How to Lose Belly Fat

Julian Whitaker, MD

Potbelly, spare tire—or maybe your six-pack abs have turned into a pony keg. Whatever you call it, you need only look around you to know that abdominal fat is the most common type of obesity. It is also the most dangerous.

Fat, or adipose tissue, on the hips, thighs, arms, and elsewhere may not be any prettier, but it poses less of a health risk. That’s because it’s stored right under the skin. Most belly fat (visceral adipose tissues) lies within the abdominal cavity, surrounding the intestines, liver, kidneys, and other organs. Excess fat in this area is linked to increased risk of diabetes, hypertension, heart disease, even cancer and dementia.

The good news is that visceral fat is responsive to weight loss interventions. I’m not talking about spot reduction—there’s no such thing. However, when you do lose weight, abdominal fat goes first.

What Makes Belly Fat Dangerous?

Fat cells (adipocytes) are like tiny balloons that fill up with fat (triglycerides) when you eat more calories than you burn, and shrink when you expend more than you take in. But they are not just energy depots. Fat cells secrete a number of hormones and signaling proteins that have far-reaching effects.

Visceral fat breaks down much faster than subcutaneous fat, and because of its close proximity to vital internal organs, it continuously floods the system with free fatty acids that contribute to insulin resistance, arterial dysfunction, elevations in blood lipids, liver disease, and fat stores.

Excess belly fat also upsets hormones and signaling proteins. Leptin, an appetite-controlling hormone, and adiponectin, involved in insulin sensitivity, get out of whack. Coagulation factors become imbalanced, increasing risk of blood clots. In addition, levels of inflammatory chemicals surge, with adverse effects on the cardiovascular system and tissues throughout the body.

An elevated waist circumference—along with low HDL cholesterol and high blood pressure, fasting blood sugar, and triglycerides—is a hallmark of metabolic syndrome, the cluster of conditions caused by insulin resistance. In fact, many scientists believe that waist circumference may be the most reliable predictor of diabetes and heart disease.

The Obvious Solutions…

So, what can you do about it? For starters, eat less and exercise more. As stored fat is mobilized for energy, those adipocytes in your belly will be the first to shrink. According to American College of Sports Medicine guidelines, a minimum of four hours of moderately intense physical activity per week is necessary for clinically significant weight loss. Unfortunately, virtually all experts agree that you can’t depend on exercise alone—you simply must make changes in your eating habits.

Some people do well simply by cutting portion sizes and eating a healthier diet. A recent study involving nearly 500,000 European men and women found that those with the greatest adherence to a Mediterranean diet—high in fiber and plant foods and low in saturated fat—were the least likely to have abdominal obesity. My experience, however, has been that a low-carbohydrate diet works best when insulin resistance is an issue. It puts your body in a fat-burning mode and helps control appetite by cutting down on blood sugar swings that cause food cravings.

If you can’t lose weight on your own, get help. At Whitaker Wellness, we have a program called Therapeutic Lifestyle Changes (TLC) that involves personalized nutritional counseling, meal replacement drinks and bars, exercise guidelines, and targeted supplements. We also test levels of thyroid, estrogen, testosterone, and other hormones. Imbalances in any of these can hamper weight loss efforts, and correcting them is, in some cases, half the battle.

…And the Not So Obvious

Other lifestyle factors also need to be addressed. One is sleep—or lack thereof. People who get inadequate sleep tend to be heavier. Furthermore, untreated sleep apnea is clearly linked with obesity, metabolic syndrome, diabetes, and cardiovascular disease. If you’re struggling with any of these conditions, especially if you snore, talk to your doctor about getting tested for sleep apnea.

Another is sun exposure. You need to regularly spend time outdoors—without sunscreen—to produce enough vitamin D. Blood levels of this vitamin are inversely associated with insulin resistance, diabetes, blood pressure, and according to recent research, excess weight and abdominal obesity. Have your vitamin D blood level tested, and if it’s not in the 50–70 ng/mL range, take enough supplemental vitamin D to get it there—and always take at least 2,000 IU of vitamin D per day during the winter.

Promising Supplements

A number of supplements claim to enhance weight loss, and some of them are quite promising. One of the most impressive is green tea, which contains EGCG and other catechins that, in addition to their immune and cardiovascular benefits, have been demonstrated to increase thermogenesis, or fat burning.

Italian researchers gave a supplement containing green tea catechins to 50 overweight or obese men and women and placebo capsules to another 50. All study participants adhered to a reduced calorie diet—1,350 calories per day for the women and 1,850 for the men. After 90 days, the men and women taking the green tea extract lost an average of 34 and 26 pounds, respectively, compared to a mean 10-pound loss among those in the placebo group. They also had significant reductions in cholesterol, triglycerides, leptin, cortisol, and, for the men, waist circumference.

Resveratrol, the phytonutrient in red wine that has gained fame as an anti-aging agent, may also be helpful. In past issues, we’ve discussed how resveratrol mimics the protective effects of caloric restriction and guards lab animals against the adverse effects of a high-fat diet—they gain weight but have none of the associated health problems. German scientists have since discovered that resveratrol inhibits fat storage and the development of new fat cells, and positively affects the hormonal/signaling protein cascade that obesity undermines. In addition, resveratrol prevents fat buildup in the liver, so it also protects against nonalcoholic fatty liver disease. (See the sidebar at left for more on this topic.)

I also recommend the herbal extract Irvingia gabonensis. In addition to facilitating weight loss, this supplement helps correct leptin levels and reverses many of the symptoms of metabolic syndrome.

The heavily advertised supplement CortiSlim claims to help you lose weight by blocking cortisol. Although I’m unaware of any research supporting this claim, I do know that DHEA, another adrenal hormone and natural counter-regulator of cortisol, has been shown to assist in abdominal weight loss. When older, overweight men and women with low blood levels of DHEA took 50 mg of DHEA daily, the men lost 10.2 percent of their visceral adipose tissue and the women lost 7.4 percent. Their insulin sensitivity improved as well.

Do You Have a Fat Liver?

Belly fat and insulin resistance are closely related to nonalcoholic fatty liver disease (NAFLD). The portal vein, which goes from the gastrointestinal tract to the liver, lies smack in the middle of visceral fat. The free fatty acids generated by this adipose tissue are released into the portal vein and delivered directly to the liver, where they replace normal liver cells.

NAFLD doesn’t make you feel ill or jaundiced, and the only real indication of this condition—besides abdominal obesity—is elevated liver enzymes. Most people don’t even realize they have it. However, it is a harbinger of potential future problems. Excess fat in the liver stimulates free-radical activity, which kicks inflammation into gear and, over time, damages hepatic cells. In some cases, NAFLD progresses to more serious diseases such as nonalcoholic steatohepatitis (significant inflammation) or cirrhosis (scarring of the liver).

Should you be concerned? Studies suggest that NAFLD affects nearly 70 percent of people with type 2 diabetes and even more of those who are obese. But there is a cure for NAFLD: weight loss. Researchers at St. Louis University recently found that when patients lost at least nine percent of their body weight, they were able to reverse even advanced NAFLD. Exercise—independent of weight loss—has also been shown to improve liver enzymes in patients with this condition.

You should also go easy on alcohol and drugs that damage the liver such as acetaminophen (Tylenol), NSAIDs (aspirin, ibuprofen), and cholesterol-lowering statins, and take nutritional supplements that support liver health. These include silymarin (milk thistle extract), alpha lipoic acid, selenium, and other antioxidants.

Probiotics for Weight Loss?

Recent research suggests that probiotics may also help fight the battle of the bulge. The bacteria that reside in your intestinal tract, known as the gut microbiota, are involved in nutrient uptake and energy regulation. Studies reveal that in obese humans and animals, the microbiota extract and absorb more calories from food and store them in fat cells.

In a study conducted earlier this year, pregnant women who took probiotic supplements during their first trimester were only half as likely as a control group to have abdominal obesity a year after giving birth. Another 2009 clinical trial found that patients who took probiotics after bariatric (weight-loss) surgery had significantly greater weight loss than those who did not take these supplements.

This research is fairly new, and there are many questions yet to be answered. However, I recommend that everyone take a good probiotic supplement. In addition to possibly facilitating weight loss, these supplements help prevent pathological bacterial overgrowth, improve digestion and elimination, and boost immune function.

Finally, make sure you eat a lot of fiber—aim for at least 30 grams a day. Some researchers suggest that one reason for the Mediterranean diet’s protective effects is its high fiber content, which “feeds” beneficial intestinal bacteria. If you aren’t getting enough fiber in your diet, try adding flaxseed or psyllium (Metamucil) to your daily regimen.

Time to Take Action

Men, if your waist circumference is more than 40 inches—and women, if yours is more than 35 inches—you need to take action now. I know from personal experience that weight loss is tough, but it’s worth it. Dropping just 10 percent of your current weight provides tremendous and lasting health benefits.

As you lose your belly fat, other signs of metabolic syndrome will recede. Your blood sugar and blood pressure will go down, and your cholesterol, triglycerides, and C-reactive protein levels will improve. Your risk of heart attack, stroke, heart failure, cancer, and liver disease will decrease. And, as an added bonus, you’ll look and feel better than you have in years.

Recommendations

• The green tea supplement discussed above is a standardized extract of catechins bound to phosphatidylcholine called GreenSelect. The suggested dose is 300 mg per day. The daily recommendations for resveratrol and Irvingia are 50 mg and 300 mg, respectively.
  The usual starting doses of DHEA are 50 mg for men and 25 mg for women. DHEA is not recommended for people younger than 45 or anyone with prostate, breast, or ovarian cancer.Blood levels should be tested three months after starting on DHEA and the dose adjusted to help you stay in the high-normal range for a young adult.
• To enroll in the Whitaker Wellness Institute’s Therapeutic Lifestyle Changes program, call (866) 944-8253.
• My book, The Whitaker Wellness Weight Loss Program, outlines the clinic’s approach to weight loss and provides detailed, step-by-step diet, exercise, and supplement guidelines. The book is available in bookstores and these supplements can be found online and in some health food stores. You may also order any of these items by calling (800) 810-6655.

References

• Di Pierro F, et al. GreenSelect Phytosome as an adjunct to a low-calorie diet for treatment of obesity: a clinical trial. Altern Med Rev. 2009;14(2):154–160.
• The Endocrine Society. Red wine’s resveratrol may help battle obesity. 2008 June 17. ScienceDaily. www.sciencedaily.com/releases/2008/06/080616115850.htm. Retrieved September 21, 2009.
• Pataky Z, et al. Gut microbiota, responsible for our body weight? Rev Med Suisse. 2009 Mar 25;5(196):662–664, 666.
• Patel AA, et al. Effect of weight loss on NAFLD. J Clin Gastroenterol. 2009 Sep 1. [Epub ahead of print].
• Romaguera D, et al. Adherence to the Mediterranean diet is associated with lower abdominal adiposity in European men and women. J Nutr. 2009 Sep;139(9):1728–1737.
• Villareal DT, et al. Effect of DHEA on abdominal fat and insulin action in elderly women and men. JAMA. 2004 Nov 10;292(18):2243–2248.

Modified from Health & Healing with permission from Healthy Directions, LLC. Photocopying, reproduction, or quotation strictly prohibited without written permission from the publisher. To subscribe to Health & Healing, click here.