by: Dr. Jillian Sarno Teta
The woman sitting in front of me is close to tears. She is in her late thirties and, for the last fifteen minutes or so, has been telling me about the creeping 15-pound weight gain she has experienced over the last three years.
The tears are of frustration. This woman, whom I’ll call Anna (it’s not her real name), eats a paleo-esque diet and works out five times a week. She sleeps like a champ, though needs to use an alarm to get up. Her menstrual cycle is normal, and she has no digestive distress.
Her weight gain has been distributed all over – she feels that her waistbands are tighter, her shirts are tighter, even her socks are tighter. She feels like she always has a “gut” and is carrying around water.
We dig in a bit more. I take a very careful diet history. She eats 4-6 meals a day, doesn’t salt her food, eats several cups of vegetables a day and almost never experiences hunger. She doesn’t eat sugar or sweets, rarely has alcohol, and has just one or two cups of coffee in the morning.
“I’ve been low carb for over eight months, and my belly is spilling over my pants!” she practically wails at me. I can understand her frustration. The more she restricts or tightens things up, the more her waist expands. Anna has been going to Crossfit regularly the last several years, and has layered in spin classes these last eight months, in an attempt to do more.
She is eating a lot. She is exercising a lot. Her clearest pattern of weight gain is slow and steady, all over, not directed to one body location, and she is distressed that she always looks puffy.
We review her workouts and her sleep. She exercises for 30-60 minutes, including weight training, 5 to 6 days a week. Some of those workouts are Crossfit, some are more body-building style, some are classes that she takes at the Y. Anna tells me she falls asleep as soon as she hits the bed. Her alarm gets her up, and she “goes non stop” during the day, getting her kids ready for school, working, picking up her kids and driving them around, working out, eating, and the like.
A picture is beginning to emerge, and I begin to see the path we are going to take, the pivot. She may not like it much, but I ask her, “When was the last time you took a break?”
“Do you ever get to relax?”
Rueful grin. A snicker, even.
“I have a TON of muscle. I am so strong, stronger than almost anyone at my gym. I cannot see any of my muscles anymore. I look like the marshmallow man from the Ghostbusters.”
Anna has been doing a couple things that are running counter to her goals of fat loss, though she is doing them completely unintentionally. In fact, she is doing all of the things that she has read on the natural blogosphere to be right, and the things that have worked for her in the past.
Her body has completely compensated to what she is doing. She was eating a lot and exercising a lot and got seemingly, little down time. Her body adjusted her metabolic rate and hormonal response to this, and the scale steadily creeped up.
My Suggestions to Anna:
My suggestions to her were as such:
On the nutrition front – On training days, add a serving of carbohydrate post training. On non-training days, add a carb into a meal before noon or 1pm.
On non-training days, wait to eat until you get a hunger signal.
Salt your veggies (add a pinch of salt to them while they are cooking)
Use a hot cocoa drink for cravings, if they show up.
On the training front: Train no more than 4 days a week. Train only using intervals/hybrids/circuits or sprint training. Sessions are limited to twenty minutes or less.
Stop spin class, for now.
Go for a walk every day, preferably in nature. Stroll as if you were walking an elderly dog that wants to smell the roses.
Anna didn’t like these suggestions very much, especially when I told her that she may actually gain a little bit more weight when she starts. Then I explained my rationale.
She was essentially overtraining and using an “eat more, exercise more” approach. It’s possible she was eating too much, even with her carbohydrate restriction. Her carbohydrate and salt restriction, although well-intentioned, were quite likely contributing to her puffiness and water gain all over.
Though we did not test her, she was likely experiencing an enhanced cortisol effect. With her high frequency of moderately intense, moderately long workouts played against less sleep than she perhaps needed, cortisol became more and more a player in her physiology.
Cortisol is not an inherently bad hormone, but when left unopposed by other hormones like progesterone and testosterone and HGH (human growth hormone), it can make us ladies lose our waists. Her levels were not yet to the space where they were interfering with her menstrual cycle, but given enough time, they could.
When we got into the nitty gritty details, I discovered she was only sleeping 6-7 hours a night. This likely is not enough for the schedule she was sustaining, but with her responsibilities she balked at my initial suggestion of going to bed earlier or getting up later. There was simply no time, at least at that time.
Between the intense exercise schedule, the lower than optimal sleep, the regimented meal times with no reference to her actual hunger and the fact that she didn’t ever get more than a few minutes to herself meant that she was a bit out of touch with the intrinsic cues of her body.
Since she had been on her current regimen for so long, a clear change was needed.
Often, this is one of the best things for a stalled metabolism and fat loss resistance – swapping things up, based on what you are currently doing – to introduce a new set of variables to your body. A set that your body is not acclimated to.
In Anna’s case, my goals were to buffer the cortisol response she was having, re-sensitize her body to insulin and catecholamines both, and give her a rest. Playing with adding salt back in was a hunch based on my experience with body builders and figure competitors in the past, who, after a long time of a low sodium, low starch diet, begin to look as if they are wearing a snowsuit made of water.
It was also important that she slow down a bit so she could begin to tune in to the messages her body was telling her. Eating when you are not hungry, in this situation, is a slippery slope. It can lead to caloric excess. Even with her training so hard, it was quite likely she was eating a bit too much. She was doing what she thought she should.
At our 4 week follow up, only a few things had changed. She had lost about a pound and a half of water and she showed me the inside crook of her elbow.
“Look,” she said. “You can see my vein here. It’s been a while. My clothes are still tight, but my socks aren’t leaving marks on my legs. I’m not hungry at all.” Her energy was a little better, something that surprised her because she thought it was fine before.
At our 8 week follow up, things had changed more significantly. She had lost another pound and a half of water, along with two pounds of fat. She was enjoying the shorter, more intense workouts complemented by the strolls. She had dropped a size in her spandex. She still was not hungry.
“Some days I don’t eat until 2pm, but it doesn’t throw me off” she said.
Anna’s progress were a direct result of giving her body an entirely new set of input to deal with, and then listening to the body’s response. Slowly, Anna is learning to listen to her intrinsic cues of hunger, energy and cravings, but especially of hunger. This new input is forcing her body to change the way it deals with fuel and fat storage and fat burning, and in a smaller way, how it deals with microcirculation and water retention.
The most important lesson that Anna can teach us is that individual sensitivity and situation can help determine what the stumbling blocks are for fat loss, and what direction to pivot into next. It is always worth taking the time to sort out what is true for you and your body, rather than relying on an off the shelf dietary plan or trying to stuff yourself into a box.
Frameworks for fat loss are fantastic, but they absolutely must be tailored for the individual. These tailorings, then, must take a bit of time to be tested. Incorporate the changes, assess the results, and adjust. This is a process that can take weeks and months, but will always give you better data than a plan that says simply to try harder or go lower carb or whatever such.
Not everyone would have responded to the changes I made for Anna, and that is exactly the point. When we are stuck, we must take a high level view at, not only what we are eating (or not), but also how we are moving, recovering and dealing with stress. These are the major dials to turn when it comes to tweaking our approach for fat loss. With a healthy metabolism, some compensation will always be present, some tweaking always needed. The pot of gold at the end of the metabolism rainbow is being able to see this larger picture, pivot, and adjust as needed.
The power of this process in undeniable. Yes, it flies in the face of 4-week jump starts and off-the-shelf diet and workout plans. Yet, it is infinitely more sustainable, more responsive, and will get you better results in the long run. It is a study into yourself, the most fascinating subject. You can become an expert on you, and be your own best fat loss detective.
Want more guidelines?
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