Why can't I lose weight?
A non-exhaustive introduction to why you likely can't lose weight. But, ALL of them can be addressed!
Blood sugar imbalance.
Calories in, calories out truly is the absolute basics of any long-term dietary weight loss strategy. While I have certain recommendations I think are best for the human body, at the end of the day if you eat more calories than you use in a day your body says “Hey! Excellent! I’ll save this as energy for later!”. Your body is smart like that, but also naive at the same time, it doesn’t realize you have food in the fridge and access to sustenance without the prospect of famine anytime soon (definitely a reason to be grateful).
However, it’s not as simple as calorie intake. Let’s talk about sugar. I will not deny that sugar tastes delicious, but it’s the poison apple of the metabolic world. When we inundate our body with a steady source of sugar long-term we can create insulin resistance. Insulin is a small hormonal gatekeeper to our cells. When we eat sugar it knocks on the cell’s door and shuttles the sugar into the cell so we don’t have excessive amounts of sugar circulating freely in the body (which we also don’t want!). However, when there is too much sugar always floating around our bloodstream the gatekeeper gets confused and less responsive to letting sugar in. Then your cells that normally have sugar in them start to feel ‘starved’ for sugar and this results in carbohydrate cravings, fatigue, and weight gain. THIS is where naturopathic medicine comes in. It’s not easy to change this process, BUT you absolutely can reverse it!
Correcting insulin resistance, diabetes, prediabetes, and any kind of suboptimal blood sugar process is imperative toward improving metabolic function to lose weight. Comprehensive lab testing, targeted dietary changes, supplements that support healthy blood sugar metabolism (eg chromium, vanadium, magnesium), and regular glucose monitoring are ways to get this under control and back to optimal!
The human body is truly an orchestra of hormones, neurotransmitters, cytokine signaling, protein synthesis and hormone shuttling just to name a few key biochemical movements. Right now, this is occurring in your body as you sit reading this. BUT, we want it to be occurring at optimal levels and in unison with different stages of life.
For example, estrogen dominance is a common and pervasive issue I see in clinical practice. Put simply, this refers to there being a disproportionate amount of estrogen in relation to progesterone levels. In women, this is commonly associated with PMS, mood swings, weight gain around the abdomen & thighs, fatigue, low sex drive, inability to lose weight, endometriosis, fibrocystic breasts, and abnormal menses. Increases in estrogen levels are impacted by diet and further influenced by insulin resistance (see above), as well as, environmental toxicity like plastics, chronic stress, and poor liver metabolism.
In men, low testosterone levels and/or increased conversion of testosterone to estrogen can also lead to weight gain and unpleasant symptoms of excessive estrogen.
Low or suboptimal testosterone levels in both men and women contributes to poor muscle mass, brain fog, low sex drive, poor motivation and focus, and decreased longterm bone integrity.
Additionally, poor thyroid function is commonly associated with weight gain. This is the master endocrine regulator of the body. Hypothyroidism is commonly associated with poor lipid metabolism, elevated blood sugar levels, and furthering hormonal dysfunction like estrogen dominance. Autoimmune thyroid conditions like Hashimoto’s thyroiditis are increasingly common and it’s imperative that the underlying cause of thyroid dysfunction be addressed to improve metabolic function and weight loss. Whether low functioning thyroid is due to an autoimmune disease, environmental factors, or nutrient deficiencies addressing these will help improve weight loss efforts.
Stress is part of life, too much stress is not your friend.
Sometimes I think I am a broken record when it comes to discussing stress. But, before you mentally check out please remember that you, as a human being, are one of the most resilient species on the planet! Truly. Our bodies and minds were designed to tolerate stress, we just need to learn to be more resilient to it.
Our adrenal glands (they sit right on top of the kidneys) help us produce cortisol which is most commonly known as the “stress hormone”. It’s production and release is increased in times of stress to encourage the body to produce more sugar (to get ready to run or fight!), control inflammation, manage arousal (think sleep/wake cycle, as well as, alertness), and signaling to the brain via the hypothalamic-pituitary adrenal axis. Your hormones are NOT isolated to one organ system but work systematically throughout the body. Excessive amounts of cortisol can lead to weight gain, poor stress response, insomnia or sleep disturbance, and poor immune function.
Low or suboptimal cortisol levels often occur after chronic stress, eventually your body stops producing as much cortisol which trickles down the hormone pathway and I commonly also see deficiencies in progesterone, testosterone, DHEA, and further driving estrogen dominance. Hopefully you can see that it’s ALL interconnected.
Improving adrenal function through diet, support of adrenal function (eg herbal supports, glandular supplements when indicated, nutrient support), stress reduction therapies, and the basics of improving cortisol balance.
You are what you eat, and you are what you eat eats. Our understanding of the microbiome is growing at an exponential rate. More and more research is linking different bacterial strains and/or deficiencies to obesity, as well as, other conditions like cardiovascular disease and autoimmunity.
Poor digestion leads to nutrient deficiencies that lead to poor insulin balance, poor hormone production, food intolerances, and poor immune function. Chronic bowel conditions like irritable bowel syndrome, commonly associated with SIBO (small intestinal bacterial overgrowth), if left-untreated can make weight loss efforts futile.
Additionally, I commonly see people post-gall bladder removal with issues digesting fats and proteins. These are the very macronutrients that are integral to improving blood sugar metabolism, supporting satiety, and losing weight. Many times a short-term trial of digestive enzymes with ox bile and lipase can remedy these issues and later be weaned off of them.
While we have all benefited from the industrialization of the modern world and the improvements in agriculture, we now know that chronic exposure to pesticides, herbicides, heavy metals, and other environmental toxicants are not to our benefit. While our body has natural ways to help detoxify itself (liver detoxification/bowel movements, urination, sweating, and even menstruation) it can only keep up with so much environmental burden. Our ancestral bodies were not made for a modern world.
Many people respond amazingly well to correcting all the aforementioned issues, however, sometimes it’s important to assess for and treat environmental issues. This ranges from determining dysfunction in your genetic makeup (eg SNPs) to doing provoked urine heavy metal testing and urinary pesticide testing to assess for chronic underlying exposures.
In sum, it's not as simple as your calorie intake. Although diet and physical activity are paramount to weight loss. If you've been try those avenues and are hitting plateaus or haven't been able to get any traction then it's time to dig deeper and assess for the above underlying issues.