The CDC estimates that 73.6% of adults aged 20+ are overweight or obese. As weight loss may be a goal that some individuals have, it is important to understand what causes weight gain and what may be hindering weight loss. Factors to consider include diet, lifestyle habits, stress, hormones, inflammation, liver health, gut health, metabolic health, obesogens, etc.

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CC: Weight Gain, Anxiety, Gas, Bloating, Reflux, Brain Fog

Nicole was a 45-year-old female who had been trying to lose weight for years. She struggled with anxiety. She worked in healthcare, and although she felt she could “handle” the stressors just fine, she knew her body was stressed. She struggled with constipation, gas, bloating, and reflux. She had slowly put on weight over the last five years, but no matter what she did, she could not lose it.

Nicole had tried various exercise programs such as HIIT, beach body, swim classes, walking on the treadmill, etc. Over the years, she had rotated various dietary programs such as Atkins, Weight Watchers, Keto, intermittent fasting, etc., in which she would lose a few pounds but regain them as soon as she came off the diet.

Nicole had tried various medications for anxiety, but she felt that she got no relief from them. She was happily married and loved her job, and she didn’t know why she felt that way. The patient’s gastrointestinal complaints stemmed from her 30s. She was told she has IBS, ulcers, and gastritis. She had tried a multitude of medications which did not help. She had only one bowel movement every 3-4 days and would experience gas and bloating with most foods, but she was unable to pinpoint which ones specifically caused them. Reflux was daily, and she had terrible brain fog.

Initial Lab Work

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Lab Analysis

Nicole's lab work showed the following:

Low nutritional levels. Vitamin D, B, and omegas were all low on the patient's lab values. That may indicate a lack of dietary intake or poor absorption in the gastrointestinal wall.

Evidence of metabolic disease. Though not high on the reference range provided by the lab, insulin was functionally high. Desirable levels are five uIU/mL, while acceptable levels are 5-8 uIU/mL.

The patient's labs showed high cholesterol, high Lp-Pla2 Activity, and high Apolipoprotein B, a sign of atherosclerosis.

In addition, the patient's labs showed prediabetes and systemic inflammation, which was tested through GlycA. The patient was metabolically unhealthy.

Labs were able to rule out various concerns. Nicole's thyroid values, for the most part, were within normal limits.

She tested negative for candida antibodies and candida immune complex. Dysbiosis was suspected during the patient's intake. Bacterial dysbiosis can have similar symptoms to candida overgrowth, so ruling in/out candida was very important.

The patient tested negative for the marker ANA, indicating potential autoimmune issues, and adrenal function came back within normal levels.

The salivary cortisol test was normal, and based on the initial intake, it was concluded that hormones were most likely not causing weight concerns.

Dietary Interventions

Based on Nicole's symptoms and lab to rule out candida, bacterial dysbiosis was suspected. She was put on the low fodmap diet for four weeks to help reduce/eliminate fermented foods from the diet to starve the bacteria. The diet naturally reduces carbohydrates and processed sugars.

After four weeks, the patient's diet was transitioned to a Paleo diet but allowed a small amount of non-gluten grains.

A healthy relationship with food is significant for weight loss patients, so the patient was encouraged to follow the 80/20 rule. 80% of the time, stick to the healthy options, and 20% of the time allow herself a little outside of her norm.

At the same time, she was encouraged to cook and bake more at home, so if she did want something sweet, she could make them gluten-free and control the ingredients. She was taught how to read labels and what ingredients to avoid.

Supplement Interventions

While on the low fodmap diet, the patient took Biocidin to help kill off the bacteria in the gut. Nicole also took B vitamins, Vitamin D (2,000-3,000 IU), and omega fatty acids (2 g).

She was given additional liver support, Clean Sweep (Mechanism Wellness), which contains NAC (1,200 mg), silymarin (200 mg), artichoke leaf extract (200 mg), and dandelion root (50 mg) to help aid in weight loss and healthy cholesterol.

At the end of 4 weeks, the patient continued her supplements but discontinued the Biocidin. Instead, the patient began taking Spore Daily T (Ortho Molecular), and GI Core (Ortho Molecular), which contain glutamine, zinc, vitamin A, and various demulcent herbs to help support a leaky gut and provide beneficial bacteria to the gastrointestinal tract.

Lifestyle Interventions

Though the patient felt like she handled the stress well at work, she did work in health care and was suggested to start a self-care routine that allowed her to relax. She was recommended to meditate, read a book for 20 minutes, sit outside in the sun by herself in peace and quiet, anything that allowed her to unwind and separate herself from her busy day. She was recommended to start exercising, which included a mixture of lifting and cardio, at least 4x/a week.

Follow Up 4 Weeks Later

At the 4-week follow-up, the patient's brain fog/ADD symptoms improved by 80-90%. Bowel movements were daily, with no gas, burping, or heartburn. She was feeling so good she stopped her anti-acid medications (with her prescribing doctor's permission).

Nicole was most excited to report that she had lost 20 pounds. Anxiety was significantly better, and she reported having no flares. At this time, the patient was taken off of the low fodmap diet, and her supplements were adjusted.

The patient was going to follow a paleo diet with non-gluten grains. Blood work was scheduled for five months. Such rapid weight loss was associated with a reduction in systemic inflammation.

Labs Follow Up Five Months Later

At our follow-up visit five months later, Nicole still felt really good. With transitioning from the low fodmap diet to the paleo diet, she added foods back in very slowly and was able to see if she had any triggers to her GI symptoms. She discovered that avocados, sweet potatoes, and cashews made her feel bloated.

She was able to eat “mostly” paleo following the 80/20 rule making sure to include the foods that she loved but making them healthier.

Within the last six months, both she and her partner were able to start cooking more at home, and it became a hobby to try to find healthy recipes.

Working out was challenging, and she had some weeks that were better than others, but she was able to work out at least 2-3x/a week.

Overall, she was down another 20 pounds, making her total weight loss 40 pounds. Her anxiety was completely gone.

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Summary

Weight loss can be such a sensitive and challenging obstacle in life that many people go through. Many doctors say to eat better and lose weight. But what does that even mean? As there are many reasons individuals are not losing weight, but functional medicine doctors are looking for the “why.” In this case, Nicole struggled with many years of gut issues, which shows the role the gut microbiome plays. She made lifestyle changes that included dietary changes and exercise. This caused her to start reading labels and making healthier choices. By doing so, she was able to lower her insulin and inflammation, which play a huge role in weight loss. In addition, her cardiac health also improved without the use of statins.