Metabolic Prehab - Episode 43

Not rehab, but prehab. Metabolic prehab has to do with spending some time attending to the conditioning of the metabolism prior to any weight loss attempts. But why? Because when we diet, we often experience issues such as metabolic compensation/adaptation, excessive hunger and cravings, the slowing of the metabolism when we are in a caloric deficit for prolonged periods of time. In order to  approach dieting like this and do our best to thwart such symptoms we can practice metabolic prehab.

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Want to read the discussion? Check out the transcript below

Jade:    [01:17] Okay, everybody. What’s up? Welcome to today’s show. I know it’s been a little bit, and I’m going to cover a topic today that a lot of you’ve been asking me about. This is the topic of what I call metabolic prehab. Not metabolic rehab, but metabolic prehab. Many of you have been asking about this, if you’ve seen some of my posts on this idea. So, let’s talk a little bit about this. Basically, metabolic prehab has to do with spending some time attending to the conditioning of the metabolism prior to your attempts at weight loss; and by doing this, we can hopefully allay, or control, some of the issues that might come up during the dieting process, such as metabolic compensation that you hear a lot about from me or other people, or some people call it metabolic adaptation. Part of this has to do with, those of you who are research junkies, thermogenic adaptations or adaptive thermogenesis is what they call it in the research – but that’s just a small part of it. Essentially what we’re talking about is the excess of hunger that can result from dieting, the cravings that can result from dieting. The metabolic slowdown, what I often times describe as the metabolic governor effect, like a governor on a car that keeps the car from going too fast, that can happen when you are dieting. So, metabolic prehab is essentially getting the physiology ready for the eat less, exercise more approach, and helps you do a little bit better job at that. If you’re going to do one of these dietary programs, like intermittent fasting, or keto diets, or any of my protocols, like the eat less, exercise less approach, or the eat more, exercise more athletic approach, or even the standard dietary approach of eating less and exercising more, metabolic prehab might be something you want to do.


            [03:19] We’ll go through a little bit who this might be suited for, but let me just kind of give you an idea with a little bit of an analogy that I used on my Instagram feed to describe the idea of metabolic prehab. In the spring, pretty much every spring, especially when I lived in North Carolina most of the time – I now spend most of my time in Los Angeles – but in the spring in North Carolina, which has 4 seasons, what would happen is, it’s almost as if every overweight couch potato decided on the first day of spring where it was warm that they were going to get in shape all in one day. What you see is these very overweight people out running, some of them not even overweight, but deconditioned people out jogging. You can tell they’re new to jogging because their gait just looks painful almost, or they’re very overweight, or they have knee braces on, and it’s just almost painful to watch. You can even see on their faces how painful it is. Obviously, their motivation to go out and jog was a little bit ahead of their ability to tolerate the pounding. So, what ends up happening is about a week later, first day of spring and warmth, all these people come out – they’re almost like squirrels, they’re everywhere and you see ‘em – and about a week later, all of a sudden you’re like, they’re all gone. One week of spring they’re there and then they’re all gone, so what happened? Well, what happened is most of them either one, injured themselves, or two, just realized it was too difficult, had excessive hunger and cravings, or realized it’s just too hard on their body or their mind to go from a standard sort of American Western couch potato to a healthy marathon runner; and they all get injured and/or unmotivated and stop. Part of that is because they did the exact wrong approach, which is trying to go from 0 to 100 all at one time and ended up injuring themselves in the process. So, what metabolic prehab does would be the equivalent of taking those individuals and saying let’s not throw you out onto the road and make you jog; you haven’t worked out since you were in high school and now you’re in your 40s; you barely walk everyday; so let’s just get you walking. Let’s just get you walking, and let’s not completely change your diet to, you know, organic kale and wild-caught salmon. Let’s just move you away from junk foods to slightly healthier foods. Let’s get you on a walking program and let’s get you eating more fruits and vegetables, basically.


            [06:00] Then, what we can do is we can help them transition and almost condition their body. Doesn’t it make sense that you’re going to want to get in walking shape and that will help you get in running shape. You don’t go right from sitting still to sprinting. There is essentially a process that you follow, and this is well known in the athletic world as well. It’s part of the reason why if you go to the NFL, NBA, or MLB, or any of these sports organizations, they don’t just say hey, everyone show up tomorrow and we’re going to start our season. No, they have, essentially, spring training or training camp. And what the point of training camp or spring training is is to get these individuals conditioned and ready to tolerate the stresses of the season. This is the same thing with metabolic prehab; instead of focusing on the physical body, what we’re now focusing on is the internal metabolic mechanisms, and there’s 3 major metabolic mechanisms that we want to deal with. One is sort of the command and control center of the metabolism, what I call the center of the stress thermostat, and it is the hypothalamus. This is the area, the hypothalamus is the area of the brain that receives all the signals from the inside world and all the signals from the outside world and integrates them into movement for the metabolism. In other words, it gathers what the cells are doing and the fuel that we have on the body, and it reads the environment outside, and it essentially says, ok, based on the needs that the environment is telling me, and based on the reserves I have inside, here is what I’ll do; and then the hypothalamus sends signals down to other organ systems, such as the thyroid and the adrenals and the gonads. We often times calls this the hypothalamic-pituitary axes. The HPA axis would be the adrenal connection, the HPT axis would be the thyroid connection, and the HPG axis would be the ovary and testicle connections to the hypothalamus. The hypothalamus is really this stress center, and I often times talk about the idea of the metabolism being nothing but one big stress thermostat or barometer. So, one of the things we want to do is to make sure that when we diet and when we exercise they don’t become extra stresses on the system, and they can when taken too far, and they certainly can when you take a deconditioned individual and try to make them a paleo CrossFitter overnight. That takes some time, and the smart approach is to take some of the stress off. So, we want to deal with the hypothalamus and the stress issues first. The other thing is, we have another major central hub of metabolic processing that is sort of the crossroads of the neuro-endocrine immune system, and that is the gut. What we know about the gut - and you’ve kind of heard about this from my sister-in-law, who’s an expert in functional gastroenterology, and a lot of naturopathic physicians have been talking about this work for some time - that the gut is a place, a major hub where, essentially, taking in food, making sure that food is seen as food and not foreign, reactive material, feeding the good bacteria in our gut and trying to keep down the bad bacteria.


            [09:27] One of the other things we’re starting to learn about these bacteria populations in our gut, what we call the microbiome, is that these things can have profound influence on our metabolism by sending hormonal-like signals into the body, by helping us detox things like estrogen and things like that, getting hormones out of our body, by regulating the immune system. Most of the immune system, more than 70% of the immune activity resides at the level of the digestive tract, and obviously, this is the first part where we have to digest, absorb, assimilate nutrients. A lot of that happens at the level of the digestive tract; so, this is why you’ll hear an awful lot about functional medicine clinicians like myself using gut restoration protocols, so that we can make sure that when you do change the diet that the gut is functioning appropriately. It’s also very important to understand that the endocrine side of the gut – the gut is sending signals to the hypothalamus all the time, at different areas of the body all the time – hormones like the incretin hormones, GIP and GLP, and CCK, and PYY, and all these hormones that control hunger and can even have an impact on cravings. Hormones like ghrelin, and you’ve heard of some of these hormones – all these are elicited from the digestive tract, so it’s very wise to make sure the digestive system, and in particular, the microbiome is healthy and functional before we start changing the diet. Then, finally, if we kind of see the hypothalamus as the sort of President, or leader of the metabolism, and the gut is sort of like the Head of State, or the Five Star General, the foot soldiers are the mitochondria. The mitochondria are the next, the third part of this metabolic prehab, and the mitochondria – these are little energy factories inside each of your cells. These are the end units responsible for burning fat and fuel, carbohydrates, etc. into energy. Really, what happens with the mitochondria is you can kind of think of these mitochondria – what we now know about them is that our degree to be metabolically flexible - in other words, to be able to pick and choose the fuels that we can burn. Obviously, we want a very metabolically flexible rather than rigid metabolism. The mitochondria and all the enzyme systems that the mitochondria uses during its processes and prior to these nutrients getting to the mitochondria are important.


[12:02] These things can be overwhelmed with certain byproducts. For example, one of the things we know is that if we overload the body with lots of mixed macronutrient meals, and we do that often – the standard western cafeteria diet – huge breakfast, huge lunch, huge dinner, and then snacking in between, what ends up happening is we get a huge amount of carbons in the form of acetyl-CoA flooding into our mitochondria, and the Krebs cycle and the electron transport chain, and what we now know is that this can cause, for lack of a better term, and some researchers are describing this – I like to use marketing language here – but metabolic gridlock, so to speak. And all of a sudden, the mitochondria start not functioning as efficiently. When that happens, they begin to release “metabolic smoke.” What is metabolic smoke? This is just some of the free radical byproducts of fuel oxidation in the mitochondria, and these things can do damage to themselves. You can imagine the mitochondria as these big energy factories that are spewing out a lot of dark smoke that are polluting the air around the factory. So, we want to take care of that. When I talk about metabolic prehab, it’s very simple: attending to the hypothalamus, reducing stress on the system, attending to the gut, making sure that you’re digesting, assimilating, and potentially have the right bacterial products present in the gut to do you the most good. And then, also giving the mitochondria time to ramp up and be healthy and be ready for extra stress from exercise, and not be overwhelming it; not go from the stress of the standard American diet to the stress of eating less and exercising more. That’s the approach. So, it’s very simple from there. The hypothalamus is really about reducing stress. So, what’s that like? Well, one of the best things that we can do is attend to leisure or leisurely activities. Sleeping 8 hours daily and making sure we get quality sleep. Walking is critical because walking is one of the only things that does all 3 of these. It’s good for the hypothalamus, it’s good for the gut, and it’s good for the mitochondria. What walking does for the hypothalamus is it lowers the stress hormone cortisol, and also helps to resensitize the body to insulin. It’s one of the only forms of activities that does both of these hormonal effects, resensitizes the body to insulin, lowers the impact of cortisol, and by the way, insulin resistance and excess cortisol are both irritants to the hypothalamus, and can lead to downstream negative consequences like inflammatory responses and extra hunger and enhanced cravings and dysfunctional energy levels.


[15:06] And so, walking becomes critical. We really want to start walking about 10,000 steps daily for people who don’t walk at all. Now, on the other side, we also know – you might think to yourself, and often times want to play this game where you say, “Well, Jade, I know plenty of people who walk a ton – nurses, construction workers, people like that who aren’t necessarily seeming to benefit from all that walking, so what is the deal there?” Well, the idea is is that the body is adaptable and reactive, so those of you who are already walking 20k steps a day, maybe you want to bring down those steps slightly. So, the people who aren’t walking, try to get 10-20k steps, around 15k. Those who are doing 20 or over, maybe you want to lower them a little bit. The idea, remember, is to take stress off the system. Some people are walking so much that it is potentially a stress to the system. Other things that you can do are yoga practice, naps, lots of leisurely activities, creative pursuits – basically anything that lowers cortisol. Cortisol is the issue here for more people in the way that it sort of irritates the hypothalamus and can cause downstream derangements in the HPA or adrenal axis, the HPT, the thyroid axis, and the gonadal axis as well. So, anything you can do to reduce stress – this would be things like mobility practices, like MELT or gentle yoga, or tai chi; this would be things like contrast hydrotherapy, the alternating of hot and cold; this would be things like sex and physical affection; this would be things like social connection and pets; this would be things like painting, listening to relaxing music – all of these things. Spa time, meditation, obviously, massage, whether it’s self-massage like foam rolling and things like that; anything to relax you and calm you. By the way, with the walking, this in Japanese research, they refer to this as shinrin-yoku, or forest bathing. Even if you’re not walking, but going into green settings and letting this lower your stress, that’s what you want to do for the hypothalamus, and you want to do that 1-4 weeks prior to beginning to engage in intense exercise and intense dieting. That covers the hypothalamus. Now, the gut is a little bit more controversial because the research around the gut and the microbiome is very difficult to wrap our heads around. It’s one of the most fascinating areas of research, and even the experts in this field can’t really agree on what’s what half the time. Sometimes they’re saying well, these probiotics when you take them, they can colonize the gut and have beneficial effects. Other people are saying no, they don’t colonize the gut at all, they may just pass through and influence them. Some people are saying they can detrimental, which potentially, they can. Other times, we’re looking at the fact that these are strain specific. So, there’s a lot of research here that needs to be sorted out.


[18:01] However, we have a very good and pretty robust clinical tool that many people in the functional medicine world have been using for quite some time to see pretty dramatic impact on things like inflammatory conditions, like inflammatory skin conditions, or autoimmune things, like rheumatoid arthritis, or ulcerative colitis, or conditions such as irritable bowel syndrome. And what we want to do with some of these protocols, which I’ll get into in just a minute, is what all we’re trying to do is we’re trying to say we want to take some of the stress off the digestive system so that it’s easier for the body to digest, absorb, assimilate these nutrients. Really, what these gut restoration protocols look like, and you may have heard of these before from, you know, often times referred to as the 4R program or the 5R program, and essentially, what these Rs stand for are: the first R is remove. What we’re essentially removing is any food irritants. This would be junk foods, in particular, that are overwhelming the system, that are loaded with sugar and fat and things like that; but also, gut irritants that act as a [???] in the system. Of course, they’re not going to be doing this to everyone, but we don’t necessarily know or can tell whether you’re being impacted or not, so it’s just wise to take them out. Some of those things are going to be especially the nightshades: tomatoes, white potatoes – not sweet potatoes, but white potatoes – eggplants, peppers, things like that, and we remove any really common allergens as well. Again, it doesn’t mean you have an allergy to these things, and these things are often times food allergy. Peanuts, if you take a peanut and you react with anaphylaxis or a severe reaction, that’s a true food allergy; but there’s also reactions that are more subtle, and we don’t necessarily know exactly what’s happening with these reactions, and we often times refer to these as negative food reactions or food sensitivities, and things like that. These are things like gluten, which you may have heard about, or dairy. Eggs are also a very common allergen for many people. Nuts and seeds can be. Corn can be. So, it’s much easier to talk about what you really want to eat on this gut restoration protocol, and essentially, it consists of lots and lots of good quality green leafy vegetables, plenty of good quality fruits and things like that, and most meats, leaving most of the grains and dairy food behind, and also looking after taking out tomatoes and potatoes and things like that, and the legumes – beans, and nuts, and seeds, and things like that. So – and including eggs. That’s the way that we do this. Then, we also will give you digestive enzymes, probiotics, and we will consider using things like berberine, which is an alkaloid that can act to help to influence the microbiome in positive ways based on the research that we’re seeing now.


[21:17] Attached to this podcast, if you go to my site,, find the episode for this podcast, and I will put a infographic there for you that will sum all this up related to the gut function. You also may want to go back and listen to the podcast I did with my sister-in-law, Dr. Jillian Sarno Teta, who’s also a naturopathic physician, who is, I think, one of the foremost experts in gastroenterology in the functional medicine world, to sort of review what we talked to there. Now, the final thing is the mitochondria. Part of what we want to do with the mitochondria overlaps with some of the things that we were doing with the hypothalamus and gut. Obviously, walking becomes one of the chief things to sort of help the mitochondria become better fat burners. Decreasing the size of meals, frequency of the meals, and also decreasing some of the mixed macronutrients, like burgers and pizza where you’re overloading lots of carbs and fat and protein all at once, and moving to a less frequent eating pattern, more time between eating, in terms of your windows, and then more sort of macro-singular meals. For example, one of the things we like to do here is fast for 12 hours daily just to make sure you’ve got equal time with and without food to give your system a little bit of a “breather” for lack of a better term, and then add in some things like less frequent eating. So, maybe you are going to have, if you’ve been snacking all day, maybe you move back to a 3 times per day meal sequence, or maybe even 2 meals per day, and/or decrease the size of those meals to smaller meals so that the mitochondria can process the carbons that are coming through from these mixed macronutrient meals better. You may even want to consider moving to singular macronutrient meals, like a protein-based meal with just chicken breast and a little bit of cucumber, or something like that rather than burgers and pizzas and things like that. Or maybe some avocado on salad with some balsamic vinaigrette, which would be more of a fat and fiber-based meal. The idea is – or maybe just oats, or something like that, which are something that you can have just fiber and carbohydrates, and not a lot of fat and protein may be beneficial. But the major thing we do here is really give you 2 nutrients that are highly beneficial in both protecting the mitochondria and helping them do a better job.


[24:03] One is alpha lipoic acid, between 200mg and 400mg per day, and the other one is acetyl L carnitine, at about 1 gram per day can do a lot to help the mitochondria be prepared and functional for the move into a more vigorous training style and a more regimented eating approach. So, this is metabolic prehab in a nutshell. The questions might be, “Well, Jade, how long do I do this for?” Well, at least a week. Ideally, about 4 weeks, and then you might say, “Well, who is this good for?” Well, if you’re someone who’s already been eating well and exercising, there’s no need to really do this unless you want to use it as sort of like a spring detox or something like that. This is mainly for, almost exclusively for, our clients or individuals who are relatively couch potatoes and are going from not doing anything to beginning to do something. This would be basically, say, let’s get you walking, let’s start cleaning up some of the diet and digestive function, and let’s give your mitochondria some help so that by the time you do begin to ramp up your activity levels, that we can then make a difference for you. So, this is essentially sending your clients, or yourself, to training camp prior to the season. That’s metabolic prehab in a nutshell. I’m going to stop there. Hope you enjoyed today’s podcast, and I will see you next time.


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