Dr. Jennifer Pearlman, MD CCFP NCMP FAARM ABAARM
Despite the fad diets, we are now the fattest generation in history. Obesity levels in Canada have increased from 3% in 2003 to over 20% in 2017, with the greatest rate of increase seen in women. But it is not that we are simply eating more and moving less. The calorie equation cannot account for the increase. Instead, a range of environmental, lifestyle and metabolic risk factors are leading to an obesity epidemic that is threatening our waistlines but also our survival.
The emerging field of epigenetics has led to insights into the impact of gene-environment interactions on our health, aging and risks of disease including obesity. Newly established genetic susceptibilities may predispose to diet-induced diabetes and obesity. Pathological shifts in the microbiome (the collection of gut bacteria) can lead to metabolic changes and increase the risk of obesity. Environmental exposures to low-level chemicals that can also affect metabolism and lead to weight gain. These obesity-inducing environmental toxins (obesogens) may work as hormonal disruptors and can increase the risk of diabetes, cancer and other disease.
These novel risk factors emerge over longer periods of low levels of exposures (i.e. toxins, stress, gene-environment interactions) and as a result contribute greatly to age-related weight gain. The complex web of interactions affecting our weight and health explains why diets, regardless of regimen, too often fail. Dieters committed to the broken calorie equation find themselves in a weight loss-weight gain yo-yo which poses risks to the body as well as to the brain. The vicious cycle of diet and rebound weight gain can indeed be hazardous. Recent research suggests that yo-yo dieting results in reduced cognitive performance and neurotoxicity as redistributed fat-stored toxins released in dieting can cross the blood-brain barrier with deleterious neurological effects during the weight loss phase. Hence the finding that diets may make you “dumb”.
So if diets don’t work and the calorie equation is broken, then a new framework is needed to combat age-related weight gain. A shift from the quantitative mindset to a qualitative one is in order; what and when we eat matters. Periods of fasting intermixed with a plant-based whole food nutrient-rich diet is ideal. There are no cookie cutter solutions. But by understanding an individual’s genetic, hormonal, metabolic, inflammatory, nutritional, and behavioural profile in the context of their habits, preferences and lifestyle a comprehensive plan may be designed. The following five steps underpin a modernized approach to target midlife weight gain:
- Fasting
Our DNA is designed upon ancestral dietary patterns that required prolonged periods of fasting. Fasting can reset your metabolism, stifle the flames of inflammation, die out dysbiotic pathogenic gut bugs and drive a nutritional ketosis. All of which are adaptations that are helpful to kick start weight loss. Try a water-only fast of 16 to 24 hours within the first week of your program!
- Lo-Hi Diet
Food choices and food energy (measure as calories) matter. The Lo-Hi diet refers to low energy (less calorically dense) and high nutrition (enriched with vitamins, minerals and health-boosting nutrients). Plan your meals by adopting a super food, nutrient enriched plant-based ketogenic approach. Translated- this means that volumetrically the diet is based on high-nutrient, low-calorie vegetables (arugula, spinach, kale, broccoli, cucumbers, peppers, carrots) combined with healthy fats, soluble fiber and lean protein (fish, poultry, nuts, seeds). Try to minimize added fats (sauces, dressings), refined sugars, and processed foods by keeping to a raw food diet.
- Reset Insulin Sensitivity
Insulin is the king of metabolic hormones. High insulin levels and acquired resistance at the cell level to respond to insulin, result in metabolic inflammation, high blood sugars, weight gain, visceral (belly) fat accumulation and eventually diabetes. Genetics, diet, lifestyle and hormones can lead to insulin resistance. For women, 50% of their insulin responsiveness is lost by their menopause. Rebooting insulin signaling is key to any successful weight loss and reshape program. A two-pronged approach is needed- addressing insulin production (by the pancreas) and insulin responsiveness (by the liver and working muscle). A low glycemic index diet is best to curb insulin. The glycemic index (GI) is a measure of how much a give food source will trigger insulin release. Ideal low GI foods are those that are low in sugars, free of refined sugars and other chemical additives and high in soluble fiber. Exercise is the best way to boost insulin sensitivity. A vigorous workout regimen combining aerobic, anaerobic and weight training can be as effective as diabetes drugs like metformin in boosting the cell’s ability to respond to insulin and control blood sugar.
- Optimize Hormone Health
Declining sex hormones; estrogen and progesterone in women and testosterone in men produce changes in body composition with redistribution and accumulation of deep fat stores coupled with a loss of lean body tissues such as bone and muscle. The role of hormone therapy is well established for maintenance of lean body mass, redistributing fat stores, and improving insulin sensitivity. A personalized assessment by a qualified expert on the risks and benefits of hormone therapy will ensure that the right hormonal plan is set.
- Restore key Nutrients
Addressing underlying nutritional deficiencies is key to metabolic health and achieving weight loss goals. Vitamin D deficiency activates insulin’s fat storing signaling. Other key nutrients include vitamin B, magnesium and essential amino acids like methionine and choline.
- Repair the Gut
Overgrowth of unfavourable gut or dysbioisis can trigger an increase in the calories extracted from the food we eat. Furthermore, bacterial signaling can affect diet-related behaviours leading to food cravings and less favourable choices. Optimizing the microbiome with a diet high in pre-biotic foods and soluble fibers can lead to increases in favourable bacteria. Adding fermented foods like kimchi and sauerkraut along with probiotic supplements can ensure a healthy microbiome with optimal gut function and metabolism.
- Reset Brain Controls
Sleeplessness and excessive psychological stress are associated with weight gain and poor dietary choices. Chronic stress produces a state of elevated cortisol- which in turn can lead to insulin resistance. Psychological stress has been shown to alter levels of the satiety hormone, leptin leading to over-consumption of comfort foods (high fat, high sugar). Mindfulness-based interventions and stress management techniques such as tai chi, yoga, meditation, visualization and deep breathing have been proven to be effective in keeping stress at bay and improving sleep.
This seven-step approach targets the metabolic, hormonal, nutritional, environmental and behavioural factors that may contribute to weight gain. The new era of Precision Medicine is delivering a new formula to replace the broken calorie equation. It is now possible with a diet and weight loss plan designed just for you to truly achieve your goals.
By Dr. Jennifer Pearlman, MD CCFP NCMP FAARM ABAARM
Dr. Pearlman is a nationally recognized expert in Women’s health, hormones and functional medicine and is Medical Director of PearlMD Rejuvenation, a state-of-the-art Women’s health and wellness facility.