What does a Resting Metabolic Nutrition Assessment look like?
We use something called a medgem, (good faq here: https://www.doylestownhealth.org/services/nutrition/medgem-metabolism-analysis )
How long does it take?
What can we do with that resting metabolism data?
The medgem will provide us with an accurate measured value of a patients calorie need. From this number, our clinical team can compare this actual measured calorie need vs what we would predict a patient calorie needs may be. Based on this information, we create a customized nutrition plan based on eating the right amount of fuel.
Additionally, when a patients measured number is less than what we predict it should be; we know there are opportunities to help a patient beyond nutrition. IE, this is often a signal for some patients there is underlying hormone imbalance, thyroid imbalance, trouble processing glucose/fuel which acts on the storage hormone insulin.
For example, a patient may measure 1400 calories, however we predict the patient should require 2000 calories. This means the patient’s metabolism is sluggish or lower than expected by 30%! So, this tells us two things: 1. When a patient says, “I’m really only eating xyz, ie not eating too much, etc but not losing weight; this number tells me they are ‘telling the truth’ ie it validates why they are not losing weight.” 2. It also tells us we need to work on several things, ie eating the right amount of fuel (not too much/little) which can make a patients metabolism worse and work on underlying reasons why the level is too low (hormones, thyroid, exercise, type of fuel, etc).
So, it becomes intuitive to patients… IE we actually need to measure what’s happening in your body to create a specific action plan. We can’t just guess. No different than trying to guess with a financial plan or budget; often this strategy is prone to significant error and can make things worse long term.
- How does that pertain to hormones?
So, there are several key hormones which act on metabolism.
- We look at insulin and leptin, which are critical hormones your body uses to process fuel.
Insulin is the storage hormone of all carbohydrate fuel in your body. All carbs require insulin to be processed and stored. Insulin as a blood test can let us know how well this hormone is working in your body. If insulin is elevated/too high, it will cause your body to ‘store’ carb fuel more frequently as fat. You can also become ‘resistant’ to insulin; meaning your body gets used to having too much of this hormone around in response to too many carbohydrates (sugars/starches) in your diet. Once this happens, it’s like ‘crying wolf’ ie the body get sensitized to this excessive insulin and ends up needing to store the excessive fuel. Once your body has too much insulin or insulin exposure; your body starts accumulating a hormone called leptin.
Leptin is a protein that’s made in the fat cells, circulates in the bloodstream, and goes to the brain. Leptin is the way your fat cells tell your body that your energy thermostat is set properly. When leptin is elevated, which we see commonly at Blue Sky MD, it literally tells us who needs to be more careful with both the amount of fuel and who will respond better to a lower carbohydrate diet. It also tells us who may have trouble with hunger and cravings; and who may need additional tools (medications/supplements) to help these symptoms. We also know once a patient has elevated leptin, their bodies have a memory, ie they are prone to have elevated leptin (estimated to be between 8-15% of the population) and need to be mindful of carbohydrate intake forever. At Blue Sky MD, we teach to a ‘threshold’ or amount of carbohydrates a patient can tolerate and this varies significantly across patients.
- Testosterone, a cornerstone hormone for both men and women
Testosterone in the context of maintaining a healthy weight is critical to many patients long term success. Testosterone is responsible for maintaining lean muscle mass. We know testosterone declines 1-2% per year from our peak, typically in our 20’s and can drop even faster with poor lifestyle choices; ie a bad diet and lack of weight bearing exercise. So, when you have more lean muscle mass, which is preserved by optimal testosterone levels in men/women, your resting metabolism is better, ie higher and therefore you are able to take on more calories/fuel without gaining weight. Also, lean muscle mass is where most (90%!!) of your insulin receptors are located; ie the more muscle you have, the less prone you are to trouble with the hormones insulin and leptin. And the more carbohydrate fuel you can take on.
So, at Blue Sky MD, we look carefully at testosterone levels and make sure they are in an optimal range. We have studied this for over 10 years with thousands of patients and this is a critical factor to both maintain your weight loss and help you lose weight more efficiently by preserving lean muscle mass. When some people lose weight, they lose muscle mass, ie sarcopenic weight loss, which has a negative long term effect on yoru metabolism. We want to lose fat not muscle!
Additionally, testosterone is your ‘sense of wellbeing’ hormone; so it typically makes you feel better/have more energy, drive/motivation, lessen depression and sleep better. All of these factors have been proven to impact weight both positively and negatively.
- Thyroid hormone, your thermostat
At Blue Sky MD, we take a comprehensive look at your thyroid hormones. Your thyroid is key to maintaining your metabolism and often can be sluggish; if you have been trying to lose weight long term and calorie restricting too much, have autoimmune disease like lupus or rheumatoid arthritis or suffer from long term depression or mood disorders. The thyroid is a good ‘short term’ compensator and can carry you through stressful times for months, not years. Often, we see patients who have had long term stressors, both physical/mental who have trouble with their thyroid. We can often help your thyroid recover through both low dose thyroid replacement, naltrexone and lifestyle changes. It’s important to note, balancing thyroid helps your body reset, so your efforts are more successful. IE, replacing thyroid alone will not help you lose weight typically, however it can make your efforts more successful.