Starvation mode, metabolic damage, weight loss resistance, adrenal fatigue... For some reason, these terms get under people's skin. You hear constantly about this myth and that myth, and how these things are bogus. Sort of reminds me of a saying by Osho, my favorite philosopher: "The less a person knows the more stubbornly he knows it."
They are not myths and there are plenty of people dealing with these issues. If you're one of those twenty-somethings with great energy and a perfect body and little real life experience, then you're probably ready to dismiss this article right off the bat. But just do me one favor: bookmark it. You may need it later.
On the other hand, if you're someone who has struggled with lack of motivation, low libido, overtraining, illness, or feel you've done all the right things but can no longer respond to diet and training the same way, then this info is for you.
Honestly, I don't know where these terms came from. Like many things in health and fitness, there are phrases that get used somewhere and then become part of the lexicon.
I'm an integrative physician. I, and many doctors like me, have been dealing with metabolic damage issues for years. Only we never called it "metabolic damage" or "starvation mode." We called it neuroendocrineimmune dysfunction. Or we called it by some of its manifestations like "adrenal fatigue." Sometimes when an actual diagnosis could be made, we called it "hypothyroid" or "Hashimoto's thyroiditis" or "adrenal insufficiency."
I have since adopted the term "metabolic damage" because it's more descriptive and easier to comprehend compared to "neuroendocrineimmune dysfunction."
Here's an insight about medicine and health that's important to grasp. A person can feel unwell and have metabolic dysfunction without being in an overt disease state. It should make sense to most people that you can have metabolic dysfunction long before you have metabolic disease. And traditional medicine doesn't have much to offer unless there's a diagnosis. This is why the field of functional medicine has emerged.
Functional medicine is a medical specialty that deals with the gray area of dysfunction between health and disease. This is the type of medicine I practice. And this is where non-diagnostic terms like "adrenal fatigue" come from.
Let me give you a tangible example of this problem. Say you're not feeling so well, you're hungry all the time, urinating more than normal, and gaining weight. When you go see your traditional doctor they'll run your blood sugar to rule out diabetes. If your fasting blood sugar levels are 119 you don't have diabetes, but if they hit 120 you do. Do you see how utterly ridiculous that is? Long before you get to a fasting blood sugar of 120, you had some serious dysfunction going on. But no one is quite sure what to call it.
So medicine calls it a lot of different things, like blood sugar dysregulation, glycemic impairment, prediabetes, etc. But none of those are accepted diagnoses. They are simply descriptive terms that describe a measurable disturbance that has not yet become a disease.
The terms metabolic damage, starvation mode, and others suffer a similar problem. They describe a functional disturbance that may or may not be associated with a particular disease.
Long before attention deficit disorder, polycystic ovarian syndrome, fibromyalgia, autism, and chronic fatigue syndrome became diagnosis, they were called myths and their existence was denied. Meanwhile, forward thinking docs went right on treating them and defining the characteristics.
So saying metabolic damage or starvation mode "is a myth" is a lot like saying prediabetes is a myth. Saying "adrenal fatigue does not exist" is a lot like saying "over-training doesn't exist." These are functional disturbances that have clinical signs and symptoms that can be picked up on physical exams and blood labs.
These disturbances may or may not have a corresponding diagnostic label, but that doesn't mean they don't exist. This is the gray area between optimal health and disease, the area where function starts becoming compromised.
Starvation mode and metabolic damage are real. For ease of following the discussion I'm just going to refer to this as starvation mode from here on out. (You'll see how metabolic damage fits in shortly.)
The funny thing is when you see what starvation mode really is, you'll likely get what we're talking about very quickly. I've found that confusion on these topics usually comes from lack of an organizing framework to understand things.
In reality, starvation mode is arguably the most accepted occurrence in all of dieting research. But researchers don't call it "starvation mode," they call it adaptive thermogenesis. I call it the Law of Metabolic Compensation. I refer to it as a law because it's a reliable and predictable phenomenon that occurs in any dieting scenario. It is the degree that varies.
You can think of this as a natural protective mechanism honed by the metabolism over millions of years. It's what kept your ancestor from starving when their next meal was never a guarantee. Whether you're a lean bodybuilder, an elite athlete, or your average Jane or Joe trying to lose some weight, you will be impacted by the metabolic compensation of the body.
Let's walk through an example. Things start out with a diet. By diet I mean you do some combination of eating less and exercising more. In the beginning you seem to be doing great. You lose a few pounds right off the bat. So far so good.
Now you're a week or so in and you start feeling hunger, your energy falls, and you find yourself craving salty, fatty and sweet foods. This is a sign the body is starting to move into metabolic compensation. Think of this as Starvation Mode Level 1.
Because of this compensation you notice that your fat loss slows down. Perhaps it halts all together. And if you're one of those people that has a very pronounced metabolic decline you may notice you even start gaining weight. And the hunger, energy, and craving issue keeps getting worse.
But you're not playing games. You pride yourself on your iron will and rock-solid work ethic. You double your efforts by cutting calories further and ramping up your gym time. Nice. Now you're getting some movement again. Another pound or two down. But it doesn't last. A few weeks later and you're stuck again. This time the hunger and cravings are worse and your energy is in the toilet.
Your metabolism is not exactly humming along. Your metabolic rate slows even more. Maybe you try even harder but now your body just won't budge. You seem to be doing everything "right" but the metabolism digs its heels in. You just moved into metabolic resistance. This is Starvation Mode Level 2.
You don't get what the hell is going on, but you do know how to deal with it. All you need to do is work harder. You go watch Conan the Barbarian and crank up the Rocky theme music. You quadruple your effort!
You see very little for your efforts this time. It's been weeks and you're feeling beat. And now you have other complaints. You start feeling gassy and bloated. The protein shakes you used to tolerate just fine are upsetting your stomach. You're getting heartburn too. If you're a women your menses becomes irregular or disappears. If you're a man your libido is shot.
Sleep is fragmented and unpredictable. You have this weird feeling of being wired on this inside, but tired on the outside. You're starting to feel sick and unwell. You might be anxious, depressed, or both. And now you're slowly gaining weight, look "waterlogged" despite a low carb diet, and just can't keep up with your workouts anymore. You may even be slowly gaining weight! This is metabolic damage, Stage 3 and the final stage of starvation mode.
So, now you go and get some help. All that stuff about "metabolic damage" being a myth is coming back to haunt you. So, you go to a physique coach. You tell them what's going on and they say, "You're in starvation mode. You need to eat more and ease up on the exercise." They tell you to double your calorie intake and take it easy on the crazy workout schedule.
Guess what happens? You blow up like a helium balloon. With your metabolism moving at a snail's pace you just did the exact wrong thing. Not a smart move.
You gain about 15 pounds in 6 days (I've had several patients see this type of effect)! Of course it's physiologically impossible to gain that much fat in such a short time; it's almost all water, but it is a sign your metabolism is not doing so hot.
You want answers so you go see a doctor. Maybe they diagnose you with hypothyroid or some other issue, or maybe they say you're normal and nothing is wrong. Obviously they don't have answers. If you're really unlucky, they tell you to go back to the eat less, exercise more approach. But it still won't work and it will just perpetuate the negative cycle and do more damage to your physiology and psyche.
Here's what you need to know about your metabolism. It doesn't work like a calculator; it works like a thermostat. And your thermostat is now "broken".
When the "eat less, exercise more" approach to body change is taken to the extreme, it's like a tug-o-war game you can never win. You pull and the metabolism pulls back harder. You try harder and the metabolism laughs and almost yanks you right off your feet. What's the only way to win tug-o-war against a team stronger than you? When they pull, you let go and they helplessly fall to the ground. That's the way out of metabolic starvation mode.
No matter what phase you're in, the first step is to stop eating less and exercising more. This is the equivalent of letting go of the rope.
At this point you have two choices. You can either eat less and exercise less, or eat more and exercise more. This is the only way to decrease the stress on your metabolism while not gaining weight in the process. If you've gotten all the way to stage 3 however, your only option is the eat less, exercise less approach.
- Metabolic Compensation. This phase is easy to deal with. Move to an eat less, exercise less OR eat more, exercise more approach. Both will work. As long as you get off the "eat less, exercise more" train, you'll usually be back on track within a week.
- Metabolic Resistance. This is also not that hard to deal with. Just cycle the diet. Spend 2-3 weeks in an "eat less, exercise less" phase, then change directions towards an "eat more, exercise more" approach. You may need to take a few other steps too. This might involve prioritizing rest and recovery. Walking, massage, sauna therapy, naps, sex/physical affection, laughter, time with pets, etc. Basically anything that lowers stress hormones and restores balance to the neuroendocrine system. Expect to be back on track within 1-3 months.
- Metabolic Damage. Once you're here, you have little choice. "Eat less, exercise less" is the only option. You'll need to focus all your time on rest and recovery. Walking and a few traditional weight training workouts are likely all you'll be able to do.
Consulting with a functional medicine doctor would be smart. They'll be able to evaluate thyroid, adrenal, and gonadal function. This is beyond the scope of a physique coach. Supplements and hormones may be required. With the right help, you can be back on track within 3 to 15 months.
The ideal scenario? Don't get yourself into that situation to begin with.
- Major GC et al. Clinical significance of adaptive thermogenesis. Int J Obes (Lond). 2007 Feb;31(2):204-12. PubMed.
- Jason LA et al. Chronic fatigue syndrome versus neuroendocrineimmune dysfunction syndrome:differential attributions. J Health Soc Policy. 2003;18(1):43-55. PubMed.
- Müller MJ et al. Adaptive thermogenesis with weight loss in humans. Obesity (Silver Spring). 2013 Feb;21(2):218-28. PubMed.
- Rosenbaum M et al. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr. 2008 Oct;88(4):906-12. PubMed.
- Camps SGJA et al. Weight loss, weight maintenance, and adaptive thermogenesis. Am J Clin Nutr. 2013 May;97(5):990-4. PubMed.
- Tremblay A et. al Adaptive reduction in thermogenesis and resistance to lose fat in obese men. Br J Nutr. 2009 Aug;102(4):488-92. PubMed.
- Labayen I et al. Role of baseline leptin and ghrelin levels on body weight and fat mass changes after an energy-restricted diet intervention in obese women: effects on energy metabolism. J Clin Endocrinol Metab. 2011 Jun;96(6):E996-1000. PubMed.
- Miller DS et al. Resistance to slimming: adaptation or illusion? Lancet. 1975 Apr 5;1(7910):773-5. PubMed.
- Winsier RL et al. Do adaptive changes in metabolic rate favor weight regain in weight-reduced individuals? An examination of the set-point theory. Am J Clin Nutr. 2000 Nov;72(5):1088-94. PubMed.