Image by burin kul from Pixabay
We’ve all heard the usual “calories in-calories out” equation for weight loss: in theory, if you burn more calories than you consume, weight loss should follow.
For some people, it’s really that simple. Unfortunately, for many, it isn’t. But why not, especially for those who are really doing everything right: intermittent fasting, a paleo or a keto diet, regular and even intense exercise like HIIT or cross-fit, all the metabolic supplements like bergamot, berberine, cinnamon and etc?
What more do you have to do?
No wonder the weight loss GLP-1 drugs are so popular (even though their potentially severe side effects are finally getting a bigger spotlight, so their popularity may be waning at last.)
For people who are doing “everything right,” there’s usually an underlying feedback mechanism at play, sabotaging your best efforts. That mechanism generally stems from stress in one form or another, whether physiologic or mental/emotional.
Acute Stress, Adrenaline, and Cortisol
Anything your body perceives as stressful triggers a release of adrenaline, the primary neurotransmitter involved with the sympathetic (“fight-or-flight”) nervous system. Adrenaline leads to rapid consumption of glucose into energy, because it’s equipping you to fight or to flee. As glucose is consumed, insulin levels fall (you don’t need insulin when there’s no glucose for it to shuttle inside your cells, anyway.)
You need to replenish your glucose on the other side of this, though. Cortisol (considered the “stress tolerance” hormone, and your body’s natural steroid) then triggers your liver to produce glucose, in a process called gluconeogenesis. (If you’re not stressed, just fasting, the pancreas hormone glucagon stimulates gluconeogenesis instead, to keep your blood sugar stable between meals.)
Just as the pancreas secretes glucagon when it senses lower glucose levels, it secretes insulin when it senses higher glucose levels. Insulin ushers the newly made glucose from gluconeogenesis into cells, just like it does with newly consumed glucose from meals. Insulin itself provides the feedback mechanism to the liver, telling it, “We have enough glucose now, shut down the production.”
This is the way it’s supposed to work, once the stress is over, and you’re able to repair. But what if you’re living in chronic “fight-or-flight”: the constant sympathetic “freeze” mode?
Chronic Stress, Constant Adrenaline
If you’re living on adrenaline, you won’t be able to burn fat efficiently—breaking down glycogen into glucose in the liver is just quicker. If you’re running on adrenaline, your body assumes it’s in a life-or-death struggle, and will thus prioritize quick energy.
Not only will adrenaline block fatty acid breakdown, but you’ll have a constant demand for cortisol, too. Excessive cortisol over time will perpetuate high glucose production from the liver, and high insulin, leading to insulin resistance. Once that happens, visceral weight gain follows.
But what if your serum or salivary cortisol don’t consistently measure as elevated? Could this process still describe your problem?
Unfortunately, conversion of inactive cortisone to the active cortisol hormone can occur in the visceral adipose tissue itself—so once you’re carrying more visceral fat, a feed-forward mechanism might perpetually activate your cortisol locally, even if cortisol doesn’t measure high systemically.
Another possibility is that cortisol is still systemically elevated, just not at the times that you’re checking it. Obese individuals tend to maintain elevated cortisol at night, when it’s supposed to be at its lowest level—the expected rhythm in which high cortisol alternates with high melatonin tends to be substantially diminished in these individuals. So even if am cortisol on blood work, or salivary cortisol looks normal, the cumulative tissue exposure over a 24 hour period might still be quite high—again, leading to insulin resistance and weight gain.
To make matters worse, when you’re chronically stressed and inflamed, your body funnels your T4 from T3 (the active form of thyroid) into reverse T3 (the inactive form), effectively putting the brakes on your metabolism. It’s trying to conserve energy to deal with the perceived threat (whatever it is that seems to keep your adrenaline and cortisol running high). High reverse T3 leads to leptin resistance.
But how might this process get started in the first place—and what do we do to stop it?
Potential Stress Triggers
Maybe you don’t think you’re stressed. But if you’re “doing everything right,” there’s a chance that the goal of losing weight itself has become a stressor. You might be overexercising. You might be at a calorie deficit. You might just be feeling self-imposed pressure to hit a goal, or frustration that you’re not hitting that goal. All of these stress the body, triggering adrenaline and subsequent cortisol release.
These are the people who tell me they actually lose weight when they eat “junk food.”
Hear my caveat here: I’m not endorsing eating junk as a lifestyle, of course. But the point is, if your rules are excessively rigid, sometimes relaxing those rules a bit actually decreases the emotional stress those rules imposed. As a result, adrenaline drops, which means the body can now access its fat stores. Also, cortisol drops, which means less gluconeogenesis, which (despite the junk food) may lead to a net drop in glucose levels. Insulin begins to decrease, and metabolic flexibility improves. T4 stops funneling into reverse T3 and instead shifts to T3.
If this is you, it might be time to give yourself a little grace to bend–or break–the rules occasionally.
Sleep Apnea: Another Hidden Stressor
Maybe it isn’t anxiety about weight loss itself that’s triggering your stress though; the problem might instead be an underlying physical stressor. These might include anything that could trigger inflammation in the body, such as food sensitivities, a chronic infection, or a toxic burden.
Or, it might be the lack of one of the most important building blocks for metabolism: oxygen.
Sleep-disordered breathing can occur secondary to the weight itself, or from anything that might restrict airways, such as allergies, or other sinus issues. If you’re not getting sufficient oxygen at night, it triggers adrenaline release, as your body will naturally perceive this to be a stressor.
Chronic hypoxia at night also renders the body hypersensitive to hypoxia, leading to an elevation in baseline adrenaline levels, too. This is why sleep apnea often presents with hypertension—and it can also set up the vicious cycle of higher cortisol, higher glucose, insulin resistance, and visceral weight gain.
If you’ve been trying to lose weight for years, and you’ve been unsuccessful, consider a sleep study. These days, there are convenient, at-home, app-based options for this.
The Upshot
If you’ve done everything right and you’re still not losing weight, the next step is to consider whether there might be any hidden stressors—physical or emotional—that might conspire to sabotage your best laid plans.
