Podcast Rewind: The Secrets to Effective Weight Management

Dr. Robert Rountree

This is The Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet supplements and lifestyle approaches to good health. I'm Dr. Robert Rountree, Chief Medical Advisor at Thorne and functional medicine doctor.

Dr. Frank Lipman

And I'm Dr. Frank Lipmann, New York Times bestseller and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the food and drug administration.

Dr. Robert Rountree

Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease. Hi, everybody. Welcome back to the Thorne podcast. How are things going for you, Frank?

Dr. Frank Lipman

Good. I'm enjoying this hybrid life or going to the office once, sometimes twice a week and I'm doing the rest from home. And one day I do virtuals from my grandson, from my daughter's place so I'm actually quite enjoying this hybrid lifestyle.

Dr. Robert Rountree

It's become a whole new way of doing things.

Dr. Frank Lipman

Yeah. We're lucky enough that we can sort of work from home. So we blessed.

Dr. Robert Rountree

Yes, very much so. So let's get into the main topic for the week. We're going to talk about... Are you ready?

Dr. Frank Lipman

I'm ready.

Dr. Robert Rountree

Weight management.

Dr. Frank Lipman

OK.

Dr. Robert Rountree

OK. Weight management.

Dr. Frank Lipman

Well, I got some very strong, clear thoughts on that because I think there's so many weight myths out there that maybe we should bust some of them.

Dr. Robert Rountree

What do you do when someone comes into your office and says, "I need to lose weight." How do you approach that? What are the kind of questions you ask? And do you do a workup? Do you think they need a workup? What kind of lifestyle issues are concerned about?

Dr. Frank Lipman

Sure. So the first thing I tell them is, "I'm not a weight loss doctor and I'm not here to just help you lose weight. My job is to help you get healthy and as a side effect, you're going to lose weight." But I don't specifically do things to lose weight. But to me, focusing on the weight alone is not particularly helpful. I'm always very clear with people. It's about getting healthy. When you get healthy, you'll lose some weight as a side effect. The second thing I say to them that you can't out exercise or outrun a bad diet. It's not about calories in and calories out. Food's much more complicated than that. There's a complicated hormonal response to different foods and it's not just about calories. Counting your calories is not the way to go.

What I do is a normal workup. I'll do a workup for metabolic health. I'll do an advanced lipid panel. I'll do a hemoglobin A1C. I'll do all my normal markers to see what's going on and then I just correct the underlying imbalances. We start off with paleo type of diet, a low carb diet, because I've seen that as a starting point. Seems to be the most effective. Most people will get the most bang for their buck by cutting out the sugars, the refined carbs. Just cutting back on the carbs, especially in the older population. So that's where I'll start. When someone comes in, after taking their history, I'll put them usually on a low carb diet.

Always will look at stress and sleep because if there's cortisol is too high at night and they're not sleeping, it's going to affect the other hormones which is going to be hard to lose weight. And for the same reason, if they're stressed out causing high cortisol is going to affect the insulin and ghrelin and leptin and all the other hormones which is going to affect their weight. So just once again, it's a comprehensive lifestyle management program that is going to get them to get healthy and as a consequence, lose weight.

Dr. Robert Rountree

So you said a few interesting things and I want to key in on this notion of the high cortisol. A number of years ago there was a book out called The Schwarzbein Effect. You might remember, I think her first name was Diana Schwarzbein. I met her and we became friends and dove into her book. She was certifying people in her method, et cetera. But what I really dove into, what I realized the main thing she was saying is, "If people go to super low-calorie diets, it raises their cortisol and the cortisol makes them gain weight." As far as I can tell that's what the Schwarzbein effect was, is simply saying this excessive calorie restriction causes problems. Your adrenal glands stress out because they think you're starving and your cortisol levels go up. Is that your take on it too?

Dr. Frank Lipman

Yeah. I would agree with that. The most important thing I tell patients is, "It's about creating a lifestyle that's going to work for you. It's not about putting you on a diet. It's finding a way of eating that's going to work for your metabolism and get you healthy." So yes, I would agree with that.

Dr. Robert Rountree

So here's a little anecdote for you, is a number of years ago I was at a conference and I got introduced to this guy who, I'm not going to name any names, but he was the CEO of a major weight loss company. One that everybody's heard of that people go to and they weigh in and they get their shakes and their diet plans and all that stuff. But he had retired from the company and I said, "Well, I bet a lot about the optimal ways for people to lose weight." And he said, "No, what I learned was the optimal way to keep people coming back in."

Dr. Frank Lipman

Right. No. Yeah. I'm not surprised with that.

Dr. Robert Rountree

A little bit of a cynical view but in a way he was saying this whole weight loss thing, the popular methods of weight loss are bogus.

Dr. Frank Lipman

Right. The one thing I didn't mention is as with anything else, the workup is going to determine if there's a thyroid issue. But for the most part, I always start people off on a low carb diet. And sometimes in the last few years of getting more and more into recommending some intermittent fasting for people. Now, some people lose some weight on that, some people don't. I don't really use it for weight loss, but consistently what I will find when we do time restricted eating is their lipid profile in particular and their metabolic numbers improve, which is, I find quite interesting. Has that been your experience?

Dr. Robert Rountree

Yeah. I mean, all the numbers seem to improve on this overnight fasting, TRF regimen. One question I would have for you is like, "Do you see a magic number that a person has to hit?" So the kind of classic recommendation is 16 hours of overnight fasting, nothing but water or black coffee. And then putting all your calories into an eight-hour window. Do you think people need to go 16 hours overnight to see those benefits?

Dr. Frank Lipman

I would say 14 to 16 seems to be the case, but I've actually seen... What I find so interesting, and I'm sure you'll concur, when you do this a long time... Some people do fine just with 12 hours but I'd say as a general rule, 14 to 16 hours seems to be what works. What I also have found, people who do more intensive fasting don't seem to get that much better results. I mean, I think at around 14 to 16 hours is great, but once you start going further and further, doesn't seem to improve the results that much more.

Dr. Robert Rountree

Well, then that jumps right back to what Dr. [Diana] Schwarzbein used to say which is, "When you get super restrictive, overly restrictive, it stresses the body."

Dr. Frank Lipman

Yeah.

Dr. Robert Rountree

But I think if people can build up to going 14 hours or 16 hours, which is beneficial in a lot of other ways. I just had a client yesterday who has gone into remission from multiple myeloma. He's engaging in a 16 hour, overnight fast every night and he feels great. He's really healthy, robust, working out. So I think it's good for you in a lot of different ways.

Dr. Frank Lipman

Right. And I think, let's talk about it, because it's that hormetic stress. The concept of hormesis that a little bit of stress is actually good for your body. It stimulates autophagy, it works in a positive way on the longevity genes as opposed to Schwarzbein concept. So a little of stress, that hormesis, a little bit of fasting is good, but too much may not be good. So you want to just talk a little bit about, what hormesis that little bit of stress does to the body?

Dr. Robert Rountree

Well, I think it actually came out of research that was done on certain toxins. Where it was found that low doses of toxins in some cases could be beneficial including one that's surprising, which is dioxin. That it's not just a straight linear curve and the more they began to study this, the more they began to realize that different substances like hormones have different effects at different levels. And then that kind of spread to looking at lifestyle issues. And that brought in this whole concept of the Wim Hof method which is the idea that jumping in super cold water, taking an ice bath, kind of shocks the body a little bit. I know there are people now that have these tanks in their office. Where these cryo tank that you climb into, I've been in one. You get in this tank and it sprays you with liquid nitrogen.

So it cools your skin to a very low temperature. And it only does this for a couple of minutes. Not enough to cause harm, but the idea is that that kind of brief exposure to stress tends to reset your body. And that's what's called the hormetic effect is that a little bit of a stress whether it's a toxin or maybe a supplement like sulforaphane from broccoli sprouts, broccoli seeds. The broccoli sprouts are not working as an antioxidant, they're hormetic agents. They actually stimulate the body to respond to the stressor, and that stimulation improves metabolism. So I've had a lot of people that do the Wim Hof method and say they found it very, very helpful. It improves their energy. They lose weight doing that every day. I'm not one to jump into ice cold water but I'd say if they're willing to do it, I will encourage them to do it.

Dr. Frank Lipman

Yeah. What I tell people to do is you can do it at home. You have a hot shower and you just finish it off with half a minute of a ice cold shower.

Dr. Robert Rountree

And you do that?

Dr. Frank Lipman

I actually go from the sauna into a cold plunge, yeah.

Dr. Robert Rountree

Oh, good for you.

Dr. Frank Lipman

And then sometimes back into the sauna and then... But I love it. It's so invigorating. I love it.

Dr. Robert Rountree

Well, I do watch people. I go for a swim twice a week at my gym and they have a cold plunge right at the end, in the corner of the pool room. And I see people go jump in there and I think, "OK. That's good for you."

Dr. Frank Lipman

It's easier to actually jump into something like that than put the cold water on in a shower to be quite honest. That's been my experience. I have a harder time putting the cold water in a shower after a hot shower on than jumping into a cold pool after my infrared sauna.

Dr. Robert Rountree

Now, what do you think about the role of the microbiome? I mean, there are studies showing you can take skinny rats and get the poop from a fat rat and transplant it into the skinny rat and the skinny routs get fat. So let's talk about that.

Dr. Frank Lipman

Absolutely. In my experience has been absolutely that an altered microbiome is probably one of the common causes of weight loss. In the old days when I used to have a cleanse, my cleanse was really just using anti-microbial herbs to balance the gut or to kill the bad guys. I hate that term "in the gut." I used to put people on basically as sort of elimination diet and use anti-microbial herbs and the weight loss results were incredible and that's why it became so popular because people were losing weight. And I think it was because we were correcting the microbiome to say, "Yes, I do see that." And I always tell people that because I'd say at least half the people I see in my practice, probably three quarters. For some reason, I've become known as fixing people's digestions, but a side effect of when you correct your microbiome is weight loss. So yes, I think that's obviously a very common cause of weight gain. I have some ideas. Why do you think that's so common? Never mind the research, but clinically, why do you think this altered microbiome is such a common cause of weight gain?

Dr. Robert Rountree

Well, I think that there are toxins in our environment that probably the top of the list is glyphosate, the main ingredient in Roundup, that are affecting our gut microbes. I mean, glyphosate, people don't know this, but it was originally licensed as an antibiotic.

Dr. Frank Lipman

Exactly.

Dr. Robert Rountree

It was an antibiotic. So here's the substance that is basically ubiquitous in our food. I mean, they found that in wine and beer.

Dr. Frank Lipman

Do you know why it's ubiquitous? Because farmers use it to speed up the drying process on a lot of grains and a lot of beans in America, are sprayed with glyphosate not because they need it, but because it speeds up the drying process that helps the farmers get it out earlier. So yes, it's totally ubiquitous. And it's permeated the whole American food system.

Dr. Robert Rountree

And it's killing off the good guys, and it kills the good guys and the bad guys. Whereas interestingly enough, I found that I often can put people on berberine, which is one of our favorites that we talk about a lot. And I see people lose weight from the berberine. Now that could be the mitochondrial effect but it could be changing the microbiome.

Dr. Frank Lipman

And its effect on glucose metabolism, maybe that too. But yes, I always use berberine as part of my anti-microbial treatment for the gut, yes. And I think it has multiple effects.

Dr. Robert Rountree

The other thing that I use a lot for weight loss is green tea. Is it through the caffeine or is it the green tea polyphenols that are doing it? I'm not really sure but there are a lot of studies on green tea for weight loss. Now, if just drink green tea then you need six cups or more a day. If you take something like the green tea phytosome which is easier to absorb, you don't need nearly as much just a couple of cups a day.

Dr. Frank Lipman

But I think for listeners, most important, is once again is weight gain is telling your body that something's not working well. It's a pointer to some imbalance. So as fatigue is, weight gain is just another symptom that you need to look at. What are you putting into your body that needs to be removed? Is a too much sugar? Is a too many foods with glyphosate? Are you too angry? Are you too stressed out? And what do you need to add? Do you need love in your life? Do you need some more sun? Whatever it is, what do you need? Are you deficient in certain nutrients? So it's the same concept. Most symptoms always look for, "Why are you presenting with a symptom?" And rather than just treating the symptom, look for the underlying problem or problems.

Dr. Robert Rountree

I totally agree. I think I made the comment about the mainstream weight loss organizations and how they're just focused on calories in, calories out. How much you exercise, how many calories do you eat and not thinking about the quality of diet, which you've already mentioned, but also they almost never talk to people about toxins. We've mentioned glyphosate, which is just one of really thousands of toxins that people are exposed to. There's a concept that I talked to docs about when I do trainings and detoxification, which is that the solution to pollution is dilution. That if we have a high toxic load in our body then we'll actually put on body fat as a way to dilute the concentration of the toxins. And so that takes us down a whole different pathway of not only cleaning up the microbiome but cleaning up the total toxic load.

Dr. Frank Lipman

Yeah.

Dr. Robert Rountree

And I know you've actually developed products for detoxification and have really gone down that pathway in some details. So detoxification, I think, is a legitimate thing even though if you read the New York times or the mainstream media says detoxification is all hoke and that there's no data that toxins are hurting us. I just think that's crazy. I mean, that's not in keeping with the research.

Dr. Frank Lipman

Right. Especially in this day and age.

Dr. Robert Rountree

How can they make an assertion that the... They say, "Oh, these invisible toxins are hurting us." Well, absolutely. The data is there. We've got animal data on it. It's pretty clear. You and I see in our practices all the time, you lower the amount of toxins and people feel better. They have more energy and they lose weight as a result of getting the toxins.

Dr. Frank Lipman

Right. What I always tell people that we do have normal detoxification mechanisms in the body. The problem in this day and age we just overloaded with so many chemicals and toxins because our bodies internally are making toxins, that's normal. But when we have so many external toxins coming in added to that, it just overloads our normal detoxification systems. So you've got to try, firstly, remove as many toxins as possible and secondly, add or replace or support your body's own detoxification mechanisms. And there are certain nutrients that can do that. And most companies make sort of detox formulas where they add a lot of the nutrients that support phase one and phase two detoxification pathways in the liver.

Dr. Robert Rountree

Absolutely. As I've mentioned several times in this podcast, one of my favorites is sulforaphane which comes from broccoli seeds and broccoli sprouts.

Dr. Frank Lipman

OK.

Dr. Robert Rountree

All right. Now, so we got to take a short break and then we'll get back and take some questions.

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And we're back. So now it's time to answer some questions from the community. Our first question this week comes from a listener who asked, "After ‘The Biggest Loser,’ the reality TV show, almost all of the contestants regained the weight they lost." Why is that, Frank?

Dr. Frank Lipman

Well, I would guess because they haven't dealt with the underlying issues that are causing the weight gain. As we always say, "You've got to look for why the oil light went on." One way is just to put a Band-Aid over the oil light. If you're not dealing with the underlying issues, it's just going to come back. That's the first thing. The second thing I would say is my, my experience has been, you want to make whether it's food or exercise or what lifestyle changes you want to create healthy habits for people and encourage them to make changes that are doable. I don't think there's just one way. The Biggest Loser is what I can't even. I don't know. Not even sure what they did.

Dr. Robert Rountree

Exercise, yeah, like crazy.

Dr. Frank Lipman

Yeah. But that's not going to work for everyone. You've got to adjust the treatment protocol and the management to whoever's sitting in front of you as a patient, where their heads are at what they're able to do and sort of take them along. And once again, look for are there any underlying issues, whether it's adrenal fatigue that we keep talking about or something else that is causing that. And if they have metabolic syndrome and they're not on a low carb diet and not dealing with that, that's going to come back if they start eating a high carb diet again, if they're not having dealt with a thyroid issue or whatever it is.

So that would be my answer. You got to deal with the underlying issue otherwise it'll come back and you've got to... There's no one way to treat. Everyone's a little bit different and you've got to sort of adjust accordingly and really tell people, "This is a new way of eating. This is not a diet. This is not a quick fix. This is a lifestyle it's about getting you healthy. And once you start getting healthy, you are going to lose the weight." So that would be my answer.

Dr. Robert Rountree

I totally agree. It's all about a long-term lifestyle transformation. That's what you got to do. And a TV show wants something that's flashy. Big flashy intervention that seems to work. But they don't want to ask that hard question of, "What's that person doing in a year or two years?" Every weight loss study that comes out, you got to ask, "Did the researchers look into that issue? Did they come back and do the follow-up in a year or two?" Otherwise it's meaningless.

Dr. Frank Lipman

Right. Absolutely. OK. Here's an interesting question that I get asked all the time. Bob, the question is, "How can I boost my metabolism?"

Dr. Robert Rountree

Well, kind of the simple answer to that is getting your body into a fat burning mode. How do you get the body into fat burning mode? Where do you burn most of the fat? In your muscles. So the more muscle mass you have, the more fat you're going to burn. And studies that have looked at that have said, "It's got to be a combination of not just a aerobics but also resistive exercises. Lifting weights, that sort of thing. So exercise is good because it bulks up your muscle mass but it's got to be a combination of exercises. And I've certainly seen people at my gym that are on the treadmill week after week after week and you see these people over months and they don't lose weight. So just getting on the treadmill for an hour or three times a week is clearly not enough to do it.

It's not a bad thing to do but it's not going to bulk up their muscles enough to make a difference. It's got to be this complete combination of exercise. So that's number one. Number two, I got to say the research on caffeine is pretty good. So for people that don't have adrenal stress where you worry about the downside of caffeine, a little bit of caffeine, especially the form of green tea, is great. So one thing I recommend a lot to people is Matcha tea, which is a powdered green tea, about a half a teaspoon twice a day. It's got just enough caffeine to stimulate the metabolism without keeping people awake at night. So I recommend that. And I also like alpha-lipoic acid, which makes mitochondria work better. It's a weird thing but I've put people on alpha-lipoic acid to a few hundred milligrams a day and seeing them start to lose weight.

Dr. Frank Lipman

And that also may be related to sugar metabolism I think.

Dr. Robert Rountree

Yes.

Dr. Frank Lipman

Yeah. I love alpha-lipoic acid. I think it has such a multi faceted nutrient that helps so many pathways.

Dr. Robert Rountree

Yeah, absolutely. So Frank, are all fat people diabetic?

Dr. Frank Lipman

Interestingly, not. I would have thought that too actually but I actually, and this happens fairly often. I mean, someone will come in and they are overweight and are just assume that they're diabetic or pre-diabetic at least, and I get their bloods back and their numbers are pretty normal. So I'd say a lot of overweight people are probably diabetic or pre-diabetic, but not necessarily. I mean, I've seen a good number who I've always expected their labs to come back abnormal and they're not. Now, they obviously have mechanisms that are metabolizing the carbohydrates pretty well. So the answer would be no.

Dr. Robert Rountree

Yeah. I agree. And you can have thin people who are diabetic.

Dr. Frank Lipman

Yes.

Dr. Robert Rountree

Thin people with type two diabetes. So metabolism is a tricky thing and you can't just go by the outward appearance. I think part of the explanation is what we mentioned earlier was the microbiome. Is you can have somebody with the type of microbiome imbalance that causes them to extract a lot of energy from food. So they eat a little bit of food and it goes a long way. They eat a little food, they extract a lot of energy from it. They don't have to eat that many calories and sure enough they put on fat.

Dr. Frank Lipman

Right.

Dr. Robert Rountree

So it really has to do with more of their metabolism of, "How do they burn fat and what's their muscle mass?"

Dr. Frank Lipman

Right. OK. So here's a question. Talk about the harm of weight stigma among healthcare providers.

Dr. Robert Rountree

Well, I think what this question is asking is do a healthcare providers judge people for being fat. And it's not as uncommon as you might think. You might think that a person is trained in medical school or PA school, whatever they went to, that they would simply look at a problem as being a problem instead of having a character judgment going along with it. But there's actually been studies on this and they showed that a lot of doctors will assume that when they have an overweight patient coming in their office, they assume that they just eat too much and they are lazy. I do think that's a big problem.

Dr. Frank Lipman

Yeah. I agree. And once again, it goes back to what I always tell my patients, "I'm here to help you get healthy. Your weight will come off as a side effect. So it's not about your weight, it's about your health. If we get you healthy, the weight won't be an issue." So I always turn it around to, "How do I get someone healthy?"

Dr. Robert Rountree

So we just need to educate healthcare providers more to understanding that concept that it's not about laziness and it's not about picking out on food.

Dr. Frank Lipman

Right.

Dr. Robert Rountree

So my doctor says weight is tied to thyroid. Can you explain more or elaborate on that one?

Dr. Frank Lipman

Yeah. Well, it could be tied to thyroid because if your thyroid is not functioning optimally, if you've got a dysfunctional thyroid hyperthyroidism. One of the symptoms is weight gain. It's as if a pedal on the accelerator is not working properly so you'll feel tired. You'll maybe have dry skin but you can gain weight. So that is one cause of weight gain but probably not one of the common causes or they're not an uncommon cause. So yes, it can be tied to low thyroid function, but definitely not always. It's one of the blood tests or the tests that need to be done. You always need to rule out hypothyroidism or low thyroid function but it's not always tied to thyroid function.

Dr. Robert Rountree

Yeah. I agree. And I think it's important to point this out because I do have clients all the time who are overweight and say, "Hey, can you just give me some thyroid?" And I say, "Well, let's test you and if the testing is normal. I mean, completely normal." Their TSH is right in the middle of the range and their T4 and T3 are good then I tell them, "The chance that taking thyroid is going to help you is almost zero." And I know doctors that have gotten the trouble that say, "OK, I'll give it to you anyway." The medical boards don't like that. So I don't encourage just using thyroid as a weight loss intervention. It doesn't work unless you've got subclinical hypothyroidism or full on hypothyroidism.

Dr. Frank Lipman

I agree a hundred percent, a hundred percent. Here's a really interesting question. "A lot of popular dieting techniques look like eating disorders, for example, intermittent fasting. What strategies are safe? Are there any that don't trigger trauma for people who formally had eating disorders?" That's a good question.

Dr. Robert Rountree

Well, yeah. I mean, that's a really touchy situation and I've actually heard talk in the audience when I've been listening to lectures on fasting, et cetera. I've heard people in the audience say, "Hey, wait a minute. This is not good for a certain segment of the population." I think that for most people that don't have eating disorders or trauma around food, then the fasting, intermittent fasting, time-restricted feeding tends to be uniformly beneficial. I mean, there's study after study showing that but you've got to pre-screen people. If somebody already has obsessions about food or obsessions about their weight, that's not the kind of person that you even want to bring this up in the first place. So that's really where the safety issue comes in is doing a really good screening, really good questionnaire on your patient and saying, "OK, this is not the kind of person that I'm going to make that recommendation for."

Dr. Frank Lipman

I agree a hundred percent. I think people with a past eating disorders or eating disorders, one has to be very, very tricky with putting them on a diet or, as you point out, even intermittent and fasting. So yes, I think history of eating disorder is something that needs to be dealt with very delicately and just slowly trying to shift people into a healthy way of eating rather than telling you're putting them on a diet as such.

Dr. Robert Rountree

Yeah and I agree. I mean, the scenario I was thinking about, this person was lecturing to... it was a doctor lecturing to a lay audience. I think maybe the doctor could have been a little bit more careful in framing it that way of saying, "If you've got an eating problem then I'm not going to recommend this." So how can I improve my health regardless of my weight?

Dr. Frank Lipman

Once again, weight is just, as I always said, a side effect. You improve your health by changing your lifestyle by removing what could be harming you and adding what you deficient in. As simple as that. A lot of it is by lifestyle changes, taking care that you sleep well, dealing with your stress, moving your body as much as possible and taking the crap out of your diet.

Dr. Robert Rountree

I fully, fully agree that it's all about kind of a complete approach lifestyle, it's not one. I think people are saying, "Is there one specific thing? Is there one specific supplement I should take, et cetera?" And I don't think that's the case. I think it's an all of the above. All right, folks. So that's all the time we have this week. Appreciate your listening and tuning in and thank you, Frank, for sharing this podcast with me.

Dr. Frank Lipman

And thank you, Bob. It's always such a pleasure. Thanks for listening to The Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice.

Dr. Robert Rountree

If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @thornehealth. You can also learn more about the topics we discussed by visiting Thorne.com and checking out the latest news videos and stories on Thorne's Take 5 Daily blog.

Dr. Frank Lipman

Once again, thanks for tuning in and don't forget to join us next time for another episode of The Thorne Podcast.