I’ve discussed this before, but it has proven such an (encouragingly!) frequent issue that I thought it was worth discussing once again.
What happens when you lose weight?
The process of weight loss is characterized by multiple shifts in metabolic patterns that can be confusing. To the uninitiated eye, weight loss can look like a disastrous distortion in metabolism. The naive doctor on seeing your lab values, for instance, might insist you take a statin drug, a fibrate like Tricor (to reduce triglycerides or increase HDL), or simply berate you for your bad health habits–when it’s actually a good thing you’ve accomplished.
So when you lose weight, say, 30 pounds in 3 months, what have you accomplished?
Energy stored as fat, especially from visceral fat stores, is mobilized into the bloodstream. It floods the bloodstream as fatty acids and triglycerides. These fatty acids and triglycerides don’t occur in isolation, but interact with other particles and metabolic patterns. The resulting blood patterns include:
–Increased triglycerides–An increase in triglycerides, for instance, from 90 mg/dl to 200 mg/dl in the midst of weight loss is common.
–Reduced HDL–The flood of triglycerides leads to increased degradation of HDL, thus a drop. A drop in HDL from, say, 40 mg/dl to 27 mg/dl–very frightening to people–is exceptionally common.
–Increased blood sugar–The flood of fatty acids and triglycerides results in insulin resistance, leading to higher blood sugars. It is not uncommon for someone with pre-diabetes to develop diabetic-range blood sugars, or a non-diabetic to show pre-diabetic blood sugars.
–Increased small LDL particles–Though small LDL is highly variable during weight loss. When it does happen, it’s probably from the interaction of VLDL (triglycerides) with LDL particles and the reaction that overloads LDL particles with triglycerides and conversion to small LDL particles.
So why don’t doctors often recognize these patterns when a patient loses weight? Because they rarely see it. Most of my colleagues are accustomed to having patients come back with weight gain, getting heavier and heavier each time. Lose weight? Impossible! So they just don’t recognize weight loss effects when they see it. As followers of The Heart Scan Blog know, a frequent conversation around here is “Am I too skinny?” or “How do I stop losing weight?”
The solution: Be patient. Be patient and wait about two months after a weight plateau has been achieved. That’s when the numbers “settle down” and you see marked drops in triglycerides, increases in HDL, drops in blood sugar, reductions in small LDL.
As with many things, it’s all about timing.
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