Why Can’t I Lose Weight? Q&A with an Endocrinologist

Weight loss is probably one of the most frustrating things. At some point in our life, we’ve all tried to shed a few extra pounds by doing things like skipping meals, increasing exercise, trying intermittent fasting, eating apples, drinking more apple cider vinegar, and the list goes on. But why is it so hard?

We asked endocrinologist Dr. Sheliza Lalani, who focuses on behavioral therapy, obesity, and nutrition, for her thoughts on weight loss and why it is so challenging.

Firstly, a lot of people believe being obese is due to being lazy and a lack of discipline. What are your thoughts on this? 

Obesity is a chronic disease, like heart disease and breast cancer – we should never blame a patient for their medical condition. It is a combination of genetics and the obesogenic environment in which we live. This means that our environment encourages us to eat in an unhealthy way and not exercise enough. But after gaining weight, diet and exercise alone are not a way to treat a medical condition: trying just this is a setup for failure. A diet does not help us change our mindset or how to manage our emotions.

In your opinion why is weight loss so hard? 

We evolved from cavemen and are not meant to lose weight. Losing weight is unnatural and our bodies naturally want to retain weight to survive. Often when patients are losing large amounts of weight, we worry about cancer or another disease. Our brains often drive us to re-gain the weight we’ve lost so when we try fad diets to lose weight, they fail.

The first thing a lot of people look for are foods that help with weight loss, like apple cider vinegar, chia seeds, apples – are there any foods or particular diets that can help with weight loss? 

There is no diet or food that will lead to weight loss. It is all about a mindset towards a healthy lifestyle. When patients ask me about intermittent fasting or any other diet, my response is simple: ‘if this diet works for your lifestyle – do it. If it’s challenging, don’t.’

Is it possible to lose weight fast?

This is unhealthy and more worrisome. 

What is the best advice you can give someone that wants to lose weight? 

When I see patients, I often ask them to tell me their values. A change often starts with defining what you value. When you know what you value, you can make more conscious choices and become more aware when you are eating out of boredom versus when you are hungry. It is important to have the right support around you, and behavioral therapy can help. In some instances, talk to your doctor, because there are medications that can help with weight management, but they work alongside changing your mindset towards a healthy lifestyle and managing emotions.

References: 

1. Lake, A., & Townshend, T. (2006). Obesogenic environments: exploring the built and food environments. The journal of the Royal Society for the Promotion of Health, 126(6), 262–267. https://doi.org/10.1177/1466424006070487
2. Devlin, M. J., Goldfein, J. A., Petkova, E., Jiang, H., Raizman, P. S., Wolk, S., Mayer, L., Carino, J., Bellace, D., Kamenetz, C., Dobrow, I., & Walsh, B. T. (2005). Cognitive behavioral therapy and fluoxetine as adjuncts to group behavioral therapy for binge eating disorder. Obesity research, 13(6), 1077–1088. https://doi.org/10.1038/oby.2005.126
3. Kim, M., Kim, Y., Go, Y., Lee, S., Na, M., Lee, Y., Choi, S., & Choi, H. J. (2020). Multidimensional Cognitive Behavioral Therapy for Obesity Applied by Psychologists Using a Digital Platform: Open-Label Randomized Controlled Trial. JMIR mHealth and uHealth, 8(4), e14817. https://doi.org/10.2196/14817

Can Vitamin D Help With Depression?

Vitamin D, also known as the ‘sunshine vitamin’, is an important vitamin that often gets overlooked. Vitamin D deficiency is considered a global health problem that affects almost 50% of the population (more than 1 billion children and adults) worldwide. Even in Southeast Asia, where many countries enjoy sunshine all year round, Vitamin D deficiency is very common.

[Image Alternative Text: A globe with the Southeast Asia region highlighted in Red]

We ask Naturopathic Doctor Julie Hwang (ND), for her thoughts on vitamin D deficiency and the role it plays in mood and mental health. Naturopathic Doctors combine conventional medicine diagnostics with nutrition, lifestyle acupuncture, physical medicine and natural remedies and treatments.

Why are there high levels of Vitamin D deficiency in countries that have year-round sunlight? 

The main source of Vitamin D exposure is via sunlight, but many factors can reduce the skin’s ability to produce Vitamin D. Here are some of the trends and risk factors we see:

1) Not getting enough sun exposure
Completely covering-up your body when you are in the sun or wearing sunscreen prevents your body from being able to absorb UVB rays to produce Vitamin D.

2) Not getting enough UVB ray exposure
Not all sunlight rays will convert to Vitamin D; only sunlight with sufficient UVB rays will convert Vitamin D into its active form when it touches the skin. As an example, in Jakarta, the highest intensity of UVB occurs between 11 a.m. to 1 p.m. The sunlight in the early morning and late afternoon contain mostly UVA, which can’t be converted to Vitamin D, not UVB.

[Image Alternative Text: Diagram showing that the ultraviolet rays from the sun that reach the earth come in the form of UVA and UVB]

What role does Vitamin D play in the body, and how is it connected to mental health?

Vitamin D is mostly known for its critical and most clearly researched role of helping the body absorb calcium and phosphorus from the small intestines. This is important for the growth and development of both bones and teeth. In addition to bone health, having low vitamin D levels can negatively impact your immune function.

What is most surprising about Vitamin D is the role it plays in so many other areas like mental health. There is a strong correlation between vitamin D and depression, but whether it can be used as a treatment is not clear yet. As an example, some interesting research shows that there are Vitamin D receptors in the brain that are known to play a key role in mood regulation.

Even though the available studies aren’t robust enough to make specific recommendations to really understand the role of vitamin D plays in mood, it’s clear it plays an important role in the body. Here are some interesting research findings and uses:

	Depression during Pregnancy & Post-Partum Depression	A few small studies have shown that Vitamin D during pregnancy helped with depressive symptoms during pregnancy and post-partum
	Depression in Adults	A few studies have shown benefit in those with clinical depression that take Vitamin D alone or in combination with an antidepressant
	Depression and anxiety in women with Type 2 Diabetes	A small study showed that Vitamin D may help improve depression in anxiety in women with Type 2 Diabetes
	Depression in Childhood & Adolescents	Vitamin D has shown to have a possible role in some psychiatric conditions such as depression, attention deficit disorder and autism spectrum disorders

How can people get more vitamin D? 

It is important to know your body can’t make Vitamin D by itself, but there are a few options to increase levels in your body:

• Direct sunlight on your bare skin (such as face, legs, arms) a few times a week can help. Although there are no precise time-limits for being out in the sun to get the right amount of Vitamin D, most studies cite time limits between 13 – 30 minutes, from 3 times a week to daily.
• Certain food groups contain Vitamin D, such as cod liver oil, swordfish, salmon and egg yolks. Some mushrooms exposed to direct sunlight may also contain small levels of Vitamin D.
• Vitamin D supplements are also a readily available option.

If you think you may be at risk for low vitamin D, talk to a medical professional to get your levels tested and discuss what the best options may be.

References:

Holick, M.F. (2017). The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord, 18(2):153-165.

1. Nimitphong, H., & Holick, M. F. (2013). Vitamin D status and sun exposure in southeast Asia. Dermato-Endocrinology, 5(1), 34–37. https://doi.org/10.4161/derm.24054
2. Charoenngam, N., & Holick, M. F. (2020). Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients, 12(7), 2097. https://doi.org/10.3390/nu12072097
3. Penckofer S, Byrn M, Adams W, et al. Vitamin D Supplementation Improves Mood in Women with Type 2 Diabetes. J Diabetes Res. 2017;2017:8232863. doi:10.1155/2017/8232863
4. Vaziri, F., Nasiri, S., Tavana, Z., Dabbaghmanesh, M. H., Sharif, F., & Jafari, P. (2016). A randomized controlled trial of vitamin D supplementation on perinatal depression: in Iranian pregnant mothers. BMC pregnancy and childbirth, 16, 239. https://doi.org/10.1186/s12884-016-1024-7
5. Miyake, Y., Tanaka, K., Okubo, H., Sasaki, S., & Arakawa, M. (2015). Dietary vitamin D intake and prevalence of depressive symptoms during pregnancy in Japan. Nutrition (Burbank, Los Angeles County, Calif.), 31(1), 160–165. https://doi.org/10.1016/j.nut.2014.06.013
6. Föcker, M., Antel, J., Ring, S., Hahn, D., Kanal, Ö., Öztürk, D., Hebebrand, J., & Libuda, L. (2017). Vitamin D and mental health in children and adolescents. European child & adolescent psychiatry, 26(9), 1043–1066. https://doi.org/10.1007/s00787-017-0949-3

A Quick Guide to Understanding & Managing Lactose Intolerance

Being lactose intolerant means your body has a hard time digesting or breaking down foods containing lactose. Lactose is a type of sugar found in dairy products and is broken down by an enzyme called lactase. Your body may not produce enough of this enzyme for reasons, such as:

• Age (often as you get older, your body makes less of it).
• Crohn’s disease or other medical conditions.
• Medications or radiation treatment.
• Genetics.
• Long courses of antibiotics.

Common symptoms of lactose intolerance

Without enough lactase, your body can’t break down lactose into smaller pieces for digestion. Undigested lactose stays in the digestive system and can cause:

• Bloating
• Gas
• Cramping
• Nausea
• Diarrhea
• Weight loss (in children)

How severe the symptoms get depends on how much lactose is in the food you ate, and how much lactase is in your body. Symptoms may be different for everyone.

Common ingredients to look for that contain lactose 

These words on ingredient lists will help you determine whether or not a product contains lactose:

• milk
• lactose
• whey
• curds
• cheese flavour
• milk by-products
• dry milk solids
• nonfat dry milk powder

What foods can I eat?

Most people with lactose intolerance are usually able to eat small amounts of lactose, but it is helpful to try swapping out foods that you have a negative reaction to.

Because many foods containing lactose are important sources of calcium and vitamin D, it is important to make sure you still get enough of these nutrients in your daily diet! If you are unsure about whether your current diet is well balanced, talking to a nutritionist or doctor can help.

Sources: 

1. National Institutes of Health. (2021, July 8). Eating, Diet, & Nutrition for Lactose Intolerance. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance/eating-diet-nutrition
2. Dieticians of Canada. (2019). Healthy Eating Guidelines for Managing Lactose Intolerance. The Global Resource for Nutrition Practice.
3. UptoDate. Lactose content of different foods. 2021.

Title: World Tuberculosis Day 2021

World Tuberculosis (TB) Day is commemorated annually on March 24 to raise awareness about the different social, economic, and health consequences of TB.

This year’s theme is The Clock is Ticking highlights the fact that the world is running out of time to act on commitments to end TB. The COVID-19 pandemic has put even more importance on lung health and protection against various diseases which spread through droplets in the air. 

Tuberculosis (TB) Facts: 

If you think you, or someone you know has TB, it is important to talk to a doctor and stay home to avoid spreading it. TB treatment requires several different medications, but it is treatable and curable!

References: 

1. Public Health Agency of Canada. (2019, March 25). Tuberculosis: Symptoms and treatment – Canada.ca. Health Canada. https://www.canada.ca/en/public-health/services/diseases/tuberculosis.html
2. World TB Day 2021. (2020, March 24). World Health Organization. https://www.who.int/campaigns/world-tb-day/world-tb-day-2021
3. Erwin, P. C., Bemis, D. A., Mawby, D. I., McCombs, S. B., Sheeler, L. L., Himelright, I. M….Thomsen, B. V. (2004). Mycobacterium tuberculosis Transmission from Human to Canine. Emerging Infectious Diseases, 10(12), 2258-2260. https://dx.doi.org/10.3201/eid1012.040094.

Dr. Sheliza Lalani MD MPH – Dr. Lalani is an endocrinologist and internist with an interest in behavioral therapy, diabetes, obesity and nutrition. She completed her Fellowship in Endocrinology and Metabolism at George Washington University in Washington, DC. She also has her Master of Public Health from Boston University where her thesis focused on the impact of nutrition on chronic disease and food security.

READ THE Q&A – Why Can’t I Lose Weight

Dr. Julie Huang, ND – Dr. Hwang studied physiology and pre-medical sciences at McGill University in Montreal with an exchange at the National University of Singapore. She completed her Doctor of Naturopathy Degree from Canadian College of Naturopathic Medicine in Toronto, Ontario. Integrating western diagnostics with traditional Chinese medicine approaches, her practice is focused on headaches, seizure disorders and eczema.

READ THE Q&A – Can Vitamin D Help with Depression?

Rebecca Minshall, RD, MHSc – Rebecca is a Registered Dietitian in Toronto, Canada who has a clinical focus on mental health and nutrition. She is a graduate of Ryerson University’s MHSc Nutrition Communication program and holds a Certificate in Nutritional Psychology from John F. Kennedy University.

Rebecca has research and practice experience in supporting those with a wide range of health disorders and chronic illnesses, including Diabetes, gastrointestinal dysfunctions (IBS, IBD and food intolerances), weight management, mental health disorders (depression, anxiety and bipolar disorder), high blood pressure and high blood cholesterol.

A Quick Guide to Understanding & Managing Lactose Intolerance

Dr. Jamal Moloo, MD, MPH – Dr. Jamal Moloo is an internist who completed his medical school at Baylor College of Medicine, internal medicine residency at the University of Colorado, a General Internal Medicine Fellowship and MPH at Harvard Medical School/School of Public Health and a cardiac imaging fellowship at Massachusetts General Hospital. Between 2005 and 2019 he served as Associate Editor of the NEJM Journal Watch. At the University of Colorado, he served as Director of Cardiac CT and Co-Director of Nuclear Cardiology (2008-2021). At present he serves as Clinical Professor of Medicine at the University of Colorado and is Medical Director of Integrated Health Services at Colorado Coalition for the Homeless.

READ THE ARTICLE – World Tuberculosis Day 2021

Dr. Aliya Kassamali – has an undergraduate degree in biology and a Doctorate in Pharmacy. She is passionate about community health and education. She has provided care for a diverse population ranging from new parents to senior care. She has experience supporting those with a wide range of health conditions, including mental health disorders, weight loss, diabetes & blood pressure management, and smoking cessation. She is an advocate for holistic care and believes in exercise as a form of therapy. She has also worked as a personal fitness trainer.

Dr. Alim Hirji, MD, MSc.-Dr. Alim Hirji is an associate professor in Pulmonary Medicine and Lung Transplantation at the University of Alberta in Edmonton, Canada. He has a Masters of Epidemiology from the London School of Tropical Medicine and Hygiene in London, UK and has been closely involved in the care of patients with Covid-19 since the start of the pandemic.

Nadia Pirbhai, BSc, MC, R. Psych – A registered psychologist in Alberta, Canada. She has been in private practice for several years, and her background is in forensic psychology. Presently, Nadia works primarily with first responders, and she is also the manager/operator of the Wayfound Mental Health Group clinic in Red Deer. She enjoys using mindfulness and psychodynamic talk therapy to help determine the root cause of problematic behavior, subsequently helping clients manage and resolve their roadblocks while simultaneously recognizing their strengths and potential.