Weight Loss: An Integrative Medicine Approach
Online Health Chat with Lyla Blake-Gumbs, MD and Kellie N. Kirksey, PhD
Tuesday, April 8, 2014
Controlling your weight can be a struggle in today’s fast-paced lifestyle and fast food mentality. Managing your hunger while trying to keep off or lose pounds is especially difficult on restrictive diets that can lead to binge eating from fear of deprivation. Integrative medicine approaches weight loss differently by using holistic psychotherapy techniques, such as hypnotherapy, mindfulness, relaxation and yoga. These techniques empower you to manage both your hunger and your weight by addressing body, mind and spirit. This can help you to adopt a brand-new relationship with food.
Through the use of mindfulness, relaxation and yoga techniques you can reduce stress eating, abandon “yo-yo” dieting and overcome food addictions. These techniques will also allow you to change the inner programming that can make sustained weight loss a challenge. This approach can help you readjust your metabolism to burn “hotter,” releasing unnecessary weight. Additionally, these techniques can also help you identify and release feelings that promote cravings and unhealthy eating behaviors. Instead , you will learn to identify what you are truly hungry for, and to work on attracting that into your life.
Hypnotherapy is used to help you shrink your stomach to its normal size. This will help you feel satisfied with smaller portions. Hypnosis also helps eliminate the desire for foods that poison your body. Hypnotherapy is also used to pair any triggers for binge-eating behavior with unpleasant associations in your subconscious.
About the Speaker
Lyla Blake-Gumbs, MD, is a board-certified family medicine physician in Cleveland Clinic’s Center for Integrative Medicine. She is also an Assistant Professor of Family Medicine at Case Western Reserve University (CWRU) School of Medicine. Dr. Blake-Gumbs has an interest in energy balance and chronic illness.
Dr. Blake-Gumbs completed a residency and internship in family practice at University of Texas Southwestern Medical Center at Dallas, Tx. She graduated from medical school at Hahnemann University School of Medicine in Philadelphia. Dr. Blake-Gumbs also completed further training as a fellow in the Case Comprehensive Cancer Center, and earned a masters degree in public health in epidemiology and biostatistics at Case Western Reserve University, in Cleveland. She earned her bachelor’s degree in toxicology from Northeastern University, in Boston.
Let’s Chat About Weight Loss: An Integrative Medicine Approach
Moderator: Let's begin with some questions.
Overweight with Associated Medical Conditions
iskiles: I have hypothyroidism. How does this affect the ability to lose weight as opposed to those whose thyroid works normally? Is there a way to "rev" up a slow metabolism?
Lyla_Blake-Gumbs,_MD: Hypothyroidism is rarely a cause of most people's difficulty losing weight. It can, however, affect weight—so for this and many other reasons, we always treat hypothyroidism. Once treated, however, it should no longer remain a major factor. The best way to stimulate metabolism is to perform regular cardiovascular exercise. Also, resistance training— by helping build lean muscle mass, this helps you to burn more calories at rest making you more "efficient" so to speak.
Gail Ann: Can you please offer weight loss suggestions to those who suffer from hypothyroidism?
Kellie_N._Kirksey,_PhD: I can speak from personal experience on this one. The first step is to make sure your thyroid levels are in balance. My T3 level was low and this really kept the weight on. Once I was able to increase my T3 by using Armour® Thyroid the weight really reduced. Clean eating is a huge help, taking grains out of the diet as well as plenty of movement. You may want to work with a nutritionist to get the assistance you need.
lfreem02: I have dysautonomia and started gaining weight about a year and a half ago after starting medication. I am currently taking Tenormin® (atenolol), Zoloft® (sertraline) (originally Lexapro® [escitalopram]), and Klonopin® (clonazepam). I have fatigue on a daily basis, but try to stay as active as possible. I participate in Zumba® and step aerobics classes three to four days a week. I walk, and take the stairs whenever possible. I occasionally run three miles, and lift weights a couple of days per week. I was a vegetarian for over 15 years, but switched to a plant-based, whole food diet about a year ago. I have also cut out 90 percent of sugar. I have issues with edema, so some of the weight is fluid. I lowered my cholesterol over 40 points since I eliminated all animal products, so I am seeing improvements there. I put turmeric in my smoothies to help with inflammation. I have been seeing an endocrinologist (my free urine cortisol has been 31, 56 and 27, but is not Cushing syndrome) and other doctors. I would like to know if there is anything I can try to help lose the 35 pounds I have gained.
Lyla_Blake-Gumbs,_MD: Congratulations! It sounds like you've been working very hard. You didn't mention how long you've been on this track, but my guess is that if you have been able to impact your cholesterol and changed your eating habits so substantially, the weight will continue to come off. Remember, slow weight loss will always be more sustainable than rapid, large amounts of weight loss. Your body requires time to reset its thermostat.
SMDTS: I have atrial fibrillation and a pacemaker. I take Tikosyn® (dofetilide) and Lopressor® (metropolol). I have gained significant weight in the last year. I also have to watch my sodium as it tends to get too low. I want to lose weight in a healthy way. Are there any special guidelines I need to be aware of due to the medications I take and my medical condition?
Lyla_Blake-Gumbs,_MD: Neither of these medications is typically associated with weight gain. However, I really applaud you for being aware of the challenges that weight loss may present—given both your medical conditions and your medications. That being said, going heavier on fruits and vegetables—as long as you don't also take Coumadin® (warfarin) —and reducing your intake of refined carbohydrates, sugars, and processed food is a good place to start. Try adding a tad of table salt to your night time meal (if your blood pressure is under good control) as this may help with the sodium regulation.
tori: I am 18 years old and slightly overweight. Ever since I was little, I have been overweight, but have tried several times to lose it. I have tried diets, exercising every day, and counting calories. Specifically now, for the past two months maybe I barely eat junk food or any sweets. I don't have a strong appetite, so my food portions really are very small. I exercise almost every day. I am also taking Adderall® (amphetamine and dextroamphetamine) for ADD/ADHD (attention deficit disorder/attention deficit hyperactivity disorder). I just don't understand why I can't seem to lose weight.
Lyla_Blake-Gumbs,_MD: Firstly, it would be helpful to see your physician to rule out any kind of medical contributions to your difficulties losing weight such as problems with your thyroid, insulin resistance or other hormonal imbalances. Next, meeting with a nutritionist or dietician to get a firm understanding of what your caloric needs and basal metabolic rate (BMR) are might help guide you to know how many calories you should take in and what level of physical activity would be required to promote weight loss. Avoiding grains, at least in the initial stages of any weight loss program, tends to be very helpful as well.
Leslie: I sometimes think I'm a food addict. I've even read that cycles of binge eating (I'm obese, not bulimic) can destroy dopamine receptors in the brain, making this addiction even more difficult to surmount. First, do you agree that food addiction is a "real" thing? If so, are there different strategies to use to overcome such an addiction without going to an inpatient rehabilitation center? Does your brain/body undergo physiological changes as a result of food addiction? If so, can these changes be reversed?
Lyla_Blake-Gumbs,_MD: Binge eating can result in bouts of excessive dopamine release, which over time can result in a down-regulation of dopamine receptors. These receptors will go up and down in number in response to amounts of dopamine present in the brain's synapses. However, there is no mechanism that I am aware of that destroys these receptors in response to repetitive bingeing. Food addictions can be addressed by outpatient therapies such as heart-centered hypnotherapy. You can find a trained heart centered hypnotherapist by going to: www.wellness-institute.org/findatherapist.html.
sw4health: What do you mean by "clean eating"?
Kellie_N._Kirksey,_PhD: Clean eating is cutting out anything that is processed. You eat fresh produce, nuts, seeds, lean meats and beans. Clean eating is releasing those fatty foods that keep us craving for more of the same. You will be amazed at how light and energized you can feel once you have added more living foods into your body. You also may want to look into the "Paleo Diet™." It helps you get back to eating how we ate back before fast food and microwaves.
janice: What about giving up wheat? I know people who lost a great deal by this.
Lyla_Blake-Gumbs,_MD: We do strongly encourage reducing your intake of wheat—and most other grains for that matter—while in the initial phases of a healthy and balanced weight loss program. Many individuals are gluten-sensitive and reducing wheat, barley and rye can help these people to shed weight and reduce symptoms. such as fatigue, brain fog, joint pain and even depression.
timmo: Do you have any recommended reading on wheat’s effects?
Lyla_Blake-Gumbs,_MD: “Wheat Belly” by William Davis, MD and “Grain Brain” by David Perlmutter, MD.
Diet Selection and Pre-packaged Diet Plans
Judy: There are so many diets out there. Which one do I choose? What do you think about low carbohydrate diets?
Lyla_Blake-Gumbs,_MD: This is the exact point! We do not advocate any "diet" per se. We want to help people reach a point where they no longer look at their nutrition as a diet because this typically is a set-up for the binge-restrict cycle. Learning about what a healthy diet looks like for the individual in question is the most sustainable model for healthy eating lifelong.
timmo: Have you seen much lasting success for people who do the pre-packed food diets like Nutrisystem® or Jenny Craig®? I am fat as a house and need to do something.
Lyla_Blake-Gumbs,_MD: I have not. You have to keep in mind what happens when those pre-packaged—and quite expensive, I might add—foods are no longer available? If you cannot lose or maintain a healthy weight for you on regular food, no pre-packaged food will result in sustainable weight loss. The challenge is to learn to plan, shop, prepare and store healthy foods. It is challenging, but definitely doable.
numbersrunner: What is your opinion of the 5:2 Diet and intermittent fasting to lose weight?
Lyla_Blake-Gumbs,_MD: The fundamental issue with this diet is that there are no long-term studies on either its efficacy nor its safety. It does not get to the heart of what a healthy, sustainable diet should look like. If you fast for two days (with a maximum intake of 500 calories) and then eat poorly the other five days, it will not likely work to either assist in either weight loss or prevent chronic diseases like diabetes or cancer. A better option to eat a healthy, organic and mostly plant-based diet every day and exercise regularly. Also addressing the mind-body connection, which can really help or hinder any weight loss approach, is very important.
Resetting Metabolism Through Exercise
spur: Is there truly a way to "reset" your metabolism? I went through years of calorie restriction and extreme exercise then switched to overeating and gaining 50 pounds in just months. Now I eat clean and exercise daily, but still feel like my body hasn't leveled out to where it was before the “yo-yo” started.
Lyla_Blake-Gumbs,_MD: The best way is through regular, sustained exercise and slow weight loss. Building lean muscle mass through the use of resistance training also not only helps give definition, but also makes you more efficient at burning calories for several hours following a burst of exercise as well as in general. Lean muscle is more metabolically active than fat tissue, so while some people (women especially) are hesitant to lift weights due to concerns over "bulking up" too much, this strategy is very encouraged. Most women, in the absence of exogenous testosterone, will not become the “Hulk” just because they lift weights.
Hypnosis for Weight Loss
cleveland8: How does hypnotherapy for weight loss work?
Lyla_Blake-Gumbs,_MD: Hypnotherapy for weight loss assists you by moving past the conscious mind and allowing you to go to the subconscious mind that houses all of your old behavioral patterns. Once you have identified old faulty patterns through hypnosis, you are now ready to learn new patterns of building a healthy relationship with food. In hypnotherapy we install techniques that will assist you in eating only until you are satisfied, eating for nutrition and decreasing emotional eating patterns. Hypnosis allows your brain to be retrained for healthier interaction with food. It has been proven to be quite effective.
DMWachholz: If someone wanted to go for hypnotherapy to curb their appetite, how many visits do you think one would need? Or does it vary be individual?
Kellie_N._Kirksey,_PhD: Hypnotherapy for releasing a craving can be done over several sessions with the individual learning the technique and reinforcing the technique through practice of the particular tool. We really encourage individuals to use the new strategies repeatedly, and to notice the changes in their behavior. It is not magic— it takes the doing of the new behavior to receive the desired results.
Tango2010: Would I have to go back for a refresher hypnosis session after the initial session?
Kellie_N._Kirksey,_PhD: It is wise to reinforce your hypnosis session. Whatever behaviors you want to recur, you need to layer it on. Reinforce, reinforce, reinforce! You can record your session and listen to it, or even write affirmations based on your hypnosis session.
12Freddy: Does a hypnotherapy session with integrative medicine require pre-testing? And is it part of a bigger package like Lifestyle 180 or a different lifestyle program?
Lyla_Blake-Gumbs,_MD: No pre-testing is needed and is not typically part of any of Cleveland Clinic lifestyle programs, although it would certainly complement any program aimed at improving wellness.
Leslie: How does one find a hypnotherapist skilled in reducing cravings, shrinking my stomach, etc.?
Kellie_N._Kirksey,_PhD: You can make an appointment at Cleveland Clinic’s Center for Integrative Medicine at 216.986.4325. We have heart-centered hypnotherapists on staff who can assist you with all of your hypnosis needs. I would say that if weight release is your main focus, then sign up for Trim Life®. It is a great six-week program for weight release utilizing hypnosis. We have seen great results. Check out Trim Life® on our website www.clevelandclinic.org/trimlife. It has been a life changer for many.
Hypnosis vs. Acupuncture
Judy: I quit smoking with one acupuncture treatment, but it didn't work for weight loss. Should I try it again or try hypnotherapy?
Kellie_N._Kirksey,_PhD: Acupuncture is great and effective for so many issues. I would try it again as well as hypnosis. The beauty of hypnosis is that it allows you to release the behaviors that derail your weight loss efforts. Consider being able to have tools at your disposal that will assist you in knowing when you are hungry, knowing when you are satisfied, and knowing when it is more about the bad day you had at the office than the hunger in your stomach. Hypnosis assists you in being more in control of your thoughts and behaviors. You become more conscious of what you truly need and want. You are more able to release old patterns and then the weight begins to release also.
Supplements for Weight Loss
Patteey: Does taking chromium supplements help with weight loss? Does chlorophyll, added to juice or water, promote weight loss?
Lyla_Blake-Gumbs,_MD: Chromium supplements are recommended for people with insulin resistance and diabetes. They are supposed to also help with cravings, although evidence of this is limited. I am not aware of chlorophyll's role or efficacy in weight loss.
Sugar, Artificial Sweeteners and Stevia
amp7282: What do you recommend for sugar cravings?
Kellie_N._Kirksey,_PhD: For sugar cravings I recommend using a hypnosis technique that pairs the sugar with a repulsive substance and creates a negative connection, which extinguishes the craving. Imagine the sugar with something horrible on it or with a terrible smell. Cancel the sugar!
spur: I use Stevia on everything—breakfast, coffee, baked goods, etc. I was told by a trainer that it doesn't affect your blood sugar like refined sugars or agave would. Do you have any concerns about the use of Stevia or any long-term effects?
Lyla_Blake-Gumbs,_MD: While it is true that Stevia doesn't seem to affect blood sugar like other sweeteners, few long-term studies have been done to document its health effects in humans. There have been some concerns over DNA damage, but not enough long-term studies—even in animal models—have been completed to say one way or the other. A better alternative might be to train your taste buds to want or need less sweetness.
peg: Could you expand on 'how to train" your taste buds to want or need less sweetness?
Kellie_N._Kirksey,_PhD: Letting go of the sugar is how you retrain the taste buds. You have to allow your body to detoxify from the sugar and then begin to really pay attention to where sugar is hiding in your diet. Begin to read the labels. Most people don't think about the sugar content in ketchup or yogurt, etc. Become mindful of where the sugar is hiding and then cancel it from your diet. Cut out the sugar and then your body will reprogram itself. You will begin to notice that sugar is not your friend. Once you are off the sugar, you will notice a difference in mood and energy level.
Gail Ann: Generally, how long would it take for the body to reprogram itself in regards to sugar after a “detox”?
Lyla_Blake-Gumbs,_MD: Binge eating can result in bouts of excessive dopamine release, which over time can result in a down-regulation of dopamine receptors. These receptors will go up and down in number in response to amounts of dopamine present in the brain's synapses, but there is no mechanism that I am aware of, that destroys these receptors in response to repetitive bingeing. Food addictions can be addressed by outpatient therapies such as heart-centered hypnotherapy. You can find a trained heart-centered hypnotherapist by going to: www.wellness-institute.org/findatherapist.html
janice: I love salt. Someone told me that if I tried sea salt it would be better for me and wouldn’t hold all of the liquid in me. Is this true? I also have low thyroid and do take medications, but is this why I crave salt.
Lyla_Blake-Gumbs,_MD: There is no difference in sodium content between sea salt and table salt. Table salt in most parts of the world has added iodine, a necessary nutrient, so drastically reducing or eliminating table salt may lead to deficiencies. There are brands of sea salt that have been iodized, so if you prefer the flavor of sea salt look for these. Regardless of which salt you choose, please remember that dietary guidelines for Americans recommend limiting sodium to less than 2,300 milligrams a day— or 1,500 milligrams if you are 51 years old or older, African-American, or if you have high blood pressure, diabetes or chronic kidney disease.
Weight Loss Surgery
timmo: In the United Kingdom some bariatric clinics are using an inflatable sphere inserted into the stomach. Will this be tried in the United States in the future?
Lyla_Blake-Gumbs,_MD: I really am not familiar with this procedure nor do I know if bariatric surgery in the U.S., at least in the near future, will include this procedure as a viable alternative to popular surgeries such as the Roux-en-Y or gastric sleeve procedures.
Integrative Medicine Providers
Luann: Are you based outside of my home state of Florida? I am very interested in this integrative approach to weight loss, what course of action would you recommend in trying to create this protocol locally? There is a Cleveland Clinic here, but do they all offer this program?
Kellie_N._Kirksey,_PhD: I would recommend you search for a heart-centered hypnotherapist in your area. Wellness-institute.org is where you can find a trained provider. Currently Cleveland Clinic Florida does not offer integrative medicine, but I would keep pushing for it in your area.
Leslie: Are there weight loss programs that use an integrative medicine approach in Michigan? If not, I could try to figure out how to get to Cleveland Clinic!
Lyla_Blake-Gumbs,_MD: For therapists that may offer similar programs with heart-centered hypnotherapy , you may wish to look at www.wellness-institute.org.
brmack: I have had type 1 diabetes since I was 17 years old, and then I was diagnosed with Graves disease when I was 30 years old. I had irradiation of my thyroid. In addition, being 52 years old, I have gone through menopause. Because of all of these things have gained 60 pounds in 10 years. I walk three to four days per week, and had been taking kick-boxing fitness classes two days per week for over a year. I lost only five pounds, and gave up the classes. My thyroids medications have me in balance, according to my endocrinologist. Nothing seems to be working to reduce my weight. I eat about 1800 calories a day, and my diet is balanced to control the diabetes. But my doctors don't talk to each other, and I think a more integrated approach would help me. I live about 30 miles north of Philadelphia. Are there clinics close to me that could help?
Lyla_Blake-Gumbs,_MD: I would search integrative medicine programs in the Greater Philadelphia area. You would be best served by one close to you so that necessary follow-up visits are not a burden to get to.
ccligal: Do you know of doctor and/or a program in New York City that promotes weight loss through an integrated approach? If it were covered by Medicare with Part B that would be a plus. Of all of the many things that I have tried, a one-month long residential treatment center worked best, but even that did not stick.
Lyla_Blake-Gumbs,_MD: You can try these two options and see what kind of weight loss approaches they employ:
Integrative Medicine Insurance Coverage
Judy: Are your programs covered by health insurance? I have insurance through Cleveland Clinic.
Lyla_Blake-Gumbs,_MD: Yes, the program is covered. You are responsible for the co-pay.
Luann: Do you have any recommending reading with regard to the mind/food connection to curtail emotional eating?
Lyla_Blake-Gumbs,_MD: “Breaking Free of the Victim Trap: Reclaiming Your Personal Power” by Diane Zimberoff, MA.
Lyla_Blake-Gumbs,_MD: I would like to thank all who participated. We look forward to upcoming webchats and hope you found this forum helpful.
Kellie_N._Kirksey,_PhD: Thanks so much for the great questions. The first step to creating a new healthy mind and body is by taking the first step. You have sent in your questions and your journey has begun! Good luck and be well.
To make an appointment with Dr. Blake-Gumbs or any of the other specialists in our TRIM-LIFE program at Cleveland Clinic, please call 216.448.8611. To make an appointment with any of our specialists in the Center for Integrative Medicine at Cleveland Clinic, please call 216.986.HEAL (4325). You can also visit us online at clevelandclinic.org/integrativemedicine.
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