As a primary care family physician, I encounter dozens of different health concerns and issues every day. One of the most common complaints I hear is about weight gain around the tummy. More than a vanity issue, belly fat has far-reaching effects because of the type of fat that the body stores around the mid-section.

Fat is stored energy, and your body makes different types of fat that release energy in different ways. There is slow-twitch fat, which is meant for long-term storage; for example, energy that could be used over a period of months if there were a hard winter and food was scarce.This type of fat is stored in the hips and thighs, which is why it takes longer to lose after being stored there.

In comparison, there is another type of fat known as fast-twitch fat, which is the stored energy that is designed to be used quickly--like if we suddenly had to run away from a predator. This type of fat is stored around the abdomen and breaks up quickly for fast use. The drawback of this is that the rapid breaking up of fat increases the amount of fat in the bloodstream, which may clog arteries and increase the risk of heart attack and stroke. 

Since fats are designed to be used during times of stress, the stress hormone cortisol greatly affects what kind of fat is produced and where it is stored.  During our middle-age years, the stress we have experienced in our lives seems to catch up with us, and we notice it most obviously in our midsection. Cortisol levels can rise slightly, or drop suddenly. Estrogens, especially in females, can drop suddenly, and in fact, all sex hormones tend to decrease as we age, especially at menopause/ andropause.

Insulin, a pancreatic hormone that moves sugar into our cells where it can be stored as fat, can increase, or it can be impaired in its ability to work properly (insulin resistance). This shifts the fat to your belly, but actually creates an environment where you have less fat to burn for energy, making you feel tired, sluggish and unable to think clearly. Combine this with a few inappropriate cortisol surges during the night (so you wake up and can't get back to sleep) and now the symptoms all get worse! 

It may seem impossible to unravel this crazy 21st-century health crisis, but I think if we work through this physiologically, together we can come up with some answers.

1. You have to convince your nervous system that you aren't being chased by a tiger! This involves a gradual process of "unwinding" your nervous system, not just suddenly deciding it is so and expecting your body to react quickly. Slow and easy does it, and begin by paying attention to your breath. You may not realize it, but when we are under stress we naturally hold our breath--it's a conditioned response. (You couldn't make noisy breathing sounds if you were hiding from a tiger!) Ask your local yoga instructor if they have breath classes (pranayama), or check out our new Meditation Class beginning March 21st (scroll down for more information). I know it may sound like a small thing, but unwinding your nervous system can be the most powerful work you will ever do for your body. Other techniques to consider are prayer, Thai Chi, Chi Gong, Yoga, HeartMath, or EMDR, to name just a few.
2. Exercise: We have presented many articles here explaining the benefits of exercise as it relates to stress relief, hormonal balancing, weight loss, blood sugar control, relief from anxiety/depression--and it just makes you feel good! The key is finding a form of exercise you love. Hiking, biking, kayaking, tennis, dancing around the house--it doesn't really matter what you do, as long as you can do it daily for at least 30 minutes. And if it's something you love, you're more likely to do it without stressing about it! It may be challenging at first to overcome the inertia, especially if you find yourself in the hormonal pattern mentioned above, but once you do it, the pay-off will be huge!
3. Diet: Yep, you guessed it--I'm coming at you with veggies again! While higher protein diets seem to work best in our 20's, 30's and even early 40's, once we start to get the belly bulge what tends to clear and balance the insulin-cortisol-sex hormone triad are the nutrients and binding power of vegetables. You've heard me say, "Eat 2 pounds of vegetables a day," and I'm sticking to that with this one! If you can't figure out what to cook, try Googling recipes or come in and chat with our nutritionist, Victoria Abel. She can evaluate your health issues and help you establish a dietary plan that fits your needs with your life.
4. Botanical Medicine: Then, of course, there are our wonderful plant medicine helpers who give us so much support when we need it!  (More on this in next weeks' newsletter.)  
5. If these things aren't making a difference in your belly fat, have your hormones tested: cortisol (measured at least 4 times throughout the day, if possible), thyroid function (a full panel will give you clues about your adrenal health as well) and sex hormones. If your belly fat is really resistant, you may want to also consider having a Sex Hormone Binding Globulin test as well. Then work with a qualified physician to help you navigate this information and help bring your body back into balance.

Blessings, and to your good health,

Dr. Susan Godman