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The following articles are a brief selection on weight success and wellness. We hope to continually add and update this section of our web site for your ongoing education and continued use.

"Doctor, I'm struggling to keep my weight under control. I've tried everything: Diets, exercise, even fasting but I'm stuck. The weight just won't budge..."

When an obese or moderately overweight individual presents with a weight problem, a cursory health overview is performed to check height, weight, thyroid function, dietary intake. A high carbohydrate/low fat diet is recommended to lower total energy intake below basal metabolic rate. Current diet theory (putting aside popular diets such as "the zone" by Dr. Barry Sears or the Dr. Atkins material) is "calories in/calories on".

One textbook expresses it tersely as "Weight gain or loss depends upon caloric intake and caloric use. If you consume more calories than you use, then you will gain weight. Weight loss occurs when you use more calories than you consume. It is often said that the best form of exercise is to push yourself away from the table!" Authors of Basic and Clinical Endocrinology wrote, "Obesity can be viewed as a failure of nutrient balance resulting from a failure to balance the intake of nutrients in relation to the daily need for nutrients to stoke the metabolic furnace."

And even more recently Groff, et al, wrote that "Negative energy balance (weight loss) is accomplished when energy expenditure exceeds energy intake... Two routes exist for creating a negative relationship between energy expenditure and energy intake: food (energy intake) can be decreased and/or physical activity (energy expenditure) can be increased."

Though an enormous amount of research has been done on our growing problem of obesity showing that weight management may or may not be related to caloric intake, this guilt-based approach isn't changing. Every day, the calorie approach to weight loss is advised countless numbers of times in lay weight loss articles and books and via verbal counsel given by doctors and nutrition counselors. When confronted with the patient who has complied with the protocol, has dropped her caloric intake below subsistence level, has denuded her diet of fat in the hopes of driving caloric intake down even further, and the weight still doesn't budge, what then is the next step?

For many practitioners, the answer is simple: "She didn't comply with the program."

Continued emphasis on obesity as a dietary issue causes enormous guilt and frustration for the struggling patient but health care practitioners also experience frustration; they see the patient's failure as a compliance issue. Often the practitioner heaps more guilt on the bewildered patient in a futile attempt to modify behavior by continued insistence on lowering calories.

Whose Fault Is It?

Dr. Barry Sears introduced the idea of the hormonal influence on weight management to the country a few years ago when his book "Enter The Zone" hit the market. While his research findings were certainly not new, his applications of "the zone" were new and hit a vital nerve in the overweight community. Finally, someone articulated the pain they had felt for years; that calorie counting didn't work and that balancing two critical hormones by balancing macronutrients did -- and that their weight problems were not due to overeating. Compliance really wasn't the issue. Successful weight management involved balancing insulin and glucagon.

For many people, the greatest gift they received from Dr. Sears was relief from guilt. They lost both fat weight and guilt weight.

For a significant number of people, however, the Zone diet doesn't work because other factors, hormonal and non-hormonal, wield an influence over how the body manages its calories, and simply balancing protein, carbohydrates and fats does not address these factors. For these people, insulin resistance or carbohydrate sensitivity may only be a piece of the puzzle. If they are going to permanently alter the way their bodies manage calories, they are going to have to address these issues, some of which are even more complex than insulin:glucagon ratios.

Female, Forty, Fat - and Frustrated

Another set of hormones that influences weight management are the female hormones, estrogen and progesterone. Many women gain their excess weight during periods of hormone imbalance such as puberty, post-childbirth, and menopause because during those periods of life, estrogen is inadequately opposed by progesterone. Estrogen dominance (the over secretion of estrogen, undersecretion of progesterone, estrogen replacement therapy, or the use of the birth control pill) pulls down the function of the thyroid gland and lowers the metabolic rate of the body, with symptoms ranging from weight gain, blood sugar imbalance, fatigue, and many psychological disturbances.

During pregnancy and oral contraceptive use, for example, serum T3 levels decrease as thyroxine-binding globulin (TBG) increases, leaving less access of the activating thyroid hormone to the cells.

Excess estrogen in relation to progesterone also causes the body to sequester salt which hangs onto excess water, and activates a fat-storing enzyme called the LPL enzyme (lipoprotein lipase).

Combine excess estrogen with ongoing stress that signals the continuous release of stress hormones, and you see a triple assault on the endocrine system that dysregulates blood sugar regulatory mechanisms, increases the breakdown of lean body tissues, slows the metabolic rate, impairs digestion, and stimulates the synthesis of fatty tissue throughout the body. This cascade of hormonal events leading to weight gain will be impossible to manage on diet alone, regardless of how elegant the meal plan.

Progesterone is favorable to weight management because it is pro-thermogenic, reduces the tendency toward water retention, low energy levels, assists thyroid function, and other mechanisms. Estrogen excites the liver to produce more and more triglycerides like an efficient internal fat factory. According to Dr. Calvin Ezrin, MD, author of the Endocrine Control Diet, estrogen increases the production of triglycerides at a rate that will not be reversed when estrogen therapy is withdrawn.

In other words, estrogen increases the rate at which triglycerides are formed from excess carbohydrates and it matters little to the body if those excess carbohydrates are from a candy bar or from a plate of low-fat pasta. Estrogen dominance produces excessive weight, usually centered between the waist and the knees (the pear-shaped woman). It will be difficult for estrogen dominant women to control their gynoid obesity through diet manipulation alone and may in fact be nearly impossible for women who have used ERT for a period of time.

While thyroid insufficiency has been blamed for weight challenges and there is evidence that both clinical and subclinical hypothyroidism can make weight management more challenging, many hypothyroid patients are thin. If hypothyroidism is causing weight gain, it will typically cause no more than fifteen or twenty pounds of weight gain. Hypothyroidism will not cause obesity, although hypothyroidism may be stacked on top of a number of other endocrine challenges that complicate solving the weight problem.

Metabolic rate may be reduced by low fat diets, low calorie diets, diets that are excessive in highly processed fats, diets that are too high in refined carbohydrates, low protein diets, iodine deficiency, water deficiency, excessive consumption of foods that suppress thyroid function (cabbage or other brassicas or soy foods), sedentary lifestyle, etc. Metabolic rate is not based on thyroid function alone.

The Other Issues Of Weight Gain

If the endocrine system doesn't contribute enough to complicate the weight loss picture, one must also consider food or environmental allergies, loss of brown fat thermogenesis, the influence of pharmaceutical drugs, genetics, and constipation or poor digestion.

Eating non-foods contributes greatly to obesity as the body's ability to handle large amounts of "dietary toxic waste" is overloaded. Consider the fact that the average American drinks less than two glasses of water per day, yet consumes less than two servings of both fruit and vegetables per day, over 200 pounds of sugar and artificial sweeteners per year, eats more strawberry ice cream than strawberries, more dehydrated potatoes and potato chips than whole potatoes, more French fries than any other vegetables... Well, the American dietary culture is less than civilized. The body may use fat tissue as a kind of toxic waste storage depot site when the liver's capacity to eliminate the toxic material is exhausted.

Binge Eating And Food Cravings

If there is any dietary phenomenon that stokes the guilt furnace, it is binge eating, episodes of eating characterized by consuming large amounts of food in a short period of time or a sense of lack of control - being unable to stop eating or to control what or how much one is eating. Is binge eating a matter of will power or is it a matter of a body trying to re-establish homeostasis?

After World War II, research was conducted to learn more about the effects of starvation. In a group of World War II prisoners of war who had been starved during incarceration, it was found that episodes of binge eating were common among these young men, and that the greater the degree of starvation, the more frequent the incidence of binge eating.

Young, healthy volunteers were recruited to go on a starvation diet and brought their weight down to seventy four percent of "normal." After researchers had achieved the weight loss they desired in their subjects, the volunteers were invited to bring their food consumption levels back to normal and within a short period of time, they had regained their weight. One factor had changed forever, however: they were no longer able to control the amount of food they ate. They indulged in binge eating episodes over which they had little control.

While dieters seldom bring their weight down to such drastic levels, the dieting experience is similar to the starvation of the prisoners-of-war and seems to trigger defense mechanisms in the brain that alter the body's ability to restrain itself. Binge eating may be an attempt by the body to normalize thyroid activity.

Mineral Deficiencies And Food Cravings

Similar mechanisms may be at work in food cravings although clinicians note that deficiencies in certain minerals may trigger carbohydrate / sugar cravings.

Five minerals (and their co-factors) are critical for adequate blood sugar control: chromium, magnesium, manganese, zinc, and vanadium. Chromium is a cofactor with insulin and is essential for normal glucose utilization, for growth, and for longevity, working hand in hand with nicotinic acid and glutathione. Chromium is required for normal fat and carbohydrate metabolism.

Manganese is also associated with sugar and fat metabolism. Studies show that manganese-deficient rats exhibit reduced insulin activity, impaired glucose transport, lowered insulin-stimulated glucose oxidation and conversion to triglycerides in adipose cells. Deficiencies in manganese lead to lessened insulin sensitivity in fat tissue and a decreased ability to transport glucose through the blood and metabolize it for energy.

Magnesium is part of over three hundred enzymes in the body but also helps maintain tissue sensitivity to insulin, helps control glucose metabolism, and participates in the regulation of insulin.

Interestingly, clinicians often note that magnesium deficiency leads to sugar cravings and chocolate cravings that disappear as soon as magnesium levels are brought back to normal. Because large amounts of magnesium are found in the hippocampus (the "emotional, thought and memory center of the brain"), deficiencies may form the emotional environment which encourages carbohydrate cravings.

A number of both animal and rat trials have shown that stress triggers chocolate cravings, which may in turn be related to noradrenaline and dopamine levels in the brain.

Dopamine has been called the "pleasure neurotransmitter" and evidence shows that dopamine is a magnesium-dependent neurotransmitter. It is possible that low levels of magnesium trigger low levels in dopamine in the brain, possibly triggering desires for chocolate as a biological attempt to increase dopamine and thus increase pleasure.

However, chocolate addiction is real. Chocolate, opiates, cocaine and alcohol may trigger a similar reaction since they share a common set of biochemical mechanisms and affect some of the same areas of the brain in producing reward (the dopamine connection?). An interesting article in Nutrition Week stated that "researchers have found that a chemical in chocolate stimulates the same receptors in the brain as marijuana." Unfortunately, women wouldhave to eat 25 pounds of chocolate to "get a buzz."

We know that chocolate contains a peptide called PEA (phenylethylamine) that triggers the release of several neurotransmitters, including dopamine.

The problem is, "addicts" don't seem to get the pleasure from eating the chocolate that they hoped to get because of increased guilt. One article in the British Journal of Clinical Psychology bleakly noted: "...eating chocolate resulted in increased feelings of guilt in the 'addicts' and no significant changes in feeling depressed or relaxed. On indices of disordered eating and depression, 'addicts' scored significantly higher than controls; however, eating chocolate did not improve mood. Although chocolate is a food which provides pleasure, for those who consider intake of this food to be excessive, any pleasure experienced is short lived and accompanied by feelings of guilt."

An obscure article in Pharmacology, Biochemistry and Behavior states that "Magnesium can potentiate cocaine's action in behavioral situations. It can be substituted for cocaine and reduce the intake of cocaine."

Cocaine obviously isn't chocolate. But in their book, "The Nutrition Desk Reference," Robert Garrison, Jr., and Elizabeth Somer note that "serotonin levels are low during alcohol recovery, which results in increased cravings for sweets and other carbohydrates in an unconscious effort to raise serotonin levels and feel better."

While magnesium appears abundantly throughout the food chain, Americans seem to be taking in far less than RDA (300-350 mg/day). One author noted that up to three-quarters of the population may consume less than RDA levels, and if studies on magnesium status were done on dieters, that figure may jump to 100%.

Vanadium, in the form of vanadyl sulfate, mimics the activities of insulin. While chromium potentiates insulin, vanadyl is biologically active even in the absence of insulin, significantly increasing liver glycogen and improving the uptake of glucose by muscle tissues. It inhibits the storage of excess calories from carbohydrates as fat by stabilizing the body's production of insulin.

Zinc is also essential to blood sugar regulation by influencing carbohydrate metabolism, increasing insulin response, and improving glucose tolerance. Zinc influences basal metabolic rate, thyroid hormone activity, and improves taste sensitivity.

The average American diet is already deficient in these minerals but in frequent dieter even more so! It has been noted that zinc deficiency is common in undeveloped countries but the diets of many Americans, particularly dieters, is no better. The best sources of zinc include oysters and red meat, neither of which is eaten frequently by many people. The average American consumes less than 10 mg. of zinc per day, far less than what is required for normal sugar metabolism or the other functions of zinc in the body.

Because it is likely that mineral deficiencies are widespread, particularly in the dieting population, it is important that some assessment of mineral status be made. Correcting mineral deficiencies can go a long way toward helping the frustrated dieter control her impulses to eat something sweet, something fatty, or something devoid of nutrition in an attempt to satisfy an inner compulsion.

Conclusion

While we cannot ignore the fact that most Americans make poor choices when it comes to diet selection and that many overweight people overeat, we also cannot ignore the fact that we simply cannot make a judgment on either the quality of the diet or the quantity of the diet based on body size or shape alone. Thin people are driven by the same compulsions to overeat or poorly-eat as their overweight friends; in fact, many studies show that thin people eat more calories and are less conscious of food intake than people who struggle with the scales.

What, then, is the real issue? Successful weight management is a holistic issue, involving the endocrine system, the digestive system, the nervous system -- in short, the whole body. Poor weight control is a syndrome, a collection of symptoms that must be acknowledged and treated in its complexity. It is not just a "mouth issue." The overweight patient, struggling against a body that does not give up its excess weight easily, must be seen with compassion -- not as just another fat person who can't stay on a diet. He must be treated as a patient whose body is out of homeostasis, out of balance, unable to manage its resources appropriately and in that light, a treatment plan must be designed to bring the entire body back into balance so that the weight loss is permanent and that overall health is achieved. when a holistic approach is given to weight management, the results will be evident not only from arbitrary numbers from a scale but will be seen in increased energy, improved digestion and utilization of nutrients, in approved ability to make wise food choices, glowing skin, balanced hormones -- in short, homeostasis. And it will be permanent!

References

1. Cunningham, John D., Human Biology, Harper & Row, Publishers, NY, 1989, 247.

2. Greenspan, Francis S., and John D. Baxter, Basic and Clinical Endocrinology, Appleton & Lange, CT, 1994, 279.

3. Groff, James L., Sareen S. Gropper, Sara M. Hunt, Advanced Nutrition and Human Metabolism, West Publishing Company, MN, 1995, 476.

4. Becker, Kenneth L., et al, Principles and Practice of Endocrinology and Metabolism, Lippincott, 1990, PA, p. 897.

5. Telephone interview with Calvin Ezrin, MD, 12 July 1995, Vancouver, Washington (As cited in Your Fat Is Not Your Fault, Jeremy P. Tarcher/Putnam, NY, 1997, p. 141).

6. Polivy, Janet, Sharon Zeitlin, C. Peter Herman, and A. Lynne Beal, Food Restriction and Binge Eating: A Study of Former Prisoners of War. Journal of Abnormal Psychology 103, no. 2 (1994):409-11.

7. Spalter, A. R., H. E. Gwirtsman, M. A. Demitrack, and P. W. Gold, Thyroid Function in Bulimia Nervosa. Biological Psychiatry 33, no. 6 (15 March 1993): 408-14.

8. Seelig, Mildred S., MD, M.P.H., F.A.C.N., Magnesium Deficiency in the Pathogenesis of Disease, Plenum Medical Book Company, NY, 1980, p. 262.

9. Pfeiffer, C. Carl, Ph.D., MD., Mental and Elemental Nutrients, Keats, CT, 1975, p. 24.

10. Willner, P., Benton, D., Brown, E., Cheeta, S., Davies, G., Morgan, J., Morgan, M., Depression increases "craving" for sweet rewards in animal and human models of depression and craving. Psychopharmacology, 136(3):272-83, 1998 Apr.

11. Amyard, N., Leyris, A., Monier, C., Frances, H., Boulu, RG, Henrotte, JG., Brain catecholamines, serotonin and their metabolites in mice selected for low (MGL) and high (MGH) blood magnesium levels. Magnesium Research, 8(1):5-9, 1995 Mar.

12. Antonelli, T., Govoni, BM, Bianchi, C., Beani, L., Glutamate regulation of dopamine release in guinea pig striatal slices. Neurochemistry International. 30(2):203-9, 1997 Feb.

13. Chocoholics, Nutrition Week, September 13, 1996;26(35):7. As cited in Clinical Pearls 1996 pg. 2.

14. Dean, Ward, M.D., John Morgenthaler, Steven Wm. Fowkes, Smart Drugs II: The Next Generation, Smart Publications, CA, 1993, 40.

15. MacDiarmid, JI., Hetherington, MM., Mood modulation by food: an exploration of affect and cravings in 'chocolate addicts'. British Journal of Clinical Psychology. 34(Pt 1):129-38, 1995 Feb.

16. Kantak, Kathleen M., "Failure of magnesium to maintain self-administration in cocaine-naive rats." Pharmacology, Biochemistry and Behavior. 1990;36;9-12. As cited in Clinical Pearls 1990, pg. 7.

17. Garrison, Robert Jr. and Elizabeth Somer, The Nutrition Desk Reference, Keats Publishing, Inc., CT, 1995, 614-615.

18. Altura, Burton M., Ph.D., et al., Magnesium: growing in clinical importance. "Patient Care," January 15, 1994;130-136. As cited in Clinical Pearls 1994, pg. 329.

19. Clouatre, Dallas, Ph.D. Getting Lean with Anti-Fat Nutrients, Pax Publishing,, CA, 1993), p. 22.

20. Groff, James L., Sareen S. Gropper, Sara M. Hunt. Advanced Nutrition ad Human Metabolism. West Publishing Company, MN, 1995, 373.

21. Sandstead, Harold H., M.D., and Alcock, Nancy W., Ph.D., Zinc: an essential and unheralded nutrient. Journal of Laboratory and Clinical Medicine, 197;130(2):116-118. As cited in Clinical Pearls 1997 pg. 271.

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