Metabolic Rehab – Metabolic Effect

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So here is the scenario. I am at the Metabolic Effect clinic sitting in my office talking to a consulting client on the phone. She has been making steady progress in weight loss for months. The last few weeks she has hit a plateau. I can tell she is a little frustrated. I explain to her, like I do with many of my clients, that body change is neither linear or predictable, and she needs to stay the course.

We talk about how these plateaus are a necessary part of the process and often lead to the greatest insights about what is required for life long health and body change. Then she says, “do you think I might have metabolic damage”?

I shake my head silently in disbelief and frustration. I think, “where the hell is all of this metabolic damage stuff coming from”? All of a sudden everyone and their grandmother seems to think they have been infected with metabolic damage. I calmly say no and explain to her what I am about to explain to you.

Background on the term metabolic damage

Honestly, I don’t know where the term metabolic damage came from. Like many things in health and fitness, it is a term that gets used by someone somewhere and becomes part of the lexicon. I think it caught on because it seems to be self-explanatory and logical. A person says, “I can no longer lose weight no matter how hard I try and no matter what I do. Something must be broken. Maybe I damaged my metabolism?” From there the term spreads.

I am an integrative physician. I, and many doctors like me, have been dealing with metabolic damage for years. Only we never called it “metabolic damage”. It was called “neuroendocrineimmune dysfunction”. Or we called it by some of its manifestations like “adrenal fatigue”. Sometimes when an actual diagnosis could be made, we called it “hypothyroid” or “Hashimoto’s thyroiditis” or “adrenal insufficiency”.

At Metabolic Effect we have adopted the term “metabolic damage” because it is far more descriptive and logical compared to “neuroendocrineimmune dysfunction”. What is important to understand is that a person can feel unwell and have metabolic disturbances without being in an overt disease state.

A diagnosis is not always possible even when dysfunction is evident. There is an entire segment of medicine that deals with the gray area of dysfunction between health and disease. It is called “functional medicine”. This is where non-diagnostic terms like “adrenal fatigue” came from.

One of the most frustrating things in all of medicine is the idea that a lab value determines whether you are healthy or not. If your fasting blood sugar levels are 119 you don’t have diabetes, but if they hit 120 you do. Do you see how utterly ridiculous that is?

Long before you get to a fasting blood sugar of 120, you had some serious dysfunction. Medicine calls this a lot of different things like “blood sugar dysregulation”, “glycemic impairment”, “prediabetes”, etc. But none of those are accepted diagnoses. They are simply descriptive terms that describe a measurable disturbance that has not yet become a disease.

Is metabolic damage a myth?

Saying, “metabolic damage is a myth” is a lot like saying, “prediabetes is a myth”. Saying, “adrenal fatigue does not exist” is a lot like saying, “over-training doesn’t exist”. These are functional disturbances that have clinical signs & symptoms that can be picked up on physical exams and blood labs. These disturbances may or may not have a corresponding diagnostic label. It is the gray area between optimal health and disease; the area where function starts becoming compromised.

Why do I bring this up? Because a lot of people in the internet space, many who are overstepping their boundaries of expertise in my opinion, are speaking about this issue as if they are well versed in it. I am a little tired of these “if there is no research it does not exist” people. It is these types that denied the existence of fibromyalgia, autism, ADD and a whole host of other conditions while at the same time many front line doctors were successfully treating patients. All of those aforementioned diseases were called “myths” before they weren’t.

I call these types “research zombies”. Like zombies, they blindly follow their one track minds and are unable or unwilling to realize the limitations of their own myopic viewpoint. Research is a critically important tool to test our clinical practices but is recently being used to deny anything for which a study was not exclusively done. Health and fitness is, and always will be, a mix of science and clinical practice. A healthy respect for both often provides the best outcome.

Metabolic Compensation

If metabolic damage is just another term for measurable metabolic disturbances, what are those disturbances and how do you know if you have metabolic damage? This is the whole reason I am writing this blog, because you probably do not have metabolic damage.

If you followed the discussion above you now realize your health is on a continuum from optimal health to functional disturbances to disease. When it comes to diet and exercise as it pertains to metabolic health there is a stepwise process we can easily see.

When you first embark on a diet and exercise program that has you eating less and exercising more, the initial stress to the metabolism is positive. The body responds to this stress normally and begins to mobilize its fuel reserves. This happens through a coordinated communication system routed through the command and control center of your metabolism called the hypothalamus and pituitary (HP).

The hypothalamus and pituitary send their signals out to the thyroid gland, adrenal glands, and gonads (ovaries and testicles). This results in a coordinated hormonal symphony that helps you burn fat and perhaps gain muscle too.

When this stress is prolonged past a few days or weeks the metabolism begins to compensate. This is one of the most agreed upon and well understood mechanisms in all of weight loss. I call it the law of metabolic compensation. This compensation creates hunger, energy changes, and cravings, as well as a metabolic slowdown led by a decline in thyroid hormone.

This slow down is very individual and can be almost absent in some while resulting in metabolic depression of 300 to 800 calories per day. For those with the biggest metabolic compensations, this can halt progress or even reverse it. For more on this compensatory mechanism and the research behind it, see this blog.

Metabolic Resistance

As a consequence of metabolic compensation, many people will begin to push on the metabolism harder. They start doing even more cardio and cutting back on calories even more. In other words, they double down on the eat less, exercise more model of weight reduction.

This may work for a short time, but then the body quickly catches on and begins to protect itself further by slowing things down more. At this point the body is essentially putting on the emergency breaks. It does this as a natural protective mechanism against stress. It wants to regain its fat and muscle stores so it sets into motion hunger and cravings. It wants you to rest and recover so it saps your motivation, lowers your energy and makes you anxious and/or depressed.

This metabolic resistance can occur for people at any weight undergoing extreme exercise and diet, but it normally kicks in when body fat begins to fall under 20% for women and 10% for men. And the truth is most people will never even reach this state. For most the metabolism handles things just fine.

Metabolic Damage

Finally when things are pushed too far, the HPT (hypothalamus pituitary thyroid axis), the HPA (hypothalamus pituitary adrenal axis), and the HPG (hypothalamus pituitary gonadal axis) become severely disrupted. Again, let me be clear. Most people will never reach this state. For those who do, the issues with hunger, cravings, energy, and weight loss resistance become the least of their concerns.

I have written about the steps that lead to metabolic damage in detail at another blog. Please review that blog here. Keep in mind the term introduced above, neuroendocrineimmune dysfunction. This includes nervous system dysfunction (neuro), hormonal dysfunction (endo), and immune dysfunction (immune). These systems are now known to share many pathways and intersect in multiple ways. Metabolic damage is neuroendocrineimmune dysfunction.

Nervous system dysfunction

While metabolic compensation is completely normal and metabolic resistance is easily reversed, metabolic damage is not. At this point there is nervous system dysfunction that manifests primarily as digestive complaints. The digestive system is a window into the delicate balance of the sympathetic nervous system (fight or flight) and the parasympathetic nervous system (rest and digest).

One of the things that tips us off to metabolic damage is the occurrence of multiple digestive disorders. Gas, bloating, heart burn, constipation and/or loose stool are a few of the issues that start popping up.

Hormone (endocrine) dysfunction

The thyroid gland becomes compromised leading to sub-clinical hypothyroid, hypothyroid and even autoimmune thyroid conditions. The adrenal glands too begin to show signs of stress. There is what we call a reverse cortisol curve in the early stages of metabolic resistance. In this stage you can see many different types of cortisol profiles, but most frequently is a low cortisol level and what integrative doctors call adrenal fatigue.

This hormonal dysfunction also leads to lowering of libido in men and women and loss of menses in women. The endocrine effects follow a pretty standard pattern clinically. In most, the adrenal glands seem to show dysfunction first, followed by the thyroid, followed by the ovaries and testicles. This is by no means always the case, but it occurs frequently enough to make a broad generalization.

Immune dysfunction

The digestive system is an interesting intersection point for metabolic disturbances. It has more nervous system innervation than any other places in the body aside from the brain. This is why we integrative physicians call it “the second brain”. It’s also a huge hub of hormone function. It communicates constantly via hormones to other parts of the body. It is also where the vast majority of immune cells reside. If there is any place in the body that is most representative of the neuroendocrineimmune system, it is the digestive track.

In addition to all of the other symptoms that begin to manifest in the digestive tract, food intolerance begins to develop. Foods that were once not an issue begin to cause reactions. This is most evident when protein rich foods begin causing heart burn. Starchy foods cause excessive gas and bloating. Fat can be malabsorbed and cause diarrhea or pale stool.

Do you have metabolic damage?

Hopefully now you are seeing that just because you hit a plateau in your weight loss efforts does not mean you have metabolic damage. Even if you have been resistant to weight loss for quite some time does not mean you have metabolic damage. In these scenarios you are more likely dealing with metabolic compensation and metabolic resistance respectively.

I don’t consider a person as “metabolic damage” until I see the neuroendocrineimmune dysfunctions that are its hallmark.

Here is a cheat list to help:

Metabolic compensation

• Metabolism slows down and weight loss slows or stops (you hit a plateau).
• One or more of the biofeedback cues hunger, energy and cravings (HEC) become moderately out of balance. Typically energy will be fine but hunger and cravings will be strongly working against you.
• This is very much like the early signs of athletic over-training. Also called overreaching.

Metabolic resistance

• Weight loss halts completely, and you can no longer lose weight with an eat less, exercise more approach. At best you maintain your weight.
• One or more of the biofeedback cues is a constant reminder something is wrong. Typically there is moderate continual fatigue but it is more of a wired on the inside, tired on the outside feeling.
• Mood changes occur. You can be anxious or depressed, but ironically it is a little of both.
• Sleep becomes dysfunctional. You may have difficulty going to sleep and/or staying asleep.
• You may notice in the evenings that you feel more wired and energetic than the rest of the day.

Metabolic damage

• All of the above
• You can’t lose weight and may even be gaining weight despite no change in diet.
• Your body is taking on a puffy/waterlogged look.
• You are suffering depression.
• You have multiple digestive complaints.
• You may be dealing with hypothyroid symptoms of dry skin, itchy scalp, and slow thinking.
• You are exhausted and have zero motivation.
• Your libido is gone.
• Your menses is completely gone or irregular.
• You may be feeling light headed.
• You may be having new sensitivity to bright lights.
• You may have developed multiple food intolerances.

Over-training, adrenal fatigue and metabolic damage

Hopefully you are now getting a bit more clear on metabolic damage; what it is and what it is not. A good way to think about this argument is to analyze the history of two other terms, over-training and adrenal fatigue. These terms too were, and still are, in some circles controversial. Many people denied the existence of over-training for a long time. Many still take issue with the term adrenal fatigue.

If you were paying attention, you probably now could care less what it is called. Call it “functional disturbance X, Y, Z” for all I care. The point is that when the metabolism is stressed to the extreme, whether through athletic training (overtraining), physical stress/illness (adrenal fatigue), or chronic dieting and extreme exercising (metabolic compensation/resistance/damage), there are consequences to the body and physical signs and symptoms will manifest.

These dysfunctions may ultimately end up resulting in a diagnosed condition, but regardless if they do or not, the functional disturbances are present none the less. Denying them or pretending they don’t exist is silly and pointless, especially if our goal is to help people achieve optimal health, fitness, and weight loss.

A starting treatment

If you have made it this far, you are probably hoping to get some insight into what to do about it. Here is one thing I can tell you with certainty.

DO NOT START EATING MORE AND EXERCISING LESS!! You should run as far away as possible from any coach, doctor or health professional that tells you that.

For some reason people are being given this message, and it is the exact WRONG thing to be doing. If you want to gain weight faster than you ever thought humanly possible, then go ahead and follow that bad advice. If you want to heal the metabolism so that it once again functions correctly, do not take that approach.

Treating Metabolic Damage and Metabolic Resistance

The idea for treatment is to decrease the dietary stress and the exercise stress while honoring the fact that your current metabolic rate is likely moving at a snails pace. The solution is to stop eating less and exercising more, and do NOT start eating more and exercising less. The approach that works is to eat less and exercise less. This approach is the most gentle way to get things back in balance.

Eat and exercise in what I call a 3:2:1 fashion. Nutrition= 3 meals – 2 of those three meals should be 30-50g protein shakes and 1 regular meal that includes carbs preferably at the end of the day (it aids sleep). These protein shakes could easily be a protein based whole foods meal, but often protein shakes (hypoallergenic ones) provide a nice, consistent, easy and hunger suppressing means of following this protocol.

Exercise= 3 R&R activities per week (massage, naps, leisure walks, physical affection, laughter, tai chi, hot epsom salt baths, how showers, sauna, etc.), 2 traditional weight training sessions per week, 1 hour of leisure walking on all or most days.

When dealing with metabolic damage, supplements and other treatments will be required, but the diet, exercise, and lifestyle changes are most critical.

Expect 3 to 15 months for complete resolution. The biggest obstacle for my clients is focusing on weight loss over healing and never truly breaking free of the eat less, exercise more diet trap. In point of fact, the metabolism may gain a slight amount during this process before it starts to lose again. Those that can’t relax into this process will likely stay stuck.

Your metabolism needs time to find balance again before weight loss will start to occur. Continuing to focus on weight loss over healing is a sure way to stay stuck.

Treating metabolic compensation & resistance

For metabolic compensation things are much easier Simply do something different than eat less, exercise less. Eat more, exercise less will work. Eat more, exercise more will work better and of course eat less, exercise less is a good option. Expect to be back on track with in a few days to weeks.

For metabolic resistance, simply alternate an eat less, exercise less approach with an eat more, exercise more approach. Spend time in an eat less and exercise less (4 to 10 days) cycle, and then spend time eating more and exercising more (4 to 10 days). This back and forth approach pretty much stops metabolic resistance in its tracks. Expect to be back on track in a few weeks to a month or two.