More than a few years ago, I had a friend who came to me complaining of her inability to control her weight. She had become significantly larger over a period of years despite her efforts to control her eating and get regular exercise. She gradually restricted her caloric intake to the point where she would only eat saltine crackers and coffee for breakfast and lunch. We discussed the unhealthy aspects of this type of diet and I suggested looking elsewhere for the cause of her weight problem. After completing a health history and symptom survey with her I realized that my friend was likely suffering from a common, very treatable condition that was causing her to gain weight.
This is what I found:
Reason #1: Underactive Thyroid Gland (Hypothyroid)
Betty (fictional name) had been an active young woman and remained so through her twenties. In her mid-thirties she began to struggle with weight, and also began to notice other changes in herself that she had always attributed to aging or inherited characteristics. As we discussed her history and her progression of symptoms that had occurred over a 10-year period of time, a clear picture began to form. The following is a list of the symptoms Betty had been experiencing:
- Gradual, inexorable weight gain
- Fatigue and weakness
- Intolerance to cold
- Muscle aches
- Dry skin
- Thinning hair
In the course of evaluating a patient, a doctor always creates a differential diagnosis which lists the most likely possibilities as well as the most serious ones that should be ruled out. In this case, referring to my medical books was simply to confirm my clear suspicion – Betty was suffering from hypothyroidism – in this case the most likely and most serious condition on my list. This condition is nothing to mess around with and requires medical tests to confirm and prompt medical intervention should the patient’s tests be positive. In Betty’s case she was, in fact, suffering from hypothyroidism, and prompt medical intervention helped normalize her body and her life.
Interestingly, as Betty began to feel better she found that her bouts of depression became shorter, less frequent and less severe. As her mood improved she found that her frequent comfort food binges (something she had not confided in me) dropped off and this, combined with her new hormonal balance and improved energy for exercise, allowed her to start making real strides toward managing her weight again.
For a health professional, figuring out Betty’s case was like being slapped in the face with a raw pork chop – pretty hard to miss. (I went to college in South Carolina. Please forgive the colloquial imagery.) Over the years I have had occasion to meet with patient’s who have had similar symptoms, yet upon testing, were shown to have thyroid function within the reference range for normal thyroid activity. They showed all the signs of early hypothyroidism (including weight gain), yet tested normal (usually low end of normal). This condition, known as subclinical hypothyroidism, may have very mild symptoms or none at all, and may be discovered incidentally through yearly checkup blood tests.
While it is still unclear as to what treatment, if any, is warranted for this condition, or effective, I believe that these cases can benefit from early intervention. I recommend taking steps that carry little or no risk of negative side effects and can have an overall beneficial effect on well-being as well as potential prevention of full-blown hypothyroid disease. In other words, if it can’t hurt and may help, it is worth a try. So, if you feel you may have a thyroid problem, here is what I recommend:
- GO SEE YOUR MEDICAL DOCTOR!
- Avoid inflammatory foods and beverages including processed foods, fast food, soft drinks, processed grains, sugars, caffeine and alcohol.
- Include the following vegetables in your regular diet as they supply a lot of the nutrients that support normal thyroid function: kale, cabbage, broccoli, Brussels sprouts, mustard greens, pears and peaches.
- Supplement your diet with a good multi-vitamin, vitamin C, vitamin B complex, essential fatty acids and a liver support complex. These supplements support thyroid function and reduce oxidative stress and inflammation.
- Consider these herbs/spices in your diet for their beneficial effect on metabolism, circulation and thyroid function: cayenne pepper, ginger and kelp – which can be found at any grocery or health food store.
There are other hidden causes of fat gain and what you can do about them. But remember, these conditions and the weight problems they cause are not your fault. . .until they have been revealed. Then it is up to you to do something about them.
Reason #2: Sleep
Every so often, be it on television, the Internet or in a magazine ad, I will see the phrase “lose weight while you sleep.” It is usually associated with some kind of cream, or belt, or capsule full of something or other that purports to melt the fat off of your body while you dream of lying on the beach in your slender new body. Now, while most of us know that these products are a bunch of hooey, they still make money because the pitch promises effortless weight-loss – and some of us fall for it. But, deep down, we all know that this is impossible, that sleep has nothing to do with your weight. Right?
In fact, sleep is one of the most important components of any weight-loss regimen, and new studies are indicating that, without doing anything else, you can lose weight simply by getting a good night’s sleep.
Sleep – It’s Not Just for Beauty Anymore
More than 40 years ago, scientists documented the role sleep plays in glucose metabolism and hormone regulation. Over that same period of time as stress, poor nutrition, technology and other factors have reduced the amount and quality of sleep that we get as a society there has been an associated increase in obesity as well as in endocrine and metabolic disorders. Scientists noticed and began to dig deeper into the sleep/metabolism connection. Not too long ago, the breakthrough came and scientists were able to identify two specific hormones that are directly affected by sleep. It turns out that these two hormones are responsible for managing appetite control.
The On/Off Switch for Your Appetite
Ghrelin is a hormone secreted in the stomach which stimulates appetite. Just before mealtimes it tells the brain you are hungry and it is time to eat. Leptin, a hormone which tells the brain enough calories have come in, is secreted by fat cells. Numerous studies have shown a link between reduced sleep and a high ghrelin/low leptin response. In other words, when you have had seven or more hours of quality sleep, your good angel (leptin) is singing in full voice. Your brain hears it loud and clear and your appetite is more likely to be under control all day. On the other hand, if you have 5 hours or less of quality sleep at night, ghrelin (Lucifer) is on the bullhorn yelling for food, and lots of it. You will wake with increased appetite and may have an increased craving for food (especially the bad stuff) that will likely be with you all day. This one-two punch to your willpower has become endemic in American society, and the obesity rates are growing as a result.
So the simple solution is get more sleep and you will begin losing weight because your appetite will be less. However, if you are one of the millions of Americans who suffer from dysfunctional sleep patterns, this is far easier said than done.
Here are a few tips to help you get back on the train to “Slumberville”:
- Go to bed earlier; watch less television.
- Avoid watching/reading/hearing the news before bedtime; an agitated mind cannot relax and fall asleep.
- Avoid large meals close to bedtime. Indigestion and heartburn will often follow, making quality sleep difficult. If you are hungry near bedtime, consider a light protein-rich snack. This will satisfy your hunger and keep your blood sugar in balance overnight.
- Reduce your caffeine intake and avoid caffeine after 2:00 pm. This will allow your system to clear the drug in time for your sleep to be unaffected.
- Reduce your stress. We all have sleepless nights due to the stressors of daily life. It is important for your overall health as well as your weight to control the amount of stress you have – or at least manage how it affects you. A few simple ways to manage your stress are using a quality herbal supplement, meditating once or twice a day, and regular exercise.
- Exercise. In addition to the obvious effect that exercise has on weight management, there is also a symbiotic relationship between exercise and sleep. Exercise has been shown to enhance the ability to sleep longer and more productively, and sleep has long been known to improve motivation to exercise and increase the energy level during the workout.
If using all of these tips doesn’t help improve your sleep, it might be a good idea to speak with your doctor about seeing a sleep specialist. After all, the long list of health benefits resulting from healthy sleep – including appetite control – far “outweigh” the costs of getting the help.
Reason #3: Depression
Conventional wisdom has long described the connection between obesity and depression as a direct causative relationship. In other words, obesity was assumed to lead to depression, because people with weight control problems are bound to be unhappy, or so the thinking goes. In recent years, however, numerous studies have pointed to the reverse relationship as a significant occurrence – depression is, in fact, a demonstrably frequent cause of obesity. This piece of news likely comes as no surprise to many people whom have lived with this debilitating condition; however it is important that the professional community is now recognizing the true nature of this complex mind/body connection. The value of this new information, in this doctor’s view, lies in using it to incorporate natural/alternative medicine into the management protocol for both conditions.
I’ve Fallen (Emotionally) and I Can’t Get Up
Emotional ups and downs happen in every life, and one common way that any of us might deal with a disappointment or a stressful situation is by eating comfort foods. The food choice will be different for every person but the common denominator is the high fat/high sugar content of the food. When you are feeling down you tend to crave the least healthy alternatives. These junk foods activate the body’s endocannabinoid system, which increases appetite and makes you feel better at the same time. These chemical changes reinforce the comfort eating behavior and create a real risk of turning a temporary binge into an unhealthy habit. In fact, studies indicate that depression increases the risk of obesity almost 60% for normal weight individuals. But the connection between depression and obesity doesn’t stop there. There is a more insidious reason why people afflicted by depression are gaining weight – their treatment.
Side effects are a ubiquitous component of the use of prescription medication for the treatment of dysfunction and disease. Usually, these effects are inconsequential or do not occur at all. It is only when these adverse effects cause obvious complications or danger to the patient that they begin to merit attention. In the case of psychotropic drugs (the medications used to treat depression), there is mounting evidence that prolonged use leads to obesity and all of the health risks and complications that go along with it.
Contributing to this complication is the fact that a high percentage of the initial diagnoses of depression (and the resulting drug prescriptions) come not from mental health professionals, but from the general practitioner. That’s fine except for the fact that, for many of these patients, the drugs become the only intervention, and other important components of treatment such as psychotherapy, exercise and nutrition fall by the wayside. The long term result of managing depression in this way can be an inactive/disabled, obese patient with Type 2 diabetes and cardiovascular disease – another unfortunate case of the cure being worse than the problem.
Dealing with Depression
Owing to the large percentage of antidepressant prescriptions being written by primary doctors, it can be surmised that many people treating depression with drugs have not had a major depressive event and could manage their problem with a more conservative approach. That being said, if you are currently taking a prescription antidepressant medication, DO NOT discontinue without your doctor’s approval. DO request that your doctor refer you to a qualified mental health professional who can: 1) manage your dosage to reduce the potential for adverse effects and, 2) use psychotherapy to help you treat the cause of your depression while you manage the symptoms with medication. Next, follow the steps outlined below for people with a milder form of depression or not currently taking meds.
- Start Exercising – If there was ever a cure for all things it is exercise. In the short term, exercise stimulates the secretion of endorphins, a mood-elevating drug. In the long run, the increased vitality and body image that will result from regular vigorous exercise will work to elevate and manage your mood on a day-to-day basis.
- Change Your Diet – The foods you are drawn to when you’re feeling low will make you feel better for a while but, in the long term, they act as depressants and will contribute to weight gain and reduced energy. Fresh whole foods will revitalize you and feed your brain with the nutrients it requires to function normally.
- Practice Meditation – Whether you get formal training in Transcendental Meditation or simply sit quietly with your eyes closed, 10 to 20 minutes of meditation twice a day has been proven to have a positive, balancing effect on emotions and mood.
- Nutritional Support – Use nutritional or herbal complex supplements designed to support stress management, balanced mood and general well-being.
- Therapy – If depression persists despite taking the steps listed above, then you should consider seeking the advice of a qualified health professional. Therapy and/or prescription antidepressants will likely be the next step on the road to recovery. Should this step be necessary, continue steps 1 through 3 above and advise your doctor of any nutritional complexes or herbs you are using before starting the medication.
The Chicken or the Egg?
Whether depression causes obesity or vice versa is really not as important as knowing how to recognize the problem and break the cycle before your health is permanently damaged. As our world gets more complicated and stressful, depression and all the complications that come with it are happening to more and more people. And, as always, awareness and early intervention are the best way to defeat this insidious health threat.
Reason #4: Syndrome X
Middle age has arrived. You are getting a little older and you notice that, with each passing year, you’ve grown longer in the tooth and have also gotten a little thicker in the waist. But so has just about everyone you know your age, except that health freak down the street who jogs at five in the morning and eats grass. A little extra around the middle is normal for your age. Just cut down on the Krispy Kremes, maybe start taking walks with the dog – and that should take care of it, right?
Well, probably not. In fact, what that spare tire or muffin top may be telling you is that you are becoming dangerously ill. What you should do is get to your doctor and get a checkup. A simple exam and a blood test will tell your doctor if you are already afflicted with Syndrome X or just well on your way.
A Confluence of Risk Factors
Syndrome X, more commonly known as metabolic syndrome, was first discovered about 20 years ago. It is not a disease but, rather, a cluster of conditions – risk factors really – including high blood pressure, elevated blood sugar, high blood triglycerides, low HDL (good) cholesterol, and excess body fat around the waist. To be diagnosed with metabolic syndrome you need only have three of these conditions. But, chances are, if you have had it for a while or don’t take steps to correct the problem, all of these conditions will show up. This will put you on the fast track to cardiovascular disease, stroke, type 2 diabetes, and kidney disease.
Think this won’t happen to you? Guess again. An estimated 47 million Americans are afflicted with Syndrome X and it doesn’t go away by itself.
Saved By the Belly
In just about every source I read, excess body fat is listed among the risk factors of Syndrome X. While it certainly can be a risk factor, my clinical impression is that it is more likely the first sign you’ll notice that this disease process is occurring in your body. I believe that before you begin having to loosen your belt, this insidious process has already been going on for a while and the culprit that got the whole ball rolling is called “insulin resistance.”
Insulin is a hormone that regulates your blood sugar. When the body becomes resistant to insulin it does not regulate the blood sugar levels effectively and more and more insulin is required in order to control blood sugar levels. Eventually, the body will no longer respond adequately to the insulin, leading to type 2 diabetes. This is why insulin resistance is often referred to as “pre-diabetes.” It is a progressive disorder that becomes more apparent as we age but may begin relatively early in life.
As the body begins to struggle with its blood sugar management, it will become harder to control weight, and excess fat around the waist will begin to build up. This is a relatively early warning sign. So, while that roll of fat may be embarrassing and annoying, it can also be a gift from your body. Taken seriously, it can lead you to deal with this malady before it ruins, or takes, your life.
If, after reading the preceding text you are thinking, “that’s me” or “that could be me” the next step is easy. Schedule an appointment at your doctor’s office. After an examination, they will do some blood tests and within a couple of days you’ll know what’s going on. Here are the risk factors they look for in diagnosing metabolic syndrome:
- Central/Abdominal Obesity – men-waist > 40 inches, women-waist > 35 inches
- Blood Triglycerides > 150 mg/dl
- HDL Cholesterol – men < 40 mg/dl, women < 50 mg/dl
- Blood Pressure – > 130/85 mmHg
- Fasting Blood Glucose > 100 mg/dl
If three of more of these conditions exist you will be diagnosed with metabolic syndrome. While this is cause for concern it is no reason to panic because, as serious as this condition can be, it is often completely reversible. Depending on the results of the tests the doctor may prescribe medications for your blood pressure, cholesterol and blood sugar, or he/she may just recommend lifestyle changes.
What to Do
Whether or not you are diagnosed with Syndrome X, and irrespective of any medications the doctor may prescribe, if you went to your doctor with these concerns it is time to make some changes. Here are some things you must do if you are to restore your health and return to a vital, vibrant way of life:
- Start Exercising – If there was ever a cure for all things it is exercise. The American Heart Association recommends 150 minutes of vigorous exercise per week. If you haven’t been exercising lately you might want to start with a brisk 30-minute walk each night after dinner. As your fitness improves you should add strength training into your fitness regimen and gradually increase the intensity of your cardio (walking) program.
- Change Your Diet – The hard truth here is that what you have been putting in your body is part of the problem. Fresh whole foods cooked at home will revitalize you and feed your body with the nutrients it requires to function normally. I like to quote Michael Pollan’s sage advice regarding diet because it says it all so succinctly: “Eat food, not too much, mostly plants.”
- Lose Weight – Well, Duh! In every source I found including AHA and CDC documents, exercise and better diet were the first two recommendations and losing weight came third. Of course it’s good advice, but it is a foregone conclusion that if you are exercising and managing your diet your weight and, more importantly, your body fat will normalize.
- Nutritional Support – This one is really important. Very often, metabolic syndrome can be controlled and even reversed with good dietary habits and exercise. Those results are even more attainable and permanent, even in advanced cases, if high quality nutritional supplements designed to address the specific imbalances of metabolic syndrome are incorporated into the health regimen. I recommend a single, well-designed, high quality complex that gives the following benefits:
- Promotes healthy cholesterol and triglyceride levels
- Manages blood glucose levels
- Supports healthy blood pressure
- Provides effective antioxidant function
- Provides natural anti-inflammatory action
- Supports healthy body weight
- Promotes healthy liver function
The Good News
The unattended truth about Syndrome X is that it is not a death sentence nor does it condemn one to a life of pills and a slow decline into decrepitude. In fact, as I have told more than one patient to walk into my office with this diagnosis, “This could be the turning point in your life. If you react properly, you can use this situation to inspire you to make profound changes. You can become healthier than you have ever been.” So, if you have heard that bad news come from your doctor’s mouth, take heart and make the decision to take control of your health. Take those “lemons” and make lemonade – just go easy on the sugar.