So you can relate to last week’s article and are constantly depriving yourself and doing regular exercise. But you can’t seem to lose weight or keep it off. What next?! Here are a few tests that I would recommend you get from your doctor. We as physicians, must do a much better job assessing and addressing these physiologic barriers patients have to successful weight loss. Unfortunately, an accurate assessment may take more than the typical eight minute office visit and more than the basic laboratory assessment typically done for patients.
Tests to request from your physician:
- Basal Metabolic Rate — this measures the number of calories burned per day at rest. It is done via a device that measures the amount of oxygen burned over a ten minute period in the office. If low, this is diagnostic, but if normal it does not rule out a low metabolic rate because stress during the test can falsely elevate the results and studies show that while some may have a “normal” metabolic rate at rest, the problem is that they burn significantly less calories than normal during exercise.
- Leptin – a leptin level above 12 shows leptin resistance (laboratory “normal” ranges cannot be used because they include overweight and insulin resistant individuals)
- TSH, free T4, free T3 and reverse T3 to adequately assess tissue thyroid levels (free T3/reverse T3 ratio should be > 2 to be optimal)
- Glucose, average glucose (HgA1C) and insulin levels to check for insulin resistance.
- Sex hormone binding globulin (SHBG) can be an indicator of low tissue thyroid levels (should be greater than 70 in women and 25 in men).
- Urinary iodine — low iodine can cause thyroid resistance (too much can cause low thyroid, as well).
- C-reactive protein (CRP) — inflammation decreases cellular T3 production (should be less than 1).
- Homocysteine – a marker for low thyroid and low B vitamins (should be less than 9)
- Lipids — high cholesterol is a marker for low thyroid and high triglycerides is a marker for insulin resistance
- Iron and ferritin – adequate iron levels are required to activated thyroid, so many symptoms that people attribute to anemia with low iron is actually due to low tissue thyroid activation
- Vtamin D — should be greater than 80
- Thyroid peroxidase antibodies (TPO) and antithyroglobulin antibodies — looks for autoimmune thyroid disease.
- The muscular reflex time — this has been shown to correlate with the degree of tissue hypothyroidism and to be a better indicator of tissue thyroid levels than standard thyroid function tests
If the physiologic barriers to weight loss are not assessed and treated, you will likely suffer from a life-long inability to lose weight, resulting in an increased risk of heart disease, diabetes and mortality, as well as a life-long frustration and reduced quality of life and self esteem. After a thorough assessment to determine the physiologic abnormalities is complete, proper treatments and options that address your dysfunction are presented, then you too can be on the way to your optimal body weight!