The timeline of weight loss . . . and why it confuses doctors

Weightloss Scale

Weight loss is no small matter. It is a 7.0-on-the-Richter-scale health event that shakes and rumbles your body, complete with aftershocks and rubble in its wake.

Problem: The process of weight loss can be confusing to some people, particularly if you are tracking parameters such as insulin, blood sugar, HbA1c (reflecting the last 90 days of blood sugar fluctuations), blood pressure, triglycerides, and cholesterol values. It can be confusing to your doctor who, not recognizing the characteristic signature changes that accompany weight loss, may even make declarations like, “See! I told that Wheat Belly stuff would kill you!”

The best solution: Just accept that there will be changes as long as weight loss is ongoing until weight has plateaued for a minimum of 4 weeks (with some measures continuing to improve over a much longer period after the plateau, such as a rise in HDL). Only then is it a good idea to start checking lab values or other measures.

However, sometimes bloodwork becomes necessary for other reasons, or you have diabetes and have to track blood sugar. So it can help to recognize the changes that accompany weight loss–NATURAL, NORMAL changes that are simply a necessary part of the weight loss process.

What is weight loss? You recognize the outward signs, of course, such as a shrinking waistline. But the internal changes all result from the process of mobilizing fatty acids from fat cells that enter the bloodstream. Once in the bloodstream, fatty acids can travel as fatty acids, or they can be transported as three fatty acids bound to a glycerol molecule, in which case we call them “triglycerides.” Ongoing weight loss therefore means higher levels of free fatty acids and triglycerides. If you were to check a cholesterol panel, for instance, and your usual (pre-Wheat Belly) triglyceride level was 200 mg/dl, it could be 250 mg/dl–worse, yes, but due to the triglycerides being mobilized from fat cells.

Triglycerides interact with other blood components. (I call the VLDL particles that triglycerides occur in “the life of the party” because they “talk” to everybody.) The flood of fatty acids/triglycerides/VLDL modify HDL particles, causing them to be degraded more rapidly and resulting in lower HDL cholesterol values that appears to be a bad thing. An HDL of 50 mg/dl, for example, can drop to 33 mg/dl, a level ordinarily associated with higher cardiovascular risk. LDL particles can become enriched in triglycerides, thereby initiating the process of increasing small LDL particles of the sort that cause heart disease, though this effect is rather modest. Fatty acids and triglycerides block the action of insulin, thereby causing higher insulin levels, higher blood glucose, and higher HBA1c levels (or at least a failure to drop). Likewise, blood pressure responds to the flood of fatty acids/triglycerides by constricting (“endothelial dysfunction”) and causing higher blood pressure or a failure to drop.

But ALL of this is transient. Once weight plateaus and the flood of fatty acids and triglycerides slows back down to its maintenance rate, blood sugars plummet, blood pressure drifts down, HDL rises, triglycerides drop, LDL particles revert back to large, etc. Typically, you will end up with spectacular values and far less “need” for prescription drugs for diabetes, hypertension, high triglycerides, etc. Most people will end up with triglycerides of 60 mg/dl or less (especially if you supplement fish oil), HDL 60 mg/dl or greater (especially if you supplement fish oil and vitamin D), true measured (not the wildly inaccurate calculated value on cholesterol panels) LDL values that are lower (especially if you supplement iodine, get thyroid in ideal range, and properly cultivate bowel flora)–in other words, values that are ideal or near-ideal.

The effects can be partially blunted by taking fish oil, since the omega-3 fatty acids, EPA and DHA, activate an enzyme that lines arteries called lipoprotein lipase that accelerates the clearance of triglycerides/VLDL from the bloodstream. Exercise also blunts this effect, likely by increasing sensitivity to insulin and subduing the after-meal rise that also raises triglycerides. Cultivation of bowel flora can likewise limit these effects.

For unclear reasons (likely genetic variation), not everybody experiences the full range of effects during weight loss. But should you see such changes, understand that it is part of an obligatory and natural process but occurring in the midst of the world’s worst epidemic of weight gain and obesity, such that most doctors won’t recognize the physiologic consequences of weight loss.

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Dr. William Davis

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