Why am I struggling to lose weight?

A common complaint I hear in clinical practice is how difficult it is to lose weight. Being overweight or obese is on the rise, and is a significant health issue because it is often accompanied by other chronic diseases. A BMI of 25-30 is classified as being overweight, and a BMI of more than 30 equates to a diagnosis of obesity. 

Some of the consequences of carrying additional weight include:

  • Diabetes mellitus and insulin resistance
  • Hypertension, high cholesterol and heart disease
  • Joint pain and difficulty with movement
  • Poor immunity
  • Gastroesophageal reflux disease
  • Sleep apnoea
  • Fatigue and breathlessness
  • Brain fog and poor memory
  • Gallbladder and liver disease
  • Poor gut health
  • Infertility
  • Some cancers (including cancers of the reproductive and digestive symptoms)
  • Mental health disorders (including depression and poor self-esteem)

There are many reasons why some people struggle to lose weight. Our supermarkets are littered with processed, addictive foods (which sometimes advertise misleading claims), and the price of good quality wholefoods is on the rise. Our lives are becoming busier and busier, leaving little time to plan and prepare meals, let alone finding time to relax and unwind. Many people are reporting an increase in stress levels, especially during the COVID-19 pandemic, and consequently mental health statistics are following suit. So, it is no wonder, that obesity statistics are also on the rise. The New Zealand Health survey 2019/20 reported by the Ministry of Health states that over 30% of New Zealanders aged over 15 years of age are obese. 10% of children (aged between 2 and 14) are classified as obese; however, these latter statistics are down on the previous year. Pasifika and Maori populations are at a greater risk of being obese, as are individuals living in socioeconomically deprived areas.

The science of obesity

Obesity is a complex endocrine condition. Endocrine refers to hormones, of which there are many involved in the pathology of weight gain. When our hormones are out of balance they do not behave in our favour, which can result in dysfunctional cellular metabolism and low-lying chronic inflammation. Some of the hormones involved in managing weight and regulating fat metabolism include:

  • Insulin – a hormone regulates blood sugar levels and moves glucose into cells to make energy
  • Leptin – a hormone which lets us know when we are full and can stop eating
  • Ghrelin – a hormone which tells us to start eating when the body detects that our cells need more energy
  • Cortisol – a stress hormone which helps our body build resilience to stressors
  • Thyroid hormone – a hormone which modulates metabolism
  • Melatonin – a hormone which regulates circadian rhythms and supports healthy sleep

Many individuals approach naturopaths for help to support a healthy weight. Because weight gain and obesity are an endocrine disorder, many naturopathic therapies aim to rebalance hormones. Keep reading to understand some of the reasons we store extra fat, and how naturopathy can support you. 

Not all fat is the same

Humans have different types of fat, including brown fat and white fat. Both types of fat are metabolically very different. Brown fat is thermogenic and burns triglycerides (fats) for energy; however, unlike white fat, humans contain only small amounts of the brown variety. White fat is the storage form of fat. It also secretes proinflammatory chemical messengers and hormones. People who store fat (the white variety) around the abdomen, also known as visceral obesity, are at greater risk for health complications. 

The calorie deception model

Weight loss is not just about calories in vs calories out. In fact, this is a flawed model which often leaves an individual who is trying to lose weight, deprived of energy. Energy is used by all cells of our body for processes we do not often think about it. This is called the basal metabolic rate and it includes brain function, digestion and absorption of nutrients, breathing, circulation, detoxification and so on. Physical activity constitutes a very small percentage of the average human’s energy expenditure. If someone wants to lose weight by calorie reduction, the body will adjust its basal metabolic rate, which often results in less energy being used to power your vital organs. Reduced caloric intake can leave you feeling tired, sluggish, and unmotivated. In addition to feeling lousy, you may feel hungrier. Remember, obesity is an endocrine disorder, and a reduction in energy will stimulate the production of hunger hormones such as ghrelin. Whatever weight loss you achieved on a calorie reduction diet, is often regained. This is why it is important to nourish your body with unprocessed, wholefoods which make you feel satiated. Furthermore, not all calories are the same. A sugar-laden biscuit will create a very different hormonal response to a high-fat avocado, which impacts the deposition of fat.

Naturopathic therapies to support healthy calorie intake: wholefood diet, good quality fats and protein, and intermittent fasting.   

Chronic inflammation – an underlying contributor to modern ailments

Inflammation can be good or it can be not so good. If you cut your finger, your body will mount an inflammatory response, which increases blood flow to the affected area so nutrients can be delivered to repair the wound. An influx of immune cells will also help to clear up cellular debris and reduce the likelihood of the cut becoming infected. This is an example of a good inflammatory response because it is self-limiting and helps the body to heal. However, chronic inflammation is quite the opposite, and can develop over months to years. Chronic inflammation stimulates the release of hormones, such as cortisol to dampen the inflammation, which in turn raises blood sugars, thereby inducing an insulin response. Insulin is a key hormone involved in fat metabolism. Adipose (fat) tissue also releases hormones and chemical messengers which have additional inflammatory effects. Some environmental triggers of chronic inflammation include stress, poor diet, cigarette smoking, overconsumption of alcohol, environmental chemicals exposure and viral infections.

Naturopathic therapies to support chronic inflammation: high dose antioxidants, herbal medicines and nutraceuticals to support detoxification and immune function, a wholefood diet, gut support protocol, stress management tools, and reducing exposure to environmental chemicals and toxins.

Insulin – a primary regulator of fat metabolism

Insulin is famous for its role in moving glucose into cells so we can make energy. Glucose is the smallest unit of energy derived from the breakdown of carbohydrates. However, insulin is also responsible for fat accumulation and storage. If an individual consumes too many refined carbohydrates or sugars, glucose needs to be stored so it does not build up in the blood stream and cause damage to the blood vessels. The liver converts glucose to glycogen (the storage form of glucose). However, when glycogen stores are at capacity, the liver then converts excess glucose into triglycerides (fats), which are destined for storage in adipose cells. In addition to fat storage, a diet high in refined carbohydrates, sugar and artificial sweeteners, can make cells insulin resistant. This means that cells do not respond to insulin, and therefore cannot let glucose into cells to make energy. Consequently, your cells become starved, prompting the body to release more hormones to stimulate appetite, which prompts you to eat more and more. The excess glucose can build up in the blood stream and damage blood vessels. This causes more inflammation, and can result in the deposition of cholesterol in the arteries, which is known as arterial plaque or atherosclerosis. Arterial plaques are a risk factor for heart disease, hypertension, heart attack and stroke.

Naturopathic therapies to support insulin metabolism and blood sugars: high fibre diet, reducing intake of processed carbohydrates, sugars and artificial sweeteners, nutraceuticals to support insulin metabolism (magnesium, chromium, alpha-lipoic acid, zinc), herbal medicines to support blood sugar levels and protect blood vessels, herbal medicines to support liver function, physical activity, and cold therapy

Supporting leptin – our satiety hormone

Leptin is a hormone which tells us that we are full, and that it is time to stop eating. It is regulated by insulin, glucocorticoids and by leptin itself. Leptin is secreted by adipose tissue which tells the body that is has enough fat storage; however, like insulin, cells can become resistant to leptin. This phenomenon is called leptin resistance, and it can make one feel constantly hungry. New research shows a link between leptin resistance and inflammation, especially inflammation in the brain. Inflammatory molecules can block leptin binding sites, thus impacting its transport across the blood brain barrier. Damage to the blood brain barrier, which can be caused by high blood sugar levels and toxins, can also impact leptin metabolism. 

Naturopathic therapies to support leptin metabolism: supporting healthy sleep, reducing neuroinflammation and systemic inflammation through herbal medicines and nutraceuticals, reducing exposure to environmental chemicals, consuming good fats and proteins in the diet, and supporting liver function and healthy blood sugar levels 

The role of the microbiome in weight management

The microbiome is a collection of bacteria residing in the large intestine. When pathogenic bacteria outnumber good bacteria, the gut can become unbalanced, thus promoting inflammation. This is called dysbiosis, and can be caused by poor diet, stress, infections, toxin exposure, and excess consumption of alcohol. When colonies of good bacteria are compromised, the gut wall (which lines the digestive tract) can become inflamed and permeable, a phenomenon recognised as leaky gut. This allows the passage of undigested foods, environmental toxins and by-products of bacterial metabolism (endotoxins) into systemic circulation, mounting an immune response. As mentioned earlier, low-lying chronic inflammation is implicated in the development of obesity. Good bacteria also metabolise dietary fibre and prebiotics to make anti-inflammatory molecules called short-chain fatty acids (SCFA’s). SCFA’s have demonstrated activity in regulating satiety hormones such as ghrelin, thus reducing appetite and food intake. Reduced colonies of good bacteria are a risk factor for the development of obesity. 

Naturopathic therapies to support the microbiome: gut repair and detoxification protocol, increasing dietary fibre and prebiotics, probiotics, and stress management.

Stress really can make you fat 

If you want to lose weight, then you really need to get your stress under control. This is easier said than done; however, there are many stress management techniques in our naturopathic toolkit. Cortisol is the body’s stress hormone which historically speaking, helped us to run away from a predator or to escape from a natural disaster. Cortisol acts by pumping glucose into the blood stream to fuel your muscles, increasing cardiac output, and dilating the bronchioles to increase oxygen capacity. As a consequence of fuelling vital organs to escape disaster, cortisol depresses the immune system. If stress becomes chronic, cortisol promotes the dominance of immune cells that release destructive inflammatory molecules. Because blood sugars also rise in response to chronic cortisol exposure, so does insulin, which promotes fat storage. Stress promotes unhealthy behaviours which help us to cope with stressors, including overeating, consumption of processed foods, drinking too much alcohol, and cigarette smoking. 

Naturopathic therapies to support stress: stress management techniques, physical activity, good quality proteins, wholefood diet, herbal adaptogens and adrenal restoratives. 

Are you getting enough good-quality sleep?

Sleep deprivation (less than seven hours of restful sleep per night) or having irregular sleep patterns, has been associated with increased appetite, immune dysfunction and impaired cellular metabolism. This is due to disruptions in the body’s circadian rhythm, our internal biological clock (present in every cell) which regulates metabolic activities in alignment with sleep/wake cycles. When hormones are imbalanced, including the sleep hormone melatonin, cellular metabolism is compromised. Research has shown that sleep-deprived individuals have lower leptin levels, and are more likely to experience an increase in hunger and appetite. Fatigue also drives one to reach for refined carbohydrates, which are the easiest and quickest way to boost energy. However, as mentioned previously, carbohydrates stimulate an insulin response, which promotes fat accumulation and storage. 

Naturopathic therapies to support healthy sleep: sleep hygiene routine, stress management techniques, magnesium and other nutrients to support melatonin synthesis, and adaptogenic herbal medicines and nervine tonics

The role of impaired thyroid function in obesity 

The thyroid gland is a butterfly-shaped organ located at the base of the throat, near the trachea. Thyroid hormone, which is released from the thyroid gland, increases the metabolism of nearly every cell in the body, including fat metabolism. Thyroid hormone metabolism is complex; however, an underfunctioning thyroid often presents as weight gain. This is called hypothyroidism. Some contributors to poor thyroid function include autoimmunity (where the immune system attacks host tissue), stress, nutrient deficiencies, food sensitivities, poor gut health, compromised liver function, estrogen excess, viral infections and environmental toxin exposure. 

Naturopathic therapies to support healthy thyroid function: stress management, supporting gut health and liver function, thyroid nutrients (zinc, selenium, tyrosine, iodine), an elimination diet (especially gluten), rebalancing reproductive hormones, and reducing environmental chemical exposure

Note: if you have Hashimoto’s thyroiditis, iodine should be used with caution. Iodine may exacerbate symptoms. It is best to work with your naturopathic practitioner to determine what therapies are best for you.

Endocrine disrupting chemicals and their relationship to obesity

Endocrine disrupting chemicals (EDC’s) are synthetic chemicals and heavy metals found in herbicides, pesticides, plastics, petroleum and fossil fuels, cigarette smoking, and household cleaning products, just to name a few. They are called EDC’s because they negatively impact the function of many hormones including insulin, leptin and thyroid hormone. Some EDCs have shown to block hormone receptor sites and cause hormone resistance (insulin and leptin). Mercury is an example of a heavy metal which reduces uptake of iodine for use by thyroid hormone, thus impacting its function.

Naturopathic therapies to reduce the effects of EDCs: implementing a strategy to reduce exposure to EDCs, supporting gut and liver function, high dose antioxidants, and improving elimination pathways

Getting started

Weight gain and obesity is a complex, multi-layered health condition. After reading this article you may feel overwhelmed and unsure of where to start, which is why it is important to have a personal, and professional support system. A qualified (or student) naturopath can help you get your journey started, with continual support along the way. Every individual is different; therefore, no weight loss journey is the same. Sometimes losing weight can make you feel worse before you feel better. As you reduce fat from adipose tissue, you also liberate toxins which are stored in fat cells. It is important to take a holistic, full-body approach to help you safely lose weight. A naturopath takes into consideration your individual health history and personal circumstances to best support you. All the best with your health journey 😊 

References

Blumberg, B. (2018). The obesogen effect. Hachette Book Group.

Business NZ, & Southern Cross Health Society. (2019). Workplace Wellness Report 2019. https://www.businessnz.org.nz/resources/surveys-and-statistics/wellness-in-the-workplace-survey/2019-Workplace-Wellness-Report.pdf

Craft, J., Gordon, C. A., Huether, S. E., McCance, K. L., Brashers, V. L., & Rote, N. S. (2019). Understanding pathophysiology (3rd Austra). Elsevier.

Crinnion, W. J., & Pizzorno, J. E. (2019). Clinical environmental medicine. Elsevier.

Fung, J. (2016). The obesity code. Scribe.

Gruzdeva, O., Borodkina, D., Uchasova, E., Dyleva, Y., & Barbarash, O. (2019). Leptin resistance: Underlying mechanisms and diagnosis. Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy, 12, 191–198. https://doi.org/10.2147/DMSO.S182406

Hechtman, L. (2019). Clinical naturopathic medicine (2nd ed). Elsevier.

Ishiguro, E., Haskey, N., & Campbell, K. (2018). Gut microbiota: Interactive effects on nutrition and health. Academic Press.

Izquierdo, A. G., Crujeiras, A. B., Casanueva, F. F., & Carreira, M. C. (2019). Leptin, obesity, and leptin Resistance: Where are we 25 years later? Nutrients, 11(11), 2704. https://doi.org/10.3390/nu11112704

Kenny, G. P., Sigal, R. J., & McGinn, R. (2016). Body temperature regulation in diabetes. Temperature (Austin, Tex.), 3(1), 119–145. https://doi.org/10.1080/23328940.2015.1131506

Kharrazian, D. (2010). Why do I still have thyroid symptoms? When my lab tests are normal. Elephant Press.

Kirwan, J. P., Sacks, J., & Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic Journal of Medicine, 84(7 Suppl 1), S15–S21. https://doi.org/10.3949/ccjm.84.s1.03

Ministry of Health. (2020a). Mental health 2016/17: New Zealand Health Survey. https://www.health.govt.nz/publication/mental-health-2016-17-new-zealand-health-survey

Ministry of Health. (2020b). Obesity statistics. https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/obesity-statistics

Paxton, F. (2015). Foundations of naturopathic nutrition: A comprehensive guide to essential nutrients and nutritional bioactives. Allen & Unwin.

Sanyal, D., & Raychaudhuri, M. (2016). Hypothyroidism and obesity: An intriguing link. Indian Journal of Endocrinology and Metabolism, 20(4), 554–557. https://doi.org/10.4103/2230-8210.183454

Sarris, J., & Wardle, J. (2020). Clinical naturopathy: An evidence-based guide to practice (3rd ed.). Elsevier.

Sivamaruthi, B. S., Kesika, P., Suganthy, N., & Chaiyasut, C. (2019). A review on role of microbiome in obesity and antiobesity properties of probiotic supplements. BioMed Research International, 2019, 3291367. https://doi.org/10.1155/2019/3291367

Zhou, Y., Rui, L., Hribal, M. L., Fiorentino, T. V., & Sesti, G. (2013). Role of C reactive protein (CRP) in leptin resistance. Frontiers of Medicine, 7(4), 609–615. https://doi.org/10.2174/13816128113199990016

August 2020Eat For: Nourishing Sleep