Working with patients to manage their weight includes prevention of weight gain, control of age-related gains and treatment of obesity. This requires a broad understanding of many factors, including insulin resistance, environmental toxicants, the gut microbiome and the effect of pharmaceuticals on weight gain. Panelists at the 2021 Southwest Conference on Botanical Medicine, naturopathic physicians Marianne Marchese, Katie Stage, and Lise Alschuler, discussed new research, practical naturopathic interventions and specific recommendations for clinical practice. A synopsis of each presentation follows.
Marianne Marchese, ND
Marianne Marchese began her lecture recounting an experience with a patient who asked if there was a pill to make her thin. Dr. Marchese told the patient that there was a pill. She outlined the side effects for each of the four medications approved by the FDA and explained that a better approach was to find the root of the weight management issue and make the necessary lifestyle changes to ensure a healthy weight.
Most people are familiar with weight management factors, i.e., nutrition/diet, genetics, etc., but rarely include the impact of sleep. Research has shown that a lack of sleep (for children less than ten hours and adults less than eight hours) directly correlates to the likelihood of becoming obese.
Another critical factor in treating obesity is understanding which medications can cause weight gain. Common over-the-counter allergy medications can contribute to obesity, in addition to prescription medications whose side effects of weight gain are more widely known, for example, the oral contraceptive pill (OCP).
The lecture then discusses the effects of environmental chemicals known as obesogenic toxicants, and where a patient will likely contact these agents. BisphenolA, phthalates, polyfluoroalkyls (PFAs), polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and organochlorine pesticides are the main culprits, all of which affect the endocrine system. Specific environmental contact points are provided to easily identify household products, food supplies, and water issues that may be unknown to consumers.
Read the transcript for this video.
A patient may require detoxification to remove chemicals stored in the liver and bowel in addition to chemical avoidance. One plan for clearing the substances from these organs involves four steps:
- Mobilize stored toxins
- Support liver metabolism
- Support elimination
- Avoid re-exposure to toxins: avoidance is the most important part of a plan.
It’s also important to follow simple principles of a detoxification diet, including consuming only organic fruits, vegetables, meats and dairy products; avoiding farmed fish, canned foods with BPA, soda and refined carbohydrates and sugar. Adding psyllium and flax seed, rooibos or green tea, legumes and 3 – 4 servings of cruciferous vegetables can further aid in detoxification.
Katie Stage, ND, RH (AHG)
In her presentation, Dr. Stage focuses on the microbiome and how antibiotics contribute to weight gain and obesity.
Experiments conducted on mice determined that antibiotics given in childhood had a direct correlation with adult-onset obesity. Interestingly, high doses of antibiotics can cause weight loss, and low doses will cause weight gain regardless of antibiotic type.
Dysbiosis is the unhealthy change in the microbiome’s bacterial ecology, and is one cause of obesity, but not necessarily a direct result of antibiotic usage. Data from the CDC correlating antibiotic usage and obesity in the United States illustrates that states with the highest percentage of obesity also had the highest use of antibiotics. Another study followed children who had been given antibiotics in their first year of life and found that it increased the likelihood of obesity by age 12 to 14, regardless of physical activity and diet, especially in males.
It is better to frame dietary considerations not as weight loss but as support for a healthy microbiome/microbial diversity. It’s also advantageous to approach diet from the perspective of “what you can add” versus “what you have to take out.”
Maintaining a diet that supports a healthy microbiome involves limiting the intake of sugary foods and recognizes the importance of fiber consumption, emphasizing its ability to feed the microbiome. To consume 30-40 grams of fiber a day will require intentionality because it is not easily achieved in a typical diet. Patients can think that a salad a day will provide adequate fiber, but that is underestimated. Dr. Stage recommends using an app that tracks daily diet, giving an accurate analysis of the nutrient and fiber content of food consumed to manage daily requirements.
People will initially think of probiotics when discussing a healthy microbiome, and they are beneficial. Still, the goal is to avoid taking something long-term and instead create and maintain a healthy microbiome. Using prebiotics can provide a fertile environment in the colon for a probiotic intervention that will improve and sustain a healthy microbiome.
Currently, a prebiotic that is a popular topic in weight management is resistance starch. This carbohydrate type provides food for the microbiome by fermenting in the colon instead of metabolizing in the small intestine. A few of the foods where resistance starch is found and that people are not averse to eating are rice, legumes, and overnight oats. To increase resistance starch in rice, cook the rice with coconut oil, cool for 24 hours, then re-heat the rice before eating. This process causes the bonding of elements that create a resistance starch.
Inulin is a complex sugar that is an example of a prebiotic present in quite a few plants, such as burdock root, chicory, slippery elm, and licorice. Many roots taste sweet because of the presence of inulin. Polyphenols are another prebiotic found in green tea, cacao, berries, black currents, grapes, onion (quercetin), and hibiscus.
Dr. Stage mentions that the amino acid N‐acetyl cysteine is supportive for the detoxification process presented by Dr. Marchese. PPAR‐γ agonists are noted as playing an essential role in insulin resistance and modulating fats. Curcumin, isoflavones, resveratrol, and cannabis are a few of the herbal agonists reviewed. The lecture concludes by stating the importance of microbiome health when working with weight management, insulin resistance, and prevention of obesity, particularly with patients who took a lot of antibiotics when they were young.
Lise Alschuler, ND
Dr. Alschuler opens her lecture with an acknowledgment of natural age-related weight gains and fat accumulation. This natural weight gain is not necessarily unhealthy, but associated changes in the fat layer’s metabolism releases chemicals that will pose a health risk. The increase in body fat promotes adipose tissue dysfunction, which results in adverse metabolic consequences. Research has found that fat cells are not quiescent, as previously believed, but are actively producing and releasing interleukins, cytokines, and hormone-like factors, so it is essential to assess dangers of obesity within any weight loss program, and this section of the panel focuses on the consequences of adipose tissue dysfunction.
The adipokines are cell-signaling proteins whose released molecules will impact vascular function, immunity, bone metabolism, and neurological function. The release from either adipocytes or adipose tissue-infiltrated macrophages leads to a chronic sub-inflammatory state and increases the risk of insulin resistance and type-2 diabetes. The inflammation state of a fat layer plays a significant role in the consequences of obesity.
High-carb diets contribute to hyperglycemia which results in elevated insulin. Increased fat storage follows and, in turn, creates insulin resistance. Increased inflammatory cytokines, as well as leptin resistance, contribute to feeling fatigued and hungry. The cycle begins again by returning to a high-carb diet.
The metabolic abnormalities associated with obesity reveal how specific diets function to achieve weight loss. The diets discussed are continuous energy restriction (CER), intermittent energy restriction (IER), and intermittent fasting (IF). Dr. Alschuler presents multiple studies that compare the efficacy of each diet within gender-specific and age-related populations. The improvement of insulin sensitivity through diet changes can be facilitated and supported by a range of botanicals and supplements.
The first insulin sensitivity restorative discussed is berberine, which also reduces adipose tissue fibrosis, a hallmark malfunction that leads to diabetes.
Magnesium supplementation and food-based magnesium help to increase insulin sensitivity. A few of the foods high in magnesium are kelp, avocado, coconut, dates and apricots.
Cinnamon not only promotes insulin signaling, but it is also an anti-inflammatory. Studies on blueberries, green tea, fenugreek, and Gymnema sylvestre also show positive effects on insulin sensitivity.
The lecture concludes with a discussion of the importance of exercise in improving insulin sensitivity and lowering inflammation. Weight loss involves a change of diet, caloric restriction, food timing, and attention to improving insulin sensitivity. This combined approach can reduce the adverse health outcomes of obesity.
Contributing blogger: Robin St James
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Marianne Marchese, ND: Because children that slept fewer than ten hours a night had a 45% higher risk of becoming obese and that’s a significant statistic given the increase in childhood obesity.
Katie Stage, ND, RH (AHG):: If we look at maps here the top one is looking at states obviously and the darker colored states are the highest rates of obesity. You can see that it looks quite similar in color to the highest rates of antibiotic use. Now this isn’t causation it’s correlation of course.
Lise Alschuler, ND: What do people eat when they are tired and hungry? High carbs. So we get this very vicious cycle which I think we need to think about interrupting and finding the most opportune place to interrupt that cycle is the art and perhaps the science of integrative medicine.