Effective behavioral strategies and supplementation target hormones, neurotransmitters, and fat metabolism
Pamela Frank, ND
Recent estimates suggest that by 2030 half of all Americans will be not just overweight but obese.1 As NDs, we know that weight loss is far more complicated than simply burning more calories than one consumes. Our thorough patient intake allows for a more detailed assessment of all the factors that may be causing or contributing to obesity in our patients and provides a more comprehensive and lasting treatment approach.
Stabilize Blood Glucose Level and Improve Insulin Sensitivity
Except in patients with diabetes, blood glucose level should be within the normal range. However, if it is frequently fluctuating within that range, production of insulin is also frequent and often promotes fat production. Blood glucose fluctuations provoke carbohydrate and sugar cravings, perpetuating the blood glucose and insulin roller coaster. Maintaining a stable blood glucose level through a low glycemic index and low glycemic load diet, daily physical activity, and stress reduction are key issues for those dealing with weight problems.
The more frequently that blood glucose level spikes and insulin is produced, the greater is the likelihood of eventually developing insulin resistance. Once in that “prediabetic” state, blood glucose level will stay higher longer, increasing the demand for insulin and promoting more fat production. Zinc,2 cinnamon,3 and aerobic exercise4 can all improve insulin sensitivity.
Reduce Stress, Modulate Cortisol Level, and Support Adrenal Stress Adaptation
Stress hormones like cortisol cause blood glucose level spikes, produce insulin, and contribute to poor eating habits and obesity.5 Vital to a weight loss program are stress reduction techniques, such as yoga6; tai chi, breathing exercises, and meditation7; massage therapy8; and regular physical activity, social support, and psychotherapy.9
Excessive cortisol can lead to weight gain through higher blood glucose level, suppressed triiodothyronine level, and increased reverse triiodothyronine level.10 Adaptogenic herbs like Rhodiola rosea, Schisandra chinensis, and Eleutherococcus senticosus have demonstrated the ability to modulate cortisol levels, improve mental performance, and increase endurance.11 Adrenal support with vitamin C, vitamin B5, vitamin B6, magnesium, zinc, and potassium and additional adaptogenic herbs like Panax ginseng, Glycyrrhiza glabra, and Withania somnifera may improve stress adaptation and reduce excessive cortisol output.
Caloric, Protein, and Amino Acid Intake
Excessive caloric consumption without a concomitant increase in energy expenditure will result in excess body fat. However, all calories are not created equal. The energy expenditure required to store excess dietary triglycerides as fat is very low (0%-2%), for carbohydrate is 6% to 8%, and for protein is 25% to 30%.12 A shift from a higher carbohydrate diet to a higher lean protein diet will enhance energy expenditure.
The amino acid precursors of dopamine and serotonin (tyrosine and 5-hydroxytryptophan, respectively) have been administered for decades to treat various clinical conditions, including depression, anxiety, insomnia, and obesity, among others. Evidence shows that these precursors usually elevate dopamine and serotonin levels within critical brain tissues and other organs, suggesting a possible role for their use in emotional or stress-related overeating and obesity.13 Consumption of the branched-chain amino acid leucine (2.5 g) triggers a postmeal anabolic response that protects metabolically active tissues like muscles during weight loss and increases loss of body fat.14
Behavioral Strategies and Social Support
One healthy habit can breed others. It may help to break weight loss down into a series of achievable health-related goals, such as eliminating soda pop, avoiding white flour, excluding sugar from the diet, cutting out coffee, taking up an exercise program, etc. The inclusion of behavioral strategies, such as self-monitoring, journaling, and goal setting, provides improved weight loss results compared with programs that do not include such behavioral interventions.
Your patients may need to cultivate relationships with other health-conscious individuals to succeed, particularly if friends and family engage in unhealthy diet or lifestyle behaviors. Online forums can also provide a sense of community and weight loss support. Web sites that provide the opportunity to track calorie, fat, carbohydrate, and protein intake and seek support through discussion boards are helpful.
Regular exercise is an essential aspect of maintaining health and a healthy weight because diet alone just is not enough. It does not require a huge time commitment, an expensive gym membership, or special equipment. Simply fostering the habit of going for a brisk walk every single day for 30 minutes is exercise enough. For those with time constraints, encourage them to get off the bus half an hour from work and walk the rest of the way, take a quick walk on their lunch hour, park the car farther from work and walk, or do a quick walk as soon as they arrive home from work before starting dinner. It needs to be a daily habit that is as vital to health and well-being and as nonnegotiable as teeth brushing or taking a shower. The question is not if they are going to exercise today but when. Ideally, the patient should choose a time of day that is unlikely to be fraught with other demands and when they will still have the energy and determination to complete their workout. I find that early morning is best because it starts the day off on the right foot and it is unlikely that the boss will call an unexpected meeting at 6 am. Quick fitness breaks throughout the day are also a good idea. Every half hour or so, get up from your desk, throw on some upbeat music and bust a move, drop to the floor and do 20 push-ups or sit-ups. Or, do some quick stretching and deep breathing at your desk. Humans are not designed to sit for 8 hours a day. We are programmed to move and be active, interspersed with periods of rest.
Hormones and Neurotransmitters
I find that most of my weight loss patients wish they had a thyroid problem as an explanation why they keep gaining or cannot lose weight, but less than 10% of obese individuals have hypothyroidism.15 If overweight patients are indeed experiencing a hypothyroid condition, we can support healthy thyroid function with appropriate amounts of iodine,16 tyrosine and copper,17 and zinc18 and with avoidance of excessive selenium.19 Herbs like ashwagandha,20 schisandra, and coleus can help to balance thyroid function.
Treatment with the serotonin precursor 5-hydroxytryptophan has been shown to promote weight loss in obese individuals.21 Norepinephrine and possibly dopamine can act as appetite suppressants.22 Healthy therapeutic levels of these neurotransmitters provide safe appetite control and reduce or eliminate emotional eating and carbohydrate or chocolate cravings. There are significant benefits to optimizing neurotransmitter levels, including alleviation of depression, anxiety, insomnia, chronic fatigue, panic disorder, obsessive-compulsive disorder, premenstrual syndrome, fibromyalgia, migraine, hormonal dysfunction, adrenal fatigue, and digestive disorders. Cysteine,23 l-tyrosine, and 5-hydroxytryptophan can help to optimize neurotransmitter levels and facilitate weight loss.
Leptin is an important component in the long-term regulation of body weight. Increasing leptin helps to decrease food intake and increase metabolism. Adiponectin is a hormone secreted by fat cells that helps to regulate metabolism of fats and sugar. Optimizing adiponectin and leptin levels is important in maintaining a healthy weight. Eicosapentaenoic acid has been shown to increase adiponectin levels in vitro.24 Mild weight loss induced by calorie restriction may have beneficial effects on leptin level.25
Deficiencies of vitamin B3, vitamin B6, vitamin C, zinc, and magnesium can adversely affect healthy fat metabolism. Lipotrophic factors, such as choline, methionine, and inositol, can have the same effect.
A study26 was performed in chickens fed a diet high in omega-3s vs a high–saturated fat diet. Results showed less abdominal fat and higher triiodothyronine levels in the chickens fed the diet high in omega-3s.
Another study27 investigated biochemical markers in healthy women of fat metabolism and serum leptin concentration. Choline and carnitine supplementation coupled with exercise balanced carnitine profiles in tissues to favor fat mobilization.
Sleep and Hydration
Insufficient sleep increases insulin resistance and heightens risk for obesity. One study28 demonstrated that even 1 night of sleep deprivation (with only 4 hours of sleep) induced insulin resistance in multiple metabolic pathways among healthy participants. A total of 8 hours of sleep per night is optimal to maintain a healthy weight and insulin sensitivity.
Patients who are chronically dehydrated may mistake thirst for hunger and eat instead of drink. Encourage consumption of water and herbal teas only. Discourage intake of calories through sweetened drinks and fruit juices.
Adverse Effects of
Antidepressant and antianxiety medications can lead to weight gain. Personally, I find that adverse effects of medications are often very difficult to undo. If there is a possibility of supporting your patient to decrease or discontinue these medications, their weight loss efforts may be more effective.
Pamela Frank, ND has 12 years’ practice experience as an ND and 20 years’ experience as a laboratory technologist. She is clinic director of Forces of Nature Wellness in Toronto, Ontario, Canada, and was twice voted “Best Naturopath in Toronto.” She maintains a busy practice with particular expertise in women’s health issues, polycystic ovary syndrome, premenstrual syndrome, menopause, acne, infertility, uterine fibroids, and endometriosis. For more information, e-mail PFrankND@ForcesofNature.ca, call 1-416-481-0222, or visit www.NaturopathToronto.ca.
Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. Health and economic burden of the projected obesity trends in the USA and the UK, Lancet. 2011;378(9793):815-825.
Hashemipour M, Kelishadi R, Shapouri J, et al. Effect of zinc supplementation on insulin resistance and components of the metabolic syndrome in prepubertal obese children. Hormones (Athens). 2009;8(4):279-285.
Qin B, Panickar KS, Anderson RA. Cinnamon: potential role in the prevention of insulin resistance, metabolic syndrome, and type 2 diabetes. J Diabetes Sci Technol. 2010;4(3):685-693.
van der Heijden GJ, Wang ZJ, Chu ZD, et al. A 12-week aerobic exercise program reduces hepatic fat accumulation and insulin resistance in obese, Hispanic adolescents. Obesity (Silver Spring). 2010:18(2):384-390.
Vicennati V, Pasqui F, Cavazza C, Pagotto U, Pasquali R. Stress-related development of obesity and cortisol in women. Obesity. 2009;17(9):1678-1683.
Telles S, Naveen VK, Balkrishna A, Kumar S. Short term health impact of a yoga and diet change program on obesity. Med Sci Monit. 2010;16(1):CR35-CR40.
Dalen J, Smith BW, Shelley BM, Sloan AL, Leahigh L, Begay D. Pilot study: Mindful Eating and Living (MEAL): weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complement Ther Med. 2010;18(6):260-264.
Han SH, Yang BS, Kim HJ. Effectiveness of aromatherapy massage on abdominal obesity among middle aged women [in Korean]. Taehan Kanho Hakhoe Chi. 2003;33(6):839-846.
Tanofsky-Kraff M, Wilfley DE, Young JF, et al. A pilot study of interpersonal psychotherapy for preventing excess weight gain in adolescent girls at-risk for obesity. Int J Eat Disord. 2010;43(8):701-706.
Kitahara H, Imai Y, Yamauchi K, Tomita A, Mizuno S. Pituitary-thyroid function in patients with Cushing’s syndrome: comparative study before and after extirpation of adrenal cortex tumor [in Japanese]. Nihon Naibunpi Gakkai Zasshi. 1983;59(8):1086-1098.
Panossian A, Wikman G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol. 2009;4(3):198-219.
Wilborn C, Beckham J, Campbell B, et al. Obesity: prevalence, theories, medical consequences, management, and research directions. J Int Soc Sports Nutr. 2005;2:4-31.
Trachte GJ, Uncini T, Hinz M. Both stimulatory and inhibitory effects of dietary 5-hydroxytryptophan and tyrosine are found on urinary excretion of serotonin and dopamine in a large human population. Neuropsychiatr Dis Treat. 2009;5:227-235.
Devkota S, Layman DK. Protein metabolic roles in treatment of obesity. Curr Opin Clin Nutr Metab Care. 2010;13(4):403-407.
Douyon L, Schteingart DE. Effect of obesity and starvation on thyroid hormone, growth hormone, and cortisol secretion. Endocrinol Metab Clin North Am. 2002;31(1):173-189.
Mirmiran P, Hajipour R, Azizi F. Iodized salt consumption maintains euthyroidism in iodine-deficient hypothyroid subjects. Int J Vitam Nutr Res. 2003;73(3):187-191.
Bousquet-Moore D, Ma XM, Nillni EA, et al. Reversal of physiological deficits caused by diminished levels of peptidylglycine-amidating monooxygenase by dietary copper. Endocrinology. 2009;150(4):1739-1747.
Kandhro GA, Kazi TG, Afridi HI, et al. Effect of zinc supplementation on the zinc level in serum and urine and their relation to thyroid hormone profile in male and female goitrous patients. Clin Nutr. 2009;28(2):162-168.
Hawkes WC, Keim NL. Dietary selenium intake modulates thyroid hormone and energy metabolism in men. J Nutr. 2003;133(11):3443-3448.
Panda S, Kar A. Changes in thyroid hormone concentrations after administration of ashwagandha root extract to adult male mice. J Pharm Pharmacol. 1998;50(9):1065-1068.
Halford JC, Harrold JA, Lawton CL, Blundell JE. Serotonin (5-HT) drugs: effects on appetite expression and use for the treatment of obesity. Curr Drug Targets. 2005;6(2):201-213.
Halford JC. Pharmacology of appetite suppression: implication for the treatment of obesity. Curr Drug Targets. 2001;2(4):353-370.
Li X, Rose G, Dongre N, Pan HL, Tobin JR, Eisenach JC. S-nitroso-l-cysteine releases norepinephrine in rat spinal synaptosomes. Brain Res. 2000;872(1-2):301-307.
Tishinsky JM, Ma DW, Robinson LE. Eicosapentaenoic acid and rosiglitazone increase adiponectin in an additive and PPAR-dependent manner in human adipocytes. Obesity (Silver Spring). 2011;19(2):262-268.
Klempel MC, Varady KA. Reliability of leptin, but not adiponectin, as a biomarker for diet-induced weight loss in humans. Nutr Rev. 2011;69(3):145-154.
Ferrini G, Manzanilla EG, Menoyo D, Esteve-Garcia E, Baucells MD, Barroeta AC. Effects of dietary n-3 fatty acids in fat metabolism and thyroid hormone levels when compared to dietary saturated fatty acids in chickens. Livestock Sci. 2010;131(2):287-291.
Hongu N, Sachan DS. Carnitine and choline supplementation with exercise alter carnitine profiles, biochemical markers of fat metabolism and serum leptin concentration in healthy women. J Nutr. 2003;133(1):84-89.
Donga E, van Dijk M, van Dijk JG, et al. A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. J Clin Endocrinol Metab. 2010;95(6):2963-2968.