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Q: My friend complains that she keeps gaining weight no matter how little she eats because she has a slow metabolism. How much does a person’s metabolism really affect body weight?

A: There is a lot of misunderstanding about the impact metabolism has on our health, especially in terms of weight loss.

In simple terms, metabolism is the internal process by which our body expends energy and burns calories. It runs 24/7, even when we’re resting or sleeping, by converting the food and nutrients we consume into the energy our body needs.

This process works at different intensities in different people. How fast your friend’s metabolism works is determined mostly by her genes. People might have fast, slow, or average metabolism, regardless of their body size and composition.

Age also affects metabolism, as it can slow over the years, even if a person starts out with a fast metabolism.

Differences in metabolism speed are evident in how easy or hard it is for people to gain or lose weight.

A slow metabolism burns fewer calories, which means more get stored as fat in the body. That’s why some people have difficulty losing weight by just cutting calories. A fast metabolism burns calories at a quicker rate, which explains why some people can eat a lot and not gain extra pounds.

But you can’t entirely blame a sluggish metabolism for gaining weight. The reality is that metabolism often plays a minor role. The factors that always will matter the most are diet quality, total daily calorie intake and level of activity.

Ways to boost metabolism

While it may only be a small change, a person can speed up a naturally slow metabolism, or rev up one that has become sluggish over time. Here’s how:

Add some high-intensity intervals and weight training to your regular exercise routine.

After a period of interval training, your metabolism can stay revved up for as much as a full day. Weight training builds muscle mass, and that extra muscle will require more calories, turning up your metabolic rate.

Your metabolism increases whenever you eat, digest and store food, a process called the thermic effect of food. Protein has a higher thermic effect than fats and carbohydrates, so eating more healthy protein-rich food sources might also help speed metabolism a bit.

Some studies suggest that drinking green tea can also rev up metabolism.

Q: I have atrial fibrillation and take Coumadin to prevent a stroke. I have not had any problem with it. But I wonder if I should switch to one of the newer drugs instead of Coumadin?

A: For 50 years, warfarin (Coumadin) was the only choice for people that needed to take an oral anticoagulant drug. While warfarin is inexpensive, it has downsides.

People taking it require regular blood testing to be sure the dose is correct. The blood test, called an INR, needs to fall into a predetermined range.

A result within the proper range means the person’s blood is “thin” enough not to clot easily but not “too thin” to cause a high bleeding risk.

Studies have shown that many people on warfarin frequently have an INR out of the desired range. This makes their blood clot prevention ineffective or puts them at risk for significant bleeding.

Taking the wrong dose and missing doses clearly affect the INR test result. But even when a person takes the dose exactly as prescribed, dietary changes and interactions with other medications can change the INR dramatically.

Now new oral anticoagulants are available that are just as effective as warfarin at preventing a stroke in people with atrial fibrillation and normal heart valves. These drugs are known as direct oral anticoagulants (DOACs).

The advantages of DOACs: they don’t require regular blood tests, have no food restrictions, and have fewer drug interactions. But they are much more expensive than warfarin.

To consider switching to a DOAC: you need to have adequate kidney function. This is determined by a blood test for creatinine and glomerular filtration rate (GFR). People with a very lower GRF cannot safely take these new drugs.

Here’s what I discuss with patients like you who are thinking of making a switch from warfarin to a DOAC.

Let’s make sure you can afford it. This may take some investigation by you to determine if insurance covers a DOAC or if you can get the drug at a substantial discount.

If your insurance only covers dabigatran (Pradaxa) and apixaban (Eliquis), it means you need to faithfully take the drug twice per day rather than once a day for warfarin.

The other DOACs, rivaroxaban (Xarelto) and edoxaban (Savaysa), are once-a-day drugs. Missing a dose puts you at risk of stroke.

The DOACs are short acting drugs, while warfarin keeps acting for well over 24 hours. So if you tend to miss doses of your medications often, you probably want to stick with warfarin.

Staying on warfarin is a fine option if your INR blood tests stay in the desired range (2.0 to 3.0) at least 70 percent of the time, meaning you don’t need frequent dose adjustments, and getting regular blood tests is not a hassle.

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