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There are four prominent endocrine and metabolic disorders that not only contribute to obesity, but also make weight loss difficult. These conditions – “bad metabolism,” hypothyroidism, an underactive thyroid, and “adrenal fatigue” – are frequently misdiagnosed by doctors, or incorrectly self-diagnosed by patients. As a result, healthy people may think that they have them, while truly affected – may miss them. Both groups suffer needlessly. Let’s review some of the long-held misconceptions about this paradox.
The first misconception is about “bad metabolism,” and it is the most common, approaching a near 100% popularity. Medically and nutritionally speaking, it is a complete opposite. What you may think is “bad” is, actually, “good,” and here is why.
Bad Metabolism
The truly “bad” metabolic disorders concern water balance and fluid volume; the balance of electrolytes (sodium, potassium, calcium, magnesium, and phosphate); acid-base regulation; disorders of carbohydrate metabolism, such as hypoglycemia, type 1 and type 2 diabetes, diabetic and alcoholic ketoacidosis; and lipid disorders, such as dyslipidemia and hypolipidemia [1].
These conditions affect people of all ages, genders, and body weights. Some of them are outright deadly, while others – such as diabetes or dyslipidemia – are chronic. Within the same group of conditions, some are associated with obesity, such as prediabetes and type 2 diabetes. Others, such as type 1 diabetes or diabetic ketoacidosis, result in profound and life-threatening weight loss.
Consequently, any time you mention “bad metabolism” in relationship to your weight, your doctor will know exactly what you mean, but may still chuckle at your misinterpretation. And if you continue insisting that you may have it, he or she may also tell you that when it comes to body weight, a true “bad metabolism” is a sign of impending death, and that a precipitous weight loss, not gain, is one of its primary symptoms.
The emaciated gentleman on the left is Steve Jobs of Apple fame, shortly before his premature and unfortunate death. Take a hard look at this heartbreaking picture. That is what an actual “bad metabolism” – meaning the body’s inability to properly metabolize nutrients essential for life – really looks like.
Not so long ago, the dominant thinking and attitudes toward metabolism was a complete opposite. When my mother met my dad, a tall and handsome man with manners to match, she was short and moderately overweight, with big hips and large breasts, an ideal body shape for the 1950s. Single men would look at her thinking: “Gosh, this lady is so attractive! I want her to become my wife and the mother of my children.”
Today’s young men, conditioned by the Victoria Secrets’ standards, are more likely to pass over someone like my mother in favor of a waifish girl like Calista Flockhart (32A-23-30), who just three generations ago would have had a hard time finding a marriage partner because of prejudices typical for that era:
- Her appearance would reflect probable malnutrition or chronic illness throughout early development. In that rough era of near-zero upward mobility, malnourished children came predominantly from impoverished households, and no man or woman wanted to marry into a poor family.
- Before the near universal availability of on-demand C-section, her narrow hips would be considered life-threatening during natural childbirth.
- Her small breasts would be assumed inadequate for motherhood because she might have difficulties breastfeeding her numerous offspring. This isn’t, really, entirely correct, but that’s, unfortunately, how it was and still is in undeveloped societies.
- Back then, her small body would be deemed too weak to chop wood, milk cows, carry buckets of water, and cook, clean, and wash from dawn to dusk for the entire family.
- Personality-wise, a person of her shape would be considered a “cold fish” because underweight women have lower levels of estrogen and are believed to be not as libidinous as normal weight or, even better, overweight women. I don’t know if that is true, but that’s how it was.
All of that primitive, misogynistic, and mostly unconscious thinking – to find a partner who will last you and your children through thick and thin – was, essentially, a basic “animal” instinct in action, honed over hundreds of thousands of years of pragmatic and merciless natural selection.
Naturally, that’s exactly what my father did without giving it a second thought – he married a woman with a good metabolism. He knew instinctively what my mom’s doctor told her after every check-up: “Polina, you have a fantastic metabolism!” For her generation it was an asset, not a curse. (The photographs of my parents on the right are from 1958, four years after my birth. They are, respectively, 43 and 37 years old).
True to form, my mother had an accidental pregnancy at the age of 45, while the usual rate of conception after age 40 is less than 5%. And that is after surviving the horrors of starvation and backbreaking labor during the four years of World War II as well as the devastation of postwar Russia.
Calista Flockhart, on the other hand, finally married actor Harrison Ford at the age of 46. In all probability, natural selection wasn’t on the mind of Mr. Ford, who at the time of their marriage in 2010 was already 68 years old. The couple is raising her adopted son Liam, who was born in 2001. Any way you look at it, the laws of evolution remain as tough today as they have ever been, even to someone as beautiful, talented, and famous as Ms. Flockhart.
So, if you too are endowed with a good metabolism just like my mother was, the problem isn’t with you, your genes, or your body, but with the times we are living – the sum of abundant food, minimal physical exertion, and all conceivable creature comforts is behind obesity epidemics on one hand, while the incorrect believe into “bad metabolism” causes many people to drop their weight loss diets too soon, or discourages them from considering one in the first place.
THE TAKEAWAY: Since it’s too late to get another set of genes, or become a lumberjack, or give up comforts, concentrate on the two factors that are still under your total control – what you eat and how your “burn” it! In fact, your “good metabolism” will work in your favor – the better it is, the faster you are going to lose weight.
Hypothyroidism and underactive thyroid
The situation with thyroid-related disorders is a lot more complicated than with bad metabolism. A true “underactive thyroid” – a vernacular for subclinical hypothyroidism – affects up to 10% of women and 6% of men, many of them over 65 years of age. The rate of clinical hypothyroidism is under 1.2% of women and 0.4% of men [2] predominantly among older adults, 33.3% of adult Americans are overweight and 35.9% are clinically obese, or 69.2% .
As you can see, the number of overweight people is significantly greater than the number of people affected by subclinical or clinical hypothyroidism [3], even though many people who are affected by adiposity – a shorthand for “overweight or obese” – believe they may have this condition because of weight loss resistance or weight gain on a moderate diet.
On the opposite side of the spectrum, there are people who are misdiagnosed and untreated because both conditions are challenging to manage even to specialists. According to The Merck Manual of Diagnosis and Therapy, the early stages of this condition are associated with the following symptoms:
“…cold intolerance, constipation, forgetfulness, and personality changes. Modest weight gain is largely the result of fluid retention and decreased metabolism. Paresthesias [tingling – KM] of the hands and feet are common, often due to carpal-tarsal tunnel syndrome…[4]”
Please also note one significant detail in the above quote: “Modest weight gain is largely the result of fluid retention…” This explains why some people who are affected by this condition can’t lose weight even on a very low calorie diet – most of that extra weight comes at the expense of water, not body fat.
Women with hypothyroidism may also be affected by menorrhagia – an abnormally heavy bleeding during menstruation, or amenorrhea – an abnormal absence of menstruation. If you are experiencing any of these symptoms, get evaluated by a board certified endocrinologist.
Because clinical hypothyroidism isn’t as common as some other disease, non-specialists may not be able to properly diagnose and treat you, especially during the earlier stages while the symptoms are still subtle, and the tests aren’t as definitive. If your diagnosis or treatment outcomes are not satisfactory, you may also consider working with alternative providers.
Things get even more complicated with Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis. It is an autoimmune inflammatory condition of the thyroid. In addition to the transient symptoms of hypothyroidism during early stages, it is distinguished by painless enlargement of the thyroid gland, and, in some cases, a feeling of fullness in the throat. It may or may not be associated with adiposity.
The prevalence of Hashimoto’s thyroiditis ranges from 0.1 to 0.15% of the population (1 to 1.5 cases per 1,000 people), and it affects women 10 to 20 times more often than men. It is most common between the ages of 45 to 65, and it often runs in families (i.e. it has a genetic component).
The same immune mechanisms which cause Hashimoto’s thyroiditis may also cause Graves’ disease (thyroid enlargement, goiter), Addison’s disease, type 1 diabetes, celiac disease (an autoimmune inflammation in the small intestine), vitiligo (skin depigmentation), premature graying of hair (same mechanism as in vitiligo), pernicious anemia, and connective tissue disorders.
If you suspect that you may have Hashimoto’s thyroiditis, GET TESTED. The level of thyroid hormones T4 and TSH may remain normal during early stages, making its diagnosis difficult in non-specialized clinical settings. Seek out a specialist trained in diagnosing and treating this relatively rare condition. 1 case in 1,000 is, indeed, rare for an internist who treats on average 2,000-3,000 patients a year, and may not encounter a single patient with Hashimoto’s in years.
I do not recommend commencing any type of weight loss diet until you are properly diagnosed and treated for hypothyroidism. A reduced calorie diet may deny your body from getting essential nutrients, and may exacerbate the progression of the disease. Besides, it isn’t likely to be effective anyway because of fluid retention.
As clinical hypothyroidism progresses, the symptoms become more severe and obvious, including precipitous weight loss. You can learn more about other manifestations of clinical hypothyroidism in countless online resources.
THE TAKEAWAY: Do not rely on outdated misconceptions about clinical and subclinical hypothyroidism. If you are experiencing any symptoms related to either condition, seek out the best treatment money can buy. Continuous weight gain in healthy people isn’t always a symptom of hypothyroidism. As epidemiological statistic – however flawed it may be – demonstrates, the majority of people with adiposity are not affected by hypothyroidism. If you are in this fortunate majority, you earlier failures to lose weight weren’t related to bad health, but to bad diets.
Adrenal fatigue
What you may think is “adrenal fatigue” endocrinologists call primary or secondary adrenal insufficiency. Both conditions are ascertained by a blood test, and treated, when necessary, with appropriate medication.
Primary adrenal insufficiency – also known as Addison’s disease – is a hard to miss condition because it is accompanied by severe skin pigmentation. Its prevalence – a medical term for the number of affected people – is less than 1 person in 14,000 (<0.007%) in population [5]. Just like truly “bad metabolism,” it causes weight loss, not gain:
“The slowly progressive loss of cortisol and aldosterone secretion usually produces a chronic, steadily worsening fatigue, a loss of appetite, and some weight loss. Blood pressure is low and falls further when a person is standing, producing lightheadedness. Nausea, sometimes with vomiting, and diarrhea are common. The muscles are weak and often go into spasm. [6]”
If you have any of the above symptoms, get tested immediately. This debilitating condition can be well controlled with medication.
The prevalence of secondary adrenal insufficiency is less than 1 person in 3,600, or 0.027% of the population. The symptoms of this condition are similar to Addison’s disease, but without pigmentation. Again, a blood test is required to screen it out and receive an appropriate and effective treatment.
A popular opinion exists that this condition may be substantially underdiagnosed. It may very well be correct, so let’s assume that there are 100 times more people affected by secondary adrenal insufficiency than what epidemiologists are telling us. Alas, it still comes to only 2.7%, a drop in the bucket next to 69.2% of the population with adiposity.
THE TAKEAWAY: Just as with “bad metabolism” and hypothyroidism, don’t rely on outdated misconceptions about “adrenal fatigue” and its relations to weight loss or gain. Seek out expert help to screen out primary and secondary adrenal insufficiency, and, if necessary, obtain adequate treatment.
References
[1] Endocrine and Metabolic Disorders; The Merck Manual of Diagnosis and Therapy, online edition; Last accessed March 30, 2013; [link]
[2] Vanderpump, Mark P.J., “The epidemiology of thyroid disease.” (2011) : 39-51. [link]
[3] This calculation is based on the following numbers: percent of adults age 20 years and over who are obese: 35.9% (2009-2010); percent of adults age 20 years and over who are overweight (and not obese): 33.3% (2009-2010). Source: Department of Health and Human Services, Health, United States, 2011, by Kathleen Sebelius, et. al., 2011, [link to PDF]
[4] Hypothyroidism; Symptoms and Signs; The Merck Manual of Diagnosis and Therapy, online edition; Last accessed March 30, 2013; [link]
[5] Division of Medical Sciences, University of Birmingham, and Department of Medicine, Endocrine and Diabetes University of Wurzburg, “Adrenal Insufficiency,” Lancet, 361 (2003): 1881-93; [link to PDF]
[6] Margulies, Paul, MD; National Adrenal Diseases Foundation; Addison’s Disease – The Facts You Need To Know; “What are the symptoms of Addison’s Disease?” Last accessed March 30, 2013; [link]
Previous posts from the “Why Diets Fail?” series:
1. The Real Reason Diets Fail and What You Can Do About It
2. How Long Will It Take Me to Lose the Weight?
3. Why One Calorie For Her Is Half a Calorie For Him
For your health and safety, please read these important Weight Loss Common Sense Warnings and Disclaimers before commencing a reduced calorie diet.
As a child and teenager my weight fluctuated 5-10 lbs. I ate healthy meals and a fair amount of deserts (perhaps a few too many deserts, but I wasn’t fat and was active). I never concerned myself much with my weight. It just came and went seemingly on its own. Then in college I ate mostly yogurt, granola bars, pastorized milk and cereal (I’d grown up on raw milk), along with several McHamburgers per week. I also went through some very traumatic emotionally difficult experiences in my twenties. By my late twenties/early thirties I had graduated from college and had my dream job, so I began to eat better meals and lots of deserts like I had in my pre-college days. After about five years I was gaining weight and battling depression. The doctor said my thyroid test was a little off. I started on 60 mg of synthroid and after awhile uped it to 90. I later switched to Armour Thyroid. Several years ago when the Armour brand was unavailable, I tried natural supplaments in place of thyroid and within four weeks I was physically exhausted and my formerly strong, healthy nails were curling up at the edge and breaking. I found a source of Armour thyroid and went back on it. It took 6 months for my energy levels to return to normal, but my nails got worse and geletin pills are now keeping my nails from breaking. I’ve struggled with weight since my 30’s and diets were temporary fixes. I’ m slowly learning how to eat a truly healthy diet and controlling portions, etc. But… having said all this… I have already wondered if taking thyroid masked a deeper problem and has caused me to be permanently dependent on a thyroid hormone. What is your opinion on this?
Aleta, non-iron deficiency anemia is the first thing that pops into my mind based on your account. Many people don’t realize that there are more “anemias” than the one related to iron-deficiency. And the same factors that may cause anemia may also cause underactive thyroid. I am going to address this subject in my future posts.
I just wanted to drop a line saying how much I am LOVING this series!!!! Thanks, Konstantin for sharing this information, even if it a hard pill to swallow for many people (including myself), and thanks to Sarah for providing a means to share this info.
I also wanted to share some interersting observations that I have made. I am a second generation American with ancestors from the Middle East where being slightly *overweight* (in american terms- over there they call it “healthy”- I swear…If a guy wants to describe a curvy woman, he says “she is of good health”!! Like you said, Konstantin, a Middle-eastern woman only 30 years ago who was skinny was regarded as unfit for marriage and childbearing! I think it is the same in many other European countries as well, such as Italy and Greece….
Konstantin, I wonder what your opinion is about this whole realm of self-diagnosis that is going on these days. I feel that it can be potentially dangerous. People are looking for reasons for their problems on the internet, and when you read a list of symptoms, almost all of them will seem to fit you!! Then you are convinced that you have a specific disease state that you may or may not have, and the more convinced you are the more you will explain everything that is going on in your life according to that explanantion. I think it is very important to find a good doctor that can run the appropriate tests to make a diagnosis. THEN, you can decide how you want to approach your treatment (naturally, homeopathically, allopathically, etc…)
Another observation regarding this society when you look at it from the outside and compare it with many other societies around the world, I also feel that our psychology plays a HUGE role in our well-being, as well as stress. We are overworked in this country, we don’t have time to take care of ourselves, let alone get enough sleep and meditate. Most of us don’t even have that money to spend. In other parts of the world, taking care of yourself by slowing down, meditating, taking a siesta (still done in many parts of the world), home-cooked meals, and sitting down for that afternoon tea with th family, etc…..that is all a normal part of life. In no other country are people so negligant of themselves. We only wake up to the fact that we are in such bad shape when are bodies can’t take it anymore, when we are obese, depressed, and in debilitating pain.
Just my two cents.
Benaan,
Thank you for your astute comments. People who aren’t familiar with Middle East can probably related to this analogy: Some of the top belly dancers may be considered overweight by Western/American standards, while at home they are considered a pinnacle of female beauty and sexines.
Closer to home, the obsession of American men with large breasts (and some women with implants), is from the same “opera” — body fat attracts opposite sex. And if you start thinking about arranged marriages, weight discriminations (i.e. anyone, but not the skinny one) is even more pernicious than in dating situations.
What do I think about self-diagnosis? Well, I am for the equality between doctors and patients. That said, people who are highly self-suggestible may pay a heavy price for having access to too much information and imagery. Still, overall, I think having access to the same info as doctors is an asset, not a liability. What some do with that information — that’s a different story.
You are absolutely correct that there are so many other factors that contribute to obesity epidemic. These very factors will be the subject of my next post.
Thank you for reading, and thank you for contributing!
I am following these posts with interest. I would like to know what “the answer” is, but I guess I will have to wait for it. I eat a strictly whole foods diet, with plenty of good fats but not overboard, have counted calories for months to stay in the 1800-1900 range, exercise with heavy strength training 3x a week and high intensity intervals 3x a week, and have been s-l-o-w-l-y losing weight but I continually have to change things, or I plateau. It did not use to be this hard to lose weight. I am getting to the point where I don’t know what there is left to change, and I have about 40 more pounds to lose! I hope your information will help me. I have four children and struggle with fatigue, even though I get 7 hours of sleep most nights.
Rebecca,
Sorry, I don’t have any ready answers. This is a very complex subject, and as we go along you’ll certainly find the “answers” that will apply to your particular situation.
Thank you for another fascinating, but challenging, post. I am a 40-something homeschooling wife with 5 sons (none of whom were good sleepers, now ages 4-14) who is overweight after many years of low-fat, high-carb, not much sleep but still happy living.
I have managed to lose some weight doing fairly restrictive things, but when I start eating at all “normally” (read: traditional diet with small amount of junk thrown in) the weight comes back rapidly with more. My BBT is low 97’s and I used to take synthroid, found my cortisol levels were disrupted (saliva testing) and moved to a couple of years of natural whole-food supplements for those things and am trying to learn to sleep again. My thyroid function is “normal” now according to the tests, but although I eat better than ever, I weigh more than ever in my life. Very discouraging!
With 5 active boys I don’t live a sedentary life, but I prefer walking a couple of miles in the mornings with a friend (I don’t like “exercise” so it has to be social for me to do it) to intense workouts. My lifestyle doesn’t lend itself to gyms or exercise clubs.
One of the things I haven’t understood that looks like will be forthcoming in this great series is how much food do I really need to eat – portions, calories, whatever description? We now eat grassfed meat, raw dairy (bought our first cow in December!), organic fruits and veggies, only sprouted or soured grains, drinks like kombucha and kvass, and soaked & dried nuts. There are occasional exceptions, and we have been moving into that diet for about the last 3-4 years. At the risk of repeating myself, “but I weigh more than ever!”
I would love, once and for all, to know what really works to lose weight permanently; what and how much I need to really eat and drink (can’t stand all the water; don’t particularly like veggies (shocking, I know!)); what supplements are REALLY necessary to nourish my family and self; and how much of an active lifestyle is active enough to live a long, healthy life. Sarah’s blog has been a lifeline in many of these areas, but there are remaining questions.
I am hoping this series may finally be the “final answer” in a world chock-full of conflicting misinformation. Here’s to you and your work, Konstantin Monastyrsky! I look forward to more….
Thank you, Louise! I am sure by the time this series will be over, you’ll have much more clarity. Meanwhile, please keep doing what you are already doing, so you can concentrate on your boys and teach them the habits of health while they are still pliable.
This has given me a lot to think about. I am 40yr, have had three kids (youngest is 4). I am struggling with something right now and am not sure what. I have so many of my “healthy” friends throwing herbs at me for adrenal fatigue, but it didn’t sound right. I listened to another seminar that suggested to ‘reset’ your ecosystem. Start by sleeping enough, eating better(listening to what my body needs), and for me, dealing with Candida problems. Doing the right thing for your body takes time and listening to it and sometimes there isn’t an immediate cure, but a change of lifestyle or mindset. I really appreciate your willingness to put out your finding and question these myths. I eagerly await your next post.
Hillary,
Thank you for reading. I’ll do my best to help you to get well.
Stimulating herbs don’t do anything for adrenal glands. If anything, they actually stress and overstimulate the body even more, just like caffeine, nicotine, or other stimulating drugs.
Dr. Monastyrsky, I think one thing that seems to be missing from the post is that we are all unique. When you say, “test positive” for hypothyroidism, what exactly do you mean? The TSH level is a continuum and different people can function better or worse at different levels. I have had many clients struggling with weight issues with “normal” TSH levels of a range from 2.5-4.0. After slightly upping the Armour dose the pounds just melted away. I have seen other clients fine at 2.5.
I myself was slightly “hypothyroid” (in how I felt) with sluggish adrenal function (total salivary cortisol of 15 for the day) with a TSH of 3.5. I have no weight issues. I upped my Armour and any tiny residual problems went away and my cortisol levels increased to normal levels as well as my DHEA and sex hormones. And this is after years of eating a quite stellar diet and seeing my adrenals spiral down. Now my TSH is at .8 and I feel this is a good place for me.
Then there is the question of reverse T3, which you don’t mention in this article. For those clients with “normal” TSH but that are experiencing “hypothyroid” symptoms I always look at their Free T3 to RT3 ratio. If it is low then we look at cellular level issus such as mineral deficiencies or fatty acid imbalances. These are the people that go to the doctor for years with all sorts of issues that are dismissed because TSH is “normal”.
And I do believe that people can have suboptimal adrenal function without Addisons. I have seen it in myself and many, many clients. Of course we rely on testing. It’s not just a guess. But we have seen over and over, if a client addresses stresses and supports the adrenals with supplements, the issues resolve. Weight is a very common issue that gets resolved.
The body is very complex and there are subtleties involved. To say that very few people suffer from hypothyroidism based on national statistics is not very practical on a clinical level, imo. I look at each individual as unique and we work together to get to the root cause. We look at adrenal and thyroid function as well as gut function, nutrient levels, stress, physical activity, etc. I agree that the thyroid or adrenal hypofunction is not the “root cause”. That is the end result of deficiencies and toxicity. But it needs to be addressed. Some people do need a little T3 or herbal support to get them through. It is part of the whole picture.
And look at this study where those testing positive for gestational hypothyroidism was about 15%…much higher than expected 2-3%. http://jcem.endojournals.org/content/97/3/777.full?sid=47fb3c24-41c8-4ebb-9e12-b8fd93b42500
That is me!! The reverse T3 to free T3 ratio was WAY off, but no doctors have diagnosed that until just the past couple weeks!!! I don’t have brittle hair or other classical symptoms of hypothyroid except the inability to lose my stomach fat, and extreme fatigue. I eat super healthy, whole foods diet with plenty of good fats, fermented foods, etc. I do not eat processed foods (maybe go out to eat once a month so I bet I get bad things there but I still try to choose something somewhat healthy on the menu). I don’t eat gluten or sugar. I have great skin and hair, and overall look extremely healthy. Except my exhaustion!!!
Thanks for pointing this out…
Hi. My name is Kelly and I am an emotional and compulsive overweight overeater. Nice to meet you.
So now that you’ve met an overweight person who does not claim to have a thyroid or metabolic problem, please don’t generalize about us. There is a whole world of overweight people at Overeaters Anonymous, Weight Watchers, Tops, etc., who are not claiming to have a medical problem that you would find “amusing.”
I’m sure you are a very intelligent and knowledgeable researcher, lecturer, and author, but I recommend you rethink your leading paragraph.
Kelly,
Nice to meet you too. Glad that you are well and healthy and self-aware. You see, overweight people that I happen to meet and discuss this subject with, come to me for help. And that’s what I hear all the time: “I am overweight because I have a medical condition.” And, in fact, most of them do, but these aren’t the medical conditions discussed in my post. And the only way that I can help these people to normalize their weight and improve their health is by, first, dispelling the predominant groupthink, and, next, by focusing them on the real culprits of their weight-related problems. Bad metabolism — it ain’t.
Also, this is a blog, not a medical reference. If I’ll write the way you want me to write, nobody will read it.
Your article this time was interesting. I can see where your arguments come from, and why you would post them. To help people become more ok with how their bodies are, and to stop the excuses that overweight people carry. I think what your article missed was how the body reacts to a sick gut. I am on thyroid meds even though my blood tests said I do not have a thyroid problem. My doctor made sure to tell me that I did not have thyroid but my body needed support. I needed to be able to think clearly, and have the energy to begin making the food my body needed. This was a hard adjustment to me mentally to cook this way, from being raised on fast food. As the thyriod gave me the support I needed to think clearly, and have a small amount of energy, I was able to do the research to figure out how to eat. :). (My thyroid was producing enough, but not enough was being properly converted for me to function, due to the leaky gut). I think your article left out a point of sometimes your body needs support in order to being healing. Thank you.
Sarah,
Thank you for your feedback. You may be surprised to learn that as the author of GutSense.org, I know a bit more about digestive disorders than I know about weight loss. This particular article was about these particular four conditions. Rest assured, I’ll write a lot about the gut…
I LOVE THIS SERIES! I would love to get an audio version of these posts and just play them on a loop in our bariatric office. Thank you, thank you, thank you for cutting through the malarky and telling us the facts. Now if you can just do one for “I can’t exercise because I have a bad…(back, knee, cold, hangnail, etc) LOL
Amanda, thank you!
In regard to exercise: It is a well known fact that about 80% of people with diabetes are overweight. Inversely, it can be said that about 80% of overweight people have prediabetes or diabetes, many of them undiagnosed, just like I was back in in 1990s. And guess what — during that stage I could barely drive and walk because of… bad back, ingrown toenail, devastating carpal tunnel, gout, knee pain, severe sinusitis, vertigo, depression, insomnia and ensuing fatigue so bad that I was literally falling asleep while driving.
After that experience I have a lot of empathy for people who say they can’t exercise because the majority of them aren’t making it up. And, unlike most readers of this blog, I didn’t have a bunch of kids on my shoulders to take care off, no full-time job (other than writing books in bed), or any other time-demanding familial obligations.
What’s a way out? Lose weight, normalize blood sugar, reverse functional disorders (as above) related to prediabetes and diabetes, start exercising as you get better. It took me about a year of strict diet before I was able to resume walking, and several more years before I could go to the gym without a fear of hurting myself.
All that said, I do encourage everyone who can to be as active as their health allows, and I will address exercise in one or more future posts.
Re: Audipodcasts: I have been thinking about making them since the inception. I’ll think again…
You’re right. I need to be more empathetic. It’s just frustrating to hear the excuses (like the ones mentioned in your post). I feel like they (our bariatric patients) aren’t looking for things they can do, but reasons they can’t do them. Thank you for your insight, as always 🙂
Amanda,
From what I see, bariatric patients, particularly past middle-age, may have an even harder time to exercise than people who are simply overweight because their diets are so limited and void of essential nutrients. And that’s on top of all other problems accrued up to surgery. I don’t beleive this particular aspect — i.e. nutritional deficiencies following bariatric procedures — is being seriously addressed outside of academia.
I also want to highlight another important point: This series (and my future book) is intended primarily for relatively healthy people with moderate adiposity (i.e. not clinically obese). Although weight loss is an incredibly effective therapeutic tool, it isn’t a viable option for do-it-yourselfers with pre-existing endocrine, metabolic, neurological, digestive, or cardiovascular disorders.
If you noticed, I take the most flack from people who are already in that unfortunate category, even though my work isn’t really intended for them because it is near impossible to account for all possible contingencies that they may encounter while on extended reduced calorie diet. (I actually say that much in “Common Sense Warnings & Disclaimers” link (http://goo.gl/bgyC2) after each post, but I am not sure all people are reading it.)
there was a time, ironically before i had kids, that i was tired all the time and I gained weight and I thought, what’s wrong with me! I went to a doctor and fortunately all testing came back normal so I have never thought of my metabolism or those types of things as the reason why I had a hard time losing weight. I did eventually lose that weight. Looking back I think it was very poor diet and off sleep and not enough sleep, and no exercise. duh! I have a lot more energy now that I eat right. I could exercise more, but I do chase kids and clean house quite a bit which is a lot more exercise than I ever got at my old desk job. Anyway, I have different, post babies weight to lose now and just wanted to say good post, looking forward to next week.
Rebecca,
I am with you. My suggestion to everyone reading this — before you start thinking about “doctoring” yourself from real and imagined diseases, think about your past and current diet, your sleep qualities, your lifestyle, and your attitude(s). All of these aspects will be the subject of the next several posts. There is much more to health and normal weight than diet or exercise.
Thank you so much for your willingness to share your wisdom and experience; that is what is important in all of this. We all have some, and it would behoove everyone to be “slow to speak” and just think about all the possibilities, before deciding to disagree. Truth will stand on its own. I am tired of everyone trying to charge for every little nugget of information; thank you for letting us have this information that will undoubtably help some. I appreciate your patience with those who are not polite in disagreeing. (A definite indicator that something is out of whack!) Like when I don’t get enough sleep or my blood sugar drops…oooh! I am a bear! Thanks again and keep it coming!
Thank you so much for your kind words! It helps to plough along. A lot!