Weight Loss

weight loss program
Weight Loss

Weight Loss

by Dr. Pamela Frank, BSc(Hons), ND

As a naturopathic physician I take the same comprehensive, individualized approach to weight loss as I do with every other health problem.  My weight loss system addresses all of the factors that may be impacting your weight such as blood sugar, insulin sensitivity, cortisol, stress, calorie/protein and fat intake, behaviour patterns, social support, exercise, hormones, neurotransmitters, fat metabolism, sleep, hydration and medication side effects.

You can read my published journal article on comprehensive weight loss below:

A Comprehensive, Naturopathic Weight Loss Program

Recent estimates suggest that by 2030 half of all Americans will be obese, not just overweight, but obese. As Naturopathic Doctors we know that weight loss is far more complicated than just calories in being less than calories out. Our thorough patient intake allows for a more detailed assessment of all the factors that may be causing or contributing to obesity in our patients and to provide a more comprehensive and lasting treatment approach.

Stabilize Blood Sugar and Improve Insulin Sensitivity

Except in diabetic patients, blood sugar will be within the normal range, but if it’s frequently fluctuating within that range then production of insulin is also frequent and frequently promoting fat production. Blood sugar fluctuations also provoke carb and sugar cravings, perpetuating the blood sugar and insulin roller coaster. Maintaining a stable blood sugar level through a low glycemic index/low glycemic load diet, daily physical activity and stress reduction are key issues for those dealing with weight problems.

The more frequently blood sugar spikes and insulin is produced the greater the likelihood of eventually developing insulin resistance. Once in that “pre-diabetic” state blood sugar will stay higher longer, increasing the demand for insulin and promoting more fat production. Zinc1, cinnamon2 and aerobic exercise3 can all improve insulin sensitivity.

Reduce Stress, Modulate Cortisol and Support Adrenal Stress Adaptation

Stress hormones like cortisol cause blood sugar spikes, insulin production, contribute to poor eating habits and obesity4. Stress reduction techniques like yoga5, tai chi, breathing exercises, meditation6, massage therapy7, regular physical activity, social support and psychotherapy8 are vital components of a weight loss program.

Excessive cortisol can lead to weight gain through higher blood sugar levels, suppression of T3 and increased rT3.9 Adaptogenic herbs like Rhodiola rosea, Schisandra chinensis and Eleutherococcus senticosus have demonstrated the ability to modulate cortisol levels, improve mental performance and increase endurance.10 Adrenal support with vitamins C, B5 and B6, magnesium, zinc, potassium and additional adaptogenic herbs like Panax Ginseng, Glycyrrhiza glabra and Withania somnifera may improve stress adaptation and reduce excessive cortisol output.

Caloric, Protein and Amino Acid intake

Excessive caloric consumption without a concomitant increase in energy expenditure will result in excess body fat. All calories are not created equal though, the energy expenditure required to store excess dietary triglycerides as fat is very low (0-2%), for carbohydrate is 6-8% and for protein is 25-30%.11 A shift from a higher carbohydrate diet to a higher lean protein diet will enhance energy expenditure.

The amino acid precursors of dopamine and serotonin, tyrosine and 5 HTP respectively, have been administered for decades to treat a variety of clinical conditions including depression, anxiety, insomnia and obesity, among others. Convincing evidence exists that these precursors normally elevate dopamine and serotonin levels within critical brain tissues and other organs, suggestive of a possible role for their use in emotional or stress related overeating and obesity.12 2.5 g of the branched chain amino acid leucine triggers a postmeal anabolic response that protects metabolically active tissues like muscles during weight loss and increases loss of body fat.13

Behavioural Strategies and Social Support

One healthy habit can breed others. Breaking weight loss down into a series of achievable health-related goals, the achievement of which can fuel the next may help such as eliminating pop, taking out white flour, excluding sugar from the diet, cutting out coffee, taking up an exercise program, etc. Behavioural strategies such as self-monitoring, journalling and goal setting provide improved weight loss results compared to programs without such behavioural interventions.

Your patients may need to cultivate relationships with other health conscious individuals to succeed, particularly if friends and family engage in unhealthy diet or lifestyle behaviors. Online forums can also provide a sense of community and weight loss support. Websites like FitDay.com provide the opportunity to track calorie, fat, carb and protein intake and seek support through the discussion boards.

Exercise

Regular exercise is an essential aspect of maintaining health as well as a healthy weight, diet alone just isn’t enough. It doesn’t require a huge time commitment, an expensive gym membership or special equipment, just fostering the habit of going for a brisk walk every single day for 30 minutes. For those with time constraints encourage them to get off the bus half an hour from work and walk the rest of the way, take a quick walk on their lunch hour, park the car farther from work and walk, do a quick walk as soon as they arrive home from work before starting dinner. It needs to be a daily habit as vital to health and well-being and as “not negotiable” as brushing teeth or taking a shower. The question is not “if” they are going to exercise today, but “when”. Ideally the patient should choose a time of day that is unlikely to be fraught with other demands and when they will still have the energy and determination to complete their workout. I find early morning best as it starts the day off on the right foot and it’s unlikely the boss will call an unexpected meeting at 6 a.m. Quick fitness breaks throughout the day are also a good idea – every half hour or so get up from your desk, throw on some Lady Gaga and bust a move, drop to the floor and do 20 push-ups or sit-ups, do some quick at your desk stretching and deep breathing. Humans were not meant for 8 hours per day of sitting, we were meant to move and be active interspersed with periods of rest.

Hormones and Neurotransmitters

I find most of my weight loss patients wishing that they had a thyroid problem as an explanation for why they keep gaining or can’t lose weight but less than 10% of obese individuals suffer from hypothyroidism.14 If overweight patients are indeed suffering from a hypothyroid condition we can support healthy thyroid function with appropriate amounts of iodine15, tyrosine, copper16, zinc17 and avoidance of excessive selenium18. Herbs like ashwagandha19, schisandra and coleus can help balance thyroid function.

Treatment with the serotonin precursor 5-HTP has been shown to produce weight loss in the obese20. Norepinephrine and possibly dopamine can act as appetite suppressants21. Healthy therapeutic levels of these NT’s provide safe appetite control and reduce or eliminate emotional eating and carbohydrate/chocolate cravings. There are significant side benefits to optimizing neurotransmitter levels: alleviating depression, anxiety, insomnia, chronic fatigue, panic disorders, obsessive compulsive disorders, PMS, fibromyalgia, migraines, hormonal dysfunction, adrenal fatigue and digestive disorders. L-tyrosine, cysteine22 and 5HTP can help optimize neurotransmitters and facilitate weight loss.

Leptin in an important component in the long term regulation of body weight. Increasing leptin helps decrease food intake and increase metabolism. Adiponectin is a hormone secreted by fat cells that helps regulate metabolism of fats and sugar. Optimizing adiponectin and leptin levels plays an important role in maintaining a healthy weight. EPA has been shown to increase adiponectin levels in vitro.23 Mild weight loss induced by calorie restriction may have beneficial effects on leptin levels.24

Fat Metabolism

Deficiencies of vitamin B3, B6, C, zinc, magnesium, and lipotrophic factors such as choline, methionine and inositol can adversely affect healthy fat metabolism.

A study done in chickens fed a high omega 3 diet versus chickens fed a high saturated fat diet showed lower abdominal fat and higher T3 levels in the chickens fed the higher omega 3 diet.25

Supplementation of choline and carnitine coupled with exercise shifts carnitine to a balance in the tissues that favors fat mobilization.26

Sleep and Hydration

Insufficient sleep increases insulin resistance and has been associated with an increased risk for obesity. One study demonstrated that even one night of sleep deprivation (4 hours of sleep) induced insulin resistance in multiple metabolic pathways in healthy subjects.27 Eight hours of sleep per night is optimal to maintain a healthy weight and insulin sensitivity.

Patients who are chronically dehydrated may mistake thirst for hunger and eat instead of drinking. Encourage consumption of water and herbal teas ONLY, avoid having patients intake calories through sweetened drinks and fruit juices.

Medication Side Effects

Anti-depressant and anti-anxiety medications can lead to weight gain. Personally, I find medication side effects often very difficult to undo. If there is a possibility of supporting your patient to decrease or discontinue these medications their weight loss efforts may be more effective.

References
1. Hormones (Athens). 2009 Oct-Dec;8(4):279-85. Effect of zinc supplementation on insulin resistance and components of the metabolic syndrome in prepubertal obese children. Hashemipour M, Kelishadi R, Shapouri J, Sarrafzadegan N, Amini M, Tavakoli N, Movahedian-Attar A, Mirmoghtadaee P, Poursafa P.

2. J Diabetes Sci Technol. 2010 May 1;4(3):685-93. Cinnamon: potential role in the prevention of insulin resistance, metabolic syndrome, and type 2 diabetes. Qin B, Panickar KS, Anderson RA.

3. Obesity (2010) 18 2, 384–390. doi:10.1038/oby.2009.274 A 12-Week Aerobic Exercise Program Reduces Hepatic Fat Accumulation and Insulin Resistance in Obese, Hispanic Adolescents. Gert-Jan van der Heijden, Zhiyue J. Wang, Zili D. Chu, Pieter J.J. Sauer, Morey W. Haymond1, Luisa M. Rodriguez and Agneta L. Sunehag

4. Obesity (2009) 17 9, 1678–1683. doi:10.1038/oby.2009.76 Stress-related Development of Obesity and Cortisol in Women. Valentina Vicennati, Francesca Pasqui, Carla Cavazza, Uberto Pagotto and Renato Pasquali

5. Med Sci Monit. 2010 Jan;16(1):CR35-40. Short term health impact of a yoga and diet change program on obesity. Telles S, Naveen VK, Balkrishna A, Kumar S.

6. Complement Ther Med. 2010 Dec;18(6):260-4. Epub 2010 Nov 11. Pilot study: Mindful Eating and Living (MEAL): weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Dalen J, Smith BW, Shelley BM, Sloan AL, Leahigh L, Begay D.

7. Taehan Kanho Hakhoe Chi. 2003 Oct;33(6):839-46. Effectiveness of aromatherapy massage on abdominal obesity among middle aged women. Han SH, Yang BS, Kim HJ.

8. Int J Eat Disord. 2010 Dec;43(8):701-6. A pilot study of interpersonal psychotherapy for preventing excess weight gain in adolescent girls at-risk for obesity. Tanofsky-Kraff M, Wilfley DE, Young JF, Mufson L, Yanovski SZ, Glasofer DR, Salaita CG, Schvey NA.

9. Nihon Naibunpi Gakkai Zasshi. 1983 Aug 20;59(8):1086-98. [Pituitary-thyroid function in patients with Cushing’s syndrome–comparative study before and after extirpation of adrenal cortex tumor]. [Article in Japanese] Kitahara H, Imai Y, Yamauchi K, Tomita A, Mizuno S

10. Curr Clin Pharmacol. 2009 Sep;4(3):198-219. Epub 2009 Sep 1. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Panossian A, Wikman G.

11. Obesity: Prevalence, Theories, Medical Consequences, Management, and Research Directions. Colin Wilborn, Jacqueline Beckham, Bill Campbell, Travis Harvey, Melyn Galbreath, Paul La Bounty, Erika Nassar, Jennifer Wismann and Richard Kreide. Journal of the International Society of Sports Nutrition 2005, 2:4-31 doi:10.1186/1550-2783-2-2-4

12. Neuropsychiatr Dis Treat. 2009;5:227-35. Epub 2009 May 20. Both stimulatory and inhibitory effects of dietary 5-hydroxytryptophan and tyrosine are found on urinary excretion of serotonin and dopamine in a large human population. Trachte GJ, Uncini T, Hinz M.

13. Curr Opin Clin Nutr Metab Care. 2010 Jul;13(4):403-7. Protein metabolic roles in treatment of obesity. Devkota S, Layman DK.

14. Hypothyroid – Endocrinol Metab Clin North Am. 2002 Mar;31(1):173-89. Effect of obesity and starvation on thyroid hormone, growth hormone, and cortisol secretion. Douyon L, Schteingart DE.

15. Int J Vitam Nutr Res. 2003 May;73(3):187-91. Iodized salt consumption maintains euthyroidism in iodine-deficient hypothyroid subjects. Mirmiran P, Hajipour R, Azizi F.

16. Endocrinology. 2009 Apr;150(4):1739-47. Epub 2008 Nov 20. Reversal of physiological deficits caused by diminished levels of peptidylglycine alpha-amidating monooxygenase by dietary copper. Bousquet-Moore D, Ma XM, Nillni EA, Czyzyk TA, Pintar JE, Eipper BA, Mains RE.

17. Clinical Nutrition Volume 28, Issue 2, April 2009, Pages 162-168. Effect of zinc supplementation on the zinc level in serum and urine and their relation to thyroid hormone profile in male and female goitrous patients. Ghulam Abbas Kandhroa, Tasneem Gul Kazia, Hassan Imran Afridia, Naveed Kazib, Jameel Ahmed Baiga, Mohammad Balal Araina, Sirajuddina, Abdul Qadir Shaha, Raja Adil Sarfraza, Mohammad Khan Jamalic, Nasreen Syedd

18. J Nutr. 2003 Nov;133(11):3443-8. Dietary selenium intake modulates thyroid hormone and energy metabolism in men. Hawkes WC, Keim NL.

19. Panda S, Kar A. Changes in thyroid hormone concentrations after administration of ashwagandha root extract to adult male mice. J Pharm Pharmacol. 1998 Sep;50(9):1065-8.

20. Curr Drug Targets. 2005 Mar;6(2):201-13. Serotonin (5-HT) drugs: effects on appetite expression and use for the treatment of obesity. Halford JC, Harrold JA, Lawton CL, Blundell JE.

21. Curr Drug Targets. 2001 Dec;2(4):353-70. Pharmacology of appetite suppression: implication for the treatment of obesity. Halford JC.

22. Brain Res. 2000 Jul 28;872(1-2):301-7 S-nitroso-l-cysteine releases norepinephrine in rat spinal synaptosomes. Li X, Rose G, Dongre N, Pan HL, Tobin JR, Eisenach JC.

23. Obesity (Silver Spring). 2011 Feb;19(2):262-8. Epub 2010 Sep 2. Eicosapentaenoic acid and rosiglitazone increase adiponectin in an additive and PPAR?-dependent manner in human adipocytes. Tishinsky JM, Ma DW, Robinson LE.

24. Nutr Rev. 2011 Mar;69(3):145-54. doi: 10.1111/j.1753-4887.2011.00373.x. Epub 2011 Feb 14. Reliability of leptin, but not adiponectin, as a biomarker for diet-induced weight loss in humans. Klempel MC, Varady KA.

25. Livestock Science. Volume 131, Issues 2-3, July 2010, Pages 287-291 Effects of dietary n-3 fatty acids in fat metabolism and thyroid hormone levels when compared to dietary saturated fatty acids in chickens. G. Ferrinia, E.G. Manzanillad, D. Menoyob, E. Esteve-Garciac, M.D. Baucellsa, A.C. Barroetaa

26. J Nutr. 2003 Jan;133(1):84-9. Carnitine and choline supplementation with exercise alter carnitine profiles, biochemical markers of fat metabolism and serum leptin concentration in healthy women. Hongu N, Sachan DS.

27. J Clin Endocrinol Metab. 2010 Jun;95(6):2963-8. Epub 2010 Apr 6. A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. Donga E, van Dijk M, van Dijk JG, Biermasz NR, Lammers GJ, van Kralingen KW, Corssmit EP, Romijn JA.

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