T Nation

Help w/ Diet Resistant Metabolism


#1

OK ladies help me out!

I've been perfecting a weight loss system for a couple years now. So far I have had almost 100% success, and frankly the failures were people who gave up and went back to eating crap.

But this week I have hit a brick wall on a girl's metabolism that I have never experienced before. I really want to help her because she is desperate to have children and is married to a close friend. Theyve been trying for a year and the Doctor says the only explanation for no pregnancy is her weight.

History:
25 year old female, 5 foot 2 inches tall, 236lbs, of polish and english descent. Overweight since early childhood. She comes from a family of thin people and is the only overweight one. She has one aunt and a grandmother who were also overweight, but no parents or siblings are overweight.

In fact, her siblings are all thin and fight to keep weight on. 4 older sisters are same height and weigh in the mid 90s. She has a small skeletal structure under her weight, tiny hands and feet, small hips. Despite the weight she does have a waist, and an hourglass figure.

Medically she is in great shape. Low cholesterol, average blood pressure, quit smoking 2 years ago. Doctor proclaimed her in great shape except for her weight. Surprisingly strong in the gym, both upper and lower body. Can walk at 3.5 mph for 3 miles with less effort than you would expect from an average person. No sleep issues or breathing problems.

Her back is bothering her a lot, especially her lower back which is even tender to the touch.

She is vigorous and energetic, almost a type A personality.

Her eating habits were normal her entire life. There's no history of overeating. She's tried Atkins, Jenny Craig, Weight Watchers and Curves with no success.

Astonishingly, she's been eating a healthy diet and exercising for almost 6 months with no results. She tracked her eating in a notebook and supplied it to me. I calculated she's been getting an average of 1,600 calories a day with a 30/40/30 split between fats/proteins/carbs. Her workouts have consisted of:

Treadmill Intervals (HIIT) - 3.5mph (4 mins) to 6mph (2 mins)
Nautilus Rotation - Upper and lower body, 3 sets of 10-12 reps at max weight. She typically is in teh gym for 60-80 minutes. I've supervised a few workout and she works HARD.

I personally verified all medical reports, weighed her and took her blood pressure. Her husband verifies all reports of history and family. her sisters confirm she has never been an overeater. Husband also confirms her diet and exercise routine. They have lived together for 3 years and been married for one year. He has eaten and done the same exercise routine as her, but has lost 20lbs of fat and now looks fit.

Normally I would say someone is sneaking snickers bars at work, but this girl is MOTIVATED and BRUTALLY honest about her behavior and weight. She's extremely distressed and wants this weight off NOW. Psychologically she is in the right place and ready to lose the weight.

Problem:

I've put her on a strict no carb diet for Sun/Mon/Tues, then a moderate carb cheat meal on Wednesday. Then its back to no carbs for Thu/Fri, and then a carb re-feed on Saturday.

Here is a typical meal plan for one week:

Mon
Breakfast
2 hard boiled eggs
salsa
cheese
1 link apple chicken sausage

Lunch
1 low carb tortilla
1 diced grilled chicken breast with sauteed mushrooms
veggies
salsa
lettuce

Dinner
Chicken Thighs
Mashed Cauliflower with Riccota Cheese & Green Onions
Green Beans

Afternoon Snack
1 thick slice of a variety of lunchmeats
2 oz cheese (Cheese sticks or baby bell, or a mix)

Tue
Breakfast
2 hard boiled eggs
1 T Chan
5-6oz Polish Kielbasa Sausage

Lunch
Salad with Tuna & 1 oz feta cheese
Green Veggies
Crumbled Hard Boiled Egg
Bok Choi sauteed with Soy Sauce & Thia Chili Sauce

Dinner
London Broil
Thai sauteed Kale with Mushrooms

Afternoon Snack
Celery sticks

Wed
Breakfast
1/2 cup oats
t flax
2 t sliced almond
2 t dried cranberries
1 T honey
4 oz greek yogurt

Lunch

Grilled Chicken
Bok Choi sauteed with Soy Sauce & Thia Chili Sauce
Roasted Vegetables
Apple

Dinner
Flat Iron Steak
Couscous
Mashed Parsnips & Rutabega

Afternoon Snack
1 thick slice of a variety of lunchmeats
2 oz cheese (Cheese sticks or baby bell, or a mix)

Thursday and Friday are repeats of Monday and Tuesday.

Saturday is a repeat of Wednesday, but a dessert is permitted at Dinner.

I've NEVER seen anyone fail to lose weight on this diet. NEVER.

She's been on this RELIGIOUSLY for almost a month. She and her husband spend all afternoon on Sundays preparing her meals for the week. Both report no cheating and she even reports she has a hard time eating all of the food.

She's been exercising 3x a week at the gym and walking 2 miles on the days in between.

In 30 days she hasn't lost a single ounce. NOT ONE OUNCE! She's been weighed daily in the morning after urinating. Her weight hasn't even fluctuated much more than a few tenths of a pound.

Has anyone ever seen a person with this stubborn a weight problem? If so, how do you solve it?


#2

Yes, ME!!!
I was following plans to the T, and I was losing inches(good thing) but couldn't get the scale to budge..

Despite what everyone around me was saying(fat loss takes time, blah blah blah) I went to the doc just to cure my suspicions, and it turns out I have hypothyroidism!

Have you been taking measurements? I still battle my weight, but I have been getting it down with more cardio than I've ever done(still lifting of course)..I have gotten rid of all dairy and all gluten(wheat products. Found out I was gluten intolerant as a kid)..my eating is the most basic(boring) you can get! :stuck_out_tongue_winking_eye:


#3

How many times a week is she doing INTENSE cardio?

I see she is doing intervals, but for how long, how many times/week?

I did the walking thing in between days last summer..not intense enough for me..

I do 30 minutes of intense cardio after lifting 4x/week(like sweating, mouth breathing kind)...I attribute the cardio and clean eating to the progress I have been making lately..

As CT would say: "Don't lift to lose weight!"

Maybe she needs to step up the cardio..I know it SUCKS, but she could try for two weeks to see what happens!

I'm even going to add a walk/bike ride to my evening routine on top of what Im already doing..I've been in a plateau for a few weeks myself.

GL!!


#4

Interesting you should bring up hypothyroidism. I'll have her checked.

But don't let anyone else let that stop them from posting. I still want to hear any more suggestions!


#5

Has she ever complained of being fatigued or tired all the time?

I would definitely get her to get a basic metabolic workup to rule anything out!

I really can't see anything worth tweaking about the diet..it's pretty solid!

However, how is the timing of food?(carbs saved for PWO ONLY!) I'm assuming enodmorph..Where does she carry most of her fat? I only ask cause by doing some reading about the BIOSIG stuff, maybe she also has some cortisol issues, and also doesn't tolerate carbs very well? Keeping the carbs to PWO only helps with this!
And you say that she sometimes has trouble eating all of her daily intake..what about just letting her listen to her hunger cues?(eat when hungry, stop when satisfied, not FULL)

This has also helped me a TON!


#6

No complaints of fatigue. She's actually a pretty energetic person. She hates TV and prefers to be doing things like cleaning, walking and just being out and about in general.

How would you test for cortisol issues?


#7

Hmm, I know it can be as simple as a saliva or blood test..but if her doctors are anything like mine they won't want to do it "just because."


#8

MM - I really like the layout of the diet and don't really have a problem with the food choices as long as she handles gluten and dairy well... however, the thing that REALLY stands out to me is how low her calories are. I mean they are astonishingly low... like I am SHOCKED! She is eating LESS THAN 7 calories per lb of BW! Also, does her caloric intake vary from day to day? I know the macros change... but what about overall calorie intake?

In my experience it is ALWAYS a good idea to err on the high side when determining your client's calorie level!

Here is an excerpt from an article I just wrote (I am too lazy to re-write it right now =D)

"You can call me crazy ALL you want? but when a client is starting with me for the first time (and not prepping for a show, and doesn?t have a good idea of their maintenance calorie level) I always, always, always start them higher than I assume their maintenance level to be. First, if they are new to clean eating, they will likely have incredible results from just cleaning up their food sources. Second, and most importantly, it just makes sense! Individual metabolisms vary wildly and it can be nearly impossible to gather some information about someone and immediately know their maintenance calorie level. You have to experiment a bit and adjust accordingly. Well, if you unknowingly start someone at a calorie level that is too low for them, there is a good chance that their metabolism will stall and instead of losing body fat, their bodies? will begin to hold on to body fat with a death grip! Then, you are forced to bump their calories up to get their metabolism going again. So you are RAISING calories with a DEPRESSED metabolism? Does that sound like a GOOD idea or a BAD idea? Yeah? that?s what I thought! On the other hand, if you start them with higher calories, and they are not losing, you can pretty much rule out (in MOST cases) the idea that the calories might be too low? so you realize that you need to lower them. That?s fine? and in this case you are LOWERING calories with an ELEVATED metabolism. Now is this a GOOD idea or a BAD idea? A GOOD idea of course! So don?t be afraid to start on the high side if you are new to clean eating. If you have been undereating for long periods of time, slowly bump up your calories by 100 to 200 every week or two until you reach maintenance or slightly above. Your body with thank you!"

Just something to think about... this may be difficult seeing as how she said she sometimes has problems getting all the food in... if this is the case, you can always add plenty of healthful oils (they keep you satiated but tend not to give you the "overly full" feeling).

I also agree with Betty about getting her thyroid tested. Poor gal! I can't imagine coming from a family of super skinny people and working my butt off in the gym and eating well and seeing no results... I wish you (and her) the best of luck! Please keep us updated and get the gal some more food! =D


#9

Thanks so much for all the feedback!

After re-examining her diet I do agree there aren't enough calories. However, I'm not incredibly confident a thyroid issue is going to present itself with testing. We are going to get the test run this week anyway. I only say I doubt it because she displays no signs of hypothyroidism.

According to the definition, she needs to show a majority of the following symptoms:

* Fatigue - None, very energetic
* Weakness - None, strong in the gym
* Weight gain or increased difficulty losing weight - Yes
* Coarse, dry hair - No, beautiful long black hair
* Dry, rough pale skin - No, she has extraordinary skin, olive complected and youthful looking
* Hair loss - No
* Cold intolerance - No 
* Muscle cramps and frequent muscle aches - No
* Constipation - No
* Depression - Quite the opposite, bubbly personality
* Irritability - No
* Memory loss - No, very sharp
* Abnormal menstrual cycles - Yes
* Decreased libido - No, quite the opposite according to husband

Now, a BIG problem we are up against is her lack of appetite, especially in the morning. She's having a hard time eating the food on her plan NOW, much less more food. In the morning her foods have to be light. Things like omelette's, ham, turkey bacon etc all made her nauseous. She skipped breakfast altogether for most of her life and just getting her to eat anything before 10AM has been a major victory for us.

I have to make a correction as well. After my original posting, I discussed a few things with them and as it turns out she HAS lost some weight. She re-weighed yesterday morning and had lost 0.6 lbs. This was a morning right after a carb cheat meal, so I expect it's more like 1 pound once the associated water weight flushes out. It also turns out that she lost 15 lbs last year on the Curves diet, but had to quit because she couldn't tolerate eating all of the food. She was nauseous constantly. After switching to eating healthy and working out 3x a week she has lost a total of 9 additional pounds over 3 months.

That's slow, but steady progress in the right direction. I'm suspecting that if we can get her food intake up, her losses will increase.

So here are the NEW questions..

What other foods can you suggest for mornings that aren't meats and will comply with a very low carb diet?

Suggestions for snacks.

What other healthful oils can you suggest. Fish oil is out as it makes her very nauseous.

Thanks everyone!


#10

Hey Mighty Maus! Can she do any morning (fasted) cardio...? (she could always take BCAAs beforehand if possible)... I know this leaves me RAVENOUS throughout the day and many clients I have worked with (men AND women) who couldn't stomach much food started doing it and found that they were hungrier throughout the day.

If I am too lazy to cook or don't feel like eating in the morning I have a protein shake with heavy whipping cream instead of food. I like Muscle Provider in Chocolate from Beverly International (but it's expensive...)

so I mix half a scoop of that (for the flavor) with a scoop of Optimum Nutrition 100% whey in Double Rich Chocolate and a little cinnamon and some heavy whipping cream... a little crushed ice... in a blender... YUM! =D

I LOVE almonds, cashews, macadamias as a snack (raw or roasted).. she should put natural peanut butter on her celery stick snack too! 1-200 calories right there! =D

AS for healthful oils: coconut, walnut, olive, flax, heavy whipping cream, canola, krill oil, sesame <--- to my knowledge this is actually sold as a fat loss supplement under the name Sesathin and Sesamin on different websites... supposed to be awesome!

Then of course avocado, hard cheese, egg yolk, red meat, salmon, nuts, seeds, etc

Also, if she likes egg salad, one of my favorites is to mix 2 hardboiled eggs and 2-3 whites with a TBSP of light mayo and some sea salt... SO YUMMY warm or cold. You could always add more whole eggs and use full fat mayo if you are trying to get her to eat more calories.

Good Luck! Keep us posted!


#11

I can relate to not eating breakfast..to this day I still have to wait a couple hours to get the grumbly hungry feeling..even then it's usually cottage cheese/fruit..or a shake..


#12

Hmmm...I'm interested to see what you found out about her hypothyroid testing.

Please update us. I have similar issues with my weight loss, and i'm wondering if i should also get tested. But I'm curious, if it turns out your client does have hypothyroidism, what can you do to fix that?

Thanks


#13

I wonder if she has become insulin resistant? You say she eats spot on now, but how did she use to eat? I'm a guy whose fiancee in spite of a history of eating a clean diet, got up to a size 18 somehow. As we have now found out, she is insulin resistant with a fasting glucose of 100 and considered pre-diabetic. Her blood work numbers are good except for the glucose, so the doctor has put her on a low dose oral medication to control the glucose issue. This medication is supposed to make her lose weight as well, so we'll see.

I have a request if allowed; would you ladies be willing to post a full body womens' workout to help out the love of my life?
I must say up front there are back issue, so squats, dead lifts, and good mornings are not a good idea right now.

Thanks in advance,
KNB


#14

Echoing what some others suggested, she should have her thyroid checked. Be aware that ordinary physicians only submit blood work for standardized tests, which may not detect anything. An endocrinologist will be more thorough and will also check the pituitary gland. She should also have her adrenals checked for hypoadrenia, aka adrenal fatigue or adrenal insufficiency. As it turns out, if there is a problem with her thyroid AND adrenals, you HAVE to treat both. If you treat a sluggish thyroid while neglecting adrenals, you will not have successful treatment.

Unfortunately, I speak from experience. I had severe hypoadrenia, and most PCPs will not diagnose or treat the problem. It is very controversial and not widely accepted. Even most endocrinologists will not treat you unless you have an extreme adrenal disorder such as Addison?s or Cushing?s. Her best bet would be to go to a holistic MD, as they know what to look for and fully understand the seriousness of the problem.


#15

Taking into account everything you have provided, there are two things that jump out at me.

Weight gain or increased difficulty losing weight - Yes

Abnormal menstrual cycles - Yes

And also that she is having difficulty trying to get pregnant.

Has she ever been checked for PCOS (Polycystic Ovarian Syndrome) Its a hormonal imbalance. When left untreated can lead to symptoms resembling and/or diabetes and heart disease. Including insulin resistant.

They treat it usually with balance diet and birth control pills, because of the high androgen levels.

Does she carry her weight around the middle?

Also does she have skin tags, darkened patches of skin around the neck, groin, anywhere where there is a fold really?

If she has chronic lower back pain, and if she is carrying her weight in the abdomen, then will of course that makes sense.

And does she have sleep apnea?

When was her last OB-GYN appointment?


#16

Here is a couple sites that may be of help:

www.stopthethyroidmadness.com
www.realthyroidhelp.com

It's always helpful to have a list of questions to ask your provider, cause like it was mentioned, most don't take the time to explain things, and some don't even have a clue..grrr..I have an appt tomorrow with a real endocrinologist that I have been three months for!!

*Thanks to Karen(aka fitnesslady) for those links!! :wink:


#17

Aww...thank you so much sweetheart. and thank you fitnesslady.

I'm going to go search these
You're AWESOME!!!


#18

It does not sound like hypothyroidism to me.

She should definitely be tested for insulin sensitivity if possible.

Protein shakes are a great breakfast for people who hate to eat first thing in the AM (I'm one of them).

I can only think of two explanations at this point. The first possibility is that everything you say is true, so she has some RARE abnormality for which nothing can be done. (I would say something like lack of leptin, BUT I think that obese people with that abnormality typically eat a lot.)

The second possibility is that she is not maintaining or averaging a calorie deficit every day, or long enough to see the results manifest on the scale.

Those are the only possibilities really.

And by the way, even if calorie burn is lower than you'd like it to be due to hypothyroid, or medication, or hormones, or just genetics, you WILL still lose IF you maintain a deficit day after day, every day.

Now before we conclude there is a rare and unsolvable abnormality, you MUST rule out the simple and obvious lack of calorie deficit. But a couple things hint to me that with the right deficit she will lose. First, the fact that she lost weight at Curves in the past; and second, the fact that the scale is starting to show a result of the current diet.

Energy balance never fails. A person burns what they burn. You CAN increase burn in a healthy person by increasing their calories, but if they are leptin resistant, they WILL put on even more fat when they increase the calories. Therefore I would highly recommend that she use a Gowear Fit device to track calorie burn (or at least get a BMR test, but I prefer the Gowear Fit), METICULOUSLY track every calorie by measuring everything using a SCALE in grams and logged in FitDay, maintain a 20-30% deficit EVERY DAY, and over time she WILL lose.

You can log a deficit for awhile without seeing the scale move. This is because it can take days to lose an actual pound, because the body holds onto water making the weight fluctuate, and also because there is some little-understood mechanism whereby the body's maintenance of weight is more stable than calorie intake. But OVER TIME, the deficit never fails.

I have coached a number of people for fat loss who have a lot to lose. And EVERY TIME that they think they are eating so little, so clean, yet still not losing, it turns out that if I make them measure every single thing they put into their mouth on a scale, they are eating a LOT more calories than they think. For example, I have a man in his 60's who needed to lose 80 pounds. On pain medication that causes weight gain. Lost 40 easily on a low-carb diet. Probably very insulin resistant. When progress stalled, his reported diet was about 1600 calories a day. In the past, I would have believed he had ruined his metabolism. However, this time, I interrogated him like I'm an FBI agent or something ("Is there ANYTHING you ate that's not in the log? Oh, some jerky? Let me see the jerky. . .How much? About this much? How about these nuts here? Have any of those? A handful. . .") See what I mean? Turns out he was REALLY eating about 2400 calories a day. (Those "healthy fats" in the nuts add up FAST.) And guess what, he typically burns about 2400 calories a day.

Even though I have hashed it all out and done the math, he still FEELS as if he is hardly eating anything. But the objective reality is different. His body produces more hunger hormones now, because he's lost a bunch of fat. And some people always have a lot of hunger hormones, so intuitive eating even with a clean diet will never work for them.

It would be nice if he burned 3000 and we could drop from there, but he doesn't. He burns 2400. He's not going to lose eating 2400. He's not going to see the scale move every day if he eats 2000. It WILL take about 9 days to see a pound drop at that deficit, and water fluctuations will mask it. But over time, the objective calorie deficit doesn't fail.

And BTW, LBM is not that good of a predictor of calorie burn. This man carries a lot of muscle mass (I had his BF tested before the diet, of course), but nonetheless he only burns 2400. I've seen a 5'7", 119-pound sedentary female who burns 2800 a day.

With your friend, if she burns 1600 per day, she's going to have to drop to 1200 or 1000 to see progress. And 1600 is not necessarily a sign of a hugely damaged metabolism. It would be in the normal range for her height.


#19

Has she been tested for food allergies? Does she ever feel like she has to run to the bathroom or feel like food "runs through her" after eating certain things?