One of the most common and frustrating problems people deal with is unexplained weight gain and difficulty losing weight. Obesity affects 20% of kids, and over 40% of the adult US population is obese, and these numbers have continued to climb yearly. Obesity-related conditions, like diabetes, high blood pressure, cardiovascular disease, stroke, and some cancers, cost the US healthcare system nearly $173 billion annually and remain the leading cause of death. Therefore it's vital to get to the root cause of this epidemic to help our patients live a longer, healthier, happier life.
5 Medical Reasons You're Having Trouble Losing Weight
Many know the most common cause of weight gain is consuming more calories than burned. But the frustration comes when someone is doing "all the right things" by staying active, eating healthy, clean whole foods, yet continuing to gain weight or can't lose weight. This is when it's time to look for the root cause of weight gain.
Unintentional weight gain, along with cold intolerance, can be some of the hallmark symptoms of hypothyroidism. The thyroid is responsible for homeostasis regulation of the body, and in particular, it is responsible for regulating metabolism. When the thyroid is under active, as in the case of hypothyroidism, the metabolism slows down. This can lead to unintentional weight gain and difficulty losing weight.
2. Chronic Stress
People with excess stress or mood disorders often have higher levels of the stress hormone called cortisol. Cortisol is a hormone that plays a crucial role in metabolism regulation. When it goes unchecked, as in times of constant stress, it leads to increased cravings for salty or sweet foods, unwanted weight gain, particularly around the midsection, and decreased testosterone production leading to reduced muscle mass. This creates the perfect storm of events resulting in a cycle of weight gain.
3. Insulin Resistance
Insulin is the hormone responsible for getting blood glucose (sugar) out of the bloodstream and into the cells for energy use. When there are high levels of insulin, in response to high levels of blood glucose, over time, the body's cells can become resistant to the insulin, and the glucose is not able to enter the cells. The glucose then builds up in the blood. This extra circulating glucose is then stored as fat in the body.
4. Poor Gut Health
More and more research is uncovering the importance of a healthy gut microbiome. It turns out that the gut microbiome may play a crucial role in the body's metabolism and immune system, neurologic, and hormone function. Recent research has shown that type of gut flora present may have a direct impact on levels of obesity. In one study, gut flora from a lean individual and gut flora from an obese individual were transplanted into sterile mice. The mice that received lean flora remained thin and at a healthy weight. The mice that received flora from the obese donor then became obese. This is a fascinating topic, and more studies are being done yearly on this phenomenon.
5. Peri-Menopause & Menopause
Many women think weight gain with menopause is inevitable. Fortunately, this is not the case. While declining levels of sex hormones, like estrogen, progesterone, and testosterone, can lead to changes in the hunger hormones, metabolism, and decreased muscle mass and predispose women to weight gain if left unchecked, it is possible to combat this. We can correct these imbalances and prevent middle-aged weight gain with careful analysis and proper diagnosis.
Specialty Labs to Test for Root Cause of Slow Metabolism
In conventional medicine, a TSH (thyroid stimulating hormone) level is often the only lab marker measured. But TSH alone does not give a complete picture of thyroid health. A full thyroid panel, commonly used in Functional Medicine, will assess a complete picture of how the thyroid functions on multiple levels and give medical insight into any possible autoimmune conditions affecting thyroid function.
A full Thyroid Panel includes the following markers and is reviewed with optimal reference ranges in mind. :
Cortisol testing can be urine, blood, or saliva, although saliva and urine are most commonly used.
Diurnal Cortisol Curve - a saliva or urine test that shows the pattern or curve of cortisol throughout the day. Alterations in the curve indicate cortisol-level imbalances. It is normal for cortisol to peak in the morning and wane throughout the day. It should be the lowest at bedtime.
Several lab tests are used to get a complete picture of insulin and glucose function in the body.
Hemoglobin A1C (HgbA1C) - is a blood test that gives a 3-month average of blood glucose levels.
Fasting Insulin - is a blood test that gives information about the levels of insulin in the body. When the fasting levels of insulin are elevated, even with normal blood glucose, it indicates insulin resistance.
Poor Gut Health
Comprehensive gut microbiome testing is an easy-to-do at-home stool test that is very beneficial in determining the microbiome's health. Comprehensive stool tests provide information on the composition and types of gut flora and can determine if there is a presence of dysbiosis, bacterial overgrowth (SIBO), candida infection, or parasites.
DUTCH Hormone Test is one of the most comprehensive hormone tests available. The DUTCH test is a dried urine test that can be easily done in the comfort of your home. It measures the levels of the major sex hormones: DHEA, testosterone, estrogen, progesterone, and cortisol. It not only gives your levels (high, low, or normal), but it also breaks down the detoxification pathways for the hormones to help determine why there may be elevated or low levels of hormones present.
Functional Medicine Treatment for Slow Metabolism
Functional Medicine aims to treat the underlying cause of weight gain. Using the functional medicine labs listed above, along with an extensive history and examination, a true root cause can be diagnosed, and a unique medical plan can be developed just for you. Other area's functional medicine focuses on include the following:
It is true that the body needs to be at a relative caloric deficit to lose weight and burn fat for energy, but the body also has to be in a safe and healthy state to be able to do that.
Inflammation is often the root cause of most all chronic conditions. The Mediterranean diet is an anti-inflammatory diet based on eating whole foods. Research has consistently shown that the Mediterranean diet effectively increases weight loss, reduces inflammation, and reduces the risk of overall mortality.
Lifestyle is a key area to focus on when working to lose fat weight. It is essential to incorporate stress management techniques into your daily routine. This helps minimize stress and hormone spikes, which increase cortisol levels and can cause metabolic dysregulation. There are many effective types of stress management, from yoga, journaling, meditation, tai chi, and mindfulness. The key is finding the one that works best for you.
Exercise and daily movement is the cornerstone of a healthy metabolism. Exercise is more effective at weight loss than any prescription medication on the market, and the benefits are seemingly limitless. Not only is it free and can be done anywhere, it lowers stress, balances hormones, improves sleep, promotes a healthy appetite and satiety, improves mental health, preserves and improves muscle and bone strength, and cuts the risk of developing chronic diseases like cardiovascular disease and cancer, it also aids in maintaining a healthy weight. It's best to move throughout the day to get the max benefits.
Functional medicine is root-cause medicine aimed at identifying and reversing any root causes of disease that may be present. A functional medicine approach to weight gain starts with a thorough history and physical examination, targeted functional medicine laboratory testing based on symptoms and exam findings, and then working to reverse the underlying condition.
Lab Tests in This Article
- American Heart Association Recommendations for Physical Activity in Adults and Kids
- CDC: Adult Obesity Facts.
- Chui, C. et al. Systematic Analysis of the Association between Gut Flora and Obesity through high-throughput sequencing and bioinformatics approach. BioMed Research International. 2013. https://doi.org/10.1155/2014/906168
- Cleveland Clinic: Insulin Resistance
- Cleveland Clinic: Hypothyroidism
- Estruch, R. et al. (2018 Jun 21). NEJM. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-virgin olive oil or Nuts. DOI: 10.1056/NEJMoa1800389
- Harvard Medical Review: Do gut bacteria inhibit weight loss?
- Hewagalamulage SD, Lee TK, Clarke IJ, Henry BA. Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity. Domest Anim Endocrinol. 2016 Jul;56 Suppl:S112-20. doi: 10.1016/j.domaniend.2016.03.004. Epub 2016 Mar 31. PMID: 27345309.
- Mayo Clinic: Insulin and weight gain: Keep the pounds off
- Saper, R. Common Dietary SUpplements for Weight loss. Am Fam Physician 2004.
- Steptoe, A. Serwinski, B in Stress: Concepts, Cognition, Emotion, and Behavior. 2016.
- Vicennati, V. et al. Stress-related Development of Obesity and Cortisol in Women. 2012 Sep. Obesity.
- Vina, J. et al. Exercise acts as a drug; the pharmacological benefits of exercise. 9 Apr 2012.