Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast, episode number six. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hey everyone. Welcome back. Last week we started talking about why weight gain happens and the hormones in our body that cause weight gain. If you haven't listened to episode number five, go back and listen to that episode. Before you check out today's episode, I am going to add for those of you who have already listened to episode five, I do realize there's an editing error right around the nine or 10-minute mark of the podcast. Thank you so much to everyone who reached out to let me know that I really appreciate your feedback and looking out for me. If you listened within the first hour of me uploading the episode, it was actually a pretty big editing error. So I went back and re-edited the podcast and I swore it was fine the second time round. It was only a couple of days ago that someone pointed out to me that there is still an error there. I think I start the phrase about the 1967 research like two or three times. So sorry y'all. So this is where I get to use life coaching to manage my thoughts around the editing error. I could choose to think, "Oh my gosh, I'm such an idiot. I can't believe I allowed myself to publish a podcast with a mistake in it twice." And I might feel embarrassed, which might lead me to obsessively re-editing the podcast, or maybe I would lose my confidence and stop podcasting altogether and I would create a result in my life where I don't allow myself to make mistakes. Possibly I don't allow myself to make mistakes because I don't even try in the first place. But the interesting thing is that I've decided to just let it go. I've decided to think I'm new to podcasting. I'm learning how to do all of this. I'm allowing myself to be a novice and to fail forward. I use fail forward to mean I've made a mistake and I'm going to learn from the situation so I can do better next time. I feel content when I think that and I get to move forward and instead of spending an hour re-editing the podcast again, I can spend an hour creating new content for you and I create a result where I continue to learn so that I can continue to create my podcast. And when I think and feel that way, it feels really good and I get the results I want in my life. And it might be interesting for you to stop and check-in. What are you thinking about me right now? Do you think wow, good for her? I'm glad to see she's human too. Or instead, are you having thoughts like, but doesn't she realize how unprofessional it looks to leave a mistake in her podcast? People are going to judge her. She should re-edit it until it's perfect. If you're having thoughts that sound more like those latter thoughts, stop and think. Why do I think that? Oftentimes when we make judgments about others, it's a reflection of how we think about ourselves. And what's really fun here is that for those of you who are thinking those latter thoughts, let me tell you, I totally hear you. You may be a perfectionist and have those expectations for others in your life, and I will tell you that I am a perfectionist in recovery. Letting things slide off my back did not come easily to me, but I have learned that my perfectionism actually didn't serve me. It seemed like it did on the surface because I could've deliver a perfect result for others, but it didn't feel good. The perfectionist in me would beat myself up. I might have gotten results, but it was from a place of fear or intimidation from some perfectionistic alter ego of mine who demanded nothing short of perfection. So instead, I've chosen to work from a place of love and compassion for myself. I can still work hard, I can still create great content, but it might not be perfect every time, and that's okay with me. Today's episode is a continuation of why we gain weight. Last week we started to talk about the different macronutrients, carbohydrates, protein, and fat. We also talked about the role of insulin in storing away energy for later this week we'll continue to talk about insulin as well as some of the other main hormones that play a role in weight. We're going to talk about how these hormonal changes impact us and what does and doesn't lead to successful weight loss. Insulin is an important hormone. Without insulin, we literally can't survive. We know this because that's exactly what type one diabetes is. Type one diabetes is an autoimmune disease that impacts the pancreas, and over time, the pancreas stops producing insulin. It used to be a disease with a hundred percent mortality. However, in the 1920s, scientists discovered insulin and began using it to treat patients with type one diabetes and it was a miracle cure. While type one diabetes still requires a lot of effort to both monitor blood sugar and then treat with the appropriate amount of insulin, it is now considered a treatable chronic condition. The problem develops when we have too much insulin, and that's what we're talking about in the setting of weight gain and obesity. Over time, our bodies are exposed to more and more insulin. We can begin to develop insulin resistance. One of the main causes of insulin resistance is the type of food we put into our bodies every time we eat carbohydrates. And to some extent, protein insulin is released to store it away for later. Interestingly, when we eat fat, there's little to no insulin response, and I don't mean to recklessly blame carbohydrates alone on weight gain, but the American diet has emphasized carbohydrates over all other macronutrients, and we've also made a huge movement towards snacking convenience, eating on the go, which has driven up our consumption of really highly processed carbohydrates. We know that not all carbohydrates are created equally. A sugary beverage like soda, juice, or sweetened coffee drink or processed food like crackers, cookies or cereal will cause our blood sugar and thus our insulin response to just spike like straight up like the Rocky Mountains. But when we eat a whole unprocessed form of carbohydrate, something like a bowl of steel cut oatmeal or a whole piece of fruit that also causes our blood sugar and insulin to increase, but it ends up being a much more rounded spike like the Appalachian Mountains, or as my Arizonan husband calls them, lovingly, the Appalachian Hills. As our bodies pack away more and more stored energy, we must release more insulin in order to continue to store that energy. The problem that happens is fat cells aren't these like inactive blobs just sitting on our body. Fat is actually quite hormonally active and storing away more and more fat leads to changes with our insulin, such as insulin resistance. It also leads to changes with other hormones like leptin and ghrelin. We'll talk about those a bit later. As we make more and more insulin, our body starts to ignore the signal. This is developing insulin resistance. Once we're starting to develop the resistance, then we make more insulin and we become more insulin resistant. It's a bad cycle that can be challenging to break. One of the earliest signs of insulin resistance is weight gain. Later on, we start to see signs of pre-diabetes or ultimately diabetes, and there are other things that impact insulin resistance beyond the foods that we eat. One of the hormones that plays a major role in insulin resistance is cortisol. Cortisol is generally known as our stress hormone. We have naturally fluctuating levels of cortisol throughout the day. So for example, our cortisol levels peak in the morning to help our body prepare to wake for the day and get our days started. Sometimes you will hear people refer to cortisol as the fight or flight hormone. So for example, if a lion is chasing you, your body releases a huge surge of cortisol, which increases the heart rate and the blood pressure. Cortisol also induces a temporary insulin resistance in order to keep our blood glucose active in our body so that it can fuel our muscles. All of these factors allow us to run away from the lion. The problem occurs when we have chronically increased cortisol due to things like poor sleep or chronic stress. These things increase cortisol similarly to when we're being chased by a lion. The problem is that these things are not just fleeting, but rather chronic problems which cause a chronically increased cortisol level. A chronically increased cortisol level leads to chronic insulin resistance, which can lead to weight gain. This is one of the reasons that the best weight loss plan is one that is comprehensive. It shouldn't address just diet and exercise, but also medical conditions, sleep and our psychological health. There are other hormones that regulate weight as well. In fact, there's actually dozens of hormones in our GI system and in our brains that contribute to weight regulation. We're just going to address two other ones today, which are leptin and ghrelin. Leptin is our fullness hormone. When we've eaten a large meal, our stomach releases leptin, which sends a signal to the brain to say, yep, I've had enough. I'm full. When leptin was first discovered, scientists actually thought they discovered the cure for obesity. Maybe people who struggled with their weight were actually just deficient in leptin, and if that was the case, then we could just give them a dose of leptin and they'd feel full and lose weight. It was disappointing though when we discovered the opposite is actually true. People who struggle with their weight have high leptin levels over time. Those high leptin levels lead to leptin resistance. This is similar to insulin resistance. Simply put, their body is sending a signal that it's full but that signal is not received. Another hormone that plays a major role in weight regulation is ghrelin. Ghrelin is our hunger hormone. When our bodies need energy, we secrete ghrelin in order to send that signal, "Hey, I'm hungry. Time to eat some food." Interestingly, when we lose weight, our body increases its ghrelin signal drastically to tell you like, "Oh no, you are losing weight. Go eat more." So when you lose weight and you start to feel that increased hunger, it's not just you imagining it or you having poor self-discipline, it's that your body has a tightly regulated system to maintain weight. With this background, I wanna talk about how to lose weight. Let's start by talking about what doesn't work. So there's old theories like calories in versus calories out and the advice just eat less and move more. Sadly, this is the advice we often give people who are struggling with their weight. This advice assumes that our bodies are a basic math equation. So if your body metabolism is say, 2000 calories per day then just eat less and you'll lose weight. So for example, if you follow a 1500 calorie per day diet, you're at a deficit of 500 calories per day. We know that one pound of fat has 3,500 calories. So if you have a 500 calorie deficit after seven days, you should have a 3,500 calorie deficit and therefore you'll have lost a pound of fat. But it doesn't actually work that way in real life. Why? The problem with the above advice is that assumes that calories in and calories out are completely independent of one another. That regardless of how many calories we eat, we're going to burn the same number of calories, but that's actually not true at all. When our body realizes that it's getting less calories, it starts to slow down the metabolism. After all, our species would've never survived, survived if our metabolisms were stagnant. Burning more calories than we're bringing in is a quick way to deplete your energy source and ultimately to die. If you were only going to have 1500 calories coming in, your metabolism will slow down to match it. When this happens, you feel symptoms of a slow metabolism like feeling tired all the time or feeling cold, and your body starts sending out those hormonal signals like ghrelin telling you to seek out more food. Similarly, we can't easily exercise off our excess calories exercise that focuses on cardio alone. So things like walking, running, elliptical, that type of thing does not have a huge impact on our weight loss goals. Have you ever met a heavy person who ran a marathon? I have all the time. When I was in medical training, I used to volunteer at the medical events like the medical booths at race events. One of the things that was so interesting to me was how many people were overweight. These people were overweight, and yet they could run a half marathon, which is 13 miles or sometimes even a full marathon, which is 26 miles. How could a person who is capable of running that much be overweight? It's because exercise alone doesn't have a huge impact on our weight. Over the last few decades, our American culture has taken up the hobby of exercising as a population, our exercise has skyrocketed. At the same time, our weight as a population has skyrocketed as well. Furthermore, Americans exercise for far more than any other country yet we're also one of the heaviest countries in the world. Have you ever had an intense cardio workout and then come home and realized you were starving? You have worked up an appetite and it's easy to eat back the calories that you worked so hard to burn off. For example, in a typical three-mile walk or run, my body only burns about 180 to 200 calories. Y'all, that's literally three to four Oreos, and I can almost hear some of you protesting like, come on Dr. Stombaugh. I'm not coming home and eating Oreos. And even if you're not, even if you don't come home and eat Oreos, you still end up making it up at the next mealtime. You unconsciously eat a larger portion simply because you're hungrier, and that's okay. Your body is doing what it's supposed to do. And please don't hear me wrong. Exercise has its role. I'm not saying it's not important. Exercise is one of the best things we can do for our overall health. The benefits to the heart are undeniable. Exercise can also have huge implications for our mental health, and there are certainly ways we can use exercise to our advantage to help with weight loss. So seriously, don't hear me wrong. Exercise is important, exercise is good, but it doesn't always have the role in weight loss that we want it to. We'll dedicate an episode to exercise in the future. We'll probably even do a couple of episodes. I plan to bring my husband on as a guest. He is a physician and a powerlifter, and he has such a fun and different perspective on exercise than a lot of us in the obesity medicine world. But let me say, if you're just starting out on your weight loss journey and you're not presently exercising, you don't have to start it right away. Sometimes adding it on too early ends up having the opposite effect on our weight. The reason that calorie cutting and trying to exercise off or exercise off our excess weight doesn't work is that our body is really good at maintaining homeostasis. The official definition of homeostasis is a tendency towards a relatively stable equilibrium between interdependent elements, especially as maintained by a physiological process. Basically, homeostasis means keeping our body the same. I'm sure you're thinking if eating loss doesn't help and exercise doesn't help, what can I actually do to lose weight? So if you think about it, if insulin resistance causes weight gain, then it makes sense that we need to address insulin resistance when we make a weight loss plan. From a dietary perspective, this means decreasing carbohydrates, particularly processed carbohydrates. For some people, this means going on a ketogenic diet where you eliminate nearly all of the carbohydrates from from your diet. For other people, this means eliminating just flour and sugar from the diet. This is where it can be helpful to meet with your doctor and obesity medicine specialist or nutritionist to help devise a plan for you, and you may start with one plan and evolve to another plan depending on what is or isn't working for your body. Everyone's body is unique, so no two people are going to have the exact same nutrition needs. One group of people who shouldn't change their diet on their own is anyone who's taking medications for diabetes. Many of the medications for diabetes can lower blood sugar. So lowering your carbohydrate intake drastically without adjusting your medications first can put you at risk for hypoglycemia or low blood sugar, and that can certainly be a dangerous or even life-threatening condition. Before making any dietary changes, you'll want to ask your doctor if you need to make any medication adjustments first. The other thing we can do to decrease insulin resistance is decrease how often we're eating or often called intermittent fasting. Last week we talked about how we are either in energy storage mode or we're in energy burning mode. We can't be in both at the same time. So when we're constantly eating, we don't give ourselves the opportunity to use up the energy we have stored away for later. So sit down and take a look at when you eat. When is your first meal of the day? When is your last meal of the day? How many times do you eat throughout the day? You might want to decrease the number of times you're eating during the day or increase the period of time in which you're fasting overnight. This doesn't mean you have to eat any less. Instead of eating, um, smaller meals, you're just thinking about eating larger meals less frequently. So for example, if you are someone who starts eating at 7:00 AM and snacks often throughout the day until 11:00 PM that's a lot of time that your body is spent releasing insulin and then putting yourself into storage mode. So if you instead switch to an intermittent fasting model by which maybe you have a larger lunch at 11:00 PM or excuse me, 11:00 AM and then a dinner at 6:00 PM and be done eating for the day, you might actually eat the same amount of food, but just at different times and in a shorter window, and that alone can decrease, can decrease your weight. We also need to address chronic elevations in cortisol that happen because of poor sleep and chronic stressors in our life. During our time together, we'll talk more in-depth about both of those two things and we'll use life coaching to learn how to manage your mind so you can feel more empowered in your life. Alright, that's it for today. If you're interested in learning more about me, head on over to my website. It's www.sarahstombaughmd.com. That's S-A-R-A-H-S-T-O-M-A-U-G-H-M-D, as in medical doctor, dot com. If you live in Illinois or Virginia and you are interested in working one-on-one with me in my weight loss practice, go ahead and fill out the form on my website and we'll connect. If you don't live in one of those states or maybe you're not interested in one-on-one visits, stay tuned. I will have nationwide group coaching available planning for early 2023. If you've enjoyed today's podcast, please subscribe wherever you listen to podcasts and please share this one with anyone or please share this with anyone you think may benefit. Thank you so much for joining me today. I look forward to talking with you next week.