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Beyond Calories and Carbs: A Broader Approach to Weight Loss

June 28, 2019

Now that summer is in full swing, it’s hard to go too long without hearing a conversation about the next best diet. If you’re like most patients, choosing the right diet can be confusing, overwhelming, and understandably stressful. With so many diets to choose from, it can be difficult to determine which program is best for you. While each one likely has its benefits, I often tell patients there is no single diet that is universally best for all of us. We are genetically and biochemically unique, which means the approach to weight loss should be specific to your body type, age and activity level. Understanding the different approaches to weight loss helps put into perspective the many possibilities when it comes to addressing weight loss goals.

The Caloric Deficit Equation
Let’s start with the basics. I joke with my patients that weight loss comes down to a very simple, yet sobering, mathematical equation. Calories are a measurement of energy and we lose weight as a result of energy expenditure; that is, “burning” calories beyond what our bodies need to sustain everyday activities. One pound of fat is the equivalent of 3,500 calories and if we divide this number by seven (for each day of the week), we need to create a deficit of 500 calories per day to lose one pound per week. I ask my patients to complete a diet diary, which not only helps me get a better understanding of their diet, but is useful in helping patients recognize “hidden” calories – calories that may be keeping them from creating a caloric deficit. We can then construct a personalized meal plan based on the appropriate caloric intake when accounting for age, gender, height, weight and activity level. It’s not only how many calories we consume, but the types of calories that play a role in weight gain. As we discuss a patient’s personalized meal plan, I make it a point to review the breakdown of macronutrients (the relative proportions of fats, carbs and fats) to optimize efficacy.

Thyroid & Metabolism: Getting the Full Picture
A healthy diet is an essential part of any weight loss program, but so is a fully-functioning metabolism. Our metabolism is controlled by the thyroid, the gland responsible for the production of hormones that affect everything from energy levels and weight loss to supporting healthy mood and libido. The thyroid is the powerhouse of the body and when sluggish or operating at suboptimal levels, can make it more difficult to lose weight. Most primary care doctors test TSH as part of a yearly physical, which works well as a screening tool, but sometimes can miss the bigger picture. In many cases we find normal TSH levels, but the hormones produced by the thyroid gland itself, T4 and T3, are either low or low-normal. This happens when the body is under stress, whether emotional or physical, as the body converts T4 to reverse T3, instead of T3. Essentially, the body tries to save for a “rainy day,” preventing the conversion to T3, which is necessary for a fully-functioning metabolism. Testing the full panel of thyroid hormones provides a more complete picture of the state of your metabolism. Fortunately, there are herbs that help improve the conversion of T4 to T3 that can in turn promote weight loss, when necessary. Since the herbs affect hormone balance, it’s important to run blood tests before supplementing and thyroid-supporting herbs should only be used under the supervision of a physician.

Herbs & Supplements: Garcinia Cambogia & 5-HTP
You’ve probably heard this before: there is no magic pill for weight loss. There is, however, research supporting the use of one herb, Garcinia cambogia, to optimize weight loss in patients who already adhere to a healthy diet and exercise program. While research is mixed, some studies show that regular supplementation with Garcinia as much as doubled weight loss in participants already following a diet and exercise regimen when compared to subjects taking a placebo. So how does it work? Widely used in southeast Asia, a component in Garcinia called hydroxycitric acid (HCA) binds to and inhibits an enzyme called ATP-citrate lyase, which converts carbohydrates to fats. For patients who gain weight more easily when consuming carbohydrates, Garcinia might be a helpful addition to block the conversion of carbohydrates to fats. If carbs aren’t your problem, but you seem to struggle with appetite and portion control, research supports the use of 5-HTP to mildly suppress appetite, which is regulated by hormones called ghrelin and leptin. If there’s an imbalance in these hormones, you may find yourself hungrier than usual, making it difficult to adhere to any given diet. As a precursor to serotonin, 5-HTP supports healthy mood so it is also beneficial in the treatment of depression. When emotional factors and poor mood contribute to “stress eating,” 5-HTP can be especially helpful.

Exercise & Lifestyle: A Visit to a Naturopath
While naturopathic doctors (NDs) are not specifically trained as personal trainers, most NDs are comfortable creating a basic exercise plan that can help address your weight loss goals. The type and timing of workouts, as well as the addition of exercises to increase heart rate, can be “game changing” when it comes to fat loss. We’ve already discussed the negative effects of stress on the thyroid, but stress also results in a rise in cortisol, our stress hormone, which can further inhibit weight loss. Consider yoga, mindful meditation, or any other form of stress reduction to help manage cortisol and optimize weight loss. When elevated at night, cortisol can disrupt sleep cycles and prevent you from getting restorative sleep, which is a fundamental part of any weight loss plan.

The approach to weight loss should never be limited to diet alone; a careful look at thyroid function and metabolism along with exercise planning and the use of supplements and herbs can help you reach your goals more quickly. The approach to weight loss should be as unique as you.

Antonio Reale, ND, MS is a licensed naturopathic physician and nutritionist practicing in Wethersfield and Middlebury, Connecticut. He specializes in personalized botanical medicine and is founder of The Herbal Room, a multidisciplinary wellness center in Wethersfield, with an in-house botanical dispensary. Dr. Reale also sees patients weekly at a satellite office in Middlebury. For insurance information and scheduling, visit: www.theherbal-room.com.

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