The Fat Loss TroubleshootThis is your place to troubleshoot your fat loss problems from nutrition to training. This section is led by Leigh Peele, author of "The Fat Loss Troubleshoot," the ultimate fat loss manual. If your results have slowed or stalled this is the place to come for advice for all your fat loss needs.
Precision Nutrition article: "Fat is Not Your Fault" by Dr. Walsh
I just got an interesting email from Precision Nutrition, (which I have not done). I am wondering whether what he is saying/advertising makes sense for those of us who do the are compliant with good deficit, good activity, healthy food, tracking and still don't lose weight or lose way too slowly.
I'm wondering whether if this stuff looks sane, perhaps he can confer with my Primary Care doctor about what I should do, because I am pretty lost for direction for my next deficit which begins Monday. It seems I'll be doing the same as I did, hoping for different results.
I have paraphrased and excerpted, but the links are below.
From: Precision Nutrition <info@precisionnutrition.com>
Subject: 4 reasons you're not losing fat;
Ever feel like you're doing everything right - with nothing to show for it? If so, today's update is for you.
Today, Dr Bryan Walsh Fat Is Not Your Fault is going to share with you his extensive knowledge of, what I call, "abnormal fat loss physiology."
But what happens if you’ve got the diet and the exercise part down pat; if your social support is great; your psychology on track… and you still can’t lose fat? .... However, there’s always that other 15%: folks who seem to be doing everything else right but still can’t lose fat. What’s up with them?....
Well, that’s when you’ve gotta dig deeper physiologically. That’s when you have to look to the 4 major physiological systems that could be holding you back. These include:
Fat Loss Barrier #1: The oxygen delivery system Fat Loss Barrier #2: The blood sugar management system (Insulin resistance - chronically elevated blood sugar levels. and Hypoglycemia - blood sugar fluctuations Fat Loss Barrier #3: The adrenal system - Cortisol; The most effective way of assessing adrenal gland function is the Adrenal Salivary Test. This test uses four salivary samples throughout the day and assesses levels of salivary cortisol and DHEA. Fat Loss Barrier #4: The gastrointestinal system
Originally Posted by AnnetteW Did I miss something? Who' is Dr Bryan Walsh Fat Is Not Your Fault?
In the Precision Nutrition email I got, Dr. Walsh has just written book for people who have done everything right, but they are still not losing fat, and he describes 4 areas: oxygen, digestion, blood sugar management system, and the adrenals.
I thought I'd get my test results and then look at these areas and see if I get any info. I don't really understand what I read about the biology and how it translates into my food and exercise program, but I guess the more I'll read it the more I'll understand.
I'd be curious how Dr. Walsh's 4 areas
1: The oxygen delivery system
2: The blood sugar management system (Insulin resistance - chronically elevated blood sugar levels. and Hypoglycemia - blood sugar fluctuations
3: The adrenal system
4: The gastrointestinal system
could translate into diet and exercise program changes that could stimulate fat loss for me?
Or is it all just increasing my deficit until it is finally big enough deficit to create fat loss? I was already at a 800-1000 cal deficit with no real fat loss.
I've begun to create my next 12 week program on my log here, still looking for results
#472 (permalink)
The book "Fat is Not Your Fault" is going to sell HUGE just because of the title. That fact that it's targeted for a minority of people will be irrelevant.
Etana, in your case, since your body only has only recently seemed to respond to complete fasts, it probably would be worth checking out.
I just got 2 PMs from Dr. Bryan Walsh, and I am moving my discussion with him here public in the forum. The first PM is quoted here first, and the second post is some first reactions from Dr. Walsh to my bloodwork that I just had done)... Please feel free to join in with your own comments and concerns!
I welcome Dr. Walsh to the JP Fitness Forum, and look forward to us all learning some more about our health. I'm sure Dr. Walsh's publishers helped with his new book's title, "Fat is Not Your Fault," and I do hope it sells well, because there are some of us who truly suffer and feel guilty that we are not dieting carefully enough and that is why we don't get results, when there are other health concerns our bloodwork shows, but doctors don't analyse correctly or even notice at all.
Quote:
Originally Posted by drbryanwalsh
Hey there, Etana.
I saw your post about my article on Precision Nutrition and would be more than happy to answer any and all questions about it if you're interested.
So many people on the internet are hard to access and at least for now, I want to make myself as available as possible to help people in any way I can.
Be well,
Dr. Bryan Walsh
P.S. I'm happy to open up discussion publically if you think it will be helpful for other members of the forum.
Dr. Bryan Walsh,
Welcome to the JP Fitness Forum, The Fatloss Troubleshoot thread! It is exciting to have you here to discuss your research and practice and findings.
This caught my eye from your article on Precision Nutrition:
"But what happens if you’ve got the diet and the exercise part down pat; if your social support is great; your psychology on track… and you still can’t lose fat?
....
"However, there’s always that other 15%: folks who seem to be doing everything else right but still can’t lose fat. What’s up with them?....
"Well, that’s when you’ve gotta dig deeper physiologically. That’s when you have to look to the 4 major physiological systems that could be holding you back. .."
I have just read the excellent links that give explanation to the 4 major physiological systems. They really helped in my understanding of these 4 psysiological systems and how to diagnose and treat based on blood work. I liked what you said about different labs having different reference ranges and and that for healthy people, markers could not show in test results, until you are sick.
My first reaction to these systems (before bloodwork analysis) is that I am probably Insulin resistant and have always had gastrointestinal issues.
I am posting Dr. Walsh's response to my bloodwork in next message.
There weren't too many markers to make any strong inferences from.
So in this video, you say that the
1. reference ranges look for disease, but do not look for health." and
2. Not enough markers to give the whole picture.
I believe you are saying that markers = tests, and that my doctor did not take enough tests or "markers." Is that right? You suggest some more tests, for me to ask my Dr. to take. Are there more you'd suggest?
1. free T3 and T4 could be helpful to see if you are converting thyroid hormone adequately.
2. T3 Uptake for measuring thyroid binding globulin levels.
3. Get actual numbers for CBC and liver enzymes
4. LDH Lactate Dehydrogenase
5. RBC magnesium
6. cortisol, do a salivary adrenal test, not a serum test.
7. salivary hormone panel (I am postmenopausal)
My thought would be to have my medical doctor take as many tests as possible, and then to make a appointment to see you for you to interpret the tests and take any that insurance would not pay for. Does this seem sensible to you? What medical reasons (feeling sick, etc?) would I give to my doctor, such that insurance would pay for these tests?
Quote:
Just because something is "normal" on your blood work, doesn't mean that it is. So if you have actual numbers for the CBC and liver enzymes, that would be great. You can watch this video for more information: http://www.vimeo.com/3161062
Quote:
With only a few markers to go by, here's a few things for you:
1. Your thyroid looks fine based on those markers. Getting free T3 and T4 could be helpful to see if you are converting thyroid hormone adequately. T3 Uptake can also be helpful in measuring thyroid binding globulin levels.
2. Your blood sugar is a bit low. 85 is my personal cut off and anything below that can indicate excessive blood sugar fluctuations. LDH is sometimes a useful marker to help confirm this. If you have excessive blood sugar fluctuations, that can cause insulin surges, which can alter hormones, etc.
From what I read in your articles, I would say that I was insulin resistant: craving sugar after eating sugar, trouble falling asleep occasionally, tired after meals.
Quote:
3. Your vitamin D is low and warrants supplementation for a few months to try to get levels higher.
This surprises me since I have been taking 1000iu of D3 about 5 times/week for about 4 months.
Quote:
Lastly yes, I'd get more tests. If you want to look at magnesium, RBC magnesium is a good marker. Also if you're interested in cortisol, do a salivary adrenal test, not a serum test. The salivary test looks at cortisol over the course of the day, not just a one-time sample. And I'm assuming you are menopausal, so I'd go ahead and get a salivary hormone panel done as well. The lab I used is called Diagnostechs in Kent, WA.
I hope that starts to give you some information.
Be well,
Dr. Bryan Walsh
So what do I do with this information? What is the treatment process?
Note from Etana: Dr. Walsh is located in Columbia, Maryland and his website says he also takes phone consultations.
Ah, I just got this email,
Here is my medical doctor's response that she just emailed me. There is something I instinctively don't trust about what she says about "following my program exactly," but I will make an appointment and see what her plan is, and report back here.
Quote:
I recommend that you follow my program exactly and you can be successful. When you come in, I will give you a copy of the labs and review everything. You are going to need to be patient and work with me to be successful.
I will be happy to help you if you allow me to.
Schedule an appointment for weight loss.
B
yeah, I think following the plan exactly would depend on what the plan is. It's usually considered good advice to follow an oncologist's plan for chemo therapy, and it's usually a good idea to follow a physical trainer's plan for training.
Ah, I just got this email,
Here is my medical doctor's response that she just emailed me. There is something I instinctively don't trust about what she says about "following my program exactly," but I will make an appointment and see what her plan is, and report back here.
what is your doctor's "program"? Did she give you anything specific to follow?
what is your doctor's "program"? Did she give you anything specific to follow?
Yes, I thought it was weird that she wrote it that way, without giving any clues as to her plan. I will make an apt to see her and find out her program.
I wrote that if her program made sense to me I would be willing to be compliant.
I also am concerned that I specifically asked her to take the labwork Leigh suggested, and it did not seem that she took the free T3 and T4, magnesium or cortisol. But my guess is that she took what Insurance would pay for. But if I asked her to take these tests, she could have responded that insurance wouldn't pay for them, and did i want them anyway if I had to pay.
I believe she does some work in the weight management area that she charges for.
IMHO you need the help of a good endocrinologist with your lab results-primary care docs can't go as in depth as an endo can. I have thyroid nodules, Vitamin D deficiency and am in perimenopause and am working with an endo to get my health problems under control. Free T3 & T4 are common thyroid tests that most insurance covers. The thyroid is tricky you can be within normal lab ranges and your thyroid can still be malfunctioning-tsh, free T3 & 4 levels should be analyzed to see where they fall within your labs normal ranges. I have perfectly normal thyroid lab tests but am hypothyroid with thyroid nodules and need meds. Check out stopthethyroidmadness.com for some good thyroid info.
I agree you should consult with an Endocrinologist. Unless you have some strange HMO plan or on Medicare/Medicaid, insurance companies don't pick and choose which lab tests they will pay for. They either cover doctor ordered lab work or they don't (or unless something is beyond the realm of what is considered normal medical practice) The tests you mentioned are all standard tests.
I am hypothyroid. My TSH actually would indicate hyperthyroid (its very low) but my Free T4 and Total T3 are low without meds for each of them. You really need to see all the thyroid levels to gauge what is going on.
I agree you should consult with an Endocrinologist. Unless you have some strange HMO plan or on Medicare/Medicaid, insurance companies don't pick and choose which lab tests they will pay for. They either cover doctor ordered lab work or they don't (or unless something is beyond the realm of what is considered normal medical practice) The tests you mentioned are all standard tests.
I am hypothyroid. My TSH actually would indicate hyperthyroid (its very low) but my Free T4 and Total T3 are low without meds for each of them. You really need to see all the thyroid levels to gauge what is going on.
Lara, thank you for the info that insurance will cover tests that doctors order. I specifically gave the list of tests from Leigh's article, and it upsets me that my PCP did not send me resulst for the Free T3 and T4; when I see her this week, perhaps those tests were taken, we'll see. If not, I lose confidence in her as my doctor, since I asked specifically for these tests.
Quote:
Originally Posted by Butterfly09
IMHO you need the help of a good endocrinologist with your lab results-primary care docs can't go as in depth as an endo can. I have thyroid nodules, Vitamin D deficiency and am in perimenopause and am working with an endo to get my health problems under control. Free T3 & T4 are common thyroid tests that most insurance covers. The thyroid is tricky you can be within normal lab ranges and your thyroid can still be malfunctioning-tsh, free T3 & 4 levels should be analyzed to see where they fall within your labs normal ranges. I have perfectly normal thyroid lab tests but am hypothyroid with thyroid nodules and need meds. Check out stopthethyroidmadness.com for some good thyroid info.
Thank you both for this good information; I will pursue it.
Just went to http://www.ratemds.com/doctor-ratings/ to look up some endocrinologists. It is still so difficult in general to find ratings of doctors when you need a new one, or I also looked for reviews of my PCP but found nothing.
Hey there, Etana.
I wanted to quickly apologize for the delay in replying to your posts. I’ve been away on business for the past week and have come back to an onslaught of emails. I’ll get to your posts by the end of the weekend.
Be well,
Dr. Bryan P. Walsh
Naturopathic Physician
443-458-8307 (phone)
(443) 740-9220 (fax) bryan@drbryanpwalsh.com http://www.drbryanpwalsh.com http://www.fatisnotyourfault.com
... and I replied:
Dr. Walsh!!!
Yes, I was really surprised NOT to see you on the JP Fitness Forum, because I think you can contribute and educate.. maybe even learn
Personally:
I am waiting for my fT3 and fT4 results, and will see my PCP Monday I think. I do believe I also will want to see you. I think I would rather first try to treat my symptoms without Thyroid medication.
I gained 9 pounds on my 16 day refeed and I have already in 6 days, lost 6 of that, now that I am eating 1200 cal and lower carb.
When i only lost 3 pounds on 11 weeks of OPT for Fatloss, I began looking at research and symptoms and treatment and diagnosing my self as hypothyroid or Hashimoto's or something. I have already made an apt with an endo doctor for Sept., and I was thinking "which meds do I want Synthroid or Armour? etc etc." But a post on JP Fitness suggested I NOT rush into thyroid medication because it is hard to stop once your thyroid gets dependent on it.
My symptoms are: very slow to negligible weight loss, high cholesterol 218 and high ldl 140 while on simvastatin low Vit D: 25-hydroxy 23.5 (normal 32-100) low morning temperature 96.2F, tired in afternoon, evening (but do I really sleep enough?),
sometime trouble falling asleep
poor memory,
history of bad periods,
... so symptoms were mounting up...
I think I have had these some of these symptoms for many years.
Recent lab tests
Sodium, Serum 140 mmol/L 135-145
Potassium, Serum 4.3 mmol/L 3.5-5.2
Midrange normal TSH: 2.080 (normal -.45-5)
Midrange normal T3 134 (normal 85-205)
Midrange normal t4 8.1 (normal 4.5-12) High: RDW 16.9 H % 11.7-15.0 Low end? T4, TBG & T4-TBG Index Thyroxine Binding Globulin 16 ug/mL (13-39)
waiting for my fT3 and fT4 results
Firstly, I think everyone needs a good blood chem for starters. The labs you included are not enough to get a good initial evaluation.
Elevated cholesterol could be a number of things, including functional hypothyroid, insulin resistance, etc.
The thyroid panel you included looks fine initially, but like another member said, there can be many defects in the thyroid chain. In fact, if you have thyroid resistance, you can have a completely normal thyroid panel, but have hypothyroid symptoms due to receptor damage not allowing thyroid hormone into the cells (most commonly caused by elevated cortisol, elevated homocystiene, and/or vitamin A deficiency).
Also, insulin resistance is one of the great hypothyroidism mimickers.
You emailed your glucose level to me, which at 81 is a little lowish. I'd need to see LDH levels to confirm it, but you might have blood sugar fluctuations that are contributing to some of your symptoms. They can be just as damaging as chronically elevated blood sugar levels.
It was difficult to interpret some of your post - did you have TBG tested directly and if so, is that showing on the low end? That could be an issue. With more thyroid free circulating thyroid hormone, it generally causes downregulation of receptor site and thus hypothyroid symtpoms, even though you have elevated levels of thyroid hormone in the blood stream. It's a balancing act. Decreased TBG in women are commonly caused by elevated testosterone levels.
If you haven't already, I think you need the following tests:
1. A good chemistry panel to screen for a number of things. It would include: CBC with differential, Chem-26, T7 panel (which you've basically already had), and lipids. That would cover most of it.
2. An adrenal salivary panel. The adrenal glands are largely responsbile for estrogen production in a post-menopausal woman. The better the adrenal glands are working, the better your hormone balance will be.
3. A post-menopausal salivary hormone profile. Reason being, salivary hormones look at free fraction hormones (which are the active hormones) instead of protein bound (inactive). Though both have value, I've had better results with the salivary testing. This would also look at testosterone, which if elevated, will cause serious problems with weight loss for a woman.
Those are the basics. Given some of the GI symptoms you mentioned, you might also ask for a RBC magnesium test to rule out magnesium deficiency. Also there are some great GI panels out there that can help look for dysfunction in that area.
I hope this helps. If you have any questions, please let me know.
Precision Nutrition article: "Fat is Not Your Fault" by Dr. Walsh
Linear Mode
