Metabolism and Hormones
While weight and body mass index may be indicators of health in many settings, they aren’t very accurate: many traditionally “overweight” people are in excellent metabolic health and many people who physically appear healthy are metabolically unhealthy. It is common for women I work with to want to focus more on their weight or ways to lose weight than on how to improve their metabolic health. We often have unrealistic perceptions of our bodies and what it means to truly be healthy. And the sad truth of the matter is that research demonstrates that we likely have a weight “set point” at which are body strives to stay…this is mostly be determined by genetics and environmental factors, some starting as early as in the womb, and, therefore, can be a source of great frustration.
Weight is objectively and subjectively easy to observe and, therefore, judge, especially given all the external influences on what a prototypical healthy body looks like. However, metabolic health, which is impacted by and can impact weight, has serious repercussions for for chronic illnesses like diabetes, cardiovascular disease, and cancer.
To be clear, abnormal weight gain or loss should be investigated and not ignored, but one typically needs more in-depth investigation to determine metabolic health vs simply stepping on a scale. Metabolic issues that increase risks of chronic disease run in families and are often “silent” for years or decades before symptoms occur and are easily screened for through routine blood work, including blood sugar parameters, cortisol, cholesterol, and thyroid function. It is also important to realize that there are times of transition where girls and women may be more prone to weight gain, including puberty, the “freshman15”, time between pregnancies, and perimenopause. Unsurprisingly, these time points often correspond to hormone flux, erratic or emotional eating, and lack of activity. And, reproductive problems like PCOS have a high probability of metabolic disturbance and metabolic disturbance can cause reproductive problems like weight issues, blood sugar abnormalities, and high cholesterol in women of all ages.
A careful review of diet (eating too little can cause weight gain, especially if very active), exercise (too much activity can cause weight gain, especially if not eating enough), and lifestyle may be able to pinpoint changes that can improve overall health and halt unhealthy weight changes. In fact, people are often surprised to learn that the one “diet” that has been shown in hundreds of research studies to improved all metabolic parameters, lead to sustained health weight, and decrease risk for chronic disease is the mediterranean diet, not the WHOLE30, HGH diet, macros, HARD75 or anything else you might see on instagram or tiktok.
Labs can play a role in uncovering predisposing factors that can negatively impact metabolism and metabolic health. With my patients, I routinely assess the following markers:
Cortisol: when elevated level can cause the body to “hold on” to fat, when decreased can cause fatigue
Thyroid function tests: more than just TSH, thyroid hormones and antibodies can often uncover underlying thyroid problems
Vitamin D: a “pro-hormone” this vitamin interacts with the endocrine system and has been associated with many metabolic issues like, hypothyroidism, obesity, diabetes, and PCOS
Blood sugar values like insulin, glucose, hemoglobin A1c: can determine those who have predisposition to diabetes and assess how your body handles the natural sugars you consume
Androgen levels like testosterone, DHEA: if high or low, both can be problematic
Liver function tests” can reveal often silent “ fatty liver disease”
Cholesterol panel: elevated cholesterol is a know symptoms of metabolic syndrome and PCOS and can contribute to heart attacks, stroke, and Alzheimers disease
After evaluating and addressing any metabolic issues, I routinely refer to local registered dietitians, counselors, and personal trainers to assist women of all ages to dispel diet myths and reset what it means to be healthy in term of diet and exercise. Unfortunately, underrating and ovepexrcising can do more to derail or metabolic health than lead to weight loss and in many cases can lead to weight gain.
This is not a quick fix or an attempt to turn back time to get you the body of the 20 year old you, but a focus on health and wellness for the future.
As a physician who has focused on integrative women’s health for over 20 years, I can help you find the right combination of treatments and referrals to help you get started on the road to wellness today. Contact me with any questions.
Metabolic Resources
Metabolic Syndrome: https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916
PCOS-focused podcast: https://thepcosnutritionist.com/podcast/
HAES Health at Every Size movement: https://haescommunity.com