Why Diet and Exercise Don’t Always Work

Fact: Most people can’t lose weight and keep it off just by focusing on calories and exercise. Millions of Americans who exercise and diet still can’t drop all the pounds they want to—or keep off the pounds that they manage to lose initially.

Why not?

It’s because weight loss (or the tendency to gain weight) depends on thousands of biochemical reactions that aren’t affected just by exercise and calories. Most people need a multilevel approach to get their weight where they want it.

Here’s what to do…

Prevent Insulin Surges

Research has shown that high insulin triggers food cravings, particularly cravings for high-carbohydrate (and ­calorie-rich) foods. And elevated insulin stimulates the liver to convert blood sugar into fat.

One cause of elevated insulin is a low-fiber diet—most Americans consume only about 15 grams a day, far less than the 30 to 50 grams that many experts recommend.

People who increase their fiber intake by eating more fruits, vegetables, legumes and other plant foods feel less hungry. They’re less likely to load up on fattening, sugar-rich foods. More of their blood sugar is burned as energy—and less is stored as fat.

Bonus: Fiber can help reduce cholesterol and reduce the risk for heart disease, high blood pressure and diabetes.

My advice: Look for foods that contain at least 5 grams of fiber per serving. A single cup of lentils, for example, has about 15 grams of fiber. A large apple has about 5 grams, and a sweet potato has about 6 grams.

Many of my patients take advantage of high-fiber powders or drinks. These products typically contain 10 grams or more of fiber per serving—some contain as much as 30 grams. Supplementing with fiber can help if you’re not getting enough from “real” foods. Make sure you choose a fiber supplement that does not have a lot of sugar added.

Important: Drink at least a few extra glasses of water a day when you’re increasing fiber. Fiber absorbs water in the intestine and can lead to constipation if you don’t stay hydrated.

Beware of Sleep-Deprivation Cravings

It’s estimated that about 60 million American adults don’t get a good night’s sleep. Sleep deprivation causes the body to produce more ghrelin (an appetite-stimulating hormone) and less leptin (a hormone that suppresses hunger).

Research has shown that sleep loss tends to trigger cravings for “quick ­energy” foods such as sodas and snacks. Paradoxically, these are the same foods that ultimately can increase your overall fatigue.

My advice: In addition to better sleep hygiene—such as keeping regular hours, not watching TV or using a computer in bed and avoiding late-day caffeine—sip a cup of chamomile tea about an hour before going to bed. It’s a natural tranquilizer that will help you fall asleep more quickly. Lemon balm tea has a similar effect.

Also helpful: Talk to your doctor about taking 100 mg to 200 mg of a ­magnesium supplement daily at bedtime. It’s a “calming” mineral that helps the brain shut down at the end of the day.

Reduce Cortisol

Cortisol is a hormone that slows ­metabolism and causes more calories to be stored as fat. Cortisol also stimulates appetite and increases levels of neuropeptide Y, a substance that triggers carb cravings.

Chronic stress increases cortisol. People have gotten so accustomed to living in a high-stress world that they don’t even notice they are stressed. But your body notices.

Warning: Elevated cortisol causes more of the body’s fat to be stored in the abdomen. Abdominal fat increases the risk for heart disease and other serious conditions—and is harder to lose than other types of fat.

My advice: Ask your doctor for a saliva test for cortisol. It will indicate how much (or how little) stress you really have. I have found that people who test high get really motivated about taking life down a notch—with exercise, meditation, fun hobbies, etc. The test typically costs between $50 and $150 or more and may be covered by ­insurance.

Lifestyle changes will help most people cope with stress more efficiently, but they don’t work for everyone. You may need a nutritional supplement to reduce cortisol. I recommend combination products because they tend to work better than single-ingredient supplements. The active ingredients should include magnesium and the herbs ginseng, ashwaghanda and rhodiola. Ask at your pharmacy or health-food store for recommendations. Take the dose listed on the label.

Reduce Inflammation

If you’re overweight, you can assume that you have ongoing inflammation in your body. Unlike the acute inflammation that accompanies wounds and infections, such chronic inflammation occurs when the body continues to produce inflammatory substances (such as cytokines) even in the absence of injuries or infections.

The body’s adipose (fatty) tissue produces C-reactive protein and other chemicals that fuel inflammation. Chronic inflammation makes the body resistant to the appetite-suppressing ­effects of leptin. It also interferes with the breakdown of fat and causes fat cells to get larger.

Inflammation also has indirect effects on your weight. Suppose that you have rheumatoid arthritis, asthma or another inflammatory condition. You’ll naturally be less active and more likely to gain weight.

My advice: Ask your doctor to test you for indicators of chronic inflammation. The tests might include CRP (C-reactive protein), ESR (erythrocyte sedimentation rate) or an inflammatory cytokine profile.

Also, eat less meat, fat and processed foods (which tend to be inflammatory) and more plant foods. A ­Mediterranean-type diet is probably ideal because it’s high in anti-­inflammatory compounds—from fish, vegetables, olive oil, etc.

Deal with Menopause

The average woman gains 12 to 15 pounds or more during menopause. This is partly due to an age-related drop in metabolism. In addition, the menopausal decline in estrogen causes the body to seek this hormone elsewhere—and fat cells are the primary source. The result is that your body works harder to convert calories into fat. The increase in fat slows your ­metabolism even more, which promotes even more weight gain.

My advice: Hormone therapy is an effective way to prevent menopause-associated weight gain. See a doctor who specializes in bioidentical natural hormone replacement. Bioidentical hormones don’t appear to have the same health risks that have been linked to synthetic hormones.

Also important: Exercise for at least 30 minutes three to four days of the week—more if you can. A combination of aerobic exercise and strength training is ideal. Regular exercise helps counteract the drop in metabolism caused by menopause-related fluctuations of estrogen, progesterone and other hormones.