By Monazza Ahmad, B.Pharm, MSc

In the fascinating world of our microbiome, there is one bacterium that has been making waves, and that is Akkermansia muciniphila. 
Among the trillions of bacteria residing in our body (yes, that's 10 times more than our own cells!), this particular species has caught the attention of researchers and health enthusiasts alike. Discovered about 20 years ago, A. muciniphila has been continuously showing promising results in promoting healthier gut lining and overall wellbeing.1*
You might wonder, don't all good bacteria do that? What sets A. muciniphila apart? Let's explore the unique attributes of this remarkable bacterium and discover how you can increase its levels to unlock its outstanding health benefits.* 

Uncovering Akkermansia muciniphila and the secret to its success
A. muciniphila is quite a unique character on the stage of the bacterial world. It thrives in areas with limited oxygen supply, making it particularly adept at flourishing even in tissues that have less oxygen supply.2

A. muciniphila does not follow the same dietary rules as its bacterial counterparts. While many bacteria rely on fiber for growth, A. muciniphila doesn't need it to survive. It can thrive on its own, without the need for any additional nutrients to reproduce.

Originating from Greek, muciniphila translates to “mucin-loving.” And true to its name, this bacterium resides in the mucus lining of our intestines, where it finds its energy source—mucin. By feasting on mucin, it encourages our epithelial cells to produce even more of it. What's so special about mucin? Mucin is a molecule that lubricates the gut lining, playing a crucial role in strengthening the walls of our gut against allergens and debris.*

Unveiling the impact of A. muciniphila on the microbial community
Here is another interesting fact about Akkermansia muciniphila: It turns mucin into something incredibly beneficial for our gut health—short-chain fatty acids (SCFAs), such as butyrate, which can be used as food by other friendly bacteria in our body. This quality makes A. muciniphila a “cross-feeder.” It makes up about 3-4% of the gut lining in healthy people, populating our gastrointestinal tract within the first year of life through breast milk but gradually decreasing as we age. Hence, it’s critical to give it lifelong care to maintain a thriving gut environment.3*

Unraveling the importance of Akkermansia in improving health
Research on the effects of A. muciniphila on human health is ongoing, but some studies have shown encouraging results, indicating that A. muciniphila may offer potential benefits for various aspects of health:

Excess weight: Overweight individuals are mostly found to have lower levels of A. muciniphila alongside other beneficial bacteria as compared to their lean counterparts. By increasing the thickness of the protective mucus layer in the intestines and enhancing gut barrier function, this microbe blocks bacteria and other substances from entering our bloodstream. The result? Our metabolic health gets a boost! From blood sugar and cholesterol to blood pressure and waist circumference, A. muciniphila helps keep them all in check.4,5*

Glucose regulation: Did you know that a thinner mucus layer is associated with health risks? This is why, if you have an adequate amount of A. muciniphila in your body, it will boost healthy gut mucus lining and improve glucose metabolism. By degrading the mucus layer in the intestines, A. municiphila can increase the production of SCFAs, which keeps the glucose regulated and produces energy in your body.6*
Therefore, supplementation with A. muciniphila can lead to reduced fat mass, improved insulin metabolism, and better blood sugar control—factors that are essential in tackling blood sugar health.7*

Cardiovascular health: There are several cardiovascular markers shown to improve with the presence of Akkermansia in the body. This bacterium works wonders helping to promote healthy arteries and healthy blood pressure. How does it support our hearts? By producing the superstar butyrate!8-13*

Understanding the difference between live vs. pasteurized forms
One more thing to consider is the live and pasteurized forms of Akkermansia. Although the difference in their effects is still inconclusive, most studies found the pasteurized form to be more effective than the live form.14,15*

Nurturing the growth of Akkermansia for optimal health
There are many ways to naturally enhance the production of this beneficial bacteria in your body.

Foods that help16,17

• Dietary fiber: Adopt a diet rich in fiber from fruits, vegetables, whole grains, legumes, and nuts, such as a Mediterranean diet, that encourages the growth of A. muciniphila.*
• Prebiotics: Incorporate prebiotic-rich foods into your diet. Prebiotics are nondigestible fibers that support the growth and activity of beneficial gut bacteria.* Foods like onions, garlic, leeks, asparagus, yacon root, and bananas are good sources of prebiotics.
• Polyphenol-rich foods: Foods rich in polyphenols, such as berries (especially cranberries), cocoa, green tea, and red wine (in moderation), may have a positive impact on your gut health and promote the growth of A. muciniphila.*
• Probiotics and fermented foods: While A. muciniphila itself is not commonly available as a probiotic supplement, consuming other probiotics and fermented foods (e.g., yogurt, kefir, sauerkraut, kimchi) may help create a gut environment that supports A. muciniphila growth.*
• Omega-3 fatty acids: Fatty fish such as salmon, mackerel, sardines, etc. as well as flaxseeds and chia seeds are a good source of fish oils to boost Akkermansia production.*

Lifestyle that helps6,16

• Avoid high-fat diets and alcohol: High-fat diets, especially those rich in unhealthy fats, as well as alcohol may negatively impact the gut microbiome. Strive for a balanced diet with healthy fats, stay away from fast food, and limit alcohol consumption.16

• Regular exercise: Regular physical activity has been associated with a more diverse and beneficial gut microbiome, which may also promote the growth of A. muciniphila.18

• Stress management: Chronic stress can negatively affect gut health. Engaging in stress-reducing activities such as meditation, yoga, or spending time in nature may be beneficial.19

Remember that individual responses to dietary and lifestyle changes can vary, and it's important to make these adjustments as part of an overall healthy lifestyle. So don’t forget to consult with your healthcare provider before making significant changes to your diet or lifestyle!

Navigating the caveats: potential risks of overabundance of Akkermansia
Just like anything out of balance in life, the overabundance of this bacteria may bring some risks as well. For example, excess Akkermansia in the body may upset the intestinal barrier due to overconsumption of mucin that makes up the epithelial lining to prevent the passage of bacteria.20*

There are other emerging studies on the possible association of the abundance of A. muciniphila with certain health parameters. Whether it’s detrimental or supportive is yet to be concluded.21-24

Remember, moderation is the key! Just like any other supplements, make sure to avoid overconsumption and always consult with your healthcare practitioner before starting supplementation. 

​References:
1. Zitong L et al. Front Microbiol. 2022;13:1037708.
2. Rodrigues CF et al. Front Immunol. 2022;13:934695.
3. Zhang T et al. Microb Biotechnol. 2019;12(6):1109-1125.
4. Mayorga-Ramos A et al. Front Nutr. 2022(9).
5. Xu Y et al. Front Micriobiol. 2020;11:219.
6. Suriano F et al. Front Immunol. 2022;13:953196.
7. Hasani A et al. J Med Microbiol. 2021;70(10).
8. Li J et al. Circulation. 2016;133(24:2434-2446.
9. Wassenaar TM et al. Eur J Microbiol (Bp). 2018;8(3):64-69.
10. Mohammad S et al. Front Immunol. 2020;11:594150.
11. Luo X et al. Int J Mol Sci. 2023;24(5):4955.
12. Tilves C et al. JAHA. 2022;11(13).
13. Yan J et al. Gut Microbes. 2021;13(1):1984104.
14. Choi Y et al. Microorganisms. 2021;9(10):2039.
15. Ashrafian F et al. Scientific Reports. 2021;11:17898.
16. Zhou K. J Funct Foods. 2017;33:194-201.
17. Anonye BO. Front Immunol. 2017;8.
18. Hintikka JE et al. Scientific Reports. 2023;13:11228. 
19. Madison A et al. Curr Opin Behav Sci. 2019;28:105-110.
20. Qu S et al. Front Microbiol. 2023;14:1111911.
21. Wang K et al. Front Microbiol. 2022;13:932047. 
22. Nishiwaki H et al. NPJ Parkinsons Dis. 2022;8:65.
23. Fang X et al. Curr Med Sci. 2021;41(6):1172-1177.
24. Floch N. Science Direct. 2017. 

By Michael Stanclift, ND

You’re feeling that rush as you catch your stride on your morning run. The air is perfect. Suddenly a cramp or muscle ache stops you dead in your tracks. You try to shake it off, but it just grabs more. Ah!
We still don’t completely understand why muscles tighten up involuntarily. Exercise, pregnancy, electrolyte imbalances, nerve compression, and diminished blood supply to the muscle all may contribute.1,2 So what can we do to combat these harmless but pesky discomforts? In this article we’ll look at what the research says. Surprisingly, some popular natural remedies don’t shine through in the current medical evidence. 

What might not help with cramping
​
Magnesium and Epsom salts:
A Cochrane Review found that oral magnesium wasn’t likely to help with muscle cramps in older people, and the findings were inconsistent in pregnant women.3 A recent randomized, placebo-controlled trial in pregnant women found no difference in leg cramps with magnesium compared to placebo.4
Epsom salt (magnesium sulfate) baths have long been a go-to for muscle relaxation, and “float” centers with sensory deprivation tanks full of the magnesium-rich water have popped up as an urban refuge from the constant stimulation of modern life. A study in nonathletic healthy men found a one-hour float (in magnesium sulfate) after exercise reduced pain perception compared to one hour of passive recovery.5 However, these findings are tough to attribute to magnesium, as the study’s control didn’t match other potentially therapeutic factors, such as body positioning and sensory deprivation.5 So a relaxing bath may help with cramping and muscles, but it’s unclear if adding Epsom salt makes a significant difference.

Active cool-down and static stretching:
Many believe after exercising intensely a period of low-to-moderate intensity will prevent muscle soreness and injuries, but this doesn’t appear to be true.6 A 2018 review found evidence on active cool-downs shows it doesn’t significantly reduce soreness, stiffness, or range of motion and may inhibit muscular glycogen resynthesis (energy storage).6 This same review found that static stretching before or after exercise didn’t reduce muscle soreness.6

What might help with muscle cramping:

​Foam rolling:
This surprisingly simple tool can be valuable if you suffer from muscle soreness and cramps. Using a foam roller after exercise can reduce muscle soreness and improve athletic performance the following day.6 Physical therapists from Harvard agree that 30-120 seconds per area can be helpful in relieving sore muscles and preventing cramps.7

Muscle soreness:

​Tart cherry or pomegranate juice:
A small randomized, double-blind, placebo-controlled trial found 355 ml (~12 oz.) of tart cherry juice drunk twice a day for a week before a 26 km (16-mile) run reduced the amount of pain reported from participants.8 A research review found similar effects from drinking tart cherry juice twice a day, and one study found pomegranate juice reduced soreness.9 But the research on these two drinks in relation to muscle soreness has shown mixed results.9 A recent study compared tart cherry, pomegranate, and placebo drinks to analyze the impact on muscle soreness in nonresistance trained men.10 In this study, the researchers were surprised to find that neither of the fruit drinks appeared to help with muscle soreness when compared to placebo.10

Ginger:
In a small double-blind, randomized, placebo-controlled trial in experienced runners, 5 days of powdered ginger supplementation (1.4 g/day) moderately reduced muscle soreness from a run (on day 3) during the supplement period.11 A review of randomized clinical trials found that consuming up to 4 g of ginger postintense exercise can reduce muscle soreness and improve muscle recovery.12 Lower single dosages of 2 g ginger did not help with muscle soreness when compared to placebo.12 This suggests it may take multiple days or higher doses to get the effect.

Curcumin:
It’s no surprise that curcumin, a bright orange compound from the spice turmeric is making news again. A research review found curcumin in a wide range of doses (150 mg-5,000 mg) can reduce muscle soreness after exercise.13 Curcumin can work when used on an “as needed” basis, with even a single dose (150-200 mg) showing effectiveness for muscle soreness following exercise.13 Interestingly, in this review they found small doses (90 mg twice a day) of curcumin taken for 7 days before exercise had no effect on postexercise soreness, while the same dosage taken after exercise for 4 days was effective.13 Other studies in the review at similar doses did not find curcumin improved muscle soreness compared to placebo, so differences in the trial participants and types of exercise may influence the effects.13

Conclusion:Cramping and muscle soreness can ruin a good exercise session, but they don’t have to. When it comes to combatting these annoying aches, you have numerous options—but beware that some popular natural treatments might be more hype than help.
​
​References:
1. Young G. Leg cramps. BMJ Clin Evid. 2015;2015:1113.
2. Mayo Clinic Staff. Muscle cramps. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/muscle-cramp/symptoms-causes/syc-20350820#:~:text=Overuse%20of%20a%20muscle%2C%20dehydration,Inadequate%20blood%20supply. Accessed February 11, 2021.
3. Garrison SR et al. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev. 2012;2012(9):CD009402.
4. Araújo CAL et al. Oral magnesium supplementation for leg cramps in pregnancy-An observational controlled trial. PLoS One. 2020;15(1):e0227497.
5. Morgan PM et al. The acute effects of flotation restricted environmental stimulation technique on recovery from maximal eccentric exercise. J Strength Cond Res. 2013;27(12):3467-3474.
6. Van Hooren B et al. Do we need a cool-down after exercise? A narrative review of the psychophysiological effects and the effects on performance, injuries and the long-term adaptive response. Sports Med. 2018;48(7):1575-1595.
7. Harvard Health Staff. Roll away muscle pain. Harvard Health Publishing. https://www.health.harvard.edu/staying-healthy/roll-away-muscle-pain#:~:text=Foam%20rollers%20are%20easy%2Dto,from%20exercise%2C%20and%20reduce%20injury.&text=As%20you%20age%2C%20occasional%20muscle,lightweight%20cylinder%20of%20compressed%20foam. Accessed February 11, 2021.
8. Kuehl KS et al. Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial. J Int Soc Sports Nutr. 2010;7:17.
9. Bowtell J et al. Fruit-derived polyphenol supplementation for athlete recovery and performance. Sports Med. 2019;49(Suppl 1):3-23.
10. Lamb KL et al. No effect of tart cherry juice or pomegranate juice on recovery from exercise-induced muscle damage in non-resistance trained men. Nutrients. 2019;11(7):1593.
11. Wilson PB. A randomized double-blind trial of ginger root for reducing muscle soreness and improving physical performance recovery among experienced recreational distance runners. J Diet Suppl. 2020;17(2):121-132.
12. Rondanelli M et al. Clinical trials on pain lowering effect of ginger: A narrative review. Phytother Res. 2020;34(11):2843-2856.
13. Yoon WY et al. Curcumin supplementation and delayed onset muscle soreness (DOMS): effects, mechanisms, and practical considerations. Phys Act Nutr. 2020;24(3):39-43.

By Cassie Story, RDN

We are social creatures. Hardwired in our being is the desire to belong, fit in, and play with our fellow humans. In fact, survival depends on our ability to bond.

So what happens to your mental state when you remove yourself from others over the course of a year and a half? While long-term data on the mental health implications of isolation are currently being studied, we do have short-term studies emerging, which evaluated mental health concerns over the past year.

A new phenomenon has occurred for workers who have been utilizing online video platforms for a majority of their day-to-day work. “Zoom fatigue” may have inadvertently activated the fight or flight system within the brain.1 This is according to a recent report from Stanford that offers four potential aspects of Zoom fatigue and the unintended psychological consequences that follow.1

With this knowledge, it is important to recognize the spectrum of emotions that you might be feeling as you prepare to “get back” into the real world—to step out from behind the screen and live life again.

This article identifies common emotions that you may be experiencing, effective mantras for change, and supportive nutrients that can play a role in taking you from feeling blah to rah!

Emotional state: fear & anxietyIt is understandable to have some lingering fear and anxiety about social reentry. Due to our constant connection to news and information, many people have likely experienced some level of fear and anxiety that is atypical for themselves over the past year. It wouldn’t be realistic to expect yourself to go from living in that state of mind, to complete joy and jubilation.
Mantra: I am safe

Supportive nutrients: palmitoylethanolamide (PEA) and hemp

PEA is a bioactive lipid molecule that the body produces naturally and is found in the lipid extracts of foods.2 PEA has been researched for over 70 years and has a wide range of clinical applications from mild bodily discomfort and immune system support to mood and neurological health.2-6

Full-spectrum hemp is sourced from aerial plant parts including the stalk, stems, seed, and flower of the hemp plant and contains beneficial phytocannabinoids and terpenes.
They work together to produce a synergistic effect on the endocannabinoid system, which has been found to support a healthy stress response and has positive neurological benefits.7
Emotional state: stressLoneliness and isolation have been found to increase stress levels in the body.8 Couple that with uncertainty about the future and worry for your own health and wellbeing, as well as that of your friends and family, and this creates a perfect brew for stress to thrive. Are you ready to reclaim your balance?
Mantra: I am at peace

Supportive nutrient: phosphatidylserine

Phosphatidylserine is an important phospholipid in the brain and a key building block of nerve cell membranes.9 Research suggests that it may support mental focus and help support a healthy endocrine response to acute mental stress.10
Emotional state: low self-confidence or decline in body imageFor most people, due in part, to our society’s environmental factors of convenience foods and little built-in day-to-day movement, maintaining health and wellbeing requires routine and planning. Removing ourselves from typical day-to-day activities, and increasing a sedentary lifestyle, may lead to undesired weight gain.
If you have experienced an increase in body weight, first remind yourself, you are not alone. Second, find something about your body to be grateful for right now. Third, speak kindly to yourself.
If you have now found that a majority of your “real life” clothes no longer fit, maybe it is time to implement a supportive weight-loss routine.
Mantra: I am strong (or flexible, sexy, healthy)

Supportive nutrient: meal replacements

Meal replacements are reduced-calorie portion-controlled products often fortified with micronutrients. Studies show that replacing just one or two meals per day with a meal-replacement product produces greater total weight loss, and a greater proportion of participants meet their total weight-loss goals both in the short- and long-term, compared to a low-calorie diet without the use of meal replacements.11
Emotional state: lack of motivationSpending the majority of your time in a seated position, whether the couch or an office chair, can wreak havoc on motivation levels. Going from staring at one screen to the next, between your computer, TV, and phone, can cause a numbness of sorts and lead to lack of desire or motivation to try new things. We are hardwired to want to try new things. Being limited from participating in your favorite activities may have decreased your motivation without your realizing it.
Mantra: I enjoy new experiences

Supportive nutrients: holy basil, ashwagandha, amla fruit

These are a classic blend of Ayurvedic herbs. Holy basil (Ociumum sanctum) leaves and stems contain a variety of compounds including triterpenes (oleanolic and ursolic acid), saponins, flavonoids, and phenols.12 Roots of ashwagandha (Withania somniferum), an herb grown in India, contain withanolides.13 Amla fruit, or Indian gooseberry (Phyllanthus emblica), is rich in vitamin C, a potent antioxidant.14 
Research suggests these adaptogens may support the body in adjusting to various stressful environmental challenges.15 These herbs may help reduce some of the challenges associated with stress.16

Emotional state: excitementPerhaps you are experiencing a different type of emotion than those listed above. Maybe you are excited and “champing at the bit” to get back out into your typical social life. If you feel that you need some calming support because you just cannot wait to get back out there, here are some things to consider:
Mantra: I am calm

Supportive nutrients: folate, magnesium, vitamins B12 and B6

Folate & vitamin B12 are cofactors in the synthesis of neurotransmitters, including serotonin.17-18 Serotonin is associated with mood, sleep, and relaxation.19

Vitamin B6 is a factor in the body’s conversion of glutamate, which is a stimulatory neurotransmitter, into gamma-amino-butyric acid (GABA), which is associated with calming and relaxation.20

Magnesium is an essential mineral and acts as a cofactor in numerous metabolic processes. There is evidence that specific nutrients, such as magnesium, may help to promote muscle relaxation and restfulness—possibly playing a role in reducing daily stress levels.21

Conclusion
However you are feeling in any given moment is okay. As humans, we experience a multitude of emotions that change throughout the day. If you’ve noticed you haven’t felt yourself lately, remind yourself that every day is a new day—filled with opportunities for growth and change. Be kind to yourself, use the mantras within this article or create your own that speak to you and consider adding the supportive nutrients listed above to your routine if you are seeking nutritional support for your emotional state.

References:
1. Bailenson J. Technology, Mind, and Behavior. 2021;2:1.
2. Beggiato S et al. Front Pharmacol. 2019;10:821.
3. PubChem, U.S. National Library of Medicine, National Center for Biotechnology Information. https://pubchem.ncbi.nlm.nih.gov/compound/4671. Accessed September 20, 2019.
4. Passavanti MB et al. Syst Rev. 2019;8(9).
5. Hesselink JM et al. Int J Inflamm. 2019;2013(9).
6. Hesselink JMK. J Pain Res. 2013;6:625–634.
7. Tagne AM et al. Pharmacol Res. 2021:105545.
8. Hwang TJ et al. Int Psychogeriatr. 2020;32(10):1217-1220.
9. Kim H et al. Prog Lipid Res. 2014;56:1-18.
10.Benton D et al. Nutr Neurosci. 2001;4(3):169-178.
11. Heymsfield S et al. Int J Obes Relat Metab Disord. 2003;27(5):537-549.
12. Cohen MM. J Ayurveda Integr Med. 2014;5(4):251-259.
13. Mirjalili MH et al.  Molecules 2009;14:2373–2393.
14. Mindell E. New York, NY, Hachette Book Group, 2011.
15. Panossian AG et al. Med Res Rev. 2021;41(1):630-703.
16. Panossian A. Pharmaceuticals. 2010;3:188-224.
17. NIH Office of Dietary Supplements. Office of Dietary Supplements – Vitamin B12. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ . Accessed: August 5, 2021.
18. NIH Office of Dietary Supplements. Office of Dietary Supplements – Folate. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ . Accessed: August 5, 2021.
19. Young SN. J Psychiatry Neurosci. 2007;32:394-399.
20. Dakshinamurti K. Adv Nutr Res. 1982;4:143-179.
21. de Baaij JH, et al. Physiol Rev. 2015; 95:1-46.

By Michael Stanclift, ND

Since the 1950s we’ve associated HDL cholesterol with being a positive for our health, and to a large extent, that’s true.1-6 However, more recent studies show us that elevated HDL cholesterol can actually be cause for concern.7,8 So what do we think is going on here? Well, first we have to look at what we’re actually measuring when we look at HDL and why we have assumed that was protective for our cardiovascular systems.
​
For years I taught patients that they can remember the “H” in HDL means that’s the “healthy” cholesterol. While this is mostly a good rule of thumb, the HDL letters actually stand for high-density lipoproteins. High-density lipoproteins are like tiny little garbage trucks that take excess cholesterol out of our system so we can get rid of what we don’t need. And when we measure HDL cholesterol, we’re basically looking at how much “garbage” (cholesterol) is inside those little trucks.

It would make sense that the more garbage we find, the more we would assume the trucks are picking up. Unfortunately, this is making a lot of assumptions based on just one finding. We’re assuming that we have enough garbage trucks, that everything on them is working, and that they’ll be dumping that garbage as soon as they get to the landfill (our livers). As you might suspect, those aren’t always the case. Sometimes our HDL particles contain a lot of cholesterol because there are just not that many little garbage trucks to handle all the cholesterol that needs to be transferred.9 Our HDL garbage trucks may also be loaded with cholesterol because they just aren’t unloading it well, which is akin to them driving around full and not picking up more garbage—not useful.10

So what we really want to know when we look at HDL and use that to predict cardiovascular health, is how much healthy HDL function does the patient have? This has been a tricky measure to pin down, but researchers and laboratories are looking to create tests that will give us a clear indication of healthy HDL function and bring that to us as patients. There are a few advanced tests available that can help give indications of our HDL function, but they still need more refinement.9
You’re probably thinking, “Are there ideal HDL levels? When should I seek more investigation?” We do have some indications of ideal levels that suggest our HDL is likely functioning well.  

​One study found the following ideal HDL ranges:9

• Men: 54-77 mg/dL
• Women: 69-97 mg/dL

If your HDL levels fall within these ranges, it’s likely functioning as it should, protecting your cardiovascular system and cleaning up other various things your body no longer needs.9 These ranges show us that there is likely an upper limit to what is healthy and ideal and that we might need to rethink the “more is always better” axiom we’ve followed for decades.

References:
1. Barr DP et al. Am J Med. 1951;11(4):480-493.
2. Gordon T et al. Am J Med. 1977;62(5):707-714.
3. Castelli WP et al. JAMA. 1986;256(20):2835-2838.
4. Cullen P et al. Circulation. 1997;96(7):2128-2136.
5. Sharrett AR et al. Circulation. 2001;104(10):1108-1113.
6. Di Angelantonio E et al. JAMA. 2009;302(18):1993-2000
7. Madsen CM et al. Eur Heart J. 2017;38:2478-2486
8. Hamer M et al. Arterioscler Thromb Vasc Biol. 2018;38(3):669-672.
9. Khera AV et al. Circulation. 2017;135(25):2494-2504.
10. Hancock-Cerutti W et al. Molecules. 2021;26(22):6862.

Deanna Minich, PhD

Have you ever felt like reaching for the pint of strawberry ice cream after a long day at work?
Or eating potato chips after an argument with a loved one?
Or even craving chocolate when feeling bored or isolated?

If you answered “yes” to any of these questions, you might be “stress eating,” or what is commonly referred to as “emotional eating.” Stress eating is turning to food in times of psychological distress as a form of comfort rather than in response to hunger. Whether it’s stress or a specific emotion, like sadness, we may develop a coping response by eating, either overeating or under-eating. In general, emotional eating involves eating nutrient-poor foods, is often repetitive and automatic, and is not connected to body senses of physical hunger, but to an emotional stimulus.1 Some of us are more prone to being high reactors to stress and may be more vulnerable than others.2
Here’s a quick checklist to see whether you might be engaging in stress eating:

• Am I eating because I’m feeling emotional about something?
• Am I craving food as a reward?
• Am I bored or feeling isolated?
• Am I stressed without feeling in control of my life?
• Am I neglecting my body’s sense of hunger?
• Am I out of touch with my body?
• Am I eating in a way that is automatic and repetitive?

Of course, stress eating may occur periodically throughout your life. It is natural to feel the need to comfort yourself in response to something threatening. Where it becomes problematic is when it becomes cyclical and difficult to escape the eventual feeling of powerlessness, guilt, and shame that can settle in as a result.
Here are some things you can do to break the cycle of stress eating:

1. Be body aware: Practice checking in with your body on a regular basis. Most of us live “in our head” and not in our belly or even down to our toes. When you get the urge to eat, allow yourself to breathe, connect deeply to your body by getting in touch with your sensations through a simple act of focus or movement, like wiggling your toes. Once you are more present, ask yourself whether you need to eat in that moment or if you are responding to an emotion. If you are responding to an emotion, let that feeling fully express. Set an “emotional date” if you can’t express it right there and then, so you come back to it later. You might even find that when you feel an emotion, a specific part of your body responds to let you know, like flushing of your skin or a butterfly-like sensation of unsettledness in the gut. Honor that impulse from the body and either act in the moment or commit to it at a designated time.

1. Exercise your emotional muscle: Most people have lost the language of emotion. When people ask how we are doing, we may give an automatic answer of “fine.” We may even intellectualize or rationalize our emotions to the extent that we make ourselves feel like we should not be having the emotions. Some may believe emotional expression will be perceived as weakness. However, emotions are powerful forces in that they drive our behaviors. It’s been said that we move toward pleasure and away from pain. Therefore, it is best to get in touch with what we are feeling, identify the emotion, and let it flow in healthy ways.3 Emotions can become problematic when we vent them in a volatile way or we repress them inside. The more we can check in with how we are feeling, the better. Try using a log at bedtime to write down key words of how you felt that day. You can also do a quick emotional check-in on your smart phone by looking at the emojis and selecting ones that resemble your feelings. Engage a friend in the check-in process via text during days that are difficult.

1. Develop eating alternatives: Once you begin to get keyed in to how your body is responding and how your emotions are surfacing, you become more aware of your responses and can develop ways to navigate eating situations. If you have the urge to eat, and you know that you are not hungry and that you are feeling emotional, it might be worthwhile to have an alternative ready. Be prepared by making a specific list of at least five healthy things you can do instead of eating. For example, walking outside for 15 minutes in the fresh air, calling a friend and talking for 10 minutes, journaling in a notebook for a few minutes, or even taking a power nap. Removing yourself from the situation and resetting your neurochemistry is one way to rewire and refine your brain so that you can make other choices. Eventually, you’ll come to use different strategies when the need to unnecessarily eat arises.

1. Have healthy foods available: If you get a bout of uncontrollable munchies and can’t seem to replace it with an alternative on your list, aim for foods that you will feel good about eating so you don’t have the guilt that can result from emotional eating. Ideas for healthy foods include a banana with almond butter, a pitted date rolled in coconut, an avocado with sea salt, or vegetable (beet, carrot) chips. As research suggests, eating whole, plant-based foods, such as more fruits and vegetables, is associated with a greater sense of well being, creativity, curiosity, and even happiness.4 On the other hand, eating fast food and drinking sugar-sweetened beverages is associated with risk for depression.5,6 Help offset your roller coaster moods by selecting colorful foods!

1. Ensure your body has enough nutrients: Our brain chemistry can be affected by the nutrients in our diet. For example, the production of neurotransmitters like dopamine, serotonin, and GABA, which all play a role in stress response, are determined by nutrients available to the body, including certain amino acids, vitamins (e.g., vitamin C and B complex), and minerals (e.g., magnesium).7-13 Stress tends to drain our body of these precious reserves, and, as a result, we may end up with imbalanced neurochemistry.14 Therefore, it’s essential to look at what is essential for a healthy diet and incorporate foods and dietary supplements to meet daily nutrient requirements.

Stress eating can be a challenging cycle to break. There are several ways to address the cycle, whether through body awareness, emotional expression, alternative options, better choices, or simply, brain chemistry balance through nutrient sufficiency. Try out a variety of these approaches to see if you feel more empowered in your eating in times of distress.
​
References:

1. Nguyen-Michel ST et al. Dietary correlates of emotional eating in adolescence. Appetite. 2007;49(2):494-499.
2. Newman E et al. Daily hassles and eating behaviour: The role of cortisol reactivity status. Psychoneuroendocrinology. 2007;32(2):125-132.
3. Whiteside U et al. Difficulties regulating emotions: Do binge eaters have fewer strategies to modulate and tolerate negative affect? Eating Behaviors. 2007;8(2):162-169.
4. Mujcic R et al. Evolution of well-being and happiness after increases in consumption of fruit and vegetables. Am J Public Health. 2016;106(8):1504-1510.
5. Huang Q et al. Linking what we eat to our mood: A review of diet, dietary antioxidants, and depression. Antioxidants (Basel). 2019;8(9).
6. Sánchez-Villegas A et al. Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr. 2012;15(3):424-432.
7. Fernstrom JD. Effects on the diet on brain neurotransmitters. Metabolism. 1977;26(2):207-223.
8. Wurtman RJ et al. Control of brain monoamine synthesis by diet and plasma amino acids. Am J Clin Nutr. 1975;28(6):638-647.
9. Meredith ME et al. Regulation of embryonic neurotransmitter and tyrosine hydroxylase protein levels by ascorbic acid. Brain Res. 2013;1539:7-14.
10. Linus Pauling Institute. Cognitive function in depth. https://lpi.oregonstate.edu/mic/health-disease/cognitive-function. Accessed March 26, 2020.
11. Harrison FE et al. Vitamin C function in the brain: Vital role of the ascorbate transporter (SVCT2). Free Radic Biol Med. 2009;46(6):719-730.
12. Mehrotra R et al. Nutrition and anemia in end-stage renal disease. 2013. https://www.sciencedirect.com/topics/neuroscience/pyridoxine. Accessed March 26, 2020.
13. Cuciureanu MD et al. Magnesium and stress.https://www.ncbi.nlm.nih.gov/books/NBK507250/. Accessed March 26, 2020.
14. Singh K. Nutrient and stress management. J Nutr Food Sci. 2016;6:528.

Unless you follow a ketogenic diet, chances are your diet is high in carbohydrates. Most of these carbohydrates consist of starches, which are composed of long glucose chains. While regular starch is quickly digested and absorbed into the body, resistant starch is not as readily absorbed.1 In other words, it resists digestion. Hence, the term “resistant starch.”
Resistant starches often function like prebiotics or soluble fiber. Foods composed of resistant starches move undigested through the stomach and small intestine to the colon, where gut bacteria can feed on them and convert a portion of them into beneficial short-chain fatty acids, such as butyrate.2-4
​
What’s so super about slow-release carbohydrates?
​Digestion benefits aren’t the only reason to take a closer look at resistant starches. Resistant starches have been shown to have numerous health benefits. For example, similar to soluble fiber, resistant starch consumption can have a “second-meal” effect by increasing the feeling of satiety, thus potentially helping people eat fewer calories.5-7
Adding foods high in resistant starches may also lead to improved insulin sensitivity.8 Some research suggests it may improve postprandial blood sugar levels9,10
A recent study compared the effects on blood sugar levels, over 90 minutes, with a proprietary resistant starch, known as UCAN SuperStarch® versus an oral glucose drink. The data indicated the oral glucose showed the typical “sugar spike” followed by a drop in blood glucose levels. On the other hand, the UCAN SuperStarch® provided a sustained glucose response without the sharp spike or crash in blood sugar.11

Resistant starch sources
​Looking to ingest more resistant starch? It’s easy to get ample amounts of resistant starch through dietary intake. Foods high in resistant starch include potatoes (except sweet potatoes), green bananas, legumes, cashews, and some grains, including whole grains, oats, and rice.12,13 Note that some people find a diet high in resistant starch may cause stomach discomfort.
​
Cook and cool!
After cooking rice and potatoes (although not sweet potatoes), simply wait to eat these items until they have cooled completely. Cooling is important, as it converts some of the starch into resistant starch, allowing it to pass unchanged through the intestinal tract and providing fuel for the “friendly” bacteria in the colon.  

As always, make sure to discuss any dietary changes with your healthcare practitioner first!

References:

1. Englyst HN et al. Br J Nutr. 1996;75(5):749-755.
2. Topping DL et al. Proc Nutr Soc. 2003;62(1):171-176.
3. Wong JM et al. J Clin Gastroenterol. 2006;40(3):235-243.
4. Hamer HM et al. Alimentary Pharmacology and Therapeutics. 2008;27(2):104-119.
5. Bodinham CL et al. Br J Nutr. 2010;103(6):917-922.
6. Anderson GH et al. Am J Clin Nutr. 2010;9(4):932-939.
7. Willis HJ et al. Nutr Res. 2009;29(2):100-105.
8. Johnston KL et al. Diabetic Medicine. 2010;27(4):391-397.
9. Raben A et al. Am J Clin Nutr. 1994;60(4):544-551.
10. Maziarz MP et al. Nutr J. 2017;16:14.
11. Results from a small study conducted at the Functional Medicine Research Center, the clinical research arm of Metagenics, Inc. Data on file, Metagenics 2014. Publication in process.
12. Tovar J. Arch Latinoam Nutr. 1996;44(4 Suppl 1):36S-40S.
13. http://www.fermented-foods.com/resistant-starch-surprising-prebiotic. Accessed June 24, 2019.

​Submitted by the Metagenics Marketing Team

Are you struggling to maintain a healthy weight?

If so, you may want to check in with your gut. Research has shown that our gut bacteria—specifically, the wrong kind of gut bacteria, or lack of microbial diversity—can hinder weight management.1
This post offers a brief overview of the gut and explains how you can improve your gut microbiome and support better weight management.

Gut health: an overview
Our intestines, or gut, are key to our digestive system and have been linked to many other aspects of our health, affecting everything from our cognitive wellbeing to our skin health and potentially our ability to lose weight.2

Our gut hosts 100 trillion microbes at any given time, and the majority of these microflora are good for us. That said, not all microbes provide the same health benefits.2
This is because we each have a unique composition of microbiota in our gut microbiome—consisting of various strains of bacteria, viruses, and protozoa (a group of single-celled microorganisms)—some of which have been shown to influence our weight and overall health. If our microbiota become less diverse, or if the amount of specific, beneficial microbes in the gut shifts, it may affect our health in various ways.2

What factors influence the gut microbiome?
Our gut breaks down the food we eat into small particles. The smallest particles are absorbed into the blood, while the rest are eliminated from the body.3
The process of digestion that takes place in the intestines is where the impact of gut bacteria is the most significant. While the majority of these bacteria help to break down food and nutrients in the gut, some are better-equipped to facilitate digestion, and potentially help with weight management, than others.3
Put simply: If the gut has higher levels of certain types of bacteria, this could be a reason why it’s more difficult to lose weight.

Some factors that can disrupt the gut microbiome and affect weight management include:4

• Poor diet

Fiber fuels healthy bacteria, while sugar promotes unwanted types of bacterial strains, parasites, and yeast. Research has shown a fibrous, low-sugar diet is better for gut health.4

• Sedentary lifestyle

If you don’t get much exercise, you may want to rethink your approach. Lack of physical activity may reduce gut bacterial diversity and potentially make you more susceptible to weight gain.5

• Stress

Even the most relaxed people experience stress from time to time. Chronic stress is much more serious, however, as it can disrupt the gut microbiome, reducing the numbers of beneficial bacteria for weight management as well as affecting overall health.

Strategies to improve gut health and promote weight loss
Results from a study published in the Mayo Clinic Proceedings reveals that even with a strict diet and exercise program, specific activities of the gut bacteria can disrupt the microbiome and make weight loss difficult.6

This is important because currently, more than two-thirds of American adults are either overweight or at risk of being overweight.7
Healthy weight loss and management are crucial to overall health—and this is where understanding research on probiotic strains is valuable.8
In addition to a nutritious diet and regular exercise, certain strains may improve gut function. Clinical studies have shown that strains, such as Bifidobacterium lactis B420, support body weight regulation and have been shown to help control body weight and body fat.8

While certain probiotic strains may be ideal for weight management, along with a comprehensive wellness regimen, they are not a substitute for a healthful diet and active lifestyle. Please speak to your healthcare practitioner before changing your diet. 

References:

1. Muñiz Pedrogo DAet al. Gut Microbial Carbohydrate Metabolism Hinders Weight Loss in Overweight Adults Undergoing Lifestyle Intervention With a Volumetric Diet. Mayo Clinic Proceedings. 2018;93(8):1104-1110.
2. Hurley AK. The Garden in Your Gut. https://www.johnshopkinshealthreview.com/issues/fall-winter-2015/articles/the-garden-in-your-gut. Johns Hopkins Health Review. Accessed May 27, 2019.
3. Komaroff AL. Do gut bacteria inhibit weight loss? https://www.health.harvard.edu/staying-healthy/do-gut-bacteria-inhibit-weight-loss. Harvard Health Letter. Accessed May 27, 2019.
4. University of Colorado Boulder. Gut Check: Exploring Your Microbiome. https://www.medicalnewstoday.com/articles/318441.php. Accessed May 27, 2019.
5. University of Colorado Boulder. Gut Check: Exploring Your Microbiome. https://www.medicalnewstoday.com/articles/318441.php. Accessed May 27, 2019.
6. Dangor J. Makeup of an individual’s gut bacteria may play role in weight loss, study suggests. https://newsnetwork.mayoclinic.org/discussion/makeup-of-an-individuals-gut-bacteria-may-play-role-in-weight-loss-mayo-study-suggests/. Mayo Clinic News Network. Accessed May 27, 2019.
7. National Institute of Diabetes and Digestive and Kidney Diseases. Overweight and Obesity Statistics. https://www.niddk.nih.gov/health-information/health-statistics/Documents/stat904z.pdf. Accessed May 27, 2019.
8. Putaala H et al. Effect of four probiotic strains and Escherichia coli O157: H7 on tight junction integrity and cyclo-oxygenase expression. Res Microbiol. 2008;159(9-10):692-698.

Submitted by the Metagenics Marketing Team

​by Ashley Jordan Ferira, PhD, RDN

Vitamin D is essential- it helps absorb calcium, supports nervous and muscle tissue, and the immune system. Compared to normal-weight counterparts, vitamin D deficiency is more prevalent in those with obesity. In the US over one-third of adults meet obesity criteria.1

A study in The Journal of Clinical Endocrinology and Metabolism2 examined cellular mechanisms of vitamin D trafficking in metabolically dysfunctional adipose tissue as compared to normal adipocytes in conjunction with a vitamin D supplementation intervention in a randomized, controlled trial.

Ninety-seven male subjects completed the vitamin D intervention study. Fifty-four normal-weight and 67 obese males were initially randomized to receive either 50 mcg/week of 25-hydroxyvitamin-D3 [25(OH)D3] (2,000 IU/week equivalent) or 150 mcg/week of vitamin D3 (6,000 IU/week equivalent) for one year. Vitamin D sufficiency was defined as a 25(OH)D blood level > 20 ng/ml. This serum concentration is aligned with the National Academy of Medicine’s cutoff for vitamin D sufficiency.3
​
Vitamin D uptake, conversion and release were investigated in control (non-insulin-resistant) and insulin-resistant 3T3-L1 adipocytes, as well as in subcutaneous adipose tissue (SAT) samples from lean and obese participants. The release of vitamin D and its metabolites were induced with the addition of adrenaline. Expression of the vitamin D receptor and vitamin D conversion enzymes, 25-hyroxylase and 1α-hydroxylase, was also examined.

The research team elucidated key differences in cellular vitamin D trafficking effects and supplementation effects:

• Uptake of vitamin D3 and 25(OH)D3 was higher in insulin-resistant adipose cells vs. control cells
• Conversely, the adrenaline-stimulated release of D3 and 25(OH)D3 from insulin-resistant adipocytes was impaired when compared to control cells
• Additionally, the cellular conversions of vitamin D3 to 25(OH)D3 and to the active 1,25(OH)2D3 form were impaired in insulin-resistant adipocytes when compared to control cells
• Blunted release of D3 and 25(OH)D3 was also seen in obese SAT when compared to lean SAT
• Control adipocytes demonstrated higher expression of vitamin D conversion enzymes, 25-hyroxylase and 1α-hydroxylase, than insulin-resistant adipocytes
• Clinically, weekly 25(OH)D3 supplementation (vs. the traditional vitamin D3supplementation approach) was more efficacious at achieving sufficient vitamin D levels in obese patients, but this advantage was not observed in normal-weight subjects

Why is this Clinically Relevant?

• Higher adiposity is consistently associated with vitamin D deficiency and should be recognized as a modifiable risk factor for hypovitaminosis D
• Key differences in cellular mechanisms of vitamin D trafficking exist in insulin-resistant adipose cells vs. normal adipocytes, as well as in subcutaneous tissue in obese vs. lean patients
• Clinical efforts to improve the prevention and treatment of obesity and cardiometabolic dysfunction are paramount
• 25-hydroxyvitamin-D3 supplementation may be more efficacious than the traditional vitamin D3 approach in combating vitamin D deficiency in obese patients, although additional research is warranted for confirmation and to inform future clinical practice guidelines

 
​
References

1. CDC. Overweight & Obesity. https://www.cdc.gov/obesity/adult/index.html. Accessed October 5, 2017.
2. Di Nisio A, De Toni L, Sabovic I, et al. Impaired release of vitamin D in dysfunctional adipose tissue: new cues on vitamin D supplementation in obesity. J Clin Endocrinol Metab. 2017;102(7):2564-2574.
3. National Academy of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. National Academy Press. Washington, D.C. 2010.

When you’re stressed, so is your thyroid
Everything seems to be going wrong this morning—you’re out of coffee, traffic is bad, and you can feel tension from the tips of your toes to the top of your head. Maybe you’re under constant pressure at work or can’t catch a break on your bills. Stress is a part of your life, and when it’s ongoing, it can affect everything—including your thyroid. Learn why this is significant and what you can do to help reduce the effects of stress on this important gland.

Your thyroid: The regulator of body functions
Sitting squarely at the front of your neck is the thyroid gland, a butterfly-shaped powerhouse of your body’s metabolism. As part of your endocrine system (a collection of glands in the body that produce hormones), the thyroid regulates many body functions including, but not limited to:

• Heart rate
• Body weight
• Body temperature
• Breathing
• Muscle strength
• Menstrual cycle
• Cholesterol levels
• Central and peripheral nervous systems

Yes, the thyroid is more than just a little important in the overall picture of you. It produces, secretes, and stores specific hormones. Two of the main hormones made by the thyroid are triiodothyronine (T3) and thyroxine (T4). Both hormones affect just about every cell in your body; having  too little or too much of either can throw several body systems out of whack and contribute to health issues such as:

• Hair loss
• Weight loss/gain
• Anxiety
• Mood swings
• Missed menstrual periods
• Temperature sensitivity

How stress affects the thyroid
The effect of stress on thyroid health is like a game of dominos: When one tile falls, the rest typically follow. Stress impacts the thyroid by influencing how other hormones balance with it. For example, cortisol (the “fight or flight” hormone) can surge due to chronic stress. This surge can cause problems with thyroid hormone production,1 pressing this important gland to work harder to produce and release more thyroid hormones, leading to an imbalance. Consequently, if the imbalance becomes chronic, it can contribute to the risk of developing a thyroid disorder.2
Another example of hormonal imbalance is insulin resistance, wherein the body resists insulin production, resulting in increased blood sugar levels. This leads to other associated health problems. Several of these conditions often occur with  hypothyroidism (when the thyroid doesn’t make enough of its hormones). The result? Increased products of dysregulated sugar metabolism, which lead to lower levels of thyroid-stimulating hormone (TSH) in the blood.3 Insulin resistance can also contribute to thyroid enlargement and nodules.4,5

Chronic stress has also been shown to increase the risk of developing an autoimmune thyroid condition.2By affecting the immune system through the nervous and endocrine systems, chronic stress can “flip a switch” and increase the risk of autoimmune thyroid disorders for people who have a genetic predisposition.2

Don’t stress about your thyroid
If you’re concerned about chronic stress and how it may affect your thyroid, ask your healthcare practitioner for more information. He or she is the best person to consult about stress and thyroid health.
This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues.
​
References:

1. Ranibar S et al. Indian J Endocrinol Metab. 2011;15(1):18–22.
2. Mizokami T et al. Thyroid. 2004;14(12):1047–1055.
3. Walter K et al. Thyroid Res. 2012;5:13.
4. Rezzonico J et al. Thyroid. 2008;18(4):461–464.
5. Yunzhao T et al. Int J Endocrinol. 2017;2017:1617458.

Submitted by the Metagenics Marketing Team

It is not a myth that men can lose weight faster than women.1 The inherent physiological differences between the sexes play a big role when it comes to losing weight, especially in the initial stages.2 Men possess characteristics that may favor greater weight loss as compared to women.3 To understand the reasons behind this, we must consider the sex differences in energy metabolism, hormonal profiles, and behaviors that may contribute to the differences we see in the ability of the sexes to lose weight. 
Body composition—women have a higher fat percentage Men and women show significant differences in the amount of body fat and lean muscle tissue they carry, with men having more lean tissue and women having greater fat mass.3,4 Lean tissue is more metabolically active than fat; thus more lean tissue contributes to a higher resting metabolic rate.3 This means that in general, men burn more calories than women, even at rest. Higher levels of testosterone in men are largely responsible for the variance in body composition, since testosterone is critical for building and maintaining muscle mass.5 On the other side of things, estrogen also contributes to the gender differences in body composition, namely fat mass.6 From the onset of puberty through to menopause, women maintain a higher percentage of body fat, which was evolutionarily  there to support the ability to reproduce.6 Evidence shows that estrogen acts on the liver and adipose tissue, preferentially promoting postprandial conversion of fuel into fat tissue—and which may make fat loss more difficult for women.3
Fat distribution—men “appear” to lose more weight  Not only is there a difference in the percentage of body fat and lean mass between genders, there is also a difference in the distribution of body fat.2 This relates back to the differing hormonal profiles of men and women and the locations of receptor sites for these hormones.3 For example, estrogen receptors are higher in the subcutaneous tissue in the buttock, hip, and thigh regions in women, which explains why women hold excess fat in these locations.3 Men, on the other hand, have a pattern of central obesity, where the fat tissue is mainly visceral, abdominal fat.2 When weight loss is controlled between the sexes, it has been found that men lose more intra-abdominal fat than women, whereas women lose more subcutaneous fat.7 Fat loss around the abdomen is generally more noticeable, so even if weight loss is similar, it appears that men are losing more weight, even if they are not. 
Emotional eating—women are more likely to turn to foodAlthough both men and women struggle with overeating, women are more likely to turn to food to cope with stressors than men, which is thought to be due to the greater intensity of expressed emotions by women.8,9 This may present as another challenge for women to lose weight. Women are more likely to report eating in response to emotions like anxiety, anger, frustration, and depression.10 Interestingly, even the stress caused by the desire to be thin and dissatisfaction with body size is positively correlated with emotional eating.11 Women who experience higher levels of emotional stressors have more episodes of binge eating, resulting in weight gain and further impairing self-esteem, adding to the existing emotional strain.8 Since women, in general, are more prone to experiencing more intense emotions, emotional eating may be contributing to the inability to lose weight as easy as a male counterpart.
Other contributing factorsBody weight is predominately controlled by diet and physical activity, but there are underlying factors that can also contribute to enhanced weight gain or difficult weight loss.12 For women struggling to lose weight, it may be important to explore some of these other potential factors.
Polycystic ovarian syndrome (PCOS)
PCOS is one of the most common endocrinopathies affecting 6-18% of reproductive aged women.13Of these women, approximately 50% are overweight or obese, specifically carrying excess weight in the abdominal region.14 Due to the underlying insulin resistance found in most women with PCOS, it can be a challenge to lose weight effectively, even after appropriate dietary and lifestyle changes.15 
Thyroid disorders
Thyroid hormones play a critical role in the regulation of body weight through controlling energy expenditure.16 It is well known that thyroid dysfunction, namely hypothyroidism, leads to a lower resting metabolic rate, and weight gain is a primary symptom of the disorder.17 When considering the prevalence of hypothyroidism in men and women, women are 4-6 times more likely to be affected, and the incidence continues to rise.18,19 This means that an underlying thyroid disorder should be considered in a woman who is unable to lose weight. Furthermore, if a thyroid disorder is identified but a woman still has symptoms or is not losing weight, an alternative management strategy may be needed; many patients are underreplaced with levothyroxine therapy or do not receive the expected results.20 Interestingly, it has been found that improving TSH levels are not associated with weight loss; rather it is the free T3 and total T3 that are the most significant predictors associated with the greatest changes in body weight and resting metabolic rate.21 Unfortunately, most practitioners test TSH only. This may suggest that a simple TSH measurement may not be enough in a women struggling to lose weight, and more comprehensive testing may need to be done in a woman with suspected hypothyroidism.
Combined hormonal contraceptive use
It is very common for a woman to be using combined hormonal contraceptives, like the pill, vaginal ring, and the patch.22 Although their effects on weight and weight gain is debated, there is some evidence that suggests combined hormonal contraceptives may contribute to  weight gain in some women by causing fluid retention and increasing storage of body fat.22 However, weight gain and weight loss are both noted as side effects of hormonal birth control, and not all women are effected.22If a woman is using hormonal contraceptives and is struggling to lose weight, this should be explored as a possible cause.
Fluctuations in the menstrual cycle
Female hormones are much more complicated than male hormones; the fluctuations in luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogen, and progesterone throughout a woman’s menstrual cycle influence her caloric intake, cravings, exercise performance, and ability to build lean muscle mass.23,24 It has been found that in the second half of a woman’s cycle, her luteal phase, women are more likely to have dysregulated eating habits, with an increase in binge-like episodes.23During this half of the cycle, woman also have greater cravings for sweet foods.23 Moreover, these hormonal variations influence the ability of a woman to build lean body mass.24 Prior to ovulation, muscle strength is increased, and this phase of the cycle favors a gain in muscle mass, which contributes to a higher metabolic rate and further weight loss.24 Fluid retention that also can occur at times in the menstrual cycle can create the illusion that a woman is carrying more body fat.25
As reviewed, there are many physiological differences between the sexes that contribute to the ability to lose weight. Body composition and fat distribution clearly differ between genders, but one must also consider the effect of emotions, hormonal variances, and certain underlying conditions that may make it more challenging for a woman to lose weight compared to a man. Now, although it is true than men can lose weight faster than women, research shows that after about six months of a weight-loss program, the results even out and become similar between the sexes.2
This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues.
References:

1. Williams R et al. Obes Rev. 2015;16(2):171-186.
2. Millward J et al. British Journal of Nutrition. 2014;111:933–943.
3. Wu B et al. J Nutr Metab. 2011:391809.
4. Chumlea WC et al. International Journal of Obesity. 2002;26(12):1596–1609.
5. LeBlanc E et al. The Journal of Clinical Endocrinology & Metabolism. 2011;96(12):3855–3863.
6. O’Sullivan AJ. Obesity Reviews. 2009;10(2):168–177.
7. Wirth A et al. Obes Res. 1998;6(6):393-399.
8. Thompson SH et al. J Diabetes Obes. 2015;2(2):93-98.
9. Kemp E et al. J Cons Pol. 2011;34:211-229.
10. Tanofsky MB et al. Int J Eat Disord. 1997;21(1):49-54.
11. Ostrovsky NW et al. Eat Behav. 2013;14(2):145-148.
12. Weinsier R et al. Am J Med. 1998;105145-105150.
13. Teede H et al. Obesity Society. 2013;21(8):1526-1532.
14. Gambineri A et al. Int J Obes Relat Metab Disord. 2002;26:883–896.
15. Escobar-Marreale H et al. The Journal of Clinical Endocrinology & Metabolism. 2005;90(12);6364–6369.
16. Reinehr T. Mol Cell Endocrinol. 2010;316(2):165-171.
17. Mullur R et al. Physiol Rev. 2014;94(2):355-382.
18. Li H et al. Minerva Med. 2015;106(2):109-114.
19. Leese GP et al. Clin Endocrinol. 2008;68(2):311–316.
20. Chakera A et al. Drug Des Devel Ther. 2012;6:1–11.
21. Liu G et al. Int J Obes (Lond). 2017;41(6):878–886.
22. Informed Health Online. 2008. Accessed from: https://www.ncbi.nlm.nih.gov/books/NBK441582/
23. Leeners B et al. Hum Reprod Update. 2017;23(3):300–321.
24. Sung E et al. Springerplus. 2014;3:668.
25. White C et al. Obstet Gynecol Int. 2011;2011:138451.

Bronwyn Storoschuk, ND 
Bronwyn Storoschuk, ND is a board-certified naturopathic doctor trained at the Canadian College of Naturopathic Medicine. Prior to attaining her ND, Dr. Storoschuk completed her Bachelor of Science (Honours) in Kinesiology at Queen’s University in Kingston, Ontario. She currently works in private practice in Toronto, Ontario. One of her practices is located within an integrative fertility clinic, where she provides naturopathic care to individuals undergoing assisted reproductive technology (ART). Dr. Storoschuk integrates evidence-based medicine with the understanding of the body’s natural physiology and innate healing wisdom. She is passionate about empowering women to take control of their hormonal health and has a clinical focus in hormone balance, reproductive health, and fertility.Dr. Storoschuk is a paid consultant and guest writer for Metagenics.

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