Episode 51 | Dr. Sara Gottfried, M.D. | The Truth About Belly Fat

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Kathy Smith:                   Sarah, welcome to the show. It’s so great to have you here again. I’m excited that you’re going to be in Park City in about a month. Hopefully, we’ll have some snow for you when you get here.

Sara Gottfried:                   I’m excited to come, and I’m happy to be here with you, Kathy.

Kathy Smith:                   Today, I wanted to focus on belly fat. Now, I know it’s a topic that so many people are concerned about mainly for cosmetic reasons. However, we know that that extra fat – especially the belly fat – it can be so risky. And it is one of the main indicators that your body is shifting out of balance and veering into some unhealthy territory. So, tell us, why is belly fat so bad for us?

Sara Gottfried:                   Well, you’re right. Belly fat isn’t just cosmetic. It’s something that tracks with a number of different diseases like diabetes, heart disease, certain cancers. So, to me, it’s a marker that your health is going downhill. So, we want to turn that around.

I think another thing that happens for a lot of us is that sometime around between the ages of 35 and 45, you start to lose muscle mass and you start to increase fat mass. For women especially, they’re noticing it around the waist. That’s just one of the things that can happen as a result of aging, but you do have a choice in the matter. So, hopefully, we’ll talk about some of the solutions today as well.

Kathy Smith:                   Well, yeah. I know. I am preaching this all the time about strength training and maintaining that muscle mass, because again, when I first started talking about strength training which is it was literally 30 years ago. I think 30 – 35 years ago, I did my first strength training workout. Back in those days, women were going, “I don’t want to get muscle mass. I don’t want to look like Arnold Schwarzenegger.”

I would sort of laugh because I’m thinking–especially as we age and I still hear these people say things like this–I’m giggling inside and going, “Oh my gosh, if only you could maintain that kind of muscle mass.” It becomes much more difficult because we are losing our testosterone levels and for a lot of other reasons – hormonal reasons – but specifically with belly fat. I know you’ve talked about it in both your books – The Hormone Cure and Younger – about this idea that belly fat is stubborn. Why, at a certain age, especially after menopause do we seem to just hang on to our belly fat and why is it so stubborn and hard to get rid of?

Sara Gottfried:                   There’s a few different reasons. I think the main reason is that your insulin can get out of whack. And, so, what happens for a lot of us is that in your 40s, blood sugar tends to start rising. It’s not just a minor thing. It goes up by an average of about 10 points per decade. So, between 40 and 50, it goes up 10 points, another 10 points between 50 and 60. That’s a sign that you’re creating more inflammation in your body.

Another issue that happens along with the problem in insulin and rising insulin is that you can have issues with your cortisol. So, cortisol’s the main stress hormone, and I saw a really interesting study a few years ago that made so much sense to me. Because it showed that for people with high cortisol–and I’m talking mostly about women here–when you have a high level of stress in your body, belly fat actually has four times the number of cortisol receptors as fat elsewhere. So, when you have a high level of stress like I used to, the high cortisol can stimulate your belly fat. If you have that combination of insulin resistance where your cells are numb to insulin plus the high cortisol, it can just make you feel like no matter what you do, nothing is helping with the belly fat.

Now, the good news is you can turn both of those things around. You can fix your insulin, you can fix your cortisol.

The third hormone that I sometimes think about with belly fat is growth hormone. That’s the hormone that’s involved with keeping you younger. It’s a growth and repair hormone. You especially make it when you’re sleeping and you tend to have less of it as you get older. It’s, as you described with testosterone, you tend to make less growth hormone. So, what we want is we want to keep all three of these hormones – insulin, cortisol and growth hormone in the sweet spot for you so that you can prevent belly fat from accumulating and, then, once it accumulates, you can turn that around.

Kathy Smith:                   So, these three hormones – the insulin, the cortisol and, then, the growth hormone – let’s start at the top again because I think sometimes we–or I make assumptions that people understand more about these hormones. Let’s just break it down to a very basic level. Let’s start with insulin.

Insulin, we know, there’s been so much talk about being on the blood sugar roller coaster and this idea that maybe you get up in the morning and have a sugary breakfast or sugar in your coffee, a protein shake, full of sugar and immediately in the morning you start triggering your body to produce this insulin. Can you explain the function of insulin and how it can go awry and how we can step into this metabolic syndrome that we hear so much about?

Sara Gottfried:                   Yeah, insulin’s one of those hormones that I think makes people’s eyes glaze over, so I’m going to try and keep it as simple as possible. I think of insulin as being almost like a bouncer outside of a cell. And it determines whether blood sugar is going to get inside your cell to fuel you, to make you feel like you have energy or if that blood sugar, instead, is going to be sent to be stored as fat.

So, if you have a problem with insulin–and I’ll talk in a moment about how this develops–but if you have a problem with insulin, you’re going to store fat no matter what. You’re going to have a lot of problems with your blood sugar where it swings too high and sometimes even too low, and your cells just get tired of the signal of blood sugar going high and low and, so, they become numb to this message. The typical things that you see for people who have a problem with insulin–you know, you hear about the extremes diabetes: Type 1 and Type 2 diabetes. But the typical story is that you have a rising fasting blood sugar. But it’s not just fasting blood sugar, it’s also blood sugar after you eat certain foods.

Everyone’s a little bit different, but I can tell you, Kathy, I used to have an issue with insulin resistance, and I had a fasting blood sugar when I was in my mid-30s that was about 105. My primary care doctors weren’t so worried about it, because the normal range is 70 to 99 for your fasting blood sugar. A lot of people get that checked every year. But 105 is actually a problem. That’s a sign of insulin resistance. It’s a sign that I was storing fat no matter what.

When I ate certain fruits, especially high fructose fruits, like bananas, it would make my blood sugar swing pretty dramatically. Like, I would go up to a blood sugar of 180 or 200 whenever I ate a banana or a cup of coffee with sugar in it. One of the problems here is eating excess refined carbohydrates that can lead to a problem with insulin resistance. And, then, another problem too is that stress can contribute to this problem. So, there’s a stress-insulin connection.

Kathy Smith:                   Right. We’re going to definitely get into the stress big time, because I don’t think any of us can avoid that. And the older I get, the more that I manage that with different techniques. And I know you do also. It’s been a life-changer for me.

Backing up to the fruits because we all know processed foods, we all know for picking up a chewy candy bar, that we equate to sugar and blood sugar levels. And we know that if we’re looking at a label on a box of sugary cereal and it says–or it doesn’t even have to be sugary cereal. I making it sound like it’s all the bad stuff. You go even to Whole Foods and you pick up a can of sparkling water, which I did the other day with blood orange in it or whatever, and it had 35 grams of sugar in it. So, reading labels, the processed foods, we know about that.

The one that always does confuse me still a little bit is this idea of fruit. I know that you mentioned bananas. I love my blueberries, I love strawberries. Where would fruit fit into my lifestyle? Yeah. Where would it fit in?

Sara Gottfried:                   For people who manage insulin normally, they don’t typically have an issue with fruit. I’m talking more about people who already have belly fat and who have an issue with what I call insulin block. To me, that’s a little more intuitive than insulin resistance.

It used to be that when my great-grandmother–I think you and I have talked about my great-grandmother before. She was a whole foodist.

Kathy Smith:                   Love her.

Sara Gottfried:                   She was a big exerciser and when she ate an apple–she was born in the year 1900–when she at an apple, the amount of fructose in an apple was about two to three grams. What’s happened is that the food industry has really changed our fruit over time. They made fruit more palatable. They’ve made apples bigger and sweeter so, now, an apple can have 20-25, sometimes 30 grams of fructose. And fructose is a fruit sugar, but for people who are susceptible, it can cause problems with your blood sugar.

So, for you Kathy, I don’t know your labs. I don’t know what your fasting glucose is, but I would suspect that you’re totally fine eating the low glycemic index fruits – things like berries, avocados, olives, coconut. Those are all probably just fine. It’s more these tropical high-fructose fruits that can be an issue for women especially who have high belly fat.

Kathy Smith:                   So, included in that would, then, be your mango perhaps, your banana, your papaya type things as well as other high-fructose fruits. I appreciate you explaining that, because I know that we are constantly putting out shake recipes for people, and I think it’s important that people understand when they’re making their protein shakes–and I know you have a wonderful protein powder that I encourage people to look at, because it really does a lot to balance hormones. But one of the things that when you’re making your shakes is not to put in too much sugar from, seemingly, the good stuff – the fruits and things.

Sara Gottfried:                   That’s right, and when I formulated the protein powder that we use, it has less than one gram of sugar. It was really important to me to make sure that what I use myself and what I put out for other people to use is really low in sugar and high in fiber. That’s kind of the combination that is the most healing for your insulin levels.

Kathy Smith:                   Ok, well, let’s skip over to cortisol, the next hormone that, as you mentioned before, is so linked to stress and can wreak havoc on all parts of your body including your waistline.

Sara Gottfried:                   Yeah, cortisol is kind of the–in many ways, it’s the most important hormone in your body because it controls your blood sugar along with insulin. It also controls your blood pressure, and it also modulates your immune system. So, it’s go these really pivotal roles in your body. It also means that it’s one of the highest priorities. So, when it comes to getting your hormones in balance–you know I often have people coming to see me in my office and they’ll say, “I just know my estrogen is off. I just need you to fix my estrogen and progesterone,” or “Dr. Sara, could you just deal with my testosterone. I’ve got no libido.” The truth is, we’ve got to work with cortisol first, because cortisol is the most important hormone to unlock when it comes to all the other hormones in your body and especially if you have an issue with belly fat.

So, I mentioned earlier that for women who are trying to lose weight, it’s really important to manage your cortisol, because you have four times the number of cortisol receptors on your belly fat as you do fat elsewhere in your body. So, if you are a high cortisol person like I used to be, I was just stimulating those fat cells with my high cortisol, and that’s not a good thing. So, there’s a lot that you can do to turn around a problem with high cortisol. I think it would be helpful, also, to share some of the techniques that you’ve found to be the most helpful. There’s some supplements that make a big difference: meditation, yoga, Pilates, I’ve found to be very helpful for me.

I think one of the keys, when it comes to high cortisol is to measure it. So, you can ask your doctor to measure it. You can do a blood test. You can also do saliva or urine testing. One of the things I’ve started doing recently, Kathy, is I measure my heartrate variability every morning. This is a way of looking at the balance between your sympathetic nervous system – kind of the fight/flight/freeze system, which produces cortisol. And your parasympathetic nervous system, which is the other half of your nervous system involved in rest and digestion. So, you can measure your heartrate variability, and it can guide your for how you script your day.

If I have a really good heartrate variability, that’s the day where I’ll do more of a maximal effort. I’ll do more burst training and maybe even a HIIT class. If I have a low heartrate variability suggesting that my stress response is not in the best place or I’m not in a good place for recovery, that’s a day where I’ll do more adaptive exercise like yoga and Pilates, meditation or just go on a walk.

So, there’s a lot to be said about cortisol and belly fat. Those are some of the quick techniques that I use to kind of assess it. I think mentioning it is really important.

Kathy Smith:                   Yeah, and I’m so excited to have you say this, because I got involved with a product called Body Metrix. This was probably two years ago. Body Metrix measures heartrate variability. So, I do the same thing every morning. I get up and measure it, and it’s one of those things that people don’t probably do and haven’t heard a lot about, but this idea of–it’s overused now–but this idea of body hacking and knowing what’s going on inside your body on a daily basis and, then, adjusting your food, your exercise, your day around what you discover. And I think that is exactly how I do my training. It’s one of those things.

Part of it for me through the years has become intuitive. Not so for everybody, but I sort of know, oh, my gosh. I can tell that I’ve pushed too hard, I haven’t gotten enough sleep, I’ve been eating too many sugary things, whatever it might be on that list, and I need some me time. I need me time to just let go of everything else and not push through a hard workout, because I don’t think a lot of people understand. I know you and I have talked about it.

But exercise is a stressor, and it stresses our bodies. The older we get, the more we need to recover from that stress. Not that we shouldn’t be exercising obviously, but how do we balance it all. And I do the same things. I go to my yoga class, I make sure that even on certain days, I’ll decide what type of yoga class I go to, depending. So, I might be going to what I call my rejuvenation or my restorative class and not going to my balls to the walls, chaturanga, handstands, all that sort of class. That starts to–every year that you are on this planet, the more that you can listen to the body and the signals of the body, it’s just remarkable.

The other thing that I know you talk about–I actually want to read something that you wrote in one of your blogs, which you are a brilliant writer. I love the way you take concepts that can be very complicated and make them very simple and also how you personalize things to your own life.

But you say in your blog, “Do you complain about the lack of time in your schedule? On a daily basis, do you feel frazzled, forgetful, rushed? Do you have belly fat? How about a hard time getting a full night of restful sleep? You, my friend, are stressed.” In case you don’t know if you are or you’re not, that sort of sums it up. And, then, you go into just about mindfulness techniques and emphasizing the importance of shifting your perspective, especially ones that are sabotaging your weight loss.

You quote one of the studies in one of your blogs from the University of California that showed that obese women who began a mindfulness program and stuck with it for four months, they lost belly fat, which is really unbelievable. So, I think this idea of being able to sit, to meditate in whatever form. It can be a slow walk, it can be a breathing technique, it can be listening to a tape, but how do we quiet the mind down to not need more, more, more but actually need less, less, less. So, thank you for that.

Sara Gottfried:                   Well, thank you for sharing those things. I love that you talked about this conversation that you have with your body, Kathy. Because I think for a lot of us, myself included, we can lose sight of that conversation. Like, that conversation that you were just talking about of, “Ok, I think I’ve pushed a little too hard over the past week. I haven’t been sleeping great, so I’m going to back off. I’m going to go restorative yoga class or maybe Kundalini Yoga, not go to the hard-core Ashtanga or Vinyasa class. Those are the kinds of conversations we want to be having.

If you’re someone like me who just denied your body for a long period of time, whether that’s due to motherhood or working in the corporate world or whatever it is. For me, it was medical training. You have to figure out how to get back into that sacred conversation with your body. So, I like these techniques as you described – biohacking – these ways of having that conversation with your body, of understanding your physiology.

Heartrate variability is just the tip of the iceberg. There are so many other things you can do to kind of look at what’s going on with your hormones and, then, when it comes to belly fat like how to address it. And not usually with just one thing. When I take care of patients, it’s rarely that only going to a mindfulness class is going to help them lose belly fat even though this data was proven at the University of California at San Francisco, I typically find that people need more than one thing. And I also find that they need some momentum.

So, I like to craft a combination of things that addresses the insulin, the cortisol, the growth hormone that really helps to make progress with getting back in the conversation with your body and getting those hormones back on your side so that they’re supporting you instead of working against you.

Kathy Smith:                   So true. And I know ever since I went through menopause and I started dealing with hormone fluctuations, the more that you fine tune what works for your body as far as food, as far as exercise, as far as sleep, as far as your circadian cycles, as far as that emotional component – love, feeling connected to people, letting go of regrets. All of these things combined allowed my hormones that were completely out of whack for a while to just rebalance. So, to your point, it wasn’t one particular thing that solved the problem.

But switching gears here, I mentioned that you’re very open about your approach to wellness and that you’ve struggled at times even with body image. And I do like another thing that you talked about and wrote about, which was this Fonda quote that you heard. Since Jane Fonda was a mentor and I just admire her so much–do you remember the quote or should I–do you remember what she said?

Sara Gottfried:                   Well, I’m going to paraphrase. It still just gives me chills every time I think about it. She something like, “We’re not meant to be perfect. We’re meant to be whole.” I feel like what she’s talking about there is this model of wholeness, which really is what you and I have been talking about since the beginning. What is the model for wholeness for you? It’s going to be different for each of our listeners. It’s different for you than it is for me.

Really understanding that model of wholeness and getting to a place, where, as you described, you’ve got the love, the purpose, the connection, forgiveness. We know that forgiveness lowers your cortisol levels. So, indirectly, it probably helps with belly fat. Really, not striving for perfection but striving for the sense of integrity is really what I think is important when it comes to radical health.

Kathy Smith:                   I think just as a female and as a female that’s now in her 60s–that’s me–that the more I do this, that I get away from perfection and get into this feeling of wholeness, it makes me just clear inside. It makes me happy. It makes me feel powerful.

The reason why I say that is because I bring the power of everything else to a situation, and I’m not focused on if I have a little extra belly fat or if I have some spider veins on my legs or if I have something that has come along with age. With that, I get up and I’m happy and I’m focusing on, “Wow, I feel good about myself.” And I think that’s what I loved about the Fonda quote. It was all about this idea that instead of getting into the imperfection of things that we could all focus on, you start leading with the heart, you start leading with the soul and you start living life to the fullest.

So, once again, I know that we have to wrap it up because you’ve been here and you’ve given so much of your time already. But before we leave, could you just let me know if you want to share one last thing with us.

Sara Gottfried:                   Well, I love that you say that this makes you feel powerful, because I think you’re absolutely right. It’s not sort of an immature male form of power. It’s not one up, one down. It’s more being totally in your essence – like wholly in what makes you, you. So, if I had to share one last thing, I would probably say, come to our talk in Park City. I’m so excited about it. We’ll be talking about some of the ways of addressing belly fat, some of the ways of slowing down the aging process.

The thing I’m totally obsessed with right now is intermittent fasting. There’s a lot of different protocols out there. I’m going to talk in our session about some of the different protocols – what’s been proven to be the most effective for women versus men. Once again, men have the advantage. Women have to have a little bit longer window when it comes to fasting. So, I’ll leave with that teaser that we’re going to talk about intermittent fasting and how it helps you with insulin and helps you with growth hormone.

I love that you brought up the Jane Fonda quote here at the end, because I admired Jane Fonda and you so much as I was growing up, when I was in my teens and 20s and wanting to develop my exercise routine at home. Exercise is also just such an important lever when it comes to belly fat. We didn’t get a chance to talk a lot about that, but we will at our session in Park City.

I think just finishing with that quote is really a beautiful place to end. Just what is that model of wholeness for you and how can that pull you forward?

Kathy Smith:                   I love that too. And I love these other topics we’re going to be discussing. Obviously, exercise, but the intermittent fasting, I was privileged to interview Valter Longo and some of the other researchers on intermittent fasting on my podcast.

But I was at the gym three days ago and I was overhearing the discussion with three women and they were going, “No, it’s 12 hours.” As soon as I heard what they were saying, I go–“No, it’s 12 hours.” “No, 14.” “No, I heard 16. No, they’re saying 16. It’s got to be 16.”

So, for anybody who doesn’t know what we’re talking about right now, show up to the talk with Sara. Because we will be finding out. Is it 12, 14 or 16? And that’ll be my little tease. I don’t even know what she is going to say actually, but I can’t wait.

Sara Gottfried:                   I’m excited too.

Kathy Smith:                   To be continued. Ok, thank you so much. We’ll see you next month.

Sara Gottfried:                   Ok. My pleasure.

Kathy Smith:                   Ok, bye, bye, Sara.

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