Why can't you lose weight even though you are trying to eat right and exercise?
Why do diets that worked in the past have little or no benefit now?
Your hormones are probably playing a huge role. These include cortisol, thyroid, leptin, insulin, testosterone, estrogen, and progesterone.
Until you get these hormones in balance, it will be almost impossible for you to get to your ideal body weight.
In this article, I will discuss how these hormones lead to weight loss resistance and give you 8 tips to get you back on track...
We have all been taught that weight loss should be easy.
As long as we are consuming fewer calories than we are burning, the weight should just drop off of our bodies. This is called the "calorie in, calorie out" model.
If we have a friend or relative who is overweight, our first thought is usually "If they would just quit eating so much they wouldn't have such a weight problem."
There is no doubt that what we eat and how much we eat impacts our body weight, but it's way more complex than that.
I suspect that many of you who are reading this article each MUCH less than other people in your family, but you gain weight while they seem to never gain.
It doesn't seem fair, does it?
Let's try to break this down further and discuss some common things that can cause weight loss resistance...
If you learn anything from this article, I hope it's this: losing weight requires much more than just eating less. In fact, eating too little can actually harm you and make losing weight even more difficult.
Studies are starting to show this phenomenon as well.
In 2016, a group of researchers released a study of 14 contestants from the 2009 season of "The Biggest Loser." 6 years after the show, all but one of the contestants had regained a substantial amount of weight. Some even weighed more than they had before being on the show.
The metabolism of the contestants had been damaged from the severe calorie-restricted diets. This damage was still present 6 years later!
It's not uncommon for me to see patients that have to eat less than 1000 calories per day just to maintain their weight. If they eat a normal amount of 1500-2000 calories per day, they will quickly start putting on pounds.
If you have tried extremely low calorie diets in the past such as the HCG diet, you very likely have a damaged metabolism and your metabolic set point (the amount of calories your burn daily) is now too low.
Raising your metabolic set point is possible, but it can take a long time and it can be very difficult.
Many doctors think that managing hypothyroidism is easy. Give the patient a T4 only medication such as Synthroid or levothyroxine, and periodically check the TSH to make sure it is in the "normal" range.
In my experience, this does not adequately treat the majority of patients with hypothyroidism. That is because it does not take into account the thyroid conversion process in the body.
For it to be used by the body, T4 must first be converted into T3, which is the active thyroid hormone.
T4 can also be converted into reverse T3. Reverse T3 binds to the thyroid receptors in the cells, but it does not trigger any activity in the cells, which effectively blocks that thyroid receptor. It therefore functions as a "brake" on our metabolism.
This is helpful in times of acute stress, such as an illness or injury because it allows us to conserve energy would normally be spend on metabolism. However, it becomes a problem when the reverse T3 levels are chronically elevated.
In effect, it slows our metabolism which can lead to weight loss resistance.
I discuss this issue in much greater detail in this article.
A digestive system that is not working properly can have a big impact on weight loss resistance.
Low stomach acid can result in the inadequate absorption of many essential nutrients such as iron, vitamin B12, and others. A deficiency of these nutrients can result in slowing of the metabolic rate of the body.
An imbalance in gut bacteria can also have negative effects by secreting chemicals that increase our hunger and cause us to eat more frequently. It can also cause us to extract more calories from food than we would normally.
Insulin resistance also makes your cells more resistant to the thyroid hormone floating around in the blood.
This is why many people may have "normal" levels of thyroid hormone in the blood but low levels of thyroid hormone in the cells (this phenomenon is known as thyroid resistance).
Leptin is an important hormone, which stimulates metabolism, reduces appetite, and signals the body to burn fat.
Fat cells secrete leptin as weight is gained to signal the brain that we have plenty of energy (fat) stores. It then turns up our metabolism and reduces our hunger.
Most overweight patients have elevated levels (>12) of leptin because the brain has become desensitized to the leptin and no longer responds to its signal. This is called leptin resistance.
Our bodies were never designed to withstand the daily onslaught of chronic stress that many of us encounter.
The adrenal glands were designed to give us an energy boost during acute stresses, such as running from a wild animal.
When we constantly live under stressful conditions such as working long hours, eating processed food, getting too little sleep, etc., it puts constant pressure on the adrenals to produce cortisol.
Eventually, the adrenal glands can no longer keep up with the demands, and our cortisol levels will drop.
This results in adrenal fatigue.
Adrenal fatigue causes fatigue, weight gain, sugar cravings, mood swings, and numerous other negative things.
Low testosterone has been linked to obesity, especially in males.
Low testosterone, in both men and women, is often caused by stress, which also leads to high cortisol, weight gain, extreme fatigue, and fat accumulation everywhere—especially the belly.
Excessive estrogen (called estrogen dominance) can also lead to many bad things, including weight gain.
Estrogen dominance leads to the accumulation of fat, especially in the belly, hips and thighs.
It also causes sex hormone binding globulin (SHBG) levels to increase which binds testosterone and results in even worsening symptoms of low testosterone.
Now that we have identified some commonly missed causes of weight loss resistance, let's discuss some things that you can do to help you have success in dropping excess weight.
Diets are the most misunderstood part of the weight loss journey.
With that in mind, lets discuss some basic points that you need to consider regarding what you eat:
You must be very smart about what type of exercise you do and how much of it you do.
This is especially true because so many people have adrenal issues.
If you have constant exhaustion from adrenal fatigue (we will discuss it more below), then doing too much exercise could do more harm than good.
If your overall energy level is pretty good, then starting an exercise program will be helpful for weight loss.
The single best type of exercise for weight loss is High Intensity Interval Training (HIIT).
In fact, doing HIIT exercise for 10-15 minutes 1-2x per week is more effective than doing typical "cardio" exercises for 45 minutes a day.
In this type of exercise, you perform bursts of maximum effort for about 30 seconds followed by a recovery period. It can be performed on any gym equipment - treadmill, elliptical, rowing machine, or even by jogging/walking.
If you simply have too much fatigue to begin exercising fully, start with walking every day and add HIIT as your energy improves.
As we discussed earlier, most of us are under increasing amounts of stress. Stress causes cortisol secretion by the adrenal glands.
If the stress continues, the adrenal glands will eventually not be able to keep up and the cortisol levels will begin dropping.
We will no longer get the cortisol surges when we need them and adrenal fatigue results.
If someone also has low thyroid, it only makes the problem worse.
You adrenal issues can be managed in this way:
- Adrenal Adaptogens - Adaptogens can actually help to lower cortisol levels when they are high and some can even raise cortisol levels when they are low. There are many types of adaptogens but I find that blends of multiple adaptogens tends to work best. These can be combined with glandulars as well for more benefit. Should be used for at least 3 months.
- Adrenal Glandulars - These work best for patients with very low cortisol levels. They also tend to provide an immediate boost to energy levels. Using glandulars in combination with other supplements listed below may be necessary. Should be used for 6+ months.
- Improve Your Sleep - Sleep is critical for optimal health. It is essential that you get at least 7 good hours of sleep per day. Poor sleep increases inflammation in the body and causes weight gain. You may need to consider some supplements to help you sleep at least at first. Read more about this here.
- Consider Daily Meditation and/or yoga - Learning to relax and unwind your mind will help lower cortisol levels.
- Avoid Caffeine - It may be providing your temporary energy but it is also depleting your adrenals.
More often than not, people who have weight loss resistance have a thyroid issue.
It is estimated that up to 40% of the population have some degree of hypothyroidism.
One of the foundational things that you must do in order for you to lose weight will be to optimize your thyroid function. Here a 3 key aspects for you to investigate:
In my experience, most people with a thyroid condition are not on the right kind of thyroid medication and/or the right dose of it.
That is because doctors are taught to treat the lab numbers and not really pay attention to the symptoms that the patient may be having.
In my medical training (this applies to almost all doctors) I was taught to only look at the TSH (and maybe the T4) level and base all of my dosing decisions on whether those labs were in the "normal" range. If they were, then any symptoms that patient may be having must be due to something besides the thyroid.
I have since learned that is flat out wrong.
The fact is, the TSH is really only a measure of the thyroid activity in the pituitary gland. The pituitary has different deiodinases than any other part of the body, which are the enzymes that convert T4 to active thyroid (T3).
The body will make sure that the pituitary gland has a good supply of thyroid hormone, sometimes at the expense of the rest of the cells in the body. So the other cells may be starving for thyroid hormone, but the TSH will be in the normal range.
That's why it's important to have a complete thyroid panel checked to get a true measurement of thyroid hormone levels in the entire body. This includes a TSH, free T4, free T3, reverse T3, and thyroid antibody levels.
Thyroid hormone comes in 2 main forms in the body:
T4 - This the transport or carrier form of thyroid hormone. It has no significant cellular activity.
T3 - This the active form of thyroid. The majority of T3 in the body comes from the deiodinase enzymes converting it from T4.
Most doctors prescribe T4 only thyroid medication, assuming that the body will have no problems converting it into active T3.
That is a false assumption, however, because most people with thyroid issues have an impaired conversion process because of things such as leptin resistance, insulin resistance, stress, nutrient deficiencies, and environmental toxins.
For this reason, most patients do better and feel better if they have some form of T3 in their thyroid medication.
If you are on a T4 only medication (Synthroid, Tyrosint, or levothyroxine) and you still have symptoms of hypothyroidism, you would likely benefit from adding T3 in some form.
Many people respond well to changing to a natural dessicated thyroid (NDT) such as Nature-throid, Armour Thyroid, or NP thyroid.
Some people may need more T3 than what NDT provides. In those cases, Cytomel, liothyronine, or compounded sustained release T3 can be prescribed either with their T4 medication or even by itself.
The thyroid needs are very unique to each person, so don't assume what worked well for someone you know will automatically work well for you. You may need to try more than one option to find the one that best controls your symptoms.
The body can convert T4 to either T3 (active hormone) or inactive reverse T3.
Reverse T3 attaches to the thyroid receptor in the cells, but it blocks it instead of activating it.
When the reverse T3 levels are high, it causes hypothyroidism at the cellular level, even if the blood levels of TSH and T4 are normal.
If the reverse T3 level is >15, and/or if the free T3 level divided by the reverse T3 level is <0.20, then you have too much reverse T3 which will cause thyroid resistance and will ultimately lead to fatigue, weight gain, and other symptoms of hypothyroidism.
You can read more about this in my article here.
This is treated by increasing the T3 in your medication either by changing to an NDT thyroid medication or by adding T3 to take with your T4 only medication.
Convincing your doctor to do this may be very difficult. If he or she is unwilling to listen to you or consider these changes, you may need to consider looking for a new one.
You might want to call some local pharmacies and ask them for a list of doctors who prescribe NDT thyroid medication and Cytomel.
You could also log onto the Institute of Functional Medicine website and click on "Find a Practitioner."
Reversing leptin resistance and insulin resistance are crucial if you want to lose weight and keep it off.
Both will respond to the following - High Intensity Interval Training (HIIT), intermittent fasting, avoiding sugar and grains, and optimizing your free T3 levels. I discuss these and other treatments in this article.
The use of targeted supplements can help reduce insulin resistance. These include:
- Alpha Lipoic Acid - This supplement can help improve insulin sensitivity and reduce inflammation, and can even help treat neuropathy caused by diabetes.
- Curcumin - Curcumin is known as a very potent anti-inflammatory. It has also been shown to reduce the risk of a pre-diabetic from becoming diabetic.
Leptin resistance may also require the use of a GLP-1 agonist medication for a few months. These include Victoza, Byetta, and Bydureon.
You might also benefit from the addition of low dose naltraxone (LDN).
All of these medications will require a prescription from a medical provider that is experienced in using them for insulin and leptin resistance.
It's difficult to discuss any medical issue without discussing the gut.
That is because the trillions of bacteria in your digestive tract play a major role in your health.
The gut bacteria can increase metabolism, change how you digest food, impact inflammation, and even produce chemicals that impact our behavior and moods.
Studies are also showing that certain bacteria in your gut can help you lose weight, while others cause weight gain.
That means if you are suffering from: bloating, alternating constipation/diarrhea, upper abdominal pain, acid reflux/GERD, IBS, IBD, SIBO, leaky gut, yeast overgrowth or any other gut related problems you HAVE to get your gut fixed if you want to lose weight.
So how do you get your gut more healthy?
- Consider taking a high quality, multiple-species probiotic. - I recommend using at least 10+ different species of probiotics and at dosages higher than 100 billion CFU per serving. Most of these will require refrigeration.
- Consider taking proteolytic enzymes - These help you digest your food and absorb nutrients.
- Consider possible food sensitivities - Many people have sensitivities to commonly-eaten foods which can lead to constant gut inflammation. Consider removing foods such as gluten, dairy, and soy from your diet to see if your gut function improves.
Chronic low grade inflammation could be a root cause of your weight loss resistance as well as other conditions you may have.
This kinds of inflammation is caused by things such as:
If you want to lose weight, you will HAVE to reduce the inflammation in your body.
Once the problems areas are identified, it is usually obvious how to treat them.
In general, most inflammation in the body can be reduced by doing these basics:
- Eat nutrient-dense, real whole foods
- Focus on relaxing and managing your stress - 20 minutes of meditation or yoga twice daily
- Get at least 7 hours of quality sleep per night
- Get your gut healthy as discussed earlier
- Take a probiotic and correct any nutrient deficiencies - usually fish oil, magnesium, zinc and vitamin B12
- Exercise as discussed earlier
We are unknowingly exposed to chemicals in the environment that directly interfere with many of the hormone systems in our body on a regular basis.
These are called endocrine disruptors.
While it is impossible to completely avoid all of these chemicals (because they are everywhere!), there are some things that you can do to lower the level of exposure:
This is not intended to make you into a paranoid, nervous wreck, but it's time that many of us take control of our health and realize that there are environmental dangers that impact our health.
There is more to weight loss than the calorie in, calorie out model that we have all been taught.
Multiple hormones play a direct role in our ability to lose weight and keep it off.
A history of being on severe calorie restricted diets can also damage your metabolism and make it impossible to lose.
In order to have success, you need to be on a good diet and a sensible exercise program. You must also optimize your gut health and manage any adrenal and thyroid issues.
You must also test for and address any insulin resistance, leptin resistance, and chronic inflammation that you may be having.
Finally, you should do your best to avoid any environmental exposures that can affect your hormone functions.
Now it's your turn...
Have you struggled with weight loss resistance?
What you have tried that helped?
What didn't help?
Leave your questions and comments below.
Dr. Whelchel is a family physician who specializes in functional medicine, especially hormone optimization. He has over 20 years experience in private practice managing patients with various medical issues. His passion is helping patients reach their full potential of wellness and quality of life. He grew up in the Texas Panhandle where he currently lives. He is married and has 3 awesome children.