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Weight Control
There are many causes of weight gain which
must be delineated before
definitive treatment can begin.
In defining a person’s ideal body weight, we
currently use a formula which involves
height and weight to determine body fat.
This formula is called the Body Mass Index,
or “BMI”. A BMI > 25 is considered
overweight.
There are many potential causes of weight
gain. The thyroid gland, which lies in the
anterior neck, controls mitochondrial energy
in all cells of the body, which means this
gland is involved in your metabolism.
Thyroid function is easily tested using
blood. We routinely test TSH, Free T3, Free
T4, Reverse T3, total thyroglobulin, thyroid
peroxidase antibodies, and thyroglobulin
antibodies.
In addition to the above testing which is
performed in all patients in whom a thyroid
disorder is suspected, we sometimes add
other thyroid tests to this protocol. For
example, in a person whom we suspect has a
defect in the 5-prime de-iodinase enzyme
system, or in a person who might have
resistance in the
thyroid-pituitary-hypothalamic axis, we
often obtain further blood testing, such as
thyrotropin antibody testing.
A person with Graves Disease would also be
tested for thyroid stimulating antibodies,
or thyroid stimulating immunoglobulins.
Adrenal function is also important in
determining etiologies of weight gain. The
adrenal glands lie on the superiormost part
of the kidneys, and make 8 hormones
including cortisol, aldosterone,
epinephrine, nor-epinephrine, DHEA-S,
progesterone, estrogens, and testosterone.
Levels of each adrenal hormone can be tested
using blood, urine, and saliva.
The most accurate testing of the adrenal
hormones involves collecting a 24 hour urine
sample to measure the average amounts.
Assessment of the adrenal stress hormones,
such as cortisol, can be overestimated in
blood testing since the needle stick of
venipuncture can stimulate production of the
stress hormones.
Therefore, in addition to 24 hour urinary
assessment of adrenal hormones, we find that
saliva testing offers accurate and
FDA-approved assessment of the “free”
estrogens, testosterone, and progesterone as
well as free cortisols and DHEA-S. “Free”
hormone means measuring that portion of a
hormone which is not bound up to a protein
in the blood, and is that fraction of a
hormone circulating in the body ready for
immediate use by the body.
Perimenopausal shifts in metabolism often
predispose women to weight gain. Women who
have never had a weight problem begin to
notice weight gain, especially around the
waist and hips. Weight gain can occur
despite increased levels of exercise and
decreased levels of food intake in some
situations. Levels of free progesterone,
estradiol, testosterone, sex hormone binding
globulin are easy to test utilizing serum,
saliva, and urine, and can be safely
balanced, in our opinion. Measuring the
insulin and fasting plasma glucose levels
will assess for insulin resistance,
dysglycemia, and diabetes.
With adrenal imbalances, we often notice
carbohydrate cravings, which contribute to
weight gain. A nutritional program must be
tailor-made for each person. A low-carb diet
is not the answer and can be dangerous.
Nutritional programs must be scientifically
delineated and individualized for each
person. We aim to normalize the insulin
level to < 6, glucose to 70-80, and
glycosylated hemoglobin to less than 6.
Sleep apnea is a frequently overlooked cause
of weight gain. In this condition, a person
stops breathing during sleep, for short
periods of time. During this apneic spells,
the oxygen level drops down, which can cause
weight gain and fluid retention.
Stress can cause weight gain. Stress, as
defined by Hans Selye, MD, is anything that
happens to the body that changes the
function of one or more organ systems in the
body. Stress can be due to pain, chemical
exposure, allergies, emotions, mood, and so
forth. Stress levels can be assessed by
measuring cortisol and neurotransmitter
levels.
Neurotransmitter abnormalities contribute to
headache, depression, weight gain, PMS, PMDD,
mood disturbance, sleep disturbance,
anxiety, ADD, ADHD, cognitive disorders, low
libido, post-menopausal hormonal imbalances,
panic disorders, and many other symptoms. A
simple urine test will measure several of
the neurotransmitters including epinephrine,
norepinephrine, serotonin, dopamine, GABA,
PEA, glutamine, glutamate, histamine, and
others. We like to utilize 24-hour urinary
collections to measure these biochemicals.
However, we realize the inconvenience
imposed on anyone to collect their urine for
24 hours, so sometimes we use a single
urinary sample, which can offer valuable
information.
Abnormal levels of the neurotransmitters can
be balanced using both a pharmacologic
therapy as well as nutritional therapies.
We like to utilize both options, as
pharmacologic therapy will not alter the
levels of neurotransmitters, rather,
allows the body to recycle its
neurotransmitters. Therefore, while we are
treating with medication, if indicated, we
can also assess whether mineral or other
nutritional deficiencies such as deficient
amino acids from which many hormones are
made, might be present. Then we can
correct the cause as well as the
symptoms of the concern.
There are many more causes of weight gain
than we can address here.
Under no circumstances do we recommend the
use of prescription nor non-prescription
drugs for weight loss, as we have seen great
damage done to many people by their choice
to use these medications.
Please refer to the Adrenal Function section
for more information.
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