We’ve had some requests for an “Ask Dr. Miranda” feature, so here is the first question we’ve been sent:

Q — I’m trying to lose weight and my biggest issue is my stomach.  How do I get it down? Any suggestions?

A – –  First, you are not alone!  Many people tend to accumulate weight below the belly button far easier than above, it is inherent to our general fat distribution and certain hormones.  In fact, very often abdominal weight isn’t just fat under the skin, but rather includes the more dangerous visceral fat that you’ve read about, so it is important to address.  For the record, any male with a waist circumference of 40+ inches, or a female with 35+ inches, is considered to have dangerous levels of abdominal fat.   So given that, there are several proven ways to target abdominal fat:   Let’s take a minute to look at the major ones.

1) Kick sugar to the curb!  Sugar in ALL of its incarnations, including High Fructose Corn Syrup (HCFS) is probably your number one trigger for abdominal fat.  Now, remember, to your body, a carb is a carb to a great extent.  White bread, potatoes, pasta, sodas, etc. all get broken down into glucose, and what you don’t immediately use up for energy expenditures, you store – and your gut is the numero uno place the body starts to store fat!   I am going to go out there on a limb and say that added sugar in general is a no-no!  It is unhealthy, and has strong, negative effects on your metabolism.  Now, sugar is composed of half glucose and half fructose, it can ONLY be broken down in the liver in any significant quantity.  So, if you are exposing your system to sugar daily, your liver gets overworked.  Your pancreas gets overworked.  Your body has no choice but to start storing as much as it can as fat.  Listen up fruit eaters – you don’t get off scot-free, fruit contains a large percentage of fructose, and large amounts of fructose were never meant to be eaten by us.  Most wild fruits are small and were only eaten in small amounts seasonally.  Our ancestors rarely got the opportunity to chow down on a giant bowl of fruit salad every day for breakfast.  Fructose is also directed into fat storage!  That is why I have specific guidelines on how much fruit you should eat for optimal fat burning AND specific times you should eat it.  Large amounts of fructose also tend to make the gut leaky, and cause digestive imbalances with your good bacteria, which leads to GI discomfort and the development of allergies.  Very often, the health benefits of fruit are not outweighed by their sugar content.  You have to really educate yourself and look at the difference between whole fruit (and its beneficial fiber content) and fruit derivatives, concentrates, and parts.  Keeping this in mind, the top way most people intake sugar, is by drinking it.  Don’t drink your calories is one of our important Lifestyle List tips for that very reason.  If you audit your daily sugar intake – most people fall short here.  Your brain doesn’t recognize liquid caloric intake in the same way it recognized calories that were chewed, and sugar-sweetened drinks are associated with a 60% increased risk of obesity.  So, a simple solution is to just avoid it as much as possible.   Now, if you are sitting there at home telling me you don’t drink soda – this also applies to sweetened teas, sports drinks, coffee drinks, and fruit juice. 

  1. Count grams of protein, not calories! Protein is the best fuel for your metabolism, and getting in enough high quality grams of protein per day is absolutely crucial for optimal fat burning.   No, this doesn’t mean that you need to eat an 18oz porterhouse steak 3 times a day, but you need to be cognizant of how much protein you are consuming.  For most people, 80-100g per day is a good range to shoot for.  If you are over 60 lbs overweight, you should be in the 100-120 g per day range.  If you’ve followed me for any length of time, you know that I’m a huge advocate of protein for breakfast.  it is my belief that having a high protein, low carb breakfast is the most important thing you can do for your metabolism and insulin levels.  Your first meal of the day literally sets the stage for how your metabolism responds for the rest of the day – so make good choices.  So, lets say you are trying to keep the 80-100 g of protein in mind, divide this up into the number of meals you consume daily to get your average per meal.  Most people eat 3 meals per day, so if you aim for a protein intake of 30g per meal, you fall exactly in the middle of the range!  Furthermore, protein provides key amino acids that reduce cravings by upwards fo 60%, and boost the amount of calories you burn by 80 or more calories per day.  Studies have shown a link between the quality and quantity of protein consumes and a reduction of abdominal fat.  People consuming enough grams of protein typically decrease their caloric intake by over 400 calories total per day, and if you’ve already lost your weight, eating enough protein helps you from putting the pounds back on — so it’s a win-win food choice!
  2. Tell carbs to take a hike ! Carb reduction is one of the most studied and most consistently successful ways to lose weight.  Now, no one is saying ALL carbs are bad, because carbs found in whole vegetables are just fine, but the starchy, sugary carbs head straight for your midline.  There are literally dozens of studies that show that low-carb diets lead to 2-3 times more weight loss than low-fat diets.  Low carb diets are difficult for some people however because they are addicted to carbs and the serotonin rush they get from eating their comfort foods, so you have to either make drastic cuts or gradual cuts based on  what suits your personality best.  Low carb diet specifically target abdominal fat, so if you need to lose belly weight – cutting carbs is crucial.   Men should look at keeping carbs below 50 g per day, women should aim for 45 g per day, however this number will vary.  Some women tell me they have done low carb but a review of their food journals show they are still getting in 60-80g of carbs per day, and the weight doesn’t start falling off until they hit 40g.  YMMV, but the above guidelines are a good place to start!  And please – keep your servings of carbs for lunch and dinner – we want breakfast to have as few carbs as possible. 
  3. Poop. Is one meal coming out for every meal that goes in? We have become the constipated generation. I guess it wouldn’t take much to convince you that your friends and coworkers are full of it!  Unfortunately it is true – most people consume a Standard American Diet (SAD) and it is SAD — it is nutritionally devoid of protein, nutrients, and fiber.  It is a hot mess.  The result is that they estimate that ~70% of the population deals with regularity issues.  To be blunt – for every meal that goes in, one should come out.  If you eat 3 meals a day, you should be having 3 bowel movements per day.  If you are not, that is your sign that you need to clean up your diet, add more fiber and fiber rich veggies, add magnesium, and drink more water.   Now, many of you are familiar with fiber associated with grains, and while that can be true, fiber is indigestible plant matter.  So, if you are reading a box of flax seed toasts – and it says 18 g of carbs per serving, 11 g of fiber.  You can subtract the g of fiber from the total amount of carbs to get your NET carbs.  In this case – 18g – 11g = 7 NET g carbs!   That makes that piece of flax toast a lot healthier looking, doesn’t it?  Now, not only does fiber help fill you up and satisfy certain cravings, but it keeps you full and satisfied longer.  It helps to hold water in your bowel, so your stools are not dry little bullets that need chemical laxatives (or dynamite) to dislodge.  One study showed that adding an additional 14 g of fiber per day to the diet  increased weight loss by 4.5 lbs over 4 months doing nothing else!  The best sources of fiber include seeds, vegetables, legumes, oats, etc.  There are also plenty of fiber supplements on the market that make it relatively easy to increase your fiber intake without adding additional calories.
  4. If you want to lose it, you’ve got to move it! It has been often repeated that you cannot out-exercise a bad diet, and that is true, however that doesn’t negate the importance being active is to your overall health. There is no such thing as spot fat reduction when it comes to exercise – that is entirely a myth, but  — when you consistently exercise, you lose weight from everywhere you’ve stored it, and since bellies often have a greater percentage of stored fat, you should notice fat loss there first.  Aerobic exercise has long been found to reduce abdominal fat.  It is also good for increasing  your basic metabolic rate, reducing inflammation , normalizing blood glucose levels, and increasing energy levels. 
  5. Write it down or it didn’t happen! One of the top predictors of whether people will be successful in losing weight is whether they are consistent about documenting everything they consume. Food journalers are typically FAR more successful at achieving and maintaining their weight goals.  Most people will tell you they eat a good diet, but an inspection of their food journal will reveal otherwise!  Many people have no clue of what they are truly consuming in the course of a day.  Most over-estimate or underestimate what they are eating.  Now, I love a plain old paper food journal, but tracking apps like MyFitness Pal  are a wonderful addition to your program.  Log everything, no matter how insignificant you think it is.  You don’t have to do it forever, but until you achieve your weight goals – it is a good idea, and it is a barometer of your success.  Food journalers find it easier to stick to their diet.  They find it easier to turn down snacks and impulse food consumption.  It is an easy way to hold yourself accountable. 
  6. You’ve got to consume (healthy) fats in order to lose fat! Yep – that low-fat diet you’ve been told to follow is bad for your waist line. Your body is a fat-burning machine.  Certain nutrients are fat soluble, and other faty are essential to your health, so when you avoid adding healthy fats to your diet, you create a deficiency state that leads to your body going into conservation mode – where it tries to hoard fat instead of burning it.  Hoarding is bad – don’t be a hoarder – sneak small amounts of healthy fats into your meals.  Not only do they help you assimilate more nutrients out of your diet, but they increase satiety, and are crucial for your health.  If you have IBD or you are missing your gallbladder and fat digestion is difficult for you – use an appropriate digestive aid to facilitate the process.