The size of your waist is believed to be a better indicator of health problems than the number on the scale or your body mass index (BMI), a measure of weight relative to height.

It is far more healthful to have a "pear" body shape (fat stored around the hips, buttocks and thighs) than an "apple" shape (fat stored around the middle). Both men and women with apple shapes (men with waists of 40 inches or more and women with waists of 35 inches or more) are more likely to be insulin resistant-a condition in which the cells do not receive insulin properly and which often leads to diabetesthan those with smaller waists. In fact, research shows that having just an extra four inches around your waist increases your risk for heart failure by 15%. Belly fat is associated with a greater risk for stroke, and every additional two inches around the waist in men increases the risk for deep-vein thrombosis and pulmonary embolism (blockage of the main artery of the lungs) by 18%.

Why abdominal fat is so bad: This fat, also known as visceral fat, produces hormones that work against you in the following ways…

  • Releasing free fatty acids (the breakdown product of fat cells that circulate in the bloodstream).
  • Decreasing insulin sensitivity (the degree to which your cells recognize insulin and use it properly).
  • Increasing cytokines, compounds that contribute to inflammation and insulin resistance, including resistin, another chemical that reduces insulin sensitivity.
  • Decreasing hormones such as leptin that help regulate metabolism and appetite.

Help Is On The Way

Abdominal fat often is associated with hormonal imbalances, such as high insulin (yes, even insulin is a hormone)...high cortisol...and high estrogen. Once the vicious cycle of abdominal weight gain and hormonal imbalance begins, it is hard to stop—especially because each one causes the other.

I put those who are caught in this cycle on a hormone-balancing protocol that they follow for at least two months and up to six months. The results are impressive.

The Protocols

If you are a man with a waist measurement of 40 inches or more or a woman with a waist of 35 inches or more, ask your doctor to test your levels of cortisol, insulin and estrogen.

Note: Excess estrogen is not just a female problem. While high levels most often occur in women younger than 45 and in postmenopausal women, they can appear in men as well, especially when made worse by the presence of environmental estrogens, compounds found in many plastic household products.

If you have excess estrogen…

High levels of estrogen, particularly combined with low levels of progesterone, can cause abdominal fat. When either a male or female patient has excess estrogen, especially in conjunction with low levels of progesterone (a condition called estrogen dominance), I recommend an estrogen detox program. This includes eating two to three daily servings of cruciferous vegetables (such as broccoli, cabbage, brussels sprouts, cauliflower and kale), which contain plant compounds called indoles that help regulate estrogen metabolism and can make estrogen less toxic.

Supplements that help include indole-3carbinol and diindolymethane (DIM). These phytochemicals in supplement form are similar to those found in cruciferous vegetables. Patients take 300 milligrams (mg) to 400 mg daily of indole-3-carbinol and 200 mg to 400 mg of DIM daily. I recommend both the food, for the fiber, and the supplements because it's difficult to get enough of these phytochemicals through food.) For women who are perimenopausal or menopausal (and some men with prostate problems) with this type of hormonal imbalance, I also may prescribe a bioidentical progesterone cream.

If you have insulin resistance…

Abdominal fat and insulin resistance often go together like the proverbial chicken and egg, and it isn't always easy to know which one was there first. Insulin resistance increases the chances of developing type 2 diabetes and cardiovascular disease. It can be effectively treated by eating a diet with high-fiber foods, including vegetables, legumes and grains. Regular exercise also helps keep insulin resistance under control. For my insulin-resistant patients, I also recommend PGX, a form of glucomannon fiber.

Brand to try: Natural Factors PGX Daily (800-322-8704, for a store locator).

Also helpful: Chromium picolinate, a trace mineral (start with 500 micrograms (mcgl daily and increase to 1,000 mcg daily, if needed), which can help balance blood sugar levels... and resveratrol (50 mg to 100 mg daily), which improves insulin resistance.

If you have high levels of cortisol…

Cortisol, the major stress hormone produced by the adrenal glands, can signal the body to store fat around the middle. For my patients whose blood tests reveal high cortisol levels, I prescribe a basic program of aerobic exercise (30 minutes daily of swimming, jogging, bicycling or walking)...strength training... stress reduction.. and deep breathing, all of which have been found to lower cortisol levels. The herb ashwagandha also can help normalize blood cortisol levels.

Brand to try: Sensoril Ashwagandha made by Jarrow Formulas (310-204-6936, www.jar for a store locator). Take one 225-mg capsule daily. Women who are pregnant or breast-feeding should not take this herb.

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