Doctor ranks top five lab abnormalities she sees in patients that hinder weight loss

A doctor who specializes in metabolic health and obesity medicine has ranked the top five lab abnormalities she sees in her patients that hold them back from losing weight. 

Dr. Alexandra Sowa, an internist based in New York City, went viral on TikTok after sharing the lab results that people should pay close attention to if they are struggling with their weight.

‘This is all I do every day all day,’ she explained in her recent video, which has been viewed more than 359,000 times. 

Dr. Sowa started with number five, vitamin B12, and worked her way up to the top offender on her list.

Dr. Sowa started with number five, low vitamin B12 levels, which have been linked to a higher risk of being overweight or obese

Number four was a high level of the thyroid stimulating hormone (TSH), which indicates hypothyroidism. An underactive thyroid can lead to a 10-pound weight gain 

She explained that low vitamin B12 levels have been linked to a higher risk of being overweight or obese, as well as low energy levels. 

‘Although some of the human data is out, rat models show that when your B12 is low, there are higher levels of adiposity or fat mass,’ she said. ‘So checking for this and supplementing appropriately is a good place to start.’

Number four was a high level of the thyroid stimulating hormone (TSH), which indicates hypothyroidism, or an underactive thyroid. 

Dr. Sowa recalled how Oprah Winfrey revealed she was diagnosed with hypothyroidism back in 2007, leading many people to think ‘their thyroid was the cause of weight gain.’

The obesity expert explained that hypothyroidism can cause weight gain, but ‘it’s not as dramatic as you might think.’   

The third abnormality was a ‘trifecta’ of lab results: low HDL (high-density lipoprotein) cholesterol, high triglycerides, and high fasting blood sugar 

‘But if you have hypothyroidism, you can definitely put on at least 10 pounds, and this is due to a decrease in basal metabolic rate and increased water and salt retention,’ she added. 

The third abnormality on her list was actually a ‘trifecta’ of lab results: low HDL (high-density lipoprotein) cholesterol, high triglycerides, and high fasting blood sugar. 

‘When I see these three things together, it means that someone has metabolic syndrome,’ she explained. ‘This is actually a very common presentation among someone who says, “I just keep gaining weight and I can’t lose weight at all.”‘

Metabolic syndrome, or insulin resistance syndrome, is a group of conditions that together raise the risk of coronary heart disease, diabetes, stroke, and other serious health problems, according to the National Heart, Lung, and Blood Institute (NHLBI).

‘When I find metabolic syndrome, it means there is an imbalance in how your body is processing carbohydrates and its blood sugar and insulin levels,’ she said. 

Dr. Sowa stressed that these results signal you need to consider medications for weight loss and also focus on carbohydrate restriction. 

The second most important lab result to look out for is a vitamin D deficiency, according to the internist. 

‘This is really common. At least 40 percent of Americans have insufficient levels,’ she said, adding that ‘vitamin D supplementation can almost be as effective in glucose and sugar and fat metabolism as exercise.’ 

Dr. Sowa ranked vitamin D deficiency as number two, saying ‘vitamin D supplementation can almost be as effective in glucose and sugar and fat metabolism as exercise’

Dr. Sowa said the most important lab marker is fasting insulin. ‘This is the thing that is holding most people back from weight loss and actually leading to significant weight gain,’ she said

Finally, Dr. Sowa said the most important lab marker is fasting insulin, which is not routinely checked at the doctor’s office. 

‘I use it on every single patient and match it up with their fasting glucose and calculate something called a HOMA-IR score to calculate early insulin resistance,’ she said. 

When people eat carbohydrates, the food is broken down into blood sugar. This tells the pancreas to release insulin, which allows glucose to enter the body’s cells.

Over time, high blood sugar levels can cause insulin resistance. When insulin is no longer effectively breaking down sugars, the body starts to produce more and more of it. 

Eventually, this leads to the pancreas becoming worn out, sending the system out of whack and causing blood sugar levels to stay high. Elevated blood sugar and insulin resistance are both linked to weight gain and excess body fat. 

‘This is the thing that is holding most people back from weight loss and actually leading to significant weight gain,’ she said. ‘When we can normalize this, we can really tap into our fat stores and get weight loss going.’