Why You Might Be Struggling To Lose Weight

Coming up on this episode of the Doctor's Pharmacy.

In America, we have an overabundance of calories, but a deficiency of nutrients. The average American basically has an extra 500 calories a day that's available to them because of the increased production of our agricultural system in the last 50 years.

Hey everyone, it's Dr. Hyman. As a busy doctor with multiple jobs, I'm all about tools that make my life simpler. And since testing is something I rely on to help almost all my patients, I'm really excited because I learned about a new company called Group of Health. They are doing such great work around making testing simple. Hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria.

Those are just some of the many.

Things I like to look at, find the most effective path for my patients to optimal health. But that means I'm usually placing orders through multiple labs, which is just an overall pain. Plus, it makes me have to keep track of all the results, which is.

More difficult for me and my patients.

Now, Rupa Health has totally changed that. They've made functional medicine testing simpler and more convenient than ever so practitioners like me can focus on more time helping our patients. With Rupa Health, functional medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like Dutch, Vibrant America, Genova, Great Plains and more. It's 90% faster letting you simplify the process of getting functional medicine tests you need and providing a noticeably better patient experience. That's awesome. This is really a much needed option in functional medicine space and I'm so excited about it. You can check out a free live demo with a Q&A or create an account at RupaHealth.com that's R-U-P-A-Health.com Now so.

Many of my patients ask me how I manage to work multiple jobs, travel frequently, well not so much anymore, and spend time with my family and still focus on my health. I know it can seem hard to eat well when you got a lot going on, but the trick is to never let yourself get into a food emergency and to stay stocked up with the right things to support your goals. Recently I discovered Paleo Valley Beef Sticks. I keep these beef sticks at home and at the office so I know that whenever I'm in a food emergency, I have a healthy and delicious option to keep me on track. It's no secret that I have high standards when it comes to what I put in my body, and Paleo Valley Beef Sticks checks all the boxes. They're gluten-free, grain-free, dairy-free, soy-free, and non-GMO. Plus, they use 100% grass-fed and grass-finished beef. which not only adds to the flavorful taste but it also means they're free of any harmful antibiotics or hormones that you'll find in most meat. With grass-fed beef, you'll get more nutrients than you would with beef fed with grains, things like higher levels of omega-3 fats that help reduce inflammation and more B vitamins and other antioxidants to support your body's converting food into energy and also more of the fat-soluble vitamins that are beneficial for a healthy heart. Plus, instead of being processed with chemicals and other questionable ingredients, these beef sticks are naturally fermented, so you get gut friendly probiotics with every bite. How cool is that? Right now, Paleo Valley is offering my listeners 15% off your entire first order. Just go to paleovalley.com/hymen to check out all their clean Paleo products and take advantage of this deal. That's paleovalley.com/heimann. I definitely recommend stocking up on the grass-fed beef sticks to keep in your house, in your car, and in your office. It's one of my favorite tricks to staying healthy while on the go. All right, now let's get back to this week's episode of the Doctor's Pharmacy. Hey everybody, it's Dr. Mark Hyman. Welcome to a new series on the Doctor's Pharmacy called Masterclass, where we dive deep into popular health topics including inflammation, autoimmune disease, brain health, sleep, and lots more. And today, I'm joined by my guest host, my good friend, my business partner, and host of the Drew Proett Podcast, Drew Proett. And we are going to be diving deep into the topic of weight loss resistance. Who out there is having trouble losing weight? Let me see.

Probably a couple hundred million people. So this is going to be a good one, Drew. Welcome. Thanks, Mark. It's a topic that I know a lot of people are very curious about. And you actually wrote a guide, and we're going to be walking people through that guide. These are eight reasons according to the world and the framework of functional medicine that you've seen thousands of patients over the years that many of the patients that had challenges losing weight would fall into one or more of these categories. So before we dive deep into each one individually, let's give an overview of the eight that are there.

Absolutely. So Drew, I wrote this guide because so many times people think it's just their fault. They're eating too much, not exercising enough. and we think it's food that's causing us to be overweight. And after 30 years of practicing functional medicine, I can tell you for a fact that it's not always food. And it's surprising to people. So I wrote this guide called Beyond Food, Other Causes of Weight Gain and Damage Metabolism. And there are eight main categories. The first two are nutritional imbalances. We're overfed and undernourished. We eat too many calories and not enough nutrients. And when we're nutrient deficient, we crave more food and eat more food. We can get into that. The second is our microbiome. Turns out our gut microbiome is hugely important in regulating metabolism and weight. The next is inflammation, which can have many, many causes. So anything that causes inflammation will make you gain weight, even a virus or a toxin or mold, even if you are not eating a lot. I have, for example, a patient who lived in a moldy apartment. She gained 50 pounds just from the toxic inflammation from the mold. The next are environmental toxins. and that can be anything from pesticides to mercury, heavy metals, they damage your metabolism and prevent you from actually efficiently burning calories.

And many are called obesogens.

They're called obesogens, that's right. And environmental toxins are a big one. Also problems with our mitochondria. And these can be genetic, they can be acquired, but our mitochondria, they're little factories that make energy. So that's when we say our metabolism is slow, it kind of is true when you have poorly functioning mitochondria or these energy factories. And the next are communication problems, hormone problems, insulin, thyroid, stress hormones, sex hormones, all go out of whack and they can cause weight gain. For example, if you are eating foods that make you estrogenic or if you're exposed to environmental toxins that increase estrogens in your body, that'll make you gain weight. That's how they make cows gain weight before they slaughter them. They inject estrogen pellets into their ear, and the male steers and they actually make them gain weight by giving them estrogen. The next one is your genes. And people say, oh, I'm genetically predisposed. Well, some people are. They're more likely to gain weight given, for example, a certain carbohydrate load like the Native Americans, where thin and fit and healthy, but we introduced all this processed food and white flour and sugar, I call it the white menace, and they all of a sudden became the fattest population in the world other than the Samoans. And then lastly, it's something that we don't think of very often, but obesity can be contagious. It's not infectious, but it can be contagious because it turns out that your social networks determine so much about your health. Your friends, your community, and if your friends are overweight, you're far more likely to be overweight than if your parents are overweight. So your social networks are more important than your genetic networks in terms of determining your obesity and health and in many, many ways.

Okay, great. So these are eight reasons that are out there. We're going to walk through them a little bit more in depth. So reason number one, starting with that, nutritional imbalances, overfed and undernourished. Walk us through that and how you would determine whether or not a patient fit in that category.

Well, there's a condition called pica, which is a condition that kids often will get where they eat dirt. And they eat dirt because they're iron deficient. So their bodies are looking for the nutrients that they're not getting. And in America, we have an overabundance of calories but a deficiency of nutrients. The average American basically has an extra 500 calories a day that's available to them because of the increased production of our agricultural system. in the last 50 years. And where does that go? That goes into all the processed food. And we also are seeing massive nutritional deficiencies. Over 90% of Americans have a deficiency in one or more nutrients at the minimum level to prevent deficiency. So how much vitamin C do you need to not get scurvy? Not very much. How much vitamin D do you need to not get rickets? Not very much. But 10% are deficient in vitamin C, 80% are deficient in vitamin D, 90 plus percent are deficient in omega-3 fats, magnesium is very important in metabolism, zinc. often are very, very low. And I, people say, oh, you know, we live in America and people aren't malnourished. Nonsense. We are. And I see this every day in my practice because I test. And when you look at the studies of obesity, it's fascinating. The most obese are often the most nutrient deficient. It's, it's, you think, oh, these people are so fat, they're going to be well nourished. They're not. They're actually malnourished. They're overfed and undernourished, and they have massive nutritional deficiencies. So often we correct those deficiencies, people will actually rebound and one, they'll stop wanting to eat all that extra food because they're basically they were looking for love in all the wrong places, right? They're like looking for nutrients so they keep eating more and more food. And one study by Kevin Hall was fascinating where he took a group of people and let them eat processed food as much as they want or whole foods as much as they want. And the people who ate the processed food ate 500 calories more a day because they were not getting what they needed from the food. So even if it's subconscious, it's still happening.

So that's why nutritional deficiencies play a big role. So processed food is both addictive, but also your body is probably saying we need to eat more, eat more, eat more. Because it's not getting all the things that it needs. Let's go into reason number two. The gut microbiome imbalances and bad bugs are a big part of this. How does something like having the wrong gut microbiome impact our ability to gain or lose weight?

It's shocking, Drew. I mean, the data is just mounting every day about the importance of the microbiome. in our health in general, particularly in obesity. And first, what is the microbiome? It's the whole ecosystem of bugs that lives in your gut. It's 10 times as many cells as your own cells. It's 100 times as much DNA. So you might have 20,000 genes. There might be a 2 million or 4 million genes in the bacterial genes in your gut. And they're all doing stuff. And if they're bad bugs, they're doing bad things. If they're good bugs, they're doing good things. Probably up to a third to half of all the metabolites in your blood come from bacteria. so you're actually in direct relation to your microbiome. And the quality of your microbiome determines the quality of your health and weight. Just a couple of quick, amazing studies. One was they did a study where they looked at animals, rats, and they transplanted the poop from a fat mouse to a skinny mouse. And the skinny mouse gained weight without changing how much they ate. That's a mind-blower because off calories, it's not all about calories. They've also transplanted poop from healthy people into diabetic patients and reversed diabetes. Okay? And made them lose weight. We know, for example, there's a phenomena called metabolic endotoxemia. So when you have bad bugs in your gut, it produces metabolites or toxins. We call it lipopolysaccharides, a big medical word, LPS. It gets absorbed across the gut. Your immune system goes, ah, what's that? That's foreign. That's a toxin. That's a bacterial toxin. I gotta do my job. I'm gonna turn out the army of cytokines. We've heard about cytokines, cytokine storms. Cytokines are the messenger molecules of your immune system. Those cytokines then inhibit the insulin receptor. So they basically block the effect of insulin. When that happens, your blood sugar goes up and your body goes, oh, I need more insulin. So you start pumping up insulin. What's the effect of insulin? Insulin makes you gain weight. so the microbiome literally can make you gain weight through activating inflammation in the body. It also can cause leaky gut and food sensitivities because we often get damage to our gut lining and the barrier breaks down and we leak in food particles and bacterial toxins. And those food particles again, the body's like, what's that? That's not me. I better kick in inflammation. Well, inflammation recruits all these cells that bring in fluid and and make you gain weight. So it's not only fluid retention, but you also get the insulin resistance. So it creates this vicious cycle. And most of us have a pretty bad microbiome. Why? Because we live in a gut-busting culture. C-sections, lack of breastfeeding, antibiotics, steroids, environmental toxins, acid-blocking drugs, Advil drugs, hormone pills, like the birth control pill, all screw up our microbiome. And so we are living in a culture where the mass majority of Americans has really bad guts. and that is also predisposing to obesity.

Super fascinating, Mark. All right, we're gonna jump into reason number three, inflammation and immune function. Talk about how inflammation and how our immune system works could be connected to weight loss.

We touched a little bit about this with the microbiome, which is a big cause of inflammation. But anything that causes inflammation will interrupt insulin signaling, which will cause you to gain weight and store fat.

And what are some common things that cause inflammation?

Yeah, so the common things besides the microbiome would be viruses. We've seen viruses actually cause obesity. We see toxins cause inflammation, environmental toxins, mold toxins. I mentioned the young woman who I saw, for example, who lived in a moldy apartment and she gained 50 pounds. I had another patient who was working out like crazy, she was a health and fitness trainer and coach, and she had 40 extra pounds on her she could not get rid of. and we looked at everything. Turned out she had really high levels of mercury. And when we chelated the mercury out, she lost 40 pounds just like that. And I still hear from her periodically, she's doing great. Food allergens, also a big one. Food sensitivities, gluten and dairy are big ones. They cause a lot of weight gain. Processed food, ultra-processed food, this high in omega-6s, low in omega-3s, low in fiber, low in phytochemicals, also drives inflammation. So all of those things can drive inflammation. And it's important to be a detective and figure out what is it? Like why is someone struggling with weight? Well, it could be mold, it could be mercury, it could be a virus, it could be their microbiome, it could be a food allergen. Sleep apnea. Sleep apnea. Well, that's another whole category.

Yeah, exactly. That's more hormonal. But yes, all those will have impact on your weight gain. Okay, let's go into number four, environmental toxins.

What's the impact of environmental toxins on our ability to gain or lose weight? Yeah, you know, it's Drew, I started writing about this a long time ago. One of my first books was called Ultra Metabolism. And one of the chapters in there was Love youe Liver. Because if you don't understand, one, how to avoid toxins and two, how to increase your ability to get rid of toxins, it's gonna have a bad effect on your health, but particularly on your metabolism. And since I've written that book, it was 17 years ago, God, really? Okay. 17 years ago. Scary to say that. But there has been so much research about the correlation between environmental toxins and obesity, and they call them obesogens, as you mentioned earlier. These are compounds in the environment, pesticides, herbicides, environmental chemicals. There's 80,000 environmental chemicals that have been, or chemicals introduced in our world and our food supply that all can interfere with our metabolism and cause us to gain weight, even in the absence of extra calories. And in the average newborn, for example, there's 287 known environmental chemicals, whether it's phthalates, PCBs, dioxin, flame retardants, Teflon, and of course all the heavy metals and pesticides and herbicides, all in the blood, umbilical cord blood of a baby before they even take their first breath. Because we live in such a polluted world and they're getting those through their mother. So trying to, one, reduce your exposures and the Environmental Working Group is a great resource for that, ewg.org, for how to reduce it in your skincare and your home care products. and your food and meat and all the fish, everything you're eating. And there's a lot of ways to boost your own detox system by filtering your water, by having, you know, clean air in your environment, having filtered water and, and helping your body detox with certain foods like the broccoli family and the garlic and onion family. Also, certain supplements can really help, like selenium, bazing, vitamin C, B complex, things that boost with a thyl like milk thistle and acetyl cysteine, Alpha lipoic acid. These are just supplements that you can take that help boost detox. But I found that getting people detoxified is hugely important for helping improve their metabolism.

Okay, great. Let's go into that. Speaking of metabolism, troubles with your energy production system.

So, you know, we basically have to take the food we eat and the oxygen we breathe, and we have to turn it into useful energy. We call ATP. That's like our fuel, our gasoline. And. And they're a little in your mind, in your body, in every cell, there's hundreds to thousands to tens of thousands of these little. energy factories called mitochondria that basically process oxygen and calories and the output is energy to run everything. And if it stops, you're dead. So really important. But these little mitochondria are so sensitive. They have their own DNA. They get damaged easily. If they are exposed to environmental toxins or inflammation or all that list of stuff we talked about, they're exposed to too many calories, processed calories like sugar, processed fats. they don't do very well. And so they end up actually degrading and the decline of our mitochondria and mitochondrial function is a key factor in the rapid decline in aging we see in a lot of people in America. The good news is you can actually help your mitochondria function better, one, by getting rid of all the things that damage the mitochondria, but two, by doing things that help boost it, whether it's diet, certain things like a very low glycemic diet, calorie restriction, Time restricted eating is a great way to make your mitochondria healthy, recycles the parts, it cleans up old junk through a process called autophagy, which means self-eating or self-cannibalism really. And then we know we can increase the function and the effectiveness of mitochondria through certain kinds of exercise. HIIT training, which is high intensity interval training, which is where you do like wind sprints, where you go really fast for 35, 40, 50, 60 seconds, and then you slow down for three minutes. and also strength training which builds both muscle mass and improves muscle function. So all that's really important. And then there's nutrients that help mitochondria too you can take.

So those are all ways you can actually help fix the mitochondria. Okay, great. Let's go to reason number six, bad communication.

And this relates to hormones. Yeah, well, you know, we live in a world in which people have so many hormonal issues, thyroid issues, adrenal issues, sex hormone issues, insulin issues. And we talked about the insulin a little bit. Let's just start with thyroid. This is often missed. And the problem is that doctors don't do the right test. They'll do TSH, which is a screening test, but often it misses people who have low grade, low thyroid functions. They might have low T3, which is really important. They might have thyroid antibodies. And so you'll often miss the problem. And this affects so many people. It affects one in 10 men and one in five women have low thyroid function. So that really is a slow metabolism and so you have to have the right tests. So you want to make sure you get the right tests for your thyroid and that's TSH, free T3, free T4 and thyroid antibodies. And all this is going to be in the show notes. We're going to have the guide. You have everything in there you need. You want to make sure you eat right for your thyroid. You want to eat foods that are high in selenium, which is important for converting T4 to T3, which is the active hormone. you want to make sure you have enough omega-3 and zinc and vitamin D. Vitamin D is important for activating the thyroid function in the nucleus, which is where T3 works on the nucleus of your cells to activate genes that increase your metabolism. So you need all, if you have low vitamin D, you're not going to have a good metabolism. And you need to take the right thyroid hormones if you're, if you're low, which is a combination of bioidentical T3 and T4. So that's thyroid. Really, really, really common. Like I said, one in five women, one in 10 men. And by the way, about 50% are not diagnosed. And the ones who are diagnosed and are on thyroid treatment are often on the wrong treatment for them because they don't check T3, they might have low T3, and they still are not perfectly better. So they need to be more tuned up. And I wrote a report called the Ultra Thyroid Solution years ago, which I think is still pretty current and relevant. And that would be a good resource for people.

We'll tag to that also. So under hormones, there's also this category of stress. Now, stress is one of those often overlooked things. People know that they can get things like a stress ulcer when they're really stressed out in life. But a lot of people don't know or realize that stress can actually play.

A role in weight gain. Yeah, it's so true. When I, when I first started learning about this, I was shocked. You know, why was stress making you gain weight? And I had, I had this patient whose daughter lived in Israel, and she was so stressed all the time because it was back in the, in the days when there was really bad fighting with Gaza and the infitada, and, and, and she was, there was bombs going off all the time, and she was worried. to death for her daughter and she gained 40 pounds and she couldn't lose it. When her daughter came back to America, she lost all the weight because she stopped worrying. And we know that stress does a number of things. One, it increases cortisol, which is a stress hormone. Cortisol makes you fat. It basically causes you to be hungrier so you eat more. It causes anybody, anybody on prednisone or steroids knows this. and I've been on them for various reasons and they do cause these problems. It makes you eat more, makes you hungrier, it causes you to gain belly fat, lose muscle mass, you get skinny arms and legs and a big fat belly. This is what stress does. And there's a phenomenon called Cushing's syndrome, which is from a tumor that produces too much cortisol. It's not because of what you're eating or stress, it's just like a tumor that is benign but produces too much cortisol. And you get this phenomenon of people who are like, giant bellies, skinny arms and legs, big hump on their neck, skin breaks down, everything breaks down. So that's what stress does. And not only that, when you eat under stress, you actually are not able to absorb the nutrients that you need. We know this is true. We also know if you're eating under stress that there's nerves that connect your brain to your fat cells. So you're literally your fat cells are listening to your thoughts. and when you're stressed, your fat cells stop doing what they're supposed to do and they start storing more fat. So if you want to gain weight, eat under stress, basically. So it's important to kind of learn techniques of relaxation, yoga, meditation, massage, hot baths, saunas, whatever works for you and we'll play, have fun. The next issue in hormones is your sex issues. sex hormones are a big thing. And for men, as they start to get older, their testosterone goes down, so they lose muscle, they gain fat, and that just creates a vicious cycle where they'll actually start to gain more weight and they'll, for example, can they actually turn into women, honestly? Like they basically get breasts and they lose all the hair on their bodies and they basically become soft skin because they produce too much estrogen from all this fat in their body. Women, they also get in trouble because they get problems with too much estrogen. And we live in an estrogen dominant world. Why? Because sugar causes high estrogen through its effect on fat cells. Environmental toxins cause high estrogen. Stress can cause high estrogen. So dairy can cause estrogen. So there's a lot of things that we're exposed to that are causing us to have high levels of estrogen in our female population. And when you have high estrogen, it makes you store fat. so having estrogen balance is really important and there's a whole other podcast on how to do that. But essentially it's, you know, alcohol, sugar, processed food, get rid of them. Eat more whole foods, vegetables, soy, whole soy foods, flax seeds, cruciferous vegetables. Also make sure you exercise and don't drink too much alcohol because that's an issue. All those things can really help. Those are the big issues around the hormones and the communication.

Great, let's go to number seven, genes. Now, you often talk about how our genes are not our destiny. That doesn't mean that we should completely ignore our genes and the role that they play in predisposing us to certain things. So let's talk about our genes.

Yeah, so you know, I read a study once where there were basically 32 genes that contribute to obesity. And if you had all 32 genes, which is almost impossible. It would only account for about 22 pounds of extra weight, not the massive obesity we see today in America. So what's going on? Well, there are certain people who have genes that predispose them to insulin resistance, to being carbohydrate intolerant. If you're one of those people, and these are a lot of people on the planet, people who were never really exposed to much sugar, who really are recently out of the hunter-gatherer world, Native Americans, Pacific Islanders, Middle Easterners, people who are East Indian, even Chinese, all potentially are at high risk of developing insulin resistance compared to someone not. For example, if I have a can of soda with 40 grams of sugar, my blood sugar will go up like this and my insulin will go like this. If you're a Native American, you have exactly the same thing, it can go skyrocketing with exactly the same input because of their genes. So if you have genes that predispose you to being carbohydrate intolerant, that's probably the biggest risk. There's another set of genes that may be a problem, which is dopamine genes in the brain. They're genes that help control your dopamine function. Dopamine is the motivation neurotransmitter. It actually makes you focus and pay attention, but it's also the pleasure stimulator. So heroin, cocaine, you know, all that stuff, food addiction, all that is driven through dopamine. And so there are people who have sort of variations in their dopamine receptors that make them less sensitive to dopamine. So they need more and more stimulus to get pleasure. Alcoholics, heroin addicts, people who are food addicts, all that is, is really related to this. incredible genetic variation that can cause people to be more addicted to sugar and processed food. So, there's a lot of genetic factors, but those are the big ones.

Yeah, and it's kind of with the genetics, if I'm hearing you clearly, it's that it's not that genetics, we should completely ignore it, and you should be aware of more your genetic lineage, and there's different tests that are out there that you often will recommend. Can you name a couple of labs or places that you talk about?

I mean, I think there are a lot of good genetic tests out there. I use one called DNA. DNA from Nordic, Nordic Labs. DNA life. DNA life. DNA health. They have DNA food ones. There's a whole panel that they do, which is really on food. It's fascinating to look at. But the, the truth is, if you want to fit into your genes, G, J-E-A-N-S, you have to fit into your genes. G-E-N-E-S. Right. So we have to understand that, that and I had a patient yesterday, it was this really wonderful 22 year old young woman who I've known since she's nine years old who struggled with her weight since she's a little girl. And she is not someone who's eating Doritos and soda and processed food. She's just extraordinarily carbohydrate intolerant. And so her fasting insulin level was so high, it should be under five. When it's over 10, I get worried. Hers was 30. and I'm like, oh, this girl, she's struggling. So when she looks at a cookie, she's going to gain weight. When she looks at a bagel, she's going to gain weight. So the key, the key is to, for a certain subset of people, you kind of have to accept, okay, I'm celiac, I'm gluten intolerant. Okay, I can't really eat wheat if I like it. You know, there is a reality to that. Or I've got a, you know, anaphylactic reaction to peanuts. I can't eat peanuts. It's the same kind of thing. There are certain people genetically who are intolerant to carbohydrates, which is really the biggest driver of obesity.

And because we're still learning a lot more about these and the genetic tests are not perfect, they give us some idea, but they don't give us the full idea. It's more being aware of it, but you can still work on all these other areas that we've listed in these eight reasons.

Yeah.

Okay, let's go to the last reason, Mark, and this one's one that often surprises people and it's our environments specifically our social network and friend group. Yeah, well, you know, I think we.

Don'T think we can catch obesity, but the truth is we can. And because our behavior is determined by our social networks, by our peer group, by peer pressure, we all want to belong, we all want to be included, we all want to connect. And so if all your friends are drinking green juices and going to yoga and jogging all day, then you're probably going to be thin. And if all your friends are eating processed food and drinking soda and sitting on the couch watching Netflix binges, you're probably going to be overweight. And the data on this is so clear. Chris Daskalos from Harvard has published this in the New England Journal and other places that if you have friends that are overweight, you're 171% more likely to be overweight. And if your sibling or your parents are overweight, you're only 40% more likely to be overweight. So it's a massive, like, 6, 4, Four times the risk of being overweight if your friend's overweight. So what's this?

Even more so than your partner, your spouse.

Yeah, I mean, spouses tend to kind of go together. I think that's.

Yeah, which is crazy that even your friends, and that makes sense, right? We want to impress our friends. We want to be like our friends. They're our peer group. Our friends have even more influence of our health and obesity, even more so than our spouse and our parents.

Yeah.

Our kids.

And it's so powerful. so just as, as obesity is contagious, so is health. And, and i'll just tell a quick story because I, i think it was so, so enlightening for me. I went to haiti and I saw how paul farmer, who started partners in health, cured tb and aids in one of the worst place on the planet, where most people make less than a dollar a day and half the people don't have sanitation. And there was rampant tb and aids, and, and everybody in the public health community giving up on these people because they need to take the drugs at a certain time. There was cures for it, for AIDS and TB, or means to manage them at least for AIDS, but they weren't able to take them and it was just too big of a hurdle. So he figured out that it wasn't a medical problem, it was a social problem. He called it structural violence, the social, economic, political conditions that drive disease. And so he said, well, I'm gonna build a network of community health workers that are their friends and their neighbors and their peers. they're gonna go make sure they're taking their medication, they're gonna help them get clean water, they're gonna make sure they do what they need to do. And it was extraordinarily successful. And I thought, geez, you know, wait a minute, obesity is also contagious. It's also a social disease. It's not a medical problem, it's a social problem. And we live in an incredibly toxic environment, a toxic nutritional landscape. I mean, I went to the airport this morning, to come to Los Angeles where we're recording today. And I'm like, what am I gonna eat? It's like, thank God I brought like, you know, a pound of macadamia nuts and some fruit in my bag that I could eat for breakfast. Otherwise, I'd be like stuck eating some garbage. Even the healthy, quote, healthy places are really hard to find anything good. So we live in a horrible landscape. And I decided, well, maybe if obesity was contagious, maybe health was contagious too. So I went to, long story short, I worked with Rick Warren, a pastor at Saddleback Church. We had 30,000 people and they met every week in small groups of six or seven or eight people and they support each other to live better lives from a spiritual perspective. But I said, why don't we use those groups to create health? He's a great idea because we're a very overweight church and I'm overweight and we need to do something. And so he was willing to let us actually create a program called the Daniel Plan in the church. and we changed the environment in the church. We basically got all the cafeteria to change their food. We got rid of the pancake breakfasts and the ice cream socials and all the junk and the soda in the environment. And we started creating programs like Jog for Jesus and everything. And in a year, they lost a quarter million pounds and got super healthy and got rid of so much medications. One guy said he was in the hospital nine times last year on a pile of meds. Now I'm not on anything and I've never been in the hospital a whole year. So that's the power of social networks to drive changes in behavior and health.

Powerful.

I always say friend power is more powerful than willpower.

It's so true, it's so true. And just taking one step in the right direction by even starting like a book club or potluck or something that allows you and the people around you to get together and practice health going on a morning hike. That's something that I do with my friends here in LA. All right, Mark, this is the part of the podcast where we go into community Questions. These are a list of questions that your audience has submitted in, and we're gonna jump right into it. So the first question is, how do I lose weight as a woman after 40? I have about 10 pounds to lose that suddenly appeared around my waistline after I turned 40, mostly in the love handle area. I have a petite frame, normal BMI, and I'm typically pear-shaped, but now I have this thicker middle that doesn't seem to want to budge. I want my cute figure back, please help! Exclamation mark, exclamation mark.

Wow, a very energized community member. Here you go. Here's the thing. I always go back to first principles. So what are those eight causes that are beyond food? And it could be a lot of things. What happens as women go through perimenopause is they start to see estrogen progesterone imbalance. They stop ovulating. Their estrogen levels increase in ratio to their progesterone, and they'll start putting on weight. Or maybe their thyroids go a little wacky. Or maybe they have kids that are, you know, they're dealing with, and then their parents are getting older, and they're in the middle of their career cycle. So you've got this, multiple stressors happening at the same time. Or maybe, you know, there's other factors involved like muscle loss. We tend to lose muscle as we get older. And if we lose muscle, our metabolism slows down. So even starting age 30, we start to decline. You have to work on keeping muscle up, and that's through exercise, strength training.

And having adequate protein.

Right.

So she could even still be eating the same diet that she ate when she was 30, but because she's losing muscle mass or not working out as much or doesn't have good metabolic health, then all of a sudden she's putting on weight more so than previously.

Exactly.

Now, it can be a little overwhelming all those eight areas and some of them, you might need to work with open-minded or functional medicine type doctor to dig into those. But would you say that there's one category? In this case, what would be one of the first ones that would be the most obvious to look at and putting aside the context of somebody eating too much because we've already talked about that on my podcast.

I think for a perimenopausal woman, it's this hormonal mess that happens. Thyroid goes off, stress hormones go off, estrogen, progesterone imbalances, and then you become more insulin resistant. You got four hormones that are just going wacky that are causing you to more likely to gain weight. So, you have to kind of look at all of that and get those imbalanced in order for them kind of start to shift and stay healthy and lose weight.

Okay, let's go into the next question that we have from the community, question two. It's about CGMs. I'll try to do my best to summarize. It's a little long. I've been using a CGM for six weeks. I'm eating clean, no caffeine, no gluten, no dairy, no sugar, mostly just organic grass-fed meats, nuts, a little dark chocolate. None of these things spike me, but I only lose two pounds every week and then I gain it all back. It's infuriating. Drink a lot of water. I try to do a sauna every few weeks and take a hot bath once a week. What is happening? P.S. I am in complete adrenal fatigue. So when I'm stressed, which I have four kids and a grandbaby, is constant. I notice that if I walk and eat within the first 90 minutes of waking up, I do better with my spikes. So somebody who's eating well, they've been on a CGM for a while, they feel like they have a pretty good diet, they lose a little bit of weight, and then they gain it all back. Some of the questions are things that they should be exploring.

Well, it sounds like she gave it away. Four kids and a grandbaby constantly drawing on her attention and stress. That can be a big factor. So often, the doorway to actually resetting your nervous system and putting you in a state of calm will help to actually drop the weight. So it sounds kind of unfair, but you have to start thinking about other factors than just what you're eating. If your sugar is not spiking and it's not insulin, it is something else, right? It could be any one of the eight things we talked about, but for her the thing that seems most likely is stress.

In addition to stress, just chatting about this, we've had a lot of people that are experts in metabolic health on my podcast, on your podcast, and one of the consistent themes is that just because you are on a CGM and maybe you've cleaned up your diet, if you don't know what your fasting insulin is, you may not know how insulin resistant you are. So especially if you've been eating a particular way for a long period of time, your fasting insulin could be in the non-optimal category. So even though your glucose isn't spiking, your insulin still hasn't come back down to an optimal or normal category.

Can you talk about that? Yeah, I mean, first of all, even with stress, you'll get a spike in glucose.

She's saying here that her glucose isn't spiking. She's saying that it's pretty balanced, but in general.

I'm just saying, like, I played tennis the other day and I had my levels glucose monitor on and I only had like a little bit of a protein shake before. So my sugar was like 90 when I started and I finished playing tennis. I'm like, I'm gonna check it. It's gonna be great. And it was like 146.

I'm like, what the heck? Which, by the way, happens to me sometimes. I know when I do a high intensity workout that obviously spikes up your.

Glucose and that's the good type of stress that's there. But go ahead with your tennis story. So any kind of stress will cause you to release glycogen from your muscles to create what we call gluconeogenesis where your liver starts to produce sugar and will create a spike. Now, she might, may, or may not be picking it up, but it'll also increase insulin levels. Maybe her insulin, her glucose is going up, but her pancreas will pump out insulin and that'll keep your sugar down, but you're getting the effects of high insulin. So it's not the glucose that makes you fat, or gain weight. It's the insulin, which is a fat storage hormone. Because in order for fuel to get in your cells, it needs the gate open. And insulin opens the gate so that glucose and free fatty acids can get into the cell, which makes you gain weight. So if you have high insulin and your sugar is normal, you could still be in big trouble. And I had many patients like this where I'm like, God, their blood sugar is perfect. A1C is perfect. And then I checked their glucose like this young. You check their insulin.

I checked their insulin.

Like this young girl, her A1C was 5.2, which is like perfect blood sugar. Her fasting blood sugar was like 90. Pretty good. Yeah. But her fasting insulin was like 35. I'm like, whoa, this girl is not going to lose weight as long as her insulin is high. Because what happens is when you buy insulin, essentially it locks the fat in the fat cells. and they can't get out. So it causes lipogenesis, which means fat storage, and inhibits lipolysis, which means fat breakdown and fat metabolism. So it's a problem. It's a problem.

It's often one of the most overlooked areas because most people, their doctor doesn't even order the test. It's a pretty cheap test.

It's a pretty cheap test. It's available everywhere, and it's shocking to me in 2022 that not every single person gets his test. Because if I would say, What is one test that you could do to determine a person's risk of obesity, heart disease, cancer, dementia, diabetes? I mean, these are all the things that are the worst problems that we are checking people's cholesterol, we're checking their A1C, we're checking all this stuff. Nobody checks insulin. And if I had my druthers, I would actually check it 30 minutes after big meal or a glucose tolerance test. Because even fasting, it can be normal at the beginning, but it will rise after you eat something. And so taking a, we'll call it postprandial or after eating insulin test is the most accurate way to see what's going on. And that's predictive of heart attacks and death and all the way weight gain, belly fat, all of it.

So I feel like that's an important note because I think that these eight reasons are super important and you work on them all the time. and before somebody goes on a deeper wild goose chase, I think it is important to even start off with the basics of do you have your fasting insulin? And the great thing is that, you know, Levels just recently announced that you can actually get a metabolic panel that includes fasting insulin and they'll send a phlebotomist right to your door. We have a link to it below in the show notes. So yes, environmental toxins, yes mold, yes all these other things that we listed, but if you don't know your fasting insulin, Let's not get too fancy yet before we have some of the basic markers.

Agreed, agreed.

Okay, great. Let's go into number three, the third question that we have from our audience. How does the adrenal fatigue or HPA access dysfunction affect weight loss?

Well, we talked a lot about this with the stress response. So if your adrenals are not working, you're either producing too much cortisol or you're not producing enough, your body will go into an altered metabolic state. And so for most of us, the beginning stages of stress is higher cortisol stress hormone levels, which then causes all the downstream effects of insulin increase, blood sugar increase, blood pressure increase, muscle loss and wasting, bone loss and wasting, fat storage, inflammation, which is sort of counterintuitive because cortisol is actually supposed to shut down inflammation, but it actually can lead to inflammation through a bunch of secondary mechanisms. So if it's a short-term stress, that's fine. If it's chronic, long-term, unmitigated stress, that's when you get into trouble.

All right, next question. What amount of carbs per day is acceptable in weight loss management?

It depends. It depends on your genetics. It depends on your body composition. It depends on your age. It depends on your overall health.

How much muscle mass you have, your fast and slow muscle mass.

So for example, if you're a Native American or a Samoan, it's probably close to zero. By the way, Drew, there are essential amino acids without which you would die. There are essential fatty acids without which you will get very sick and have a deficiency disease. But there are no essential carbohydrates. They're not required for life. at all. Even though we hear, oh, well our brain requires 25% of our glucose and we have to have sugar for our brain, that's just nonsense. Our brain runs way better on fat.

And so-- and your body will make its own glucose.

And your body will make its own glucose from protein and other things. So the truth is that we don't require them for life. That said, depending on your genetics, some people like Native Americans and and African Americans, Asians, East Indians, Samoans, Pacific Islanders, all are much more likely to be carbohydrate intolerant. That's why we see Hispanics populations, which often are mixed with native populations from Mexico and other places and African Americans having such disproportionate levels of obesity and diabetes and problems. Why they're so disproportionately affected by COVID. is because they are carbohydrate intolerant and they're really struggling with actually dealing with the underlying biology that they've been handed. And so, like this young girl, she's carbohydrate intolerant. I would say she needs to be pretty much off grains, off beans, you know, off sugar, off most fruit, and she'll do fine or even be keto and would help her. But other people who are fit, who have good muscle mass, who exercise a lot, who, for example, like me, I kind of have to eat sweet potatoes and have some, you know, whole grains occasionally because my body, you know, I'm not bragging or anything, but I have very low body fat. I don't, I'm not insulin resistant. My metabolism is great. And I, and I essentially, if I don't eat some carbohydrate, I don't do as well. I'll lose too much weight. So it's really about finding what's right for you. and there is no magic number, what's the amount of carbohydrate you should eat? If you're a type two diabetic on insulin, the answer is probably 5% or less of your diet.

And really, just to clarify, because we've done so many episodes on this, we're really talking about the refined carbohydrates that are there. Exactly.

Right.

So this woman, even in her case, probably actually like a true ketogenic diet where she's actually producing ketones and stuff, if she's having a lot of vegetables and things, we're not talking about We're talking about a plant-rich, keto diet.

Yes, exactly. Exactly. My joke is, I said, the single most important thing you need for long-term health and vitality is carbohydrates. And then I go, what do you mean, Dr. Hyman? I'm like, well, vegetables. Yeah, vegetables. Phytonutrients. We should be eating a ton of phytonutrients.

And that's why the Pegan diet is 75% plant-rich diet with lots of colorful fruits and vegetables. All right, next question from the community, Mark. I work out three days a week and do yoga two to three days a week. I eat healthy, whole foods and never eat fast foods or processed foods. I fast and do 16-18 hours mostly and I eat two meals a day, but I never seem to lose weight. I just don't understand why.

Well, now hopefully you do because we covered the eight reasons beyond food that are responsible for unexplained resistance to weight loss. So I'd encourage you, without knowing much more of your history, to actually go explore some of these areas. Maybe it's a food sensitivity, maybe it's a microbiome issue, maybe you've got heavy metals, maybe your thyroid's not working, maybe there's an estrogen-progesterone imbalance.

Something in that realm of non-food related causes of obesity is probably what's going on, so you want to dig down into all of those. And also to add into this, you know, this plays into the societal level, is that what's your definition of ideal weight, right? What's your definition of that? and that goes into, you know, maybe you don't need to lose weight, maybe nothing wrong with wanting to actually have the motivation to lose weight, but we just want to bring that in because sometimes people have maybe unrealistic ideas. Everybody should be able to lose whatever weight that they want to lose and be able to pursue that aspect, but there is a component and our different life stages, like if you just gave birth and are a mom, it's going to take a little bit of time for you and there's be fundamental changes that happen to your body where maybe you actually just don't end up losing a certain amount of weight.

Yeah, well that's a good point, Drew. I think the number of weight is not the most important number. And we use a surrogate number called body mass index, which is basically your height and weight kind of normalized. So, if you're 300 pounds but you're seven feet tall and a basketball player, that's not a problem, but if you're five feet tall and 300 pounds, that's a problem, right? So that's one problem. The problem with the body mass index though is that it doesn't account for your body composition. So if you're a jacked muscle builder, body builder, if you're the Rock, right, or if you're Shaquille O'Neal, you're gonna have a high body mass index. It might be 35 and be considered obese. but you're not. You're fit, your metabolism is good, you're very lean, you just have a lot of muscle, which makes you have more weight in relation to your height, but you don't really have a weight problem, even if you're quote overweight technically. Also distribution matters. So not only the size and so forth in the muscle mass, but the body composition, which is how much of your body is made of fat or of muscle. So for example, if you're 25, you might, in a woman, your body composition should be 10 to 20 to 30%. If you're a guy, 10 to 20%. And that's normal. If you are, meaning 20% fat or 10% fat. But if you're 65 and you're the same weight as you were when you were 25, you could have lost half your muscle and be requiring half the calories. to actually stay the same weight. And this is a big problem for people. It's what we call sarcopenia, which is a loss of muscle, and they end up maybe looking like thin, but they're actually fat. They're what we call skinny fat or a metabolically obese normal weight. And they have all the same risks of chronic disease as people who are actually overweight. So it's a real problem in America, and there's so much we do to cause our muscles to waste. We're sedentary, we don't exercise, but also the food we eat and the stress we're under. stress causes muscle loss and sugar causes muscle loss. So you're in this vicious cycle of stress and sugar, which is basically our diet in America, and you're in this crazy world where we're not exercising like we used to as hunter-gatherers. And so it's just a perfect storm for a metabolic disaster and for slow metabolism. So you got to check body composition. And I love that test. It's like basically a machine that uses x-ray technology and a very, very low dose. It's like going through an airport scanner. And it basically measures where the fat is and how much fat and how much muscle. And it's the same machine we use for, for example, using bone density testing and anybody can do it. So I love that test. And a lot of gyms have it.

Yeah, and I'm like, and there are.

Different ways to measure body composition. That's the best gold standard way. It's a DEXA scan. There's scales you can use and they're not that accurate, but they're good enough. So it's worth trying to look at your body composition to see what's going on. if you actually are over fat and under lean. Yeah, I'd like to toss out another.

Thing that's there as a recommendation for the audience. You know, you had her on your podcast, Mark, Byron Katie. Oh, yeah. She has some incredible content out there about accepting reality. And there's this one. Loving what is.

She calls it loving what is. Loving what is.

Loving what is and not being in resistance with life.

Yeah.

There's both the motivation to want to change things, which is a beautiful thing, and then there's the acceptance that this is the way the situation is right now. And a lot of times in our life when we don't have acceptance, we create stress internally. Why isn't my body better? Why do I not have less weight? My body is against me. We create all these stories. And those stories are not helpful for our health. And there's a really beautiful video that I saw many years ago that Byron Katie had on this topic for a woman who felt that her story was, My body has too much weight. and Byron Katie walks her through her four questions and helps her understand that her body is only there for her. It's not there against her. Now, of course, you could throw a layer of functional medicine on top of that, which is, do you want to change the underlining environment to help your body do better what it wants to do? Great. But that can be done without having this heavy resistance on the way that things are now. So I'll send that to the team and we'll include them in the show.

That's great. I love Byron Katie. quite an amazing human being and her perspective of looking at your life and going, you know, are my beliefs true? Like, is this what I believe actually true and what I'm saying? And can I know it's absolutely true? And how would I feel without that thought? And how would I, you know, change that thought to make it different? And it's just a powerful, simple set of four questions that allows you to look at your beliefs and question them in a way that can free you from some of those really imprisoning thoughts that keep us struggling.

Right, who's to say that you have more weight? Is it because Cal Newport, who's a past guest of yours on the podcast, is it because you've been on Instagram all day and you've been seeing all these people who are in bikinis or whatever? Right? Or bulimic anorexic Instagram models? Right, or we're blessed with great genetics, right? Or actually that's their main job. They work out all the time, they may not be happy but they work out all the time, they watch every single thing they eat, they might be miserable, you don't know, you don't know what they're going through. So we want to just make sure that we keep all these things into mind when we're thinking about the story of like, I need to lose extra weight.

The other thing I would say about weight, and we didn't really talk about this, and it's sort of implied in the stress area, but it's a really deep conversation about trauma. And in my experience, and I think the literature supports this, that if you have a lot of trauma, whether it's sexual abuse or psychological or physical trauma, that it correlates with chronic disease and with obesity. And most people have really severe obesity, there's some level of trauma. And one in four women in America have been sexually abused. I was a victim of incest myself. So I understand what this is like. And I think that we basically need to help people identify the trauma, and sometimes it's buried and they don't know it, they don't remember it, they don't feel it. And so it's really an exciting body of work emerging in the psychiatric field that is totally disrupting everything we thought about trauma. And it's using things like psilocybin, which is magic mushrooms, or MDMA, which is also known as ecstasy, which sound like party drugs, but they're used therapeutically in a therapeutic context to help you work through trauma, or ketamine therapy, or stellate ganglion blocks, or other kinds of therapies that can be very powerful in resetting the nervous system in ways that help to deal with the trauma. And I literally yesterday I was talking to a patient who was sharing with me because I actually was so much trauma and she had struggled with her weight a little bit. But she, I sent her to get therapy and she ended up having a life-changing experience and she was bulimic, for example. And she said when I came back from the journey that I did, from the work I did with this woman, I literally stopped being bulimic. My whole nervous system changed. And every time I talked to her, she was in a hyper vigilant state all the time. Every consult I had with her. And this was the first time I talked to her. She was grounded and stable. So there's a lot of doorways into healing trauma. But I encourage people to think about trauma and look at the work of Gabor Mate, who I think will have on the podcast soon and, and really look at some of the wisdom of trauma film he made. He also wrote a book called, I think, Hungry Ghost, something, something about Hungry Ghost, we'll put in the show notes. But it's important to start to investigate that because that might be part of your weight issues too.

Mark, I think that's a perfect note to end on with the questions. So let's do a recap of the eight reasons that we talked about and we'll go ahead and conclude from there. Yeah, well, thanks, Drew.

It's been a great conversation. I hope it's been enlightening for people because a lot of stuff that happens around weight is that people blame themselves or they feel like they're doing all the right things and it's still not working and what's going on. And that's really why I, I wrote a lot about the issue of weight loss resistance. And just to summarize, the first is nutritional imbalances and deficiencies. Second is challenge changes in your gut microbiome. The third is anything to cause inflammation. The fourth is environmental toxins. The fifth is trouble with your mitochondria and energy metabolism. The sixth is bad communication, which includes your thyroid, sex hormones, stress hormones. We talked a lot about that. It's trauma included in that. The seventh is fitting into your genes, G-E-N-E-S, learning what your genetics are and how to actually live in a way that's adapted to that. And lastly is the role of your social networks and how obesity is contagious and how to actually start to build networks and social containers that actually support your health. Find friends that are healthy. Go to places where there are people who focus on doing healthy stuff like gyms or yoga classes or different restaurants or bars where there's actually good stuff. So I think that's really important.

Those are all great things and I'm glad we did this episode. And the add-on to this is that the science is always evolving and you always have new and interesting guests on your podcast that have their own take on it. You know, who might say, we need a little bit more protein to help us build with muscle mass and that could be a factor into weight loss. So if you're trying a lot of these things, I would add in, and if something feels like it isn't working, just continue to dig a little bit, but dig without all the stress that's attached to the story, and slowly, slowly, you'll start to make progress on it.

For sure. Well, thanks, Drew. It's been great. Great conversation. Thank you all for listening to our masterclass on the Doctor's Pharmacy. If you love this episode, share with your friends and family on social media. Leave a comment. How have you dealt with weight loss resistance and what have you discovered works for you? We really love to hear, leave comments and subscribe wherever you get your podcast and we'll see you next week on the Doctor's Pharmacy. Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing which is called Mark's Picks, it's my weekly newsletter, and in it I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Hi everyone.

I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed.

Healthcare practitioner, and can help you make changes, especially when it comes to your health. Don't forget, there's a way to listen completely ad free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and tap try free to start your seven day free trial.