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January 18, 2017
Weight Loss & Hormone Imbalance:
The Missing Link

Now that the holidays have passed, practitioners around the country are working to help patients achieve New Year health resolutions. Likely at the top of the resolution list is weight loss; a poignant goal to work towards as patients are often aware not just of the health risks associated with excess weight, but also the more obvious feelings of frustration, low self-esteem and lack of self-worth. Practitioners should be armed with effective tools to help aid successful weight loss so patients are both physically and mentally fit in 2017.

Many patients are told that if the amount of calories consumed is less than the calories expended, weight loss will occur. However, this equation leaves out the complex interplay between hormones and the metabolic process. To illustrate this, a 2015 review from Molecular and Cellular Endocrinology describes how estrogen influences metabolism in both men and women. Estrogen seems to augment the sympathetic tone of adipose tissue depots differentially in men and women. Males tend to accumulate more visceral fat, leading to the classic android or “apple” body shape. Visceral fat has been correlated to increased cardiovascular risk, abnormality of fatty acid metabolism, increased oxidative stress, endothelial dysfunction, liver insulin resistance and inflammation, increased VLDL and small dense LDL particles, reduced HDL cholesterol levels and excessive production of adipokines.

In contrast, females tend to accrue more subcutaneous fat in pre-menopausal years, which appears to protect against the negative health consequences associated with obesity and metabolic syndrome. Estrogens and their receptors influence adipocyte cells’ ability to expand, enhancing deposition in the subcutaneous depot and inhibiting it in the visceral depot. After menopause, adipocyte deposition morphs into a more visceral pattern. This shift is accompanied by a parallel increase in metabolic risk eerily reminiscent to that seen in men. Further support of this pathophysiology comes from a 2013 study, which finds estrogen in women protects against adiposity, insulin resistance, type II diabetes, and also regulates energy intake and expenditure. During menopause, a reduction in estrogen coincides with a shift towards a metabolically compromised android phenotype.

Estrogen imbalance is not the only culprit to hormonally linked weight gain. Testosterone is also a key hormone in the pathology of metabolic diseases such as obesity. Low testosterone levels are associated with increased fat mass (particularly visceral adiposity) and reduced lean mass in males. The Journal of Diabetes Complications reports a study suggesting that low testosterone and elevated estradiol may be associated greater risks of insulin resistance and type II diabetes by interacting with overall and central obesity in adult men.

Notably, estrogen replacement in deficient postmenopausal women, and testosterone replacement in androgen-deficient men have been shown to favorably modulate body fat distribution and cardiometabolic risk to various degrees.

Just as this hormonal imbalance pattern seems clear, it is important to also note that while estrogen deficiency is correlated to visceral adiposity, excess estrogen is also problematic. Inappropriate estrogen function, due to excess estrogen or stimulation with xenoestrogens such as bisphenol-A, can actually provoke insulin resistance by exhausting beta-cells through insulin overstimulation. Insulin resistance and elevated blood sugar levels, as part of the metabolic syndrome picture, are linked to excess visceral adiposity. As with so many medical pathologies, it is the overall balance of hormones, neither excess nor deficiency, that is necessary for stable metabolic processes.

Weight loss can be one of the most elusive aspects to manage in patient care. While research overwhelmingly agrees that excess weight has deleterious effects on health, effective weight loss tools are often underutilized in many clinic settings, often because the vast majority of the work accomplished in order to achieve weight loss is done outside of the clinic setting itself- mainly dietary and exercise improvements, which can only be done by the patients themselves. However, patient education on the connection between hormone imbalance and excess weight may be the missing link for more successful outcomes. Helping patients understand the role of sex hormones in metabolism can help to remove much of the self-blame that so often accompanies excess weight, and lead patients towards participatory and proactive treatments.

Behind the healthy, vital patient is a positive outlook on life and a loving relationship to the physical body. With education, patients often feel empowered and more energetic as self-confidence and self-esteem improve, and a positive mental outlook may synergistically improve long term health. When patients are frustrated by their inability to lose weight, even after improvements in diet and exercise have been implemented, use Labrix’ Comprehensive Hormone Panel to elucidate potential hormone imbalances. Shed some light on metabolic disruption to assist patients with shedding the pounds.

References:
  • Li J, Lai H, Chen S, Zhu H, Lai S. Interaction of sex steroid hormones and obesity on insulin resistance and type 2 diabetes in men: the Third National Health and Nutrition Examination Survey. J Diabetes Complicat. 2016.
  • Nadal A, Alonso-magdalena P, Soriano S, Quesada I, Ropero AB. The pancreatic beta-cell as a target of estrogens and xenoestrogens: Implications for blood glucose homeostasis and diabetes. Mol Cell Endocrinol. 2009;304(1-2):63-8.Nadal A1, Alonso-Magdalena P, Soriano S, Quesada I, Ropero AB.
  • Palmer BF, Clegg DJ. The sexual dimorphism of obesity. Mol Cell Endocrinol. 2015;402:113-9.
  • Rettberg JR, Yao J, Brinton RD. Estrogen: a master regulator of bioenergetic systems in the brain and body. Front Neuroendocrinol. 2014;35(1):8-30. levonorgestrel-containing combined oral contraceptive. Psychoneuroendocrinology. 2013;38(7):1133-44.
  • Tchernof A, Després JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93(1):359-404.
  • Zhang H, Sairam MR. Sex hormone imbalances and adipose tissue dysfunction impacting on metabolic syndrome; a paradigm for the discovery of novel adipokines. Horm Mol Biol Clin Investig. 2014;17(2):89-97.
Disclaimer:

All information given about health conditions, treatment, products, and dosages are for educational purposes only and do not constitute medical advice



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