'I'm eating well and exercising but nothing seems to be working' – a common complaint I hear in my clinic. Losing weight is often associated with food restrictions and exercising but the popular belief of 'eating less than you burn' doesn’t always work. What’s more, even with the best of dietary plans, progress can be slow or stalled. If you dream about long lasting weight loss, this article will uncover some of the potential road blocks to achieving that success.
1. Expectations: holistic weight loss is not an overnight solution. For long term success, it is best to get healthy to lose weight rather than lose weight to get healthy. This, however, means time and patience. A healthy weight loss is between 0.5-1 kg per week but that doesn’t happen every week and make take a while to kick in, for one of the reasons discussed below. Moreover, there will always be times of plateau and more rapid weight loss, which is controlled by various hormones. Cherish the success and patiently go through the less productive times. Try and keep up the good work - it will pay off eventually.
2. When it comes to weight loss, hormones matter more than calories: there are 11 hormones which dictate how efficiently you will burn fat, maintain or grow healthy muscle mass to replace fat tissue, and impact hunger and satiety signalling. These are: insulin, leptin, ghrein, cortisol, thyroid, growth hormone, CCK, peptide YY, estrogen and testosterone. In order to regulate these, we need ample amounts of protein, some good fats, fibre from vegetables and micronutrients.
4. 7. Nutrient deficit: for calories to burn, we need robust ‘fire’ (good metabolism) which is fuelled by nutrients. No nutrients, no fire. Weight loss diets often restrict fat, which limits not only fat soluble vitamins and essential fatty acids necessary for weight loss, but also disturbs hunger and satiety signalling. Eating empty calories leads to an overfed body and a starving brain which induces appetite. You provide a lot of energy but no fire. Nutrient-poor diets result in the storage of ingested energy as fat for future use because the body senses a potential famine - it's a protective mechanism. Nutrient deficit may also result in specific cravings, depending on deficiencies, e.g. neurotransmitter imbalance can cause emotional eating. Digestive problems also warrant a mention because if digestion is malfunctioning, nutrients cannot be extracted from food and utilised by the body. In short, the less nutrients, the slower metabolism becomes. If you wish to reduce calories, you will have to increase nutrient density or optimise nutrient extraction from food by improving digestion and gut function.
3. Sleep: Hormonal health is closely related to the circadian rhythm, sleep quality and sleep window. For example, growth hormone, which regulates metabolism, is most active between 22:00-24:00pm. Many people miss this window by not getting to bed early enough.
Main lifestyle habits that prevent from getting a good night’s sleep are:
exposure to blue light, which blocks melatonin activity: looking at the computer / laptop / phone / tablet till late - reduce the effect by stopping exposure 30 minutes before bed or wearing blue light blocking glasses
eating sugary or starchy foods late, which causes a glucose drop at night. This will stimulate the release of adrenaline, which will wake you up
doing cardio exercise in the evening
If you had a bad night’s sleep, you will induce insulin resistance the next day and make very different food choices altogether. You ill most probably want to get out of bed later than is optimal for kicking off metabolism, or get up feeling groggy. You may reach out for something sweet or stimulanting to wake up but this will get your blood glucose out of balance for the whole dday
4. Insulin resistance and inflammation: insulin's main function is to transport glucose from blood to cells. Too much glucose is inflammatory to cells, so the body responds by employing a protective mechanism called insulin resistance, resulting in cells becoming unresponsive to insulin for fear of more glucose. When too much glucose is present in blood because it’s not getting into cells, the cells are striving for energy. Constant hunger, cravings and tiredness are key symptoms of insulin resistance. Inflammation of any sort (especially silent, low grade inflammation unreflected by standard inflammatory markers like CRP and ESR) induces insulin resistance. It means that all chronic health issues may contribute to slow metabolism. I see chronic inflammation as the main reason for reaching weight a loss plateau.
Insulin is also the fat storage hormone. Every time insulin is present in blood, fat burning is blocked. Constantly circulating insulin in blood (as it happens with insulin resistance) makes it impossible to burn fat.
5. Chronic stress: the body does not recognise the source of stress but all sources of chronic stress will elevate blood glucose so that we can have fuel for ‘fight or flight’. The more chronic the stress is and the more glucose in blood, the more possible insulin resistance is, also because chronic stress is inflammatory. Stress sources include: nutrient deficiency, emotional stress, skipping meals, starting the day with a coffee on an empty stomach, going to bed late, unrefreshing sleep, over exercising (usually too much cardio), exercising after 6pm, chronic health issues, unstable blood sugar, food sensitivities, work and unhappy relationships. In the absence of dietary glucose, stress hormone cortisol stimulates the break down of muscle tissue to create glucose. And the less muscle, the more fat one accumulates. Muscles are metabolically active and by just having muscles, fat burns. The foundation of true weight loss is burning fat - not losing water or muscle.
6. You recenty had a baby: female body changes significantly after birth - mostly in relation to stress and metabolic hormones. What once came without much effort may now pose adrenal stress or increased need for stimulants, especially if sleep is broken. If your weight has stalled, try and rethink your daily routine. Do you go to bed early enough (22:30 max)? Do you sleep well? Do you have breakfast that is protein dense? Do you start your day with caffeine? Do you still ´go go go´ even though you have lots of new duties of being a mum so now you have twice as much responsibilities? The immune system also shifts and many women develop Hashimoto´s thyroditis which can stall weightloss, too. More on that below.
7. Nutrient deficit: metabolism is fuelled by nutrients. Diets often restrict fat, which limits not only the fat soluble vitamins and essential fatty acids necessary for weight loss, but also disturbs hunger and satiety signalling. It's a syndrome of an overfed body and a starving brain. Animal fat has a vital role of protein assimilation. In other words, eating low fat but a high protein diet reduces the chances to properly assimilate that protein. Nutrient-poor diets result in the storage of ingested energy as fat for future use because the body senses a potential famine - it's a protective mechanism. Nutrient deficit may also result in specific cravings, depending on deficiencies, e.g. neurotransmitter imbalance can cause emotional eating. Digestive problems also warrant a mention because if digestion is malfunctioning, nutrients cannot be extracted from food and utilised by the body. In short, the less nutrients, the slower metabolism becomes. If you wish to reduce calories, you will have to increase nutrient density or optimise nutrient extraction from food by improving digestion and gut function.
8. Toxicity: fat tissue stores toxins. When fat burns, toxins are released into blood stream. When detox pathways are not working optimally, toxins stimulate the immune system which then turns on inflammatory processes. Again, inflammation will result in insulin resistance which can cause stall weight loss Supporting detox pathways is key, and that includes the liver, kidneys, bowels and sweat.
9. Snacking: we used to be told to eat little and often. While eating less when increasing nutrient density is great, snacking can stall weight loss due to the constantly circulating insulin. If you feel that you snack or pick on food often, pay more attention to how you compose your main meals. Are they big and satisfying enough? Is there sufficient protein, fat and fibre? Generally, eating 3 proper meals a day is preferable. When you’re ready, you may even want to try the ketogenic diet, with 2 meals and intermittent fasting.
Snacking on nuts is especially tricky. While nuts are a source of good fat and protein, they can quickly contribute to extra weight by significantly increasing calorific intake. Having max 10 nuts a day as part of meals is a better strategy.
10. Underactive thyroid: although it is commonly known that an underactive thyroid can slow down metabolism, thyroid disorders can be left undiagnosed. Often upon sole inspection of Thyroid Stimulating Hormone (TSH), one may arrive at a wrong diagnosis. Not only does this not present a full picture, but also diagnostic ranges vary between countries, labs, conventional and functional medicine. Hashimoto's thyroiditis is an autoimmune condition, and autoimmunity often goes hand in hand with insulin resistance, and insulin resistance is the main block to fat burning. Yet, thyroid antibodies are dismissed in routine health check-ups. I have clients with optimal TSH, and yet high anti-thyroid antibodies.
11. Estrogen dominance: having too much estrogen compared with the balancing hormone progesterone causes weightloss resistance, especially around the hips and arms.
12. Gut microbes: certain strains of bacteria are associated with weight gain. One experiment showed how implanting gut bacteria from obese into sterile mice made them put on weight. Moreover, beneficial gut bacteria guard the small intestine from becoming 'leaky'. Leaky gut is associated with chronic inflammatory processes and again, inflammation results in insulin resistance. Also, some organisms (e.g. candida) drive cravings towards starch and sugar, which can also result in a blood sugar roller coaster and ultimately, insulin resistance.
13. Lifestyle and beliefs: diet is only a portion of the holistic approach to long term weight loss. Both, under and over exercising are associated with metabolic disorders, and so is the wrong type of physical activity or lack of variety. Go for HIIT, resistance training like pilates and dynamic yoga. Cardio can stall fat burning by increasing cortisol. Spending too much time indoors, little contact with nature, exposure to blue light after 8pm, being a 'night owl', sleeping less than 7 hours, lack of hobbies, life goals or not being part of a community, misconceptions about what really is healthy may all slow down weight loss.
Maybe you are losing weight, after all?
Using regular scales can be misleading because even when you burn fat, you may weigh the same because muscle is heavier than fat. Again, it is desirable to build muscle. The key is to get into the fat burning mode.
The best strategy for staying on track is measuring how much fat you burn. I recommend a body composition monitor as opposed to scales. It will measure your water, fat and muscle. What you want to see is a steady decline in fat tissue until you rich your optimum.
Alternatively, you can use a measuring tape. Measure your waist, hips, thighs and arms every week or two. See if clothes fit any different, too.
What do do?
Get healthy to lose weight, and that may take some time. Fixing metabolism scan take 1 year so having realistic expectations is key.
A weight loss plan should be personalised, with thorough diagnostics and health evaluation. ‘Template’ plans taken from the internet or advice from someone who’s had amazing results on a certain diet (often fad diets) is not a successful strategy because they don't take any individual aspects into account. Food can be both medicine and poison, depending on who eats it and in what circumstances. Lack of sufficient knowledge on bodily processes, physiology and metabolism can do more harm than good – this is where professional help can be invaluable. A food and symptom diary is a great place to start. By observing how your body reacts to foods in terms of energy, sleep, cravings and bowel movements can be an fantastic tool to guide you down the right path.
Article published in The Islander, August 2018 edition