Carl and Cindy have always lived active lives. Married 30 years, they still enjoy biking and golfing, and they pride themselves in their healthy lifestyles. They eat a nutritious diet and their friends have always envied their fit bodies and loads of energy. But recently, things have changed. Carl has had to loosen his favorite belt a notch. Cindy has noticed a little “muffin top” when she puts on her best pair of jeans. Neither Carl nor Cindy has changed anything – they are just as active and healthy as they’ve always been. Sure, Carl has more stress at work and Cindy is quite sure she’s going through menopause, but what’s happening? Where’s the belly fat coming from, and more importantly – how can they make it disappear?
Carl and Cindy’s stories probably sound familiar. Most Americans have a little (or a lot) of extra weight they’d like to lose, and much of it lies around our middles. Belly-fat busting fad diets and cleanses are everywhere. For some, poor diet and lack of exercise contribute to added pounds in the belly and beyond, but something else plays a major role in our expanding waistlines – our hormones. Hormones? Most people think of things like sex drive, puberty, mood swings, and pregnancy when they hear the word hormones. But as we’ll review here, our hormones have many other roles, and mastering them may be a key to staying slim and healthy.
Types of Fat
Belly fat comes in two flavors, so to speak. The first is subcutaneous fat, the stuff you can pinch between your fingers along your waistline – often a dreaded consequence of poor lifestyle choices. Most people abhor this added layer of chub because it is physically unattractive, but the danger of belly fat goes much deeper than surface level. Often times, expanding waistlines are due to a second type of belly fat as well – visceral fat. This fat lies deep in our abdominal cavities, hugging many of our vital organs such as our liver, intestines, pancreas, and stomach. Visceral fat is even more dangerous than subcutaneous fat because of its proximity to our organs and its ability to communicate with the rest of our body, typically in detrimental ways.
Visceral fat has a life of its own and acts like an angry, troublemaking organ in our bodies. Visceral fat cells, also called adipocytes, release chemical messengers called adipokines which contribute to chronic systemic inflammation that can lead to insulin resistance, type 2 diabetes, and cardiovascular disease. Studies have also linked visceral fat to an increased risk for dementia. Leptin, often called the “satiety hormone”, is a hormone released by fat cells which tells our brains when we are full. Sounds like a good hormone to have around, right? Well, it is – until we produce so much of it that our brain turns off its ability to hear leptin’s message and we become leptin resistant. We no longer know when we are truly full, so we keep eating and eating…and eating. Having excess visceral fat increases the risk of leptin resistance, and leptin resistance increases the chance that you’ll overeat and gain more weight. This creates a vicious cycle which can be difficult to halt.
What causes the accumulation of belly fat?
It should come as no surprise that making poor food choices contributes to fat everywhere, including within our abdominal cavity. But our hormones have a big role to play and their contribution can’t be overlooked when we are planning strategies to eliminate this dangerous extra layer.
Let’s go back to Carl and Cindy to examine how hormonal havoc can pack on the pounds. We’ll start with Carl. He is active and eats a diet which is high in vegetables and lean animal proteins. He rarely drinks alcohol. But what we don’t know at first glance is that his stress levels have recently topped the charts due to downsizing at work and his fears of being laid off. He lays awake in bed at night worrying about what might happen if he loses his job. He’s averaging about 5 hours of sleep at night, much of it interrupted.
Carl’s crazy stress load and lack of sleep are cranking up his cortisol – his internal stress hormone. Cortisol is a crucial hormone made by our adrenal glands which serves many important functions in our bodies. A certain amount of stress is important for survival – it mobilizes us to avoid dangerous situations. Cortisol is what helps our bodies physically adapt to stress. When our ancestors in prehistoric times were in danger, like when faced by an approaching predator, a surge of cortisol would tell their bodies to get ready to either fight or flee (hence the term “fight or flight” response). Cortisol causes a rush of glucose into the bloodstream to use as fuel and raises blood pressure and heart rate – all important physiologic responses when running fast or fighting hard. Once danger has passed, cortisol levels return to normal, and bodily functions follow.
Our lives today, thankfully, do not include protecting our families from wild animals. But our bodies have not changed much when it comes to how we react to stress. The difference is the type and duration of stress we endure, and that’s where the trouble lies. The chronic stress we are under on a day-to-day basis (relationship struggles, financial woes, concern about our children, workplace anxiety) contributes to chronic cortisol release. And with that comes excess glucose dumped into the bloodstream, the risk for insulin resistance, and subsequent weight gain. Studies have shown that visceral fat cells have four times the receptors for cortisol than subcutaneous fat cells, indicating a close relationship between stress and visceral fat. Further, the enzyme needed to turn inactive cortisol into active cortisol is found in much higher quantities in visceral fat compared to subcutaneous fat. High cortisol levels have been shown to trigger cravings for foods high in fat and sugar. So cortisol pours the gasoline and visceral fat cells light the match.
What puts out the fire?
While we can’t always control the stressors in our life, what we CAN control is how we deal with them. Finding an outlet for negative emotions and utilizing stress relieving techniques such as deep breathing, meditation, exercise, and journaling can be useful tools for keeping cortisol levels in check. Getting adequate sleep is paramount to keeping cortisol levels in check, as lack of sleep can further trigger cortisol release. Eating a nutrient dense diet which is low in sugar and refined carbohydrates is important, as is eating on a regular basis to avoid long periods without nourishment which further stresses our bodies. Restorative exercise such as yoga and Tai Chi can help with stress relief. Certain botanicals have been used for generations to balance stress hormones. Ashwaganda, rhodiola, and maca are just a few examples.
The Dreaded Muffin Top
Now let’s talk about Cindy. Cindy’s “muffin top” is an all too common problem that women experience as they approach, and surpass, menopause. And it’s no coincidence that this hormonal shift is associated with a shift in body composition as well. During menopause, diminishing production of estrogen causes an alteration in where fat is stored in a woman’s body, favoring accumulation of fat around the middle instead of the hips and breasts where it is commonly stored in the reproductive years. Changes in estrogen levels have also been found to directly impact fat storage. A study done at the Mayo Clinic in 2013 compared fat tissue between premenopausal women and postmenopausal women and found that postmenopausal women had higher levels of certain enzymes associated with fat storage compared to their perimenopausal counterparts. This is thought to be due to hormonal changes, mainly decreased estrogen. Estrogen has been shown to help insulin work more efficiently at removing glucose from the bloodstream and shuffling it into our cells where it can be utilized. So waning estrogen may impact insulin by decreasing its effectiveness.
Many women feel defeated by the weight gain that creeps up around them, literally, during the menopausal transition. Like Cindy, they may not be doing anything differently, but their waistline expands and the pounds accumulate. Some women choose to restore their hormone levels through synthetic or bioidentical hormone use, but this is not a cure-all for menopausal weight gain, and not all women feel comfortable starting a hormone regimen.
Menopause can be a wonderful time of self-reflection, re-organizing, and goal-setting for the next stage of life. Taking an inventory of your diet and exercise regime to find areas for improvement is a good place to start. Perhaps it’s a good time to cut out that extra latte and add more vegetables, or increase your protein intake and incorporate some interval training. Recognizing and accepting that you may not burn fat like you did when you were 25, or even 35, is crucial. So be patient and gentle with yourself as you make long lasting changes to support your changing metabolism and your new hormonal milieu. Working with a practitioner or health coach who has experience with menopausal changes and holistic nutrition can be useful, particularly for the emotional support and encouragement that can be provided. It is also important to consider things like sleep quality, stress level, and thyroid function, as all weight gain during menopause is not necessarily from menopause! Exercise is key during menopause as it has been shown to decrease hot flashes in perimenopausal women, and is a key player in maintaining a healthy weight.
Insulin Resistance
One of the main concerns of increased belly fat, whether related to stress, hormone disruption, or both, is the increased risk for insulin resistance. Insulin may be the most important hormone when it comes to belly fat. Like all hormones, insulin is a messenger which communicates with our cells. Insulin’s main job is to allow glucose to enter our cells so that it can be utilized for energy or stored away for later use (typically as fat). When the system is working well and we aren’t overloading our bodies with sugar (or producing tons of it from stress), we make just enough insulin and our cells hear insulin’s, “let that glucose in!” message loud and clear. Our cells open their doors for glucose to enter and they are sufficiently fueled. The trouble begins when glucose levels run too high. With time, our cells get (literally) sick and tired of hearing insulin’s naggy voice, which is now extra loud and obnoxious. Our cells put in their earplugs so they don’t have to hear the racket, effectively tuning out insulin and restricting glucose’s entrance. This is also known as insulin resistance, a precursor to type 2 diabetes.
Our fat cells are the exception to the rule when it comes to ignoring insulin’s call. Even when our muscle and liver cells are resistant to insulin, fat cells remain in insulin’s posse. They like the company of glucose and accept insulin’s request to store extra glucose inside as fat. And where does this fat storage tend to take place? You guessed it, in all of the storage units right around your belly.
Remember leptin, the satiety hormone? Well, high insulin levels have the tendency to block leptin. This means that your brain doesn’t get the message that you are full, so you throw back another handful of chips even though your belly is full and you know cognitively that you’ve had enough.
Keeping insulin levels in check is important for weight management, and for the prevention of many diseases associated with insulin resistance such as type 2 diabetes, dementia, some cancers, stroke, and heart disease. Most of our insulin response is directly related to the foods we are putting into our mouths on a daily basis. Our insulin has to work hard and fast when we feed ourselves substances that are high in sugar or that quickly break down into sugar once digested. Foods that contain refined sugars and grains such as white bread, white rice, baked goods, sweets, crackers, and cereals will take your insulin on a wild ride that ends in Fatsville. On the other hand, eating foods that were given to us by mother nature, in as close to their natural state as possible, leads to much less insulin spiking because these foods tend to also contain nutrients, fiber, and protein which slow the absorption of glucose when digested.
Is Your Belly Fat Subcutaneous or Visceral?
Knowing whether your belly fat is subcutaneous or visceral can be tricky, but a few simple measurements can help to determine your risk. For women, a waist circumference greater than 35 inches spells trouble, while for man a waist greater than 40 inches around is reason to take action. Waist-to-hip ratio is another way to determine whether you are at increased risk for cardiovascular disease and suggests that you may have too much visceral fat. This is done by measuring your waist at its narrowest point just above the belly button and measuring the hips at their widest point around the buttocks. Your waist measurement divided by your hip measurement gives your waist-to-hip ratio. For women, less than 0.85 is ideal. For men, the goal is less than 0.95.
Measuring Body Composition
Most of us turn to the scale when monitoring weight changes, but this provides only one piece of data (weight) and tells us nothing about how much fat and muscle we have under the surface. Other tools exist to help evaluate body composition and can be useful in tracking the positive changes in body fat percentage and lean muscle mass that come with successful dietary interventions.
Bioimpedance analysis (BIA) is a quick, easy method which sends a painless current through the body via several electrodes to measure resistance and reactance. These measurements are then used to calculate many body composition parameters such as fat mass, body fat percentage, fat free mass, skeletal muscle mass, and basal metabolic rate. BIA is an FDA-approved medical device and is often used in research settings, speaking to its accuracy and legitimacy. BIA is utilized by some health coaches and medical providers who specialize in weight loss and is inexpensive and readily available. Air displacement plethysmography, such as “BodPod,” involves sitting in a small machine which measures how much air is displaced by the body to calculate body mass. Dual-energy x-ray absorptiometry, or DEXA, is used to measure bone density in clinical settings but can also be used to measure body composition. It is perhaps the most accurate way to evaluate body fat and muscle mass but is rarely available for use outside of medical or research settings.
Carl and Cindy have nothing to fear. While their bodies and metabolisms may gently change as they age, they are not doomed to live forever with extra padding around their middles. With attention to diet, exercise, stress relief, and sleep, they can prevent hormonal havoc and keep their waistlines trim. Most importantly, avoiding the accumulation of dangerous belly fat will allow them to decrease their risk for diabetes, dementia, and heart disease so they can continue to enjoy life for many years to come.
ProNatural Physicians Group is an integrated group of practitioners including naturopathic doctors, acupuncturists, APRNs and massage therapists. The practice is growing to include more medical modalities and to offer more family treatment options including vaccinations.
Moving soon to 120 Webster Sqr. Rd. Kensington. For more information, go to www.ProNaturalPhysicians.com or call 860-829-0707. Like us on FaceBook!