Diet, nutrition & weight loss

Natural weight loss

A holistic approach that’s healthy, effective and lasting

by Marcelle Pick, OB/GYN NP

Over the years I’m sure I’ve lost over 100 pounds — the same 10 pounds ten times! And my patients tell me the same thing.

On any given day about half of all American women (and girls) are on a diet. We spend over $40 billion on diets and weight loss products. But 65% of us are still significantly overweight, and the failure rate of the fad diets and the diet chains (Weight Watchers and Jenny Craig included) is over 97%.

Clearly there are powerful factors that push us toward weight gain and all its related health problems. But the equally important question is, why, even with dieting, can’t women lose weight?

I’ve worked as hard on this issue as on any other medical question in my 27 years of practice. And I think I finally have discovered a way to unravel the knot of issues that work together to produce weight gain and resist weight loss.

Before we explore Women to Women’s approach to weight loss, let me emphasize one vital point. You must restore your health and hormonal balance before you try to lose weight. Think of it as getting healthy from the inside out. Only once you’re in balance can you lose weight and keep it off.

There is a series of steps that will lead you to lasting, healthy weight loss. It involves both emotional and physical factors. Let’s go through them together.

Women to Women’s approach to weight loss

Creating a healthy, lean body depends on how well each individual woman’s body copes with the demands made on it. This is highly individual: what works for you may not work for your friend, but the important thing is that you understand what works for you.

To understand this, you need to know that almost every major system in your body relates to your metabolism and your ability to lose weight and keep it off, specifically your central nervous, limbic, thyroid, neurotransmitter, endocrine, digestive and immune systems. Parts of your metabolic blueprint are genetically predisposed or formed in utero, while others are highly influenced by your nutrition, emotional state, stress level and lifestyle.

So this means you need to get healthy on all these levels before you can lose those stubborn pounds.

Think of it this way. Let’s say your body is like a garden and weight loss is the precious rose plant you’ve been cultivating that just won’t bloom. You’ve sprayed it and pruned it and applied Miracle-Gro, and even though you’ve seen a few buds, the darned thing still won’t blossom — in fact, it’s withering. Then one day you read a book about organic gardening and you begin to pay more attention to the whole plant, not just its flower.

You rule out the simplest stresses (Not enough light? Disease? Pests?). You stop treating it with artificial chemicals and take note of the unique aspects of your garden. You then add customized support: enriching the soil with nutrients, adjusting the quantity of water, mulching the roots.  If the problems are more severe, you call a professional gardener for help. Eventually, your plant is brimming with health. It feels safe and nurtured and robust. Then one day, lo and behold, it blooms with abandon — and does so reliably year after year if you keep up the same measures of care.

So treat yourself like that precious rose and begin to pay some loving attention. The first place to start is your expectations, including your self-image — because no matter how much someone tells it to, a red rose can’t naturally bloom yellow... and shouldn’t have to!

Reexamining your expectations

In my medical practice, I begin each consultation with a list of questions. Most women are familiar with a holistic approach but are surprised at the breadth of my questions. I am, of course, extremely interested in their medical history, but I am equally curious about their family history, their relationships, and their attitudes towards work, play, and food.

If a patient wants to lose weight, as most of them do, I also discuss how she thinks losing weight will affect her life. The interesting thing is that very few women first mention their health. They are more concerned with how they look and feel in their clothing. While I recognize how important this is to women, I always remind them that it won’t matter how skinny or attractive they feel if they can’t get out of bed without pain or have no energy.

Having a BMI (body mass index) over 28 or being substantially overweight (more than 20 pounds) raises the risk of developing diabetes, polycystic ovarian syndrome (PCOS), cardiovascular disease, infertility, hypertension, arthritis, or the serious combination of insulin resistance and cardiovascular conditions that characterizes metabolic syndrome X. But BMI isn’t everything, since it does not reflect the ratio of body fat to muscle mass. A muscular, athletic woman may have a high BMI but a healthy weight. You won’t know until you test your basal metabolic function, which indicates how efficiently your body converts energy into work.

The point is, you can’t tell a book by its cover, so take the time to understand your body. Every woman has a healthy weight range and muscle mass that is right for her, but this is not represented in the majority of women’s magazines. The average American woman is 5’-4” and 140 pounds. The average supermodel is 5’-11” and 117 pounds — measurements that are incompatible with realistic goals of health and weight loss. (Click here for more on this subject.)

So think about your ideas of body perfection. Do they come from the media, your family or mate? Think about whether or not you can really be healthy and happy and live up to those expectations. How will your loved ones feel when you do lose weight (because you will)? Many curvaceous women meet with resentment and anxiety when they lose fat. I call this the Mrs. Santa Claus effect. Often largeness evokes a sense of jolliness, protectiveness, and generosity in others, something they may be loathe to give up when it actually happens.

Because for most of us, food is love. Eating is joy. Delving into your own feelings about food is the next step in unlocking the keys to your weight loss.

What kind of eater are you?

Some women simply can’t begin to take the necessary measures to heal their physiology without first addressing their emotional attachment to food.

Everyone holds certain associations with food. In many cultures, being fed means being nurtured and cared for. During times of high stress, many women look to food for comfort. One way you can keep track of your food associations is by keeping a daily food journal. Use pages from our Wellness Diary or create your own. Note any moods, certain times of day, or certain days of your menstrual cycle that inspire you to eat when you really aren’t hungry. You may notice a pattern.

Interestingly, emotional eating and food disorders may have physiological underpinnings. It may be that your neurotransmitter balance is off, creating a serotonin depletion that interferes with your ability to handle stress. Or it may be that the cross-talk between one or two of your hunger hormones has been disrupted due to chronic lack of sleep or sleep apnea. Corticotropin, a signaling factor involved in appetite, is orchestrated by the limbic system, the part of the brain that processes emotion. Fear, anxiety, and depression all work along this axis and as such can influence how hungry you are and when.

Recognizing a pattern of emotional eating will help you to get a handle on whether or not your caloric intake is related to your body’s physical signals, hormonal situation, or — as is so common with women — to a kind of emotional black box that no amount of food can fill.

Once you have a clear idea of how you eat, you can begin to peel back another layer to understand why.

Appetite and metabolism

Healthy leanness results from burning fat and building muscle — two of the key processes of a functioning metabolism, which on the macro level includes digestion and elimination and on the micro level involves various forms of cellular “work,” such as membrane repair, cell division and endocrine function.

A well-functioning metabolism has three jobs:  1) to convert energy from the food we eat into work and heat (on both a cellular and a muscular level); 2) to eliminate any toxins or unnecessary nutrients in the form of waste; and 3) to store glucose in the form of glycogen and extra energy as fat for future use. All of these functions are interrelated and interdependent; one cannot function properly without the support of the other two. And as research increasingly shows, our nutrition serves as the backstop for the whole game. That’s why the saying “you are what you eat” is no joke.

Metabolic function is primitive in humans — its purpose and mechanisms have not changed much since prehistoric times. When your metabolism functions well you experience a healthy ratio between energy consumption and output — enough calories in to support the energy going out, with a little left over for emergencies. When blood sugar is low, you feel hunger, and when you have appropriately sated that hunger you feel full, but not stuffed or sick.

A well-functioning metabolism is supported by regular, good nutrition. No matter how often you hear that “a calorie is a calorie,” it is just not that simple:  what, when, and how you eat do matter. And nothing shuts down metabolism faster than starvation and deprivation. Your body immediately switches into hoarding mode: conserving fat and burning the liver’s glycogen reserves for energy. Once the reserves of glycogen are depleted, your brain sends out intense hunger signals that will not be denied. This is the source of so much failed yo-yo dieting and repeat weight gain.

Adequate nutrition combined with moderate physical activity automatically keeps our bodies at a healthy set point: a predetermined body fat ratio within a 10–15-pound weight range. Your metabolism is designed to vigorously defend your set point by speeding up or slowing down if its thresholds are threatened.

One way your body signals that it needs (or wants) more calories is through hunger. A constellation of appetite signals work in your body at different times and are highly subject to stress. Hunger hormones, or signaling factors, are part of a larger global feedback system that “talks” to almost every major body function and vice versa. Our much-maligned fat cells are actually metabolically active tissue that help sense “fullness” and regulate body heat and weight.

The amount you eat and when are governed by your brain, fat cells, and central nervous system (which are highly influenced by your environment). How well you digest your food and rid your body of toxins relies on the health of your GI tract and other organs, like your liver. How efficiently the cells in your body convert energy is affected by the health of your respiratory, musculoskeletal, endocrine, and immune systems.

There has been some discussion recently about the metabolic importance of “brown fat,” which differs significantly from the adipose tissue, or white fat, with which you are probably more familiar. Brown fat burns energy at a faster rate than white fat to create heat. Babies have the highest percentage of brown fat to help them keep warm. Most of our fat turns white as we age, so as adults we have practically no brown fat cells, but studies show we do maintain precursor cells that could prove to be a key factor in cutting-edge obesity treatments.

But the current reality for the large majority of women is that losing weight really means shifting your point of view away from the failed traditional model — calories in, calories out — and toward a more holistic approach. Your body is designed to naturally defend a certain weight that it considers normal. Our modern way of life has confused this primitive biochemistry into accepting what is essentially an “abnormal” state: being unhealthy and overweight. In order to permanently lose weight, your body has to feel safe enough to just let go.

And feeling safe means restoring balance and, importantly, a smooth flow of “chatter” among your major systems. For this your body relies on its chemical messengers, your hormones.

Hormones and weight gain

New data appear on an almost daily basis on this weight loss frontier — the relationship between hormones and weight gain — but I’ll provide a brief overview.

Metabolic hormones — otherwise known as “hunger hormones.” Of course, the major player in this scenario is insulin. Insulin is a primary hormone that is directly affected by your diet. It determines whether blood sugar gets used right away for immediate energy or stored as fat instead. Any disruption in the insulin-regulating mechanism, such as insulin resistance, has an instant effect on some of the lesser metabolic hormones — the list of which grows longer every year as we uncover more of the inner workings of human metabolism.

The satiety hormone leptin, which is synthesized within fat cells, is just one part of a complex hunger-satiety network. Ghrelin, a hormone released by the cells lining the stomach, stimulates appetite when levels of leptin fall too low. New hopes of a magic weight-loss pill based on leptin never reached fruition (magic solutions rarely do). But the buzz has led to more research. Other signaling factors, like adiponectin and PYY3-36, are in the spotlight now, both showing a definitive link between stress, insulin levels, and cravings.

Other major hormones: Human growth hormone (hGH) and DHEA are steroid hormones that play a role in ramping up metabolic function. One reason our metabolism slows as we age is the decline in these hormone levels. Chronically high or low levels of cortisol, the stress hormone secreted by the adrenals, short-circuit the cross-talk between fat cells and insulin, leading to a higher percentage of fat accumulation — especially around the abdomen.

Adrenal fatigue, a very common condition in women, is associated with static high levels of cortisol and can lead to intense cravings and binge eating. The simple significance of this is that no diet will succeed if you are under tremendous stress — no matter what you do. A simple saliva test can reveal whether cortisol levels are in line.

Melatonin, the hormone that regulates the circadian rhythm, also factors into your hunger time clock. Research shows that sleep deprivation throws off melatonin production, which in turn influences leptin and ghrelin production. In one study, subjects who were chronically sleep deprived had 15% more ghrelin than those who were well-rested. There is also some evidence that lack of sleep affects your levels of human growth hormone, because “pulses” of hGH are released at night.

And let’s not forget estrogen, progesterone, and testosterone. Adequate levels of estrogen seem to help in hunger regulation, simulating the soothing “full” effect of serotonin. An imbalance in the ratio between estrogen and progesterone triggers cravings, as anyone who is familiar with premenstrual binges can attest. Add the negative effects of too much cortisol and you begin to understand why women accumulate abdominal fat during perimenopause. For more on this specific topic, please see our article on weight gain in perimenopause and menopause.

If a woman is testosterone deficient, which can occur with poor nutrition or during perimenopause, she lacks the ability to build muscle mass no matter how much she works out. Testosterone production relies on adequate levels of cholesterol, the building blocks of DHEA, and progesterone.

The thyroid hormones may also be playing a lead role in your unique physiology. Women often ask me if recent weight gain is due to a thyroid imbalance. But very often, it is an imbalance between other hormones that is affecting the thyroid.

So, identifying any form of hormonal imbalance is a crucial part of understanding how you can lose weight and keep it off. And so is looking at your neurochemistry.

Neurotransmitters, the brain, and weight loss

The metabolism’s first priority is to feed the brain. The brain needs a steady stream of glucose to perform, and when that stream is disrupted the body responds with a multitude of coping mechanisms, like flooding the pathways with cortisol and adrenaline. Designed to satiate the brain during short periods of stress, these emergency measures were never intended to stay switched on. Unfortunately, that is exactly what’s happening in many women — leading to chronic depletion in certain areas, food addiction, depression, and weight gain.

In our article on the trouble with fad diets, I describe in detail the importance of adequate serotonin, the “happy” neurotransmitter, in maintaining a healthy weight and calming food binges. Overlooking the connection between serotonin, cortisol, and food “crashes” is one of the big mistakes made by conventional diets. Other neurotransmitters, specifically norepinephrine (noradrenaline) and epinephrine (adrenaline), are also very important when it comes to metabolism.

These brain chemicals are managed by the hypothalamus and directly affect appetite. They are released (along with cortisol) as part of the parasympathetic mechanism — commonly called the “fight or flight response” — and they curb hunger. Most prescription and over-the-counter appetite suppressants, like phenylpropanolomine (the active ingredient in products like Dexatrim), work along this same pathway by stimulating the release of norepinephrine.

Interestingly, it wasn’t until the controversy over phen-fen some years ago that it clicked for me that weight loss was not about willpower. I saw patients turn their lives around by adjusting their biochemistry. Then the pieces just began falling into place.

The basic idea connecting appetite and neurotransmitters is that if you are running away from a predator, you can’t stop to graze. Natural appetite suppressants, like nicotine or the caffeine in green tea, operate on the same principle. The newer diet drug Meridia actually ups the levels of serotonin and norepinephrine by blocking their re-uptake. But think about this! Nature never intended for us to be in a perpetual state of fight or flight. Of course there are going to be health ramifications — and the older you are the more complicated these may be.

Whatever goes up must eventually come down. And when it comes to neurotransmitters, this usually results in some pretty severe cravings and mood swings. Rebalancing your brain chemistry helps calm the rest of your system by sending out signals of wellbeing. And if your brain feels safe, it is more likely to switch your metabolism from calorie-saving mode (diverting energy to fat, not work) to calorie-losing mode.

And one of the best ways to help move your body into a safety zone is to understand the role inflammation plays in weight gain.

Inflammation and obesity

In our article on chronic inflammation, we delve into the systemic problems that arise when the immune system stays in overdrive. Let’s examine the role inflammation plays in weight loss.

One of the more overlooked symptoms of a taxed metabolism is inflammation, especially of the fat cells. New data confirm that proteins synthesized in adipose tissue, also called adipocytokines, are two types of compounds, one pro- and the other anti-inflammatory. Which kind gets the upper hand depends on the healthy balance of all the other elements we’ve discussed. For instance, adiponectin enhances insulin sensitivity and soothes inflammation, so any disruption in its synthesis and reception will have the opposite effect. We still don’t know if inflammation is a symptom or a cause of obesity, but the two go hand-in-hand.

Another source of inflammation is a stressed digestive tract. Many enzymes and peptides are involved in triggering hunger signals and initiating healthy absorption of nutrients. Good digestion improves the fat-to-energy conversion rate and supports the rest of your system. Allergies, food sensitivities, parasites, yeast overgrowth, and emotional stress can all inflame the GI system. One of the first signs accompanying inflammation is digestive upset.

What’s interesting is that a diet rich in essential fatty acids (EFA’s) and other healthy fats helps combat inflammation in fat cells and lowers irritating acids such as homocysteine in the blood. It also helps the liver synthesize the proteins that build muscle and the fatty acids (like cholesterol) that build hormones.

We know that a diet high in sugar and the wrong kind of fats (the typical American diet) feeds inflammation like crazy. It also promotes the growth of free radicals and encourages the body to burn sugar and not fat for fuel. This has a direct effect on a woman’s ability to make muscle and lose weight.

Building muscle and losing fat

As a species, we are meant to be active. Our ancestors had to walk, run, dig and till for their food. Over and over again, the magic pill that everyone is looking for appears to be exercise. This doesn’t mean you have to become a fanatic, but you do have to incorporate physical activity into your daily routine. The right amount or style will, again, depend on your individual circumstances and metabolic profile.

The basic premise on exercise is this: your body stores energy in two ways, as fat and as glycogen. Glycogen is glucose stored in the liver, muscles and other tissues. Muscles store about 12 hours’ worth of glycogen as a ready supply. Regular exercise, both aerobic and anaerobic, depletes these stores at a faster rate, forcing the body to dip into fat reserves. On a calorie-restricted diet, it is not unusual to drop 5–10 pounds right away, but it is primarily glycogen and water loss and not fat. Once you resume eating regularly, those pounds reappear as quickly as they went away.

A diet high in simple carbohydrates and sugar means that your body has a ready supply of glucose and rarely has to burn fat. A balanced diet that includes more protein, micronutrients, and fiber reverses this process and builds muscle.

Muscle strength depends on good bone health and nutrient absorption, as well as a healthy demand for work. One nutrient that often gets overlooked in this calculus is oxygen, in the form of air and water. In one study, subjects were able to increase their rate of exercise by 25% after drinking a few mouthfuls of water.

Hydration is also critical when it comes to the next layer of understanding — ridding your body of toxins.

The need for detoxification

Let’s go back to the garden metaphor for a moment and imagine your rose plant choked with weeds. Depending on the species, it’s possible that your plant will continue to grow for a while. Eventually, however, those weeds will take their toll.

It is amazing to me that in this day and age, when our lives are fraught with dangerous toxins and stressors, more attention isn’t paid to cleaning out our systems. Allergens, heavy metals, unhealthy bacteria, pesticides, and the cumulative effects of toxic exposure over many years directly influence how well everything else in your body functions. It is the piece that ties everything together.

How well you are coping with your “toxic load” is highly individual, but weight gain is a telling sign that demands are outweighing support. The health of your liver and kidneys, your essential detox organs, should be addressed as part of any good weight loss plan.

If you read our article on detox, you’ll see that there are many levels of cleansing. Everyone can benefit from a gentle system detox, like the Fat Flush Plan or a week-long diet of organic fruits and vegetables a couple times a year. If you are struggling with more severe issues, you may want to discuss a deeper cleanse with your healthcare practitioner.

I can’t overstate how important this is. You cannot achieve a healthy leanness if your body is choked with digestive, cellular, and emotional debris.

Putting it all together

So now you know all the factors that can play into your weight-loss blueprint. The question then becomes what to do with it all. Over the years at my practice, I have discovered a basic plan that builds a foundation of support for most women. The plan is successive. Follow the guidelines sketched out in the first stage and move through the stages progressively, even if you’re not losing weight — because problems at the next stage may be blocking your weight loss.

The goal of this plan is a firm, healthy body that is glowing with health and stability. We want your body to learn to defend a new, lower set point and to recognize a balanced biochemistry as its normal state. This means a different weight for every individual, but the right weight for you. Focus on getting healthy, feeling good, and building muscle — not on attaining some magazine’s idea of the perfect body.

A healthy weight loss is no more than two pounds per week — any more and you are losing muscle, not fat.

Stage One

• Follow the Nutritional and Lifestyle Guidelines we use in our Personal Program or a similar protocol. Eat three well-balanced meals a day (containing protein, healthy fats, complex carbohydrates, and nonstarchy veggies), with two snacks that include some protein. Do your best to limit carbs to 16 grams per meal and 9 per snack, and to maintain a low glycemic load in your food sources overall.
• Take a medical-grade multivitamin rich in EFA’s, calcium and magnesium to fill in any nutritional gaps.
• Gentle endocrine support can help you maintain a healthy progesterone/estrogen balance, particularly during perimenopause.

Stage Two

• Continue previous measures.
• Start a food journal or investigate our Wellness Diary.
• Follow a hypoallergenic diet for one week. A good tool for this is Michael Thurman’s 6-Day Body Makeover.
• Consider a gentle detox and colon cleanse, like the Fat Flush Plan. Or try Women to Women’s two-week Quick-Cleanse
• Increase exercise sessions to 5 times per week, including 3 aerobic sessions with a target heart rate of 130–150 beats per minute for 45 minutes. Add 2 anaerobic sessions such as weight-training.
• If you have issues with emotional eating, get help from a professional. For referrals, talk to your friends, religious institution or healthcare provider.

Stage Three

• Continue to follow the above measures.
• Enlist the help of a nutritionist and other healthcare practitioners to run a full diagnostic work-up. At Women to Women we offer First Line Therapy, a program that includes a total bioimpedence analysis, providing our patients with a full understanding of their blueprint. We look at fat mass, muscle mass, cell health, BMI and work output, food sensitivities and adrenal, GI and liver function, then tailor a specific supplement, detox, and action plan to the individual.

Moving toward a new vision of weight loss

I sincerely believe that if women understand how to support the unique needs of their bodies there should be no hindrance to maintaining a healthy, lean weight throughout their lives. This means before, during, and after menopause.

It’s my hope that through the knowledge you’ve learned here you will finally be able to get off the dieting merry-go-round that leads nowhere and enjoy a whole new life — one that blooms with vigor and beauty for all the seasons to come.

Our Personal Program is a great place to start

The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.

• To learn more about the Program, go to How the Personal Program works.
• To select the Program that's right for your symptoms, go to Choose the plan that works for you.
• To assess your symptoms, take our on-line Hormonal Health Profile.
• If you're ready to get started, learn about our risk-free trial.

If you have questions, don't hesitate to call us toll-free at 1-800-798-7902. We're here to listen and help.

We’re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment.

Related to this article:

References & further reading on natural weight loss

 

Original Publication Date: 11/15/2005
Last Modified: 07/01/2008
Principal Author: Marcelle Pick, OB/GYN NP