Each month, we'll ask one member of our Expert Panel to write an article they think will be of interest to our readers based on their area of expertise. This month, Dr. Keith Berkowitz shares his insights on what could be keeping you from losing weight when you think you're doing everything right...

Keith Berkowitz began his practice using low carbohydrate nutrition and complementary therapy as an associate of Dr. Robert C. Atkins in 1999. He later joined The Atkins Center for Complementary Medicine and served as Medical Director and Business Director. Prior to joining The Atkins Center, Dr. Berkowitz spent five years as a faculty member in the Department of Medicine at North Shore University Hospital, Manhasset, New York in addition to supervising and teaching medical students as a clinical instructor at New York University School of Medicine, New York, NY. He is currently founder and Medical Director of the Center for Balanced Health in Manhattan.


"Weight loss is easy. Just reduce calories and exercise more."

I must have said this to hundreds of my patients. Despite my urging, less than a handful of individuals were actually successful. My advice was based on conventional practice. I now know the weight loss principle of "eating less calories and exercising more" will not always result in weight loss. For those of you who are "following doctor's orders" and are not getting results, there is still hope. Your lack of progress may be due to an underlying medical condition.

How can I be so confident in telling you this?

It's based on my experience as Medical Director of The Atkins Center for Complementary Medicine. My interest in Dr. Atkins' medical philosophies began in 1999. After speaking with him, observing his practice, doing my own investigation into supporting research, and following this diet myself, I began my own journey of rediscovering the practice of medicine.

Dr. Atkins taught me that weight loss and improved health is attainable by using complementary approaches to medicine and nutrition (controlling carbohydrates, using healthy fats and nutritional supplements.) I shared these fundamental concepts with one of my colleagues — another physician. He used my nutritional advice to lose 30 pounds and then run his first marathon at age forty. Five years later, I continue to provide this health advice in my practice, the Center for Balanced Health.

One of the greatest lessons I learned was that generalizations about "easy weight loss" should not be made. Open dialogue is important. I listen to patients describe common symptoms that help me target medical screening and identify the reason why they are unable to lose weight despite following a strict diet regimen. Many people try relentlessly to lose weight. Unsuccessful weight loss only leads to extreme frustration and depression — especially when no-one recognizes your hard efforts.

There is hope.

Your inability to reach weight and health goals may not be your fault. Weight loss plans need to be individualized, and in certain situations medical guidance is needed.

What you need to know is that underlying causes of resistant weight loss are common. Factors such as excess insulin production, under-active thyroid gland, undiagnosed hormonal imbalances including polycystic ovarian syndrome, yeast overgrowth, and the use of prescription medications can sometimes make weight loss almost impossible.

Balance your health and you will lose weight. These are medical issues better resolved with the guidance of a knowledgeable physician.

Insulin Resistance:
Many of the medical conditions we treat at the Center for Balanced Health have one common denominator: Insulin. Insulin is involved in:

• Regulating blood sugar
• Increasing fat storage
• Changes in hormone levels (estrogen, progesterone and testosterone)
• Metabolizing carbohydrates, fats and proteins

This underscores its role in weight and health. Elevated levels of insulin alone can be the underlying cause of resistant weight loss, diabetes, unstable blood sugar, hypoglycemia, metabolic syndrome, heart disease, increased blood pressure, hormonal imbalance, polycystic ovarian syndrome and certain cancers. It is the direct relationship between carbohydrates and insulin that make what we eat so important to our health and well-being. Unlike fat and protein, 100% of carbohydrates turn into sugar or blood glucose. So high carbohydrate diets promote spikes in blood sugar causing excess insulin production. Insulin promotes fat storage — one of the reasons why these individuals are not successful losing weight.

Under Active Thyroid:
An under-active thyroid is another factor that interferes with health and weight control. The American College of Clinical Endocrinologists estimates that 1 in 10 Americans have an under-active thyroid and that 50% of these people remain undiagnosed. Thyroid hormone plays a major role in regulating metabolism, energy levels, depression, body temperature and in keeping the brain, heart and muscles functioning well. Besides the symptoms of unexplained weight gain or resistant weight loss, individuals can experience slow heart rate, low body temperature, depression, dry skin, thinning hair, decreased sex drive, joint pain, muscle aches, high cholesterol, and fatigue.

Typically a thyroid condition remains undiagnosed and therefore is not treated. In addition to medical treatment, it's important to consume adequate amounts of carbohydrates and not to consume excessive amounts of soy or soy containing products which can decrease thyroid function.

Hormonal Imbalance:
Another factor potentially affecting weight control is hormonal imbalances (i.e. estrogen, progesterone, testosterone and DHEA). In women, a hormonal imbalance can be responsible for symptoms of fatigue, weight gain, decreased sex drive, sleep disturbance, fertility problems, mood swings and hot flashes. In fact, polycystic ovarian syndrome (PCOS) is a condition characterized by obesity, excessive facial hair, infertility increased testosterone levels and irregular periods, affecting approximately twenty percent of American women. Unfortunately, PCOS is very often overlooked and under diagnosed.

Although not typically considered, men suffer from hormonal imbalances too and experience similar symptoms: weight gain, fatigue and decreased sex drive. Because carbohydrates directly effect insulin and in turn insulin impacts hormone levels (i.e., estrogen and testosterone), controlling carbohydrate intake along with balancing hormones is part of any successful treatment.

Yeast Overgrowth:
An overgrowth of yeast (Candida) is still another cause of weight gain and resistant weight loss that affects health. Yeast, a normal inhabitant of our digestive system, tends to overgrow in a "high sugar" environment or when the immune system is compromised. Chronic illness, weakened immune system, stress, the use of certain medications, high blood sugar, and excessive alcohol intake can all cause yeast to flourish. If you have symptoms of diarrhea/constipation, gas and bloating, gastric reflux, post-nasal drip, "brain fog", fatigue, increased appetite, headaches, rashes and multiple food allergies, it's likely you have yeast overgrowth.

Avoiding foods that are fermented or moldy and taking away the "high sugar" foods that yeast thrives on will help. Supplements should also be used in order to boost the immune system and restore healthy digestive flora.

Medications can hinder weight loss too. Some examples of common prescription medications that affect weight include: steroids, hormone replacement therapy and birth control pills in addition to medications for diabetes, high blood pressure, arthritis, and depression. In this situation, a knowledgeable physician can help you achieve success by tapering medications as needed and suggesting nutritional alternatives when appropriate.

Weight loss is not solely dependent on reducing carbohydrates or calories or increasing activity. Medical conditions can affect ones ability to lose weight. If you are not achieving weight and health goals, it's not your fault. Speak with someone who can help you. Identify underlying reasons of resistant weight loss in order to balance health and improve well-being, and you'll achieve results and improve your quality of life!

                                Keith Berkowitz, M.D.
                                Medical Director, Center for Balanced Health
                                www.centerforbalancedhealth.com


Copyright © August 2004  Keith Berkowitz, M.D. and Low Carb Luxury