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MetabolicEffect – Metabolic Rehab

Metabolic Damage & Rehab Program

So here is the scenario. I am at the Metabolic Effect clinic sitting in my office talking to a consulting client on the phone. She has been making steady progress in weight loss for months. The last few weeks she has hit a plateau. I can tell she is a little frustrated. I explain to her, like I do with many of my clients, that body change is neither linear or predictable, and she needs to stay the course.

We talk about how these plateaus are a necessary part of the process and often lead to the greatest insights about what is required for life long health and body change. Then she says, “do you think I might have metabolic damage”?

I shake my head silently in disbelief and frustration. I think, “where the hell is all of this metabolic damage stuff coming from”? All of a sudden everyone and their grandmother seems to think they have been infected with metabolic damage. I calmly say no and explain to her what I am about to explain to you.

Background on the term metabolic damage

Honestly, I don’t know where the term metabolic damage came from. Like many things in health and fitness, it is a term that gets used by someone somewhere and becomes part of the lexicon. I think it caught on because it seems to be self-explanatory and logical. A person says, “I can no longer lose weight no matter how hard I try and no matter what I do. Something must be broken. Maybe I damaged my metabolism?” From there the term spreads.

I am an integrative physician. I, and many doctors like me, have been dealing with metabolic damage for years. Only we never called it “metabolic damage”. It was called “neuroendocrineimmune dysfunction”. Or we called it by some of its manifestations like “adrenal fatigue”. Sometimes when an actual diagnosis could be made, we called it “hypothyroid” or “Hashimoto’s thyroiditis” or “adrenal insufficiency”.

At Metabolic Effect we have adopted the term “metabolic damage” because it is far more descriptive and logical compared to “neuroendocrineimmune dysfunction”. What is important to understand is that a person can feel unwell and have metabolic disturbances without being in an overt disease state.

A diagnosis is not always possible even when dysfunction is evident. There is an entire segment of medicine that deals with the gray area of dysfunction between health and disease. It is called “functional medicine”. This is where non-diagnostic terms like “adrenal fatigue” came from.

One of the most frustrating things in all of medicine is the idea that a lab value determines whether you are healthy or not. If your fasting blood sugar levels are 119 you don’t have diabetes, but if they hit 120 you do. Do you see how utterly ridiculous that is?

Long before you get to a fasting blood sugar of 120, you had some serious dysfunction. Medicine calls this a lot of different things like “blood sugar dysregulation”, “glycemic impairment”, “prediabetes”, etc. But none of those are accepted diagnoses. They are simply descriptive terms that describe a measurable disturbance that has not yet become a disease.

Is metabolic damage a myth?

Saying, “metabolic damage is a myth” is a lot like saying, “prediabetes is a myth”. Saying, “adrenal fatigue does not exist” is a lot like saying, “over-training doesn’t exist”. These are functional disturbances that have clinical signs & symptoms that can be picked up on physical exams and blood labs. These disturbances may or may not have a corresponding diagnostic label. It is the gray area between optimal health and disease; the area where function starts becoming compromised.

Why do I bring this up? Because a lot of people in the internet space, many who are overstepping their boundaries of expertise in my opinion, are speaking about this issue as if they are well versed in it. I am a little tired of these “if there is no research it does not exist” people. It is these types that denied the existence of fibromyalgia, autism, ADD and a whole host of other conditions while at the same time many front line doctors were successfully treating patients. All of those aforementioned diseases were called “myths” before they weren’t.

I call these types “research zombies”. Like zombies, they blindly follow their one track minds and are unable or unwilling to realize the limitations of their own myopic viewpoint. Research is a critically important tool to test our clinical practices but is recently being used to deny anything for which a study was not exclusively done. Health and fitness is, and always will be, a mix of science and clinical practice. A healthy respect for both often provides the best outcome.

Metabolic Compensation

If metabolic damage is just another term for measurable metabolic disturbances, what are those disturbances and how do you know if you have metabolic damage? This is the whole reason I am writing this blog, because you probably do not have metabolic damage.

If you followed the discussion above you now realize your health is on a continuum from optimal health to functional disturbances to disease. When it comes to diet and exercise as it pertains to metabolic health there is a stepwise process we can easily see.

When you first embark on a diet and exercise program that has you eating less and exercising more, the initial stress to the metabolism is positive. The body responds to this stress normally and begins to mobilize its fuel reserves. This happens through a coordinated communication system routed through the command and control center of your metabolism called the hypothalamus and pituitary (HP).

The hypothalamus and pituitary send their signals out to the thyroid gland, adrenal glands, and gonads (ovaries and testicles). This results in a coordinated hormonal symphony that helps you burn fat and perhaps gain muscle too.

When this stress is prolonged past a few days or weeks the metabolism begins to compensate. This is one of the most agreed upon and well understood mechanisms in all of weight loss. I call it the law of metabolic compensation. This compensation creates hunger, energy changes, and cravings, as well as a metabolic slowdown led by a decline in thyroid hormone.

This slow down is very individual and can be almost absent in some while resulting in metabolic depression of 300 to 800 calories per day. For those with the biggest metabolic compensations, this can halt progress or even reverse it. For more on this compensatory mechanism and the research behind it, see this blog.

Metabolic Resistance

As a consequence of metabolic compensation, many people will begin to push on the metabolism harder. They start doing even more cardio and cutting back on calories even more. In other words, they double down on the eat less, exercise more model of weight reduction.

This may work for a short time, but then the body quickly catches on and begins to protect itself further by slowing things down more. At this point the body is essentially putting on the emergency breaks. It does this as a natural protective mechanism against stress. It wants to regain its fat and muscle stores so it sets into motion hunger and cravings. It wants you to rest and recover so it saps your motivation, lowers your energy and makes you anxious and/or depressed.

This metabolic resistance can occur for people at any weight undergoing extreme exercise and diet, but it normally kicks in when body fat begins to fall under 20% for women and 10% for men. And the truth is most people will never even reach this state. For most the metabolism handles things just fine.

Metabolic Damage

Finally when things are pushed too far, the HPT (hypothalamus pituitary thyroid axis), the HPA (hypothalamus pituitary adrenal axis), and the HPG (hypothalamus pituitary gonadal axis) become severely disrupted. Again, let me be clear. Most people will never reach this state. For those who do, the issues with hunger, cravings, energy, and weight loss resistance become the least of their concerns.

I have written about the steps that lead to metabolic damage in detail at another blog. Please review that blog here. Keep in mind the term introduced above, neuroendocrineimmune dysfunction. This includes nervous system dysfunction (neuro), hormonal dysfunction (endo), and immune dysfunction (immune). These systems are now known to share many pathways and intersect in multiple ways. Metabolic damage is neuroendocrineimmune dysfunction.

Nervous system dysfunction

While metabolic compensation is completely normal and metabolic resistance is easily reversed, metabolic damage is not. At this point there is nervous system dysfunction that manifests primarily as digestive complaints. The digestive system is a window into the delicate balance of the sympathetic nervous system (fight or flight) and the parasympathetic nervous system (rest and digest).

One of the things that tips us off to metabolic damage is the occurrence of multiple digestive disorders. Gas, bloating, heart burn, constipation and/or loose stool are a few of the issues that start popping up.

Hormone (endocrine) dysfunction

The thyroid gland becomes compromised leading to sub-clinical hypothyroid, hypothyroid and even autoimmune thyroid conditions. The adrenal glands too begin to show signs of stress. There is what we call a reverse cortisol curve in the early stages of metabolic resistance. In this stage you can see many different types of cortisol profiles, but most frequently is a low cortisol level and what integrative doctors call adrenal fatigue.

This hormonal dysfunction also leads to lowering of libido in men and women and loss of menses in women. The endocrine effects follow a pretty standard pattern clinically. In most, the adrenal glands seem to show dysfunction first, followed by the thyroid, followed by the ovaries and testicles. This is by no means always the case, but it occurs frequently enough to make a broad generalization.

Immune dysfunction

The digestive system is an interesting intersection point for metabolic disturbances. It has more nervous system innervation than any other places in the body aside from the brain. This is why we integrative physicians call it “the second brain”. It’s also a huge hub of hormone function. It communicates constantly via hormones to other parts of the body. It is also where the vast majority of immune cells reside. If there is any place in the body that is most representative of the neuroendocrineimmune system, it is the digestive track.

In addition to all of the other symptoms that begin to manifest in the digestive tract, food intolerance begins to develop. Foods that were once not an issue begin to cause reactions. This is most evident when protein rich foods begin causing heart burn. Starchy foods cause excessive gas and bloating. Fat can be malabsorbed and cause diarrhea or pale stool.

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