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Now that the swine flu appears to be playing itself out, we can take up a health concern that I am asked about at least ten times a week, always by women and always with various degrees of desperation in their voices.
“I never had this before!,” she’ll say, pointing to some midsection roundness (some will prod it, others jiggle it slightly). “I look pregnant!” (forgetting how pregnant women actually look). “Do I have a tumor? I know it’s not gas…”
Given the number of before-and-after advertisements I see online offering the “secret” to a flat abdomen (a single, non-calorie-burning mouse click away), it appears we’re in some sort of a pouch epidemic threatening the well-being of Western womanhood.
Getting rid of the tummy is your job. Explaining it is mine:
• It’s easier to gain weight as we get older simply because our metabolism slows down. Conversely, you may have noticed, it is harder to lose weight with the usually effective combination of exercise and calorie restriction.
• With aging, starting in your thirties, muscle mass diminishes, replaced by (guess what?) fat.
• Genetically, some people gain weight in their abdominal areas, while others gain it in their hips and buttocks.
• The real villain accelerating weight gain in the tummy is stress.
The negative mental energy of chronic stress–worrying about a terrible job, bad relationship, the economy, your tummy itself–activates your brain to stimulate two stress-responding glands, your adrenals (two walnut sized glands sitting one each atop your kidneys) and your thyroid (in your neck). When your fight-or-flight response is triggered, to escape some sudden threat against you such as a mugger, both glands speed their hormone release to put your body into temporary overdrive and get you out of the scary situation.
However, if mental stress goes on non-stop, these glands become fatigued.
With thyroid fatigue, your metabolism slows down, you feel cold, you put on weight, and you’re too tired to exercise. With adrenal fatigue, you’re not only tired, but your energy level crashes at about 3 pm every afternoon.
The adrenal response to life’s stresses occurs in two phases. First, a burst of adrenalin to initiate the adrenalin rush, triggered by something that really blew your mind (the child support check bounced). It generally lasts a few seconds (“I was so mad I felt my heart was pounding through my chest.”). With more protracted stress (“every day at the office is sheer Hell”), a second adrenal hormone, cortisol, takes over, churning out for weeks and weeks, until it too finally depletes (adrenal fatigue).
The cortisol sets in motion some changes in your body that are called “primitive,” meaning that while they may be useful in the long-term stress situations for mammals and Neanderthals, they are less useful if you’re a working woman. One primitive message from cortisol: “Prepare for danger! Food is going to be scarce,” as it issues a directive to your metabolism to prepare for starvation.
This message has a twofold result. First, you want to eat more food (ever notice you eat more when stressed?). And second, it signals your body not to burn those precious calories, instead storing them as high-energy fat in case actual starvation hits the herd/tribe. Hoard the fat where it can be used (it’s soft fat, did you notice, the kind that’s burned first) and keep it portable in case the herd/tribe has to move to a new location. That’s why your fat is stored in your tummy, rather than your legs.
Sometimes these primitive physiologic reflexes can be so annoying.
Interestingly, this sequence of events is exactly what occurs when people are given high doses of the medication prednisone, a potent synthetic form of cortisone. Patients get very hungry when taking prednisone, and after a few weeks can feel their belts tighten as their midsections expand.
So the very first question I ask my patient sitting across from me, either prodding angrily at her tummy or grabbing it with both hands and jiggling, is “So what kind of stress have you been under for the past year?”
Frozen like a deer in headlights, eyes widen, “Horrible! It’s been a terrible year.”
Next time: what to do about your burgeoning tummy.
David Edelberg, MD