The struggle with weight loss and weight control is a deeply personal one. From the clinician perspective, I see patients so often who have tried every variation and plan for diet and exercise and still nothing works, leaving patients frustrated and feeling helpless. Why does this happen? Often, the problem is much deeper than can be solved simply by diet and exercise.
The fact is obesity is a chronic disease of a metabolic nature that leads to excessive development of fat, which leads to cardiovascular disease, Type 2 diabetes, high blood pressure, fatty liver disease and more. The conventional thinking has largely been that a sedentary lifestyle and overeating are the main causes of obesity; however, not everyone who overeats and doesn’t exercise is overweight.
BMI, or Body Mass Index, is how obesity is typically assessed. This is calculated by weight in kilos divided by height in meters squared. For adults, a person’s BMI is considered normal or healthy if it falls between 18 to 25; 25 to 30 is the overweight range; low risk obesity falls within 30 to 35; moderate risk fall between 35; and over 40 is considered severely (high risk) obese. And it should be noted these classifications could vary depending on muscle mass with similar height and weight.
That’s why BMI is not very reliable as a sole measurement. Lately we also take waist measurements into consideration. Normally, in women, this should not exceed 31”; and 37” in men. An example to consider: if a woman has a pear-shaped body, she would not necessarily be obese; but a woman shaped like an apple would be very dangerously obese.
The Role of Fat (Pun Intended!)
As it turns out, fat is a particularly important endocrine organ. When fat builds up on the abdomen, it’s not only immediately below the skin surface, but can also be around organs such as the liver, stomach, pancreas, etc. The question becomes how much fat is surrounding these organs; excessive internal fat can hinder the activity of these organs. This can lead to: cardiovascular disease; diabetes; hypertension; osteoarthritis; infertility; gout; cancer; low levels of sex hormones (progesterone, estradiol, testosterone); and can even reduce life expectancy by up to 12 years.
With this information, obesity is now considered to be a hormonal metabolic disease, with causes attributed to: 1) low secretion of fat burning hormones; 2) low level of vitamins and microelements responsible for fat metabolism; 3) high secretion of fat building hormones such as cortisol and insulin; 4) chronic overeating; and 5) low physical activities.
High levels of cortisol and insulin are problematic for weight loss and weight control, among other issues. Cortisol is a stress hormone. Under stress, in small dosages, it acts as a fat burning substance; however, during chronic stress, it creates fat expansion, particularly around the waist. Insulin is a hormone required for absorption of glucose into the cells. Increasing waist measurements by even half an inch means you will require more insulin to perform the same amount of work, and over time, cells become resistant to insulin receptors. So, the key doesn’t fit the lock. As a result, glucose cannot penetrate those cells starving for energy, and extra glucose built up in the blood turns into fat tissue. Extra insulin creates all kinds of inflammation and growths such as cysts, skin tags, even tumors and cancerous growths.
Following are the clinical signs of high insulin level:
- Hyperpigmentation of elbows, underarms, creases, back of the neck
- Ability to pinch greater than 1 inch of skin
- Sweet cravings
- Often hungry
- Light-headed and weak with long breaks without food
- Tremors and increased appetite during eating; difficulty reaching satiety.
Diagnosing high levels of insulin should be done with venous blood (a normal blood test; after levels are determined, monitoring can be done with blood from a finger prick), and a glucose tolerance test. If blood glucose drops too much 2 hours after ingesting the glucose drink, it indicates insulin resistance and its overproduction. High levels of insulin or sugar can also be related to high levels of LDL, or bad cholesterol, and possibly to a fatty liver.
Functional Medicine Approach To Obesity
Weight loss and management from a Functional Medicine perspective involves taking the full picture of the person’s current health status, and using the results of comprehensive testing to address the dangerous insulin levels, as well as the other contributing factors to the why and how those levels reached the point of high risk and severity. Controlling insulin levels can then be done with proper diet and healthy eating habits, as well as with lifestyle changes, nutritional & hormonal supplements, and even acupuncture.
The first line approach is an appropriate diet and healthy eating and lifestyle routines. Consider the following tips:
- Do not skip breakfast. Skipping breakfast can set the body up on an insulin level high for the whole day. Instead, be sure to have a daily breakfast that includes protein and good fat, such as an omelet, yogurt, low fat cheese, nuts/nut butters, and lean organic turkey breast and more; for vegans/vegetarians, include a protein powder with full amino acids.
- Do not have snacks. Frequent snacking triggers insulin production throughout the day, increasing the opportunity for fat formation. Eat 3 times a day.
- Eat complex carbs only during the first part of the day. Your dinner should be protein and good fat, and include low glycemic veggies (there are plenty to choose from!): carrots, greens (spinach, kale, collards, beet), green beans, tomatoes, cucumbers, Brussels sprouts, broccoli, cauliflower, mushrooms, and many more.
- Exclude simple carbs like sugar, pastries, grapes, melons, dates, and sugary beverages.
- Exercise! Walk at least 5k – 10k steps daily.
Next is to make sure your body isn’t experiencing any deficits of naturally occurring fat burning substances. One of the most critical, and underappreciated, is Vitamin D.
Vitamin D is produced by sun exposure, and synthesized in the skin and metabolized in the liver. The latest research indicates Vitamin D is not only a vitamin but also behaves in the body as a hormone, and every cell has a receptor to it. Vitamin D is the most important fat burning hormone, responsible for calcium/phosphorus metabolism and needed for sufficient calcium in the bones. It’s also important for immune response to avoid infections; and it plays a role in preventing the development of cancer and other growths. Additionally, it can help to normalize both sex hormones and insulin level.
Vitamin D levels should be tested regularly as part of a blood test so deficiencies can be revealed and addressed, either with adding more naturally occurring Vitamin D into your diet from food sources like eggs, fish, butter and fish oil; or with supplements.
Other naturally occurring fat burning substances include:
- Sex hormones
- Thyroid hormones
- Growth hormones
- Vitamin B-Complex
- Omega-3
Omega-3 is part of the building blocks for all cellular membranes, and is another crucial nutrient, but over 90 percent of the population suffers from some level of deficiency, leading to cellular inflammation. The benefits of Omega-3 are numerous, ranging from improving brain function, circulation and the immune system to decreasing inflammation, LDL (bad cholesterol) levels, risk of cardiovascular disease, and stress.
Increasing the levels of fat burning hormones in the body is an important part of a weight loss plan, and diet and exercise work well and fast if hormones are in check. However, if a patient is going through menopause or andropause (in men), then it requires more than just diet and training. With age, after 40 the levels of estrogen, progesterone, testosterone, growth hormones, and thyroid hormones are decreasing. Conversely, levels of fat building substances—cortisol, insulin, and oxidative stress—are building up. Therefore, as we age, it takes more vigilance and effort to make sure the scale doesn’t tip in the wrong direction.
Oxidative stress is a process where tissues become too acidic. In this terrain cells cannot produce enough energy, so fat tissue cannot burn effectively, which leads to slower metabolism. One good example of oxidative stress is cellulite, which demonstrates cells that are too acidic and cannot get enough oxygen in the tissue.
Oxidative stress is easy to check with the help of pH paper. Normally saliva pH should not be lower than 7. Fat tissue is not going to decrease in the absence of oxygen and at low pH.
To keep oxidative stress within a safe and acceptable range, it is highly recommended to take antioxidants, especially after age 40. An easy way to do this is to drink more water during the day, and include more alkaline-rich foods rather than acidic foods into your diet, such as lemons, green tea, vegetables and leafy greens, and fruit. For more concentrated support, the best antioxidant supplements for healthy levels are: Alpha Lipoic Acid, Vitamin C, Selenium, and Curcumin (the main active ingredient in the spice turmeric!).
Finally, there are additional levels in the body to check to make sure they are within healthy ranges:
- Iron, ferritin level. This is often hidden, and an iron deficit leads to lack of oxygen in the cells since iron transports it to cells. This can be especially concerning for women during menstruation, when the loss of blood can be very high. Signs of a lack of iron include: tiredness, lost of hair, brittle nails, frequent headaches, feeling cold, feeling depressed, breathing difficulties, throat dryness, infertility, and neurological symptoms.
- B-12. This vitamin plays an essential role in the production of your red blood cells and DNA, as well as the proper functioning of your nervous system. It is involved in transporting iron to the cells. Vitamin B-12 is naturally found in animal foods, including meats, fish, poultry, eggs and dairy; vegetarians should take supplements as a viable replacement.
- Thyroid hormones. These need to be checked, as well as iodine. A simple application of topical iodine can indicate deficiency if it disappears within 24 hours.
- Body biome balance. A healthy gut biome is important for carbohydrate metabolism. The right probiotics and prebiotics will help balance the gut flora and increase metabolism, key for fat burning and weight reduction.
Acupuncture for Obesity
The combination of Functional Medicine with acupuncture can bring fast and significant results when included in a weight loss treatment plan. For example, auricular points—pressure points on the ear—are particularly effective for appetite suppression. The use of acupuncture facilitates many additional benefits that support sustainable weight reduction, and offers relief from or eliminates many of the side effects that come with excessive weight on the body. These benefits include:
- Increasing metabolism
- Detoxifying and draining the lymph system
- Increasing circulation in the pancreas, liver, hormonal glands such as thyroid, adrenals, sex hormones, pituitary and more
- Balancing digestion
- Decreasing/eliminating headaches, other pain
- Decreasing stress, depression
- Decreasing inflammation
- Improving circulation
There really is no straightforward, one-size-fits-all approach to ridding your body of excessive weight, but taking a holistic approach like the one used in Functional Medicine can be a strategy for treating obesity and achieving successful and sustainable weight loss.
Helena Amos, M.Ac., L.Ac., is a licensed acupuncturist, European physician and Functional Medicine practitioner with more than 30 years of clinical experience combining the best of modern Functional Medicine with the ancient wisdom of Traditional Oriental Medicine. She is Founder/Owner of the Acupuncture and Natural Medicine Clinic in Rockville, MD, and is available for in-office and telehealth consultations. Visit rockvilleacupuncturemd.com/ for appointments and to sign up for her monthly health e-newsletters.