Abdominal Fat and What to do About it

Though the term might sound dated, “middle-age spread” is a greater concern than ever. As people go through their middle years, their proportion of fat to body weight tends to increase — more so in women than men. Extra pounds tend to park themselves around the midsection

At one time, we might have accepted these changes as an inevitable fact of aging. But we’ve now been put on notice that as our waistlines grow, so do our health risks. Abdominal, or visceral fat is of particular concern because it’s a key player in a variety of health problems — much more so than subcutaneous fat, the kind you can grasp with your hand. Visceral fat, on the other hand, lies out of reach, deep within the abdominal cavity, where it pads the spaces between our abdominal organs.

Visceral fat has been linked to metabolic disturbances and increased risk for cardiovascular disease and type 2 diabetes. In women, it is also associated with breast cancer and the need for gallbladder surgery.

Are you pear-shaped or apple-shaped?

Fat accumulated in the lower body (the pear shape) is subcutaneous, while fat in the abdominal area (the apple shape) is largely visceral. Where fat ends up is influenced by several factors, including heredity and hormones. As the evidence against abdominal fat mounts, researchers and clinicians are trying to measure it, correlate it with health risks, and monitor changes that occur with age and overall weight gain or loss. .

The good news is that visceral fat yields fairly easily to exercise and diet, with benefits ranging from lower blood pressure to more favorable cholesterol levels. Subcutaneous fat located at the waist — the pinchable stuff — can be frustratingly difficult to budge, but in normal-weight people, it’s generally not considered as much of a health threat as visceral fat is.

Research suggests that fat cells — particularly abdominal fat cells — are biologically active. It’s appropriate to think of fat as an endocrine organ or gland, producing hormones and other substances that can profoundly affect our health. Although scientists are still deciphering the roles of individual hormones, it’s becoming clear that excess body fat, especially abdominal fat, disrupts the normal balance and functioning of these hormones.

Scientists are also learning that visceral fat pumps out immune system chemicals called cytokines — for example, tumor necrosis factor and interleukin-6 — that can increase the risk of cardiovascular disease. These and other biochemicals are thought to have deleterious effects on cells’ sensitivity to insulin, blood pressure, and blood clotting.

One reason excess visceral fat is so harmful could be its location near the portal vein, which carries blood from the intestinal area to the liver. Substances released by visceral fat, including free fatty acids, enter the portal vein and travel to the liver, where they can influence the production of blood lipids. Visceral fat is directly linked with higher total cholesterol and LDL(bad) cholesterol, lower HDL (good) cholesterol, and insulin resistance.

Insulin resistance means that your body’s muscle and liver cells don’t respond adequately to normal levels of insulin, the pancreatic hormone that carries glucose into the body’s cells. Glucose levels in the blood rise, heightening the risk for diabetes. Now for the good news

Exercise and dieting can help you get rid of belly fat

So what can we do about tubby tummies? A lot, it turns out. The starting point for bringing weight under control, in general, and combating abdominal fat, in particular, is regular moderate-intensity physical activity — at least 30 minutes per day (and perhaps up to 60 minutes per day) to control weight. Strength training (exercising with weights) may also help fight abdominal fat. Spot exercising, such as doing sit-ups, can tighten abdominal muscles, but it won’t get at visceral fat.

Diet is also important. Pay attention to portion size, and emphasize complex carbohydrates (fruits, vegetables, and whole grains) and lean protein over simple carbohydrates such as white bread, refined-grain pasta, and sugary drinks. Replacing saturated fats and trans fats with polyunsaturated fats can also help.

Scientists hope to develop drug treatments that target abdominal fat. For example, studies of the weight-loss medication sibutramine (Meridia), have shown that the drug’s greatest effects are on visceral fat.

For now, experts stress that lifestyle, especially exercise, is the very best way to fight visceral fat.

Originally published by http://www.health.harvard.edu

Testosterone Gives Some Men Back Their Pep, Study Finds

Testosterone can help some men get back a little of their loving feelings, and helps them feel better in general, according to a new study published Wednesday.

The effects are modest, and men didn't objectively get any more vitality, although they felt like they did, the government-funded study found.

It's the first study in years to show any benefit for testosterone therapy. The Food and Drug Administration has previously warned against over-promotion and overuse of testosterone replacement products, saying they can raise the risk of heart disease.

"This was the first time that a trial demonstrated that testosterone treatment of men over 65 who have low testosterone would benefit them in any way," said Dr. Peter Snyder of the University of Pennsylvania, who helped lead the study team.

"The trial showed that testosterone treatment of these men improved their sexual function, their mood, and reduced depressive symptoms—and perhaps also improved walking."

The FDA does not approve the use of testosterone to treat the effects of aging. But it's already a $2 billion industry, with millions of men buying gel, pills or getting injections.

Experts stress that the results, published in the New England Journal of Medicine,only apply to men over 65 who have medically diagnosed low testosterone. And it was a small trial, including fewer than 800 men, so it's not clear if their heart risks went up.

A few men had heart attacks or were diagnosed with prostate cancer during the study, but the rate were about the same in men who got real hormone and in those who got placebo cream.

Researchers across the country gave testosterone gel or a placebo cream to men who had demonstrated loss of the "male" hormone. They got enough to return testosterone levels to the mid-normal range for men 19 to 40 years old.

"Men in the testosterone group were more likely than those in the placebo group to report that their sexual desire had improved since the beginning of the trial," Snyder and colleagues wrote.

"Testosterone treatment showed no significant benefit over placebo with respect to vitality," they added.

"Men who received testosterone reported better sexual function, including activity, desire, and erectile function, than those who received placebo. Although the effect sizes were low to moderate, men in the testosterone group were more likely than those in the placebo group to report that their sexual desire had improved."

The effects on sexual performance were not as marked as erectile dysfunction drugs such as Viagra and Cialis, the researchers found.

"However, testosterone was associated with small but significant benefits with respect to mood and depressive symptoms. Men in the testosterone group were also more likely than those in the placebo group to report that their energy was better."

As men age, their bodies make less testosterone. It's not as sudden as when women lose estrogen, but the effects can be similar - loss of energy, sexual desire, depression and bone loss.

Dr. William Reilly, an orthopedic surgeon in Southlake, Texas, said it happened to him.

"I hit a brick wall when I was about 62 years old,"said Reilly, who is now 68.

"All of a sudden my energy level just wasn't the same. I'd wake up and I just felt tired and I'd be going to work and by the second case I'd be getting a little bit of brain fog," Reilly told NBC News.

He started getting less out of his gym workouts. "My arms were starting to get smaller. My belly was getting bigger," Reilly said.

So did Ed Stevens of Ft. Lauderdale, Florida.

"At about age 55, which was about almost eight years ago, I was fatigued, I was getting depressed — which is not like me," Steven said.

Stevens who at 63 would not be considered a candidate for the therapy according to the trial findings, said the hormone helped him feel better.

"I wouldn't call it a huge difference," he said. "I just saw over the months my body mass came back to where it was, my energy was better, libido was a little better."

Results are expected later from four other related studies, which tested the hormone's effects on mental function, bone density, heart function and anemia. 

Read the full study article here.

Click to get the complete guide to Low T: Symptoms, Causes, and Treatments.

Why To Exercise Today: Minimizing ‘Menopause Misery’

A new report suggests a path toward reducing “menopause misery”: Give up your sedentary lifestyle.

A paper — titled “Sedentary lifestyle in middle-aged women is associated with severe menopausal symptoms and obesity,” and published online in the journal Menopause — looks at more than 6,000 women across Latin America ages 40-59. Researchers found that compared to active women, sedentary women (who made up about 63 percent of participants) reported more “severe” menopause symptoms, including hot flashes, joint pain, depressed mood and anxiety and other symptoms like sex problems, vaginal dryness and bladder problems.

Sedentary lifestyle was self-reported (always a possible red flag in a study like this) as less than three 30-minute sessions of physical activity per week; activities included walking, biking, running, jogging, swimming or working out.

From the news release:

The study analyzed data from the Collaborative Group for Research of the Climacteric in Latin America surveys and health records of 6,079 women … who attended one of 20 urban health centers in 11 Latin American countries. The women completed standard questionnaires about depression, anxiety, insomnia, and menopause symptoms. Symptoms on the Menopause Rating Scale (MRS) questionnaire include somatic symptoms … and urogenital symptoms… The women also answered other questions, such as what their activity level and menopause status were.

JoAnn Pinkerton, M.D., executive director of the North American Menopause Society, and not involved in the study, said that being sedentary carries with it all sorts of health risks far beyond menopausal symptoms — from heart disease to some types of cancer. But, she notes, regular exercise can relieve “menopause misery,” and more. In an email, she adds:

Other studies have shown that being active whether women choose gardening, yoga, walking, biking or swimming at least 30 minutes a day improves menopausal symptoms… Being sedentary is bad for your health, physical and mental. Being active every day not only will help you have less severe menopausal symptoms, but it improves mood, coping, and has health benefits as well.

I encourage women including myself to add activity to our days, every day, whenever and however we can. Don’t wait til Saturday or the days you can go to the gym. If you are in your 40s and looking towards menopause, avoid the 12-15 pounds that most women gain by increasing your activity level now.

To be fit and strong after menopause requires women to gradually increase the amount of time and intensity of exercise to get most benefit.