The Story of Belly Fat

We have all seen those huge bellies that some people have.  And perhaps we are one of those people.  Some of the abdominal fullness is due to subcutaneous fat (fat underneath the skin), but some of the protuberance is due to belly or visceral fat (fat that accumulates in the mesentery and inside the abdominal cavity).  There are several reasons for the occurrence of a generous abdomen.

As we age, men and women will have a tendency to deposit visceral fat.  Part of the problem is hormonal.  With women, their estrogen and progesterone levels start to decline and then disappear with menopause.  Menopause for a woman in the United States is age 50 plus or minus two years.  There are exceptions, however, like premature menopause.  Hormone replacement with estrogen and progesterone is something that may help with the belly fat.  You have the option of using a commercially available preparation like premarin and provera or you can use bioidentical hormones.  You can talk to your provider about which modality to use.  If you don’t have a uterus, you can use estrogen alone.  If you have a uterus, you should use both estrogen and progestin to avoid overstimulation of the endometrial tissue which could lead to endometrial cancer.  If you have had breast cancer, you should be cautious about using hormones especially if the tumor tissue was positive for estrogen receptors.  Be aware that hormonal replacement may have negative effects on your lipid profile, and you could be more at risk for deep vein blood clots among other conditions.

With a man, his testosterone level starts to decline after age 30-35.  Testosterone supplementation in men, however, is not as medically accepted as hormonal replacement in women.  There are not really set guidelines for testosterone replacement.  Ideally, there should be a low testosterone level on blood work, but even though some men have signs of “andropause” like fatigue, loss of libido, and declining mental acuity, a low testosterone blood level is not always found.  I believe that there is a lack of correlation between the symptoms of andropause and actual lab value confirmation just like there can be a lack of correlation in women between the symptoms of menopause (perimenopause) and actual lab confirmation of high follicular stimulating hormone (FSH) which can signal failed ovarian function.  It can take a few years for the lab correlation to catch up to the declining hormone levels in the blood work.  There are physicians who will provide testosterone replacement.  You just to look for them, as many mainstream physicians do not believe in andropause.

One of the issues with testosterone replacement that is mentioned for not providing testosterone supplementation is a possible increased risk of prostate cancer.  There is also the possibility of developing deep venous thrombosis (blood clots in the deep veins of the legs), alopecia (hair loss on the head), acne, and steroid rage among others.  What I found when I was in practice, however, was that administering 0.8cc of 200mg/ml testosterone cypionate IM (intramuscular) every two weeks helped the patient feel better without any of the above side effects.  I do recommend being followed closely by a physician if you decide to pursue this course of action.  Your provider may elect to run lab work on you every few months looking at your PSA (prostate specific antigen) to make sure that your prostate is in good health, and checking your liver enzymes among others.

Another medical condition that can influence belly fat is polycystic ovaries (PCO).  In this condition, there are a myriad of immature cysts on the ovaries that can help increase body weight and hirsutism (excessive facial and body hair growth).  Your provider can obtain lab work to check for this entity.  This condition requires medical treatment for improvement.

Since we’re talking about hormones, let us not forget cortisol.  Cortisol is secreted by your adrenal glands and causes you to hold on to fat.  Cortisol is often increased in stressful states which are increasingly common in our modern life.  Try to lower stress by meditating, and exercising.  The exercise will help to calm you down, and get rid of the nervous energy.

Studies have shown that sleeping five or less hours a night can cause an increase in belly fat as well.  The general recommended sleep time is seven to eight hours a night.  Try to get enough sleep every night.  Performing an aerobic exercise like walking or jogging for thirty minutes daily has been shown in clinical studies to help you get a good night’s sleep and to help stave off depression.

Diet can be a big factor in belly fat.  Avoid processed foods which are full of additives and unhealthy fats.  Foods like white bread, and those with refined white sugar are deadly for this condition.  If you are a big soda drinker, stop.  Drink water instead.

Exercise is one of the keys to losing belly fat and overall body fat.  Remember that the best exercise is a combination of weight bearing exercises (weights) and aerobic exercise (jogging, walking, spin class).  If you are already performing this exercise regimen and are not seeing results, you may consider increasing the intensity of the work outs.  You may be taking it too easy on yourself.  Situps can help your core, but may not necessarily help your belly fat.  Remember to include exercises to work out your oblique muscles and lower back along with your pelvis. Planks are a great exercise for your core along with your chest, arms, and legs.

Belly fat is more than physically unattractive.  An increased abdominal girth can be associated with type II diabetes mellitus, heart disease, and some cancers.

I hope you found the above suggestions helpful.  Wishing you continued success with your weight loss and maintenance.  Pablo.