Breaking out the summer clothes for warmer weather can be an unwelcome “reality check” after a winter of carb loading. As benign as a plate of pasta or a Snickers bar may seem, the blood sugar imbalances that ensue as a result of these food choices can influence your hormone levels. Even Europeans, long touted for their low obesity rates and the health benefits reaped from their adherence to the (low-sugar, produce-heavy) Mediterranean diet, are second only to the Americas in obesity rates due to the recent dietary additions of soda and sugary, processed snacks.
So what? A little weight around the middle never hurt anyone, right? Unfortunately, this thinking cannot be farther from the truth. There are two kinds of fat in the belly area. Subcutaneous fat is found just below the skin in the region called the hypodermis. It is the fat that you can pinch between your fingers, most commonly associated with the lower body in women, and referred to as “muffin top” when located on the abdomen. Subcutaneous fat is fairly benign as it is not related to the pathologies associated with visceral fat. Visceral fat (VF), on the other hand, refers to the fat located inside the abdominal cavity, packed between the organs (stomach, liver, intestines, kidneys, etc). Visceral fat is responsible for a distended or protruding belly, also referred to as “central obesity.” It is more common in men than in women, although many women also suffer from visceral fat, especially during perimenopause and menopause. VF is directly associated with health risks including heart disease, type 2 diabetes, insulin resistance, inflammatory diseases and other obesity related diseases.
Belly fat is a result of elevated insulin levels. Dietary choices with a high “glycemic index” (sugary foods and simple carbohydrates that are quickly converted into glucose) require high levels of insulin to move the sugar into the cells quickly. These insulin spikes cause fat to be stored in the liver and in the belly. This metabolic response of fat deposition to high glycemic intake is designed for survival during lean times. (Think: primitive humans preparing for a long hunt when food will be scarce, or primitive women storing fat for pregnancy and lactation.) When this cycle is repeated multiple times per day from consuming modern, processed foods, the cells become resistant to the perpetual presence of insulin, creating insulin resistance (Think: the boy who cried wolf). This insulin resistance at the cellular level interferes with the normal feedback loop between the cell and the liver, causing the liver to pump out even more insulin (hyperinsulinemia), creating a vicious cycle of insulin resistance and fat deposition.
In women, the insulin resistance associated with belly fat decreases a protein produced by the liver called sex hormone binding globulin, or SHBG. SHBG binds to testosterone and as such “keeps it in check.” Spikes in insulin and insulin resistance decrease SHBG, enabling more testosterone to be free in circulation and available to the tissues, and contributes to increased levels of testosterone produced in the ovaries and DHEA from the adrenal gland. For women, belly fat means higher levels of androgens which may manifest in hair deposition and acne on the face, as well as male pattern hair loss.
In men, the process is similar with the opposite effects: insulin resistance leads to an increase in SHBG which binds testosterone at an increased rate, rendering less free testosterone available to the tissues, contributing to hypogonadism. As well, the enzyme aromatase found in fatty tissue can metabolize testosterone into estradiol and dihydrotestosterone, further depleting testosterone. This decrease in testosterone and increase in estradiol associated with visceral fat may lead to the development of breast tissue, known as gynecomastia. Elevated estradiol may also contribute to cellular hypertrophy in the prostate, leading to increased urgency, decreased flow and nocturia, and contribute to decreased erections.
In this way VF serves as an endocrine organ in its ability to decrease testosterone and increase estradiol levels in men, and increase estradiol and androgens in women.
The good news is that visceral fat is very responsive to a balanced diet and exercise. Blood sugar is best managed by avoiding starchy, sugary carbohydrates and eating a diet made up of healthy protein, fiber and fat, in short “whole” foods that come from the earth rather than foods that come from a box. A low carbohydrate ketogenic diet may help to control hunger and improve fat metabolism to enable weight loss. Additionally, exercise has been shown to stimulate blood flow to adipose tissue and mobilize fat. The regularity of exercise is important as each exercise bout creates these important changes. The more committed to movement someone suffering from VF is, the sooner and longer lasting the changes will be. As well, exercise has been shown to stabilize insulin levels for up to sixteen hours after activity.
Hormone testing with Labrix is a great way to take a first glance at these metabolic processes. Sometimes one’s first inkling that they lean toward disordered insulin is through rising androgen levels in women, and decreased testosterone and/or rising estradiol levels in men. Test don’t guess! Help your patients establish a plan to stabilize blood sugar and decrease belly fat for healthier hormone levels.
