Originally posted by Dr. Davis on 2015-05-07
on the Wheat Belly Blog, sourced from and currently found at: Infinite Health Blog.
PCM forum Index of WB Blog articles.

Inner Circle members have access to more recent content on this issue:
Breaking Through Stalled Weight Loss:
Part 1 (0:05:55) | Part 2 (0:09:56) | Part 3 (0:09:19)
Wheat Belly Weight Loss Secrets Workshop
Module 1 (0:16:07) | Module 2 (0:23:01) | Module 3 (0:18:54) | Module 4 (0:20:16) | Module 5 (0:43:00)
Module 5 addresses weight loss stall.

I lost the wheat, but didn’t lose the weight: Updated version

Yes, it happens: Rid your life of all things wheat and you get relief from acid reflux, joint pain, and high blood sugars . . . but not weight loss.

While most people enjoy rapid and dramatic weight loss with wheat elimination due to the loss of the appetite-stimulating effect of gliadin-derived opiates, the loss of repetitive glucose-insulin provocation of amylopectin A, the reduction of inflammation from the combined effects of gliadin/wheat germ agglutinin/amylopectin A, and reversal of the leptin-blocking effect of wheat germ agglutinin, this doesn’t happen to everybody. Or you lose, say, 20 pounds, only to have weight loss stall for an extended period with another 50 pounds to go.

Why? Elimination of wheat is an extremely powerful strategy for regaining control over health, appetite, and weight. But it cannot correct or undo every abnormal situation that causes weight gain or blocks weight loss. For some people, there is one reason. For others, there can be several. Sometimes the problem is something else in diet, others it can be entirely unrelated to diet.

While wheat elimination is the most powerful strategy of all, given its ubiquity in foods and because it has the greatest weight gain effect, removing other grains also adds extra weight loss punch, since all grains share genetic characteristics, much like all the fish in the ocean share many traits. Lose the wheat, but then lose all other grains for maximum weight loss impact. This means getting rid of all rye, barley, corn, oats, amaranth, triticale, bulgur, rice, millet, sorghum, spelt, and teff. You are not “removing an entire food group”; you are removing components of diet that should never have been added in the first place, the seeds of grasses that were added in desperation when real food fell in short supply, but now celebrated, proliferated, and added to virtually all processed foods. Say “no” to all seeds of grasses–grains–and you obtain further health and weight loss benefits after wheat elimination. (The anthropological and scientific bases of this argument is discussed at length in Wheat Belly Total Health.)

But even after elimination of all grains, weight loss still eludes some people. So let’s consider the factors that can block weight loss even after wheat and grain elimination and how to solve each issue:

1) Excessive carbohydrates
Many people have high blood levels of insulin with resultant resistance to insulin that has to be reversed for weight loss to occur. Beyond getting rid of grains and their extravagant insulin-raising effect, it therefore helps to restrict other carbohydrates. This is one the reasons I condemn gluten-free foods made with rice flour, cornstarch, tapioca starch, and potato flour. Cutting carbohydrates can allow weight loss to proceed. We do this by counting net carbohydrates and limiting ourselves to no more than 15 grams net carbs per meal (net carbs = total carbs – fiber). (There are several smartphone apps useful to obtain total carbs and fiber content of foods, as well as nutritional analysis websites and hard copy handbooks.) Another way to manage carbs: Get a fingerstick glucose meter and check blood sugars immediately prior to meals, then 30 to 60 minutes later; aim for NO CHANGE in blood sugar. This works wonders for many people and can be conducted in concert with counting carbohydrates.

An occasional person will actually require a ketogenic state to achieve weight loss, i.e., complete elimination of carbohydrates in order to metabolize fats, evidenced by the fruity breath odor of ketones or urine dipstick testing positive with Ketostix. Pay no mind to those people who argue that ketosis is dangerous–it is not; it is a natural physiologic adaptation.

2) Not enough fats and oils–Fat is satiating and reduces appetite. Liberal fat intake, contrary to conventional “wisdom,” does not make you fat; it helps you get skinny. The only fats to avoid are fried (high-temperature), hydrogenated, and highly-processed polyunsaturated seed or GM oils like safflower, sunflower, grapeseed, soybean, and canola.

Eat fatty cuts of meat and don’t trim off the fat. Eat the skin and dark meat from chicken. Save the oil from cooking bacon to cook other foods. You can add fats/oils to many foods, e.g., add 2-3 tablespoons extra-virgin olive or coconut oil to scrambled eggs or soups. Some people even choose to consume coconut oil “straight.”

And do not limit calories. Limiting calories will work against you, causing metabolic rate to drop and stop your ability to lose weight.

3) Dairy gets in your whey–The problem with dairy is not fat; it’s the whey fraction of protein. Some people are susceptible to the “insulinotrophic” action of whey–a tripling of insulin output by the pancreas, a situation that stalls weight loss. The solution: Avoid all dairy except for full-fat cheese, butter, and ghee (low in whey) when trying to lose weight. I know of no other way to confidently identify this as the culprit . . . except a trial of elimination. This approach does, however, make the diet very restrictive, so this may be necessary for only as long as you are trying to lose weight.

4) Thyroid dysfunction–VERY, VERY common. Thyroid dysfunction is really part of a broader modern problem in human health: Endocrine disruption from industrial chemicals. We are witnessing more obesity, diabetes, pituitary, thyroid, ovarian, and other endocrine gland disruption due to chemicals such as perchlorates (residues of fertilizers in produce), perfluorooctanoic acid (non-stick cookware), bisphenol A (polycarbonate plastics, resin lining of cans), polybrominated diphenyl ethers (flame retardants), triclosan in antibacterial hand soap and hand sanitizers, along with many others. The end result of decades of exposures: disruption of endocrine status. The most common: impaired thyroid hormone production, both T4 and T3.

Problem: Even if diagnosed, most of my colleagues prescribe the T4 thyroid hormone only (Synthroid or levothyroxine), while failing to address T3–even if it is abnormally low. This is a big mistake, since many of the endocrine-disrupting chemicals we are exposed to are blockers of the 5′-deiodinase enzyme that converts T4 to active T3. If you are deficient in T3, you will not lose weight, no matter how much T4 you take. Also, ideal TSH? 1.5 mIU or less–NOT the 3.5 or 4.0 many doctors are content with. The key: Find a practitioner willing to explore this question, usually a functional medicine practitioner or naturopath, virtually NEVER an endocrinologist.

Some people (proportion varying by region, age, ethnicity; this represents about 20% of the people I meet with underactive thyroid status in Wisconsin) have underactive thyroids due to iodine deficiency. (I am, in fact, seeing a rise in goiters–enlarged thyroid glands due to lack of iodine). This will respond to the simple supplementation of iodine, e.g., 500 mcg per day from kelp tablets or iodine drops from the health food store. (Adverse reactions are rare but need to be explored to rule out, for instance, Hashimoto’s thyroiditis or active thyroid nodules.) Supplementing iodine is no more dangerous than salting your food with iodized salt. Take iodine for at least 3 months to observe the full effect.

A full thyroid assessment begins with measuring TSH, free T3, free T4, reverse T3, and thyroid antibodies through blood work. If even marginal thyroid dysfunction is present, or undertreated hypothyroidism (e.g., taking only levothyroxine when free T3 is deficient), it can completely block weight loss. Correct thyroid status to ideal and weight loss proceeds. You will find further discussion on re-achieving ideal thyroid status on this Wheat Belly Blog post.

5) Drugs can block weight loss–(Also discussed here.) Many drugs, prescription and non-prescription, can block weight loss. Getting off these drugs is therefore the solution, though this should be undertaken with the knowledge of your healthcare provider. Among the culprit drugs are beta blockers, such as metoprolol, atenolol, and propranolol; antihistamines such as loratadine and diphenhydramine; antidepressants like amitryptiline, doxepin, paroxetine (Paxil), and trazodone, though nearly all antidepressants have been associated with weight gain in some people; Lyrica for fibromyalgia and pain; and insulin. I’ve seen 20, 30, even 50+ pounds gained within several months of initiating long-acting insulin preparations like Lantus. This is only a partial list, as there are many others.

6) Excessive cortisol–Excessive levels of cortisol, as well as disruptions of circadian rhythm, can impair weight loss. Cortisol should surge in the morning, part of the process to arouse you from sleep, then decline to lower levels in the evening to allow normal recuperative sleep. But this natural circadian cycling is lost in many people represented, for instance, as a flip-flopping of the pattern with low levels in the morning (with morning fatigue) and high levels at bedtime (with insomnia), which can result in stalled weight loss or weight gain. Others have higher than normal levels of cortisol in the morning. High cortisol is like taking the steroid, prednisone, accompanied by extravagant weight gain. Cortisol status is best assessed by measuring salivary cortisol levels. (A functional medicine practitioner is most helpful here.)

High cortisol or disrupted circadian rhythm often starts with an exceptional emotional or physical stress; reversing the stressful situation is therefore the start (if possible). There are other efforts to pursue to bring this back in line, but that is something managed with the help of someone skilled in management of this issue.

7) Inadequate sleep–Sleep deprivation increases adrenaline, cortisol, and insulin, while increasing appetite (especially for snacks), all of which add up to stalled weight loss or weight gain. Adequate sleep, occurring in 90-minute “packages” (e.g., 7½ hours, 9 hours) is crucial. Just missing out on adequate sleep several days per week can be responsible for 20 or more pounds of weight gain over the course of a year.

8) Consider intermittent fasting–Intermittent fasting of, say, 15-48 hours in duration, can be a wonderful way to break a weight loss plateau. However, this is best undertaken after you’ve confidently removed all wheat, concluded your wheat withdrawal experience, and all the above strategies have been explored and squared away. Be sure to hydrate vigorously, as dehydration is the most common reason for failing and experiencing symptoms like lightheadedness, nausea, and unexplained fatigue. (People with diabetes or hypertension need to talk to their healthcare provider about the advisability of taking their drugs during a fast.) Intermittent fasting should not be confused with habitual skipping of meals, e.g., always skipping breakfast; habitual and consistent meal skipping actually causes weight gain. If you skip meals, do so in an unpredictable and random pattern, so that your body does not adjust and ratchet down its metabolic rate.

9) Disrupted bowel flora–Disrupted bowel flora is the rule in modern life, given intermittent exposure to prescription antibiotics, occasional high levels of antibiotic residues in factory farm-raised meats, chlorinated and fluoridated water, Bt toxin in genetically modified corn, and many other factors. Modern bowel flora is enriched in Bacterioides species that cause weight gain. We therefore “seed” our bowels with a high-potency probiotic, then “water and fertilize” our microorganisms with prebiotic fibers/resistant starches, all discussed further here.

One of the most common disrupters of bowel flora are the sweeteners aspartame, sucralose, and saccharine, found in diet sodas, for instance. This explains why people who drink diet soda are no skinnier than people who drink sugared sodas, or even heavier. We therefore eliminate all such sweeteners, including from diet sodas.

Those are the biggies. There are several others, less common, discussed in Wheat Belly Total Health.