So when people come to see and they're struggling with weight issues, there are some common underlying factors: number one, I commonly see imbalance of hormonal states, so in peri-menopause and menopause, we'll see things like estrogen dominance, which make it difficult to lose weight. Men over forty -- we call this "hormonal shift andropause," and it's actually when we see testosterone and progesterone levels declining, and estrogen is again building up in the system. Hypothyroidism is a situation where individuals will have difficulty losing weight. High stress, believe it or not, can actually lead to weight gain, and this is because we'll have elevated cortisol levels, and this will preferentially pack on weight around the abdomen. Poor dietary choices is another big one, and we'll typically see elevations in insulin, which will also help to put on weight around the waist, and of course the poor dietary choices will really aggravate all of the other things I just mentioned.
So when patients come in and they're struggling with weight problems, it's really important that I understand why they're struggling with that weight problem, where that's coming from. During that initial intake, what I'm primarily doing is differentiating in my mind: I am listening to the symptoms that they're telling me to correlate which syndromes they might be correlated with. Diet is really important information, so I pay close attention to that piece during the initial intake. And then I'm primarily going to rely on some lab testing to help me differentiate. So I'm going to run some blood work, and in the blood work, I'm going to look at thyroid hormones. So I'm going to look at a TSH level, a free T3 and a free T4 to really look at full thyroid function. I'm also going to assess sex hormone balance, so I'm going to look at progesterone, testosterone, and estrogen. I'll also look sometimes at things like DHEA, sometimes pregnenolone. In addition, I will then do some saliva testing, and the saliva testing I'm going to use to rule out any type of hypercortisol issue, so looking at the adrenals, and I'm also going to look at sex hormones again in the saliva. And those tests, combined with a history and physical exam, will really give me a complete picture so I understand what's going on with this person and where their problem with weight is originating.
So my treatment plans always have dietary recommendations, and I start out by asking patients of mine to remove any synthetic foods, so any additives or preservatives, or artificial sweeteners leave the diet. The second thing that's also very important is that people remove all processed foods and refined carbohydrates, so that looks like everything from breakfast cereal, toast, bagels, muffin, any kind of bread, crackers, pasta, chips, all of that is removed from the diet. And then, we're essentially going to focus on a whole-foods-based diet that's very rich in good, clean proteins; organic, fresh vegetables and fruits, nuts and seeds; good oils to take in are things like coconut oil and avocado, and olive oil and fish oil are great additions as well. Clean water, so purified water is very important. Hydration is extremely important in managing weight, and so at least half of your body weight in ounces. And there's a few reasons -- in parts, this is to actually help you stay satiated. When you're hydrated, you actually are not as hungry. But in addition, flushing out toxins will actually help you lose weight.
In terms of the times for people to eat that I advise my patients, earlier is better. When a person skips breakfast, they actually lower their metabolism for the entire day, so I make all of my patients eat breakfast even if they tell me they're not breakfast-eaters. They need to start eating breakfast. Traditionally, what happens is people actually consume fewer calories over the duration of the day when they eat breakfast, so this is good and their metabolism stays elevated all day long. So those are the dietary recommendations.
In addition, I'll recommend some supplements to help give the cells more energy and give people more energy, so the cells are doing their job better and you have more energy so you can do things like exercise more easily. Some of the nutrients I really like to recommend are L-carnitine, at least 2 grams a day. And L-carnitine is going to specifically help you take your fat to the mitochondria of the cell and burn it to make ATP, so that's fantastic. You're going to lose weight and you're going to have increased energy. Vitamin B5 is another good one in therapeutic doses; it's an excellent nutrient to add in. And then other things like alpha-lipoic acid and co-Q10 are excellent for just supporting energy function of the cell, and the B vitamins as well -- the B complex. So that's what my supplement recommendations are.
If, when the labs come back, I see patterns that are indicative of hormone imbalance, I'll address that. So very commonly, in the peri-menopausal/menopausal age category, what I'll find is that there's estrogen dominance happening, so not enough progesterone to balance out the estrogen ratios. If that's happening, then I will go ahead and supplement with a little bit of bio-identical progesterone, which is natural progesterone. The same is true for men who are over 40, they typically will start to have lower testosterone and progesterone levels, and so if I see this in my patient I will go ahead and prescribe bio-identical testosterone or progesterone which are natural to help combat this imbalance in hormones.
If I see on blood work that the insulin levels are elevated, this tells me that someone is struggling with too much carbohydrate intake, that's a reinforcement that the diet is really off, and so in that person, a huge emphasis on lower glycemic foods in the diet is very important. If I see a cortisol picture, where there's hypercortisolemia, which helps put on weight around the waist -- so this underlines the person is stressed, I will address their adrenal health with them. They will get specific supplements that will take of this, and so those nutrients are vitamins B5, vitamin C, and magnesium, and then I'll work with a combination of botanicals, typically adaptogens and nerve vine botanicals. The adaptogens are going to help bring the cortisol levels back into the normal range and support the adrenal glands while this is happening. So good botanicals for this are rhodeola and asuraganda, those are really the good adaptogens which are not stimulating. Some good nerve vines are things like chamomile or passionflower, hops is great, oats, any of those are really wonderful for just helping a person to feel more calm and relaxed if stress is really getting in their way.
So that's how we'll deal with that, and then eventually, as these hormone imbalances are corrected, people will naturally lose weight because the weight is really an issue having to do with the hormone imbalance, and in the case of the hyper-insulin, the dietary focus is going to be a lot more important. But with all individuals, having that strong, clean diet will really help promote the weight loss.
So once the thyroid tests are back, if I see an abnormal value, I'm going to run additional tests at this point -- because what I'm trying to determine is, is this just a classic hypothyroid case that needs some thyroid hormone supplementation, or is this a hypothyroid case because the person's actually hypoadrenal, or is it a hypothyroid case because this person has autoimmune thyroiditis? And so those are important points to differentiate and I'll treat accordingly based on the information I find.
I've had really great success helping people lose weight in my practice, and the reason I've had really great success is because I've always helped my patients get to the underlying cause of why they're not able to lose weight. So, sometimes it's been dietary; we've also managed to look at adrenals and thyroid problems, peri-menopause and menopause and andropause, and a combination of those problems. So whatever the root cause has been for the weight gain, we've always found the problem and then addressed the root cause, and as a result, within three to six months the weight comes right off.
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