Jade Teta ND, CSCS
As a clinician in integrative & functional medicine, I often get the hard cases. Integrative medicine, while exploding in popularity, is still a specialty that is a little off the beaten path. Well, at least is an area where most doctors have almost no training at all. Its focus is on finding the underlying cause of illness not simply following protocol by putting a band-aid drug or surgery in place. Of course, I also span expertise into the fitness and weight loss world. One of the most difficult things I deal with is what many often refer to as a “metabolic damage” or a “broken metabolism“.
This is a condition where the nervous, endocrine and immunological systems lose their ability to function properly due to extreme weight loss measures or repeated dieting. In functional medicine we call it neuroedocrineimmune dysfunction, because these systems are not separate at all but have overlapping communication and integrated function.
What is Metabolic Damage and what makes a metabolism stop working and what can be done about it?
Imagine your physiology and every system in it as a see-saw that is constantly trying to seek balance. It bounces back and forth slowly and deliberately in a well orchestrated attempt to keep homeostasis. This is the dualistic and diphasic aspect of physiology that is summed up perfectly in the traditional Chinese medicine concept of yin and yang. The metabolism stops working when it becomes pushed and/or stuck on one side of the see-saw. This is very much like a 300 pound man sitting on a see-saw with a small child on the other end. The metabolism is unable to find balance no matter what measures it puts into place.
The metabolism also has a hierarchy. You have nervous system function and when that becomes disrupted, it negatively impacts the endocrine system (hormone system), and both negatively impact the digestive system which then leads to nutrient deficiencies, compromised antioxidant defense systems, damaged cell membranes and then all of this of course makes the nervous system more dysfunctional and a viscious cycle ensues.
So, you can think of metabolic dysfunction as a lot like dominoes, once one domino falls the rest are directly impacted and will likely fall as well.
Metabolic Dominoes
The nervous system is separated into two parts, the sympathetic nervous system and the parasympathetic nervous system. The sympathetic system is the alert, hyper-vigilant, stressed out side of the see-saw. It is often called the fight or flight nervous system as it was designed by our ancient physiology to protect us by mustering resources to deal with acute stress, like the sabertooth tiger.
The parasympathetic nervous system is the laid back, calm and collected side of the nervous system. It is often called the rest and digest nervous system as it was designed to help us recover, repair and adapt to stresses. The sympathetic parasympathetic balance in the body is often the first domino to fall in extreme or repeat dieting.
Stress pushes the see-saw in the direction of the sympathetic nervous system. But, when that stress becomes extreme, repeated or chronic the see-saw can get stuck in the on position. Extreme low calorie diets and heavy continuous daily cardio is the most insidious extreme diet stress. This is a classic example of pushing so hard and so fast on both sides of the see saw, that the see-saw eventually breaks.
A sympathetic system in overdrive that will not calm down is like an old lawn mower we had when I was a teenager. I would mow the lawn and when I finished would hit the off switch, but this old mower would just keep going for several minutes. One time it just kept going for like an hour and since my dad was not around to “fix it” I just let it run until the gas ran out. I think this is a good analogy to what happens with extreme dieting athletes and chronic repeat dieters.
When the sympathetic system gets stuck in the “on” position you wake in the morning with a faster heart rate. Your heart rate does not recover as quickly from a working bout of intervals. Your joints ache, your sleep is disrupted, you become more sensitive to bright lights, you may yawn repeatedly during the day and during your workouts, your motivation for exercise is low, you start holding water, you feel fatigued, you may get sick, you start experiencing digestive dysfunction (heart burn, IBS, gas and bloating) and you gain fat despite vigilantly adhering to the eat less exercise more model.
All this happens because once you tip the sympathetic see-saw the parasympathetic system is suppressed. This decreases stomach acid production and pancreatic enzyme secretions. Food is now more poorly digested leaving larger food particles lower in the digestive tract. Chronic stress also leads to atrophy of the lining of the small intestine and widening of the gap junctions in the intestines. Food sensitivities and reactivity increase. You may now notice foods that you once did great on seem to be causing issues. You also notice certain food combinations your friends seem to tolerate fine, no longer sit well with you.
The stress leads to inability for ligaments and tendons to recover. Your sleep is light and not refreshing. Your eyes stay somewhat dilated due to the stress hormones making you light sensitive. Your resting heart rate is elevated and your heart does not recover as fast from bouts of intense exercise (heart rate is all about sympathetic parasympathetic balance).
Hormonal command and control
The hypothalamus and pituitary gland (collectively called the HP) act as the command and control center of the hormone system and integrate the signals from the sympathetic and parasympathetic arms of the nervous system. So, when the nervous system is stuck in overdrive, the HP is the next thing to struggle. The HP has to then increase its hormonal signals to the rest of the endocrine system sending the entire metabolism into overdrive and overwhelming much of the regulatory balance antioxidant/free radical balance, acid/base balance, blood sugar balance, etc.
The hypothalamus and pituitary send signals to the adrenal, thyroid and gonads (ovaries and testicals). This is called the HPA, HPT and HPG axes. The adrenal and thyroid glands are part of the major metabolic engine for fat loss, so you can see where this is going. The over-stimulation of these glands greatly increases production of their hormones (catecholamines, cortisol, T3 and T4) and these hormones then feedback to the hypothalamus and pituitary. This is a delicate control and feedback system similar to a thermostat. The issue comes when the feedback to the hypothalamus and pituitary becomes too strong. This leads to down-regulation of the receptors for these hormones, not just on the hypothalamus, but in other cells all over the body. This is called hormone resistance and it is not a good thing for your metabolism. If this goes on for too long, it essentially breaks the metabolic thermostat and you see all manner of weight loss resistance. These are the people the twenty something ego driven bodybuilders scoff at in disbelief and simply label them lazy gluttons. Ignorance in any field is expected, we simply don’t know all there is to know, but when ignorance is combined with arrogance it is a dangerous combination.
So, the HPA, HPT and HPG axes stand for hypothalamus-pituitary adrenal/thyroid/gonadal axis respectively. Clinically I can tell you these three systems have significant overlap, but the usual progression of dysfunctional dominoes starts with the adrenals, then the thyroid and finally the gonads. This is why women who are athletes, extreme dieters or chronic dieters who lose their ovulation and menses, may have a much harder time getting the metabolism back online.
This is one of the reasons many people will complain of low thyroid like symptoms but have normal thyroid numbers on a lab. Unfortunately, physicians have no great tools to measure adrenal function so they only catch the issue after the thyroid is involved already (we use a very effective clinical salivary cortisol test in our clinic that is incrasingly being utilized to deal with this issue). When this fatigue and lack of metabolic responsiveness kicks in, it is wise to look to the adrenals first.
This is where the term “adrenal fatigue” comes from which is a rather unscientific term and not a true clinical diagnosis. It is used in the same way overweight is used relative to obesity. Before you become obese you are overweight. Well adrenal fatigue is just a way to explain the adrenal dysfunction seen clinically prior to a diagnosis of adrenal insufficiency. All conditions are on a continuum, long before you wake up with a diagnosis there was smoldering metabolic dysfunction occurring. Adrenal fatigue is a term used to describe adrenal dysfunction occuring before a diagnosis is made. Fatigue is the number one complaint general care physicians see and almost all of this fatigue is from adrenal fatigue.
A brief note about adrenal fatigue, some say this does not exist just as some said fibromyalgia, chronic fatigue syndrome, sub-clinical hypothyroid, insulin resistance and a host of other medical diagnosis did not exist at one point. This is another example of individuals simply not knowing what they don’t know. If you don’t like the word adrenal fatigue than use over-training, post-traumatic stress, chronic stress disturbances or some other name of your liking as they all describe elements of varying degrees of adrenal dysfunction. Adrenal fatigue can be measured both clinically and in the laboratory.
Downstream effects
After the nervous and endocrine system become dysfunctional, the dominoes begin to fall very quickly. Digestive function is usually the first to go and this is not always perceived by the individual. This causes decreased absorption and assimilation of nutrients further disrupting metabolic function.
One of the more insidious insults for those losing extreme amounts of fat is the damage to cellular and mitochondrial membranes that are without adequate antioxidant defenses, fatty acids and phospholipids for repair. The immune system also sufferers leaving individuals susceptible to multiple illnesses and frequent colds and flus. Food intolerances may begin to surface and reproductive dysfunction occurs with men and women having decreased libido and women losing ovulation and menses.
The Metabolic Rehab Protocol
To fix this issue the see-saw imbalance that started the dominoes falling in the first place needs to be fixed. If its not you simply keeping knocking down the dominoes after putting them back up. This is what is essentially being done when people use stimulants or supplements or detoxes or any other number of quick fixes that don’t deal with the real cause of the problem. A sure sign you have missed it is when you feel a little better, but never lose the weight again and never feel quite the same.
1) Balance the sympathetic and parasympathetic. This is the hardest for chronic and extreme dieters because it requires you to STOP the incessant cardio. No, cardio is not evil but when taken to the extreme it is the most common cause of this dysfunction especially when combined with low fat low calorie diets.
This must be done carefully though. A person eating less and exercising more who just stops cold turkey and starts eating more and exercising less with blow up like a water balloon. So, step one is to balance the see-saw by eating less and exercising less. This can be accomplished by eating much higher protein and fiber based foods allowing you to quell the hunger and cravings that are a huge part of this issue. Doing things this way allows you to eat unlimited quantities of certain foods while still keeping calories low.
Now, you can stop the cardio and move to two forms of activity
- Traditional weight training with plenty of time between sets (3-5 minutes between sets). This is the original interval training as it teaches the body to exert and then recover. You can also engage in short complete recovery intervals. This means you push hard for 1 minute and then you move in slow motion until the heart rate returns to resting before repeating (limit this to 20 minutes or less). The most dysfunctional metabolism will only be able to do one work bout because the heart rate will never return to resting. This method allows you to measure your progress
- Leisure walking, restorative yoga (not intense power yoga) and/or tai chi. All of these train the parasympathetic nervous system to regain function. Some will need brain chem training as well such as cognitive behavioral therapy and mindfulness meditation to quite the mind which can be an insidious trigger for sympathetic overdrive.
2) Restore HPA axis function. This is done through exercise as well as through supplementation. The relaxing adrenal adaptogen herbs work very well in this regard with the two best clinically for us at metabolic effect being Rhodiola Rosea (RO-DEE-OH-LAH) and Ashwaghanda (ASH-WAH-GON-DAH). Both work to restore HPA function and protect from further stress effects, Many women experiencing ovarian dysfunction will likely benefit from Vitex berry as well.
3) Digestive Repair. This part i a topic all its own as getting the digestive tract back on line takes a systematic and layered approach. We use what functional medicine docs call the 4R program.
- R= Remove offending agents (foods, infections, etc) that are compromising GI function.
- R= Replace digestive enzymes and/or HCL that was suppressed from high sympathetic (fight/flight) and low parasympathetic (rest/digest) function
- R= Repopulate with good bacteria that aid gut integrity and immune system balance.
- R= Repair the atrophied gut lining from chronic stress
4) Replete nutrients. When digestion is restored nutrient repletion is started with focus on zinc, magnesium and the B-vitamins. This includes the use of fat and amino acids to restore brain chemistry which can lift peoples depression and anxiety. Vitamin D is another issue that needs to be looked after here.
5) Restore membrane integrity. This comes from fat supplementation along with phospholipids. Krill oil is the best and most useful oil in this regard as are saturated fats.
6) Finally, metabolic restart happens. This is where we switch over to more stimulating adrenal adaptogens including the ginsengs and begin to use mitochondrial factors lipoic acid, acetyl carnitine, and co Q 10.
Total time for the metabolic rehab protocol depends on the person as their is much individuality and tailoring to the person. Typical time period for recovery is 3 to 12 months (some shorter some longer)