintaining a regular workout routine and making healthy food choices. In a national survey about weight loss barriers, 90 percent of respondents discounted one of the most important factors — the mind.7 Reconfiguring the way you look at your body and the foods you feed it, is more effective for weight-loss than mindlessly following a fad diet.
We become emotionally attached to food at a very young age. Most holidays and celebrations are food-focused. The smell of certain foods, like cookies, can create powerful emotional connections. Over our lifespan we have become conditioned to use food not only for nourishment, but also for comfort.
The more we can recognize and acknowledge this, the better equipped we are to manage it appropriately. The goal is to take emotion out of eating and view food as nourishment, not as a reward or coping mechanism. To help recognize the emotional connection you may have to food: identify foods that bring you that comfort and write down why you eat them. Do they evoke a memory, promote a feeling of health, or are you craving those foods out of stress?
Most diets don’t work because they fail to address the root causes that are the most common reasons for weight loss resistance, especially excess cortisol, insulin and/or leptin resistance, estrogen dominance, and problems with the HPA coordination. Starting with lifestyle restructuring and filling nutrient deficiencies, administering herbal therapies if necessary, and addressing the psychological barriers are key to generating weight loss.
- Vicennati V, Pasqui F, Cavazza C, Pagotto U, Pasquali R. Stress-related development of obesity and cortisol in women. Obesity. 2009;17(9):1678-1683.
- Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature. 2006 Dec 21;444(7122):1022-3.
- Ferrini G, Manzanilla EG, Menoyo D, Esteve-Garcia E, Baucells MD, Barroeta AC. Effects of dietary n-3 fatty acids in fat metabolism and thyroid hormone levels when compared to dietary saturated fatty acids in chickens. Livestock Sci. 2010;131(2):287-291.
- Telles S, Naveen VK, Balkrishna A, Kumar S. Short term health impact of a yoga and diet change program on obesity. Med Sci Monit. 2010;16(1):CR35-CR40.
- Donga E, van Dijk M, van Dijk JG, et al. A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. J Clin Endocrinol Metab. 2010;95(6):2963-2968.
- Panossian A, Wikman G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol. 2009;4(3):198-219.
- Orlando Health. “Food and Emotions: 90 percent overlook key to weight loss, survey finds: Expert says diets fail because people don’t address the emotional aspects of food.” ScienceDaily. ScienceDaily, 1 December 2015.