You joined the local gym in January. You've been pumping iron and pounding the treadmill. But your body fat hasn't decreased. The much outdated calories in, calories out model says that you must be in a caloric deficit, e.g., burn off more than you consume to lose weight. While calories certainly count, hormones count more. Insulin is produced by the pancreas to help balance blood sugar and get glucose into your cells. The higher your insulin levels, the harder it is to lose body fat. Following are some of the mechanisms that interfere with your weight loss goals:
1. Insulin Resistance: As described above, insulin is produced in response to food intake, with higher carbohydrate meals causing a greater increase in insulin. Hormones in our body must bind to receptors. If levels of any hormone, including insulin, is too high for too long, you end up with resistance to that hormone. That means your body will pump out even more insulin in response to the same type and amount of food. How can you lower insulin? Decrease your intake of carbohydrates, particularly simple sugars. Exercise, particularly resistance exercise, will improve your insulin sensitivity, making fat loss easier. Nutrients, such as chromium, magnesium, and the herb Berberine may help improve insulin sensitivity as well.
2. All hormones interact either directly or indirectly with one another. One situation that can drive up insulin is high cortisol levels, the stress hormone produced by the adrenal glands. Any type of stressor--internal or external--will raise cortisol. Elevated cortisol leads to insulin resistance and muscle wasting. The muscle wasting is particularly concerning because that is the portion of our body mass that keeps our metabolism working at full-throttle. A simple test known as an Adrenal Stress Index, which measures cortisol 4 times and DHEA, our youth hormone, once can evaluate the level the level of cortisol and DHEA . Dysregulated cortisol can result when its levels become too high or too low at various points during the 24 hour cycle. There are adaptogenic herbs that can be used to help rebalance cortisol levels.
3. Poor digestive health: Every nutrient in the body must pass through the gastrointestinal tract. Therefore, poor digestive health can lead to cellular malnutrition in any bodily tissue. In addition, certain bacterial imbalances can lead to greater caloric extraction and therefore, weight gain or difficulty losing weight. Other problems that may occur include gram-negative bacteria releasing lipopolysaccharides into the blood stream. This can lead to thyroid hormone resistance, as well as increased cortisol and insulin levels.
4. Chronic Infections: Surprisingly enough, the connection between acute infections has been known for almost 26 years. Viruses, bacteria, and fungal infections result in what is known as a 'cytokine storm'. Cytokines are molecules produced by immune cells. There are pro-inflammatory cytokines and anti-inflammatory cytokines. In an acute situation, pro-inflammatory cytokines are beneficial as part of the immune response. However, with chronic infections they rarely get turned off. Cytokines are those molecules that make you feel as if you've been hit by an 18-wheel truck when you have a cold or the flu. The most notorious of these are Interleukin-6, Interleukin-1 Beta, and Tumor Necrosis Factor-alpha. They result in a surge of cortisol being produced, which as described above, contributes to insulin resistance. The long-term solution is to address the infection with the appropriate nutraceutical, through diet, and even prescription drugs, when required.
5. Sex-hormone Imbalances: So far, we've discussed cortisol, insulin, and DHEA. Typically, this is where hormonal imbalances first show up. However, if these are not addressed, downstream hormones, such as testosterone, estradiol, progesterone, and IGF-1 are impacted. Testosterone, while higher in males, is also needed by females for energy and sex drive. In addition, it helps to build and maintain lean muscle mass. If you are deficient in testosterone, it can lead to a net catabolic state in which your body is breaking down muscle tissue and you will have trouble recovering from both exercise and injury. Estrogen, while predominantly a female hormone, is also needed in small amounts in males. Estrogen dominance can develop in males and females. In males, it generally means your Estradiol, or E2, is high relative to your free and total testosterone. It may lead to extra adipose(fat) tissue around the chest. In females, the E2:Progesterone ratio must be examined. In most functional medicine circles, you want this number to be above 400. Estrogen dominance leads to difficulty losing weight. How does one become estrogen dominant? There are a myriad of causes, including: poor gut bacteria, certain genetic polymorphisms, and inflammation. In females, estrogen dominance can result in mood changes, trouble sleeping, and menstrual cramps. One important note is that estrogen can increase thyroid binding globulin, which results in less available free thyroid hormone.
There are many other physiological situations that make fat loss difficult. The five covered above just scratch the proverbial surface. Fundamentally, you should now understand that losing body fat is about much more than how much you eat and how much you move. What you eat, e.g., the proportion of proteins, fats, and carbohydrates, plays a much more important role than the total number of calories you consume. Changing macronutrient proportions will alter your body's hormonal response. As mentioned above it is not how much you move but what you do when you move that has the most effect. Resistance training, with dumb-bells, barbells, kettlebells, etc., is the most metabolically stimulating activity in which you can engage. By building and increasing your lean body mass, you increase your resting metabolic rate, which aids fat loss. Combining a moderate protein, moderate fat, and low-to-moderate carbohydrate diet with resistance training gives you the best chance of achieving your optimal body composition. Addressing the above five factors is paramount when your efforts to lose fat are not proceeding as expected.
1. Poa, N. and Edgar, P. Insulin Resistance is Associated with Hypercortisolemia in Polynesian Patients Treated with Antipsychotic Medication. Diabetes Care. 30:1425-1429, 2007.
2. Das, S., Sharma, N. and Bin Zhang. Integrative Network Analysis Reveals Different Pathophysiological Mechanisms of Insulin Resistance Among Caucasians and African-Americans. BMC Medical Genomics (2015)8:4
3.Gheorghita V, Barbu AE, Gheorghiu ML, Caruntu FA. Endocrine Dysfunction in Sepsis: A Beneficial or Deleterious Host Response? GERMS. 2015;5(1):17-25
4. Straub, R. Interaction of the Endocrine System with Inflammation: a Function of Energy and Volume Regulation Arthritis Research and Therapy. 2014, 16:203.
5. Chengcheng, J., and Richard Flavell. Innate Sensors of Pathogen Stress: Linking Inflammation to Obesity. J Allergy Clin Immunol. August 2013;132:287-94.
6. Sanz, Y. et al. Insights into the Roles of Gut Microbes in Obesity. Interdisciplinary Perspectives on Infectious Disease. 2008. Article ID 829101.
7. Janket, S.J., H. Javaheri, L.K. Ackerson, S. Ayilavarapu, and J.H. Meurman. Oral Infections, Metabolic Inflammation, Genetics, and Cardiometabolic Diseases. JDR Clinical Research Supplement. No dates or volumes listed.
8. Sominsky L, Fuller EA, Bondarenko E, Ong LK, Averell L, et al. (2013) Functional Programming of the Autonomic Nervous System by Early Life Immune
Exposure: Implications for Anxiety. PLoS ONE 8(3): e57700.
9. Yki-Jarvinen, H. et al. Severity, Duration, and Mechanisms of Insulin Resistance During Acute Infections. Journal of Clinical Endocrinology and Metabolism. 69(2). Pp 317-323. 1988.