Looking at weight loss through a functional lens

Let’s be real - the prevalent use of GLP-1s could put weight-loss dietitians out of a job nowadays. This is honestly a running joke in the dietitian world. There is no need for people to count calories, track their macros or reverse insulin resistance solely through effort anymore when there is such an easy pharmaceutical option available. This medication automatically increases satiety signals, quiets food noise and promotes insulin sensitivity. That is a huge relief for some people who have struggled with reaching a healthy weight their whole life or who have the genetic odds stacked against them for developing type two diabetes. I personally do not promote the use of them but am happy to work with someone already on a GLP-1. For me, GLP-1s are simply one other tool in quite a large toolbox for weight loss and metabolic health. 

I want to share some perspectives on weight loss and other factors to consider from my own professional experience that shape metabolic health beyond calories and macros. People have come to me before saying “I have lost 20 lbs counting calories and macros and now I’ve plateaued and my weight won’t budge. What else can I do?” or “I gained 30 lbs the past year eating the way I’ve always eaten and I have no idea why.”

Man, I love solving a good puzzle. To approach these situations, let’s first consider the underlying pieces as to what even impacts metabolism. Yes, at the end of the day weight loss happens when there is a calorie deficit to “trick” the body into having to pull from its own fat stores to meet metabolic demand. However, I recommend going deeper to see what is actually dictating metabolism and hormones. Let’s look at some of the other areas worth considering: 

Thyroid health. 

I am sure many of you are thinking “Yep, I knew she was going to talk about this.” If I was paid $50 for every time someone came to me with just a TSH and free T4 level checked and was told “your thyroid is fine.” I could probably finally buy a flight to Japan to visit my brother. But in all seriousness, getting a full thyroid panel with a TSH, free T4, free T3, TPO and Thyroglobulin antibodies is going to show you so much more. Even if someone’s free T4 is normal and even within the optimal range for metabolic health, that doesn’t mean the thyroid is functioning well. T3 is the active form of thyroid hormone - not T4, and the body requires specific nutrients for that conversion process. Going further, if thyroid antibodies are increased, we know the immune system is reacting to something and that the body has actually decided it needs to attack its own thyroid gland. Hmmm. When I come across that situation I think “Ok, this is a piece of the puzzle that’s keeping weight on for this person. Why is this happening?” From there, we have to assess everything else that comes into play when supporting the thyroid. Gut health, nutrient status, oxidative stress and immunity all come to mind as areas to investigate further. 

Gut health. 

Even if the thyroid checks out, I recommend assessing someone’s microbiome and satiety/hunger cues. This can be as simple as increasing prebiotic fibers, fermented foods and resistant starch in someone’s diet which will help fuel a robust, healthy microbiome. The microbiome is a topic of its own that could be written about for days and days, so for the sake of time I will make this short. Beneficial bacteria crowd out “bad” bacteria that could be triggering an immune reaction and causing inflammation. They promote healthy intestinal lining which prevent possible “intruders” from entering the bloodstream. Having healthy intestinal mucosa and intact tight junctions helps keep the immune system calm because it is less likely to encounter those “intruders” that would otherwise mount an immune response. Finally, beneficial bacteria produce short chain fatty acids like butyrate which modulate glucose metabolism (fancy way it impacts or changes how people metabolize carbohydrates.) These are just some reasons why looking more deeply at gut health can go a long way. 

Inflammation and Stress

Let’s talk a little more about immunity and the impact on cortisol. Cortisol is made by the adrenal glands in response to stress whether real or perceived. MANY things can release cortisol - a car accident - and also things like skipping meals and having low blood sugar! The body perceives low blood sugar as a stressful event and as a result, will release cortisol to bring glucose back out into the bloodstream to try to even out levels again. 

When someone is eating foods they are sensitive to the immune system reacts by bringing T cells to the “problem” area and releases inflammatory chemicals called cytokines in response. This is also perceived as stress to the body, so food sensitivities can cause cortisol release. One of the problems with so many things promoting cortisol release is that cortisol impacts blood glucose. Cortisol is like an alarm to the body saying “All hands on deck! I need quick energy available to deal with this emergency and I need it NOW.” So now we have glucose in the bloodstream signaling insulin to be released to bring the glucose inside the cells so it can be broken down for energy. Here we can start to talk about how this cycle can promote insulin resistance which can absolutely be fueling stubborn weight loss. 

Ok. There are other areas I could chat about such as sleep and muscle mass that also have a huge impact on metabolism, but I will end it here because this is getting too long to be a blog post. If any of the above sounds like you and you want to partner with a functional RD whose strategy goes beyond calorie counting and weighing food for metabolic health  I would love to work with you!