The Role of Blood Chemistry in the Weight Loss Process

by Dr. Chris Cherubino, Medical Director, ARCpoint Labs

In the realm of weight loss, the scale is still seen as the king. This is certainly true with the patients I see in my office. ‘I lost two pounds,’ is accompanied by an ear-to-ear smile, while ‘…guess I gained a few over the holidays…’ is clearly a source of guilt. This belief system is true cross-sectionally: impacting women and men, young people and old, and multiple ethnic groups. The reasons for this aren’t only physiological, of course – they’re sociological, anthropological, and historical. But from the perspective of someone who sees patients on a daily basis, there is only one factor we can impact directly: the science, and, more importantly, the interpretation thereof.

The world is full of fad diets, from Atkins to Paleo to the Mediterranean diet. All of these named systems are designed to give people a short cut to weight loss and tout that number on the scale as the ultimate way to determine success or failure. While there are plenty of reasons to maintain a certain number, that number isn’t the only measure and, in a world where ‘thin is in’, it’s important to show patients of different body shapes and sizes that they can be healthy and fit without starving. In fact, there are some tangible reasons why lighter may not be better. For example, a recent study shows that thyroid hormone balance can be impacted by even moderate weight loss[1]. Cortisol levels, and sensitivity to them, spike in a caloric deficit[2]. And, even more upsettingly, multiple dieting phases can contribute to metabolic adaptation, which means subsequent weight loss may be more difficult[3] and potentially physiologically harmful.

Instead, I’m trying to train my patients to look at measurable physiological milestones in their blood chemistry. Through custom panels built by ARCpoint, I’m tracking multiple levels with patients all the time, and while these will vary person-to-person – based on personal health history and goals – there are a few levels that every person in a weight loss setting might want to focus on:

Lipid balance, specifically HDL vs LDL levels, and the breakdown of cholesterol molecule size. HDL levels are associated with cardioprotective properties and these panels can assess the risk of whether or not higher cholesterol levels overall mean increased risk of arteriosclerosis. Remember that cholesterol is actually the band-aid that our body uses to fortify weak areas in our arterial walls and a building block of hormones and fat-soluble vitamins, as well as an essential form of lipoprotein for cell walls. Throughout a healthy weight loss process, HDL cholesterol should optimally increase while LDL and VLDL decrease. Knowing particle size (with a test like the Lipoprotein Profile from Spectracell) can also be a nice way to differentiate between harmful and helpful cholesterol and give patients a more holistic picture.

C-reactive protein. This level shows a measure of cellular inflammation, which may be the reason your patients struggle to lose weight or a sign that their dieting phase needs to be scaled back to maintenance while their body catches up. Physiological stress is one of the major factors that contributes to weight loss plateaus and the unsustainability of dieting phases. With this test result in your back pocket, you’ll be able to tell if a patient has the physiological capability of continuing or needs to take a break in a maintenance phase before pushing forward. It also has a role to play at the beginning of a dieting phase, as a baseline measure of cardiovascular risk[4].

Thyroid panel with TSH. When dieting becomes problematic (or the macronutrient breakdown of carbohydrates, proteins, and fats is distributed incorrectly) hormones may be impacted. One of the first ways to detect this process is through periodic monitoring of T3, T4, and TSH. Thyroid stimulating hormone, produced by the pituitary gland, is highly sensitive to physiological stress, inflammation, and drastic changes in caloric intake. In a healthy dieting phase, these values should remain steady. A sudden dip in thyroid hormones or an increase in TSH can signal that it’s time to re-evaluate the intensity of workouts, or the level of caloric restriction.

These objective measurements can begin to take some of the guesswork, and scale-focus, out of the process of beginning a diet and exercise journey. While it’s likely that the journey will still be a physiologically – and emotionally – difficult one, having measurements to track can be a way to separate patients from the guilt and stress that often accompanies weight loss experiences.

 

Dr. Chris Cherubino is a chiropractic physician and certified medical examiner. She is committed to healthcare information access and demystifying the diagnostic process in the realms of musculoskeletal, neurological, and laboratory medicine. In her work with ARCpoint Labs, she attempts to provide information and education to other physicians in order to increase patient compliance, understanding, and wellbeing.

 

[1] Agnihothri RV, Courville AB, Linderman JD, Smith S, Brychta R, Remaley A, Chen KY, Simchowitz L, Celi FS. (Jan 2014). Moderate weight loss is sufficient to affect thyroid hormone homeostatis and inhibit its peripheral conversion. Thyroid. 24(1): 19-26.
[2] Andrews RC, Herlihy O, Livingstone DE, Andrew R, Walker BR (Dec 2003) Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance. J Clin Endocrinology Metabolism. 87(5587-93).
[3] Trexler ET, Smith-Ryan AE, Norton LE. (Feb 2014) Metabolic adaptation to weight loss: implications for the athlete. Journal of International Sports Nutrition. 11(7-15).
[4] Goff DC Jr., et al. (2013) ACC/AHA guideline for assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49.
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