A Functional Medicine Approach to Weight Loss

Weight is a complicated issue. You may want to lose weight for aesthetic or health reasons, but as a woman, don’t admit you are trying to lose weight because critics will judge that too.

Diet culture is everywhere, telling us how we should look and what we should eat, leaving us feeling bad about ourselves when we don’t fit the unrealistic standard of beauty. On the other hand, anti-diet culture tells us to love our bodies as they are without desiring weight loss.

The truth is there is a middle ground, and both things can be true at the same time. It’s okay to work on loving and accepting your body more while simultaneously wanting to change your body in a healthful way.

Unfortunately, most of the messages women get every day about weight loss are unhealthy, promoting food restriction, cutting calories, and excessive exercise. These methods rely on willpower and rarely have lasting results.

In my last article (Add link to cardiometabolic article), I discussed the connection between weight and cardiometabolic health. It’s possible to be skinny and at your ideal weight while metabolically unhealthy or to be in an overweight or obese category yet metabolically healthy. It’s on a spectrum, so there’s also a lot of in-between.

It’s essential to broaden the conversation about weight to include all bodies and note that your weight is only a slice of the pie when it comes to your overall health. We tend to put too much emphasis on weight.

In addition, weight loss is challenging. Even when you work hard on nutrition by meeting your fiber needs, increasing plant foods, and ditching most of the processed products, other factors can play a role. 

The path to long-term weight loss is creating new health habits that will last a lifetime and addressing the underlying factors (root causes) affecting your metabolism. Let’s explore an integrative, functional, root-cause approach to weight loss.

A Functional Medicine Approach

In a functional medicine model, we seek to uncover the root causes of symptoms and diseases. This framework acknowledges all body systems are connected, unlike conventional medicine, which separates each body system. You go to your cardiologist for heart health, the endocrinologist for hormones, etc.

So many women tell me that the strategies that used to work to manage their weight no longer work. This statement is my primary clue that we need to take a different, more comprehensive approach and look through a functional lens. It’s time to peel back the layers and uncover the root causes of fat gain or weight loss resistance.

Root Causes to Address for Weight Loss

Often, when you desire to shift your metabolic health, you need to shift your gut health, hormones, lifestyle, and other underlying factors. Let’s look at some of the common root causes I see in my practice.

Gut Health

Poor digestive function and microbiome imbalances impact weight. The microbes in the gut directly affect digestion, absorption, and metabolism. The composition of the gut microbiome influences and regulates metabolism, hormones, and immunity, which all influence weight.

Further, microbes produce metabolites that influence genetic expression and may promote metabolic health or inflammation and insulin resistance. Modulating the gut microbiome is a primary focus of developing new weight loss therapies.

Gut Health Action Steps:

• Get a functional stool test to assess microbiome composition and discuss results with your TārāMD Spoiler alert: if your Akkermansia is low, we need to get to work!

• Follow a personalized treatment approach to restore gut health and balance, including personalized nutrition, lifestyle change, and targeted pharmaceuticals or supplements.

• Maintain gut health by eating fiber-rich, prebiotic foods like berries, onions, apples, asparagus, and dandelion greens. Eat probiotic-rich fermented foods such as sauerkraut, yogurt, and kefir. And if you’re not doing so already please begin incorporating a daily serving of whole grains and legumes into your diet.

Adrenal Health

Your adrenal glands sit on top of your kidneys and play a primary role in your body’s stress response via the HPA axis (hypothalamic pituitary adrenal axis). When the brain interprets stress, whether real or imagined, it will signal to the adrenals to release stress hormones so you can run and fight danger.

We live in a stressful world during a stressful time. Many of us have high levels of stress hormones (including cortisol) or HPA axis dysregulation resulting from chronic stress.

Stress directly impacts weight.

For example, stress changes eating behaviors and increases preference for processed, hyper-palatable foods, which contributes to food addiction and weight gain. Stress also influences hormones, including cortisol, insulin, and appetite hormones (leptin and ghrelin) that play roles in metabolic health, affecting fat storage and weight.

Adrenal Health Action Steps:

• Prioritize stress management strategies such as meditation, journaling, yoga, and gratitude practices.

• Get a 4-point salivary or urinary cortisol test to assess your cortisol rhythm and HPA axis.

• Use integrative approaches to restore regulation to the stress response, including targeted supplements, vagus nerve stimulation, somatic therapy, and others.

Blood Sugar Health

What we eat, stress levels, exercise, and other behaviors influence blood sugar balance. Blood sugar balance is an essential consideration for weight loss and metabolic health.

When you eat a high carbohydrate food, mainly processed ones made with sugar and refined flour, your blood sugar can rise quickly and suddenly fall. This blood sugar rollercoaster contributes to hunger, cravings, poor energy, gut imbalances, elevated stress hormones, and generally doesn’t make you feel your best.

On a metabolic level, excess glucose turns into fat. Excess fat can get stored in the liver and pancreas, contributing to insulin resistance and cardiometabolic disease (link to cardiometabolic article), making weight loss more challenging. It’s not the carbohydrate causing insulin resistance but the amount of fat tucked away in your organs, known as visceral fat.  When visceral fat levels exceed your threshold, your insulin function starts to decrease. Eventually over time, lower insulin function leads to poor tolerance of carbohydrates. So if you eat an apple and your blood sugar spikes you might think apples are bad and lead to high glucose levels. But, it’s not the apple that caused the problem so eliminating the apple isn’t the solution. 

Blood Sugar Action Steps:

• Eat protein with every meal and snack.

• Choose fiber-rich whole food sources of carbohydrates, including fruit, vegetables, legumes, nuts, seeds, and whole grains. Doing so prevents the root cause of insulin resistance that leads to weight gain down the road.

• Fast for 12 hours overnight, from after dinner to breakfast.

• Wear a continuous glucose monitor for a month to learn how your regular eating patterns (and exercise, stress, sleep, and other factors) affect your blood sugar balance. (Only do this if it’s fun and not stressful, though.)

• Check your fasting blood sugar, hemoglobin A1C, fasting insulin, and other labs recommended by your TārāMD provider.

Nutrient Deficiencies

When you hear about nutrition for weight loss, there is a lot of emphasis on calories and macronutrients – protein, carbohydrates, and fat. However, micronutrients – vitamins and minerals – are vital to consider. Even moderate deficiencies in essential nutrients can affect metabolic function and make it challenging to release weight.

Here are some nutrients to consider:

• B vitamins – B vitamins assist with turning calories into energy for your cells. Optimizing B vitamins may help improve calorie-burning functions.

• Vitamin D – Vitamin D is a common deficiency and essential for immune function and genetic expression. Optimizing vitamin D levels may help with fat loss in people with excess abdominal fat.

• Iron – I see iron deficiency in many patients with heavy periods. Iron carries oxygen to your cells, and low oxygen means low ability to make energy (burn calories). Iron deficiency also causes weakness and low energy, which make it harder to exercise and cook healthy meals.

• Magnesium – Magnesium deficiency is widespread and impacts sleep, blood sugar control, stress, and other factors linked to weight.

Action Steps to Optimize Nutrient Status:

• Review your diet with a TārāMD nutritionist or dietitian.

• Test micronutrient levels with standard blood tests and advanced micronutrient testing, followed by personalized supplementation and diet change.

• Optimize gut health to optimize micronutrient absorption.

Hormone Health 

In addition to insulin and cortisol, many other hormones influence weight and metabolic health. Let’s look at thyroid hormones and estrogen, which are incredibly important in women’s health.

Thyroid hormones bind to every cell in the body and set the metabolic rate. Hypothyroidism (low thyroid hormones) because of nutrient deficiencies, autoimmunity, or other factors causes metabolism to slow, weight gain, and difficulty losing weight. Thyroid imbalances can arise during times of hormonal transition.

Speaking of hormonal transition, changes in body composition are common in midlife. Declining estrogen in perimenopause and menopause contributes to weight gain. Estrogen supports insulin sensitivity, and estrogen loss leads to more insulin resistance, making nutrition and blood sugar balance even more critical with age.

Hormone Health Action Steps:

• Ask your doctor for a full thyroid panel that includes at least free T4, free T3, TSH, and thyroid antibodies.

• Consider a DUTCH comprehensive hormone panel to examine estrogen, progesterone, testosterone, hormone metabolites, cortisol, DHEA, and more.

• Use integrative tools such as targeted supplements and medications (such as thyroid replacement and bioidentical hormone replacement therapy) to support underlying hormonal balance.

Mindset 

I tell my patients, “You can’t hate yourself into a body you love.” If your strategy for changing your body is solely focused on weight loss through pain, judgment, deprivation, and torture, you may not find the peace you are looking for.

If you are constantly worried about food, having negative thoughts about your body, and comparing yourself to others, your body is stressed. We know how stress affects weight: it will work against all your efforts.

Mindset Action Steps:

• Switch the narrative from food deprivation to nourishment and from punishment to finding movement that brings you joy.

• Practice self-compassion and send love to the parts of you that you don’t like to look at.

• Catch negative thoughts and reframe the approach, moving away from diet culture and towards self-care.

Not all weight loss is healthy, but there is a healthy way to approach weight loss. When we understand your unique root cause pieces, we can design an integrative treatment approach utilizing the best tools conventional medicine and functional medicine offer. When we can take some of the focus off of weight and focus on deep healing and health restoration, weight loss is a welcome side effect.

References

1. Van Hul, M., & Cani, P. D. (2023). The gut microbiota in obesity and weight management: microbes as friends or foe?. Nature reviews. Endocrinology,19(5), 258–271.
2. Cuevas-Sierra, A., Ramos-Lopez, O., Riezu-Boj, J. I., Milagro, F. I., & Martinez, J. A. (2019). Diet, Gut Microbiota, and Obesity: Links with Host Genetics and Epigenetics and Potential Applications.Advances in nutrition (Bethesda, Md.), 10(suppl_1), S17–S30.
3. Asadi, A., Shadab Mehr, N., Mohamadi, M. H., Shokri, F., Heidary, M., Sadeghifard, N., & Khoshnood, S. (2022). Obesity and gut-microbiota-brain axis: A narrative review.Journal of clinical laboratory analysis, 36(5), e24420.
4. Yau, Y. H., & Potenza, M. N. (2013). Stress and eating behaviors.Minerva endocrinologica, 38(3), 255–267.
5. Rosenblum, J. L., Castro, V. M., Moore, C. E., & Kaplan, L. M. (2012). Calcium and vitamin D supplementation is associated with decreased abdominal visceral adipose tissue in overweight and obese adults.The American journal of clinical nutrition, 95(1), 101–108.
6. Wilson, S. A., Stem, L. A., & Bruehlman, R. D. (2021). Hypothyroidism: Diagnosis and Treatment.American family physician, 103(10), 605–613.
7. Johnson, A., Roberts, L., & Elkins, G. (2019). Complementary and Alternative Medicine for Menopause.Journal of evidence-based integrative medicine, 24, 2515690X19829380.