Posts Tagged ‘visceral fat’

All Fat Is Not Created Equal

September 29, 2018

Andrew Siegel MD  9/29/2018

www.maxpixel.net-Obesity-Weight-Obese-Fat-Heavy-Overweight-3313923

Thank you, Max Pixel for image above

My next few entries concern weight and diet. Clearly, obesity is unhealthy on many levels and I do not encourage anyone to carry excess pounds. However, fat can be advantageous under certain circumstances: see below 12 Benefits to Being Overweight (to be taken tongue in cheek).  Next week’s entry (to be taken seriously) will discuss a healthy eating style that  effectively can improve your shape and shred excess pounds that I am excited to share with you.

Some fat is good, but not too much

Having some fat on our bodies is actually a good thing, as long as it is not excessive. Fat serves a number of useful purposes: it cushions internal organs; it provides insulation to conserve heat; it is a means of storing energy and fat-soluble vitamins; it is part of the structure of the brain and cell membranes; and is used in the manufacture of certain hormones.

All fat is not created equal

Not all fat is the same. It is important to distinguish between visceral fat and subcutaneous fat.  Visceral fat–also referred to as a “pot belly” or “beer belly”– is  fat deep within the abdominal cavity that surrounds the internal organs.  Subcutaneous fat–also known as “love handles,” “spare tires” or “muffin top”– is present between the skin and the abdominal wall. In addition to the physical distribution of the fat being different, so is the nature of the fat. Although neither type is particularly attractive, visceral fat is much more of a health hazard than is subcutaneous fat since its presence increases the risk of heart disease, diabetes and metabolic disturbances.  This is as opposed to subcutaneous fat, which is inactive and relatively harmless and generally does not contribute to health problems.

 

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Thank you Pixabay, for above image of visceral obesity (“beer belly”)–NOT GOOD FOR ONE’S HEALTH

OLYMPUS DIGITAL CAMERA

Image above, subcutaneous fat (“muffin top”), Attribution: Colin Rose from Montreal, Canada–MIGHT NOT BE THAT ATTRACTIVE, BUT GENERALLY NOT A HEALTH ISSUE

 

A beer belly is called a beer belly for good reason. One of the real culprits in the formation of visceral fat is drinking liquid carbs, whether sweetened beverages including sodas, iced tea, lemonade, sports drinks, etc., fruit juices such as orange, grapefruit, cranberry, etc., and alcoholic beverages.  Liquid carbs have no fiber and are essentially pre-digested, stimulating a massive insulin surge and rapid storage as fat. It is much healthier to eat the real fruit rather than drink the juice, since the product in its original form is loaded with fiber that fills you up and slows the absorption process and also contains abundant phytonutrients.  You would have to eat 3 oranges to get the same sugar and calorie load as drinking a glass of OJ, and it is hardly possible to do that.

Visceral fat is a metabolically active endocrine “organ” that does way more than just create an unsightly appearance. It produces numerous hormones and other chemical mediators that have many detrimental effects on all systems of our body.  So, fat is not just fat. Visceral fat ought to have a specific name, as do other endocrine organs (thyroid gland, adrenal gland, etc.). This name should convey the dangerous nature of this “gland.”  I suggest “die-roid” gland because of its dire metabolic consequences, including risk of metabolic syndrome, diabetes, heart disease and premature death.

The good news about visceral fat is that it is metabolically active so that with the appropriate lifestyle modifications it can readily melt away, as opposed to subcutaneous fat, which is tenacious and can be extremely difficult to lose.

12 benefits to being overweight

  1. Less prominent crow’s feet, wrinkles and nasal-labial folds
  2. More comfort in the cold winter months because of more insulation
  3. More likely to survive hypothermia if your ship should sink in icy waters or your plane goes down on a snow-laden mountaintop
  4. Better buoyancy in the water
  5. Better survival when stranded on a desert island because of the fat (stored energy) that will keep you sustained and alive long after the thin people have perished
  6. Less osteoporosis (bone thinning) because of the weight-bearing that keeps bones mineralized
  7. Strength because of all that weight-bearing—think NFL offensive linemen
  8. Built-in airbag for better survival of traumatic motor vehicle crashes and other forms of trauma
  9. More comfortable when sitting on tailbone or lying on vertebra because of better padding
  10. More stable footing under conditions of gale-force winds
  11. Curvier, more voluptuous bodies
  12. Cuddlier, like a teddy bear!

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

 

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

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On Beer Bellies, Heart Disease And Sexual Function

July 30, 2016

Andrew Siegel MD  7/30/16

fat

 

A bit of fat is good…but not too much

Having some fat on our bodies is not a bad thing, as long as it is not excessive. Fat serves a number of useful purposes: it cushions internal organs; it provides insulation to conserve heat; it is a means of storing energy and fat-soluble vitamins; it is part of the structure of the brain and cell membranes; and it is used in the manufacturing process of several hormones.

All fat is not created equal…It’s all about location, location, location.

Not all fat is the same. It is important to distinguish between visceral fat and subcutaneous fat. Visceral fat–also referred to as a “pot belly” or “beer belly”– is internal fat located deep within the abdominal cavity. Subcutaneous fat–also known as “love handles,” “spare tires,” “muffin top,” or “middle-age spread”–is superficial fat located between the skin and the abdominal wall. In addition to the physical distribution of the fat being different, so is the nature of the fat. Although neither type is particularly attractive, visceral fat is much more hazardous to one’s health than subcutaneous fat since it increases the risk of heart disease, diabetes and metabolic disturbances. Subcutaneous fat is inactive and relatively harmless and generally does not contribute to health problems.

Factoid: A beer belly is called a beer belly for good reason. One of the real culprits in cultivating visceral fat is drinking liquid carbs, whether they are sweetened beverages (sodas, iced tea, lemonade, sports drinks, etc.), fruit juices such as orange, grapefruit, grape, cranberry, etc., or alcoholic beverages. These liquid carbs have no fiber and are essentially pre-digested, stimulating an insulin surge and rapid storage as fat. It is always better to eat the fruit rather than drink the juice, since the fruit is loaded with fiber that fills you up and slows the absorption process and contains abundant phytonutrients. You would have to eat 3 oranges to get the same sugar and calorie load as drinking a glass of OJ, and it is hardly possible to do that.

Visceral fat essentially is a metabolically active endocrine “organ” that does way more than just create an unsightly protrusion from our abdomens. It produces numerous hormones and other chemical mediators that have many detrimental effects on all systems of our body. So, fat is not just fat. Visceral fat ought to have a specific name, as do other endocrine organs (thyroid gland, adrenal gland, thymus gland, etc.). This name should convey the dangerous nature of this “gland.” I suggest “die-roid” gland because of its dire metabolic consequences, including risk of diabetes, cardiovascular disease, low testosterone, erectile dysfunction (ED) and premature death.

When a patient walks into the office and the first thing I observe is a protuberant and bulging belly, a siren goes off screaming “metabolic syndrome, metabolic syndrome, metabolic syndrome.”

Factoid: Anybody with a big belly is pre-diabetic, if not diabetic already.

“Metabolic syndrome” is a cluster of risk factors that are dangerous to one’s health. These include visceral obesity as defined by waist circumference (men > 40 inches; women > 35 inches), elevated blood sugar (> 100 mg/dL), high blood pressure (> 130/85 mm), elevated triglycerides (>150 mg/dL) and low HDL cholesterol (the good cholesterol): (men < 40 mg/dL; women < 50 mg/dL).

Sexual dysfunction

Beer belly and metabolic syndrome are highly associated with low testosterone and poor erection and ejaculation function. The fatty tissue present in obese abdomens contains abundant amounts of the enzyme aromatase, which converts testosterone to estrogen—literally emasculating obese men. So, visceral fat can steal away our masculinity, male athletic form and body composition, mojo, strength, as well as the ability to obtain and maintain a good quality erection.

ED serves as a good proxy for cardiac and general health. The presence of ED is as much of a predictor of heart disease as is a strong family history, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson expanded the initials ED to mean: Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries); Early Detection (of heart disease); and Early Death (if missed).

Factoid: The penis can function as a “canary in the trousers.” Since the penile arteries are generally rather small (diameter of 1- 2 mm) and the coronary (heart) arteries larger (4 mm), it stands to reason that if vascular disease is affecting the tiny penile arteries and causing ED, it may affect the larger coronary arteries as well—if not now, then at some time in the future. In other words, the fatty plaque that compromises blood flow to the smaller vessels of the penis may also do so to the larger vessels of the heart and thus ED may be considered a genital “stress test.”

“Fatal retraction”

While the penis can genuinely shrink for a variety of reasons, most of the time it is a mere illusion—a sleight of penis. Obesity causes a generous pubic fat pad that will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding or buried behind the fat pad, the “turtle effect.” Lose the fat and presto…the penis reappears. Yet another reason to remain lean!

Trivia: It is estimated that for every 35 lbs. of weight gain, there is a one-inch loss in apparent penile length.

What does this all mean?

  • Visceral fat is a bad, metabolically-active form of fat that is highly correlated with metabolic syndrome, diabetes, heart disease and sexual dysfunction.
  • ED often occurs in the presence of “silent” heart disease (no symptoms) and serves as a marker for increased risk for heart disease (as well as stroke, peripheral artery disease and death) often occurring 3-5 years before heart disease manifests. Early detection of ED provides an opportunity to decrease the risk of heart disease and the other forms of blood vessel disease.  ED has a similar or greater predictive value for heart disease as do traditional factors including family history, prior heart attack, tobacco use and elevated cholesterol. The greater the severity of the ED, the greater the risk and extent of heart disease and blood vessel disease.
  • Intensive lifestyle intervention has the potential for reversing visceral obesity, metabolic syndrome and sexual dysfunction. This lifestyle intervention involves achieving a healthy weight, losing the belly fat, healthy eating, regular exercise, smoking cessation, moderation of alcohol intake, stress management, etc.
  • The good news about visceral fat is that it is so metabolically active that with the appropriate lifestyle measures it can readily melt away, as opposed to subcutaneous fat, which is tenacious and can be virtually impossible to lose.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc  

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

Fat: Location, Location, Location Matters

September 14, 2012

Andrew Siegel, M.D.     Blog #74

 

We all have body fat; even elite athletes have a body composition that is a svelte 5-10% fat—this translates into roughly 10-20 pounds of fat for a 180-pound athlete.  What is important is that all fat is not created equal—where the fat accumulates in our bodies dramatically effects how that fat behaves.  So, the very location where your fat takes up residence has a tremendous influence on your health.

Fat on our body surface is much less problematic than fat deep within our body. Humans have two basic types of fat: subcutaneous fat and visceral fat. Subcutaneous fat—also known as “love handles,” “spare tires,” “muffin tops,” or “middle-age spread”—is present between the skin and the abdominal wall. When present in normal amounts, it gives us nice contours and makes us look less bony and skeletal and more smooth and curvy. When present in excessive amounts, it makes us look plump, roly-poly and pear-shaped. A moderate amount of subcutaneous fat is of little danger to our health and, in fact, provides us numerous advantages including padding and insulation to conserve heat and help with temperature regulation, a means of storage of fat-soluble vitamins, and a ready source of energy. Visceral fat—also referred to as a “pot belly,” “beer belly,” or “Buddha belly”—is internal fat deep within the abdominal cavity that can make us apple-shaped.  It wraps around our internal organs including our liver, kidneys, and pancreas. Visceral fat is always unhealthy fat that can have dire metabolic consequences. In general, waist circumference is a reasonably good measure of visceral fat. (Of course, morbid obesity due to either type of fat can prove extremely  dangerous to one’s health.)

It’s kind of like real estate, the value of which is predicated on location, location, location. Think of visceral fat as prime, expensive beachfront property on the gold coast with a short walk to the ocean, the ocean of metabolic disasters.  Think of subcutaneous fat as less expensive, inland property, quite removed from this ocean of metabolic disasters.  Clearly, visceral fat is fat that behaves badly and fat that is strongly desirable to avoid.

In many ways, the distinction between subcutaneous and visceral fat parallels the distinction between good fats and bad fats in our diet.    The not unhealthy one or two inches of subcutaneous fat that you can pinch around your waistline can be thought of as a good fat such as the fat in olive oil, avocados, or nuts.   On the other hand, the unhealthy visceral fat that causes a man to have a big protuberant abdomen—creating an appearance not unlike a very pregnant female—can be thought of as bad fats such as the partially hydrogenated fats present in vegetable shortening that are commonly used in fast foods and other processed baked goods.

Visceral fat storage is not static but dynamic, meaning that there is continuous mobilization of our fat (as fatty acids) and storage (as triglycerides).  Lipolysis is the chemical reaction in which the fat is broken down into fatty acids that the body can use as energy. This can occur very readily in visceral fat. Likewise, accumulation of visceral fat can occur in a very rapid fashion. Excessive intake of calories will be rapidly stored as visceral fat, whereas under circumstances of a reduced calorie intake, the visceral fat is broken down to provide fuel for our bodies’ metabolic processes, particularly muscle contraction.

Visceral fat is not just a bland collection of fatty tissue sitting inertly within your belly causing an oversized appearance to your abdomen.  It is an extremely metabolically active endocrine organ with a life of its own.  Fat is the largest endocrine organ in our bodies and it releases a myriad of pro-inflammatory factors, hormones and immune cells that can affect metabolism and other bodily functions. Fat has an abundance of the hormone aromatase, which converts testosterone to the female hormone estrogen.  One consequence of too much fat in men is excessive conversion of testosterone to estrogen. Men with plentiful visceral fat often will bear the consequences of lower testosterone and higher estrogen levels, including sexual issues and breast development as well as numerous other negative consequences of insufficient levels of testosterone.

Visceral fat is intimately connected to the inflammatory process and can result in insulin resistance, metabolic syndrome, cardiovascular disease and an entire array of negative health ramifications, including chronic diseases such as arthritis and cancer.  This is in contradistinction to subcutaneous fat, which produces far less inflammatory chemicals. Since men have a tendency towards visceral fat collection whereas women have a tendency towards subcutaneous fat collection, this might explain why women are less susceptible to cardiovascular disease then men are.

Insulin is the principal regulator of fat metabolism. After a sugar and carbohydrate load, insulin is released to get the fuel into our cells. When we go without food, as happens when we sleep, insulin levels decrease and fat is released to be used as fuel.  Insulin levels are determined primarily in response to our carbohydrate intake in order to keep our blood sugar regulated. Insulin has much to do with the way our bodies store or burn fat. You can think of insulin as our fat hormone—when insulin levels are elevated, we accumulate fat; when levels are low, we burn fat for fuel.  So if you have a substantial collection of visceral fat, it becomes highly desirable to reduce sugar and refined carbohydrate intake to decrease insulin and burn away that bad, pro-inflammatory fat as fuel. The good news is that by losing abdominal fat, the potentially bad health repercussions can be reversed. The dangerous visceral fat submits relatively easily to diet and exercise whereas the less harmful subcutaneous fat at the waist is more stubborn and resistant to reversal measures.

How To Burn Fat:

  • Eat in accordance with nature’s design—meaning whole foods.  Avoid processed foods.  The best diet is an “anti-processed-atarian” diet.
  • Avoid “naked” calories (stripped of fiber), so restrict sugar, simple white carbohydrates, and liquid calories. Specifically avoidsugared drinks, white pasta, white rice, white bread, doughnuts, bagels, potatoes, etc.  Aggressively steer clear of high fructose corn syrup.
  •  Eat high-quality, whole-grain, high-fiber carbohydrates (whole grain pasta, brown rice, whole grain breads, legumes, whole fruits and vegetables), lean protein sources (easy on meat and dairy) and healthy fats (vegetable and seafood-origin).
  • Avoid giant meals in which the caloric load will be stored as fat; substitute with multiple smaller meals in which the calories will be used for immediate energy.
  • Limit after dinner snacking since unnecessary calories at a time of minimal physical activity will be stored as fat.
  • You must incorporate exercise into your lifestyle, achieving balance between aerobic, resistance and core workouts.  Aerobic exercise has great potential in burning fat for fuel and interval training seems to really rev up our fat-burning capabilities.
  • Portion control is the name of the game: in order to burn fat, energy intake must be less than energy output.  Even if you eat only the healthiest of foods, if calories in exceed calories out, you will not burn fat for fuel.
  • Minimize stress; if you can’t eliminate it, work to manage it.
  • Get adequate amounts of quality sleep.  See my previous blog entitled “Sleep To Slim” to find details: https://healthdoc13.wordpress.com/2012/07/20/sleep-to-slim/

The bottom line is that while body fat in any excessive amount is unhealthy and unattractive, it becomes a potentially life-threatening issue depending on its location in our bodies.  An enormously protuberant belly can lead to processes that result in disease—and even death.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Now available on Amazon Kindle

 

Where’s Your 6-Pack?

January 28, 2012

Blog # 43 written by Andrew Siegel, M.D.

 

I posed this question to my nurse friend Jen and she replied “in the fridge.”  She made me laugh with that reply, but in reality she has a pretty hard body, especially for a woman who has given birth to several children.  However, if your answer to the question truly is “in the fridge,” then you might just want to read on!

If you would like the short version, skip to the end of this blog where you can read “10 pearls to help your washboard abdomen emerge”—itprovides nuggets of information that if heeded, will allow your to firm up your abdomen and start the process of unveiling the 2-pack, 4-pack or 6-pack that lies obscured within.  Read the full blog if you would like to know the more detailed science.  Although vanity may be an important driving force for wanting to develop that 6-pack, it’s really about living a healthy lifestyle—in brief, the aesthetics will follow a healthy existence and our internal health often mirrors our external physiques.

Sporting a six-pack is a badge of honor emblematic of one’s discipline, restraint and tenacity.   A “hard core” can only be earned through the combined efforts of healthy eating and vigorous exercise.  Chances are if you’re wearing a 6-pack, then you are fit and healthy and that in all probability you have rejected the Western diet of processed foods, lots of added fats, sugars and loads of refined grains and instead have chosen a healthy diet consisting of real food that comes from nature, rather than from a chemistry lab.

We all have 6-packs hidden beneath our winter-weighted physiques.  We may be flabbier and less toned than desirable, but somewhere within is a sinewy, tight, and lean torso.  The question is: what can we do to bring out this svelte body?  How do we reduce our shapeless stockpile of stored energy that is shrouding our underlying sculpted physique?

Michelangelo’s “David” was at one time a mere solid block of marble.  The master artist crafted this magnificent sculpture by knowing exactly what to carve away—what did not belong. In the words of Antoine de Saint-Exupery (author of Le Petit Prince): “Perfection is not when there is no more to add, but when there is no more to take away.”  The late Steve Jobs was a grand master at removing the unnecessary and superfluous to reveal the elegant simplicity that remains. In the words that follow, I will offer sound advice on how to peel away the nonessential to reveal your own magnficence that lies obscured.

Having some fat on our bodies is not a bad thing, as long as it is not excessive. Fat actually serves a number of useful purposes.  It functions to cushion our internal organs and as insulation to conserve heat.  Fat provides a means of storing energy and fat-soluble vitamins.  During periods of decreased caloric intake, fat reserves are broken down to release energy.  Fats are important parts of the structure of the brain and cell membranes and are used in the manufacture of several important hormones.  Fat has more than twice as many calories per gram than carbohydrates or protein.   Anybody who has barbecued any kind of meat with a high fat content and has witnessed their would-be dinner engulfed in flames realizes what a concentrated form of fuel that fats are.

As we age, many of us tend to slowly and insidiously gain weight.  A collection of fat often becomes apparent on our abdomens, particularly around our waistlines.  An accumulation of fat in our midsections not only is unattractive from a cosmetic standpoint, but also can have dire metabolic consequences.  It is important to distinguish between visceral fat and subcutaneous fat.  Visceral fat—also referred to as a “pot belly,” “beer belly,” or “Buddha belly”—is internal fat deep within the abdominal cavity.  Subcutaneous fat—also known as “love handles,” “spare tires,” “muffin top,” or “middle-age spread”—is present between the skin and the abdominal wall.  Although neither type is pretty, visceral fat is much more hazardous than subcutaneous fat since it increases the risk of diabetes, cardiac issues, and metabolic disturbances.  Subcutaneous fat is inactive and relatively harmless and does not contribute to the health problems that visceral fat does.

The good news is that by losing abdominal fat, the potentially bad health repercussions can be reversed and the six-pack within can become more unveiled.  The dangerous visceral fat submits relatively easily to diet and exercise whereas the less harmful subcutaneous fat at the waist is more stubborn and resistant to reversal measures.  It is this accumulation of belly fat that masks the underlying rectus abdominis muscle that is our 6-pack muscle.

And now a few necessary paragraphs on metabolism: Dietary carbohydrates are broken down to the simple sugar glucose, which is the “energy of life” and the fuel source of every cell in our body. When it is not used immediately for energy, it is stored as glycogen. The pancreatic hormone insulin is responsible for converting glucose into glycogen. Glycogen is present in our liver and muscles; when a state of saturation has been achieved and no more glycogen can be stored in our liver and muscles, the excess glucose is converted to fat.  There is a finite limit to the amount of carbohydrate stored in the muscles and liver—it amounts to about 1600-1800 calories.

When talking metabolism, it is helpful to think of our glycogen as our “small fuel tank.”  Once the fuel in the liver and muscles is exhausted, our “large fuel tank”—our fat—needs to be tapped to provide energy.  In contrast to the limited carbohydrate storage in our liver and muscles, our bodies abundantly store fat.  Depending on how much fat we have, many days to weeks of energy can be provided.  To reveal your 6-pack, you need to have as small a “large fuel tank” as possible, since it is these stored energy reserves that are obscuring the glorious sculpted abdominal musculature that lies beneath.

There are a few important facts that are fundamental to our understanding of the science of fat. First off, our fat stores are not static, but are dynamic.  In other words, there is continuous mobilization of our fat (as fatty acids) and storage (as triglycerides).  Secondly, fat storage is largely under hormonal control.  Hormones are chemical messengers that cause specific actions in our body.  The hormones involved in fat metabolism are insulin, cortisol, estrogen, and testosterone.  Thirdly, fat is not just fat—it is a metabolically active endocrine organ that does not just protrude from our abdomens in an inert state, but has a life of its own.  Fat produces pro-inflammatory factors, hormones and immune cells.  Fat has an abundance of the hormone aromatase, which converts testosterone to the female hormone estrogen.  One consequence of too much fat in men is excessive conversion of testosterone to estrogen, creating the potential for male breast enlargement.

Insulin is the principal regulator of fat metabolism. After a sugar and carbohydrate load, insulin is released to get the fuel into our cells. When we go without food, as happens when we sleep, insulin levels decrease and fat is released to be used as fuel.  Insulin levels are determined primarily in response to our carbohydrate intake in order to keep our blood sugar regulated.

Insulin has much to do with the way our bodies store or burn fat. You can think of insulin as our fat hormone. When insulin levels are elevated, we accumulate fat; when levels are low, we burn fat for fuel.  Insulin is all about increasing fat storage and decreasing fat burning—this is why diabetics on insulin injections typically get fat.  If we have a substantial amount of belly fat, then by definition we have insulin-resistance, a condition in which our pancreas works overtime to make more and more insulin to get fuel into our cells.  This is a precursor to diabetes, cardiovascular disease and all the havoc they can wreak.

Our insulin levels are determined by the carbohydrates we eat—the more carbs we eat, the sweeter they are, the easier they are to digest, the greater the insulin levels and the more that fat accumulation is driven.  Insulin secretion caused by eating carb-rich foods—flour and cereal grains, starchy vegetables like potatoes and rice, sugars and high-fructose corn syrup—is what makes us fat.  The sweeter the food, and the easier it is to digest, the fatter it will make us, and liquid carbs such as sodas, fruit juices and beer are the biggest culprits.

If we want to get leaner and reveal the 6-pack within, we must lower our insulin levels.   To lower our insulin levels requires carbohydrate restriction, meaning decreased consumption of sweets and starchy carbs.  Even if we don’t reduce our quantity of carb intake, we can improve the quality of our carb intake by eating healthier carbs—whole grains, fruits, vegetables, legumes, etc.  Aside from shrinking our waistlines, there are numerous other health benefits that accrue from a lower carb diet.  If we replace a high carb diet with a diet lower in carbs and higher in healthy protein and healthy fat, the consequences are the following: weight loss; HDL (good) cholesterol rises; triglycerides decrease; glucose levels stabilize; blood pressure decreases; heart disease risk decreases; body fat reduces; energy levels surge.

The adrenal gland hormone cortisol—releasedin response to stress—can stimulate our appetites and cravings for sugar, causing fat storage and promoting weight gain and obesity. This is the very reason people on corticosteroid medications tend to have enormous appetites, gain weight and have a central distribution of body fat known as centripetal obesity, even if they were very thin prior to starting on the cortisol.  Chronic stress literally can make us soft and flabby and sabotage our efforts to achieve that chiseled 6-pack.  So what can we do about stress, because we all have it, and it’s not going away anytime soon?  Stress busters include exercise, yoga, meditation, massages, getting into a Jacuzzi, aromatherapy, chamomile or other herbal teas, sex, etc.  Sounds nice…relax to help bring forth that 6-pack!

The sex hormones estrogen and testosterone play a key role in fat regulation. One of the key reasons that women have a different physical appearance and body fat distribution than men is because of the different levels of these two hormones in each gender.  Around the time of menopause, when the ovaries stop producing estrogen, central fat deposition is promoted and many women start packing on pounds in their mid-section.  Similarly, as men age, testosterone levels often drop, contributing to a loss of muscle mass and an increase in body fat. Low testosterone is present in about half of obese men.

Believe it or not, a good night’s sleep will help us on our mission for that elusive 6-pack.  When we sleep poorly and become sleep-deprived, we are often driven to eat. Sleep deprivation results in decreased levels of leptin, our chemical appetite suppressant, and increased levels of ghrelin, our appetite stimulant, in addition to increased levels of the stress hormone cortisol.  Furthermore, being exhausted can sabotage our exercise regimen.

Six-pack diet

Lean sources of protein including egg whites, wild salmon (or any other wild fish that is grilled or broiled), skinless chicken, turkey breast, fat-free yogurt and soy products such as tofu and edamame are money.  We need to be sparing with meat and dairy intake since they are rich in saturated fats and high in calories.  Vegetables—including nuts, avocados and olives—are a much healthier source of fat.

High fiber foods—vegetables, fruits, legumes (lentils, peas and beans) and whole-grain cereals and breads—are very filling and the fiber regulates the rate of carbohydrate absorption. Intake of a variety of brightly colored fruits and vegetables will ensure getting ample doses of phyto-nutrients and anti-oxidants. Dietary fiber (roughage) refers to the indigestible part of a carbohydrate.  Insoluble fiber, e.g., cellulose from plant foods, serves as plants’ armor against predatory pests and serves as humans protection against obesity.  Since we do not have the enzymes necessary to dissolve insoluble fiber, it increases stool bulk, decreases intestinal transit time, increases our satiety, reduces the rate of carbohydrate absorption and the conversion of complex carbohydrates to simple sugars, and decreases the absorption of some fats.  Soluble fiber binds cholesterol in the intestinal tract; for example, oatmeal can help lower serum cholesterol levels.

It is very important to minimize refined carbohydrates, substituting whole grain products for white bread, white pasta, white rice, etc.  Curtailing sugar intake is equally important since sucrose is a 50% fructose/50% glucose combination and fructose gets metabolized completely differently from glucose, pushing our bodies towards fat deposition.  The same is especially true for high fructose corn syrup (HFCS), that gooey liquefied sweetener abundant in processed foods and beverages in a 55% fructose/45% glucose ratio. Every cell in our body can metabolize glucose, but it is primarily the liver that metabolizes fructose. Fructose, more readily than glucose, replenishes liver glycogen, and once the liver is saturated with glycogen, fats are made and stored. So, HFCS gives us a fatty liver, a fatty body and a masked 6-pack.  Fructose does not suppress ghrelin (our hunger hormone), does not stimulate insulin, and is truly a toxin to our body in immoderate doses. Let fruits be the source of fructose for our bodies, not refined sugars and HFCS.

Nature is very clever—whenever it provides us with a nutrient that is potentially bad for our health, it limits access to that nutrient by adding lots of fiber to it.  So when nature has given us fructose, it has also included the antidote.  Did you ever try to get the sugar out of a sugar cane plant?  It is literally like gnawing on a piece of bamboo stick—you can’t chew it and have to suck it out!  Processing has allowed us to cheat nature by refining sugar, permitting consumption in unrestrained, unhealthy amounts, contrary to nature’s design.  For example, it is very easy to drink 12 ounces of orange juice, to the tune of about 170 calories of fiber-free sugar.  To get that kind of caloric load from nature’s whole product—the orange—you would have to eat almost 3 of them.  Can you imagine sitting down and eating three oranges?  I sure can’t.  So go easy on anything that comes in a bottle, box, carton or can…think whole foods that resonate with nature, not refined foods that are unfaithful to nature.

While at the dinner table the other evening, I found myself staring at a colorful salad on my left and a basketful of white Italian bread (not whole grain) on the right.  I pondered the “order” of eating in terms of insulin release—would there any difference if I had salad first followed by bread vs. bread first followed by salad, vs. eating them together and would the order of eating play a role in the way calories are burned or stored?

Salad first followed by bread (bulky, fiber-rich carbs then fiber-less carbs): This gives us a gradual, low-level insulin spike followed by rapid, high-level insulin spike.  It is likely that the bolus of salad slowly digesting in the gut will modulate (regulate) the insulin spike from the bread’s fiber-less carbs, resulting in less of a tendency for fat deposition.

Bread first followed by salad: (fiber-less carbs then fiber-rich carbs):  This gives us a rapid, intense insulin spike followed by gradual, lower-level insulin spike.  It is likely that this order will result in fat deposition, since by the time the salad gets to the gut, the bread has already been digested and absorbed.

Together: The salad mixing in the gut with the bread will modulate the insulin spike from the fiber-less carbohydrate load of the bread, resulting in less of a tendency for fat deposition.

Bottom line: If you are going to eat white carbs, you can minimize the intensity of the insulin spike and thus the tendency for fat deposition by mixing in some fiber-rich foods; better yet is to ditch the white carbs completely and eat the whole-grain product. If you are going to use the strategy of using the powers of fiber-rich food like salad to lessen the “damage” from fiber-less white carbs, be sure to go easy on the croutons, cheese and excessive amounts of salad dressing that can sabotage the strategy.

A very important principle in the acquisition of a 6-pack is not to drink calories, so avoid liquid calories such as soda, juices, processed iced tea, lemonade, etc.  These are particularly bad since they are essentially pre-digested, fiber-less carbohydrates that get “mainlined” into our bodies causing a massive insulin spike and caloric storage as fat.  A “beer belly” resulting from the carbohydrate alcohol and a “soda belly” resulting from the carbohydrate fructose are substantially equivalent. The best drink is water or seltzer—it can be jazzed up with a squeeze of lemon or lime.  Water keeps us well hydrated, dampens our appetite and will quell our thirst that is sometimes confused for hunger.

It is important to be careful not to overdo sodium intake as it can cause fluid retention, high blood pressure, bloating, weight gain and a number of potential cardiac issues, aside from thwarting the emergence of our 6-packs.

Six-pack exercise regimen:

A general rule of thumb is to think “athletics” and the “aesthetics” will follow.   The key to exercise is diligence—carving out the time—and variety—strength  (resistance) training, cardiovascular (aerobic) training and core (abdominal and torso) conditioning, and perseverance.  A core synergistic exercise regimen, which is a combination of the aforementioned three types of exercise, provides a terrific overall workout. Pilates, yoga, and martial arts are three great means of obtaining a hard core, although there are many other effective exercises as well.  Pilates, in particular, is an awesome means of developing core strength.  I have been taking Pilates lessons weekly for over a year from an amazing instructor, Catherine Byron, who has been instrumental in helping me achieve a toned abdomen, core strength, better balance, posture and muscle symmetry (www.cbperformancepilates.com).  My friend and yoga instructor Ben Wisch, has also helped whip my core into shape (www.homeyogaexperience.com).  I  enjoy and have derived great benefit from home exercise DVDs from beachbody.com:  the P90x “ab ripper,” “core synergistic,” and “yoga” workouts and the P90x plus “abs-core” workout can’t be beat.

Muscles play a key role in our metabolism: they are extremely metabolically active, each pound of lean muscle burning about 50 calories/day.  With a sedentary existence and aging, there is a gradual loss of muscle mass and a resultant slowing in our resting metabolism.  By building and maintaining our muscle mass with strength training, we will raise our resting metabolic rate and burn more calories.  Additionally, exercise serves to increase the “insulin sensitivity” of muscle, which means that are muscles become more efficient at burning off carbohydrates as fuel. Exercise is also our endogenous stress reducer, lowering cortisol levels, suppressing our appetites and helping us burn carbs before they have a chance to be stored to fats.

We can measure our maximal heart rates by doing an aerobic activity, such as swimming, running or cycling full throttle until we can’t go on, and then taking our pulses.  In our workouts, if we can achieve a heart rate of 75% of our maximum rate and sustain that for 30-60 minutes daily, it is easily conceivable to burn 600 or more calories per day.   High intensity interval training—alternating between extremely intense exertion and regular “normal” exertion—can rapidly help propel us towards that sculpted body that lies within.
10 pearls to help your washboard abdomen emerge:

 1.    If you want a hard waist, you must incorporate exercise into your lifestyle, achieving balance between aerobic, resistance and core workouts.

2.    Eat high-quality, whole-grain, high-fiber carbs, lean protein sources (easy on meat and dairy) and healthy fats (vegetable and seafood-origin).

3.    Eat in accordance with nature’s design—meaning whole foods.  Avoid processed foods.  The best diet is an “anti-processed-atarian” diet.

4.    If you want to look good naked, don’t eat “naked” calories (stripped of fiber), so restrict sugar, simple white carbs, and liquid calories.  Aggressively steer clear of high fructose corn syrup.

5.    Soft foods (sugared drinks, white pasta, white rice, white bread, doughnuts, bagels, potatoes, etc., will earn you a soft core; hard foods (whole grain pasta, brown rice, whole grain breads, legumes, whole fruits and vegetables) will help earn you a hard core.

6.    Avoid giant meals in which the caloric load will be stored as fat; substitute with multiple smaller meals in which the calories will be used for immediate energy.

7.    Limit after dinner snacking since unnecessary calories at a time of minimal physical activity will be stored as fat.  If you restrict your evening snacking to one piece of fruit, you will wake up in the morning with less to pinch on your waistline.

8.    Drink plenty of water; use salt sparingly.

9.    Minimize stress; if you can’t eliminate it, manage it.

10. Get adequate amounts of quality sleep.

 

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com