I’m working with a 65-year-old client, he’s dealing with chronic insomnia for many years. He takes quetiapine”—I’m not familiar with that drug—“and losartana potassica, 25 mg for high blood pressure and Simbrinza eye drops. Besides having an acute buzzing in his ears each of the last six months, he considers himself healthy and strong. He’s been a very low, as you said, accidentally low-carb diet and gaining some weight in the last few years. He’s eating less than 1,000 calories per day and he’s 6 feet tall and weighs 200 pounds. He drinks most of his water intake while exercising, 1.5 L while he’s doing an hour of intense exercise a day, seven days a week. Even feeling tired, he works out every day and has lost almost all of his muscles. He describes it even with the sleep drugs, he’s a very light sleeper and before he falls asleep, he feels his body temperature go up and he starts sweating. He hasn’t had digestive symptoms. I’m working on HPA axis and also testing his gut, but your opinion is greatly appreciated.

Chris Kresser:  Wow, at 6 feet tall and over 200 pounds he is in a severe caloric deficit and I imagine that has really, really messed his metabolism up. If you Google the “Biggest Loser effect,” you can read a little bit more about this. Some of you may know, I’ve never actually seen the show, but it’s a show where they put people on crash, calorie-restrictive diets and they lose dramatic amounts of weight. But in a study that was recently published analyzing what happened to those people later, they found that not only had most of them regained the weight that they lost, many of them had gained more weight than they were before they started the show. And they had a lot of trouble losing weight again at that point, and they felt like they were metabolically broken. And we’ve talked I think, or we will talk in the hyperglycemia section about some of the harmful effects of severe calorie restriction over a long period of time. But, I mean, if he’s exercising intensely seven days a week and he is 200 pounds, I would guess that in order even to maintain his weight, he needs over 3,000 calories a day. So I understand how this is possible. I think he must be significantly underreporting his calorie intake. But still, even if he is below, I think that he’s probably really harmed his metabolism and that’s what’s happening almost certainly causing the sleep issues, and getting him back on a appropriate diet in terms of calories and macronutrients, particularly carbohydrates, would be the thing that you need to do here. And you can refer to the Exposome presentations for more information about that.