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Krista Edwards
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.Estrogen, Progesterone and TestosteroneNo discussion of belly fat is complete without considering the impact of the sex steroids. Human fat tissue has receptors for estrogen, progesterone and testosterone, and these hormones impact fat metabolism (Mayes & Watson 2004).Receptors have varying concentrations in the different belly fat regions.Estrogen has anti-insulin and anticortisol effects on the belly (Yematani et al. 2013; Pallottini et al. 200. Progesterone also has anticortisol effects. This hormone combination is very effective at controlling belly fat. Thisis a big part of the reason why young women tend to maintain an hourglass shape and older women tend to lose it (Björntop 1997). Testosterone is interesting because higher levels in women are associated with more belly fat, while lower levels in men are arisk factor for more belly fat. Testosterone decreases LPL activity and raises beta-receptors density, but it also opposes the action of estrogen, which explains its positive impact in male belly fat and more negative impact in women (De Pergola 2000).Diets Don’t WorkBefore we tackle the fix for belly fat, we have to talk about the elephant in the room: dieting. Diets do not work! Research has proven this over and over again. The long-term success rate of the standard dieting model is around 5%(Hafekost et al. 2013). What’s worse is that 66% of dieters don’t just gain back the weight—they gain back more fat (Mann 2007). All that regained weight or extra weight gets stored preferentially in the belly (Banasik et al. 2013). Dieting makes bellyfat fatter.If you use a standard, calorie-counting, “eat less, exercise more” approach to belly fat, you may see short-term success; however, it will almost certainly make things worse in the long run.Why does the standard approach to dieting fail for belly fat? Burning belly fat requires a calorie deficit and balanced hormones. The problem with the “eat less, exercise more” model is that it accomplishes the calorie deficit butmakes the hormone balance worse. Interestingly, if hormones are balanced it’s easier to achieve a calorie deficit. Insulin resistance makes people hungrier. Excess cortisol secretion increases hunger and cravings. Even estrogen has been shown to impact sensitivityto hunger hormones (Kok et al. 200. This is why hormonal considerations must be addressed with calories.The Belly Fat FixSince insulin and cortisol produce the greatest negative impact on belly fat, they must be controlled first. Although it is a drastic oversimplification, it is clinically useful to think of insulin as a “starch and sugar” hormoneand cortisol as a “sleep and stress” hormone.The natural inclination when dealing with belly fat is simply to focus on eating fewer carbohydrates instead of lowering calories overall. Reducing carbs is a better strategy for belly fat reduction than traditional low-fat dieting(Volek et al. 2004). However, low blood sugar stresses the body and raises cortisol levels (Ebbeling et al. 2012); therefore, you do not want to eat a diet that is too low in carbohydrates, either. The idea is to modify starch/sugar intake to provide energyand stabilize blood sugar, while at the same time lowering insulin slowly over time and keeping cortisol stable. Choosing carbohydrates that are lower in glycemic load can do this, and this approach has been shown to reduce the chance of weight regain (Grosset al. 2013).Increasing protein intake also decreases the potential for weight regain. Higher protein, along with a lower-carbohydrate diet, has a favorable impact on belly fat as well (Volek et al. 2004; Ebbeling et al. 2012; Soenen et al. 2013).The Belly Fat FormulaStarch and sugar combined with fat may represent the best combination if you want to gain fat. Starch and sugar raise insulin levels. Fat alone is neutral in its impact on insulin. But when fat and starch/sugar are combined,they may be especially troublesome for belly fat (La Fleur et al. 2010). A meal that combines fat and starch/sugar results in higher calories at that meal and at subsequent meals (La Fleur et al. 2010). Insulin and fat also independently raise two other fat-storinghormones: acylation-stimulating protein (ASP) and glucose-dependent insulinotrophic peptide (GIP). Add stress on top of fat and starch/ sugar and you multiply the effect (Kuo et al. 200. The first step in beating belly fat is to avoid this fat, starch/sugarand stress combination when possible.The Six-Pack FormulaProtein and vegetables create a high-volume, hunger-suppressing combo punch with minimal insulin production. This results in fewer calories consumed and a favorable hormone balance. Sleep and stress management aid this action by loweringcortisol. Finally, smart carbohydrate management is critical to controlling any unfavorable cortisol-elevating incident. The six-pack formula focuses on managing stress and consuming protein and fiber over starch and sugar. Both visceral fat and subcutaneousfat will respond to this approach. However, there are some differences and slight modifications.Remember that visceral fat—compared with subcutaneous fat—is far more insulin resistant, has better blood flow, is more responsive to catecholamines (has more beta-receptors), and is helped by estrogen in women and testosterone inmen. For this belly fat depot, carbohydrate reduction can be more moderate. Going too low in carbs may not help cortisol metabolism in this area. Visceral fat is also far more responsive to exercise, which is often enough to deal with it. Stress managementbecomes a big piece of the approach in this area, given cortisol’s central role in visceral fat metabolism.When dealing with “love handles” (subcutaneous fat), things get trickier. This area is far more stubborn owing to its high sensitivity to insulin, its rich supply of alpha-receptors and its reduced blood flow. This fat is far lessresponsive to exercise and requires a stricter dietary approach. Reducing carbohydrate intake to low levels is usually the major focus when addressing this depot.A Sample PlanTo review, there are three major considerations for a nutrition and lifestyle plan for belly fat:Belly fat results from a mix of calorie- and hormone-related concerns.Traditional “eat less, exercise more” programs have an atrocious track record and almost always cause rebound weight gain centered in the belly.Belly fat is dramatically impacted by stress and cortisol management.There are two alternatives to an “eat less, exercise more” approach. Both approaches create a calorie deficit, and both seem to balance hormones. They are the “eat less, exercise less” approach and the “eat more, exercise more” approach.Both of these “plans” generate low-calorie intake and naturally pare starch intake in a way that provides enough fuel to keep hunger, energy and cravings stable, but not enough to slow fat loss.The 3:2:1 PlanThe “eat less, exercise less” approach can be thought of as a 3:2:1 plan. The “3” stands for three meals per day. The “2” means two of those meals should be mostly protein and fiber with less starch. Healthy starch sources are higherin fiber and hypoallergenic; they include brown rice, quinoa, beans/legumes, sweet potatoes with the skin on, and oats. The “1” means one meal per day should have heavier starch. This meal is best consumed postworkout. Another way to look at the 3:2:1 designationis to visualize a plate. Three parts should be vegetables, two parts protein and one part starch. You can also think in terms of bites. For every three bites of vegetables, you have two bites of protein and one bite of starch. The 3:2:1 approach works wellfor people who are not heavy exercisers. Daily walking and a few weight training sessions are recommended with this plan.The 3:2:2 PlanThe “eat more, exercise more” approach is for people who exercise regularly. It can be summed up with a 3:2:2 designation. The “3” stands for three meals per day. The first “2” means two snacks per day. The second “2” means you shoulddouble the starch intake once per day, post workout as well. You can visualize a plate and/or bites for this approach as well. The meals and snacks should be half vegetables and then equal parts protein and starch. Or, if you like, use bites. For every threebites of vegetables, take two bites of protein and two of starch.Making It PracticalTo know if you’ve been successful in helping clients reduce calories and balance hormones so that belly fat can be burned instead of stored, you need two more tools. The first tool centers on hunger, energy and cravings and is calledHEC (pronounced “heck”.Since abnormal insulin and cortisol metabolism strongly impacts all three of these sensations, HEC provides an indirect assessment of how well your clients are managing those two hormones.Have your clients rank each parameter on a scale from 1 to 10, with 10 being high and one being low. Hunger and cravings should be less than 5. Energy should be 6 or higher. If “HEC is in check,” you have met half of the equation.Assess HEC at the end of each week, averaging the results.The next step is to assess body shape. For women, use waist- to-hip ratio. Research shows this ratio should be 0.7 (Weeden & Sabini 2005; Platek & Singh 2010). As a client progresses and is losing weight, you want this number to approach0.7. If it moves up toward 0.8 or does not change, this is an objective indication that you have not adequately addressed hormonal influences on belly fat. For men, the waist-to-chest ratio may be a better indicator and the optimal number is 0.77 (Price etal. 2013). Again, if this number moves past 0.8 you are going in the wrong direction.The Fat FinaleBeating belly fat requires that a client produce calorie deficits in the context of hormone balance. Understanding how carbohydrates and stress will impact cortisol and insulin is the first critical step to understanding a more holisticapproach to belly fat. From there, you can use more nuanced approaches for visceral versus subcutaneous fat and female versus male belly fat. The keys to beating belly fat include a higher-protein diet, as well as a modified carbohydrate intake, along withstress management techniques.

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