Obesity & Metabolism
by Ron Manzanero, M.D.
Obesity is one of the most serious epidemics facing our nation today. It is a complex subject that is confusing to the lay public and poorly understood by the medical profession. In my medical practice, obesity is a chief complaint. At least 90% of my patients — who are mostly female — are overweight, fatigued, stressed, and eating fast foods.
Is diet the only problem? Not at all. Though I am educated in family medicine, much of my practice evolves around endocrine-based problems. I have found it useful to rule out potential concurrent problems: hypothyroidism, insulin resistance, and anabolic/catabolic imbalances. There are certainly other matters to evaluate, but I usually start with these three issues.
Regarding hypothyroidism, if you are highly symptomatic, don’t be satisfied if your doctor says your tests are “normal.” The main blood test for hypothyroidism are the TSH (Thyroid Stimulating Hormone) test, Free T4 (the main hormone made by the thyroid gland), and Free T3 (the active form of thyroid hormone the body uses). The standard TSH range is 0.3 – 5.1. Many doctors use only the TSH test, and, if your TSH level falls within this range, they will dismiss your symptoms and conclude that you are “normal.” But in my experience, if you are tired and have brain fog, depression, cold intolerance, dry skin, brittle nails, low body temperatures, constipation, weight gain, and muscle aches, you probably are hypothyroid, regardless of the TSH range! Recent studies have confirmed that the average TSH in healthy individuals is around 1.0 – 1.5. Optimally, the T4 and T3 ranges need to be evaluated as well. A standardized combination of T4 and T3, Armour thyroid, has proven effective for many people.
After checking the thyroid status, the next thing I look for is insulin resistance. This can be a precursor to Type 2 diabetes and is a common cause of obesity. Some clues are a family history of diabetes, a diet high in refined carbohydrates, and obesity in the lower abdomen. I confirm the diagnosis with the following tests: hemoglobin A1C (tests the 3-month average blood glucose level), fasting insulin, and a fasting lipid/cholesterol profile. These tests also need to be viewed from the perspective of “what is optimal?” An optimal hemoglobin A1C test will be less than 5.1 despite the “normal” range of 4.0 – 6.0. So if your A1C is greater than 5.1, and your triglycerides are greater than 100, you could have insulin resistance syndrome.
Insulin resistance is triggered mainly by consumption of refined carbohydrates and lack of exercise. Did our ancestors have white bread, toaster tarts, and soft drinks? No; they generally had to chase their foods or pick them from the ground or from trees. Their diet consisted of primarily low-fat proteins like buffalo, deer, turkey, fish, and whatever nuts, eggs, green veggies and fruits they could find. Notice that “hunter-gatherer” foods tend to be low fat and low glycemic.
The final aspect of my evaluation involves looking at the anabolic/catabolic balance, or forces of “wear and tear” on an individual. As teenagers, our bodies are in high “build and repair,” or anabolic, gear; but as we age and add emotional and dietary stresses to our bodies, our “wear and tear” metabolism, or catabolism, increases. (This anabolic/catabolic seesaw has been described in detail by Stephen Cherniske, M.Sc., author of The Metabolic Plan.) Increased catabolism exacerbates the symptoms of aging and can result in low muscle mass and obesity.
To understand catabolic metabolism, look at hydrocortisone that is made by our adrenal glands as a stress response hormone. Without it we couldn’t live and survive stress, but with excess cortisone we begin to break down, and DHEA declines. Decreasing DHEA levels have been correlated with aging effects like obesity, insulin resistance, osteoporosis, and cognitive decline. Cherniske has shown that by signaling the brain with small doses of DHEA and its metabolite, 7-Keto DHEA, along with proper diet, exercise, and lifestyle, we can shift our metabolism back towards an anabolic balance and reduce obesity. I have outlined a treatment protocol to help regain a more youthful, anabolic metabolism.
In summary, my prescription for correcting obesity involves ruling out or correcting suboptimal thyroid functioning with full-spectrum T4/T3 hormone, ruling out or correcting insulin resistance, and helping the metabolism to become more anabolic. There is hope, and people are finding that they can lose weight and regain their youthful vitality.
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