PART THREE Understanding Health and Well-Being

20 Metabolic Resistance: Causes and Solutions

This chapter is dedicated to all you tortured souls who have been told that the only reason you are overweight is because you eat too much. What this statement ignores is the we!ldocumented fact that people who are significantly overweight may also have metabolic disorders. Such conditions not only cause weight gain, but also make it difficult to lose the accumulated weight.

Part of the obesity epidemic we face in the United States may be due to the misconception that those of us who are overweight are simply gluttons or lazy couch potatoes. For most of the last century, the majority of doctors involved in treating obesity did not accept extreme metabolic resistance as a possible explanation for their patients' plight, but rather chose to believe that they were being untruthful about what they ate.

This chapter is about extreme difficulty in losing weight and will help you understand why certain ways of eating that should lead to weight loss simply do not work.

The inability to burn fat or lose weight, the phenomenon called metabolic resistance to weight loss, is not uncommon. In my clinical practice, I have been called upon to treat hundreds if not thousands of patients who simply could not reach their goal weight no matter what weight loss they tried. But my co-practitioners and I were determined to help, and ultimately we did!

How to Overcome Metabolic Resistance

There are four major categories of problems that contribute to metabolic resistance:

1. Excessive insulin and insulin resistance, usually accompanied by high triglycerides. 1-4

2. The use of prescription drugs or hormones which im pede weight loss.

3. Underactive thyroid (hypothyroid) function, which can he present even when blood tests indicate no abnormality.

4. Overgrowth of the yeast organism Candida albicans.

There are a multitude of other problems, as well, but they occur rarely and aren't within the purview of this book. In stead, I will go into greater detail to show you how the Atkins Nutritional Approach and complementary medicine can successfully help overcome these four most common obstacles to weight control.

When Insulin Is Out Of Whack

We've discussed the issue of excessive insulin output-what the medical profession calls hyperinsulinism—and the inefficiency of insulin usage—what is called insulin resistance. There can be no question that overweight individuals whose weight control difficulties are caused by hyperinsulinism respond best to the Atkins controlled cat.hydrate nutritional approach. Even the majority of people who do not lose weight on a 1,000-calorie low-fat diet will lose weightonan 1,800-to 2,000-calorie meal plan-if carbohydrates are limited to 20 grams per day.

The vast majority will lose weight, yes. but not absolutely everyone.

For those individuals who have not lost weight during the Induction phase of Atkins, nutritionally oriented medicine offers ways to break through this last barrier. In conjuction with Induction, certain vitanutrients can assist in breaking up weight loss logjams.

In my experience, the leading nutrient to accomplish this fat-busting feat is L-carnitine. When carnitine is deficient, the conversion of burned fat to ketones is impaired,5-7 The mechanism for carnitine's effectiveness is that it has the ability to ensure that fat converts to fuel. But very high doses of carnitine are often necessary. I start most of my patients off with 500 mg, three times daily (taken before meals), but frequently the dose must he increased, to perhaps as high as 5,000 mg in divided doses before meals. Often, more effecfive responses occur with the use of aceytl carnitine, a compound that helps focus the carnitine action.

Co-enzyme Q10 (CoQ10), another vital nutrient necessary for fat to serve as fuel,s may also require large doses, often in excess of 300 mg daily. Both CoQ10 and carnitine are extremely valuable for other reasons, such as preserving heart health. You should read more about them and other nutrients in Dr Atkins'Vita-Nutrient Solution.

Other nutrients capable of overcoming slow weight loss include chromium, alpha lipoic acid, glutamine, phenylalanine and the combinations of inositol, choline and methionine. To get the optimum benefits of these vitanutrients, you should work with doctors experienced in their use to combine them with the Induction phase of Atkins.

The Role of Prescription Drugs

As much as metabolic abnormalities can cause a true inability to lose weight, an even greater number of people are stymied because of prescription medic.'om they are taking. The shocking truth is that the vast majority of these weight loss-stymied victims are completely unaware that the drugs are holding back their weight loss. The breakthrough answer lies simply in getting off the medications that inhibit weight loss. One of complementary medicine's greatest contributions to good health is its ability to find safe and effective alternatives to many pharmaceuticals with unacceptable side effects.

Of the numerous prescription drugs that are frequently found to slow or prevent weight loss, these are the most common:

·Estrogens and most synthetic hormone replacement therapies (HRTs), including birth control pills

·Anti-depressant drugs

·Insulin and insulin-stimulating drugs

·Anti-arthritis medications (including steroids)

·Diuretics and beta-blockers

Let's study them, item by item.

IF YOU ARE ON HORMONES

How many of you on HRT are now realizing that weight gain coincides with the period during which youhave been taking these powerful drags? I'll wager that the doctor who prescribed HRT for yoti did not warn you it might cause weight gain. Many standard hormones also increase bloodsugar imbalances, causing cravings and the inability to control intake of carbohydrate foods.

Your objective, once you learn that HRT has been inhibiting weight loss, is to, find the lowest dose of HRT that keeps menopausal symptoms under control. Your doctor will have to work with you to achieve this goal. The first consideration is to optimize the balance between progesterone and estrogen. The majority of women with menopausal symptoms (even those who ste not on HRT)-and certainly those on HRT-have a significant dominace of estrogen over progesterone, and estrogen is a fat-producing hormone. Also be aware that the progesterone usually prescribed (provera) is a synthetic version, which also tends to promote obesity. Natural progesterone, which does not lead to weight gain, should be prescribed, and frequently cnn stand alone (without estrogen) in relieving menopausal symptoms.

Among the vitanutrients that have proven' invaluable to ease the symptoms of estrogen withdrawal is the B vitamin folic acid, but it does require prescri·ou dosages of 20 mg or more. To my knowledge, no one has ever published or performed a study on what effect folic acid has on hormone levels. However, since I was taught to use it by my mentor, Carlton Fredericks, PhD, one of the twentieth century's most highly regarded nutritionists, I have prescribed it for thousands of women, i found it not only to be ns safe as all the other B vitamins, but to also consistently enable a significant lowering of estrogen dosage without bringing on any symptoms that indicate estrogen deficiency.

Another useful nutrient to allow reduction in HRT dosages is the mineral boron, which serves as a building block for the liver to manufacture natural estrogens. Boron, which is valuable for preventing and reversing osteoporosis, is us, rally recommended in the 6to 18-mg-per-day range. You will get additional benefits by bringing the normal precursors of the sex hormones, such as DHEA and pregnenolone, to the levels considered normal for a 30-ycar-old woman.

Once the above nutrients and nnmral hormones are provided, I am usually able to reduce the HRT dosages by seventy-five percent-sometimes more, sometimes less,

ANTI-DEPRESSANT DRUGS

Another drug category that matches HRT in providing obstacles to weight loss is the anti-depressants, particularly those which are in the SSRI (selective serotonin reuptake inhibitors) category. Strangely enough, these drags--such as Zoloft, Prozac, Paxil and Celexa—were originally touted as drags that would accelerate weight loss, but a reality check soon put an end to those misleading statements. In general, these drugs have certainly been overpreseribed, and many people who suffer from depression would get'great benefits from metabolically innocuous, natural anti-depressants. Many of the older psychotrophic drugs (tricyclic antidepressants) are also known to cause weight gain.

The Atkins Approach to Depression

Serotonin drugs are effective because this natural neurotransmitter helps the brain function, relieves depression and relaxes the mind. But the drugs work by blocking the body's normal ability to destroy serotonin once it has been created. Blocking agents block other normal chemical functions as we!l, resulting in such unwanted side effects as diminished sex drive and performance, dry mouth and constipation, to say nothing of slowed metabolism, which, of course, can stall weight loss.

The safe way to build up the serotonin level is to enable the body to manufacture its own serotonin by taking the immediate precursor to serotonin. This natural substance does not block a reaction, but simply enables a reaction to take place. The precursor to serotonin is a chemical called uyptoplum; its immediate precursor is 5-hydroxy tryptophan, a popular vitanutrient available in health food stores.

Other natural substances for depression include N-acetyl tyrosine, S-adenosyl methionine (SAble), St. John's Wort, acetyi L-carnitine, phosphatidyl serine and most of the B complex vitamins. These supplements relieve anxiety, ss do inositol, GABA (gamma amino butyric acid), kava kava and valerian.

It would be inappropriate to go into full detail about how to determine dosages to replace anti-depressant pharmaceuticals with safe, effective natural substances. It takes considerable experience to individualize the dosage and combination of therapies. But do know that you can get off anti-depressant pharmaceuticals with the help of a complementary physician experienced in managing depression and anxiety.

DO DIABETICS NEED INSULIN AND OTHER DRUGS?

A large number of diabetics are overweight because they put out too much insulin. As you might imagine, nothing would he more inappropriate than to give insulin to these overweight diabetics, who already put out excessive insulin and have elevated blood sugar resulting from insulin resistance, rather than lack of insulin. Are you a Type H diabetic taking insulin, or one of the oral drugs called sulfonylureas, which work by increasing your insulin levels? And do you seem to be metabolically resistant to weight loss? Then chances are a hundred to one that you are a diabetic who is simply a victim of a poor assumption on the part of your physician. My approach with those already diagnosed diabetics on oral medications md/or insulin who come to me is to determine if they can poduce insulin on their own.

Here's how you find out if the insulin you are taking is cessary or not: Have your doctor mn a test of insulin levIs (as well as glucose levels) both before and ninety rainutes after a typical Low-fat/high-carbohydrate breakfast (inclnding perhaps a blueberry muffin, cereal with skim milk and eight-ounce glass of orange juice). Make sure you take no long-acting insulin after 6 P.M. the evening before and no diabetes medications of any kind the morning of the test until after the second blood sample is drawn, (The blood drawn after eating or after drinking a glucose solution is called a postprandial reading.)

Here's how to interpret the results: If the second insulin level is 10 or more points higher than the first, it means your pancreas is working and that you probably can get off insulin if you are willing to follow the Atltins Nutritional Appreach. If it is 20 or more points higher, it is almost a certainty that you can do so.

The induction phase of Atkins is essential to accomplish this feat, as is a program for gradually reducing your dosage level of insulin (and sulfonylurea drugs), as I discuss in Chapter 24. My staff and I have taken hundreds of diabetics off insulin and thousands off oral medications, all without any iii effects. Do not discontinue mediation, however, except under the care of a doctor. In Chapter 24, you will also learn that the only drug useful for overweight, insulin-resistant, but not insulindependent, diabetics is metformin. And that chromium, vanadium, alpha lipoic acid, zinc, biotin and Co-enzyme Q10 can also help individuals who are insulin resistant.

ANTI-ARTHRITiS MEDICATIONS

If you cannot lose weight and are taking powerful arthritis medications known as NSAIDs (non-steroidal antiinflammatory drugs), it's time for you to consider getting off the drugs. The story is simple. Virtually all drugs known to be effective in controlling the pain and discomfort of arthritis may lead to weight gain. Some do so more than others, but no one has ever funded a study to find out which drugs had the most impact on weight gain. The best solution is for you to try to recall whether any of your weight gain coincided with the use of one or more arthritis drugs. The good news is the truly impressive number of vitanutrients documented in scientific journals that can relieve arthritic symptoms. When arthritis has an inflammatory basis (the painful joints get red and swollen and a blood test shows your sod rate is high), the most effective natural therapiea are M** (methylsulfonylmethane), cetyl myfistoleate, copper, broraelain, ginger, turmeric and pantethine (vitamin ap. For the non-inflammator type (osteoarthritis), natural therapies include glucosamine sulfate, chondmitin, sea cucumber, fish oil, niacinamide and the B complex group of vitamins.

Using vitanutrients to substitute for drugs in the case of arthritis is somewhat more direct than the previous examplea. For dosages of natural therapiea for arthritis symptoms, refer to Dr. Atkins' 'vita-Nutrient Solution. Since reducing the quantity of pharmaceuticals is the objective, the dose of alternatives should be on the liberal side. Since most pharmaceutical drugs do afford pain relief, I tell my patients to determine what is the lowest dosage they feel comfortable with and settle for that. Any significant dose-lowering will probably allow for weight loss to resume.

Steroids such as prednisone are powerful medications that can be lifesaving but have a definite metabolic downside, especially if used for long periods of time. They are often prescribed for arthritis as well as for autoimmune disorders, inflammation of the bowel and any other inflammatory condition. These drugs actually cause water retention and weight gain. They can also damage the kidneys and pancreas and cause diabetes. The same nutritional supplements that can relieve arthritis are safer alternatives that will not hinder weight loss.

DIURETICS AND BETA-BLOCKERS--HIGH BLOOD PRESSURE MEDICATIONS

For your sake, I hope that your inability to lose weight dates from the time you were put on anti-hypertension drugs. The reason? In my experience, no medication has proven easier to get off than blood pressure drugs. And, if you can get off of them, since most widely used medications carry considerable side effects, there is an additional motivaLion to wean yourself.

At the top of the no-no list are the diuretic medications, which work by preventing your kidneys from doing one of

most important jobs: reabsorbing the minerals your body needs. Blocking the kidneys' ability to reabsorb sodium and chloride takes salt out of the body and Lowen blood pressure by lowering the fluids that stay in the body. But those blocked kidneys also lose their ability to retain valuable minerals: not only potassium, but magnesium, cal. cium, chromium, zinc and many others. Prescription diuretics induce mineral deficiencies that can cause many problems. Numerous studies demonstrate that diuretics aggravatediabetes, elevate blood sugar and increase insulin levels, triglycerides and body mass index (the measure for obesity).9-11 For all these reasons, I insist that my patients on diuretics discontinue them and replace them with L-murine, the natural amino acid that is a powerful diuretic but has no iii effects on kidney function. The other types of anti-hypertension drugs that aggravate all of the above are beta-blockers. If you are on a betablocker, you have little cause for concern about discontinuing your medication. In the first place, the controlled carb lifestyle that you are adopting lowers blood pressure itself. In addition to L-taurine, you may control blood pressure with magnesium, hawthorne, Co-enzyme Q10, cnmitine and garlic. Because Atkins will naturally lower your blood pressure, continuing to take pharnmceuticals could put you at risk for an overdose. Again, speak to your doctor before discontinuing any medication!

HOW MANY OTHER DRUGS DO IT?

I'm sure you are beginning to see how frequenfiy the very drugs that people take for granted as necessary are in fact problematic. Safer, more natural options exist, and even people with no weight problem should consider using them. There are probably hundreds of other &rugs, certainly including psychotropic drugs and lithium, which also create difficulty in losing weight. If I were to go into full detail, it would require an entire book. So let me give you some general advice. If you have been on medication for any length of time, try to recall whether weight gain, increased appetite or lack of responsiveness to weight loss efforts might have coincided with the time frame in which you began that drug. If so, you probably will be able to find a set of nutritional altematives in Dr. Atkins' Vita-Nutrient Solution, which lists therapies for about sixty different conditions.

REPLACEMENT TECHNIQUES

How do you replace a drug in question with a natural alternative? in most situations, you begin the vitanutrient program that will replace the drug and work with your doctor to gradually lower the drug dosage by some ten to fifteen percent each week, as long as the condition that the drug is meant to control does not worsen. Combining vitanutrients with the personalized eating regimen this book describes has allowed me to reduce the intake of medications by virtually all my patients.

The Role of the Thyroid

Your thyroid gland's main purpose in life is tO regulate the speed of your metabolism. So it is not difficult to understand that if it is underactive-the medical word is hypothyroidyour slowed metabolism makes you more resistant to weight loss. Among other things, your thyroid gland regulates your body temperature. In fact, sensitivity to cold is one of the first signs that you may have a sluggish thyroid. Like other hormones, thyroid production naturally diminishes slightly with age; in fact, easily twenty-five percent of adults suffer from low thyroid 'function. The swings of estrogen production in perimenopause or menopause can also throw thyroid function off.

To ascertain whether you have hypothyroidism, your doctor will do blood tests to evaluate your production of thyroid hormones T4 (also known as thyroxine) and T3 (your body converts T4 to T3), as well as another hormone called TSH (thyroid stimulating hormone), which is produced by your pituitary gland. I do tests on free T3, T4 and TSH levels. However, these clinical tests do not catch all cases. First think about whether you are experiencing any of the signs of an underactive thyroid—which include the aforementioned sensitivity to cold, as well as weight gain or inability to lose weight, hair loss, fatigue and lethargy, depression, dry skin, chronic constipation, poor nails, poor memory and elevated cholesterol levels, if so, there is a simple way—the Barnes technique of basal metabolism to ascertain if you are hypothyroid. It doesn't even require a trip to your doctor.

Simply take your temperature orally four times a day (before each meal and before you go to bed) for four days. Average your temperature each day, and if it is consistenfiy below 98 degrees Fahrenheit, you are likely to have hypothyroidism. If it is significantly lower, you almost deftnitely do, and you should bring this information to the attention of your physician. (Be prepared: Not all doctors take basal metabolism as seriously as they should.) Occasionally, the reason for an underactive thyroid is the deficiency of the amino acid tyrosine and the mineral iodine, both of which help make 'I'3. Zinc and selenium help produce the enzyme that converts T4 to T3. But nutritional deficiency is rarely the cause of hypothyroidism. There are other causes, one of which can be an autoimmune response.

The major reason for hypothyroidism that l'd like to address is simply the body's own attempts to preserve. the stares quo while on a weight loss program.

I use the therapeutic trial to treat thyroid problems. I start patients with a very law dose of a prescription thyroid hormone replacement and build up gradually and very carefully. In most cases, when we reach the right dose, patients start to feel dramatically better, with a much better overall sense of well-being and increased energy and vitality. Best of all, they start to lose weight!

The solution is to take thyroid honnone-T3 and T4 preferably-in a natural form (rather than the synthetic type). I prescribe the synthetic kind of thyroid hormone only in cases of an autoimmune disease, when your own immune system might destroy the natural kind.

Candida

There is one other potential reason for blocked weight loss: Candida albicans, known as yeast. Candida is so important that it merits its own detailed discussion in Chapter 25. If yon think this problem may be interfering with your weight loss, please consult that chapter.

None of the Above?

I expect close to one hundred percent success in achieving weight loss with my patients, but there are still exceptions. Certain individuals are so metabolically resistant that only more intense dietary restrictions prove successful. Read on, and I'll explain what I mean.

Once medications, thyroid problems and Candida are brought under control, we can quite logically expect that almost ninety-nine percent of overweight people who do Atkins diligently will lose and keep off weight. Bm since 'there are 150 million overweight Americans, even the remaining one percent means that there are one and a half million rnetabolically resistant people who still need help. For that group, I suggest something more than the Induction phase's 20-grams-of-carbohydrnte-a-day meal plan.

I have treated ated hundreds of these people-all of whom were depending on me to help ihem-and I had no intention of letting them down. So I nsked myself, "What is the most effective weight loss eating pattern ever described?" There can be no question what that is. Yon rend about it in 7 in the discussion of the metabolic advantage. British researchers Alan Kekwick and Craston Pawan developed it, and Frederick Benoit and his team confirmed its superiority in burning off fat, compared to an absolute total fast. This extreme diet consists of 1,000 calories, ninety percent of which is comprised of fat. No other weight loss regimen, before or since, has matched its ability to burn off stored fat.

The Fat Fast

The rationale behind the Kekwick diet is crystal clear: It forces the body into lipolysis so it burns its stores of fat. Lipolysis cannot take place if there is a significant source of glucose. Since all carbohydrates and some protein convert to energy by way of glucose, eliminating almost everything but fat from the diet forces even the most resistant body into lipolysis. That explains the ninety percent dietary fat component of the Kekwick diet. Lowering the caloric intake accelerates the need to burn up body fat thus the 1,000calorie limit. When I wrote the first edition of this book years ago, I realized that a small but intensely suffering segment of my readers would need to know how to overcome metabolic resistance. So I decided to make the Kekwick diet as enjoyable as possible. But no matter how ! tried, the quantities were simply 'too small and the selection too limited to meet the satiety and tastiness criteria that I had been demanding for people following my program. I gave it the name "Fat Fast" because it contained virtually no food except for fat. I tried it on scores of patients and was not surprised to observe how often it worked for those who were unable to lose in any other safe, dmgiess way. Nor was I surprised to hear that none of my patients relished the idea of staying on it. But ten more years of experience with the Fat Fast has taught me how to make Kekwick and Pawan's brilliant concept a truly useful technique with which to combat metabolic resistance. The Fat Fast is one controlled carb program where you do have to count calories, I am afraid. You'H eat 1,000 calories a day, with seventy-five to ninety percent fat. Since frequent "feedings" prevent hunger better than three meals a day, I recommend five feedings, perhaps one every four hours, comprising 200 calories each. Because of the high fat content and frequent feedings, very few people on the Fat Fast experience much hunger. The stumbling block for some people is the absence of meals as we know them. Let's look at some choices for a Fat Fast 200-calve feeding. Each item equals approximately 200 calories:

·One ounce of macadamia nuts or macadamia nut butter

·Two ounces of cream cheese or Brie

·One ounce of tuna or chicken salad with two teaspoons of mayonnaise served in one-quarter of an avocado

·Two deviled eggs made with two teaspoons of mayonnaise

·Two ounces of sour cream and two tablespoons black or red caviar

·Two and a half ounces whipped heavy cream topped sucralose zero-calorie syrup

·Two ounces of pate (check label for fat conten0

·Two egg yolks (hard-boiled) with one tablespoon of mayonnaise

When to Do the Fat Fast

Let me make it clear that the Fat Fast is actually dangerous for anyone who is not metabolically resistant. For people who lose weight fairly easily, the rate of weight loss is too rapid to be safe. But it carries very little risk for people who can barely lose on any other regimen. The reason why I ask such people to try the Fat Fast is to let them know that it is possible to lose weight.

I ask them to try the regimen for four or five days to see if they achieve what the Fat Fast is capable of doing-weight loss, curbed appetite, positive lipolysis testing strips and im proved well-being, If these results occur, most people are willing to stick with it for a few days, even if tho food selcctions are unfulfi!ling.

Modifying the Fat Fast

If increasing the fat-to-carbohydrate ratio and cutting the calorie count works, any dietary change in that direction might get the job done. Next, you can try four meals a day of roughly 300 calories for a total of 1,200 calories. That should work too, and what it allows is definitely: more appealing to the taste buds:

·Two ounces of beef chuck (do not drain fat) cooked in two tablespoons of olive oil

·TWo scrambled eggs with two strips of nitrate-free bacon

·TWo tablespoons of full-fat sour cream with a tablespoon of sugar-free syrup

·Cboe-quarter cup chicken or tuna salad made with two tablespoons of mayonnaise

·Three ounces of pat6 (check fat content)

·One-and-a-half ounces of macadamia nuts

Try the 1,200-calorie regimen for a week, then go back to Induction. Or simply follow the concept of increasing the ratio of fat to protein. No one should have to feel that losing weight is hopeless. Somethnes the key to achieving your goal weight perrmnently is quite difficult to adhere to, but rarely is it simply impossible! With a clear-eyed approach to the factors that may be standing in your way, you should finally beable to slip into clothing a size or two smaller.